Type of paraneoplastic syndrome most commonly associated w/ cancers of lung, breast, ovary, uterus, and lymphoma; patients present w/ limb and truncal ataxia, loss of coordination, dysarthria, and nystagmus
Describe the histologic presentation of silicosis.
Nodular densities and "eggshell" calcifications of the hilar nodes
Describe the histologic presentation of berylliosis.
What types of RBC abnormalities are consistent w/ traumatic hemolysis such as that found in microangiopathic hemolytic anemia or mechanical damage due to prosthetic valves?
RBC fragments; burr cells; helmet cells
Describe Peutz-Jeghers syndrome.
Autosomal dominant syndrome featuring multiple nonmalignant hamartomas throughout the GI tract, along w/ hyperpigmented mouth, lips, hands, and genitalia; associated w/ increased risk of colorectal cancer and other visceral malignancies
(T/F) Villous adenomas are more likely to undergo malignant transformation than tubular adenomas.
(T/F) Hypercholesterolemia is associated w/ acute pancreatitis.
Hypertriglyceridemia causes acute pancreatitis via _____.
Direct tissue toxicity
What condition should be associated w/ an African American presenting w/ constitutional symptoms, bilateral hilar adenopathy, and pulmonary complaints?
Describe the pathogenesis of atherosclerotic plaque formation.
Exposure of subendothelial collagen promotes platelet adhesion, aggregation, and release of factors that promote migration of smooth muscle cells (SMCs) from the media into the intima, as well SMC proliferation
Name 2 factors released by platelets that mediate SMC chemotaxis/mitogenesis.
Platelet-derived growth factor (PDGF): chemotactic/mitogenic for SMCs; transforming growth factor-β (TGF-β): chemotactic for SMCs
Describe the liver pathology associated w/ Reye syndrome.
Hepatic dysfunction w/ microvesicular steatosis (the presence of small fat vacuoles in the cytoplasm of hepatocytes)
What is the mechanism of encephalopathy associated w/ Reye syndrome?
Toxic effect of hyperammonemia on CNS, leading to cerebral edema
What is one instance in which salicylates would be given to a child < 16 years of age?
Treatment of Kawasaki's disease
Differentiate between the complications of acute and chronic mitral regurgitation.
How are acebutol and pindolol different from other β-blockers?
They have intrinsic sypathomimetic activity (ISA) and thus act as partial agonists
In what condition are acebutol/pindolol contraindicated?
Contraindicated in angina because they do not cause a significant decrease in heart rate and maintain a high myocardial oxygen consumption
Discuss the mechanism and action of selegiline in treatment of Parkinson disease.
Inhibits MAO-B, which preferentially metabolizes dopamine (whereas MAO-A preferentially metabolizes norepinephrine and sertotonin); slows the breakdown of dopamine, thus prolonging the clinical effects of levodopa
What is the most common cause of peritoneal carcinomatosis?
Metastasis of ovarian cancer
Tay-Sachs disease is typically the result of a frameshift mutation in the gene encoding _____.
While supine, what portion of the lung is most likely to trap an aspirated body?
Superior segment of the right lower lobe
What is the most numerous cell in an granuloma?
Modified macrophage (epithelioid cell)
What heart valve is commonly involved in Libman-Sacks endocarditis?
Mitral valve (both the ventricular and atrial surfaces)
Discuss the mechanism of botulinum toxin.
Blocks neuromuscular conduction by binding to receptor sites on motor nerve terminals, entering nerve terminals, and inhibiting the release of ACh; inhibition of ACh release occurs because the neurotoxin cleaves a protein (SNAP-25) that is essential to the successful docking and release of ACh from vesicles located within nerve endings
What test is used to assess viral load during HIV infection?
The most important chemotactic factors for neutrophils are _____ and _____.
Complement factor C5a; IL-8
Discuss the relationship of digoxin toxicity and hypokalemia.
Digoxin toxicity does not cause hypokalemia; however, hypokalemia can lead to development of digoxin toxicity by sensitizing the myocardium
What test is used to evaluate granulocyte phagocytic function in chronic granulomatous disease?
Nitroblue tetrazolium test
Discuss 4 characteristics of common variable immunodeficiency.
Onset in adolescence or early adulthood; low levels of all immunoglobulins; normal levels of circulating B cells; frequent bacterial infections
Discuss the mechanism and indication for use of cyclophosphamide.
Alkylating agent that causes DNA cross-linking; used to treat Hodgkin's and non-Hodgkin's lymphoma and breast/ovarian cancer
What are 3 adverse effects of cyclophosphamide?
Hemorrhagic cystitis (treat w/ mesna); bone marrow suppression; hepatotoxicity
What 2 β-blockers are used to treat superventricular tachycardia? Describe the mechanism of action.
Propranolol, esmolol; decrease AV conduction velocity (class II antiarrhythmic)
Describe the use of timolol.
Used to treat glaucoma by decreasing the secretion of aqueous humor
Name 4 non-selective β-blockers.
Propranolol; timolol, pindolol; nadolol
What are 5 β1-selective antagonists?
Acebutolol (partial agonist); Betaxolol; Esmolol (short-acting); Atenolol; Metoprolol; A BEAM of B1-blockers
Name 2 non-selective α- and β-antagonists.
What 2 β-blockers have partial agonist activity?
What 2 β-blockers can be given post-myocardial infarction to decrease mortality?
Discuss the effect of phosphorylation of enzymes as it relates to glycogenolysis.
When phosphorylated, glycogen phosphorylase is more active and glycogen synthase is less active
Discuss the mechanism of Gq receptors.
G protein-coupled receptor that stimulates phospholipase C, leading to hydrolysis of PIP2; PIP2 is hydrolyzed into IP3 and diacylglycerol (DAG); IP3 triggers release of intracellular calcium while DAG activates protein kinase C
What is Monckeberg arteriosclerosis?
Medial calcification of smaller arteries
Describe the mechanism and indication for use of cytarabine.
Pyrimidine analog that acts via inhibition of DNA polymerase to treat acute myelogenous leukemia (AML)
What are the adverse effects of cytarabine?
What 4 topics are considered under the partial emancipation of minors ages 15 - 17?
Treatment for STDs; treatment for substance abuse; birth control; prenatal care
What is desmopressin? What are its uses?
Synthetic analog of ADH; indicated as antidiuretic replacement therapy in management of central diabetes insipidus and short term management of polyuria/polydipsia following pituitary trauma or surgery
Desmopressin can be used in the treatment of what 2 hematologic disorders?
Hemophilia A; von Willebrand's disease
What is the triad of McCune-Albright syndrome?
Precocious sexual development; irregularly shaped ("Coast of Maine") pigmented skin macules; polyostic fibrous displasia (local bony defects containing unmineralized whorls of connective tissue)
What is hypertrophic osteoarthropathy? With what conditions is it associated?
Formation of new bone beneath the periosteum of phalanges; associated w/ thoracic cancer and chronic lung/liver disease
What is Krabbe disease? How does it present?
Lysosomal storage disease (galactocerebrosidase deficiency) that affects myelin sheaths of CNS; presents w/ hypertonicity, irritability, hyperesthesia, psychomotor retardation, and early death
What enzyme is deficient in McArdle's disease?
Myophosphorylase (muscle glycogen phosphorylase)
Differentiate between Camper fascia and Scarpa fascia.
Camper fascia is the superficial layer of the anterior abdominal wall containing adipose tissue and continuing in men over the external genitalia to form the Dartos fascia; Scarpa fascia is found deeper and contains fibrous tissue
What class of antibiotics cause a severe drug-drug interaction w/ warfarin, resulting in an increased anticoagulant effect?
What 3 hormones can prevent atrophy of the GI mucosa and exocrine pancreas during long-term IV feeding?
Gastrin: stimulates mucosal growth throughout the GI tract and growth of the exocrine pancreas; cholecystikinin (CCK) / secretin: stimulate growth of the exocrine pancreas
What 2 categories of drugs are the drugs of choice in patients w/ atrial fibrillation who are not in heart failure?
Patients w/ atrial fibrillation who are in heart failure should be treated w/ _____.
What is the effect of hypertension on arteriole density and total cross-sectional area of arterioles.
Hypertension decreases both the numerical density of arterioles and therefore the total cross-sectional area of arterioles
What is the effect of prevalence on specificity, sensitivity, PPV, and NPV?
Changing prevalence has no effect on sensitivity/specificity; increasing prevalence increases PPV and decreases NPV, and vice versa
What causes minimal change disease?
Associated w/ abnormal secretion of lymphokines by T cells, which reduces the production of anions in the glomerular basement membrane, thereby increasing glomerular permeability to albumin and other proteins
Differentiate between hypnagogic and hypnopompic hallucinations.
Hypnagogic: occur when a person is falling asleep; hypnopompic: occur when a person is just awakening from sleep
With what condition are hypnopompic hallucinations associated?
Narcolepsy, along w/ sleep paralysis, cataplexy, and sleep attacks
Describe the innervation of the external ear canal.
What compounds should be used to treat overdoses of acidic and basic drugs?
Treat acidic drug overdose (e.g., salicylates) w/ NaHCO3, which traps the acidic drug in the basic urine; treat basic drug overdose (e.g., amphetamines) w/ NH4Cl, which traps the basic drug in the acidic urine
Describe the DUMBBELSS mnemonic relating to excess parasympathetic activity.
Diarrhea; Urination; Miosis; Bradycardia; Bronchospasm; Excitation of CNS and skeletal muscle; Lacrimation; Sweating; Salivation
What drug combination is used to treat an excess of parasympathetic activity?
Atropine + pralidoxime (regenerates active AChE)
Name 3 anticholinesterase drugs used in the treatment of Alzheimer's disease.
Donepezil; Rivastigmine; Galantamine
What is the msot common presentation of a patient w/ myesthenia gravis?
Patient w/ ptosis/diplopia that worsens throughout the day
What test is used to confirm the diagnosis of myastenia gravis?
Tensilon test (edrophonium)
Discuss the thymus pathology related to myasthenia gravis.
Discuss the effect of β-2 and M-3 receptors in the lungs.
β-2: bronchodilation; M-3: bronchoconstriction and increased mucus secretion
Describe the rash present in secondary syphilis.
Maculopapular, bronzing rash that is diffuse and includes the palms and soles
Describe the microscopic appearance of the inflammation associated w/ Bartonella henselae infection (cat-scratch disease).
Stellate granulomas w/ central necrosis and small, gram-negative bacilli
Describe the presentation and effect of fructokinase deficiency.
Generally presents as an accidental finding of a reducing substance in the urine that is not glucose; fructokinase catalyzes the first step of dietary fructose metabolism by converting fructose to fructose-1-phosphate; excess fructose accumulates in the blood and is excreted in the urine
What types of drugs are affected by increased CYP450 activity due to rifampin?
What form of therapy is immediately indicated in a patient suspected of having a pulmonary embolus?
Fibrinolytic therapy (e.g., plasminogen activators), such as tenecteplase or alteplase
What dose-related adverse effect is associated w/ valproic acid?
Name 2 methods to distinguish secondary adrenocortical insufficiency from primary adrenocortical insufficiency (Addison's disease).
Caused by disorders that affect the pituitary gland or hypothalamus and lead to reduced ACTH production; not associated w/ skin hyperpigmentation
Describe the mechanism and use of sorafenib.
Anti-neoplastic agent that acts as a multi-kinase inhibitor targeting serine/threonine and receptor tyrosine kinases in the tumor cell and vasculature; approved for the treatment of both renal cell carcinoma and hepatocellular carcinoma
Describe the common initial presentation of a patient w/ carcinoma of the head of the pancreas.
Painless distention of the gallbladder (Couvoisier's sign) resulting in jaundice
What tumor marker is most sensitive and specific for pancreatic cancer?
What lung characteristic is increased in a patient w/ pulmonary fibrosis secondary to sarcoidosis?
Increased elasticity (decreased compliance), typical of restrictive pulmonary diseases
What is the drug of choice for toenail fungal infections? Fingernail/hair fungal infection?
Terbinifine; imidazole, griseofulvin
What is the respiratory response to salicylate poisoning?
Define secondary pulmonary hypertension.
Pulmonary artery systolic pressure of more than 30 mmHg secondary to pulmonary (COPD, emboli, interstitial disease) or cardiac causes (left-sided heart failure, mitral stenosis, congenital)
Name and describe the nerves associated w/ the 4 muscle stretch reflexes.
Alport's syndrome is due to a variety of gene defects resulting in abnormal _____.
Type IV collagen
What causes Kluver-Bucy syndrome?
Bilateral lesion of the amygdala
What is the triad of Conn's syndrome (primary aldosteronism)?
Hypertension; hypokalemia; metabolic alkalosis
What 2 muscarinic antagonists are used to reduce urgency in mild cystitis and reduce bladder spasm?
What component of gram positive and gram negative bacteria induce production of IL-1 and TNF-α?
Gram positive: teichoic acid; gram negative: lipid A
Define the periplasm and define its function.
Space between the cytoplasmic membrane and peptidoglycan wall in gram-negative bacteria; contains many hydrolytic enzymes, including β-lactamases
How is Bacillus anthracis different from other encapsulated bacteria?
The capsule of B. anthracis contains D-glutamate (peptide) as opposed to polysaccharides like other encapsulated bacteria
Name the encapsulated bacteria.
S. pneumoniae; Klebsiella pneumoniae; H. influenzae; Neisseria sp.; Salmonella; Group B Streptococcus (S. agalactiae)
Describe the concept of bacterial vaccines.
For vaccines containing polysaccharide capsule antigens, a protein is conjugated to the polysaccharide antigen to promote T cell activation and subsequent class-switching; a polysaccharide antigen alone would not be recognized and presented by T cells, and only IgM antibodies would be produced
Name 3 polysaccharide-protein bacterial vaccines.
Pneumovax; H. influenzae type B; meningococceal vaccines
Autoimmune-antibody mediated conditions caused by S. pyogenes include _____ and _____.
Glomerulonephritis; rheumatic fever
What 3 bacteria are most commonly implicated in subacute endocarditis?
S. epidermidis, Enterococci, S. viridans
What is the most common causative agent of mastitis?
Name 2 conditions associated w/ increased production of erythropoietin, resulting in polycythemia.
Renal transplantation; renal cell carcinoma
Describe atrial natriuretic peptide (ANP).
Released by atrial cells following expansion of extracellular and intravascular fluid volumes; acts to relax vascular smooth muscle and suppress RAAS, resulting in a decrease in plasma volume, vascular resistance, arterial pressure, and cardiac output
Describe the cyst associated w/ Echinococcus granulosus. What vector spreads this organism?
Associated w/ dog feces; defining feature of cyst are tiny, hook-like scolices, which detach from the wall and accumulate within the cyst producing a sand-like sediment;
Usual locations of echinococcosis include the _____ and _____.
What 2 arteries arise from the splenic artery? Of these, which does not have strong anastomosis w/ surrounding arteries?
Left gastroepiploic artery (strong anastomosis w/ right gastroepiploic artery); short gastric artery (no strong anastomosis)
Describe Menetrier disease. How does it present?
Hyperplastic gastropathy characterized by enlarged rugal folds because of the increased proliferation of the mucus-producing cells of the stomach; presents as a protein-losing enteropathy
In any normal curve, what percentage falls within 1, 2, and 3 standard deviations from the mean?
1SD: 68%; 2SD: 95.5%; 3SD: 99.7%
Describe chronic lympocytic leukemia (CLL). What cell is characteristic of this disease?
Indolent disorder of malignant lymphocyte clonality (usually B cell) that presents in older individuals w/ signs and symptoms of immunosuppression and bone marrow failure; characteristic "smudge cells" are seen on peripheral smear
Expansion of what trinucleotide repeat is associated w/ Fragile X disease?
Describe 2 microscopic features of meningiomas.
Whorls; psammoma bodies
Describe the pathogenesis of Hirschsprung disease.
Failure of neural crest cells to form the myenteric plexus in the sigmoid colon and rectum
Name 2 heat-stable molecules not affecting by autoclaving.
Endotoxin (LPS); prions
Describe the neurovascular bundle of the intercostal space.
Runs in the order of vein-artery-nerve (VAN) from top to bottom; transverses the inferior border of the rib within the costal groove and should be avoided when performing a thoracostomy or any other procedure that requires passing a needle through the chest wall
Name 5 medications commonly associated w/ priapism.
Describe the hormonal imbalances associated w/ Klinefelter syndrome.
Decreased testosterone and inhibin; increased LH, FSH, and estrogen
Describe Werdnig-Hoffmann disease.
Type of spinal muscular atrophy (infantile motor neuron disease), a group of autosomal recessive conditions that are similar to adult ALS; results from mutation of the survival motor neuron gene (SMN1) on chromosome 5 and typically presents at birth, w/ patients rarely surviving past age 3
(T/F) Lymph fluid from the testes drains to the superficial inguinal nodes.
False; testicular lymph fluid drains to the superficial and deep plexuses and continues to the para-aortic plexus
Describe the primary lymph node draining site for the anal canal above and below the pectinate line.
Above the pectinate line: internal iliac plexus; below the pectinate line: superficial inguinal plexus
Where does positive and negative selection of T cells occur in the thymus?
Where does the thoracic duct drain into the general circulation?
Junction of left subclavian vein and internal jugular vein
Type 1 diabetes mellitus is associated w/ what 2 HLA subtypes?
Name 4 diseases associated w/ HLA-DR2.
Multiple sclerosis; hay fever; SLE; Goodpasture's disease
HLA-DR5 is associated w/ _____ and _____.
Pernicious anemia; Hashimoto's thyroiditis
W/ what HLA subtype is hemochromatosis associated?
Differentiate between NK cells and CD8+ T cells as it relates to use of MHC-I.
NK cells recognize absence of MHC-I, while CD8+ T cells use the TCR to recognize the presence of MHC-I
Name 3 antigen presenting cells (APCs).
Macrophage; dendritic cell; B cell
What costimulatory signal is required for activation of helper T cells?
CD28 ( helper T cell) to B7 (APC)
What costimulatory signal is required for activation of cytotoxic T cells?
Release of IL-2 by helper T cells
Interaction of what 2 receptors provides the costimulatory signal for B cell class switching?
CD40 (B cell) to CD40L (helper T cell)
Name the cytokines secreted by Th1 and Th2 cells and what cytokine inhibits each.
Th1: secretes IL-2 and IFN-γ, inhibited by IL-10; Th2: secretes IL-4/5/10, inhibited by IFN-γ
Describe the HOT T-BONE stEAk mnemonic for interleukin activity.
IL-1: fever; IL-2: stimulates T cells; IL-3: stimulates bone marrow; IL-4: stimulates IgE/IgG; IL-5: stimulates IgA/eosinophils
Describe 4 methods by which antibody diversity is generated.
Random "recombination" of VJ (light chain) or V(D)J (heavy chain) genes; random combination of heavy chains w/ light chains; somatic hypermutation (following antigen stimulation); addition of nucleotides to DNA during recombination by terminal deoxynucleotidyl transferase (TdT)
What are the 2 regions of antibodies? What types of chains compose each?
Fab (antigen-binding fragment): heavy chain and light chain; Fc (constant fragment): heavy chain only
What portion of the antibody binds complement (IgG/IgM only)?
What is the only antibody that can exist as a dimer?
Which antibody has the lowest concentration in serum?
Distinguish between thymus-independent and thymus-dependent antigens.
Thymus-independent: lack a peptide component and thus cannot be presented by MHC to T cells, stimulate release of IgM antibodies only and do not result in immunologic memory; thymus dependent: contain a protein component and thus induce class-switching and immunologic memory
Name the 3 macrophage acute phase cytokines.
IL-1, IL-6, TNF-α
Describe the use of recombinant α-, β-, and γ-interferon.
Describe the equations for odds ratio (OR), relative risk (RR), and attributable risk (AR).
OR = ad/bc; RR = [a/(a+b)]/[c/(c+d)]; AR = [a/(a+b)]-[c/(c+d)]
What is Number Needed to Treat (NNT)? What is the equation?
Number of patients you would need to treat in order to save/effect one life; NNT = 1/absolute risk reduction
How are prevalence and incidence of a disease related to the chronicity of the disease?
Prevalence > incidence for chronic diseases; prevalence = incidence for acute diseases
Differentiate between the Pygmalion and Hawthorne effect as they relate to study bias.
Pygmalion effect: occurs then a researcher's belief in the efficacy of a treatment changes the outcome of that treatment; Hawthorne effect: occurs when the group being studied changes its behavior owing to the knowledge of being studied
Differentiate between mean, median, and mode.
Mean: average of values; median: divides the frequency of distribution in half; mode: value of greatest frequency
Differentiate between a positively and negatively skewed statistical distribution.
Positive skew: mean > median > mode, asymmetry w/ tail on the right; negative skew: mode > median > mean, asymmetry w/ tail on the left
Odds ratio approximates relative risk if disease ______ is not high.
Differentiate between random and systemic error.
Random error reduces test precision; systemic error reduces test accuracy
What is the equation for standard error of the mean (SEM)?
SEM = σ / √n, where σ = standard deviation and n = sample size
What is the equation for confidence interval (CI)?
CI = mean ± Z(SEM), where Z = 1.6 for 90%CI, 2 for 95%CI and 2.5 for 99%CI
What is the purpose of chi-square tests?
Check difference between 2 or more percentages or proportions of categorical outcomes (not mean values)
Describe the PDR mnemonic as it relates to disease prevention.
Prevent; Detect; Reduce disability
Supplementation w/ what vitamin should be avoided in smokers?
Vitamin A, as it increases risk for lung cancer
What are the 5 leading causes of death in the U.S. for patients 1 - 14 years of age?
NO activates guanylate cyclase, which produces cGMP and triggers smooth muscle relaxation by facilitating the dephosphorylation of myosin light chains
What 3 coronary structures are derived from the sinus venosus?
Smooth part of right atrium; coronary sinus; oblique vein of left atrium
The smooth parts of the right and left ventricles are derived from the _____.
Differentiate between the uses of Pearson correlation coefficient, chi-square, t-test, and ANOVA.
Pearson correlation: interval data; chi-square: nominal data; t-test: combination of interval and nominal data w/ 2 groups only; ANOVA: combination of interval and nominal data w/ > 2 groups
What translocation is associated w/ follicular lymphoma?
t(14;18) leading to activation of bcl-2, which produces a protein that inhibits apoptosis
To where do the inferior and superior rectal veins drain?
Inferior rectal vein: IVC; superior rectal vein: portal system
Describe steroid myopathy due to Cushing disease/exogenous steroid use.
Proximal muscle weakness; muscle biopsy demonstrates selective atrophy of type II muscle fibers
In what 2 conditions is the presence of schistocytes common?
DIC; prosthetic heart valves
What is the initial drug of choice to treat symptomatic hypertrophic cardiomyopathy?
β-blockers, such as metoprolol
What is graft vascular disease?
Late and serious complication of heart transplantation; characterized by intimal thickening of the coronary arteries, resulting in progressive stenosis of the lumen; cannot be prevented w/ current immunosuppressant therapy
What is a common cause of first trimester pregnancy loss? Second/third trimester loss?
First trimester: chromosomal abnormalities; second trimester: chorioamnionitis; third trimester: abruptio placentae, placenta previa, chorioamnionitis
Qualitatively describe the levels of iron, ferritin, and transferrin in iron deficiency anemia.
Salivation (parotid gland); taste and tactile sensation of the posterior 1/3 of the tongue; tactile sensation from external ear, pharynx, middle ear; input from carotid body/sinus; motor efferents to stylopharyngeus muscle
Hirano bodies are associated w/ what neurodegenerative disease?
What are Lewy bodies? W/ what diseases are they associated?
Round, eosinophilic, intracytoplasmic inclusions seen in dopaminergic nigrostriatal neurons; Parkinson disease
What 3 drugs can be used during pregnancy to treat chronic hypertension?
Methyldopa; labetalol; nifedipine
What is the treatment for Klebsiella pneumonia.
3rd generation cephalosporin with or without an aminoglycoside
What cell type is infected by Babesia microti?
What test is used as a confirmatory test for HIV? How is the test interpreted?
Western blot; positive when results show antibodies to at least 2 of the 3 HIV antigens (gp24, gp41, gp120)
An indeterminate HIV Western blot is followed by a _____.
HIV polymerase chain reaction (PCR)
Describe the serologic tests used to diagnose Mycoplasma pneumoniae infection.
Presence of one or both of the following antibodies: cold agglutinins (autoantibody to O-positive red blood cells in cold), streptococcal MG agglutinins (antibodies against Streptococcus salivarius strain MG)
What is the most common cause of nephrotic syndrome in adults? The second most common cause?
What nerve is closest to the pituitary gland within the cavernous sinus?
Abducens nerve (CN VI)
What disease is transmitted by the Aedes aegypti mosquito? Describe its clinical course.
Yellow fever; high fever, jaundice, epistaxis, anuria, and hematemesis
Describe cri-du-chat syndrome.
Due to a terminal deletion of 5p; congenital abnormalities include catlike neonatal crying, microcephaly w/ dysmorphic facial features, cardiac defects (e.g., VSD), hypotonia, and severe mental retardation
What are Russell bodies?
Abnormal plasma cells containing accumulations of IgG immunoglobulin found in bone marrow biopsy of patients w/ multiple myeloma
What is the most common bacterial STD in the U.S.?
Chlamydia trachomatis (serotype D-K)
What hand muscles are NOT supplied by the ulnar nerve?
3 thenar compartment muscles; 1st and 2nd lumbricals
How are the 4th and 5th digit affected by a lesion of the ulnar nerve at the elbow versus a lesion at the wrist?
Elbow: completely extended; wrist: ulnar "claw hand", hyperextension of the 4th and 5th MCP joints w/ flexed 4th and 5th PIP/DIP joints
(T/F) Release of aldosterone is mediated by ACTH levels.
False; aldosterone is relatively independent of ACTH because it is controlled by angiotensin II and plasma potassium levels
What are the most frequent immediate causes of death of patients w/ paroxysmal nocturnal hemoglobinuria (PNH)?
Thrombosis and thromboembolism, w/ the intrahepatic veins being a common site for thrombosis (producing Budd-Chiari syndrome)
What types of cells are diagnostic of human papilloma virus (HPV)?
Koilocytic cells; cells w/ enlarged nuclei and perinuclear cytoplasmic vacuolization
What is the mechanism of estrogen in treating osteoporosis?
Inhibition of osteoclastic resorption and stimulation of bone deposition by osteoblasts so that bone density and mass increase
What structure is weakened in an indirect inguinal hernia?
Describe the affinity of epinephrine for α1 and β2 receptors.
Physiologically, epinephrine has a higher affinity for β2 receptors than α1 receptors
What autonomic receptors are present in the uterus? What does each mediate?
What type of medication would be indicated to treat both hypertension and BPH?
α1 antagonists, such as terazosin or prazosin
What is the Trendelenberg sign? What 2 muscles are tested?
Positive Trendelenberg sign occurs when a patient stands on one leg, and the hip on the lifted leg side drops; paralysis of the gluteus medius or gluteus minimus
How does the presence of jaundice influence the diagnosis of a patient who presents w/ symptoms of acute cholecystitis?
Jaundice: stone in common bile duct; no jaundice: stone in cystic duct or, less commonly, a gallbladder packed w/ stones
Name 3 Class 1B antiarrhythmic drugs and their mode of administration.
Lidocaine (IV); mexiletine (PO); tocainide (PO)
Describe Legg-Calve-Perthes disease.
Avascular necrosis of the femoral head due to interruption of blood supply from the medial femoral circumflex artery
Describe the TAN mnemonic of structures in the arm near the cubital fossa.
Tendon of the biceps brachii; brachial Artery; median Nerve
What type of lipid profile is present in a patient w/ nephrotic syndrome?
Increased cholesterol, triglycerides, and LDL; decreased HDL
Describe progressive supranuclear palsy.
Characterized by ophthalmoplegia, pseudobulbar palsy, axial dystonia, and bradykinesia; presents w/ widespread neuronal loss and gliosis of subcortical areas w/ sparing of the cerebral and cerebellar cortices
Name 2 hormones secreted from the duodenum and their actions.
Cholecystokinin (CCK): decreases gastic emptying; secretin: inhibits gastrin secretion and the secretion of several other peptides released from intestinal cells
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