1. What is the effect of Handgrip on heart murmurs?
    • Handgrip increases afterload
    • So it increases the intensity of backflowing murmurs: MR, AR, VSD
    • It decreases the intensity of hypertrophic cardiomyopathy murmur (any maneuver that increases preload/afterload decreases this type of murmur because increased LV by these parameters reduce the LV outflow tract obstruction)
  2. Which of the following is the complement binding site for the immunoglobulin showed below?
    Image Upload 1
    • D- complement binding (located on Fc portion, closer to hinge region)
    • A&B- hypervariable regions of Fab (antigen binding fragment)
    • E- macrophage binding
  3. What is the MOA and use of Donepezil?
    • AChE inhibitor
    • Alzheimers disease
  4. What is the MOA and use of Memantine?
    • NMDA receptor antagonist; helps prevent excitiotoxicity (mediated by Ca2+)
    • Alzheimer's disease
  5. How do we treat manic episodes?
    • Mood stabilizing agents: 
    • Lithium
    • Valporate
    • Carbamazepine
    • + Atypical antipsychoitc
  6. What is the MOA and use of Brupropion?
    • Increase NE and dopamine
    • Depression and Smoking addiction
  7. Describe the presentation of rubella.
    • Maculopapular rash that resolves in 3-5 days.
    • Spreads from head -> Trunk -> extremities.
    • Occipital/ postauricular lymphadenopathy.
  8. Describe the presentation of scarlet fever.
    • Fever
    • Sore throat
    • Diffuse erythematous rash with numerous small papules "sandpaper-like"
    • S.pyogenes (group
    • A)
  9. Which virus causes Roseola?
    HSV-6/ HSV-7
  10. Describe the clinical presentation of Roseola.
    High fever that lasts for 3-5 days, which resolves following the appearance of a maculopapular rash/ diffuse macular rash that starts on the trunk and spreads peripherally.
  11. What is this pathology?
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  12. What is this pathology?
    Image Upload 3
  13. What is this pathology?
    Image Upload 4
    Erythema infectiosum (fifth disease)
  14. What is this pathology?
    Image Upload 5
    • Scarlet fever
    • S.pyogenes
  15. What is this pathology?
    dImage Upload 6
  16. Where does neonatal intraventricular hemorrage usually occur?
    • Bleeding (in ventricle) usually originates from the germinal matrix whcih is  highly vascularized and where neurons and glial cells migrate out during brain development.
    • Image Upload 7
  17. This pathology can result from the rupture of cortical bridging veins.
    • Subdural hematoma
    • Image Upload 8
  18. What causes a subdural hematoma?
    Rupture of bridging veins.
  19. What is ectopy? Which disease demonstrates this?
    • Normal tissues/ cells found in an abnormal loaction due to embryonic maldevelopment.
    • Meckel diverticulum-  ectopic acid secreting gastric mucosa and/ or pancreatic tissue
  20. What is hypoplasia?
    • Decrease in number of cells resulting in decreased volume/ size of organ.
    • e.g. Renal hypoplasia.
  21. What is hyperplasia?
    Increase in number of cells.
  22. What is hypertrophy?
    Increase in size of cells.
  23. What is metaplasia?
    Replacement of one cell type by another.
  24. What is dysplasia?
    • Abnormal growth with loss of cellular orientation, shape and size in comparison to normal tissue maturation. 
    • Commonly preneoplastic.
  25. What is the function of Golgi tendon organs? What innervates them?
    • Innervated by group 1b sensory axons.
    • Maintains MUSCLE TENSION- When a muscle exerts too much force, the golgi tendon organs inhibit contraction of the muscle, causing sudden muscle relaxation.
  26. What are A-delta fibers?
    • Fast, myelinated fibers whose free nerve endings detect temperature and nociceptive (pain) stimuli.
    • Associated with acute (sharp) pain that mediates reflex withdrawal from a noxiois stimuli (e.g retracting hand away from hot stove)
  27. Which sensory receptors are responsible for one retracing their hand away from hot stove?
    Free nerve endings- A-delta
  28. What is the function of muscle spindles? What innervates them?
    • Innervated by group Ia and group II sensory axons.
    • Sensitive to changes in muscle length (resists muscle stretch)
  29. How do opoids (eg morphine) block pain transmission?
    • Open K+ channels: INCREASING K+ EFFLUX
    • Close Ca2+ channels: DECREASE Ca2+ INFLUX
  30. What is confounding bias?
    Part of the exposure-disease relationship can be explained by another variable.
  31. What are the stop codons? What is their function?
    • UGA
    • UAA
    • UAG
    • They DO NOT code for amino acids.
    • Releasing factors stimulate release of the formed polypeptide chain from the ribosome and dissociated from the ribosome-mRNA complex
  32. What are the functions of small nuclear ribonucleoproteins?
    Splicing- removes introns from pre-mRNA/ hnRNA
  33. What is the function of releasing factors?
    Recognize stop codons (UGA, UAA, UAG) to terminate protein synthesis.
  34. What are the functions of Elongation factors?
    Facilitates tRNA binding and translocation.
  35. Which viridans group streptococci cause subacute bacterial endocarditis and how does it do so?
    S.sanguinis makes dextrans, which bind to fibrin-platelet aggregates on damaged heart valves.
  36. What is the pathology shown below? Causative agent?
    Image Upload 9
    • Hydatid cyst in liver (can cause anaphylaxis if antigens released).
    • Echinococcus granulosus- ingestion of eggs from dog faeces. Sheep are intermediate host.
    • Tx: Abendazole
  37. What risk is associated with a hydatid cyst in liver?
    • Anaphylaxis if antigens released.
    • Hydatid cyst injected with ethanol or hypertonic saline to kill daughter cysts before removal.
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