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Question

MainDivision
Id

SubDivision

Notes

654

Anatomy

Cardiovascular System

A laterally directed chest wall stab wound at the fifth intercostal


space along the midclavicular line. The structure injured would be
the *Left Lung*

1699

Anatomy

Cardiovascular System

A puncture wound at the left sternal border in the fourth intercostal


space will injure the *Right Ventricle*

Cardiovascular System

The aorta and superior mesenteric artery can compress the left
renal vein. The increase pressure in the left renal vein causes
retrograde blood flow to the testes and dialtion of the pampiniform
plexus ==> *VARICOCELE*

Cardiovascular System

A skull fracture at the junction of the frontal, pariatal, temporal and


sphenoid bones (pterion) risks lacerating the middle meningeal
artery and causing epidural hematoma. The MMA is a branch of
*Maxillary Artery*

1805

1813

Anatomy

Anatomy

1871

Anatomy

Cardiovascular System

In most poeple with right coronary dominance, Inducible ischemia


of the inferior surface of the heart would probably be due to
occlusion of *Right coronary artery*

1967

Anatomy

Cardiovascular System

For graft purposes, the Great Saphenous Vein can accessed at a


site *Just inferolateral to the pubic tubercle*

2023

Anatomy

Cardiovascular System

The Superior Venecava is derived from the common cardinal


veins.

2130

Anatomy

Cardiovascular System

A high speed motor vehicle accident that leads to injury of aorta


would most liley ruptur that ismthus (just after subclavian artery) of
the aorta. Pt usually dies before reaching hospital. If they do reach
they present with non specific chest and abdominal pain.

7646

Anatomy

Cardiovascular System

Left ventricular leads in biventricular pacemaker course through


the coronary sinus, which resides in the *Atrioventricular Groove*
on the post aspect of the heart.

8294

Anatomy

Cardiovascular System

IV drug users can have righ sided endocarditis involving the


*TriCuspid Vavle* most often due Staph Aureus infection. This
often presents as an early systolic murmur best heard over the left
lower sternal border due to tricuspid regurgitation.

8332

Anatomy

Cardiovascular System

Pt undergoes transesophageal echocardiography. The ultrasound


probe is placed in the mid-esophagus facing "anteriorly". The
cardiac chamber closest to the probe is *Left Atrium*

8333

Anatomy

Cardiovascular System

Transesophageal echo probe facing posteriorly would interrogate


the *Descending Aorta*

11764

Anatomy

Cardiovascular System

While cannulating the Right Common Femoral artery for cardiac


catherization, the physician penetrates the arterial wall above the
right ingiunal ligament. Soon after pt becomes cold, and
hypotensive. Bleeding is susupected. Most likely location is
*Retroperitoneal Space*
[CFA cannulation shud be below inguinal ligament]

11780

Anatomy

Cardiovascular System

Pulmonary capillary wedge pressure (measured via a swan-ganz


catheter into the pulmonary artery) closely reflectsend-diastolic
pressure in *Left Atrium* and the Left Ventricle.

11956

Anatomy

Cardiovascular System

Radiofreqyency ablation of the AV node in a pt with arrhythmia is


achieved at the *Interatrial septum near the opening of the
coronary sinus*

1106

Anatomy

Dermatology

Pt with inflamatory acne. The glands involved release secretions by


*Holocrine* manner.
[Sebacious glands]

1686

Anatomy

Ear, Nose & Throat (ENT)

The recurrent laryngeal nerve is in close proximity to the inferior


thyroid artery and can accidently damaged during inferior thyroid
artery ligation during a thyroidectomy.

1698

Anatomy

Ear, Nose & Throat (ENT)

Blunt trauma to the globe can cause orbital blowout fractures.


These fractures most commonly involve the medial or inferior
orbital walls due to thin bone bordering the ethmoid and *Maxillart*
sinuses.

1814

Anatomy

Ear, Nose & Throat (ENT)

Pt who faints after otoscope exam has experience vasovagal


syncope due to stimulation of post ext auditory canal. *Vagus
Nerve is affected*

11783

Anatomy

Ear, Nose & Throat (ENT)

Pt with epistaxis. Silver nitrate cautery is performed and bleeding


stops. Cautery was most likely applied to *Nasal Septum*
[Most bleeds happen here in Kiesselback's plexus]

Anatomy

Endocrine, Diabetes &


Metabolism

A nerby nerve injury while ligating an artery entering the superior


pole of the thyroid lobe(superior thyroid artery) would most likely
deninnervate the *Cricothyroid Muscle* which is innevated by the
external branch of the superior laryngeal neerve.

1747

1632

Anatomy

FemaleReproductive
System & Breast

*The suspensory ligament of ovary* must be ligated during removal


of ovaries to prevent bleeding. It carries the ovarian artery. It also
known as the infundibulopelvic ligament. Note that the Cardinal
Ligament (transverse cervical ligament) holds the uterine artery
and needs to be ligated in a hysterectomy.

1739

Anatomy

FemaleReproductive
System & Breast

A *pudendal nerve* block is performed by injecting an anesthetic


intravaginally, medial to the ischial spine, through the sacrospinous
ligament. This provides anesthesia to most of the perineum.

8390

Anatomy

FemaleReproductive
System & Breast

16 year old female with pelvic pain every 28 days and resolves in a
day or two with fully developed 2ndry sexual characteristic. She
has a palpable mass anterior to the rectum. Serum Beta-hCG is
negative. Most likely Dx is *Imperforate hymen*

11781

Anatomy

FemaleReproductive
System & Breast

Pt with right sided back pain and voiding is normal after a


hysterectomy probably has an injured *Ureter* during the surgery.
Voiding is normal becuase other ureter is functionl.

11820

Anatomy

FemaleReproductive
System & Breast

Exercise to strengthen pelvic floor targets *Levantor Ani Muscle*

Anatomy

FemaleReproductive
System & Breast

To help with delivery, a vertica; midline incision is made at the post


vaginal opening through the vaginal and subvaginal mucosa. The
structure most likely involved in this incision is the *Perineal Body*

Anatomy

FemaleReproductive
System & Breast

Woman who delivers twins and has postpartum hemorrhage and


surgery is started. To control her bleeding, bilateral ligation of
*Internal Iliac* arteries is preformed and this would preserve her
fertility due to the dual supply of the uterus from the ovarian
arteries.

Anatomy

submucosal glands that have alkaline secretions in Gi endoscopy


probably are the Submucosal (Brunner) glands which can be
Gastrointestinal & Nutrition
found at the *First part Duodenum* (ampulla of vater) and the
Pylorus.

Anatomy

A peptic ulcer localized PROXimally on the lesser curvature


Gastrointestinal & Nutrition probably penetrated the *Left gastric Artery* which is a branch of
the celiac trunk.

303

Anatomy

Laparotomy shows decreased angle between superior mesenteric


artery and aorta. The structure most likley obstructed is
Gastrointestinal & Nutrition
*Transverse portion of duodenum*
[Superior mesenteric artery syndrome]

838

Anatomy

Gastrointestinal & Nutrition Head and Body of Pancreas are Retroperitoneal.

11823

11908

129

292

Anatomy

A mass in the third portion of the duodenum that is infiltrating


Gastrointestinal & Nutrition beyond guy wall carrys the risk of compromising the *Superior
Mesenteric Artery*

Anatomy

Obese pt is interested in adjustable gastric band. In order to


encircle the stomach, the band must pass thru the *Lesser
Gastrointestinal & Nutrition
Omentum*
(Hepatoduodenalligamnet+hepatogastricligament)

10583

Anatomy

Pt was stabbed in RUQ. He is bleeding. Brisk, n"onpulsatile"


bleeding is seen emanating from behind the lover. The surgeon
occludes the "hepatoduodenal ligament", but the pt continues to
Gastrointestinal & Nutrition hemorrhage. Most likley source of bleeding is *Inferior Vene cava*
[Pringle maneuver, hepatoduodenal ligament includes the portal
triad of hepatic artery, ven and comon bile duct][the nonpulsatile
nature of bleed make it not from an artery]

11771

Anatomy

External Hemorrhoids originate below the dentate the line. They


Gastrointestinal & Nutrition have cutanoeous (somatic) innervation from the inferior rectal
nerve which is a branch of the *Pudendal Nerve*

11775

Anatomy

Gastrointestinal & Nutrition

11782

Anatomy

Gastrointestinal & Nutrition *Teniae coli* are used to locate the appendix.

Anatomy

Pt has mass in the middle third of the rectum extending to


rectosigmoid junction. It was resected. The lymph nodes that shud
be assessed are the *Internal Iliac lymph nodes*
Gastrointestinal & Nutrition
(lymph drianage of rectum proximal to the anal dentate line occurs
via inferior mesenteric and internal iliac nodes, while distal to
dentate line drain into inguinal nodes)

Anatomy

Internal hemorhoids is characterized by painless bleeding,


mucosal lesnions above the dentate line on anoscopy. Constipation
can lead to it. The venous component is drained into Superior
Gastrointestinal & Nutrition
rectal veins wich drian into The *Inferior Mesenteric Vein* which
drains into the splenic vein which drains into the hepatic portal
vein.

Anatomy

Pelvic fracture in a male can result in urethral injury leading to


inability to void despite full bladder sensation. The most commonly
MaleReproductiveSystem injured site is the *membraneous urthera* which is right after the
prostatic urethra. Both membranoeous and prostatic are part of the
post urethra.

1737

Anatomy

In a pt with BPH who is given Finasteride that acts on *The


MaleReproductiveSystem prostate* (below the bladder on CT)
(5-alpha reductase inhibitor)

8326

Anatomy

MaleReproductiveSystem The scrotum is drained by the superficial inguinal lymph nodes.

11658

Anatomy

MaleReproductiveSystem Gonadal arteries originate from the abdominal aorta!

11762

Anatomy

Undescended testes that can be felt medial to the mid-inguinal


MaleReproductiveSystem point have to only be passed through the Superficial inguinal ring
which is formed by the *External oblique muscle aponeurosis*

Anatomy

Pt that presents with amenorrhea and notes that her breasts have
become engorged. She is taking an antipyschotic drug. She
probably has galactorhea in which the dopaminergic athway
disturbance responsible is the the *Tuberoinfundibular*. It
connects the Hypothalamus to ant pit and is responsible for
dopamine-dependent prolactin tonic inhibition. The drug she is on
blocks dopain in that pathway.

1832

8587

11817

11840

839

513

Nervous System

The somatic pain in appendicitis that shifts from the umbilicus to


Mcbirney point is due to *Inflammation of parietal peritoneum*

566

635

1452

Anatomy

Anatomy

Anatomy

Nervous System

Pancoast tumors are non-small cell lung cancers that arise near
the superior sulcus. Pts may develop ipsilateral shoulder pain,
upper limb parethesias and areflexic arm weakness due to involv of
brachial plexus. Horner syndrome (ipsilateral partial ptosos, miosis,
anhydrosis) can occur due to invlove of cervical sympathetic
*Autnomic Ganglia*

Nervous System

Old pt with long standing HTN who presents for involuntary


movements, "Threw remote control across the room" P,E shows
Large amplitude flinging movements affecting proximal muscles of
upper extremity. Pt most likely has injury to *Subthalamic Nucleus*

Nervous System

Symptoms of hyeracusis (high sensitivity to everday sounds)


accompanied by ear pain and difficulty hearing is due to damage
to the stapedius muscle wich is innervated by the stapedius nerve
which a branch of the *Facial nerve*

1687

Anatomy

Nervous System

Pt with initial resistance to passive extension followed by sudden


release has Clasp-knife Spasticity which is seen in upper motor
neuron lesion due to lack of inhibition on spinal stretch reflex arch.
Pts with *INTERNAL CAPSULE* stroke have pure motor weakness
affecting contralateral limbs and lower face.

1696

Anatomy

Nervous System

Embolism to ACA would impared ability to *Climb stairs*

1741

Anatomy

Nervous System

Vomiting from sysetmic chemotherapy is triggered by


chemoreceptor trigger zone located on the *Dorsal surfce of
Medulla at the caudal end of 4th Ventricle* (Area postrema)

1742

Anatomy

Nervous System

Pt with nerve injury and prsents with foot slapping the ground with
each step (steppage gait) has *Common peroneal nerve injury*

1749

Anatomy

Nervous System

Injury to median nerve at the wrist is manfiested by diminished


sensation in first 3 digits with preserved sensation along the thenar
eminence. The median nerves courses between the *Flexor
digitorum superficialis and Flexor digitorum Profundus*

1815

Anatomy

Nervous System

CN IX resection would lead to loss of sensation over the *Tonsils*

1829

Anatomy

Nervous System

Pt who falls from tree and tries to break fall ny grabbing tree
branch will likely suffer from *Lower trunk injury of Brachial
Plexus*. He will be unable to perform fine finger movements with
hand (Lower trunk supplies median and ulnar)

1846

Anatomy

Nervous System

Occlusion to the *Middle cerebral Artery* can cause both


Wernicke and Broca's aphasia.

1933

Anatomy

Nervous System

Pt with diplopia and has problems walking down stairs and trouble
reading probably has a lesion to the trochlear nerve which is
responsible for depression of adducted eye.

2024

Anatomy

Nervous System

jaw deviation to right on opening mouth, difficulty chewing food


suggest CN V3 Injury (Mandibuar) It passes through *foramen
ovale*.

Nervous System

loss of touch, temperature, and vibratory sensations indiacte


damage to spinothalamic and dorsal column tracts. These two both
project into the Ventral Post. Lateral Nucleus of Thalamus. Also if
pt experiences diminished sensation over right side of face, then
his trigeminal pathway is damaged. The trigemical pathway is also
received by the thalamus at the Ventral Post. Medial Nucleus. So
damage to *Venral Post Thalamus* can trigger all above sensory
loss involving 3 paths.

2076

Anatomy

2077

Anatomy

Nervous System

fluid filled cavities in the deep structures of the brain arise from
lacune formation due to occlsuin of small penetrating arteries that
supply the structures. These lacunar infarcts are cause by
LIPOHYALINOSIS (hyaline thickening of vascular wall) &
Microatheromas (athersclerotic accumulation of lipid-laden
macrophages on intimal layer of penetrating arteries. These
predispose to *Small-Vesel Occlusion*

2127

Anatomy

Nervous System

The most common finding in *PCA* territory infarction is


Contralateral Hemianopia.

8522

Anatomy

Nervous System

The vagus and spinal accessory nerve exit through the *Jugular
Foramen*

8564

Anatomy

Nervous System

Premature neonate with decreased level of conscousnes and


hypotonia. She is weak, has prominent scalp veins and tense
fontanels. Ultrasound shows blood in the lateral ventricles. Source
of ventricles is *Germinal Matrix*
(This interventricular hemorrhage in a premature neonate)

8592

Anatomy

Nervous System

Pt with homonymous hemianopia with macular sparing could have


occlusion of *PCA*

8594

Anatomy

Nervous System

Injury to meyer's loop in the temporal lope results in contralateral


superiorquadantanopia.

Nervous System

Pt with right nasal hemianopsia who has an interal carotic artery


aneurysm. Most likely portion of visual pathway that is dirupted is
the *right peri chiasm*
[review optic lesions]

Nervous System

Orbital floor fractures can impair the infraorbital nerve which is a


continuation of the maxilaary nerve and result in numbness and
paresthesia in the uppercheeck, UPPER LIP, and upper gingiva.
This can also impair inferior rectus muscle amd impair superior
gaze

8636

11742

Anatomy

Anatomy

11744

Anatomy

Nervous System

The three trunks of the brachial plexus pass between the middle
and anterior scalene muscles (scalene triangle). Interscalene
nerve block (anesthesia) in this arrea would also affect the Phrenic
Nerve and hence affect the *Diaphragm* causing transient
ipsilateral diaphragmatic paralysis. (Phrenic nerve roots pass thru
the interscalene sheath)

11777

Anatomy

Nervous System

The Quadraceps tendon is supplied by the femoral nerve. The


femoral nerve can be blocked best in the *Inguinal Crease* at the
lateral borde of the femoral artery.

11952

Anatomy

Nervous System

Postpartumn fecal incontinence can be caused by injury to


*Pedundal Nerve*

1535

Anatomy

Pulmonary & Critical Care

The *Phrenic Nerve* carries paim fibers form the Diaphragmatic


and Mediastinal Pleura. Irritation of pleura at either area will
produce sharp pain worsened by "inspiration" that will be referred
to the c3-c5 distribution at the "base of the neck and over the
shoulder".

1695

Anatomy

Pulmonary & Critical Care

Stab wound immediately above the clavicle and lateral to the


manubrium can puncture the *Pleura* and cause pneumothorax,
tensionpneumothoraxorhemothorax.

1745

Anatomy

Pulmonary & Critical Care

Pts who is supine will aspirate into the *Post segment of the upper
lobe* and the Superior segment of the lower lobes of the right lung

8703

Anatomy

Pulmonary & Critical Care

Pt with a fish bone lodged in the left piriform recess would impair
his internal laryngeal nerve which is a branch of superior laryngeal
nerve (CN X) and hence would impair his *Cough Reflex*

11845

Anatomy

Pulmonary & Critical Care

In Obstructive Sleep Apnea. Electric stimulation of *Hypoglossal


nerve* help the pt

1680

Anatomy

Renal, Urinary Systems &


Electrolytes

The "proximal" part of the ureter is supplied by the *Renal Artery*.


The middle part is highly variable receiving supply from the
gonadal artery, the common iliac, and uterine arteries. The distal
part (close to bladder) is supplied by Superior Vesical artery,
which is a branch of the internal iliac.

1700

Anatomy

Renal, Urinary Systems &


Electrolytes

A fracture of the elft 12th rib can cause laceration to *Left Kidney*

10962

Anatomy

Renal, Urinary Systems &


Electrolytes

Pt leaking urine with coughing (stress incontinence) is due *to


Urethral sphincter dysfunction*

11708

Anatomy

Renal, Urinary Systems &


Electrolytes

In suprapubic cystostomy, besides the bladder, the structure most


likely penetrated by the trocar and cannula is the *Anterior
AbdominalAponeurosis*

Anatomy

A gardner who comes in with knee pain with no visible erythema or


Rheumatology/Orthopedics abrasions. He spends hours on on his knees while working. The
bursae most likely affected in this pt is *Prepatellar*
& Sports
[Prepatellar Bursitis][a.ka "housemaids knee]

1634

Anatomy

Pt with sensory loss over the medial 1 and 1/2 digits and
Rheumatology/Orthopedics
hypothenar eminence indicate ulnar nerve injury which often
& Sports
occurs at *Hook of Hamate*

1697

Anatomy

Rheumatology/Orthopedics An anterior translation of the tibia relative to the femur on stability


& Sports
testing indicates an inury to the *Anterior Cruciate Ligament*

Anatomy

CHild Pt who falls on his outstretched arms and fractures his


clavicle. What causes the medial fragment of the fractured bone to
Rheumatology/Orthopedics
be displaced superiorly is the *Sternocleidomastoid muscle* while
& Sports
the lateral portion would be pulled inferiorly by the wieght of the
arm and the pectoralis major muscle.

1704

Anatomy

Pt who falls on his can hands and cant extend wrist. Mid humoral
Rheumatology/Orthopedics shaft fracture is detected. Artery is injured is *Deep Brachial
Artery (Profunda brachi)*
& Sports
(Runs along the radial nerve)

1730

Anatomy

Rheumatology/Orthopedics The most important structure in the Valsalva Meneuver is *Rectum


& Sports
Abdmonis Muscle* which can be seen anterioly on a CT scan.

1812

Anatomy

Mastectomy with axillary lymph node removal can injur the long
Rheumatology/Orthopedics
thoracic nerve and henc injury seratius anterior and lead to winged
& Sports
scapula.

1956

Anatomy

Rheumatology/Orthopedics In a pt with a femoral neck fracture. The injury that would lead to
& Sports
osteonecrosis most likley involves the *Medial Cicrumflex* Artery.

7621

Anatomy

Psoas major muscle contributes to hip flexion which is an action


Rheumatology/Orthopedics
taken when sitting up from a supine position without using the
& Sports
hand.

8671

Anatomy

Pt presents because of right lower abdominal and groin pain and


difficulty walking. He is on warfarin. His abdominal CT (image)
Rheumatology/Orthopedics shows retroperitoneal hematoma lying anterior to psoas muscle.
& Sports
Additional expected finding would be *Loss of sensation on the ant
aspect of right thigh*
[Femoral nerve compressed due to bleeding from warfarin use]

11659

Anatomy

Rheumatology/Orthopedics pt with a comminuted patella fracture would be unable to *Extend


the knee against gravity*
& Sports

11683

Anatomy

Rheumatology/Orthopedics In Carpal Tunnel Syndroem, Incicision of the *Transverse Carpal


& Sports
Ligament* (Flexor retinaculum) would improve symptoms.

11727

Anatomy

Rheumatology/Orthopedics The *Piriformis muscle* passes through the greater sicatic


& Sports
formaen and occupies most of its volume.

1491

1702

Anatomy

15 year old boy presents with right arm numbness. He plays


baseball. He has had fluctuating tingling and numbness involving
the right shoulder arm and hand. Also he felt dull pain in right little
Rheumatology/Orthopedics
finger and hand. He has a cervical rib. Exam shows decreased
& Sports
sensation over emdial 2 fingers and hypothenar eminence. The
structure contributing to this pts condition is *Scalene Muscle*
(Thoracid outlet syndrome, compression of brachial plexus)

11819

Anatomy

13 yr old boy comes with right knee pain. It started as a mild ache
in lower part of knee then worsened and now causes him to limp.
Pain is relieved with rest and reproduced when knee is
Rheumatology/Orthopedics straightened. Evaluation reveals avulsion of 2ndry ossification
center of tibia due to repetitive muscle contraction and traction of
& Sports
bone. Most likely insertion site of involved muscle tendon is *Tibial
Tuberosity*
[Osgood-Schiatter Disease]

11629

Behavioral
science

If a hypertensive and diabetic patient is using herbs to lose weight,


Gastrointestinal & Nutrition explain to them that these are poorly regulated and have potential
health risks.

8456

Behavioral
science

GeneralPrinciples

Providing care to all company employees in exchange for a set


monthly fee is *Capitation*

11534

Behavioral
science

Miscellaneous
(Multisystem)

Pt with many diseases including neurocognitive disorder, in order


to achieve drug adherence, you should *Involve a social worker in
discharge planning*
-Note: Checklist wont work since pt's cognition is impaired.

11550

Behavioral
science

Miscellaneous
(Multisystem)

Pt who is becoming an outpatient and has complex medication


regimens should be given a *Hospital discharge checklist*

247

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Buspirone is an nonbenzodiazepine anxiolytic used to treat


Generalized Anxiety disorder. It has a SLOW ONSET. It lacks
muscle relaxant or anticonvulsant properyes and carries no risk of
dependence. It is a partial agonist of 5HT (1a)

248

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

SSRI's & SNRI's are first line medication in generalized anxiety


disorder. Benzos should be limited to short term use and for pts
who respond poorly to antidepressants.

Psychiatric/Behavioral &
Substance Abuse

Pt has been receiving treatment for mood swings and sleep


problems. Now the pt has constipation, dry skin, and hair loss.
Also she has weight gain despite regular diet. BP is 110/70. Pt
appears tired but exam is otherwise normal. Most likely responsible
drug is *Lithium*
[Hypothyroidism due to lithium used in bipolar disorder]

11778

520

Behavioral
science

574

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Following amitriptyline overdose (TCA). There is QRS widening


and QTc prolongation. And Death occurs. Deat is related to
*Sodium Chanel inhibition*
[Fast Na chanel inhibition resulting in conduction defects and
arrythmias]

707

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Pt with painful erection for more than 4 hours. Past med history is
sig for treatment-resistent depression, OCD, and insomnia. Drug
most likley used is *Trazadone*
[Priapism, rare side effect of trazadone]

Psychiatric/Behavioral &
Substance Abuse

Pt smoked unknown substance. He displays uncoordinated jerky


movements of extremities and assualts someone. He appears
immune to pain. In the ER he has visual hallucinations and
alternates between agitation and sedation. He is hyptertensive and
tachycardic and has vertical nystagmus. Later, he doesnt
remember anything that happened. MOA of drug is
*N-Methyl-D-aspartatereceptorAntagonism*(NMDAAntagonist)
[This is PCP]

1165

Behavioral
science

1287

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Methadone which is used in Heroin Addicts (Opiate) during


withdrawal phase, it is beneficial due to *Long Half-Life* and can
therefore suppress cravings and withdrawal symptoms for >24 hrs.
It is a full Mu-opiod receptor agonist (not partial)
The partial agonist is "Buprenorphine" also used. (Usually alone
with Nalaxone which is an opoid anatagonist)

1288

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

PCP is a hallucinogen that causes agitation, halluciantions, violent


behavior. Distinguishing factors of abuse are are Ataxia,
Nystagmus, and Memory loss

1352

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Pt who requires benzodiazepam with least imapaired judjement or


daytime fatigue should be given one with a short T1/2 and least
hepatic metabolismlike *Lorazepam*
[LOTbenzos,lorazepam,oxazepam,temazepam][Undergodirect
glucuronidation]

1429

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Young man who says that his parents who are about to get a
divorce are angry at him. His defense mechanism is *Projection*

2047

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Pt with mood symptoms and history of psychotic symptoms for


more than 4 weeks in absence of moods symptoms suggests
*Schizoaffective Disorder*

2049

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Use SSRI'S to treat OCD.

2053

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Shifting of emotions assciated with a significant person from the


past to a person in the presentis called *Transference*

7752

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Patients with frontal lobe injury often experience executive


dysfunction and personality changes secondary to impairement of
the ogranizational, restraint, and motivational systems. Changes in
social behavior can manifest in variable ways with *Left* sided
lesions more often associated with "Apathy" and right-sided lesions
withdisinhibition.

8954

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Majority of overdose deaths are related to *Opioids*

9814

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Access to firearms increases risks for suicide.

10581

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Pt with somatic symptom disorder should be *Scheduled regular


outpatient office visits*

10785

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Stimulus conrtol therapy in Tx of insomnia involves leaving the


bedroom if unable to fall asleep within 20 minutes.

11594

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Suspicion and distrust, feeling of being exploited, together with


histroy of repetitive conflict suggests *paranoid personality
disorder*

11603

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Fear of Elevators is treated with *Behavioral Therapy*

11605

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Pts who has pyschotic symptoms has been staying up late for
exams probably has *Substance Induced Psychotic disorder*

11743

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Use clozapine in treatment resistent schizophrenia.


(Agranulocytosis, seizures and metabolic syndrome are side
effects)

11746

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Depression, Fatigue, Hypersomnia, Hyperphagia, and Vivid


dreams are characteristic of *Cocaine Withdrawal*

Psychiatric/Behavioral &
Substance Abuse

Pt with recurrent episodes of chest ain, ,tachycardia, shortness of


breath, sweating, and tremulousness in a young otherwise healthy
pt with normal ECG. Best next step in management is
*Benzodiazepine*
[Panic Disorder]

11756

Behavioral
science

11807

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Pts who is bulimic (bulimia nervosa) (Binging, exercise, normal


weight, self induced vomiting proven by pharyngeal erythema,
hypokalemia, and increased amylase)can be given an SSRI such
as*Fluoxetine*

11809

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Methylphenidate used in ADHD has a side effect of *Decrease


Appetite and Weight loss*

11810

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

A child at age 2 with only 40 words of vocabularly should be


*Assessed further*
(Normal is 50-100 words at age 2)

11838

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Use *SRRI's* in panic disoder in pt who presents camly and


normal vital signs.

11854

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

srri's used in depression *Block Serotonin Receptor*

11866

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Dont confuse *Anxiety to due medical condition* as in


Hyperthyroidsim with generalized anxiety disorder. Weightloss,
tachycardia, warm moist skin, tremor along with anxiety suggest
hyperthyroidism.

11899

Behavioral
science

Psychiatric/Behavioral &
Substance Abuse

Delirium can be treated with first gen antipsychotic such as


*Haloperidol* in addition to treating the underlying cause.

2057

Behavioral
science

Social Sciences
A pregnant minor is entitled to consent to prenatal care. Not an
(Ethics/Legal/Professional) electiveterminationhowever.

10290

Behavioral
science

Social Sciences
The requirement for hospice care referal is *Prognosis of less or
(Ethics/Legal/Professional) equal to six months*

10399

Behavioral
science

Social Sciences
Physicians must report impaired collegues in a timely manner.
(Ethics/Legal/Professional)

11668

Behavioral
science

Social Sciences
a health insurance plan with low monthly premieums is *Health
(Ethics/Legal/Professional) MaintenanceOrganization*

1064

Biochemistry

Dermatology

Pallegra which is due to niacin (ViB3, precursor to NAD)


deficiency is characterized by Dermatitis (skin rash on sun
exposed), Diarrhea, and Dementia (irritable, hostile, dioriented).
Niacin is obtained from diet or synthesized in body from
*Tryptophan*. Therefore, Tryptophan is the precursor for the
compensatory pathway for NAD synthesis.

1244

Biochemistry

Dermatology

Ehlers Danlos Syndrome which presents with hyperextensible skin,


easy bruising, hypermobile joints is a defect in collagen synthesis.

1245

Biochemistry

Dermatology

Ehler-Danlos Synrome can be caused by procollagen peptidase


deficiency which results in impaired *cleavage of terminal
propeptides* Where? --> Extracellular space.

Dermatology

Signs of scurvy such as bleeding gums , ecchymoses and


corkscrew hairs implicate vit C deficiency. Vit C is required in
postranslational hydroxylation of proline and lysin residues by
hydroxylases in collagen synthesis. It happens in the Rough
Endoplasmic reticulum

Dermatology

12 yr old is evaluated for ataxia acompanied by episodic


erythematous and puritic skin lesions and loose stools. Lab shows
loss of neutral aromatic amino acids in urine. The pt symptoms
would most likley respond to to supplementation with *Niacin Vit B3*
[Hartnup dsiease, defective intestinal and renal absorption of
tryptophan. Ttryptophan is a precursor to Nicotinic acid, serotonin,
andmelatonin.]
[Tryptophan, phenylalanine and tyrosine are all aromatic
aa][note:Pallegra?]

1247

1334

Biochemistry

Biochemistry

2037

602

Biochemistry

Biochemistry

Dermatology

tRNA containts chemically modified bases such as dihydrouridine,


ribothymidine, and pseudouridine. It has a *CCA* sequence at the
its 3'-end that is used a recognition sequence by proteins. The 3'
terminal hydroxyl group of the CCA tail serves as the aa binding
site.

Endocrine, Diabetes &


Metabolism

Pituitary resection decreases ACTH which decreases Cortisol,


decrease in cortisol decreases expression of
*PHENYLETHANOL-N-METHYLTRANSFERASE* which the
enzyme that converts Norepi into Epi. Therefore, putituwary
resection leads to decreased EPI production.

847

Biochemistry

Endocrine, Diabetes &


Metabolism

Cells that express more glucose transporters as insulin levels


increase are *skeletal muscle cells* and adipocytes.
Cell that have constant glucose transporter expression even as
insulin level increases are *Renal tunular cells* also brain,
intestine, RBC, and Liver

934

Biochemistry

Endocrine, Diabetes &


Metabolism

Sorbitol produced by aldolase reductase is normally metabolized to


*Fructose*

997

Biochemistry

Endocrine, Diabetes &


Metabolism

Oxaloacetate-----> Phosphoenolpyruvate (catalyzed byPEP


carboxykinase) is the 2nd commited step in gluconeogenesis
which predominates in starvation states.

998

Biochemistry

Endocrine, Diabetes &


Metabolism

Pts with pyruvate dehydrogenase deficiency should be on a


ketogenic diet. Soley Ketogenic aminoacids include *lysine* and
leucine.

1010

Biochemistry

Endocrine, Diabetes &


Metabolism

Insuline resistance by the pancreatic cells i sstimulated by


increased ATP production. *Glucokinase* functions as a glucose
sensor in pancreatic beta cells by controlling the rate of glucose
entry into the glycolytic pathway. Mutations in the *glucokinase*
gene are a cause of maturity-onset diabetes of the young.

1019

Biochemistry

Endocrine, Diabetes &


Metabolism

Pt has absent lactate dehydrogenase activity in muscles. In this pt,


strenuous exercise leads to inhibition of glycolysis in skeletal
muscles due to intracellular depletion of *NAD+*

1021

Biochemistry

Endocrine, Diabetes &


Metabolism

Homeless pt with signs of wernicke encephalopathy after admin of


glucose without thiamine supplemenation would have an impaired
*Alpha ketoglutarate to Succinly CoA reaction*
[Thiamine is needed for alpha ketogluyerate dehydrogenase][Also
needed for other dehydrogenases and transketolase]

1022

Biochemistry

Endocrine, Diabetes &


Metabolism

A direct source of energy in the TCA cycle is in the conversion of


succinylcoA into Succinate thus yeilding GTP.

Biochemistry

Endocrine, Diabetes &


Metabolism

Increasing fructose-2,6-bisphosphate promotes glycoloysis (insulin


like effect) and inhibits Gluconeogensis. Inhibiting
Gluconeogenesis means less alanine and other glucuneogenic
substrates are converted to glucos.

Endocrine, Diabetes &


Metabolism

During fasting, maintenance of pt blood glucise is facilitated by


hepatic conversion of pyruvate into glucose. The substance that is
an allosteric activator of the first step of this process is
*Acetyl-CoA*
[Gluconeogenesis]

Endocrine, Diabetes &


Metabolism

Pt presents with myalgias, anorexia, and skin rash. He has been


consuming raw white eggs for several months. P.E shows macular
dermatitis of extremities. A water soluble vit def is suspected. The
biochemical conversions that most likely uses the def vit as a
cofactor are *Pyruvate to Oxaloacetate*
[Vit B7 (Biotin) needed as a cofactor for Carboxylases]

1031

1034

1063

Biochemistry

Biochemistry

Pt with hereditary defect in fructose metabolism. He is


asymtomatic however. This pt is still able to metabolize fructose
due to compensatory activity of *Hexokinase*
[Essential fructose uea]

1070

Biochemistry

Endocrine, Diabetes &


Metabolism

1073

Biochemistry

Endocrine, Diabetes &


Metabolism

In Aldolase deficiency, remove *Sucrose* from Diet.

1119

Biochemistry

Endocrine, Diabetes &


Metabolism

Reactions of the pentos phosphate pathway (HMP shunt) occur in


the cytoplasm. Therefore this includes activity of enzyme
*Transketolase*

1121

Biochemistry

Endocrine, Diabetes &


Metabolism

Insulin increases intracellular glycogen stores and decreases


hepatic glucose release into blood (gluconeogenesis), it does so
by activating *Protein Phosphatase-1*

Endocrine, Diabetes &


Metabolism

*Orinithine Transcarbamoylase* deficiency is the mcc urea cycle


disorder. The high NH3 causes neurologic abnormalities. Typical
tell tale sign is high urine OROTIC ACID. becasue with no OTC,
carbamoyl phosphate is converted to orotic acid in pyrmidine
synthesis.

Endocrine, Diabetes &


Metabolism

Pt with Phenylalanemia who is place on dietary requirements and


supplemented with tyrosine and presents with normal
phenylalanine levels but with axial hypotonia and microcephaly.
Also, prolactin is elevated. The enzyme missing in this pt
*Dihydrobiopterin reductase*
(Involved in converting tyrosine to DOPA, hence high prolacin)

1370

1501

Biochemistry

Biochemistry

1990

Biochemistry

Endocrine, Diabetes &


Metabolism

An autosomal recessive diroder of Sphingomyelinase deficiency.


Most consistent with this condition is *Neurodegenration and
Hepatosplenomegaly*
[Neiman-Pick disease. aslo foamy macrophages and cherry-red
macular spot]

2066

Biochemistry

Endocrine, Diabetes &


Metabolism

Pt with orotic acid urea and normal ammonia levels could have a
defect of UMP synthase (hereditary orotic aciduria)
Supplementation with *URIDINE* helps this pt.

11917

Biochemistry

Endocrine, Diabetes &


Metabolism

*Hormone Sensitive Lipase* is found in adipose tissue, it catalyzes


the mobilization of stored triglycerides into free fatty acids and
glycerol. The liver can further oxidize FFA to acetyl-coA and then
further metabolized into Ketoen Bodies.
This can be seen during Starvation.

11918

Biochemistry

Endocrine, Diabetes &


Metabolism

In an animal that well fed with CHD's. beta-oxidation of fatty acids


is inhibited via *Malonyl-coA* which inhibits carnitine
acyltransferase from shuttling acyl groups into the mitochondria.

11950

Biochemistry

Endocrine, Diabetes &


Metabolism

Zinc finger mtoif are composed of chains of aminoacids bound


together around a zinc atom via linkage with cystein and histidine
residues. Intracellular receptors that bind steroids, *Thyroid
Hormones*, and fat-soluble vitamins act directly as transcription
factors and conatin zinc biding domains.

67

Biochemistry

Gastrointestinal & Nutrition

Gallstones caused by the use of fibrates for dyslipidemia are


caasued by decreased activity of 7-lpha-hydroxylase.

790

Biochemistry

Gastrointestinal & Nutrition

Under normal cirumstances the Ras protein is activated only when


boud to *GTP*

1068

Biochemistry

Gastrointestinal & Nutrition

The substance with the fastest rate of metablosim in the glycotic


pathwayis*Fructose-1-phosphate*

1072

Biochemistry

Gastrointestinal & Nutrition

Lactose intolerance is due to absence of enzyme lactase which


convertsGalactosyl-B-1,4-glucose(LACTOSE)intoGalactose.

Biochemistry

In the duodenum, Enteropeptidase convert Trypsinogen to the


Gastrointestinal & Nutrition active form trypisn. Pt with impaired enteropeptidase will fail to
form *Trypsin*

Biochemistry

Pt who presents with difficulty swallowing and is found to have an


mass in esophagus. He is a hunter and put sodium nitrite in his
meat. Analysis of biopsy sample show Cytosin Demaination. This
Gastrointestinal & Nutrition
damage is usually repaired (Base Excision Repair) by this
enzymatic sequence; *Glycosylase, Endonuclease, Lyase,
Polymerase, Ligase*

1807

Biochemistry

Chronic alcoholic pt with angular stomatitis, cheilitis, glossitis and a


"low riboflavin" probably has riboflavin (B2) deficeincy. Riboflavin
can become FMN (flavin mononucleotide) then FAD (dinucleotide)
Gastrointestinal & Nutrition
which act as coenzymes in reactions thru acceptance of electrons
(ETC (complex2)& Krebs). FAD is a component of *Succinate
Dehydrogenase*

8425

Biochemistry

Gastrointestinal & Nutrition

Biochemistry

Pt with Abdominal pain who ingested mmushrooms, he is


jaundiced with tender palpable liver and elevated liver enzymes and
Gastrointestinal & Nutrition
bilirubin most likey has Amatoxin that binds to DNA-dependent
RNA polymerase type 2 and halts *mRNA synthesis*

1251

1475

8482

Mutations in Leptin gene or receptor will lead to *Hyperphagia and


Obesity*

995

Biochemistry

GeneralPrinciples

After a ligand binds to a G protein-coupled receptor that activates


phopholipase C, membrane phospholipids are broken down to
DAG and IP3. *Protein Kinase C* is subsequently activated by
DAG and Ca.

996

Biochemistry

GeneralPrinciples

If lactic acid is accumulatimg that means there is increased activity


of Lactate dehydrogensae and DECREASED activity of *Pyruvate
Dehydrogensae*

1028

Biochemistry

GeneralPrinciples

The rate of glycogenolysis within myocytes increases several x100


during active skeletal muscle contraction. The substance that
synchronizes these two processes is *Ca2+*

1248

Biochemistry

GeneralPrinciples

Collagen made by fibroblasts has Glycine as every third amino


acid (GLY-X-Y) it is thefefore the most abundant.

GeneralPrinciples

Certain tRNA molecules can recognize multiple different codons


coding for the same amino acid, a phenomenon explained by the
*Wobble hypothesis*
{Genetic code is Degenerate]

1424

Biochemistry

1434

Biochemistry

GeneralPrinciples

E.coli with enzyme-mediated nucleotide removal in the " 5' to 3'


direction " is done by *DNA polymerase 1*
[Other 3 have 3' to 5' exonucelease activity][DNA p1 Removes the
RNA Primer]

1437

Biochemistry

GeneralPrinciples

The factor that makes eukayotic DNA replication quick and


effective despite large size and complexity of genome is *Multiple
origins of replication*

2035

Biochemistry

GeneralPrinciples

mRNA *Interaction with P bodies* occurs only in the CYtoplasm.

868

Biochemistry

Hematology & Oncology

A new born baby has fetal HB prdominantly (alpha 2 gamma 2)


which changes to adult Hb (alpha 2 Beta 2) within the next six
months.

1035

Biochemistry

Hematology & Oncology

Synthesis of ribose from fructose-6phosphate can be done using


*Transketolase*.

1036

Biochemistry

Hematology & Oncology

G6PDconvertsglucose-6-phosphateto6-phosphogluconate

1337

Biochemistry

Hematology & Oncology

Pt comes due to recurrent blistering on back of hands and


forearms for several years. P.E shows vesicles and erosion on the
dorsum of both hands. Most likely deficient enzyme in this pt is
*Uroporphyrinogen Decarboxylase*
[Porphria Cutaneo Tarda]

1338

Biochemistry

Hematology & Oncology

Pt with neurologic symptoms (tingling, difficulty concentrating) and


recurrent episodes of nonspecific abdominal pain likely has acute
intermitten porphyria. (PBG deaminase def) This attack is helped
with infusion of heme which downregulates hepatic *ALA synthase*

1386

Biochemistry

Hematology & Oncology

Oxygen binding to Hb involves the release of *Protons*


[H+ is released]

Hematology & Oncology

In an experiment where scientist were able to separate hemoglobin


tetramers into individual alpha and beta subunits. If a solution is
created that contains only monomeric beta-hemoglobin subunits
and the o2 dissociation curve is measure, it would be have a *very
high affinity (P50%=1)* The beta subunit is almost identical to
Myoglobin which has a stong affinity to O2 (p50%=1) vs p50%=26
of HbA.

1413

Biochemistry

1419

Biochemistry

Hematology & Oncology

Differences between synthesis of 2 daughter DNA strands include


*The joining of DNA fragments by ligase*
This is beacuse the leading strand is less affected by ligase
compared to the lagging strand which has okazaki fragments that
must be constantly ligated by ligase.

1456

Biochemistry

Hematology & Oncology

The change in color of a bruise from blue to green is explained by


activity of *Heme Oxygenase*
[Biliverdin is Green, Bilirubin is yellow]

1470

Biochemistry

Hematology & Oncology

Both HbS and HbC result from *Misense Mutations*

Hematology & Oncology

Duchenne Muscular Dystrophy can also results from None-sense


Mutations (premature stop codon)
[Usually from deletions (frameshift) thu]

1487

Biochemistry

1847

Biochemistry

Hematology & Oncology

In an experiment where folate is deprived. Provision of


*Thymidine* would reduce erythroid precuros cell apoptosis.
[Folate def inhibits formation of dTMP, Thymidine supplementation
can increase dTMP and hence reduce erythroid precursor cell
apotosis]

1471

Biochemistry

Infectious Diseases

Bacterial *DNA polymerase 1* removes RNA primers during DNA


replication.

Nervous System

Pt presents for exertional dysnpnea and fatigability. On P.E her


gait is unstable when her eyes are closed and tehre is impaired
vibratory sensation in the lower extremities. There is marked Pallor
in conjunctiva, nail beds, and palms. The lab test that would
confirm Dx is *Serum Methylmalonic acid*
[Vit B12 Def]

64

Biochemistry

598

Biochemistry

Nervous System

Wernicke syndrome manifests with opthalmoplegia, ataxia, &


confusion. There is foci of hemorrhage and necrosis in the
"mamillary bodies" and periaqueductal gray matter om autopsy.
Diagnosis involves measuring *Eythrocyte Transketolase activity* It
occurs due to chronic Thiamine (B1) def commonly in alcoholics.

1335

Biochemistry

Nervous System

Hypertonicity, muslce rigidity and sugar smelling diapers are signs


for maple syrup urine disease and branched chain amino acids
such as leucine, isoleucine and valine should be restricted.

1371

Biochemistry

Nervous System

Infant with lethargy vomiting and seizures. Lab shows high


ammonium levels. Liver biopsy suggest impaired formation of
N-acetylgutamate as the cause. The reaction impaired in this pt
would be *Conversion of CO2+NH3 into Carbamoyl-Phosphate*
{N-acetylglutamateactivatescarbamoylphosphatesynthase1
which is th enzyme that converts co2+NH3 into Carbamoyl
phosphate]

1372

Biochemistry

Nervous System

Pt with inherited condition wich imapirs transport of ornithine from


cytosol to mitochondria. Restric *proteins* from diet to improve
condition.

1480

Biochemistry

Nervous System

High Arginine in plasma and CNS suggest arginase deficiency


which works to convert arginine into *Urea* in the urea cycle.

Nervous System

Pt with imapaired Tetrahydrobiopetrin synthesis would have


phenylketonurea and would therefore have deificency of
*Serotonin*

Nervous System

Pt with mutation in Protein involved in the assembly of small


nuclear ribonucleoproteins (snRNP's) in motor neurons. Pt will
have impaired function of *Spliceosomes*

Nervous System

In lesch-Nyhan syndrome, there is increased activity of *PRPP


Amidotransferase* due to compensatory increase in Denovo
Purine Synthesis.

Biochemistry

Nervous System

Infant with normal development in first few month then progressive


neurologic deterioration. P.E shows macrocephaly and an
abnormal startle reflex with acoustic stimuli. Funduscopy shows a
bright red fovea centralis. (chery red macula spot)Pt most likley
has accumulation of *GM2 ganglioside*
[Tay-Sachs]

Biochemistry

Infant with language regression and anemia probably has lead


Poisoning&Environmental
posioning and probably has an inhoiibited *ALA Dehydratase
Exposure
enzyme* plus ferrochelatase inhibition.

1500

2036

2067

8524

1454

1249

Biochemistry

Biochemistry

Biochemistry

Biochemistry

Pulmonary & Critical Care

The stretch and recoil property of elastin is mediated by


*Interchain cross-links involving lysine*
[involveslysyloxidase]

1989

Biochemistry

Renal, Urinary Systems &


Electrolytes

18 year old male with progressive skin rash. He has long standing
history of intermittent burning sensation in his palms and soles that
is exacerbated bt stres and fatigue. Burning is severe after
exercise. He sweats very little. Lab test reveals undetectable levels
of alpha-galactosidase A. Pt is at greatest risk for *Renal Failure*
[Fabry Disease, X-linked alpha-galactosidase A def]

11939

Biochemistry

Renal, Urinary Systems &


Electrolytes

Pt with anion ga metabolic acidosis would rewuire renal


metabolism of *Glutamine* for maximizing acid excretion pt.

361

Biochemistry

Rheumatology/Orthopedics SnRNA has the function of *removal of introns from RNA


& Sports
transcripts*

1250

Biochemistry

an elstin associated glycoprotein defecct that is abundant in the


Rheumatology/Orthopedics lens, periosteium, and aortic media refers to *Marfan Syndrome*
an autosomal dominant disease with a defect in FBN1 gene coding
& Sports
for fibrillin glycoproten that forms around elastin.

2090

Biochemistry

Mutation in PRPP synthetase (enzyme in purine denova synthesis)


Rheumatology/Orthopedics
can lead to hyperuricemia due increased production of purines.
& Sports
Thus increasing the risk for Gout Which affects *Joints*

2091

Biochemistry

Negatively Birefringent crystals under polarized light indicates


Rheumatology/Orthopedics
Gouty Arthritis, for which the inflamatory response is mediated by
& Sports
*NEUTROPHILS*

8802

Biochemistry

Pt with signs of RA. Serum autoantibodies with "high specificity"


Rheumatology/Orthopedics for this pt condition are most likely to react with *Citrullinated
peptides*
& Sports
[ant-CCP]

1175

Biostatistics

Biostatistics &
Epidemiology

Absolute risk reduction = Event rate in the control group - event


rate in the Tx group

1178

Biostatistics

Biostatistics &
Epidemiology

Check other calculations in choices.

1187

Biostatistics

Biostatistics &
Epidemiology

A trend in whoch there is a rising prevalence but stable incidence


is due to prolonged duration of disease (*IMPROVED QUALITY
OF CARE* for e.g)

1188

Biostatistics

Biostatistics &
Epidemiology

Disproportionate loss of follow up btw exposed and control leads to


attrition bias which is a form of *Selection Bias*

1189

Biostatistics

Biostatistics &
Epidemiology

Matching involves grouping patients with similar characteristics in


both the control and treaetment (case) group. It is done to control
confounding bias.

1272

Biostatistics

Biostatistics &
Epidemiology

Statistical power *1-Beta* represents a study's ability to detect a


difference when one exists. Basically the ability to reject the null
hypothesis when its truly false.

1303

Biostatistics

Biostatistics &
Epidemiology

A study's power increases as its *Sample Size* increase.


Therefore, the larger the sample size, the larger the ability of a
study to detect a difference when one truly exists.

10570

Biostatistics

Biostatistics &
Epidemiology

When the unit of analysis in a study is "Populations" and not


individuals, then it is an *Ecological Study*

1174

Biostatistics

Cardiovascular System

Number Needed to Treat is 1/Absolute Risk Reduction.


(ARR is: conrol rate - Tx rate)

1301

Biostatistics

Cardiovascular System

Blinding prevents observer bias.

1190

Biostatistics

GeneralPrinciples

*Negative Predictive Value* is the probability of being free of


disease. Answers the question: What are the chances that I really
do not have cancer?

1233

Biostatistics

Pulmonary & Critical Care

Know how to calculate Sen, Spec, PPV, NPV (QUICKLY)

1208

Biostatistics

Rheumatology/Orthopedics Case-fatality rate is calculated by dividing the number of fatal


& Sports
cases by the total number of people with the disease.

35

Embryology

Cardiovascular System

Cyanosis in transposition of the great vessels is classic. This


condition is due to failure of Septation. Failure of the
aorticopulmonary septum to spiral. It can be conducive to life only
if accomanied by another condition that allows mixing of blood. E.g
Patent ductus arteriosus which presents with machine like murmur.

202

Embryology

Cardiovascular System

Pt with signs of a stroke and echocardiogram shows bubbles on


left heart when agitated saline is inserted has an Patent Foramen
Ovale due to *Incomplete fusion of atrial septum primum and
secundum*

1705

Embryology

Cardiovascular System

Teratology of Fallor results from *Deviation of Infundibular Septum*

1750

Embryology

Cardiovascular System

The common carotid artery which is palpatrd along the inner side
of the sternocleidomastoid muscle is derived from the 3rd
pharyngeal aortic arch.

1740

Embryology

Ear, Nose & Throat (ENT)

a uni lateral cleft lip is caused bt failure of *Fusion on the maxillary


prominenceandintermaxillarysegment*

543

Embryology

Endocrine, Diabetes &


Metabolism

Pt with absent thymic shadow and narrowing of aortic arch on xray


probably has DiFeorge syndrome and lacks a thymus due to
failure of *Third pharyngeal Pouch* to develop.

550

Embryology

Endocrine, Diabetes &


Metabolism

*Cortisol* has the greatest effect on lecithin to sphingmyelin ratio


(greater than 1.9 indicates mature lung)

1809

Embryology

FemaleReproductive
System & Breast

*Vaginal Agenesis* is characterized by short vagina and


rudimentary uterus and Amenorrhea with normal 2ndry sex
characteristics and normal wieght and stature. It is a.k.a Mullerian
Aplasia or MRKH syndrome. It often presents with urologic issues
as as unilateral renal agensis.

320

Embryology

Gastrointestinal & Nutrition

Pt with Imperforate Ausu often have *Urinary tract Abnormalities*


accompanying the condition.

321

Embryology

Gastrointestinal & Nutrition Meckels diverticulum is an example of ECTOPY.

330

Embryology

Gastrointestinal & Nutrition

If neural crest migation to the intestine is interrupted by the final


week (12 week) of migration, The *Rectum* would be affected.

437

Embryology

Gastrointestinal & Nutrition

The ventral pancreatic primordium gives rise to the *Main


ppancreatic duct*

11803

Embryology

New born Pt with down syndrome who has reducible midline


abdominal protrusion covered by skin probably has an
Gastrointestinal & Nutrition
uncomplicated umblical hernia due to *Incomplete Closure of
Umbilical Ring*

419

Embryology

MaleReproductiveSystem

1449

Embryology

If Leydig cells are working in a male (46xy) and Sertoli cells are
not then the fetus will have female and male internal genitalia and
MaleReproductiveSystem
male external genitalia. Why? becuase sertoli cells produce MIF
which inhibits female internal gonad differentiation.

252

Embryology

Miscellaneous
(Multisystem)

Fetus that has closely set eyes, middline mass cosistent with a
proboscis, fused cerebral hemispheres, and an absent forebrain
fissure has Holoprosencephaly whicha type of *Malformation*

496

Embryology

Nervous System

Vitamine supplementation prevents neural tube defects in pregant


women. For exampel those defects involving the pos neural folds
such as meningocele and meningomyelocele.

502

Embryology

Nervous System

Acetylcholinestrase in the amniotic fluid indicates a neural tube


defect in which there is a *Failure of Fusion*

8702

Embryology

Nervous System

The anterior pituitary is derived from *Surface Ectoderm*


(Rathke's pouch)
-Check Table

337

Embryology

Pregnancy, Childbirth &


Puerperium

Pregnant pt on anti-convulsants who presents with


polyhydroamnios, fetus probably has *Anencephaly* due to
antiepileptic medication whic is a risk factor for neural tube
defects.

1833

Embryology

Pulmonary & Critical Care

High blood oxygen in a fetus can be found in the inferior


venecava.

652

Embryology

Renal, Urinary Systems &


Electrolytes

urine discharge from the umbilicus is caused by a persistent


allantois remnant.

837

Embryology

Renal, Urinary Systems &


Electrolytes

The mcc of unilateral fetal hydronephrosis is inadequate


canalization of *UretroPelvic Junction*

Renal, Urinary Systems &


Electrolytes

Neoborn who has tachypnea and hypoxia. He has a flattened nose


and bilateral club feet. He dies one hour later. To be found during
autopsy is *Renal Agenesis*
[Potter sequence of pulmonary hypoplasia, falttened facies, and
limb deformity due to Oligohydroamnios due urinary tract anomaly]

Renal, Urinary Systems &


Electrolytes

Ultrasound of fetus with bilaterally enlarged fetal kidneys with


diffuse small cysts and oligohydroamnios has Autosomal recessive
polycystic kidney disease (ARPKD) and is the oligohydroamnios
can lead to Potters sequence which is Flattened facies, Limb
deformity, and "Pulmnary Hypoplasia" and therefore the baby can
be born with *Respiratory Disress*

1752

1915

Embryology

Embryology

A patent processus vaginalis causes a communicating hydrocele.


It can also cause an *Indirect Inguinal Hernia*

Embryology

Rheumatology/Orthopedics Both the thymus and *Inferior parathyroid* originate from the 3rd
& Sports
pharyngeal pouch.

1684

Embryology

Infant with flaccid lower extremity and absent ankle reflexes


Rheumatology/Orthopedics bilaterally and with poorly developed lumbar spine and sacrum
(agenesis) has Caudal Regression Syndrome which is related to
& Sports
mother *Uncontrolled Diabetes* during pregnancy.

11835

Genetics

Biostatistics &
Epidemiology

Good Question On Hardy Wieiberg analysis

756

882

Genetics

Cardiovascular System

Majority of Down syndrome have trisomy 21 that happens as a


result of *Chromosomal nondisjunction* during the 1st meitic
division of the ovum. Incidence increases with maternal age. Only
about 4 percent of down syndroem is caused by Robertsonian
Translocation.

1476

Genetics

Dermatology

Pt with xeroderma pigmentosum have a defect in *Endonucelease*


enzyme.

256

Genetics

FemaleReproductive
System & Breast

Pt with signs of Turner Syndrome is likey to have *Bicuspid Aortic


Valve*

8556

Genetics

FemaleReproductive
System & Breast

Turner syndrome pt can become pregnant but with oocyte


donation.

8283

Genetics

Gastrointestinal & Nutrition

Differences in halotype frequencies in a population can be as a


result of *Linkage Disequilibrium*

GeneralPrinciples

A protein that has reverse transcriptase activity that functions to


add TTAGGG repeat to the 3'end of chromosomes. The cell type
with this protein is most likely *Epidermal Basal cells*
[Temlomerase protein on stem cells]

1438

Genetics

1462

Genetics

GeneralPrinciples

The acqusition of a new viral surface rotein is often all that is


necessary for a virus to infect a new type of host cell. This is an
example of *Phenotype Mixing* Here there is no change in
parental genome and tehrefore, subsequent progeny will revert to
having only original host attacking properties.

1469

Genetics

GeneralPrinciples

Viruses with segmented genomes can undergo genetic shift


through reassortment. Such viruses inclide orthomyxoviruses
(influenza) and *RotaViruses*

1728

Genetics

GeneralPrinciples

*Classic Galactosemia* is autosomal recessive.

1970

Genetics

GeneralPrinciples

The occurence of multiple, seemingly unrelated phenotypic


manifestation, often in different organs system as a result of a
single genetic defect is termed *Pleiotropy*
[Vignette example is Homocysteinurea, manifesting with pitting
edema (from DVT), caved in chest wall (marfinoid habitus), DVT,
singlegene mut in cystathionine beeta-synthase enzyme]

2015

Genetics

GeneralPrinciples

The homeobox genes code for proteins that are *Transcription


regulators*

2025

Genetics

GeneralPrinciples

Enhancers can be *Located upstream, downstream or within


introns of the gene*

2029

Genetics

GeneralPrinciples

Releasing factor 1 recognizes stop codons.

2030

Genetics

GeneralPrinciples

Mutations in promotor regions such as TATA box can likely affect


*Transcription Initiation*

2033

Genetics

GeneralPrinciples

The poly A tail at the *3' end of RNA* is not transcriped from DNA
template and was a post transcription modification.

8328

Genetics

GeneralPrinciples

In Trisomy 21, chromosomal nondisjunction occurs in *Meiosis 1*

11904

Genetics

GeneralPrinciples

Spina Bifida has a *Multifactorial* Inheritance pattern

11913

Genetics

GeneralPrinciples

*Alternative Splicing* is a process by which a single gene can


code for various unique proteins by selectively including or
excluding different DNA coding regions (Exons) into mature mRNA.

1474

Genetics

Hematology & Oncology

External Beam Radio therapy kills cancer cells through


*Double-strand DNA breaks*

2087

Genetics

Hematology & Oncology

In beta thalassemia there is *Microcytosis*


Virus that develop a trait (due to culturing with another viruse) and
their subsequent progeny continue to have the trait. Mechanism
that explains this is *Reassortment*
(Recombination is if progency acquires completely new trait)

11907

Genetics

Infectious Diseases

807

Genetics

Recurrent pneumonia, Azoospermia, Digital clubbing, No vas


MaleReproductiveSystem deferens are signs of Cystic Fibrosis. It can be diagnosed with
measuring *Chloride level in the sweat*

701

591

Genetics

Genetics

Miscellaneous
(Multisystem)

Husband short with a large head and prominent forehead. Wife is


normal. They are concerned about unborn child's height. Best
response is *Rsik of short stature in child is 50%*
(Achondrolasia is autosomal dominant, father must heterozygous
(otherwise be dead), mom is unaffected therefore 50%)

Nervous System

Young man who is aysmptomatic and found to be homozygous for


the apolipoprotein E-4 allele. In the future he most likely to suffer
from*Alzheimer'sdementia*
[Late onset familial Alzheimer's disease]
[Eary onset is assoc with 1) Amyloid precursor protein on chrom
21. 2) Presenilin 1 gene on chrom 14. 3) Presenilin 2 gene on
chrom 1.]

1307

Genetics

Nervous System

Pt with Fleshy, dome shaped lesions plus cafe-au-lait spots


probably has cutaneous neurofibromas which is a hallmark of
NF-1 which exhibits an inheritance pattenr of *Single Gene
Autosomal Dominant*
-The NF-1 gene is on chromosome 17.

1421

Genetics

Nervous System

CGG Trinucleotid repeats is characteristic of Fragile X syndrome.


Symptoms results from *Gene methylation* of FMR1 gene.

955

Genetics

Pregnancy, Childbirth &


Puerperium

Pt with Clitromegally and High Androgen levels with Maternal


Virilization probably has *Aromatase Deficiency*

1688

Genetics

Pregnancy, Childbirth &


Puerperium

An ovulated oocyte is at *Metaphase of Meiosis 2*

1830

Genetics

Pregnancy, Childbirth &


Puerperium

A complete mole usually results when an empty ovum is fertilized


by a haploid sperm. Subsequent duplication of the paternal genetic
complement (23X) results in characteristic *46,XX* genotype

Genetics

Renal, Urinary Systems &


Electrolytes

Pt with painless hematuria, right sided renal mass, cytoology of


malignant cells with chromosome 3p deletion. No significant family
history. Findings indicate Sporadic Renal cell carcinoma which is
due to deletion of VHL gene on chromosome 3.

1935

Genetics

Presence of ragged skeletal muscle fibers and lactic acidosis is


suugestive of mitochondrial myopathy. Heteoroplasmy is
Rheumatology/Orthopedics responsible for variable expressiion of mitochonndrial disease in
& Sports
those affected. Heteroplasmy is having both mutated and wild
mitochondrial Genomes in one individual, severity of disease
depends on ratio of these.

8711

Histology

Cardiovascular System

Scar tissue in the heart is Type 1 Collagen, Just like tendons,


ligaments, bone and blood vessels are type 1.

8424

Histology

Endocrine, Diabetes &


Metabolism

The adrenam medulla is demaracted from the cortex and is


composed of Chromaffin cells with a deeply basophilic (blue)
cytoplasm. The medulla is stimulated by Acetycholine.

904

Tumor of cells heavely loaded with mucus that has metastasized to


the ovaries suggests adenocarcinoma of the *Stomach* Classicly
they are mucin-producing signet-ring neoplastic cells in ovarian
stroma. (Krukenberg tumor)

127

Histology

FemaleReproductive
System & Breast

1957

Histology

FemaleReproductive
System & Breast

Pt with heavy and painful menstrual bleeding with uniformly


enlarged uterus has Adenomyosis, which is *Endometrial tissue in
theMyometrium*

11890

Histology

FemaleReproductive
System & Breast

Revisebreastneoplasia!

367

Histology

*Hep B* infection causes hepatocellular cytoplasm to to fill wih


surface hep b antigen. The inclusions are (finely
Gastrointestinal & Nutrition
granular,homogenous, pale pink), dull eosnophilic,ground glass
apearance. Commonly transmitted sexually or in "IV drug users"

889

Histology

Hematology & Oncology

Hemolytic anemia signs with blood smear showing spherocytes (no


cetral pallor) indicates spherocytosis which is *RBC cell
memberanecytoskeletonabnormality*

483

Histology

Infectious Diseases

The *True vocal cords* have stratified squamous epithelium. These


can be affected by HPV which is a DNA virus casuing warty
growth (papillomas) on the true vocal cords.

20

Histology

Nervous System

Pt with 1 week history of hemiplegia, expressive ahagia and CT


that shows hypodensity in his brain probably had an ischemic
brain infarct. Histologic finding after stainling for lIPIDS would
produce cells marked densely for lipids which are the
*MICROGLIA* and the lipids are from breakdown prduucts that
werephagocytosed.

1536

Histology

Nervous System

The Blood brain barrier has Tight Junctions (Zonula Occludens)

1922

Histology

Nervous System

Kinesin & dynein are *Microtublar* motor proteins responsible for


rapid axonal transport.Kinesin acts in Anterograde transpor,
Dynein in Retrograde.

1936

Histology

Nervous System

A toxic insult that targets protein KInesin will affect *Secretory


vesicles in nerve terminals* and will make them absent from tissue
histological examination.

478

Histology

Pulmonary & Critical Care

*Type 2 Pneumocytes* have the ability to proliferate in response to


cell injury. They can regenerate!

480

Histology

Pulmonary & Critical Care

The epithelium of the bronchi is psuedostratified ciliated epithelium


with goblet cells and submucosal mucoserous glands and cartilage.
Bronchioles, terminal bronchiols and respiratory bronchioles lack
goblet cells, glands, & cartilage. The terminal brocnhioles have
ciliated simple cubioidal. So CILIA is last to disappear moving
distally.

488

Histology

Pulmonary & Critical Care

smoking induced emphysema is contributed to by neutrophils.

524

Histology

Pulmonary & Critical Care

Pt with tickened bronchial walls, lymphocytic infiltration, mucous


gland enlargement, and patchy squamous metaplasia of bronchial
wall mucosa are features of Chronic Bronchitis. Smoking is a
leading cause of that. Smoking is *Behavioral contributor*

Histology

Renal, Urinary Systems &


Electrolytes

In PSGN there is deposition of IgG, IgM, an *C3*, thus producing


a star-sky appearance on immunolfourescent microscopy.

1159

Histology

Rheumatology/Orthopedics
Osteocytes are connected to each other by *Gap Junctions*
& Sports

1734

Histology

Rheumatology/Orthopedics Antibodeis against Actin would be against the Z-line since it


& Sports
contains only actin

556

Immunology

Allergy & Immunology

Pt stung by a bee displaying edematous and erythematous plaque


with evanescent borders and mild central pallor. This is a local
allergic reaction (type 1 hypersensitivity) leading to the release of
*HISTAMINE*, heparin, leukotrienes, and prostaglandins that are
responisble for the increased vascular permeability leading to the
presentation.

743

Immunology

Allergy & Immunology

The classic triad of Urethritis, Conjunctivitis, and Mono- or


Oligoarticular arthritis indicates "Reactive Arthritis" which is a
seronegative (RF -ve) spondyloarthropathy (HLA-B27). Symptoms
usually present 1-4 weeks after a primary infection causing
urethritis (dysurea). Skin finding include a vesicular rash on palms
& soles, circinate balanitis, and *SACROiLiiTiS* (inflammation of
sacroiliac joint)

965

Immunology

Allergy & Immunology

We conjugate the H. Influenza capsular polysaccharide together


with diptheria toxoid in the vaccine because this combination
*IncreasesImmunogenicity*.

2068

Immunology

Allergy & Immunology

Histamine and *Tryptase* are elevated in Anaphylaxis.

2069

Immunology

Allergy & Immunology

Mast cell degranulation is triggered by *Receptor aggregation*


during High affinity IgE receptor activation.

Dermatology

Pt presents with highly Pruritic (itchy) erythematous rash


consisting of papules, vesicle and bulla following exposure to
wilderness (Elctrician working in unmaintained woody area). Cells
responsible for tissue damage are *T cells*
[Poison IVY dermatitis, type 4 hypersen]

Dermatology

Symptoms of Maculopapular Rash (skin) and multiple intestinal


ulcers (GI) after Liver transplant (or bone marrow) suggest
Graft-versus-Host disease which is characterized by *Graft T cell
sensitization against Host MHC antigen.*

Immunology

Dermatology

Pts with history of otitis media, chronic diarhea who on on exa


have pneumocystis probably have SCID. (Otitis meedia is from
bacteria and that reuires Humoral immunity) (pneumocystits
requires t cells) Thefere *Combined Immune deficiency*

Immunology

Imigrant pt who is otherwise healthy and labfinding yiled Positive


Anti-Hepatiitis A IgG. He was never vaccinated against hep A.
Gastrointestinal & Nutrition
Thi slab finidng suggest him having an *Anicteric viral infection as
a toddler*

589

Immunology

Secretory IgA exists as a dimer with J chain in the middle and a


secretory piece that kind of cross links the dimer, it functions to
Gastrointestinal & Nutrition prevent IgA dimer degradation in mucosal membranes. Secretory
IgA is present in mucus, tear, and *Colostrum*. (Note: the serum
form is a monomer)

745

Immunology

Gastrointestinal & Nutrition NK cells kill cells that do not express MHC class 1 antigen.

1467

Immunology

The live attenuated oral (Sabine) poliovirus vaccine produces


stronger mucosal sectretory igA immune resposne than Salk killed
Gastrointestinal & Nutrition vaccine. Secretory IgA maybe refered to as *Duodenal Luminal
IgA*. Remember the route of entry of the virus is thru the intestinal
epithelial cells.

1596

Immunology

Gastrointestinal & Nutrition

Immunology

The molecule involved in mediating the accumulation of pus is


Gastrointestinal & Nutrition *IL-8*
[Neutrophil chemotaxis]

1133

1613

2078

373

8539

Immunology

Immunology

Immune mechanism against Giradia involves CD4+ T helper cells


and *Secretory IgA Production*

11674

537

545

Immunology

Immunology

Immunology

GeneralPrinciples

The ubiquitin proteasome pathway is essential for breakdown of


intracellualr proteins, both native and foreign. Ubiquitin works as a
tag for proteasome recognition. This is performed by *Ubiquitin
Ligase* that catalyzes ubiquitin attachment.

Hematology & Oncology

Male Infant with eczema, recuurent infections and


thrombocytopenia has *Wiskot-Aldrich Syndrome*
[X-linked][Combined B and T cell disorder][Tx with Bone marrow
transplant]

Hematology & Oncology

ErthroblastosisFetalis(Jaundice,hepatosplenomegaly,edema,
low Hb, nucleated erythrocytes, extramedullary hematopoiesis) is
caused by *RBC opsonization by maternal antibodies*

558

Immunology

Hematology & Oncology

During the process of T-lymphocyte maturation, T cell receptors of


many lymphocytes demonstrate a very high-affinity interaction with
MHC molecules expressed on thymic medullary epithelial and
dendritic cells. At this time, lymphocyte undergo *Negative
Selection*

953

Immunology

Hematology & Oncology

CCR5 protien plays a role in HIV entry into CD4+ Cells. Blocking
of CCR5 receptor blocks entry of HIV into cells.

1598

Immunology

Hematology & Oncology

The surface marker for the macrophages of TB is CD14

1614

Immunology

Hematology & Oncology

B cells undergo *ISOTYPE SWITCHING* in germinal centres


(round) of the cortex of lymph nodes.

8480

Immunology

Hematology & Oncology

PECAM-1 gene is involved in Transmigration during the


inflamatory process.

Infectious Diseases

Pt with HIV history whose "bood" cultures grow psuedohyphae


producing yeast species with ability to form germtubes. This pt
probably has "Cadidemia" (disseminated candida infection).
Development of Candidemia is directly contributed by a *Low
Neutrophil Count*
Note: Superificial Candida Infection is contributed to by a "Low
T-lymphocyte count"

112

Immunology

378

Immunology

Infectious Diseases

Presence of HBeAg (marker for viral replication and increased


infectivity) in pregnant women with hep B infection increases the
risk of vertical transmision to child.

379

Immunology

Infectious Diseases

If HBeAg persists for several months and host ant-HBeAg remain


at low or undetectable levels, suspect *Chronic Hep B with high
infectivity*

Infectious Diseases

Sexually active pt presents with fevers and arthralgias (arthritis).


She has several postules on her arm (Dematitis). Her wrist and
ankle are tender on palpation (Tensosynovitis). Pt blood shows
G-ve bacteria that produces an ezyme that splits IgA at the hinge
regions. Most imp role of this bacterial enzyme is *Mucosal
adherence of bacteria*
[Disseminated Gonorrheal Infection, produce IgA proteases]

560

Immunology

676

Immunology

Infectious Diseases

Symptoms of Fever, Vomiting, Diarrhea, Muscle pain, low BP and


Erthroderma Indicate Toxic shock syndrome mostly caused by
Staph Aureus toxic syndrome toxin which acts a superantigen that
activates many *T Cells & Macrophages*
leading to production of cytokins that cause capillary leakage,
circulatory collapse, hypotension, fever, shock, and multiorgan
failure.

1468

Immunology

Infectious Diseases

The antiviral action of interferon is *Decreased prtein synthesis by


infected cells*

673

Immunology

Nervous System

4 year old Pt with ataxia, repeated respiratory infections, and


cultured cells that show high rate of genetic mutations probably
has Ataxia-telangiectasia and has *Cerebellar Atrophy*

762

796

1466

1763

1995

2128

569

742

Pulmonary & Critical Care

Pt wih T cells that lack IL-12 receptor would be unable to release


*IFN-Gamma* and supplementation would be needed to improve
pt's recurrent respiratory infections.

Pulmonary & Critical Care

African American woman presents with exertional dyspnea and dry


cough. Chest xray shows bilateral hilar adenopathy and reticular
pulmonary infiltrates. Serum ACE & Ca levels are elevated. PPD
test is negative. Bronchoscopy is arranged. The cell type that is
most likely to predominate in the lavage is *CD4+ cells*
(Sarcoidosis)

Pulmonary & Critical Care

Pt given an inactivated viral component vaccine. On exposure to


real virus, would result in *Inhibition of viral entry into cells*
(Humoral immunity and not cell mediated immunity since it is not a
live virus)

Pulmonary & Critical Care

2 yr old boy Pt with sinopulmonary infections (otitis media &


pneumococal pneumonia for e.g) Together with G. lamblia
gastroenteritis, failure to thrive and low Serum Imunoglobulins.
Flow cytometry of pts peripheral blood would show def of cell
bearing *CD19* marker
[X-linedAgammaglobulinemia, Bcells]

Pulmonary & Critical Care

Infant with recurrent otitis media and bronchiolitis. He has oral


candiasis. He has a Hx of chronic Diarrhea. Serum protein
electrophoresis shows very low gamma globulin level. X-ray shows
absent thymic shadow. Most likley Dx is *SCID*
[Recurrent viral infections, Oral thrush, Persistent Diarrhea.
Absent thymic shadow is due to severe T cell def.
Hypogammaglobulinema is due to low B cells. Both low humoral
and cell med immunity]

Immunology

Pulmonary & Critical Care

*Anti IgE Antibodies* are effective add-on-therapy to severe


allergic asthma patients that are already on glucucorticoids and
beta-agonists.ExamplesincludeOmalizumab.

Immunology

Renal, Urinary Systems &


Electrolytes

Hyperacute renal transplant recjection is an *Antibody-mediated


hypersensitivity*
(preformed Ab's against graft)

Renal, Urinary Systems &


Electrolytes

Female Pt with glomerulinephritis, photosensitive skin rash and


arthralgias together witha positive trepnemal RPR but with -ve
T.pallidum enzyme ummunoassay and also prolonged aPTT
probably has SLE with Antiphospholiid antibody syndrome and is
therefor at risk of *Recurrent Miscarriages*

Immunology

Immunology

Immunology

Immunology

Immunology

Immunology

747

Immunology

Renal, Urinary Systems &


Electrolytes

Pt who received emergency blood transfusion who quickly


develops dyspnea, chills, chest/back pain, and hemoglobinurea
probably has acute hemolytic transfusion reaction. This is a type 2
hypersensity and therefore can be due to *Complement mediated
cell lysis*

750

Immunology

Renal, Urinary Systems &


Electrolytes

When it comes to handling parasites, eosinophile do it via the


*Antigen-Dependent-Cell-Mediated Cytotoxicity (ADCC)*

8530

Immunology

Renal, Urinary Systems &


Electrolytes

Pt with renal cell carcinoma and given high dose IL-2. There is
reduction in tumor burden. Mechanism? -> *Enhanced Activity of
NK cells*

11786

Immunology

Renal, Urinary Systems &


Electrolytes

An immuno suppressant that inhibits lymphocyte proliferation by


blocking interleukin-2-signal transduction is similar to *Sirolimus*

298

Immunology

Rheumatology/Orthopedics
& Sports

Pts with Lymphocytes with mutated Fas gene product (i.e Fas
receptor) would have an impaired *Activation-Induced T
Lymhocyte Death*
Fas ligand that binds to Fas receptor on t cells activates Fas assoc
death domian (FADD) which activates caspases leading to
Apoptosis.

Immunology

2 year old with recurrent skin and mucosal infections. Skin


infection drainage grows Staph aureus with no purulence. Lab test
Rheumatology/Orthopedics
reveals absent CD18 antigens on leukocytes. Pt is at greatest risk
& Sports
for *Persistent Leukocytosis*
(Leukocyte Adhesion Deficiency type 1)

Immunology

Pt who is given infliximab for Crohn Disease. Ten days later he


develops a pruritic skin rash. Skin biopsy shows scattered areas of
Rheumatology/Orthopedics Fibrinoid necrosis and neutrohil infiltration involving his small
vessels. The finding most likely to accompany this condition is
& Sports
*Decreased Serum C3 level*
(Serum Sickness, Type 3 (immune-complex) hypersensitivity)

754

Immunology

Pt with sign of RA. Pt serum most likely has IgM antibodies that
Rheumatology/Orthopedics
react with *Fc portion of Human IgG*
& Sports
(Rheumatoid Factor)

759

Immunology

Rheumatology/Orthopedics
IL-4 & 5 are respnsible for antibody class switching.
& Sports

538

741

1388

Microbiology

Allergy & Immunology

Immigrant 6 year old who presents with dyspnea. He has Fever.


Exam shows neck swelling, palatal paralysis and a gray
pharyngeal exudate. His vaccination history is unknown. The
intervention that will imrove his symptons is *Passive Immunization*
(C.Diptheria infection, exotoxin)

1389

Microbiology

Allergy & Immunology

Non pathogenic C. Diptheria become pathogenic thru *Phage


conversionpermitingexotoxinproduction*

645

Microbiology

Cardiovascular System

Coagulase-negative streptococci such as staph epi are methicilin


reistant and should be treated with *Vancomysin*

679

Microbiology

Cardiovascular System

Staph epi is differentiated from staph aureus by the coagulase


test. Staph epi is coagulase negative while staph aureus is positive.

733

Microbiology

Cardiovascular System

Old pt presents with low-grade fever and fatigue. Exam shows a


diastolic murmur at left sternal border. He has nontender
erythematous macules on his hands and feet. Blood cultures grow
g+ve cocci that are catalase-ve and grow in hypertonic saline and
bile. Pt medical history is likley to inculde *Cytoscopy* within the
past month
[Entercoccal Endocarditis, colonizes genitourinary tract]
[Viridans are bile insoluble and dont grow on hypertonic saline]

1001

Microbiology

Cardiovascular System

Pt with Strep Gallolytics (S.Bovis) infection. Additional workup


should focus on *Colonic Neoplasia*

Cardiovascular System

Viridans Steptococci are normal inhabitants if the oral cavity and


are a cause of transient bactremia after dental procedures in
healthy and diseased individuals. In pts with pre-existing valvular
lesions, viridans streptococci can adhere to *Fibrin-Platelet
Aggregates* and establish infection that leads to endocarditis.

Cardiovascular System

Emigrant child with unknown history of vaccination who presents


with fever, throat pain, an dyspnea. There is coalescing gray
pharyngeal exudate and cervical adenopathy. He later dies of
Myocarditis and HF. Pt most likely has Diptheria and could have
been prevented by DTP vaccine which has diptheria toxoid which
provides *IgG against circulating proteins*

1003

1092

Microbiology

Microbiology

8282

680

1313

Microbiology

Microbiology

Microbiology

Cardiovascular System

The action that most likely prevents intravascular catheter-related


infections is *Alcohol-based hand scrub prior to beginning the
procedure*

Dermatology

Infant with diffuse skin erythema, and epidemris comes off easily
with gentle pressure. This is caused by *Exotoxin-mediated skin
damage*
(SSSS by staph exofoliatin exotoxin)

Dermatology

Pt presents with skin changes. Blotches of skin on her arms


appear to be of different color. She also has a tingling sensation in
her hands. Exam shows patchy area of skin anesthesia and
hypopigmentation on her upper extremities. Nerve biopsy shows
organisms invading Schwann cells. Hiv test is negative. Most likley
cause is *Myobacterium Leprae*
[Tubercolid Leprosy, TH1 response. mild form compared to
Lepromatousleprosy(TH20]

1316

Microbiology

Dermatology

When pt's serum is added to a mixure of cardiolipin, lecithin, and


cholestrol and extensive flocculation is observed, the next step is to
evaluate for *Spirochetal Antibodies*. This is a nonspecific
treponemal serologic test known as the rapid plasma reagin test.

1553

Microbiology

Dermatology

a unilateral vesicular rash involving a single dermatome is


Shingles. The pt would siffer from *Persistent local pain* in the
next 6 months

Dermatology

Child of immigrants with a rash that started in face and spread


rapidly down the body. Exam shows a generalized, fine pinkish,
maculopapular rash and tender lymphadenopathy bilateral behind
the ears. Most likely cause of this disease is a *Togavirus*
[Rubella is a togavirus]
[Rubeola by paramyxovirus which causes measles has no post
auricular lumphadenopathy usually assoc with it]

Dermatology

Pt with animal exposure and scratch marks together with tender


regional LYMPHADENOPATHY likely has Cat-Scratch Disease
caused by Bartonella Henselae, a g-ve organism that also causes
*Bacillary Angiomatosis* in immunocompromised pts

Dermatology

Burn patients are susceptibe to infection with pseudomonas


aeruginosa which a gram -ve rod that is oxidase positive and
non-lactos fermenting. Tx can be with 4th generation
cephalosporin *CeFePiMe*

Ear, Nose & Throat (ENT)

ELderely diabetic with severe pain and discharge from ear.


Touching pinea causes extreme pain. Otoscopy shows granulation
tissue in left ear canal with scant amount of discharge. Tymapnic
membrane is clear, and no middle ear effusion. Cultures grow a
g-ve rod. Characteristic best describing infecting organism is
*Motile and Oxidase +ve*
[PsudemonasOtitisExterna]

Microbiology

FemaleReproductive
System & Breast

Pt presents to fertility clinic. Attempting to concieve for past year,


no success. She used OCP for 15 years. 7 years ago she got
ceftriaxone for fever, abdominal pain, and vaginal discharge. Major
contributing factor to her inability to conceive is *Insufficient
antibiotic use*
[PID was treated only for gonorhea, azithro was not used for
coverage of chlamidya, this led to subclinical continous infection
that led to scaring of fallopian tubes and subsequent infertility]

Microbiology

FemaleReproductive
System & Breast

Pt with gray white fishy vaginal discharge with no inflammation that


shows clue cells is characteristic of bacteril vaginosis caused by
Gardnerella vaginitis which an *Anaerobic gram variable organism*

1669

1898

8858

8342

1027

1929

Microbiology

Microbiology

Microbiology

Microbiology

FemaleReproductive
System & Breast

Pt with abdominal pain, bloody vaginal discharge, orthostatic HTN


and a positive preganancy test. Prior infection with
*N.Gonorrhoeae* is likely responsible for her current condition.
[Pt has a ruptured ectopic preganncy. Primary resik factor for
Ectopic preg is tubal scaring and prior infection with Chlamidya
and N. gonorrhea are major predisposing factors.]

Microbiology

FemaleReproductive
System & Breast

Septic Abortiontypically prsents with fever, abodominal pain,


uterine tenderness, and/or foul-semlling discharge after
preganancy termination. Common offending pathogens inculude
*Staph Aureus* and E. coil due to seeding of the uterine cavity
duringinstrumentation.

Microbiology

The prsence of a fluid-filled cavity in liver in conjuction with fever,


chills and RUQ pain. Microorganism/route combinations that is
Gastrointestinal & Nutrition
most likely cause is *Staph Aureus via Hematogenous route*
[Hepatic Abscess caused by staph]

278

Microbiology

Dysphagia for liquids and difficulty belching in association with a


diated esophagus and absent peristalsis in the smooth portion is
Gastrointestinal & Nutrition
diagnostic of Achalasia. If pt is from south america or central
america suspect *T. Cruzi*

976

Microbiology

V Cholera is oxidase positive, g-ve, commam shaped rod that can


Gastrointestinal & Nutrition grow on alkaline media. Stool microscopy reveals *Mucous and
some sloughed epithelial cells* with No fecal leukocytes or RBC's.

1100

Microbiology

Gastrointestinal & Nutrition

1136

Microbiology

Depending on age and condition of host and the species of


Shigella, as few as 10-500 cells can cause infection. *Shigella
Gastrointestinal & Nutrition
flexneru*
[others include Entamoeba Histolytica, Giardia and C. jejuni]

1397

Microbiology

Pt takes Clindamycin and develops C.diff Colitis. The causative


Gastrointestinal & Nutrition agent damages the *Cytoskeleton Integrity* of intestinal mucosal
cells.

1398

Microbiology

In the absence of normal intestinal microbial flora, C.difficile can


Gastrointestinal & Nutrition overgrow and produce toxins. Therefore, persons with a
*Preserved Intestinal MicroBiome* may not develop an infection.

Microbiology

Enteric pathogen causing diarhea that can be transmitted from


domestic animals to humans is *Campylobacter*
extra note:
Gastrointestinal & Nutrition
-(Curved G-ve rod that moves in corkscrw fashion)
-MCC of acute gastroenteritis in kids and adults
-Assoc with GBS

Microbiology

Pt ingests solution containing 13C labeled urea. He then is aksed


to blow into a tube and labeled carbon is detected in his breath
Gastrointestinal & Nutrition samples. This is most likely part of the evaluation of *Duodenal
Ulcer*
(H.pylori is urease positive)

Microbiology

Culture of a "periappendiceal fluid collection" in the abdomen


could reveal the anaerobic *Bacteroides Fragilis* which express
Gastrointestinal & Nutrition
surface polysaccharides that favor abscess formation. Others
could include E.coli, enterococci, & streptococci.

Microbiology

The finding most suggestive of Strongloides Stercoralis infection is


Gastrointestinal & Nutrition *Rhabditiform Larvae in Stool*
[Tx with Ivermectin]

1932

11961

62

1422

1602

7573

8873

Microbiology

The toxin of EHEC *Inactivates ribosomal subunits*


[Just like shigella toxin]

10401

1592

732

1097

Microbiology

Microbiology

Microbiology

Microbiology

C. Difficile Infection is treated with Metronidazole, Vanco or


*Fidaxomicin* The first two are first line treatments but
Gastrointestinal & Nutrition
*Fidaxomicin* is used in recurrent CDI and is bacteriocidal with
minimalsystemicabsorption.
GeneralPrinciples

Pt with CMV postive antibody probably had a *Mononucleosis-like


illness* in the past due to CMV infection, symptoms include fever,
malaisse, myalgia, atypical lymphocytosis, and elevated
transaminases.

Hematology & Oncology

PT dies from Strep Pneumo infection. He has history of motor


vehicle accident that required laparatomy. The mechanism that
contributed to the severeity of this pt's infection is *Systemic
Bacterial Clearance*
[Pt most likely had part his spleen removed after accident and
became suscptible to encapsulated bacteria due to inability to
clear them]

Hematology & Oncology

Pt with somnolence, lethargy, and oliguria with bloody diarrhea. He


has high urea, BUN and creatinine. Blood smear reveals
fragmented erythrocytes, Pt has HUS which is related to the
consumption of *Undercooked Beef*

1374

Microbiology

Hematology & Oncology

Mother had still bith at 18 weeks. Autopsy shows pleural effusion,


pulmonary hypoplasia, and ascites. Infection with *Non-enveloped,
single stranded DNA virus* is most likely etiology.
[Parvovirus causing fetal hydrops]

1722

Microbiology

Hematology & Oncology

pt being Tx for HIV. Viral strains show significant increase in POL


gene. This is related to *Antiretroviral chemotherapy*
(Resistance to drugs)

45

Microbiology

Infectious Diseases

A population that is universally vaccinated with recombinent


HBsAg. The disease that would almost entirely disappear is *Delta
Agent Infection*
{Hep D causes infection only when encapsulated with HBsAg, it is
a replication-defective RNA virus]

48

Microbiology

Infectious Diseases

Hepatitis that causes high incidence of fulminant hepatitis in


pregnant women with high mortality (20%) is hep E which is an
*unenveloped RNA virus* spread thru fecal oral route.

Infectious Diseases

Mucormycosis is an opportunistic infection caused by Rhizopus,


Mucor, and Absidia. Clinical picture is paranasal involvememnt in
diabetic or immunocompromised patient. Fungi form broad
nonseptate hyphae at 90 degree angles!!

Infectious Diseases

Pt with signs of diabetic ketoacidosis together with Black Necrotic


Escha on nasal cavity examination, facial pain, & headache
probably has "Mucormycosis" and Diagnosis can be made with
*Mucosal Biopsy* to see borad-ribbon-like nonseptate hyphae with
right-angle branching.

Infectious Diseases

Oral thrush (can be scaped off) in an otherwise healthy pt is


suggestive of immunosuppression and HIV should be suspected.
Therefore, Medical history can be focused on *Sexual Practices*

Infectious Diseases

Pt has fever and joint pain. He has abnormal lynphocytes on blood


smear. Condition is caused by an enveloped virus containing
partially-double stranded circular DNA. An enzyme packed in its
virion has RNA-dependent DNA-polymerase activity. Pt is most
likely infected with *Hep B virus*

106

107

111

376

Microbiology

Microbiology

Microbiology

Microbiology

532

Microbiology

Infectious Diseases

Pt presents due to fever, night sweats, weight loss and productive


cough. He says his sputum is greenish and foul smelling. Chest
X-ray shows a cavitary lesion in the middle lobe of right lung with
air-fluid levels. Most likley cause of this cavitary lesion is
*Aspiration of oropharyngeal contents*
[Lung Abscess]

678

Microbiology

Infectious Diseases

Youn woman with UTI. Sexually active. Culture shows catalase


+ve, g+ve cocci. Organism responsible is *Novobiocin resistant*
[Staph Saprophyticus UTI]

722

Microbiology

Infectious Diseases

Strep pyogenes (Group A)(G+ve cocci)(Beta hemolytic) (Catalse


-ve) (can cuse PSGN, Acute rehumatic fever, scarlet fever,
pharyngitis, & impetigo) is *Pyrrolidony Arylamidase Positive (PYR
+)* and Also Bacitracin sensitive.

728

Microbiology

Infectious Diseases

*Intravascular devices* contriubute to increase in staph bactremia


thru the nation

Infectious Diseases

Signs of encephalities (fever, headache, aphasia, mental


alteration) with temporal lobe lesions indicate *HSV
ENCEPHALITIES*

Infectious Diseases

Neoborn presents with inability to open mouth and hands are


clenched all day. P.E shows increased muscle tone, arching of the
back, and dorsiflexed feet.
This could ve been prevented with *Vaccination of pregnant
woman*
(Neonatal tetanus)

Infectious Diseases

Ulcer with central black eschar surrounded by edema suggest


Bacillus Anthracis. Helping in making a diagnosis would be
*Occupation*
[exposure to animal or animal products, if no risk of occupational
exposure then there is potential of bioterrorism]

907

968

971

Microbiology

Microbiology

Microbiology

1007

Microbiology

Infectious Diseases

Pt with asymmetric polyarthritis (knee, elbow, wrist)with synovial


fluid analysis showing neutrophilic predominanc and intracellular
organisms most likey has "Neusseria Gonorrhoeae". *Condom use
could ve prevented it*

1026

Microbiology

Infectious Diseases

Tx of Neisseria Gonorrhea does not appear to provide lasting


protective immunity due to *High variability of microbial antigenic
structure* and hence recurrent infections occur.

Infectious Diseases

6 year old of recently immigrant family comes due to sore throat


and fever. Exam shows mild tonsilar erythema with exudates.
Microscopy shows clumped, gram +ve bacteria with polar granules
that stain deeply with aniline dyes. The pathogenicity of the
organism likely causing this condition is *Impairment of protein
Synthesis*
(Diptheia toxin, ADP-ribosylation of EF-2)

Infectious Diseases

6 yr old with fever and sore throat. Non immunized. P.E shows a
grey pharyngeal exudate and gram stains shows g+ve organisms.
The culture type that facilitate teh growth of this organism is
*Cystein-tellurite agar*
[C.DIPTHERIA]
[Bordet-Gengou medium is for pertusis, thayer martin for
gonorrhea, mcConkey is for enterics]

1093

1095

Microbiology

Microbiology

1137

Microbiology

Infectious Diseases

AfricAmer womann with fev, malaise, and intense pain over right
thigh. She has long history of frequent presentation to hospital with
painful crises that respond to supplemental O2 & IV narcotics. The
new episode is diff cuz is Febrile with exquisite thigh pain &
abnormal MRI finding. Blood grows nonlactose-ferment, oxidase
-ve, motile organism. Virulence mechanism is *Resistance to
Opsonization*
[Salmonella osteomyelitis in Sickle cell pt, encapsulated, functional
asplenia]

1139

Microbiology

Infectious Diseases

E.coli which shows green metalic sheen on EMB agar, hemolysis


on blood agar, and lactos fermentation (pink) on McKonkey agar
causes UTI's thru use of *Fimbrial antigen* which allows adhesion
toUrothelium

1309

Microbiology

Infectious Diseases

Isoniazid inhibits mycolic acid synthesis in the treatment of TB


thus making Tb cells less resistent to decoloration by acid-alcohol.

Infectious Diseases

Phospholipid composition of viral particle surface is highly similar


to that of cell nucelar membrane. This is most likely
*Cytomegalovirus*
(Herpes viruses bud thru and acquire the lipid bilayer envelope
from the host cell nuclear membrane)

1408

Microbiology

1498

Microbiology

Infectious Diseases

Symptoms of acute dysurea and heamturia in the setting of a day


care (mostly boys) is Hemorrhagic Cystis caused by the
*ADENOVIRUS* which its genomic fragments can be found in
urine.

1550

Microbiology

Infectious Diseases

Recurrence of genital hepres can be reduced by *Continous daily


valacyclovir*

Infectious Diseases

A virus that gives B lymphocytes the ability to proliferate


indefinitely and retain their bility to secrete immunoglobins is
diagnosed "in vivo" using *Heterophile Antibodies"
(EBV virus)

Infectious Diseases

An HIV protein that is Glycosylated then proetolytically cleaved in 2


smaller proteins. This protein is gp160 which is cleaved into gp120
and gp41 which help in *Virion attachment to the Target Cells*

1594

1672

Microbiology

Microbiology

1723

Microbiology

Infectious Diseases

Pt with HIV who presents due to several months of pain and itching
in perirectal area. He also has intermitten rectal bleeding. Exam
shows a visible ulcerative mass. Most likely responsible pathogen
is*HumanPapillomavirus*
[Anal squamous cell cacinoma]
[CMV causes retinits and colitis, not a mass]

1949

Microbiology

Infectious Diseases

N. Gonorrhea urethritis is treated treated with *Ceftriaxone (3rd


gen Ceph) and Azithromycin (Macrolide) *

8593

Microbiology

Infectious Diseases

Isopropanol has antiseptic properties through *Disruption of cell


membranes*

10168

Microbiology

Infectious Diseases

Scabies causes an intesnse pruritic (ITCHY) rash at the wrsit, later


surface of fingers and finger webs. Pts excoriate (ITCH) Caused
by Sarcoptes Scabiei. Diagnose under microscpe for egg and
mite itself.

11459

Microbiology

Infectious Diseases

Fever and Diarhea after Antibiotic adminstration suggest C. Diff


infection and precaution of wearing *Nonsterile gloves and Gown*
should done.

11524

11540

11547

11604

11670

11766

11812

11822

11859

113

Microbiology

Microbiology

Microbiology

Microbiology

Microbiology

Microbiology

Microbiology

Microbiology

Microbiology

Microbiology

Infectious Diseases

Pt with fever and malaise. He had fever and chills which later
became fatigue. He lives in easter Massachusetts. There are lung
crackles and palpable splenomegaly. Peripheral blood smear
shows Intraerythrocytic pleomorphic forms (Maltese Cross). Most
likely source of infection is *Ixodes Tick*
(Babesiosis)

Infectious Diseases

Pt who presents with febrile illness, bilateral infiltrates on x-ray,


abnormal liver funcion tests, anemia, and (most importantly)
*CROSS-SHAPED IntraErythrocytic Inclusions* has Babesiiosis
by the Babesia microto which is a TICK Borne infection by the
IXodes Tick which also transmits the organism *BORRELIA
BURGDORFERI* that causes Lyme disease.

Infectious Diseases

Pt bitten by his dog. Wound is warm, red and swollen after 24hrs.
Wound culture grows g-ve coccobacilli and culture has mouse-like
odor. Organism? => *Pasturella Multicoda*

Infectious Diseases

20 yr old woman comes due to vaginal pain with sex annd dysuria.
She has a new boyfriend. Exam shows multiple, painful, shallow
ulcers with an erythematous base on the left labia. There is no
vaginal discharge. And no cervical motion tenderness. She has
bilateral inguinal lymphadenopathy. Best diagnostic test for pts
condition is *PCR fro viral DNA*
[Genital Herpes, Tzanck smear is also possible][Syphilus is
painless chancre]

Infectious Diseases

Pt presents with tonic-clonic seizure. He grew in rural Guatemala


and immigrated to US 3 years ago. All other test are negative. MRI
of brain reveals 2.5-centimetre cyst within the left sylvian fissure
that has minimal enhancement and no associated edema. Most
likely means of acquisition of infection is *Exposure to infected
stool*
[Neurocysticercosis by Taenia solium]

Infectious Diseases

Old pt with fever and altered mental status whos urine culture grow
g-ve rods that are lactos fermenting and indole-postive probably
has *E. Coli*
(UTI) (Indole positivity distinguishes it from Enterobacter cloacea)

Infectious Diseases

Pt with UTI after recent cytoscopy in which urine culture shows


g+ve cocci in chains most likey has Enteroccocus which shows
*Gamma hemolysis on blood agar*

Infectious Diseases

Infant comes due to generalized seizure. She fever for past 12


hrs. Pt is discharged with no medication. Three days later, she has
no fever but develops a maculopapular rash on her trunk. She is
most likely infected with *Human Herpesvirus 6*
[Roseola infantum, the seizure can happen with any febrile illness]

Infectious Diseases

Pt presents with shortness of breath, myalgias and retroorbital


headaches. Pt was cleaning Animal waste at a farm. He is febrile,
bronchial breath sounds are hear in right lower lung. Chest xray
shows right lower and middle lobe consolidation. Lab shows
thrombocytopenia and elevated liver enzymes. HIV test is negative.
Most likley cause is *Coxiella Burnetii*
[Q fever, has headaches and pneumonia with thrombocytopenia
andelevatedthrombocytopenia]

Nervous System

HIV pt infected with organism stained with india ink in CSF


showing spherical yeast with thick capsules (C.neoformans). Most
likely primary foucs is *Lungs*
[found in pigeon droppings and soil, enters thru resp route]

116

118

735

737

Microbiology

Microbiology

Microbiology

Microbiology

Nervous System

Pts with headache and fever. CSF has low glucose and high
protein. Microscopy shows transparent capsules on india ink is
suggestive of Cryptococcal meningeoencephalitis. Tx with
Amphoterain B. `

Nervous System

Pt with Hx of viral encephalitis and pneumocystis pneumonia most


likey has HIV and if they present with signs of meningitis with latex
agglutination positive for soluble polysaccharide antigen probably
has Cryptococcal meningitis and you should expect *Budding
yeast* on light microscopy.

Nervous System

Adult pt with signs of meningitis. CSF analysis shows elevated


opening pressure, increased neutrophils (10%), decreased
glucose and elevated protein. Pt most likely has Strep Pneumo
Meningitis and gram stain of csf would reveal *Lancet-Shaped,
Gram positive cocci in pairs*

Nervous System

Pt with CSF sample with bean-shaped g-ve cocci in pairs probably


has Neisseria Meningitidis which reaches the meninges via
*Pharynx--> blood---> choroid plexus-->Meninges*
This means that neisseria meningitidis is transmitted via respiratory
droplets.

738

Microbiology

Nervous System

Autopsy of 14 yr old male died of septic shock. Shows extensive


hyperemia and infarcts of internal organs. Purpuric cutaneous
lesions and hemorrhagic destruction of both adrenals are also
present. The organism responsible for death more commonly
causes*Meningitis*
[N. Meningitidis]

1005

Microbiology

Nervous System

Neisseria meningitidis uses pilus roteins to attach to *Nasopharynx


epithelial cells*

Nervous System

Pt with signs of meningitis and blood culture showing g-ve kidney


bean-shaped diplococci, the microbial component causing
morbidity is *Outer membrane LipoOligosaccaride*

Nervous System

3 month old infant with Hydrocephalus, Intracranial Calcifications


and Chorioretinitis has "Congenital Toxoplasmosis" which is
tansmitted transplacentally and the cause is therefore
*In-Utero-Infection*

Nervous System

Infant with meningitis and culture grows gram -ve rods that form
pink colonies on McConkey agar has E.coli neonatal meningitis
and the bacterial virulence factor is *Capsule*
(K1 capsular polysaccharide)

Nervous System

A motile gram +ve rod that has a narrow zone of beta hemolysis,
and can grow well at refrigiration temp is likely Listeria which is an
Inracellular Organism and therefore requires *Cell Mediated
Immunity* to eliminate.

Nervous System

Bacterial product that when injected into muscles with relentless


focal dystonia produces dramatic but temporary relief of symptoms
is C. Botulinum toxin, The bacteria demonstrates *Subterminal
SporeFormation*

Nervous System

Pt with presenting to ER with seizures. On exam he has oral thrush


and lymphadenopathy and MRI shows multiple ring enhancing
lesions (shown) probably has HIV and has acquired
*Toxoplasmosis.* that explain his seizures.

Nervous System

Campylobacter Jejuni can lead to Guillain-Barre Syndrome. GBS


is a demyelinating syndrome of the peripheral nerves
characterized by ascending muscle weakness and paralysis. Pt
has history of self resolving diarhea. C. jejuni is a common cause
of infectious diarrhea.

1006

1038

1140

1391

1401

1573

1601

Microbiology

Microbiology

Microbiology

Microbiology

Microbiology

Microbiology

Microbiology

1853

Microbiology

Nervous System

Young college stduent with headache, fever, altered metal status,


nuchal rigidity, purpuric rash) has Meningococcal meningitis and
could have been prevented with *Capsular Polysacharide*
vaccine.

1906

Microbiology

Nervous System

An elderly person with Confusion and flaccid paralysis and CSF


PCR shows Viral RNA. Most likey it is West Nile Virus which is
transmitted by *An Insect Bite* of the Culex Mosquito.

1966

Microbiology

Nervous System

Child with fever, headaches, vomiting, mild pharyngeal erythema


and neck stiffness. CSF analysis shows normal glucose and mildly
elevated protein. Leukocyte count is 300 with lymphocytic
predominance. Most likely cause is *Entervirus*
(Viral meningitis (aseptic), entervirus include cosackie, polio,
echovirus)

2082

Microbiology

Nervous System

Toxoplasmosis is Tx with *Pyrimethamine and Sulfadiazine*


[If u see ring enhancing lesions in HIV , suspect toxo before
lymphoma]

8324

Microbiology

Nervous System

Agitation, disorienttion, Pharyngospasm, Photophobia, COMA and


Death strongly suggests Rabies Encephalitis which binds to
*ACETYLCHOLINERECEPTORS*(nicotinic)

Nervous System

Blood cultures that grow coagulase negative staph after a


ventriculoperitoneal shunt placement. The most imp virulence
mechanism of bacterium is *Synthesis of an extracullular
polysaccharide matrix*
[Staph Epidermidis releasing a biofilm]

Microbiology

Nervous System

Pt with "fever", "stiff neck", altered mentation, "severe headache


with photophobia" could have Bacterial Meningitis and there *CSF
should be analyzed* to confirm diagnosis. Note: Migrains don't
present with fever!

Microbiology

Pregnancy, Childbirth &


Puerperium

Infant Pt with White pupils (Cataracts), heaing loss, and Machine


like murmur (PDA) probably has congenital Rubella. This could
have been prevented by giving the mother the *Live attenuated*
Rubella virus vaccine.

8533

11862

1464

Microbiology

1575

Microbiology

Pregnancy, Childbirth &


Puerperium

Pregn pt who is a migrant and develops low grade fever and


maculopapular rash that spreads from face and chest to trunk and
extremities over next 48 hrs. P.E shows postauricular
lymphadenopathy. The mother is at immediate risk for
*Polyarthralgia* while the fetus at risk *Sensineuronal Deafnes*.
This pt has German measles (Rubella) and has not been
vaccinated with MMR

117

Microbiology

Pulmonary & Critical Care

An organism's capsule that stains red on Mucicarmine staining is


the capusle of *Cryptococcus Neoformans*

Pulmonary & Critical Care

Pt with flue like symptoms and lung symtoms of crackles and


pulmonary infiltrate who works a capenter and suptum KOH
preparation shows "Broad Based-Bud" most likey has
*Blastomyces Dermatitidis*

120

Microbiology

266

Microbiology

Pulmonary & Critical Care

Pt returning from cave exploation i central USA develop fever,


cough and malaise. Pulmonary infiltrates and hilar adenopathy are
present on x-ray. Lung tissue specimen will show *Ovoid cells
withinMacrophages*
(Histoplasma Capsulatum)

267

Microbiology

Pulmonary & Critical Care

Hiv pt with cough, fever, hepatosplenomegaly (sysetmic symptoms)


and a bone marrow aspirate that shows small ovoid bodues wuthun
a macrophage is caused by *HISTOPLASMA Capsulatum*

269

Microbiology

Pulmonary & Critical Care

Exam of lung tissue that shows spherules oacked with endospores.


Pt history will most likely reveal *Recent travel to Arizona*
[Coccidoides Immitis][Southern and central California, Arizona,
New Mexico, & Western Texas]

665

Microbiology

Pulmonary & Critical Care

Pt presents with recurrent transient pulmonary infiltrates. She has


a history of bronchial asthma. He takes albuterol and inhaled
glucocorticoids. CBC shows Eosinophilia. Chest CT shows
proximal bronchiectsais. This pt has colonization of *Aspergilus
Fumigatus*

730

Microbiology

Pulmonary & Critical Care

Virulence factor of Strep Pneumoo (g+ve diplococci, alpha


hemolytic) is *Polysaccharide Capsule*

731

Microbiology

Pulmonary & Critical Care

G+ve lancet shaped cocci in pairs is Strep Pneumo which is *Bile


Soluble*

Pulmonary & Critical Care

Pt with persistent cough and pulmonary infiltrate. Pt's blood shows


clumping in ice but not in warm water. Organism causing
condition? => *Mycoplasma Pneumonia*
-(ColdAgglutinin)

Pulmonary & Critical Care

Heavy smoker with fever, confusion, headache, watery diarrhea


and mildy productive cough. Sputum gram stain show numerous
neutrophils but no bacteria. Most likely cause is *Legionella
Pneumophila*
[Triad of atypical pneumonia, diarrhea, and hyponatremia][poor
gram stain][long smoking Hx]

Pulmonary & Critical Care

Microogranism causing pneumonia is isolated and demonstrates


slow growth on Buffered Carcoal Yeast Extract that is
supplemented with L-cystein and Fe. It is visualized with a silver
stain. Most likely cause of increased incidence of nosocomial
punemonias in his hospital is *Colonization of the hospital water
sysetm*
(Legionella)

Pulmonary & Critical Care

5 yr old boy has hugh serum level of antibodies against Polyribitol


ribose phosphate(PRP). The antibodies would most likely carry
protectionagainst*Epiglottitis*
[Anti H. Influenza capsule antibodies]

Pulmonary & Critical Care

H. influenza requires a blood agar supplemented with hematic and


NAD+. Pathogenicity is related to *Capsule* Virulence factor
[H.INFLU type B (HiB)]

958

960

961

962

964

Microbiology

Microbiology

Microbiology

Microbiology

Microbiology

999

Microbiology

Pulmonary & Critical Care

A newborn who develops lethargy and respiratory distress. Blood


cultures shows beta-hemolytic gram+ve cocci in chains that are
bacitracin-resistant. The measure that could have prevented this
patients condition is *Intrapartum ampicilin*
[Strep Agalactiae, ie. Group B strep]

1216

Microbiology

Pulmonary & Critical Care

Pt with sign of Tb and the observed bacterial growth is


mycobacteria that grow in parallel chains (Serpentine cords). This
growth correlates with bacterial *Virulence*

Pulmonary & Critical Care

If viral paricles lose their infectivity once exposed to ether. We can


conclude that the are *Enveloped*
[Ether and other organic solvents can inactivate the enveloped
virus]

Pulmonary & Critical Care

Pts olde than 65 are particularly prone to developing secondary


bacterial pneumonia after influenza infection. In order, the
ppathogens often most responsible for 2ndry bacterial pneumonia
are Strep Pneumo, *Staph Aureus*, and H. Influenza.

1377

1666

Microbiology

Microbiology

Pulmonary & Critical Care

Child with upper-respiratory tract symptoms "followed" by brassy


(barking) cough and difficulty breathing probbaly has
parainfluenza virus Croup which is a *Paramyxovirus*

Pulmonary & Critical Care

Mycoplasma hominis is a genus that includes Ureaplasma


urealyticum and those have no cell walls. They are therefore
resistent to cell wall synthesis inhibitors. We tend to use
anti-ribosomal agents (macrolides, tetracyclies)

Pulmonary & Critical Care

Pt with persistent coughm low-grade fever and malaise. Chest xray


shows pulmonary infiltrates more severe than would be expected
based on clinical status. Causative agent required cholestrol
enriched medium to grow. This is walking pneumonia caused by
*Mycoplasma Pneumonia*

Microbiology

Pulmonary & Critical Care

*Klebsiella Pneumoniae* is a g -ve rod that grows pink-colored


(lactose fermenting) mucoid colonies on MacConkey agar. It is
encapsulated and casues community acquired pnemonia in
Alcholicpateints.

646

Microbiology

*Staph Aureus* is the most commin cause of Acute Hematogenous


Rheumatology/Orthopedics osteomeylitis in children (10 year old for eg) characterized by pain
over long bones (tibia, femur)with high fever and chills. Possible
& Sports
soft tissue swelling. Vague symptoms.

845

Microbiology

Rheumatology/Orthopedics rash with slapped cheek appearance is of Erythema infectiosum


& Sports
caused by parvo virus B19, disease is also called Fifth disease.

Microbiology

Pt who has recently been to a resort presents with ithcy rash.


Exam shows diffuse, pruritic, papuloppustular rash on trunk and
Rheumatology/Orthopedics extremities. Analysis of fluid shows oxidase +ve grame -ve rods
that prodcuces a pigment on culture medium. Most likely source of
& Sports
this infection is *Pool water*
(Psuedomonas hot tub folliculitis)

1101

Microbiology

Pt present with sore on his right hand. He is in Wool business.


Was recently in Asia. P.E shows an ulcer with black eschar and
siginificant surrounding edema. The toxin causing the edema
Rheumatology/Orthopedics
around the ulcer has a MOA similar to a toxin produced by
& Sports
*Bordetella Pertussis*
(Bacillus Anthracis, anthrax exotoxin edema factor similar to
adenylate cyclase toxin of bordetella pertusis)

1394

Microbiology

Crepitus on physical and radiographic visualization of gas in


Rheumatology/Orthopedics
tissues esuggests Gas gangrene by C. Perfringes which also
& Sports
causes Transient Watery Diarrhea and Abdominal Discomfort.

11868

Microbiology

Pt who acquire staph infection thru hemodialysis catheters and


Rheumatology/Orthopedics
present with backpain could have developed osteomyelitis which
& Sports
can be evaluated using *MRI of the spine*

1667

1677

1679

9989

974

458

459

Microbiology

Microbiology

Microbiology

Pathology

Pathology

Allergy & Immunology

Skin biopsy from thigh of a child shows vascular lesions with IgA
and C3 deposition. The most likely clinical presentation is *Skin
rash and abdominal pain*
[Henoch-Schonlein Purpura]

Allergy & Immunology

Pt is hospitalized with recent onset oliguria and a high serum


creatinine level. He has been seen in clinic several times for an
untranasal ulcer that has failed to heal. The pt's condition is most
likely assoc with antibodies against *Neutrophils*
[Wegner's Granulamatosis with polyangiitis, Cytoplasmic staining
Antinuetrohil cytoplasm antibodies (c-ANCA) is pathognomonic]

39

Pathology

Cardiovascular System

Pt with chest pt shows near-toal-occlusion of LAD artery. The


absence of myocardial necrosis and scarring despite vessel
occlusion in this pt is explained by the *Slow Growth Rate* of the
occluding plaque.
(arterial collaterals have developed around point of occlusion)

41

Pathology

Cardiovascular System

Light Microscopic changes of ischemic myocyte after 12 days is


*Granulationtissuewithneovascularization*

Cardiovascular System

Pt with dyspnea and chronic exertional angina is evaluated for


coronary revascularization. His Echho shows Hypokinesia of the
anterior wall of the left ventricle and a left ventricular ejection
fraction (LVEF) of 35%. The pt undergoes coronary artery bypass
grafting. Repeat eccho 10 days later shows that hypokinesia is no
longer evident and LVEF increased to 50%. The best explanation
for the changes in cardiac contractility is *Hibernating
Myocardium*
[Due to chronic ischemia

Cardiovascular System

MI in the setting of normal coronary arteries. Mitral valve


thickening with vegetations is noted. Pt cardiac condition is most
likely associated with *SLE*
(Libman-sacks endocarditis (verucous endocarditis) occurs in 25&
of sle pts. SlE may cause acute coronary syndrome at young age
even with normal coronary arteries)

43

73

Pathology

Pathology

74

Pathology

Cardiovascular System

Pt comes in with fatigue and shortness of breat. Recently he


noticed bilateral leg swelling and abdominal distention. Pt dies
despite Tx. Autopsy shows significant endocardial thickening with
dense fibrous deposits around the tricuspid and pulmonary valves
as well as moderate pulmonary valve stenosis. The left sided
cardiac chambers and valves are normal. Measuring levels of
*Urinary 5-hydroxyindoleacetic acid* would ve helped in
diagnosing pt
[Carcinoid Sydnrome]

82

Pathology

Cardiovascular System

MCC of sudden cardiac deaths in young persons is *Hypertrophic


cardiomyopathy*

Cardiovascular System

Presentation of "Sudden Cardiac Death" in young pt with family


history of SCD and autopsy finding of septal hypertrophy suggest
Hypertrophic CardioMyopathy which is Autosomal Dominant in
whcih there are mutations in sarcomere genes. These include
*Beta-Myosin Heavy Chain* and Myosin-binding protein C.

83

Pathology

84

Pathology

Cardiovascular System

Young pt with an episode of syncope that was not provoked by any


activity. No significant past medical history and no medications.
ECG shows QT-interval prolongation. Assuming this is an inherited
condition, the relevant mutations likely affects *Membrane
Potassiumchannelproteins*
[sudden cardiac arrhythmia, QT interval reflects cardiac myocyte
action potential duration which is determined in part by K+ current]

91

Pathology

Cardiovascular System

6 year old pt with Long QT interval and with family histo of sudden
death probably has congenital long QT syndrome and can have an
associated*Neurosensorydeafness*

94

Pathology

Cardiovascular System

Localized amyloid in the atria of heart is amyloid derived from


Naturiretic peptide.

Cardiovascular System

Acute-onset, mid-chest pleuritic pain that decreases on sitting up


and leaning forward is characteristic of acute pericarditis.
Fibrinous or serofibrinous pericarditis is the most common form.
Pericardial *Friction Rub* is the most striking physical finding.

97

Pathology

98

Pathology

Cardiovascular System

Pt died. Autopsy is done. Gross inspection of heart shows shows


dense thick fibrous tissue in the pericardial space between
bisceral and paretal pericardium. The most likely sign that would ve
been detected during physical exam is *Kussmaul Sign*
[Constrictive Pericarditis]

176

Pathology

Cardiovascular System

*Mitochondrial Vacuolization* indicates irreversible cell injury.

181

Pathology

Cardiovascular System

Pt wih increased thickness of left ventricular wall and decreased


left ventricular cavity size have concentric cardiac hypertrophy.
This is associated with *Long standing HTN*

185

Pathology

Cardiovascular System

Pt with lungs that reveal macrophages containing golden


cytoplasmic granules that turn dark blue with Prussian blue
staining. Prussian blue detects intracellular Fe. This is consistent
with hemosiderin laden macrophages (heart failure cells). This
presenc indiacates chronic elevation of hydrostatic pressure most
commonly as a result of *Left Ventricular Dysfuction* (i.e left-sided
heart failure)

188

Pathology

Cardiovascular System

ASD is assocated with *Down Syndrome*

Cardiovascular System

Pt is fatigued. P.E shows lesions involving nail beds. Further


evaluation would reveal additional abnormality during *Cardiac
Auscultation*
[Infective endocarditis reveals a mitral regurg murmur]

Cardiovascular System

Autopsy finding of platelet-rich thrombi attached to mitral valve


leaflet. Most likely associated condition is *Advanced Malignancy*
[nonbacterial thrombotic endocarditis, associated with advanced
malignancy, especially mucinous adenocarcinoma]

Cardiovascular System

42 year old. Pt dies from stroke.SHe had history of diastolic


murmur. Autopsy of left atrium shows diffuse fibrous thickening
and distortion of the mitral valve laflets, commissural fusion at the
leaflet edges and narrowing of the mitral valve orifice. The finding
is most likely the restult of *Rheumatic fever*

228

231

232

Pathology

Pathology

Pathology

241

Pathology

Cardiovascular System

10 yr old boy presents with restlessness and involuntary kerking of


face, arms & legs 3 months after a sore throat. Pt is at greatest
risk fro developing *Valvular Heart Disease*
[Sydenham chorea as part of Acute Rheumatic Fever after Group
A strep infection]

242

Pathology

Cardiovascular System

*Calcific Degenration* of trileaflet aortic valve is the most common


cause of Aortic Stenosis in Developed Nations.

445

Pathology

Cardiovascular System

An athersclerotic plaque is likely t occur at the *ABDOMINAL


AORTA*

Cardiovascular System

Plaque stability is reduced by macrophage release of


*Metalloprotinases* that degrade collagen. likelihood of plaque
rupture (and hence casuing acute coronary syndrome) depends
on plaque stability not size.

447

Pathology

451

Pathology

Cardiovascular System

30 year old asian male presents with exertional calf pain and
painful foot ulcers. He demonstrates hypersensitivity o
intradermally injected tobacco extract. The process responsible for
his condition is *Segmental vasculitis extending into contiguous
veins and nerves*
[Buerger's disease]

452

Pathology

Cardiovascular System

The morphologic changes observed in the arteries of a pt with


Giant cell arteritis are most similar to *Takasu Arteritis*

453

Pathology

Cardiovascular System

Old Pt with severe drug resistant HTN who dies and autopsy shows
shrunken right kidney probably has unilateral renal artey stenosis
due to atheromatous plaque at origin of renal artery. Stenosis
eventually leads to renal atrophy due to *O2 and nutrient
deprivation*

460

Pathology

Cardiovascular System

In Polyarteritis Nodosa. The arteries spared are usually the


*Pulmonary* Arteries.

462

Pathology

Cardiovascular System

Myxomatous degeneration with pooling of proteoglycans in the


media layer of arteries is associated with *Aortic Aneurysm*
[assoc w/ Marfan synd]

466

Pathology

Cardiovascular System

Baby with strawberry-type hemangiomas (bening vascular tumor)


in his buttocks. These *First Increase in size then Regress*

Cardiovascular System

Pt with recurent severe nosebleed and with pink spider-like lesions


on his oral and nasal mucosa, face and arms. This pt probably has
*Osler-Weber-Rendu Syndrome* also called hereditary
hemorrhagictelangiectasia.

469

Pathology

470

Pathology

Cardiovascular System

Female with history of breast cancer treated by radical


mastectomy and radiation years ago. She now presents with
persistent right arm swelling. This pt is at increased risk of
developing*Lymphangiosarcoma*
[Persistent lymphedema predisposes to lymphangiosarcoma, a
rare malignant neoplasm of endothelial lining of lymphatic
channels]`

471

Pathology

Cardiovascular System

A vascular tumor that is associated with Arsenic and


Polyvinylchloride. The tumor is also postive for CD31. This is
*LiverAngiosarcoma*

474

Pathology

Cardiovascular System

Pt with dilated and tortuous superficial veins in her lower legs. Pts
condition is most likely to be complicated by *Skin Ulcerations*
[Varciose Veins][Rarely to they lead to pulmonary embolism since
they are superficial]

751

Pathology

Cardiovascular System

A substance that is secreted by the vascular endothelium and


inhibits platelet aggregation is *Prostacyclin*

782

Pathology

Cardiovascular System

Pt with reduced plasma lipoprotein activity. If condition is untreated


he may develop *Acute Pancreatitis*
(Familial chylomicronemia type1)

809

Pathology

Cardiovascular System

Pt with flank pain, hemturia, elevated lactate dehydrogenase (cell


necrosis) and a wedge-shaped right kidney on CT likely has renal
infarction most commonly due to thromboembolism. Systemic
thromboembolism commonly is due to *Atrial Fibrillation*

939

Pathology

Cardiovascular System

Most common cause of aortic stenosis in the elderly is *Valvular


Calcification*

Cardiovascular System

Pt with midsystolic click followed by short late-systolic murmur at


apex. Murmur disappears with squating. Pt's condition is related to
*Connective Tissue*
[Pt has Mitral valve prolapse with mitral regurgitation]

Cardiovascular System

Pt with chest pain that radiates to left shoulder. Pain increases with
inspiration and partially relieved by sitting up and leaning forward.
She was seen for a facial rash 6 month ago. She is also being
evaluated for proteinurea. Cause of this pt's chest pain is
*Pericardial Inflammation*
(Manifestation of SLE)

Cardiovascular System

Pt with blunt chest and head trauma who has pulsus paradoxus (fall
in systolic BP greater than 10 on inspiration), Jugular venous
distention and tachy cardia. He probably has *CARDIAC
TAMPONADE*

947

1040

1439

Pathology

Pathology

Pathology

1875

Pathology

Cardiovascular System

In the event of an interruption of blood flow secondary to arterial


occlusion of left atrium. The organ that would be least vulnerable to
infarction is the *LIVER*
[Has dual blood supply][The exception is during liver transplant and
there is hepatic artery thrombosis. This becuase during the
transplant the collateral supply is severed]

1882

Pathology

Cardiovascular System

Transient myocardial ischemia causes myocardial hypertrophy is


due to *Inttracellular Ca2+ accumulation*

8296

Pathology

Cardiovascular System

Pt complains of worsening dyspnea. Also low grade fever and


weight loss, also syncopal episodes when lying down. Auscultation
shows low-pitched mid-diastolic rumble at cardiac apex. ECG
shows left atrial enlargement and echo shows large pedunclated
mass attached to the left atrium. Histology of mass will likley show
*Scattered cell within a mucopolysaccharide strome*
[Atrial Myxoma]

8458

Pathology

Cardiovascular System

Most common cause of death a lightening strike is *Cardiac


Arrythmia* and Respiratory failure.

Dermatology

Pt with skin rash. He noticed it while in beach resort. He is works


in hot humid areas. Skin finding is shown (image). Most likely
cause is *Malassezia globoss*
[Pityriasis versicolor]

Dermatology

Pt with small bluish lesion under the nail of her right index finger. It
is extremely tender to touch. If the lesion is a tumor, its cells of
origin are likely to have a function of *Thermoregulation*
[This could be a glomangioma or a melanoma, since pigmentation
is not in answer choice, it must be a glomangioma][A glomangioma
is a tumor of modified smooth muscle cells of a glomus body.
Glomus bodies are involved in thermoregulation]

Dermatology

3 year old presents with recurrent skin rashes. He develops


erythematous itching rash on his cheeks, trunk, and arms abut 5
or 6 times a year. Mother says eruptions seem to be related to
consumption of certain foods. The pt's condition is most likely
associated with *Astham*
[Atopic Dermatitis or Eczema]

Dermatology

In shingles, affected are would have *Multinucleated cells with


Intranuclear inclusions*
[VZV]

Dermatology

Pt comes for routine check up and you notice several


subcutaneous bumps attached to Achilles tendons. Best initial test
is *Blood Cholestrol*
Pt has tendinous xanthomas (yellow nodules composed of "lipid"
laiden histiocytes in the dermis)
-Associatedwith(FamilialHypercholestrolemia)

104

467

876

1042

1108

Pathology

Pathology

Pathology

Pathology

Pathology

1111

Pathology

Dermatology

Pt presents with pruritic skin rash over elbows and knees. He also
has prolonged abdominal discomfort, faltulence and voluminous
greasy stools. The finding most likely to be seen in this pt is
*IncreasedIntestinalintraepitheliallymphocytes*
[Pt has Dematitis Herpetiform which is associated with celiac
disease that has increased intraepithelial lymphocytes]

1113

Pathology

Dermatology

Highest risk of metastasis in a malignant melanoma is *Active


Vertical Growth*

1114

Pathology

Dermatology

Biopsy of Urticaria would show *Dermal Edema*

1117

Pathology

Dermatology

Pt with bilateral skin lesions over his elbows. Biopsy shows very
thing stratum granulosum and prominent parakeratoic startum
corneum with occasional foci of neutrophil accumulation. Most
likely Dx is *Psoriasis*.

1314

Pathology

Dermatology

Pt that was injected with heat killed M. Leprae and developed a


large indurated nodule demostrates *Increased IL-2 & IFN-gamma
in skin lesions*

1937

Pathology

Dermatology

54 yr old woman comes due to multiple firm violaceous nodules on


her right upper arm. She was diagnosed with breast cancer and
treated with radical mastectomy. And had axillary lymph node
disection that shows no metastases. Post-operatively developed
chronic lymphadema involving her right arm. Most likley etiology of
her current skin lesions is *Angiosarcoma*
[Chronic lymphedema is a risk factor for cutaneous
angiosarcoma][lymph node disect is classic predisposing
procedure]

11502

Pathology

Dermatology

*Compound Nevi* are benign proliferation of melanocytes that


involve both the dermis and epidermis. They have uniiform
pigmentation and symmetrical sharp borders.

11852

Pathology

Dermatology

Allergic reaction to Morphine is *IgE- Independent mass cell


Degranulation*

191

Pathology

Endocrine, Diabetes &


Metabolism

Pt with xanthelsama (xanthomas on medial eyelids). Best next step


is *Serum lipids and glucose*

Pathology

Endocrine, Diabetes &


Metabolism

Post delivery woman who presents with signs of


panhypopituitarism with failure of lactation, central hypothyroidism,
and adrenal insufficiency. Most likley represents *Ischemic
necrosis* of pituitray gland (Sheehan Syndrome).

Endocrine, Diabetes &


Metabolism

50 yr old man with sudden, severe headache. He complains of


mild headaches and decreased libido. P.E shows bilateral deficits
involving temporal visual fields and impaired extraoccular eye
movements. Shortly after admittance he becomes hypotensive and
dies. Mostlikely finding in autopsy is *pituitary hemorrhage*
[Pituitart apoplexy]

Endocrine, Diabetes &


Metabolism

Pt with a pianful rash involving groin and perineum, DM and exam


that shows coalescing erythematous lesions with crushing and
scaling and central areas of bronze-colored induration and biopsy
of lesions shows superifical necrosis has a GLUCAGONOMA, He
shouldhave*ElevetaedGlucagonLevels*

220

225

585

Pathology

Pathology

768

Pathology

Endocrine, Diabetes &


Metabolism

Pt with signs hyperthyroid symptoms together with painful thyroid


enlargememt. Thyroid scan reveals decrease in radioactive iodine
uptake. ESR is elevated. Biopsy of thyroid will most likely reveal
*Mixed, cellular infiltration with occasional multinucelated giant
cells*
[Sabacutegranulomatousthyroiditis]

848

Pathology

Endocrine, Diabetes &


Metabolism

Pt with Type 2 Diabetes. Most likely assoc with his condition is


*Pancreatic islet amyloid deposition*

986

Pathology

Endocrine, Diabetes &


Metabolism

Pt with elevated serum gastrin levels. Multi organ disease is


suspected. Pt should be asked for a history of *MEN type 1*
(MEN Type 1 has primary hyperparathyroidism, pituitary tumors,
and pacnreatic tumors (esp "Gastrinomas"))

1659

Pathology

Endocrine, Diabetes &


Metabolism

Medullary thyroid carcinoma would show *Nests of polygonal cells


with Congo-ed positive deposits*
[Amyloid stains with Congo red]

1660

Pathology

Endocrine, Diabetes &


Metabolism

In Medullary Thyroid Cancer, the gene changes responsible is


*Activating mutation of RET proto-oncogene*

1844

333

Pathology

Pathology

Endocrine, Diabetes &


Metabolism

Pt with history of thyroidectomy (Medullary thyroid Cancer), flesh


color nodule on lips and tongue (Mucosal Neuromas), & Marfinoid
Habitus (tall, long fingers etc) probably has *MEN 2B*

FemaleReproductive
System & Breast

Woman comes for infertility evaluation. She complains of


dyspareunia. Menstrual cycles are accompanied by moderate to
sevee lower abdominal pain. Pelvic exam shows a normal-sized,
retroverted uterus. The post vaginal fornix is very tender to
palpitation. Pt's condition most likely involves *Ectopic Endometrial
Tissue*
[Endometriosis][Adhesions interfere with
ovulation=infetolity][imaplantsandadhesionsinvolvinguterosacral
ligament result in retroverted uterus, ligament]

1057

Pathology

FemaleReproductive
System & Breast

Asymptomatic pt's mamogram reveals microcalcifications. Biopsy


shows ducts distended by pleomorphic cells with prominent central
necrosis. Origin of this lesion is the *Breast Duct*
[Ductal Ca in Situ]

1928

Pathology

FemaleReproductive
System & Breast

Pt's P.E reveals a large adnexal mass. Ultrasonography reveals a


large ovarian cyst. She has signs of virlization togther with
clitoromegaly. Most likely Dx is *Sertoli-Leydig tumor*

1992

Pathology

FemaleReproductive
System & Breast

Pt with HIV whose PAP semar shows high grae cervical dysplasia.
The strongest risk factor for cervical dysplasia in this pt is
*Immunosupression*
[Risk factors for cervical cancer]

2056

Pathology

FemaleReproductive
System & Breast

The female reproductive structure that contains simple cuboidal


epithelial cells is *Ovary*

11858

Pathology

FemaleReproductive
System & Breast

Histopathology of High-grade cervical intraepithelial neoplasia


(CIN) would show *Expansion of immature basal cells to the
epithelial surface*

54

Pathology

Gastrointestinal & Nutrition

A cavernous Hemangioma is the MC benign liver tumor. Typically


in adults 30-50 years.

56

Pathology

Pt with chronic hepatitis C, a large hepatic mass and multiple


Gastrointestinal & Nutrition satelite lesions has hepatocellular carcinoma. The marker for
recurrenc is *ALPHA FETOPROTEIN*

57

Pathology

Moldy grains from asia that cause specific G-to-T mutation in gene
Gastrointestinal & Nutrition p53. This is aflatoxin exposure, the mutation of which can increase
risk for developing *Hepatocellular Carcinoma*

71

Pathology

Gastrointestinal & Nutrition

Pathology

Pt with severe right upper quadrant tenderness and laprascopic


surgery that reveals an erythematous, distended gallbladder with
Gastrointestinal & Nutrition patchy necrosis probably has acute calculous cholecystitis which
usuallu results from a *Gallbladder outflow obstruction* due to
gallstone obstruction of cystic duct.

88

Pathology

Pt with a mass obstructing the iliocecal valve with a high cholestrol


content. A radiographic finding conistent with this presentation
Gastrointestinal & Nutrition
would be *Air in the billary tree*
(Gallstone ileus, gallstone penetrated intestine and lodged)

125

Pathology

Pt who is in shock and Hb level drops from 14 to 12. Nasogastric


Gastrointestinal & Nutrition suctioning reveals bright red blood. Pt's bleeding is most likely a
result of *Physiologic strss*

79

Pt with slow and incomplete gallbladder emptying (gallbladder


hypomotility) is at risk of developing a *Billiary Sludge*

Pathology

Pt presents with abdominal discomfort, greasy stool, and weight


loss. He has been treated for joint pain with Ibupropfen. Intestinal
biopsy shows multiple macrophages loaded with PAS-positive
Gastrointestinal & Nutrition
granules in the lamina propria. This pt shud be Tx with *Antibiotics*
[Wipple disease caused by g+ve actinomycete Tropheryma
whippelii]

132

Pathology

The *Glycoprotein* in cell walls of actinomycete Tropheryma


whippeli colors magenta with PAS and is diastase-resistant,
Gastrointestinal & Nutrition
making this stain an excellent choice for evaluating tissue for
whippledisease.

135

Pathology

Gastrointestinal & Nutrition The NF-kB factor pathway stimulates *Cytokine Production*

255

Pathology

Pt with sharp pain and bright red rectal bleeding on defecation


Gastrointestinal & Nutrition suggest an Anal Fissure. Which is at the *Posterior midline Distal
to the Dentate line*

Pathology

65 yr old man with iron def anemia. He has weight loss and
anorexia. He has no change in bower habits. Rectal exam shows
guaiac-positive brown stool. A 3cm mass is found on colonoscopy.
Biopsy shows pleomorphic cells with large, dark nuclei forming
Gastrointestinal & Nutrition
irregular, crowded glands, some of which contain mucus. Studis
show multiple mass lesions in the liver and lungs. Pt's neoplasm
most likely originated from *Ascending colon*
[Right sided colon Cancer]

Pathology

Alcoholic male presents with hematemesis. Endoscopy shows


longitudinal mucosal tears at the gastroesophageal junction. This pt
Gastrointestinal & Nutrition
condition is most likely related to *Intraabdominal pressure*
[Mallory-Weiss syndrome]

284

Pathology

Pt presents with anatcid resistant severe Heart Burn. P.E shows


scattered Telangiectasias on face, several ulcers at tip of fingers,
and small Ca deposits on hands and elbows. Most likely cause of
pt heart burn is *Fibrous Replacement of the muscularis in the
Gastrointestinal & Nutrition loweresophagus*
[CREST syndrome, Calcinossi, Raynaud Phenomenon,
Esophagealdysmotility,Sclerodactly,Telangiectasia]
[Esophageal dysmoti is result of atrophy and "Fibrous
replacement" of muscularis in lower esoph]

290

Pathology

Gastrointestinal & Nutrition

Pathology

Pt with paraital cell hyperplasia (Zollinger-Ellison) causing visible


Gastrointestinal & Nutrition enlargement of gastric folds. The stimuli that caused this probably
*Gastrin*

131

257

281

304

305

Pathology

Erosions are defined as mucosal defects that do not fully extend


thru the *Muscularis Mucosa*

A pt with distal ulcer and high-normal gastrin levels that rise in


response to secretin adminstration are suggestive of
Zollinger-Ellison Syndrome. The is caused by gastrin-secreting
Gastrointestinal & Nutrition
tumors (Gastrinomas) which is a *Neoplasia*
Usually secretin inhibits gastrin production.

326
327

Pathology

Gastrointestinal & Nutrition Celiac disease is diagnosed with *Small intestine Biopsy*

Pathology

Infant with poor weight gain since birth. He has bulky and greasy
stools. Jejunal Biopsy (Image) shows foamy or clear cytoplasm of
Gastrointestinal & Nutrition
enterocytes with normal mucosal structure. Dx is
*Abetalipoproteinemia*

Pathology

Pt who recently travelled to south america. His liver biopsy shows


spotty hepatocyte necrosis and inflammatory cell infiltration. Most
likely clinical presentation of this pt is *Fever, Anorexia, and
Gastrointestinal & Nutrition
dar-colored urine*
[Acute Hep A infection]
[Dark color urine is due to increased conjugated bilirubin levels]

368

Pathology

Pt dies from profuse upper gastrointestinal hemorrhage and gross


examination of liver is shown after autopsy. This resulted from
Gastrointestinal & Nutrition *Fibrosis and Nodular parenchymal regenration* of the liver. Pt
probably died from Liver Cirhosis that led to portal HTN and
eventualGIhemorrhage.

370

Pathology

Gastrointestinal & Nutrition

Pathology

55 yr old caucasian male who is recently diagnosed with cardiac


arrhythmias is found to have mild hepatomegaly. He also
complains of a dark tan despite avoiding sun exposure. Pt most
Gastrointestinal & Nutrition
likely suffers from *Hemochromatosis*
[Bronze diabetes, the triad of skin hyperpigmentation, DM, and
pigmnet cirrhosis with hepatomegaly]

Pathology

*Primary Biliary Cirrhosis is a chronic liver disease characterized


by autoimmune destruction of the intrahepatic bile ducts and
Gastrointestinal & Nutrition cholestasis (elevated alkaline phosphatase). The condition is most
common in middle-aged women, with severe pruritis (especially at
night) one of the first symptoms reported.

403

Pathology

Liver biospy showing extensive lymphocyte infiltration and


granulamatous destruction of interlobular bile ductis. Biopsy was
Gastrointestinal & Nutrition most likely taken from a *45 yr old woman with a long history of
pruritis and fatigue who has pale stools and xanthelasma*
[Primary Billary Cirrhosis}

405

Pathology

Pt with abdominal pain, diarhea and heme-positive stools. Stool


Gastrointestinal & Nutrition cultures are negative. Biopsy of colonic mucosa reveals
non-caseating granuloma. Pt most likely has *Crohn's Disease*

406

Pathology

Gastrointestinal & Nutrition

Pathology

A finding most suggestive of Ulcerative colitis is *Continous


Mucosalinvolvement*
Gastrointestinal & Nutrition
[Transnural inflam, rectal sparing, perianal fistula and
noncaseating granuloma are all suggestive of crohn's disease]

Pathology

Pt with Ulcerative Colitis who comes due to worsening pain and


bloody diarrhea. He has been non compliant with his medication.
He has hypotension and tachycardia. Pt is lethargic and has dry
mucus membranes. There is marked abdominal distention and
Gastrointestinal & Nutrition
tenderness without rebound or guarding. Rectal exam shows
guaiac-positive, maroon-colored, liquid stool. Best next step in pt's
workup is *Plain abdominal x-ray*
[Toxic Megacolon assoc with UC]

Pathology

A differenc bewteen sporadic colorectal carcinoma and


Gastrointestinal & Nutrition colitis-associated carcinoma is that colitis associated carcinoma is
*Multifical in Nature*

Pathology

Pt with abdominal pain and bloody diarrhea following a


complicated surgical procedure likely has acute nonocclusive
Gastrointestinal & Nutrition
ischemic colitis. Primary areas affected are the Splenic flexure
and the *Rectosigmoid Junction*.

366

394

401

407

410

411

413

Alcohol induced hepatic steatosis is due to *Decreased Free fatty


acidOxidation*

inflamed and swollen terminal ilieum is probably crohns disease in


which there is involvement of TH1 helper t cells.

421

Pathology

In the Adenoma-to-Carcinoma sequence in colon cancer, The


increase in the size if the polyps that mediates the late adenoma
Gastrointestinal & Nutrition part of thes sequence is a result of mutation of *K-ras*
protooncogene.
[APC > K-ras > p53]

426

Pathology

Gastrointestinal & Nutrition The initiating factor in acute appendicitis is *Lumen Obstruction*

427

Pathology

A pathologic finding in a polp that is associated with greatest risk


Gastrointestinal & Nutrition of malignant transformation includes a *2-cm villous adenomatous
polyp*

Pathology

38 year old man with colonoscopy showing ulcerative colon mass


with no polyps and biopsy showing adenocarcnoma. Gene
Gastrointestinal & Nutrition
mutation responsible is most likely *MSH2*
(Hereditary Nonpolyposis Colorectal Canceer HNPCC)

Pathology

Pt is found to have colon adenocarcinoma in the asceding colon.


Pt most likely initially presented wuth *Weight loss and progressive
fatigue*
Gastrointestinal & Nutrition
[Ascedning colon is wide and would prevent obstruction, pt usually
develop anemia due to occult blood loss and non specific
symptoms also occur]

434

Pathology

Pt has acute pancreatitis with normal gallbladder and common bile


duct (hence due alcohol). He has a >2 AST:ALT ratio. An
additional lab finding that is likely to be associated with the
Gastrointestinal & Nutrition underlying cause of this pt's pancreatitis is *Mean Corpuscular
Volume of 108 fl*
[Alchol causes Macrocytosis (MCV >100)likely due to poor
nutrition (folate def))

435

Pathology

Gastrointestinal & Nutrition

Pathology

65 yr old man comes due to weight loss, Jaundice and anorexia.


He notes his urine has been dark and his stools pale. P.E shows
enlarged but nontender gallbladder. Most important risk factor
Gastrointestinal & Nutrition predisposing of his condition is *Smoking*
[Adneocarcinoma of the head of pancreas, Palpable nontender
gall bladder + weight loss + obstructive jaubdice (assoc with
priritis, dark urine, and pale stools). Smoking doubles the risk.]

Pathology

23 year old is hospitalized with acute pancreatitis that resolves


rapidly with fasting. Pt does not consume alcohol. One of the tests
that sould be considered during the workup is *Serum
Gastrointestinal & Nutrition
Triglycerides*
[Hypertriglyceridemia can cause acute pancreatitis]
[Two main causes however are gallstones and alcoholism]

881

Pathology

6 yr old is brough tdue to confusion and intractable vomiting.


Mother says he had a febrile illness two dasy ago and she gave
him "Some over-the-counter pills and it helped his fever. While you
Gastrointestinal & Nutrition talk to mother, the boy lapses into a coma. Light microscopy of his
liver will reval *Microvesicular steatosis*
[Rye Sydnrome, hepatic encephalopathy due to aspirin intake
after a viral illness in kids]

1143

Pathology

Gastrointestinal & Nutrition

429

432

436

440

A pancreatic psuedocyst is lined by *Fibrous and Granulation


Tissue*

Infection with Shigella Sonnei though food. The cells primarily


responsible for uptake of bacteria are *Microfold (M) cells*

1396

Pathology

Pt presents with abdoinal pain and diarrhea. Recent trip to


mexico.He is febrile. Elevated leukocytes. Sigmoidoscopy shows
white/yellow plaques on colonic mucosa and biopsy shows that
Gastrointestinal & Nutrition plaque are composed of fibrin and inflammatory cells. Given pt'd
Dx, the element likely elicited on further Hx taking regarding
mexico trip is *hospitalization and antibiotics for pnemonia*
[C. Deficile Colitis]

1783

Pathology

Pt with abdominal pain, diarrhea, and tender abdomen without


Gastrointestinal & Nutrition guarding. There is a draining fistula near her coccyx. Most likley
Dx is *Crohn Disease*

Pathology

Pt recently went to mexico. He presents with low grade fever,


anorexia, dark colored urine and RUQ tenderness. Liver biopsy
Gastrointestinal & Nutrition most likely shows *Hepatocye Swelling*
[Acute viral hepatitis, most likely by Hep A virus]
[Hall mark is hepatocyte necrosis which characterized by swelling]

1927

Pathology

IV drug used wuth fever, jaundice and anorexia. Liver biopsy


shows mononuclear infiltrates, hepatocyte swelling and acidophilic
Gastrointestinal & Nutrition
bodies. Formation of acidophilic bodies is the result of *Apoptosis*
[viralhepatitis]

7710

Pathology

Gastrointestinal & Nutrition

Pathology

HIV pt with multople hemorrhagic polypoidal lesions on


colonoscopy. Biopsy reveals spindle cells with surrounding blood
Gastrointestinal & Nutrition
vesselproliferation.
Most likely cause is *Kaposi's Sarcoma* [HHV-8]

Pathology

Infant with abdominal distention, vomiting and blood streaked


stools. She was born out of preterm delivery. Abdominal x-rays
Gastrointestinal & Nutrition
shows curvilinear areas of lucency that parallel the bowel wall
lumen. Most likely Dx is *Necrotizing Enterocolitis*

Pathology

Renal transplant pt who presents with worsening retrosternal chest


pain, dysphagia, and odynophagia. An
esophagogastroduodenosopyshowslinearshallowulceraionon
Gastrointestinal & Nutrition
lower esophagus. Likely finding on esophageal biopsy is *Enlarged
cells with Intranuclear inclusions*
(CMVesophagitis)

Pathology

Hematology & Oncology

Pt dies from liver disease. Both changed and unchanged


hepatocytes domonstrate foreign DNA Fragments integrated into
their genome. These fragments likely belong to *Hep B virus*
[Hep C is RNA virus and has no reverse transciptatse and does not
integrate into host genome]

Hematology & Oncology

Backpain that is constant (i.e not relieved by rest or positional


changes) and that is worst at night is suggestive of *Neoplasm* as
in spinal metastasis.

Hematology & Oncology

55 year caucasian male is found on colonoscopy to have a solitary


mass in his sigmoid colon. Biopsy shows colon cancer. The
feature that carries the worst prognosis is *Tumor Penetration into
the Muscularis Propria*
(Tumor staging, more imp than grade)

Hematology & Oncology

Child who presents with headaches and gait instability. MRI shows
tumor in the cerebellum wtih both cystic and solid components
(white and dark). Most likely Dx is *Pilocytic Astrocytoma*
(Medulloblastoma is only solid, ie dark)

1863

8290

9920

11548

58

341

423

615

Pathology

Pathology

Pathology

Pt with duodenal ulcer. H. Pylori can be found in *Prepyloric area*


[Antrum of stomach]

710

Pathology

Hematology & Oncology

Neoborn with no postnatal care or medication. He has Cystic


Fibrosis. He develops Intracranial Hemorrhage. Cause is *Impared
gammacarboxylation*
(Neonatal Vit K deficiency)
(CF more suscepptible due to fat (ADEK) malabsorption)

829

Pathology

Hematology & Oncology

Pt has had an aortic valve replacement. His peripheral bloods


smear shows fragmented RBC's (Shistocytes or helmet cells) will
have *Decreased Serum Haptogloboin*

873

Pathology

Hematology & Oncology

Alcoholic with hypersegmented neutrophils in blood smear likely


has *Folate Def*

894

Pathology

Hematology & Oncology

G6PD has an *X-linked recessive* mode of inheritance.

Hematology & Oncology

infant with Hb electrophoresis showing: HbF=70%, HbA=20% &


HbS=10%. Mother has sick cell trait. Pt hasn no pallor or
splenomegaly. Most likely true abt this pt is that *She has relative
protection from Plasmodium Falciparum*
[Sickle cell trait]

895

Pathology

896

Pathology

Hematology & Oncology

African Am woman with sickle cell disease is admitted cuz of fever,


chills, and malaise. She has a hight WBC count and neutrophilia.
She becomes hypotensive and dies. Her blood cultures are most
likely to grow *Step Pneumo*
[Sicle Cell pts eventually become "functionally asplenic" and at risk
with encapsulated bacteria infection. Strep Pneumo is the most
commob. H flu is the second]
[Salmonella is MMC of osteomyelitis in children]

1083

Pathology

Hematology & Oncology

BRCA1/2 (breats and ovarian cancer) is responsible for *DNA


repair*

1086

Pathology

Hematology & Oncology

Previously healthy woman comes due to fever and sore throat. P.E
shows tonsillar exudate and nontender cervical lymph nodes
measuring 3.5cn. Antibiotics are started. A week later, pt says
symptoms resolved but the cervical lymph decreased lil bit inside.
On follow ups, the node fluctuates in size but doesnt disappear.
Most likely seen on biposy is *Follicular Lymphoma]

1292

Pathology

Hematology & Oncology

Pt on Warfarin who develops warfarin-induced skin necrosis, most


likely had *Protein C deficiency*

Hematology & Oncology

Pt end-stage renal disease. Dialysis is to be given. Before that, he


develops bleeding around the catheter exit. Furtehr evaluation
would show *Normal PT, aPTT, Platelet count, But Prolonged
Bleeding time*
{Uremic platelet dysfunction due to accumulation of toxins in blood,
Bleeding time is an indication of platelet function]

Hematology & Oncology

RBC cell fragments, burr cells, and helmet cells are associated
with either microangipathic hemolytic anemia or mechanical cell
destruction.
In pts with prosthetic valves, red blood cells are exposed to
excessive shear and turbulence in the circulation, causing damage
from mechanical trauma.

1293

1297

Pathology

Pathology

1405

Pathology

Hematology & Oncology

The presence of rod-shaped intracytoplasmic inclusions known as


Auer rods is characteristic of many forms of acute myeloblastic
leukemia (AML). The M3 varian of AML, acute promyelocytic
leukemia, is associated with the cytogenic abnormality *t(15:17)*

1406

Pathology

Hematology & Oncology

Auer rods which are seeen in Acute Myelogenous Leukemia stain


positive for *Peroxidase*

1580

1630

1717

1754

Pathology

Pathology

Pathology

Pathology

Hematology & Oncology

Pancreatic calcification with abdominal pain and finding of low


hemoglobin and high MCV suggest Macrocytic anemia. The pts
probably has Chronic pancreatitis due to ethanol abuse. The
anemia is due to folic acid def or b12 def and is causing impaired
DNA synthesis leading to *diminished thymidine synthesis*

Hematology & Oncology

IV drug used with HIV infection. He comes due abdominal


distention and anorexia. CT scan shows ascites and large mass
surrounding small intestine. Biopsy of mass shows unifrom, round,
medium-sized tumor cells with basophilic cytoplasm and
proliferation fraction of >99%. Agent assoc is *EBV*
[Burkitt Lymphoma, t(8:14) involving c-myc]
[Kaposi sarcoma (hhv8) would shows large cells, big nuclei, and
prominent nucleoli]

Hematology & Oncology

Hypophosphorylated RB protein is likely to *Prevent G1/S cell


cycle Transition*
(hypophosphorylated is active, abnormal phosphorylation results in
inactivation and proceeding of cycle unchecked)

Hematology & Oncology

Benign lympph node enlargement in response to antigenic


stimulation is associated with a Polyclonal proliferation of
lymphocytes. A monoclonal lymphocytic proliferation of
lymphocytes. A *Monoclonal lymphocytic proliferation* is a strong
evidenc of malignancy.

1755

Pathology

Hematology & Oncology

8 year odl pt from east africa with Large tumor on Mandible with
palbable regional lymphadenopathy. Biopsy shows diffuse infiltrate
of lymphoid cells with numerous mitotic figures and interspersed
macrophages surrounded by clear spaces (star-sky app). The
gene translocated in these lymphoid cells produces a protein that
is most directly responsbile for *Transcription Activation*
-(Burkits lymphoma, C-myc gene, t(8:14))

1758

Pathology

Hematology & Oncology

bcl-2 gene normally inhibits *Cell death cascade*


(inhibits apoptosis)

Hematology & Oncology

An example of Anaplastic tumor cells is *Brain tumor cells forming


giant cells*
[No resemblence to tissue of origin. Composed of pleomorphic
cells with large, hyperchromatic nuclei that grow in disorganized
fashion. Anaplastic tumors may also contain numerous, abdnormal
mitoses and giant tumor cells]

Hematology & Oncology

Pt has cancer. Genetic study shows a single nucleotide


substitution causing an "activating mutation". Gene most likely
involved is *KRAS*
[Activating mutation indicates a proto-oncogene, like KRAS][APC,
BRCA, RB, & TP53 are tumor suppressors hence are
anti-oncogenes]

Hematology & Oncology

Pt presents with skin rash. He has history of pneumocystic


pneumonia and painful ulcers. He uses Ilicit drugs frequently. P.E
shows a widespread rash of lesions (image shown). Most likely
cause is *Human Herpes Virus 8*
[Kaposi Sarcoma]

1759

1760

1761

Pathology

Pathology

Pathology

1785

Pathology

Hematology & Oncology

Pt with anemia (manifesting as fatigue), thrombocytopenia (Easy


bruising), and neutropenia (recent respiratory infection), with
profound reticilocytopenia, morphologically normal cells line in
eriheral smear and no splenomegaly. Bone marrow biopsy would
most likely show *Hypocellular marrow filled with fat cells and
marrow stroma*
[Aplastic Anemia]

1786

Pathology

Hematology & Oncology

Calculate Corrected reticulocyte count or sth.

1793

1796

1797

Pathology

Pathology

Pathology

Hematology & Oncology

Pt with progressive fatigue and occasional palpitations. She is post


menopausal. Blood Hb level is 8.5. Peripheral blood smear shows
pale microcytes. WHat should be ruled out initially in this pt
*Occult blood loss*
[hypochromic, microcytic anemia in setting of iron deficiency]
[primary mechanism of iron def is blood loss and shud be
excluded first]

Hematology & Oncology

Pt with hypochromic microcytic anemia who is treated with Fe


supplementation. several week later her blood smear shows
numerous enlarged RBC that appear blue on Wright-Giemsa stain.
The bluish color on hese RBC is explained by the presence of
*rRNA*
[Enhance erythropoiesis and release of mature RBC's and
reticulocytes, reticulocyte lacks nucleus but retain basophilic
residual rRNA that appears blue on said stain)

Hematology & Oncology

Individuals who demonstrate increased ativity of a specific


intracellular enzyme are more susceptible to developing
benz(o)pyrene induced lung cancer. The enzyme that is most
likely overactive in these pts is *Microsomal Monooxygenase*

1848

Pathology

Hematology & Oncology

Pt with Atrophic Gastritis who is given cyanocobalmin (vit B12) to


treat his macrocytic anemia (penicious anemia) would have a
rapid rise then fall of his *Reticulocyte count*
His Hemoglobin would rise steadily but less rapidly.

1851

Pathology

Hematology & Oncology

In HUS thee is *Elevated seum indirect bilirubin*

1873

Pathology

Hematology & Oncology

Angiogenesis is predominantly driven by *Fibroblast Growth


Factor* and Vascular Endothelilal Growth Factor.

Hematology & Oncology

A pt with a single amino acid substitutiion near the protein C


cleavage sit in he coagulation factor V gene products. This pt is at
greatest risk for *Pulmonary thromnoembolism*
[Factor V leiden, predisposes to hypercoagable state and DVT]

Hematology & Oncology

Pt with chest tightness and dyspnea, with chest CT showing a


saddle pulmonary embolus. Pt has history of cancer, smoking and
age (70). This places him at risk of developing a vebous
thromboembolism. A factor that contrinutes to this a
*Hypercoagulable state*
(Virchow's triad: endothelial injury, venous stasis, and
hypercoagulable state)

Hematology & Oncology

Hemophilia is an X-linked cogulopathy that presents with


intramuscular hemorrhage, hemarthroses, delayed bleed after
procedure. Lab results show prolonged Partial Thromboplastin
Time.

Hematology & Oncology

Pt has epistaxis, ecchymoses, and marked thrombocytopenia.


SHe has a normal hematocrit, leukocyte count and differential,
frinogen and PT. She takes no medication, and there is no
hepatosplenomegaly on P.E. These findings suggest an isolated
acquired thrombocytopenia. Most likely mechanism in this pt is
*Immune destruction of platelets* like "Immune thrombocytopenic
purpura"

Hematology & Oncology

The finding of a high peak in gamma-globulin region on serum


protein electrophoresis (SPEP) usually represents an M protein
consisting of an overproduced monoclonal immunoglobin. Multiple
myeloma causes an M protein peak on SPEK as well as anemia
(weakness), lytic bone lesions (back pain, pathologic fractures)
and renal insufficiency (related to amyloid deposition and
hypercalcemia).
*Multiple myeloma is *Plasma cell neoplasm**

1879

1880

1953

1954

1964

Pathology

Pathology

Pathology

Pathology

Pathology

2084

Pathology

Hematology & Oncology

Pt with signs of sickle cell disease (african american, recurrent


back pain, bony tenderness, low Hb). Histopathologic evaluation of
his spleen would show *Fibrosis and Atrophy*

2093

Pathology

Hematology & Oncology

Breast cells that over express 185kD glycoprotein and that have
intracellular tyrosine kinase activity are probably the HER2/neu
oncogenes that *Accelerates Cell Proliferation*

11750

Pathology

Hematology & Oncology

55 yr old man with generalized weakness and easy fatigability. He


has abdominal discomfort. Exam shows abdominal distention, and
massive hepatomeglay with spleen crossing midline. Peripheral
blood smear shows pancytopenia.Bone marrow aspiration is
attempted but no marrow can be aspirated. Finding most likely to
be seen in this pt is *Lymphocytes with cytoplasmic prjections*
[Hairy cell luekemia, "Dry Tap" due to marrow infiltration.
Splenomegaly to infiltration of red pulp]

11754

Pathology

Hematology & Oncology

Bone Metastases that is Osteoblastic (Sclerotic) on imaging can be


related to *Prostate cancer*
[Also small cell lung Ca and Hodgkin Lymphoma]

11869

Pathology

Hematology & Oncology

Paroxysmal nocturnal hemoglobinuria is due to a gene defect that


leads to uncontrolled complement-mediated hemolysis. The classic
triad includes hemolytic anemoa (hemoglobinuria), pancytopenia,
and thrombosis at atypical sites. Chronic hemolysis can cause
deposition in the kidney(*Hemosiderosis*)

390

Pathology

Infectious Diseases

The most common outcome in HBV-Infected adults is acute


hepatitis with mild or subclinical symptoms that eventually
*completely resolve*

472

Pathology

Infectious Diseases

Pt with aortic regurg murmur (diastolic) in the presence of


mediastinal widening. FTA-ABS psotive (syphilus). The pathologic
process responsible starts at *Vasa Vasoum Obliteration*
[Teriary Syphilus causing aortic aneyrysm, which beigns with vasa
vasorum endarteritis and obliteration resulting in inflam, ischemia
and weakening of adventitia.]

651

Pathology

Infectious Diseases

Tertiary Syphilus genital lesions are called *Gummas*

Infectious Diseases

An unvaccinated infant is brought with a rash. Three days ago,


she developed fever, along with cough, congestion, and red eyes.
Rash appeared on face and spread to trunk and arms. The def
assoc with increased complications from this pt condition is *Vit A*
[Measles virus]

1045

Pathology

1138

Pathology

Infectious Diseases

Pt recently went to south america presents with fever, headache,


abdominal pain and 1 week history of watery diarrhea that has
recently become bloody. He is febrile and P.E shows
hepatosplenomegalyandseveralfainterythematousmaculopapular
lesions on chest and abdomen. Most likely cause is *Salmonella
Typhi*
[Typhoid Fever]

1958

Pathology

Infectious Diseases

Bacterial Vaginosis can be Tx with *Clindamycin* or


Metronidazole.

Pathology

Pt presents with a painless scrotal nass. He also has increased


sweating and heat intolerance. P.E shows an enlarged nontender
right testicle. Lab shows increased serum T4 and T3. The
constellation of findings seen in this pt most likley suggest an
MaleReproductiveSystem
elevation of serum *hCG*
[Testicular malignancy releases hCG which has a similar structure
to TSH and can bind and activate thyroid to produce
ParaneoplasticHyperthyroidism.]

624

Pathology

Male comes for infertility evaluation. Semen analysis shows normal


sperm count but completely immobile sperm due to abnormal tail
MaleReproductiveSystem function. The finding most likely associated with this condition is
*Persistent bronchial dilation*
[Primary cilary dyskinesia, auto recessive]

Pathology

In klinefelters syndrome there is *Increased FSH* due to loss of


feedback Inhibition due to decrease in Inhibin levels (from sertoli
MaleReproductiveSystem
cells. There is also decreased testestrone (damage to leydig cells)
that is from primary hypogonadism.

Pathology

Miscellaneous
(Multisystem)

A renal mass that is composed of fat, smooth musscle, and blood


vessels. The pt is most likely to have additional finidng of *brain
Hamartomas and ash-leaf skin pathches*
[Angiomyolipoma, associ with Tuberous Sclerosis]

14

Pathology

Nervous System

HIV pt with diffuse cortical atrophy and CT scan shows enlarged


ventricles. The Hydrocephalus is secondary to the cortical atrophy
and hence termed *Hydrocephlus Ex Vacuo*

63

Pathology

Nervous System

In Wernicke-Korsakoff syndrome, when thiamin infusion is started,


the nuerologic deficit that most likely to persist despite treatment is
*Memory Loss*

Nervous System

1 month old infant brought due to difficulty awakening. Mother says


he rolled off the bed. P.E shows lethargic biy with large full ant
fontanlle. Bilateral retinal hemorrhages are seen on funduscopic
exam. You should suspect *Abusive heard trauma*
[Shaken baby sybcrome]

Nervous System

21 yr old man comes with impared balance, tremor, and diffculty


speaking. Symptoms developed slowly over several months. Pt is
found to have elevated serum transaminases. Viral Hep serologies
are negative. His cousin was Dx at young age with progressive
neuro disease. The Dx study most beneficial during work up is *Slit
Lamp Exam*
[Wilson Diseae]{Tx with D-penicilamine]

664

1055

347

397

Pathology

Pathology

468

Pathology

Nervous System

MRI of head of young t shows an angiomatous lesion involving the


cerebellum. There is also a cystic mass in the right kideny on
abdominal ultrasound. The differentail Dx must include
*Von-Hippel-Lindau disease*

492

Pathology

Nervous System

Light microscopy of bran tissue that shows neurons with shrunken


nuclei, no detectable nissle substance and intensely eosinophilic
cytoplasm. These findings indicate *Irreversible cell injury*

494

Pathology

Nervous System

Cell body rounding, peripheral displacement of the nuclei and


dispersion of Nissl substance to the periphery of the cells. These
findings described indicate *Axonal Reaction*

495

Pathology

Nervous System

Pt (who is right handed) presents with acute onset headache and


difficulty with vision. She passes out en route to hospital. CT scan
shows an acute hemorrhage in left temporal lobe and compression
of the ant medial temporal against the free margin of the the
tentorium cerebelli. The CN most likely compromised is
*Oculomotor*

497

Pathology

Nervous System

Sudden onset severe headache with no other abnormalities with


subarachnoid hemorhhage on ct is likey caused by a *Saccular
Anyeurysm*

499

Pathology

Nervous System

Elderly with Lobar Hemorrhage in occipital and parietal areas with


history of frontal lobe hemorrhage. Probably he has *Cerebral
AmyloidAngioplasty*

504

Pathology

Nervous System

Youn woman who presents with episodic headaches, dizziness


and gait disturbance. MRI of brain shows low lying cerebellar
tonisls extending into vertebral canal. Cause of this is a
*CongenitalMalformation*
(Chiari type 1)

505

Pathology

Nervous System

Pt involved in motor vehicle accident who sustains fracture of


temporal bone. Bloody most likely accumulates between *Bone and
Dura Mater*
[Epidural Hematoma]

593

Pathology

Nervous System

In alzheimer's disease, there is *Decreased acetycholine activity


in the nucelus basalis*

597

Pathology

Nervous System

Homeless man who is hospitalized and then develops acute


confusion, nystagmus, abducens palsy and opthalmoplegia
probably has Chronic Thiamine Deficiency due to liver
dysfunction. Thiamine is needed for Glucose metabolism and
therefore *Glucose Infusion* can percipitate Wernicke
Encephalopathy.

636

Pathology

Nervous System

Friedreich ataxia is associated with *Cardiomyopathy*

Nervous System

Lung cancer irritating the phrenic nerve can cause dyspnea,


hiccups and referred ppain to shoulder. Phrenic Neve arise from
*C3-C4*

Nervous System

PT with gait instability, dysmetria, and dysarthria. MRI shows


degenration of Post columns and spinocerebellar tracts. The
condition that has clinical manifestation that closely resemble this
pt disease is *Vit E deficiency*
[this pt has Friederich's Ataxia][vit E defi results in oxidative
damage and mimic F ataxia]

647

671

Pathology

Pathology

674

Pathology

Nervous System

Pt with a lesion involving teh corticospinal tract would have an


additional finidng of *Hyperactive deep tendon reflex*
(Hyperreflexia in UMN signs)

794

Pathology

Nervous System

Atrophy in Alzheimer's disease involves the *Hippocampus*


[Identify on MRI]

871

Pathology

Nervous System

Ischemic injury to the brain results liquefactive necrosis in which


there *Lysosomal Digestion of (necrotic) Tissue*

Nervous System

Pt been acting strange, not seeming to care about family (flat


affect), aggressivness, periodic random jerky movements
(Choreiform). Pts probably has Huntington's disease. There is Def
of *GABA* neurotransmitter.

902

906

Pathology

Pathology

Nervous System

Sensory ataxia and argyll robertson pupils are characteristic of


tabes dorsalis which a manisfestation of tertiary syphils caused by
treponemapallidum*Spirochete*.
The argyll roberston pupils are casued by spirochete inavading the
midbrain tectum.

915
969

1058

Pathology
Pathology

Pathology

Nervous System

Rapid correction of Hyponatremia results in *Osmotic


Demyelination Syndrome*

Nervous System

Pt with suspected tetanus who sustained a minor lower extremity


wound 1 week ago should have *History and Physical exam* as
the most important in making a Dx.

Nervous System

Ascending paralysis after upper resp tract infection. Condition


most likely associated with *Endoneural inflammatory infiltration*
[GBS after C.jejuni infection]

1152

Pathology

Nervous System

A child with an intracranial calcified mass. On gross exam of mass


after removal, it shows cystic spaces with thick brownish-yellow
fluid that is rich in cholestrol. The mass is likely derived from cell
responsible for forming the *Ant pititary*
[Craniopharyngioma derived from Rathke's pouch]

1153

Pathology

Nervous System

Child with brain tumor comprised o spindle cells that have hair like
glial processes and are associated with microcysts. These cells
are mixed wuth Rosenthal fibers and granular eosinophilic bodies.
Most likely Dx is *Pilocytic astrocytoma*

1260

Pathology

Nervous System

Pt with HIV and has mass on temporal lobe and biopsy shows cells
with EBV probably has a *Primary CNS Lymphoma*

Nervous System

Pt undergoing hemodialysis who has dminished sensation over


thumb, first two fingers, and radial half of her thrid finger probably
has carpal tunnel syndrome. The underlying mechanism of which
is *Nerve compression within an anatomic compartment*
[Median nerve compression thru deposition of Beta2-microglobulin
in carpal tunnel (dialysis assocated amyloidosis)]

1264

Pathology

1268

Pathology

Nervous System

Myotonia dystrophy is an autosomal dominant disorder caused by


trinucleatide repeats of myotonia protein kinase (CTG). Sustained
contraction, frontal baldness and cataratcs along with weakness
and type one fiber muscle atrophy is commonly seen. Also
gonadalhypertrophy.

1304

Pathology

Nervous System

*Schwannoma* is S-100 positive. (indicates neural crest origin)

Nervous System

Pt with long history of parkinson disease who recently develops


freezing episodes could benefit from high frequency deep brain
stimulation of the *Subthalamic Nucelus* or the globus pallidus
internus.

Nervous System

HIV-Associated dementia should be suspected in AIDS pateients


with progressive cognitive decline. Characteristic histopathologic
finding is Microglial Nodules formed around areas of necrosis that
may fuse to form multinucleated giant cells.

11462

11568

Pathology

Pathology

11574

Pathology

Nervous System

Pt involved in a truama who is camatose and has a rigid extension


of the upper and lower extremities. Damage to the *Pons* could
explain his posturing.
[Decerebrate posture, damage to brainstem at/below level of red
nucleus (midbrain, tegmentum, pons). It is due to loss of
descending excitation to the upper limb flexors (via rubrospinal
tract) and predominance of extensors (via vestibulospinal tract)

11627

Pathology

Nervous System

Pt with cavernous hemangioma is at greatest risk of developing


*Intracerebral Hemorrhage*

11632

Pathology

Nervous System

The cerebellar Vermis modulates axial/truncal posture via


connections with the medial descending motor systems. Lesions
on the vermis will results in TRUNCAL ATAXIA. Characterized by
unsteady gait, vertigo, nystagmus. Also, HEADACHE, nausea.

863

Pathology

Ophthalmology

Infant with white pupillary reflex and father has had a retinal
neoplasm during childhood most likely has Familial Retinoblastoma.
He is at greastest risk for developing *Osteosarcoma*

Ophthalmology

Pt with pathcy vision loss and flame-shaped retinal hemorrhage on


fundoscopic exam probably is due to *HTN* Poorly controlled HTN
can cause acute retinal hemorrhage which presents as painless,
unilateral visual disturbances ranging from mild loss of visual acuity
topermanentblindnes.

11675

Pathology

8325

485

486

531

Pathology

Pathology

Pathology

Pathology

Pregnancy, Childbirth &


Puerperium

Neoborn with a palpable swelling of neck. He is comfortable only


when held sideways. The child favors looking toward right and
cries when his head is turned to left. Most likely condition present
prenatally is *Intrauterine Malposition*
[Congenital torticollis, sternocleidomastoid muscle injury and
fibrosis]

Pulmonary & Critical Care

Pt hospitalized for abdominal pain. Lab show elevation of serum


amylase and lipase. He has Hx of alcohol abuse. His condition
worsens and develops severe resp distress. He dies to resp failure.
Most likely finding on autopsy is *Alveolar hyaline membrane*
[Pancreatitis led to ARDS][Enzymes and inflam cytokines leak into
cirulation leading to infiltration of neutrophils in lung interstitium
and alveolar space. Injury leads to edema & fibrin depos leading
hyalinized alveoli]

Pulmonary & Critical Care

Pt who history of heavy alcohol use and was admitted before for
acute pancreatitis. He presents with nausea vomitting and severe
abdominal pain. On 2nd day he develops dyspnea, and
hypoxemia. The parameter that is most likely normal in this pt is
*Pulmonary Capillary Wedge pressure*
[signs suggest ARDS for whch pancreatitis is major risk factor,
pulmonary edema with normal PCWP]

Pulmonary & Critical Care

t dies from pulmonary infection. Autopsy shows a right lower lung


lobe that is pale, firm and airless. Histologically, the alveoli are
filled with "exudate containing neutrophils, fibrin, and some
fragmented RBC's". This pt died during the *Grat Hepatization*
phase of his disease.

533

Pathology

Pulmonary & Critical Care

Pt with Peptosreptococcus and Fusobacterium in his lung.


Predisposing factor to his condition is *Seizure disorder*
[Lung abscess, caused by Oropharyngeal aspiration which can
occur due to seizures (loss of consciousness)]

552

Pathology

Pulmonary & Critical Care

Hamartomas are the most common benign lung tumors. They are
composed of disorganized *Cartilage, fibrous, and adipose tissue*

Pulmonary & Critical Care

55 yr old woman present due to cough and recent weight loss. She
doesnt smoke. P.E shows decreased breath sounds and dullness
to percussion at the left lung base. Image studies show an irregular
mass in the lower lobe of her left lung and left-sides pleural
effusion. It malignancy is diagnosed it is most likley
*Adenocarcinoma*
[Most common lung cancer in general populattion]

Pulmonary & Critical Care

65 yr old presents due to nonproductive cough with anorexia and


weight loss. He has a 50 pack year smoking history. Exam show
enlarged supraclavilcular lymph node. Imaging shows a large
mediastinalmasscausingtrachealdeviation.Immunohostochemical
staining of mass is positive for chromogranin. Pt most likely suffers
from *Small cell carcinoma*

Pulmonary & Critical Care

Pt presents with cough and headaches and dyspnea. He


complains of a puffy face. P.E shows facial swelling and
conjunctival edema. Dilated vessels are seen over his neck and
upper trunk. The pts condition is most likely caused by a
*Mediastinal Mass*
[Superior Venecava syndrome]

Pulmonary & Critical Care

Pt with shoulder pain (pain under scapula and in right arm). Pain
is associ with numbness on his right forearm and tips of fingers.
He has Hemoptysis. He smoked 2 packs/day for 40 years. Most
likey cause is *Superior Sulcus Tumor*
(Pancoast Tumor)

554

555

565

648

Pathology

Pathology

Pathology

Pathology

649

Pathology

Pulmonary & Critical Care

Histopathology reveals lung tumor cells with numerous, long


slender microvilli and abudnant tonofilaments. This is
*MESOTHELIOMA*

668

Pathology

Pulmonary & Critical Care

Bronchoscopy with transbronchial biopsy of a calcified node is


done. Polarized microscopy shows birefringent particles
surrounded by dense collagen fibers. Pt most likely had exposure
to *Silica*

795

Pathology

Pulmonary & Critical Care

African american female with Dry cough, pulmonary infiltrates,


hilar adenopathy, biopsy shows Non-caseating granuloma ==>
*SARCOIDOSIS*

799

Pathology

Pulmonary & Critical Care

Retinal vascularization in premature neonate was most likey due


*NeonatalO2supplementation*

Pulmonary & Critical Care

Newborn with Abdominal distention with normal rectal tone. Pt has


severl episodes if green emesis (hence billous). Laparotomy
shows inspissated green fecal mass obstructing distal ileum. Most
likely cause of mortality for this pt will be *Pneumonia*
This pt has meconium ileus (inspissated meconium at "Ilius") due
to "Cystic Fibrosis" and hence at risk for Pneumonia.

803

Pathology

806

Pathology

Pulmonary & Critical Care

Pancreatic squamous metaplasia of the pancreas in a pt with CF


(recurrent pulmonary infections, finger clubbing)is due to
deficiency in *Vit A*
[vit A is needed for maintenance of orderly differentiation of
specialized epithelia]

877

Pathology

Pulmonary & Critical Care

Black woman Pt with malaise, cough and rash wityh X-ray


revealing bilateral hilar lymphadenopathy and transbronchial
autopsy showing non-caseating granuloma has *SARCOIDOSIS*

Pulmonary & Critical Care

Finding of small fibrotic focus in lower lobe of right lung and a


calcified lymph node in the right lung hilus. This findings are most
consistent with *Primary exposure to M. tuberculosis*
[Ghon foucs and Ghon complex]

1221

Pathology

1579

Pathology

Pulmonary & Critical Care

Pt with fevers, hemodynamic instability, tachypnea and evidence


of UTI has Urosepsis likely complicated by ARDS causing her
hypoxia. Her resp symptoms are most likely due to *Fluid
accummulation in alveolar spaces*
[increased recruitment of neutrohils causing capillary damage and
leakage*

1925

Pathology

Pulmonary & Critical Care

*Animal Dander should be avoided by pts with Asthma.

Pulmonary & Critical Care

Pt with long history of smoking who comes due to shortness of


breath and chonic mild cough. Lung x-ray shows hemithorax
opacification on the right and deviation of the trachea toward
opacified side. Most likely cause is *Righ mainstem bronchus
lesion*
[Collapsed lung due to bronchial obstruction]

2116

Pathology

Pathology

Renal, Urinary Systems &


Electrolytes

Antibodies detected in the serum of a young male are found to


react with teh alpha3-chain of collagen type 4. The pt is most likely
to have *Hemoptyis and Oliguria*
[Goodpasture disease,Anti-GBM antibody]

10

Pathology

Renal, Urinary Systems &


Electrolytes

Pt with recurrent, self-limited painless hematuria "within days" after


an upper respiratory infection has Ig A nephropathy. Kidney
biopsy will show *Mesangial Deposits of IgA*

11

Pathology

Renal, Urinary Systems &


Electrolytes

PSGN:
1)Enlarged, hypercellular glomeruli on light microsc
2) Lumpy-Bumpy granular deposits of IgG & C3 on
immunofluorescence
3) Electron dense deposits (Humps)on epithelial side of the basal
membrane on electron micros

12

Pathology

Renal, Urinary Systems &


Electrolytes

In post-strep Glomerular Nephritis there is *DECREASED SERUM


C3*

28

Pathology

Renal, Urinary Systems &


Electrolytes

Pt with signs of Nephrotic syndrome would a seconday change of


*Increased Live Lipoprotein Synthesis*

Pathology

Renal, Urinary Systems &


Electrolytes

Pt with colon cancer who has Nephrotic Syndrome


(edema+proteinurea)with biopsyshowingglomerular cappillarywall
thickening without increase in cellularity. When sample is stained
with silver, irregular spikes from the GBM are seen. Pt has
*MembranousGlomerulopathy*

Pathology

Renal, Urinary Systems &


Electrolytes

Child with signs of nephrotic syndrome. Pathologic change that


causes protein loss is *Glomerular podocyte damage*
[Effacement of podyctes im Minimal Change Disease]

382

385

811

Pathology

Renal, Urinary Systems &


Electrolytes

Pt with urgency, frquency, a weak urinary stream and straining on


micturition. He notes noturia, and Oliguri alternating with polyurea.
Pts kidneys most likely will demonstrate *Parenchymal pressure
atrophy*
(BPH)

814

Pathology

Renal, Urinary Systems &


Electrolytes

Pt with hexagonal crystals on urinalysis has cystinuria which


*AMinoAcidUrea*

832

Pathology

Renal, Urinary Systems &


Electrolytes

Pt with multiple risk factors for athersclerosis including age, HTN,


hyperlipidemia and smoking. He presents with post prandial
abdominal pain accompanied by weight loss. He has one large
kidney on CT. This characteristic of *Renal Artery Stenosis*

834

Pathology

Renal, Urinary Systems &


Electrolytes

Acute onset Gross hamturia in an otherwise healthy pt with family


history of sickle cell disease suggests *Renal Papillary Necrosis*
and an underlyin sicke cell trait.

886

Pathology

Renal, Urinary Systems &


Electrolytes

In acute Tubular necrosis. The most important complication during


the Recovery Phase is *Hypokalemia*

888

Pathology

Renal, Urinary Systems &


Electrolytes

Pt with UTI. Most specific finding for a Dx of Pyelonephritis is


*White blood Cell casts*

Renal, Urinary Systems &


Electrolytes

Hypovolemia reduces RPF and hence *GFR*. This activates a


compensatory mechanism that systemical vasocnstricts leading to
further *reduction in RPF*. However, another reflux is increased
angiotensin 2 release due to decreased GFR that would
vasoconstrct efferent arteriole and help maintain GFR. As *RPF is
lower than GFR*. *FF Rises*.

Renal, Urinary Systems &


Electrolytes

Pt with chronic lower back pain who has been using over the
counter NSAIDS ever since pain started 8 years ago. He has
elevated BP, trace lower extremity edema. High BUN. High
Creatinine. 1+ protein and 3-4 WBC in urine. Renal ultra sound
shows bilateral shrunken and irregular kidneys with few papillary
calcifications. Most likley cause of renal dysfunction is *Crhonic
Interstitial Nephritis*
[NSAID associated chronic renal injury]

1016

1049

Pathology

Pathology

Pathology

Renal, Urinary Systems &


Electrolytes

7 yr odl with two day history of colicky abdominal pain develops


bloody stools. His urine appeared red today. P.E shows palpable
skin lesions on his buttocks. An additional finding consistent with
his condition is *Joint Pain*
[Henoch-SchonleinPurpura][Mostcommonsmallvesselvasculitis
in children]

1862

Pathology

Renal, Urinary Systems &


Electrolytes

Old pt with blood in urine. Renal biospy shows rouned/polygonal


cells with abundant cytoplasm. The process that acconts for
abnormal appearance of cells is *Glycogen and lipid accumulation*
[C lear cell Ca of Kidney]

1913

Pathology

Renal, Urinary Systems &


Electrolytes

Screening for early-stage diabetic nephropathy is done by


measuring urinary concentration of *Albumin*

Pathology

Renal, Urinary Systems &


Electrolytes

Proteinurea with serum containing IgG4 antobodies to


phospholipase A2 receptor (PLA2R) suggests idiopathic
*Membranious Nephropathy*

Pathology

Pt with recurrent nonpitting edema of hands, raynaud phen, and


Rheumatology/Orthopedics
retrosternal burning has CREST syndrome which would find
& Sports
*Anti-centromere* Antobodoes.

Pathology

Pt with multi system systems and history IV drug use. His muscle
biopsy shows transmural inflammation of mid-sized arteries with
areas of homogeneous, eosinophilic arterial wall necrosis (i.e
Rheumatology/Orthopedics
fibrinoid necrosis). Areas of internal elastic lamina disruption are
& Sports
also present. Most likely predisposing factor to this pt's current
condition is *Viral Hepatitis*
[Polyarteritis Nodosa]

Pathology

Pt with persistent headache and pain in the jaw when chewing


Rheumatology/Orthopedics food. Artery biopsy shows multinuclear giant cells and internal
elastuc membrane "fragmentation". Pt has Giant cell arteritis and
& Sports
treatment reduces risk of *Ischemic optic Neuropathy*

Pathology

Eosiniphilic granulomatosis with polyangiitis (Churg-Strauss) is a


small to medium vessel vasculitis characterized by late-onset
Rheumatology/Orthopedics asthma, rhinosinusitis, and eosinophilia. Mononueritis multiplex due
& Sports
to involvement of the epineural vessels of peripheral nerve is
common. The finidning of antibodies against neutrophil
myeloperoxidase is also common.

Pathology

Pt with blue sclera and easily fractured bones probably has


Rheumatology/Orthopedics osteogenesis imperfecta due to defect in type 1 collagen which is
& Sports
the primary collagen in bone. Therefore, the primary impairement
is *Bone Matrix Formation*

721

Pathology

Child with fever and malaise. He parents say he refrains from


using his right leg. Passive range of motion does not elicit pain and
Rheumatology/Orthopedics no joint effusion is seen. However, the pt refuses to bear weight
with his right lower extremity. Scintigraphy is most likely to reveal
& Sports
increased focal radiotracer uptake in the *Long Bone Metaphysis*
[Hematogenous Osteomyelitis]

820

Pathology

Rheumatology/Orthopedics Digital Clubbing can be caused by Lung Disease. E.g:


& Sports
Bronchiectasis

Pathology

Elderly woman with jaw pain during chewing (Jaw claudication),


Rheumatology/Orthopedics An episode of vision loss in one eye that resolved (amaurosis
fugax). Best initial test is *Erythrocyte Sed Rate*
& Sports
[Giant cell Arteritis][C-reactive protein is also indicated]

1850

2131

340

457

461

667

702

914

Pathology

Pt with non-caseating granuloma, lymphadenopathy, and


hypercalcemia could have sarcoidosis. The elevated Ca level is
Rheumatology/Orthopedics due to *Activated Macrophages* how? There is increased
expression of 1-alpha hydroxylase in activated macrophages which
& Sports
causes PTH-independent production of 1,25-dihydroxyvitD leading
to increase intest abs of ca and hence hypercalcemia.

Pathology

Pt presents with worsening scoliosis. Pt with mutation in dystrophin


Rheumatology/Orthopedics gene on x chromosome. Histopathology of pt's calf would reveal
*Fibrofattymusclereplacement*
& Sports
(Duchene Muscular dystrophy)

Pathology

pt comes with fever, right flank pain, and difficulty walking. He has
diabetes. The pt lies supine with his right knee flexed and externally
roatated. He resists extension of the leg and thigh, particularly at
Rheumatology/Orthopedics
the hip. The pathologic process occuring in this pt involves the
& Sports
*Psoas Major* Muscle.
[Psoas abscess associated with diabetes as a rsik factor][Psoas
sign is elicited on hip extension]

11653

Pathology

Pt with who presents with pelvic pain. She has fibrous Dysplasia
(multiple osteolytic-appearing lesions of the hip and pelvis),
Rheumatology/Orthopedics
enodocrine abnormalities (hyperthyroidism, percocious puberty)
& Sports
and cafe-au-lait spots. (Triad) suggest a Dx of *McCune-Albright
Syndrome*

11798

Pathology

Rheumatology/Orthopedics
Pt with sign of SLE would have *Low C3 and C4*
& Sports

11821

Pathology

Rheumatology/Orthopedics
Rheeumatoid arthritis most likely affects *Cervical Spine*
& Sports

984

1266

8710

761

PathophysiologyAllergy & Immunology

23 yr old Female with migratory arthritis and skin rash exacerbated


by skin exposure. Urinalysis shows moderate proteinuria and RBC
casts. Serum Ab with specificity for this pts condition react with
*Double stranded DNA*
[SLE]

33

PathophysiologyCardiovascular System

Bicsupid aortic valve can lead to *aortic stenosis by 50 years old. *

42

PathophysiologyCardiovascular System

In myocardial ischemia, the depletion of ATP in critical cellular


areas results in loss of contractility within about *60 seconds* of
total myocardia ischemia.

96

PathophysiologyCardiovascular System

Pt with Hypotension, tachycardia, Jugular venous distension with


clear lungs and Pulsus Paradoxus (loss of palpable pulse during
inspiration) is consistent with *Cardiac Tamponade*

186

PathophysiologyCardiovascular System

In isolated diastolic heart failure there is *Increased LV


end-diastolic pressure, normal LV end-diastolic volume, and
Normal LV ejection fraction*

187

PathophysiologyCardiovascular System

Pt with VSD would also have a *Holosystolic murmur over the left
sternal border*

PathophysiologyCardiovascular System

PT dies due to MI. Autopsy show slit-like tear in infarcted


myocardoum. This *typically occurs within 5-14 days after an
acute MI*
[Free wall rupture]

PathophysiologyCardiovascular System

12 year old with a wide, fixed splitting of second heart sound on


routine physical exam. The congenital heart disease in this pt may
require surgical repair to prevent irreversible changes in
*Pulmonary Vessels*
(ASD, Pulmonary artery develop laminated medial hypertrophy,
irreversible)

193

201

PathophysiologyCardiovascular System

The best indicator for mitral stenosis severity is *A2-to-opening


snapp time interval*
(shorter when more severe) (atrial pressure builds up causing
more forceful opening of valve "snap")

PathophysiologyCardiovascular System

Mitral valve stenosis with *Increased left ventricular diastolic


pressure* suggests that the mitral stenosis is acoompanied by an
aoirtic valve problem such as stenosis or regurgitation. Both of
which can increase LV diastolic press.

235

PathophysiologyCardiovascular System

The opening snap in mitral stenosis occurs shortly after the mitral
valve opens when *the left ventricular pressure drops below the left
atrial pressure*

238

PathophysiologyCardiovascular System

Head poudning and bobbing are associated with *Widening of


pulsepressure*

244

PathophysiologyCardiovascular System

PT with aoric stenosis can develop pulmonary edema due to


*Sudden decrease in LV preload* due to loss of atrial contraction
that is due to atrial fib. `

446

PathophysiologyCardiovascular System

In the pathogenesis of athersclerotic plaques, release of


platelet-derived growth factor (PDGF) by locally adherent
*PLATELETS*, endothelial cells, and macrophages promotes the
migration of smooth muscle cells (cellualr component of plaques)
from the media into the intima and their subsequent proliferation.
Platelets also release trnsforming growth factor Beta (TGF-Beta)
which is chemotactic for SMC'S

843

PathophysiologyCardiovascular System

In CHF there is a compensatory *Increase in Arterial Resistance*

944

PathophysiologyCardiovascular System

Presence of a holosystolic heart murmur indicates Mitral valve


Regurgitation. Its severity can be indicated by the presence of an
*S3 gallop* which indiactes severe disease and indicates rapid
ventricular filling due to large volume of regurgitant blood
re-entering the ventricle during mid-diastole.

1578

PathophysiologyCardiovascular System

In signs for Cor Pulmonale due to COPD, moderate increase in


capillary fluid transudation can be ofset by a compensatory
increase in *Tissue Lymhatic Drainage*

1903

PathophysiologyCardiovascular System

A normal bleeding time indicates adequate platelet function. A


normal Activated partial thromboplastic time (aPTT) indicates an
intact intrinisic coagulation system. A prolonged prothrombin time
in the setting of a normal aPTT indicates a defect in th extrinsic
coagulation systen (E.g *fACOTR 7*)

2099

PathophysiologyCardiovascular System

Pulsus Paradoxus can be seen in *Pericardial Disease*

2100

PathophysiologyCardiovascular System

Pt with dyspnea, tachypnea, prolonged expiration and bilateral


wheezing is suggestive of acute exacerbation of Obstructive
Pulmonary Disease. This is usually treated with beta agonists
which relax bronchial smooth muscles by stimulating
beta-2-adrenergic receptors. The receptor is Gs coupled and
activates adenylyl cyclase and *Increases intracellular cAMP
concentration*

2105

PathophysiologyCardiovascular System

Pt presents with fatigue and dyspnea. An early diastolic murmur is


heard at the left sternal border. Pt most likey has *Aortic
Regurgitation*

2117

PathophysiologyCardiovascular System

A low pitched holosystolic murmur heard best at the left sternal


border with accentuation during the handgrip exercise is
characteristic of *VSD*

1860

PathophysiologyDermatology

Wrincles are a result of *decreased collagen fibrils production*

233

234

8904

PathophysiologyDermatology

Young girl with a soft raise, hyperpigmented, 0.5cm nontender


lesion iinferior to the right breast. Most likely cause is *Failed
involution of the mammary ridge*
[Accessory Nipple]

308

PathophysiologyEar, Nose & Throat (ENT)

Symptoms of recurrent vertigo together with unilateral hearing loss


is characteristic of Meniere's disease which there is *Increased
pressure and volume of endolymph*

212

226

Pathophysiology

Pathophysiology

Endocrine, Diabetes &


Metabolism

Primary (psychogenic) polydipsia is a psychological disorder


characterized by increased intake of free water leading to
hyponatremia and production of large volume of dilute urine.
*Water restriction* will correct the serum Na levels and leads to
increse in urine osmolality.

Endocrine, Diabetes &


Metabolism

Signs of Hyponatremia (altered mental status, headache,


weakness, seizures) plus a lung mass suggest SIADH casued by
small cell carcinoma. An additional finding would be *normal
extraceullar fluid volume*. Regulatory mechanism in the body deal
with the hyponatremia resulting a Euvolemic hyponatremia.

454

Pathophysiology

Endocrine, Diabetes &


Metabolism

Adrenal Tumor that is functionally similar to the outermost layer of


the adrenal cortex (Glomerulosa) would have primary
hyperaldostrnism due to Aldostrone-producing Adenoma (Conn
Syndrome)and would therefore have *Sweating & Tremulousness*
as an added symptom.

582

Pathophysiology

Endocrine, Diabetes &


Metabolism

Pt with Klinefelters have azospermia. That mean sperm count is


*None*
Ofcourse together with low LH, FSH and Testestrone.

608

Pathophysiology

Endocrine, Diabetes &


Metabolism

Adminstration of Metyrapone will cause a decrease in cortisol


synthesis via inhibition of 11-beta-hydroxylase. In pts with an intact
hypothalamic pituitary axis, this will cause a reactive increase in
ACTH, 11-Deoxycortisol, and "urinary 17-hydroxycorticosteroid
levels"

611

Pathophysiology

Endocrine, Diabetes &


Metabolism

11-hydroxylase deficiency in congenitl adrenal hyperplasia causes


high PB and Hirstutism (Big clit)

623

Pathophysiology

Endocrine, Diabetes &


Metabolism

Peritibial myxedema and exopthalmos are specific features of


hyperthyroidsim due to Grave's disease. Peritibial myxedema is
*Lower Leg Skin thickening and induration*

656

Pathophysiology

Endocrine, Diabetes &


Metabolism

Oral conraceptives decrease hirsutism by suppressing LH


secretion and thereby *Decreasing ovarian androgen production*

764

Endocrine, Diabetes &


Pathophysiology
Metabolism
Endocrine, Diabetes &
Metabolism

Pt with fatigue, bradycardia, weight gain, constipation, and


delayed relaxation of deep tendon reflexes has Hypothyroidism,
the most sensitive marker for Dx is *Serum TSH*
Signs of fatigue, weight gain and lumps rising from surface of
skeletal muscle following percussion with reflex hammer
(MYOEDEMA) combined with Elevated CK level indicate
HYPOTHYROID MYOPATHY and *TSH levels* should be checked.

765

Pathophysiology

766

Endocrine, Diabetes &


Pathophysiology
Metabolism

772

Pathophysiology

Endocrine, Diabetes &


Metabolism

An increase in estrogen activity leads to an increase in levels of


thyroxine-binding globulin. This leads to an *Increased Total T4
pool*

921

Pathophysiology

Endocrine, Diabetes &


Metabolism

To diagnose Type diabetes melitus use *Fasting blood glucose


level*, random glucose, or HbA1c.

Pt being scheduled to be treated for hyperthryoidism usning


radioactive iodine therapy. Pretreatment with *Potassium
perchlorate* would decrease the effects of radiotherapy thru
competitive inhibition of iodine transport.

922

Pathophysiology

Endocrine, Diabetes &


Metabolism

A fetus born to a mother who had gestational diabetes would have


hypoglycemia due to *Beta cell hyperplasia*
[Pancreas is used to a lot of glucose from mother. After delivery,
glucose suddenly stops but beta cells are still high in number and
secreting insulin, resulting in hypoglycemia]

925

Pathophysiology

Endocrine, Diabetes &


Metabolism

Amenorhea in pt involved in strenous excersie and low body wieght


is caused by *HYpothalamic Suppression*

Endocrine, Diabetes &


Metabolism

Pt with history of SLE dies at home. At her last P.E, her BP was
150/90. Clinical records show progressive truncal obesity, facial
plethora, and proximal muscle weakness. Lab showed mild
hyperglycemia. Evaluation of her adrenal galnds will most likely
show *Bilateral cortical atrophy*
[Iatrogenic cushing syndrome due to prolonged glucucorticoid
use, leads to supression of of hypothalamic oituitary axis]

Endocrine, Diabetes &


Metabolism

Pt with HTN at young age together with weakness and paresthesias


(electrolye or acid-base disturbance) and low Renin levels is
consisent with Primary Hyperaldostronism. His Serum level of *Na
is normal, K is low, HCO3 is High*
(Na is normal due to aldostrone escape)

Endocrine, Diabetes &


Metabolism

An infant boy with recurrent vomitting (salt wasting) and poor


feeding and P.E shows dehydration (salt wasting) and hypotension
with labs showing low sodium (wasting) and hyperkalemia. Pt
probably has Congenital Adrenal Hyperplasia - 21-hyrdoxylase
deficiency. There would be low cortisol, low aldo, high ACTH, and
*High 17-hydroxyprogestrone* which is a precuror to cortisol
synthesis.

928

929

Pathophysiology

Pathophysiology

930

Pathophysiology

933

Endocrine, Diabetes &


Pathophysiology
Metabolism

Symptoms of Headache, tachycardia, diaphoresis and severe


HTN. THese resolve before Tx is given. Same thing happened a
month ago. This is pheochromocytoma and there is *Elevated
catecholamine release*

981

Pathophysiology

Endocrine, Diabetes &


Metabolism

Pt with celiac disease will also develop vit D deficiency due to


defective mucosal absorption, presenting as bone pain and
weakness (Adult). Lab test would reveal *low Ca, Low PO4-, High
PTH*
[No vit D decreases absorption of Ca AND PO4- from GI tract]

985

Pathophysiology

Endocrine, Diabetes &


Metabolism

In DKA there is *Increased (or normal) extracell K & Decreased


Intracell K**

1326

Pathophysiology

Endocrine, Diabetes &


Metabolism

Upregulation of *Serine Phosphorylation* decreases


insulin-mediated glucose uptake.

1327

Pathophysiology

Endocrine, Diabetes &


Metabolism

Insulin Resistance correlates strongly with Ecxess Visceral Fat


which can be assessed using *Wasit Circumference* or waist-to
hip-ratio.

869

Pathophysiology

FemaleReproductive
System & Breast

Cervical Intraepithelial neoplasia can be caused by HPV infection


which can result from sexual infection due to *Lack of barrier
contraception*.

1549

Pathophysiology

FemaleReproductive
System & Breast

Symptoms of primary herpes infections include inguinal


lymphadenopathy, tender vesicular lesions covering both labia
majora and pernium with dysuria and itching. The infection
(probably hsv-2) can lead to *Recurrent Genital Ulcers* (less
sever) (HSV lies dormant in sacral dorsal root ganglia)

2094

Pathophysiology

FemaleReproductive
System & Breast

Pt with menstrual irregularities, who is obese and has acne and


hirsutism probably has Polycystic Ovarian Syndrome, and
therefore has *Enlarged Ovaries*

2095

Pathophysiology

FemaleReproductive
System & Breast

Pts with PCOD who desire fertility are treated with Clomiphene,
*An estrogen receptor Modulator*

78

PathophysiologyGastrointestinal & Nutrition

Pt with cholestrol gall stones would have *High cholestrol, low bile
salts and low Poshatidylcholine* in the gallbladder.

80

PathophysiologyGastrointestinal & Nutrition

The diagnostic test most specific fro acute cholecystitis is *Failed


gallbladder visualization on radionuclide billary scan*

133

PathophysiologyGastrointestinal & Nutrition

Lactase deficeiency causes osmotic diarhea and *Acidification of


stool*

279

PathophysiologyGastrointestinal & Nutrition Zenker Diverticulum is due to *Cricopharyngeal motor dysfunction*

306

Pt with systemic signs and rash with skin biopsy showing large
clusters of mast cells positive for KIT probably has Systemic
PathophysiologyGastrointestinal & Nutrition
Mastocytosis and an additional finding will be *Gastric
Hypersecretion*

363

*Absent Liver Conjugation enzymes* as seen in Criggler-najjar


PathophysiologyGastrointestinal & Nutrition syndrome type 1 (UGT enzyme def) can cause Neurlogic
abnormalities due to accumulation of unconjugated billirubin.

369

Pt who presents with nausea, fatigue, anorexia who recently had


surgery. Pt is weak and incteric and later dies. Liver biopsy shows
PathophysiologyGastrointestinal & Nutrition shrunken liver. Pt probably had Anesthetic Induced Hepatotoxicity
due to Haloethane use during surgery. You would expect to also
find a *Prolonged Prothrombin Time*

391

63 yr old woman died of congestive heart failure. Autopsy shows a


dilated heart and brownish pigmentation of the myocardium. Light
microscopy of liver after prussian blue is shown. The pt's brother
PathophysiologyGastrointestinal & Nutrition died of upper GI beed at age 43. Assuming this pts condition is
hereditary, what contributed to her delayed onset of symptoms is
*Premenaupasual menstrual bleed*
[Hemochromatosis]

402

Pt with generalized pruritus and high alkaline phosphatase along


with high titers of Antimitochondrial antibodies have Primary Billary
PathophysiologyGastrointestinal & Nutrition
Cirrhosis. Liver autopsy would morphologically resemble
*Graft-vs-host disease*

441

PathophysiologyGastrointestinal & Nutrition

1581

Vit A deficiency is characterized by night blindess and dry skin


(hyperkeratosis). Deficiency of this fat soluble vitamin can result
PathophysiologyGastrointestinal & Nutrition
from Billary disorders, exocrine pancreatic insuffciency, or
intestinalmalabsorption.

1907

Pt who has acute pancreatitis and has a malignant mass on


pancrease and undergoes subtotal pancreatectomy would have
PathophysiologyGastrointestinal & Nutrition normal *IntestinalD-xyloseAbsorptioon*
(xylose is simple sugar, doesnt need pancreatic enzymes for
absorption)

11860

Intestinal Bacteria can produce *Folate* and vit K.


PathophysiologyGastrointestinal & Nutrition (In gastric bypass surgey there is bacterial overgrowth leading to
increase in these two substances)

425

890

Acute pancreatitis is nitiated by the inappropriate activation of


*Trypsinogen*

PathophysiologyHematology & Oncology

Pt with skin flushing, diarhea and cramping. P.E shows purple


vascular lesions surrounding her nose (Telangiectasias). Urinary
excretion of 5-HIAA is increased over 24 hrs. Imagings shows
tumor in small intestine. Most likely resposnible for condition is
*Metastatic Carcinoid*

PathophysiologyHematology & Oncology

Pt with anemia, reticulocytosis and increased indirect bilirubin.


Blood smear shows RBC without central pallor. Pt is most likely to
have *Increased mean corpuscular Hb concentration*
{HereditarySpherocytosis]

PathophysiologyHematology & Oncology

Pt with sign of abdominal pain, ascites, anemia, thombocytopenia,


hypercoagulability (e.g hepatic vein thrombosis) and a flow
cytometry that shows CD55 & CD59 Deficiency has Paraoxysmal
nocturnal hemoglobinuria whcih results in a hemolytic anemia due
to*ComplementActivation*

1339

PathophysiologyHematology & Oncology

Pt with acute abdominal pain, nausea and confusion with reddish


urine that darkens after standing for 24 hrs and her symptoms are
releived by IV dextrose probably has *acute intermittent porphyria*
in which there is deficient PBG Deaminase. Symptoms are
exacerbated by CYP450 inducers including smoking and alcohol
and relieved by glucose and heme.

1855

PathophysiologyHematology & Oncology

Infant with hand and foot syndrome (Dactylitis) with family hsitory
of penumococcal sepsis (encapsulated) probably has sickle cell
disease and his *Serum Haptoglobin would be Reduced*

1877

PathophysiologyHematology & Oncology

Pea d'orange is an erythematous itchy breast rash with skin


texture changes analogous to an orange peel. This is the key
dermatologuc presentation of inflammatory breast cancer and is
caused by cancerous cells obstructing lymphatic drainage to the
dermal lymphatic spaces.

1940

PathophysiologyHematology & Oncology

Target cells are seen in Beta Thallesemia. Its a condition in hwich


there is impaired *mRNA formation*

2133

PathophysiologyHematology & Oncology

Antocoagulant that prolongs both PTT and PT with no effect on TT


is *Direct factor Xa Ihibitor*

11805

PathophysiologyHematology & Oncology

Pt with muscle weakness. P.E shows Gotrons papules. (image)


Further evaluation would likely reveal *Ovarian Adenocarcinoma*
[Dermatomyositis, perimysial infiltrates. It can occur alone or as a
paraneoplastic syndrome. Most commonly associated with
Ovarian, lung, colorectal and non-hodkins lymphoma]

822

PathophysiologyInfectious Diseases

In HBV caused hepatocellular carcinoma, the *Viral DNA


integration into Host Genome* us the cause of neoplastic change.

PathophysiologyInfectious Diseases

Pt with fever, skin flushing and altered level of consciousness. Low


BP and blood culture positive for E. coli. They most likey have
Septic shocks due to *Lipid A* which is part of E.Coli LPS which
is released during either bacteriolysis and/or cell division.

1390

PathophysiologyInfectious Diseases

Pts who are migrants (unknown vaccine status) who develop


severe pharyngitis with exudates and cervical lymphadenopathy
(neck swelling, dysphagia) and one them dies of heart failure.
These people probably has respiratory diptheria infection. The
diptheria toxin works like the Exotoxin A produced by
*Psuedomonas Aerugionsa*

966

PathophysiologyNervous System

In tetanus, release of *Glycine* neurotransmitter is inhibited.

PathophysiologyNervous System

Newborn that is crying, has tremors, tachynea, sneezing and


diarhhea and mother has history of mental illness and/or hep c
infection history probably has Neonatal Abstinence Syndrome and
should be treated with opoids such as *Methadone*

PathophysiologyNervous System

Hydrocephalus in infants presents with macrocephaly and poor


feeding. Imaging studies showing enlarged ventricles are
characteristic. Untreated hydrocephalus leads to spasticity due to
stretching of periventricular pyramidal tracts, developmental
delays, and seizures.

PathophysiologyNervous System

Pt presenting with weakness, dizziness and paraesthesias with


recent history of eating japanese food has probably a Tetrodotoxin
from eating Puffer fish. These toxins block Sodium channels
thereforepreventingmuscledepoolarization.

897

1141

1255

1854

8352

360

PathophysiologyOphthalmology

68

Pathophysiology

11919

Pathophysiology

Acute and painless monocular vision loss is characteristic of


*Central retinal artery occlusion* Fundoscopic findings include a
pale retina with a "Cherry-Red Macula".

Pregnancy, Childbirth &


Puerperium

Pregnant woman who develops Cholelithiasis is due to


*Estrogen-induced Cholestrol hypersecretion &
Progestrone-inducedgallbladderhypomotility*

Pregnancy, Childbirth &


Puerperium

Woman who has a complication after c-section delivery of


dyspnea, hypotension, bradycardia, hypoxia, and DIC (bleeding
from incisons) and later dies most likely has Amniotic Fluid
Emboism (amniotic fluid enters maternal circulation). Histology of
lungs reveals *Pulmonary artery branch with swirls of fetal
squmous tissue*

527

PathophysiologyPulmonary & Critical Care

Young pt with paroxysmal episdoes of breathlessness and


wheezing unrelated to anything. Sputum microscopy shows many
granule containing cells and crystalloid masses. The sputum
finding suggest the role of *IL-5* in this pts condition.
[granule containing cells are eosinophils and crystalloid bodies are
charocot-leyden crystalsl, a response to IL-5 released by allergen
activated TH2 cells]

528

PathophysiologyPulmonary & Critical Care

Hypocapniaimplies*alveolahyperventilation*

661

PathophysiologyPulmonary & Critical Care

Only *Leucotrienes* and acetycholine produce asthma that is


relieved by pharmacologic antagonists.

PathophysiologyPulmonary & Critical Care

In pts with Cystic Fibrosis, nasal muccosal basleine potential


difference is more negative becuase of Increased Sodium
reabsorption due to blocked Chloride channels due to CFTR
protein defect. Therefore the respiratory mucosa of the pt
demonstrates*Increasedsodiumreabsorption*

1910

PathophysiologyPulmonary & Critical Care

Middle aged man with new-onset fever, productive cough and a


dense lobar infiltrate likely has community acquired pneumonia.
Most commonly caused by Strep Pneumo. What accounts for the
green color of his sputum is *Myeloperoxidase* of the neutrophil.

1939

PathophysiologyPulmonary & Critical Care

Pt with CF has Na loss in sweat.

PathophysiologyPulmonary & Critical Care

Chronic smoker with chronic cough who has been hospitalized


before for respiratory infections and treated with antibiotics
probably has COPD and therefore hypoxia and an additional
finding would be *Increased Erythropoitin production* in repsonse
to the hypoxia.

1985

PathophysiologyPulmonary & Critical Care

An obese man who has excessive daytime sleepiness and signs of


upper air way obstruction such as snoring has obstructive sleep
apnea which is associated with syestemic hypertension and can
also lead to Pulmonary HTN!

8262

PathophysiologyPulmonary & Critical Care

Cheyne-stokes breathing (rapid breathing followed by apnea) is


associated with *Congestive Heart Failure*

11900

PathophysiologyPulmonary & Critical Care

Obesity related restritive lung disease decreases *Expiratory


reserve volume, functional residual capacity, forced expiratory
volume, forced vital capacity and total lung volume, Residual
volume is unchanged however*

813

Renal, Urinary Systems &


Pathophysiology
Electrolytes

Stones in the ureter suggests calcium stones. The most common


risk factor for calcium stone is *Hypercalciurea* that is usually
idiopathic. Patients however have *Normocalcemia* due to Ca
regulation by vitD.

817

Pathophysiology

804

1942

Renal, Urinary Systems &


Electrolytes

*Increased citrate saturation* helps prevent claculi formation.

831

Pathophysiology

Renal, Urinary Systems &


Electrolytes

*vesicouretral urine reflux* predisposes a woman who had frequent


bladder infections to pyelonephritis because the the vesicouretral
junction is weakened.

956

Renal, Urinary Systems &


Pathophysiology
Electrolytes

Pt with Metablic Alkalosis (pH > 7.45 & pCO2 >24). Lab study most
useful in diagnosing pt is *Urine Chloride*
Note: Volume status and urine chloride are important in the workup
of metablic alkalosis.

1050

Pathophysiology

7569

11038

11040

Pathophysiology

Pathophysiology

Pathophysiology

Renal, Urinary Systems &


Electrolytes

Uric acid would percipitates in *Collecting duct and distal tubule


due to low urine pH*

Renal, Urinary Systems &


Electrolytes

Significant renal artery stenosis causes renal hypoperfusion and


activation of the RAAS system. This leads increased release of
renin by the JG cells.
These cells would undergo hyperplasia and hypertrophy and they
are *Modified smooth muscle cells of the afferent arteriole*

Renal, Urinary Systems &


Electrolytes

Pt with MS who develops urge incontinence. Reason is


*Uninhibited bladder contraction*
[Loss of central nervous inhibition of detrusor contraction, as
disease progresses the bladder can become atonic and dilated
leading to overflow incontinence]

Renal, Urinary Systems &


Electrolytes

Diabetic autonomic neuropathy is common in type 1 diabetes and


can cause overflow incontinence due to inability to sense a full
bladder and incomplete emmptying. *Postvoid Residual* testing
with ultrasound or catheterization can confirm inadequate bladder
emptying.

11464

Pathophysiology

Renal, Urinary Systems &


Electrolytes

Pts with MS often develop a spastic bladder a few weeks after


developing an acute lesion of the spinal cord. These pt present
with increased urinary frequency and urge incontinence.
Urodynamic studies show the presence of *Bladder Hypertonia*

11516

Pathophysiology

Renal, Urinary Systems &


Electrolytes

Preventing UTI's from catheter can be done with *Prompt removal


of catheter when no longer indicated*

753

34 yr old man comes due to lower bk pain for several years. He


has stiffness and pain that are worst in the morning but gradually
improve during the day. Ibuprofen provides some relief. Lab shows
Rheumatology/Orthopedics
a positive HLA-B27 antigen. X-ray shows fusion of sacroiliac
Pathophysiology
& Sports
joints. Most helpful in monitoring progression of pt's disease is
*ChestExpansion*
[Ankylosing Spondylitis]

867

Pt with persistent shoulder and back pain and easy fatigability.


She has pain and stiffness in all her muscles.She has difficulty
Rheumatology/Orthopedics
Pathophysiology
concentrating. There is normal range of motion and 5/5 muscle
& Sports
strength. Soft tissue tenderness is present at several locatons.
Most likely DX is *Fibromyalgia*

978

Pathophysiology

Pt with lung mass and Hypercalcemia but with no bone focal lytic
Rheumatology/Orthopedics
lesions probably has Malignancy-associated hypercalcemia that is
& Sports
characterized by elevated *Parathyroid hormone-related protein*

982

Pathophysiology

Rheumatology/Orthopedics In primary osteoporosis, serum Ca and PTH levels are typically


& Sports
*Normal in range*

1450

Pt with recurrent acute Monoarthitis (one knee) and a history of a


Rheumatology/Orthopedics myeloproliferative disorder (E.g Polycytemia Vera) has typical
Pathophysiology
features of "GOUT" and would therefore have *Needle Shaped,
& Sports
Negatively Birefringent Crystals* on needle aspiration of the joint.

1600

A young man with acute lower extremity artthritis and a sterile (no
bacteria) joint effusion following a GI infection (diarrheal illness)
Rheumatology/Orthopedics
has typical symtoms of "Reactive Arthritis". It is a associated with
Pathophysiology
& Sports
*HLA-B27*
[Sponduloarthropathy assoc with HLA-B27]

11646

Biopsy that shows Endomysial Mononuclear inflammatory


Infiltrates and Patchy Muscle Fiber Necrosis inidcates
Rheumatology/Orthopedics
Polymyositis which present with insidious proximal muscle
Pathophysiology
& Sports
weakness. Usually, Autoantibodies such as antinuclear antibodies
(ANA) and *Anti-histydle-tRNA-Synthetase (anti-Jo1)* are present.

11770

Pt with headaches, visual and muscular symptoms, an enlarged


Rheumatology/Orthopedics temporal artery, an elevated ESR has Giant cell Arteritis with
Pathophysiology
assoc. polymyalgia rheumatica. The most imp mediator of this
& Sports
conditon is *IL-6* (cell mediated immunity, vasculitis)

11818

Pathophysiology

1612

726

Pharmacology

Pharmacology

Acute joint pain, swelling, and erythema with restricted range of


Rheumatology/Orthopedics
motion is consistent with synovitis. Diagnosed with *Synovial Fluid
& Sports
Analysis*

Allergy & Immunology

Pt with decreased serum complement C4 and C1 esterase inhibitor


levels. Drug that is contraindicated is *Captopril*
[Hereditary angioedema][ ACE inhibitors make bradykinin
accumulate in addition to already high bradykinin due to loss of
inhibitory action of C1 esterase inhib on kalikrein which converts
kinogen into bradykinin]

Biostatistics &
Epidemiology

Early penicilin Tx of Group A strep pharyngitis is important 4


prevention of Acute Rheumatic Fever which a major cause of CVS
death in many developing nations. ARF affect mainly heart and
CNS. Chronic cardiac inflammation can progres sto rheumatic
heart disease, esp valvualr. (Mitral valve)and would need *Heart
Surgery* Therefore, early Tx lowers need 4 Heart surgey!!

38

Pharmacology

Cardiovascular System

Pt with episodic and transient anginal chest pain, occuring during


night time hours and accompanied by temporary ST-segment
elevations. Pt chest pain would be provoked by *Ergonovine*
[Prinzmetal Angina]
[Ergonovine is an egot alkaloid that constricts vascular smooth
muscle by stimulating both adrenergic and serotonergic receptors,
low doses inudce coronary spasm in pts with prinzmetal angina]

136

Pharmacology

Cardiovascular System

Nitrates activate guanyl cyclase and increase levels of intracellular


cGMP which leads to *dephosphorylation of myosin light chain*
leading to relaxaton and hence vasodilation of vessel.

137

Pharmacology

Cardiovascular System

At low doses, Nitroglyerin acts as a VENO-DILATOR, *Large


Veins* are the most Susceptible. Vasodilation causes decreasd
preload becuase blood collects in the venous system.

138

Pharmacology

Cardiovascular System

Sublingual nitreates *Decrease left Ventricular Volume*


[Thru venodilation and hence decreasing preload]

140

Pharmacology

Cardiovascular System

Adverse affect of nitrates is *HEADACHE* !!

141

Pharmacology

Cardiovascular System

Pt with signs of hypertrophic cardiomyopathy (family history of


premature sudden death, systolic mumur). Due to the left
ventricular outflow obstruction, avoid drugs that reduce ventricular
volume such as vasodilators and diuretics. An example of a
vasodilator is *Isosorbide dinitrate*

142

Pharmacology

Cardiovascular System

Pts taking daily nitrates need to have a nitrate free period to


prevent tolerance to the drug

Cardiovascular System

Pt with A fib and CHF that is on multiple medications and develops


nausea, decreased appetitte and "Vison difficulties" and lab finding
of "Hyperkalemia" probably is on *DIGOXIN*

147

Pharmacology

149

Pharmacology

Cardiovascular System

Milrinone is a phosphodiesterase-3 inhibitor that leads to an


increase intracellular cAMP which promotes intracell Ca influx and
increase cardiac contractility. An increase in cAMP in vascular
smooth muscle cells cause systemic *Vasodilation*

156

Pharmacology

Cardiovascular System

A major complication of digoxin tox is Life threatenig


*Arrhythmias*.

689

Pharmacology

Cardiovascular System

*FENOLDOPAM* is a selective D1 agonist that is used in


hypertesnive emergencies.

711

Pharmacology

Cardiovascular System

Tx with statins causes increased *LDL receptor density*

713

Pharmacology

Cardiovascular System

Elderely pt that comes with sudden-onset right arm weakness and


difficulty speaking that resolve within 20 minutes, and who also has
a history of HTN and hypercholestrolimia most likely had a
Transient Ischemic Attack and Aspirin should be indiacted. Being
an NSAID aspirin can cause *GI BLEEDING*

780

Pharmacology

Cardiovascular System

Before giving statins check *Liver transaminases*

823

Pharmacology

Cardiovascular System

Pt wirg ST segemnt MI who is given a fibrinolytic and becomes


camatose with asymmetrical pupils and irregular breathing
probably has *Intracerebral Hemorrhage* as an adverse affect of
fibrinolytic therapy.

899

Pharmacology

Cardiovascular System

Amiodarone (class 3 antarrythmic) tho it prolongs QT interval (like


other class 3's and 1A's) it does not increase risk of torsades.

900

Pharmacology

Cardiovascular System

An antiarrhythmic agent that binds perferentially to rapidly


depolarizing and ischemic ventricular myocardial fibers and has
minimal effect on normal ventricular myocardium is *Lidocaine*
It is effective in inhibiting ischemia-induced ventricular
arrhythmias.

901

Pharmacology

Cardiovascular System

Know that Dofetilide is a class 3 anti-arrhythmic medication (K


channel blocker)

949

Pharmacology

Cardiovascular System

A side of ACE inhibitors is cough and Angioedema (elnlarged lip)


tat is caused by *Bradykinin accumulation*

Cardiovascular System

The anthracyclines (daunorubicin, doxorubicin, epirubicin, and


idarubicin) are chemotherapeutic agents associated with severe
Cardiotoxiity thru generation of free radicals. They cause *Dilated
Cardiomyopathy*

Cardiovascular System

A drug given in periheral artery disease that provides symptomatic


improvement due to direct dilation of arteries and inhibition of
platlet aggregation is *Cilostazol*
[Phosphodiesterase Inhibitor]

1014

1080

Pharmacology

Pharmacology

1118

Pharmacology

Cardiovascular System

Phosphodiesterase inhibitors such as Sildenafil lead to rise in


intracellular cGMP and result in vasodilation. This signaling
pathway is most similar to *Brain (and Atrial) Natriuretic Peptide*
which bind to transmembrane receptors linked to guanyl cyclase
that increases cGMP which activates cGMP-dependent kinase
leadingtovasodilation.

1164

Pharmacology

Cardiovascular System

Blanching of a vein into which NE is being infused together with


induration and pallor of surrounding tissue suggets NE
extravasation which is treated with *Phentolamine*

1194

Pharmacology

Cardiovascular System

Pregnanct associated deep vein thrombosis is treated with


*Enoxaparin*
[Low molecular wieght heparin]

1252

Pharmacology

Cardiovascular System

Medication that causes selective direct relaxation of smooth


muscles of arterioles but does not affect veins would have an
adverse effect of *Na and fluid retention*

1343

Pharmacology

Cardiovascular System

A drug that is a pure adrenergic agonist that causes immediate


increase in BP and delayed decrease in heart rate. Admin of drug
to healthy individuals would most likely result in *Decreased
atrioventricular node conduction velocity*
[The delayed decrease in heart rate was a reflex bradycardia, the
drug affects alpha 1 receptors]

1344

Pharmacology

Cardiovascular System

Dobutamine increases *myocardial oxygen consumption*

1365

Pharmacology

Cardiovascular System

*Dopamine* at lower doses stimulates D1 receptors in the renal


vasculature and tubules therey inducing an increase in renal blood
flow. At somewhat higher doese, dopamine stimulates the
beta-1-adrenergic receptors in the heart thereby increasing
Cardiac Contractility. At still higher doess, dopamine stimulates
alpha-1-receptors in the systemic vasculature thereby causing
generalized systemic vasoconstriction and hence lower cardiac
output due to higher after load.

1367

Pharmacology

Cardiovascular System

Noreepi therapy results in *cAMP increase in cardiace muscle


cells*

1507

Pharmacology

Cardiovascular System

*Dofetilide* is a class 3 antiarrhythmic and blocks K channels,


Just like Sotalol and Amiodarone.

1509

Pharmacology

Cardiovascular System

A drug that depresses phase 0 ventricular depolarization (Na) and


prolongs phase 3 (K) is probably a class 1A antiarrythmics which
include*Disopyramide*

1565

Pharmacology

Cardiovascular System

In pts with HTN and chronic ischemic myocardial failure, ACE


inhibitors (*Lisinopril*)are considered most effective long term
treatment.

1828

Pharmacology

Cardiovascular System

If pt cant handle aspirin and he has stable angina. Give him


*Clopidogrel*

1947

Pharmacology

Cardiovascular System

Norepi is an agonist for alpha 1 and Beta 2 but significantly more


agonist effect for alpha1 and therefore causes vasoconstriction
(B2 causes dilation). Therefore, norepi increases vascular tension
(vasoconstriction). A drug that reduces this ability of norepi would
have to block its alpha 1 agonist effect Irrevesibly
(non-competitively), and therefore a nonselective, non-cmpetitive
alpha antagonist such as *Phenoxybenzamine* can do it.

1948

Pharmacology

Cardiovascular System

Betal Blockers inhibit renin release.

2006

Pharmacology

Cardiovascular System

Beta Blockers prolong *PR interval* by decreasing AV nodal


conduction.

8289

Pharmacology

Cardiovascular System

Low dose Atenolol affects B1 adrenergic receptors on *cardiac


cells and JGP cells but not vascular smmoth muscle*

8869

Pharmacology

Cardiovascular System

*Flacainide* reduces QRS interval.

11844

Pharmacology

Cardiovascular System

Fenofibrate therapy *Rduces Hepatic VLDL production*

836

Pharmacology

Dermatology

Terbinafine*inhibitssqualeneepooxidase*

Dermatology

28 yr odl pt who has history of childhood dermatitis has been


routinely applying corticosteroid cream to the flexor area of his
skin for many years. A punch biopsy of area subjected to this
topical therapy would most likely show *Dermal Atrophy*
[corticosteroids in addition to anti-inflammatory effect, cause
decreased production of extracellular matrix collagen and GAGS]

Dermatology

Pt with hair loss at anterior scalp and vertex has typical features of
androgenetic alopecia.
5-alpha-redyctase inhibitors such as *Finasteride* help minimize
progression of this disease.

1214

1726

Pharmacology

Pharmacology

8569

Pharmacology

Dermatology

In Tx of psoriasis, we use Vit D analogs such as *Calcitriene*


which activates Vit D receptor, which is a *Nuclear Transcription
Factor*

166

Pharmacology

Endocrine, Diabetes &


Metabolism

A drug that can massively decrease Triglycerides is *Fenobirate*

167

Pharmacology

Endocrine, Diabetes &


Metabolism

Acute falre of gouty arthritis (-ve birefringent crystals) can be due


to Tx with *NIACIN*

209

Pharmacology

Endocrine, Diabetes &


Metabolism

Leuprolide is GnRh Analog and can be used in treatment of


prostate cancer. (metastasizes to vertebrae)
On initial therapy with Leuprolide *Testestrone and DHT rise then
fall with continued use*

548

Pharmacology

Endocrine, Diabetes &


Metabolism

Glucucorticoids such as Prednisone cause Increased LIVER


gluconeogenesis, therby activation *LIVER Protien Synthesis*

549

Pharmacology

Endocrine, Diabetes &


Metabolism

High-dose Prednison (Corticosteroid) would elevate *Neutrophil*


levels.

584

Pharmacology

Endocrine, Diabetes &


Metabolism

Anastrozole is used to treat estrogen receptor positive breast


tumors. It *Decreases Androgen Aromatization*

600

Pharmacology

Endocrine, Diabetes &


Metabolism

Pt with diabetic ketoacidosis is treated with regular insulin that has


no aminoacid modification Regular insulin which has a short half
life ,longer than lispro however.

604

Pharmacology

Endocrine, Diabetes &


Metabolism

You should monitor *BUN & Creatinine* when admistring


Canagliflozin which is a SGLT2 inhibitor that decreases renal
abasorption of glucose used in type 2 diabetes

605

Pharmacology

Endocrine, Diabetes &


Metabolism

Pioglitazone which is Thiazolidinedione antidiabetic dryg targets


*intracellular nucelar receptor*
[Binds peroxisome proliferator activated receptor gamma]

606

Pharmacology

Endocrine, Diabetes &


Metabolism

Meglitinides (repaglinide, nateglinide) are short acting glucose


lowering medications. They are functionally similar to sulfonylureas
and act by binding and closing ATP-dependent K+ chanel in
pancreatic beta cell membrane, inducing depolarization and L-type
Ca channel opening. The increased Ca2+ influx stimulates beta
cells insulin release. They therefore, *Target membrane ion
channels*
Check Table

622

Pharmacology

Endocrine, Diabetes &


Metabolism

Pt with signs of Hyperthryroidism with eye involvement (bilateral


redness,proptosis(exopthalmos))wasgivenmedicationthat
reduced her proptosis. The drug did that by affecting
*Inflammatory infiltration*
[Glucorticoids to treat exopthalmos in Grave disease pts]

625

Pharmacology

Endocrine, Diabetes &


Metabolism

*TSH levels* should be monitored in pts receiving Amiodorone


therapy!

626

Pharmacology

Endocrine, Diabetes &


Metabolism

Methimazole inhibits *Coupling of iodotyrosines* in the thyroid


gland.

Pharmacology

Endocrine, Diabetes &


Metabolism

Pt with difficulty urinating and dribbling affecting quality of life


probably has BPH, treatment with Finasteride can cause releif but
also cause increase hair growth over scalp. That's becuse
Finasteride is a *5-alpha-reductase inhibitor*. This is the enzyme
that converts testestrone into its active metaboloite DHT.

Pharmacology

Endocrine, Diabetes &


Metabolism

A drug that activates peroxisome-proliferator activated receptor-y


(a nuclear receptor and transcription factor) (such drugs are the
-glitazones) results in *Decreased Insulin Resistance*

658

920

Pt with type 2 diabetes. Tx that would increase serum C-peptide


level include *Glyburide*
{Sulfonylureases like glyburide and Meglitinide increase
endogenous insulin producttion and henc c-peptide]

1655

Pharmacology

Endocrine, Diabetes &


Metabolism

1673

Pharmacology

Endocrine, Diabetes &


Metabolism

Pt with redistribution of fat from the extremities to the trunk. This is


a common adverse effect of *highly-active antiretroviral therapy
(HAART)*

1984

Pharmacology

Endocrine, Diabetes &


Metabolism

In a non medical setting, severe hypoglycemia is treated wih *IM


Glucagon*

11565

Pharmacology

Endocrine, Diabetes &


Metabolism

A diabetic drug that can cause hypoglycemia is *Glyburide*


[Sulfonlureas increase insulin secretion from pancrease. Glipizide
is also a sulfonylurea but it is short acting (unlike Glyburide) and
hence its risk of hypoglycemia is reduced]

11634

Pharmacology

Endocrine, Diabetes &


Metabolism

An anti-hyperlipidemia drugs that inhibits cholestrol absorption at


the brush border of the small intestine is *Ezetimibe*

808

Pharmacology

Gastrointestinal & Nutrition

Pt with cystic fibrosis can be helped with *Pancreatic enzyme


supplementation* to aid absorption.

Pharmacology

Pt who attempts suicide using an insecticide. She presents with


nausea, vomiting, abdominal pain and copious diarhea. Her breath
Gastrointestinal & Nutrition
has a garlic odor. This most likely Arsenic Poisoning and
*Dimercaprol* should be adminstered immediately.

865

Pharmacology

Treatment with osmotic laxatives such as polyethylene glycol


represents the same mechanism of *lactase deficiency* in which
Gastrointestinal & Nutrition
there is a nonabsorbable osmotic substance that causes increase
in water and electrolyte secretion leading to diarrhea.

1156

Pharmacology

Colichy abdominal pain, constipation, irritability and headaches,


Gastrointestinal & Nutrition and works at battery factor, history of iron def anemia --> Lead
posinong

Pharmacology

Pt is given an opioid analgesic and develops upper abdominal


pain. P.E shows tenderness over RUQ. An adverse drug effect
invlving *SMooth muscle cells* is responsible.
Gastrointestinal & Nutrition [Admin of mu opioid analgesics can cause contraction of smooth
muscle of the sphinctor of Oddi leading to spasm and increase in
common bile duct pressure which can lead to increase pressure in
gallbladder and billary colid formation leading to pain]

1290

Pharmacology

Pt with 4 week history of mucoid diarrhea with benign findings on


evaluation (intermitten mild heart burn, unpleasant tase with dairy
products).Pt is started on Diphenoxylate therapy. Primary target of
Gastrointestinal & Nutrition this drug is *Motility*
[Pt has uncomplicated diarrhea, diphenoxylate is an opoid
anti-diarrhea agent structurally related to meperidine, it binds to
mu opiate receptor in gi tracts and slows motility]

8455

Pharmacology

Gastrointestinal & Nutrition

Ribavirin wich is used in Hep C infection works by *Interferring


with duplication of viral genetic material*

11661

Pharmacology

Gastrointestinal & Nutrition

Rifaxim is given in hepatic encephalopathy. It works by


*Decreasingintraluminalammoniaproduction*

11739

Pharmacology

Pts with cholestrol gallstones who refuse cholecstectomy can be


treated with Hydrophilic bile acids (ursodeoxycholic acid) that
Gastrointestinal & Nutrition reduce billary cholestrol secretion and *Increase billary bile acid
concentration*, which promotes gallstones dissolution by improving
cholestrol solubility. Howver, gallstone recurrence may occur.

1710

Pharmacology

GeneralPrinciples

841

1258

low Vd (3-5L) indicates highly charged/ hydrophilic drug and that it


has a high molecular wieght thereby highly protein bound.

1712

Pharmacology

GeneralPrinciples

Graph that is bimodal in measuring the concentration of Isoniazid


in plasma suggest pharmacologic polymorphism in drug
metabolizing capacity. Isoniazid is metabolized by *Acetylation*
and therefore you have slow and fast acetylators.

2112

Pharmacology

GeneralPrinciples

During continous infusion of a drug metabolized by first order


kinetics, the "stead state" is reached in *4-5 half lives*
(calculate it)

219

Pharmacology

Hematology & Oncology

In

Hematology & Oncology

Dapsone when used as prophylactic Tx for pneumocystis jiroveci


in the setting of allergy to TMP-SMX (Drug of choice)in HIV
infected patients can trigger GDPD anemia, which is an *Ezyme
deficiency Anemia*. Symptoms include red cell fragments,
microspherocytes, and bite cells.

893

Pharmacology

1077

Pharmacology

Hematology & Oncology

A medication that is a low molecular weight fraction of a negatively


charged chemical stored in mast cell granules. Its mechanism of
action is *Binding to antithrombin 3*
[LMW Heparin]

1079

Pharmacology

Hematology & Oncology

A platelet surface glycoprotein receptor that normally binds


fibrinogen to support platelet agreggation is Gp2b/3a. This is
targeted by *Abciximab*

1087

Pharmacology

Hematology & Oncology

For Heparin Overdose give *Protamine*


(Not Fresh frozen plasma)
(For warfarin overdose give FFP before vitK, protamine ineffective
for warfarin overdose)

1628

Pharmacology

Hematology & Oncology

Monloclonal antibody against CD20 marker is *Rituximab*

1674

Pharmacology

Hematology & Oncology

An HIV antiviral drug that is structurally unrelated to nucleosides


and is not phosphorylated intracellularly. The drug acts within the
cytolplasm of infected cells to inhibit sunthesis of viral DNA from
RNA template. The drug is *Nevirapine*
[Non nucleaoside Reverse transcriptase Inhibitor, e.g nevirapine
and efavirenz]

1784

Pharmacology

Hematology & Oncology

Enoxaparin is a form of low molecular weight heparin and


therefore binds to *Antithrombin 3* which once activated binds
factor Xa and stops it from converting prothromin to thrombin.

Hematology & Oncology

Pt undergoing chemotherapy who presents with signs of


hemorrhagic cystitis. Pt is probably undergoing
Cyclophosphamide or ifosfamide. This could have been prevented
with giving *MESNA*

1816

Pharmacology

1819

Pharmacology

Hematology & Oncology

Tumor cells become resistant to anticancer agents through


expression of cell surface glycoprotein (P-glycoproetin, coded for
by the human multi-drug resistance gene MDR1) which functions
as an *ATP-dependent transporter*

1890

Pharmacology

Hematology & Oncology

6-mercaptopurine is inactivated by *Xanthine Oxidase*

1893

Pharmacology

Hematology & Oncology

Vincristine inhibits cell synthesis at the M phase. (Microtubules)

2018

Pharmacology

Hematology & Oncology

Etoposide is a chemotherapeutic agent that inhibits the sealing


activity of *Topoisomerase 2*

2132

Pharmacology

Hematology & Oncology

Unfractionated Heparin binds to thrombin and inactivates it better


than low molecular weight heparin.

8371

Pharmacology

Hematology & Oncology

The step that Raltegravir imapirs in viral replication is *mRNA


transcription*

8542

Pharmacology

Hematology & Oncology

Rasburicase converts uric acid into more soluble metabolites.

11585

Pharmacology

Hematology & Oncology

Pt with Human epidermal growth factor receptor 2 tumor positivity


(3+over expression). Adjuvant therapy of a monoclonal antibody is
started. Target of this therapy is *Tyrosine Kinase Receptor*
[Breat Ca, HER2-neu is a tyrosine kinase receptor, antibody is
TrasTUzumab]

11728

Pharmacology

Hematology & Oncology

A therapy for vomiting would involve blocking of *Neurokinin 1*


receptors.
[Part of 5 receptors involved in vomiting, others are 5-H3, H1, M1,
& D2]

271

Pharmacology

Infectious Diseases

*Nystatin* bind Ergosterol in fungal cell membranes

274

Pharmacology

Infectious Diseases

Adminstering Amphoteracin B (binds to ergosterol) has a risk of


Renal Toxicity that could result in Severe hypokalemia and
hypomagnesemia due to increased tubular permeability.
Therefore, *Serum K & Mg levels* should be monitored.

277

Pharmacology

Infectious Diseases

Fungus with mutations in genes coding for Cellwall enzyme would


be resistant to *Capsofungin*, an antifungal that targets cellwall
glucansynthesis.

819

Pharmacology

Infectious Diseases

An HIV drug that can cause Hyperglycemia is *Atazanavir*


{Protease Inhibitors cause hyperglycemia, lipodystrophy, and
dyslipidemia]

1000

Pharmacology

Infectious Diseases

Bcteria that produce an enzyme (Aminoglycoside-modifying


enzyme) transfer an acetyl group to exogenous substance can
gain resistanc to *Gentamicin*.

1004

Pharmacology

Infectious Diseases

Management of household contacts of Meningococcl infection sis


*Prophylactic Rifampin*

1104

Pharmacology

Infectious Diseases

Trimethoprim has the same inracellular target as *Methotrexate*

1198

Pharmacology

Infectious Diseases

A drug for Beta-lactamase producing Bacteroides species is


*Pipercillin-tazobactam*

1223

Pharmacology

Infectious Diseases

M. Tuberculosis with significantly decreaed activity of intracellular


catalse peroxidase exhibit resistance to *Isoniazid*

1228

Pharmacology

Infectious Diseases

Pt being treated with TB that develops blurry vison (bilateral central


scotomas). Likely responsible agent is *Ethambutol* (optic
neuropathy)

1488

Pharmacology

Infectious Diseases

Antibiotic that causes tinitis and hearing loss is most likey an


aminoglycoside which affects *mRNA genetic code reading*
(binds irreversibly to 30s ribosomes)

1644

Pharmacology

Infectious Diseases

Pt with HIV being treated for Colitis (most likely CMV) with IV agent
that does not require intracellular activation and is known to bind in
vitro with viral encoded enzymes such as DNA polymerase, RNa
polymerase, and reverse transcriptase is *FOSCARNET*

1648

Pharmacology

Infectious Diseases

Oseltamivir is a neuramidase inhibitor and is useful in treatment of


Influ A and B viruses. It inhibits *Virion Particle Release*

1952

Pharmacology

Infectious Diseases

Penicilins are structurally similar to *D-alanine-D-alanine* and they


inhibit transpeptidases by binding to its site.

1965

Pharmacology

Infectious Diseases

In treating Malaria by vivax (recurrent fever every 48 hrs).


Primaquine is added to chloroquine in order to *Prevent disease
Relapse*

Infectious Diseases

Antibiotic against MRSA (pt is allegric to vanco) that causes


increassed Creaatinine Kinase and causes muscle pain. The
agent used affects *Maintenance of membrane Potential* of
bacteria.
(Daptomycin, creates transmembrane channels that depolarize
cellular membrane)

8288

Pharmacology

8538

Pharmacology

Infectious Diseases

Tx of enterobius vermicularis is *Albendazole*


[Scotch tape test]

11590

Pharmacology

Infectious Diseases

Pt with HLA-B*57:01 positive results is associated with *Abacavir*

8930

Pharmacology

Pt with BPH and treated with drug that reduces prostate volume is
MaleReproductiveSystem probably beig treated with 5-alpha reductase inhibitors such as
*Finasteride*

264

Pharmacology

Nervous System

Long treatment of Parkinsons with Levidopa renders *DRUG


RESPONSEUNPREDICTABLE*

265

Pharmacology

Nervous System

Entacapone *Increases the quantity of levodopa entering the brain*


[It inhibits Catechol-O-Methly transferase, and hence prevents it
degradation]

348

Pharmacology

Nervous System

Elderly pt with insomnia should be given *Ramelteon* which is a


melatonin agonist. It is safe and effective. Avoid bezos,
antihistaminesandsedatingantidepressants

349

Pharmacology

Nervous System

Benzo for insomnia with a lower rsik of tolerance and dependence


is*Zolpidem*

351

Pharmacology

Nervous System

Phenytoin is metablized by the P45O oxidase liver sysetm and


therefore drugs that induce this sysetm will decrease levels of
phenytoin. Such drugs include: Barbiturates, *RIFAMPIN*,
carbamezapine, grieseifulvin, and chronic alcoho.

352

Pharmacology

Nervous System

Do not use DIazepam with CNS depressants such as


*Chlorpheniramine* which is a 1st gen anti-histamine.

Nervous System

Pt with sudden episodes of severe, right-sided (Unilateral)facial


pain (knife stabbing my face) that lasts several seconds (instigated
by a meal or teeth brushing) with no other symptoms probably has
Trigeminal Neuralgia. The DOC for Tx is *Carbamezapine*.Works
like phenytoin by inhibiting high frequency firing by reducing the
ability of Na channels to recover from inactivation. (Reduces pain).
Side effects: aplastic anemia (check cbc) and drug interactions
(p450 inducer)

Nervous System

Drug interaction 2-3 weeks after New medication (e.g


phenytoin)that presents with cutaneous and systemic symptoms
such as diffuse erythema, generalized lymphadenopathy and
facial swelling arise from DRESS (drug reaction with Eosinophila &
systemic Symptoms) as the name suggests, lab finding would be
*EOSINOPHILIA*

Nervous System

Inahled anesthetic with a vey large atriovenous conc gradient


shortly after begining inhalation would have a *Slow Onset of
Action*
(high atriovenous conc gradient means increased peripheral tissue
solubility which negatively affects brain saturation)

354

508

660

Pharmacology

Pharmacology

Pharmacology

774

Pharmacology

Nervous System

The agent that can perciptate opoid wthdrawal in an opioid tolerant


pt is *Buprenorphine*
[An opiod partial agonist that can act as antagonis in presence of
other opioid medications]

851

Pharmacology

Nervous System

The parameter that correlates to the potency of an inhaled


anesthetic is *Minimal Alveolar Concentration*

852

Pharmacology

Nervous System

Thioepntal is a short acting barbiturate used for anesthesia


induction. After equilibrium in the brain, rapidly redistributes into
SKELETAL MUSCLE and adipose tissue. It mechanism is
increasing the inhibitory effects of GABA receptors in the CNS.

854

Pharmacology

Nervous System

Anesthesia with isoflurane would increase *Cerebral blood flow*

855

Pharmacology

Nervous System

Pt with fever and muscle rigidity soon after surgey. He has high
BP and high HR. P.E shows muscle stiffness and cyanotic skin
mottling. Most approprate treatments affects *Intracell Ca release
in skeletal Muscles*
(Pt has Malignant Hyperthermia, Treated with Dantrolene, a muscle
relaxant that acts on ryandoine receptor and prevents further
release of Ca)

856

Pharmacology

Nervous System

The cause of rapid plasma decay of thiopental was not metabolism


of the drug but rather *redistribution of the drug to other tissues*
throughout the body.

866

Pharmacology

Nervous System

Child with High fever and seizures has febrile seizures and shud
be given *Acetominophen* (Antipyretic, never give aspirin to a
child)

1322

Pharmacology

Nervous System

ST-Segment elevation in inferior leads tells you its Inferior MI. Inf
MI is due to blockage of right coronary artery which supplies SA &
AV nodes. Thus, inf MI's Often present with bradycardia. Treating
bradycardia with ATROPINE thru blocking vagal influence on
nodes thus increasing HR. Side effect of Atropine in the eye is
GLAUCOMA. So pts complains of severe right sided eye pain.

1360

Pharmacology

Nervous System

Receptor that when stimulated causes immediate change in


transmembrane Ca, Na, and potassium secondary to opening of
receptor channel is *Nicotinic Cholinergic Receptor*

Nervous System

A drug that causes less uterine contractions (i.e uterine relaxation)


and Eye Midryasis is *Alpha and beta-adrenergic agonist*
[B2 stimulation in uterus causes relaxation while Alpha 1
stimulation in eyes causes mydriyasis (the basis of using
phenylephrine befor eye exams)]

Nervous System

If pt is on warfarin and a new drug was added and pt developed


thrombotic event, then the new drug lowered efficacy of
anticoagulation property of warfarin through the induction of
CYP450, which is how Warfarin is metablized. One such drug is
Phenobarbital.

Nervous System

Pt with a hand tremor. It is most prominent in activity such drinking


from a glass. She says alcohol improves the tremor. Family Hx is
significant for similar problems. Best Tx for this pt is *Propranolol*
[Essential Tremor, nonselective beta blockers lessens it via CNS
effects]

1368

1777

1946

Pharmacology

Pharmacology

Pharmacology

2000

Pharmacology

Nervous System

Pt that presents with chest pain and has history of HTN,


Diabetesm, and asthma. Tx is given and chest pain disappears but
he now develops dyspnea. Pt was most likey given beta blockers to
relieve chest pain (B-1 block) and develoved bronchoconstriction
(B-2 block) which caused the dyspnea. B-blockers work by
*Inhibiting the neurostransmitter-receptor interaction in adrenergic
synapses*

2089

Pharmacology

Nervous System

Treat serotonin syndrome with *Cyproheptadine* (a first gen.


antihistamine that has nonspecific 5-HT & 5-HT2 receptor
antagonism)

Nervous System

Woman who presents with a migrain who is given a medication to


be used immediately during an attack. Medication most likely affect
*Postsynaptic serotonin receptor stimulation*
(Triptans, e.g sumatriptan, serotonin agononist 5-HT 1B & 1D)

Nervous System

Pt with MS who has spastic paraparesis. Most effective


monotherapy for this pts spasms is *Baclofen*
(agaonist at GABA-B receptor)
(Tizanidine is also effective)

8476

11458

Pharmacology

Pharmacology

11680

Pharmacology

Nervous System

Topical Capsaicin in the non-systemic Tx of post herpetic


neuralgia depletes *Substance P* by over releasing it.

1363

Pharmacology

Ophthalmology

Timolol in Tx of Glaucoma targets *Ciliary epitheliium*


[Decreases aquoeus humor production]
Pt with decreased vision. Says its blurry and distorted. Exam
shows a grayish discoloration of the macula with area of adjacent
hemorrhage. In treatment of this condition, *Vacsular Endothelial
Growth Factor* should be specifically targeted.
(Age related Macular degeneration (AMD), Retinal
neovascularization due to VEGF)
[Txwithranibizumab,bevacizumab)

7721

Pharmacology

Ophthalmology

172

Pharmacology

Poisoning&Environmental
Theophylline toxicity leads to *Seizures and Tachyarrhythmias*
Exposure

507

Pharmacology

Pregnancy, Childbirth &


Puerperium

Valproate increases risk of neural tube defects in pregnant women


such as *Meningocele*

1568

Pharmacology

Pregnancy, Childbirth &


Puerperium

Pt who has severe acne with scarring and now is interested in


Isotretinoin treatmnet. Best next step in management is *Urine
Beta-hCG*
[ral isotrtinoin is Teratogenic]

1775

Pharmacology

Pregnancy, Childbirth &


Puerperium

Tetracyclines (Doxycycline) that are given to treat pregnant women


with Lyme disease can cause fetal *Teeth Staining*.
If pregnancy is known, give Penicillin instead.

222

Pharmacology

Psychiatric/Behavioral &
Substance Abuse

Antipsychotics such resperidone block dopamine and can


therefore allow prolactin release which can cause amenorrhea.
Therefore, persons on respiridone can develop *Drug Induced
Amenorrhea*. Breast tenderness is also seen here.

350

Pharmacology

Psychiatric/Behavioral &
Substance Abuse

First line therapy for pyschomotor agitation in Alcohol withdrawal is


*Chlordiazepoxide*
[Long acting benzo]

519

Pharmacology

Psychiatric/Behavioral &
Substance Abuse

Drug interactions with lithium include Thiazide diuretics. Symptoms


of toxicity include resting tremor, balance issues (ataxia).

704

Pharmacology

Psychiatric/Behavioral &
Substance Abuse

A side effect of Buprion (Norepi and Dop reup inhib) (used in


depression, no sex probs or weight gain) is Seizures.

706

Pharmacology

Psychiatric/Behavioral &
Substance Abuse

Pt on depression medication that is casuing him sexual


dysfunction (SSRI's) can be switched to BUPROPION which
doesnt cause sexual dysfunction.

937

Pharmacology

Psychiatric/Behavioral &
Substance Abuse

Pt that is Dx with panic disorder and is given a drug that relieves


symptoms within an hour. Drug is prbably Benzodiazepine which
*Binds Allosterically to GABA receptor*
Barbiturates work on a different allosteric site and prolong duration
of channel opening in response to GABA.

1868

Pharmacology

Psychiatric/Behavioral &
Substance Abuse

Signs of confusion, fever, flushing, dry mouth, mydriasis and


decreased bowel sounds indiacte an Anticholinergic crisis which
can be caused by Tricylic Antidepressants such as *Amitriptyline*

8259

Pharmacology

Psychiatric/Behavioral &
Substance Abuse

Tx Narcolepst with *Modanfil*

8327

Pharmacology

Psychiatric/Behavioral &
Substance Abuse

Treating pt already on SSRI such as paroxetine with antibiotic


Linezolid can ilicit Sertonin Syndrome characteized by tremor,
hyperflexia, clonus, confusion, agitaton, cramps and diarrhea.

11577

Pharmacology

Psychiatric/Behavioral &
Substance Abuse

A pharmcotherapeutic agent that "reduces craving" for alcohol


Naltrexons which *Blocks Mu-opoid Receptor*

168

Pharmacology

Pulmonary & Critical Care

Pt on glucocorticoids for asthma should be advised to perform


*Oral Rinsing* to avoid side effects of medication.
(if drug lodges in oral mucosa, it can candiasis)

170

Pharmacology

Pulmonary & Critical Care

Drug that revereses irritant induced brochoconstriction but does


not work in vagectomized animals (meaning drug has effect on
vagus nerve) is probably *IpraTROPium* which is a muscurinic
antagonist. It combats the release of Ach due to vagus nerve
stimulation.

171

Pharmacology

Pulmonary & Critical Care

Inhaled Cromolyn is used in Asthma. It *Inhibits Mast cell


degranulation*

Pulmonary & Critical Care

Pt presents with dyspnea and weakness. Mother had similar


symptoms and died at age 42. Lung biopsy shows medial
hypertrophy, intimal fibrosis and decreased intraluminal diameter if
small branches of pulmonary artery. Pt is scheduled for lung
transplantation. The medication indicated for management during
the waiting period is *Bosentan*
[Pt has idiopathic pulmonary a hypertension][Bosentan is
endothelin-receptor antagonist, it blocks vasoconstricting affects of
endothelin]

903

Pharmacology

1312

Pharmacology

Pulmonary & Critical Care

Hiv Pt with CD4 Count of 40 and blood culture grow acid fast
bacteria that grow optimally at 41 C. This could have been
prevented by prophylaxis with *Azithromycin*
(MACComplex)

1446

Pharmacology

Pulmonary & Critical Care

Alcoholic pt with poor dentition whose chest CT shows air fluid


microabscesses. best treatment option is *Clindamycin*
[Oral Anaerobic bacteria causing aspiration pneumonia]

Pulmonary & Critical Care

*Vacrenicline* is a partial agonist of nicotinic acetycholine


receptors. It can assist pts with cessation of tobacco use by
reducing withdrawal cravings and attenuating teh rewarding effects
of nicotine.

Pharmacology

Renal, Urinary Systems &


Electrolytes

With with Diabetes showing peripheral neuropathy and increased


urinary albumin excretion. He has high BP. Best Pharm therapy
for HTN for hypergylcemic pt with microalbuminurea is ACE and
Arbs. E.g: *Lisinopril*

Pharmacology

Renal, Urinary Systems &


Electrolytes

The most dangerous adverse effect of Amhoteracin B is


Nephrotoxicity which can be called *Renal Tubular Dysfunction*
[pt presents with ECG finding of frequent premature ventricular
beats, a finding due to kidney damage induced hypokalemia]

681

Pharmacology

Renal, Urinary Systems &


Electrolytes

Pt with dyspnea, orthopnea, elevated JVP, lower extrem edema,


and lung crackles have acute decomensated heart failure and
should be treated with IV loop diuretics. Which work on *Thick
ascending limb of loop of henle*

685

Pharmacology

Renal, Urinary Systems &


Electrolytes

Loop diuretics such as *Furosemide* can cause Ototoxicity.

1425

Pharmacology

Renal, Urinary Systems &


Electrolytes

Pt on Chlorthalidone that develops muscle weakness. It is due


*Hypokalemia*

Pharmacology

Renal, Urinary Systems &


Electrolytes

Pt on Acyclovir who develops acute elevation of serum creatine


levels. This could have been prevented with *Agressive IV
Hydration*
(Acyclovir Nephrotox)

Pharmacology

Renal, Urinary Systems &


Electrolytes

*Foscarnet* can be used in Ganciclovir resistent CMV. Being a Ca


chelator it can cause hypocalcemia. Also it induces renal wasting
of Mg causing hypomagnesemia. Also reduces production of PTH
further contributing to Hypocalcemia.

Pharmacology

Renal, Urinary Systems &


Electrolytes

Thiazides prevent calcium loss in urine, Thiazides keep calcium in


the body. Thus, they are useful in Tx of nephrolithiasis due to
calcium oxalate stones. Loop diuretics on the other hand lose
calcium. Loops Lose Calcium.

8754

151

275

1642

1643

2003

Pharmacology

8249

Pharmacology

Renal, Urinary Systems &


Electrolytes

Pharmacologic therapy of Urge incontinence involves


*Antimuscurinic Agents*

11945

Pharmacology

Renal, Urinary Systems &


Electrolytes

Erythropoiesis-stimulating agents are associated with increased


risk for *hYPERTENSION* and thromboembolic events.

699

Pharmacology

Rheumatology/Orthopedics Bisphosphanates (e,g alendronate) have similar structure to


& Sports
*Pyrophosphate*

718

Pharmacology

Rheumatology/Orthopedics *Methotrexate* which is used in RA can cause GI ulcers such as


& Sports
"painful mouth ulcers*. It also causes Liver Tox (high liver enzymes)

Pharmacology

Etanercept is TNF-alpha inhibitor used in RA for failed


methotrexate therapy. It is not an Ab but a decoy receptor for
TNF-alpha. Inhibition of TNF-alpha leads to impaired cell-mediated
Rheumatology/Orthopedics
immunity particularly for control of mycobacteria within
& Sports
granulomas and therefore inhibition can result in reactivation of TB
and hence beofore adminstration a *Tuberculin Skin Test* should
be made.

Pharmacology

Colchicine has side effects of ABdominal pain, nausea and


Rheumatology/Orthopedics
diarhea. It binfs to tubulin and therefore affects the cell
& Sports
*Cytoskeleton*

Pharmacology

A gout drug that causes nausea, vomiting and diarhea after intake
Rheumatology/Orthopedics
is a drug that *Inhibits microtubule formation*
& Sports
[Colchicine]

Pharmacology

A muscle relaxant that shows initial equal reduction in response


Rheumatology/Orthopedics
followed by fading away unequal response in the TOF stimulation
& Sports
test is a depolarizing muscle blocker like *Succinycholine*

1773

Pharmacology

Prolonged use of glucocorticoids such as *Prednisone* in pts with


Rheumatology/Orthopedics
Rheumatoid A. can lead to osteoarthritis and cause fractures of
& Sports
vertebral bones for example.

7792

Pharmacology

Rheumatology/Orthopedics A medication that selectively binds to an IL-1 "inducible" enzyyme


& Sports
is probably a selective COX-2 inhibitor such as *Celecoxib*

8481

Pharmacology

Quadriplegic pt who is givena a skeletal muscle relaxant before


Rheumatology/Orthopedics intubation goes into cardiac arrest. He has V fib and massive
& Sports
Hyperkalemia. Admistration of *Succinylcholine* probably caused
hissymptoms*

144

Physiology

Cardiovascular System

The reason why Verapamil has no effect on skeletal muscle


contractility is because skeletl muscle has *No dependence on
extracellular Ca influx*

183

Physiology

Cardiovascular System

During Systole, there is decreased blood flow to the *Left


Ventricular Myocardium*

192

Physiology

Cardiovascular System

Pt with occlusion of "right" coronary artery causes acute MI. This


could lead to Sudden Cardiac Death, the most common
mechanism of death here is *Ventricular Fibrillation*

Cardiovascular System

Really old pt with BP 180/70 at one visit then 175/68. The age
related changes that best explains his BP reading are *Aortic
Stiffening*
[Isolated systolic HTN, Aortic stiffening decreases comppliance of
aorta and elevates pressure during systole]

Cardiovascular System

The most significant factor limiting coronary blood supply during


an exercise test is *Duration of Diastole*
(Myocardial Perfusion happens during Diastole)

Cardiovascular System

Rightward extension of ventricular filling portion of graph indicates


increase in ventricular preload. This can occur in any state of fluid
overload (renal failure, CHF) or after infusion of *NORMAL
SALINE*

720

859

1168

1212

456

951

1511

Physiology

Physiology

Physiology

1512

1513

Physiology

Physiology

Cardiovascular System

Pt presents with sign of hypovolemic shock who is give Normal


Saline. This intervention increases *End-Diastolic Sarcomere
Lenght*
(Increase in preload stretches myocardium and hence the
sarcomere length)

Cardiovascular System

Cardiac tissue conduction velocity is from fastest to slowest as:


Purkinje system-->Atrial muscle--->Ventricular muscle---> AV node
[Park AT VENTure AVenue]

1515

Physiology

Cardiovascular System

Pt with sudden onset palpitation plus rapid regular tachycardia that


responds to carotid massage probbly has PSVT. Carotid massage
increases afferent firing which increases vagal parasympathetic
tone which slows conduction thru AV node and hence *Prolongs
AV node Refractory period*

1516

Physiology

Cardiovascular System

Within the zone of autoregulation of coronary blood flow. The main


endogenous factor for control of coronary blood flow is *Nitric
oxide*

1528

Physiology

Cardiovascular System

The *Blood Flow Per Minute* in the pulmonary circulation closely


matches the blood flow in the systemic circulation. This is true in
both exercise and rest.

1529

Physiology

Cardiovascular System

Cardiac Output= Rate of O2 consumption/arteriovenous O2


content difference.

1557

Physiology

Cardiovascular System

Pt that presents with with dyspnea, orthopnea, and fatigue and with
a history of MI that was not revascularized due to delya in Tx. The
fact that the pt also presents with a diastolic heart sound that is
best heard in the left decubitus position at the apex is consistent
with a decompensated HF. The physical exam finidng (i.e the heart
sound) can be accentuated when *Listening at the end of
expiration*

1589

Physiology

Cardiovascular System

Increase in HR and cardiac output with no changes in PaO2 and


PaCO2 indicate *Exercise*

1609

Physiology

Cardiovascular System

Pt with lightheadedness when pressure is placed on the carotid


sinus has carotid sinus hypersensitivity and the carotid sinus has
AFFERENT sensory fibers to the meduula via the hering nerve
which is a branch of the *Glossopharyngeal nerve*

1621

Physiology

Cardiovascular System

Decrease flow by a factor of 16 decreases radium of lumen by a


factor of 2 meaning *50%*

Cardiovascular System

Decreased Cardiac output with unchanged venous return suggests


a problem in the contractility of the heart either due to a negative
inotropic drug or due to an injury to the myocardium such as with
a myocardial infarction.

1624

Physiology

1625

Physiology

Cardiovascular System

A Cardiac output and venous return curve shows the cardiac


output is increased and the venous return is increased as well with
a rightward shift in right atrial pressure (increased mean arterial
pressure). Most likely cause is *Chronic Atriovenous Fistula*
[High cardiac output with increased venous return indicates
lowering of TPR. The rightward shift of right atrial pressure in the
venous return curve indicates higher mean arterial pressure which
indicates a chronic fistula]

1653

Physiology

Cardiovascular System

In heart catheterization. The structure the produces a pressure


changed of a max of 25 and a min of 2 is *Right Ventricle*

1661

Physiology

Cardiovascular System

Pt with a cardiac murmur and P.E reveals bouding femoral pulses


and carotid pulsations that are accompanied by head-bobbing
most likely suffers from *Aortic Regurgitation*

1931

Physiology

Cardiovascular System

Ca efflux prior to myocyte relaxation is caused by use of


Ca2+ATPase and *NA+/Ca+ Exchange Mechanisms*

1973
1977

Physiology
Physiology

Cardiovascular System

Calcium channel blockers as as verapamil slow *diastolic


depolarization* in SA and AV node.

Cardiovascular System

Pt with irregular beat rhythm, narrow QRS complexes and Absent


P waves has A fib. What determines his ventricular contraction
rate is the *AV node refractory period*

2009

Physiology

Cardiovascular System

During a study, the blood oxygen content of the aorta and several
other vessels is measured at rest. The greatest difference in these
measurements will most likely be between the aorta and the
*Coronary Sinus*
[myocardial oxygen extraction is very high]

8546

Physiology

Cardiovascular System

In pts with CHF, compensatory activation of of RAAS and


*Sympathetic Nervous System* results in increased afterload,
excess fluid retention and cardiac remodelling.

8563

Physiology

Cardiovascular System

When you give Acetycholine to dilat blood vessles. The amino acid
resposnible for this vasodilation is *Arginine*

11513

Physiology

Cardiovascular System

A drug that selectively decreases heart rate but has no effect on


myocardial contractility or relaxation. The ion transpoters that this
medication works on are *Funny Na channels during S4*
[Ivabradine]

770

Physiology

Endocrine, Diabetes &


Metabolism

Thyroid peroxidase enzyme is involved in *Thyroglobin Iodination*


also in oxidation of iodide, and coupling of 2 iodized tyrosine
residues.

821

Physiology

Endocrine, Diabetes &


Metabolism

tan-Fat containing tissue found around the kidneys and adrenals of


a newborn is Brown Fat that helps to prevent *Hypothermia* by
producig heat.

Physiology

Endocrine, Diabetes &


Metabolism

Aching bones and insdeous pain in back, pelvis and lower


extremities, combined with reduced sunlight exposure suggests Vit
D deficiency. UV light from the sun converts
*7-dehydrocholesterol* into *Cholecalciferol (Vit D3)*. Vit D3 is
then converted into 25-hydroxycholecalciferol by 25-hydroxylase.
25-hydroxycholecalcifrol is then converted to
1,25-dihydroxycholecalciferol (active vitD) by 1-alpha-hydroxylase.
This is the enzyme in the kidney acted on by PTH (+) and Ca2+
(-).

Physiology

Endocrine, Diabetes &


Metabolism

Pt with mild hypercalcemia, borderline high PTH levels and urinary


Ca that is very low and normal 25-hydroxyvit D pobably has a
mutation in *Membrane-bound receptor coupled with a G-protein*

990

992

1065

Physiology

Endocrine, Diabetes &


Metabolism

Pt presents with progressve lethargy. For past 3 weeks she had


loss of appetite, constipation, muscle weakness, polyuria and
polydipsia. She has been taking large doses of vitamins. Exam
shows she is stuporous and has dry mucus membranes. The
metabolic abnormality in this pt can also be found in *Sarcoidosis*
[Hypercalcemia]

1615

Physiology

Endocrine, Diabetes &


Metabolism

High T3 would have negative feedback effects reducing TSH, T4


and rT3.

1768

Physiology

Endocrine, Diabetes &


Metabolism

Proinsuline is cleaved by beta peptidases into Insulin and


C-peptide, both of which are then *Packed in Secretory Granules*

11660

Physiology

Endocrine, Diabetes &


Metabolism

Postoperative HypoParaThyroidism is common after


thyroidectomy. Symptoms include Tingling, Numbness, Muscle
Spasms, Seizure, Trousseau and Chvostek signs ( twitching of
lower face muscle on percusiion below zygomatic arch)

208

Physiology

FemaleReproductive
System & Breast

Pulsatile (every 90 mins 4e.g) adminstration of GnRh is indicated


in Infertility (e.g Anovulation)

299

Physiology

FemaleReproductive
System & Breast

Progestron withdrawal leads to menses (i.e bleeding) which is a


result of *Apoptosis*

1560

Physiology

FemaleReproductive
System & Breast

LH stimulates the theca interna cells of the ovarian follicle to


produce androgens. Aromatase within the follicle's *Granulosa*
cells subsequently converts these androgens to estradiol under
FSH stumulation. The theca externa cells serve as connective
tissue support structure for the follicle.

126

Physiology

Gastrointestinal & Nutrition

*Intestinal Influences* help Down-Regulate gastric secretions after


a meal.

1018

Physiology

Gastrointestinal & Nutrition Lipid absorption occurs in the Jejunum.

1358

Physiology

Gastrointestinal & Nutrition

A drug that inhibits primary active transports across cell


membranesis*Omeprazole*

1546

Physiology

Gastrointestinal & Nutrition

Secetin, released by the *Duodenal S cells* stimulates release of


bicarbonate from the pancreas.

1938

Physiology

Pt with secretory diarhea. Her gastric cells lack gastric acid.


Somatostatin relieves her symptoms. An excess of *Vasoactive
Intestinal Peptide* is responsible.
Gastrointestinal & Nutrition
[VIPoma, a pancreatic islet cell tumor results in watery diarhea,
hypokalemia and achlorhydria. Somatostatin decrease productuon
of GI hormones]

1971

Physiology

Gastrointestinal & Nutrition

Secretin increases concentration of *Bicarbonate* released from


the pancreas.

1616

Physiology

GeneralPrinciples

Resistance in parallel is 1/T=1/R1+1/R2+1/R3+...etc


[Remeber to inverse the answer]

787

Physiology

Hematology & Oncology

*The Hepatic Parenchymal Cells* secrete Hepcidin which is a


substance that controls the storage and release of iron through its
binding to ferroportin. Once bound to ferroportin it inactivates it
thus prevents iron intestinal absorption into blood and also prevents
its release from macrophages.

1062

Physiology

Hematology & Oncology

Intracranial Hemorrhage and its associated signs without signs of


trauma in a newborn that didnt receive vaccines is most likely due
to *Impaired clotting facotor carboxylation* as in vit K deficiency.

1082

Physiology

Hematology & Oncology

Fibrinolytics are used in ST segment elevation MI. They may


cause reperfusion arrythmias on arterial re-opening. These are
usually benign. An example is *tPA* [Tissue plasminogen activator]

Hematology & Oncology

CO poisoning causes *Increased CarboxyHb together with


unchanged PaCo2, Methoglobin level is unchanged*
[In Co poisoning, O2 contect is decreased BUT not oxygen partial
pressure which is represented by PacO2]

Hematology & Oncology

Pt who wwas in motor vehicle accident and has received several


units of packed-red blood cells. He now complains of tingling
sensation in his toes and fingers. Ca level is 7.2. Most likely cause
of symptoms is *Ca chelation by a substancce in the transfused
blood*
(Citrate is added prior to storage, chelates Ca)

Nervous System

A pentapeptide with strong affinity to delta and mu receptors


produced after application of noxious stimuli. This substance most
likely has a common molecular origin with *ACTH*
(POMC us cleaved into beta endorphins, ACTH & MSH)

1545

1654

775

Physiology

Physiology

Physiology

776

Physiology

Nervous System

The most likely postsynaptic action of low-dose morphine on the


spinal level (epidural) of a pt who has severe back pain due to
metastatic Ca is *Increasing K efflux out of cells*
[Upon binding to Mu receptors, morphine causes G-protein
coupled activation of K channels to increase K efflux. Increase K
efflux leads to Hyperpolarization of postsynaptic neurons and
termination of pain transmission]

1318

Physiology

Nervous System

In MS, *Length Constant* is decreased.

1356

Physiology

Nervous System

Macular lesions can result in *Central Scotomas*

Nervous System

Pt with cerebral edema who is on a ventilator adjusted to achieve a


pCO2 level bwteen 26-30 mmHG. Most likley effect of this
intervention is *Increased cerebral vascular resistance*
[a dro in pCO2 causes vasoconstriction and increases resistance
and hence reduces cerebral blood flow]

1493

Physiology

1657

Physiology

Nervous System

A pt is being evaluated for hypoventilation. He is asked to take


several deep breathe in rapid succession. Physiograph shows
decreasing amplitude of cyclic intrapleural pressure changes
during deep rapid breathing. Most likely site of this pts disease is
*Neuromuscular Junction*
[Pleural pressure changes indicate diaphragmatic contraction.
Decreasing contraction with each breathe (weaker with repition)
This most likely involves NJM (e.g Myasthenia Gravis or restrictive
lung)

11682

Physiology

Nervous System

Gaba pentin Inhibits presynaptic voltage-gated Ca channels thus


preventingneurostransmittervesiclerelease.

1987

Physiology

Pregnancy, Childbirth &


Puerperium

Progestrone inhibits prolactin during getstation thereby preventing


lactation.

481

Physiology

Pulmonary & Critical Care

The resistance in the airways starts high from the begining and
jumps up more at medium sized bronchioles due to highly turbulent
flow. The resistance then decreases going towards subsequent
generations till reaching the terminal bronchioles due increased
surface area allowing low resistance laminar flow.

536

Physiology

Pulmonary & Critical Care

Dust particles smaller than 2 micrometres are eliminated by


macrophagesthroughphagocytosis.

1357

Physiology

Pulmonary & Critical Care

Pt with acute metabolic acidosis (Normal HCO3 with low pH and


High Pco2)could most likely suffer from *Heroin Overdose*
[Heroin causes respiratory depression and hypoventilation]

1514

Physiology

Pulmonary & Critical Care

The CFTR protein is a transmembrane *ATP-gated* Chloride


channel.

1521

Physiology

Pulmonary & Critical Care

Pt with illness like with Obstructive Lung disease would have air
trapping in lungs and hence a high *RV/TLC ratio*

1522

Physiology

Pulmonary & Critical Care

Pt with tracheal pO2 of 150, Alveolar pO2 of 145, and Alveolar


pCO2 of 5 has *Pulmonary alveolar perfusion*
note: tracheal pO2 is normal. Normal alveolar pO2 is 104.

1526

Physiology

Pulmonary & Critical Care

P(A)O2(Alveolar)=150-(PaCO2(Arterial)/0.8)

Pulmonary & Critical Care

The PO2 in the left atrium and ventricle is lower than that in the
pulmonary capillaries due to mixing of oxygenated blood from the
pulmonary veins with *Deoxygenated blood* arising from the
bronchil arteries and thebesian veins.

Pulmonary & Critical Care

Sudden-onset tachypnea and chest pain in a hospitalized pt shud


raise suspicion for Pulmonary Embolism. Especially if pt is
immobilized or had recent surgery. Thrombotic occlusion of
pulmonary circulation leads to increased blood flow to remainder
of lung causing a *Ventilation-perfusion V/Q mismatch*

1542

1584

Physiology

Physiology

1586

Physiology

Pulmonary & Critical Care

Increase in hemtocrit with normal red blood cell mass indicates


*RelativeErythrocytosis*

1587

Physiology

Pulmonary & Critical Care

The tissue that would Increase vascular resistance due to low


Oxygen tissue content is the *Lungs*

1620

Physiology

Pulmonary & Critical Care

Increased lung volume increases PVR in alveolar vessels and


decreases PVR in extra-alveolar vessels. *PVR is lowest near FRC*

Pulmonary & Critical Care

In high altitudes Po2 decreases and body responds by


hyperventilation which hence decreases PCO2 causing a
respiratory alkalosis (low pH). After 2 days the kidney respond to
the alkalosis by excreting HCO3 and decreasing it in blood.

1980

Physiology

1981

Physiology

Pulmonary & Critical Care

Obese truck driver with history of calf swelling who presenst to ER


with sudden onset dyspnea probably has PE lodged from DVT
(calf swelling). In PE there is *respiratory alkalosis, low CO2, Low
O2, and normal HCO3*

1161

Physiology

Renal, Urinary Systems &


Electrolytes

ADH acts on *Medullary segment of collecting duct*

1559

Physiology

Renal, Urinary Systems &


Electrolytes

In a study a volunteer is given a substance that that specifically


and complete inhibits glucose transport in the proximal renal
tubules. In this volunteer, glucose clearance will best approximate
the clearance of *Inulin*
[No tubular reabsorption or secretion, filtered amount equals
excreted amount]
[Note that PAH is secreted as well]

1588

Physiology

Renal, Urinary Systems &


Electrolytes

The nephron segment that will have the lowest concentration of


PAH is *Bowman's capsule*

1607

Physiology

Renal, Urinary Systems &


Electrolytes

In the setting of low ADH, the highest osmolality is at the *Bottom


of Loop of Henle*

1608

Physiology

Renal, Urinary Systems &


Electrolytes

If animal is deprived of water, ADH will be high, high ADH


promotes water reabsorption. The place with the lowest urine
osmloarity (highest dilution) would be the distal convoluted tubule.
Why? because its impermeable to water but continues to reabsorb
electrolytes. Also, the fluid just came from the ascending limb
which is also impermeable to water but reabsorps electrolytes.

2012

Physiology

Renal, Urinary Systems &


Electrolytes

After adminstration of Desmopressin, renal clearance of *Urea*


decreases.

8881

Physiology

Renal, Urinary Systems &


Electrolytes

When GFR is normal, relative decease in GFR results in only a


small increase in serum creatinine. However, when GGFR is
significantly decreased, small decrements of GFR produce large
changes in serum creatinine.

638

Physiology

Rheumatology/Orthopedics The marker that reflects the activity of osteoblasts is *Serum Level
& Sports
of bone-specific Alkaline Phosphatase*

639

Physiology

Pt with pain and deformity of long bones with hearing loss (due to
bony deformity of the skull). The pathologists identifies
Rheumatology/Orthopedics multinuncleated cells containing over a 100 nuclei. The factor that
is essential for the differentiation of these cells is *Receptor
& Sports
Activator of Nuclear factor Kappa-B ligand (RANK-L)*
(Pagets disease of bone, Osteoclasts)

824

Physiology

Rheumatology/Orthopedics Lack of Tubules in muscle fibers will result in *Uncoordinated


& Sports
contraction of myofibrils*

Physiology

Biopsy of a pt shows haphazardly oriented segments of lamellar


Rheumatology/Orthopedics bone with prominent cement lines. The pathogenesis of the
condition initially involves increases activity of *Osteoclasts*
& Sports
(Osteolytic phase of paget disease of bone)

987

1665

8266

Physiology

ATP helps release *Myosin head from Actin binding site*, and thus
Rheumatology/Orthopedics
lack of ATP leads to persistance of myosin-actin cross bridge
& Sports
(Rigor mortis)

Physiology

Wieght lifter who raises wieght above head and then his arms
Rheumatology/Orthopedics suddenly and involuntarily give away and he drops the wieght to
ground. The structure that was most likley responsible for the
& Sports
suddent muscle relaxation is *Golgi tendon organ*