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1185 Cards in this Set

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When is a Third heart sound normal?
A Third heart sound is normal in children.
What is the relationship between Cl-/HCO3 in Pancreatic secretions? How are they regulated with regard to one another? What do the K+ values of the pancreatic secretion look like?
The fluid secreted by the Pancreas is alkalinized due to the action of Cl-/HCO3- ion exchange proteins in the apical surfaces of pancreatic ductal cells. Thus as more HCO3 is added, more Cl- will be removed. The K+ values of the pancreatic secretion approximate plasma K+ values.
What happens to the levels of HCO3-, Cl-, and K+ in the small intestinal fluid secretions normally vs. during a diarrheal state?
Small intestinal fluid secretions tens to be slightly alkaline with [HCO3-] exceeding [Cl-] on rare occasion. At high rates of net intestinal fluid secretion, such as diarrhea, [HCO3-] can rise and [Cl-] can fall greatly. As the net rate of intestinal fluid secretion increases, [K+] also rises. Thus, IN DIARRHEAL STATES WE LOSE HCO3- AND K+!!!
What are the [HCO3], [Cl], and [K], in the salivary gland secretions with respect to plasma? What about when the salivary glands are maximally stimulated?
Salivary gland secretions are initially similar to plasma with respect to their solute concentrations. Within the salivary ducts, Na and Cl are reabsorbed while K and HCO3 are secreted. When salivary glands are maximally simulated, however, the concentrations of all of these ions return to values near those of plasma due to lack of time for the ductal cells to modify the ion concentrations.
How does the [Cl] relate to the [HCO3] in sweat?
Sweat, once it reaches the surface of the skin from the eccrine glands, primarily consists of hypotonic NaCl with very little HCO3-. Consequently [Cl-] exceeds [HCO3] in sweat.
What is the enzyme deficiency associated with Acute Intermittent Porphyria (Autosomal Dominant)? What molecules will build up in the urine during an acute attack?
The enzyme deficiency associated with Acute Intermittent Porphyria is a deficiency of Hydorxymethylbilane synthase (aka Porphobilinogen deaminase and Uroporphyrinogen I synthetase). This causes excessive levels of Porphobilinogen and Aminolevulinic Acid in the urine.
What are the inciting events that lead to attacks of Acute Intermittent Porphyria? Describe the signs and symptoms.
Many patients with this condition may never experience symptoms, When symptoms do occur, they typically do not begin until after puberty and usually follow consumption of DRUGS THAT INCREASE HEME SYNTHESIS!!! Symptoms include svere vague abdominal pain, nausea and vomiting, and motor/sensory neuropathy. Cutaneous findings and photosensitivity are absent and patients are completely symptom-free between attacks. Urine from the patient during an attack will classically darken during standing with exposure to light.
Because HIV encephalitis affects the temporal lobes there are some unique clinical findings, such as what?
Such as olfactory hallucinations or anosmia, temporal lobe seizures, personality changes, bizarre or psychotic behavior, delirium, aphasia, and/or hemiparesis. Tx is IV acyclovir.
The Number Needed to Treat (NNT) is the inverse of what value?
The NNT is the inverse of the absolute risk reduction calculated between two therapies, or between a therapy and placebo.
A screening test for a disease has a Specificity of 90%. Apply this to a population where the disease prevalence is 10,000/100,000 to find out how many false positives per 100,000 individuals is expected.
(1-specificity) = rate of false positive --> (1- 0.9) = .10

Prevalence of disease = 10,000/100,000 so 90,000 do not have the disease -->

False positives =0.1 x 90,000 = 9,000
What are the distinguishing criteria between Schizophrenia, and Schizophreniform disorde, and a brief psychotic episode?
These two conditions are distinguished by the duration of symptoms.

Schizophreniform disorder is characterized by the presence of two or more of: delusions, hallucinations, disorganized speech/behavior, or negative symptoms for at least 1 month, but less that 6 months. The diagnosis of Schizophrenia is made when symptoms persist beyond 6 months. A brief psychotic episode is marked by similar symptoms but lasts less than 1 month.
What is the differentiation between Acute Stress Disorder vs. Post-traumatic Stress Disorder (PTSD)?
Acute stress disorder develops following a life-threatening traumatic event. Symptoms include re-experiencing the event via nightmares or flashbacks, sleep disturbances, poor concentration, irritability, hypervigelance, and restlessness. The symptoms must cause significant distress or functional impairment. Acute stress disorder does not last more than 4 weeks. After 4 weeks the diagnosis is PTSD.
What are the symptoms and conditions for diagnosing Adjustment disorder?
Adjustment disorder is characterized by behavioral symptoms that develop within 3 months of a stressor and are considered excessive relative to the expected response. Symptoms can be similar to those found in acute stress disorder, but stressor is of the emotional type (not life-threatening). Symptoms rarely last beyond 6 months.
All known trinucleotide repeat disorders cause what type of symptoms?
Neurological symptoms.
What X-linked trinucleotide repeat disorder presents with difficulty swallowing, and reveals facial and tongue fasciculations?
This is X-linked Bulbospinal Musclular Atrophy (Kennedy disease).
What does the term Pleiotropy mean?
Pleiotropy refers to the ability of a single genetic defects to have multiple simultaneous phenotypic effects.
What is Variable Expressivity?
Expressivity is variable in phenotypic severity among individuals with the same genetic mutation.
What is Incomplete Penetrance?
Incomplete Penetrance refers to the proportion of individuals with a given genotype that express the associated phenotype.
What is Genetic Heterogeneity?
Genetic heterogeneity exists when mutations of different genes cause similar phenotypes.
What is Genetic Linkage?
Genetic Linkage describes alleles that tend to be inherited jointly, usually because they are located near one another on the same strand of DNA.
Does viagra work on the Corpus Cavernosa (2cc), or the Corpus spongiosum (1c)?
The Corpus Cavernosa.
What % of GFR is attained long term after Heminephrectomy?
80% of previous GFR is reestablished post heminephrectomy.
What are the respiratory findings associated with the vasoconstrictive effects of long-term intranasal cocaine abuse?
Nasal septum perforation, oropharyngeal ulcers, and osteolytic sinusitis.
What is meant by the interviewing technique of reflection?
Reflection is an interviewing technique where the physician repeats what she has just been told. Similar is summarizing, wherein the physician encapsulates several ideas into on or two statements.
What is meant by the interviewing technique of Facilitation?
Facilitation is a basic interviewing technique where the interviewer encourages the patient to talk more about his or her experience. "Tell me more about how your drinking increased"
This dermatologic condition most commonly occurs in the setting of xerosis. The use of harsh soaps and exposure to environmental irritants can exacerbate the condition. This classically presents with puritic, coin-shaped, erythematous patches. Diagnosis?
Nummular eczema
This derm condition classically affects infants and young children and is frequently associated with a family history of this condition. Infants typically experience eruptions on their cheeks and diaper area, while older children are classically affected on flexural surfaces. Diagnosis?
Atopic dermatitis.
When do most cases of Endometritis (infection of the uterus) occur?
Most cases follow delivery of a child. Most commonly caused by mixed flora with Bacteroides being the most commonly isolated organism.
During normal embryological development, when the testes develop within the abdomen and subsequently descend into their appropriate anatomic location, how do they gain access to the scrotum?
The testes gain access to the scrotum by passing through the bilateral inguinal canals.
The Superficial and deep inguinal rings are formed by physiological defects in what tissue layers?
The Superficial and Deep inguinal rings are formed by defects in the external abdominal oblique aponeurosis and the transversalis fascia, respectively.
Describe the path through the inguinal canal from proximal to distal.
Parietal peritonemum ---(inferior epigastric vessels, medial umbilical, median umbilical)---> Transversalis facia (Internal inguinal ring, Rectus abdominus m., Pyramidalis m.)---> Transversus abdominis m. ---> Internal Oblique m. ---> External Oblique m (External Inguinal ring) ---> Inguinal ligament
Describe the spermatic cord from the outside in.
External spermatic fascia ---> Cremasteric m. and fascia ---> Internal spermatic fascia
In posterior and anterior dislocations of the knee what popliteal structure is at highest risk of injury?
The Popliteal artery is, because it is located deep within the popliteal fossa, close to the articular surfaces of the joint, and is tightly fixed proximal and distal to the popliteal fossa by the adductor magnus and soleus muscles, respectively, making it highly susceptible to tearing by traction forces.
Which nerve is the most commonly injured nerve in the distal leg (often by blunt trauma to the lateral knee)?
The Common Peroneal nerve is the most commonly injured nerve in the distal leg. It courses superficially and laterally around the head of the fibula and is often injured by blunt trauma to the lateral knee.
Penetrating trauma to the popliteal fosa is a common cause of injury to what nerve?
The Tibial nerve courses through the popliteal fossa just like the Popliteal artery, however, it is not subject to the same sort of traction forces as the popliteal artery, therefor penetrating trauma to the popliteal fossa is the most common cause of tibial nerve injury.
Adherens junctions and Desmosomes are cell-cell adhesions that rely on what transmembrane proteins and what ions to hold them together?
Cadhereins are transmembrane proteins that bind to intermediate filaments or microfilaments in the cytoplasm, via intermediate proteins, and bind extracellulary to cadherin molecules on adjacent cells, forming adherens junctions and desmosomes. Importantly, interactions between the extracellular domains of adjacent Cadherins is Ca 2+ dependent!!
What is the cell junction that Hemidesmosomes are responsible for making? What are the proteins that mediate this binding?
Hemidesmosomes mediate cell binding to the basement membrane and binding is mediated primarily by Integrins.
Which cytokine works in a autocrine fashion for T-cells?
IL-2 is produced exclusively by antigen stimulated T-cells. When IL-2 binds to T-cell IL-2Rs in an autocrine fashion, the stimulated T-cells proliferate clonally. Both IL-2 production and IL-2R expression are required for this T-cell proliferation, thereby ensuring that only th T-cells specific for the provoking antigen will be activated. IL-2 can also promote Fas-mediated apoptosis if it is present for a long period of time.
Which cytokine is most responsible for the symptoms of septic shock and cachexia?
TNF-alpha, which is a cytokine produced primarily by macrophages
What is the main role of the cytokine Interferon-alpha (IFN-alpha)? Which cells make it?
INF-alpha is chiefly generated by monocytes, macrophages, B-cells, adn NK cells. It has numerous antiviral functions (e.g. viral replication inhibition within cells, protection of uninfected cells from viral infection, stimulation of cytotoxic lymphocyte and NK cell antiviral activity.
Which lymphoma presents with a peripheral blood smear that often demonstrates malignant cells with notches or clefts ("centrocytes")? (* t(14;18)
Follicular B-cell lymphoma
What mechanism of genetic inheritance/transmission of a disease (e.g. Osteogenesis imperfecta) should be considered when a genetic mutation (esp. a dominant one) is identified in the offspring, but not the parents?
Germline mosaicism in the parent. The likelihood that a couple will have another child affected by the same mutation depends on the proportion of mutant to wild-type germ cells in the mosaic parent.
What are some of the contributing factors that lead to decreased drug metabolism in elderly patients vs. younger patients?
The elderly individual has an increased volume of distribution, secondary to decreased total body water, decreased total body mass, and increased body fat. There is also reduced hepatic size and blood flow.
What is DNA laddering seen on gel electrophoresis? What process does it indicate was occurring in the cell?
DNA laddering is a phenomenon that occurs in which the appearance of DNA fragments in multiples of 180 base pairs is seen on gel electrophoresis. This finding is a sensitive indicator of APOPTOSIS.
Where does the post-translational processing of Collagen proteins take place?
N-terminal and C-terminal propeptides are cleaved by procollagen peptidases in the extracellular space.
Proteins destined for export form the cell undergo what sort of posttranslational modifications before they reach their destination?
Posttranslational cleavage of protective and signaling sequences either within or outside the cell of origin.
Describe the mechanism by which Oseltamivir treats infections with Influenza A and Influenza B viruses. When MUST it be taken if it is to be effective?
Oseltamivir inhibits the Neuraminidases of Influenza A and B by acting as an inhibitory sialic acid analogue. Influenza viruses attach to cells and respiratory tract mucins through Hemagglutinin binding of glycoconjugate receptors. Neuraminidase cleaves sialic acid residues on the receptors, allowing attached virions to release and spread to infect other cells. Oseltamivir inhibits this spread by inhibiting Neuraminidase-mediated release and can prevent or shorten the course of Influenza A and B infections ONLY when TAKEN WITHIN 48 HOURS of symptom onset.
What are some of the complications that can arise with Vitamin A (retinoids) consumption during pregnancy?
Microcephaly, cardiac anomalies, early epiphyseal closure, growth retardation, and spontaneous abortion.
What is Globus hystericus? What causes it, and what exacerbates it?
Globus hystericus is the experience of a globus sensation in the throat ("lump in the throat") without physical, endoscopic, or radiological findings. Most individuals experience this sensation intermittently, but for some it is persistent. Emotions commonly trigger Globus hystericus (e.g. fear, anger, tension, and mental anguish). Multiple organic and functional disorders may also be associated (e.g. GERD, achalasia, psychiatric disorders, UES abnormalities, and stress).
What is the main cause of Zenker's diverticula?
Zenker's diverticula are mucosal outpouchings caused by motor abnormalities of the esophagus.
Osteosarcoma is the bone tumor most associated with Paget's disease, but in what parts of the body does it most commonly arise? Describe the radiographic/histological features of disease that you will see.
Femur, tibia, humerus or other bones; the radiographic findings of osteosarcoma include destruction of the normal trabecular bone pattern, mixed radiodense and radiolucent area, periosteal new bone formation, lifting of the cortex and Codman's triangle. Adjacent soft tissue usually demonstrates ossification in a "sunburst" pattern.
Describe the radiographic/histologic features that will be seen with Osteosarcoma.
Radiographic findings of Osteosarcoma include destruction of the normal trabecular bone pattern, mixed radiodense and radiolucent areas, periosteal new bone formation, lifting of the cortex (*periosteal elevation*), and Codman's tirangle.
What medication is most commonly the cause of Avascular necrosis of the head of the femur? What will the description of Avascular necrosis be?
Avascular necrosis can be caused by Glucocorticoid use (typically high dose). Radiographic findings include the pathognomonic CRESCENT SIGN, which includes SUBCHONDRAL COLLAPSE.
What are the four bone diseases associated with Renal Osteodystrophy due to advanced chronic renal failure?
Hyperparathyroid bone disease, Osteomalacia, Mixed uremic osteodystrophy, and Aplastic bone.
Where does the post-translational processing of Collagen proteins take place?
N-terminal and C-terminal propeptides are cleaved by procollagen peptidases in the extracellular space.
Proteins destined for export form the cell undergo what sort of posttranslational modifications before they reach their destination?
Posttranslational cleavage of protective and signaling sequences either within or outside the cell of origin.
Describe the mechanism by which Oseltamivir treats infections with Influenza A and Influenza B viruses. When MUST it be taken if it is to be effective?
Oseltamivir inhibits the Neuraminidases of Influenza A and B by acting as an inhibitory sialic acid analogue. Influenza viruses attach to cells and respiratory tract mucins through Hemagglutinin binding of glycoconjugate receptors. Neuraminidase cleaves sialic acid residues on the receptors, allowing attached virions to release and spread to infect other cells. Oseltamivir inhibits this spread by inhibiting Neuraminidase-mediated release and can prevent or shorten the course of Influenza A and B infections ONLY when TAKEN WITHIN 48 HOURS of symptom onset.
What are some of the complications that can arise with Vitamin A (retinoids) consumption during pregnancy?
Microcephaly, cardiac anomalies, early epiphyseal closure, growth retardation, and spontaneous abortion.
What is Globus hystericus? What causes it, and what exacerbates it?
Globus hystericus is the experience of a globus sensation in the throat ("lump in the throat") without physical, endoscopic, or radiological findings. Most individuals experience this sensation intermittently, but for some it is persistent. Emotions commonly trigger Globus hystericus (e.g. fear, anger, tension, and mental anguish). Multiple organic and functional disorders may also be associated (e.g. GERD, achalasia, psychiatric disorders, UES abnormalities, and stress).
What is the main cause of Zenker's diverticula?
Zenker's diverticula are mucosal outpouchings caused by motor abnormalities of the esophagus.
Osteosarcoma is the bone tumor most associated with Paget's disease, but in what parts of the body does it most commonly arise? Describe the radiographic/histological features of disease that you will see.
Femur, tibia, humerus or other bones; the radiographic findings of osteosarcoma include destruction of the normal trabecular bone pattern, mixed radiodense and radiolucent area, periosteal new bone formation, lifting of the cortex and Codman's triangle. Adjacent soft tissue usually demonstrates ossification in a "sunburst" pattern.
Describe the radiographic/histologic features that will be seen with Osteosarcoma.
Radiographic findings of Osteosarcoma include destruction of the normal trabecular bone pattern, mixed radiodense and radiolucent areas, periosteal new bone formation, lifting of the cortex (*periosteal elevation*), and Codman's tirangle.
What medication is most commonly the cause of Avascular necrosis of the head of the femur? What will the description of Avascular necrosis be?
Avascular necrosis can be caused by Glucocorticoid use (typically high dose). Radiographic findings include the pathognomonic CRESCENT SIGN, which includes SUBCHONDRAL COLLAPSE.
What are the four bone diseases associated with Renal Osteodystrophy due to advanced chronic renal failure?
Hyperparathyroid bone disease, Osteomalacia, Mixed uremic osteodystrophy, and Aplastic bone.
Where in the heart is the cardiac action potential conduction velocity the slowest vs. highest? The conductivity of which muscle is higher: atrial vs. ventricle?
The cardiac action potential conduction velocity is slowest in the AV node (0.05m/sec) vs. the Purkinje system (2.20m/sec). The conductivity of the atrial muscle is higher than that of the more massive ventricular muscle.
The destruction of which cells are key in the pathology of ARDS? Describe what the radiographic picture will look like.
Type II pneumocyte destruction is of greatest importance in ARDS because this results in complex surfactant abnormalities. The chest radiograph of ARDS will demonstrate diffuse, fluffy alveolar infiltrates in the absence of cardiomegaly.
What is the adverse reaction that occurs when Vancomycin is infused TOO RAPIDLY into a patient? What is the mechanism? How do you treat the condition?
One of the most common adverse reactions of Vancomycin is Redman syndrome. This is the result of widespread histamine release via nonspecific mast cell degranulation that occurs when Vancomycin is infused TOO RAPIDLY!!! This IS NOT an IgE MEDIATED ALLERGIC REACTION. It can be lessened or prevented by decreasing the rate of infusion.
What are some of the main side effects associated with TMP/SMX?
Megaloblastic anemia (synergistically inhibits folate production in bacteria) thrombocytopenia, leukopenia, and toxic epidermal necrolysis (Stevens-Johnson).
NF1 is an autosomal dominant condition with variable expressivity, but 100% penetrance. Thus, what are the only three explanations for observed generational "skipping", with NF1?
The presence of a new germline mutation, and incorrect family tree (i.e. the father is not the true father), or the failure to diagnose the syndrome in predecessors with subtle findings.
What molecule activates Protein C anticoagulant?
Thrombomodulin.
What is Platelet Activating Factor (PAF)? What are its effects at low and high doses? What is the signaling pathway that it works through to activate platelets?
PAF is a phopholipid ifalmmatory mediator that at high doses causes severe bronchoconstriction, vasoconstriction, and platelet aggregation, with microthrombus formation. At low physiologic concentrations PAF is a vasodilator (through NO) that promotes leukocyte adhesion to endothelium, diapedesis, degranulation, and oxidative bursts. PAF activates platelets through the Gq --> PLC --> IP3(Ca 2+)/DAG pathway.
Which cells make Platelet activating factor (PAF)?
Platelets, basophils, mast cells, neutrophils, monocytes, macrophage, and endothelial cells.
How does the Prostacycline (PGI2) found in the endothelial cells of vasculature, work to inhibit platelet functions?
Prostacyclin strongly inhibits platelet functions and increases platelet cAMP synthesis by stimulating adenylate cyclase.
What will the findings of Pulmonary embolism be with regard to the acid/base blood gas disorder that it will present with?
A significant PE causes hypoxemia secondary to a V/Q mismatch, which leads to hyperventilation and RESPIRATORY ALKALOSIS!!! An increase in pH and reductions in PaCO2 and PaO2 would therefore be expected.
Tyrosine --> DOPA --> Dopamine --> Norepinephrine --> Epinephrine --> Metanephrines --> VMA

List the enzyme/reaction type for each step in this pathway.
Tyrosine --(RATE LIMITING!!! tyrosine hydroxlase)--> DOPA --(DOPA decarboxylase)--> Dopamine --(Dopamine hydroxylase)--> Norepinephrine --(PNMT/methylation w/SAM)--> Epinephrine --(COMT/methylation)--> Metanephrine --(MAO/oxidation)--> VMA
The round ligament of the uterus is a vestige of what embryonic structure? What was its purpose in males and females? What is its course in the adult?
The round ligament of the uterus is a vestige of the GUBERNACULUM. The shortening of this structure as the fetus develops pulls the gonads from their original position high in the retroperitoneum down into the pelvis in females and into the scrotum in males. In males the gubernaculum attaches inferiorly to the scrotum. In females, it passes from the uterus through the inguinal canal and attaches to the labia majora.
What is the purpose of Red safranin O stain?
Red safranin O stains cartilage, mast cell granules, and mucin red.
What are the types of glands of the skin that are innervated by Sympathetics?
Eccrine and Apocrine (but NOT Sebaceous) glands.
Which type of skin gland is responsible for hyperhydrosis? What type of receptors respond to the Sympathetic innervation of these glands? Thus, how do you treat hyperhydrosis?
The Eccrine gland is responsible for hyperhydrosis. The postganglionic sympathetic neurons that synapse on Eccrine glands are Cholinergic (Muscarinic). Systemic anicholinergic medications, local anticholinergic injectable medications such as botulinum toxin, or surgical sympathectomy may be used to treat hyperhidrosis. Surgical sympathectomy targets the T2 sympathetic ganglion.
What are the major end organs that the Superior Cervical sympathetic ganglion provides sympathetic innervation to?
The Tarsal muscle, Lacrimal gland, Radial muscle of the Iris, and all Salivary glands.
Where do the Greater, Lesser, and Least thoracic splanchnic nerves transmit sympathetic preganglionic neurons in the abdomen to synapse at which ganglia?
These thoracic splanchnic nerves transmit sympathetic preganglionic neurons into the abdomen where they synapse on postganglionic cell bodies within the Celiac and Aorticorenal ganglia to provide sympathetic innervation to the abdominal viscera. *They may, however, pass directly to the adrenal medulla without synapsing.
What intracellular signaling pathway does Glucagon most likely work through? What types of cells does it affect?
Glucagon works through the Gs protein to enhance the activity of adenylate cyclase in hepatocytes (and in myocardiocytes and adipocytes as well), thereby increasing intracellular cAMP. In hepatocytes increased cAMP stimulates glycogenolysis and gluconeogenesis.
What are the four enzyme complexes that require Thiamin as a cofactor?
Pyruvate Dehydrogenase, Alpha-Ketoglutarate Deydrogenase, Branched chain alpha-keto acid Dehydrogenase!!! and Transketolase.
In Branched-Chain Amino Acid disease (maple syrup urine disease), what is the enzyme deficiency and what is it's normal job? What molecules accumulate due to the enzyme deficiency? What cofactor is required in this reaction?
The enzyme deficiency is the Branched-chain alpha-keto acid dehydrogenase complex. This defect results in the inability to degrade branched chain alpha-amino acids and their alpha-ketoacid metabolites. These substances accumulate in the urine and plasma and can cause CNS TOXICITY. Alpha-ketoacid decarboxylase requires THIAMINE!!! as a coenzyme.
Describe the major functions of Vitamin A and its major forms. What symptoms occur with its deficiency?
Vitamin A (retinol) is converted to retinaldehyde and retinoic acid. It is required for normal vision, certain reproductive functions, maintenance of epithelial differentiation and normal growth. Vitamin A deficiency causes night blindness, follicular hyperkeratosis, and xerophthalmia.
What is the signal sequence that destins proteins for the ER? During translation of a protein what molecules are responsible for recognizing this signal sequence and targeting the peptide to its destination?
N-terminal peptide sequences identify proteins that are destined for the ER. Signal Recognition Particles (SRPs), halt translation and target the ribosome to protein pores in the RER. Signal sequences that call for protein targeting to the RER are composed of 15-20 hydrophobic amino-acid residues. Deletion of the N-terminal signal sequence causes inappropriate accumulation of these proteins in the cytosol.
What happens to a protein after it has been targeted and delivered to the ER? What happens to the signal sequence? What part does the Golgi play? What happens after Golgi interaction?
Signal peptidases cleave the signal peptide after a protein has been targeted to the ER. The ER FOLDS, GLYCOSYLATES, and COUPLES proteins with their other subunits that are required for functioning. Next is the Golgi where proteins undergo further modifications are are sorted towards their ultimate destinations: the extracellular space, secretory granules for storage and release upon stimulus, endosomes and lysosomes for degradation of phagocytosed material, or the plasma membrane.
Graft vs. Host disease results from DESTRUCTION of RECIPIENT TISSUES by what type of donor cells?
T-lymphocytes.
What type of cells mediate the destruction involved in Acute Rejection of solid organ transplants?
Acute Rejection of solid organ transplants is cell-mediated and involves destruction of the organ by the recipient patient's T-cells. This is usually due to HLA-antigen mismatch.
What is the defective gene associated with Bruton Agammaglobulinemia (X-linked agammaglobulinemia)? Describe the mechanism of the agammaglobulinemia.
X-linked agammaglobulinemia results from a defect in the signal transduction molecule known as Bruton's Tyrosine Kinase (BTK). This protein is important in B-cell maturation; without it B-cells cannot leave the bone marrow to enter circulation so antibodies are not produced. T-cell numbers are normal, but B-cell numbers are low or absent (<1% CD19 or CD20 positive lymphocytes).
What are some of the more common genetic diseases associated with Chromosome 7?
Cystic fibrosis, Ehlers-Danlos, and OI.
What are some of the more common diseases associated with mutations on chromosome 16?
Polycystic kidney disease and Tuberous sclerosis
What is the genetic mutation associated with Achondroplasia and tissue functions are impaired?
Achondroplasia is due to an autosomal dominant condition characterized by point mutation of the gene for Fibroblast Growth Factor Receptor 3 (FGFR-3) on Chromosome 4, which is responsible for inhibition of cartilage proliferation. A defect in paracrine cell signaling leads to increased function of FGFR-3, which causes the condition.
Fused syndactyly is seen in what condition due to what gene mutation?
These are fused digits which are commonly seen in Apert syndrome, which is caused by a missense substitution mutation of FGFR-2 on Chromosome 10.
What chromosome and gene mutation is associated with Marfan's syndrome?
Chromosome 15; mutation of FBN1 gene.
What chromosome(s) and gene mutation(s) is/are associated with Osteogenesis Imperfecta (OI)?
Chromosome 17; mutation of COL1A1

Chromosome 7; mutation of COL1A2
Efflux pumps of bacteria used for resistance to antiboiotics generally require energy from what gradient?
Protons; Na+ and ATP may also be used.
What bacteria is most commonly associated with intraabdominal abscesses?
Bacteroides fragilis.
Is Latex Agglutination used to detect antibodies or antigens?
Latex agglutination is used to detect a specific antigen in a sample of interest. This assay is carried out by adding the sample to a collection of specific antibodies fixed to latex beads.
What are the components needed for a Compliment Fixation test?
Complement Fixation tests involve combining complement with known antigen, unknown patient serum, and antibody-coated sheep erythrocytes.
This disease presents mostly after the age of 40 with HEPATOMEGALY, DIABETES, impotence, arthropathy, cardiac disfunction and enlargement, and skin hyperpigmentation. Diagnosis?
HEMOCHROMOTOSIS!!!
Abnormally pigmented, kinky hair and hypopigmented irises; decreased serum copper content. Diagnosis?
Menkes' disease.
Albinism is due to a deficiency in an enzyme that catalyzes what reaction?
Tyrosine --(tyrosinase/oxidation)--> Dihydroxyphenylalanine
Defects in melanocyte proliferation and migration from the neural crest produce blue-gray macules called "Mongolian spots". Diagnosis?
Piebaldism (partial albinism); also Waardenburg syndrome is thought to be due to this.
Child presents with short stature, short metacarpal and metatarsal bones. High PTH and low serum Ca 2+, hyperphosphatemia. High TSH, FSH, and LH. Diagnosis?
Albright Hereditary Osteodystrophy (AHO); end organ resistance to PTH, TSH, LH/FSH.
What intracellular pathway do PTH, TSH, and LH/FSH work through?
Gs stimulatory pathway!!!
What is the most common mechanism by which G-proteins are anchored into plasma membranes?
Palmitoylation; this is a process in which fatty acids are covalently anchored to plasma membrane cysteine residues, thereby increasing the hydrophobicity of a protein. Many G protein-coupled receptors have carboxy tails palmitoylated on cysteine residues.
Patient that has a surgery to remove thyroid carcinoma experiences occasional episodes of sweating, tachycardia and chest tightness. Diagnosis?
MEN IIa !!! with medullary carcinoma and pheochromocytoma!!!
What are the two enzymes most responsible for the breakdown of catecholamines? Where do these reactions occur in the cell? what type of reactions are they?
MAO is a (M)itochondrial enzyme that does oxidation. COMT is a (C)ytoplasmic enzyme the catalyzes methylation.
Explain the mechanism behind why we see Hyponatremia in Diabetic Ketoacidosis. (*Hyperosmolar hyponatremia)
The serum Na+ is decreased in DKA because of the osmotic activity of glucose (serum Na+ drops 1.6 mEq/L for every 100mg/dl rise in blood glucose) and because of the hyperglycemia-induced osmotic diuresis, which results in sodium and free water losses.
What are the metabolic derangements asociated with DKA in terms of serum pH, ketones, glucose, K+, Na+, and Nitrogen leves?
Metabolic derangements associated with DKA include metabolic acidosis, ketonemia, hyperglycemia, hyperkalemia, and hyponatremia. Hyperammonemia can also be observed due to muscle degradation associated with the starvation state.
What is another term for the Hypersensitivity vasculitis causes by allergic reactions to drugs such as Penicillin? What is the time frame from drug administration to onset of symptoms?
Leukocytoclastic vasculitis; this happens very soon after drug administration.
What is Hypersensitivity syndrome that is associated with drug administration? When does the onset of this occur?
Hypesensitivity syndrome is a severe reaction (typically to aromatic antiepileptics agents or sulfonamide antiboitcs) that results in rash, fever, hepatitis, arthralgias, lymphadenopathy, or hematologic dysfunction approximately two to six weeks after the drug is first used.
What are the paraneoplastic syndromes associated with Hodgkin lymphoma?
Cholestatic liver disease, alcohol-induced pain, skin lesions, neurologic syndromes, and nephrotic syndrome.
Young male with normal secondar sex characteristics and normal testosterone blood levels, but the testosterone concentration in his seminiferous tubules and epididymis are very low. Diagnosis?
Androgen-binding protein (ABP) is synthesized by the Sertoli cells (herein lies the problem) of the seminiferous epithelium. ABP is secreted by these cells into the seminiferous tubule lumen to maintain the high local concentration of testosterone necessary for normal sperm production and maturation. Leydig cells (in the testicular interstitium) are mainly responsible from synthesizing and secreting testosterone into the blood stream, so overall testosterone levels are normal.
Whenever anyone has been in any sort of shock state with low blood pressure, what should you think of with regard to the kidneys? Describe the histologic picture of this condition.
Ischemic Acute Tubular Necrosis; this typically occurs in the setting of prolonged hypotension, dehydration, shock, or in postsurgical patients. ATN histologic features include detachment of tubular cells from the basement membrane and occlusion of tubule lumens with casts composed of intact or degenerating epithelial cells, proteins, and pigments. Cellular necrosis with ischemic ATN is limited to the outer medullary regions.
This is an inflammatory condition believed to have an underlying autoimmune pathophysiology with autoantibodies directed against ECM1 protein. Most common involvement is female genital and perineal region. Lesions begin as white atrophic macules and coalesce to form plaques. Diagnosis? What other disease is there a risk of?
This is Lichen Sclerosus et Atrophicus.
During the fasting state, a high baseline plasma insulin level, in the setting of normoglycemia, is a sign of what condition?
This is a sign of insulin resistance in the peripheral tissues.
What are two conditions, that are not lead poisoning, associated with Sideroblastic anemia?
Alcoholism and Myelodisplastic syndrome. Peripheral blood smears show basophilic stippling. Ringed sideroblasts may be seen in bone marrow.
B2 Microglobulin can be responsible for expressing what sort of peptides on APC surfaces for T-cell binding?
Viral proteins, because it is part of the MHC I complex.
CD1 molecules present what type of foreign antigens to CD1 specific T-cells?
CD1 molecules present lipid-containing foreing antigens (e.g. mycobacerial cell wall components) to CD1-specific T-cells.
What portion of the MHC II molecule on APCs gets removed and degraded during the antigen processing/presentation process?
During antigen processing, the INVARIANT CHAIN is removed from the MHC-invariant complex and replaced by and external protein. This MHC-peptide complex (containing an alpha-chain, Beta chain, and external protein) is then expressed at the cell surface.
Type I error vs. Type II error?
Type I error = detecting a difference when there is not one

Type II error = failing to detect a difference when one exists.
What does the "Power" of a study mean? How does changing the P values affect the Power (1-Probability Type II error)?
The Power of a study is the ability of the study's statistical power to detect a difference between groups. Lowering the statistical significance level (e.g. P=0.05 --> P=0.01) lowers the study's statistical power detect a difference between groups.
What are examples of important UNMYELINATED neurons in the body?
Postganglionic autonomic axons, Afferent neurons that conduct heat sensation, Afferent neurons that transmit slow-onset dull, burning or visceral pain, and first order bipolar sensory neurons of olfaction. Unmyelinated neurons are also refered to as group C nerve fibers.
What type of neuronal fibers are Motor neuron axons to skeletal muscle? Are they myelinated?
These are Group A-alpha fibers. They allow rapid conduction velocity and are myelinated.
What type of neuronal fibers are Sensory axons that innervate Golgi tendon organ and conduct afferent information on muscle tension? Are they myelinated?
These are Group A-beta neuronal fibers that are myelinated.
What type of mechanoreceptors are Pacinian corpuscles? Are they fast or slow adapting? Where are they located? What do they detect? What neuronal fiber types innervate them? Are they myelinated?
Pacinian corpuscles are rapidly adapting mechanoreceptors located in the subcutaneous tissue of the skin as well as the mesentery, peritonium, and joint capsules. They mediate touch and vibratory sense and are innervated by meylinated Group A-beta fibers.
What type of neuronal fibers are Preganglionic autonomic fibers? Are they myelinated?
Preganglionic autonomic nervous system fibers (both sympathetic and parasympathetic) are myelinated Group B fibers.
Which afferent neuronal fibers are unmyelinated? Which efferent neuronal fibers are unmyelinated?
Among primary sensory (afferent) fibers, those responsible for slow pain, heat sensation and olfaction are unmyelinated. Efferent neuron axons tend to be myelinated, with the notavble EXCEPTION of unmyelinated fibers that originate from POSTGANGLIONIC AUTONOMIC NEURONS. Unmyelinated neurons are also referred to as Group C fibers.
Speech nonfluent; Comprehension good; Repitition poor. Diagnosis?
Broca (motor) aphasia; Inferior Frontal Gyrus
What type of neuronal fibers are Motor neuron axons to skeletal muscle? Are they myelinated?
These are Group A-alpha fibers. They allow rapid conduction velocity and are myelinated.
Speech fluent; Comprehension poor; Repitition poor. Diagnosis?
Wernike (sensory) aphasia; Superior Temporal Gyrus
What type of neuronal fibers are Sensory axons that innervate Golgi tendon organ and conduct afferent information on muscle tension? Are they myelinated?
These are Group A-beta neuronal fibers that are myelinated.
What are two medications that you would use if a patient had Heparin Induced Thrombocytopenia?
Lepirudin ( both directly inhibits Thrombin); Argatroband (better for people with kidney problems because it is metabolized by the liver).
What type of mechanoreceptors are Pacinian corpuscles? Are they fast or slow adapting? Where are they located? What do they detect? What neuronal fiber types innervate them? Are they myelinated?
Pacinian corpuscles are rapidly adapting mechanoreceptors located in the subcutaneous tissue of the skin as well as the mesentery, peritonium, and joint capsules. They mediate touch and vibratory sense and are innervated by meylinated Group A-beta fibers.
Speech fluent; Comprehension good; Repitition poor. Diagnosis?
Conduction aphasia; Arcuate fasciculus (insula)
What type of neuronal fibers are Preganglionic autonomic fibers? Are they myelinated?
Preganglionic autonomic nervous system fibers (both sympathetic and parasympathetic) are myelinated Group B fibers.
Which afferent neuronal fibers are unmyelinated? Which efferent neuronal fibers are unmyelinated?
Among primary sensory (afferent) fibers, those responsible for slow pain, heat sensation and olfaction are unmyelinated. Efferent neuron axons tend to be myelinated, with the notavble EXCEPTION of unmyelinated fibers that originate from POSTGANGLIONIC AUTONOMIC NEURONS. Unmyelinated neurons are also referred to as Group C fibers.
Speech nonfluent; Comprehension poor; Repitition poor. Diagnosis?
Global aphasia; both Broca and Wernike areas are affected
Speech nonfluent; Comprehension good; Repitition poor. Diagnosis?
Broca (motor) aphasia; Inferior Frontal Gyrus
Speech fluent; Comprehension poor; Repitition poor. Diagnosis?
Wernike (sensory) aphasia; Superior Temporal Gyrus
What are two medications that you would use if a patient had Heparin Induced Thrombocytopenia? Which is better for patients with kidney problems?
Lepirudin ( both directly inhibits Thrombin); Argatroband (better for people with kidney problems because it is metabolized by the liver).
Speech fluent; Comprehension good; Repitition poor. Diagnosis?
Conduction aphasia; Arcuate fasciculus (insula)
Speech nonfluent; Comprehension poor; Repitition poor. Diagnosis?
Global aphasia; both Broca and Wernike areas are affected
Speech nonfluent; Comprehension good; Repitition good. Diagnosis?
Transcortical motor aphasia; near Broca area.
Speech fluent; Comprehension poor; Repitition good. Diagnosis?
Transcortical sensory aphasia; Near Wernike area.
What are the signs and symptoms of anemia induced cardiac compromise? What is the first step in treatment at the recognition of theses signs and symptoms?
Signs and symptoms of anemia-induced cardiac compromise are DYSPNEA ON MINIMAL EXERTION and SUBSTERNAL OR ANGINAL CHEST PAINS!!! These symptoms typically warrant treatment with BLOOD TRANSFUSION BEFORE implementation of cause specific treatment.
Atrial septal defects should be associated with sort of heart sound?
A widely split and fixed S2.
Thyroid manifests gradual failure with an atrophic or goitrous thyroid gland; intense, diffuse lymphocytic infiltration of the thyroid gland by thyroid-specific B and T cells, accompanies by formation of lymphoid germinal centers and destruction of thyroid follicles. Diagnosis?
Hashimoto thryroiditis.
Diffusely enlarged thyroid gland associated with thyroid gland follicular epithelium that is tall and crowded, forming small psuedopapillae that project into the follicular lumen. Diagnosis?
Graves disease; associated with hyperthyroidism, exopthalmos, and pretibial myxedema.
Diffuse non-toxic goiter that can occur on an endemic or sporadic basis. Flattening of the crowded columnar epithelium occurs in the thyroid follicles, allowing the gland to become enlarged and colloid rich. Diagnosis?
Colloid goiter.
This presents as a painless, unilateral neck mass. Histologic findings include an intact capsule that separates normal thyroid tissue from numerous large, well-differentiated, colloid-containing follicles. Diagnosis?
Follicular thyroid adenoma.
This typically presents as a single nodule in an older woman. Histologic features include relatively uniform cells taht form small follicles, nests, or sheets. Colloid may be present in the follicles. Capsular invasion occurs, and area of hemorrhage or vascular invasion are common. Diagnosis?
Follicular Thyroid Carcinoma.
Prolonged venous filling time, shiny colored skin, skin atrophy, hair loss, and nail changes all suggest what type of disease?
Peripheral Arterial Disease (PAD).
Lactuose is a classic treatment for what condition? Describe the mechanism by which it works.
Lactulose is the classic treatment for Hepatic Encephalopathy. This is a nonabsorbable disaccharide that is degraded to lactic acid and acetic acid by the colonic bacteria in your gut. The contents of the gastrointenstinal tract become acidified and NH3 is converted to NH4+. More NH3 diffuses from the blood to the lumen to form more NH4+ and as an osmotic effect is established in the colon, resulting luminal distension promotes peristalsis.
How many molecules of ATP are produced via Anaerobic glycolysis? How many are produced via Aerobic glycolysis?
Anaerobic = 2 ATP

Aerobic = 38 ATP
What is the difference between the meglitinide derivatives and sulfonylureas?
Meglitinide derivatives are short acting, insulinotropic agents used as adjuncts to diet and exercise in the treatment of Type 2 Diabetes mellitus. Their mechanisms of action are similar to that of the sulfonylureas, however, meglitinides do not stimulate insulin release when extracellular glucose levels are low.
What is the most common genetic deficiency in Beta-oxidation of fatty acids?
Hypoglycemia after prolonged fasting with inappropriately low ketone bodies suggests impaired B-oxidation. Medium Chain Acyl-CoA Dehydrogenase deficiency is the most common genetic defect in Beta-oxidation of fatty acids.
What can happen to the spleen of an alcoholic who cirrhosis of the liver?
Alcoholics with cirrhosis of the liver will likely have portal hypertension. This will result in backflow to the spleen and congestive hypersplenism. This congestion of blood will create an apparent expansion of the red pulp of the spleen, which is composed of blood filled sinuses and cords lined by reticuloendothelial-type cells.
What is a benefit of using octreotide for treatment of portal hypertension vs. other medical therapies?
Octreotide will not cause systemic vasoconstriction, but it will reduce splanchnic blood flow and divert blood from the portal system to the systemic circulation by indirectly inducing splanchnic vascular constriction.
What area of the brain functions as the body's "internal clock"?
The Suprachiasmatic nucleus; ("Supraclockmatic nucleus")
Which band of the Sarcomere is the only band that contains an overlap of thick (myosin) and thin (actin) filaments?
The A band.
Why are the maxillary sinuses the most commonly affected sinuses during an upper respiratory tract infection?
This is because their path of drainage is located superior to the floor of the sinuses, inferior to each orbit; thus gravity does not favor drainage of these sinuses.
The triad of sudden onset of back pain, hematuria, and oliguria, in an individual with an anion gap metabolic acidosis is suggestive of what?
Ethylene glycol poisoning.
Mutations in what gene are associated with Hand-foot-genital (HFG) syndrome?
HoxA-13; Homeobox genes function in guiding embryologic morphogeneis. Mutations in thes genes can cause structural defects. The Hox genes are a family of homeobox genes.
How do you treat a tension pneumothorax?
Chest tube placement.
The triad of sudden onset of back pain, hematuria, and oliguria, in an individual with an anion gap metabolic acidosis is suggestive of what?
Ethylene glycol poisoning.
Mutations in what gene are associated with Hand-foot-genital (HFG) syndrome?
HoxA-13; Homeobox genes function in guiding embryologic morphogeneis. Mutations in thes genes can cause structural defects. The Hox genes are a family of homeobox genes.
Methenamine silver stain has what common use?
Methenamine silver stain is a stain commonly used to identify fungal elements in histological sections of tissue.
Which fungus has a propensity for patients with a history of prior TB infection, that has a reproductive form that classically exhibits a "broom-like" structure on silver staining?
Aspergillus; the broom-like form contains conidiospores, and treatment is surgical excision of the fungal mass.
How do you treat a tension pneumothorax?
Chest tube placement.
Methenamine silver stain has what common use?
Methenamine silver stain is a stain commonly used to identify fungal elements in histological sections of tissue.
In the fetal circulation, the maternal blood is taken from the placenta to the fetus via the Umbilical Vein. From the the Umbilical vein it is then taken to the Liver where it is shunted to the Inferior Vena Cava via what structure? What do the Umbilical vein and the other structure become in the adult?
The Ductus Venosus shunts from the Liver to the IVC!!! The ligamentum teres and the ligamentum venosum are the remnants of the umbilical vein and ductus venosus in the adult respectively.
The triad of sudden onset of back pain, hematuria, and oliguria, in an individual with an anion gap metabolic acidosis is suggestive of what?
Ethylene glycol poisoning.
Infliximab and Etanercept work on inhibiting what inflammatory cytokine?
TNF-alpha
Which fungus has a propensity for patients with a history of prior TB infection, that has a reproductive form that classically exhibits a "broom-like" structure on silver staining?
Aspergillus; the broom-like form contains conidiospores, and treatment is surgical excision of the fungal mass.
Clinical manifestations of this disease appear in childhood and include severe EXTREMITY PAIN, DECREASED ABILITY TO SWEAT, corneal and lenticular changes, GI dysfunction, and ANGIOKERATOMAS. Diagnosis?
Fabry's disease; X-LINKED; alpha-galactosidase deficiency, with lysosomal retention of Ceramide trihexoside.
Mutations in what gene are associated with Hand-foot-genital (HFG) syndrome?
HoxA-13; Homeobox genes function in guiding embryologic morphogeneis. Mutations in thes genes can cause structural defects. The Hox genes are a family of homeobox genes.
On what bases does methylation of DNA occur? Which types of sequences are preferentially methylated? What are the enzymes that perform this inactivation by mehtylation?
DNA methylation refers to the enzymatic addition of methyl groups to Cytosine residues in the genome. Cytosine-Guanine dinucleotide repeat sequences are preferentially methylated, and genes with methylated cytosine residues are effectively silenced. DNA methyltransferases perform DNA methylation. Methylation patterns are thought to be a heritable form of epigenetic gene regulation.
How do you treat a tension pneumothorax?
Chest tube placement.
In the fetal circulation, the maternal blood is taken from the placenta to the fetus via the Umbilical Vein. From the the Umbilical vein it is then taken to the Liver where it is shunted to the Inferior Vena Cava via what structure? What do the Umbilical vein and the other structure become in the adult?
The Ductus Venosus shunts from the Liver to the IVC!!! The ligamentum teres and the ligamentum venosum are the remnants of the umbilical vein and ductus venosus in the adult respectively.
Explain how, in the setting of IMPAIRED liver function, GI BLEEDING can be an important cause of HEPATIC ENCEPHALOPATHY.
Increased nitrogen load causing hepatic encephalopathy is thought to happen through two mechanisms:
1) Enterocyte production of ammonia in the metabolism of Glutamine
2) Colonic bacterial production of ammonia in the breakdown of nitrogen containing substances (i.e. protein)

Thus, the impaired liver is unable to process the increased ammonia load from these two mechanisms resulting in its release into the systemic circulation.
Infliximab and Etanercept work on inhibiting what inflammatory cytokine?
TNF-alpha
The triad of sudden onset of back pain, hematuria, and oliguria, in an individual with an anion gap metabolic acidosis is suggestive of what?
Ethylene glycol poisoning.
Methenamine silver stain has what common use?
Methenamine silver stain is a stain commonly used to identify fungal elements in histological sections of tissue.
Clinical manifestations of this disease appear in childhood and include severe EXTREMITY PAIN, DECREASED ABILITY TO SWEAT, corneal and lenticular changes, GI dysfunction, and ANGIOKERATOMAS. Diagnosis?
Fabry's disease; X-LINKED; alpha-galactosidase deficiency, with lysosomal retention of Ceramide trihexoside.
Mutations in what gene are associated with Hand-foot-genital (HFG) syndrome?
HoxA-13; Homeobox genes function in guiding embryologic morphogeneis. Mutations in thes genes can cause structural defects. The Hox genes are a family of homeobox genes.
Which fungus has a propensity for patients with a history of prior TB infection, that has a reproductive form that classically exhibits a "broom-like" structure on silver staining?
Aspergillus; the broom-like form contains conidiospores, and treatment is surgical excision of the fungal mass.
On what bases does methylation of DNA occur? Which types of sequences are preferentially methylated? What are the enzymes that perform this inactivation by mehtylation?
DNA methylation refers to the enzymatic addition of methyl groups to Cytosine residues in the genome. Cytosine-Guanine dinucleotide repeat sequences are preferentially methylated, and genes with methylated cytosine residues are effectively silenced. DNA methyltransferases perform DNA methylation. Methylation patterns are thought to be a heritable form of epigenetic gene regulation.
How do you treat a tension pneumothorax?
Chest tube placement.
In the fetal circulation, the maternal blood is taken from the placenta to the fetus via the Umbilical Vein. From the the Umbilical vein it is then taken to the Liver where it is shunted to the Inferior Vena Cava via what structure? What do the Umbilical vein and the other structure become in the adult?
The Ductus Venosus shunts from the Liver to the IVC!!! The ligamentum teres and the ligamentum venosum are the remnants of the umbilical vein and ductus venosus in the adult respectively.
Explain how, in the setting of IMPAIRED liver function, GI BLEEDING can be an important cause of HEPATIC ENCEPHALOPATHY.
Increased nitrogen load causing hepatic encephalopathy is thought to happen through two mechanisms:
1) Enterocyte production of ammonia in the metabolism of Glutamine
2) Colonic bacterial production of ammonia in the breakdown of nitrogen containing substances (i.e. protein)

Thus, the impaired liver is unable to process the increased ammonia load from these two mechanisms resulting in its release into the systemic circulation.
Infliximab and Etanercept work on inhibiting what inflammatory cytokine?
TNF-alpha
Methenamine silver stain has what common use?
Methenamine silver stain is a stain commonly used to identify fungal elements in histological sections of tissue.
Clinical manifestations of this disease appear in childhood and include severe EXTREMITY PAIN, DECREASED ABILITY TO SWEAT, corneal and lenticular changes, GI dysfunction, and ANGIOKERATOMAS. Diagnosis?
Fabry's disease; X-LINKED; alpha-galactosidase deficiency, with lysosomal retention of Ceramide trihexoside.
Which fungus has a propensity for patients with a history of prior TB infection, that has a reproductive form that classically exhibits a "broom-like" structure on silver staining?
Aspergillus; the broom-like form contains conidiospores, and treatment is surgical excision of the fungal mass.
On what bases does methylation of DNA occur? Which types of sequences are preferentially methylated? What are the enzymes that perform this inactivation by mehtylation?
DNA methylation refers to the enzymatic addition of methyl groups to Cytosine residues in the genome. Cytosine-Guanine dinucleotide repeat sequences are preferentially methylated, and genes with methylated cytosine residues are effectively silenced. DNA methyltransferases perform DNA methylation. Methylation patterns are thought to be a heritable form of epigenetic gene regulation.
In the fetal circulation, the maternal blood is taken from the placenta to the fetus via the Umbilical Vein. From the the Umbilical vein it is then taken to the Liver where it is shunted to the Inferior Vena Cava via what structure? What do the Umbilical vein and the other structure become in the adult?
The Ductus Venosus shunts from the Liver to the IVC!!! The ligamentum teres and the ligamentum venosum are the remnants of the umbilical vein and ductus venosus in the adult respectively.
Explain how, in the setting of IMPAIRED liver function, GI BLEEDING can be an important cause of HEPATIC ENCEPHALOPATHY.
Increased nitrogen load causing hepatic encephalopathy is thought to happen through two mechanisms:
1) Enterocyte production of ammonia in the metabolism of Glutamine
2) Colonic bacterial production of ammonia in the breakdown of nitrogen containing substances (i.e. protein)

Thus, the impaired liver is unable to process the increased ammonia load from these two mechanisms resulting in its release into the systemic circulation.
The triad of sudden onset of back pain, hematuria, and oliguria, in an individual with an anion gap metabolic acidosis is suggestive of what?
Ethylene glycol poisoning.
Infliximab and Etanercept work on inhibiting what inflammatory cytokine?
TNF-alpha
Clinical manifestations of this disease appear in childhood and include severe EXTREMITY PAIN, DECREASED ABILITY TO SWEAT, corneal and lenticular changes, GI dysfunction, and ANGIOKERATOMAS. Diagnosis?
Fabry's disease; X-LINKED; alpha-galactosidase deficiency, with lysosomal retention of Ceramide trihexoside.
Mutations in what gene are associated with Hand-foot-genital (HFG) syndrome?
HoxA-13; Homeobox genes function in guiding embryologic morphogeneis. Mutations in thes genes can cause structural defects. The Hox genes are a family of homeobox genes.
On what bases does methylation of DNA occur? Which types of sequences are preferentially methylated? What are the enzymes that perform this inactivation by mehtylation?
DNA methylation refers to the enzymatic addition of methyl groups to Cytosine residues in the genome. Cytosine-Guanine dinucleotide repeat sequences are preferentially methylated, and genes with methylated cytosine residues are effectively silenced. DNA methyltransferases perform DNA methylation. Methylation patterns are thought to be a heritable form of epigenetic gene regulation.
How do you treat a tension pneumothorax?
Chest tube placement.
Explain how, in the setting of IMPAIRED liver function, GI BLEEDING can be an important cause of HEPATIC ENCEPHALOPATHY.
Increased nitrogen load causing hepatic encephalopathy is thought to happen through two mechanisms:
1) Enterocyte production of ammonia in the metabolism of Glutamine
2) Colonic bacterial production of ammonia in the breakdown of nitrogen containing substances (i.e. protein)

Thus, the impaired liver is unable to process the increased ammonia load from these two mechanisms resulting in its release into the systemic circulation.
Methenamine silver stain has what common use?
Methenamine silver stain is a stain commonly used to identify fungal elements in histological sections of tissue.
The triad of sudden onset of back pain, hematuria, and oliguria, in an individual with an anion gap metabolic acidosis is suggestive of what?
Ethylene glycol poisoning.
Which fungus has a propensity for patients with a history of prior TB infection, that has a reproductive form that classically exhibits a "broom-like" structure on silver staining?
Aspergillus; the broom-like form contains conidiospores, and treatment is surgical excision of the fungal mass.
Mutations in what gene are associated with Hand-foot-genital (HFG) syndrome?
HoxA-13; Homeobox genes function in guiding embryologic morphogeneis. Mutations in thes genes can cause structural defects. The Hox genes are a family of homeobox genes.
How do you treat a tension pneumothorax?
Chest tube placement.
In the fetal circulation, the maternal blood is taken from the placenta to the fetus via the Umbilical Vein. From the the Umbilical vein it is then taken to the Liver where it is shunted to the Inferior Vena Cava via what structure? What do the Umbilical vein and the other structure become in the adult?
The Ductus Venosus shunts from the Liver to the IVC!!! The ligamentum teres and the ligamentum venosum are the remnants of the umbilical vein and ductus venosus in the adult respectively.
Infliximab and Etanercept work on inhibiting what inflammatory cytokine?
TNF-alpha
Methenamine silver stain has what common use?
Methenamine silver stain is a stain commonly used to identify fungal elements in histological sections of tissue.
Clinical manifestations of this disease appear in childhood and include severe EXTREMITY PAIN, DECREASED ABILITY TO SWEAT, corneal and lenticular changes, GI dysfunction, and ANGIOKERATOMAS. Diagnosis?
Fabry's disease; X-LINKED; alpha-galactosidase deficiency, with lysosomal retention of Ceramide trihexoside.
On what bases does methylation of DNA occur? Which types of sequences are preferentially methylated? What are the enzymes that perform this inactivation by mehtylation?
DNA methylation refers to the enzymatic addition of methyl groups to Cytosine residues in the genome. Cytosine-Guanine dinucleotide repeat sequences are preferentially methylated, and genes with methylated cytosine residues are effectively silenced. DNA methyltransferases perform DNA methylation. Methylation patterns are thought to be a heritable form of epigenetic gene regulation.
Which fungus has a propensity for patients with a history of prior TB infection, that has a reproductive form that classically exhibits a "broom-like" structure on silver staining?
Aspergillus; the broom-like form contains conidiospores, and treatment is surgical excision of the fungal mass.
In the fetal circulation, the maternal blood is taken from the placenta to the fetus via the Umbilical Vein. From the the Umbilical vein it is then taken to the Liver where it is shunted to the Inferior Vena Cava via what structure? What do the Umbilical vein and the other structure become in the adult?
The Ductus Venosus shunts from the Liver to the IVC!!! The ligamentum teres and the ligamentum venosum are the remnants of the umbilical vein and ductus venosus in the adult respectively.
Explain how, in the setting of IMPAIRED liver function, GI BLEEDING can be an important cause of HEPATIC ENCEPHALOPATHY.
Increased nitrogen load causing hepatic encephalopathy is thought to happen through two mechanisms:
1) Enterocyte production of ammonia in the metabolism of Glutamine
2) Colonic bacterial production of ammonia in the breakdown of nitrogen containing substances (i.e. protein)

Thus, the impaired liver is unable to process the increased ammonia load from these two mechanisms resulting in its release into the systemic circulation.
Infliximab and Etanercept work on inhibiting what inflammatory cytokine?
TNF-alpha
Clinical manifestations of this disease appear in childhood and include severe EXTREMITY PAIN, DECREASED ABILITY TO SWEAT, corneal and lenticular changes, GI dysfunction, and ANGIOKERATOMAS. Diagnosis?
Fabry's disease; X-LINKED; alpha-galactosidase deficiency, with lysosomal retention of Ceramide trihexoside.
On what bases does methylation of DNA occur? Which types of sequences are preferentially methylated? What are the enzymes that perform this inactivation by mehtylation?
DNA methylation refers to the enzymatic addition of methyl groups to Cytosine residues in the genome. Cytosine-Guanine dinucleotide repeat sequences are preferentially methylated, and genes with methylated cytosine residues are effectively silenced. DNA methyltransferases perform DNA methylation. Methylation patterns are thought to be a heritable form of epigenetic gene regulation.
Explain how, in the setting of IMPAIRED liver function, GI BLEEDING can be an important cause of HEPATIC ENCEPHALOPATHY.
Increased nitrogen load causing hepatic encephalopathy is thought to happen through two mechanisms:
1) Enterocyte production of ammonia in the metabolism of Glutamine
2) Colonic bacterial production of ammonia in the breakdown of nitrogen containing substances (i.e. protein)

Thus, the impaired liver is unable to process the increased ammonia load from these two mechanisms resulting in its release into the systemic circulation.
DiGeorge syndrome presents with what types of cardiac abnormalities?
Great Vessel abnormalities.
Why do Varicoceles tend to occur on the left side?
This is because the left renal vein is compressed between the aorta and the superior mesenteric artery, thereby increasing the pressure in the left renal vein, which transmits to the left gonadal artery.
Which chromosome is involved in both Prader-Willi and Angelman syndrome
Chromosome 15.
What is another name for Reiter's syndrome?
REACTIVE ARTHRITIS!!!
What are the most serious and potentially fatal side effects of Digoxin toxicity? How do you treat Digoxin toxicity?
VENTRICULAR TACHYARRHYTHMIAS!!! are the most serious and potentially fatal effects of Digoxin toxicity. These need to be treated with management of hyperkalemia and possible with antidigoxin antibody fragments!!!
Where are some of the lymph nodes/sites that gastric cancer can metastasize to?
Virchow's node (left supravlavicular), Sister Mary Joseph node (periumbilibal node), or Krukenberg tumor of the ovary.
What is the pattern of involvement of the rectum compared to other areas of the intestine, in Ulcerative Colitis? How do pain and bloody diarrhea present in UC?
The rectum is ALWAYS involved in Ulcerative Colitis; involvement of other areas of the intestine is variable. Bloody diarrhea, with or without abdominal pain, is the hallmark of Ulcerative Colitis!!! (In Crohn's disease there may also be bloody stools, but abdominal pain is virtually always present)
Acute renal failure following induction of chemotherapy for a malignancy is due to accumulation of what in the renal tubular cells?
Tubular obstruction with URATE crystals.
A patient with signs of renal failure and toe gangrene, or livedo reticularis, following an invasive vascular likely has what condition? What will you see on light microscopy?
This patient likely has Atheroembolic renal disease. Light microscopy shows cholesterol emboli obstructing renal arterioles!!!
How will you be able to tell the difference between a Fructokinase deficiency and a Galactose-1-phosphate uridyl transferase deficiency if the question stem tells you that there is non-glucose reducing sugars found in the urine?
Fructosuria is an asymptomatic and benign disorder. In contrast many other enzymatic difficiencies associatd with sugar metabolism are not (e.g. hereditary fructose inolerance = Aldolase B deficiency). Galactose-1-phosphate uridyl transferase deficiency (essential galactosemia) leads to Galactosemia characterized by neonatal jaundice, bleeding diathesis, feeding intolerance, hypotension and death if untreated. Treatment here is by elimination of all milk products from the diet and feeding with soy-based formula.
What does it mean that a Meckel diverticulum is a TRUE diverticulum?
This means that is consists of all parts of the intestinal wall: mucosa, submucosa, and muscular layer.
What is the toxic metabolite that is associated with hemorrhagic cystitis following Cyclophosphamide therapy? What is an alternative therapy to treatment of this condition with Mesna?
Acrolein is the toxic metabolite that is toxic to uroepithelial cells and can cause cell death and necrosis. 2-Mercaptoethanesulfonate is an alternative treatment to Mesna that can bind and inactivate the toxic metabolites.
What is used in treatment of Methotrexate overdose?
Leucovorin (Folinic acid)
What is Filgrastim and when do you use it?
Filgrastim is granulocyte colony-stimulating factor (G-CSF) analog used to simulate proliferation and differentiation of granulocytes in patients with neurtopenia following chemotherapy.
How is Doxorubicin cardiotoxicity treated?
Dexrazoxane is an iron-chelating agent that can help prevent anthracycline-induced (i.e. doxorubicin) cardiotoxicity.
What agent is used to decrease the cumulative nephrotoxicity associated with Platinum-containing and alkylating chemotherapeutic agents?
Amifostine is a cytoprotective free-radical scavenger used to decrease the cumulative nephrotoxicity.
What is special about the antineoplastic drug Cladribine and its accumulation in the cell? What is it resistant to? What does it treat?
Cladribine is a purine analog that achieves high intracellular concentration because it is resistant to degradation by adenosine deaminase. Cladribine is the drug of choice for Hairy cell leukemia.
What class of antimetabolite drug is Fludarabine? What is it used to treat?
This is a PURINE analog. It treats CLL!!!
Inhibin B is a downregulator of FSH secretions in males that is produced by which cells? What is controls LH levels?
Sertoli cells; testosterone concentration is controlled primarily by testosterone feedback.
How do you treat acute life threatening bleeding associated with Warfarin toxicity?
Fresh frozen plasma.
If you were trying to inhibit fibrinolysis by inhibiting plasminogen, what two medications would you use?
Aminocaproic acid and Tranexamic acid.
What is the difference between Myxedema and Pretibial myxedema?!?
Myxedema = describes the overall process of HYPOTHYROIDISM

Pretibial myxedema = non-pitting EDEMA and THICKENING of the skin, usually present over the tibia and lower legs, associated primarily with GRAVE'S DISEASE.
70 year old man; MOSAIC pattern of LAMELLAR bone; highly vascularized arteriovenous shunting causing high output heart failure. Diagnosis?
Paget's disease of bone.
Homozygous Apolipoprotein E-4 allele is associated with what disease later in life?
LATE ONSET ALZHEIMER'S!!!
Name all of the mutations associated with Early-onset Alzheimer's and Late-onset Alzheirmer's.
Early-onset:
1. Amyloid Precursor Protein on Chromosome 21
2. Presenillin 1 gene on Chromosome 14
3. Presenillin 2 gene on Chromosome 1

Late-onset: Apo-E4
Why is Hepatitis C virus so strongly associated with chronic infection?
Because of the variety in antigenic structure of the Hep C VIRAL ENVELOPE PROTEINS, the production of host antibodies lags behind the production of new mutant strains of HCV and effective immunity against infection is not conferred.
Candida vaginitis can be caused by use of broad spectrum antibiotics, but what are other potential causes?
CONTRACEPTIVES, steroids, diabetes mellitus, and immunosupression.
What are the differences in the 3'-5' and the 5'-3' exonuclease activities seen in DNA polymerase?
The 3'-5' exonuclease activity confers the "proofreading" ability of the DNA polymerase. The 5'-3' exonuclease activity removes RNA primers as well as damaged DNA.
What determines whether a patient's M.leprae infection will develop into lepromatous leprosy vs. tuberculoid leprosy?
The mos severe form termed "lepromatous leprosy" occurs in patients with a weak cell mediated (Th1) immune response. Without an appropriated cell-mediated response, macrophages are never given the skgnal to kill the mycobacterial organisms. As a result, M.leprae multiplies and disseminates widely. The features of leprosy are primarily observed in skin, superficial nerves, eyes, and testes.
Describe the process of Base excision repair.
GLYCOSYLASE cleaves the altered base leaving an AP (apurination/apryamidation) site. ENDONUCLEASE cleaves the 5' end and LYASE cleaves the 3' sugar phosphate. DNA POLYMERASE and LIGASE fill the single nucleotide gaps.
What enzyme other than histamine is used as a marker for mast cell activation?
TRYPTASE!!!
What causes the degranulation of mast cells in response to IgE binding with regard to receptor action?
Degranulation of mast cells is accomplished by the CROSS-LINKING (and receptor aggregation) of multiple membrane-bound IgE antibodies by a specific antigen
What is the anabolic effect that testosterone and estrogen have on bone production?
These steroids increase osteoblast activity and decrease osteoclast activity.
Name the 7 major risk factors for osteoporosis.
1 Smoking
2. Menopause
3 Corticosteroid therapy
4. Physical inactivity
5. Caucasian race
6. Low total body weight
7. Alcohol use
What are the signs and symptoms most associated with tension pneumothorax? What is the cause of tachycardia?
TACHYCARDIA, HYPOTENSION, TACHYPNEA, hypoxia, and absent breath sounds and hyperresonance to percussion on the affected side. Tachycardia occurs because the increased pressure within the chest cavity causes decreased systemic venous return to the heart leading to decreased cardiac output, and reflex induced tachycardia.
Stab wound immediately above the clavicle and lateral to the manubrium. First thought of injury?
Puncture to the lung pleura causing pneumothorax, tension pneumothorax, or hematothorax.
Juvenille tumor comprised of cells with hair-like glial processes that are associated with microcysts. These tumors can arise in the cerebellum, brainstem, hypothalamic region, or optic pathways. (*Rosenthal fibers). Diagnosis?
Pilocytic astrocytoma!!!
What is special about BAL fluid in a patient with sarcoidosis and their CD4+/CD8+ T-cell ratios?
Immunologic abnormalities in sarcoidosis include intraalveolar and interstitial accumulation of CD4+ T cells, resulting in high CD4:CD8 T-cell rations in bronchoalveolar lavage fluid.
Where is the site for compliment attachment on an antibody?
In the Constant region right above the site for attachment to phagocytic cells (Fc recptor region) ---> Y (right there :) ).
What is the order of hemorrhagic skin lesions in increasing size: Purpura, Petechiae, Ecchymoses?
1) Petechiae = cutaneous or subcutaneous; non-palpable, asymptomatic, tend to appear in areas of increased venous pressure, such as feet and ankles; <5mm

Pupurae = cutaneous or subcutaneous collections of extravasated blood 5mm-1cm

Ecchymoses (normal bruise) = extravasated blood <1cm
What is TTP due to?
An acquired or genetic deficiency in vWF-cleaving metaloprotease in endothelial cells.
What is ITP due to?
IgG antibodies directed at GpIIb/IIIa receptors (Type II Hypersensitivity) --> Macrophages phagocytose platlets.
Blanching of a vein into which NE is being infused together with induration and pallor of the tissues surrounding the IV site are signs of what condition? How do you treat it?
These are signs of NE extravasation and resulting vasoconstriction. Tissue necrosis is best prevented by local injection of an Alpha-1 blocking drug such as Phentolamine.
Which muscles contract in the acoustic reflex that serves to dampen the effects of prolonged loud noise?!?
The Stapedius and Tensor tympani muscles to contract, lessening the responsiveness of the ossicles to sound.
Briefly describe the transduction of mechanical auditory forces into nerve impulses.
1) Sound reaches middle ear via vibrating Tympanic membrane ---> 2) Ossicles transfer vibration to Oval window ---> 3) Vibration of Oval window vibrates Basilar membrane, which bends Hair cells against Tectorial membrane ---> 4) Hair bending causes oscillating hyperpolarization and depolarization of the auditory nerve, thus creating nerve impulses from sound.
What drug given for Hypertensive crisis has the notable side effect of Cyanide toxicity?
Sodium nitroprusside.
What is the oral nitrate preparation that has nearly 100% bioavailability due to extermely low first pass metabolism?
Isosorbide 5-mononitrate (which is an active metabolite of Isosorbide dinitrate) has nearly 100% bioavailability when taken orally.
When you suspect localized amyloidosis, what general choice should you make when picking the correct substance responsible?
Pick a local substance to the organ of interest!!! Common causes of localized amyloidosis:

Cardiac atria: atrial naturetic peptide
Thyroid gland: Calcitonin
Pancreatic islets: Islet amyloid protein (amylin)
Cerebrum/Cerebral blood vessels: B-amyloid protein
Pituitary gland: prolactin
What are the two main chemicals that are seen to be increased on prenatal screening when there is a Neural tube defect present?
Acetylcholinesterase!!! and of course Alpha-Fetoprotein!!!
How does the genetic mutation associated with Wilson's disease hinder copper metabolism?
By reducing the formation and secretion of ceruloplamin and by decreasing the secretion of copper into the biliary system.
What are the copper chelating agents that are used to treat Wilson's disease?
Penicillamine and Trientine.
Over the last 20 years the increase in infection incidence in hospitals most closely correlates with the increased use of what?
Intravascular devices and catheterization.
What is the major risk factor for a person infected with HBV for developing Hepatocellular carcinoma?
Integration of the viral DNA into the host genome of host hepatocytes, which triggers neoplastic changes. The changes that occur ONLY AFTER the DNA has been integrated into the genome (MOST IMPORTANT FACTOR) include stimulation of insulin-like growth factors and receptors, suppression of p53 with HBV gene products, and chronic inflammation and regenerations induced by HBV infection.
Pathogenic strains of C.difficile produce what two distinct toxins? How do they cause pathogenesis?
C. difficile produces Toxins A and Toxin B. Toxin A attracts neutrophils causing mucosal inflammation, loss of water into the gut lumen and diarrhea, as well as mucosal death. Toxin B, the cytotoxin, causes actin depolymerization, loss of cellular cytoskeleton integrity, cell death and mucosal necrosis
What is the mechanism by which the characteristic Alpha Toxin Lecithinase of C.perfringens causes pathogenesis?
Cell membrane integrity loss is a characteristic of the alpha toxin lecinthinase produced by C.perfringens.
What are the Auer rods of AML (M3) made of?
Auer rods are made up of fused lysosomal granules; this is why you stain them for myeloperoxidase
What are all of the translocations associated with Burkitt's lymphoma?
t(8;14), t(8;22), and t(8;2). All of these translocations move the myc protooncogene from Chromosome 8 to regions near the immunoglobulin promoter sites on Chromosomes 14, 22, and 2.
Opioid analgesics, Iron supplements, calcium channel blockers such as verapamil, and anticholinergic medications such as atropine all have what side effect in common?
Constipation.
Urinary retention is a frequently tested side effect of what medications?
Anticholinergic medications like atropine and drugs exhibiting anticholinergic effects such as TCA's and ANTIHISTAMINES!!!
Joint pain could be caused in a patient with Gout if what type of diuretic is used?
THIAZIDES!!! = HyperGLUC
Cold extremities resulting from Reynaud's phenomenon have been associated with the use of what two type of medication?
Beta-blockers! as well as Ergotamine! used in the treatment of MIGRAINE headaches.
Nocturnal wheezing can be a symptom of what two diseases?
Asthma and GERD.
Generally, the risk of dependence of a drug is directly proportional to what other feature of that drug?
Risk of dependence is directly proportional to the rate of clearance.
Which benzodiazapenes are most likely to produce dependence? Which are most likely to be associated with impaired mental function and "hangover" side effects?
Dependence = short acting = (A)lprazolam,(T)riazolam,(O)xazepam

Hangover effects = Long acting = (C)hlordiazepoxide,(C)lorazepate,(D)iazepam,(F)lurazepam
What antibiotic should always be included in any empiric treatment of meningitis in infants and in immunocompromised adults to cover for LIsteria?
AMPICILLIN!!!
Chronic lymphedema predisposes to what what malignant development?
ANGIOSARCOMA!!! other risk factors include toxin exposure and radiation.
Which cells of the collecting duct primarily have the H+/K+ exchanger?
The Intercalated cells
Which cells of the distal tubule and collecting duct are most responsible for responding to Aldosterone stimulation and ADH stimulated insertion of Aquaporin channels?
The Principal cells.
Which diuretic should be used in patients with Sulfa Allergies?
Ethycrinic Acid!
Propothouracil and Methimazole are two antithyroid drugs that both have what dreaded side effect? How do the drugs differ, and which one is used in pregancy?!?
AGRANULOCYTOSIS is the side effect they share; They differ in that PTU also decreases the peripheral conversion of T4 to T3, has a shorter half-life, and is the drug of choice in pregnancy (Propothiuracil is PRO-pregnancy), as Methimazole is TERATOGENIC.
How do patients with Agranulocytosis from thyroid medications usually present?
Recent onset of fever and sore throat (sometimes severe); immediately get a blood differential to evaluate for Agranulocytosis!!!
What is a new xanthine oxidase inhibitor that is thought to be safer in patients with renal dysfunction and has fewer drug interactions compared to allopurinol?
Febuxostat is the new, safer, Allopurinol :)
What are examples of stressors that can lead to ammonia imbalance and precipitate hepatic encephalopathy? What is the mechanism by which ammonia is thought to inhibit CNS function?
GI bleeding, hypovolemia, hypokalemia, metabolic alkalosis, hypoxia, sedative usage, hypoglycemia, or infection. The pathogenesis of hepatic encephalopathy is likely related to inhibitory action of ammonia on neurotransmission via the GABA receptors in the central nervous system.
What is the only Gram (+) bacteria to produce (L)PS? Does it live in/out of cells?
Listeria!!! It is facultatively intracellular.
What are the main virulence factors produced by Bacillis anthracis?
1. Anthrax EXOTOXIN composed of Edema factor (a calmodulin dependent adenylate cyclase that increases cAMP), Lethal factor, and Protective antigen.
2. The antiphagocytic Poly-Gamma-D-Glutamic acid capsule
Minor can or cannot be treated without parental consent for pregnancy, STD, birth control, and drug or alcohol addiction?
Yes they CAN!
What is the triad of Wiskott-Aldrich syndrome?
Eczema, thrombocytopenia, and combined B- and T-lymphocyte deficiency.
Oculocutaneous albinism, peripheral neuropathy, and immunodeficiency related to dysfunction of phagocyte phagosome-lysosome fusion. Diagnosis?
Chediak-Higashi!!!
Child with progressice ataxia together with telangiectasia and an immunodecficiency due to combine defect of both B and T-lymphocytes. Diagnosis?
Ataxia-Telangectasia!!!
What is the mechanism of Protamine's action of Heparin reversal?
It binds and chemically inactivates Heparin.
What is Desmopressin used for? (*fluid-disorder and coagulation disorder)
Desmopressin is a synthetic analogue of anti-diuretic hormone used in the treatment of diabetes insipidus. At high doses, desmopressin increases factor VIII activity in patients with Hemophilia A and von Willebrand disease. High-dose desmopressin can help control bleeding associated with these disorders.
Clenched hands with overlapping fingers is consider one of the distinguishing features of what syndrome Trisomy syndrome?
Trisomy 18; Edwards syndrome
Is the cortical segment of the collecting duct more sensitive to ADH or Aldosterone?
Aldosterone; ADH is more in the Medullary segment of the collecting duct, although both work in principal cells.
A stroke in this region of the brain is characterized by total sensory loss on the contralateral side of the body. Although there are no motor deficits, proprioception is often profoundly affected and may lead to difficulty ambulating and falls. Diagnosis?
This is Thalamic syndrome; lesion to the VPL or VPM.
A stroke in this region of the brain is frequently associated with coma, bilateral paralysis, decerebrate rigidity, pinpoint pupils and often death. Diagnosis?
An ischemic event in the PONS.
A stroke of this location in the brain is associated with TRANSIENT HEMIPARESIS, as well as frontal lobe symptoms and agitation, psychosis, and dyskinesias. Diagnosis?
Lesion in the CAUDATE.
Mutation of what proapoptotic receptor is thought to underlie certain autoimmune disorders?
Mutation of the FAS protein is thought to prevent apoptosis of auto-reactive lymphocytes, thereby disposing the individual to develop autoimmune disorders such as SLE.
Desmopressin is a synthetic analog of ADH that is used in coagulation disorders (Hemophilia A and vWD) because it works on ENDOTHELIAL cell production of what two molecules? (*one is in the coagulation cascade, and one is outside the coagulation cascade)
Desmopressin acetate (DDAVP) stimulates release of FACTOR VIII and vWF from endothelial cells!!!
Which Prostaglandin is most responsible for raising the thermoregulatory set point in the Anterior Hypothalamus during fever?
Prostaglandin E2.
Patients who overdose on Beta-blockers should be given what treatment?
GLUCAGON!!! because it increases heart rate and contractility of myocytes at receptors that are independent of adrenergic receptors.
Methotrexate is structurally similar to Folic acid and inhibits what enzyme?
Dihydrofolate reductase.
Sulfonamide antibiotics are chemical analogs of PABA, which is a folic acid precursor in prokaryotes, that inhibits what enzyme and reaction?
Sulfonamides inhibit Dihydropteroate Synthetase and prevent the bacterial conversion of PABA to Folic acid.
This drug is Folinic acid, which is a pre-reduced form of Folic acid that can be used for the synthesis of purines and thymidylate without first being converted by DHF reductase and thus can be used for rescue therapy in cancer patients receiving Methotrexate. What am I?
LEUCOVORIN!!!
Psammomabodies; ground glass nuclei with intranuclear grooving; follicular hyperplasia lined by tall cells. These are indications of what thyroid lesion?
Papillary THyroid Cancer.
Mixed cellular infiltration with occasional Giant Cells is seen in what type of Thyroiditis? This is often painful.
de Quervain's, or granulomatous subacute thyroiditis caused usually by viral infection.
Where is C-peptide formed in the cell? How is it released with respect to insulin?
C peptide is formed from proinsulin in the pancreatic Beta-cell Golgi apparatus, packaged along with insulin in islet cell secretory granules, and secreted in equimolar concentrations with insulin.
Which member of the Picornaviridae family of viruses is not and enterovirus and is thus acid labile?!
RHINOVIRUS!!! which is why it cannot cause a gastroenteritis and only URIs.
What type of anemia is seen to allow the bone marrow be replace by fat cells and fibrous stroma? A bone marrow biopsy must be done in order to distinguish this disease from what other disease?
Aplastic anemia causes pancytopenia with this histological picture of the bone marrow. A bone marrow biopsy must be done to distinguish Aplastic anemia from myeloproliferative diseases that can also cause pancytopenia.
What is the mechanism by which H.pylori is associated with duodenal ulcer formation?
H.pylori is associated with the formation of duodenal ulcers due to increased gastric acidity. The increased gastric acidity is caused by a decrease in Somatostatn-secreting cells in the gastric mucosa leading to unchecked gasrtin production.
Ras, N-myc, erb-B1(squamous cell carcinoma of the lung), erb-b2 (breast and ovarian cancer), TGF-alpha (astocytoma, hepatocellular carcinoma), sis (astrocytoma, osteosarcoma), abl ---> these are all what type of oncogenes?
Proto-oncogenes.
BRCA1, BRCA2, NF-1, APC/Beta-catenin, DCC, p53, RB, WT-1 --> these are all what type of oncogenes?
Anti-oncogenes (tumor suppressors)
Compare and contrast DIC, TTP, and HUS.
DIC =patients bleed; coagulation cascade is activated; PT and PTT are prolonged; LOW fibrinogen and INCREASED fibrin degredation products

TTP-HUS = patients usually do not bleed; only platelets are activated; thus normal PT and PTT; thus normal fibrinogen
PAH is used in measures of RPF because all that enters the afferent arteriole is generally excreted through filtration and secretion. How is PAH secreted?
PAH is secreted from the blood in the peritubular capillaries into the tubular fluid by the cells of the PROXIMAL TUBULE by a CARRIER-MEDIATED process. The secretion of PAH can be saturated at high blood concentrations because this is a carrier-mediated process.
Thiazolidinadiones bind to what receptor target inside of cells? Since the glitaziones upregulate transcription and expression of GLUT4 and other insulin response elements, what family of receptors must this target belong to?
Thiazolidinediones bind to Peroxisome Proliferator-Activated Receptor-gamma (PPAR-y), a receptor that belongs to the steroid and thyroid superfamily of nuclear receptors.
Night-time abdominal pain that is relieved by food is indicative of what type of ulcer? What is standard treatment of this ulcer (most likely due to H.pylori)?
Duodenal Ulcer. Standard treatment includes two antibiotics (Metronidizole, Tetracylcine, Amoxicillin, or Clarythromycin) with an adjunctive agent (proton pump inhibitor and/or bismuth) for 14 days.
Which antimycobacterial agent works best in acidic environments (i.e. within phagolysosomes of macrophage that have MTB organisms)? vs. those have their best antimicrobial effects against extracellular mycobacteria?
Pyrazinamide works best in at acidic pHs

Isoniazid, Rifampin, and Ethambutol work better on extracellular mycobacteria.
Why do Risperidone and other antipsychotics cause hyperprolactinemia?
This is due to their antidopaminergic action.
Whenever you have a Pelvic fracture you should consider injury to what portion of the Urogenital system?
Injury to the Posterior Urethra is associated with Pelvic Fracture. It presents with inability to void despite a full bladder, and a high riding prostate on rectal examination.
Urinary tract injury due to a saddle injury, such as falling on the crossbar of a bike, injures what portion of the urinary tract?
The Anterior Urethra.
What is the name of the disease that Parvo B19 causes?
Erythema infectiosum (fifth disease); slapped cheek; aplastic crises in sickle cell and HS patients; hydrops fetalis.
What are the major viruses responsible for causing bronchitis/bronchiolitis?
Influenza A, RSV, and Coronavirus.
Woolsorter's disease; inhalation of spores while working with goat hair or hides; Hemorrhagic Mediastinitis (WIDENED MEDIASTINUM!!!); long chains that are "Serpentine" or "Medusa head" on appearance under microscopy; unique D-glutamate capsule. Diagnosis?
INHALATION ANTHRAX!!! RUUUUUUNNN!!!!!
Gram-positive rod; intracellular Polyphosphate granules after growth on Loeffler medium and staining with methylene blue. Diagnosis?
Corynebacterium diptheriae.
What are the three treatments in order of importance, for someone with acute C.diptheriae infection?
1) administration of Diptheria Antitoxin 2) administration of Penicillin or Erythromycin, and 3) administration of DPT vaccine
Hypoxia-induced lactic acidosis is due to low activity and high activity of what two dehydrogenases?
Low activity of Pyruvate Dehydrogenase (oxidative phophorylation pathway) and High activity of Lactate Dehydrogenase.
Deletion of what receptor results in resistance to HIV infection? Which HIV gp is used to bind to this receptor?
The CCR5 receptor; HIV gp120 binds this receptor for entry into the cell.
What are the jobs of the Nef and Tat HIV viral genes?
Nef =decreases expression of MHC I molecules on surfaces of infected cells

Tat = plays a role in viral replication
Nephrogenic diabetes insipidus; HYPOTHYROIDISM; tetratogenic Ebstein's anomaly. These are the adverse side effects of which antipsychotic drug?
LITHIUM!!!
Clozapione and Carbamazeine are two antipsychotics that can cause the same dreaded side effect as antithyroid medications. What is it?
Agranulocytosis.
Tetrahydrobiopterin (BH4) is a cofactor used by hydroxylase enzymes in the synthesis of what molecules? What enzyme regenerates BH4 after it is used, and deficiency of this enzyme is an unusual cause of what inborn error of metabolism?
Phenylalanine ---(BH4)---> Tyrosine ---(BH4)---> DOPA (which makes melanin and catecholamines)

Tryptophan ---(BH4)---> 5-hydroxytryptamine (which makes Serotonin)

***Dihydropterin reductase is the enzyme that regenerates BH4 after it is use, and deficiency of Dihydropterin reductase is an uncommon cause of Phenylketonuria (PKU).
CN V3 exits the skull through what opening?
Foramen Ovale; V3 innervates the muscles of mastication including the asseter, the medial and lateral pterygoids, and the temporalis muscles.
CN V2 exits the skull through what opening?
Foramen rotundum; V2 is the maxillary nerve
The Foramen spinosum transmits what structures through the skull?
Middle meningeal artery and middle meningeal vein and the meningeal (recurrent) branch of CN V3.
Spike-and-dome carotid pulse upstrokes are characteristic of what cardiac condition?
Hypertrophic cardiomyopathy.
What medications are indicated in treating Neuroleptic Malignant Syndrome (*fever, rigidity, autonomic instability, altered mental status- all from D2 antogonism)?
Dopamin agonists such as Bromocriptine and/or direct muscle relaxants (dantrolene) can decrease mortality rates of this syndrome.
How long after onset of infarction is it that irreversible ischemic injury to myocytes occurs, and ATP has dropped to 15% of normal, and lactate levels are very high?
About 30 min; loss of cardiac myocyte contractile function occurs within 60 seconds.
Alteration of gene expression in Huntington disease is believed to occur due to what process?
Hypermethylation of histones.
Name all this signigicant hemoglobins with their greek names.
Alpha-Beta = HbA
Alpha-Delta = HbA2
Alpha-Gamma = HbF
Zeta2-Epsilon2 = Earliest fetal hemoglobin
Gamma-4 (Y4) = HbBarts
Staging of carcinomas is often the most important prognosticating factor and is assigned through what observation?
Staging of a carcinoma is assigned though level of invasion.
Infant with mousy body odor and fair skin coloring. Diagnosis?
Phenylketonuria.
Infant presents lethargic, feeding poorly, exhibits prolonged jaundice, demonstrates constipation, muscle hypotonia, and a hoarse cry; pale, dry, cool skin; macroglossia, coarse facial features, and umbilical herniation; ASD or VSD may be present; myxedema. Diagnosis?
Congenital HYPOTHYROIDISM!!!
Which class of diuretics are the most potent diuretics with excellent efficacy and thus would be used to treat initial symptoms of Congestive Heart failure associated with pulmonary congestion?
LOOP DIURETICS!!! because the ascending limb of the Loop of Henle has significant reabsorptive capacity and blocking the Na/K/Cl Triporter there is the most effective!!!
What is the definition of a gastric erosion? What are the most common causes of Erosive gastritis?
A gastric erosion is defined as a mucosal defect that DOES NOT penetrate the MUSCULARIS MUCOSA. The use of NSAIDs, having surgery, head trauma (Cushings ulcers), burns (Curling ulcers), smoking, and alcohol consumption, are the most common causes of Erosive gastritis.
Describe a unique sequelae of Parvovirus infection in adults that can mimic an autoimmune disease.
In adults, parvovirus can cause arthritis involving the proximal interphalangeal, metacarpal, knee and ankle joints. This can mimic rheumatoid arthritis with involvment that is usually symmetric, but unlike rheumatoid arthritis, symptoms generally resolve spontaneously.
What are three examples of tumors that exhibit psammoma bodies?
Meningiomas, Papillary thyroid cacinoma, and Serous Papillary ovarian adenocarcinoma.
Hemolytic anemia, hypercoagulable state, and decreased blood counts/pancytopenia. What disease should you think of? What is the gene deficiency associated with this disorder? Deficiency of what membrane proteins is DIAGNOSTIC of this disorder? Why is this disorder associated with pancytopenia?
This is Paroxysmal Nocturnal Hemoglobinuria; PNH involves a mutation of the PIG-A gene that codes for the GPI cell membrane anchor. This anchor is necessary for attachment of CD55 and CD59, without which complement stays activated and hemolysis of the cell results. ABSENCE of CD55 and CD59 is DIAGNOSTIC of PNH. Since PNH is a stem cell disorder, it is often associated with pancytopenia.
Why do we get wrinkles?
With aging fine skin wrinkles appear due to decreased collagen synthesis and a net loss of dermal collagen and elastin.
What is the mechanism of action of the chemotherapeutic agent Etoposide (derivative of podophyllotoxin)? What is the normal job of the enzyme this drug inhibits?
Etoposide inhibits the sealing activity of TOPOISOMERASE II. Treatment with Etoposide causes chromosomal breaks to accumulate in dividing cell, ultimately causing cell death. Topoisomerases normally relieve the DNA supercoling that occurs during replication by inducing double strand breaks and then resealing them. Etoposide inhibits the resealing of double strand breaks.
Dofetilide is a Class III antiarrhythmic agent that works on what Phase and ion of the cardiac ventricular action potential?
Class III antiarrhythmics work on K+ blocking and therefore affect Phase 3 of the cardiac action ventricular potential.
Class I antiarrhythmics work on what phase and what ion of the cardiac ventricular action potential?
Class I antiarrhythmics work on modulating Na+ conduction and thus work on Phase 0 of the cardiac ventricular action potential.
Class II antiarrhythmics decrease cAMP and decrease Ca2+ currents via Beta-receptor antagonism. Class IV drugs are direct Ca2+ blockers. Which cells do they most effect and which phase of the action potential curve?
These drugs affect conduction through the AV NODE the most and they affect Phase 4 of the curve by decreasing the slope and inhibiting depolarization.
Which fungi are most likely to present in a patient with Diabetic Ketoacidosis?
Rhizopus, Mucor, and Absidia are the saprophytic fungi that cause mucormycosis in immunocompromised and DKA individuals.
Aspergillus and Cryptococcus are only observe in one morphological fungal form. What is that form for each?
Aspergillus has only a mold form. Cryptococcus has only a yeast form.
Increased serum B-type Naturetic Peptid (BNP) is characteristic of what cardiac disease?
Congestive heart failure.
What is normally the volume status of patients with SIADH?
Initially the extra ADH in SIADH leads to excessive water absorption from the kidneys, cause early hypervolemia. Excess water suppresses RAAS which leads to low aldosterone and salt-wasting. Eventually though, most patients with SIADH equilibrate with a near normal total body volume and low plasma Na+ (because of salt-wasting). There is no gross hypervolemia, nor peripheral edema (due to salt-wasting)
What are the main deleterious side effects of Carbamazepine? (*blocks voltage gated Na+channels for simple partial, complex partial, and generalized tonic-clonic)
Agranulocytosis, SIADH, Hepatotoxicity
Which blood vessel carries blood with lower oxygen content: Pulmonary artery, or Coronary sinus?
Coronary sinus; the brain, GI tract, kidneys, and extremities extract less oxygen from arterial blood than does the heart. The heart has the highest O2 requirements of any tissue or organ in the body. Resting myocardium extracts 70% O2 from the blood; myocardium at work extracts up to 90%.
What is the sequence seen on the 3' end of tRNA? What group does aminoacyl tRNA synthase bind the amino acid to?
The 3' sequence is a CCA tail where aminoacyl tRNA synthase attaches the aminoacid to the 3' OH- group.
What unique bases does the D arm of tRNA contain. What is the function of the D arm? What about the T arm? What special bases does it contain and what is its function?
The D arm contains numerous DIHYDROURACIL residues (modified bases often present in the tRNA), the exact function of which has yet to be identified. The T arm contains the "T;psi;C" sequence, which is necessary for binding of tRNA to ribosimes. This seqeunce name refers to the presence of (T)hymidine, (Ps)eudouridine, and (C)ytidine residues in this arm. ***tRNA is the only RNA species that contains the nucleoside Thymidine***
Sickle cell, steroid therapy, SLE, and alcoholism all have what lesion of the femoral head in common?
Avascular necrosis of the femoral head.
All three prokaryotic DNA polymerases have proof reading activity and remove mismatched nucleotides via 3'-5' exonuclease activity. But which one has 5'-3' exonuclease activity that is responsible for excising and replacing RNA PRIMERS and DAMAGED DNA sequences?
DNA POL I !!!
Mitochondria are necessary for which steps of heme synthesis? Which enzymes are involved?
Mitochondria are needed for the First and Final Three steps in heme synthesis. The main enzymes involved are Ferrochetalase and ALA synthase.
What modification allows MRSA to be resistant to all B-lactam antibiotics, including the B-lactamase resistant antibiotics?
An ALTERED PENICILLIN BINDING PROTEIN in its peptidoglycan cell wall that does not bind beta-lactams as effectively.
Does the B-lactamase produced by Staph aureus work extracellularly or intracellularly?
S.aureus prodcues an extracellular B-lactamase.
What is a main mechanism of resistance to Rifampin by S.aureus and possbly M.tuberculosis?
A mutation in the RNA polymerase.
What is a major mechanism of resistance to Tetracycline and Sulfonamide antibiotics?
Resistance to these drugs is due at least in parts to a decrease in the levels of drug accumulation due to decreased uptake and/or increased efflux.
What is the main mechanism of resistance to Quinolone antibiotics?
Mutations in DNA gyrase.
What parameter is the most sensitive inducer of cerebral vasodilation?
pCO2; increased pCO2 is the most potent vasodilator (e.g. patients with COPD usually have low pO2 and high pCO2, thus their cerebral circulation is most likely to be increased)
How far down do Cilia reach in the airways of the lungs?
Epithelial Cilia persist up the the END of the RESPIRATORY BRONCHIOLES.
What part of the eye produces aqueous humor? What anti-glaucoma drugs act at this location? What is the job of the Trabecular meshwork?
Aqueous humor is produced by the epithelial cells of the Ciliary Body. Beta-blockers work here (e.g. Timolol). The Trabecular meshwork is where the aqueous humor diffuses into Schlemm's canal (scleral venous sinus)
What are the prostaglandins that are used to treat narrow angle glaucoma by increasing the outflow of aqueous humor from the eye? What are the cholinomimetics used for the same effect?
PROSTAGLANDIN F2alpha (increases (F)LOW!) = Latanoprost, Unoprostone, Travapost). Cholinomimetics = Pilocarpine, Carbechol
What muscle do cholinomimetics contract to relieve occular pressure and improve the outflow of aqueous humor in Narrow Angle Glaucoma?
CILIARY MUSCLE!!! causing the lens to become more convex.
What are the status of the sertoli cells, leydig cells, and gonadotropins found in patients with Kleinfelter syndrome?
Both Sertoli and Leydig cells are destroyed in Kleinfelter syndrome leading to increased FSH (decreased Inhibin) and LH (decreased circulating Testosterone)
The congenital absence of GnRH-secreting neurons is defining of what syndrome?
Kallmmann's syndrome.
What structures in and around the Ureter are important to keep in mind during abdominal surgery? Where is the Ureter in relation to the Iliac arteries, the Gonadal arteries, and the Uterin vessels (hysterectomy)?
Midway from the kidney to the pelvic inlet the gonadal artery and vein cross OVER the Ureter ("water under the bridge"). The Ureters gain access to the pelvis by crossing over the external iliac artery and vein medial to the gonadal vessels and lateral to the internal iliac vessels. The Ureters then course through the uterosacral ligament just deep to the Uterine vessels in the female before gaining access to the bladder.
Which product of HBV is a glycoprotein that forms spheres and tubules approx. 22nm in diameter. This glycoprotein turns out to be a product of viral synthesis that poorly correlates with viral replication.
This describes HBsAg, which is a noninfective envelope glycoprotein.
What is the name of the transcriptional transactivator of viral genes in HBV that is necessary for viral replication and is also thought to function in the feregulation of hepatocyte replication and the development of hepatocellular carcinoma?
HBx.
What are the main manifestations of Hypokalemia?
Muscle weakness and cramping.
What is the only sensory pathway where input is not processed through the thalamus?
The OLFACTORY TRACT!!!
What is the function of the VPL nucleus in the thalamus? Which sensory tracts does it talk to? Where does it transmit to?
VPL receives input from the spinothalamic tract (pain and temp) and medial lemniscus (position and proprioception). It transmits impulses to the Primary somatosensory cortex (Broadmann areas 3, 1 &2)
The VPM nucleus of the Thalamus receives sensory information from what tracts? Where does it transmit to?
The VPM recieves inputs from the trigeminal and gustatory pathways and transmits them to the Primary Sensory Cortex (Broadmann's 3, 1 & 2).
The Lateral geniculate body is a relay nucleus in the Thalamus for what pathway? Where does it receive input from and where does it send it?
The LGB is a relay nucleus for the vision pathway. It receives impulses from the optic nerve and transmits them via the optic radiations tothe visual cortex (calcarine sulcus)
What sensory pathway is the Medial geniculate body of the Thalamus in charge of? Where does it receive info from and where does it transmit?
The MGB is part of the auditory pathway. It receives impulses from the superior olivary nucleus and the inferior colliculus of the pons, and projects them to the auditory cortex of the temporal lobe (Brodmann's areas 41 &amp;42)
Patients with inherited deficiencies of the terminal compliment cascade (C5b-C9) are unable to form what complex and are at risk for what type of infections?
These patients are unable to form a Membrane attack complex and will have predisposition to recurrent Neisseria infections.
What is first line treatment for any type of partial seizure (Simple or Complex), which involves no rhythmic jerking?
Carbamazepine
What is first-line treatment for Tonic-clonic seizures (Tonic extension of extremities, followed by Clonic rhythmic movements)?
Phenytoin, carbamazepine, and valproate.
What is the first-line treatment for Mycoclonic seizures (Brief arrhythmic jerking movements with no loss of conciousness)?
Valproic acid.
What is first-line treatment for Absence seizures?
1st: Ethosuximide or 2nd: valproate
How can Citrate influence renal salt crystalization?
Citrate binds to free (ionized) Ca 2+, preventing its precipitation and facilitating its excretion. Therefore, increased citrate and high fluid intake help prevent calculi formation.
Which hypothalamic nuclei are responsible for the production of Oxytocin and Vasopressin?
Oxytocin = paraventricular nuclei

Vasopressin = supraoptic nuclei
What are the differences in ulcer presentation in HIV-esophagitis between HSV-1 and CMV?
HSV-1 = small vesicles that evolve into "punched out" ulcers, with eosinophilic nuclear inclusions (Cowdry Type A)

CMV = linear ulceration
What set of illnesses is known as the allergic triad?
Atopic dermatitis, Allergic rhinitis, and Asthma. People with one of these diseases are at risk for developing the others.
Childhood disease with PRURITUS, erythematous weeping papules and plaques that occur in response to certain environmental antigens. Diagnosis?
Eczema. One member of the atopic triad of Atopic dermatits (eczema), Allergic rhinitis, and Asthma.
PAS is good for staining the cell walls of what type of organism? Which organism in particular that affects the GI tract?
PAS is particularly effective at highlighting the polysaccharides of the fungal cell well. PAS is an excellent choice in evaluating tissue for Whipple disease.
Explain the mechanism of action of N-acetyl cysteine in treating Acetaminophen overdose.
NAC acts as a Glutathione substitute and binds to the toxic metabolite of acetominophen. NAC also provides sulfhydryl groups to enhance the non-toxic sulfation elimination of acetominophen.
What type of analysis are Two-sample t-tests and Two-sample z tests used for?
These are used to compare two means.
What type of analysis is used to compare a 2 x 2 table that is trying to compare observed values with expected values (*comparing proportions)?
The Chi-square test.
What is ANOVA used for?
This is used to compare the means of 3 or more variables
What is the main stimulation for increased production of RBCs?
Tissue hypoxia.
Why are inferior MI's (observed with ST segment elevation in the inferior leads) associated with Bradycardia?
Inferior MIs are often due to blockage of the right coronary artery, the artery responsible for SA node perfusion.
Streptomycin is indicated in what three outlier infections?
Francisella tularensis, Mycobacterium, Yersinia pestis.
What are the two enzymes of heme synthesis are inhibited by lead poisoning and what two molecules are built up behind the enzyme blocks?
ALA-dehydratase (build up of delta-ALA)

Ferrochetolase (build up of Protoporphyrin IX)
What is the cause of the Hyperacute rejection associated with organ transplantation?
Hyperacute rejection is due to preformed antibodies against ABO antigens. Screening for ABO blood group incompatability has virtually eliminated hyperactue rejection as a possibility in organ transplant recipients.
What mediates acute rejection in organ transplantation?
Acute rejection occurs within weeks of transplantation and is primarily mediated by host T-lymphocytes against donor MHC (HLA) antigens.
Cutting the superior thyroid artery could damage which nerve? Cutting the inferior thyroid artery could damage which nerve?
Superior thyroid artery could damage the External branch of the Superior Laryngeal nerve.

Inferior thyroid artery could damage the Recurrent Laryngeal nerve.
The Recurrent Laryngeal nerve is a branch of the Vagus nerve that loops below what structures in the thoracic region? What are the differences from left to right? What muscles do the Recurrent Laryngeals supply?
Loops below the Aortic Arch on the Left, and loops below the Subclavian Artery on the Right; these nerves supply all the muscles of the Larynx (except the cricothyroid muscle).
How do each of these sugars enter the glycolytic pathway? Which one is metabolized the fastest and why?
1) Glucose
2) Galactose
3) Mannose
4) Fructose
Glucose --> Glucose-6-phosphate

Galactose --> Glucose-6-phosphate

Mannose --> Fructose-6-phosphate

Fuctose --> Glyceraldehyde-3-phophate

***Fructose is the most rapidly metabolized because is bypasses PFK-1, the rate-limiting step of glycolysis, and none of the other sugars do.
What does mitochondrial DNA actually encode for?
There are 37 genes coding for 13 proteins,2 forms of rRNA, and 22 forms of tDNA.
Explain the mechanism by which inherited or acquired hypertriglyceridemia causes acute pancreatitis when the level of triglycerides in serum exceeds 1000mg/dl?
Normally fatty acid in the serum is bound to albumin. If the triglyceride levels are higher than 1000mg/dl, the concentration of free fatty acids exceeds the binding capacity of albumin and leads to direct injury to acinar cells and pancreatic capillaries.
Which naturetic peptide can be diagnostic for CHF?
BNP (B-type naturetic peptide), which is predominately secreted by the ventricles.
The Middle Meningeal artery is a branch of what artery? Provide a description of the bony structures that overlie the middle meningeal artery.
The Middle Meningeal artery is a branch of the Maxillary artery, which itself is a branch of the External Carotid. The location of the Middle Meningeal artery can be described as where the Frontal, Parietal, Temporal, and Sphenoid bones meet (*This site is known as the Pterion)
Provide definitions or reliability, precision, and accuracy.
A RELIABLE/PRECISE tool is one that consistently provides the same value when measuring a fixed entity. An ACCURATE tool is one that gives a measurement close to the (ACC)tual value (as reflected in the gold standard measurement.
Where are Serotonergic neurons found in the brain? What role do these neurons play for us?
Serotonergic neurons are ONLY found in the RAPHE NUCLEI of the brainstem. The Raphe nuclei are located in the midbrain, pons, and medulla, and axons from these cell bodies project widely throughout the CNS. These neurons play a role in the sleep-wake cycle and in the patient's level of arousal. Lesions can cause insomnia and depression.
The Nucleus Ceruleus houses what type of neurons that do what job? Where is it located?
The Nucleus Ceruleus houses Norepinephrine-secreting neurons that participate in activation of the "flight or fight" response to physical and emotional stressors. It is located in the DORSAL PONS.
What is the function of the neurons located in the RED Nucleus?
The RED nucleus is located in the anterior midbrain. Its neurons participate in MOTOR COORDINATION of the Upper Extremities.
What type of neurons are lost in the caudates of Huntington's patients?
Cholinergic and GABA-releasing neurons in the striatum.
What are the two most common immediate physical symptoms of Marijuana use?
Rapid heart rate and Conjunctival injection.
What nerves are most commonly seen to be affected first in poisoning with Botulinum toxin?
The Cranial nerves
The t(15;17) of AML(M3) results in what fusion protein?
PML/RAR-alpha; this is from the translocation of the gene for the retinoic acid receptor. This abnormal fusion gene product inhibits differentiation of myeloblasts and triggers the development of APL.
How do Osteocytes and Myocytes communicate with their respective neighbors?
Via GAP JUNCTIONS!!!
TIGHT JUNCTIONS (1st component of the junctional complex) are observed usually between what types of cells?
Tight Junctions (zona occludens) are observed at the apices of GLANDULAR cells, and consist of two closely adherent cytoplasmic membranes without intervening space.
Desmosomes (3rd component of the junctional complex) and Hemidesmosomes are common to what type of tissue?
Stratified squamous epithelium. They contribute significantly to the structural cohesiveness of tissues subject to mechanical stressors.
What are Intermediate Junctions (zona adherens)(2nd component of the junctional complex)? Describe what they look like under electron microscopy.
Intermediate junctions are a delicate network of cytoplasmic filaments that radiate from the cell membrane to hold adjacent cells together. They are the 2nd component of the junctional complex.
5-aminosalicylic acid (5-ASA) compounds are found in what bowel ccondition?
Inflammatory bowel disease.
Why do 3rd generation Cephalosporins have better activity against Gram-negative bacteria than 1st or 2nd generation?
This is because 3rd generation Cephalosporins are more beta-lactamase resistant.
What are the three main beta-lactamase inhibitor drugs that are given in combination with Beta-lactam drugs, in order to improve their efficacy?
These are Clavulanic acid, Sulbactam, and Tazobactam.
Why are penicillins and aminoglycosides used together?
Penicillins inhibit peptidoglycan synthesis cell wall synthesis, allowing amminoglycosides to gain access to the cell interior where they act on the 30s subunit of the bacterial ribosome.
The body's satiety centers reside in what section of the Hypothalamus (*think about where this resides in the thalamus)? What happens to lesions of this region? What childhood tumor cold cause lesions here?
In the Ventromedial Nucleus (VMN) of the hypothalamus. Bilateral lesions of the VMN cause hyperphagia and obesity. Episodes of rage and/or savage behavior are also sometimes noted. The most common cause of such rare lesions is tumor invasion, for example by a craniopharyngioma.
What Hypothalamic region is responsible for hunger?
The lateral nuclei of the hypothalamus signal hunger. Bilateral lesions would cause one to lose the desire to eat. In adults starvation ensues; in infants, failure to thrive
Which Hypothalamic nuclei are responsible for regulating the body temperature in overheating? Which branch of the autonomic nervous system is engaged?
When body temperature rises, the Anterior hypothalamic nuclei coordinate cooling by stimulating the parasympathetic nervous system to produce vasodilation and sweating. Destruction of these nuclei can result in uncontrolled hyperthermia and death.
What Hypothalamic nuclei is responsible for regulation of body temperature during the cold?
The Posterior hypothalamic nuclei regulate heat conservation and heat production via sympathetic vasoconstriction when the body is cold.
Myeloperoxidase (MPO) is an enzyme that is used as a marker for what type of cells?
Myeloid cells.
Vimentin is an intermediate filament used as a marker for tissues of what origin?
Mesenchymal.
Chromoranin A and Neuron-specific enolase are markers for what type of tumors?
Neuroendocrine tumors.
The HER2/neu oncogene encodes for what type of receptor that is a member of what receptor family?
It has intracellular tyrosine kinase activity and is a member of the family of EGFRs. Over expression of this protein is associated with increased rates of breast and ovarian cancer.
What are the 3 most common childhood CNS tumors in descending order of frequency?
1) Pilocytic astrocytomas = cerebellum most common location; BOTH cystic and solid components; contains tumor nodule of active growth; Rosenthal fibers
2) Medulloblastoma = ONLY in CEREBELLUM (most commonly vermis); only solid components; sheets of small blue cells; highly malignant with poor prognosis; presents with headache and cerebellar dysfunction
3) Enpendymomas = arise from ependymal lining of ventricle; can obstruct CSF flow; gland-like structure called "rosettes"
When a naive Th0 cell is presented antigen from a Machrophage, what IL-? is secreted in order to differentiate that Th0 cell? Which subset will it become? What will it secrete?
When a naive Th0 cell is presented antigen from a Macrophage, that Macrophage releases IL-12! IL-12 will promote the differentiation of the Th0 cell into a Th1 cell. Th1 cells secrete IL-2 and IFN-y in order to activate more Macrophage and CD8+ cells.
When a naive Th0 cell is presented antigen from a B-cell, what IL-? is secreted in order to differentiate that Th0 cell? Which subset will it become? What will it secrete?
When a naive Th0 cell is presented antigen from a B-cell, that B-cell releases IL-4! IL-4 will promote the differentiation of the Th0 cell into a Th2 cell. Th2 cells activate B-cells and release IL 4,5,6, and 10.
Children with severe recurrent respiratory infections found to lack the IL-12 receptor on Th0 lymphocytes are at risk for what types of infection? What do you treat them with?
These children get recurrent mycobacterial infection. You treat the with IFN-gamma. *Do you remember why? :)
High levels of prolactin cause hypogonadism in females via what mechanism?
Hyperprolactinemia inhibits GnRH release from the hypothalamus.
Which respiratory anesthetic is an exception to the rule that all inhalation anesthetics are respiratory depressants?
Nitrous oxide.
How do inhalation anesthetics affect the cardiovascular, respiratory, cerebral, renal, and hepatic systems?
Cardio = myocardial depression

Respiratory = depressant (except for Nitrous oxide)

Cerebral = Increases blood flow through decreased resistance and ICP :(

Renal = lowers GFR and RPF through raising renal vascular resistance

Hepatic = decreases flow
Thiopental (Ultra-short acting barbiturate anesthetic-NO analgesia) produces hypnosis and anesthesia and can be used in minor, rapid, surgical procedures because of the drug's rapid plasma level decline. By what mechanism does this happen and what would happen if Thiopental were used for a prolonged period?
The cause of rapid plasma decay of Thiopental is due to REDISTRIBUTION of the drug to tissues through out the body. This is good for short procedures and small doses. If there is prolonged administration of Thiopental, however, storing in the tissues and continuous release can cause prolonged recovery from the drug.
In addition to degeneration of the the Posterior columns and the Spinocerebellar tract, what other pathologies are associated with Fredreich's ataxia?
Poor Friedreich:

Hypertrophic cardiomyopathy, Diabetes mellitus, Kyphoscoliosis, pes cavus, and foot deformities such as hammertoes.
What is Cholera's main sensitivity given it route of infection?
GASTRIC ACID and pH of the STOMCH!!! (thus high infectious does needed)
Bone marrow sample composed of greater than 30% plasma cells is diagnostic of what plasma cell dyscrasia?
Multiple myeloma.
PID, especially in women, must!!! be treated for the possibility of coinfection of N.gonorrhoeae and C.trachomatis. Which medications are used to treat the possibility of each infection?
N.gonorrhoeae = 3rd generation Cephalosporin

Chlamydia = Azithromycin or Doxycyclin
How can Debranching enzyme deficiency be differentiated from other glycogen storage diseases??
By demonstrating the accumulation of abnormally short outer dextrins-like structures in the cytosol of hepatocytes and muscle cells, with an ABSENCE of fatty liver infiltration.
Non-motile, unencapsulated, Gram-positive rod; found in clumps resembling Chinese letters or joined in V- or Y-shaped chains on microscopic examination. Cytoplasm contains metachromic polar granules that stain with analine dyes like methyline blue.
Corynebacterium diptheriae.
What are the molecules that induce ALA-synthase and which inhibits it?
Alcohol, Barbs, hypoxia, and other drugs that induce CP450 induce ALA-synthase. Conversely, HEME and glucose inhibit ALA-synthase.
Are the processes by which the liver hepatocytes take up and secrete unconjugated and conjugated bilirubin, respectively, active or passive processes? What are the enzymes responsible for Gilbert's, Crjglar-Najjar, and Dubin-Johnson symdromes?
The liver takes up indirect (unconjugated) bilirubin through a passive process and secretes direct (conjugated) bilirubin through an active process. UDP-Glucuronyl transferase is LOW in most newborns and Gilbert's and is ABSENT is Crigler Najjar syndrome. Dubin-Johnson and Rotor syndrome have defective scretion of conjugated bilirubin due to an impaired Canalicular Organic Anion Transporter (cMOAT).
Patients with Imperforate Anus often have what other abnormalities?
Urogenital tract anomalies. Meconium may discharge from the urethra or vagina is a fistula is present.
Where is PAH secreted into the nephron?
In the PROXIMAL TUBULE!!!
Periodic, non-peristaltic contraction of the esophagus describe what condition? What condition does this mimc?
This condition is referred to as Diffuse Esophageal Spasm (DES). In DES several segments of the esophagus contact at the same time, which prevents the propagation of the food bolus toward the stomach. Esophageal manometric studies show disorganized non-peristaltic contraction of the body of the esophagus. Simultaneous contractions cause "corkscrew" esophagus, as seen on barium esphagogram and can cause symptoms that mimic as Angina pectoris.
What is the time frame that separates post-partum blues from post-partum depression?
Blues last less than 2 weeks; after 2 weeks it is post-partum depression
Why does the decrease in pH and pCO2 in tissues allow Hb to be favored in releasing its O2? How does this contrast with the process in the lungs? How do RBCs contribute to CO2 release in the lungs and water production? (HIGH YIELD BOHR EFFECT QUESTION).
The decreased pH favors protonation of Histidine residues at the N-terminal alpha amino group of Alpha and Beta Hb subunits . Once these histidine groups are protonated they are able to form SALT BRIDGES which make the Hb molecule more rigid and favors the release of O2. This is known as the Bohr affect!!! In the lungs, the opposite takes place; the Hb releases protons and accepts O2!!! The lungs use carbonic anhydrase to combine the protons and carried bicarb to then produce CO2 and H2O!!!
What is the new aldosterone antagonist that has less frequent occurrence of gynecomastia then Spironolactone?
Eplerenone.
What type of renal tubular acidosis is associated with HYPOALDOSTERONSIM?
TYPE IV renal tubular ACIDOSIS.
What causes Type I RTA?
Defects of the H+/K+ ATPase of the Collecting Tubules.
What is the cause of Type II RTA?
Defects in Proximal tubule HCO3- reabsorption.
Which RTA (I, II, IV) is the only one that can lead to Hyperkalemia?
Type IV because it is due to Hypoaldosteronism.
How are Poly-A tails added to mRNA?
Polyadenylation signal sequence at the 3' end signals the Poly-A Polymerase to add the tails; this is NOT RNA polymerase from the DNA.
How does the laboratory test that serves to identify H.influenzae by using S.aureus work? What are the factors that are released/secreted that are required for H.influenze growth?
H.influenzae requires the presence of Factors X(hematin) and V(NAD+) in order to grow. This can be accomplished by growing in the presence of S.aureus and demonstrating the "satelite phenomenon" where H.influenzae grows only near the beta-hemolytic S.aureus colonies because they produce the needed Factors X and V.
How do HIV fusion inhibitors (Enfurvirtide) work? What do they prevent exactly?
They bind HIV's transmembrane envelope protein gp41. The prevent gp41 from undergoing the conformational changes necessary for the viral membrane to fuse with the target cellular membrane of CD4+_cells.
Attachment of HIV to target cells is mediated by what protein?
gp120.
Prolonged, untreated obstructive sleep apnea can cause what cardiovascular conditions?
Pulmonary Hypertension and RIGHT HEART FAILURE.
Which cells of the testes are responsible for secreting Mullerian inhibitory factor during embryogenesis?
Sertoli cells.
Where in the gonadotropin pathway does Inhibin produced by the Sertoli cells in the testes block?
Inhibin blocks the release of FSH.
Does the testosterone inhibit LH or GnRH secretion?
BOTH!!!
Child presents with fever, bilateral conjunctivitis, lymphadenopathy; Cutaneous involvment could include:
1) Oropharyngeal- strawberry tongue, erythema of palatine mucosa, fissured lips
2) Extremities- edema of hands and feet, erythema of palms and soles, desquamating of fingertips (periungual)
3. Generalized rash- usually urticarial beginning on extremities and moving to the trunk

Diagnosis? Most serious complication?
This is KAWASAKI DISEASE! Formatin of coronary artery aneurysm is the most serious complication.
What vasculitis is monocular blindness associated with?
Temporal Arteritis.
Which vasculitides is Mononeuritis multiplex associated with?
Mononeuritis multiplex is a peripheral neuropathy of multiple individual nerves. It is associated with a variety of diseases including Wegener granulomatosis and Polyarteritis nodosa.
Kaposi sarcoma is derived from what type of cells?
Primitive mesenchymal cells.
What medication that is used to induce ovulation has been linked to increased incidence of ovarian cancer?
Clomiphene citrate.
Why are oral contraceptives thought to decrease the risk of ovarian cancer?
Oral contraceptives reduce the risk of non-hereditary ovarian cancer by decreasing the total number of times a woman ovulates in her life, thus decreasing the need to repair the ovarian surface..
Hydroxyzine, Promethazine, Chlorpheniramine, and Diphenhydramine are all examples of what class of drugs? WHAT ARE THEIR SIDE EFFECTS?
FIRST GENERATION H1 BLOCKERS!!!
Side effects include Anti-Muscarinic, Anti-Serotonergic (appetite stimulation), and Anti-Alpha-adrenergic (postural dizziness)
What class of medication is Fexofenadine?
Second generation H1 block; DOESN'T CROSS BBB!!!
Succinylcholine is a depolarizing NMJ blocker that normally has a duration of action around 10 min after a standard dose. Can it ever last longer than that in a patient, and if so why?
Yes it can last longer than that because about 1 in 3000 patients are heterozygous for an atypiical plasma cholinesterase, which breaks down Succinylcholine more slowly, over 1 to 3 hours.
What disorder results in severe dysfunction (vomiting, lethargy, failure to thrive) after the initiation of breast feeding? What is the enzyme deficiency associated?
This describes Classic Galactosemia which results from a deficiency of Galactose-1-phosphate uridyl transferase (GALT). Impaired liver function, hyperchloremic metabolic acidosis, and aminoaciduria are also associated.
What are the enzyme deficiencies in the benign versions of Fructosuria and Galactosemia? What are the symptoms of each?
Fructokinase (urinary fructose) and Galactokinase (isolated bilateral cataracts due to Aldose Reductase)
Aldose Reductase causes problems in the eyes associated with what two carbohydrate related disorders?
Diabetes (catarcts and retinopathy; sorbitol) and Galactokinase deficiency (cataracts; galacitol)
What is one of the main sequelae associated with a Subarachnoid hemorrage caused by a ruptured berry aneurysm if a person is stable?(*symptoms manifest no earlier than 3 days after hemorrhage and most occur 7-8 days after) What is used to treat this sequelae?
Cerebral vasospasm which causes altered mental status as well as focal neurological deficits is believed to occur due to substances generated from degradation of subarachnoid blood clots. Nimodipine is a Ca 2+ blocker that decreases morbidity and mortality associated with this phenomenon.
What infection usually presents with the abrupt onset of fever, chills, headache, myalgia, and malaise that gradually improves of a period of two to five days? There is a subset of patients that go on to develop a secondary type of infection with what organisms?
The first symptom are indicative of infection with Influenza A. Some patients who acquire Influenza A infection (commonly the older than 65) will be subject to developing secondary bacterial pneumonia. The most common organisms in descending order are Strep pneumoniae, Staph aureus, and H.influenzae.
What CN is responsible for stimulating secretions from the sublingual and submandibular glands?
CN VII; Facial Nerve
Which CN is responsible for stimulating secretions from the Parotid gland?
CN IX via CN V.
What is the only muscle that the Glossopharyngeal (CN IX) nerve innervates?
Stylopharyngeus muscle.
What does the sensory limb of the Glossopharyngeal (CN IX) nerve do?
General sensory innervation of the upper pharynx (upper portion of the gag reflex) and tonsilar region; carotid body and carotid sinus relfex; TASTE sensation and general sensation of the posterior 1/3 of the tongue
This disease manifests clinically with symmetric PROXIMAL muscle weakness of the arms and legs. There is increased creatine kinase in the serum and there are anti-Jo-1 antibodies present. There is an increased risk of malignancy in general. Muscle biopsy reveals inflammation, necrosis and regeneration of muscle fibers. Preceding damage to myocytes with subsequent over-expression of MHC class I proteins on the sarcolemma leads to infiltration with CD8+ lymphocytes and myocyte damage. Diagnosis?
POLYMYOSITIS!!!
This disease is associated with bilateral stiffness of the shoulder and pelvic girdle muscles, fever, weight loss, and an increased sedimentation rate. There is an association with TEMPORAL ARTERITIS (*older people)
Polymyalgia Rheumatica; older people
Describe the mechanism of pathogenesis associated with Eaton-Lambert syndrome.
This is a paraneoplastic disorder associated with small cell carcinoma of the lung that causes muscle weakness that improves with activity. ANTIBODIES AGAINST PRESYNAPTIC Ca 2+ CHANNELS prevent the release of acetylcholine from presynaptic neurons causing symptoms very similar to those of myasthenia gravis.
Hematuria, proteinuria and urine RBC casts are present in a child patient with hypercellular glomeruli seen on light microscopy. Diagnosis? Antibodies in serum?
This is most likely Post-Streptococcal-GN. Anti-strep antibodies include Anti-Streptolysin O, Anti-DNAse B, and Anti-Cationic proteinase. There will also be low C3 concentration
Slow acetylators are more likely to acquire what syndrome with Hydralazine and Procainamide?
Drug-induced-Lupus. This condition has been linked to drugs that are metabolized by N-acetylation in the liver. Slow acetylators are more susceptible to developing the condition, but discontinuation of the agent is only warranted in patients who develop symptoms, not just if they have autoantibodies present.
snRNPs and mRNA are synthesized by which RNA Pol in the nucleus?
RNA Pol II.
Which androgen is responsible for developing male internal genitalia and which for external male genitalia: Testosterone vs. DHT?
Testosterone = Internal genitalia

DHT = External genitalia
What is the gene on the Y chromosome that codes for TDF, testes-determining factor, which is responsible for gonadal differentiation into testes containing Sertoli and Leydig cells?
The SRY (Sr."Y") gene.
What are the two classes of Dopamine agonists (i.e. directly stimulate dopamine receptors) and which medications are associated with each class?
Ergot compounds: Bromocriptine and Pergolide

Non-ergot compounds: Pramipexole and Ropinerole
Drugs that inhibit Dopamine breakdown centrally work on which enzyme vs. those drugs that inhibit breakdown peripherally?
Decreased central dopamine degredation describes the action of SELEGILINE, an MAO-B (present in the brain) INHIBITOR.

Both COMT inhibitors and Dopa Decarboxylase Inhibitors (DDIs) decrease the breakdown of levodopa in peripheral tissues and increase the amount of levodopa available to cross the BBB.
What Antiviral agent has been seen to enhance the endogenous effects of Dopamine?
Amantidine.
What type of Parkinsonism are anticholinergics most used in? What are examples of these anticholinergics?
Anticholinergics such as Trihexyphenydyl and Benztropine, inhibit central muscarinic receptors and are mainly used for drug-induced Parkinsonism.
What is the condition that can deteriorate to become Torsades de Pointes?
PROLONGED QT INTERVAL!!!
What does CREST stand for?
Calcinosis Raynaud Esophagus Sclerodactyly TELANGECTASIA!!! It is a systemic sclerosis variant that mostly invovles the skin of the face and fingers.
Decreased expression of D-cadherin and E-cadherin (intercellular adhesion molecules) overexpression have been associated with GI cancers. Which hereditary GI cancer gene is an adhesion molecule gene?
APC
Which HIV drug is given to HIV positive pregnant women as prophylaxis for their fetus?
AZT/ZDV
What type of selective medium is used to culture Neisseria?
Thayer-Martin VCN (Vancomycin/Colistin/Nystatin)
Which metabolic pathway, that is the main source of energy for the heart, best explains why the heart has such high O2 requirements?
Fatty Acid Oxidation!!!; this yields more energy, but also has great O2 requirements than glucose oxidation.
What type of glands are found in the Duodenum that aren't found anywhere else? What do they do?
Brunner's glands are unique to the Duodenum and they lie in the submucosa and secrete alkaline mucous into ducts that empty into the crypts of Lieberkuhn. Peyer's patches, in contrast are lymphoid aggregates specific to the Ileum.
Where is the only place in the body that Peyer's patches are found?
The Ileum.
Why does Silicosis promote TB infection in those affected with this pneumoconiosis?
In Silicosis, there may be disruption of macrophage phagolysosomes by the internalized silica particles, which leads to impaired TB killing.
What are some of the possible contraindications to using NSAIDs in a patient? What patient population do we avoid using NSAIDs in (besides chlidren)?
NSAIDs should be avoided in patients with renal and hepatic dysfunction. There is a risk for GI bleeding with the use of NSAIDs, and they can also cause fluid retention, aggravation of hypertension, and precipitation of CHF. NSAIDs are thus generally avoided in elderly patients!!!
A patient with renal failure has GOUT. What do you use other than NSAIDs and Colchicine?
Glucocorticoids.
If a patient must be on a drug regiment that includes a P450 inhibiting enzyme as well as a Statin, which Statin should they take?
Pravastatin is the statin of choice
Which macrolide antibiotic does not have significant effects on CytP450 3A4?
Azythromycin; (*zith one does not affect P450)
Which syndrome is a syndrome of hereditary hemorrhagic telangectasias?
Osler-Weber-Rendu syndrome. Rupture of theses telangectasias ma cause epistaxis, GI bleeding, or hematuria.
A cerebellar hemangioblastoma in association with congenital cysts of the kidneys, liver, and/or pancreas is highly suggestive of what disease?
von Hippel-Lindau disease; Autosomal Dominant
Patients with Homocystinuria most commonly have a defect in what enzyme? Thus what amino acid is essential for them that would not normally be?
Cystathione beta synthetase; these patients cannot make Cysteine from Homocysteine, thus it is essential
What action does Hexokinase have on Fructose?
Hexokinase converts Fructose into Fructose-6-phosphate, just like it converts Glucose into Glucose-6-phosphate.
What is the driving force mechanism behind the high PTH, low Ca2+, high PO4-, and low Calcitriol (Vit D) in a patient with Chronic Renal Failure? What type of secondary disease condition does this lead to?
The inability to excrete Phosphorus; this leads to complexing with ionized calcium and lowering of Ca2+ leves. Additionally, loss of renal parenchyma in kidney disease causes a decreased renal calcitriol production. The net low Ca2+ and high PO4- leads to high PTH secretion. This is a form of SECONDARY HYPERPARATHYROIDISM!!!
Why might patients with Conn's syndrome experience muscle weakness and parasthesias?
Patient's with hyperaldosteronism will have hypokalemia (muscle weakness) and metabolic alkalosis (parasthesias).
How might Lyme disease affect the heart?
It can produce AV node conduction block.
If you cannot choose to treat Lyme disease with a tetracycline antibiotic, what type of antibiotic should you use?
A PENICILLIN-TYPE ANTIBIOTIC!!!
What is the mechanism behind why a prolonged course of Total Parenteral Nutrition (TPN) is often complicated by the formation of gallstones? How do you prevent gallstone formation in patients receiving TPN?
1) Biliary stasis from absent enteral stimulation secondary to decreased CCK release.

2) Those with ileal resection have a disturbance of enterohepatic bile acid circulation resulting in supersaturation of hepatic bile with cholesterol.

Exogenous CCK administration will prevent gallstone formation in patients on TPN.
Which antibiotic blocks peptide bond formation by inhibiting at the 50s ribosomal subunit, and is used to treat anaerobic infections ABOVE the diaphragm? (i.e. oral flora causing lung abssess, but also has coverage for Gram-positives). What do you use to treat anaerobic infection BELOW the diaphragm (*plus parasites, BUT not Gram-positives)?
Above = CLINDAMYCIN!!!

Below = METRONIDAZOLE!!!
How is Follicular Thyroid Carcinoma differentiated from benign follicular adenomas?
By capsular invasion and vascular invasion.
Psammoma bodies (concentrically calcified structures) are particular to what type of Thyroid cancer?
Papillary carcinoma
Hurthle cells (enlarged epithelial cells with abundant eosinophilic granular cytoplasm as a result of altered mitochondria) of the Thyroid are often associated with what two lesions?
Hashimoto's thyroiditis as well as Folllicular Thyroid Cancer.
How is Hereditary Spherocytosis inherited?
Autosomal Dominant.
In Hereditary Spherocytosis which cytometric red cell index parameter is best to help confirm the diagnosis and why?
The most helpful red cell index in making the diagnosis of Hereditary Spherocytosis is the MCHC- Mean Corpuscular Hemoglobin Concentration. An elevated MCHC indicates membrane loss and red cell dehydration. Diagnosis is best confirmed, however, with the osmotic fragility test.
Potency of a drug is the concentration of a drug necessary to produce half its maximal effect (ED50). What two factors affect potency?
1) Binding affinity of the drug at its target.

2) Ability of a drug to reach its target.
Which artery can produce life-threating hemorrhage if there is an ulceration of the posterior wall of the duodenal bulb?
The GASTRODUODENAL artery lies along the posterior wall of the duodenal bulb and is likely to be eroded by posterior duodenal ulcers, and can produce life-threateing hemorrhage if it is eroded into.
What is the normal value of the Reid Index used for Chronic Bronchitis?
40%
What cytologic index/description will tip you off to an EBV-mediated B-cell lymphoma in an HIV patient or otherwise?
Diffuse medium-sized lymphocytes producing the characteristic "stary sky appearance, a HIGH PROLIFERATION INDEX represented by a HIGH Ki-67 FRACTION (~99%), and INCREASED APOPTOSIS.
What are the mechanisms of Isoniazide resistance that have been found in M.tuberculosis?
Isoniazid resistance specifically occurs by two adaptive gene mutations:
1) Decreased bacterial expression of the catalase-peroxidase enzyme that is required for Isoniazide activation once the drug enters the bacterial cell.

2) Modification of the protein target binding site for Isoniazide.
What type of TB infection is safe to treat with monotherapy?
Patients who have a positive PPD and a negative chest x-ray (i.e. no evidence of clinical disease).
Viridans streptococci are capable of producing extracellular polysaccharides (Dextrans) using sucrose as a substrate. These dextrans facilitate streptococcal adherence to what molecule? How does this facilitate valvular endocarditis caused by these organisms?
Dextrans facilitate streptococcal adherence to fibrin. Fibrin and platelets are deposited at sites of endothelial trauma, providing a site for bacterial adherence and colonization during bacteremia leading to the formation of valvular vegitation.
Possible food poisoning characterized by fever, abdominal pain, diarrhea, and faintly erythematous macules on the abdomen called "rose spots" Diagnosis? Mode of travel for the bug?
This describes Typhoid, or enteric, fever caused by S.typhi. This bug penetrates the intestinal mucosa and travels to the mesenteric lymph nodes where it multiplies and is phagocytosed by macrophages within which it can survive.
What is the classic route of transmission for HCV vs. HBV?
HCV = Innoculations and blood transfusions (i.e. IV DRUG ABUSE!!!)

HBV = Any and all body secretions (i.e. SEX!!!)
Bilateral renal Angiomyolipomas are associated with what disease? Describe the histology of an Angiomyolipoma. In contrast, what disease is associated with the development of bilateral renal cell carcinoma?
Bilateral renal angiomyolipomas, or any angiomyolipoma, is associated with Tuberous sclerosis. A renal angiomyolipoma is a benign tumor composed of blood vessels, smooth muscle, and fat (angio-myo-lipoma!!!) These tumors can be diagnosed with an abdominal CT scan, as the density of fat is less than water.

Bilateral renal cell carcinomas are associated with von Hippal-Lindau syndrome!!!
Cortisol increases the synthesis of what enzyme involved in catecholamine synthesis in the adrenal medullla?
Phenylethanolamine-N-Methyltransferase (PNMT), which is involved in conversion of Norepinephrine to Epinephrine.
The production of which catecholamine is under the control of Cortisol?
Epinephrine.
Describe the attachment of the PCL (Posterior tibia/Medial femur) and the ACL (Anterior tibia/Lateral femur).
The PCL attaches to the Posterior part of the intercondylar area of the tibia and the anterior lateral surface of the medial condyle of the femur. The ACL attaches to the Anterior part of the intercondylar area of the tibia and the posterior lateral surface of the lateral femur condyle
The nerves, arteries, and lymphatics supplying the ovary are all delivered by which ovarian ligament?
The SUSPENSORY LIGAMENT!!!
The Parasympathetic innervation of the ovary is derived from what nerve? (*it's a CN)
CN X; VAGus nerve
Which ligament of the pelvic region, extends from the cervix and lateral fornix of the vagina to the lateral pelvic walls, and carries the uterine artery which requires ligation during radical hysterectomy?
This is the TRANSVERSE CERVICAL LIGAMENT; also known as the CARDINAL LIGAMENT!!!
Migratory polyarthritis is characteristic of what disease?
Rheumatic fever.
Which vaccines contain polysaccharide capsules of bacteria covalently bound to protein carriers, to create T-cell dependent antigens, from a T-cell independent antigen?
The three main encapsulated bacteria; S.pneumoniae, N.meningitidis, and H.influenzae.
What is the make up of the Tetanus vaccine?
The Tetanus vaccine consists of tetanus toxoid, an inactivated form of tetanus toxin.
What is the make up of the Pertussis vaccine?
The ACELLULAR pertussis vaccine available in the U.S. contains purified components of Bordetella pertussi and pertussis toxoid.
What is the make up of the HBV vaccine?
The HBV vaccine contains inactivated HBsAg particles obtained from yeast through recombinant DNA technology.
What is the make up of the Varicella vaccine?
The Varicella vaccine contains LIVE ATTENUATED varicella virions.
What is the make up of the BCG vaccine?
The BCG vaccine is a live-attenuated vaccine obtained from a strain of MYCOBACTERIUM BOVIS. It is used in young children throughout the world to immunize against the sequelae of M. tuberculosis.
What are the unique properties of Brown Adipose tissue that make it so adapted to create heat?
Brown adipose cells contain several intracytoplasmic fat droplets and many more mitochondria than white adipos cells. They function to produce heat by uncoupling oxidative phophorylation in the mitochondria via the protein THERMOGENIN.
How does LSD (lysergic acid diethlyamide) exert its affects?
It is a Serotonin receptor agonist that produces profound effects on mood. The effects of LSD are very unpredictable but can include dilated pupils, tremors, confusion, sweating, diorientation, and increased heart rate. LSD produces hallucinations and delusions leading to severe paranoia.
How do nitrites (*dusky color to the skin) shift the oxygen dissociation curve of Hb? Explain.
Nitrites oxidize Ferrous (2+) iron to Ferric (3+) iron. The iron in the ferric (3+) state cannot bind O2, but the affinity for O2 of the residual ferrous (2+) iron in the hemoglobin tetramer is increased, which actually causes a LEFTWARD SHIFT of the O2 dissociation curve, even though Methemoglobin is unable to carry O2.
Which embryonic structure gives rise to the Collecting System (from collecting duct to ureters) of the kidney? Which gives rise to structures from Bowman's space to collecting TUBULES?
The Ureteric bud; the Metanephric Mesoderm.
What is the cause of a Cleft Lip? A Cleft Palate?
Cleft Lip = improper fusion of the Maxillary Prominence with the Medial Nasal Prominence

Cleft Palate = the palate is formed from the Intermaxillary Segment (PRIMARY PALATE) and Maxillary Prominences (SECONDARY PALATE). The palatine shelves grow from the maxillary prominences medially toward on another and forward, toward the primary palate. If the palatine shelves fail to fuse with one another or with the primary palate, a cleft palate results.
This condition is typified by contrallateral loss of pain and temperature sensation, and ipsilateral deficits of CN V, VII, IX, X, & XI, and by Horner's syndrome. Diagnosis?
PICA occlusion; Wallenberg syndrome.
This condition is typified by contralateral loss of pain and temperature sensation, with ipsilateral deficits of CN V & VII, and Horner's syndrome, and cerebellar symptoms. Diagnosis?
AICA occlusion; Lateral Inferior Pontine Syndrome
In patients infected with HBV, hepatocellular CYTOPLASM takes on a finely granular, EOSINOPHILIC appearance commonly described as ground glass. What is responsible for this characteristic appearance of HBV infected cells?
The cytoplasm becomes filled with spheres and tubules of HBsAg and this is responsible for the finely granular appearance.
What is the abnormal amino acid substitution in HbC that makes the hemoglobin electrophoresis move more slowly than either HbS or HbA towards the (+) pole?
HbC has Lysine substituted for Glutamate at the 6th position in the Beta-chain. Since Lysine is a (+) amino acid HbC moves even more slowly toward the anode than HbS (with a nonpolar sub. of Valine replacing Glutamic acid), or HbA.
What will electrophoresis of hemoglobin from patients with HbSC look like in a gel?
Patients with HbSC disease will have two hemoglobin bands on hemoglobin electrophoresis, one coinciding with HbS and another with HbC.
What are three main examples of ATPase pumps in the cells of our bodies?
Na/K ATPase, H/K ATPase, and the Ca ATPase.
What is the mechanism of Flutamide and Cyproterone in treating Prostate cancer? Does it increase or decrease testosterone levels? How do you treat this increase/decrease?
It competes with testosterone and DHT for their receptors in the target cells. Due to blocking of androgen receptor binding it causes a gradual increase in blood testosterone levels due to a lack of negative feedback inhibition. This effect is reduced by the simultaneous administration of GnRH agonists in a non-pulsatile fashion.
Why is Methadone the drug of choice to treat Heroin addiction?
Very potent, LONG ACTING, with good ORAL bioavailability. Its long half-life allows for prolonged effects to suppress withdrawal symptoms in heroin dependent patients.
What are the actions of Methotrexate, 5-Fluorouracil and Leucovorin?
MTX = Dihydrofolate reductase (recycles TH4F inhibitor

5-FU = Thymidylate synthetase irreversible inhibitor

Leucovorin = TH4F derivative that doesn't need dihyrofolate reductase; for MTX rescue.
Describe the sequence of events involved in skeletal muscle and cardiac muscle contraction.
1) Ca2+ binds troponin C, which causes a conformational change, allowing tropomyosin to move out of the way to allow myosin/actin cycing (at this time myosin has split one molecule of ATP holding on to ADP and Pi in its "cocked" state)

2) Cross-bridging between myosin and actin takes place (this causes myosin to release Pi

3) Releasing of Pi initiates the powerstroke step and ADP is spontaneously released

4) Actin and myosin are permanently bound until replacment ATP comes into bind myosin head and so that it can release the actin filament, allowing cross-bridge cycling and shortening to occur. ATP is split and cycle starts over. ***Lack of ATP causes rigor mortis
Describe the sequence of events invovled in smooth muscle contraction.
Increased intracelluar Ca2+ --> Ca2+ binds Calmodulin --> Ca/Calmodulin complex activates MLCK --> phosphorylated Myosin interacts with actin to form cross bridging and contraction --> MLCP (active in dephophorylated form) dephophorylates Myosin and there is relaxation.
How does increased cGMP lead to smooth muscle relaxation?
It leads to decreased levels of intracellular Ca2+ and myosin dephosphorylation.
Which adrenergic receptor is responsible for hepatic gluconeogenesis stimulation?
Beta-2's!!!
What is a normal reaction to a Metyrapone challenge of the HPA axis with reference to CRH-ACTH-Cortisol?
An ACTH surge with a resultant increase in steroid 'half-product' excretion is a normal reaction to Metyrapone administration, because Metyrapone blocks the last step of cortisol synthesis by inhibiting 11-B-hydroxylase.
Materna virilization during pregnancy and masculinization of the female fetus, with ambiguous genitalia is suggestive of what fetal condition?
AROMATASE DEFICIENCY!!!
What is the most common cause of adrenal insufficiency?
GLUCOCORTICOID THERAPY!!! Thus, when pharmacological doses of glucocorticoid therapy are used for more than 3 weeks, treatment cessation should be gradual to prevent development of adrenal insufficiency.
What is the regulatory substance that stimulates (K+)ATP channel closure in insulin producing pancreatic Beta-cells?
ATP; Glucose enters the cell through GLUT2 --> increased ATP production from breakdown of this glucose leads to the blocking of K+ outflow from the cell from the (K+)ATP channel --> this causes membrane depolarization and Ca2+ influx, which leads to stimulated release of Insulin.
What is the difference between the way infantile botulism and adult botulism are acquired?
Infantile botulism results from consuming C.botulinum spores, whereas adult botulism results from consuming preformed toxin, typically in canned food.
End-stage renal disease can cause what metabolic derrangements in terms of Ca2+ and tissue deposits, and Thryroid function?
ESRD causes increased retention of PO4-. This can complex with ionized Ca2+ and deposit in tissue known as Osteitis fibrosa cystica, or Renal osteodystrophy. Uremia associated with ESRD can also cause endocrine dysfunction, including decreased peripheral tissue conversion of T4 to T3, and this could produce a functionally hypothyroid state.
The translocation of Mantle cell lymphoma is a B-cell malignancy associated with t(11:14), but what is the gene activation?
Cyclin D.
Which is the GLUT transporter responsible for moving Fructose?
GLUT 5!!!
Why would a patient with Tetralogy of Fallot want to squat?
Because it increases Total systemic vascular resistance and would decrease a Right-to-Left shunt!!! Maybe even make it Left-to-Right for a second ;).
What does the ATM gene associated with Ataxia-Telangectasia syndrome normally do? Which Ig is deficient in these patients?
ATM is a gene that is normally responsible for DNA repair. The immune deficiency consists of both cell-mediated and humoral dysfunction, but the primary immune deficiency manifests as an IgA deficiency and predisposes to infection of the upper and lower airways.
Antibodies to a capsular antigen (on Strep. pneumoniae for example) would be expected to produce what reaction that can be sen under the microscope?
This would be expected to make the capsule of Strep. pneumoniae swell, which is an effect known as the "Quellung reaction".
Vitamin A deficiency leaves a patient particularly open to infection with what virus?
Rubeola (Measles)
A mentally slow woman of northern European descent who is "lemon colored' (anemia and icteric), has a smooth, shiny tongue indicative of atrophic glossitis, and demonstrates a broad-based gait is the classic presentation for what disease and what vitamin deficiency?
Pernicious Anemia and B12 deficiency.
Increased numbers of trinucleotide repeats within the FMR1 gene on the X-chromosome is diagnostic of what syndrome?
FRAGILE-X SYNDROME!
What is the primary mechanism of resistance to Ethambutol by M.tuberculosis?
Increased production of Arabinosyl Transferase (makes arabinogalactan, one of the key constituents of the mycobacterial cell wall).
What is the primary mechanism of resistance to Pyrazinamide by M.tuberculosis?
Modified pyrazinamidase, which is necessary to activate the drug.
What is the mechanism behind the increase in flushing and warmth after taking Niacin pills?
This side effect is mediated by Prostaglandins, as evidenced by the fact that 325mg of taken 30-60 minutes before Nicotinic acid with meals decreases flushing.
Where does the majority of Serotonin reside in the body?
90% of Serotonin resides in the GI tract; the remainder is in the brain or associated with platelets.
What is the main function of Substance P? What molecule is thought to regulate Substance P?
Substance P acts as a pain neurotransmitter in both the peripheral and central nervous systems. In the CNS, substance P is also thought to regulate mood, anxiety, and stress behavior. CAPSACIN decreases the level of Substance P in the peripheral nervous system and thereby decreases pain.
Alkalosis, decreased 2,3 DPG, decreased Temperature, Carbon Monoxide, and Methemoglobinemia all do what to the O2 dissociation curve?
They cause a LEFT SHIFT of the curve.
When a question stem provides you with a new up-and-coming drug and they give you mechanism of action and ask for potential side effects, how should you compare it first?
Try and liken its strongest component of its mechanism of action to side effects of other drugs caused by that same mechanism of action.
What is the histological process that is underlies infective endocarditis at the heart valves that produces vegitations with organisms such as Staph. aureus?
Following bacterial binding, tissue factor expression results in PLATELET and FIBRIN deposition and the formation of a valvular vegitation. S.aureus can the embolize from the diseased valve into the systemic circulation, resulting in sepsis and infection.
What is the mechanism of access in Gallstone Ileus, where there is mechanical bowel obstruction, usually of the Ileum because it has the smallest lumen of the intestinal tract, caused when a large Gallstone is found to obstruct the intestinal lumen?
This rare occurrence happens when Large gallstones erode into the intestinal lumen, creating a Cholecytoenteric fistula. This creates Pneumobilia (air to enter into the biliary tree), which is sugestive of this diagnosis.
What is the general treatment for patients with Adrenal Cortical Hyperplasia?
Treatment of ACH aims to suppress ACTH, which is being over stimulated to be released, due to a lack of negative feedback inhibition, due to a lack of Cortisol production from an enzyme block. This inhibition of ACTH is accomplished by therapy with exogenous Corticosteroids.
What is the second most common cause of UTIs in women after E.coli?
Staphlococcus saprophyticus.
What are some of the diseases that have an association with Carpal tunnel syndrome?
Hypothyroidism, Diabetes Mellitus, Rheumatoid athritis, and Dialysis associated amyloidosis (usually presents with bilateral involvement)
What are the fetal conditions that lead to Polyhydramnios through decreased fetal swallowing? What about increased fetal urination?
Decreased swallowing = Duodenal, esophageal, or intestinal atresia, and ANENCEPHALY!

Increased urination = high cardiac output due to anemia or twin-to-twin transfusion syndrome.
What is the mainstay therapy for Acute Mania treatment?
A mood stabilizing agent (e.g. Lithium, Valproate, or Carbamazepine) plus an atypical antipsychotic (e.g. Olanzapine)
What mood medications have been known to precipitate manic episodes, or unmask, bipolar disorder?
SSRIs.
What is Berkson's bias?
This refers to selection bias created by selecting hospitalized patients as the control group.
What is the Pygmalion effect that can take place during a study?
This describes the researcher's beliefs in efficacy of a treatment potentially affecting the outcome.
What is Lead-time bias?
This refers to apparent prolongation of survival after applying a screening test, without any real effect on prognosis.
What is the Hawthorne effect in terms of affecting research studies?
This describes the tendency of a study population to affect an outcome due to the knowledge of being studied.
What type of anxiety related disorders is Buspirone good to treat?
It is good to treat Generalized anxiety disorder and will not create addiction, but it is not useful for treating any other mood disorders. It also take 2 week to exert an effect so it is not good for an as-needed basis.
What makes the Chlamydial cell wall unusual?
It lacks muramic acid.
Describe the course of Lymphogranuloma Venereum, caused by Chlamydia trachomatis serotype L1-3.
Lymphogranuloma venerum is a chronic disease characterized by an initial small papule on the genital mucosa the contains cells infected with C.trachomatis. This papule is followed weeks later by swollen, painful inguinal nodes which coalesce, ulcerate, and rupture. If left untreated fibrosis and anogenital strictures can occur. This is endemic to regions of Africa, Asia, the Caribbean, and South America.
What STD can resemble both infection with Wucheria Bancrofti (elephantiasis), and Chalmydia L1-3 (lymphogranuloma venereum)?
Calymmatobacterium inguinale (DONOVANOSIS) - encapsulated coccobacillus
Polyarteritis nodosum shows what type of changes in blood vessels?
Transmural inlfammation of the arterial wall with fibrinoid necrosis.
What type of changes in blood vessels are associated with Temporal Arteritis and Takayasu arteritis?
Granulomatous inflammation of the media.
What are the two types of 5-alpha-reductase and where do they reside in the body?
There are two types of 5-alpha-reductase in the body: Type 1 is present in postpubescent skin, while Type 2 is found in the genitals.
Explain the steps involved in the Schilling test (testing for causes of Vitamin B12 deficiency).
1) Administer oral radiolabeled B12 and an intramuscular injection of unlabeled B12 (this distinguishes between malabsorption and lack of dietary inclusion); look for radiolabeled B12 in urine to have normal excretion; if normal then it is not malabsorption problem

2) If Malabsorption: administer again with intrinsic factor to distinguish between pernicious anemia vs. other cause (low excretion after administration of intrinsic factor rules out pernicious anemia).
What are the Histone molecules that make up the nucleosome core? Out of all histones which (1) is left out of the core?
H2A, H2B, H3, and H4 all make up the nucleosome core. There are two of each protein, which makes 8 molecules total. H(1)!!! is the (1) histone that is left out of the core.
How does Histone 1 participate in the packaging and folding of DNA?
H1 histones participate in DNA packaging by binding the segment of DNA that lies between nucleosomes and facilitating the packaging of nucleosomes into more compact structures.
Thiazolidinediones can exacerbate what heart condtion? How?
They can exacerbate CHF due to their side effect of promoting weight gain and fluid retention!!!
What are the genes that are upregulated by Thiazolidinediones?
Adiponectin, Fatty acid transport protein, Insulin receptor substrate, and GLUT4.
How does PPAR-y, affected by TZD's, affect adipocyte proliferation?
It leads to an increase in fat mass secondary to the increased differentiation of preadipocytes into mature adipocytes.
What is the reason that most of the impulses in the atria during atrial fibrillation are not transmitted to the ventricles?
This is "bottleneck" of transmission, which is due to the refractory period of the AV node.
Explain the theory/mechanism behind the treatment of infertility due to anovulation that is treated with Menotropin and hCG.
One way to treat anovulation is the administration of drugs that act like FSH and LH. Treatment with Menotropin (human menopause gonadotropin) acts like FSH and leads to the formation of a dominant ovarian follicle. Ovulation is then induced by administration of a large dose of hCG, which stimulates the LH surge!
The same "Cord factor" that is responsible for causing Mycobacteria to grow as "serpentine" cords on enriched media under the microscope, is important for what part of their virulence in the pathogenic process?
Cord factor establishes virulence through neutrophil inhibition, mitochondrial destruction, and the induced release of TNF-alpha.
The presence of Cord factor correlates with what property of M.tuberculosis?
VIRULENCE!!!; mycobacteria that do not possess Cord factor cannot cause disease.
PA(B)A-sunscreens block what kind of UV-radiation? What about (A)vobenzone, and Zinc-oxide containing sunscreens?
PA(B)A-sunscreens are UVB absorbers only; (A)vobenzone absorbs UVAI and UVAII; Zinc-oxide absorbs all three types and provides broad spectrum protection.
What are the two main chemical mediators found in the beginnings of an atherosclerotic plaque that are thought to play a role in the attraction and proliferation of Smooth Muscle cells into the plaque from the media into the intima?
Platelet Derived Growth Factor (PDGF) and Transforming Growth Factor-Beta (TGF-Beta).
In figuring out incidence of a disease what number must you subtract from the total population first? WHY?
THOSE WHO ALREADY HAVE THE DISEASE!!!; this is because the incidence of the disease = the total number of new cases, divided by, the total number in the population at risk. If you already have the disease you are not at risk, you have it!!!!
What two medications are most commonly used for hypertensive emergencies? How does each work? Which one can cause Cyanide poisoning with extended use? Which one improves renal blood flow while lowering BP (*good for high BP and renal insufficiency)?
Nitroprusside = potent direct acting arterial and venous vasodilator (quick onset and short duration); it is metabolize to Cyanide and thocyanate, so it can cause Cyanide poisoning with prolonged use and renal insufficiency.

Fenol(DOP)am = selective Dopamine-1 agonist; causes arteriolar dilation (esp renal) and natriuresis leading to decreased systemic vascular resistance and load pressure reduction. Since this is the only intravenous agent that improves renal perfusion, it may be exceptionally beneficial in hypertensive patients with concomitant renal insufficiency.
What is the genotype of a Complete Hydatidiform Mole in a molar pregnancy? Where are the genes derived from?
A Complete Mole has NO FETAL STRUCTURES and is composed entirely of large edematous and disordered chorionic villi that appear as a bunch of grapes. Complete moles almost always have a 46 XX karyotype and all chromosomes are PATERNALLY DERIVED; a complete mole forms when a sperm fertilizes an egg (could be empty) and replicates its own chromosomes while eliminating the maternal chromosomes!!! (This process is called Androgenesis)
What is the genotype of an Incomplete/Partial Hydatidiform Mole in a molar pregnancy? Where are the genes derived from?
Partial moles show FORMATION OF SOME FETAL STRUCTURES; typically results from fertilization of an ovum by two or more sperm, resulting in karyotypes like 69XXY or 69XXX (more imput from father than mother).
What is responsible for the "Greenish" color of pus or sputum arising from a bacterial infection?
The greenish color is due to Myeloperoxidase, which is released from the azurophilic granules of Neutrophils. MPO is a BLUE-GREEN HEME-BASED PIGMENT molecule that catalyzes the production of hypochlorus acid (HOCl/bleach) from chloride and hydrogen peroxide during the phagocytic respiratory burst of Neutrophils.
What are the typical clinical features associated with Cerebellar Pontine Myelinosis, which occurs from rapid correction of chronic hyponatremia?
Quadriplegia due to demylination of the Corticospinal tracts and Psuedobulbar palsy due to demyelination of the corticobulbar tracts of CN IX, X, and XI.
Antiphospholipid Antibody (APLA) is indicative of what syndrome associated with SLE? What is it due to? How does this affect laboratory values? What are the main characteristics of this syndrome?
An APLA syndrome due to Lupus Anticoagulant may occur in SLE. Lupus Anticoagulant is the most frequent cause of a PROLONGED PTT and FALSE POSITIVE VDRL, without any other hematological abnormality. Lupus Anticoagulant can cause APLA syndrome defined by elevated blood levels of APLA, with hypercoagulability (venous and arterial THROMBOEMBOLISM) and/ or repeated 2nd or 3rd TRIMESTER MISCARRIAGES!!!
The first symptoms of this condition show a pink or brown scaly plaque with CENTRAL CLEARING and a collarette of scale (*herald patch) on the TRUNK, NECK or EXTREMITIES.This is FOLLOWED BY developments of a MACULOPAPULAR RASH in a pattern ALONG THE SKIN TENSION LINES (*christmas tree dist). Diagnosis?
Pityriasis Rosea!!!
Which NERVE and ARTERY can be damage by a midshaft humerus fracture?
RADIAL NERVE; BRACHIAL ARTERY!!!
The clinical triad of acute-onset neurological abnormalities, hypoxemia, and PETECHIAL RASH in a patient with severe long bone and/or pelvic fractures is strongly suggestive of what occurrence? What are the symptoms of the triad caused by?
FAT EMBOLISM SYNDROME!!!; this condition is observed in 1-3% of patients with a single long bone fracture, and up to 33% of patients with bilateral femoral fractures!

Hypoxemia = free fatty acid escape from fat emboli in lungs cause local toxic injury (possibly leading to ARDS)
Neuro problems = fat globule escape via arteriovenous shunts in lungs that open up, and travel to the CNS
Petechiae/Thrombocytopenia = platelet adherence to and coating of fat microglobules
Elderly patient presents with easy fatigability (anemia), constipation (hypercalcemia), bone pain most commonly in the back and ribs (lytic lesions), renal failure (associated with eosinophilic casts). Diagnosis?
MULTIPLE MYELOMA!!!
Hirsutism, coarsening facial features, acneiform skin rash, and gingival hypertrophy are undesirable cosemtic side effects of what antiseizure drug?
Phenytoin, of course.
What drug used for the treatment of generalized tonic-clonic and partial seizures can also treat trigeminal neuralgia and diabetic neuropathy, and bipolar disorders (*agranulocytosis is the most feared complication)?
CARBAMAZEPINE
What is Valproic acids most common side effect?
Severe Hepatotoxicity, thus liver function tests should be monitored at the beginning of medication.
What antiseizure medication has been associated with GENERALIZED LYMPHADENOPATHY?
PHENYTOIN!!!
What is differential cyanosis, restricted to the lower body in an older CHILD (10 yrs old or so) most suggestive of? What about TOF? or Coarctation of the aorta?!?! - what cyanosis picture do these present with?
PDA WITH LATE-ONSET REVERSAL OF SHUNT FLOW!!!

TOF = WHOLE BODY cyanosis!

COA = in the child form presents with PDA, but these patients generally develop CHF and are unlikely to survive infancy withour surgical correction!
Excessive erythrocyte destruction by the spleen causes splenomegaly by what process?
Work hypertrophy; just doin' its job...and workin' overtime.
Homocysteine can be firstly metabolized into what two products, with what two enzymes, requiring what two cofactors?
Homocysteine --(methionine synthase/B12)--> Methionine

or

Homocysteine --(cystathione synthetase/B6)--> Cystathione --(cystathionase/B6)--> Cysteine
What is the only treatment currently available for patients with Homocystinuria?
Pyridoxine (B6) supplementation is the only treatment available at this time (about 50% of patients respond dramatically).
Exotoxin A (EF-2 inhibitor), collagenase, elastase, fibrinolysin, phospholipase C and DNAase are all toxins that which one organism can produce? Which toxin contributes most to its pathogenesis?
Pseudomonas aeruginosa; Exotoxin A is a major virulence factor and responsible for the high mortality associated with P.aeruginosa septicemia.
CutaneousT-cell lymphoma; proliferating CD4+ lymphocytes infiltrate the dermis and epidermis where they form microabscesses (of Pautrier); condition manifests with plaques that may be confused with eczema or psoriasis; generalized erythema, scaling and thickening of the skin (erythroderma) may result. Diagnosis?
Mycosis fungoides; cutaneous T-cell lymphoma.
Lymphoma of B-cell origin and presents with painless "waxing and waning" lymphadenopathy. Diagnosis?
FOLLICUAR B-CELL LYMPHOMA; the most common indolent non-Hodkin lymphoma in adults.
What is the majority cause of the genetic error associated with Turner syndrome?
Mosaicism! originating from a single zygote (mitotic error early in development) ; this can result in 45,XO (complete monosomy), 45XO.46XX (mosaicism), or 46XX (with partial deletion of one X chromosome).
What are the three reactions that require the two forms of Riboflavin (FMN, FAD)?!?
1) Succinate --(succinate dehydrogenase/FAD)--> Fumarate

2) FMN is a component of Complex I of the electron transport chain.

3) FAD is a component of Complex II of the electron transport chain.
If you see a positive VDRL or anything indicating Syphilis in the CSF what stage of Syphilis is this?!? If there is a PAINLESS lesion present what type of lesion is this?!?
Tertiary syphilis; GUMMA!!!
Describe the associated findings of the three stages of Syphilis.
PRIMARY: chancre, one to three weeks after contact; organism is disseminating systemically

SECONDARY: diffuse macular copper colored rash that includes the PALMS and SOLES; WART-LIKE growths in the genital and perianal region call CONDYLOMATA LATA; five to ten weeks following resolution of chancre

TERTIARY: neurosyphilis; aortic inovlvment; GUMMAS (white-gray granulomatous, painless ulcerations)
What are the normal pressures of the heart from the RA all the way to the Aorta?
RA = (~5)8/0; RV = 25/4; PA =25/9

LA =(~10)12/2; LV =130/9; Aorta = 130/70
Describe the Ca2+ exchange mechanisms on the Sarcoplasmic Reticulum and Sarcolema. Which one requires an ATPase. What part of the contraction relaxation cycle uses these transporters?
Relaxation of excitation-contraction coupling occurs through Ca2+ efflux from the cytoplasm through the use of Ca2+-ATPase (sequesters calcium within the SarcRetic. against its gradient, in order to re-establish the gradient) and the (3)Na+/(1)Ca2+ exchange on the Sarcolemma (does not require ATP)
What enzyme deficiency is the most common cause of the autosomal recessive disorder Xeroderma Pigmentosum?
UV-specific endonuclease.
What are the pharmacological targets of current Alzhemier therapies?
Current AD-specific therapies offer either:
1) Enhanced Cholinergic neurotransmission (Donepezil)
2) Neuroprotection via antioxidants (Vitamin E/ alpha-Tocopherol
3) NMDA receptor antagonism (Memantine- to prevent CNS NMDA-receptor overstimulation injury)
What is an example of a cholinesterase inhibitor that begins with a "D" that is used in Alzheimer's therapy?
Donepezil.
What makes up the dense pigment that turns the liver black, that is associated with Dubin-Johnson syndrome?
Epinephrine metabolites; so don't freak out when you see it :)
What are the compensatory changes that are trying to correct the problems associated with CHF, but are actually making the condition worse?
Decreased cardiac output triggers the 1) RAAS system and 2) Increased Sympathetic output. This raises arterial resistance (afterload) through increased blood volume (Na+ retention of ANGII and ALDO), increased vasoconstriction (ANGII and Sympathetics), and also increases the work of the heart (Sympathetics increase heart rate and contractility). All these attempt to help, but increase the work of the failing heart.
What is another name for the anti-Smith antibodies associated with SLE?
ANTI-snRNPs!!!
What CN nerve palsy is the most common cause of vertical diplopia?
Vertical diplopia is most noticeable when the affected eye looks toward the nose, as when occurs when reading the newspaper or walking down stairs. One of the more common causes of vertical diplopia is CN IV (Trochlear nerve) palsy.
Which never courses with the Superior Thyroid Artery and Vein? This nerve has two branches; what do they innervate?
The Superior Laryngeal nerve runs with the Superior Thyroid artery and vein. The EXTERNAL BRANCH innervates the Cricothyroid muscle (all other laryngeal muscles and sensory below the vocal cords are innervated by the Recurrent Laryngeal nerve). The INTERNAL BRANCH supplies sensory innnervation above the vocal cords.
What are the treatments for acute Cryptococcal meningitis in AIDS patients? What is the lifelong prophylaxis?
Acute = Amphotericin B and Flucytosine

Prophylaxis = Fluconazole
Embryologic cause of Hydrocele?
Incomplete obliteration of the Processus vaginalis; if that's not offered as an answer choice, choose Tunica vaginalis.
Embryogical causes of Hypospadias vs. Epispadias?
Hypospadias = incomplete fusion of the urethral folds, which results in an abnormal opening of the urethra along the ventral surface of the penis
Epispadias = faulty positioning of the genital tubercle in the fifth week of gestation, resulting in an abnormal opening of the urethra on the dorsal surface of the penis.
Embryologic origin of a Bifid scrotum (two separate sacs)?
Malunion of the Labioscrotal folds; in females the labioscrotal folds form the LABIA MAJORA
What is the (K)ey antigen that C.diptheriae produces that allows it to colonize the posterior pharynx and produce exotoxin, depspite the action of IgA?
K-antigen!!! :)
When IgA nephropathy (found in Berger's) is accompanied by extrarenal symptoms, such as abdominal pain and purpuric skin lesions, what is the diagnosis?
Henoch-Schonlein purpura.
Why does Staph Protein A lead to decreased production of C3b which leads to impaired opsonization?
This is because Protein A binds to the Fc portion of IgG at the complement-binding site.
What are the most common side effects associated with Verapamil, a medication used as a rate control therapy for patients experiencing atrial fibrillation?
Constipation and Gingival hyperplasia.
Thiazide diuretics and Dihydropyidine Ca2+ antagonists are first-line drugs to treat Isolated Systolic Hypertension in nondiabetic patients (where an ACE-I or ARB would be utilized first). What is the side affect profile of Amlodipine, a Ca2+ antagonist?
Peripheral edema and Flushing.
In patients with infiltrating invasive breast cancer, what mechanism is responsible for nipple inversion and retraction of overlying skin vs. the mechanism that is responsible for pitting and thickening of the skin overlying the tumor?
COOPER'S suspensory ligament infiltration in the central region of the breast causes retraction of skin and nipples.

Lymphedema and pitting and thickening of the skin (peau d'orange) occurs if the lymphatic drainage becomes impeded by tumor.
Where do surgeons access the Great Saphenous Vein when performing a coronary artery bypass due to severe stenosis of the LAD & the Circumflex coronary arteres? What blood vessel would be used if just the LAD were affected?
Surgeons access the Great Saphenous vein in the Femoral triangle just below the pubic tubercle. The Femoral triangle is borders by the inguinal ligament superiorly, the sartorius muscle laterally and the adductor longus muscle medially.
If only the LAD were affected, coronary bypass would be performed with the Left Internal Mammary (thoracic) Artery.
Demyelination of a neuron decreases what property of that neuron?
Demyelination decreases the Space Constant of a neuron and is responsible for symptoms such as those that we see in Multiple Sclerosis.
Which cells of the intestinal crypts are responsible for secreting antimicrobial molecules into the intestines?
PANETH CELLS: these have both phagocytic and secretory properties and thus provide the FIRST LINE of immune defense against intestinal microorganisms. Paneth cells secrete lysozyme, bacteria, and also defensins, which polypeptides that have antimicrobial and antiparasitic properties.
Through what cells does Shigella invade into the intestinal mucosa? How does it destroy tissue?
Shigella invades the GI mucosa by first gaining access to M (microfold) CELLS in Peyer's patches in the ILEUM through endocytosis. Shigella subsequently lyses the endosome, multiplies, and spreads laterally into other epithelial cells, causing cell death and ulceration with hemorrhage and diarrhea.
How do the side effects of Niacin affect anti-hypertensive and diabetic medications?
Niacin potentiates the effects of some anti-hypertensive medications, such as vasodilators and ganglion blocking agents, because of its vasodilatory effects (prostaglandins). Anti-hypertensives may need to be decreased.
Niacin is also associated with increased insulin resistance, which sometimes manifests as acanthosis nigracans. Thus, the need for diabetes medications is likely to increase when niacin is used in diabetic patients. Additionally, there is an increase in serum uric acid in some patients being treated with Niacin, so patients with GOUT should be cautious!!!
What medications are first-line therapy for HYPERTRIGLYCERIDEMIA? What is the mechanism of action of these meds? What if further medication is needed after the first-line?
Fibrates (Gemfibrizil) are the first-line therapy for HYPERTRIGLYCERIDEMIA. They work by activating PPAR-alpha!!! If further triglyceride reduction is needed, NIACIN can be a second-line agent.
Which lipid parameters does Niacin affect?
Niacin improves hypertriglyceridemia by decreasing the SYNTHESIS of hepatic TGs and VLDL. It also raises HDL.
Fish oil containing Omega-3 fatty acids is useful in treatment of hypertriglyceridemia. Which parameters does it reduce?
Fish oils decrease hepatic VLDL production and decrease serum TGs by 20-30%.
What are the lipid and cholesterol parameters that Statins affect?
Statins inhibit cholesterol synthesis, and increase LDL receptor activity on hepatocytes. They produce only a modest reduction in triglycerides (unless patients with marked TGs are treated with high-dose Statin therapy = up to 20% reduction)
What is the first-line treatment for High LDL (hypercholesterolemia)? If still high after, what is the second-line treatment that is added?
Statin first, add Ezetimibe (PPAR-alpha) if needed.
What is the first-line treatment for High TGs (hypertriglyceridemia)? If still high after, what is the second-line treatment that is added?
Fibrates (Gemgibrizil) first; add Niacin if necessary
What is the first-line therapy for Low HDL?
Niacin.
The two most common congenital syndromes with QT-prolongation, Jervell/Lange-Nielsin syndrome (recessive, with neurosensory deafness) and Romano-Ward (dominant, no deafness) are thought to be due to mutation in what ion channel?
Mutations in the K+ channel protein that contributes to the delayed rectifier current (Ik) of the cardiac action potential.
What is the amino acid that is used to transport Ammonia in the blood? Where does it release this Ammonia for excretion?
Glutamine; in the the nephron, the nitrogen is hydrolyzed by glutaminase, thereby producing glutamate and free ammonium ion, which can be excreted in the urine.
(Car)ful (Cit)izens (Argino) (Ar)gue (Or)ver Urea. What does this mneumonic correspond to?
The Urea cycle: Carbamoyl phosphate --> Citruline --> Arginosuccinate --> Arginine (and fumarate) ---> Ornithine (and UREA)
What is the rate limiting step of the Urea cycle? What molecule enhances this reaction?
CPSI (carbamoyl phosphate synthetase I) produces carbamoyl phosphate in the mitochondria from CO2 + NH4 + 2ATP; N-acetylglutamate enhances this reaction.
Where do nitrogen atoms in the Urea cycle derive from? (*one is inside the mitochondria, one is outside)
The Nitrogen atoms in the Urea molecule of the urea cycle are derived from NH3 (in the mito.) and Aspartate (in the cyto.). Remember that CPSI is the rate-limiting enzyme in the urea cycle reaction and is activated by N-acetylglutamate (NAG).
Where is the most common location for GASTRIC ulcers? Therefore, what are the most common arteries that are eroded into?
The great majority of GASTRIC ulcers occur at the LESSER CURVATURE of the stomach, at the border between acid-secreting and gastrin-secreting mucosa. Left and Right Gastric Arteries run along the lesser curvature and thus are likely to be damaged, causing gastric bleeding.
Presence of erythroid precursor cells in the liver and spleen; hyperplastic marrow cell invasion of extramedullary organs; bony cortex thins and bone growth is impaired; pathologic fractures are common; maxillary overgrowth and frontal bossing are associated with "chipmunk facies" in the pediatric population. Diagnosis? Most common cause?
This is Extramedullary Hematopoesis, which is most frequently caused by SEVERE CHRONIC HEMOLYTIC ANEMIA, such as Beta-Thalassemia.
What are the penicillinase resistant penicillins that are used to treat non-methicillin resistant strains of S.aureus? Which of these is used empirically to treat skin infections suspected to be S.aureus?
Nafcillin, methicillin, and oxacillin are the penicillinase-resistant penicillins that are used to treat S.aureus.
Nafcillin is commonly used empirically to treat skin and soft tissue infections (e.g. folliculitis, abscesses) for which S.aureus is the usual cause.
Even at its maximum efficiency, how much urine must the kidney produce per day in order to eliminate metabolic wast products?
0.5 Liter
The earliest manifestations of this disease are hypohidrosis, acroparethesia (debilitating neuropathic pain in the extremities) and angiokeratomas (punctate, dark red, non-blanching macules and papules that classically occur between the umbilicus and the knees). Diagnosis? Most common complication?
These symptoms indicate the earliest manifestations of Fabry disease (angiokeratoma coporis diffusum). These patients accumulate Globoside Cer(A)mide Trihexoside in tissues. Without enzyme replacement, patients typically develop progressive RENAL FAILURE!!!
Patients with complete Alpha-1-antitrypsin deficiency are most likely to develop what two conditions?
Panacinar emphysema and Liver cirrhosis.
Why is D-Xylose important in malabsorption testing?
Because D-Xylose, like glucose and galactose, is a monosaccharide that can be absorbed by the small intestine directly, without the action of pancreatic enzymes. Thus, D-Xylose is sometimes used to test for brush border absorptive function independent of pancreatic function in cases where it is necessary to determine if malabsorption is due to pancreatic or intestinal pathology.
What is ABPA and how does it complicate the condition of asthmatic patients? What will their serum Ig levels show? What will their lungs look like?
ABPA is Allergic BronchoPulmonary Aspergillosis. ABPA occurs in 5-10% of steroid-dependent asthmatics (another fungus problem with steroids in asthmatics). Patients with this condition have high IgE level, Eosinophilia, and IgE and IgG to Aspergillus. Intense inflammation and mucus plugging with repeated exacerbations may produce BROCHIECTASIS!!!
What are two fungal conditions that asthma patients on long term corticosteroids are more susceptible to?
Candidiasis and Allergic Bronchopulmonary Aspergillosis.
How do you confirm the diagnosis of suspected Mucormycosis in a patient with Diabetic Ketoacidosis? What is the treatment?
Histologic examination of the affected tissue is necessary to confirm the diagnosis. These fungi show broad nonseptate hyphae with right angle branching. Treatment consists of surgical debridement and Amphotericin B.
What is the mechanism of pahtogenesis of alcohol-induced hepatic steatosis?
This is primarily related to a decrease in fatty acid oxidation secondary to excess NADH and lack of NAD+. Additional pathogenic factors include impaired lipoprotein assembly and secretion, and an increase in peripheral fat catabolism.
Matching is a technique used to control for what type of problem in what type of study?
Matching is used in Case-Control studies to control for Confounding.
What is Ebstein's congenital anomaly? What drug causes this development in the Fetus?
Ebstein's anomaly is characterized by "atrialized right ventricle" because of a downward displacement of the tricuspid valve. It is seen in infants of mothers who take LITHIUM during pregnancy.
How is Valproate teratogenic?
The risk of NEURAL TUBE DEFECTS in Valproate is 1-3%. Valproate INHIBITS intestinal FOLIC ACID absorption!!!
Explain the mechanism behind the DIAGNOSTIC test for Acute Cholecystitis, which is Cholescintigraphy (HIDA scan).
The diagnosis of acute cholecystitis must be made by Cholescintigraphy (HIDA scan), which uses an intravenously injected radiolabeled agent that is taken up by hepatocytes and excreted into bile. If the cystic duct is patent the radiolabeled agent will enter the gallbladder and the organ is visualized. If the cystic ducts is obstructed (by a gallstone), the radiolabeled agent cannot enter the gallbladder and the organ is not visualized.
What is an example of a Benzodiazepine that can use on an (A)cute as-needed basis for axienty, that will act quickly and has a short half-life?
ALPRAZOLAM has a half-life less than twelve hours and is useful for acute anxiety.
Erythrocyte Transketolase Activity can be used to diagnose what Vitamin deficiency?
Thiamine because transketolase needs Thiamine.
In general, which types of diverticula are True diverticula and which types are False? How do the False occur?
Most diverticula acquired during ADULT LIFE are created by the mechanism of PULSION and are FALSE (e.g. colonic diverticulum, Zenker diverticulum). These were created through increased pressure which caused the mucosa and submucosa to herniate through "weak spots" in the colonic muscular layer. If, however, the outpouching occurs during FETAL development, the diverticulum usually contains all layers of the wall of the organ (such as Meckel diverticulum) and is a TRUE diverticulum.
What is Meconium Ileus?!? Who gets it?
Meconium Ileus is a distal small bowell obstruction in a neonate due to abnormally dehydrated meconium. This is specific for Cystic Fibrosis!!!
Susceptibility to developing Malignant Hyperthermia after surgery die to administration of an inhalation anesthetic and succynlcholine is an autosomal dominant inheritable trait. Describe the mutation associated and the mechanism of the this condition.
Malignant Hyperthermia is related to a defect on the Ryanodine receptors (a Calcium channel) of the surface of the Sarcoplasmic reticulum of skeletal muscles. Abnormal Ryanodine receptors release large amounts of Ca2+ after exposure to anesthetic. Excess free Ca2+ in the cytoplasm stimulates ATP-dependent reuptakke by the SR and excessive ATP consumption generates heat; loss of ATP along with high temp induces muscle damage. Rhabdomyolysis leads to realease of K+, myoglobin and Creatine kinase into circulation.
How does Dantrolene work to treat Malignant Hyperthermia?
Dantrolene is a muscle relaxant that acts on Ryanodine receptors and prevents the efflux of Ca2+ into the cytoplasm of muscle fibers that is triggered from the exposure of this autosomal dominant mutated receptor to inhalation anesthetic and succinycholine.
Explain the mechanism of action of how N-acetylcysteine inhalation therapy is beneficial to Cystic Fibrosis patients.
N-acetylcysteine works by cleaving (reducing!!!) the disulfide bonds within mucus glycoprotein, thus loosening thick sputum; it is a mucolytic agent.
What is the thyroid treatment for exposure to radiation or radioactive material?
Administration of Potassium Iodide is the treatment, because it tries to prevent thyroid absorption of radioactive Iodine isotopes through COMPETITIVE INHIBITION.
What are the 5 cofactors that are required by the "Dehydrogenase" enzymes of the mitochondria (PDH, a-KGDH, BCKADH)?
CoA, FAD+, LIPOIC ACID, NAD+ and TTP (Thiamine).
Lipoic acid is used as a cofactor in what mitochondrial enzymes?
Pyruvate Dehydrogenase (deficiency results in lactic acidosis), alpha-Ketoglutarate Dehydrogenase, and Branched-chain Ketoacid Dehydrogenase (deficiency results in maple syrup urine disease). The DEHYDROGENASE NEEDS LIPOIC ACID!!!
Ductal dilation and inspissated breast secretino; chronic granulomatous inflammation in the periductal and interstitial areas. Diagnosis?
Mammary duct ectasia.
Brenner tumor of the ovary contains what type of epithelial cells?
Urothelial.
What types of drugs can create toxicity in a patient that is taking lithium?
Any drug that stimulates the body to increase the reabsorption of Na+ (e.g. Diuretics, and NSAIDs).
Why are NSAIDs contraindicated for patients with CHF?
Because they stimulate Na+ reabsorption by the kidneys when they sense decreased blood flow from the inhibition of prostaglandin vasodilation.
What protein is mutated in Myotonic Dystrophy (impaired relaxation after a single contraction; autosomal dominant trinucleotide repeat disorder)?
Myotonin Protein Kinase.
How do you prevent Doxorubicin dilated cardiomyopathy? How does this treatment work?
Administer Dexrazoxan, which is an iron-chelating agent that decreases formation of O2-free radicals by Doxorubicin and other anthracyclins.
Paramesonephric and Mesonephric ducts exist in the embyro. Which corresponds to Mullerian and which corresponds to Wolffian?
Paramesonephric (Mullerian) and Mesonephric (Wolffian).
What is the primary problem associated with Kallman syndrome? How does this condition present?
Kallman syndrome occurs due to diminished synthesis of gonadotropic hormones by the anterior pituitary gland. The condition present with primary amenorrhea, absent secondary sex characteristics, and an OLFACTORY SENSORY defect.
Primary amenorrhea in a patient with fully developed secondary sexual characteristics suggests the presence what types of anatomic defects in the genital tract?
Imperforate hymen or Mullerian duct abnormalities.
What molecule is thought to be the cause of cutaneous petechiae and hemorrhagic bullae found in meningococcemia. This molecule is also believed to be the cause of the bilateral adrenal cortical hemorrhage characteristic of the Waterhouse-Friderichsen syndrome.
Neisseria meningococcal LOS is analogous to other Gram (-) LPS, and it is thought to be the cause of these sequelae.
What are the most important adverse effects associated with Amphotericin B?
Nephrotoxicity, hypokalemia, and hypomagnesemia.
Why is the proximal 1/3 of the donor ureter typically viable in kidney transplantation? Where does it get its blood supply from?
The proximal 1/3 of the ureter receives its blood supply from branches of the renal artery. For this reason, this portion of the donor ureter is typically viable after renal transplantation.
Palpable skin lesions in association with abdominal pain, arthralgias, and renal involvement. Diagnosis? What is the age range for this disease?
Henoch-Schonlein Purpura (HSP). This disease predominantly affects children between the ages of 3 and 10. Antigen exposure from preceding infections leads to IgA production and immune complex formation. HSP manifests cutaneously as a form of leukocytoclastic vasculitis.
Do Sensitivity and Specificity depend on the disease prevalence in a population?
NO!!!, but PPV and NPV do :).
What are the criteria for diagnosing Schizophreniform disorder?
Symptoms of Schizophrenia are present 1 < x < 6 months
What is necessary to make the diagnosis of Schizoaffective disorder?
This is characerized by mood symptoms (major depressive, manic, mixed) with concurent symptoms of Schizophrenia. For the diagnosis, patients must have at least a two week period of psychotic symptoms (delusions or hallucinations), IN THE ABSENCE of prominent mood symptoms.
What is the most reliable test to confirm the onset of Menopause?
Measuring the levels of FSH, which should be elevated. A rise in LH also occurs, but is seen later in menopause, making it a less sensitive test than FSH.
What is the cause of urine discharging from the umbilicus of a newborn?
The Urachus is a remnant of the allantois that connects the bladder with the yolk sac during fetal development. Failure of the Urachus (allantois remnant) to obliterate by birth, results in a patent Urachus and urine coming out of the bellybutton.
What is another name for the vitelline duct that causes Meckle diverticulum?
Yolk stalk.
What makes bile acid-binding resins unique among hypolipidemic agents?
What makes them unique is that they increase hepatic production of TGs and VLDL, while they try to reduce serum Cholesterol. They increase the cholesterol content of bile, thus they also increase the risk for formation of cholesterol gallstones.
What type of acute inflammatory gallbladder condition is seen in hospitalized and severely ill patients?
Acute acalculous cholecystitis, which is thought to arise secondary to gallbladder stasis and ischemia, which can cause inflammation and injury to the gallbladder.
This drug decreases serum TGs. It decreases VLDL conversion to LDL, thus decreasing serum LDL concentrations as well. It increases HDL by 20-30% making it the most effective HDL-increasing agent currently available. What am I?
Niacin.
When Leuprolide (GnRH analog) for the treatment of prostate cancer, does it immediately suppress gonadotropins- Testosterone and DHT?
No, the body probably sees this as a large pulsatile rise, and pulsatile release of GnRH is stimulatory on gonadotropins levels, while continuous release is inhibitory. Thus, there is FIRST a transient INCREASE, THEN a DECREASE in in both Testosterone and DHT levels.
Pentamidine is used to treat what type of pneumonia in AIDS patients?
Pneumocystis pneumonia.
At what CD4+ does CMV retinitis come into effect?
<50 CD4+
If two different studies compute similar relative risks, or similar differences between groups, but differ in the their p-values and the statistical power of their study, what is the most likely cause?
The most likely cause is due to sample bias. They need more participants and would, which would likely make their findings significant.
What types of strokes result in pure motor or pure sensory syndromes?
Lacunar strokes.
What are the cells and cellular substances that make up the crescents of RPGN that are observed under light microscopy?
Crescents consist of glomerular parietal cells, monocytes, macrophages, as well as ABUNDANT FIBRIN. Crescents eventually become sclerotic, disrupting glomerular function and causing irreversible renal injury.
The filtration fraction (FF) can be calculated if the glomerular filtration rate (GFR), renal blood (RBF), and hematocrit (Hct) are known. What is the formula and why must Hct be included?
FF = GFR/[(1-Hct)(RBF)]; Hct must be included because the RBF includes both plasma and blood cells, but the FF only contains plasma. So you must account for only the portion of blood that is plasma.
The average total body water is approximately 41 liters. Of that, how much is Extracellular fluid volume? Within the ECV, how much is in the plasma and how much is in the interstitium?
41 TBW --> 14 ECV --> 4 Plasma volume
If a drug has a large molecular weight, is bound extensively to plasma proteins, or is highly charged (hydrophilic), then this drug remains in what body compartment and has what Vd?
This type of drug will remain in the PLASMA COMPARTMENT, and have a Vd of 3-5L.
If a drug has a small molecular weight, but is hydrophilic what body compartments will it be found in and what will its volume of distribution be?
This drug will be found in the plasma and the interstitium, and will have a Vd = ECV = (14-16L)
If a drug has small molecular weight and is also uncharged, what will its apparent Vd be?
This type of drug will be hydrophobic/lipophillic and will be able to cross cell membrane and reach the intracelluar compartment in addition to the ECV. Thus, it will have an apparent Vd close to TBW ~41L
What type of drugs have a Vd that appears to be greater than TBW?
These are drugs that are avidly bound in the tissues. They exhibit the highest Vd, often much higher than TBW, because they accumulate readily within cells thereby maintaining low plasma concentrations. Recall that Vd (L) = amount drug given (mg)/ plasma concentration of drug (mg/L)
What is the associated pathophysiology that has been found in Primary Pulmonary Hypertension (PPH)? What is the mechanism of action of drugs that try to treat PPH?
This disease has been associated with decreased apoptosis of endothelial and smooth muscle cells in pulmonary arterioles. The symptoms of PPH are pharmacologically managed with oral Endothelin-receptor antagonists such as BOSENTAN. Endothelin is a potent vasocontrictor and stimulant of endothelial proliferation. When BOSENTAN blocks endothelin-receptors there is a decrease in pulmonary arterial pressure and lessened progression of right ventricular hypertrophy.
Phenotype mixing of viruses involves the exchange of what molecules?
Nucleocapsid proteins only, no exchange of genetic material; thus the next generation of viruses reverts to the original unmixed phenotype.
What is the most common source of E.coli bacteremia? (*not asking for its most original origin)
Urinary tract infection.
What is the main Ig passed from mother to newborn in breastmilk? What about through the placenta?
IgA only in breast milk!!! IgG through the placenta!!!
How long will maternally derived IgG that crosses the placenta, remain active in the newborn? (e.g. tetanus antibody)?
An immunized mother will be able to pass IgG through the placenta to the fetus and provide passive immunity against neonatal tetanus until the child receives its first tetanus vaccination at two months of age.
Bartonella, Coxiella, Mycoplasma, Histoplasma, Chlamydia, and the HACEK organisms (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella). What cardiac condition are these organisms are most notably associated with?
Culture-NEGATIVE Endocarditis!!!
What is the mechanism by which ANP and BNP work in the setting of Heart Failure?
Both ANP and BNP activate guanylate cyclase, which induces an increase of intracellular cGMP. Naturetic peptides cause vasodilation of both arteries and veins, diuresis/naturesis, and decreases in blood pressure. They counteract Edothelin and sympathetic affects, and ANGII.
What receptors do Endorphins work on and where are they released from in the body?
Endorphins (ENDOogenous mORPHINe) works on the Mu receptors just like narcotic analgesics. They are synthesized in and released from the pimarily Corticotroph Cells in the Anterior Pituitary.
What role does Bradykinin play in kidney homeostasis? When is it released? What is its primary action?
Bradykinin is produced in the kidney in situations where the adrenergic and RAAS systems are stimulated. It acts locally to constrict veins and dilate arterioles to INCRESASE RENAL PERFUSION.
What medication is a recombinant form of human Brain Naturetic Peptide (BNP) and is indicated in decompensated LV CHF?
Nesiritide.
What is the mechanism that predisposes women to Gallstone formation during pregnancy?
Estrogen-induced upregulation of hepatic HMG-CoA reductase activity causes the bile to become supersaturated with cholesterol. Progesterone-induced gallbladder hypomotility reduces bile acid secretion and slows gallbladder emptying, which helps precipitate cholesterol into insoluble crystals that eventually form to make gallstones.
Why is skeletal muscle resistant to the effects of Ca2+ blockers, while smooth muscle is not??
Skeletal muscle is resistant to the effect of Ca2+ channel blockers because they are largely dependent on an intracellular Ca2+ pool for excitation-contraction coupling, whereas smooth muscle depends on extracelluar Ca2+ entering the cell via voltage-gated Ca2+ channels for excitation-contraction coupling. These voltage-gated channels are not present on the extracellular membrane of skeletal muscle and are not necessary for contraction.
How is Ca2+ released from the SR in skeletal muscle vs. smooth muscle?
Skeletal muscle = membrane depolarization

Smooth muscle = Ca2+ dependent-Ca2+ release
What parts of the Duodenum are retroperitoneal?
The 2nd, 3rd, and 4th parts!!!
Which lung parameter is typically normal in the setting of ARDS? What is the mechanism of interstitial and avleolar edema?
The pulmonary capillary wedge pressure (PCWP) is typically normal in ARDS. An elevated PCWP would be more suggestive of a cardiogenic cause in a patient with pulmonary edema. The interstitial and alveolar edema and exudate in ARDS result in large part from the increased pulmonary capillary permeability.
What are the differences in HUS-TTP, and DIC in terms of coagulation tests?
PT and PTT are not prolonged in HUS-TTP!!! but the are in DIC, of course.
What are some of the generalized differences in HUS and TTP in terms of their presentations in particular patient populations? What are the commonalities? How do you treat them?
These syndromes represent different points on a spectrum of disease. TTP often occurs in adults with predominant neuroogical symptoms, while HUS usually occurs in children and has predominant renal involvment. Fever, thrombocytopenia, and MAHA are common for both conditions. Both conditions are life-threatening, and treatment includes emergent PLASMAPHERESIS.
What are two viruses that can infect and induce an autoimmune hemolytic anemia?
Mycoplasma pneumoniae and EBV.
Which antituberculous drug is notorious for causing adverse visual changes? What is the mechanism of action of this drug?
Ethambutol is associated with optic neuritis and causes decreased visual acuity, color blindness, and central scotoma. Ethamutol exerts its antimycobacterial effect by inhibiting Arabinosyl Transferase, an enzyme that polymerizes arabinose into arabinan and then arabinogalactan. This carbohydrate polymerization is necessary for mycobacterial cell wall synthesis.
This embryonic tissue gives rise to skin and its appendages, the nasal and oral epithelium, the anal epithelium to the dentate line, and the lens and cornea. What am I?
The Surface Ectoderm.
This embryonic tissue gives rise to the choroid plexus, ependymal cells, astrocytes, preganglionic autonomic fibers, the pineal gland, the retina, the neurohypophysis, and all the neurons of the CNS. What am i?
The Neuroectoderm.
This embryonic tissue is divided into paraxial, intermediate, and lateral sections and most notably does not give rise to any epithelial stuctures!!! It does give rise to muscles, bones, blood, genital tissues, the dermis, and most organ systems. What am I?
Mesoderm.
This embryonic tissue gives rise to thyroid tissues (descendant from the base of the tongue) and the epithelial linings of the GI tract, lung, urethra, bladder, and outer and middle ear. This also gives rise to the bulk of the liver, pancreas, and lungs, as these structures form from outpouchings of the primitive gut tubes. What am I?
Endoderm.
Which salivary glands are stimulated by CN VII?
CN VII makes you salivate from your submandibular and sublingual glands.
What nerve is in charge of reflex mediated syncopal episodes such as fainting after putting an otoscope in your ear?
A vasovagal syncopal episode results from stimulation of the Vagus nerve, leading to a decrease in blood pressure and heart rate.
What molecule is an allosteric activator of Pyruvate Carboxylase and therefore is an important activator of gluconeogenesis?
Acetyl-CoA!!!
Which amino acid of gluconeogenesis is an important allosteric inhibitor of the glycolytic enzyme Pyruvate Kinase?
Alanine.
What is Identification?
Identification refers to modeling one's behavior after someone who is perceived to be more powerful (e.g. abused child becoming a child abuser).
What do these proteins have in common: transcription factors, steroids, thyroid proteins, vitamin D receptors, retinoic acid receptors, DNA transcription and replication proteins? What special identification technique does their commonality allow for?
These are all examples of proteins that are capable of binding DNA. Thus you can radiolabel and identify these proteins using a DNA probe!!!
What is a Porcelain Gallbladder? What disease are patients with this finding at an increased risk for?
Porcelain Gallbladder is a term used to describe the bluish, brittle, calcium-laden gallbladder wall that can develop in some patients with chronic cholecystitis, Although patients are often asymptomatic, some may present with RUQ pain or with a firm nontender mass in the RUQ. Cholecystectomy is recommended for patients with porcelain gallbladder because 11-33% of this patient population will eventually develop Gallbladder Carcinoma.
What is NF-kB?
NF-kB is a transcription factor responsible for cytokine production in the immune response to infectious pathogens.
What is the association of NOD2 and NF-kB to Crohn's Disease?
NOD2 is acts as an intracellular microbial receptor that triggers the NF--kB pathway. NF-kB is responsible for cytokine production. It has been proposed that the NOD2 mutation linked with Crohn's disease increases the activity of the NF-kB protein, thereby allowing inflammation-inducing intracellular microbes to persist.
HLA-DR1/DR1/DQw5 is associated with what disease?
Crohn's disease.
HLA-DR2 is associated with which inflammatory bowel disease?
Ulcerative Colitis.
Where does the hydroxylation, glycosylation, and assembly of pro-a-chains of collagen into a triple helix take place in the cell?
The ER.
The initial prodromal period of infection with this virus is described as "seruum-sickness like", with patients experiencing malaise, fever, skin rash, pruritus, lymphadenopathy, and joint pain. Anorexia, nausea, jaundice, and right upper quadrant pain may ensue. Diagnosis?
HBV infection.
What type of receptor is the ERB-B2/HER2-neu recpetor found in some breast cancers? Their presence indicates a better response to what drug?
This is a receptor is a member of the EGFR family and it has abnormal TYROSINE KINASE activity. It can be treated with the monoclonal antibody TRASTUZUMAB!!!
This is a protooncogene that is associated with astrocytomas and osteosarcomas.
Sis protooncogene.
What is the first-line treatment for Essential Tremor?
Non-specific BETA-BLOCKER!!!; just like the archer's in the Olympics use to control their tremors.
What is Coronary Steal Syndrome? What type of drugs cause it?
This syndrome is caused by any drug that dilates coronary vessels without decreasing cardiac work. This causes a paradoxical decrease in blood flow to an area of ischemic myocardium because blood will preferentially flow through the pharmacologically dilated arteries of the hear that are not obstructed by atherosclerosis.
Patients about to start treatment with TNF-a inhibitors for RA, need to have what test done first?
PPD skin test!!!
What are the possible side effects of DAPSONE?
METHEMOGLOBINEMIA, oxidative stress, fever, and rash.
Severe nighttime pruritus, hepatosplenomegal, xanthomatous lesions in the eyelids or in the skin and tendons; this disease progresses with jaundice, steatorrhea, portal hypertension, and osteopenia; associated with CREST symptoms and elevated IgM. Diagnosis?
Primary Biliary Cirrhosis.
What are the cardiac associations of Down syndrome?
Ostium primum ASD and regurgitant AV valves!!!
What is the cardiac defect associated with Friedreich's ataxia?
Hypertrophic cardiomyopathy! (poor Friedreich :( )
Gag (virion core proteins), Pol (polymerase), and Env (envelope glycoproteins) are the three structural genes of HIV. What does each encode?
Gag = p24, p7

Pol = reverse transcriptase, integrase, protease

Env = gp160 --> gp120 & gp 41
Tat, Rev and Nef are HIV genes that are required for replication. What do the do?
Tat = encodes a protein that transcriptionally activates other proteins; expression of this gene is thought to contribute to the virulence of HIV

Rev = encodes a protein that facilitates transport of unspliced viral transcripts out of the nucleus.

Nef = enhances viral replication, and is thought to do so through DOWNREGULATION of CD4 and MHC class I expression.
What is the difference in side effect symptoms that traditional high potency antipsychotics (Haloperidol, Fluphenazine, Pimozide) will have vs. the low potency traditionals (Chorpromazine, Thioridazine)?
High potency = more likely to cause extrapyramidal symptoms

Low potency = more likely to cause anticholinergic and antihistaminic side effects.
Neural crest cell migration helps to partition the Truncus Arteriosus into the two great arteries, the aorta and the pulmonary artery, by causing fusion and twisting of the truncal and bulbar ridges. This process results in the normal spiral relation between the aorta and the pulmonary artery; failure of this process results in what abnormalities?
Transposition of the Great Vessels, and Tetralogy of Fallot.
In early embryological development, the body's veins fall into three main groups: Umbilical, Vitelline, and Cardinal veins. What does each become?
Umbilical veins = degenerate

Vitelline veins = for the veins of the portal system

Common Cardinal veins = drain directly in to the sinus venosus in the embryo and ultimately give rise to the Superior Vena Cava and the other constituents of the systemic venous circulation.
What type of pulse pressure do you get with Aortic Regurgitation? What are the signs of a severe regurgitation?
Pulse pressure is WIDENED is Aortic Regurg. The most likely cause of a repetitive, widened pulse pressure together with unusually large stroke volumes is AR. Signs and symptoms include involuntary head bobbing, head "pounding" with moderate exertion, heart palpatations when lying down.
Involuntary head bobbing, head "pounding" with moderate exertion, heart palpatations when lying down. WIDE PULSE PRESSURE. Diagnosis?
Aortic Regurgitation.
Narcolepsy is characterized by poor regulation of which sleep stage?
REM.
Loss of what proteins in the urine make Nephrotic syndrome a hypercoagullable state? Which veins are at particular risk for thrombosing?
Loss of anticoagulant factors, especially Antithrombin III, is responsible for the thrombotic and thromboembolic complications of nephrotic syndrome. The renal veins are at particular risk of venous thrombosis, and a well-known complication of nephrotic syndrome (*Left-sided varicocele can occur because of this too).
What type of epithelial lining does the Trachea have?
Ciliated, pseudostratified, columnar, mucus secreting epithelium.
In the respiratory tract, the nose, paranasal sinuses, nasopharynx, most of the larynx, FALSE vocal cords and the tracheobronchial tree are lined with what type of epithelium? In contrast, what type of epithelium is found in the oropharynx, laryngopharynx, anterior epiglotis, upperhalf of the posterior epiglottis, and TRUE vocal cords?
Ciliated, pseudostratified, columnar, mucus-secreting epithelium; Stratified squamous epithelium
What are the areas of the spinal cord cross-section that are most commonly seen to be damaged in patients with Syringomyelia? Which senses are lost? Which sense are preserved?
Then Ventral White Commisure and the Ventral Horn; Pain and temperature sensations are lost in the arms and hands bilaterally. Touch, vibration, and position senses are preserved.
The Lateral Spinothalamic tract is responsible for transmitting what information?
Pain and Temperature sensation from receptors to the somatosensory cortex.
What type of information is the Ventral Spinothalamic tract responsible for?
Light touch and pressure sensation.
What type of information are the dorsal columns responsible for transmitting?
Proprioception, vibration, and tactile sensation.
Cortico steroids and Chloroquine can do what to skeletal muscle?
These drugs can cause medication-induced muscle atrophy.
Perifascicular muscle inflammation is seen in what disease?
Dermatomyositis.
What is the enzyme deficiency associated with Porphyria Cutanea Tarda (the most common porphyria)?
Uroporphyrinogen Decarboxylase.
What is the first enzyme responsible for the breakdown of Heme? What gives the greenish color after briuses?
Heme oxygenase; BILIVERDIN give the greenish color.

Heme --(heme oxygenase)-> Biliverdin --(reduction)-> Unconjugated-Bilirubin
In TMP/SMX what is the mechanism of action of TMP vs. SMX?
TMP = Dihydrofolate reductase inhibitor (same as methotrexate)

SMX = competes with Paraaminobenzoic acid (PABA) for incorporation into folic acid.
What antibiotic is a structural analog of D-Ala-D-Ala that inhibits the enzyme transpeptidase by binding covalently to its active site?
Penicillins, of course.
Where is the Superior Vena Cava located in the thorax? Therefore where must a mass be located in order to cause Superior vena caval syndrome? Which lung cancer is the most common cause of SVCS?
The Superior Vena Cava iis a 6-8cm long vein that drains into the right atrium. It is located in the MEDIAL MEDIASTINUM and is surrounded by the sternum, trachea, right bronchus, aorta, and pulmonary artery. It is located in close proximity to the PREHILAR and PARATRACHEAL lymph nodes. This vein has thin walls and is easily compressed by MEDIASTINAL MASSES. Bronchogenic carcinomas are the most common cause of SVCS, and Non-Hodgkin lymphomas are the second most common.
Superior sulcus tumor is also called what?
A Pancoast tumor; this may cause shoulder pain due to compression of the brachial plexus and involve sympathetic ganglia leading to Horner's syndrome.
What makes up the basophilic, reticular mesh-like network seen in RBC reticulocytes?
rRNA.
What is the condition caused by a fixed atheromatous obstruction of one or more coronary arteries occluding at least 75% of the luminal cross sectional area?
Stable Angina.
In general, atherosclerotic plaques do not produce an imbalance of myocardial oxygen supply and demand sufficient to cause angina until the obstruct what percentage of the lumnial cross sectional area?
At least 75% of the luminal cross-sectional area.
What type of angina is defined by New onset angina, existing angina of increased frequency, intensity, and/or duration, or angina at rest?
UNSTABLE ANGINA.
What is found in the Munro abscesses of Psoriasis?
Neutrophils that form spongiotic clusters in the superficial dermis and the parakeratotic stratum.
This dermal condition is thought to be caused by CD4+ T cell that activate CD8+ T cells in the epidermis after interacting with APCs in the skin. Interaction between T cells and neighboring dermal cells result in production of cytokines (eg. TNF, IL-12, INF-y) and keratinocyte growth factors. In response keratinocyte proliferation, inflammation, and angiogenesis occur. Diagnosis?
PSORIASIS.
Where is the pressure lower: Pulmonary circulation or Systemic?
Pulmonary; all blood pumped out of the LV must return to the LV. The lower pulmonary pressure (afterload for the RV) allows the thin RV to keep pace with the more substantial LV.
What is the pathogenic mechanism that is thought to be the cause of Slceroderma/CREST syndrome? What are the first histological changes that can be seen? What is a common pulmonary syndrome that is involved do to these changes?
Scleroderma/CREST syndrome develop due to increased deposition of COLLAGEN in tissues. Proliferation and accumulation of Monoclonal T-cells in the affected tissues secrete a variety of cytokines , esp. TGF-beta, that increase production of collagen and extracellular matrix proteins by fibroblasts. All tissues can be affects, but the earliest damage is seen in SMALL ARTERIOLES AND CAPILLARIES. Thus, microvascular injury of pulmonary arterioles leads to narrowing of the lumen and increased pressure in pulmonary circulation. Pulmonary hypertension leading to RV hypertrophy, with subsequent right-sided CHF (Cor Pulmonale) is common.
Charcot-Marie-Tooth disease is caused by a mutation of a myelin protein gene and is a so-called "neural form" of muscular atrophy. What is a common motor sign associated with this disease?
Charcot-Marie-Tooth disease often presents with WEAKNESS of FOOT DORSIFLEXION due to involvement of the Common Peroneal Nerve.
What is the main therapeutic indication for the use of Reserpine? What is its mechanism of aciton? What are its most dangerous and less serious side effects?
Reserpine is an old anti-hypertensive drug that is cheap and still used in some economically disadvantaged regions. Reserpine blocks the storage of adrenergic mediators in presynaptic vesicles, thus when a vesicle binds it is empty and releases no adrenergic NT's (pharmacoogic sympathectomy). Reserpine also predisposes to depression because it depletes NE and 5HT from vesicles. Nasal congestion and increased gastric acid secretion leading to peptic ulcer formation are also associated with Reserpine use.
What type of stool osmotic gap, breath hydrogen content, and stool pH do Lactase-Deficient individuals have?
Increased stool osmotic gap; increased breath hydrogen content; decrease (acidic) pH.
POMC (ProOpioMelanoCortin) is a polypeptide precursor that goes through enzymatic cleavage and modification to produce not only Beta-Endorphins, but also ACTH and MSH. The fact that Beta-Endorphin and ACTH are derived from the same precursor suggests that there may be a close physiological relationship between what two axes in the body?
The Stress axis and the Opiod/Pain axis.
Congenital deficiency of Propionyl CoA carboxylase, the enzyme responsible for the conversion of Propionyl CoA to Methylmalonyl CoA, leads to the developments of Propionic Acidemia. This is characterized by poor feeding, vomiting, hypotonia, lethargy, dehydration and anion gap acidosis in newborns. What are the molecules that from which Propionyl CoA is dervived?
Amino acids = Val, Ile, Met, and Thr

Odd-numbered fatty acids, and Cholesterol side chains.
Narcolepsy is believed to be due to low levels of what nuerotransmitter?
Orexin (hypocretin).
What is the tetrad of symptoms that are associated with Narcolepsy?
1) Excessive daytime sleepiness with sleep attacks
2) Cataplexy
3) Hynagogic or hypnopompic halllucinations
4)Sleep Paralysis.
These patients experience excessive daytime sleepiness and have very short sleep latencies and enter REM sleep almost immediately. Diagnosis?
Narcolepsy.
This type of insult causes double strand DNA fractures that require repair, which can be joined together by nonhomologous or homologous re-ligation. What type of insult does this?
Ionizing radiation can cause these double-stranded breaks (X-rays and gamma rays).
Deamination of bases in DNA (Cytosine to uracil; Adenine and Guanine to xanthine and hypoxanthine respectively) requires removal of abnormal bases and replacement with the correct base. In this process abnormal bases are recognized and removed by specific GLYCOSYLASES without disruption of the phosphodiester backbone. This removal produces apurinic and apyrimidinic sites that are cleaved by specific nucleases. The gap is then filled by DNA polymerase and joined by ligase. What is the name of this process?
BASE EXCISION REPAIR; is done in deamination of bases.
During DNA replication, when an incorrect base substitution occurs, how do the DNA repair enzymes and proteins know which strand is the template strand (correct) and which strand is the growing (mis-substituted) strand?
In this process specific proteins scan the newlly synthesized DNA strands looking for mismatched bases. This process is guided by the presence of ADENINE METHYLATION IN THE TEMPLATE STRAND and the absence of methylation in the newly synthesized strand. This allows the repair mechanism to differentiate.
Indinavir is an HIV protease inhibitor. What are the main side effects of protease inhibitors? Which anti-tuberculous drug should not be given with protease inhibitors and why? Which one is used instead?
The side effects of protease inhibitors include Lipodystrophy (buffalo hump with central obesity and peripheral wasting), Hyperglycemia, and Inhibition of P-450. Thus, protease inhibitors should not be used with Rifampin, because Rifampin will reduce the levels of the protease inhibitor; Rifabutin should be used instead
Which anti-tuberculous drug should not be given with protease inhibitors and why? Which one is used instead?
Protease inhibitors inhibit P-450. Thus, protease inhibitors should not be used with Rifampin, because Rifampin will reduce the levels of the protease inhibitor; Rifabutin should be used instead
What is the most important toxic side effect of Acyclovir?
Renal toxicity.
What drug is used in the treatment and prophylaxis of Mycobacterium avium intracellulare (MAC) infections?
Azithromycin.
What is the typical glomerular filtration fraction of a healthy individual?
0.20 or 20%.
What is the equation for clearance of a substance in the kidney in terms of urine concentration of a substance, urine flow, and plasma concentration of a substance?
C = [(urine concentration) x (urine flow rate)] / plasma concentration
What is a Gram-negative non-lactose fermenting rod that is a common cause of urinary tract infections in patients with indwelling catheters?
Pseudomonas aeruginosa
Humoral hypercalcemia of malignancy is most often due to over-production of what substance?
Parathyroid Hormone-related peptide (PTHrP).
The femoral head and neck derive their blood supply from the superior and inferior gluteal arteries and the medial and lateral femoral circumflex arteries. These all together form the trochanteric anastomosis. Which of these arteries provides the largest contribution and is vulnerable to damage from femoral neck fractures due to its close associated with the posterior aspect of the femoral neck?
The Medial Circumflex artery.
Attempts at gene therapy with retroviruses have been promising in the treatment of what congenital immunodeficiency syndrome?
SCID; adenosine deaminase deficiency
When dealing with a leprosy case what does "several well-circumscribed lesions on the skin of his lower extremities and a strong skin reaction to heat killed Mycobacerium leprae" translate into?
This is meant to describe the hypopigmented plaques of Tuberculoid leprosy with a strong Th1 response.
What test will be positive in the patient with Tuberculoid leprosy?
The skin test with M.leprae antigens (much like a positive PPD) because patients with Tuberculoid leprosy have a strong CD4+ Th1 cell-mediated immune response mounted by the host.
Skin lesion with basal cell layer atypia, hyperkeratosis and parakeratosis. This lesion is the result of chronic sun exposure. Diagnosis?
Actinic keratosis.
What is the order of appearance of the following after ischemic damage to the brain: Glial scar; Macrophage infiltration and phagocytosis; Reactive Gliosis and vascular proliferation; Red neurons; Necrosis and neutrophilic infiltration
Red neurons = 12-48 hrs.
Necrosis and neutrophilic infiltration = 24-72 hrs.
Macrophage infiltration and phagocytosis = 3-5 days
Reactive Gliosis and vascular proliferation =1-2 weeks
Glial scar = > 2weeks
What is the main form of anemia in patients with SLE? What is SLE-ITP?
Autoimmune hemolysis; formation of warm IgG antibodies to RBCs; characterized by spherocytosis, positive direct Coombs test, and EXTRAVASCULAR hemolysis. SLE-ITP is just what it sounds like; antibodies against platelet cause autoimmune throbocytopenia. The same thing can happen to WBCs. Thus SLE can destroy all these cell types, outside the bone marrow and cause SLE-Pancytopenia via TYPE II HYPERSENSITIVITY.
What is the mechanism of SLE-Pancytopenia?
Type II hypersensitivity again all blood cell types.
What is a life-threatening side effect of SSRIs? What is the most common setting for this side effect to occur? What is the antidote for this condition?
Serotonin syndrome may occur, which has symptoms that look very much like NLMS. It most commonly occur when SSRIs are given in a temporal proximity to MAOIs (3-4 weeks lag-time is needed) or Tryptans (headaches!!!). The ANTIDOTE for this condition is a SEROTONINE RECEPTOR ANTAGONIST such as CYPROHEPTADINE, which is a histamine antagonist with nonspecific 5HT1 and 5HT2 receptor antagonist properties.
What are the atypical antipsychotic drugs that are most and least likely to cause Extrapyramidal symptoms (EPS)?
Risperidone = most likely

Clozapine = least likely; but because it is associated with agranulocytosis it is considered to be a medication of last resort.
The individual subunits of the Hemoglobin molecule are structurally analogous to myoglobin. If separated, the subunits will demonstrate an oxygen dissociation curve similar to that of myoglobin. What will this look like?
This will look like a FAR-LEFT-SHIFTED Hb O2 binding curve.
When dealing with a leprosy case what does "several well-circumscribed lesions on the skin of his lower extremities and a strong skin reaction to heat killed Mycobacerium leprae" translate into?
This is meant to describe the hypopigmented plaques of Tuberculoid leprosy with a strong Th1 response.
What test will be positive in the patient with Tuberculoid leprosy?
The skin test with M.leprae antigens (much like a positive PPD) because patients with Tuberculoid leprosy have a strong CD4+ Th1 cell-mediated immune response mounted by the host.
Skin lesion with basal cell layer atypia, hyperkeratosis and parakeratosis. This lesion is the result of chronic sun exposure. Diagnosis?
Actinic keratosis.
What is the order of appearance of the following after ischemic damage to the brain: Glial scar; Macrophage infiltration and phagocytosis; Reactive Gliosis and vascular proliferation; Red neurons; Necrosis and neutrophilic infiltration
Red neurons = 12-48 hrs.
Necrosis and neutrophilic infiltration = 24-72 hrs.
Macrophage infiltration and phagocytosis = 3-5 days
Reactive Gliosis and vascular proliferation =1-2 weeks
Glial scar = > 2weeks
What is the main form of anemia in patients with SLE? What is SLE-ITP?
Autoimmune hemolysis; formation of warm IgG antibodies to RBCs; characterized by spherocytosis, positive direct Coombs test, and EXTRAVASCULAR hemolysis. SLE-ITP is just what it sounds like; antibodies against platelet cause autoimmune throbocytopenia. The same thing can happen to WBCs. Thus SLE can destroy all these cell types, outside the bone marrow via and cause SLE-Pancytopenia via TYPE II HYPERSENSITIVITY.
What is the mechanism of SLE-Pancytopenia?
Type II hypersensitivity again all blood cell types.
What is a life-threatening side effect of SSRIs? What is the most common setting for this side effect to occur? What is the treatment?
Serotonin syndrome may occur, which has symptoms that look very much like NLMS. It most commonly occur when SSRIs are given in a temporal proximity to MAOIs (3-4 weeks lag-time is needed) or Tryptans (headaches!!!). The antidote for this condition is a Serotonin receptor antagonist such as Cyproheptadine, which is a histamine antagonist with nonspecific 5HT1 and 5HT2 receptor antagonist properties.
What are the atypical antipsychotic drugs that are most and least likely to cause Extrapyramidal symptoms (EPS)?
Risperidone = most likely

Clozapine = least likely; but because it is associated with agranulocytosis it is considered to be a medication of last resort.
Local cutaneous adverse effects of chronic topical treatment with this drug include atrophy/thinning of the dermis that is associated with loss of dermal collagen, drying, cracking, and tightening of the kin, teleangectasias, and ecchymoses. Which drug am I?
Corticosteroids.
The individual subunits of the Hemoglobin molecule are structurally analogous to myoglobin. If separated, the subunits will demonstrate an oxygen dissociation curve similar to that of myoglobin. What will this look like?
This will look like a FAR-LEFT-SHIFTED Hb O2 binding curve.
MEN I is caused by a mutation in what gene on what Chromosome?
MENIN gene; Chromosome 11
Acid urine excretion occurs in the form of free hydrogen ions and titratable acids. What are the titratable acids that will have an observed increase when the body is excreting acid?
NH4+ and H2PO4- !!!; During metabolic acidosis excretion of free H+ and titratable acids increases, excretion of HCO3- decreases, and urinary pH decreases.
Why must HbF bind O2 better than adult HbA? How does it accomplish this?
The affinity of HbF to O2 is much higher than that of HbA because HbF does not effectively bind to 2,3-DPG. This altered affinity is due to the presence of Serine instead of charged Histidine residues at the normal 2,3-DPG binding site. HbF needs to bind O2 more avidly than adult HbA because the HbF must obtain O2 from the mother's HbA in the placenta!!!!
What phase of the cardiac depolarization cycle do class IB antiarrhythmics affect? (*has an affinity for activated and inactivated Na+ channels, but not resting)
They have the effect of shortening the length of the action potential and Phase 3 repolarization, while they have little effect on Phase 0 depolarization.
Class 1A antiarrhythmic drugs have an affinity for non-resting sodium channels that is intermediate between that of class 1B drugs (low affinity) and class 1C drugs (high affinity). Which phases do Class 1A drugs affect?
Class 1A drugs slow both Phase 0 depolarization as well as Phase 3 repolarization. They can also prolong the refractory period. Quinidine is the major drug of this class and is used for tachyarrhythmias arising in the atria and AV junction.
What is the main phase of the Cardiac conduction cycle that is affected by class 1C antiarrhythmics such as Propafenone and Flecainide?
These drugs have more of an effect on normal cardiac myocytes leading to their negative ionotropic effect which limits their use. This class of drugs slows Phase 0 depolarization, with little effect on repolarization or the length of the refractory period.
Which Ca2+ channel blocker is selective for vascular smooth muscle and does not have a notable effect on the heart?
Nifedipine.
On the Proximal tubule ultrafiltrate graph which lines belong to which substances? What does each line mean?
Substances: Inulin, PAH, Creatine, Urea, Na+, K+, (osmolarity), Bicarbonate, Amino acids, Glucose.
Line 1-3 = concentrations of PAH/Inulin (line with a slope of 1 b/c all is filtered and not reabsorbed), Creatine, and Urea increases as fluid runs along the Proximal Tubule

Line 4 = Na+, K+ (osmolarity); here there is no concentration change along the proximal tubule because Na+ and K+ are reabsorbed in concentrations equal with H2O in the Proximal tubule.

Line 5-7 = Bicarbonate, amino acids and Glucose because these substances are actively reabsorbed
What are the drugs used in myocardial perfusion studies that are selective vasodilators of Coronary microvasculature (arterioles) that may cause "coronary steal syndrome" through accidental reversal of collateral blood flow that was feeding ischemic areas of the heart?
Adenosine and Dipyridamole.
When a question stem asks about a heart at autopsy seen in a patient that had no Cardiovascular disease, but was perhaps aging, cachectic, and malnourished, and has myocardial or liver cells show prominent intracytoplasmic granules that are tinged YELLOWISH-BROWN, what do you know caused it and what is it called?!?!
This was caused by LIPID PEROXIDATION AND THIS IS CALLED LIPOFUSCIN!!!, you know this.
What is the "unhappy triad" of knee injuries?
MCL, Medial meniscus, and ACL damage; these result from a blow to the lateral knee.
High levels of this toxin in the diet are associated with G:C --> T:A transversion in codon 249 of the p53 gene, a mutation thought to greatly increase the risk of developing hepatocellular carcinoma. What toxin is this?
Aflatoxin from Aspergillus
What are the differences in the structure of MHC I and MHC II molecules?
MHC I = Heavy chain and B2-microblobulin!!!

MHC II = Alpha and Beta polypeptide chains
Swallowed amniotic fluid contributes to the development and maturation of this fetal organ. Infants with bilateral renal agenesis or other causes of prolonged Oligohydramnios often die from this syndrome after birth, due to immaturity of this organ. What is it the organ? What is the syndrome that causes death?
Lungs; RDS and respiratory failure due to pulmonary hypoplasia.
Explain how a Radioimmunoassay (RIA) experiment works. (*start with baseline radioactivity, and positive tests for antigen show decreases in radioactivity from the plate)
1) Antibody is bound to a plate
2) Known radiolabeled antigen is added
3) Unknown antigen is added
-if that unknown antigen shares epitopes with the known antigen, then it will bind the antibody and displace the radiolabeled antigen, thus the presence of antigen in the unknown will cause the radiosignal emitted from the plate to decrease.
What is meant by the term consensus sequence?
This means HIGHLY CONSERVED SEQUENCE.
Why would Phenylephrine cause a decrease in heart rate and an increase in pulse pressure?
Phenylephrine is a SELECTIVE ALPHA-1-AGONIST. Thus it would increase arteriolar resistance and increase blood pressure. The BP increase elicits a baroreceptor-mediated increase in vagal tone, which results in decreased stroke volume and slowed heart rate. The PULSE PRESSURE is defined as the systolic pressure minus the diastolic pressure, and is DECREASED BY PHENYLEPHRINE because of the reflex decrease in stroke volume and increased after load.
What are the main effects of Dobutamine?
Dobutamine has the primary effects of Beta-adrenergic receptor agonism. Dobtamine increases the heart's rate and contractility, but exerts little effect on peripheral vascular resistance.
How will Isoproterenol and Epinephrine affect pulse pressure?
They both increase the pulse pressure.
Does Epinephrine have a greater effect on Alpha-1 or Beta-2 adrenergic receptors in the vasculature?
Beta-2.
How does chronic alcoholism affect the Cerebellum? What nerve fibers are damaged? How will the patient present?
Chronic alcoholism can cause atrophy of the ANTERIOR LOBES and CEREBELLAR VERMIS, resulting in gait ataxia, truncal instability, intention tremor, and rhythmic, postural "Parkonsonian" tremor of the fingers and hands. The specific pathophysiology is due to the loss of Purkinje cells in the anterior lobes and cerebellar vermis.
Where are the lesions in the brain associated with Korsakoff and amnestic disorders associated with alcoholism?
Korskoff syndrome, and amnestic disorders associated with alcoholism, result from damage to the BILATERAL TEMPORAL LOBES.
How can tumors of the Pineal gland affect occulomotor movement? What are the CNs affected? What is the name of the condition?
A Pineal gland tumor may cause a lesion from mass effect on the dorsal midbrain in the region of the SUPERIOR COLLICULUS. Affected patients experience UPWARD GAZE PALSY, ABSENT PUPILLARY LIGHT REFLEX, FAILURE OF CONVERGENCE, and a wide-based gait. This is called Parinaud syndrome. The is damage to CN III, IV as well as the Edinger-Westphal nucleus, which provides parasympathetic innervation to the eye.
What is the action of Bromocriptine?
Bromo --> Promo(tes) --> Dopo(amine)

It is a dopamine receptor agonist.
What is the mechanism of action of Clomiphene citrate on inducing ovulation?
Clomiphene is an antiestrogen that stimulates ovulation by blocking the feedback inhibition of estrogen on the hypothalamus thereby enhancing the release of pituitary gonadotropins.
When a child presents with a condenital Cyanotic heart condition, what are the only three conditions it could be?
Tetralogy of Fallot, Transposition of the great vessels, Truncus Arteriosus.
This electrolyte change causes QT interval prolongation, the appearance of U-WAVES and ST segment depression. Severe cases of the imbalance may cause Torsades de Pointes. What am I?
HYPOKALEMIA.
Hypocalcemia is associated with what EKG change? Hypercalcemia?
Hypocalcemia caues prolonged QT interval. Hypercalcemia causes shortening f the QT interval and may cause T-wave flattening or inversion in severe cases.
At what CD4+ count does Pneumocystis pneumonia begin to affect HIV patients? What do they then have?
Penumocystis pneumonia takes hold when a patient has a CD4+ T-cell count less than 200. Thus, a patient with Pneunocystis would likely have AIDS.
At what CD4+ count does CMV retinitis occur in AIDS patients?
CD4+ 50 >
HIV protease inhibitors function by inhibiting polyprotein cleavage. They specifically inhibit the cleavage of what viral gene product?
The Gag-Pol viral gene product.
Which anti-mycobacterial drug inhibits "lipid synthesis", by inhibiting acyl carrier protein and ketoacyl carrier protein synthase?
Isoniazide, which inhibits Mycolic acid (lipid) synthesis.
What solubility properties of Heparin make it safe to use during pregancy vs. Warfarin?
Water soluble material such as Conjugated bilirubin, do not readily cross the placenta while lipophilic materials, such as unconjugated bilirubin, may easily cross the placenta. Heparin sulfate is a charged, water soluble molecule, while Warfain exhibits significant binding to albumin an is a lipophilic molecule. Thus Warfarin readily crosses the placenta and Heparin does not.
Where do the majority of Pancreatic pseudocyts present in the pancreas? How will the patient present?
90% of Pancreatic pseudocyts develop in the body or tail of the pancreas. Only 10% occur in the head of the pancreas. Patients with pseudocysts typically present with chronic abdominal pain, and physical exam may reveal an epigastric mass that is tender to palpation.
What are the musculoskeletal complications associated with Thyroxine deficiency?
Joint pains, aches, and stiffness.
Dipalmitoylphosphatidylcholine (Lecithin) and Phosphatidylglycerol are two key phospholipids found in lung surfactant. What are the methods to assess the quantity and functionality of surfactant in amniotic fluid in order to evaluate fetal lung maturity?
Lecithin:sphingomyelin ratio (>2 indicates maturity), Surfactant:albumin ratio, Slide agglutination test for phosphatidylglycerol, and the Foam stability test
What is the Foam stability index that evaluates the surfactant functionality of the newborn from amniotic fluid?
To perform this test, multiple wells containing mixtures of ethanol and amniotic fluid are shaken and then examined to find the highest value well that contains a ring of stable foam. This is considered a reliable predictor of lung maturity in the fetus.
Tamm-Horsfall glycoprotein is exclusively secreted by renal tubular epithelial cells of the Ascending Limb of the Loop of Henle. A patient with what condition, can accumulate Tamm-Horsfall glycoprotein in the tubular lumen to form hyaline casts?
A patient with Pre-renal azotemia and a low urine flow rate.
In an ischemic situation which ion would be expected to show no increase or decrease in extracellular concentration due to its propensity to follow water in equimolar amounts?
Cl-
A sharp tug on a child's outstretched arm is a common cause of this injury. What is the injury and what is the ligament that is damaged?
This is describes trauma that would lead to Radial head subluxation. This results from tearing of the annular ligament, which normally stabilizes the radial head against the humerus.
Homogentisic acid oxidase (HGO) catalyzes the conversion of homogentisate to maleyacetoacetate in the degradation pathway for the amino acids Phenylalanin and Tyrosine. A deficiency of HGO causes what disease? Where can Ochronotic pigment deposit?
Alkaptonuria; Deposition of Ochronotic pigment in occurs in joint cartilage, the skin, ear cartilage, and as a dark blue/grey discoloration of the sclera.
What effect does Metoclopramide have on dopamine receptors? What gastric conditions is it used to treat? When should it NOT be used?
Metoclopromide is a dopamine receptor antagonist. It is indicated in treating vomiting or gastric stasis. In is contraindicated in Gastric Obstructions!!! and Parkinson's patients!!!
Cylcosporine is usually used in the prevention of rejection in solid organ transplant patient, but what skin condition can it also treat?
Severe Psoriasis.
What is the definition of Accuracy in terms of the 2 x 2 square? What is the area under the Receiver Operating Characteristic (ROC) curve equal to [Sensitivity vs. (1-Specificity)]? What would an area close to 1 mean, and what would it look like?
Accuracy = (TP + TN)/ All observations

The area under the ROC curve is the measurement of accuracy. An area close to 1 would mean 100% accurate and would look like a rectangle, where as random guessing would be a straight line with a slope of 1.
What type of blood transfusion do patients with IgA-deficiency need?!?
IgA-deficiennt people in need of transfusion should only receive blood from an IgA-deficieny individual. This is because about 1/3 of all individuals who are IgA deficient will produce anti-IgA antibodies (IgG antibodies that react with IgA).
What type of inheritance pattern describes Hypertrophic Cardiomyopathy? What molecule is defective?
Hypertrophic Cardiomyopathy has an autosomal dominant inheritance pattern. Mutations in the beta-myosin heavy chain have been identified in addition to other defects in myofilament proteins.
What is the cell that mediates most of the hair loss in Alopecia areata?
Cytotoxic T-lymphocytes
What are the skin levels that the antibodies to these conditions are seen: Pemphigous vulgaris, Epidermolysis billous aqcuisita, Dermatitis herpetiformmis, Bullous pemphigoid.
Pemphigus vulgaris = Epidermis

Epidermolysis Bullosa acquisita = Dermal-epidermal junction

Bullous Pemphigoid = Basement membrane

Dermatitis herpetiformis = Dermis
Describe the histological differences seen between Lipomas and Liposarcomas.
Liposarcomas = composed of lipoblasts; non-membrane-bound cytoplasmic lipid that shifts periodically causing SCALLOPING OF THE NUCLEAR MEMBRANE.

Lipoma = soft-rubbery some what mobile subcutaneous nodule composed of mature fat cells without pleomorphism
Peutz-Jegher syndrome is associated with what gene mutation on what chromosome? What type of polyps does this lead to in the small intestine? Are the skin lesions associated, seen at birth?
Autosomal Dominant disease; mutations in Serine/Threonine Kinase 11 (STK11) gene on Chromosome 19. There are Hamartomarous polyps in the small intestine. The skin lesions are NOT PRESENT AT BIRTH, but they develop during the first few years of life and PRECEDE INTESTINAL POLYPOSIS. THEY CAN ALSO APPEAR ON THE HANDS AND FEET.
What type of growth is the Lisch nodule seen in the iris of patients with NF-1?
This is a HAMARTOMA.
What are the cutaneous findings in a patient with Wilson's disease?
Cutaneous findings of Wilson's disease include blue nail lunulae and dyspigmentation of the lower legs.
If when the patient lies in the left lateral decubitus position and exhales fully, you hear a low-pitched, mid-diastolic murmur at the cardiac apex, and you hear it best in this position, what is the probable diagnosis no matter what other symptoms the question stem tries to confuse you with?
MITRAL STENOSIS; if its mitral stenosis then it is always Rheumatic heart disease/fever
The urease breath test, fecal antigen sampling, serology for specific IgG or IgA antibodies, and PCR are all used to confirm the presence of what bacterium?
H.pylori in the Gastrointestinal tract.
Patients undergoing the urease breath test consume radiolabeled urea. What does H.pylori convert this urea into?
Urea --> CO2 (radiolabeled) + NH3 (raises pH and protects bacteria)
Familial Hypercholesterolemia is an autosomal dominant disorder caused by defective LDL receptors. What chromosome is the defective gene located on?
Chromosome 19.
During healing of the intestinal epithelium, from where do new intestinal epithelial cells differentiate from stem cells?
The stem cells of the intestinal epithelium reside in the deepest portions of the Crypts of Lieberkuhn!!! (*Lieberkuhn "Liebs" to new cells)
Symmetricallly bilateral lower extremity edema with prominently visible abdominal wall collateral venous circulation; patient has a left-sided mobile flank mass that is palpated on abdominal examination, over which there is a faint systolic bruit. Diagnosis?
IVC obstruction due to a renal tumor (CRAZY!!!)
What diagnosis should be suspected in any patient with new, unexplained, severe lower extremity edema in the absence of an explanation for such edema (such as right heart failure severe hepatic cirhosis, or nepphrotic syndrome)?
IVC obstruction.
Liver, spleen, and thymus can all participate in what process?
EXTRAMEDULLARY HEMATOPOESIS!!!
What are the two most common CMV infections seen in HIV?
CMV retinitis and CMV colitis (ulcers in the GI tract)
Abdominal pain may be vague initially, but becomes more localized as the disease progresses; Colonoscopy reveal mucosal erythema, erosions, ulcerations, hemorrhage and/or nodular lesions; HIV patient with full blown AIDS. Diagnosis?
CMV colitis.
What is the mechanism of action of the HIV drug Indinavir?
This is a protease inhibitor that impairs Gag-pol cleavage.
Conditions that lead to microsatelite instability in DNA include defects in what type of enzymes? What is an example of a cancer that occurs because of such a deficiency?
Mutations in DNA mismatch repair enzymes can result in microsatelite instability, which predisposes to accumulation of microsatelites of abnormal lengths in DNA. Hereditary nonpoylposis colorectal cancer (HNPCC, Lynch syndrome) is one condition caused by microsatelite instability.
Which MHCs process Viral antigens?!? Does it matter on how it enters the cell? Who does this present to?!
Viral antigens are processed as "intrinsic" antigens and are presented on MHC I molecules by most cells to CD8+ cells when they infect a cell on their own because the exist free in the cytoplasm with normal cellular proteins.
However, viral proteins that gain access to the cell via phagocytosis are presented on MHCII molecules like other foreign proteins to CD4+ cells.
What must happen to the antibodies bound to the surface of B-cells in order for antigen to activate those B-cells? What type of signaling pathway is used to stimulate activation in this scenario?
Crosslinking of membran Ig by antigen stimulates Tyrosine kinase activity and B-cell activation. Which makes sense because B-cells are being stimulated to grow and divide via monoclonal proliferation.
If a patient has a mutated HLA haplotype that interferes with immune response generation, then what leg of the response is impaired?
Antigen presentation!!!; HLA = MHCs

Class I MHC = HLA-A, HLA-B, HLA-C

Class II MHC = HLA-DP, HLA-DQ, HLA-DR
What is one of the main mechanisms by which Loop diuretics and other diuretics cause contraction alkalosis? What are the early signs of this condition? What condition should you not confuse this with if a heart patient is taking both diuretics and statins?
Aldosterone!!! is increased in the setting of Loop diuretic use, putting the patients at risk for hypokalemia and contraction alkalosis. Early signs of hypokalemia include fatigue, myalgias, muscle cramps and weakness. Be careful about confusing these side effects with Rabdomyolisis of statins when a heart patient is taking both. Rhabdomyolysis will present more acutely and patients will have muscle pain and dark urine die to myoglobinuria.
What are the life-threatening developments that can occur in the setting of contraction metabolic alkalosis with use of a diuretic?
Respiratory depression and ventricular arrhythmias.
What is the first rate-limiting step in Heme synthesis? What are the enzyme and substrates used? What is the cofactor that is needed?
ALA-synthase making ALA from Glycine and Succinyl CoA. Vitamin B6 is the cofactor needed for this reaction.
What are the substrates used in the first step in pyrimidine synthesis?
Glutamine + CO2 --> Carbamoyl phosphate; Aspartate and Phosphotibosyl pyrophosphate are additional substrates required.
What are the two starting molecules that are needed for the Urea Cycle?
CO2 + NH3.
What is Pseudodementia and how is it differentiated from real dementia?
Pseudodementia is compromised cognitive functioning that occurs in patients with a HISTORY OF PSYCHIATRIC ILLNESSES like severe depression. GAIT REMAINS NORMAL IN THESE PATIENTS.
Mutiple physical complaints before the age of 30, without finding causes for any of them; 4-pain, 2-GI, 1- sexual, 1-pseudoneurogenic; typically female. Diagnosis?
Somatization disorder.
What is the simple, repetitive amino acid sequence that allows collagen molecules to have a triple helix conformation?
Gly-X-Y; many of the -X- and -Y- amino acids are Proline residues that are important for formation of collagen's alpha helical structure because the Proline ring structure kinks the polypeptide chains.
What is the change in collagen that decreases its solubility and allows in to form as part of the Extracellular Matrix?
The cleavage of the N-terminal and C-terminal disulfide bonds, which occurs once the procollagen molecule has been exported from the cell.
What is the most common enzyme deficiency of the Urea Cycle? What molecules will be seen to build up behind this enzyme block?
Ornithine Transcarbamolyase (OTC) deficiency is the most common defect of the urea cycle. This results in the accumulation of Carbamoly phosphate, with is then converted to OROTIC ACID by the pyrimidine biosynthetic pathway and congenital hyperammonemia.
What is one of the main mechanisms by which Loop diuretics and other diuretics cause contraction alkalosis? What are the early signs of this condition? What condition should you not confuse this with if a heart patient is taking both diuretics and statins?
Aldosterone!!! is increased in the setting of Loop diuretic use, putting the patients at risk for hypokalemia and contraction alkalosis. Early signs of hypokalemia include fatigue, myalgias, muscle cramps and weakness. Be careful about confusing these side effects with Rabdomyolisis of statins when a heart patient is taking both. Rhabdomyolysis will present more acutely and patients will have muscle pain and dark urine die to myoglobinuria.
What are the life-threatening developments that can occur in the setting of contraction metabolic alkalosis with use of a diuretic?
Respiratory depression and ventricular arrhythmias.
What is the first rate-limiting step in Heme synthesis? What are the enzyme and substrates used? What is the cofactor that is needed?
ALA-synthase making ALA from Glycine and Succinyl CoA. Vitamin B6 is the cofactor needed for this reaction.
What are the substrates used in the first step in pyrimidine synthesis?
Glutamine + CO2 --> Carbamoyl phosphate; Aspartate and Phosphotibosyl pyrophosphate are additional substrates required.
What are the two starting molecules that are needed for the Urea Cycle?
CO2 + NH3.
What is Pseudodementia and how is it differentiated from real dementia?
Pseudodementia is compromised cognitive functioning that occurs in patients with a HISTORY OF PSYCHIATRIC ILLNESSES like severe depression. GAIT REMAINS NORMAL IN THESE PATIENTS.
Mutiple physical complaints before the age of 30, without finding causes for any of them; 4-pain, 2-GI, 1- sexual, 1-pseudoneurogenic; typically female. Diagnosis?
Somatization disorder.
What is one of the main mechanisms by which Loop diuretics and other diuretics cause contraction alkalosis? What are the early signs of this condition? What condition should you not confuse this with if a heart patient is taking both diuretics and statins?
Aldosterone!!! is increased in the setting of Loop diuretic use, putting the patients at risk for hypokalemia and contraction alkalosis. Early signs of hypokalemia include fatigue, myalgias, muscle cramps and weakness. Be careful about confusing these side effects with Rabdomyolisis of statins when a heart patient is taking both. Rhabdomyolysis will present more acutely and patients will have muscle pain and dark urine due to myoglobinuria.
What is the simple, repetitive amino acid sequence that allows collagen molecules to have a triple helix conformation?
Gly-X-Y; many of the -X- and -Y- amino acids are Proline residues that are important for formation of collagen's alpha helical structure because the Proline ring structure kinks the polypeptide chains.
What are the life-threatening developments that can occur in the setting of contraction metabolic alkalosis with use of a diuretic?
Respiratory depression and ventricular arrhythmias.
What is one of the main mechanisms by which Loop diuretics and other diuretics cause contraction alkalosis? What are the early signs of this condition? What condition should you not confuse this with if a heart patient is taking both diuretics and statins?
Aldosterone!!! is increased in the setting of Loop diuretic use, putting the patients at risk for hypokalemia and contraction alkalosis. Early signs of hypokalemia include fatigue, myalgias, muscle cramps and weakness. Be careful about confusing these side effects with Rabdomyolisis of statins when a heart patient is taking both. Rhabdomyolysis will present more acutely and patients will have muscle pain and dark urine due to myoglobinuria.
What are the life-threatening developments that can occur in the setting of contraction metabolic alkalosis with use of a diuretic?
Respiratory depression and ventricular arrhythmias.
What is the first rate-limiting step in Heme synthesis? What are the enzyme and substrates used? What is the cofactor that is needed?
ALA-synthase making ALA from Glycine and Succinyl CoA. Vitamin B6 is the cofactor needed for this reaction.
What is the change in collagen that decreases its solubility and allows in to form as part of the Extracellular Matrix?
The cleavage of the N-terminal and C-terminal disulfide bonds, which occurs once the procollagen molecule has been exported from the cell.
What are the substrates used in the first step in pyrimidine synthesis?
Glutamine + CO2 --> Carbamoyl phosphate; Aspartate and Phosphotibosyl pyrophosphate are additional substrates required.
What is the first rate-limiting step in Heme synthesis? What are the enzyme and substrates used? What is the cofactor that is needed?
ALA-synthase making ALA from Glycine and Succinyl CoA. Vitamin B6 is the cofactor needed for this reaction.
What is the most common enzyme deficiency of the Urea Cycle? What molecules will be seen to build up behind this enzyme block?
Ornithine Transcarbamolyase (OTC) deficiency is the most common defect of the urea cycle. This results in the accumulation of Carbamoly phosphate, with is then converted to OROTIC ACID by the pyrimidine biosynthetic pathway and congenital hyperammonemia.
What are the two starting molecules that are needed for the Urea Cycle?
CO2 + NH3.
What are the substrates used in the first step in pyrimidine synthesis?
Glutamine + CO2 --> Carbamoyl phosphate; Aspartate and Phosphotibosyl pyrophosphate are additional substrates required.
What is Pseudodementia and how is it differentiated from real dementia?
Pseudodementia is compromised cognitive functioning that occurs in patients with a HISTORY OF PSYCHIATRIC ILLNESSES like severe depression. GAIT REMAINS NORMAL IN THESE PATIENTS.
What are the two starting molecules that are needed for the Urea Cycle?
CO2 + NH3.
Mutiple physical complaints before the age of 30, without finding causes for any of them; 4-pain, 2-GI, 1- sexual, 1-pseudoneurogenic; typically female. Diagnosis?
Somatization disorder.
What is Pseudodementia and how is it differentiated from real dementia?
Pseudodementia is compromised cognitive functioning that occurs in patients with a HISTORY OF PSYCHIATRIC ILLNESSES like severe depression. GAIT REMAINS NORMAL IN THESE PATIENTS.
Mutiple physical complaints before the age of 30, without finding causes for any of them; 4-pain, 2-GI, 1- sexual, 1-pseudoneurogenic; typically female. Diagnosis?
Somatization disorder.
What is the simple, repetitive amino acid sequence that allows collagen molecules to have a triple helix conformation?
Gly-X-Y; many of the -X- and -Y- amino acids are Proline residues that are important for formation of collagen's alpha helical structure because the Proline ring structure kinks the polypeptide chains.
What is the simple, repetitive amino acid sequence that allows collagen molecules to have a triple helix conformation?
Gly-X-Y; many of the -X- and -Y- amino acids are Proline residues that are important for formation of collagen's alpha helical structure because the Proline ring structure kinks the polypeptide chains.
What is the change in collagen that decreases its solubility and allows in to form as part of the Extracellular Matrix?
The cleavage of the N-terminal and C-terminal disulfide bonds, which occurs once the procollagen molecule has been exported from the cell.
What is the most common enzyme deficiency of the Urea Cycle? What molecules will be seen to build up behind this enzyme block?
Ornithine Transcarbamolyase (OTC) deficiency is the most common defect of the urea cycle. This results in the accumulation of Carbamoly phosphate, with is then converted to OROTIC ACID by the pyrimidine biosynthetic pathway and congenital hyperammonemia.
What is the change in collagen that decreases its solubility and allows in to form as part of the Extracellular Matrix?
The cleavage of the N-terminal and C-terminal disulfide bonds, which occurs once the procollagen molecule has been exported from the cell.
What is the most common enzyme deficiency of the Urea Cycle? What molecules will be seen to build up behind this enzyme block?
Ornithine Transcarbamolyase (OTC) deficiency is the most common defect of the urea cycle. This results in the accumulation of Carbamoly phosphate, with is then converted to OROTIC ACID by the pyrimidine biosynthetic pathway and congenital hyperammonemia.
What does JAK-STAT stand for?
Janus Kinase (JAK); Signal Transducers and Activators of Transcription (STAT)
What are the main functions of the NF-kB pathway? How is it activated?
NF-kB is a second messenger that acts as a pleiotropic transcription factor, increasing the transcription of anti-apoptotic gene and multiple inflammatory genes taht code for cytokines, chemokines, enzymes and adhesion molecules. NF-kB is located in the cytosol and requires cytoplasmic phosphorylases to disengage it from a bound inhibitor and then it can migrate to the nucleus.
What type of antidepressant is most likely indicated in a patient with Prostatic Hyperplasia?!?
An SSRI, NOT a TCA like Amytryptiline :).
Anti-B-hCG antibodies are coated on a plate. Urine is added. B-hCG+Latex is added next. Agglutination is seen. Exlplain why and the what the result means.
The B-hCG+Latex was able to bind antibodies (only when the they bind antibodies can the latex agglutinate) because there was no B-hCG in the urine to fill the spots. Thus the presence of Agglutination in this case means there is no B-hCG in the Urine and the patient is not pregnant.
In Follicular atresia of the follicles that do not undergo maturation in a female's ovary, what happens to the Theca cells versus the Oocyte and Granulosa cells?
The Thecal cells outside the basal lamina dedifferentiate and return to a pool of ovarian interstitial or stromal cells, while the Oocyte and granulosa cells in the basal lamina become apoptotic.
In Ulcerative Colitis what type of cells accumulate in the crypt lumina, a finding called "Crypt Abscesses"?
Neutrophils.
At what CD4+ count are AIDS patients particularly susceptible to Diarrheal Cryptosporidial infection?
< 200/ul CD4+
What are the tissues that can metabolize ketone bodies that are produced by the liver during starvation states?
Skeletal muscles, Cardiac muscle, Renal cortex, and Brain
What is the enzyme that directly turns HMG-CoA into the production of the Ketone body Acetoacetate?
HMG-CoA Lyase; HMG-CoA synthase may be the rate-limiting step in ketone production though, so be careful on a question that has both of these options.
In DKA what blood test is used to confirm the presence of Ketone bodies; which ketone is detected? What Urine test may alternatively be employed, and which ketone does it detect if a Sodium Nitroprusside strip is used and turns purple?
Blood tests normally detect B-hydroxybutyrate because it comprises 75% of the ketones in circulation, and thus this test is prefered. If a Na+ nitroprusside strip is used in the urine, this will most likely be detecting Acetoacetate.
Severe dysmenorrhea, dyspareunia, and infertility suggest what female condition?
ENDOMETRIOSIS.
What are the most common side effects of Endometriosis?
Dysmenorrhea, dyspareunia, and infertility (due to pelvic adhesions that distort the pelivc anatomy, disturbances of oviduct mobility and fibrosis and encasement of the ovary by ectopic endometrial tissue.
What are the main functions of the NF-kB pathway? How is it activated?
NF-kB is a second messenger that acts as a pleiotropic transcription factor, increasing the transcription of anti-apoptotic gene and multiple inflammatory genes taht code for cytokines, chemokines, enzymes and adhesion molecules. NF-kB is located in the cytosol and requires cytoplasmic phosphorylases to disengage it from a bound inhibitor and then it can migrate to the nucleus.
What is the only bone that fixes the upper extremity to the thorax, so that when it is fractured, the shoulder tends to be displaced anteriorly and inferiorly?
The Clavicle.
How does insulin increase Glycolytic activity? What molcule, enzyme and, kinase are at play?
Insulin increases Glycolytic activity by causing the inactivation of PKA, which phosphoylates, and thus inactivates, PFK-2. PFK-2 in the unphosphorylated state then is active and makes F-2,6,-BP from F-6-P in glycolysis. F-2,6-BP feeds back on PFK-1 (it is the most POTENT activator of PFK-1) and causes PFK-1 to make more F-1,6-BP from F-1-P.

Thus, Insulin regulates glycolysis by working on PFK-2 upregulation through inactivation of PKA.
How does Insulin drive K+ into a cell?
By activating the 3Na+/2K+ ATPase pump.
What are the ONLY TWO RNA viruses that replicate in the NUCLEUS?!? Where do the others replicate?
INFLUENZA VIRUS and RETROVIRUSES!!! All other RNA viruses replicate in the cytoplasm!!!
What is the most common cause (i.e. what type of mutation) of the different RFLPs we see on a gel from different patients?
SINGLE NUCLEOTIDE POLYMORPHISMS!!! A SINGLE BASE-PAIR CHANGE!!!
Calipotriene is a synthetic vitamin D3 analog that binds to nuclear Vitamin D receptor on epidermal cell. The Calipotriene-Vitamin D receptor complex then binds DNA and acts as a transcription factor thereby inhibiting cell proliferation and inducing normal cell differentiation. What dermatological condition is Calcipotriene used to treat?
Psoriasis.
Methotrexate, cyclosporine, retinoids such as Acretin, Infliximab, Etanercept, Adalimumab, and phototherapy; Topical treatments include emollients, salicylic acid, corticosteroids, Calciptriene, coal tar, anthralin, retinoids and calcineurin inhibitors. All these drugs and treatments can be used to treat what dermatological condition?
PSORIASIS!!!
How does Lithium affect the thryoid and Psoriasis?
Lithium can cause HYPOTHYROIDISM and exacerbate Psoriasis!
What is one of the main mechanisms by which Loop diuretics and other diuretics cause contraction alkalosis? What are the early signs of this condition? What condition should you not confuse this with if a heart patient is taking both diuretics and statins?
Aldosterone!!! is increased in the setting of Loop diuretic use, putting the patients at risk for hypokalemia and contraction alkalosis. Early signs of hypokalemia include fatigue, myalgias, muscle cramps and weakness. Be careful about confusing these side effects with Rabdomyolisis of statins when a heart patient is taking both. Rhabdomyolysis will present more acutely and patients will have muscle pain and dark urine due to myoglobinuria.
What are the life-threatening developments that can occur in the setting of contraction metabolic alkalosis with use of a diuretic?
Respiratory depression and ventricular arrhythmias.
What is the first rate-limiting step in Heme synthesis? What are the enzyme and substrates used? What is the cofactor that is needed?
ALA-synthase making ALA from Glycine and Succinyl CoA. Vitamin B6 is the cofactor needed for this reaction.
What are the substrates used in the first step in pyrimidine synthesis?
Glutamine + CO2 --> Carbamoyl phosphate; Aspartate and Phosphotibosyl pyrophosphate are additional substrates required.
What are the two starting molecules that are needed for the Urea Cycle?
CO2 + NH3.
What is Pseudodementia and how is it differentiated from real dementia?
Pseudodementia is compromised cognitive functioning that occurs in patients with a HISTORY OF PSYCHIATRIC ILLNESSES like severe depression. GAIT REMAINS NORMAL IN THESE PATIENTS.
Mutiple physical complaints before the age of 30, without finding causes for any of them; 4-pain, 2-GI, 1- sexual, 1-pseudoneurogenic; typically female. Diagnosis?
Somatization disorder.
What is the simple, repetitive amino acid sequence that allows collagen molecules to have a triple helix conformation?
Gly-X-Y; many of the -X- and -Y- amino acids are Proline residues that are important for formation of collagen's alpha helical structure because the Proline ring structure kinks the polypeptide chains.
What is the change in collagen that decreases its solubility and allows in to form as part of the Extracellular Matrix?
The cleavage of the N-terminal and C-terminal disulfide bonds, which occurs once the procollagen molecule has been exported from the cell.
What is the most common enzyme deficiency of the Urea Cycle? What molecules will be seen to build up behind this enzyme block?
Ornithine Transcarbamolyase (OTC) deficiency is the most common defect of the urea cycle. This results in the accumulation of Carbamoly phosphate, with is then converted to OROTIC ACID by the pyrimidine biosynthetic pathway and congenital hyperammonemia.
Why does Hyperestrogenism occur in liver failure?
This is due to DECREASED METABOLISM of estrogen by the failing liver.
Palmar erythema, gynecomastia, testicular atrophy, Dupuyten's contractures and decreased body hair (*and spider angiomas) are all due to physical manifestations of what condition in the patient with liver cirrhosis?
HIGH ESTROGEN LEVELS!!!
This disease can present with a wide range of findings including splenomegaly, hepatomegaly, anemia, thrombocytopenia, bleeding, ostepenia, bone pain, dvelopmental delay, hydrops and neurological dysfunction. Glycolipid-laden macrophages are seen in the bone marrow. Diagnosis?
Gaucher Disease!
Where do retinoids accumulate in the tissue of a fetus and what defects do they cause?
They accumulate in adipose tissue and cause craniofacial defects and cardiac defects.
What are the main teratogenic effects seen with ACE inhibitor use?
Defects in fetal kidney development.
Does Chlamydia synthesize a peptidoglycan cell wall?
NO!!!
Explain the purpose and the mechanism of therapeutic effect in coating drug-eluting stents with drugs like Paclitaxel and Sirolimus.
Major complications following placemnt of a metal stent include acute stent thrombosis and restenosis due to intimal hyperplasia. The use of drug-eluting coronary artery stent has reduced both of these complications. Paclitaxel is an antineoplastic agent that functions by binding b-tubulin and preventing microtubule break down thus causing arrest of teh cell cycle in the M phase. Sirolimus binds mTOR, which is a serine/threonine kinase that is needed for cell cycle progression, and thus both drugs inhibit intimal proliferation.
What is the purpose of Penicillin-Probenecid, and Imipenem-Cliastin combinations?
Both are combinations of an antibiotic with a drug that directly or indirectly inhibits renal tubular secretion of the antibiotic. Probenecid inhibits renal tubular secretion of Penicillins, most Cephalosporins and other weak organic acids thereby prolonging the action of these agents by slowing elimination. Cliastin prevents the proximal renal tubular brush border hydrolysis of Imipenemm by dehydropeptidase (dipeptidase).
How does Hypercalcemia (e.g. in the context of a lung malignancy) affect the kidneys?The pathophysiology is similar to what other disease?
Hypercalcemia adversely affects renal concentrating ability and may produce polyuria, polydipsia and dilute urine. The pathophysiology is similar to Diabetes Insipidus.
What are the three mechanism at high altitude that the kidney uses in an attempt to compensate for respiratory alkalosis?
Decreased HCO3- reabsorption, increased H+ reabsorption, increased production of Erythropoetin (low PaO2 in blood)
Fungi actually have a cell wall that is present outside of their cell membrane. What are the key antibiotics that work on inhibiting components of either of these two structures?
Caspofungin inhibits the Fungal Cell Wall!!!

Amphotericin B and Nystatin bind ergosterol in the cell membrane.

Azoles inhibit the synthesis of ergosterol.
What is the most common site of cervical malignancy (i.e. which epithelial zone)? Why is this more common in teenage girls than adult women?
The Squamocolumnar junction (aka the Transformation zone) is the site where the squamous epithelium of the ectocervix abruptly converts to the columnar epithelium of the endocervix. This is the where Metaplasia occurs as female patients age. In teenage girls, the Transfomration zone is on the outer (vaginal) surface of the cervix (more susceptible than adult women.
What are the most common sites for hypertension-related intracerebral hemorrhages?
Thalamus and Putamen.
Pinpoint pupils, loss of horizontal gaze, quadrapareisis, decerebrate posturing, and rapidly evolving coma culminating in death within hours indicates an intracerebral hemorrhage (usually due to hypertension) in what part of the CNS?
THE PONS!!!
Contralateral sensory loss, aphasia and temporary homonymous hemianopia, unilateral abducent nerve palsy, pupil asymmetry and nonreactivity, and a downward gaze are all sign of intracerebral hemorrhage of what structure?
The Thalamus.
Ipsilateral facial weakness or sensory loss, ataxia, gaze paresis, miosis, or decreased conciousness. Strength in the extremities is typically preserved and limb posturing is not observed. What type of intracerebral hemorrhage is this (i.e. what structure is involved)?
The Cerebellum.
Homogentisate oxidase is required for the degredation of what amino acids? What disease has a deficiency of this enzyme?
HGO is required for the breakdown of Tyrosine and Phenylalanine. A deficiency of this enzyme is what causes Alkaptonuria.
What is unique about Pompe's disease (deficiency of Lysosomal alpha-1,4-glucosase/Acid Maltase/Acid alpha-Glucosidase) in terms of being a glycogen storage disease
Pompe disease is the only glycogen storage disease that causes early clinical findings in the heart specifically and the only glycogen storage disease caused by a defective lysosomal enzyme!!!
Which is the ubiquitous enzyme and which is the one found only in the Liver and Pancreas: Hexokinase vs. Glucokinase? How does the one found in the liver and pancreas act as an "glucose sensing device" for insulin release?
GLUCOKINASE is in the LIVER and PANCREAS ONLY!!! Hexokinase is in all other cells. Glucokinase has a higher Km and thus requires a higher concentration of glucose for activation than Hexokinase. When Glucokinase starts glycolysis it leads to more ATP production which is needed to start the insulin release cascade.

*A mutation in Glukokinase that decreases the enzyme's affinity for glucose is responsible for one subtype of Maturity Onset Diabetes of the Young.
What is the only enzyme defect that leads to Type 2 MODY?
Glucokinase deficiency/defect in the PANCREAS!!!
The dihydropyridine class of calcium channel blockers (Amlodipine, Nifedipine, Felodipine) are selective for what tissue target? What is there effect?
More selective for arteriolar smooth muscle. They dilated the smooth muscle and thus decrease afterload and the work of the heart.
What structures travel through the diaphragm with the Esophagus? With the Aorta?
The Anterior and Posterior Vagal trunks travel with the Esophagus. The Thoracic Duct travels with the Aorta (Crazy!!!)
Painful bones, Renal stones, Abdominal groans, Psychic moans. Diagnosis?
Hypercalcemia!!!; PRIMARY HYPERPARATHYROIDISM most commonly due to a Parathyroid adenoma.
Seen in the uterus are SHEET of trophoblasts that LACK VILLI. There is an elevated hCG. What type of Gestational Trophoblastic disease is this?
Choriocarcinoma; highly agressive, but responds well to chemotherapy.
This condition is characterized by the absence of the decidual layer that normally separates the placental villi from the myometrium. This condition is associated with immediate postpartum bleeding secondary to failed placental separation. Diagnosis?
Placental accreta.
What are the two genera of microorganisms that are classically acid fast?
NOCARDIA, and Mycobacterium, of course.
Patients with what enzyme defect are more susceptible to Dilated Cardiomyopathy from the toxic effects of Alcohol? What does the histological picture look like at autopsy?
The risk of developing alcoholic cardiomyopathy is increased in patients who have specific inherited defects in Alcohol Dehydorgenase or the DD SUBTYPE OF ACE. At autopsy the heart is enlarge and the ventricular chambers are increased in volume. Transmural thickness is unchanged or slightly decreased. Fibrosis and cardiac myocyte hypertrophy are observed.
What molecules and enzymes are used in the first step in Pyrimidine base synthesis that occurs in the cytosol (Purine synthesis also happens here)(*how is this differentiated from the first step in the Urea cycle)?
Pyrimidine base synthesis (1st step cytosol) = CO2 + Glutamine + 2ATP --(CPSII)-> Carbamoyl Phosphate

Urea cycle (1st step mitochondria) = CO2 + NH3 + 2ATP --(CPSI)-> Carbamoyl Phosphate
What type of proteins generally stimulate the JAK-STAT pathway (results from binding a receptor that lacks intrinsic tyrosine kinase activity)?
Cytokines.
What is the classic histologic finding in Leishmaniasis?
Intracellular organisms situated PERIPHERALLY WITHIN HISTIOCYTES!!!
Reed-Sternberg cells WITH large Atypical lymphocytes on a peripheral blood smear. Diagnosis?
RARE finding of Reed-Sternberg in INFECTIOUS MONONUCLEOSIS!!! (CRAZY!!!)
Short alpha-helix protein fragment with leucine residues (leucine zipper formation/basic zipper protein); Helix-loop-helix; Zinc finger motif. What do these sequences bind? What are they for?
These are DNA-binding domains on Transription factor proteins.
What are the CNS structures that arise from: Telencephalon, Diencephalon, Mesencephalon, Metencephalon, and Myencephalon?
Telencephalon = Cerebral hemispheres/ Lateral ventricles

Diencephalon = Thalamus/ 3rd Ventricle

Mesencephalon = Midbrain/ Aqueduct

Metencephalon = Pons, and Cerebellum/ 4th Ventricle

Myencephalon = Medulla
Severe fasting hypoglycemia, lactic acidosis, hyperuricemia and hyperlipidemia; thin extremities, but abdomen is enlarged due to hepatomegaly and renomegaly; patients should avoid fructose and galactose due to defects in gluconeogenesis. Diagnosis?
Von Gierke disease; deficiency of Glucose-6-phosphatase
Dysplastic Nevus syndrome is associated with what type of dermal cancer? What is the gene mutation and on what chromosome? What is the function of this gene?
Malignant Melanoma; CDKN2A on Chromosome 9.p21. This gene encodes p16 (cyclin dependent kinase inhibitor 2A), which negatively regulates cell cycle progression at the checkpoint between G1 and S by binding to and inhibiting the cyclin-dependent kinase CDK4.
What is the role of p16 (Cyclin-dependent kinase inhibitor 2A)? What familial syndrome is it associated with?
p16 negatively regulates cell cycle progression at the checkpoint between G1 and S by binding to and inhibiting the cyclin-dependent kinase CDK4. It is associated with Dysplastic Nevus syndrome.
Young person who has a family history of melanoma in more than three first-degree relative. This syndrome is associated with CDKN2A gene on Chromosome 9p21. Diagnosis?
DYSPLASTIC NEVUS SYNDROME!!!
ISLANDS of basaloid timuor cell budding from the epidermis or residing within the dermis with NUCLEAR PALISADING and RETRACTION ARTIFACT evident along the periphery of cell nests. Diagnosis?
Basal Cell Carcinoma.
Proliferation of highly atypical and pleomorphic fibroblasts, histiocyte-like cells and bizarre giant cells in the skin. Diagnosis?
Malignant fibrous histiocytoma (MFH)
Skin Fibroblasts in a cartwheel or storiform pattern and supernumerary ring chromosome that contain sequences from Chromosomes 17 and 22. Diagnosis?
Dermatofibrosarcoma protuberans (DFSP).
This breast disease is the most common cause of palpable nodular masses in the breast. Typically presents as a poorly defined diffuse increase in consistency throughout the breast tissue. Lesions are often multiple and painful, with TENDERNESS MAXIMAL during the PREMENSTRUAL PHASE OF THE CYCLE. Diagnosis?
Fibrocystic disease of the breast.
What is the most likely diagnosis of a firm, discrete, and freely movable mass found in the breast of a young woman that changes size based on hormonal fluctuations?
Fibroadenoma.
In what part of the eye is Copper deposited in Wilson's disease?
Descemet's membrane in the Cornea. These rings are identifiable with a slit lamp.
Does HbKansas have high or low affinity binding for O2?
LOW affinity and thus a right-shifted curve.
The suffix -navir is attributed generally to what type of HIV drug?
PROTEASE INHIBITORS
Elevated Alk-Phos is not a particularly specific finding as it could occur in a number of diseases. What other test should you do to quickly narrow down the possibilities of the etiology of this elevation?
You should test GGTP levels to see if they are elevated. This would more likely rule in or rule out Bone as being the source of the Alk-Phos.
What is a key difference is the progression of symptoms caused from a Hemorrhagic stroke vs. an Ischemic stroke?
Hemorrhagic stroke = acute onset of focal neurological deficits

Ischemic Stroke = symptoms evolve over a few hours
What is the name of the lesions that lead to intracerebral hemorrhage (i.e. intracerebral hemorrhagic strokes) found, due to HYPERTENSION?!
CHARCOT-BOUCHARD ANEURYSMS!!!; most commonly found in the basal ganglia or internal capsule
How dose cerebral amyloid angiopathy affect the brain?
It causes recurrent intracerebral hemorrhages.
What are the three major causes of malabsorption?
Pancreatic exocrine insufficiency, Intestinal mucosal defects, Bacterial proliferation
Can a fecal sample diagnose malabsorption? What stain do you use to test for fat when testing a stool sample?
The first step in screening for malabsorption is Sudan III stain, which will identify the presence of fat in a stool sample. Quntitative analysis for fecal fat is used to confirm the diagnosis (>7gm/day of excreted fat is DIAGNOSTIC FOR MALABSORPTION!!!
What is the medication used in patients with Graves' disease that helps to treat their exopthalmia?
GLUCOCORTICOIDS!!!; remember that antithyroid drugs do not have a direct effect on opthalmopathy.
HIV patients frequently have superficial Candida infections, but rarely suffer from disseminated candidiasis (i.e. hematogenous spread). Why? What does this say about which cells must be important in protecting against hematogenous spread of Candida?
This is because NEUTROPHILS prevent the hematogenous spread of Candida! Disseminated candidiasis is more likely to occur in neurtopenic patients and those with inherited impairments of phagocytosis.
Deficiency of Compement components C1,2, and 4 leads to increased susceptibility to what?
Infections and SLE-like disease!.
IFN-alpha is mainly used to combat infection with what two viruses that attack the same organ?
Hepatitis B and C viruses.
What is the mechanism of action of RIbavirin? What disease is it specifically used to treat in infants? What other disease can it be used to treat in adults?
Ribavirin is a nucleoside analog that inhibits the synthesis of Guanine nucleotides; This medication is most often given to infants with confirmed RSV infection who are at risk for disease progression; it is also active against HEPATITIS C virus
When is the PULMONARY CAPILLARY VASCULAR RESISTANCE!!! in the lung the lowest? Why?
Pulmonary Vascular Resistance (PVR) is the lowest at the FRC or Functional Residual Capacity. Inhalation increases PVR due to the pressure place on the pulmonary vessels by the expanding alveoli. Forced exhalation increases PVR due the the collapsing positive pressure placed on the lung parenchyma.
What are the top four most important factors contributing to the development of Pancreatic Cancer in descending order of most to least important?
1) AGE
2) SMOKING!!!; it doubles the risk
3) Diabetes mellitus
4) Chronic Pancreatitis
5) Genetics
What are two effective preventions for Colon Cancer? (*recent discoveries?)
Screening for polyps with excision is an effective prevention of colon adenocarcinoma. Recent discoveries suggest that COX-2 INHIBITORS!!! may decrease adenomatous polyp formation (CRAZY!!!)
Crohn's disease is associated with Oxalate Kidney Stones. Explain the mechanism of why this is.
Impaired bile reabsorption in Crohn's due to inured Ileum --> Impiared fat absorption, due to loss of bile acids --> Lipids bind Ca2+ in lumen and Ca2+ is excreted in the feces due to lipid malabsorption ---> Free Oxalate (which is normally bound by Ca2+ ions) is absorbed and forms urinary calculi. (CRAZY!!!)
Octreotide is used in the treatment of what two hormone secreting tumors and what esophageal condition?
OCTREOTIDE treats CARCINOID SYNDROME, VIPomas, and Esophageal Varices!!!
What are the three pKas of Histidine, Aspartic Acid, and Tyrosine? (*three pKas due to three titratable protons)
Aspartic acid = 2, 4,10

Histidine = 2, 6, 9

Tyrosine =2, 9, 10
Enox(*h)aparin is the low weight molecular form of what anticlotting drug?!?
HEPARIN!!!
What is the reason that patients are treated with Enox(*h)aparin or Heparin during initiation of Warfarin therapy?
This is because Warfarin inhibits the activation of all Vitamin K dependent factors including Proteins C and S. This leads to a transient hypercoagulable state that is managed with administration of Heparin and Enoxaparin.
What is the treatment for bacteremia in the hospital with Coagulase-negative Staphylococcal infection?
This involves empiric treatment with Vancomycin with or with out Rifampin or Gentamicin due to the widespread resistance of S.epidermidis, especially in nosocomial infections.
Can glucuronidation of drugs by hepatic enzymes activate them?
Yes!!!
If a pregnant mother has an active HBV infection with HBeAG present the neonate's risk of infection is 95%. Once the infant becomes infected, the chance of progression to chronic hepatitis is 90%. But why is there only mild liver injury upon histological examination of the liver?
This is because HBV is NOT INHERENTLY CYTOTOXIC and the neonatal immune system, which would normally be the cause of the damage, is still immature.
Patients with who receive massive transfusions of packed RBCs can develop what Ca2+ and K+ abnormalities?
Hypocalcemia due to elevated plasma levels of CITRATE (a substance that is added to stored blood cells), which chelates Ca2+ AND Mg2+.

Stored RBCs also gradually loose intracellular K+ to the surrounding solution, so there is also the potential for Hyperkalemia!!!
Rathke's pouch (oral ectoderm) that leads to Craniopharyngiomas also contributes to which part of the Pituitary gland? Where does the other half come from?
Anterior Pituitary = oral ectoderm derivation = same as Rathke's pouch

Posterior Pituitary = neuroectoderm.
Which anti-HIV drugs inhibit reverse transcriptase activity, but DO NOT require activation via intracellular phosphorylation?!?
Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)!!!; Nevir, Efavir, Delavir nucleotides!!!
What is the mechanism of action of Griseofulvin on Fungi?
Griseofulvin interacts with fungal cell mictrotubules inhibiting mitosis. It accumualtes in keratin containing tissues and is used to treat dermatophyte infections.
Pre-eclampsia is the triad of Hypertension, Proteinuria, and Edema, usually occurring after the 20th week of pregnancy, and its cause is thought to be due to poor placental perfusion!!! What are the symptoms of the HELLP syndrome that this may progress to?
(H)emolytic anemia (E)levated (L)iver enzymes, and (L)ow (P)latelets.
What is the most reliable marker of Osteoclastic activity in the urine?
Urinary Deoxypyridinoline; Tartrate-resistant acid phosphatase, and Urinary Hydroxyproline are others.
C3-5 keeps what muscle alive?
C3, 4, 5 keeps the diaphragm alive!!!
Even though the Spleen is supplied by the Celiac artery (the primary supply of the foregut) it is not a derived from Foregut structures. Where is it derived from?
The Spleen forms from the mesodermal dorsal mesentery.
Southwestern blotting is a detection technique for what type of proteins?
Proteins that bind DNA!; Transcription factors, Nucleases and Histones!
Acute nausea following the adminitstration of systemic chemotherapy results from simulation of what "trigger zone"? Where does this lie in the brain stem?
This results from stimulation of the Chemoreceptor Trigger Zone (CTZ), which lies in the AREA POSTREMA of the DORSAL MEDULLA, near the 4th ventricle.
What are the CSF findings associated with Multiple Sclerosis?
Increased IgG levels in the CSF, detected as an oligoclonal band on electrophoresis.
Is Colorectal adenocarcinoma related to the stage or grade of the tumor?
STAGE!!!
Acyclovir can cause crystaline nephropathy that can be prevented and treated through what means?
Agressive hydration so that concentrations of the drug do not build up in the renal tubules!
What are two factors that make Proximal tubules and the Thick ascending limb of the loop of Henle more susceptible to ischemic injury?
The fact that there is low O2 in the medulla where these segments of the nephron are located, and the fact that these segments participate in the active (ATP-consuming) transport of ions.
What is the mechanism of action of Phenytoin?
It inhibits neuronal high-frequency firing by reducing the ability of Na+ channels to recover from inactivation.
What is the mechanism of action of Valproic acid?
Blocks NMDA receptor and affects K+ current. Also affects Na+ channels and GABA receptors.
What is the mechanism of action of Ethosuximide?
Blocks T-type Ca2+ channels in THALAMIC NEURONS
Is mitochondrial vacuolization associated with reversible or irreversible cell injury?
Reversible!!!
Pyroxidine (B6) deficiency can result in what type of anemia?
Microcytic hypochromic anemia because it is required as a cofactor in the first step of Heme synthesis.
All of the skin from the umbilicus down, including the anus (up to the dentate/pectinate line) but excluding the posterior calf, drains to which lymph nodes?
The Superficial Inguinal Lymph nodes
What are the conditions that promote sickling of HbS?
Low O2, Low pH, and Low Blood Volume (dehydration).
What are the molecules that lead to increased angioedema in Hereditary Angioedema syndrome? Why does this happen?
Bradykinin, C3a, and C5a all mediate angioedema by increasing vasodilation and vascular permeability. This condition is due to lack of C1 esterase inhibitor which allows increased Kallikeinin production and increased C1 activity.
What are the different effects that Alpha-adrenergic stimulation vs. Beta-adrenergic stimulation has on Insulin release?
Alpha decreases insulin release; Beta increases insulin release
Which cells are responsible for synthesizing ApoB-100 and ApoB48 respectively? What is there relation to one another?
ApoB-100 is synthesized in the hepatocytes of the Liver and is a component of LDL, IDL, and VLDL. ApoB-48 is a truncated form of ApoB-100 which consists of 48% of the protein. ApoB-48 is synthesized by the INTESTINAL ENTEROCYTES and is specifically incorporated into chylomicrons.
Incretins are gastrointestinal hormones produced by the gut mucosa that stimulate pancreatic insulin secretion in response to sugar-containing meals. What are the two most important incretins to know about?
GLP-1 (glucagon-like peptide-1); GIP (glucose-dependent insulinotropic peptide)
What congenital heart defect is characterized by cyanosis due to a predominant right to left shunt through a VSD, that worsens with feeding, crying, or exrercise?
Tetralogy of Fallot
Protein's membrane-traversing domains are typically composed of hydrophobic amino acids arranged, in an alpha-helical fashion, with their hydrophobic R-groups projected outwardly, so as to strengthen the association between the transmembrane region of the protein and the hydrophobic core of the phospholipid bilayer. What are some of the hydrophobic amino acids that might be contained in those regions?
Glycine, Alanine, Valine, Leucine, Isoleucine, Phenylalanine, Tryptophane, Methionine, and Proline.
What are the cells of the liver that can differentiate into myofibroblasts upon injury to the liver and play a large role in the production of fibrosis in cirrhosis?
These are stellate cells.
What is unique about the hepatic sinusoidal cells compared to other endothelial cells?
Hepatic sinusoidal endothelial cells are unique from other endothelial cells in that they are fenestrated and lack a basement membrane.
What types of cells are found in the nodules seen in the cirrhotic liver?
The regenerative nodules seen in liver cirrhosis are composed of PROLIFERATING HEPATOCYTES!!!
This patient demonstrates flat affect, inappropriate sexual behavior and hyperphagia accompanied by constant food seeking. Diagnosis? Part of the brain that is damaged?
This is Kluver-Bucy syndrome, which most commonly results from bilateral damage to the temporal lobes, particularly the Amygdalae. Potential causes include HSV encephalitis or traumatic brain injury.
What are the key differences between Hyperchylomicronemia (hypertriglyceridemia due to Lipoprotein lipase deficiency) and Familal Hypercholeserolemia (due to LDL receptor deficiency), in terms of most likely complications to develop and cardinal signs and symptoms?
Abdominal pain due to acute pancreatitis is the most likely presentation for Hyperchylomicronemia. Patient with this disorder are not usually at increased risk for premature coronary artery disease, like those with Hypercholesterolemia are. Skin xanthomas may be present in Hypertriglyceridemia as well, but tubular/Tendon Xantomas and Xanthelasmas are present only usually with homozygous Familial Hypercholesterolemia (High LDL).
What part of the duodenum do most ulcers occur in? If there is an ulcer present in a part of the duodenum other than this, what is the most likely cause?
Most Duodenal Ulcers occur in the duodenal bulb (first portion of the duodenum). An ulcer found in the distal duodenum or other atypical location suggests Zollinger-Ellison syndrome. Other suspicious factors include multiple ulcers, ulcers refractory to therapy, and recurrence of ulcers after acid-reducing surgery.
Why do patients with Zollinger-Ellison syndrome get diarrhea/malabsorption along with their condition?
Diarrhea occurs because pancreatic and intestinal enzymes are inactivated by gastric acid, so the body cannot properly digest nutrients.
Where are the most common locations for ulcers in the duodenum and stomach?
Duodenum = duodenal bulb

Stomach = Lesser Curvature
Chronic gastritis with antral sparring is associated with what type of gastritis? Vs. what type is associated with antral involvement?
Chronic gastritis with antral sparing is seen in autoimmune gastritis. H.pylori infection causes chronis Antral-Predominant Gastritis.
Several of the pneumoconioses can cause exertional dyspnea and nodular interstitial densities on chest x-ray. Which one is distinguished by eggshell CALCIFICATIONS of HILAR NODES and BIREFRINGENT PARTICLES SURROUNDED BY DENSE FIBROUS TISSUE?
Silicosis.
Dyspnea on exertion; chest X-ray shows interstitial patten of involvement; hilar lymphadenopathy uncommon; histology may show ferruginous bodies (fusiform or beaded rods with a translucent center and coated with an iron-containing proteinaceous material best seen with Prussian Blue staining. Diagnosis?
Asbestosis.
Dyspnea on exertion with ill-defined nodular or irregular opacities on chest X-ray; hilar adenopathy present in only about 40% of cases; histology reveals noncaseating epithelioid granulomas indistinguishable from those of sarcoidosis, without obvious associated particles. Diagnosis?
Beryliosis.
Whats is the test that differentiates CML and a leukemoid reaction (increased reaction of WBCs to infection)?
These conditions can be differentiated based on the Neutrophil Alkaline Phophatase Level, which is normal or elevated in a Leukemoid reaction, but decreased in CML!!!
What type of reaction occurs with Metronidazole when it is taken with alcohol?
A DISULFUIRAM-LIKE REACTION!!! CAN'T DRINK ALCOHOL ON THE "METRO"nidazole!!!
What serious blood cell complication can occur with Chloramphenicol? What are the two versions of this complication?
Chloramphenicol can lead to both dose-dependent (reversible) and dose-independent (often irreversible) pancytopenia.
The solubility of an inhalation anesthetic is directly related to what special coefficient?
Its BLOOD/GAS PARTITION COEFFICIENT!!! Highly soluble anesthetics have high blood/gas partition coefficients. Thus is an agent is poorly soluble (has a LOW coefficient), the amount of gas needed to saturate the blood (in other words, when the partial pressure of the anesthetic in the blood equals the partial pressure in the inspired air) is small, and saturation occurs fairly quickly.
What is the driving force that stimulates the Central Chemoreceptors located in the medulla? What about the Peripheral Chemoreceptors in the carotid and aortic bodies?
The Central Chemoreceptors detect decreases in pH and stimulate the respiratory center (PaCO2). The Peripheral Chemoreceptors mainly respond to hypoxia (PaO2).
O2 has a relatively small effect on respiratory drive if its partial pressure in the arterial blood is >70 mmHg. In profound hypoxemia (PaO2 < 60 mmHg), however, this mechanism plays a more important role in maintaining respiratory drive. Thus, what patients could it be dangerous to administer O2 to?
In patients with longstanding COPD with chronic profound hypercapnia, high PaCO2 ceases to stimulate the respiratory center. In these patients hypoxemia is the only drive. SO in this case supplemental O2 can depress their respiratory drive and this can be dangerous (respiratory failure).
How is Celiac disease confirmed with diagnosed? And what are the portions of the small intestine that are seen to be the most effected?
Celiac disease is diagnosed when flattening of the mucosa with loss of villi and chronic inflammatory infiltration of the lamina propria are seen on small intestine biopsy. The most pronounced changes are seen in the duodenum and proximal jejunum because the concentration of gluten is higher there.
What is the most common viral cause of acute hemorrhagic cystitis in children (and males in particular)?
Adenovirus; Serotypes 11 and 21 of Adenovirus subgroup B have been particularly implicated in this illness.
Cavernous Hemangiomas are the most common benign liver tumor, typically presenting in adults aged 30-50 years. What is thought to be the origin of this tumor? Describe its histology.
Cavernous Hemangiomas are thought to be congenital malformation that enlarge by ectasia, not hyperplasia or hypertrophy. Microscopically, these tumors consist of cavernous, blood-filled vascular spaces of variable size lined by a signle epithelial layer. Collagenous scars or fibrous nodules may be seen in association with thrombosis. The bopsy of a suspected hemangioa is not advisable, as the procedure has been known to cause fatal hemorrhage and is of low diagnostic yield.
Dobutamine is a relatively selective B1-adrenergic agonist that has what effects on the heart?
It increases heart rate, contractility, and CARDIAC CONDUCTION VELOCITY, which may result in arrhythmias.
Trabecular thinning of bone with fewer interconnections; decreased total bone mass. Diagnosis?
Osteoporosis.
"Marble bone disease"; persistence of primary, unmineralized SPONGIOSA in the medullary canals. (*in normal individuals bone marrow replaces the primary spongiosa). Diagnosis?
Osteopetrosis, characterized by decreased osteoclastic bone resorption.
Subperiosteal thinning that, radiologicallyy, appears as subperiosteal erosions in the medial sides of the second and third phalanxes of the hand, and as a graunular, "salt-and-pepper" appearance of the calvarium; high blood Ca2+ and low PO4-. Diagnosis?
Primary Hyperparathyroidism.
What type of formations in the Gallbladder does Gallbladder hypomotility often result in?
Biliary Sludge!!!; which results from bile precipitation.
What is unique about the BETA-BLOCKER Carvedilol?
Carvedilol is unique among the BETA-BLOCKERS in that it non-specifically antagonizes B1 and B2 receptors AS WELL AS Alpha-1-adrenergic receptors. One of the best beta blockers for reducing morbidity and mortality.
Where are should all of the injections into the gluteal region target? What are they trying to avoid by doing this?
All injections into the gluteal region should target the superiolateral quadrant, to avoid damage to the Gluteal and Sciatic nerves, which are located in the SUPERIOMEDIAL QUADRANT!!! AVOID THIS AREA!!!
What does the histologic picture of Halothane-induced hepatitis look like? What is the mechanism of cell injury?
Massive hepatic necrosis is a rare but severe complication of Halothane exposure. It occurs due to direct liver injury by halothane METABOLITES and formation of AUTOANTIBODIES against liver proteins. Light microscopy shows mnassive centrilobular hepatic necrosis.
What is the major determinant of virulence among strains of E.coli that cause neonatal meningitis?
The K-1 capsular antigen!!!
Most enveloped nucleocapsid viruses acquire their lipid bilayer envelope by budding through the plasma membrane of the host cell. Which dsDNA virus is an exception?
HERPESVIRIDAE; which gets it ENVELOPE from the HOST NUCLEAR MEMBRANE!!!
Where does methylation of the 5' end of all mRNAs occur vs. where the capping occurs?
THe 5' end of all mRNA is capped with a 7-methylguanosine residue by a unique 5' to 5' linkage, which occurs in two stages. The 1st step is the addition of guanine triphosphate to the 5' end in the nucleus. Methylation of the guanosine cap is the second step of this process, which occurs in the cytosol. SAM acts as the methyl donor in this step.
Secondary pathways involved in growth hormone signaling are what two pathways?
Janus kinase and STAT5 (JAK-STAT) pathways.
What is the secondary hormone that Growth Hormone works through to increase linear growth? Where is this secondary molecule produce?
Growth hormone increases linear growth by stimulating the production of IGF-1 from the liver
Laron Dwarfism is due to a defect in what type of receptors? What are levels of GH and IGF-1?
Defective growth hormone receptor; there are HIGH serum levels of GROWTH HORMONE in the presence of LOW IGF-1!!! because there are defective receptors!!!
Blotchy red muscle fibers on GOMORI TRICHROME STAIN; "red-ragged fiber" disease: diagnosis?
MITOCHONDRIAL DISEASE!!! Myoclonic epilepsy with ragged red fibers (MEERF); others include MItochondrial encephalopathy with stroke-like episodes and lactic acidosis (MELAS), and Leber optic neuropathy
Eosinophilic cytoplasmic inclusions in the HIPPOCAMPUS NEURONS are pathognomonic for what infection?
RABIES infection! "HIPPO"campus = animal bit
What are the major retroperitoneal blood vessels?
Abdominal Aorta, IVC and the their branches.
What are the retroperitoneal Solid Organs?
Pancreas (except the tail), Kidneys, Adrenal glands,
What are the retroperitoneal Hollow Organs?
Part 2 & 3 and a portion of the 4th part of the Duodenum, the Ascending and Descending Colon (secondarily retroperitoneal), rectum, ureters and bladder.
Which muscles and bones are retroperitoneal?
Vertebral column and pelvic muscles.
Which bleeding time is extended in Hemophilia A: PTT or PT?
PTT.
This disease is the most common cause of blindness of people over the age of 50. It is due to deposition of fatty tissue (drusen) behind the retina and neovascularization of the retina. Diagnosis?
Macular degeneration; progressive loss of the central vision field.
What is the Chromosome associated with the development of Wilm's Tumor?
Chromosome 11.
What is the main enzyme that the Thionamides, Methimazole and Propylthiouracil, inhibit?
They decrease the formation of Thyroid hormones by inhibiting Thyroid Peroxidase.
Apoptotic hepatocytes form round ACIDOPHILIC (pink staining on H&E) bodies known as what type of "bodies"?
Councilman bodies, or apoptotic bodies, or acidophilic bodies.
Osteoclasts in the bone disease are very large and can have up to 100 nuclei (normal osteoclasts have 2-5 nuclei); these cells are positive for RANK-L and M-CSF; the bone turnover is markedly increased culminating in chaotic bone formation; disease thought to be initiated by a Paramyxovirus early in childhood. Diagnosis?
Paget's disease.
What are other causes of an elevated maternal AFP during pregnancy?
Dating error, neural tube defects, anterior wall defects (omphalocele), gastroschisis, and multiple gestation!!!
The most common cause of elevated AFP levels is dating error (underestimation of gestational age). If an elevated AFP is seen on triple test, what is the next best test to run?
Fetal ULTRASONOGRAPHY to check for fetal development consistent with the mother's reported dates.
Decreased Estriol levels during pregnancy are suggestive of insufficiency of what organ?
Placental insufficiency!!!
What is the equation for Attributable Risk Percent in terms of Relative Risk?
ARP = (RR-1)/RR
Positive symptoms: hallucinations (usually auditory), delusions, and disorganized speech and behavior.
Negative symptoms: a decrease in emotional range, poverty of speech, and loss of interest in living

These lists are the positive and negative symptoms associated with Schizophrenia. Unlike Typical antipshchotics (mostly just the Positive symptoms), Atypical antipsychotics improve both Positive AND Negative symptoms. What are examples of these drugs?
Clozapine, Olanzapine, Risperidone, Quetiapine.
Patient presents with progressive weakness and red or violacious flat-topped papules with a light scale that appear over bony prominences; MP, PIP, DIP are most commonly involved (Gottron's papules); There is an erythematous or violaceous edematous eruption on the upper eyelids and periorbital skin (Heliotrope rash); Proximal Muscle weakness, difficulty climbing stairs, rising from chairs, and combing hair; elevated CK; ANA antibodies and Anti-Jo1!!! Diagnosis?
DEMATOMYOSITIS; patients that develop this after 50 years old have increased risk of an underlying malignancy as the occult cause.
Which hyperTG drug puts you at increased risk of Gallstones?
Fibric acid derivatives
Which hyperlipidemia drug can cause HYPERURICEMIA and exacerbate GOUT?
NIACIN!!!
MUCICARMINE stain is used to detect the POLYSACCHARIDE CAPSULE of what pathogenic fungus?!?
CRYPTOCOCCUS!!!; pigeon
Which pathogenic fungus has a THICK DOUBLY REFLECTIVE WALL, and is seen with broad-based buds?
Blastomyces dermatiditis.
The presentation for Rubeola (Measels; Paramyxovirus) and Rubella (German measels; Togavirus) can look extremely similar! But what are two defining features of Rubella that allow you to diagnose this infection?
POSTAURICULAR (ruBELLa; bell-ear) and OCCIPITAL LYMPHADENOPATHY are particularly common in RuBELLa!!!
Roseola causes exanthem subitum (also called Roseola infantum), which is characterized by transient maculopapular rash that appears for a few days on the chest and trunk AFTER THE PATIENT'S FEVER FALLS!!! Which Herpesviridae is responsible for this infection?
HHV-6.
Neurophysins are specific carries proteins for what two Hypothalamic hormones?
Oxytocin and Vasopressin!!!
Which Neurophysin is thought to be involved in the etiology of Autosomal Dominant Central (Hypothalamic) Diabetes Insipidus?
NEUROPHYSIN II !!!
Increase in what type of blood lipids is known to be correlated with the development of Insulin resistance?
FREE FATTY ACIDS and serum TGs!!!; the induction of insulin resistance and beta cell dysfunction along with high free fatty acids is termed "Lipotoxicity"
What are the three main treatments for HIV CMV-induced retinitis?
Foscarnet, Gancyclovir, and Cidofovir.
This drug used for treating HIV-CMV-retinitis is a pyrophosphate analog that can chelate Ca2+. There can be associated with renal wasting of Mg2+ that may lead to hypomagnesemia and a reduction in the release of PTH, which contributes to the hypocalcemic state. Both hypocalcemia and hypomagnesemia can cause seizures while a patient is on this drug. Which Drug?
Foscarnet!
Which class of HIV drug can cause fat redistribution, insulin resistance (hyperglycemia), and hypertriglyceridemia? Adequate hydration is recommended because some drugs in this class is can are also associated with kidney stones. Drug?
Protease inhibitors; (e.g. Indinavir)
What molecules are contained in the nucleolus and what enzymatic actions are taking place there?
The nucleolus is the site of rRNA synthesis form rDNA, the site of ribosomal protein synthesis, and the site of ribosome formation. RNA polymerase I synthesizes rRNA with its greatest activity being in the nucleolus.

Nucleolus = Ribosomal preparation activity
What is the biologically active form of Pantothenic Acid? Which reaction of the TCA cycle requires this Vitamin?
The biologically active form of Pantothenic acid is Coenzyme A, which binds with Oxaloacetate (as from acetyl-CoA) in the first step of the TCA (Krebs) Cycle to form Citrate and then Succinyl-CoA.
What type of deposits are seen in patients with Type II diabetes?
Deposits of Islet Amyloid Polypeptide (amylin, IAPP) are universally seen in pancreatic islets of patients with Type 2 Diabetes Mellitus.
A strong linkage with HLA Class II gene makeup, pancreatic islet infiltration with leukocytes (insulitis), and antibodies against islet antigens are frequently seen in Type 1 or Type 2 diabetes?
TYPE 1 DIABETES!!!
Even though high levels of this treatment could potentially delay fetal lung maturation, what is the medication of choice for treatment of gestational diabetes in patients for whom diet and light exercise have failed to control blood glucose levels?
INSULIN!!! (CRAZY!!!)
First-dose hypotension is an adverse effect and concern when initiating ACE inhibitors. Predisposing risk factors of first-dose hypotension include hyponatremia, hypovolemia secondary to diruetics, low baseline blood pressure, high renin or aldosterone levels, renal impairment, and heart failure. What medications could predispose to this condition?
Diruretics!!!, which cause hypovolemia and hyponatremia, thus potentiating the effects of first dose hypotension.
Name a short-acting hypnotic medication chemically unrelated to benzodiazepines, that has the same mechanism of action as benzodiazepines, but a much lower risk of tolerance and dependence.
Zzzzzolpidem.
What location on the body is the most common site of colonization for both Methicillin-Sensitive and Methicillin-Resistant Staph aureus?
The Anterior Nares!!!; don't pick you nose around patients!!!
Methylmalonyl-CoA is converted to Succinyl-CoA by a reaction that uses B12 as a cofactor. Defects in this reaction lead to the development of Methlymalonic Acidemia. What type of reaction is this and, for fun, what is the enzyme?
This is an Isomerization Reaction done by Methylmalonyl-CoA isomerase, which converts Methylmalonyl-CoA to Succinyl-CoA
What artery courses along the posterior aspect of the humerus with the Radial nerve? What type of fractures risks injuring these structures? What about injuring the Brachial artery?
The Deep Brachial Artery. Midshaft humerus fractures risks injury to these structure. Supracondylar fractures are associated with injury to the Brachial artery.
Where is the main location of Lipid and fat soluble vitamin absorption in the Small Intestine?
This occurs in the Jejunum.
Patient presents with recurrent stone formation from a young age; Pathognomonic HEXAGONAL CRYSTALS are present in the urine.; the Na+ Cyanide-Nitroprusside test, which detects Sulfhydryl groups, positive and diagnostic; these crystals form in an acidic pH and treatment involves hydration and alkalinization of urine. Diagnosis?
Cystinuria!!!; this results from a defect in the renal proximal tubule, which results in the decreased reabsorption of the amino acid Cystine.
The measels, mumps, rubella vaccine is what type of vaccine?
This is a LIVE-ATTENUATED-VACCINE.
Hepatitis A and Rabies vaccines are examples of live or killed vaccines?
These are examples of KILLED-VACCINES!!!
Killed-vaccines induce what type of immunity vs. Live-attenuated-vaccines?
Viral component or Killed vaccines tend to induce only Humoral Immunity, whereas the Live-attenuated vaccines induce BOTH Humoral AND Cell-mediated immunity.
Why is the pO2 in the left atrium lower than that in the pulmonary veins?
This is because deoxygenated blood from the Bronchial Arteries mixes with oxygenated blood in the Pulmonary Veins.