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Placenta Previa Bright Red Blood >24 weeks

prev C, Twin, Smoke, Coke


Placental Abruption HT (mc), coagulopathy
PolyHydromneos MC in DM mother
OligoHydromneos PCKD, dehydration of Mother, ACE I of Mother
Oral Con Endometrial and Ovarian RF ↓
HYPERTENTION
Lactose in Lac ON Inducer binds to Repressor / Rep can not bind
Glucose in Lac OFF via ↓ cAMP
Lobar Consolidation Strep
Patchy Pneumoniea hospital
HL or NHL Neoplastic enlargement

K+ Sparing Toxicity? Gyno


THIAZIDES Tox? ⇑ Ca
LE Syn (screen for) SCL CA
Dexamethazone test for ? Pit Adenoma

Tyramine MOA Block MAO-A


Dobutamine use?, receptor? CHF, β 1

Opioid rx on mm? Strait (rlx) Circular (cons)


Opioid receptor Gi

β blockers w/r to Glaucoma ↓ Formation


M3 agonist (cholinergic) ⇑ drainage

PN Cushing Syn SCLC, Pancreatic CA, Nural tx, Thymomo


ACTH or ACTH like
PN SIADH SCLC
PN HyperCa+ SqCLC, Breast, Renal, MM, ATcL, Ovarian
PTH-like, TNF, IL-1
PN Carcinoid Syn Bronchial Carcinoid Adenoma, Pancreatic, Gastric
Serotonin, Bradykinin Carcinoma

Glucagon stimulates? GluconeoGeneses, GlycoLysis


Insulin inhibits? GluconeoGeneses, GlycoLysis
Epiniephrine stimulates GluconeoGeneses, GlycoLysis
Insulin stimulates PFK 2

Addisons Disease low? Cortisol


OOA -> PEP requires (3) PEPCK via Cortisol, Glucagon

Low Cortisol -> hypoglycemia

Malate Shuttle transfers ? OOA across mito in gluconeogen


Cori Cycle RBC -> Lactate -> Glucose -> RBC

SCID via ADA No B or T cells


SCID via IL-2 No T-cells (CD8 & CD4)
SCID via MHC II No CD4

Macrolide tox Blood


Aminoglycosides tox Ear, Kidney
Chloramphemnicol GB via no UDP-GT in infants
FluoroQ’s tox (think athlete) Tendon rupture (Q = Naladixic Acid)

(INH) isoniazide tox? SLE-like


CMV can release Renin
Trympanosoma (America) Chaga Nifurtimox
Trympanosoma (Africa) Suramin

Hypovolemic Shock ↓LVEDP via loss of blood or fluid


↓CO -> ⇑PVR via NE, E & Angio II
Cardiogenic Shock ↓CO via ↓FOC of LV -> ⇑PVR
⇑LVEDP via more blood
Septic Shock Gr “–“ pathogens
Endotox-> endothelial dmg -> NO, I2
All forms of shock -> Endotox-> C3a, C5a-> mast cell-> histamine (VD)
⇑ lactic acid via tissue hypoxia
Tubulare Nec via coagulation in PT TAL Macrophage-> IL-1, TNF
⇑CO via ↓ PVR from histamine
↓LVEDV via neutrophils in alvoli-> pul edema

Risk of Having Disease and Test + (TP) ↓ a/(a+c) sensitivity


Risk of NOT Having and Test - (TN) ↓ b/(b+d) specificity
Risk of Having + Test w Disease (TPPV) -> a/(a+b)
Risk of – Test and NO disease (TNPV) -> d/(c+d)

Risk of Having Disease X (Odds Ratio) X ad/cd


Risk of Getting Disease (Relative Risk) -> a/(a+b)
->c/(c+d)
Exposed Risk (Attributed Risk) a/(a+b) – c/(c+d)

More or less likely an outcome is? + LR sensitivity/1-specificity


- LR 1-sensitivity/specificity

MOA Hypoglycimics (Sulfonyls) Block K+, Open C+

Vitamin C Osteoid Matrix Formation


V-D low -> Steatoria

Horseshoe Kidney Inferior Mesenteric, Inc in Turners Syn

EXO
Shiga Toxin Protein Syn Inhibitor (PsI) @ 60S
Diptheria, Psudomona EF2 is ADP-r -> PsI
Vibrio c. (A-B toxin), V.p and V.v ⇑ cAMP by ADP-r
ENDO
N. meningitides PLS-> CD14-> macrophage, NO-> shock

Acyclovir pro-drug To acyclo-GMP by viral thymidine kinase


Dinotrophenol -> Uncoupling -> thermogenisis in ETC

Somatic Mosaicism in 46/47 XY/XXY


Gonadal/Germline Mosaicisam -> Skip Generations in AD

Chromium Potentiate Insulin


Selenium T4->T3 and Stimm Immune sys
Goat Milk NO B6 or Folate

Hurshsprungs Myentaric (auerbouch), Sub Mucosal (meissners)


Achalasia Myentaric only

SLE (drug induced) Anti – Histone, ssDNA


SLE Anti – Sm, dsDNA

Metyrapone ACTH stim

Meningititis < 1month S. agalactaie


< 18yrs N. menengititis
> 18yrs S. pneumonia

String Test Giardia, Strongyloides, Cryptosporidium


Crunching sound on Aus, or touching of skin Subcutaineous emphysema

Ciliac Villous atrophy


Wipple Foamy macs in the lamina propria
Lithochoic acid VDR, solubilize fats in colon

1st degree HB _ __ ___ ____ ⇑ PR


2nd a HB _ _ _ _ _ X dropped PR
2nd b HB _ _ _ _ _ X dropped QRS
3rd degree HB _ _ P _P _ _ _ P Lime Dz

Comedocarcinoma Firm mass, with purulent exudates, calcification


Restrictive Cardiomyopathy (stiff wall) Pompes, Iron Overload, Amyloid, Fibrous
Pericardial Effusion ⇑ P in all chambers yet Hypotension.
Kussamals (JVD)
Pulsus Paradoxus (↓ pulse on inspiration)
Constrictive Pericarditis (thick wall) MCC is TB, knock when Ventricles hit pericardium
Bronciectasis CF, TB, Kartangers
Atelectasis After surgery, elevated diaphragm, ↓ surfactant
Choanal atresia Blockage of nasal passage
Cardiogenic Shock PW LVEDP ⇑
ARDS PW LVEDP , neutrophil injury

Sq Sm CC Central
Adenocarcinoma Peripheral

Plummer Vinson Syn Dysphagia for solids not liq


PSS, CREST BOTH

HSP C-reactive Protien, IgA & C3 deposits

Bombestin SCC, Gastric C, Neuroblastoma MARKERS & - feedback


with CCK
Amitryptiline CI in glaucoma (MOA M blocker)
CI in Glaucoma M blocker α agonist
Remember β -blockers ↓ Aq Humor

Von Gerk Dz Hepatomeg, Hypogly


Gaucher HepatoSplenomeg, Lymphadenopathy
N Pick Dz Splenomeg, Lymph, Mental, Motor
Questions:
REPRODUNCTIVE/EMBRIOLOGY
1) Pt presents with: Painless bleeding in 4th month of pregnancy and Hypertension. Blood test reveal increased hCG and
Hyperthyroidism.

a) 69XXY
b) partial mole
c) Echinococcosis
d) DIC
e) 46XY
f) placenta previa

2) 12 yr old girl presents to clinic with stage 4 Tanner development of the breast. Increased levels of Inhibin are seen on BT, if
untreated it is expected to progress to Endometrial Hyperplasia. Estrogen secretion is elevated, as well as pathogenic Eosinophilic
secretions.

a) 21 –hydroxylase deficiency
b) pituitary tumor
c) hyperprolactinemia
d) granulose cell tumor
e) adrenal adenoma

HEMATOLOGY/ONCOLOGY
3) Chronic Alcoholic Pt comes to ER complaining of sudden onset of dyspnea, chest pain and is coughing large amounts of dark
blood after a lengthy car trip. Osculation reveals a friction rub. Blood tests will reveal?

a) increased AST
b) increased bleeding time
c) d-dimers
d) increased erythropoietin

4) A diabetic pt complaining of sever and reoccurring abdominal pain is presented to the psychiatric ward with paranoia,
anxiety and family confirmed depression and occasional seizures. Past medical history is consistent for Phenobarbital, Clozapine,
Metforman, Acarbose. What drug is contributing to the psychiatric symptoms and abdominal pain and why?

a) Acarbose via delayed sugar hydrolysis


b) Metformin via lactic acidosis
c) Phenobarbitol via increased CYP 450
d Clozapine via agranulocytosis

50 An elderly pt presents with swollen gums, easy bruising. It is found that her diet consists mainly of toast and sugar filled
juice. What would the blood hemostasis show?

Platelet Count Bleeding Time PT PTT


a) ↓ ⇑ N N
b) ↓ ⇑ ⇑ ⇑
c) ⇑ ↓ N N
d) ⇑ ↓ N ⇑
e) ↓ ⇑ N ⇑

6) 35 yr old Male complains of erectile dysfunction and gynocomastia. Alcohol consumption is extremely high. Examination
shows no dysfunction to seminiferous tubules. Identify the correct hormone levels?

Testosterone Sperm Count LH FSH


a) ↓ ⇑ ⇑ ⇑
b) ↓ ↓ ⇑ N
c) ↓ ↓ ⇑ ↓
d) ↓ ↓ ↓ ↓

7) 54 year old woman presents to ER with amenorrhea, hot flushes and night sweats. Physical exam reveals clitoromegaly and
excess pubic hair. Lab findings show increased Testosterone and Estrogen. What is the dx.

a) Menopause
b) Exogenous Estrogen from OCP
c) Poly Ovarian Syndrome, LH:FSH ratio >2
d) Secondary Amenorrhea

8) 13 year old pt comes to ER presenting chronic weakness and hypotention and hyperpigmentation. Lab results revile
increased ACTH, eosinophilia, lymphocytosis and neutropenia. Physical exam reveals enlarged liver. What is the cause of the
disorder?
a) Neisseria Meningitidis
b) M. pneumonia
c) S. Areus
d) Miliary TB

9) Pt presents to ER with painful rash in mouth and on skin. Tests reveal immunoflorescence throughout epidermis. What is
the explination?

a) IgG antibody against hemidesmosomes


b) Type IV sensitivity reaction
c) DNA-Anti DNA immunocomplex deposition in basement membrain
d) IgG antibody against desmosomes
e) IgA antibody deposit at tip of the dermal papillae

10) Pt is presented to the ER after a car crash. Xray shows hemisection of the spinal cord at L2. What will the pt present with?

a) Ipsilateral UMN signs L2 and below, Ipsilateral loss of tactile stimulation and proprioception L2 and below, Ipsilateral loss of
sensation at L2, Contralateral pain and temp loss at L2 and below.
b) Hornors Syndrome
c) Ipsilateral UMN signs L3 and below, Ipsilateral loss of tactile stimulation and proprioception L3 and below, Ipsilateral loss of
sensation at L2, Contralateral pain and temp loss at L3 and below.
d) Ipsilateral UMN signs L3 and below, Ipsilateral loss of tactile stimulation and proprioception L3 and below, Ipsilateral loss of
sensation at L2, ipsilateral pain and temp loss at L3 and below.

11) Pt presents with increased weight gain, moon face, hyperinsulinemia. What additional findings will be present?

a) pheochromocytoma
b) hypophsphate
c) osteoporosis
d) legg-calve-perthes disease
e) osteomylitis

12) Pregnant woman with hypertention. What is the MOA given the most appropriate aanti-hypertensive?

a) competitive inhibition of DOPA decarboxlase


b) β agonist
c) Alpha 2 agonist
d) Alpha agonist
e) a, c, d
f) a, c

13) Pt is being examined for visual function. The Dr shines a light in the right eye of the pt and sees constriction of the pupil he
notices that the left pupil does not respond at the same time. What nerve and nucleolus is damaged.

a) CN II, Lateral Geniculate


b) CNII, Suprachiasmatic
c) CNIII, Edinger-Westphal
d) CNIII, Suprachiasmatic
e) CNII, Edinger-Westphal

14) Pt is being examined for Corneal Reflex with a cotton swab. The Dr touches the left eye of the pt and the pt blinks. Given
that the right eye should also blink through efferent stimulation what could the pt also be suffering from?

a) Sjögren's syndrome
b) mastication
c) lock jaw
d) hperacusis
e) tinnitus

15) Predict the phenotype of a lacZ mutant, which has a mutation in the gene for β-galactosidase.

a) The production of all protein products would be affected.


b) The production of β-galactosidase would be affected, but other protein products would be unaffected.
c) The production of β-galactosidase would be affected, and the production of some other protein products might also be affected.
d) The production of β-galactosidase would be unaffected, but other protein products would be affected.

1) Why do drugs such as Penicillin, Rifampin, Sulfas, NSAIDs and Diuretics -> Interstitial Nephritis

a) hypersensitivity
b) allergic
c) drug concentration toxicity
d) urine retention

2) Why is there swelling associated with Nephrotic syndrom

a) decreased protein
b) osmotic change
c) low urine outflow
d) blocked tubules

3) Administration of a drug that increases Cortisol will lead to?

a) increased metabolism
b) increased T-cell proliferation
c) increased gluconeogenisis
d) increased bone formation
e) decreased urine

4) Individual flies to the alps from sea level. What is the physiological body compensation?

a) respiratory acidosis leading to glycolisis


b) respiratory alkalosis leading to glycolisis
c) decreased 2,3 BPG
d) decreased Oxygen % in air

5) How can alcohol lead to Hyperthermia

a) Mitochondrial toxin to the outer matrix decreasing protons inside the matrix
b) Coupling of Oxidative phosphorylation
c) Mitochondrial toxin to the inner matrix increasing protons inside the matrix
d) Vasoconstriction of peripheral artieries

6) Why are electrolyte levels low in Bartter Syn?


A: defective cotransport in the TA loop

7) Loop diuretics functions are based on the?


A: disruption of the hypertonic renal medulla -> hypotonic

8) Albright Syndrom is caused by?


A: increased adrenal signaling via G-proteins

9) A 12 yr old boy presents with fever, malaise, hypertension and smoky urine. He did have an upper throat infection about 2
days ago. On physical exam, his vitals are normal.

a) IgA mediated vasculitis


b) Post streptococcal glomerulonephritis
c) Anti GBM disease
d) Acute tubular necrosis
e) Interstitial Nephritis
f) Cryoglobulinemia
g) HSP

DDx:
a) Berger, hematuria, URI, children more common
c) Goodpastures, age 20-40 more common, pulmonary hemoptysis
d) ⇑ BUN, brown urine casts (ischemic, dehydration, shock)
e) drug induced (penicillin, cephalexin, NSAID, anti-freeze)
f) HCV, GI, Palpable Purpura, Raynauds
g) joint pain, child, PP of bum and lower extremities

10) Pt becomes sick after being out for a sushi dinner, lab shows No bacteria in culture.
What is the mechanism of action?

a) Protein Syn Inhibitor (PsI) @ 60S


b) EF2 is ADP-r -> PsI
c) ⇑ cAMP by ADP-r
d) LPS-> CD14-> macrophage, NO-> shock

11) From Q 10 above, What is the bacteria that caused the sickness?

a) V. cholerae
b) V. parahemolyticus
c) V. vulnificus
d) C. diphtheria

12) Young AIDS pt with dyphagia and pain while swallowing.

a) CMV
b) VZV
c) H esophagitis
d) oral thrush

13) See a AD pedigree with skip generations. What is the reason for the skiped den?
a) non disjuction
b) random
c) somatic mosaicism
d) gonadal mosaicism

14) Child presents with diarrhea and convulsions. On physical exam it is noted that his nails have transverse lines or bands of
blood across. What would the ingested substance affect.

a) RAA
b) liver parenchyma
c) Cytochrome IV ofETC
d) OOA in gluconeogenisis

30) Child w/ numerous bacterial infections, chronic diarrhea and ear infections is brought in for testing. Blood test reveals pro-T
cells however no mature T or B cells. What is the deficient enzyme?

a) adinosine deaminase
b) IL2
c) MHC II
d) IgM

31) Pt returns home after an MI with warfarin, asparin to take. INR is within normal range for the first week and then proceeds
to increase. What could have the pt been adding to his diet in excess to account for the problem?

a) Vitamin A
b) Vitamin C
c) Vitamin K
d) Vitamin E

32) Pt has 46 XY genotype, delayed puberty, and hypogonadism.


Lab reports show ↓ LH, ↓ FSH. What is the disease?
Physical exam reviel color blindness and lack of smell associated with CN I.

a) Klinfelters Syndrome
b) Kallman Syndrome
c) Noonans Syndrome
d) Turners Syndrome

33) Pt taking a mesna to counter the actions of a drug she is on for sever rheumatoid arthritis is at risk of developing which of the
following?

a) bone marrow suppression (bms)


b) anemia
c) hemorrhagic cystitis
d) breast cancer
e) bladder carcinoma (tcc)
f) c & e

34) Pt presents with Magenta tongue (blue red), neovascularization of cornea, angular stomatitis (chilitis). What is the Vitamin
deficiency?

a) pyridoxine B6
b) riboflavin B2
c) pantothenic acid B5
d) V-A
e) biotin B7

35) Person on a camping trip drinks the stream water and becomes tired, dizzy and bluish in color. What is happening
metabolically ?

a) Increased Ferric acid Fe3


b) Increased Ferrous acid Fe2
c) acute polycythemia
d) lead poisoning

36) In the pt above in Q20, what would be the cure?

a) pyridoxine B6
b) pantothenic acid B5
c) methyl blue
d) V-C
e) d & e

37) A company has done a drug survey and they are interested in increasing the probability of a Normal (disease free) test. What
factors need to be in place?

a) increase the Sensitivity


b) increase the Specificity
c) increase the PPV
d) increase the NPV
e) b & c + decreased sensitivity and NPV

38) pt on corticosteroids will have atrophy the adrenal gland in?

a) glomerulosa
b) facicularis
c) reticularis
d) b, c

39) Which of the following decreases adhesion molecule synthesis?

a) endotoxins
b) C5a
c) LTB4
d) IL-1
e) TNF
f) lithium

40) Woman on OBC estrogen with have?

a) decreased platelet aggregation


b) increased angiotensinogen -> hypertension
c) increased antithrombin III
d) decreased cholesterol in bile
e) increased libido

41) Stable cell? (must have stimulation to pass G0 phase?

a) skeletal mm cell
b) smooth mm cell
c) cardiac mm cell
d) stem cells
e) intestinal cell

42) MC bone met to the vertebral column is?

a) prostate cancer
b) potts syndrome
c) batson venous plexus
d) transitional carcinoma of the bladder

43) Esophageal varices drain venous blood into?

a) right gastric, azygous


b) coronary, azygous
c) left gastric, right gastric
d) left gastric, portal vein

44) Pt with CMV has used gancyclovir with minimal results. Given the next drug req. what is the MOA?

a) erogosterol synthesis antagonist (k)


b) pyrophosphate binding antagonist of DNA (f)
c) conversion to acyclo GMP by thymidine kinase blocking DNA polymerase (a)
d) conversion to dGTP thus inhibiting binding of viral DNA polymerase (g)

45) pt is sensitive to sunlight, with wine-red urine upon voiding what is the defect?

a) decreased uroporphyrynogyn synthase


b) decreased uroporphyrinogen decarboxylase
c) increased ALA (α -aminolevulinic acid)
d) decreased coproporphyrins

46) pt has intermittent nuerological dysfunction, psychosis, and abdominal pain. What is the defective enzyme?

a) decreased uroporphyrynogyn synthase


b) decreased uroporphyrinogen decarboxylase
c) increased ALA (α -aminolevulinic acid)
d) decreased coproporphyrins

47) 35yr old male with chronic lower back pain radiating to other spinal areas as well as fatigue. The pt also complains of
floaters in the eye along with an aversion to bright light. What is the diagnosis?

a) anemia
b) osteoporosis
c) ankylosing spondylitis
d) SLE

48) Given the above pt, what is a common cause of the disease?

a) klebsiella
b) E.coli
c) S. pneumonia
d) N. meningititis

49) Pt on thiazide diuretics will show a ECG with the following?

a) short QT interval
b) long QT interval
c) T wave
d) U wave

50) Pt has neck vein distention when breathing in (Kussmauls sign), radial pulse is decreased (pulsus paradoxus). On
auscultation there is MUFFLED heart sounds. What is the problem with the heart?

a) Congestive Cardiomyopathy
b) Hypertrophic cardiomyopathy
c) Constrictive Pericarditis
d) Tuberous sclerosis

51) In above question, what is the dx if the pt has a diastolic KNOCK on auscultation?

a) Congestive Cardiomyopathy
b) Hypertrophic cardiomyopathy
c) Constrictive Pericarditis
d) Tuberous sclerosis