Rrr_Gj2_1

Front 1

Physiologic effects of hemorrhage

Back 1

drop in dlast~ ‘Aood pressure, activation of the RAA system from decreased renal blood flow and catecholamine stimulation, ~~cholamjne release from the high pressure baroreceptors (sinus tachycardia, increased cardiac contraction, increase in peripheral resistance, stimulation of the JG apparatus, venoconstriction), increased reabsorption of sodium from the kidneys, release of atrial natriuretic peptide, release of ADH.

Front 2

Cause of Pneumococcus infection in HbSS

Back 2

autosplenectomy or functional asplenia

Front 3

Key elements in wound healing

Back 3

granulation tissue, fibronectin

Front 4

Aortic aneurysm

Back 4

hoarseness from stretching of the left recurrent laryngeal nerve

Front 5

HbF

Back 5

left shifts ODC, protects newborns with sickle cell disease and severe ~-thaIasscmis, increased with hydroxyurea, resistant to alkali/acid denaturation

Front 6

AIDS patient with *cute cholecystitis

Back 6

Cryptosporidium and CMV are the most common causes (CMV was not listed on the last exam)

Front 8

Traveler to Mexico who 1 week later develops a watery diarrhea with’ mucus and blood and colicky bowel movements

Back 8

arnebiasis

Front 10

Cyanosis not relieved by oxygen in a patient coming home from * camping trip

Back 10

mcthcmogiobincm1s~ (water h nitrites that oxidized iron to fenic condition); Sa02 not PaOz is decreased; methylenc blue treatment of choice; ascorbic icid has an ancillary role

Front 11

County jail with outbreak of hepatitis

Back 11

HAy most likely; if IVDA then HBV most likely

Front 12

Picture of child with fetal alcohol syndrome

Front 13

Familial polyposis

Back 13

mother has, what percent chance for kids with the disease 50%, since it is an AD disease; those that have gene will get cancer~ screen with flexible sigmoidoscopy in those affected beginning age 10-12 every 1-2 years; genetic testing to confirm and to test first degree family members

Front 14

Newborn

Back 14

high Hb due to increase in HbF

Front 15

Most common cause of pneumonia in cystic fibrosis

Back 15

P. aeruginosa

Front 16

it fistula

Back 16

polyhydramnios in mother, proximal esophagus ends blindly and distal esophagus arises from the trachea (air in the stomach) -

Front 17

Raising the upper limit of normal of a test

Back 17

increases specificity and predictive value of a positive test; decreases sensitivity and predictive value of a negative test result

Front 18

Lung findings in RDS

Back 18

atelectasis (massive intrapulmonary shunting due to lack of surfactant); hyaline membranes composed of protein

Front 19

Prevalence

Back 19

Prevalence (number of people with disease in the population studied) Incidence (number of new cases over a period of time) x Duration of the disease

Front 20

Photomicrograph of sarcoid with non-caseating granuloma.s in a black man

Front 21

Picture of adrenal cortex

Back 21

what part is atrophied in a patient on corticosteroids

Front 22

Smoker

Back 22

identify the x-ray with emphysema—increased A? diameter, depressed diaphragms

Front 23

Apoptosis

Back 23

individual cell necrosis; normal involution of structures (atrophy, thymus), progrmnrned ccli death, loss of Mullerian structures in males and Woifflan structures in females, Councilman (acidophilic) bodies, psammoma bodies, mechanism of atrcsia in the bowel (no lumen)

Front 24

PC? in AIDS patient treat with TMP/SMX; most common initial AIDS-defining lesion

Front 25

Cause of death in 15-25 age bracket

Back 25

MVA; Black male in this age bracket is homicide

Front 26

Sjogren’s syndrome

Back 26

dry mouth and eyes due to destruction of the minor salivary glands and lacrimal glands

Front 27

Paraneoplastic syndromes

Back 27

ectopic hormones, hypercalcemia (PTH-like peptide from primary squamous carcinoma of the lung renal adenocarcinoma), acanthosis nigricans (stomach cancer), Eaton-Lambert syndrome (myasthcnia-like; small cell carcinoma), polyrnyositis (lung cancer) lii.

Front 28

Staphylococcus aureus food poisoning

Back 28

1-6 hours after eating contaminated food with preformed toxin; self-limited

Front 29

Meckels diverticufum

Back 29

vitelline duct remnant; true diverticuluni; most common cause of iron deficiency in a newborn and young child (01 bleed)

Front 30

Metalloeuzyme that aids tumor invasion of tissue

Back 30

collagenase with Zn as a cofactor

Front 31

157

Back 31

117 serotype of E. coil hemolytic uremic syndrome; raw hamburger

Front 32

Smoker with history of peptic ulcer disease—? advice

Back 32

stop smoking

Front 33

Malaria

Back 33

treat with primaquinc and develop acute intravascular hemolysis in G6PD deficiency

Front 34

Normal karyotype in a child with Down Syndrome

Back 34

probable translocation with chromosome 21 sitting on top of chromosome 14, or an acrocentric (Robertsothan) translocation of chromosome 21

Front 35

Deficiency associated with terminal ifeal resection

Back 35

B12 deficiency; duodenum (iron), jejunum (folate, most of the water reabsorption, most of the sodium reabsorption), ileum (812 reabsorption, bile salt/acid reabsorption)

Front 36

Sepsis in a elderly man with benign prostatic hyperplasia

Back 36

usually E coil and can produce endotoxic shock (warm shock due to activation of complement system and release of anaphylatoxins + release of nitric oxide from damaged endotbelial cells)

Front 37

Vitamin K deficiency

Back 37

causes bleeding; newborns lack bacterial colonization for K synthesis, hence the need to inject K at birth

Front 38

DNA repair defects

Back 38

Fanconi’s anemia (cross-linking agents)

Front 39

Renal agenesis

Back 39

oligohydramnios

Front 40

Effect of barbiturates and other drugs that enhance the liver cytochrome system

Back 40

it will decrease bane and increase activity of ALA synthase, the rate limiting enzyme in herne synthesis; dangerous in precipitating porphyric attacks

Front 41

People in a room with a space heater have a headache

Back 41

CO poisoning, treat with 100% oxygen

Front 42

Genomic imprinting

Back 42

did chromosome come from mother or father, e.g., chromosome 15 microdeletion syndromes— Prader Willi and Angehnan’s syndrome

Front 43

X-ray with multiple lytic lesions in the hip in a patient with anemia and hypercalcemia

Back 43

multiple myeloma

Front 44

Normal changes in pregnancy

Back 44

greater increase in plasmavolume than RBC mass leading to decreased Mb, increased GFR and CCr, decreased BUN, creatinine~ and uric acid; increased alkaline phosphatase; respiratory alkalosis from progesterone effect; increased T4 and cortisol from increased synthesis of their binding proteins (free hormone normal)

Hint 44

None

Front 45

Girl playing soccer is on tetracycline—distribution of the rash

Back 45

contact photodermatitis involving face, neck, forearms, and probably the legs (shorts); asked the same question in di; past in a baseball player (legs would not be involved)

Front 46

Xeroderma pigmentosum

Back 46

AR disease with absent DNA repair enzymes and increased incidence of UVB-related skin cancers

Front 47

Mitochondrial DNA disorder

Back 47

mother gives the disease to all of her children; affected males do not give the disease to their children, since the mitochondria are lost in the tail of the sperm after fertilization.

Front 48

Main difference in adult male and female

Back 48

iron studies all lower in females

Front 49

CNS reaction in a stroke

Back 49

giiosis due to proliferation of astrocytes; not collagen deposition

Front 50

Children

Back 50

increased alkaline phosphatase (osteoblasts from bone growth) and phosphate, slight decrease in Mb

Front 51

Dissecting aortic aneurysm

Back 51

unequal pulses in the upper extremity-left radial absent

Front 52

Analytes increased with hemolyzed blood sample

Back 52

LDH, potassium

Front 53

Picture of a diabetics lower leg with pigmented lesions

Back 53

probably necrobiosis lipoidica diabeticorum

Front 54

Lipid most affected by fasting

Back 54

triglyceride component coming from chylomicrons; CM and }IDL not affected

Front 55

Compare Wegener’s granulomatosis (necrotizing granulomatous vasculitis; c-ANCA antibodies) with Goodpasture’s syndrome (anti-basement membrane antibodies)

Back 55

both involve the lungs and kidneys; WG involves upper airway, GP does not.

Hint 55

None

Front 56

Enhance cytochrome system in the SER of the liver

Back 56

alcohol, barbiturates; increase in serum GGT; decreased drug levels from increased metabolism

Front 57

Gross of a mass in the kidney in an adult most likely a renal adenocarcinorna

Front 58

Inhibit cytochrome system

Back 58

H2 blockers, proton blockers; danger of drug toxicity

Front 59

Gross of torsion of the testicle

Back 59

testicle has a bluish black color

Front 60

First sign of tissue hypoxia

Back 60

swelling of cell from inactive Na/K ATPase pump

Front 61

Gross of a colloid cyst in the third ventricle

Back 61

round object in third ventricle; cause of hydrocephalus

Front 62

Fatty liver

Back 62

most commonly due to alcohol

Front 63

Breast budding (thelarche)

Back 63

first step in menarche

Front 64

Examples of growth alterations

Back 64

atrophy, hypertrophy, hyperplasia, metaplasia, dysplasia; see tables in cell injury notes

Front 65

Picture of an elderly patients hands with senile purpura

Back 65

normal age-dependent finding and not a sigu of patient abuse

Front 66

Examples of cell accumulations

Back 66

melanin, iron, calcium (dystrophic, inetastatic), glycogen, bilinibin products

Front 67

Polyhydramnios

Back 67

TE fistula, anencephaly, duodenal atresia

Front 68

Cytoehrome oxidase

Back 68

inhibited by CO and cyanide

Front 69

FSH and LH are increased with removal of the ovaries or testes

Front 70

Cell cycle

Back 70

know parts of the cell cycle, role of p53 suppressor gene in inhibiting kinases, drugs that block specific areas of the cycle; see cell injury notes

Front 71

Cross-section of brainstem in a child—yellowish discoloration

Back 71

probably kernicterus from hemolytic disease of the newborn

Front 72

Free radicals

Back 72

superoxide, OH, peroxide, drugs [acetaminophen, CCL]); iron increases FR formation

Front 73

Esophagitis in AIDS

Back 73

Herpes I most common

Front 74

Types of cell necrosis

Back 74

coagulation (infarction; exception CNS), liquefactive (infections, brain infarct or infection), caseous (systemic TB and atypical TB, systemic fungi; all the rest are non-caseating), enzymatic fat necrosis (acute pancreatitis), fibrinoid (necrosis of immunologic injury; small vessel vasculitis, vegetations in RHD and LibmanSacks), gummatous (tertiary syphilis)

Front 75

Hepatitis most commonly chronic

Back 75

HCV

Front 76

Chemical mediators of inflammation

Back 76

histamine, C3a, C3b, C5a, LTB4, LTC-D-E4, bradykinin, prostaglandins; see table in inflammation notes

Front 77

URI in a child followed by epistaxis and petechia

Back 77

ITP (IgO antibody against platelets; type II hypersensitivity)

Hint 77

None

Front 78

Factors increasing and decreasing adhesion molecule synthesis

Back 78

increase CSa, LTB4, endotoxins, IL-i, TNF; decrease, catecholamines, corticosteroids, lithium

Front 79

Roofer for 25 years and a smoker for 10 years

Back 79

greatest risk is for primary lung cancer, not a mesothelioma

Front 80

Recognize a granuloma (circumscribed, red, contain multinucleated giant cells)

Back 80

example of type N hypersensitivity; macrophages when activated become epithelioid cells arid fuse into multinucleated giant cells

Front 81

Bridge painter in New York City with respiratory infectiouf most likely histoplasmosls (stmlIngdimg) ti cryptococcus (pigeons); may ask what to treat the patient with

Back 81

amphotericin

Front 82

Rat poison ingestion~ contains warfarin and will cause bleeding; treat with vitamin K

Front 83

Types of inflammation

Back 83

suppurative (abscess), celiulitis (streptococcus), granulomatous (FB), pseudomembranous (diphtheria, C. diffidile), fibrinous (pericarditis), scrous (blister)

Front 84

Patient who is going to receive a packed RBC transfusion

Back 84

must do an antibody screen

Front 85

Important suppressor genes

Back 85

p53 (most cancers; chromosome 17), APC (familial polyposia; chromosome 5), BRCAI (breast/ovarian cancer; chromosome 17), BRCA-2 (breast cancer, chromosome 13), NP-i and -2 (neurofibromatosis), Rb (retinoblastoma; chromosome 13)

Front 86

ABO incompatibility

Back 86

0 mother with A or B baby; may occur in first pregnancy; no increase in severity with future pregnancies; spherocytes in cord blood; positive direct Coombs on cord blood RBCs, mild hemolytic anemia, most common cause of jaundice in first 24 hours, protects against.Rh sensitization

Front 87

Fragile X syndrome

Back 87

SXR disease; most common genetic cause of mental retardation in males (Down syndrome most common overall); triplet repeat; macroorchidism at puberty

Front 88

Child with rash and skin infiltrate with CD1 positive cells

Back 88

histiocytosis X (probably Letterer Siwe disease)

Front 89

Chronic granulomatous disease of childhood

Back 89

SXR disease, absent NADPH oxidase, absent respiratory burst, cannot kill catalase positive S. aureus but can kill catalase negative streptococci

Front 90

Diabetes insipidus

Back 90

hypernatremia, very dilute urine, thirsty, polyuria (absence of concentration), CDI corrected with vasopressin, NDI not corrected with vasopressin

Front 91

Cri-du-chat

Back 91

deletion of short arm of chromosome 5; mental retardation, cry like a cat, relation with VSD

Front 92

Elderly male with low back pain

Back 92

do a rectal exam to rule out prostate cancer before any other test; if they state that the serwn alkaline phosphatase is elevated, it is osteoblastic metastasis

Front 93

Marfan’s syndrome

Back 93

AD; fibrillin defect in elastic tissue; MVP with sudden death; dissection most common cause of death; dislocated lens; boniocystinuria is similar (AR diseasr, differences are mental ietaidation, vessel ~wombosla from increase in homocysteine)

Front 94

Most significant risk factor for child having open neural tube defect

Back 94

mother’s diet lacks folate prior to pregnancy

Front 95

Neurofibromatosis

Back 95

AD; brain tumors, meningioma, acoustic neuroina, pheochromocytonia, cafe au lait, Lisch nodules (hamartomas in iris)

Front 96

Treatment regimen to prevent osteoporosis in a woman who had a previous total hysterectomy and bilateral salpingo-oophorectomy

Back 96

exercise + calcium 1000 mg + vitamin D 400 U + estrogen with or without pcogesteree~

Hint 96

None

Front 97

Von Hippel Lindau

Back 97

AD; cerebellar hemangioblastomas pheochmmocytoma renal adenocarcinoma (high incidence)

Front 98

Treatment regimen to prevent osteoporosis in a 35 year old woman who Is still menstruating

Back 98

exercise + calcium 1000 mg + vitamin D 400 U (does not need estrogen since she is still menstruating)

Front 99

Congenital malformations

Back 99

see genetics notes; alcohol number I teiatogen

Front 100

Treatment regimen to prevent osteoporosis in a postmenopausal woman who had a previous radical mastectomy that was ERA-PRA positive

Back 100

exercise + calcium 1000 mg + vitamin D 400 U (estrogen contraindicated, however, can give tamoxifcn which is a weak estrogen)

Hint 100

None

Front 101

Oncogene relationships

Back 101

erb-B2lneu [HER-2) codes for a growth factor receptor. breast, ovarian and colon cancer (erb B2); ras codes for membrane associated GTP-binding proteins (G proteins) that transduce signals received from growth factor receptors to the phosphatidyl inositol second messenger system

Front 102

Oocysts that are acid-fast positive in a patient with AIDS

Back 102

Cryptosporidium

Front 103

Grade of cancer (histologic appearance of tumor)

Back 103

well differentiated [low grade) if you can tell what its origin is; poorly differentiated [high grade, anaplastic) if you cannot tell its tissue of origin

Front 104

Elderly man, who lives at home with his wife, develops pneumonia

Back 104

Streptococcus pneumoniae (most common community acquired typical pneumonia)

Front 105

Stage of cancer

Back 105

T = tumor size, N nodal metastasis, M other metastatic sites; more important than grade

Front 106

Most common benign tumor in the brain of an adult

Back 106

meningioma (glioblastoma multiforme is the most common primary malignant tumor)

Front 107

Tumor nomenclature

Back 107

carcinoma (squamous, adeno-, transitional), sarcoma (mesenchymal origin), hamartoma (not neoplastic; bronchial harnartoma, P1 polyp, hyperplastic polyp), choristoma (not neoplastic, normal pancreas in stomach wail), mixed tumor (parotid salivary gland Uumor 2 tissues from same cell layer), teratoma (tissues from ecto-, endo-, and mesoderm; cystic teratoma of ovary with teeth and hair); review first part of neoplasia notes

Front 108

Most common site to evaluate in a child with hypertension

Back 108

kidneys (Wilm’s tumor, renal dysplasia), adrenal medulla (neuroblastoma)

Front 109

Increased AG metabolic acidosis (AG = Na - ICI + HCO3) =12+/-4 mEq/L)

Back 109

adding an acid and the anion of the acid replaces the bicarbonate used to buffer the hydrogen ions; e.g., lactate, acetoacetate, ~-hydroxybutyrate, phosphate/sulfate (renal failure), sahicylate, formate (methanol poisoning), oxalate (ethylene glycol poisoning), acetate (paraldehyde)

Hint 109

None

Front 110

AIDS patient diarrhea—?what organisms can be identified with the string test (Enteroteat)

Back 110

Giardia, strongyloides, Cryptospondium

Front 111

Picture of coagulation necrosis in an acute myocardial infarction

Front 112

Adult polycystic kidney disease (APKD)

Back 112

relation to CNS berry aneurysms and subarachnoid hemorrhage

Front 113

Normal AG metaboJic~ acidosis

Back 113

losing bicarbonate and bicarbonate is replaced by an equal number of Cl anions, hence the normal AG; type I renal tubular acidosis (distal)

Front 114

Elderly man with sudden onset of abdominal pain and bloody diarrhea

Back 114

thrombosis/embolism of the superior mesenteric artery with small bowel infarction (common association with heart disease and atrial fibrillation)

Front 115

Acute transplant rejection

Back 115

within 3 months; predominantly cellular immune reaction (type IV; CD5 cytotoxic T cells; parenchymal damage) and smaller humoral component (vessel damage with fibrosis)

Front 116

Young girl with grape-like masses protruding from the vagina

Back 116

embryonal rhabdomyosarcoma (most common sarcoma; not related to DES)

Front 117

Chemical carcinogens

Front 118

Crunching sound is noted in the neck and anterior chest in a patient involved in a head-on collision

Back 118

ruptured esophagus (Hazuman’s sign in the chest due to subcutaneous emphysema from air dissecting into the tissue; other scenarios could be an alcoholic who is retching or a buliznic who. is vomiting)

Front 119

Woman complains of generalized muscle weakness, ptosis of the right eye with no papillary abnormalities

Back 119

myasthenia gravis (autoantibody against acetyicholine receptors; type II hypersensitivity)

Hint 119

None

Front 121

Schistocytes in the peripheral blood

Back 121

prosthetic heart valve, aortic stenosis (most common), DIC, thrombotic thrombocytopenic purpura, marathon runner

Front 123

Most frequent cancer in the bone in an adult

Back 123

metastatic cancer (breast is the overall most common cause)

Front 125

Most common location in bone for osteomyelitis

Back 125

metaphysis (most vascular part of bone; S. aureus most common cause; hematogenous spread)

Front 127

Most appropriate treatment for an elderly woman with a headache localized to the side of her head accompanied by diffuse muscle aches and pains, and an elevated serum CK and ESR

Back 127

corticosteroids (temporal arteritis with polymyalgia)

Front 128

carcinomas

Back 128

lymphatic to regional nodes (subcapsular sitius), vessel invasion (uncommon; exceptions follicular cancer of thyroid~ renal adenocarcinoma, hepatocellular carcinoma), seeding (ovarian cancers); sarcomas

Front 129

Athlete presents with jaundice, no previous health problems, no history of liver disease, and no previous transfusions; serum transantinases Ii tly elevated and serum alkaline phosphatase is markedly elevated

Back 129

patient is taking anabolic steroids cholestatic jiia1~e~

Front 131

Most common primary brain tumor oc~ñin chil~in

Back 131

cerebellum (cerebellar astrocytoma #1, medulloblastoma #2—First An) for Boards is wrong on this one [has medulloblastoma as #1])

Front 133

Cause of atrophy in a muscle in a cast

Back 133

lack of muscle stimulation

Front 134

MCC of rabies in USA

Back 134

skunk bites (not bats, dogs, or raccoons)

Front 135

Sturge Weber

Back 135

port wine nevus on the face in a trigeminal nerve distribution; ipsilateral AV malformation in the brain

Front 137

Cancers associated with parasitic disease

Back 137

squamous cancer of the bladder Schistosorira hematobium (egg has a nipple at the end), cholangiocarcinoma Clonorchis sinensis

Front 139

Hepatitis associated with urticaria, fever, arthralgias, and the nephrotic syndrome

Back 139

Hepatitis B (serum sickness type of disease with type 111 iinmunocomplex mechanism; vasculitis associated with polyarteritis nodosa)

Front 141

Targetoid lesions on the skin

Back 141

erythema multiforme (most often associated with Herpes simplex; Mycoplasma is another relationship; others include sulfonamides, NSAJDs, phenytoin Steven’s Johnson syndrome involves the mouth)

Front 143

Flat, hyperpigmented lesions on the forehead and cheeks of a woman

Back 143

most commonly due to oral contraceptives (pregnancy is the next most common; this is called chloasma or melasma)

Front 145

Axillary freckling in a patient with hypertension

Back 145

neurofibromatosis

Front 147

Most common cause of alopecia

Back 147

genetic predetermination (most commonly in males; telogen effluviurn is when all the hairs enter the resting phase at once [postpartum, BCPs, high fever, crash diet])

Front 149

Irregular patches of hair loss in child

Back 149

trichotillomania (pulling out of one’s own hair, note the relationship to the 4 dominant hand)

Front 151

Young woman with intermittent bouts of diarrhea and constipation associated with cramping right and left lower quadrant pain

Back 151

irritable bowel syndrome; flexible sigmoidoscopy is negative; intrinsic bowel niotility problem

Front 153

Immunizations given at birth to a baby whose mother is positive for HBsAg

Back 153

Hep B (active immtmization) and HBIG (passive immunization)

Hint 153

None

Front 155

Mosaicism

Back 155

non-disjunction in somatic cells

Front 156

Treatment of pseudornembranous colitis

Back 156

melronidazole (cheaper than oral vancomycin)

Front 157

Farmer and his wife are brought to the ER by their son because they are too weak to walk or drive and their vision is blurry and exam reveals ptosis, facial weakness, nonreactive dilated pupils, dry mucous membranes, and normal DTRs—? diagnosis

Back 157

C. botuliraim food poisoning (the toxin inhibits the release of acetylcholine at the neuromuscular junction; Rx with botulism antitoxin; danger of respiratory paralysis)

Front 159

Cell cycle

Back 159

p53 suppressor gene produces a protein product that has an inhibitory effect on the kinases that control the movement from one phase to the next in the cell cycle

Front 160

Diabetic with wet gangrene of the foot followed by stiffening of the Jaw, neck stifihess, and increased irritability and increased hyperreflexia—? diagnosis

Back 160

tetanus (Rx tetanus immune globulin, penicillin, sedation; give fill immunization with toxoid when the patient recovers since the infection does not produce high enough titers of protective antibodies) C174

Front 161

Labile cells

Back 161

contain stem cells; bone marrow stem cells, skin (stratum basalis), intestine (base of the glands)

Hint 161

None

Front 162

Patient has hyperpigmented spots on the skin which when scratched become intensely pruritlc and red; the cells most likely responsible for this reaction arc

Back 162

mast cells (the patient.~ms urticaria pigmentosa, which is a mast cell disease where pressure causes the release of histamine setting up an urticarial reaction) -173. -

Front 163

Stable cells

Back 163

in Go phase and must be stimulated to go into the 01 phase (e.g., hormones); most parenchyrnal cells in organs; smooth muscle; astrocytes and other neuroglial cells

Front 164

Permanent cells

Back 164

cannot enter the cell cycle; skeletal and cardiac muscle; neurons

Front 165

Patient with dysphagia and a fetid odor to his breath

Back 165

Zenker’s diverticulum (most common diverticulum in the esophagus; collects food)

Front 166

Most common bone metastasized to

Back 166

vertebra; due to the Batson vertebral plexus which communicates with the vena cava. Systemic Pathology Questions

Front 167

Young man with low back pain and limited chest movement ankylosing spondylitis (vertebral fusion produces kyphosis, which restricts chest movement)

Front 168

Drug of abuse that produces reddening of the conjunctiva

Back 168

marijuana

Front 169

Mechanism of action of 1W light in the treatment of newborns with physiologic jaundice

Back 169

oxidizing UCB into harmless water soluble dipyrroles

Front 170

Differentiate all the thyroid disorders

Front 171

Separate Addison’s disease from secondary hypocortisolism

Back 171

main differences are in ACTH levels, and electrolytes; Addison

Hint 171

None

Front 172

Calculate the reference interval of the test given the mean of the test and 1 SD

Back 172

remember to double the SD, since 2 SD covering 95% of the normal population.is used

Front 173

Treatment of CMV retinitis in AIDS if ganciclovir does not work

Back 173

foscarnet (renal toxicity)

Front 174

Picture of patient with Cushing’s syndrome

Back 174

central obesity, purple stria; use low dose dexamethasone test and 24 hour urine for catecholamines

Front 175

Carcinoid syndrome

Back 175

metastasis to the liver from a primary in the small intestine; measure 5-RIAA

Front 176

Male with clusters of vesicles on penis

Back 176

HSV II; acyclovir decreases recurrences

Front 177

Treatment of condyloma venereum

Back 177

topical podophyllin

Front 178

Treatment of syphilis

Back 178

penicillin

Front 179

Treatment of gonorrhea

Back 179

ceftriaxone (for GC) + doxycycline (for Chiamydia)

Front 180

Treatment of bacterial vaginosis

Back 180

metronidazole (not the partner); clue cells, Gardnerella vsgisialis

Front 181

Treatment of trichomoniasjs

Back 181

mctronidazole (treat partner); Trichomonas is an anacrobe

Front 182

Treatment of pseudomembranous colitis

Back 182

metronidazole

Front 183

Cause of Graves disease

Back 183

stimulating thyroid stimulating antibody against the TSR receptor (type II hypersensitivity)

Front 184

Factors altering the oxygen dissociation curve

Back 184

left and right shift see cell injury notes or Harvey Champ biochemistry book

Front 185

Primary treatment of CMV retinitis

Back 185

ganciclovir retinitis most common cause of blindness in AIDS

Front 186

Microcytic anemia with increased HbA2 and HbF

Back 186

alpha (??)-thalassemia II

Hint 186

None

Front 187

Most common anemia

Back 187

iron deficiency (women <50 menorrbagia, mah <50 duodenal ulcer, man/woman >50 colorectal cancer)

Front 188

Vitamin deficiency with prolonged PT

Back 188

vitamin K

Front 189

Most common fracture in postinenopausal osteoporosis

Back 189

vertebral fracture; osteoclastic activity > osteoblastic activity

Front 190

IndIa ink prep with narrow based bud

Back 190

Cryptococcus

Front 191

Respiratory problem with pigeons

Back 191

cryptococcus

Front 192

Aspergillus

Back 192

fungus ball in abandoned TB cavity; hemoptysis, fruiting body

Front 193

Frontal lobe abscess in a patient with DKA

Back 193

mucormycosis

Front 194

Pseudomonas related infections

Back 194

CF pneumonia (green colored sputum), most common cause of death in burns, malignant otitis externa, ecthyma gangrenosum, step on nail with smelly tennis sneakers, hot tub folliculitls, respirator infections (loves water)

Front 195

Legionella

Back 195

water coolers, flu-like syndrome, hyponalremia and hyperkalemia from interstitial nephritis, Dicterle silver stain, erythromycin

Front 196

Opportunistic infections in AIDS

Back 196

know Pneumocystis, CMV, Cryptococcus, MAI, TB, Herpes (esophagitis), Candida (thrush,, esophagitis), Cryptosporidium (acid fast; diarrhea)

Hint 196

None

Front 197

Vessels in esophageal varrces

Back 197

left gastric and azygous veins

Front 198

Mitochondrial inheritance

Back 198

mother gives the disease to all her kids but her married son to none of his kids

Front 199

ERA and PRA positive breast cancer

Back 199

use tamoxifen, an anti-estrogen, protects against CAD and osteoporosis, can produce endometrial cancer

Front 200

Pasteurella multocida

Back 200

cat bite; potential for septic arthritis/tendinitis

Front 201

Disseminated gonococcemia

Back 201

decreased C5-C8 (final common pathway complement components)

Front 202

Know how to interpret MST 11 restriction endonuclease studies to separate sickle trait from disease

Back 202

see hematology notes table in hematology

Front 203

Treatment for prolactinoma

Back 203

bromocriptine; most common pituitary tumor, secondary amenorrhea and galactorrhea

Front 204

Most common cause of myocarditis, pericarditis, aseptic meningitis

Back 204

coxsackievirus; picture of lymphocytes in myocardial tissue on an endomyocardial biopsy

Front 205

High MP

Back 205

open neural tube defects, hepazoceliular carcinoma, yolk sac tumors of ovary or testis

Front 206

Drugs that increase surfactant

Back 206

glucocorticoids, thyroxine

Front 207

ECG changes

Back 207

short QT hypercalcemia, prolonged QT hypocalcemia, U wave bypokalcrnia, peaked T wave hyperkalemia

Front 208

Most common cause of jaundice in the first 24 hours after birth

Back 208

ABO incompatibility; 0 mother with an A or B baby; 0 mother normally has anti-A,B IgG antibodies

Front 209

WBC abnormality in the peripheral blood in B&folate deficiency

Back 209

hypersegmented neutrophil (picture on exam)

Front 210

MC vitamin deficiency in alcoholics

Back 210

folate

Front 211

Next step if there is a positive RPR in a patient with SLE

Back 211

do an FFA-ABS to rule out a true from a false positive RPR, the latter due to anti-cardiolipin antibodies.

Front 212

Tear drops in peripheral blood

Back 212

myeloflbrosis in the marrow

Front 213

Coarse basophilic stippling in peripheral blood

Back 213

Pb poisoning

Front 214

PICA for clay and ice

Back 214

iron deficiency

Front 215

Iron studies in iron overload

Back 215

increased iron, % saturation, ferritin, but decreased TtBC (transferrin decreased)

Front 216

MCC of folate deficiency

Back 216

alcohol abuse (not beer)

Front 217

Polycythemia differential

Back 217

hematology notes; relative polycythemia (volume depletion)

Front 218

Leukemias by age

Back 218

<15 ALL, 15-39 AML, 40-60 AML and CML, > 60 CLL

Hint 218

None

Front 219

Hairy ccli leukemia

Back 219

B cell leukemia, positive TRAP stain

Front 220

CML

Back 220

t9;22 translocation of c-myc oncogene, low LAP score, Philadelphia chromosome

Front 221

ALL

Back 221

CAILA positive pre-B cell leukemia most common

Front 222

MC metal deficiency in alcoholics

Back 222

magnesium

Front 223

Progressive systemic sclerosis

Back 223

replacement of smooth muscle with normal collagen and increased subcutaneous deposition of collagen; R.aynaud’s first sign; scierodactyly; tight face; dysphagia for solids (no peristalsis, relaxed LES); restrictive lung disease; renal disease; anti-Scl-70 antibodies; CREST syndrome a variant

Front 224

TdT

Back 224

marker of very immature B cells and T cells

Front 225

Congenital spherocytosis

Back 225

AD, spectrin deficiency, increased osmotic fragility

Front 226

Howell Jolly body

Back 226

indicates absent or dysfunctional spleen

Front 227

Heinz bodies

Back 227

peroxide damaged Hb in R.BCs in G6PD deficiency

Front 234

Vitamin, associated with pyruvate dehydrogenase

Back 234

thiamin

Front 235

Always determine the genetic sex of a child with ambiguous genitalia

Front 236

SLE

Back 236

Libman Sachs endocarditis; immunocomplex glomenilonephritis (anti-dsDNA); fibrinous pericarditis; pleural and pericardial effusions; false positive syphilis serology; autoimmune hemolytic anemia, neutropenia, and thrombocytopenla; butterfly rash; joint pains with morning stiffness; anti-Sm and anti-dsDNk ANA positive in most cases

Front 247

Effect of metyrapone

Back 247

blocks adrenal cortex I 1-hydroxylase, hence decreasing cortisol, increasing ACTH~, and increasing fl~eoxycorti~pro~wna1 to the block; excellent check of ACTH reserve and adrenal function

Front 254

direct detects IgG/C3 on RBC, indirect is an antibody screen of serum (e.g~, anti-i)); used in autoimmune hemolytic anemias Ferritin

Front 255

Respiratory burst

Back 255

NADPH oxidase conversion of molecular oxygen into superoxide free radicals; neutrophils and monocytes only

Front 256

B12 metabolism and deficiency

Back 256

thoroughly review B12 and folate metabolism in the hematology and nutrition notes, know role of B12 in propionate metabolism and formation of SAM from methionine (ATP + inethioninc), methyhnaionic acid increases in B12 deficiency (not folate), homocysteine increases in both B12 and folate deficiency (most common cause)

Front 257

Know all the types of hepatitis

Back 257

see HB notes

Front 258

Photograph of mass in the vulva

Back 258

Bartholin gland abscess/cyst; relationship with GC

Front 259

Tzanck prep

Back 259

detect viral etiology of vesicular disease; e.g. Herpes multinucleated cell with intranuclear inclusions; same for varicella

Front 260

Picture of pseudohypha and yeast for Candida bilirubin metabolism and causes of jaundice (Gilbert’s, physiologic jaundice of newborn, Crigler-Najjar,

Front 261

In caisson disease, what is decreased when a diver comes up too quickly

Back 261

PN2 in blood, since it forms bubbles in the vessels and moves into tissue

Front 262

Hypercalcemia and multiple inyeloma

Back 262

secretion of osteoclast activating factor from myeloma cells

Front 263

Clear cell adenocarcinoma of vagina

Back 263

DES exposure; vaginal adenosis is the precursor What happens to the other kidney if one is damaged

Front 264

Obstructive jaundice

Back 264

fat soluble vitamin deficiencies from reduction in bile salts leading to malabsorption; bile contains cholesterol and bile salts/acids

Front 265

Effects of methotrexate

Back 265

megaloblastic anemia from block in dihydrofolate reductase, myelosuppression

Front 266

Drug-induced SLE

Back 266

procainarnide is the most common drug; no renal disease; ~ ~neand anti-saD, rather than anti-dsDNA and anti-Sm antib a

Front 267

Cocaine

Back 267

decreased uptake of DOPA and NOR.; review environmental path notes

Front 268

Congenital adhesion molecule (integrins) defect failure of the umbilical cord to separate at birth no adhesion of neutrophils to the endothelial cells, no inflammatory cells in the umbilical stump

Front 269

Biotin reaction

Back 269

carboxylase reaction in the conversion of pyru’vate to oxaloacetate

Front 270

Heberden’s nodes

Back 270

osteophytes in IP oints in osteoarthritis

Front 271

Cherry red inacula

Back 271

Tay Sach disease

Front 272

Amebiasis

Back 272

flask shaped ulcers in the cecum

Front 273

Know how to interpret pedigree for all of the inheritance patterns

Back 273

review genetics notes

Front 274

AMI complications

Back 274

rupture most common on the 3rd to 7th day; Dressier’s syndrome autoimmune pericarditis 6-8 weeks later

Front 275

Pyridoxine (B6)

Back 275

transarnination reactions involving the transaminases AST and ALT Know how to interpret ABGs

Front 276

Goodpasture’s syndrome

Back 276

anti-pulmonary and gloinenilar capillary basement membrane antibodjes~ begin, with hemoptysis and ends with renal failure (crescentic glomemlonephrjtis); linear lmmunofluo~~

Front 277

haylsldeis

Back 277

review table in lymph node notes

Front 278

Functions of atrial natriuretic peptide

Back 278

opposite of angiotensin II— inhibition of ADH release, inhibits Alit effect on stimulating thirst~ inhibits aldosterone secretion, inhibits renal reabsorption of Na (direct effect; loss of sodium in the urine), and inhibits renin release; vasodilatation of the peripheral resistance vessels

Front 279

HBV questions

Back 279

review hepatobiiaiy notes

Front 280

Disorders associated with smoking and alcohol

Back 280

see environmental pathology notes

Front 281

Sepsis in AIDS patients

Back 281

disseminated MA! most common and most common cause of death

Front 282

Chance of a male with cystic fibrosis having a child

Back 282

<5%, since the vas deferens never fully develop or are atrctic; females with CF can get pregnant but it is difficult owing to the thick cervical mucus

Front 283

Most common cause of post-transfusion hepatitis

Back 283

HCV (CMV is the most common infection pos-trans1baj~ located in donor lymphocytes)

Front 284

Vitamin supplements in CF

Back 284

all of the fat soluble vitamins

Front 285

Most common cause of septic arthritis

Back 285

N. gonorrhoeae; knee, wrists, feet

Front 286

Women is a pure vegan and is breast feeding her baby and the baby develops anemia

Back 286

B12 deficiency.

Front 287

Rusty colored sputum

Back 287

Streptococcus pneurnonzae pneumonia (other causes chronic congestive heart failure, mi~a] stenosis, Goodpasture’s).

Front 288

Signs/symptoms of drugs of abuse

Back 288

review environmental path notes

Front 289

Mechanism of spread of Cryptococcus neoformans

Back 289

hematogenous rouse; most common cause of meningitis in Afl)S and other ininlunocompromised states

Front 290

EBV attaches to CD~ molecule in B cells ~

Back 290

Hypogonadism, mental retardation, n4 unilateral gynecomsstia Kilnefelter syndrome ( 43~ Hypogonadism and color blindness+C287

Front 291

Problems in cystic fibrosis patients associated with P. aeruginosa. pneumonia, brOnehiectaSiS, sepsis

Front 292

Tetralogy of Pallot

Back 292

most common cyanotic CHD; degree of infravalvular pulmonary stenosis is the key to whether the patient has cyanosis or is acyanotic

Front 293

Baby with icterus and edema

Back 293

which virus probably congenital CMV infection C305

Front 294

EM of hepatocyte

Back 294

glycogen present in fed state (black granules) and disappears after 6 hours (fasting state)

Front 295

Abdominal abscess

Back 295

most commonly due to Bacteroides fragilLv (B. fragili.r below the diaphragrn B. melanogenicus above the diaphragm)

Front 296

Tuberous sdero.1s

Back 296

AD; mental retardation astrocyte hamartomas in CNS (candlestick drippings on ventricles); adenoina sebacewn; angiomyolipoma (hamartoma) of kidneys; rhabdomyoma of heart

Front 297

Hypogonadism and anosmia (lack of smell)

Back 297

Kallznann syndrome

Front 298

Staphylococcus aureus

Back 298

prn~~~~es to Fe receptor of macrophages, hence blocking opsonization of bacteria

Front 299

Male pseudohermaphrodite with cryptorchidism

Back 299

testicular feminizatIon (absent androgen receptors; SXR most common cause of male pseudohermaphroditism)

Front 300

Acute Intermittent porphyr~~~ AD; two basic defects

Back 300

an increased activity of ALA synthase when heine is decreased (drug metabolism in liver) and decreased activity of uroporphyrinogen synthase; net effect increase in 8-aminolevuljnjc acid (ALA), porphobilinogen (PBG; when oxidized by light, it becomes porphobilin, which gives port wine color to urine; “window sill” test); intermittent exacerbations of neurologic dysfunction including psychosis, neuropatiijes, severe colicky abdominal pain that is frequently mistaken for a surgical emergency (“bellyful of scars.”); periodic infusions of heme reduce the number of attacks.

Front 301

Microdeletion syndrome with hypogonadiam, mental retardation, short stature, and obesity

Back 301

Prader-Willi syndrome (chromosome 15 deletion is of paternal origin); Angelman syndrome deletion is of maternal origin

Front 302

Porphyria cutanea tarda (PCT)

Back 302

acquired disease; decreased activity of uroporphyrinogen decarboxylase; net result increased excretion of uroporphynn I (urine is wine-red color on voiding), slight increase in the formation of coproporphyrins, normal porphobilinogen levels; photosensitive skin lesions in sun-exposed areas, hyperpigmentation, fragile skin1 increased amounts of vellus type hair (hypertrichosis) C327

Front 303

Patient with neurofibromatosis has severe diastolic hypertension

Back 303

probable pheochromocytoma

Front 304

Group A streptococcus

Back 304

pharyngitis predisposes mainly to rheumatic fever (less commonly glomerulonephritis), skin infections predispose mainly to glomerulonephritis (less commonly rheumatic fever)

Front 305

Serum protein etectrophoresis interpretation

Back 305

see Table in inflammation notes; now difference between polyclonal (chronic inflan~imation) and monoclonal (one clone of plasma cells; monoclonal gammopathy of undetermined significance is the most common cause)

Front 306

Diagnosis of rotavirus infection

Back 306

Rotazyme test of stool; ELISA test with antibodies against the virus

Front 307

Complications of cyclophosphamide

Back 307

hemorrhagic cystitis and transitional carcinoma of the bladder

Front 308

EM findings consistently present in all primary causes of nephrotic syndrome

Back 308

fusion of podocytes

Front 309

Decline in deaths due to SIDS is attributed to

Back 309

having the baby sleep supine (babies rebreathe their own C02 those with immature central chemoreceptors do not respond to the respiratory acidosis by moving their heads and die)

Front 310

Glomerular crescents

Back 310

sign of increased severity of glomerulonephritis; most common ON to progress into chronic renal failure

Front 311

Most important risk factor for increased morbidity/mortality in a single 25 year old Black male

Back 311

unprotected sex (AIDS #1 killer in this agebracket also applies to women regardless of age, but not white men, where MVAs are the #1 killer)

Front 312

Goodpasture’s

Back 312

. hernoptysis (first) + glomerulonephritis (crescentic ON)

Front 313

Several employees that work in a car assembly plant present with headache, nausea, vomiting, muscle weakness, and abdominal cramps

Back 313

lead poisoning from incineration of batteries; may change the history to people making moonshine in an old car radiator

Front 314

Monosodium urate crystals in synovial fluid

Back 314

needle shaped and yellow when parallel to the slow axis of the compensator

Front 315

Newborn female presents with edema of the hands and feet and a cystic mass in the neck

Back 315

Turner’s syndrome with a 45 XO kaiyotype

Front 316

2 year old with 94% HbF

Back 316

indicates hereditary persistence of Hgb F (variant of ~-thalassemia) owing to absent ~ and

Front 317

Compared to mature breast milk, cow’s milk has

Back 317

more vitamin K, less ascorbic acid, more vitamin B12, more casein (breast milk has low iron but it is better absorbed; casein is the key protein in cow’s milk, while whey is the primary protein in breast milk)

Front 318

Mechanism of acute pyelonephrith (upper urinary tract infection) in females

Back 318

vesicoureteral reflux

Front 319

Vitamin that is absent in colostrum

Back 319

vitamin D

Front 320

Pneuniothorax in a skin diver

Back 320

sudden onset of pleuritic chest pain, collapsed lung with elevation of the diaphragm and shift of trachea to the side of the collapse

Front 321

Anemia in an infant that develops when switched from cow’s milk to goat’s milk

Back 321

goat’s milk is low in folate, 86, iron, and high in potassium, chloride, arachidonic acids, and linoleic acids when compared to cow’s milk

Front 322

Reactivation TB

Back 322

in apex of lung where the oxygen is greatest; strict aerobe

Front 323

Type of UV light with the greatest potential for producing a corneal burn (e.g., snow skiing)

Back 323

UVB (UVB is also the culprit for cancer; B is bad)

Front 324

Shift of mediastinum

Back 324

tension pneumothorax where the air enters the pleural cavity but cannot exit, hence the mediastinal structures shift to the opposite side and the diaphragm is depressed on the affected side

Front 325

Retinal hemorrhages in young children

Back 325

possible child abuse (shaking syndrome)

Front 326

Elderly male smoker with painless jaundice, weight loss

Back 326

carcinoma of the head of pancreas

Front 327

Absence of Y chromosome

Back 327

gerrninai ridge moves in the direction of ovarian differentiation; presence of the Y chromosome —~ testes differentiation

Front 328

Normal times for gynecomastja

Back 328

newborn, puberty, old age; NOTE it may be unilateral (picture of a young boy with unilateral breast enlargement)

Front 329

Patient is stung by a bee and begins to have respiratory difficulty, flushing, and abdominal cramping— ?treatnzent aqueous epinephrine 1

Back 329

1000 sc. (0.01 mL/kg sc. or IM)

Front 330

Resting tremor

Back 330

Parkinson’s disease; intention tremor multiple sclerosis C373

Front 331

Fire ant bites

Back 331

multiple wheals that later develop into vesicles, and pustules

Front 332

Lou Gehrig’s disease

Back 332

same as amyotrophic lateral sclerosis; destruction of upper and lower motor neurons; defective superoxide disinutase; neuron damage by superoxide free radicals; intrinsic muscles of the band a common starting point

Front 333

Black widow bite

Back 333

painful bite (carrying some logs from outside, moving boxes in a basement) followed by crarnpy pain in the thighs and abdomen (Rx with muscle relaxant [calcium gluconate is excellent], tetanus prophylaxis, antivenin if available in severe cases)

Front 334

Superficial dermatophytes

Back 334

located in the stratum corneum

Front 335

Poisonous type of scorpion bite in Southwest

Back 335

painful sting followed by local itching, paresthesias, nausea and vomiting and hypertension

Front 336

Hyperpiasia of JG apparatus with increased blood pressure

Back 336

renal artery stenosis

Front 337

Brown recluse spider bite

Back 337

painless bite beginning with a slightly tender red papular lesion on the arm that latter forms a hemorrhagic blister surrounded by purpura

Front 338

Exostosis

Back 338

gross of an exostosis from a child (most common benign bone tumor, capped by benign cartilaginous tissue)

Front 339

Chigger bites

Back 339

extremely pruritic discrete, bright red papules on legs and around the waist

Front 340

Cause of gallstones

Back 340

picture of GB with stones; too much CH or too little bile salts/acids

Front 341

Child who ingests 30 adult aspirins will most likely develop

Back 341

an increased anion gap metabolic acidosis (children, unlike adults, do not commonly develop a mixed metabolic acidosis and respiratory alkalosis. Rx is to perform gastric lavage and add activated charcoal and to produce an alkaline urine for increased excretion of the acid)

Front 342

PCi2 functions

Back 342

vasodjlator, decrease platelet aggregation

Front 343

What disease is more likely to infect the fetus after the first trimester

Back 343

syphilis

Front 344

Signs and symptoms of anemias

Back 344

B12/folate, exercise intolerance, dyspnea, high output failure; see tables in hematology notes

Front 345

Engineer driving a train involved in a crash with an oncoming train was found to have THC metabolites in his urine—why did this occur

Back 345

a delayed reaction time (it also impairs the ability to judge speed and distances)

Front 346

Picture of black spot on leg

Back 346

ecthyma (pyoderma) gangrenosum, due to Pseudomonas aeruginosa; forms black ulcers; relationship with ulcerative colitis

Front 347

Fever in malaria

Back 347

coincides with rupture of RBCs

Front 348

Angiosarcoma of the liver—causes

Back 348

vinyl chloride, arsenic, Thorotrast

Front 349

Know sensitivity, specificity, prevalence, incidenEe, predictive value of a positive and negative test, risk ratio, odds ratio, case fatality risk

Back 349

some of this is in general principles notes and the remainder in Fadem’s chapter on statistics

Front 350

Treatment of astrocytoma

Back 350

radiation

Front 351

Primaqulne

Back 351

often precipitates hemolysis in G6PD deficiency

Front 352

Condom

Back 352

best protection against syphilis

Front 353

Signs and symptoms of meningitis/organiams by age

Back 353

nuchal rigidity, fever; causes in different age brackets (group B s1reptococcz~g in NB (<I roth; ~ coli #2, L monocytogenes #3), N. nzeningitidfs (1 mth to 18 years; S. pneumoniae #2),> 18 years old

Front 354

Osteomyelitis in HbSS

Back 354

Staphylococcur aureus most common; Salmonella, if producing osteoniyelitis, is most commonly seen in patients with sickle cell disease.

Front 356

Most common CHD in Downs

Back 356

endocardial cushion defect (ASD + VSD); most common cause of death in early age; Alzheimer’s most common cause of death after 35

Front 358

Adult polycystic kidney disease

Back 358

AD disease; berry aneurysm relationship and subarachnoid hemorrhage; cysts not present at birth; hypertension

Front 360

Ankylosing spondylitis

Back 360

HLA B27 positive relationship; young man with low back pain (sacroiiitis) progressing to bamboo spine; aortitis and uveitis as well; other relationships—Reiter’s syndrome, psoriasis, enterocolitis (Campylobacter, Yersinia, Shigella), ulcerative colitis

Front 361

Most common cause of esophageal cancer

Back 361

smoking (alcohol has a synergistic action)

Front 362

Philadelphia chromosome

Back 362

chromosome 22 with the bcrabl fusion gehe in chronic myelogenous leukemia

Front 363

Cause of familial hypercholesterojemig

Back 363

AD disease with absent LDL receptor

Front 364

Absence seizures

Back 364

abrupt onset of impaired consciousness (stare into space); 3-Hz splice and wave activity on EEG, ethosuximide treatment of choice

Front 366

UVB light

Back 366

produces thymidine dimers, which if not replaced with normal DNA by DNA repair enzymes, may result in cancer (basal cell, squame, melanoma)

Front 367

Defect in a-chain in sickle cell frait/disease

Back 367

valine for glutamic acid on 6th position of a-chain

Front 368

Osteogenic sarcoma

Back 368

gross of tumor in knee area; located in the metaphysis

Front 369

Inflammatory bowel disease

Front 370

Cause of thrombosis after angioplasty

Back 370

localized dissection (not thrombosis)

Front 371

Mitral valve prolapse

Back 371

earliest valvular lesion in Marfans; may be a cause of sudden death; increased myxoinatous connective tissue in the valve due to an increase in mucopolysaccharides; click and murmur move closer to SI with anxiety (shorter diastole) and closer to S2 when lying down (more venous return to the heart); see cardiovascular notes and Section on physical diagnosis

Front 372

Congestive cardiomyopathy

Back 372

previous myocarditis (coxsackie most common cause), drugs (doxorubicin, tricyctics), postpartum, alcohol

Front 373

Gross of the tricuspid valve in the right heart

Back 373

infective endocarditis in an intravenous drug abuser

Front 374

Aschoff body

Back 374

pathogriomonic lesion of rheumatic fever

Front 375

H. pylon

Back 375

urease producer, gram negative coccobacillus

Front 376

Treatment for recurrent ulcers

Back 376

vagotomy

Front 377

ESR increase with age

Back 377

probably abnormal and indicates a disease process rather than being an age-related finding

Front 378

Achalasia

Back 378

absent myenteric ganglion (Hirschsprung both submucosal [Meissner’s] and myentcric plexus [Auerbach’s] are missing)

Front 379

Rickets vs osteomajacig in adults

Back 379

craniotabes and rachitic rosary in rickets, not osteomalacia; both hive an increase in unmincrajjzecj osteoid

Front 380

Cave explorer in Arfr~na with respiritory infection

Back 380

coccidloidomycosis (not histoplasmosis too dry a Clim~~ and mainly in Ohio and Midwest)

Front 381

Vitamin E deficiency

Back 381

cerebellar dysfunction; heinolytic anemia; toxicityinterferes with vitamin IC dependent factors leading to a hemorrhagic diathesis

Front 382

Know the renin-angiotensin-aldosterone system

Back 382

see fluid and hemodynamic notes

Front 383

Vitamin C deficiency

Back 383

teeth bleed when brushed; glossitis; perifollicular hemorrhagea; ~a ~d tos~t diet

Front 384

Gross picture of a hydatidiform mole

Front 385

Thiamin deficiency

Back 385

alcohol abuse most common cause (poor nutrition); important biothemica] reactions pyruvate dehydrogenase, transketolase, ketoglutarate debydrogenase; Wernicke (confusion, ataxia, nystagrnus)-Korsajcoff (antegrade and retrograde memory deficits); ring hemorrhages in maznillaiy bodies and periventricular area; high output failure; congestive cardiomyopathy; peripheral neuropathy

Front 386

Postductal coarctation

Back 386

unequal pulses between upper and lower extremity; rib notching; systolic murmur between the shoulder blades; Turner’s syndrome has a preductal not postductal coarctation

Front 387

Niacin deficiency

Back 387

important biochemical reactions NAD/NADH, NADP/NADPH pdllagra; tryptophan can be used to synthesize niacin (1!yptophan decreased in Hartnup’s disease, carcinoid syndrome [converted into scrotonin], corn diet); diarrhea, dermatitis (hyperpignientation), dementia

Front 388

Treatment of DKA

Back 388

volume replacement first

Front 389

Riboflavin deficiency

Back 389

" important biochemical reactions NAD/NADH, NADP/NADPH pdllagra; tryptophan can be used to synthesize niacin (1!yptophan decreased in Hartnup’s disease, carcinoid syndrome [converted into scrotonin], corn diet); diarrhea, dermatitis (hyperpignientation),

Front 390

Galactorrhea in 3 month old girl

Back 390

probable influence of maternal hormones

Front 391

Pyridoxine deficiency

Back 391

" INH most common cause; important reactions

Front 392

Child with scrotal enlargement and transilluminates

Back 392

hydrocele due to persistence of the tunica vaginalis

Front 393

Pantothenic acid

Back 393

important in fatty acid synthase complex; cocnzyme tcactions

Front 394

Indirect Inguinal hernia

Back 394

most common type; lateral to the lateral border of the triangle of Hesselbach (lateral border superficial epigastric artery, inferior border inguinal ligament; medial border the lateral aspect of the rectus abdominis muscles)

Front 395

Biotin deficiency

Back 395

avdin in raw eggs binds the vitamin; alopecia

Front 396

Intravenous drug abuser in prison—?type of hepatitis

Back 396

HBV

Front 397

Alcohol metabolism

Back 397

review in cell injury notes, liver notes, or Champe-Harvey biochemistry

Front 398

9 Weber syndrome

Back 398

lesion of oculomotor nerve and UMN signs with.a midline, midbrain lesion Homer’s syndrome diagram of vertebra and sympathetic trunic pick cervical sympathetic ganglion 61. Pupil light reflexes with eye diagrams of pupils one set is an oculomotor nerve lesion 62. Extent of the spinal cord in adults

Front 399

320.Communicating hydrocephalus

Back 399

CSF communicates with the subarachnoid space; choroid plexus papillosna (makes too much CSF), block arachnoid granulations

Front 400

321. Non-communicating hydrocephalus (obstructive)

Back 400

no communication with subarachnoid space; block at aqueduct of Sylvius (most common), blocks in 4th ventricle, blocks at base of the brain (~B meningitis, blood), Dandy Walker syndrome, Arnold Chiari syndrome

Front 401

322. AIDS dementia

Back 401

most common HP/-related CNS disease; multinucleated mieroglial cells (reservoir for the virus)

Front 402

323. Psoriasi~hyperkeratosis, regular rete ridge hyperplasia, Munros microabscess, superficial dermis next to epithelial surface (Auspitz sign), erythematous plaques with silvery scales, nail pitting, psoriatic arthritis if HLA-B2’7 positive, elbows and scalp

Front 403

324. Read skin notes for quick coverage of main skin diseases

Front 404

325. Bone tumors in order of increasing age

Back 404

Ewings (“onion skinning”, fever, small cells), osteogenic sarcoma (knee area, “sunburst appearance”, “Codxnan’s triangle”), chondrosarcoma (pelvic girdle, knee area, most common malignant cartilage tumor), multiple myeloma (most common primary cancer of bone)

Front 405

326. Paget’s disease of bone

Back 405

male dominant; initial osteoclastic breakdown and then osteoblastic; thick, weak, mosaic bone prone to pathologic fracture; large head; AV flstulas in bone (high output failure), risk for osteogenic sarcoma, elevated alkaline phosphatase; bisphosphonates treatment of choice

Front 406

327. Know CNS bleeds

Back 406

epidural (top of dura, skull fracture, torn middle meningeal artery), subdural (convexities, tear of bridging veins, fluctuating levels of consciousness), atherosclerotic stroke (usually pale infarct, since no reperfusion), embolic stroke (hemorrhagic infarct extends to surface of the brain), intracerebral bleed (hypertension; rupture of lenticulostriate Charcot-Bouchard aneurysms; hernatoma not an infarct; globus pallidus/putamcn area most common), subarachnoid bleed (ruptured congenital berry aneurysm [junction of communicating branch with anterior cerebra! artery, severe occipital headache, blood covers the brain [may turn yellow after a week from breakdown into bilirubin])

Front 407

328. Hodgkin’s Lymphoma

Back 407

RS cell is the neoplastic cell; nodular sclerosmg most common type (females, lwmar cells, anterior mediastinum involvement); fever, night sweats, weight loss; youngest (lymphocyte predominant, very few RS cells, excellent prognosis); oldest (lymphocyte depletion; many RS óells, poor prognosis); death by second malignancies from alkylating agents (non-HI) lymphoma)

Front 408

329. Breast cancer risk

Back 408

overall, age most common rislq family history (mother~ sister only); history of contralateral breast cancer); unopposed estrogen ( menarche, laze menopause); history of endometrial cancer

Front 409

330. ilicosis risk for TB, not cancer; nodules’ lung with crystals; foundry worker, sandblaster

Front 410

331. As os

Back 410

pipefitter in shipyard, roo Cr, risk for TB; smoker + asbestos primary lung cancer, non-smoker + asbestos mesotheliotna asbestos body (ferruginous body) looks like a dumbbell (fiber covered by iron)

Front 411

332. Fibrocystic change

Back 411

most common breast mass <50 years (atypical ductal hyperplasia only risk factor for cancer), bloody nipple discharge <50 (benign intraductal papilloina in lactiferous duct), tumOr <35 years of age (fibroadenoma); breast mass >50 (infiltrating ductal cancer)

Front 412

333. Breast cancer types

Back 412

infiltrating ductal (most common), Paget’s (nipple involvement by underlying cancer), medullary (bulky tumor with pushing margins), inflammatory carcinoma (peau du orange; plugging of subepiderrnal lymphatics by tumor, worst prognosis), lobular cancer (most common cancer of terminal lobules; bilaterality), comedocarcinorna (central area of necrosis in ducts resembling a zit)

Front 413

334. Row to recogfllzEleukemia and leukemia typeE acute vs chronic (bone marrow exam revealing >30% blast cells is acute leukemia, blast count not high in chronic); usual profile

Back 413

anemia, thrombocytopenia (CML only leukemia that may have thrornbocytosis), high WBC count with blast cells (may be a normal count, but blast cells will be present), generalized lymphadenopathy, hepatosplenomegaly, bone pain, fever; use age brackets to pick out most likely choice (see #438); always do a bone marrow to diagnose leukemia, stains PAS for ALL, specific estaase for AML, LAP score for CML, non-specific esterase for monocytic leukemias, TRAP stain for hairy cell leukemia

Front 414

335. Hemangioma on face of a child

Back 414

leave it alone

Front 415

336. Osteopetrosis

Back 415

too much bone; anemia, marble bone disease; pathologic fractures; entrapment of cranial nerves; deafness

Front 416

337. Polycystic ovarian syndrome

Back 416

obesity, hirsutism, irregular menses, infertility; increased LH stimulates ovary to produce testosterone and 17-ketosteroids (androgens leading to hixsutism); increased adipose aromatizes androgexis to estrogens (endometrial hyperplasia/cancer), which inhibit FSH and enhance LH release, hence continuing the cycle of LH stimulation; lack of FSH causes atresia of follicles and large ovaries with subcortical cysts; LH/FSH ratio >3/I; treat with __________if patient wants to become pregnant

Front 417

338. Pituitary Cushings

Back 417

no suppression with low dose dexamethasone but can be suppressed with high dose dexamethasonc (indicates only partial autonomy); cannot suppress adrenal Cushings or ectopic Cushings;

Front 418

339. Anemia since birth, splenomegaly

Back 418

probable congenital spherocytosis, do splenectomy

Front 419

340. CT with enlarged internal acoustic meatus in a patient with tinnitus, nerve deafness, vertigo

Back 419

acoustic neuroma (schwannoma, neurilemoma)

Front 420

341. Hemoptysis with foul smelling stools or pneumonia with foul smelling stools (malabsorption) in a child

Back 420

cystic fibrosis, do sweat test

Front 421

342. Mother states that child has a salty taste when kissed

Back 421

cystic fibrosis, do sweat test

Front 422

343. Picture of coronary vessel

Back 422

atherosclerosis (slit like spaces), dystrophic calcification (blue blotches), fibrofatty plaque (beneath intimal surface)

Front 423

344. Picture with acute inflammation

Back 423

numerous neutrophils (nucleus looks like squigglies, small capillaries

Front 424

345. Picture with chronic inflammation

Back 424

numerous round cell nuclei (lymphocytes) and plasma cells (eccentric nucleus with perinuclear clearing)

Front 425

346. Picture of healed myocardial infarction

Back 425

blotchy fibrosis unlike sheets of pale staining tissue as in a pale infarction

Front 426

347. Heart softest and prone to rupture

Back 426

3-10th day; rupture with taxnponade (pericardial sac filled with blood), posteromedial papillary muscle rupture (murmur of mitral insufficiency; pansystolic, apical, systolic; RCA thrombosis), interventricular septal rupture (systolic murmur, hole in 1VS)

Front 427

348. Peripheral blood pictures

Back 427

hypersegrnented neutrophil (folatef.Biz) microcytic hypochromic cells (iron deficiency, ACD, thalassemia, sideroblastic anemia), sickle cells, target cells (bullseye), sphcrocytes (no central area of pallor), macroovalocytes (PA, folate), tear drop (myeloflbrosis), Howell Jolly body (spleen surgically removed or dysfunctional spleen as in HbSS disease), platelet (small, red, anucleate cell), lymphocyte (black dot with a thin rim of cytoplasm), Auer rod (myeloblast with immature nucleus and splinter-like structures in the cytoplasm), smudge cells with lymphocytes (CLL; smudge cells are fragile lymphocytes that rupture), hairy cells (projections from cytoplasm; HCI; B cell malignancy), atypical lymphocyte (big cell with abundant sky blue cytoplasm), eosinophil (large red granules that do not cover the nucleus, same color as RBCs), basophil (large purple granules that do cover the nucleus), rouleau (RBCs with stack of coins effect), schistocytes (fragmented RBCs), reticulocyte (special stain; thin filaments representing RNA), Heinz bodies (special stain, large blue inclusions with involvement of the RBC membrane), coarse basophilic stippling (routine stain, looks like measles of the RBC)

Front 428

349. Bone marrow pictures

Back 428

megaloblastic marrow (all the cells appear big; giant band; B12/folate deficiency), myelofibrosis (marrow is composed of fibrous tissue, large cells represent rnegakaryocytes), aplastic anemia (empty marrow with predominantly fat, and islands of lymphocytes), multiple myeloma (piasmablasts with bright blue cytoplasm, eccentric nuclei, perinuclear halo), ringed sideroblast (Prussian blue stain, ring of blue around the nucleus of a normoblast defect in heme synthesis, sideroblastic anemias [alcohol, pyridoxine, Pb poisoning])

Front 429

350. Patient with left supraclavicular node

Back 429

Virchow’s node, associated with metastatic stomach cancer or any cancer arising in the abdominal cavity; right supraclavicular node drains the lung and upper neck

Front 430

351. Roth’s spot in the retina, splinter hemorrhages, Osler’s nodes (palflful) on hands/feet, Janeway lesions hand and feet (painless), hematuria with EEC casts

Back 430

immunocomplex vasculitis associated with infective endocarditis

Front 431

352. X-ray with local dilated bowel

Back 431

sentinel loop indicating localized infection, near duodenum or transverse colon acute pancreatitis, cecum retrocecal appendicitis

Front 432

353. X-ray with step-ladder appearance and air/fluid levels

Back 432

bowel obstruction

Front 433

354. X-ray with collapsed lung and clear space along the margin

Back 433

spontaneous pneumothorax

Front 434

355. X-ray of baby with ioops of bowel in left pleural cavity

Back 434

diapbragmatic hernia

Front 435

356. Classic urine casts

Back 435

EEC casts ncpbritic syndrome (post-strcptococcal, IgA nephropathy, Goodpasturc)1 WBC casts = acute pyelonephritis, renal tubular casts acute tubular necrosis, waxy casts chronic renal failure, broad casts = chronic renal failure, hyaline casts (ghost-like casts, non-refractile, smooth bordets) = proteblurla or no clinical significance, fatty casts with Maltese crosses nephrotic syndrome (niinimal change, mcmbranous GN)

Front 436

757. Urine crystals

Back 436

calcium oxalate (looks like the back of an envelope or a square with an X drawn in it think stone, Crohn’s disease, ethylene glycol poisoning), cystine (hexagonal ciystal, cystinuria)

Front 437

358. Staghorn calcuhis in kidney

Back 437

struvite stone, magnesium aznmonium phosphat~ alkaline urine that smells like ammonia indicating a urease producing urinary pathogen (e.g., Proteus)~

Front 438

359. Lipid deposits

Back 438

Achilles tendon xanthoma = familial hypercholesterolcmia (AD; absent LDL mceptor)i xanthelasma (yellow plaque on eyelid, consider type II hyperlipidemia with increase in LDL), arcus senilis (rim of white around the outer part of the cornea, consider increased LDL if a young patient or normal age-related change if older patient), eruptive xanthomas (yellow papular lesions over the body; increased ~ig1ycer~j

Front 439

360. Psammoma bodies

Back 439

dystrophic calcification of apoptotic neoplastic cells; meningioma, papillary adenocarcinoina of thyroid, serous cystadenocarcinomas of the ovaries

Front 440

361. Addison’s disease

Back 440

autoimmune destruction; hyperpiginentation; hypotensive; hyponatremia, hyperkalemia, normal gap metabolic acidosis from aldosterone lack; hypoglycemia from hypocortisolism (no gluconeogenesis); eosinophilia (no cortisol effect)

Front 441

362. Diabetes insipidus

Back 441

central DI hypernatremia (increased Posm) with very low Uosm (no concentration, losing free water from lack of ADH); slier water deprivation, Uosm increases >50% with injection of ADH—nepbrogenic DI same as for central, except ADH is present but cannot reabsorb free water in the collecting tubules and Uosin is <50% increased after ADH administration

Front 442

363. Pathology of DM

Back 442

non-enzymatic glycosylation

Front 443

HbAIc for long-term glycemic control (4-8 weeks), byalinc arterioloscierosis (nephropathy, lacunar infarcts in the brain), enhanced large vessel atherosclerosis; osmotic damage due to conversion of glucose to sorbitol by ~ cataracts, microaneurysm in the eye, peripheral neuropathy (Schwann cell destroyed) B48

Front 444

364. DM most common cause of

Back 444

blindness, chronic renal disease, peripheral neuropathy (most common cause of pressure ulcers on the bottom of the feet), non-traumatic amputation of the lower leg, ketoacidosis, Charcot athic joint, glucosuria

Front 445

365. KA

Back 445

read endocrine notes and the discussion on diabetes mellitus

Front 446

366. hromocytoma

Back 446

benign tumor (brown color) of adrenal medulla; most unilateral, in adrenal medulla, benign; paroxysmal hypertension, headache, drenching sweats; screen urine VMA, metanephrines (best); associations+B51

Front 447

367. Neuroblastoara

Back 447

child; malignant tumor in adrenal medulla and paraganglial tissue; hypertension; metastasis to bone, skin, orbit; Homer Wright rosettes; increased urine catccholamines; SlO0 antigen positive; age <1 best prognosis

Front 448

368. ZE syndrome

Back 448

malignant islet cell tumor secreting gastrin; ulcers in usual place but can be multiple or in unusual places; increased basal acid output; increased gastrin with IV secretin test; Whipple’s procedure if operable; proton blockers can decrease gastrin; rule out other causes of hypergastrinemia (H2 or proton blockers, chronic atrophic gastritis of body and fundus, renal failure, gastric distention)

Front 449

369. MEN I (AD inheritance)

Back 449

pituitary tumor, parathyroid adenoina, 22 syndrome, peptic ulcers MEN Ha (AD inheritance)

Front 450

parathyroid adenoma, pheochromocytoma, medullary carcinoma of thyroid (calcitonin tumor marker~ calcitonin converted into amyloid) MEN Ub (AD inheritance)

Front 451

370. Left heart failure

Back 451

decreased cardiac output. dyspnea, pulmonary edema (increased pulmonary venous hydrostatic pressure), left ventricular dilatation (volume overload), S3 heart sound, mitral insufficiency murmur (stretching of MV ring), paroxysmal nocturnal dyspnea and/or pillow orthopnea at night (increased venous return at night cannot be handled by the left heart)

Front 452

371. Right heart failure

Back 452

most commonly cause by LHF, decreased cardiac output, volume overload of right ventricle, S3 heart sound, murmur of tricuspid insufficiency (stretching of TV ring), jugular neck vein distention, congestive hepatomegaly (nutmeg liver, increased LDH5 isoenzyme, RHF most common cause), ascites, dependent pitting edema (kidney reabsorbs slightly more water than salt, but both are increased and are pushed into the interstitial space by the increased venous hydrostatic pressure; restrict water and salt; ACE inhibitor decreases preload and afterload; diuretics decrease preload)

Front 453

372. High output failure

Back 453

hyperthyroidism, thiamine deficiency, too much isotonic saline, AV fistula, endotoxic shock in early phases, Paget’s disease of bone

Front 454

373. Sudden cardiac death

Back 454

death within 1 hour; severe atherosclerotic CAD but no thrombus; die of ventricular arrhythmia

Front 455

374. Angina

Back 455

exertional (severe atherosclerotic CAD; ST depression on stress ECG; pain relieved by stopping exercise or taking nitroglycerin); Prinzinetal (vasoconstriction from release of TXA2 from platelet thrombi~ atherosclerotic CAD not primary cause of disease; ST elevation on stress ECG); unstable angina (angina at rest; severe atherosclerotic CAD; infarct waiting to happen)

Front 456

375. Restrictive cardiomyopathy

Back 456

cannot fill properly; glycogen (Pompe’s glycogenosis), iron (iron overload), amyloid (senile ainyloidosis; prealbuniin), endocardial fibroelastosis in child

Front 457

376. Pericardial effusion

Back 457

neck vein distention ~ijjtJ~ inspiration (Kussmaiil sign), pulsus paradoxus (drop in blood pressure on inspiration), muffled heart sounds, hypotension; all pressures in all chambers are increased but the cardiac output is decreased; echocardiogram first step and pencardiOcentesis is treatment

Front 458

377. Constrictive pericarditis

Back 458

TB most common cause worldwide; heart cannot completeiy fill; pericardial knock when ventricles hit thickened pericardium

Front 459

378. Hypersensitivity pneumonitis

Back 459

farmer’s lung (inhalation of thcrmopbilic actinomycetca), silo filler’s (inhalation of nitrogen dioxide fumes), byssinosis (Monday morning blues; patient works in a textile factory and has contact with cotton, linen, hemp)

Front 460

379. Hamman Rich lung

Back 460

honeycomb lung; end-stage of alveolitis syncfroines (interstitial pneumonitis syndromes)

Front 461

380. Bronchiectasis

Back 461

CF most common cause; obstruction and infection; bronchi extend to lung pcripheiy; cough up cupfuls of foul smelling sputum; other causes TB (most common worldwide), Kartagener syndrome (absent dyncin arm in cilia, situs inversus) Atelectasis most common cause of fever 24 hours after surgery; elevated diaphragm

Front 462

82. Choanal atresia

Back 462

baby breaks away from breast and cyanosis is relieved by crying Nasal polyps

Front 463

aHergic~ aspirin (patient with headache develops asthma), cystic fibrosis (child with polyps)

Front 464

384. Pulmonary hypertension

Back 464

increased P2; PH leads to RVH (cor pulmonale if PH is of primary origin or due to primary lung disease not heart disease); chronic hypoxemia (vasoconstricts pulmonary vessels and vasodilates peripheral vessels), loss of pulmonary vasculature (COPD, restrictive lung diseases), left to right shunts with eventual volume overload of right heart, mitral stenosis with backup of blood into pulmonary veins; gross atherosclerosis of pulmonary arteries, smooth muscle bypertrophy of pulmonary vessels, angiomatoid lesions; primary PH mainly in young women

Front 465

385. ARDS

Back 465

non-cardiogenic pulmonary edema from neutrophil related injury; endotoxic shock most common cause; intrapulmonary shunting most important abnormality; separate from cardiogenic pulmonary edema by pulmonary capillary wedge pressure (measure of LV end-diastolic pressure; decreased in ARDS, increased in cardiogenic shock)

Front 466

386. Lung cancer

Back 466

squamous/small cell centrally located; adenocarcinomas peripherally located

Front 467

387. Dysphagia for solids not liquids

Back 467

think obstruction—strictures, Plummer-Vinson, esophageal omcer

Front 468

388. Dysphagia for solids and liquids

Back 468

think peristalsis problem—PSS, CREST syndrome, polymyositis, achalssii

Front 469

389. Leukoplakic lesions in mouth or genital area

Back 469

biopsy to rule out squamous dysplasia/cancer

Front 470

390. Smokeless tobacco

Back 470

verrucoid squamous cancer in the mouth

Front 471

391. Squamous cancer in mouth

Back 471

lateral border of tongue followed by lower lip; upper lip is a basal cell

Front 472

392. Hairy leukoplakia of tongue

Back 472

EBV glossitis, predates onset of AIDS

Front 473

393. Oral pigmentation

Back 473

PJ syndrome, Addison’s disease, Pb poisoning in adult

Front 474

394. Gum hyperplasia

Back 474

phenytoin, pregnancy, scurvy, acute monocytic leukemia

Front 475

395. Leiomyoma

Back 475

most common benign tumor in women (uterus location), most common tumor of GI tract (most commonly in stomach)

Front 476

396. Extranodal lymphoma

Back 476

most commonly in stomach (most are high grade immunoblastic lyniphomas), next in Peyer’s patches; H. pylon associated with low grade lymphomas

Front 477

397. Bowel obstruction

Back 477

adhesions from previous surgery (if no history of previous surgery, pick indirect inguinal hernia)

Front 478

398. Intussusception

Back 478

child, colicky abdominal pain, bloody diarrhea, terminal ileum into cecum

Front 479

399. Carcinoid tumor

Back 479

yellow tumor on tip of appendix most common overall site; terminal ileum most common sight for tumor that metastasizes to liver to produce the carcinoid syndrome

Front 480

400. Colorectal cancer. left side obstructs and right side bleeds

Front 481

401. Sigmoid colon most common site for

Back 481

cancer in GI tract, diverticular disease, polyps

Front 482

402. Hematochezia

Back 482

diverticulosis followed by angiodysplasia (cecum; elderly patient)

Front 483

403. Budd-Chiari syndrome

Back 483

hepatic vein thrombosis (PR.V most common cause); liver congested, ascites, portal hypertension

Front 484

404. AAT deficiency

Back 484

PAS positive globules in hepatocytes in children; panacinar emphysema in adults (lower lobes)

Front 485

405. Exfrahepatic biliary atresia

Back 485

bile duct proliferation in triads, radioactive dye cannot get into the small intestine, jaundice in first week of life

Back 486

407. Wilson’s disease

Front 487

408. Primary biliary cirrhosis

Back 487

female; early presentation with pniritus (bile salt deposition in skin), increased ~1kn1ine phosphatase. no jaundicà until late; granulomatous destruction of bile ducts in triads; increased anti-initochondrial antibodies and 1gM; association with Sjogrcn syndrome and renal tubular acidosis

Front 488

409. Sclerosing pericholangitis

Back 488

complication of ulcerative colitis; jaundice; ERCP for diagnosis

Front 489

410. Hydatid cysts in liver

Back 489

sheepherder (Basque. Greek) with liver cysts; anaphylactic shock; dog is definitive host, sheepherder is intermediate host

Front 490

411. Pipestem cirrhosis

Back 490

Schistosoma mansoni (sharp latcra1~~~adults lay eggs in portal vein tributaries producing fibrosis; ascites and portal hypertension

Front 491

412. Stone in common bile duct

Back 491

most common cause of obstructive jaundice

Front 492

413. Granulomatous hepatitis

Back 492

think TB if infective and sarcoid if non-infective

Front 493

414. lschemic ATN

Back 493

prerenal azotemia most common cause; affects multiple parts of the nephron; basement membrane disrupted; pigmented renal tubular casts

Front 494

415. Nephrotoxic ATN

Back 494

aminoglycosides and IVP dyes most common cause; o tubule only

Front 495

416. Renal papillary necrosis

Back 495

analgesic abuse (acetaminophen + aspirin), di

Front 496

417. NydrOnephrosis

Back 496

most commonly due to a renal stone

Front 497

418. Renal stone

Back 497

calcium oxalate most common stone; colicky flank pain with radiation into groin; bematuria; flat plates identifies most stones (calcium); hypercalciuria most common metabolic abnorma1it~, hydrocblorothiazidc increases calcium reabsorption in ncphron; uric acid stone non-visualized

Front 498

419. Epididymitis

Back 498

<35 GC, Chlainydia; >35 E~ col4 Pseudomonas

Front 499

420. Varicocele

Back 499

left side; bag of worms; cause of infertility; sperinatic vein comes off the left renal vein

Front 500

421. Prostatic hyperplasia

Back 500

transitional zone around the urethra; testosterone and estrogen mediated; prostate cancer is in peripheral zone (outside and detected by rectal exam), hence dribbling, urinary retention is more likely benign than malignant; PSA does not distinguish hyperplasia from cancer

Front 501

422. Testicular cancers

Back 501

serninoma most common (ciyptorchid relationship; most radiosensitive; para-aortic lymph node metastasis), choriocarcinoma most malignant (increased ~-hCG), yolk sac tumor most common in children (endodennal sinus tumor; Schiler Duval bodies; increased AFP), malignant lyinphoma most common in elderly man (metastatic)

Front 502

423. Malignant hypertension

Back 502

background of essential hypertension and benign nephrosclerosis; gross flea bitten kidney; micro necrotizing arteriolitis, fibrinoid necrosis in glomerular capillaries, onion skinning of arterioles (hyperplastic arteriolosclerosis) B118

Front 503

424. Vulvar Paget’s disease

Back 503

intraepithelial adenocarcinoma

Front 504

425. Koilocytosis

Back 504

HPV effect in squamous cells; pyknotic nucleus surrounded by a clear halo

Front 505

426. flJD

Back 505

Actinomycosis with sulfur granules; actinomycosis also for draining sinus from the jaw

Front 506

427. Endometritis

Back 506

plasma cells present; group B streptococcus

Front 507

428. Adenomyosis

Back 507

glands and stroma in myometrium; not endometriosis

Front 508

429. Eudometriosis

Back 508

glands and stroma outside confines of the uterus; reverse menses; most common ~ tJsNIUWy ~ dysmenorrhea ovaries most often involved (chocolate cysts); laparoscope most common for diagnosis and treatment; only in reproductive life

Front 509

430. Leiomyosarcoma

Back 509

most common uterine sarcoma

Front 510

431. Cervical polyp

Back 510

non-neoplastic; hangs out of cervical Os; posicoital bleeding

Front 511

432. Endometrial polyp

Back 511

no malignant potential; menorrhagia

Front 512

433. Cervical cancer

Back 512

death due to renal failure from extension into the retroperitoneum and blockage of ureters

Front 513

434. Ectopic pregnancy

Back 513

due to previous P11); rupture is most common cause of death in early pregnancy; ~-hCG initial test; vaginal ultrasound to check for amniotic sac; unclotted blood in pouch of Douglas

Front 514

435. RectaL pouch of Douglas

Back 514

anterior to rectum and posterior to uterus; can palpate with rectal exam; induration in young woman = endometrial implants; induration in elderly woman = seeding from primary ovarian cancer; unclotted blood = ruptured ectopic; pus = P11)

Front 515

436. Follicular cyst

Back 515

most common overall ovarian mass

Front 516

437. Surface derived ovarian tumors

Back 516

benign serous cystadenoma (most common overall benign tumor), Brenner’s tumor (Waithard’s rests); malignant serous cystadenocarcinorna (most common primary cancer of ovary; most common bilateral ovarian tumor; psammoma bodies), mucinous cystadenocarcinoma (largest ovarian tumor, most often associated with pseudomyxoma peritonei), endometrioid carcinotha (greatest association with cndometriosis)

Front 517

438. Germ cell tumors of ovary

Back 517

cystic teraloma most common (undergoes torsion; struma ovarii = component of thyroid tissue; teeth and bone seen on x-ray); dysgerminoma most common malignant tumor (Turner syndrome relationship; female counterpart of male seminoma with cryptorchid testis), yolk sac tumor most common tumor in girl (increased AFP)

Front 518

439. Sex cord stromal tumors

Back 518

fibroma most common (benign tumor, Meig syndrome fibroma, ascites, right sided pleural effusion), granulosa cell tumor (feminizing tumor, low grade malignancy; Call Exner bodies), Sertoli Lcydig cell tumor (benign; masculinizing tumor, alias androblastoma and arihenoblastoma), Leydig cell tumor (benign masculinizing tumor, alias hilar cell tumor, crystals of Reinke), gonadoblastoma (germ cell and sex cord stromal; catcifies; association with Turner’s)

Front 519

440. Xrukenberg tumor~ metastatic gastric cancer to both ovaries; signet ring cells

Front 520

441. Hydatidiforni moles

Back 520

complete mole (46 XX, both chromosomes of paternal origin, most often associated with choriocarcinoma grape-like mass; preeclampsia in first trimester; uterus too large for gestational age; increased ~-hCG), partial mole .(trisomy; embryo present does not transform into choriocarcinoma)

Front 521

442. Gestationally derived choriocarcinoma

Back 521

syncytiotrophoblast (synthesizes bCG and human placental lactogen) and cytotrophoblast; not chorionic villi; metastasizes to lungs; responds dramatically to methotrexa~

Front 522

443. Function of f~-hCG

Back 522

LH analogue that maintains the corpus luteum of pregnancy for 8-10 weeks, then placenta takes over

Front 523

444. Twin placenta

Back 523

monochorionic = identical twins whether monoamniotic (Siamese twins, fetal to fetal transfusion, tangle in umbilical cord) or diamniotic; dichorionic. fraternal or identical twins

Front 524

445. Abruptio placenta

Back 524

painful bleeding; retroplacental hemorrhage; maternal hypertension or cocaine abuse

Front 525

446. Placenta previa

Back 525

painless bleeding; implantation over cervical os

Front 526

447. Two umbilical arteries and one vein (oxygenated blood)

Back 526

single artery has an increased incidence of congenital anomalies

Front 527

448. Lecithin/Sphingomyelin ratio

Back 527

>2/1 in amniotic fluid indicates adequate pulmonary surfactant

Front 528

449. Urine estriol

Back 528

derived from fetal adrenal, placenta, maternal liver; low levels indicate fetal, placental or maternal problem

Front 529

450. Human placental lactogen

Back 529

growth hormone of pregnancy; anti-insulin activity

Front 530

451. Amniotic fluid

Back 530

fetal urine; alkaline PH; swallowed and recycled by the fetus

Front 531

452. Dysfunctional uterine bleeding

Back 531

bleeding not secondary to an anatomic cause; hormonal imbalance; anovulatory bleeding most common cause of bleeding after menarche; ovulatory types inadequate luteal phase and irregular shedding

Front 532

453. Ovulation

Back 532

increase in temperature; subnuclear vacuoles; presence of secretory endometrium on day 21

Front 533

454. Implantation on day 21

Back 533

3 days in the tube and 2 days in the uterus

Front 534

455. Primary amenorrhea (no menses by 16 years of age)

Back 534

no bleeding post progesterone challenge means there is no estrogen primed uterus or there is an end-organ defect; hypothalamic! pituitary defect decreased FSH/LH (anorexia nervosa, weight loss syndrome, pituitary tumor); ovarian defect increased FSH/LH (probable Turner’s syndrome), end-organ defect normal FSHJLH; most cases are normal constitutional delays with good secondary sex characteristics and withdrawal bleeding think Turner’s if there are poor secondary sex characteristics, high gonadotropins, and no withdrawal bleeding; check for imperforate hymen/absent vagina if good secondary sex characteristics and no bleeding with progesterone challenge

Front 535

456. Secondary amenorrhea (no menses for 3 months)

Back 535

pregnancy most common cause; same classification as above; Asherman syndrome stratum basalis removed owing to repeated dilatation and curettage (end-organ defect; normal gonadotropins)

Front 536

457. Cervical Pap smear

Back 536

must be endocervical cells (gold standard) indicating proper sampling of the endocervical canal where dysplasia occurs; superficial squamous cells = estrogen, intermediate squamous cells = progesterone, parabasal cells unstimulated squamous cells; normal female

Front 537

70% superficial and 30% intermediate; pregnancy/prepubertal

Front 538

100% intermediates; atrophic predominantly parabasals

Front 539

458. Lewis antibodies

Back 539

naturally occurring antibodies with no clinical significance; no risk of hemolytic disease of newborn (HDN)

Front 540

459. Duffy antigens

Back 540

uncommon in Blacks; surface receptor for P. vivax~ hence protection against malaria

Front 541

460. I antigens

Back 541

anti-I is a cold agglutinin (1gM) seen in M. pneuznoniae infections; anti-i (1gM) is seen in infectious mononucleosis

Front 542

461. Blood group 0

Back 542

universal donor, no antigens on surface and cannot be destroyed; must receive 0 blood, increased incidence of duodenal ulcers, have 3 antibodies (anti-A 1gM, anti-B 1gM, antiA,B IgG [can cross the placenta])

Front 543

462. Blood group AB

Back 543

universal recipient; no antibodies to destroy transfused RBCs

Front 544

463. Blood group A

Back 544

has anti-B 1gM; increased incidence of gastric cancer

Front 545

464. Blood group B

Back 545

has anti-A 1gM

Front 546

465. Rh positive

Back 546

means the patient has D antigen; other Rh antigens C, c, E, e, d does not exist

Front 547

466. Major crossmatch

Back 547

patient serum against donor RBCs to see if there are any patient antibodies that react against donor RBCs; if compatible~ it does not guarantee that infused RBCs will not be destroyed or that the patient will not develop antibodies against other donor RBC antigens

Front 548

467. HP? risk post-transfusion

Back 548

1

Front 549

468. HBV risk post-transfusion

Back 549

1

Front 550

471. Fresh frozen plasma

Back 550

contains all coagulation factors; only for multiple factor deficiencies; risk of hepatitis

Front 551

472. Packed RBCs

Back 551

high hematocrit contains some plasma; transfuse only if patient is symptomatic and does not respond to medical therapy; risk of hepatitis

Front 552

473. Platelet transfusion

Back 552

only if patient is symptomatic; risk of hepatitis

Front 553

474. Cryoprecipitate

Back 553

all factor VIII molecules, fibrinogen, factor XIII, fibronectin; hepatitis risk

Front 554

475. Rh immune globulin

Back 554

anti-D from pooled human donors (passive immunization); does not cross the placenta; give to pregnant women who do not have anti-D to protect during each pregnancy; give if baby is Rh positive and mother does not have anti-D (give within 3 days); amount of Rh immune globulin to give is based on Klelhauez’Be&e teat performed on maternal blood that detects the amount of fetal-maternal bleed (fetal RBCs resistant to alkali and c14 no hepatitis risk

Front 555

476. Rh HDN

Back 555

mother Rh negative and baby Rh positive; first pregnancy with Rh + baby has no effect on baby but mother could be exposed to fetal RBCs with D antigen during delivery and develop antibodies (purpose of Rh immune globulin is to prevent this); if subsequent pregnancies have Rh + babies, maternal anti-D IgG antibodies cross placenta -~ attach to fetal RBCs -, RBCs extravascularly removed by fetal macrophages in the spleen —‘ unconjugated bilirubin (UCB) is end-product of hemolysis —, fetus develops anemia (chance of heart failure and hydrops fetalis) and mother’s liver takes care of the UCB —, bilirubin pigment can be detected in amniotic fluid (optical wavelength of 450) and mapped on a Liley graph to determine severity of hemolysis -+ at delivery, baby cannot handle UCB load and is often exchange transfused to prevent kernicterus, remove UCB, remove antibodies, correct anemia

Front 556

477. Febrile transfusion reaction

Back 556

patient has anti-HLA antibodies against HLA antigens on donor Icukocytes causing release of pyrogens from destroyed donor leulcocytes; type II hypersensitivity

Front 557

478. Allergic transfusion reaction

Back 557

patient develops hives against proteins in donor unit; type I hypersensitivity

Front 558

479. Hemolytic transfusion reaction

Back 558

ABO incompatibility (patient receives wrong blood type; e.g., patient A thas anti-B 1gM] and donor blood is B; anti-B 1gM attaches to B positive donor cells -4 activates complement system -~ intravascular hemolysis; type II hypersensitivity reaction); patient has undetected antibodies that react against donor RBC antigens (extravascular hemolysis; jaundice, drop in Hb, positive direct Coombs; type II hypersensitivity)

Front 559

480. Factors preventing small vessel bleeding

Back 559

heparin (enhances antithrombin III [ATm], which neutralizes most serine protease coagulation factors-prothrombin, X, DC~ XIL Xl, thrombin), P012 (synthesized by endothelial cells, vasodilator, inhibits platelet aggregation), protein C and S (inactivate factors V and VIII, enhance fibrinolysis), tissue plasminogen activator (release of plasmin, which destroys coagulation factors and clots)

Front 560

481. Factors acting as procoagulants in small vessel injury

Back 560

thromboxane A2 (synthesized by platelets, vasoconstrictor, enhances platelet aggregation; cyclooxygenase blocked by aspirin and NSA.1DS), von Willebrand factor (Vffl VWF; synthesized by endothelial cells and megakaryocytes, platelet adhesion factor [platelets have receptors for VIIl VWF]), extrinsic and intrinsic coagulation system B44

Front 561

482. Normal events with vessel injury

Back 561

vessel injury —~ activation of factor VII in the extrinsic coagulation system by tissue thromboplastin and activation of factor XII in the intrinsic system by exposed collagen —4 platelets stick to VIIJ VWF via their receptors (platelet adhesion) - stimulus for platelet release of AD? from dense bodies causing platelet aggregation and synthesis of TXA2 - temporary platelet plug with fibrinogen draped over it (fibrinogen flbrinogen into flbrin and forms a stable platelet plug -+ plasmin destroys the plug and reestablithes blood flow

Front 562

483. Bleeding time

Back 562

detects platelet abnormalities up to the formation of the temporary hemostatic plug (thrombocytopenia; no VflI VWF for platelet adhesion; patient on aspirin and no TXA2 for aggregation [most common cause])

Front 563

484. Ristocetin cofactor assay

Back 563

best test for Vffl VWF (von Willebrand factor, which is synthesized by endothelial cells and megakaryocytes and is necessary for platelet adhesion [platelets have receptors])

Front 564

485. Prothrombin time (Fl)

Back 564

detects extrinsic coagulation system factors down to formation of a clot—VU (extrinsic system) -~ X —~ V -4 U (prothrombin) -, I (fibrinogen) -+ clot; international normalized ratio (for patients on warfarin) standardizes the test throughout the world so all test results are the same regardless of the reagent used; PT is best test for liver synthetic function

Front 565

486. Partial thromboplastin time (PTT)

Back 565

detects intrinsic coagulation system factors (XII, XI, IX, Viii) down to formation of aclot-XU -, XI -4 IX -4 VIII -4 X .4 V —311 (prothrombin) - I (flbrinogen) —4 clot; used to follow heparin therapy and factor deficiencies

Front 566

487. Factor VU deficiency

Back 566

prolonged PT and normal PU

Front 567

488. Factor VIII deficiency (hemophilia A

Back 567

decreased VUI coagulant, normal VIII antigen and Vffl VWF) normal PT and prolonged PU

Front 568

489. Factor X deficiency

Back 568

prolonged PT and PiT

Front 569

490. Patient on heparin

Back 569

prolonged PT and PTT but PU is the better test to follow patients; if ovcranticoagulatcd give protamine sulfate

Front 570

491. Patient on warfarin (blocks vitamin Ks ability to y-carboxylate factors U, VU, IX, X, protein C and S by blocking epoxide reductase, which normally keeps vitamin K in its active KI state)

Back 570

prolonged PT and PU but PT is better test for following patients; if overanticoagulated and seriously bleeding give fresh frozen plasma and IM vitamin K; if bleeding not serious, give TM vitamin K

Front 571

492. Patient with VWD (all factor VIII components decreased

Back 571

VIII coagulant, Vffl normal PT and prolonged PU autigen, Vffl VWF) prolonged bleeding time, normal PT, prolonged PT!’

Front 572

493. Patient with antibody against factor Vui

Back 572

coagulant (circulating anticoagulant, inhibitor) and prolonged PTT normal PT and prolonged PTT; after mixing 0.5 cc of normal plasma with 0.5 cc of patient plasma, the Pfl is repeated and is still prolonged because antibodies inhibited VIII coagulant in the normal plasma as well; a true factor ViiLcoagulant deficiency would have correction of the PIT after adding normal plasma

Front 573

494. Fibrinolytic system tests

Back 573

fibrin (ogen) split.products (X, Y, D, E fragments) after plasmin breakdown of fibrinogen or a fibrin clot; D-dimers, which measures cross-linked fibrin monomers in a fibrin clot

Front 574

495. NC

Back 574

intravascular consumption of clotting factors (fibrinogen, V, VIII, prothrombin, platelets) with diffuse, oozing of blood from all breaks in the skin; causes . endotoxic shock, infections, snake envenornation, amniotic fluid embolism); prolonged PT and PU, low fibrinogen, increased split products and. D-dimer (these are the best tests for DIC), thrombocytopenia, schistocytes (RBCs hit fibrin clots); treat the underlying disease causing DIC; use blood components to keep the patient alive; heparin blocks thrombin, hence preventing clots and consumption of coagulation factors B161

Front 575

496. Hereditary thrombosis syndromes

Back 575

venous thrombosis and pulmonary emboli; ATIII deficiency (no prolongation of PIT after starting heparin), protein C and S deficiency

Front 576

497. Heparin

Back 576

prevents venous clot formation; does not dissolve the clot; can be used in pregnancy; can produce thrombocytopenia

Front 577

498. Warfarin

Back 577

blocks epoxide reductase (normally keeps vitamin K in its active K! state); previously y-carboxylatcd vitamin K dependent factors must disappear before patient is fully anticoagulated (reason why heparin is given along with warfarin); VII and protein C have the shortest half-life (6 hours) and prothrombin the Longest (3 days);. hemorrhagic skin necrosis patient with heterozygote protein C deficiency and 50% factor level, when put on warfarin will have 0% protein C levels in 6 hours causing thrombosis of vessels in the skin before the patient is fully anticoagulated B174

Front 578

499

Back 578

Henoch-Schoenlein’s purpura most common immunocomplex (igA-anti-IgA) vasculitis in children; URI followed by palpable purpura (sign of small vessel vasculitis), polyarthritis, bematuria (glomenilonephritis), Gi bleed

Front 579

500. Thromboangiitis obliterans (Buerger’s)

Back 579

smoker’s vasculitis; thrombosis of digital vessels with gangrene; quit smoking

Front 580

501. Kawasaki’s disease

Back 580

most common cause of childhood myocardial infarction; coronary artery vasculitis + mucous membrane inflammation and skin desquamation at tips of fingers

Front 581

502. Polyarteritis nodosa

Back 581

immunocomplex vasculitis of muscular arteri HBsAG —30%; vessels in different stages of healing; aneurysm formation; renal infarction; p-ANCA antibodies; 1 ose th arteriography

Front 582

503. Takayasu’s arteritis

Back 582

pulseless disease in Asian female; granulomatous vasculitis of aortic arch vessels; blindness; strokes

Front 583

504. HbAIc

Back 583

best test to following glycemic control over the last 4-8 weeks in diabetes

Front 584

505. Aseptic necrosis

Back 584

Legg-Perthe (femoral head; child under 10), femoral fracture in elderly (most common cause), scaphoid bone in wrist, corticosteroids (femoral head), HbSS (femoral head)

Front 585

506. Osgood Schiatters

Back 585

inflammation of proximal tibial apophysis at insertion of patellar tendon; active boys

Front 586

507. Hypoglycemia

Back 586

most commonly due to insulin overdose in a type I diabetic I

Front 587

508. Bell’s palsy

Back 587

droopy face; cannot close eye; association with HSV-1

Front 588

509. Islet cell tumors

Back 589

510. Myotonic dystrophy

Front 590

511. Alcohol and CNS/PNS

Back 590

Wernicke-Korsakoft cerebellar atrophy, cerebral atrophy, central pontinc mydlinolysis (too rapid infusing of sodium in hyponatremia), peripheral neuropathy

Front 591

512. Guillain-Barré

Back 591

autoimxrnme dernyclination of peripheral nerves primarily affecting motor fibers; follows URI; ascending paralysis (LMN symptoms); increased CSF protein, no increase in cells

Front 592

513. Menetrier disease

Back 592

increased endolymph; dizziness, vertigo, hearing loss, horizontal nystagmus

Front 593

514. Benign positional vertigo

Back 593

most common cause recurrent vertigo; no hearing loss or tinnitus; nystagmus; dislocation of otoliths

Front 594

515. Multiple sclerosis

Back 594

most common deniyelinating disease; association with HSV-6 and HLA-Dr2; scanning speech (sound drunk), intention tremor, nystagmus; paresthesias and muscle weakness; plaques commonly periventricular; cerebellar ataxia internuclear ophthalmoplegia; increased CSF protein and slight increase in lymphocytes

Front 595

516. Parkinson’s

Back 595

dcpigrnentation substantia nigra decrease in dopamine; Lewy bodies in neurons; rigidity bradykinesia, cogwheeling resting tremor (pill rolling); festinating gait; blank stare; MflP association, drugs (chiorpromazine) B179

Front 596

517. Oligodendroglioma

Back 596

adult; frontal lobes; benign tumor that calcifles

Front 597

518. Calcium/PTH disorders

Front 598

519. Kidneys with irregular white patches on the cortical surface

Back 598

pale infarcts from enibolization from the left heart

Front 599

520. Concentric hypertrophy of left ventricle

Back 599

increased afterload; essential hypertension most common cause; aortic stenosis; not mitral stenosis (no hypertrophy, since blood is not getting into the LV)

Front 600

521. Hypertrophy and dilatation of left ventricle

Back 600

volume overload due to aortic or mitral valve insufficiency, left to right shunts with increased return to left heart, aortic valve ring dilatation (dissection, aortitis) Anatomy Questions

Front 601

1. Gsp junction

Back 601

dye passes from one cell to the next

Front 602

2. Derivation of adrenal medulla

Back 602

neural crest origin; neuroblasts develop into ganglia know the layers of the adrenal gland from outside in

Front 603

3. Tibial nerve function

Back 603

plantar flexion of toes; injury loss of plantar flexion, foot dorsiflexed and everted (calcaneovalgocavus), sensory loss on sole of foot

Front 604

4. Composition of aortic valve (also pulmonic valve)

Back 604

lined by endothelium and have abundant fibroclastic tissue plus a dense collagenous core; avascular~ MV and TV have a loose connective tissue core which is increased in initral/iricuspid valve prolapse (myxomatous degeneration)

Front 605

5. Break humerus, wrist drop

Back 605

radial nerve injury

Front 606

6. Post-radical mastectomy—winged scapula

Back 606

indicates injury to the long thoracic nerve; paralysis of the serratus anterior muscle

Front 607

7. Patient with a nosebleed and rhinorrhea

Back 607

fracture of cribrif’orm plate in ethmoid sinus

Front 608

8. Medial longitudinal fasciculus demyelination in MS

Back 608

internuclear ophthalmoplegia

Front 609

9. Parathyroid derivation

Back 609

third and fourth pharyngeal pouches

Front 610

10. Aortlc arch derivatives

Back 610

review in embiyology book or First Aid for Boards

Front 611

11. Phase of meiosis eggs are in before and after ovulation

Back 611

before mciosis I is arrested in prophase until ovulation; meiosis II is arrested in metaphase after fertilization B206

Front 612

12. What runs along the radial artery

Back 612

median nerve

Front 613

13. Artery affected in femoral neck fracture

Back 613

medial femoral circumflex artery

Front 614

14. EM of egg

Back 614

where does sperm penetrate (zona pellucida)

Front 615

15. Where is metaphase II completed

Back 615

in uterus

Front 616

16. Types of collagen

Back 616

I (bone, tendon, skin; greatest tensile strength), ifi (initial collagen of wound repair, replaced by type I [collagenase with Zn as a cofactor]), IV (basement membrane), X (epiphyscal plate; picture of bone on the exam and had to label where X was located)

Front 617

17. Wallerian degeneration

Back 617

Schwann cells begin to proliferate and form a tube that will serve to guide axon sprouts in the regeneration process; regeneration of the nerve occurs by the outgrowth of multiple axon sprouts from the proximal surviving segment of the axon; sprouts are directed distally (growth rate of 1-3 mm/day) down the tube established by the proliferating Schwann cells; sprouts are remyelinated and reestablish continuity with the motor end plate of the muscle.

Front 618

18. Circle of Willis diagram

Back 618

name arteries

Front 619

19. Kidney CT

Front 620

20. CT liver~ show where the bepatic vein drains into the inferior vena cava

Front 621

21. Nerve injured in inidshaft humerus fracture

Back 621

median nerve

Front 622

22. Know the layers of the gastric inucosa

Front 623

23. Oligodendrocytes

Back 623

myelinate in the CNS, while Schwann cells myelinate in the PNS

Front 624

24. Stage of eggs post-partum

Back 624

meiosis I arrested in prophase

Front 625

25. Eye closed cannot open and eye deviated down and out

Back 625

oculomotor nerve palsy; eye down and in trochlear nerve palsy B210

Front 626

26. Child with a popsicle stick in his mouth falls down causing the popsicle stick to hit the back of his throat and develops ptosis and ineiosis of the right eye

Back 626

injury to the cervical sympathetic ganglion

Front 627

27. Vertical diplopia is associated with

Back 627

cranial nerve IV palsy

Front 628

28. Patient with headache and physical findings of mydnasis in the right eye in association with mild lid lag, and deviation of the eye down and out

Back 628

an aneurysm compressing cranial nerve 111 (headache is the giveaway for aneurysm)

Front 629

29. Patient with a recent history of bacterial meningitis has horizontal diplopia in the left eye, which is worse on gaze to the left

Back 629

cranial nerve VI palsy (lateral rectus weakness from VI nerve palsy)

Front 630

30. Patient with bilateral lateral rectus muscle weakness

Back 630

increase in intracranial pressure (classic sign; papilledema usually present)

Front 631

31. Paralysis of upward gaze in an infant bydrocephalus secondary to stenosis of the aqueduct of Sylvius (this is called Parinaud’s syndrome)

Front 632

32. Multiple ocular motor nerve disorders

Back 632

diabetes mellitus (common cranial nerve palsies from osmotic damage to nerves)

Front 633

33 Weakness of the quadriceps muscle and an absent knee jerk reflex

Back 633

herniated L3 - L4 disk .~

Front 634

36. Young child falls on his outstretched arm and has pain in the middle and lateral portion of his clavicle; upper extremity remains in abduction, extension, and internal rotation

Back 634

nerve injured is C5-C6 (Erb-Duchenne syndrome, or superior brachial plexus injury due to a clavicular fracture; these are also the most common fractutas In newborns; C8-T1 are inferior brachial plexus injures or Klumpke’s syndrome)

Front 635

37. Patient has paralysis of the oculomotor nerve after a head injury

Back 635

uncal herniation with compression of the Ifird nerve (ptosis of eye, mydriasis)

Front 636

38. Numbness of the thenar aspect of the hand

Back 636

median nerve (carpal tunnel)

Front 637

39. Wrist bone with greatest incidence of aseptic necrosis

Back 637

navicular bone (scaphoid) _____

Front 638

40. Supracondylar fracture

Back 638

injury to brachial artery and median nerve; danger of ischemic contractures in forearm muscle (VoI1rm~nn’s ischemic contracture)

Front 639

41. Know the fetal circuistion

Back 639

ductus venosus and umbilical vein have the highest oxygen content

Front 640

42. EM of alveolus with macrophage, type~ U pneumocytes (lamellar bodies (surfactanti)

Front 641

43. EM of small bowel with microvilli on the surface

Front 642

44. Histologic section of seminiferous tubule

Back 642

identify cell that makes sex hormone binding globulin (Sertoli cell)

Front 643

45. Know the bands In skeletal muscle

Back 643

A band has myosin ATPase

Front 644

46. RespIratory bronchiole

Back 644

last airway structure with cilia -~

Front 645

48 EM

Back 645

know normal organdies in a cell-see picture in First AID for Boards

Front 646

49. Know normal structures CT exams of the chest, abdomen, leg, arni.CNS

Front 647

50. Voice hoarseness post thyroid surgery

Back 647

injury to laryngeal nerve

Front 648

51. MRI of orbit

Back 648

find superior oblique muscle

Front 649

52. MR.! of abdomen

Back 649

identify splcnic artery above the pancreas

Front 650

53. Chest x-ray

Back 650

fluid in the costophrenic sulcus in CHF

Front 651

54. Barium study of small intestine

Back 651

need to know how to separate from large bowel; superior mesenteric artery supplies small bowel X-ray showing enlargement of the posterior heart enlarged left atrium in a patient with mitral stenosis B241

Front 652

56. Neuroanatomy

Back 652

emphasis on blood supply and lesiofls of the brainstan and cortex, all of the cranial nerves and their flmctions

Front 653

57. MRI of the carotids with occlusion of the anterior cerebral artery

Back 653

would effect the contralateral leg

Front 654

58. Scbwannoma in jugular foramen

Back 654

weakness of palate/loss gag reflex/laryngeal paralysis (X), trapezius/stemocleidomastoid (XI), loss taste sensation posterior third of tongue (IX)

Front 655

9 Weber syndrome

Back 655

lesion of oculomotor nerve and UMN signs with.a midline, midbrain lesion Homer’s syndrome diagram of vertebra and sympathetic trunic pick cervical sympathetic ganglion 61. Pupil light reflexes with eye diagrams of pupils one set is an oculomotor nerve lesion 62. Extent of the spinal cord in adults

Front 656

65;

Back 656

Bitemporal bemianopsia

Front 657

66. Inferior quadrantanopia

Back 657

defect in the superior fibers in the parictal lobe

Front 658

67. Loss of sensation in the hands, history of burns without knowing it

Back 658

syringomyelia in cervical cord and involvement of crossed spinothalamics syringomyelia B250

Front 659

68. C transection of fasciculus gracilis

Back 659

effects vibration and fine touch of lower extremity only

Front 660

CN III and UMN signs on opposite side

Back 660

midline midbrain lesion

Hint 660

None

Front 661

70. Loss of pain and temperature and UMN signs on opposite side

Back 661

mid pons lesion

Front 662

71. Homer’s syndrome with localization of lesion on a diagram

Back 662

j !LflhI1~LiXJl4!~ with associated cranial nerve palsy in the medulla and hypothalamus with associated temperature regulation problems

Front 663

72. Parkinson’s disease

Back 663

MPTP drug of abuse association

Front 664

73. Cross-section of an embryo

Back 664

identify neural crest tissue

Front 665

74. Blood production prior to birth

Back 665

liver, bone marrow

Front 666

75. Bochdalek hernia in posterolateral part of diaphragm on left

Back 666

present early in life; visceral contents extend into the chest cavity causing severe respiratory distress at birth; parasternal diaphragmatic hernias ~end through the foremen of Morgagni beneath the sternum and do not usually develop symptoms until later in lifc~

Front 667

76. Artery associated with foregut

Back 667

celiac; midgut superior inesenteric; hindgut inferior mesenteric Damage to hearing in a rock and roll band player. injury to cochlea B260

Front 668

78. Know normal histologic appearance of small bowel and stomach Argyll-Robertson pupil

Back 668

accommodates when patient follows finger moving towards the nose but does not react to direct light neurosyphilis

Front 669

1. Mechanism of action of Streptococcus ~ga1actiae (group B streptococcus)

Back 669

inhibits phagocytOSiS

Front 670

2. Cause of an immunodeficiency with a high 1gM

Back 670

defect in isotype switching

Front 671

3. Cyclosporme necessary in identical twin transplant—?why

Back 671

there is still some difference in MHC sites from crossover of chromosomes during mciosis

Front 672

4. Major drift with influenza

Back 672

major changes in the reassortment of genome pieces indicating a need for a new vaccine; only protects against influenza A; egg based vaccine; killed virus vaccine

Front 673

5. Receptor for H1V

Back 673

CD4 molecule on helper I cells (also macrophages, dendritic cells)

Front 674

6. Tetany at birth

Back 674

DiGeorge syndrome, a pure 1 cell deficiency due to absence of the third and fourth pharyngeal pouches (3rd inferior parathyroids + thymus; 4th superior parathyroids); absent thyrnic shadow

Front 675

7. Graft versus host reaction

Back 675

common in T cell deficiencies; must irradiate the donor blood to destroy lymphocytes (also destroys CMV)

Front 676

8. CD common to both B and T cells

Back 676

CD45 is present in all leukocytes

Front 677

9. Complement fixation reactions

Back 677

read Jawilz section in Medical Microbiology on iruniunologic tests

Front 678

10. Hanta virus

Back 678

carried in rodents (deer mice); ARDS, hemorrhage, renal failure; viral RNA in lung tissue (PCR test)

Front 679

11. Staphylococcus aureus

Back 679

protein A attaches to Fc receptor of macrophages, hence blocking opsonization of bacteria

Front 680

12. Proteus mirabilis

Back 680

moves with flagella; urease producer

Front 681

13. C diphtheria

Back 681

toxin inhibits elongation factor 2 by ADP-ribosylation, hence blocking protein synthesis

Front 682

14. Mycoplasma pnesimonlae

Back 682

requires sterols

Front 683

15. Pneumonitis (larval transinigration) + ova in stools

Back 683

Ascaris or h okworm; not Strongyloides (rhabditiform larvae in the stool not eggs)

Front 684

16. Latex agglutination reactions

Back 684

antibody to capsular antigens is attached to the beads

Front 685

17. Locations of cells in lymph node

Back 685

B (follicles), I (paracortex), histiocytes (sinuses)

Front 686

18. Cells that attack protozoans

Back 686

CD4 I cells

Front 687

19. What gives bacteria their shape

Back 687

peptidoglycan layer in the cell wall

Front 688

20. Tumbling motility, Gram positive rod

Back 688

Listeria monocytogenes; invades mononuclear cells, beta-hemolysis in blood agar, transpiacental infection hi fetus or occurs in renal transplant patients, mainly contracted from eating unpasteurized cheese

Front 689

21. Gray membrane that bleeds when removed

Back 689

Diphtheria

Front 690

22. Dengue

Back 690

transmitted by mosquito (Aedes aegypti; same mosquito as in yellow fever); “breakbone fever”; may be hemorrhagic

Front 691

23. Infection associated with premature rupture of the membrane

Back 691

group B streptococcus (S. agalacziae); CAMP test

Front 692

24. IL-I function on B Lymphocytes

Back 692

activates B cells

Front 693

25. Location for S. aureus carriers

Back 693

anterior nares

Front 694

26. River blindness

Back 694

Onchocerca, bite of blackfly, do skin biopsy, ivermectin

Front 695

27. Rhinovirus

Back 695

common cold occurs more often in fall and winter, person to person droplet infection and contamination of hands; acid-labile (does not cause gastroenteritis because of this)

Front 696

28. Virus responsible for a cold in spring and summer

Back 696

adenovirns

Front 697

29. LactobaciLlus in vagina

Back 697

responsible for the acid pH

Front 698

30. Influenza vaccine

Back 698

killed; egg-based

Front 699

31. Pruritic skin lesion in Gulf War veteran

Back 699

cutaneous leishmaniasis due to bite of sandfly

Front 700

32. Hib vaccine

Back 700

antibody against capsular polysaccharide

Front 701

33. In addition to the normal childhood immunizations, what additional immunizations are recommended in sickle cell disease and cystic fibrosis

Back 701

Pneumococcus and influenza (Pneumovax is given after 2 years of’ age)

Front 702

34. Which live vaccine can be given to a patient with AIDS

Back 702

MMR (MMR is given only because the natural infection for measles is worse than the one that potentially could happen with the attenuated virus)

Front 703

35. List the live vaccines

Back 703

MMR, varicella, OPV, BCG, smallpox, and yellow fever

Front 704

36. List the polysaccharide vaccines

Back 704

Pneuinococcus and Hib (nieningococcal vaccine is another example)

Front 705

37. List the killed virus vaccines

Back 705

influenza, rabies, SALK vaccine

Front 706

38. List the immunizations that are contraindicated in patients with anaphylactic reactions against eggs

Back 706

MMR, influenza, yellow fever

Front 707

39. List immunizations that are contraindicated in patients with anaphylactic reactions against neomycin

Back 707

MMR, varicella (neomycin is used as a preservative)

Front 708

40. Verrucoid lesion in lower extremity in a patient returning from South America

Back 708

South American blastomycosis, yeast with a ships wheel appearance; North American blastomycosis has wide based buds

Front 709

41. AIDS patient with 2 peaks in the natural history of his disease

Back 709

p24 antigen

Front 710

42. ELISA test for 11W

Back 710

anti-gp 120 antibodies, confinn with western blot

Front 711

43. Best test for detecting fflV viral burden in blood

Back 711

HIV R.NA by PCR

Front 712

44. Newborn baby in H1V positive mother

Back 712

newborn has anti-gp 120 in the serum (IgG antibody); prevent HIV in newborn by giving mother AZT.

Front 713

45. Animal association with toxoplasmosis

Back 713

cat

Front 714

46. Most common cause of diarrhea in children

Back 714

rotavirus

Front 715

47. E. coli

Back 715

attaches to the urogenital epitheliuzn, hence its #1 status for urinary tract infections

Front 716

48. Bruton’s agammaglobulineinia

Back 716

SXR; defect in pre-B to B cells; prone to respiratory infections; need N gamma globulin

Front 717

48. SCID

Back 717

first immunodeficiency treated with gene therapy (replacement of adenosine deaminase) I

Front 718

50. Wiskott Aldrich

Back 718

SXR; triad of sinopulmonary infections, eczema, thrombocytopenia; B and T cell deficIci~y; increased incidence of leukemia/lymphoma SI. Part of a vaccine that is antigenic polysaccharide capsule B262

Front 719

52. Person working with animal hides develops lung disease

Back 719

Bacillus anthrax (woolsorter’s disease)

Front 720

53. Cryptococcus

Back 720

evades host destruction via its polysaccharide capsule

Front 721

54. Child with anemia and diarrhea—? parasite

Back 721

hookworm produces iron deficiency

Front 722

55. Lympbocutaneous nodules in a rose gardener

Back 722

sporotrichosis; treat with potassium iodide

Front 723

56. Elderly male smoker with non-productive cough, bacteria fails to grow on ordinary media (must be supplemented with iron and cysteine), need Dieterle silver stain to identify

Back 723

LegioncLia; treat with erythromycin Macrophage activation ‘y-interferon secreted from helper T cell Know examples of all the hypersensitivity reactions see immunopatholo~’ notes IgA deficiency

Front 724

66. Know antibodies in different diseases

Back 725

Destroy C difficile in bedpan

Front 726

1. Rate limiting reaction in cbolester~I synthesis

Back 726

HMG Co reductase

Front 727

2. Findings in PKU

Back 727

mousy odor, tyrosine missing, hence it must be supplied in the diet, can diagnose by amniocentesis and finding the abnormal gene; eliminate phenylalaninc from diet (Nutrasweet is aspartate and phenylalanine, so cannot use it)

Front 728

3. I cell disease

Back 728

inability to phosphorylate the mannose residues of potential lysosomal enzymes, hence they cannot be taken up by the lysosomes to degrade complex substrates

Front 729

4. Number of glucoses necessary to build palmitic acid a 16 carbon compound

Back 729

4 glucoses, each glucose run producing 2 acetyl CoA, the latter containing 2 carbons each

Front 730

5. Insulin lack in DKA

Back 730

decreased glycolysis, glycogenesis, fatty acid synthesis, storage of fat in adipose

Front 731

6. Uncoupling agents (e.g., alcohol, salicylates)

Back 731

produces brown fat from increased heat from reactions flying to increase the generation of more protons to make Al?

Front 732

7. Von Gierke’s

Back 732

decreased glucose 6-phosphatase (gluconeogenic enzyme) with decrease in glucose (fasting hypoglycemia) and increase in glucose 6-phosphate with production o(normal glycogen in the liver and kidneys; stinnilation tests with glucagon, fructose, etc. cannot increase the glucose levels owing to the missing enzyme

Front 733

8. Biochemical processes in both cytosol and mitochondria

Back 733

urea cycle, heme synthesis, gluconeogenesis

Hint 733

None

Front 734

9. Female with pheochromocytoina

Back 734

what dietary alteration probably decrease phenyl~nine (essential AA) and tyrosinc (not an essential AA) in the diet

Front 735

10. Pregnant female with PKU

Back 735

what diet low in phenylalanine and high in tyrosine; avoid Nutrasweet since it contains aspartate and phenylalanine iL Lesch Nyhan SXR with absent }IGPRT, seIf~mutilation, hyperuricemia, mental retardation

Front 736

12. Glucokinase

Back 736

only in liver, high Vm and high Kin, not inhibited by glucose 6-phosphate; hexokinase in all tissues; inhibited by glucose 6-phosphate; low Vm and low Kin

Front 737

13. Branched chain amino acids and maple syrup urine disease

Front 738

14. Glycogenolysis

Back 738

review biochemistry

Front 739

15. Key enzyme in gluconeogenesis

Back 739

fructose 1,6 bisphosphatase (catalyzes the conversion of fructose 1,6-bispbosphatc to fructose 6-phosphate)

Front 740

16. Locations of glucose 6-pbosphatase (gluconeogenic hormone)

Back 740

liver, kidney, intestinal epitheium (lesser extent than others); absent in von Gierke’s disease

Front 741

17. Shuttles and what they carry

Back 741

carnitine (even chained fatty acids), malate (NADH)

Front 742

18. Functions of LDL

Back 742

vitamin D synthesis, other steroid synthesis, cell membranes, synthesis of bile salts/acids

Front 743

19. Acetyl CoA uses

Back 743

how many times used in FA synthesis, CH synthesis, ketone body synthesis

Front 744

20. Km and Vmax Lineweaver Burke

Back 744

competitive vs non-competitive inhibitors

Front 745

21. Question on fatty acid length and energy production

Front 746

22. Urea cycle

Back 746

method of eliminating ammonia

Front 747

23. Epinephrine given and only small branched chains found

Back 747

debrancher deficiency

Front 748

24. Know cholesterol synthesis

Back 748

review Harvcy/Champc

Front 749

25. Origin of apolipoproteins 100 (liver) and 48 (intestine)

Front 750

26. Rate limiting step in glycogenolysis

Back 750

glycogen phosphorylase

Front 751

27. Reason why liver can not use ketones for fuel

Back 751

liver cannot activate acetoacetate in the mitochondria, which requires succinyl CoA acetoacetate CoA transferase (a thiotransferase enzyme) in order to convert AcAc into acetoacetyl CoA.

Front 752

28. McArdles disease

Back 752

absent muscle phosphorylase; increased glycogen in muscle; no increase in lactic acid after exercise

Front 753

29. Pregnant woman is a beer drinker—what supplements does she need

Back 753

still needs folate because alcohol increases loss of folate in urine and stool which offsets the amount of folate present in beer, furthermore, she would probably be taken off beer because of fetal alcohol syndrome and would need folate; iron is not affected by beer drinking

Front 754

30. Insulin

Back 754

key hormone of the fed state; glucagon key hormone of the fasting state

Front 755

31. Mannose 6-phosphate

Back 755

involved in transfer of dolichol (lipid) in the RER in the synthesis of 0-linked glycosides

Front 756

32. Know all the lysosomal storage diseases

Back 756

see Genetics notes; two SXR diseases are Fabry’s and Hunter’s syndrome

Front 757

33. Know all the reactions involving NAD/NADH and NADP/NADPH review Chainpe Harvey book

Front 758

34. Major source of NADPH

Back 758

HMP shunt; malate dehydrogenase reaction to a lesser extent; NADPH supplies reducing equivalents

Front 759

35. Mutation changes an amino acid sequence—which one would have the greatest effect on migration in a serum protein electrophoresis

Back 759

one with the most negative charges (most acidic)—glutamine; one that would remain closest to the anode (- pole) is the most basic amino acid—arginine

Front 760

36. Mechanism of ketoacidosis in DKA

Back 760

increased ~3-oxidation of fatty acids and production of acetyl CoA, which is used by the liver to synthesize ketone bodies

Front 761

37. Promoter location

Back 761

linear gene drawing with labels pick upstream location

Front 762

38. Energy source for protein synthesis

Back 762

GTP

Front 763

39. Isoenzyme with 2 genes, 4 subunits

Back 763

LDH isocnzymes; 5 isotypcs

Front 764

40. Second messengers

Back 764

atrial natriuretic peptide cGMP, insulin tyrosine kinase, nicotinic

Front 765

41. Best method of detecting relatedness of a new bacteria

Back 765

restriction fragment length polymorphism

Front 766

1. Treatment of schistosomlasjs

Back 766

praziquantel

Front 767

2. Treatment of benzodiazepam overdose

Back 767

flumazenil

Front 768

3. Arachidonjc acid metabolism

Back 768

review notes in inflammation or pharmacology

Front 769

4. Cause of cough in patient on an ACE inhibitor

Back 769

bradykinin

Front 770

5. Use of epinepbrine in shock

Back 770

1

Front 771

6. Dantrolene

Back 771

used in the treaflnent of malignant hyperthermia after halothane

Front 772

7. Treatment of scetaminophen overdose

Back 772

acetylcysteine to replace used up GSH (neutralizes acetaminophen free radicals formed in the liver cytochrome system) -

Front 773

8. Mechanism of loop diuretic

Back 773

blocks Na-K-2C1 cotransport pump in the thick ascending limb in the renal medulla; also blocks calcium reabsorption

Front 774

9. Cyanide poisoning treatment

Back 774

review in envimnrnentaj pathology notes; amyl nitrite and thiosul6te

Front 775

10. Thrush

Back 775

may be a complication of a corticosteroid inhaler

Front 776

11. Isotretinoin

Back 776

always do a pregnancy test in females; put them on BC?

Front 777

12. Mechanism of propylthjouracjj

Back 777

blocks iodination of the tyrosine residues of thyroglobulin; also blocks coupling of DIT and MiT; only drug that can be used in pregnancy but may produce goiter in the newborn and nail defects

Front 778

13. P450 system in the liver

Back 778

makes drugs water soluble

Front 779

14. Angloedema and renal failure

Back 779

ACE inhibitor relationship

Front 780

15. Mechanism of action of retinoic acid

Back 780

behaves like a steroid in that it binds to receptors in the nucleus with subsequent transcription of genes; proteins produced by this action are important in growth, differàntiation, reproduction, and embryonic development

Front 781

16. Allopurinol action in puriue synthesis

Back 781

blocks xanthine oxidase (schematic of purinc metabolism was provided and had to identify the reactions [hypoxanthinc to xanthine and xanthine to uric acid])

Front 782

17. Most common antibiotic used to prevent endocarditis in patients with valvular disease

Back 782

amoxidilhin is the drug of choice; all valvular diseases except asymptomatic MV? and all congenital heart disease except asyxnptomatic ASD)

Front 783

18. Yellow coloration of the skin that can be mistaken for jaundice—? drug

Back 783

quinacrine; chlorproma~ine and arsenic produce a blue-gray color to the skin)

Front 784

19. Diffuse erythema followed by separation of the skin (scalded skin syndrome or toxic epidennal necrolysis)— ?drug

Back 784

barbiturates, sulfonamides, phenytoin, NSAIDs

Front 785

20. Hair loss in a woman-?drug oral contraceptives (predictable side effect; estrogen causes hair to be at same stage of development; may also occur after delivery)

Front 786

21. Erythematous, hyperpigmented plaque-like lesion that recurs at the same site every time

Back 786

fixed drug eruption (phenolphthalein, NSAIDs, tetracycline, Bactrim, and barbiturates are the most common cause of these reactions)

Front 787

22. Group of drugs has the highest association with urticarial and maculopapular lesions

Back 787

amoxicihin, TMP/SMX, ampicihlin/penicillin (rashes are the MOST COMMON adverse reaction to drugs, with maculopapular rashes leading the list; most drug reactions involving skin are NOT type I hypersensitivity histamine-related)

Front 788

23. Elderly woman on thiazides is most at risk for developiuç gout

Front 789

24. Tardive dyskinesia, malignant syndrome (sweating, hyperpyrexla, autonomic instability)

Back 789

neuroleptics

Front 790

25. Antipsychotic drug requiring visual examination

Back 790

thioridazine (also produces heart conduction defects)

Front 791

26. Nephrogenic diabetes insipidus—? drug

Back 791

lithium for bipolar disturbances

Front 792

27. Drug contraindicated with MAO inhibitors

Back 792

epinephrine

Front 793

28. Use of phentolamine

Back 793

non-selective a-blocker that lowers blood pressure during surgery for a pheochromocytoma

Front 794

29. Mechanism of AZT

Back 794

inhibits reverse transcriptase

Front 795

30. Treatment of Pb poisoning

Back 795

SAL and EDTA

Front 796

31. Drugs involved in folate metabolism

Back 796

phenytoin blocks intestinal conjugase (polyglutamate to monoglutamate, BC? blocks uptake of monoglutaxnate, methotrxatefl’Mp-~~< block dihydrofolate reductase

Front 797

32. Cromolyn sodium

Back 797

stabilizes mast cell membrane preventing release of preformed mediators and release of prostaglandins/leukotrienes after the release reaction

Front 798

33. Methotrexate; blocks dihydrofolate reductase and the conversion of dihydrofolate to tetrahydrofolate

Front 799

34. Glucuronyl transferase in liver renders compounds water soluble

Front 800

35. Cyclooxygenase

Back 800

aspirin inhibits irreversible, NSAIDs reversible

Front 801

36. Thromboxane. A2

Back 801

synthesized in platelet; vasoconstrjctor and increases platelet aggregation

Front 802

37. Effect of proton blockers

Back 802

blocks H~-K4-ATPase proton pump in parietal cell; not a receptor mediated event; H2 blockers blocks H2 receptor, which normally activates adenylate cyclase producing cAMP which stimulates protein kinase; acetyicholine activates cholinergic receptor causing the release of calcium, which stimulates protein kinase; misoprostol blocks the prostaglandin receptor, which nonnally inhibits adenylate cyclase and cA!~vW production

Front 803

38. Pharmacology general

Back 803

heavy emphasis on antimicrobials, cardiovascular drugs, asthma drugs, NSAIDs, endocrine drugs, CNS drugs; know the class of drug, mechanism of action, and significant side effects

Front 804

39. 7-fold membrane spanning protein-? drug

Back 804

propanolol a beta blocker

Front 805

40. Phase 3 clinical trials

Back 805

double blind

Front 806

41. Ticlopidine

Back 806

substitute for aspirin in preventing strokes, CAD if the patient is allergic to aspirin

Front 807

42. Drug induced SLE

Back 807

procainamide and hydralazine

Front 808

43. Overdose of succinyicholine

Back 808

use acetyicholinc blockers

Front 809

44. Finasteride

Back 809

blocks 5-a reductase, which converts testosterone into dihydrotestosterone, hence testosterone would increase proximal to the block and dihydrotestosterone would decrease

Front 810

45. Flutamide, cyproterone, spironolactone

Back 810

block androgen receptor, hence testosteronel dihydrotestosteronc increase but have not physiologic effect

Front 811

4~. Ketoconazole

Back 811

inhibits testosterone synthesis (suppresses adrenal steroid synthesis)

Front 812

47. Leuprolide

Back 812

GnRH analogue, which when given in sustained fashion, inhibits FSH and Lii, hence lowering testosterone and estrogen levels

Front 813

48. ACE inhibitors

Back 813

increase in renin and All, but a decrease in AT!! and aldosterone

Front 814

49. Arsenic poisoning

Back 814

dirnercaprol

Front 815

50. Chloroquine in treatment of malaria—malaria recurred-why?

Back 815

exoerythrocytic/hepatic stage (e.g., P. vivax, P. ovole); drug kills active disease but does not eradicate hepatic stage

Hint 815

None

Front 816

51. Primaquine in treatment of malaria

Back 816

not good in the active stage but does kill the hepatic stage of P. vivax and ovaie

Front 817

52. Dantrolene

Back 817

reduces the release of calcium from the sarcoplasmic reticulum of skeletal muscle; antispasmodic drug, also used in treating malignant hyperthcrmia

Front 818

53. Methanol

Back 818

increased anion gap metabolic acidosis due to conversion of methanol into formic acid; optic nerve degeneration and blindness; treat with alcohol infusion to block metabolism of methanol by alcohol dehydrogenase

Front 819

54. Botulism toxin

Back 819

blocks the release of acetyicholine (diagram of neurotransmitter synthesis and must locate the block); good diagram in Katzung/Trevor book on page 41

Front 820

55. Ribavirin

Back 820

used in severe R.SV infections in children

Front 821

56. Asthma

Back 821

albuterol (~-selective agonist; bronchodilator)

Front 822

57. Acetylcholine breakdown

Back 822

occurs in the synapse into choline and acetate by acetyicholinesterase in the cleft; products are recycled and not excreted

Front 823

58. Know the graph of NORlEPllisoproterenol and effects on blood pressure and heart rate, plus the effect of aiblockers

Back 823

see graph in Katzung/Trevor book page 70

Front 824

59. Amphotericin

Back 824

disrupts cell membrane permeability; binds to ergosterol in the membrane

Front 825

60. Ketoconazole

Back 825

inhibits the metabolism of nonsedating antihistainines like Seldane leading to cardiac arrhythmias

Front 826

61. Be very familiar with second messengers

Back 826

see Harvey/Champe biochem book page 80

Front 827

62. Oploid toxicity

Back 827

naloxone (opioid receptor antagonist)

Front 828

63. Opioids

Back 828

no tolerance to iniosis and constipation

Front 829

64. Codeine

Back 829

metabolized into morphine in small amounts owing to significant first pass metabolism of morphine in the liver

Front 830

65. Delirium tremens

Back 830

use benzodiazepines

Front 831

66. Lovastatin

Back 831

inhibits HMG CoA reductase

Front 832

67. Patent ductus arteriosus

Back 832

keep open with PGE Physiology

Front 833

2. Most effective nephron site for acid excretion

Back 833

proximal tubule of the

Front 834

3. Nephron site for ADH effect

Back 834

collecting tubule

Front 835

4. Nephron site for greatest generation of free water

Back 835

thick ascending limb in the medulla

Front 836

5. Compression of the thorax under water

Back 836

produces a restrictive pattern on PETs

Front 837

6. Constriction of the efferent arteriole

Back 837

increases the GFR and decreases renal plasma flow

Front 838

7. Know Starling equation for GFR mi/mm

Back 838

GFR = KS [(P~c - Pus) - 7L3C), where Kf = hydraulic conductance in mi/mix’ mm Hg or filtration coefficient in mi/mm . mm Hg, ~ = hydrostatic pressure in the glomerular capillary in mm Hg (pushes fluid out of the capillary; e.g., +45 mm Hg; it is increased if the efferent arteriole is constricted and decreased if the afferent arteriole is constricted), PBS hydrostatic pressure in Bowman’s space in rein Hg (pushes fluid into the capillary; e.g., -10 mm Hg), arid 1CGC the oncotic pressure in the glomerular capillary ix’ mm Hg (brings fluid back into the capillary; e.g., -19 mm Hg); the net filtration is the algebraic sum of the above 3 parameters (in the above example, the net pressure would be -10 + 45 -19 = + 16 mm Hg)—fluid should move out of the glomerular capillaries; question what Starling force changes to produce a net ultrafiltration of zero (answer icoc~ which becomes increased (pulls fluid back into the glomerular capillaxy; using the above example— 10+45-35 0 net pressure); it is the oply factor that does not remain constant along the length of the capillary owing to differences in protein concentration; the high n~c at the end of the glomerular capillary extends into the peritubular capillaries that surrounds the nepbrons and allows for the reabsorption of solutes).

Front 839

8. Filtration fraction in the glomerulus

Back 839

FF = GFRJRPF; constrict afferent arteriole, no change in FF (4. GFR/4~ RPF), constrict efferent arteriole increases FF (if GFR/4. RPF), increase plasma protein concentration, hence increasing ICGC, decreases the FF (4. GFR/no change RPF); decreasing plasma protein concentration, hence decreasing ~tOC, increases the FF (t OFRIno change RPF); constricting the ureter, decreases PBS, hence decreasing GFR and the FF without affecting RPF (4. GFR/no change RPF)

Front 840

9. Negative charge of GEM

Back 840

heparan sulfate

Front 841

10. Si heart sound correlates with C wave in the jugular venous pulses (C wave is closure of the tricuspid valve); know the jugular venous pulses

Back 841

see box in cardiovascular notes on physical diagnosis

Front 842

11. Carotid massage

Back 842

decreases heart rate and increases vasodilatation (carotid sinus baroreceptor mneriatcd by the IX and Xth nerve; impulses generated in this receptor inhibit tonic dischaige of the vasoconstrictor nerves and excite vagal innervation of the heart producing vasodilatation, venodilation, drop in blood pressure and heart rate, and a decrease in cardiac output)