A 72 yo man with HTN, regular HR, and extensive calcinosis around the mitral and aortic valves has an extra sound immediately before the first heart sound.
1. What's the heart sound?
2. What causes it?
3. Why does this patient have that?
1. S4
2. Blood from atrium crashing into stiff venticular wall
3. Venticular hypertrophy due to aortic stenosis and HTN.
In a 65 yo woamn who was hospitalized for a PE, what drug is indicated for long term prophylaxis? Aspirin or Warfarin?
Warfarin....both would work, but Warfarin is way more effective.
A 65 yo female with ovarian cancer is treated with cisplatin.
1. What is the MOA of cisplatin?
2. What are the common side effect?
3. How can you prevent those side effects?
1. Cisplatin is a platinum-containing compound that forms ROS that can crosslink DNA.
2. Most common side effect is NEPHROTOXICITY.
3. AMIFOSTINE is a thiol-based cytoprotective free-radical scavenging agents that can decrease the Nephrotoxic Effects.
A neonate born to a 41 yo woman at term has flattened face and epicanthal folds. ECHO reveals an endocardial cushion defect. What caused this?
Down Syndrome. Meiototic Non-disjunction. She's old, so it most likely wasnt caused by Robertsonian Translocation.
What is the major function of the following muscles on the hip?
1. Iliopsoas
2. GLuteus Maximus
3. Semitendinosus
4. Gluteus Medius
5. Adductor Brevis
6. Adductor Longus
7. Gluteus Minimus
8. Biceps Femoris
9. Rectus Femoris
10. Tensor Fascia Lata
1. iliopsoas = flexion
2. Glut Max = Extension
3. Semitendinosus = Extension
4. Gluteus Medius = Abduction
5. Add. Brevis = Adduction
6. Add. Longus = Adduction
7. Gluteus Minimus = Abduction
8. Biceps Femoris = Extension
9. Recturs Femoris = Flexion
10.
A 64 yo man comes to the physician because of persistent back pain, constipation, and easy fatigability for the last several months. He has a low hemoglobin level and his serum creatinine is 2.9 mg/dL. Renal biopsy shows atrophic tubules, many with large,
MULTIPLE MYELOMA.
Why?
1. Elderly Patient
2. Constipation (due to hypercalcemia)
3. Bone pain (back and ribs) due to lytic lesions
4. Renal Failure (caused by hypercalcemia, hyperuricemia, AL amyloidosis, frequent infection.
5. Eosinophilic (not eosinophi
A 45 yo male sustains a traumatic injury at work and presents to the ED with deep laceration of his right hand. Three weeks later, actin-containing fibroblasts and increased metalloproteinase activity are detected the site of injury. What is the complicat
ANSWER = Contracture. MMPs are secretes by many cells (fibroblasts, macrophages, neutophils, synovial cells, and epithelial cells). They are important in wound healing because the encourage myofibroblast accumulation and scar remodeling.
Increased levels
A woman with schizophrenia is started on a new drug. After 6 months of no menstrual bleeding, she is brought to the hospital.
1. What drug?
2. Why might it cause ammenorhea?
1. Risperidone (or other anti-psychotics). Many of these drugs reduce the levels of dopamine in the brain. Normally, prolactin is inhibited by dopamine, but prolactin levels can rise with use of these drugs.
2. Prolactin will suppress the secretion of FSH
A man is brought to the ED after getting hammered and vomitting at a party. He has been drinking very heavily and has acute pancreatitis. His BAC is 0.245%. He tells you that he hates hospitals and that he will sue you if you touch him. He says that he wa
You can't release him until he is sober. He is drunk and therefore incapacitated. Patients who are temporarily incapacitated should not be allowed to make important health care decisions.
How do you test for Gardernella Vaginalis?
Add KOH solution to the discharge and smell for a strong fishy odor.
A 34 yo woman has nephrolithiasis that is not visible on X-ray, but is seen on ultrasound. What type of stone is it?
Uric Acid stones are the only type of radioleucent stones.
An infant has urine discharge from the umbilicus that irritates the surrounding skin. What part of development failed?
Persistent ALLANTOIS remnant. During the 3rd week of gestation, the yolk sac forms a protrusion know as the allantois that extends to the urogenital sinus. Once the urogenital sinus develops into the bladder (5-7 weeks), the it becomes the URACHUS and con
If a patient has a megaloblastic anemia that doesn't correct upon administration of folate or B12, what are you thinking?
Orotic Aciduria.
A patient presents with increased orotic acid in his urine. You check his ammonia levels, but they are normal. How should you treat him?
He has orotic acid deficiency. You should treat him with uridine (bypass the enzyme deficiency).
Name 11 X-linked recessive disorders. (There's a mneumonic)
Be Wise, Fool's GOLD Heeds Silly HOpe"
B = Bruton's agammglobulinemia
W = Wiskott-Aldrich syndrome
F = Fabry's disease
G = G6PD Deficiency
O = Ocular Albinism
L = Lesch-Nyhan Syndrome
D = Duchenne's and Becker's Muscular Dystrophy
H = Hunter's Syndrome
H
Name 4 Trinucleotide repeat expansion diseases, and the 3 base sequence that is associated with it. (There's a Pneumonic)
1. TRY (trinucleotide) HUNTING for MY FRIED eggs.
-Huntingdon's
-Myotonic Dystrophy
-Friedrich's Ataxis
-Fragile X Syndrome
2. Fragile X = cGg (X-Girlfriend's)
Friedrich's = gAa (First Aid)
Huntingdon's = cAg (Helped Ace)
Myotonic Dystrophy = cTg (My Test
1. Endocardial cushion defects are common in which Trisomy? What is the embryological derivative?
2. What is the AFP level? B-hcg level? Estriol? Inhibin A?
1. Down's Syndrome. Endocardial cushin is a neural crest derivative.
2. The AFP is low, the B-hcg is high, estriol is low, and the inhibin A is high.
Which chromosomes are most commonly involved in Robertsonian Translocation?
The Acrosomal Chromosomes. 13, 14, 15, 21, 22. They have almost no P arms, so they can easily combine.
If a patient has a microdeletion of the short arm of chromosome 5, what will the clinical presentation be?
-Microcephaly, MR, high-pitched cry (Cri-du-chat), epicanthal folds, cardiac abnormaltiies (VSD)
A patient has a congenital microdeletion of the long arm of chromosome 7.
1. What is the syndrome?
2. What is the most important gene in that region?
3. Name the clinical features (6).
1. William (7 letters)
2. Elastin gene
3. -Elfin Facies
-Intellectual disability
-Hypercalcemia (due to increased sensitivty to Vit D)
-Well-developed verbal skills, extreme friendliness with strangers, CV problems (supravalvular aortic stenosis)
Picture
What purpose does G-banding serve?
It can help you identify very LARGE delecitons during karyotype analysis.
How can INH cause Pellagra?
INH can cause a deficiency in Vitamin B6, which is a necessary cofactor for the production of Niacin (B3) from tyrptophan. Deficiency of Niacin causes Pellagra (dermatitis, Dementia, and Diarrhea).
Alcohol Quiz
1. Ingestion of Alcohol causes Hyper/hypo glycemia?
2. Where does ethanol metabolism take place?
3. Does it increase or decrease the production of NADH? Consequence (2)?
4. What is the MOA of Fomepizole? Disulfuram?
5. What is the clinical us
1. Causes hypoglycemia.
2. The first step (Ethanol to acetylaldehyde) takes place in cytosol. The second step (acetylaldehyde to acetate) occurs in the mitochondira.
3. It increases the production of NADH.
-Increased NADH causes increased conversion of ox
WHat is the difference between Marasmus and Kwashiorkor?
Marasmus = Energy Malnutrition
Kwashiorkor = protein malnutrition
Metabolism Site Quiz
1. Where does the TCA cycle take place?
2. Glycolysis?
3. HMP shunt?
4. Heme Syntehsis
5. Urea Cycle
6. Fatty Acid Synthesis
7. Cholesterol Synthesis
8. Fatty acid oxidation?
9. Gluconeogenesis?
10. Steroid Synthesis?
1. Where does the TCA cycle take place? MITOCHONDRIA
2. Glycolysis? CYTOPLASM
3. HMP shunt? CYTOPLASM
4. Heme Syntehsis BOTH
5. Urea Cycle BOTH
6. Fatty Acid Synthesis CYTOPLASM
7. Cholesterol Synthesis CYTOPLASM
8. Fatty acid oxidation? MITO
9. Gluconeog
In Pyruvate Dehydrogenase Deficiency....
1. What is the genetic mutation?
2. What would acid-base analysis show?
3. What would the clinical deficits be? When?
4. How do you treat it?
1. X-linked gene for E1-alpha subunit of PDC
2. Lactic Acidosis because of backup of pyruvate
3. Neuro defects that start in infancy
4. Increased fat consumption and Purely Ketogenic Amino Acids (Lysine and Leucine).
1. Which 3 amino acids are basic?
2.Which two amino acids are negatively charged at physiologic pH?
1. BLAH
B = Basic
L = Lysine
A = Arginine
H = Histine
2. Aspartate and Glutamate
What is the mechanism by which PTH increases Calcium reabsorption from bone (2)?
1. PTH causes OSTEOBLASTS to increase the production of RANK ligand and Monocyte-CSF. These two precursors stimulate osteoCLASTIC precursors to differentiate into mature osteoclasts.
2. PTH also Decreases the release of osteoprotegerin (OSP), which is a d
A 46 yo female with severe upper abdominal pain, vomiting and fever is found to have an inflamed and partially necrotic gallbladder on laparatomy. What most likely initiated this condition?
THis patient has acute calculous cholecystitis (ACC), which is characterized by acute inflammation of the gallbladder. 90% of the time, it is INITIATED by a gall stone obstruction.
Later, the stones damage the wall, causes stasis, ischemia, and eventually
A 73 yo male has epigastric pain that starts 30-40 minutes after meals and does not respond to antacids. He has lost weight because he is afraid to eat. PMHx of HTN, HLD, CABG, and right-sided endardectomy. Upper GI endoscopy shows nothing.
The pathophysi
ANSWER = Stable Angina. This guy has reduced blood flow to the colon, which is fine normally. HOwever, when he eats and the bowel needs to work harder to digest the food, the blood supply is inadequate and he gets ischemic pain.
It's like exercise intoler
1. Which step of the TCA cycle creates creates a GTP molecule?
2. What step of Gluconeogenesis needs this?
1. Succinyl CoA --> Succinate via Succinyl-CoA synthetase enzyme.
2. Conversion of Oxaloacetate into Phosphoenopyruvate.
A 45 yo Caucasian Male with advanced HIV infection undergoes bronchoscopy for cough and chest pain. Mucicarmine staining of his bronchoalveolar fluid shows budding yeast forms with thick capsules.
1. What is the organism?
2. What kind of infection does it
1. Cryptococcus Neoformans. Mucicarmine stain is used when in the tissues (RED STAIN)
2. It is inhaled and causes lung infection first, but this is usually asymptomatic. It MOST COMMONLY presents as MENINGITIS in an immunocompromised (AIDS) person.
3. In
A man is tested for suspected terminal cancer. Before you get the results, he says he doesn't want you to tell him or his family ANYTHING about the diagnosis or treatment. He wants to live at home without treatment for the rest of his life. What do you do
Let him go home...follow his wishes.
A 24 yo man complains of bilateral tinnitus, vertigo, and hearing loss. A contrast-enhanced T1 CT shows bilateral tumors at the cerebello-pontine angle.
1. Diagnosis?
2. On what chromosome is the mutation?
3. What does the gene code for?
4. What is the ge
1. He has NF2, which is found on Chromosome 22.
2. 22
3. Gene codes for MERLIN
4. NF1 is a mutation on chromosome 17 that codes for NEUROFIBROMIN
5. Cafe-au-lait Spots, Multiple neurofibromas, lisch nodules.
A 32 yo man presents to the ER with severe weakness and dizziness two weeks after a mild respiratory illness. ECHO shows fluid in the pericardium with late diastolic collapse of the right atrium. What change in BP would you expect to see during inspiratio
She has Cardiac Tamponade. You would expect to see PULSUS PARADOXUS. Pulsus Paradoxus is an exaggeration of the normal physiologic decrease in BP that occurs during inspiration (more than 10mmhg).
A woman undergoing chronic glucocorticoid therapy for SLE treatment has minor surgery. During the surgery, she develops nausea, dizziness, and abdominal pain. Compaired to the normal physiological response, how would her levels of CRH, ACTH, and Cortisol
They would all be LOW. Long term therapy with glucocorticoids causes adrenal atrophy. During the surgery, she would need a more robust stress response, but she wouldn't be able to do it because of the atrophy of her HPA axis.
What nerve is most commonly injured by use of improperly fitted crutches?
Radial Nerve.
A 28 yo woman with a history of PID was brought to ER with severe abdominal pain in the RLQ and vaginal bleeding. Her last menstrual period was 7 weeks ago. Her BP is 80/40, pulse is 130. She is pale and her extremities are cold and clammy. Endometrial cu
ANSWER = Decidualized endometrium. She most likely has an ectopic pregnancy due to her history of PID. Over time, the ectopic pregnancy compromises blood supply to surrounding tissues and can lead to organ rupture (why she's cold and clammy with low BP).
A 59 yo man with fatigue and chronic back pain for 3 months that is getting worse. PE shows midline tenderness over his mid to lower back. Labs reveal a normocytic anemia and mild hypercalcemia. His creatinine is also elevated. What would you expect to se
Multiple Myeloma. Bone Marrow would be infiltrated with plasma cells with abundant basophilic cytoplasm, eccentrically place nuclei, and a "wagon wheel" or "clock face" distribution of nuclear chromatin. You would usually see more than 30% plasma cells in
EKG shows a 67 man has bradycardia with regular rhythm and narrow QRS complexes. However, there is complete desynchronization between the P waves and QRS complexes. Which of the following is responsible for pacing this patient's ventricles?
1. SA Node
2.
ANSWER = AV Node. This guy clearly has a complete block, so his AV node has taken over as the primary pacemaker. The AV node usually produces a HR of 45-55 beats per minute.
A 34 yo female is being evaluated for periodic low-volume vaginal bleeding. Cytological finding shows a Koilocyte. What is a Koilocyte, and why does she have it?
Koilocyte is a immature squamous cell with dense, irregularly staining cytoplasm and preinuclear clearing resulting in a halo. There are also perinuclear vacuoles. The nuclear is classically described as PYKNOTIC, meaning that the chromatin has condensed
1. What is the MOA of Zidovudine?
2. Which of the following is Zidovudine most likely to disrupt?
-Nucleoside Phosphorylation
-Folate-dependent uracil methylation
-3'-5' phosphodiester bond formation
-Proper base pairing and hydrogen bond formation
-Integ
1. Nucleoside reverse transcriptase inhibitor used to treat HIV infection!!
2. 3'-5' phosphodiesterase bond formation. It competitively binds to reverse transcriptase and is incorporated into the viral genome as a thymidine analog. AZT does not have a 3'-
A new medication inhibits fungal colony growth by altering the fungal cell membrane composition. However, it inhibits the P450 system metabolism of several drugs. This new drug is most like which of the following?
1. Amphotericin B
2. Itraconazole
3. Terb
ANSWER = Itraconazole. The -azoles MOA is to inhibit fungal sterol (ergosterol) synthesis, by inhibiting the P-450 enzyme that converts lanosterol to ergosterol. However, it inhibits the cytochrome P450 system.
MAGIC RACKS in GQ
-Macrolides (Azithromycin,
Name 8 Sulfa based drugs. (Theres a pneumonic)
Knowing the sulfa drugs is a Popular FACTSSS on step one
P = Probenecid
F = Furosemid
A = Acetazolamide
C = Celecoxib
T = Thiazides
S = Sulfonamide Antibiotics
S = Sulfasalazine
S = Sulfonylureas
Eukaryotes are able to quickly and effectively transcribe their HUGE genomes. What unique feature allows them to do that?
Multiple Origins of Replication!!
Binding of intracellular GTP to a specific membrane-associated protein causes rapid metabolic changes in hepatocytes. These include a decrease in intracellular glycogen and release of glucose into the blood. Which of the following is the most likely media
ANSWER = Protein kinase A. The question is describing GLUCAGON. Glucagon works via a Gs protein pathway. (you know this because its the antidote to B-blocker toxicity).
1. Glucagon binds to receptor protein (7 transmembrane protein)
2. ATP activates ADENY
A man develops difficulty walking over the last two days with tingling in his feet. He has reduced strength bilaterally in his LE and absent DTRs. He had a bout of diarrhea two weeks ago. What's the deal?
Onset of GBS, caused by Campylobacter infection.
A 34 yo male who recently returned from vacation in Arica now complains of recurrent fevers, chills, and excessive sweating. These symptoms occur every 48 hours. A blood smear of Geisma staining reveals RBC inclusions. Treatment is started with Chloroquin
You should also give primaquine to PREVENT DISEASE RELAPSE (not reinfection, relapse). Chloroquine can treat the blood infection, but it has no activity against the latent hepatic infections established by the vivax and ovale species.
Clustered Gram positive bacteria are isolated from the tonsillar exudates of a 6-yo boy. On microscopic exam, the bacteria have polar granules that stain deeply with analine dyes. The pathogenicity of these organisms is a result of:
1. Widespread T-cell a
The bug is clearly C, Diptheria (gram positive, non-motile, unencapsulated, rod). They are often found in clumps resembling chinese letters!
Their cytoplasm contains metachromatic granules that stain with analine dyes like methylene blue.
Produce an AB-to
A man has a serious MVA and needs a blood transfusion. He develops difficulty breathing, chills, and pain in his chest and back. Dark-colored urine is seen draining from the catheter. What is the most likely cause of his new symptoms?
1. mediator release
ANSWER = Complement mediated cell lysis. He probably was given the wrong kind of blood, so he's having an acute hemolytic transfusion reactions. It's a type II HS reaction. Pre-formed antibodies are attacking the transfused RBCs. Once the antibodies are b