question

67 yo has urinary urgency after placement of urinary catheter during transurethral resection of prostate, most appropriate therapy?

answer

inhibition of muscarinic receptors

question

Female pt w/ mt breast cancer, transferred to an hospice. Only family member are allowed to stay after visiting hours. Most appropriate response by the physician?

answer

You seem very important to each other, you can stay...

question

male with 3 month history of gynecomastia, is taking injections of beta hCG, what is the most likely binding site and action of b-hCG causing development of gynecomastia?

answer

Testicle---Estradiol production. hCG has the same alpha unit as LH, FSH, TSH. Increase in hCG -> increase in LH -> more testosterone (via Leydig cells) -> more estrogen (via aromatase in adipose tissue and testis) -> gynecomastia

question

reviously healthy 72 year old man with weakness and fatigue. His Hb 9.2 g/dL, leukocyte count is 5400/mm3, and platelet count is 350,000/mm3. A peripheral blood smear is shown (many small RBCs with various shape andd big central palor, one WBC and its size is bigger than the RBC shown). Which of the following is the most likely cause of these findings??

answer

GI BLOOD LOSS---CLASSIC presentation for right sided colon cancer.smear sounds classic for a microcytic anemia, so iron deficiency from GI blood loss is definitely correct

question

63-year-old man comes to the physician because of a 6-month history of exertional chest pain that is relieved by rest. He has smoked 1 pack of cigarettes daily for 45 years. He has mild hypertension, but he takes no medications. Which of the following types of lesions in the left anterior descending coronary artery is the most likely cause of his condition 100% vasospasm=one aneurysm, dec's from there <50% stenosis=plaque--MI

answer

Calcified 80% stenosis...on exertion = stable angina. occlusion of more than 70-75% Variant/Printzmetal--@ rest and nighttime, 2* to Vasospasm, ST elev, Tobacco, cocaine, triptans/ younger pt Unstable--Thrombosis with incomplete artery occlusion. any chest pain at rest, no exertion. st depression or t-wave inversion

question

56 year old Woman comes to the physician for a follow up examination after recovering from Pneumococcal Pneumonia, X-ray shows no abnormalities. What allowed for full resolution:

answer

metaplasia of mesenchymal cells----type 2 pneumocytes proliferate in damage... shouldn't be fibroblasts and shouldn't be BM integrity (think this references invasion of cells)

question

54 y/o female h/o htn and bilateral renal a stenosis, starts using nsaids for back pain. over next week her s.creatinine increases from 1.0 to 5.0mg/dl. most likely cause is drugs ability to inhibit

answer

vasodilating PGs at afferent arteriole

question

RCT study of 2000 patients with insomnia, conducted to evaluate the efficacy of new medicine to treat the condition. subjects in treatment group are able to fall asleep on avg of 5 mins faster than subjects in control group. difference is stat. significant p=0.001. subjects in neither group report improvement in quality of life. investigators conclude new medication is efficacious for insomnia. which type of error

answer

failure to distinguish btw statistical and clinical significanc

question

55 y/o man with sepsis gets confused and anxious. Treated with vanco/ceftriaxone. Temp 104, BP 84/50. Warm flushed skin. Give what solution?

answer

0.9% saline <--- boost the BP asap, so 0.9% normal saline; 3% too hypertonic, don't need the sugar 3% saline (not this

question

10 year old boy has had anemia since birth. His spleen is five time times normal size. Splenectomy is indicated if the anemia is caused by which of the following disorders?

answer

Glucose 6 phosphate dehydrogenase deficiency----patients are able to live with spherocytes. its the extravascular hemolysis which is causing the problem and symptoms. so if remove the source of the hemolysis, we can help the patient.

question

38 year old man comes to the physician because of a 1 week history of watery, itchy eyes and a runny nose. He works as a crane operator. Physical examination shows inflamed nasal mucosa. There is no congestion in the lower lung. Which of the following is the most appropriate pharmacotherapy

answer

Loratadine, 1st generation has antimuscarinic effect and it wouldn't hel him since his job is a crane operator and Ranitidine is for peptic ulcer disease

question

atient is 30 y/o 22 weeks gestation. One day history of fever, chills, and muscle aches. Fever, high pulse, and low BP. Uterus size is consistent with gestation. Fetal heart sounds present. Leukocyte count 12,000. Blood cultures show gram positive rods What the organism that causes this?

answer

(In pregnant if you see a vignette like this one always link it with L. monocytogenes).

question

Patient is 9 y/o with poor growth and weight. Bitemporal hemianopsia. Labs show GH deficiency. MRI shows calcified cystic mass in suprasellar region. Tumor is derived from which of the following?

answer

Diverticulum of the roof of the embryonic oral cavity, Ependymal layer of the median eminence, Hypophyseal cartilage, Neural crest cells of the rhombencephalon, Neuroectoderm of the diencephalon. (Craniopharyngioma given her age).

question

44-year-old woman comes to the physician for a follow-up examination after two separate Pap smears showed atypical squamous cells of undetermined significance. Results of a molecular diagnostic test show the presence of the viral E6 protein of human papillomavirus. This protein is known to promote cell growth and malignancy by causing cellular p53 protein degradation. This degradation most likely begins when the p53 protein is targeted to which of the following types of cellular enzymes?

answer

Ubiquitin ligase protein degradation

question

42-yo amek is brought to the ED by his wife because of a 5hr history of fever, chills, and severe pain and swelling of his left arm. His wife says he scratched his arm on a nail while repairing a fence in the yard yesterday. He appears confused. His temperature is 40C/104F, pulse 140, resps 25, and BP 71/38mmHg. PE of the left upper extremity shows edema and erythema in the area of the scratch. Lab studies. pt's symptoms are most likely directly attributable to systemic release of which of the following cytokines

answer

IL-1 for fever (thus acute phase), so that eliminates d-f. IFN-alpha is released by virus-infected cells, and TNF-alpha is involved in making granulomas, leaving b) as the answer

question

24-year-old man with a history of intravenous drug use is brought to the emergency department by his roommate 30 minutes after he could not be aroused. The friend reports that the patient injected himself with a drug approximately 6 hours ago. Laboratory studies show a serum drug concentration of 0.30 mg/L. Assuming the drug exhibits first-order one-compartment kinetics, has a half-life of2 hours, and a volume of distribution of 200 L in this patient, which of the following is the most likely approximate quantity of the drug (in mg) injected?

answer

480 (6hrs post injection. So 3 half lives by now. Which means initial concentration of drug in the plasma was (0.3*2*2*2). Multiply that with 200 (Volume of distribution to get amount of drug that was in the body in mg)

question

newborn delivered at 38 weeks gestation, weighs 1800 grams, shows petechial rash, microcephaly, HPSM, serologic testing shows, mother= CMV-IgG +, CMV-IgM - baby is CMV-IgG+, CMV-IgG+, most likely explanation??

answer

PASSIVE transfer of maternal CMV IgG and IgM antibodies through the breastmilj. congenital CMV infection that was transmitted transplacentally during the first or second trimester of pregnancy. In contrast, the infant with acquired CMV infection after birth resulting in illness several weeks later. Perinatally, CMV can be transmitted through breast milk or vaginal secretions. Premature infants however, are particularly susceptible to transmission through transfusion of blood products

question

30y/0 female training for marathon, running 20 miles/d. she says as long as she takes adequate calories, she feesl well on long distance runs of 20 miles. p/e normal. serum glucose 60 mg/dl. after her glucose stores have been depleted which organ in addition to liver is likely to release newly produced glucose in this pt.

answer

kidney

question

17y/o healthy girl in ER due to 1 day h/o SOB, weakness and muscle tenderness. she completed triathalon the previous day. she appears restless. she is 163 cm tall and weighs 110 lbs bmi is 19 kg/m2. temp is 110.4*F, resp 20/min , BP 150/90 mmhg. bilateral crackles in lower lung lobes. P/E show muscle tenderness . s. creatinine is 4 mg/dl. urinalysis show +3 protein and +4 hb. most likely cause of pt. condition is increased release of

answer

myoglobin

question

6 week old girl is brought to the physician by her mother because of 6 day history of vomitting a small amount of milk 2-3 times daily. She appears well. She is at the 50th percentile for length and weight. Physical examination shows now abnormalities. Which of the following is most likely cause of the patient's findings

answer

Immature lower esophageal sphincter

question

40 yo woman has a mole on her back that has increased in size during the past 4 mo. PE shows Raise irregular lesion with variegated black-tan pigmentation and ill-defined margins. Examination of tissue from the tissue shows pleomorphic, hyperchromatic cells within clear islands that tend to coalesce and are present at all levels of the epidermis, with extension into the paipillar dermis. What is it?

answer

melanoma. Border irregularity, Variegated black-tan color, Evolution over time are 3/5 cardinal characteristics of melanoma grossly. Histology describes melanoma.

question

Old man with 2 year history of decrased force of his urinary stream and increase frequency. BUN is 55 and Creatinine is 5. Ultrasound of Urinary tract shows bilateral hydronephrosis and dilated ureters. What is the mechanism of this patient's renal failure?

answer

Increased hydrostatic pressure in Bowman space. Pressure from BPH outlet obstruction is backed up all the way to the collecting system of the kidney. GFR is increased by increased hydrostatic pressure in the glomerulus (pushing filtrate thru membrane) or by increased oncotic pressure in bowman's space (filtrate is attracted to higher solute concentration across membrane). GFR is decreased by increased hydrostatic pressure in bowman's space (due to pressure increase traveling all the way up from prostate, which resists filtrate from crossing membrane) and by increased oncotic pressure in glomerulus (attracts filtrate to state in glomerulus

question

45 year old lady diagnosed with invasive ductal cell CA breast. She was started on tamoxifen and serum analysis showed decreased conc. of enoxifen the active metabolite of prodrug tamoxifen. Genetic analysis showed homozygous presence of CYP450 2D6*4 alleles. WHich of following best represents the likelihood that this patient sister has same alleles?

answer

25%, which would be the case if each parent is a heterozygous carrier (more likely than each parent being homozygote) of the autosomal recessive allele.

question

A 12 yo boy is swimming in a mountain stream. he is immersed up to his neck n 60F water for 20 mins. which of the following sets of physiologic changes is most likely to occur in this boy? Central Blood volume / ADH / ANP

answer

f he's in cold water, his peripheral arterioles are going to intensely vasoconstrict, leading to increased central blood volume. As a result of this increased central blood volume, ADH is likely to be decreased (owing to the relative blood volume increase, i.e. your body thinks it has enough volume), and by the same logic, ANP would also be increased owing to the relatively hypervolemic state (atria thinks it has more fluid).

question

A healthy 70-year-old woman has participated in a longitudinal study of the effects of aging on performance during pulmonary function tests for the past 50 years. She has undergone a complete set of tests, including arterial blood gas analysis, every 5 years. Which of the following sets of changes represents this woman now compared with her results at the age of 20 years? Residual volume: up, down, or no change

answer

RV- UP Arterial PO2- Down Alv-Art PO2 Diff- UP

question

rash on arms and legs after camping trip in woods, edematous, erythematous rash with linear vesicles, activation of what cells?

answer

T-cell lymphoctyes---poison ivy..Dealayed T cell mediated type, Mactrophage activation.

question

38 year old man, allergy symptoms, crane operator, most approprate tx?

answer

Loratadine--2nd gen--less sedating

question

ld woman with DVT. Platelet dropped significantly after a week of tx. Drug of action?

answer

Potentiates the action of antithrombin iii (Heparin induced Thrombocytopenia HIT)

question

40 yof 6 month hx of episodic sinusitis now comes with 2wk hx of intermittent headaches fatigue gen. pain worsening cough now productive blood tinged sputum rx with antibiotics decongestans nasal corticosteroids didnt improve her sinus related prbs p/e shows nasal mucosa erythema with small ulcerations auscultation lungs show scat. crackles x ray reveals pathchy opacities B/L labs Hb 13 ESR 70 WBC 10500 serum ANCA increased dx?

answer

WEGENERS granulamotassis

question

A pregnant women with abd pain for 12 hrs and upper quadrant pain. her labs show decreased platelets and hemoglobin and elevated liver enzymes. what would you expect on peripheral blood smear?

answer

HEELP--schistocytes because of Low platelet count. which is haemolytic ,elevated liver enzymes, low platelet

question

52-year-old man is brought to the physician by a social worker because his neighbors have reported that he has been confused and not taking care of himself. He has a 4-month history of diarrhea. Physical examination shows extreme muscle wasting, stomatitis, and a diffuse rash that is worse in sun-exposed areas. The patient is mildly disoriented and has poor long-term memory and paranoid ideation. Which of the following is the most likely diagnosis?

answer

Pellagra (niacin def- triple d)

question

A 42-year-old woman comes to the physician because of a 1-month history of abdominal pain, especially after eating fatty meals. She is 180 cm (5 ft 11 in) tall and weighs 100 kg (220 lb); BMI is 31 kg/m2. Physical examination shows jaundice and tenderness of the right upper quadrant of the abdomen. An increase in which of the following liver functions is most likely in this patient?

answer

Cholesterol synthesis (increased cholesterol/bile acid =cholesterol stone) B

question

83 yr old man found bedridden and confused, no hx of meds. temp: 35.6, pulse 100, BP 85/50... bp unchanged from IV saline 1L; pulmonary artery catheder shows following: cardiac output - high, PCWP- low, systemic vasc resistance- low. which of the following is cause of hypotension?

answer

early septic shock---CO is high because afterload is decreased from the low systemic resistance. Fever isn't required.

question

4 year old boy is brought to the physician because he has had 2 bacterial urinary tract infections during the past year. physical examination shows no abnormalities. radiologic studies of the urinary tract show marked dilation of the left ureter and renal pelvis and minimal left side renal function. a left nephrectomy is performed. which of the following is most likely cause of the renal disease in the patient?

answer

congenital ureteral obstruction

question

20 year old man is brought to the physician because of a 6 hour history of difficulty breathing and vomiting. he has a 10 year history of type 1 DM currently treated with insulin twice daily. pluse is 90/min, resp are 30/min and deep and bp is 90/60. physical exam shows dehydration. ollowing compounds most likely stimulated hormone sensitive lipase in adipocytes that resulted in the accumulation of metabolites causing the acidosis? labs serum Na 130mEq/L K 6.5mEq/L HCO3 5mEq/L glucose 500 mg/dL blood gas pH 7.2 PCO2 25mm Hg

answer

epepinephrine

question

65 yr old woman progressive vulvar itching over past 2 months treatment miconazole is not effective. examination show atrophy of labia minora n thin , parchment of skin of vulva n around anus. what is the diagnosis?

answer

lichen sclerosis-skin disorder that causes the skin to become thin, whitened, wrinkled, and can cause itching and pain. LS usually occurs in postmenopausal women, although men, children, and premenopausal women may be affected. It can develop on any skin surface, but in women it most commonly occurs near the clitoris, on the labia (the inner and outer genital lips), and in the anal region

question

70 year old man is admitted to the hospital for recent loss of mental function. He has low sodium and Chloride, anemia. A) adrenal carcinoma

answer

pulmonary neoplasm

question

5 year old man comes to the physician because of intermittent bloody diarrhea and abdominal pain during the past month. Sigmoidoscopy and rectal biopsy specimens show inflammatory bowel disease. A trial of a monoclonal antibody preparation is begun. the antibody in the preparation is most likely to be directed against which of the following components?

answer

tnf

question

most predivtive of clonal lymphoid proliferation

answer

Surface kappa:surface lambda ratio

question

80-year-old woman comes to the emergency department because of a 2-day history of "feeling funny." She says, "I have lost my pep." She has never been admitted to the hospital, but she has a history of poorly controlled hypertension. She just started a medication 2 weeks ago but does not recall the name. Her blood pressure is 130/85 mm Hg. Physical examination shows no abnormalities. Her serum potassium concentration is 3 mEq/L. Which of the following drugs is the most likely cause of this patient's condition?

answer

hctz

question

mva in 27 yo, markeed edema and tenderness of jaw, what additional finding/ cause?

answer

inferior alveolar nerve

question

occlusion of marginal branch? increased CK after stent placement?

answer

Recanalization -> reperfusion injury via ROS -> membrane lipid peroxidation --> spill **** out of cell

question

Dissecting Aneurysm and cocaine

answer

Diminished pulses in left upper extremity Crackles heard over all lung fields Chest x-ray w/ widened aortic arch

question

MLF Syndrome (intranuclear opthalmoplegia)

answer

Common in MS - Convergence intact bc cortex sends signal directly to CN III nuclei - MLF syndrome causes ipsilateral eye to not adduct

question

Inhaled glue toxicity

answer

14 y/o boy Bilateral aching in the temple forgetting names, dates, and places Clumsy w/ frequent falls Broad Based Ataxic Gate

question

Stroke Findings in Parietal Temporal Lobe

answer

Sensory loss with agraphesthesia

question

Familial Hypercholesterolemia

answer

heterozygotes- 30omg/dL homozygotes 700 mg/dL

question

Pacemaker indications

answer

Mobitz II and 3rd degree heart block

question

Poison Oak

answer

Woods+Linear Vessicles Type IV Hypersensitivity- T Lymphocytes

question

Difference between distributive shock and cardiogenic/hypovolemic shock?

answer

Distributive shock is high output failure, while hypovolemic/cardiogenic shock is low output failure. High output means high return and low resistance. PCWP (which measures pulmonary vascular resistance) is also low because of massive vasodilation. All this vasodilation makes the skin warm and dry, and it cannot be fixed with fluids because the increased permeability still persists. Examples include *septic, neurogenic and anaphylactic shock.* In low output failure (hypovolemic/cardiogenic), all of these parameters are reversed.

question

Cause of sudden death in left ventricular hypertrophy?

answer

aortic stenosis (anterior valve leaflet gets in the way)

question

Exertional Rhabdomyolysis

answer

Due to poor hydration during activity Post triathlon event--> releasing myoglobin--> heme+ fe-> inc oxidative stress (Inc ROS)--> Renal damage

question

Histological appearance of a myxoma?

answer

Pathologically, myxomas are gelatinous structures that consist of myxoma cells embedded in a stroma rich in glycosaminoglycans.

question

Tubular Adenoma

answer

Smooth discreet surfaces Lesions are common in adults Generally a symptomatic! (Do not confuse with Inflammatory Pseudopoly w/ UC)

question

Aldosterone Tumor

answer

Check Plasma Renin Isotonic Sodium Increase therefore serum sodium will not increased!

question

Lesion of CN X?

answer

uvula deviates away

question

Difference between avoidant and schizoid personality disorders?

answer

avoidant: desires relationships with others schizoid: content with isolation

question

Increased expiratory flow rate in pulmonary fibrosis patient?

answer

increased radial traction on airways

question

Nerve damage during repair of internal carotid aneurysm location?

answer

Cranial Nerve III Damage after repair of aneurysm in right internal carotid artery Right pupil larger than left pupil, sympathetic fibers on the outside of the nerve is damaged

question

A fib

answer

Antithrombic therapy, rate control, cardiac conversion

question

A flutter

answer

Same as A fib + CATHETER ABLATION

question

V fib

answer

CPR + Defib

question

1st degree HB

answer

No treatment Reqd

question

Early Septic Shock

answer

Hypotension (inc vasodilation) with Inc CO

question

Puberty stages: Males and Females

answer

Male: Testicular growth --> Adrenarche (Axillary and pubic hair) --> Growth --> Spermarche Females: Thelarche (Breast development) --> adrenarche --> Growth Acceleration --> Menarche

question

P450 Inducers

answer

Chronic Alcoholic Mona Steals Phen-Phen and Never Refuses Greasy Carbs Chronic Alcohol Modafenil St. John's Wort (anti-dep) Phenytoin Phenobarbitol Nevirapine Rifampin Griseofulvin Carbamazepine

question

Antacid (omeprazole, cimetidine, ranitidine) effect

answer

Decreases absorption of drugs that require an acidic environment to dissolve (like itraconazole)

question

Mechanism of hypercalcemia in SARCOIDOSIS

answer

Increased intestinal Vitamin D (1,25-dihydroxyvitamin D)

question

Artery supply to female GU

answer

Ovary/Uterus - Ovarian artery (from abdominal aorta) in suspensory ligament Uterus/Cervix - Uterine artery (br. of hypogastric/internal iliac) Vagina - Vaginal artery (br. of hypogastric/internal iliac) Perineum/labia/rectum/vestibuule - pudendal artery (from internal iliac)

question

Tuberculosis leprae

answer

Likes cold termperatures Human-human transmission; armadillos Skin lesions Contained in macrophages (tuberculoid form) Tx: clofazimine

question

Phases of clinical research

answer

Preclinical: Testing in non-human subjects Phase 0: Assess pharmacodynamics and pharmacokinetics Phase 1: Testing on healthy volunteers Phase 2: Testing on patients to asses efficacy and safety Phase 3: testing on patients to assess efficacy, effectiveness and safety Phase 4: long-term consequences

question

Incomplete formation of pleuroperitoneal membrane

answer

Congenital diaphragmatic hernia

question

Treatment for DVT + side effects

answer

Warfarin: red/brown urine, severe bleeding, joint pain, bruising Heparin: HIT

question

Consequences of inhalants (Spray paints, glues, dewaxers, dry-cleaning chemical)

answer

Slurred speech, lack of coordination, euphoria, dizziness, lightheadedness, hallucinations, delusions

question

Hyperthyroidism in pregnancy

answer

End of 1st trimester, Hcg (which resembles TSH) may increase T4 transiently. Diagnosis can be done by measuring free T4

question

Acute onset abd pain and tenderness nausea vomiting bloody diarrhea dark purple-red hemorrhagic small intestin

answer

Mesenteric venous thrombosis

question

Leak in H+ions inward across inner mitochondria leads to what effect on oxidative phosphorylation

answer

Increased ratio of O2 consumption to ATP generation destroying the H+ gradient, so you get less ATP per O2 consumed

question

Recovery from pneumococcal pneumonia and xray shows no abnormalities

answer

No fibrosis, nothing bad. The Basement membrane integrity was maintained

question

Belly button dermatome

answer

T10

question

PG effect on kidney

answer

Vasodilates the afferent arteriole

question

Polyarteritis nodosum

answer

Fibromuscular dysplasia Transmural inflammation of the arterial wall

question

Chronic bronchitis blood gas

answer

Increased CO2 retention, increased blood HCO3 in response, decreased O2

question

Osteoarthritis produce bone spurs on vertebrae, compression in which intervertebral foraminae will cause distal ant thigh and medial leg and foot pain.

answer

L3 and L4

question

what does increased radial traction on airways mean?

answer

increased recoil

question

drugs used in urinary urgency

answer

antimuscarinics: oxybutynin, darifenacin, solifenacin tolterodine, foestrodine, trospium

question

What does the pelvic splanchnic nerve do?

answer

1. Empty urinary bladder 2. Control and closing of the internal urethral sphincter 3. Influence motility in the rectum 4. Sexual functions like erection

question

Hypogastric nerve

answer

Responsible for emission (prior to ejaculation, which is instead the pudendal nerve); emission is SYMPATHETIC NS medaited

question

Branches of the pudendal nerve

answer

1. Inferior rectal nerve 2. Perineal nerve 3. dorsal nerve of penis 4. dorsal nerve of clitoris

question

Sacral splanchnic nerves

answer

Sympathetic nerves

question

Menarche vs. thelarche vs. pubarche

answer

Pubarche: development of pubic hair Thelarche: breast buds form Menarche: onset of menses (usually occurs 2 years after thelarche!)

question

what is the first objective sign of puberty for girls?

answer

1. Thelarche - firm, tender lump under the center of the areola of one or both breasts (10.5 yrs) 2. Pubic hair - pubarche

question

First objective sign of puberty in males

answer

1. Testicular enlargement (gonardarche)

question

1. Nodulatiry of the uterosacral ligaments 2. Fixed retroversion of the uterus 3. Dysmenorrhea 4. Painful intercourse

answer

ENDOMETRIOSIS

question

Formation of vesicles and blisters on the skin which frequently takes weeks to heal after sensitivity to sunlight

answer

Porphyria cutanea tarda

question

Disorder caused by increased synthesis of compounds in the skin that are subject to excitation by visible light

answer

Excess uroporphyrinogen close to the skin due to UROD deficiency

question

Cyclophosphamide MOA

answer

Attaches the alkyl group to the guanine base of DNA, at the number 7 nitrogen atom of the imidazole ring. This interferes with DNA replication by forming intrastrand and interstrand DNA crosslinks

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