Uw 3

Front 1

Osteocytes remain connected to one another via ______________

Back 1

gap junctions

Front 2

In the presence of ADH, which parts of the tubule contain the most concentrated fluid? the most dilute?

Back 2

most concentrated - collecting tubules

most dilute - thick ascending limb and DCT

Front 3

Test where pt serum is mixed with cardiolipin, cholesterol, and lecithin

Back 3

Rapid plasma reagin (RPR) test - nonspecific treponemal serologic test; if this is positive, confirm with FTA-ABS

Front 4

what occurs in the lymph node germinal centers?

Back 4

B cell differentiation, isotype switching

Front 5

formula for clearance

Back 5

(urine concentration x flow rate) / (plasma concentration)

Front 6

orotic aciduria

Back 6

disorder of pyrimidine metabolism

defective enzymes: orotate phosphoribosyl transferase and OMP decarboxylase - they catalyze the conversion of orotate to UMP

Front 7

symptoms + tx of orotic aciduria

Back 7

symptoms: megaloblastic anemia, neuro abnormalities, growth retardation

tx: uridine supplementation (inhibits carbamoyl phosphate synthetase II)

Front 8

How does diphtheria acquire virulence?

Back 8

via bacteriophage-mediated "infection" with the tox gene (lysogenization), which codes for the diphtheria AB toxin

Front 9

Why must the dose of digoxin be reduced in order to prevent toxicity in elderly patients?

Back 9

because their renal clearance decreases

Front 10

which heart defect can lead to paradoxical embolization?

Back 10

PFO (much more common than ASD) and ASD (very rare)

Front 11

How would a sample from a VZV infected vesicle appear under light microscopy?

Back 11

intranuclear inclusions in keratinocytes and multinucleated giant cells (positive Tzanck smear)

Front 12

clinical findings in primary aldosteronism

Back 12

HTN, low plasma renin, hypokalemia (muscle weakness, cramps, rhabdo, arrhythmias) , metabolic alkalosis

Front 13

what does the common cardinal vein give rise to?

Back 13

SVC and other components of systemic venous circulation

Front 14

what's another word for precision?

Back 14

reliability

Front 15

What occurs in the nucleolus? Which enzyme is involved?

Back 15

Site of ribosomal maturation and assembly; RNA polymerase I synthesizes the vast majority of rRNA from within nucleolus

Front 16

Which enzyme deficiency results in excess of both mineralocorticoids and androgens?

Back 16

11B-hydroxylase

Front 17

how does the actual cell structure between osteoblasts and osteoclasts vary?

Back 17

osteoblasts have a single nucleus (arise from mesenchymal cells) while osteoclasts originate from mononuclear phagocytic cell lineage and are formed when several precursors create a large multinucleated cell (osteoclasts in Paget's can have up to 100 nuclei - normal is 2 to 5)

Front 18

most important factors for osteoclast differentiation

Back 18

M-CSF and receptor for activated nuclear factor kappa- B ligand (RANK-L)

Front 19

pramipexole and ropinirole

Back 19

nonergot dopamine agonist

Front 20

what effect do loop diuretics have on prostaglandins?

Back 20

they increase their release, which increases GFR

Front 21

where does the hydroxylation of proline and lysine residues in collagen occur?

Back 21

rough ER

Front 22

what is one mechanism of mycobacterial resistance to isoniazid?

Back 22

decreased activity of bacterial catalase-peroxidase (which is needed to convert INH to active metabolite)

Front 23

which receptor does rabies virus bind?

Back 23

nicotinic Ach receptors in the PNS - then it travels retrograde to CNS

Front 24

which drugs would you use to combat visceral nausea? vestibular nausea? nausea associated with migraine?

Back 24

visceral - 5HT3 antagonist

vestibular - H1 or M1 antagonists

migraine - D2 antagonist

Front 25

where does the right testicular vein drain?

Back 25

directly into IVC; left testicular vein drains into left renal vein first

Front 26

kidney tumor composed of BVs, smooth muscle, and fat

Back 26

angiomyolipoma; seen with tuberous sclerosis

Front 27

which type of cancer has increased in incidence and mortality in women in the last four decades?

Back 27

lung cancer

Front 28

what can lead to increased fetal urine output (and subsequently polyhydramnios)?

Back 28

high fetal cardiac output (alloimmunization, parvovirus infection, fetomaternal hemorrhage) or twin to twin transfusion

Front 29

what would the absence of IL-12 receptors lead to?

Back 29

the inability of helper T cells to differentiate into TH1 cells (which produce IFN-gamma)

Front 30

what is the main side effect of TZDs?

Back 30

fluid retention due to increased Na+ reabsorption in the renal collecting tubules leading to weight gain, peripheral edema, and decompensation of underlying CHF

Front 31

foreign bodies lodged in the piriform recess can damage which nerve?

Back 31

internal laryngeal nerve, resulting in impaired cough reflex

Front 32

palpable but nontender gallbladder (Courvoisier sign), weight loss, and obstructive jaundice

Back 32

adenocarcinoma at the head of the pancreas obstructing the common bile duct

Front 33

which compound is an allosteric activator of gluconeogenesis that acts by increasing the activity of pyruvate carboxylase?

Back 33

acetyl-coA

Front 34

what is the primary route of copper elimination?

Back 34

secretion into the bile

Front 35

what can the prolonged use of appetite suppressants lead to?

Back 35

secondary pulmonary HTN

Front 36

which bacteria are pyrrolidonyl arylamidase (PYR) positive?

Back 36

S. pyogenes and enterocci (the PYR test has largely replaced the test for bacitracin sensitivity)

Front 37

preferred imaging test for dx of acute cholecystitis? and alternate test if first test is inconclusive?

Back 37

Preferred - ultrasonography to identify signs of inflammation (e.g. wall thickening, pericholecystic fluid)

Alternate - nuclear medicine hepatobiliary scanning (cholescintigraphy) to assess cystic duct patency

Front 38

first order vs zero order kinetics

Back 38

first order - constant fraction of drug is metabolized per unit time

zero order - constant amount of drug is metabolized per unit time

Front 39

failure to metabolize ceramide trihexoside

Back 39

Fabry disease (XR) - deficiency of alpha-galactosidase A

Front 40

What kind of internal/external genitalia would result from functioning Leydig cells but nonfunctioning sertoli cells in an XY genotype?

Back 40

both female and male internal genitalia (because sertoli cells secrete MIF) and male external genitalia

Front 41

linkage disequilibrium

Back 41

two allele loci are said to be in linkage disequilibirium when a pair of alleles from two loci are inherited tougher in the same gamete (haplotype) more or less often would be expected by random chance alone given their corresponding allele frequencies

Front 42

Diphtheria toxin is most similar to which other toxin?

Back 42

Exotoxin A of Pseudomonas - both inactivate EF-2 via ribosylation, thus inhibiting host cell protein synthesis

Front 43

which T cells play the pivotal role in TB infection?

Back 43

CD4+ TH1 cells

Front 44

which nitrate has the best bioavailabity when taken orally?

Back 44

isosorbide mononitrate

Front 45

when does the murmur of VSD become audible?

Back 45

4-10 days after birth, when pulmonary vascular resistance declines, enabling left to right shunting

Front 46

histology of Hep B vs Hep C

Back 46

Hep B: finely granular, dull eosinophilic, "ground glass" appearance (pale pink cytoplasm)

Hep C: lymphoid aggregates within the portal tracts and focal areas of macrovesicular steatosis

Front 47

what is the mechanism by which diabetics can get cataracts following a prolonged hyperglycemic state?

Back 47

Oversaturation of the polyol pathway: Aldose reductase converts glc into sorbitol; sorbitol dehydrogenase (this enzyme has a lower Vmax and thus becomes saturated) converts sorbitol into frc

Front 48

how does pulmonary vascular resistance change with breathing?

Back 48

inhalation: increases alveolar vessel resistance

exhalation: increases extra alveolar vessel resistance

PVR = alv R + extra alv R

Thus PVR is increased at high and low lung volumes, and it is lowest at the FRC

Front 49

Which organ(s) can use the glycerol produced by the degradation of TGs by hormone sensitive lipase? How is it used?

Back 49

Only the liver - glycerol kinase is used to turn glycerol into DHAP for gluconeogenesis or glycolysis; glycerol can also be used for TG synthesis

Front 50

caudal regression syndrome

Back 50

rare condition in which an infant is born with a genesis of sacrum/lumbar spine and experience flaccid paralysis of legs, dorsiflexed contracts of feet, and urinary incontinence

related to poorly controlled maternal diabetes

Front 51

which NT is involved in morphine tolerance?

Back 51

Glutamate binds NMDA receptors and causes increased phosphorylation of opioid receptors and increased NO levels leading to tolerance

Front 52

which drugs can prevent morphine tolerance?

Back 52

drugs with NMDA antagonist properties such as ketamine and dextromethorphan

Front 53

what is the mechanism of drugs given to reduce alcohol cravings?

Back 53

Naltrexone blocks mu opioid receptor - blocks rewarding and reinforcing effects of alcohol

Front 54

Is to possible for Turner pts to become pregnant?

Back 54

Yes, if they receive a donated egg they can carry a baby because they have a normal uterus and the endometrial response to E and P is normal

Front 55

which vocal cords are lined by stratified squamous epithelium?

Back 55

true vocal cords

Front 56

Which region of the brain is damaged in preterm infants during childbirth?

Back 56

intraventricular hemorrhage (IVH) usually originates from germinal matrix

Front 57

How does TNF-alpha induce insulin resistance?

Back 57

Through the activation of serine kinases, which then result in phosphorylation of IRS-1 serine residues, which inhibits IRS-1 tyrosine phosphorylation by insulin

Front 58

Which compounds (in addition to TNF-alpha) can induce insulin resistance via phosphorylation of serine residues?

Back 58

catecholamines, glucocorticoids, and glucagon

Front 59

What is the oxidative portion of the Pentose Phosphate Pathway used for?

Back 59

It converts G6P into Ribulose-5-P, producing NADPH, which is used for (1) cholesterol, FA, and steroid synthesis and Cytochrome P450 metabolism, (2) regeneration of glutathione, (3) respiratory burst (NADPH oxidase)

Front 60

What is the non oxidative portion of the PPP used for?

Back 60

Ribulose-5-P is interconverted into glycolytic intermediates for energy production

Front 61

JVP tracing

Back 61

a = atrial contraction

c = tricuspid closure

x = atrial diastole

v = passive atrial filling

y = atrial emptying

Front 62

which drug can be given to prevent recurrence of calcium oxalate stones?

Back 62

hydrochlorothiazides because they decrease urinary Ca2+ excretion

Front 63

which antibiotic can cause serotonin syndrome?

Back 63

linezolid - it is a weak MOA inhibitor

Front 64

Which medication is the best alternative to aspirin (if the pt has an allergy) for the purposes of prevention of thromboembolic disease?

Back 64

clopidogrel

Front 65

Increased prothrombin time would point to a deficiency in which clotting factor?

Back 65

VII (extrinsic pathway)

Front 66

immune complex vasculitis in a child associated with IgA and C3 deposition

Back 66

Henoch Schonlein purpura - leukocytoclastic angiitis in small vessels of dermis and GIT leading to purpuric rash, colicky abdo pain, and polyarthralgias

Front 67

bisphosphonate mechanism

Back 67

inhibition of mature osteoclast-mediated bone resorption - they have a chemical structure similar to pyrophosphate and attach to hydroxyappetite binding sites on bony surfaces; osteoclasts then take up the drug and undergo apoptosis

Front 68

pt with membranous nephropathy, flank pain, hematuria, and right-sided varicocoele

Back 68

renal vein thrombosis (loss of ATIII leads to hypercoaguable state)

Front 69

Back 69

actin - thin filament

myosin - thick filament

Front 70

which bacterial enzyme is responsible for removing RNA primers and replacing them with DNA?

Back 70

DNA polymerase I

Front 71

which pathogen is responsible for anogenital squamous cell carcinoma?

Back 71

HPV types 16 and 18

Front 72

What causes RBC distortion in sickle cell anemia?

Back 72

Glutamic acid is replaced by the non polar hydrophobic valine residue - the bulging created in the beta chain then fits into a hydrophobic site in the alpha chain resulting in polymerization when HbS is deox

Front 73

most common form of congenital long-QT syndrome

Back 73

Jervell and Lange-Nielsen syndrome - AR condition accompanied by neurosensory deafness

Front 74

How does acute hemolytic transfusion reaction present?

Back 74

Fever/chills, hypotension, dyspnea, chest/back pain, hemoglobinuria

Front 75

What causes TOF?

Back 75

Anterior and cephalad deviation of the infundibular septum during embryologic development, resulting in a misaligned VSD and overriding aorta

Front 76

Which Class 1 antiarrhythmics are more selective for ischemic myocardium?

Back 76

Class IB b/c the reduced resting membrane potential delays sodium channel transition from the inactivated to resting state, resulting in increased drug channel binding (b/c class I drugs preferentially bind the channel in the active and inactive but not resting state)

Front 77

What does use dependence refer to with respect to antiarrthymics?

Back 77

Higher rates of depolarization lead to increased sodium channel binding due to the channels spending less time in the resting state. Class IC exhibit the most use dependence, Class IB the least

Front 78

In which condition would muscle biopsy reveal MHC class I over-expression on the sarcolemma and CD8+ lymphocyte infiltration?

Back 78

polymyositis

Front 79

What are the findings in polymyositis?

Back 79

Proximal muscle weakness, increased serum CK, anti-Jo-1 antibodies

Front 80

which artery supplies the diaphragmatic surface of the heart?

Back 80

Posterior descending (branch of RCA in most people) supplies the inferior wall of L ventricle (diaphragmatic surface)

Front 81

what enzyme deficiency leads to clitoromegaly in an XX infant where the mother experience virilization during pregnancy?

Back 81

Aromatase - which converts androgens into estrogens in the ovaries, testes, placenta, and other peripheral tissues

Front 82

Extremely painful, swollen hands and feet in a young african american child

Back 82

Dactylitis (small infarctions in bone and extremities) due to sickle cell disease

Front 83

What can be supplemented in homocystinuria to improve outcomes?

Back 83

It's most often due to a deficiency of cystathionine synthetase, which uses B6 as a cofactor - thus pyridoxine (B6) can be supplemented

Front 84

What is the problem with using selective coronary vasodilators (i.e. adenosine, dipyridamole) in myocardial ischemia?

Back 84

Coronary arterioles are already maximally dilated during ischemia and use of these agents causes vasodilation of coronary arterioles in nonischemic arteries, diverting blood flow from ischemic to nonischemic areas (coronary steal)

Front 85

what is the criteria for referring a pt to hospice care?

Back 85

life expectancy < 6 mo

Front 86

lesion of the ventromedial hypothalamic nuclei

Back 86

obesity due to destruction of satiety center

Front 87

where is high/low frequency sound best detected?

Back 87

high - base of cochlea near oval and round windows

low - apex of cochlea near helicotrema

Front 88

What kind of hormone receptor do glucagon, TSH, and PTH act on?

Back 88

GPCR -PKA is primarily responsible for the intracellular effects of the G protein / adenylate cyclase 2nd messenger system

Front 89

Which injury results in interstitial and intraalveolar edema, acute inflammation, and alveolar hyaline membranes consisting of fibrin exudate and plasma protein-rich edema fluid mixed with cytoplasmic and lipid remnants of necrotic epithelial cells?

Back 89

ARDS

Front 90

which enzymes does lead inhibit?

Back 90

delta-ALA dehydratase (b/c of this, delta ALA levels accumulate in the blood and urine in pts with lead poisoning) and ferrochetolase

Front 91

What is the first (and rate-limiting) step of protoporphryin synthesis?

Back 91

Enzyme: δ-ALA synthase

This step is faulty in XL siderblastic anemia

Front 92

which drug is contraindicated in HIV pts with HLA-B*57:01?

Back 92

Abacavir - leads to hypersensitivity reaction

Front 93

Drug often used for rate control in aFib that can lead to constipation, gingival hyperplasia, bradycardia and AV nodal block

Back 93

verapamil

Front 94

The degree of LVOT (and thus the intensity of the murmur) in HCOM varies according to what?

Back 94

LV-EDV: mechanisms that decrease preload (i.e. venous return) or afterload, reduce LV chamber size, which decreases the separation b/w the mitral valve and inter ventricular septum, increasing obstruction

Front 95

Which mechanisms decrease preload?

Back 95

Valsalva, abrupt standing, GTN administration

Front 96

Which mechanisms increase after load?

Back 96

Sustained hand grip, squatting

Front 97

Which mechanisms increase preload?

Back 97

Passive leg raise, squatting

Front 98

Why does squatting cause increased preload and afterload?

Back 98

Increased preload due to increased skeletal muscle tension > increased blood pumped back to heart

Increased after load due to obstruction of peripheral arteries - this only occurs in a sustained squat

Front 99

A pt receives in an injection into which part of the buttock if a trendelenburg gait results?

Back 99

Superomedial buttock - leading to damage of

superior gluteal nerve or gluteus medius

Front 100

Where should intragluteal injections target in order to minimize the possibility of nerve damage?

Back 100

Anterolateral gluteal area (von Hochstetter triangle)

Front 101

An acute lacunar ischemic stroke of the medial pons at the level of the middle cerebellar peduncle can damage which cranial nerve?

Back 101

CN V - trigeminal

It arises at the level of the middle cerebellar peduncle at the lateral aspect of the mid-pons

Front 102

Infarcts involving the anterior portion of the medial pons can produce which symptoms?

Back 102

contralateral hemiparesis/Babinski sign - corticospinal tract

contralateral lower facial palsy, dysarthria - corticobulbar tract

contralateral dysmetria and dysdiadochokinesia (ataxic hemiparesis) - disruption of corticopontine fibers (pontocerebellar)