Cases/questions:

Female patient is on a whole bunch of drugs including Warfarin, diuretics, antihyperlipedimics,

etc. She has recently become pregnant and has consulted the doctor, which of the drugs should be
discontinued.
Answer: Warfarin (teratogenic for fetus).
Which of the abdominal aorta branches supply the foregut
Answer: Celiac trunk
Patient presents with inflammation and necrosis of small intestine, ascending colon and proximal
2/3 of transverse colon, which blood vessel is involved:
Answer: superior mesenteric A.
Which branchial arch makes up Mandible and Mylohyoid, etc.
Answer: first arch
Picture of endochondral bone formation (similar to picture in first aid) and asks which of the
following bones are formed by the shown process. Choices were clavicle, skull, femor, etc.
Answer: Femur (long bones)
Picture of a child being able to bring her shoulders together, which bone is she missing:
Answer: clavicle
Which cells in testes provide the Blood Testes barrier:
Answer: Sertoli cells
Knee injury and tear in MCL and ACL
Which organ in the body releases most ANG II into the body?
Answer: lungs (has ACE)
EM of muscle asking to point to Z line
Scraping the stratum corneum from the skin, what is the most important complication?
Answer: loss of fluid from body and dehydration (since stratum corneum contains Keratin and
protects against blood loss)
Gap junctions are able to transmit Electrical current between cells

Patient presents with fever and shivering. What is the purpose of shivering?
Answer: thermoregulation (it generates heat).
Sudden wild flailing of one arm, where is the lesion of the drawing:
Answer: subthalamus
Patient presents with deviation of uvula and shoulder droop, where is the lesion?
Answer: jugular foramen
Point to the muscle that depresses the eye from the adducted position
Answer: Superior Oblique muscle (same diagram as in page 108 first aid, 2001 edition).
Marcus Gunn Pupil
Lesion in which blood vessel causes left homonymous hemianopsia (angiography similar to circle
of willis pictures in High Yield Neuro)
Answer: right post. Cerebral
Brown Sequard lesion
Dorsal Column pathway and lesions of Gracilis fibers and Cuneatus fibers and how they affect
sensation on upper and lower limbs.
Radial nerve injury
Cervical rib and what it affects
Answer: inf. Trunk of brachial plexus
Cohort study
Heroin addiction and long term maintenance
Answer: methadone
Delirium (patient not oriented as compared to dementia in which patient is oriented)
Conversion disorder
Post traumatic stress disorder
Personality disorders: Avoidant and Schizotypal

Narcolepsy
Borderline patient using splitting as a defence mechanism (either everything is good or
everything is bad)
Lots of questions on shizophrenia (at least 4)
Thought disorder, Loose associations, etc.
Hardy Weinberg population genetics calculations
Glucose-6-phosphate dehydrogenase deficiency and reaction to sulfa drugs
Which a.a. become essential in a patient with PKU with phenylalanine restricted diet:
Answer: tyrosine
Picture of patient with blue sclera
Answer: abnormal collogen synthesis
Patient presents with muscle weakness and hypertrophy of calf muscles, which chromosome is
defective?
Answer: X chromosome (DMD)
Uncoupling agents and on which part of mitochondria they work?
Anwer: dissipate proton gradient across the inner mitochondrial membrane
Urea cycle
Arachidonic Acid products (very heavily tested, at least 5 questions)
LT B4 (neutrophil chemotactic agent)
LT C4, D4, E4 (slow reacting substances of anaphylaxis)
TX A2 (vasoconstrictor and stimulates platelet aggregation)
PG I2 (inhibits platelet aggregation and vasodilation)
Collogen Synthesis and structure
Vitamins (heavily tested):
B1 (alcoholics)

B2 (cofactor in oxidation and reduction-FADH2)

B6 (given along with isonizid to prevent peripheral neuropathy)
Vitamin C (hydroxylation of proline and lysine in collogen)
Vitamin D (which organ hydroxylates 25 hydroxy D3 at alpha1 position: kidney)
Vitamin K (coagulation factors)
Which test diffentiates staph aureus from other staph (believe it or not!)
Answer: Coagulase test
Alpha Hemolytic bacteria
H. pylori infection (at least 2 questions)
BMT regimen
Which of the pairs result in long term neurological complications?
Answer: Borrelia and Treponema
Mucor infection in diabetics
(same picture shown as on page 191 of first aid, 2001 edition)
After an earth quake in california, epidemic of lower respiratory infection which lasts for 2-3
weeks, which of the bugs responsible for it?
Answer: Coccidiodomycosis
Candida vaginalis in diabetics
Toxoplasma and brain abcess in HIV
Giardia and foul smelling stools
Most important sequale in infectious Mono:
Anwer: splenic rupture (I think).
Patient has C3 deficieny, which disease is he most likely to be susceptible to
Answer: only capsular organism listed was pnomococcus
2 questions on Huntington Disease:

trinuclear repeat pattern

point to Caudate Nuclei on MRI
alpha fetoprotein as a marker for malignancy
11,22 translocation in Ewing sarcoma of the bone

Hereditory Spherocytosis and treatment

Answer: splenectomy
IgG spike on plasma proteins (shown in a diagram) and asked how the patient presented
Answer: bone pain
Hirschprungs disease and what causes it
Patient presents with cirrhosis after being diagnosed of liver disease many years ago. When he
presented at first ALT was elevated, what is the most likely cause of cirrhosis?
Answer: Hep C (if AST was higher, it would have been alcoholic cirrhosis).
Chronic pancreatitis and its association with alcoholism
Pancreatic adenocarcinoma and signs associated with it (eg. Weight loss, obstructive jaundice and
palpable gallbladder
Diagnosis of emphysema in a non-smoker 25 year old with dyspnea, hyperexpanded lung fields
and lowered breath sounds and its association with a1antitrypsin deficiency (panacinar
emphysema)
Restrictive lung disease and FEV/FVC ratio (>80%)
Paraneoplastic syndromes associated with small cell carcinoma of the lung and the signs
associated with it (eg. Hyponatremia associated with SIADH in small cell carcinoma)
Patient presents with tremor and rigidity, upon taking history you find out that patient has been
experiencing with a designer drug. What is the most likely region of the CNS thats involved
Answer: Dopaminergic neurons of substantia nigra
Treatment of Parkinsons
Patient presenting with upper and lower motor neuron problems

Answer: ALS
Epidural and Subdural hematomas and their diagnosis based on history.
Patient presenting with signs of Brocas Aphasia, point to region of the brain that is most likely
involved.
Diagnosis of Horners Syndrome
Patient presents with signs and symptoms of arthritis, morning stiffness and Dup. Deformity of
the hands and fingers, what abnormal test result is expected.
Answer: Anti-IgG antibodies in the serum (diagnostic of RA)
At least 3 questions on gout and drugs used for it (eg. Patient presents with joint pain after
chemotherapy for Hodgkins lymphoma, etc.)
SLE and kidneys wireloop lesions, False positive on syphilis test (VRDL) and drugs which
induce SLE and diagnostic features
Patient presents with Sacroiliac joint inflammation, which HLA tests are likely to be positive
Answer: choose whichever one had HLA B27
Hyperaldosteronism and its diagnosis based on renin, Na and K values in plasma
Distinguishing between primary and secondary adrenal insufficiency
Pheochromocytoma and drugs used for it (esp. nonselective irreversible alpha blocker)
All the features associated with MEN I and MEN II
Hypho and Hyperthyroidism and diagnosis based on symptoms and signs and plasma values of
T3, TSH for each
Diabetes types I and II (at least 5 questions)

Ketoacidosis associated with type I

Symptoms associated with diabetic coma
Renal complications (arteriosclerosis and glomerular lesions on light microscope
Lab values associated with diabetic ketoacidosis

Carcinoid tumor diagnosis based on symptoms and what abnormal test is positive in urine
Answer High HIAA in urine

Osteoprosis and its association with corticosteroids

BPH and drugs used for it
Hyadid mole and increased HCG associated with it early in pregnancy
Endometrial hyperplasia and incrased risk of endometrial carcinoma with abnormal uterine
bleeding
An obese female presents with high LH and hirsutism. Dx?
Answer: Polycystic Ovarian Syndrome
Cardiomyopathies esp. Hypertrophic cardiomyopathy: hypertrophy involves the interventricular
septum and 50% is caused by mutation in B globin gene of heavy chain (familial). Usually seen
in athletes.
Heart murmurs and their diagnosis based on features of the murmur
DVT and pulmonary embolism. Bone marrow embolism seen as a complication of bone fractures.
May lead to sudden death.
Wegeners granulomatosis and its Dx based on symptoms (C-ANCA was not given). WG
involves the upper airways and youll see granulomas (this is the distinguishing feature from
Goodpastures syndrome
Minimal change disease effacement of BM
Acid Base physiology
Pharmacodynamics graphs distinguishing Agonist with competitive antagonist and irreversible
antagonist
Mechanism of Tetracycline
Nephrotoxicity associated with Aminoglycosides and also ototoxicity.
Isoniazid and B6 which can prevent neurotoxicity
HIV triple therapy (two nucleotide reverse transcriptase inhibitors with a protease inhibitor.
Mechanism of Dantrolene
Isoprotrenol effect and reflex tachycardia associated with it
Mechanisms of action of sympathetic receptors, Dopamine receptors (eg. cAMP, IP3, etc.)
Antipsychotics and Tardive dyskinesia

Lithium and its effect on thyroid (may cause hypothyroidism)

Sumatriptan and its mechanism of action
ACE inhibitors and its effect on blood pressure and its mechanism of action
Cardiac glycosides and its effect on intracellular and extracellular Na and K
Busulfan associated with pulmonary fibrosis
Cisplastin associated with Nephrotoxicity
Lead poisoning and its features (eg. lead lines) and treatment
H2 Blockers and their mode of action and their effects on gastrin and stomach acid
Arachidonic acid products and their effects on vascular tone and platelet action
Leuprolide and its indications (also mechanism of action).

Pacemaker action potential and its differences with ventricular action potential (eg. upstroke is
opening of Ca channels rather than Na channels).
Calculation of cardiac output with Fick principle
Cardiac cycle graphs
Mechanism of smooth muscle contraction and its differences with skeletal muscle (eg.
involvement of calmodulin)
Capillary fluid exchange and calculations involving hydrostastic and oncotic pressures, etc.
Glucose clearance and at plasma glucose of 200 glucosuria begins
PTH and Vit D effects on plasma Ca and phosphate.
Steroid hormone mechanisms (binds to receptor located in nucleus or in cytoplasm)
Distinguishing 11B hydroxylase and 21B hydroxylase
Prolactin regulation and Dopamine
Oxygen dissociation curve and which factors effect it (eg. pH)
Secretin and stimulation of release of antacid

Bile and how its recycled (absorption via ileum and how it causes malabsorption of fat in
patients with ileal resection).

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Here are the q's I recall:

1. know your mediators (IL-2, IL-456, IL 10,
TNf,TGF, IFN)
2. know cd 16 and 56 are killer cells
3. where both clotting pathways meet
4. acute MI what the gross and histo look like at
all stages,
5. brachial plexus- I had ulnar nerve b/c interossei
weren't working
6. know 2nd messengers-oxtyocin, alpha 1
7. herpes pneumonitis, with giant cells
8. splenic infarct, from where?
9. cardiac tamponade
10. go over jamie's sheets- 10 icm type q's
11. know the arachadonic acid pathway and enzymes
and inhibitors
12. t(9;22) cml
13. lat rectus on mri
14. wilsons- they showed the kleiser fleicher ring
15. cystic hygroma- turners syn
16. mitochondrial inheritance -2 q's
17. know everything about digoxin 4 q's
18. pku
19. b-cell def- no germinal centers in LN
20. know the cyto p450 inducers and inhibitors - 6
q's
21. scleroderma- ab against?
22. I had no sle
23. bph and prostate cancer- drugrs, recepters, 3q's
24. ebv in Aids cancer- lymphoma
25. know your endocrine physio- hormones up and down
26. know the resp. curves in first aid, where would
fibrosis be?
27. know histo of the hepatocyte- fxn of organelleI had mitochiondria
28. know histo of kidney- pct, dct, loh- where
glucose is reabsordeb, where
vit d is activated
29. restrictive cardiomyopathy
30. p. carinii -know what it looks like
31. marasmus
32. carcinogens in bladder cancer
33. schistosomes in bladder cancer

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34. ASCVD-2 q's

35. prinzmetal angina- drugs, recepters, -2 q's
36. endocarditis-viral, bacterial
37. India ink-crypto
38. ida, anemia of chronic dz
39. vwb dz- whats up?
40. henoch-scholheim purpura on the leg-vasculitis
41. pathogenesis of TB
42. didn't have a lot of behavioral but what I did
have was alzheimers, and
a few "what do u tell the pt" q's
43. hand foot mouth dz- coxsackie
44. cherry red macula and European-hexoaminidase a2
45. gauchers
46. tuberous sclerosis- 2 q's (when did we learn
this)- know it is assoc. w/
embryonal rhabdomyosarcoma and calcifications in
brain
47. cancer met. to colon
48. crohns dz
49. hirshprungs dz- failure of neural crest cells
50. know your gi physio- 5 q's
51. moa of omeprazole
52. moa of vancomycin
53. moa of neostigmine
54. causes of malig. Hyperthermia
55. pathogenesis of spider angioma
56. malig. Htn- pic
57. min. change dz- vignette was classic
58. pid-chlamydia
59. carnitine def-s/s
60. transformation- dnase
61. fracture to fibula- loss of deep peronial nerveloss of dorsiflexion2q's
62. damage to base of penis-blodd flow is lost in
which part of urethra
(weird q)
63. hypertinic bladder-whereis lesion?
64. where does seminoma drain?
65. know your fractures- what muscles pull them
where- 3 q's
66. fracture to lt. 9-11 ribs- spleen
67. cavernous sinus thrombosis- fxn's lost
68. av nicking , banking- learnit well ,2q's
69. myasthenia gravis- 2 q's
70. hashimotos= 2 q's
71. dermatomes
72. 6-8-10, 8-10-12, lung -pleura relationship
73. rt. Atrial hypertrophy on cxr

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74. paradoxical emboli

75. brca met. via axillary nodes
76. soft tissue sarcoma
77. hemoglobin c
78. hla b27- reiters syn
79. proteus- uti stones
80. pathogenesis of gall stone-supersat. Of
cholesterol
81. acute panreatitis vignette-inc. amylase
82. nodular glomerulosclerosis in D.M.
83. know your vaccines, and active and passive
immunizations
84. cohort study, case series
85. I had 5 q's on epidem. (ppv, spec, sens)
86. p=id
87. endometriosis
88. 2 bitemp. Hemianopsia's
89. know your goiters- toxic, hot, cold, non toxic,
multitoxic
90. brached hyphi- dermatophyte
91. hyper -PTHism
92. cushings syn
93. addisons dz
94. duchenne's musc. Dystrophy- pedigree
95. osteo sarcoma
96. comparing osteomyleitis and osteo chondritisweird q
97. pseudo gout
98. neuro syph- arguile robinson pupil
99. vitamins- b12, pyridoxine, and vit c
100. desmopressin in diabetes insipidus
101. know your murmers. How thy look normally and on
a wiggers
102. I had no ekg-s
103. salmonella
104. mhc 1- tap ptotein
105. cavernous hemangioma, is it bad?
106. lot of angio tension -renin stuff- 4 q's
107. ipratropium in copd
108. colchicimein acute gout
109. filtration fraction up and down..why?
110. know your acid-base stuff- weird q's with
combined.alcoholic that
vomits and had diarrhea (what the !@#$#$?) know the
values
111. know your lesions in the CNS- whats ipsi whats
contra
112. little biochem on the exam-know the rls's

>>>
>>>1. I had two questions r/t Baye's Theorum (Genetics)
>>>2. Remember how I said ANS &CNS Pharmacology are Key!!
>>>3. Gliaden and wheat causing Celiac Sprue
>>>4. They showed a picture of a Penis with a lot of Painful nodules. They
>>>did not have H. ducreyi, T. pallidum, Herpes, as the choices!!! By the
>>>way, this was the first question I saw after I got back from Lunch.
>>>5. Conditions favoring Metabolic Acidosis/Alkalosis
>>>6. Slide of Hairy Cell Leukemia.
>>>7. I had five Questions on Lyme Disease (Go Watsons!) A word of
Caution,
>>>Lyme Disease does happen in Oregon.
>>>8. What Causes Trendelenberg Sign and Waddling Gait
>>>9. Know all about Heparin and Warfarin
>>>10. I had a question on Croup and Slapped Cheek Disease (Fifth Disease)
>>>11. Lots of Vitamin Questions, so know the roles of Vitamin
A,C,K,B12,B6,
>>>Thiamine.
>>>12. For the behavioral questions, they would ask you what the next step
>>>is. Pick the least invasive and the answer that gives the most degree of
>>>freedom. What I mean is that if the competent patient refuses to comply
>>>with the doctor, that is his right.
>>>13. For those that have the plagarized MSA Notes (Red ICM Book), it
would
>>>be a good idea to go over them before the exam. I had a few respiratory
>>>questions that could not have been answered had I not red the chart in
>>>the book.
>>>14. Role of Gap Junctions
>>>15. Nephritic and Nephrotic Syndromes
>>>16. I only had one SLE Question
>>>17. McArdles Disease, Tay Sachs, Gaucher's Disease were questions.
ANATOMY
-mesonephric ducts=male spermatochord
-inguinal fascia and saddle injury (kids starts to pee, where will urine go
inside body cavity, NOT down thigh)
-diaphragmatic hernia
-GI blood supply (celiac trunk=forgeut)
-ureters and obstructions
-macula adherens
-ciliar dynein (Kartagener's syn)
-picture of lesion in Broca's area
-spianl cord lesions
-braichial plexus (of course, mine was axillary n.)
BEHAVIORAL
-lots of "how would you respond as the physician" questions, WITH lengthy
clinical descriptions. read the actual question first, it will allow you to skip a
lot of the data they give

-graph asking how you would maximize sensitivity

-odds ratio
-types of studies (cohort, case-control)
-speech development (what the hell?)
-developmental milestones
-narcolepsy
-sleep apena (central vs. obstructive) X2
BIOCHEM
-DNA mutations
-where in cell introns are removed
-tRNA attachemnt to ribosomes
-modes of inheritence (I actually had one ask me the chance of a MAN
passing an X-linked recessive gene to a son, read CAREFULLY)
-urea cycle
-carnitine
-glucokinase vs. hexokinase kinetics
-enzyme kinetics
-collagen structure and the role of lysyl oxidase
MICRO
-staph aures food poisoning
-fungal questions X3
-pork tape worm
-normal flora for nose
-infant pnuemonia
-hypersensitivity (for contact dermatitis)
-Rhogam is PASSIVE immunity
PATH
-congenital heart defects
-fragile X dz
-risk of translocation with maternal age
-Duchenne's MD is xlinked
-CF: psuedomaonas infections and autsomal recessive
-marfans and dissecting aortic anuerysms
-neural tube defects and alpha FP
-melanoma (depth of lesion is worst sign)
-epidural hematoma (they called it extradural)
-anemias
-bleeding disorders
-multiple myeloma
-obstructive lung dz
-ARDS
-arthritis
-SLE
-ankylosing spondylitis
-osteoporosis and compression fractures
-hydatidiform mole is 46 XX
-breast dz (what a blocked lymph duct would look like??)

-Coxsackie B (dilated cardiomyopathy)

-heart murmurs
-temporal ateritis (tx: prednisone)
-acid/base graphs
-Xray of pnuemothorax
PHARM
-maintanence dose
-first order elim.
-effect of antagonist in general
-tetracycline mechanism (MORE than knowing 30S)
-aminoglycosides=ototoxicity
-INH mechanism
-cocaine additction mech.
-PAM
-Dantrolene mech. (Ca2+ from SR) (yes, got it right Kelly)
-Beta blockers
-Alcohol and Benzodiazipenes
-Sumatriptan mech
-Diuretics X5-6
-Quinidein efx X3
-Bleomycin side efx (cancer bear will be your friend)
-warfarin mech
-misoprostol (w/NSAIDs)
-H2 blockers
-Arachidonic acid pathway X3
-diabetic drugs (increasing insulin receptor sens)
-prednisone
PHYS
(not that many calculations, few were there weren't too bad)
-cardic output
-cariac loop cycle (then inferring which one had largest CO)
-control of BP
-filtration fraction
-Glc. clearance
-kidney hormones
-PTH
-uses of estrogen
-menopause profile
-O2 diss. curve
-secretion and bicarb
-calculate calories (from CHO, prot. and fat)

"G-d Does not Play Dice with Nature, The only reason for time is so
everything doesn't happen at once."
"-Albert Einstein- (1879-1955)"

Every obstacle presents an opportunity to improve our condition