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poxidicu's version from 2016-06-19 19:00

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Question Answer
Fever, Chills, severe hemolysis, and circulatory collapseABO incompatibility
Pt who presents with recurrent pneumonia, GI problems and celiac disease go into anaphylaxis during blood transfusion after accident that contain small amounts of IgAIgA deficiency
Fish bone stuck in the piriformis recess leads to the damageInternal Laryngeal nerve which leads to damage of Vagus -> Impaired Cough Reflex
Pt with homocystinuria(marfanoid habitus, ectopia lentis, cerebral infarction) needs to be supplemented withB6 Pyridoxine which is a cofactor for cystathionine beta-synthase and restricted from methionine in diet
Fastest rate of metabolism in glycolytic pathway?Fructose-1-Phosphate -> due to the fact it bypass phosphofructokinase 1(PFK 1)
Cancer pathogenesisGrowth factor binding leads to mTOR activation -> Cause translocation of the nucleus and gene transcription
Recurrent cutaneous infection without pus, poor wound healing, umbilical cord delayed separationLeukocyte Adhesion deficiency Cd18
Impairment of Antibody production protective mechanismX-linked agammaglobulinemia -> B cell immunodeficiency leading to reduced mature B cell -> Lower respiratory tract infections & GiardiaLambia
Disseminated mycobacterial disease in infancyDefective Interferon-gamma Signaling
Exotoxin prior to ingestion(Mayonaise containg foods)S.Aures & B Cereus
Direct Thrombin Inhibitors -> Inactivates both circulating and clot formationDabigatran,Bivalirudin,Argatroban
Posterior columns and Lateral corticospinal tract demyelination/ peripheral nervesVitamin E & B12
Calcipotriene, Calcitrol, TacalcitolTx Psoriasis Moa- Activate Vit-d receptor a nuclear transcription factor causes inhibition of keratinocyte proliferation & differentiation
Pt who presents with MI who after initial treatment has a repurfusion complex ventricular arrhythmiatPA, Reteplase, Tenecteplase
Non specific Fibrinloytic(Systemic clot)Steptokinase
Contraindication of fibrinolytics such as tPA,Reteplase,Tenecteplase, streptokinaseHx of hemorrhagic stroke, ischemic stroke, active internal bleeding
Side effect of FibrinolyticsReperfusion Arrhythmia
Diffuse Esophageal SpasmPeriodic simultaneous non-peristaltic contractions of large amplitude and long duration due to impaired neural inhibition
Corticospinal tract lesionUpper due to strokeor brain tumor(Hyperreflexia) and lower(damage to motor neurons)
Brown pigmented gall stonesDue to infection
Black pigmented gall stonesHemolysis(Sickle cell)
Pt who presents with right upper quadrant pain after fatty meals and cholecystokinin stimulation test shows slow and incomplete gallbladder emptyingBiliary Sludge -> Leads to formation of gallstones
Aminoglycosides drug resistanceProduce an enzyme that is involved in acetyl group transfer to exogenous substances and is located on the surface of cytoplasmic membrane
Enterobiasis(Scotch tape) PinwormTx- Albendazole in kids & Pyrantel Pamoate in pregnant women
Mitral Regurgitation what increases ratio of forward flow?Decreasing left ventricular afterload
Aortic regurgitation what is the best thing to increase cardiac outputIncrease stroke volume
Mycobacterium Avium complex ~Immunocompromised, fever, weight loss. Specific - Anemia, Hepatosplenomegaly, elevated alkaline phosphatase & lactate dehydrogenaseCD4 count less than 50 -> Azithromycin
Pt who presents with chronic diarrhea, , abdominal pain, flatulence with similar duodenal biopsy as celiac disease(atrophic villious) with RECENT TRAVEL historyTropical Sprue
Pt who has a history of non compliance with medication VS Primary HyperaldosteronismUnchanged BP WITH Normal Renin Vs Unchanged Bp with Low Renin
Proximal Lesser curvatureLeft Gastric
Distal Lesser curvatureRight Gastric
Proximal greater curvatureLeft gastroepiploic
Distal greater CurvatureRight gastroepiploic
Proximal grater curvature above the spleen or the fundusShort gastric
Proximal Part of duodenumGastroduodenal
34 yr old female bleeding from right nipple with no fever & pain, No breast skin or mass changes no PMHInvasive Ductal carcinoma of breast is the most common Histopatholgic - Pappilary cells with fibrovascular core
Fat necrosis breastLiquefactive necrosis of adipocytes with hemorrhage
Pagets disease of the breastAtypical cells infiltrating the nipple skin
Fibroadenoma of the breastStromal proliferation compressing the ducts to slits
Mature Cytotoxic t-lymphocytesCD 8
Mature Helper t-lymphocytesCD 4
Immature cortical t-lymphocytesFetal thymus with cells positive for CD 4 & CD 8 surface antigens
Drug of choice in treating pt with multiple sclerosis spasmsBaclofen or Tizanidine agonist GABA-B receptor
Fluid runs along PCT INCREASES what concentrationPAH, Creatinine, Inulin, Urea
Fluid runs along PCT DECREASES what concentrationBicarbonate, glucose and amino acids
Pt who has mild cognitive problem whos medication care is given by daughter is readmitted for heart failure. What could've prevented this revisit?Involvement of a social worker in discharge planning
Protein Primary Structure BOND "Bunch of aminod acids held together"Peptide
Protein Secondary Structure B-pleated BONDHydrogen Bond
Protein Tertiary Structure BONDHydrogen Bond, Ionic, disulfide, hydrophobic
Most like cause of death in an MI patient (Severe chest pain,short lived episodes of chest pain recently)Ventricular Fibrillation -> Most common cause of death in the first 48 hrs after MI
Headaches, fever, with hsitory of HIV, INDIA ink with spherical yeasts forms with thick capsuleC.Neoformans -> Primary focus of infection Lungs - Pigeon Droppings
Cystic FibrosisMutation of CFTR chromosome 7 is a transmembrane ATP gated chloride channel -> pumps chloride out of ions out of epithelial cells
Neurons Voltage gated
cGMP-gated sodium channelsVision
G-protein activated receptorsHormone receptors
Janus Kinase 2Signialling pathway for myeloproliferation(polycythemia vera,essential thromobcytosis, myelofibrosis)
A wound healing shows increased metalloproteinase activitySeen usually in cancer(degradation of collagen -> Spread of cancer) & Excessive wound contraction -> Contractures
Kyphoscoliosis, Pes cavus, Bilateral lower extremity ataxia(Spinocerebellar tracts), impaired vibration(posterior columns & dorsal root ganglia)Friedreich Ataxia -> Greatest risk of dying Cardiomyopathy
Loperamide, DiphenoxylateOpiod anti-Diarrheal binds to the mu receptor -> Used in pts with diarrhea
14 month old boy presents with failure to thrive & developmental delay, low hemoglobin, Increased MCV & Orotic acid crystals in the urineHereditary Orotic aciduria-> Tx with Uridine -> UMP
14 month old presents with failure to thrive & developmental delay. low hemoglobin, Increased MCV & Orotic acic in urine & Hyper-AmmoniaOrnithine Transcarbamylase Deficiency
Excessive weight loss, Exercise,Eating Disorder -> Decreased adipose tissue/ Fat reserves & leptin levelsHypothalamus(LowGnRH) -> Pituitary(Low LH,FSH) -> Ovaries(Low estrogen)
AmiodaroneThyroid function test needs to be done before putting pt on this medication due to Sx of hyper OR hypo thyroidism
AML has which protein abnormal in the hematopoietic cellsRetinoic acid receptor
K1 Capsule E.coli Virulence factorMeningitis
Lipopolysaccharide aka lipid A E.Coli virulence factorBactremia & Septic Shock
Verotoxin E.coli virulence factorBloody shiga like toxin diarrhea
P.Fibriae E.coli virulence factorUrinary tract infection
Primary Anterior Pituitary AdenomaHas increased ACTH & Cortisol -> Dexamethasone test would suppress ACTH & Cortisol
Ectopic ACTH SecretionIncreased ACTH & Cortisol
Adrenal AdenomaLow ACTH & High Cortisol
Sciatica S1Pain & Sensory loss down the posterior thigh to calf & lateral foot & Absent ankle reflex
L4 neuropathyPain & Paresthesia down the anterior thigh to medial leg and foot & Diminished Knee reflex
Despite having negative results, pt asks "What are the chances that I really do not have cancer"Negative Predictive value
Outer membrane Lipooligosaccharide N.Meningitidis virulence factorBactremia & Septic Shock -> Morbidity & Mortality
Dimpling of the breast when cancer is presentCancer infiltration of the Suspensory Ligament aka copper ligament
7yr old boy, abdominal pain & arthralgias with a history cough and runny nose a week ago. Palpable purpura buttocks & thigh, RBC casts in urine(Renal disease)Henoch-Schonlein purpura -> Circulating Immune complexes -> IgA deposition in blood vessels
Ankylosing SpondylitisHLA B27 -> Disease progression can be monitored by Chest Expansion -> The worse the condition the less chest expansion leading to hypo ventilation
Poor feeding, emesis(bilious vomiting) in an infant "fibrous bands are seen extending from the cecum and right colon to the retroperitoneum causing extrinsic compression of the duodenm"Malrotation -> Midgut rotation around the superior mesentric artery
42 yr old women with long standing history of diastolic murmur, autopsy of left atrium shows diffuse fibrous thickening & distortion of the mitral valve leaflets, commissural fusion at the leaflet edges and narrowing of mitral valve orificeRheumatic fever
Calcific deposits in the mitral annulus nodular calcific deposits in women age 6-+ with no functional valve impairmentDegenerative valvular calcinosis
Metanephros Ureteric budUreter, Pelvises, calyces, collecting ducts
Metanephros Metanephric aka mesoderm(Blastema)Glomeruli, Bowmens space, Proximal tubules, loop of henle, DCT
Girl with seizures, fever, speaking problems, difficulty staying awake, headache with Bilateral hemorrhagic necrosis of the inferior & medial temporal lobesHSV encephalitis
Calling a pt by her first nameAs an attendng physician you should 1. Ask preferred name of choice 2. Clear any sort of pronunciation problems 3. Address the pt always by her surname and ask for her preferred form of address
Antigen Presenting CellsMHC Class I(CD8) & MHC Class II(CD4)
Affected cells shows impaired interaction with T-Lymphocytes upon antigen exposureMHC Class II -> Cd4
Affected cells shows impaired killing with T-Lymphocytes upon antigen exposureMHC Class I -> Cd8
Activation of MHC Class I needB2-Microglobulin
Activation of MHC Class II needInvariant chain
APC's(B7)Dendritic cells, Macrophages, B-Lymphocytes
Leukocyte Adhesion deficiencyIntegrins ->binding of inflammatory cells to vascular walls during the process of transmigration through the endothelial layer from the blood stream to the tissues
Molecules that recognize the stop codon(do not code for tRNA) isReleasing Factor protein
ClozapineTransiently bind to D2 receptors -> Fever pyrimidal side effects Sx -Neutrophil count should be regularly monitored(Agranulocytosis), Seizure & Myocarditis
Lithium SxRegularly monitor TSH & Creatinine
Respiridone SxCheck prolactin levels regularly
Abdominal cramps, rash is worse after scratching, fatigue, flushing, Rash, vasodilation syncope, uriticaria after warm shower,KIT+Mastocytosis -> Abnormal proliferation of mast cells leading to Increased secretion of Histamine induced leads to Gastric hyper secretion -> Gastric ulcer Tx- Omperazole
Pernicious Anemia is related toH.Pylori -> due lack of intrinsic factor
Oxidase positive G-rodsPsuedomonas
Nonlactose fermenting oxidase negative motile in a sickle cell pt with intense pain over her right thighSalmonella osteomyelitis -> Virulence - Resistance to opsonization
Calcified hilar nodes, nodular densities, birefringent particlesSilicosis(Mineral dust)
Pleural plaques on the lungAsbestosis
Non-caseating epitheliod granulomas without particles and looks similar to pneumoniaBerylliosis
Colchicine -> Inhibiton of microtubule formationSx is nausea, vomiting and diarrhea
Pt who is presenting with absent p waves and irregular rate & rhythm afib, diffuse tenderness in the abdomen and decreased bowel sounds, high ph and acidic urineAcute ischemic colitis due to embolus from A-fib -> Renal metabolism of Glutamine amino acid is most important for acid excretion in this pts urine -> Due to Glutamine to Glutamate creates ammonium in the urine
CMLElevated WBC, Metamyelocytes, Myelocytes,Basophils, Eosinophils Decreased Alkaline Phosphatase
Leukomoid ReactionElevated WBC, Metamyelocytes, Myelocytes Normal OR Increased Alkaline Phosphatase
Pt with a history of long time smoking presents with right sided face & arm swelling, and engorgment of subcutaneous veins on the same side of neckBrachiocephalic vein
Pt with a history of long time smoking presents with right side arm swellingSubclavian vein
Pt with a history of long time smoking presents with left side arm swellingSubclavian vein
Pt with a history of long time smoking presents with left side face swellingInternal Jugular vein
Pt with a history of long time smoking presents with Bilateral face,neck and chest and both arms swellingSuperior Vena Cava syndrome
Neuroendocrine tumor of the pancreas, pt presents with diarrhea with NO IMPROVEMENT in symptoms with fasting and NO ulcersVIPOMA
Neuroendocrine tumore of the pancreas pt resent with diarrhea with IMPROVEMENT in symptoms during fasting and HAVE duodenal ulcersGastrinoma -> Test for MEN 1 syndrome also
RERProteins
SERSteroid and phospholipid biosynthesis
Corpus LuteumProgesterone
No vaginal discharge & no cervical motion tenderness(Gonorrhea -), multiple painfull shallow ulcers with an erythematous base on the left labia & bilateral tender inguinal lymphadenopathyHSV -> PCR for viral DNA OR TZANCK smear
14 yr old pregnant what is your best answer"You can consent to prenatal care but need consent or parental notification before termination" 1. Emergency care, Sexually transmitted infections, substance abuse, prenatal care
Defective signaling between Cd4+ T cells and B cells(Isotype Switching) -> Gi, Pneumonia infectionsHyper IgM syndrome
Latent periodTaking antioxidants for a longer period of time changes the outcome of stroke vs pts taking antioxidants for less time
Low hemoglobin, Low reticulocytes and RBC(Anemia), Normal Platelets and Leukocyte count, Bone marrow shows abscence of erythroid precursors and preserved myeloid and megakaryocytic elements"~Pure Red Cell Aplasia -> Thymic tumor removal -> Aplastic Crisis due to ParvoVIRUS b19
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