1. how do eosinophils destroy parasites?
    • ADCC
    • stimulated by IgE bound to a parasitic cell
  2. VIPoma
    • secretory diarrhea
    • no blood or pus (not inflammatory)
    • not corrected by changes in diet (not osmotic)

    • VIP:
    • inhibits H+ secretion
    • relaxes GI tract
    • stimulates HCO3- and Cl- secretion
    • released for PNS ganglia
  3. Central sleep apnea
    • patient cannot initiate breaths
    • neurological, not mechanical problem
  4. how to assess concentration vs. comprehension on a MMSE?
    concentration: counting down by 7 from 100, spell world backwards

    comprehension: follow a 4-step command
  5. Bisphosphanates are structural analogs of what structure?
    pyrophosphate, important component of hydroxyapetite
  6. adverse effect of warfarin with a protein C deficiency
    • warfarin inhibits protein C further
    • leads to hyper-coagulation (protein C normally inhibits factors V and VIII)
    • causes thrombotic occlusion of microvasculature + skin/tissue necrosis
  7. Aneurysm of the left PCA will cause CN III loss on what side?
    left (I/L lesion)
  8. Properties of an anesthetic with a high arterio-venous concentration gradient
    • Increases solubility in the tissues (high tissue uptake)
    • slow onset of action (more gas needed to saturate the blood)
    • * longer in the tissues, longer it takes to leave the tissues *
  9. Primidone (anti-epileptic drug) can metabolize into?
    phenobarbital and phenylethylmalonamide (PEMA), and increase the drug levels 
  10. Biopsy of what colon segment will be dx for Hirschprung's
    • narrow segment
    • submucosa and muscularis externa

    dilated segments are proximal to the aganglionic segment part (distention occurs due to fecal retention)
  11. Vitamin E function
    • protects fatty acids (eg. cell membranes) from oxidative stress
    • cells most susceptible to vitamin E def: neurons and RBCs
  12. C. difficile toxins A and B
    • Toxin A: attracts neutrophils causing mucosal inflammation and loss of water into the gut
    • Toxin B: cytotoxin; causes actin depolymerization, loss of cytoskeleton integrity, mucosal necrosis
  13. Less common causes of acute pancreatitis (not alcohol or gallstones)
    • steroids
    • trauma
    • mumps
    • hypercalcemia
    • hyper-TG
  14. Hypertensive encephalopathy
    • severe HT
    • global sx with cerebral edema

    intraparenchymal hemorrhage would give focal lesion deficits (e.g. sensory loss on 1 arm)
  15. Branches off the ascending aorta
    • Brachiocephalic --> right common carotid and right subclavian
    • Left common carotid
    • Left subclavian
  16. autopsy findings of lacunar infarcts
    small vessel lipohyalinosis and microartherosclerosis
  17. Pyruvate kinase deficiency and splenomegaly
    hemolytic anemia due to failure of glycolysis and cannot make ATP to main RBC structure

    spleen has to increase its work to take out these deformed RBCs
  18. Passive congestion of the spleen causing splenomegaly
    • portal HT, splenic vein thrombosis and congestive heart failure
    • splenic sinusoids dilate
  19. age for first dose of tetanus vaccine
    2 months
  20. Corticosteroids cause what changes to the CBC
    • increase neutrophils (demargination from the vessel wall)
    • decrease eosinophils, basophils, lymphocytes, monocytes
  21. Neurotransmitter affected in narcolepsy
    low levels of hypocretin (orexin) - maintains wakefulness and suppresses REM-related causes
  22. second-generation anti-histamines (less sedating and less adverse effects)
    • fexofenadine
    • loratidine
    • cetrizine

    do not cross the BBB
  23. B-blockers tx for hyperthyroidism
    • symptomatically to decrease HR and contractility
    • decreases peripheral conversion of T4 to T3 (cannot act on tissues)
  24. Composition of vegetations of bacterial endocarditis
    fibrin and platelet deposition
  25. what is seen on stool microscopy of V.cholera?
    • no leukocytes or erythrocytes (does not invade the mucosa)
    • do not cause cell death
    • only epithelial cells and mucous
    • -->¬†modify electrolyte imbalances by enterocytes
  26. Hepatocyte injury with viral hepatitis
    • ballooning degeneration
    • empty cytoplasmic spaces

    hepatocyte death --> bridging necrosis connecting lobules, inflammation seen
  27. Uric acid precipitates in what segment of the nephron?
    • low acidic environments
    • distal tubule and collecting duct

    *uric acid is soluble at physiological pH*
  28. Non-antidepressant drugs that can worse serotonin syndrome:
    1) Abx
    2) anti-emetic
    3) analgesics
    • 1) linezolid (weak MAO inhibitor, used to treat VRE)
    • 2) ondasetron
    • 3) tramadol (weak opiod agonist, inhibits 5HT and NE reuptake, causes seizures)
  29. What chamber forms the diaphragmatic part of the heart, and supplied by what artery?
    • inferior wall of the LV
    • posterior descending a of the R coronary a.

    left circumflex supplies the lateral and superior wall of the LV
  30. Which Abx can increase penicillin's ability to penetrate bacteria?
    Aminoglycosides (synergistic affect)
  31. can penicillins treat Bacteriodes (anaerobic)?
    • bug: B-lactamase that breaks down penicillins
    • Pens only work if given with a B-lactam inhibitor.
  32. Lipoprotein lipase deficiency will increase what levels
    • chylomicrons
    • TG (cannot be transported by VLDL)
  33. antiphospholipid syndrome
    • hypercoagulable state
    • VDRL +
    • spontaneous abortions

    *seen with SLE*
  34. cause of lacunar infarcts vs. charcoat-bouchard aneurysms
    • ischemic tissue : hypertensive arteriolar sclerosis
    • lipohyalinosis and microartheromas

    • due to long-standing HT and are prone to rupture
    • hemorrhagic stroke is evident due to intraparenchymal hyperdensity
  35. where are B1 receptors located?
    • cardiac
    • JG cells

    * not located on vascular SM *
  36. Liver has a dual blood supply to protect against infarcts, when can it not do this?
    • liver transplant
    • collateral blood supply is destroyed
  37. zona occludens also known as?
    tight junctions
  38. AA sequence of collagen

    where X and Y are proline and lysine
  39. do platelet disorders (e.g. TTP and ITP) bleed? do they increase PT and PTT?
    • No, no.
    • decrease PLT # and increase BT
  40. what lab values lead to gallstone formation?
    • increased cholestrol and bilirubin
    • decreased bile salts
    • bile stasis
  41. Treatment of MRSA with Daptomycin and Linezolid - MoA and adverse effects
    • daptomycin: membrane depolarization, inhibition of DNA, RNA and protein synthesis
    • a/e = myopathy and increased CPK, inactivated by pulmonary surfactant

    • linezolid: binds to 50S and inhibits protein synthesis
    • a/e = thrombocytopenia, optic neuritis, can lead to serotonin syndrome
  42. ulcerative-colitis associated colon cancer features
    • progresses from flat, non-polyp dysplasia
    • mucinous/signet cell appearance (higher histological grade)
    • early p53 and late APC mutations
    • multifocal in nature
  43. patient presents with hematuria 2-3d after a respiratory infection vs. a few weeks later
    • few days: IgA nephropathy, C3 levels are normal
    • weeks: PSGN, decreased C3 levels
  44. Image Upload 1
    • Gottron's papules = red lesions over knuckles, elbows, knees
    • Dermatomyositis
  45. Bone tumor?
    Image Upload 2
    • Fibrosarcoma
    • Herring bone pattern
  46. Bone tumor?
    Image Upload 3
    • Maligant fibrous histioctyoma
    • Storiform pattern
  47. DNA repair defect for xeroderma pigmentosum vs. HNPCC
    • DNA excision repair
    • DNA mismatch repair
  48. pulmonary edema due to LVF causes a decrease or increase in lung compliance
    decrease due to fluid accumulation (= less air)
  49. Prophylatic vaccine against rabies is what kind?
    killed vaccine (part of live vaccine) = live viral strains grown and then inactivated 
  50. Patient undergoes invasive cervical cancer and now has right-sided flank pain radiating to groin and palpable kidney mass
    • hydronephrosis
    • damaged ureter = therefore, pressure backs up in the kidney which bladder cannot drain
  51. proprionyl-coA is derived from what AA?
    what does propionyl coA become?
    • AA: val, ile, met, thr and odd # FA
    • uses propionyl coA carboxylase to convert from propionyl coA to methymalonyl coA (which goes to succinyl coA)
  52. GI disease?
    Image Upload 4
    • T.whipelli
    • PAS+ macrophages
  53. GFAP stains + for what brain tumors?
    What brain tumor stains GFAP - and synatophysyin -?
    astrocytomas, GM, ependymoma, oligodendrogliomas

    mengioma (dx by CT) from arachnoid cells
  54. which requires more oxygen and produces more ATP?
    : FA metabolism
  55. antigenic mimicry
    • sharing of antigen sites on host and organism
    • e.g. rheumatic fever
  56. whooping cough
    • Bordatella pertussis
    • coughs on expiration and whoops on inspiration
    • inhibits Gi to increase cAMP

    (croup = paramyxovirus (parainfluenza) - seal-like barking cough)
  57. Reaction occurring from propionic coA to methylmalonyl coA and from methyl-coA to succinyl coA
    • carboxylation via propionyl coA carboxylase
    • isomerization via methyl-malonyl coA mutase (B12)
  58. Most frequenct CNS tumor in AIDS patients
    • primary CNS lymphoma
    • often associated with EBV (B cell lymphoma)
  59. how do patients with SIADH have a normal total body water
    • initially, hypervolemia
    • then, suppresses the RAAS system - decreased aldosterone will not absorb Na+ and hence, no water absorption either = salt wasting via the urine

    total body water becomes equal
  60. High potency and low potency anti-psychotics
    • high potency: haloperidol, fluphenazine, pimozide
    • low potency: clorpromazine, thioridazine
  61. Direct thrombin inhibitors
    • hirudin
    • lepirudin
    • argatroban
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