QID Topic Educational Objective System Subject Repeats

539 Antipsychotics Pts Tx w/ clozapine are req to have regular monitoring of the absolute neutrophil count due to the risk of life-threatening agranulocytosis. Allergy & Immunology Immunology 9
(AI) (Immu)
540 Bipolar disorder Antidepressant monotherapy can induce mania in susceptible pts, esp. those w/ unrecognised BD. Allergy & Immunology Immunology 7
(AI) (Immu)
541 Lithium Chronic lithium tox (e.g. confusion, ataxia, NM excitability) can be precipitated by volume depletion and drug interactions w/ TZDs, ACEIs, and NSAIDs. Allergy & Immunology Immunology 2
(AI) (Immu)
556 Lung abscess Lung abscess is most often due to aspiration of anaerobic oral bacteria such as Peptostreptococcus, Prevotella, Bacteroides, and Fusobacterium species. RFs for lung Allergy & Immunology Immunology 4
abscess incl conditions that ↑ aspiration risk, such as alcoholism, drug abuse, seizure disorders, previous stroke, and dementia. (AI) (Immu)
557 Lung transplantation Chronic lung transplant rejection is due primarily to progressive scarring of the small airways, leading to bronchiolitis obliterans. Manifestations occur months or years Allergy & Immunology Immunology 2
after transplantation and include obstructive lung disease (eg, reduced FEV1) with dyspnea and dry cough. (AI) (Immu)
558 Lung transplantation Chronic rejection is a major problem in lung transplant recipients; it affects small airways, causing bronchiolitis obliterans. It's characterised by lymphocytic Allergy & Immunology Immunology 2
inflammation, fibrosis, and, ultimately, destruction of the bronchioles. (AI) (Immu)
561 Primary immunodeficiency Leukocyte adhesion deficiency is due to absence of CD18 antigens necessary for the formation of integrins. Clinical features are caused by failure of leukocyte Allergy & Immunology Immunology 7
disorder chemotaxis and include recurrent skin and mucosal infections without purulence, delayed separation of the umbilical cord, and persistent leukocytosis. (AI) (Immu)
569 Hypersensitivity reactions Type IV (delayed) hypersensitivity reactions (eg, Candida extract skin test, contact dermatitis) are characterized by erythema and induration that develops 24-48 hours Allergy & Immunology Immunology 4
after repeat exposure to an antigen. T lymphocytes mediate the inflammation in these reactions through cytokine release, CD8+ cytotoxicity, and macrophage recruitment. (AI) (Immu)
571 Rhesus alloimmunization HDN most commonly occurs from maternal sensitization to Rh Ags during a prior preg w/ an Rh(D)+ fetus. In subseq Rh(D)+ pregs, maternal anti-Rh(D) IgG Abs cross Allergy & Immunology Immunology 2
the placenta and cause a severe AIHA in the fetus and life-thr hydrops fetalis. (AI) (Immu)
743 Antidepressants TCA overdose can Px w/ mental status changes, seizures, prolonged QRS duration, ventricular arrhythmias, and anticholinergic findings. NaHCO3 is used to Tx Allergy & Immunology Immunology 4
associated cardiac toxicity and works by ↑ serum pH and extracellular Na (alleviating fast Na channel blockade). (AI) (Immu)
745 Vitamin K deficiency VitK is necessary for the carboxylation and fxnality of coag Fs II, VII, IX, and X. Newborns who don't receive prophylactic supplementation are at risk for bleeding Allergy & Immunology Immunology 2
complications. Pts w/ CF are also at risk for vitK defic due to poor absorption of fat-soluble vits. (AI) (Immu)
750 COX 2 inhibitor Selective cyclooxygenase 2 (COX 2) inhibitors relieve pain with lower risk of bleeding and gastric ulceration than nonselective nonsteroidal anti-inflammatory drugs. Allergy & Immunology Immunology 1
(AI) (Immu)
759 Rheumatic fever Acute RF is a complication of untreated group A streptococcal pharyngitis. RHD is the most common cause of acquired valvular heart disease and CV death in developing Allergy & Immunology Immunology 5
countries. The incidence of acute RF and RHD has been ↓ in industrialized nations w/ prompt Tx of streptococcal pharyngitis w/ penicillin. (AI) (Immu)
762 Endocarditis Staphylococcus aureus causes acute BE w/ rapid onset of SSx, including shaking chills (rigors), high fever, dyspnea on exertion, and malaise. In IVDUs, it can cause Allergy & Immunology Immunology 15
right-sided endocarditis w/ septic embolization into the lungs. (AI) (Immu)
965 Multiple sclerosis MS is an AI disorder of the CNS Chx by recurrent episodes of demyelination, leading to ↓ saltatory conduction. INO and optic neuritis are common MFx. Allergy & Immunology Immunology 6
(AI) (Immu)
1132 Glanzmann thrombasthenia Abciximab is a blocker of GP IIb/IIIa receptor, which normally promotes platelet binding to FI. GP IIb/IIIa is either defic or defective in pts w/ Glanzmann Allergy & Immunology Immunology 1
thrombasthenia. (AI) (Immu)
1155 Child abuse Physicians should contact CPS immediately if there is suspicion of child abuse. Allergy & Immunology Immunology 2
(AI) (Immu)
1468 Acute myeloid leukemia Auer rods are deformed azurophilic granules found in the cytoplasm of myeloblasts that stain (+)ly for MPO. Auer rods are found in abundance in AML M3 (APML). Allergy & Immunology Immunology 3
(AI) (Immu)
1614 Gastrointestinal hormones Secretin is prod by S cells in the duodenal mucosa in response to stim by intraluminal activity. Secretin stims the release of HCO3-rich secrs from the exocrine pancr, Allergy & Immunology Immunology 2
which is the major source of acid-neutr HCO3 entering the duodenum. (AI) (Immu)
1995 Ischemic stroke UMN SSx include abnormal plantar flexion (Babinski sign), spastic paralysis, ↑ muscle tone, clasp-knife rigidity, hyperreflexia, pronator drift, and pyramidal weakness Allergy & Immunology Immunology 19
(weakness more pronounced in lower extremity flexors and upper extremity extensors). LMN SSx include flaccid paralysis, weakness w/ hypotonia and muscle atrophy, (AI) (Immu)
fasciculations, and suppressed or absent reflexes.
2068 Fabry disease In Fabry disease, α-galactosidase A deficiency causes accumulation of the sphingolipid Gb3. The earliest MFx of Fabry disease are neuropathic pain and angiokeratomas. Allergy & Immunology Immunology 1
Glomerular (e.g. proteinuria, renal failure), cardiac (e.g. LVH), and cerebrovascular (e.g. TIA, stroke) complications develop in adulthood. (AI) (Immu)
2069 Niemann-Pick NPD is an AR disorder that's common in the Ashkenazi Jewish pop. This disorder is characterised by sphingomyelinase defic and sphingomyelin accumulation, which Allergy & Immunology Immunology 2
cause hepatosplenomegaly and neuro regression in infancy. (AI) (Immu)
2078 Cocaine Cocaine is a stim that inhibs the presynaptic reuptake of NE, DA, and 5-HT. Intox pts develop agitation, tachycardia, HTN, and light-responsive mydriasis due to ↑ Allergy & Immunology Immunology 3
sympathetic activity. Cocaine is also a potent vasoconstrictor that can cause myocardial ischemia and atrophy of the nasal mucosa and septum. (AI) (Immu)
2079 Primary hypertension TZDs ↑ serum Ca, uric acid, Glc, cholesterol, and triglyceride lvls. They ↓ serum Na, K, and Mg lvls. Allergy & Immunology Immunology 14
(AI) (Immu)
8384 Antiretroviral therapy The HIV genome contains 3 major structural genes that are translated as polyproteins and subsequently cleaved by host protease (env gene products) or viral protease Allergy & Immunology Immunology 7
(gag-pol gene products) into the individual proteins that compose the HIV virus. PIs block viral protease from cleaving gag-pol polyproteins, which results in the (AI) (Immu)
formation of immature virions that are noninfectious.
8530 Iliopsoas muscle Muscles used when sitting up from the supine position incl the ext. abdo obliques, the rectus abdominis, and the hip flexors. The iliopsoas muscle is the most important of Allergy & Immunology Immunology 1
the hip flexors and incls the psoas major, psoas minor, and iliacus. The rectus femoris, sartorius, tensor fascia lata, and the med. compartment of the thigh also contribute (AI) (Immu)
to hip flexion.
8539 Infectious mononucleosis The 1° immune response to EBV is mediated by CD8+ T lymphocytes, which are activated thru the presentation of viral Ags on infected CD21+ B lymphocytes. These Allergy & Immunology Immunology 5
reactive (atypical) CD8+ T lymphocytes can be observed in the peri blood smears of pts w/ IM. (AI) (Immu)
11677 Medical errors Physicians must be able to identify pts w/ limited English proficiency and ensure that professional interpreters are made available in high-risk clinical situations. Allergy & Immunology Immunology 8
(AI) (Immu)
11872 Grief Normal grief presents w/ SSx similar to those of a major depressive episode. However, in normal grief, pervasive anhedonia, worthlessness, and suicidality aren't present. Allergy & Immunology Immunology 3
(AI) (Immu)
15293 Zika virus Zika virus is an ssRNA that infects foetal neural progenitor cells, causing severe congenital malformations (e.g. microcephaly, arthrogryposis), cerebral cortical thinning, Allergy & Immunology Immunology 1
and possible foetal demise. (AI) (Immu)
732 Renal artery stenosis In RAS, incr production of AT-II causes incr syst BP (to incr renal perfusion) and pref constriction of the glom eff art (to incr GFR). Pts w/ bilateral RAS are dependent Allergy & Immunology Microbiology 9
on this response to maint renal fxn; initiation of ACEIs or ARBs can precip ARF. However, UA is typically u/r (i.e. no hematuria, proteinuria, or casts). (AI) (Micr)
1388 Diabetes mellitus α2 adrenergic receptors inhib insulin secretion, and β2 adrenergic receptors stim insulin secretion. The α2 mediated inhib effect is gen predominant, causing sympathetic Allergy & Immunology Microbiology 31
stim to lead to overall inhib of insulin secretion. (AI) (Micr)
7581 Congenital adrenal Tx of CAH involves low doses of exogenous CSs to suppress excessive ACTH secretion and ↓ stim of the AC. Allergy & Immunology Microbiology 6
hyperplasia (AI) (Micr)
11525 Femoral neuropathy FNMN can occur due to trauma, compression from a retroperitoneal hematoma or abscess, or injury during Sx or childbirth. Findings incl quadriceps weakness, ↓ patellar Allergy & Immunology Microbiology 1
reflex, and sensory loss over the ant. and med. thigh and med. leg. (AI) (Micr)
458 Acute pancreatitis Pancreatic pseudocyst is a common complication of acute pancreatitis. It is a collection of fluid rich in enzymes and inflammatory debris. Its walls consist of granulation Allergy & Immunology Pathology (Path) 9
tissue and fibrosis. Unlike true cysts, pseudocysts are not lined by epithelium. (AI)
459 Pancreatic cancer Smoking is the most important environmental RF for pancreatic ca. Other RFs incl advanced age, chronic pancreatitis, and genetic predisposition (e.g. Peutz-Jegher's Allergy & Immunology Pathology (Path) 1
syndrome). (AI)
11667 Infection control HH is the single most important measure to ↓ the risk of transmission of hospital-acquired infections. Allergy & Immunology Pathology (Path) 3
(AI)
761 Catheter related Nosocomial bloodstream infections are usually a/w intravascular catheters, which allow skin commensals such as S. aureus and CoNS to enter the bloodstream. Allergy & Immunology Pathophysiology 3
bloodstream infection (AI) (Patp)
174 Diabetic nephropathy The risk of progression of DN in pts w/ proteinuria can be decr by approp glycemic and BP control. ACEIs and ARBs are the pref antiHTN agents due to their Allergy & Immunology Pharmacology 4
antiproteinuric effects, which're independent from their effects on syst BP. (AI) (Phar)
1366 Vestibular schwannoma Schwannomas Px histologically w/ a biphasic pattern of cellularity (Antoni A and B areas) and S-100 (+) (indicating neural crest origin). Schwannomas can arise from the Allergy & Immunology Pharmacology 3
peripheral nerves, nerve roots, and CNs (except CN II). Acoustic neuromas are the most common type of intracranial schwannoma and are located at the CPA at CN VIII. (AI) (Phar)
1612 Aspirin poisoning Aspirin intoxication should be suspected in a pt w/ the triad of fever, tinnitus, and tachypnea. Adults w/ aspirin toxicity initially develop a 1° resp alkalosis f/b a mixed Allergy & Immunology Pharmacology 1
resp alkalosis and AGMA. When the PaCO2 and HCO3 are outside the normal range, a normal pH suggests a mixed acidosis/alkalosis disorder, as compensatory (AI) (Phar)
responses do not correct the pH completely.
1170 Phosphodiesterase ANP, BNP, and NO activate guanylyl cyclase and ↑ conversion of GTP to cGMP. PDEIs (e.g. sildenafil) ↓ the degradation of cGMP. ↑ intracellular cGMP lvls lead to Biostatistics & Biostatistics 1
inhibitors relaxation of vascular smooth muscle and vasodilation. Epidemiology (BS) (Bios)
1171 Principles of cell biology Cellular compartmentalisation allows multi bch processes to occur simultaneously at max efficiency. β-oxidation of FAs, the TCA cycle, and the carboxylation of Biostatistics & Biostatistics 1
pyruvate (GNG) all occur w/i the mitochondria. The enzymes responsible for glycolysis, FA synthesis, and the PPP reside in the cytosol. Epidemiology (BS) (Bios)
1172 Peroxisomal disorders The buildup of very long chain and branched-chain (e.g. phytanic) FAs due to impaired oxidation is the hallmark of peroxisomal disorders (e.g. Zellweger syndrome, Biostatistics & Biostatistics 1
adrenoleukodystrophy). Accumulation of these FAs in the brain results in permanent neuro dysfxn. Epidemiology (BS) (Bios)
1173 Diabetes mellitus Insulin is an anabolic hormone that acts via RTK signalling to ↑ the synthesis of glycogen, proteins, FAs, and NAs. Tyrosine kinase/PI3K stim promotes glycogen Biostatistics & Biostatistics 31
synthesis by activating protein phosphatase, an enzyme that dephosphorylates (activates) glycogen synthase. Epidemiology (BS) (Bios)
1174 Signal transduction The phosphoinositol 2nd messenger system begins w/ ligand-receptor binding and Gq-protein activation leading to activation of PLC. PLC then hydrolyzes PIP2 and Biostatistics & Biostatistics 1
forms DAG and IP3. Finally, IP3 activates PKC via an ↑ in intracellular Ca2+. Epidemiology (BS) (Bios)
1175 Physician patient Physicians are frequently asked to evaluate whether a pt is entitled to disability benefits. When interacting w/ demanding pts, it is best to explain that the physician has a Biostatistics & Biostatistics 11
communication responsibility to perform a thorough Ax prior to making this determination. Epidemiology (BS) (Bios)
1176 Decision making capacity When pts are unable to make their wishes known and there is no written documentation of them, the responsibility for medical decision-making falls to their designated Biostatistics & Biostatistics 5
health care proxy. If a pt has not designated a surrogate decision maker, medical decisions default to the NOK. In the case of a married person, the NOK is usually the Epidemiology (BS) (Bios)
spouse.
QID Topic Educational Objective System Subject Repeats
1177 Ethical principles in Consent of a married or unmarried significant other is not required for a pt to undergo any type of procedure, including sterilization. Physicians should counsel the pt Biostatistics & Biostatistics 3
healthcare regarding the risks and benefits of, and alternatives to, any procedure or Tx. Epidemiology (BS) (Bios)
1178 Physician patient In situations in which a parent's presence may interfere w/ obtaining honest answers from an adolescent pt, physicians should politely ask the parent to wait outside and Biostatistics & Biostatistics 11
communication interview the pt privately. This is also important when discussing drugs, alcohol, tobacco, and sexual activity w/ teenagers. Epidemiology (BS) (Bios)
1183 Hypersensitivity reactions Type 1 hypersensitivity reactions are mediated by the interaction of allergen with preexisting IgE bound to basophils and mast cells. This facilitates cross-linking of the Biostatistics & Biostatistics 4
surface IgE molecules that signals the cell to degranulate releasing chemical mediators (eg, histamine, heparin). These agents are responsible for the immediate signs and Epidemiology (BS) (Bios)
symptoms of allergy, from a local wheal and flare to life threatening anaphylaxis.
1184 Chediak-Higashi syndrome CHS is an AR disorder of neutrophil phagosome lysosome fusion that results in neuro abns, partial albinism, and an ID caused by defective neutrophil fxn. Biostatistics & Biostatistics 1
Epidemiology (BS) (Bios)
1185 Contact dermatitis Poison ivy dermatitis is a form of allergic contact dermatitis, which is a type IV hypersensitivity reaction mediated primarily by T lymphocytes. It manifests as intensely Biostatistics & Biostatistics 2
pruritic erythematous papules, vesicles, or bullae that often form linear patterns. Epidemiology (BS) (Bios)
1186 X-linked XLA (Bruton) is caused by a defect in B cell maturation, resulting in the absence of mature B cells w/ severe defic of all Ig types. T cell # and fxn remain intact. Due to Biostatistics & Biostatistics 2
agammaglobulinemia the absence of B cells, 1ary lymphoid follicles and germinal centers won't form w/i LNs. Epidemiology (BS) (Bios)
1187 Acute diarrhea Shigella is a non-motile, non-lactose fermenting organism that doesn't produce H2S when grown on triple sugar Fe agar. Mucosal invasion of the M cells that overlie Biostatistics & Biostatistics 13
Peyer's patches is an essential pathogenic mech for Shigella infection. Shigella then escapes the phagosome and spreads laterally to other epithelial cells via actin Epidemiology (BS) (Bios)
polymerisation.
1188 Acute diarrhea Depending on the age and condition of the host and the species of Shigella, as few as 10-500 cells can cause infec. Biostatistics & Biostatistics 13
Epidemiology (BS) (Bios)
1189 Typhoid Typhoid strains of Salmonella contain a capsular Ag (Vi) that inhibs neutrophil phagocytosis, neutrophil recruitment, and macrophage-mediated destruction. Therefore, Biostatistics & Biostatistics 2
typhoid strains are able to undergo extensive replication w/i the intracellular space of macrophages w/ subseq spread thru the lymphatic and RES, leading to a widespread Epidemiology (BS) (Bios)
systemic disease (typhoid fever).
1191 Urinary tract infection E coli is one of the dominant components of the normal flora in the intestinal tract of humans and animals. It causes approximately 80% of all UTIs. P fimbriae are the Biostatistics & Biostatistics 12
most important VF that UPEC express. W/o P fimbriae, E coli would not be able to bind to uroepithelial cells and infect the bladder, ureters, and kidneys. Instead, the Epidemiology (BS) (Bios)
bacteria would simply be washed away during urination.
1192 Neonatal sepsis E. coli is a freq cause of neonatal meningitis, 2nd only to GBS. E. coli strains that cause neonatal meningitis possess the K1 capsular Ag. The K1 capsule is a VF that Biostatistics & Biostatistics 1
allows the bacteria to survive in the bloodstream and establish meningeal infection. Epidemiology (BS) (Bios)
1201 Sarcoidosis Sarcoidosis is an inflammatory disorder characterised histologically by NCGs consisting of aggregates of epithelioid macrophages and multinucleated giant cells. Biostatistics & Biostatistics 7
Common MFxs incl hilar adenopathy, pulm infiltrates, skin rash, ophthalmic findings, and constitutional SSx. Epidemiology (BS) (Bios)
1202 Primary hypertension Common AEs of ACEIs incl decr GFR, hyperkalemia, and cough. Angioedema is a rare, but life-thr, AE. Biostatistics & Biostatistics 14
Epidemiology (BS) (Bios)
1204 Meningiomas Meningiomas are common adult intracranial tumours that typically arise in regions of dural reflection (e.g. falx cerebri, tentorium cerebelli). Parasagittal lesions Biostatistics & Biostatistics 2
compressing the medial portion of the 1° somatosensory cortex in the parietal lobe can result in contralateral lower limb sensory loss along w/ contralateral hemineglect if Epidemiology (BS) (Bios)
there's also dmg to the parietal assoc cortex (non-dom hemisphere).
1205 Meningiomas Meningiomas are slow-growing, well-circumscribed, benign intracranial tumors typically found at the cerebral convexities in adults. Chx histopathologic features include Biostatistics & Biostatistics 2
a whorled pattern of cellular growth that forms nests, which may calcify into round, eosinophilic laminar structures called psammoma bodies. Epidemiology (BS) (Bios)
1207 Brain tumors A cystic tumor in the cerebellum of a child is most likely a pilocytic astrocytoma. Biopsy will show a well-differentiated neoplasm comprised of spindle cells with hair- Biostatistics & Biostatistics 10
like glial processes that are associated with microcysts. These cells are mixed with Rosenthal fibers and granular eosinophilic bodies. Epidemiology (BS) (Bios)
1208 Lymphogranuloma C. trachomatis serotypes L1 thru L3 cause LGV, an STD characterised initially by painless ulcers w/ later progr to painful inguinal LAD ('buboes') and ulceration. Biostatistics & Biostatistics 1
venereum Chlamydial inclusion bodies are seen in host cell cytoplasm. Epidemiology (BS) (Bios)
1209 Calcineurin inhibitors Calcineurin is an essential protein in the activation of IL-2, which promotes the growth and diff of T cells. Immsups such as cyclosporine and tacrolimus work by inhib Biostatistics & Biostatistics 1
calcineurin activation. Epidemiology (BS) (Bios)
1210 Lead poisoning Pb pois in adults typically occurs thru occup exposure. SSx incl colicky abdo pain, constipation, Pb lines on the gum, peri neuropathy, and anemia. LFx shows microcytic Biostatistics & Biostatistics 4
anemia w/ normal Fe studies, and PBS may reveal basophilic stippling. Epidemiology (BS) (Bios)
1230 Risk RRR = (absolute risk [control] - absolute risk [Tx]) / absolute risk [control] Biostatistics & Biostatistics 6
Epidemiology (BS) (Bios)
1231 Sensitivity, specificity, Sensitivity = true positives / (true positives + false negatives). Screening tests should have high sensitivity. Biostatistics & Biostatistics 4
positive predictive value Epidemiology (BS) (Bios)
PPV, negative predictive
value NPV
1232 Sensitivity, specificity, The specificity of a test is its ability to correctly identify individuals w/o the disease. Specificity should be high in confirmatory tests to ↓ FPs. Biostatistics & Biostatistics 4
positive predictive value Epidemiology (BS) (Bios)
PPV, negative predictive
value NPV
1233 Decision making capacity Capacity to refuse Tx requires the ability to express a choice, understand the relevant medical information, appreciate the consequences of Tx options, and offer a Biostatistics & Biostatistics 5
rationale for the decision. Pts w/ decision-making capacity have the right to refuse any medical Tx. Epidemiology (BS) (Bios)
1270 Neuromuscular blocker Succinylcholine is a fast-acting, depolarizing neuromuscular blocking agent used for rapid-sequence intubation that causes equal reduction of all 4 twitches during train- Biostatistics & Biostatistics 1
of-four stimulation (phase I blockade). Prolonged administration of succinylcholine or use in patients with abnormal plasma cholinesterase activity causes transition to a Epidemiology (BS) (Bios)
phase ll (nondepolarizing) block, seen as a progressive reduction in each of the 4 twitches.
1271 Hyperthyroidism Hyperthyroidism causes upregulation of β-adrenergic receptor expression, leading to ↑ catecholamine effect. β blockers are used to blunt the adrenergic MFxs of Biostatistics & Biostatistics 8
hyperthyroidism. In addn, lipid-soluble β blockers ↓ conversion of T4 to T3 by inhib 5'-monodeiodinase in peri tissues. Epidemiology (BS) (Bios)
1272 Atopic dermatitis Local cutaneous adverse effects of chronic topical corticosteroid administration include atrophy/thinning of the dermis that is associated with loss of dermal collagen, Biostatistics & Biostatistics 2
drying, cracking, and/or tightening of the skin, telangiectasias, and ecchymoses. Epidemiology (BS) (Bios)
1273 Tuberculosis The acid-fast stain IDs organisms that have mycolic acid present in their cell walls, incl Mycobacterium and some Nocardia species. Acid-fast staining is carried out by Biostatistics & Biostatistics 18
applying an aniline dye (e.g. carbolfuchsin) to a smear and then decolourising w/ acid alcohol to reveal whether the organisms present are 'acid fast'. Epidemiology (BS) (Bios)
1274 Tuberculosis M. tuberculosis grows in long, serpentine cords due to the presence of cord factor, a surface glycolipid, on the cell wall. Cord factor is a 1° VF of M. tuberculosis; it Biostatistics & Biostatistics 18
prevents macrophages from being bactericidal due to the inhib of phagolysosome acidification and also leads to the formation of CGs. Epidemiology (BS) (Bios)
1275 Tuberculosis 1° Tb infection is marked by initial unchecked M. tuberculosis replication w/i the alveolar space and alveolar macrophages. after a few wks, CD4 lymphocytes are stim to Biostatistics & Biostatistics 18
release IFN-γ, which activates macrophages and leads to control of the infection. Epidemiology (BS) (Bios)
1276 Tuberculosis Mycobacteria tuberculosis primarily replicates w/i the phagosome, leading to display of mycobacterial Ags on MHC-II molecules. This results in the activation of CD4 Biostatistics & Biostatistics 18
cells and subsequent control of the infection w/ macrophages. Epidemiology (BS) (Bios)
1277 Tuberculosis 1° TB causes the formation of Ghon foci in the lower lungs. 2° (reactivation) TB occurs in pts w/ prior TB infection that never cleared completely. Reactivation TB occurs Biostatistics & Biostatistics 18
most often in immunosuppressed pts and is characterised by apical cavitary lesions and hemoptysis. Epidemiology (BS) (Bios)
1278 Tuberculosis Mycobacterium tuberculosis triggers CD4 T lymphocytes to release interferon-gamma, which leads to macrophage activation (improves intracellular killing ability) and Biostatistics & Biostatistics 18
differentiation into epithelioid histiocytes. These cells, along with horseshoe-shaped, multinucleated Langhans giant cells (fused, activated macrophages) are a key Epidemiology (BS) (Bios)
component of granuloma formation.
1279 Tuberculosis The Ghon complex describes the 2 initial sites (lower lobe of lung, ipsilateral hilar LN) of 1° TB infection. Over time, these sites become calcified and fibrosed and can be Biostatistics & Biostatistics 18
visualised on gross pathology and radiographic imaging (Ranke complex). Epidemiology (BS) (Bios)
1280 Tuberculosis The control of Mycobacterium tuberculosis infection is primarily mediated by activated macrophages, which surround extracellular mycobacteria and wall them off within Biostatistics & Biostatistics 18
granulomas. The release of digestive enzymes by these cells helps control the infection but also leads to damage of the surrounding tissue and the formation of cavitary Epidemiology (BS) (Bios)
lung lesions.
1281 Tuberculosis Mycobacterial resistance to INH can be accomplished thru non-expression of the catalase-peroxidase enzyme or thru genetic mod of the INH binding site on the mycolic Biostatistics & Biostatistics 18
acid synthesis enzymes. Epidemiology (BS) (Bios)
1282 Tuberculosis Active TB is never Tx w/ Rx monotherapy due to the fast emergence of mycobacterial Abx resistance from rapid, selective gene muts. INH monotherapy may be used for Biostatistics & Biostatistics 18
pts who have a (+) PPD and a (-) CXR (i.e. no evidence of clinical disease). Epidemiology (BS) (Bios)
1284 Tuberculosis Ethambutol can cause optic neuropathy that results in colour blindness, central scotoma, and ↓ visual acuity. This AE may be reversed w/ discontinuation of the drug. Biostatistics & Biostatistics 18
Epidemiology (BS) (Bios)
1285 Sensitivity and specificity When undergoing Dx testing, pts w/ the disease can test (+) (true (+), TP) or (-) (false (-), FN). The sensitivity of a test determines the proportion of pts that are correctly Biostatistics & Biostatistics 4
classified: Epidemiology (BS) (Bios)
TP = (Sensitivity) x (Number of pts w/ the disease)
FN = (1 - Sensitivity) x (Number of pts w/ the disease)
1299 Collagen synthesis Ehlers-Danlos syndrome is a group of rare hereditary disorders characterized by defective collagen synthesis. It can be caused by procollagen peptidase deficiency, which Biostatistics & Biostatistics 1
results in impaired cleavage of terminal propeptides in the extracellular space. Patients often have joint laxity, hyperextensible skin, and tissue fragility due to the Epidemiology (BS) (Bios)
formation of soluble collagen that does not properly crosslink.
1300 Vitamin C deficiency The hydroxylation of proline and lysine residues in collagen helps it attain its maximum tensile strength. This process occurs in the rough endoplasmic reticulum and Biostatistics & Biostatistics 3
requires vitamin C as a cofactor. Impaired collagen synthesis resulting from vitamin C deficiency (scurvy) can lead to fragile vessels, predisposing to gingival bleeding, Epidemiology (BS) (Bios)
ecchymosis, and petechia.
1302 Alpha1 antitrypsin The rubber-like properties of elastin are due to high content of nonpolar (hydrophobic) amino acids and extensive cross-linking between elastin monomers facilitated by Biostatistics & Biostatistics 8
deficiency lysyl oxidase. Patients with α-1 antitrypsin deficiency can develop early-onset, lower lobe-predominant emphysema due to excessive alveolar elastin degradation. Epidemiology (BS) (Bios)
1303 Marfan syndrome Marfan syndrome is due to a defect in fibrillin-1, an extracellular glycoprotein that acts as a scaffold for elastin. It is abundant in the zonular fibers of the lens, periosteum, Biostatistics & Biostatistics 2
and aortic media. Aortic root dilation with dissection and rupture is a common cause of death. Epidemiology (BS) (Bios)
1765 Pneumothorax The lung apices extend above the level of the clavicle and first rib through the superior thoracic aperture. Penetrating injury in this area may lead to pneumothorax, tension Biostatistics & Biostatistics 2
pneumothorax, or hemothorax. Epidemiology (BS) (Bios)
QID Topic Educational Objective System Subject Repeats
8422 Tension headache THs are the most common form of h/a. They are Chx by an achy or pressure-like pain that is often bilateral and a/w pericranial muscle tenderness. THs are not a/w other Biostatistics & Biostatistics 1
neuro SSx and do not typically limit a pt's ability to perform daily fxns. Epidemiology (BS) (Bios)
8519 Muscle structure & The contractile mechanism in skeletal muscle depends on proteins (myosin II, actin, tropomyosin, and troponin) as well as calcium ions. Biostatistics & Biostatistics 8
physiology Epidemiology (BS) (Bios)
10443 Pheochromocytoma Chromaffin cells are modified neuroendo cells derived from the neural crest. Chromaffin cells in the AM are stimulated by ACh released by sympathetic preganglionic Biostatistics & Biostatistics 4
neurons and secrete CAs directly into the bloodstream to amplify SNS activity. Epidemiology (BS) (Bios)
10570 Inflammation Interleukin-8 is a chemokine produced by macrophages that induces chemotaxis and phagocytosis in neutrophils. Other significant chemotactic agents include leukotriene Biostatistics & Biostatistics 3
B4, 5-HETE (the leukotriene precursor), and complement component C5a. Epidemiology (BS) (Bios)
10579 Myelofibrosis The chronic MPDs (PV, ET, and PMF) often have a mutation in JAK2, a cytoplasmic tyrosine kinase. This results in constitutive tyrosine kinase activity, and Biostatistics & Biostatistics 3
consequently, in the cytokine-independent activation of STAT proteins (JAK-STAT signaling pathway). Epidemiology (BS) (Bios)
10672 Cirrhosis In cirrhosis, portal HTN arises from ↑ resistance to portal flow at the hepatic sinusoids. This causes ↑ pressure in the portosystemic collateral veins w/i the lower end of Biostatistics & Biostatistics 7
the oesophagus, ant. abdo, and lower rectum. Dilation of these collateral vessels is responsible for the oesophageal varices, caput medusae, and anorectal varices Epidemiology (BS) (Bios)
commonly seen in pts w/ cirrhosis.
11105 Splenic artery The splenic artery originates from the coeliac artery and gives off several branches to the stomach and pancreas (pancreatic,short gastric, andleft gastroepiploic arteries) Biostatistics & Biostatistics 1
before finally reaching the spleen. Due to poor anastomoses, the gastric tissue supplied by the short gastric arteries is vulnerable to ischemic injury following splenic Epidemiology (BS) (Bios)
artery blockage.
12854 Delirium Delirium may MFx as acute changes in cognition and behaviour. When non-Rx interventions are ineffective, low-dose antipsychotics (e.g. haloperidol) are the Rx of Biostatistics & Biostatistics 4
choice to Tx the behavioural (e.g. severe agitation) and psychotic MFxs of delirium. Epidemiology (BS) (Bios)
14853 Fecal incontinence Stretch injury of the pudendal nerve may occur due to stress placed on the pelvic floor during labour. Pudendal nerve injury leads to weakness of the perineal musculature Biostatistics & Biostatistics 1
causing faecal and urinary incontinence, perineal pain, and sexual dysfxn. Epidemiology (BS) (Bios)
14861 AV node The AV node is located on the endocardial surface of the RA, near the insertion of the septal leaflet of the TV and the orifice of the coronary sinus. Biostatistics & Biostatistics 1
Epidemiology (BS) (Bios)
14862 Autosomal recessive SCA is an AR disease that results in recurrent episodes of anemia, jaundice, and painful swelling of the hands and feet. Offspring of carrier parents have a 25% chance of Biostatistics & Biostatistics 5
inheritance being affected and a 50% chance of being heterozyg carriers, resulting in a 75% change of inheriting at least 1 mut allele. Epidemiology (BS) (Bios)
11835 Schizophrenia The antipsychotic clozapine is the DOC for Tx-resistance schizophrenia. Tx req monitoring of the absolute neutrophil count due to the risks of neutropaenia and Biostatistics & Genetics (Gene) 4
agranulocytosis. Epidemiology (BS)
654 Hyperthyroidism Thioamides (e.g. methimazole, PTU) ↓ the formation of THs via inhib of TPO, the enzyme responsible for both iodine organification and coupling of iodotyrosines. PTU Cardiovascular (CV) Anatomy (Anat) 8
also ↓ the peri conversion of T4 to T3.
1538 Hemoglobin C disease HbC is caused by a missense mut that results in a glutamate residue being substituted by lysine in the beta globin chain. This results in an overall decr. in (-) charge for the Cardiovascular (CV) Anatomy (Anat) 1
Hb molecule. The spd of Hb movement during GE is HbA > HbS > HbC.
1623 Urinalysis Most of the K+ filtered by the glomeruli is resorbed in the proximal tubule and loop of Henle. The late distal and cortical collecting tubules are the primary sites for Cardiovascular (CV) Anatomy (Anat) 2
regulation of K* concentration in the urine. K depletion stimulates a-intercalated cells to reabsorb extra potassium; principal cells secrete K under conditions of normal or
increased K load.
1699 Lymphadenopathy Most of the cutaneous lymph from the umbilicus down, including the anus below the dentate line, drains to the superficial inguinal lymph nodes. Exceptions are the glans Cardiovascular (CV) Anatomy (Anat) 1
penis and posterior calf, which drain to the deep inguinal nodes.
1751 Ureter injury The proximal ureter receives its blood supply from the renal artery whereas the distal ureter is supplied by the superior vesical artery. Circulation to the middle portions of Cardiovascular (CV) Anatomy (Anat) 3
the ureter is variable and anastomotic.
1805 Muscle structure & A single sarcomere is defined as the distance between two Z lines. Thin (actin) filaments in the band are bound to structural proteins at the Z line, whereas thick (myosin) Cardiovascular (CV) Anatomy (Anat) 8
physiology filaments in the Aband are bound to structural proteins at the M line.
1871 ALL and T cells ALL is the most common malignancy of childhood. B-cell ALL is responsible for approximately 70-80% of all cases of ALL, whereas T-cell ALL accounts for 15-17% Cardiovascular (CV) Anatomy (Anat) 1
of all cases of ALL. T-cell ALL often Px as a mediastinal mass that can cause resp symptoms, dysphagia, or SVC syndrome.
1883 Turner syndrome Pts w/ TS may have karyotype 45,X (complete monosomy), 45,X/46,XX (mosaicism), or 46,XX (w/ partial deletion of one X chromosome). Complete monosomy X Cardiovascular (CV) Anatomy (Anat) 8
usually results from meiotic nondisjunction during gametogenesis.
1884 Brachial plexus Dissection of the axillary LNs can injure the LTN. This results in weakness of the serratus ant. w/ winging of the scapula and impaired abduction of the shoulder past the Cardiovascular (CV) Anatomy (Anat) 6
horizontal.
1943 Wound healing During wound healing, excessive MMP activity and myofibroblast accumulation in the wound margins can result in contracture. Contractures produce deformities of the Cardiovascular (CV) Anatomy (Anat) 1
wound and surrounding tissues, most often on the palms, soles, ant. thorax, or at serious burn sites.
1967 Vincristine The vinca alkaloids are cell cycle-specific agents that prevent proper separation of chrom into daughter cells during the M phase of the cell cycle. The main dose-limiting Cardiovascular (CV) Anatomy (Anat) 1
AE of vincristine is neurotox, which commonly MFx as peri neuropathy.
2023 Brachiocephalic vein The BCV drains the ipsilateral jugular and SCVs. The bilateral BCVs combine to form the SVC. BCV obstruction causes SSx similar to those seen in SVC syndrome, but Cardiovascular (CV) Anatomy (Anat) 1
obstruction only on one side of the body.
2130 Schizoaffective disorder For Dx of schizoaffective disorder, psychosis must occur in the absence of major mood episodes, but mood episodes must be present for a majority of this lifelong illness. Cardiovascular (CV) Anatomy (Anat) 1
In BD and MDD w/ psychotic features, psychotic SSx occur exclusively during mood episodes.
7646 Breast cancer The HER2 oncogene encodes for a transmembrane glycoprotein w/ intrinsic tyrosine kinase activity and is a member of the family of EGFRs. Overexpression of this Cardiovascular (CV) Anatomy (Anat) 7
protein is a/w a worse prognosis and ↑ risk of disease recurrence.
8294 Direct factor Xa inhibitors Direct FXa inhibs (e.g. apixaban, rivaroxaban) incr the PT and aPTT but don't affect the TT. UFH and DTIs (e.g. dabigatran) prolong the TT. Cardiovascular (CV) Anatomy (Anat) 1
8332 Diabetes mellitus Incretin fxns by stim insulin release following oral consumption of Glc. Incretin-stim insulin release is independent of the ↑ in insulin secretion brought on by ↑ in the Cardiovascular (CV) Anatomy (Anat) 31
BGL.
8333 Septic shock Phenylephrine is a selective α1 adrenergic receptor agonist that ↑ PVR and SBP and ↓ PP and HR. Cardiovascular (CV) Anatomy (Anat) 6
10467 Inflammation Inflam is char by the passage of circulating inflam leukocytes into the inflamed tissue. The steps involved incl. margination, rolling, activation, tight adhesion and Cardiovascular (CV) Anatomy (Anat) 3
crawling, and transmigration.
11730 Diabetes mellitus SUs (e.g. glyburide, glimepiride) ↑ insulin secretion by pancreatic β cells independent of BGC. These Rx have a high incidence of hypoglycaemia, esp. in the elderly. Cardiovascular (CV) Anatomy (Anat) 31
11763 Depression Pts w/ sufficient depressive SSx are Dx w/ MDD even if there's a clear psychosocial stressor that precipitated the depression. Cardiovascular (CV) Anatomy (Anat) 8
11764 Thrombotic TTP is 1 of several 1ary TMAs resulting in MAHA and thrombocytopenia, which are essential to the Dx. Plasma exchange therapy has prompted more rapid Dx and is Cardiovascular (CV) Anatomy (Anat) 3
thrombocytopenic purpura life-saving.
11780 Nocardiosis Nocardia is a filamentous, branching, gram (+) bacteria that's partially acid-fast. It most commonly causes pneumonia and brain abscesses in immsup pts. Cardiovascular (CV) Anatomy (Anat) 1
11831 Adverse drug reaction Most adverse drug reactions are predictable and due to the known pharmacologic properties of the drug. Unpredictable reactions are less common and are due to genetic Cardiovascular (CV) Anatomy (Anat) 2
differences, immune interactions, or other mechanisms.
11832 Thoracentesis A chest tube for drainage of pleural effusion is placed through the skin and subcutaneous fat into the 4th or 5th intercostal space in the anterior axillary or midaxillary line. Cardiovascular (CV) Anatomy (Anat) 2
The tube traverses through the serratus anterior muscle, intercostal muscles, and parietal pleura.
11837 Brachial plexus An interscalene nerve block is used to provide anaesthesia for the shoulder and upper arm by anaesthetising the upper brachial plexus (C5-C7) as it passes b/w the anterior Cardiovascular (CV) Anatomy (Anat) 6
and middle scalene muscles. Anaesthetic also transverses along the interscalene sheath, freq resulting in transient ipsilateral diaphragmatic paralysis due to involvement of
the phrenic nerve roots (C3-C5).
11842 Hairy cell leukemia HCL is an indolent B-cell neoplasm predominantly found in middle-aged men and characterised by bone marrow failure and infiltrations into the RES, causing massive Cardiovascular (CV) Anatomy (Anat) 1
splenomegaly. Other typical features incl a 'dry tap' (unsuccessful bone marrow aspiration) and the presence of lymphocytes w/ cytoplasmic projections.
11956 Bulimia nervosa Tx options for bulimia nervosa incl nutritional rehab, CBT, and Rx w/ SSRIs. Fluoxetine is the DOC. Cardiovascular (CV) Anatomy (Anat) 4
12046 Lymphatic drainage In the lower extremities, the superficial lymphatic system is divided into medial and lateral tracks. The medial track runs up to the superficial inguinal lymph nodes, Cardiovascular (CV) Anatomy (Anat) 2
bypassing the popliteal nodes. Consequently, lesions on the medial foot cause inguinal lymphadenopathy, whereas lateral lesions are more likely to cause
lymphadenopathy in both the popliteal and inguinal areas.
12144 Medical errors A preventable adverse event is defined as injury to a patient due to failure to follow evidence-based best practice guidelines. Cardiovascular (CV) Anatomy (Anat) 8
12151 Antipsychotics As a class, 2nd-gen antipsychotics are a/w meta AEs (e.g. weight gain, dyslipidaemia, hyperglycaemia, ↑ risk of DM). W/i the class, olanzapine and clozapine carry the Cardiovascular (CV) Anatomy (Anat) 9
greatest risk.
15197 Gastroesophageal reflux Mg salts and Al-OH are basic mineral salts used to neutr gastric acid and relieve GERD SSx. AEs incl diarrhea and constipation, respectively. Therefore, these Rx are Cardiovascular (CV) Anatomy (Anat) 7
disease often combo to offset the AEs of the indiv Rx.
788 Immunology principles CD8+ cells recognize foreign antigens presented with MHC class I proteins. Each MHC class | molecule consists of a heavy chain and a β2-microglobulin. Cardiovascular (CV) Biochemistry 2
(Bioc)
1047 Group B streptococcal Universal prenatal screening for group B strep colonization by vaginal-rectal culture at 35-37 weeks gestation is recommended to identify colonized women who require Cardiovascular (CV) Biochemistry 2
infection INTRAPARTUM antibiotics, most frequently with penicillin or ampicillin, to prevent neonatal GBS sepsis, pneumonia and meningitis. (Bioc)
2034 Aphasia Broca (motor, nonfluent) aphasia results from damage to the inferior frontal gyrus of the dominant hemisphere. Patients are often frustrated as they understand language Cardiovascular (CV) Biochemistry 2
but cannot properly formulate the motor commands to write or form words (eg, slow, fragmented speech). Aphasia may be associated with right upper limb and face (Bioc)
weakness due to extension of the lesion into the primary motor cortex.
1229 Risk ARR = event rate in the control group - event rate in the Tx group. Cardiovascular (CV) Biostatistics 6
(Bios)
1283 Tuberculosis The rifamycins block the action of the bacterial DNA-dependent RNA polymerase, thereby inhib transcription. Resistance is acq by mod of the rifampin binding site on Cardiovascular (CV) Biostatistics 18
the bacterial DNA-dependent RNA polymerase. Common AEs incl hepatotox, blood dyscrasias, and harmless red-orange discolouration of body fluids. (Bios)
1301 Collagen structure Glycine is the most abundant amino acid in collagen. The triple helical conformation of collagen molecules occurs due to the repetitive amino acid sequence within each Cardiovascular (CV) Biostatistics 1
alpha chain, in which glycine (Gly) occupies every third amino acid position (Gly-X-Y). (Bios)
35 Transposition of the great An echocardiogram showing an aorta lying anterior to the pulmonary artery is diagnostic of transposition of the great arteries (TGA). This life-threatening cyanotic Cardiovascular (CV) Embryology 1
vessels condition results from failure of the fetal aorticopulmonary septum to spiral normally during septation of the truncus arteriosus. (Embr)
QID Topic
202 Necrosis
1705 Tibial nerve injury
1750 Community acquired
pneumonia
30 Turner syndrome
882 Arsenic poisoning
8292 Membranous nephropathy
13600 Ovarian torsion
8711 Pharmacokinetics
568 DiGeorge syndrome
679 Syphilis
729 Beta blockers
733 ACE inhibitors
1001 Community acquired
pneumonia
1002 Community acquired
pneumonia
1003 Cephalosporins
8282 Ischemic stroke
31 Aortic coarctation
32 Patent ductus arteriosus
36 Atherosclerosis
37 Myocardial infarction
39 Vasospastic angina
40 Atherosclerosis
43 Myocardial infarction
72 Gallstone disease
73 Endocarditis
74 SLE
76 Dilated cardiomyopathy
82 Cholecystitis
83 Hypertrophic
cardiomyopathy
84 Hypertrophic
cardiomyopathy
86 Hypertrophic
cardiomyopathy
89 Bowel obstruction
91 Wolff-Parkinson-White
syndrome
92 Long QT syndrome
94 Restrictive cardiomyopathy Diastolic HF is caused by ↓ ventricular compliance and is characterised by normal LV EF, normal LV EDV, and ↑ LV filling pressures. HTN, obesity, and infiltrative
disorders (e.g. transthyretin-related amyloidosis, sarcoidosis) are important causes of DHF.
95 Amyloidosis
98 Acute pericarditis
176 Heart block
179 Digoxin
180 Natriuretic peptides
181 Antiarrhythmic drugs
185 Drug induced myopathy
188 Liver cholesterol
production
192 Asthma
203 Coronary blood flow
228 Infertility
230 Prostate cancer
Educational Objective System Subject Repeats
Lethal tissue ischemia causes coag necrosis in most tissues (e.g. kidney, myocardium); cellular architecture is maintained but nuclei are absent. The exception is ischemic Cardiovascular (CV) Embryology 3
cell death in the CNS, which causes liquefactive necrosis. (Embr)
The tibial nerve may be injured at the lvl of the popliteal fossa due to deep penetrating trauma or knee Sx. Pts typically have weakness on foot plantarflexion, foot Cardiovascular (CV) Embryology 1
inversion, and toe flexion, w/ sensory loss over the sole. (Embr)
M. pneumoniae is the causative agent of 'walking pneumonia', an infection typically characterised by a nagging nonproductive cough, low-grade fever, and malaise. Often, Cardiovascular (CV) Embryology 21
the CXR suggests a severe pneumonia even though the pt appears relatively well. Mycoplasma species req chol supplementation to grow on artificial media. (Embr)
Aortic coarctation in a child/young adult presents with lower-extremity claudication (eg, pain and cramping with exercise), blood pressure discrepancy between the upper Cardiovascular (CV) Genetics (Gene) 8
and lower extremities, and delayed or diminished femoral pulses. Turner syndrome (45,XO) is associated with coarctation of the aorta in up to 10% of cases.
Acute arsenic poisoning impairs cellular resp and Px w/ abdominal pain, vomiting, diarrhea, hypotension, and a garlic odor on the breath. Insecticides and contaminated Cardiovascular (CV) Genetics (Gene) 1
water are common sources of arsenic. Dimercaprol is the chelating agent of choice.
1° (idiopathic) MN is a/w IgG4 Abs to the PLA2 receptor, which might play a role in devel of the disease. Ab titres are useful for Dx and correlate w/ disease activity. Cardiovascular (CV) Genetics (Gene) 2
Ovarian torsion typically involves twisting of the infundibulopelvic ligament, often due to the weight of a large adnexal mass. The resulting occlusion of the blood and Cardiovascular (CV) Genetics (Gene) 1
nerve supply to the ovary results in severe, acute pelvic pain and ovarian ischemia.
Clearance (CL) determines the dose rate required to maintain a steady-state plasma concentration (Cpss): Cardiovascular (CV) Histology (Hist) 1
Maintenance dose = Cpss x CL / [Bioavailability fraction]
The bioavailability fraction = 1 if administered IV.
DGS results from maldevel of the 3rd (inf PT and thymus) and 4th (sup PT) pharyngeal/branchial pouches. Subseq PT and thymic hypoplasia results in hypcalcemia and T Cardiovascular (CV) Immunology 2
cell defic. (Immu)
The clinical Px of 3° syphilis includes CV involvement and gummas. Gummas are necrotizing granulomas occurring on the skin, mucosa, subcutaneous tissue, and bones Cardiovascular (CV) Microbiology 9
and w/i other organs. Neurosyphilis can occur at any stage of infection. (Micr)
Beta-adrenergic blocking drugs inhib renin release by blocking beta1 receptor-mediated regulation of the RAAS. This decr PRA, w/ a resulting decr in AT-I, AT-II, and Cardiovascular (CV) Microbiology 3
aldo lvls. (Micr)
ACEIs decr AT-II lvls and cause eff art dilation, thereby decr the GFP and GFR. This can precip ARF in pts w/ decr intrarenal perfusion pressure at baseline (e.g. RAS, Cardiovascular (CV) Microbiology 7
CHF, hypovolemia). (Micr)
Mycoplasma pneumoniae binds an oligosaccharide on the respiratory epithelium that is also present on erythrocytes, leading to the generation of cross-reacting IgM Cardiovascular (CV) Microbiology 21
antibodies (cold agglutinins). Patients with M pneumoniae infections often develop mild, transient hemolytic anemia that resolves as IgM antibody titers decline (6-8 (Micr)
weeks after infection begins).
Infection w/ M. pneumoniae can result in the formation of cold agglutinins, which are IgM Abs (1arily) that bind RBCs and cause clumping/agglutinations at low body Cardiovascular (CV) Microbiology 21
temps. Other illnesses resulting in cold agglutinin formation incl IM and certain heme malignancies. (Micr)
Penicillins, cephalosporins, and vancomycin are able to disrupt the PGCW of gram (+) and gram (-) organisms. The PGCW of these organisms gives them the ability to Cardiovascular (CV) Microbiology 2
survive osmotic stress; this ability is lost after Tx w/ these Abx agents. (Micr)
The PCA branches off the basilar artery and supplies CNs III and IV and other structures in the midbrain. It also supplies the thalamus, medial temporal lobe, splenium of Cardiovascular (CV) Microbiology 19
the corpus callosum, and occipital lobe. The most common finding w/ PCA stroke is contralateral homonymous hemianopia, often w/ macular sparing. (Micr)
Pts w/ adult-type coarctation of the aorta commonly die of HTN-assoc complications, incl LV failure, ruptured dissecting AA, and SICH. These pts are at ↑ risk for Cardiovascular (CV) Pathology (Path) 1
ruptured intracranial aneurysms b/c of the ↑ incidence of congenital BAs of the COW as well as aortic arch HTN.
Digital clubbing and cyanosis w/o BP or pulse discrepancy are pathognomonic for a large PDA complicated by Eisenmenger syndrome (reversal of shunt flow from L-R Cardiovascular (CV) Pathology (Path) 4
to R-L). Severe coarctation of the aorta can cause lower extremity cyanosis. R-L shunting in pts w/ large septal defects and TOF results in whole-body cyanosis.
Stable angina pectoris results from myocardial O2 demand-supply mismatch and MFx as chest pressure, tightness, or pain that is reliably produced by exertion and Cardiovascular (CV) Pathology (Path) 8
relieved by rest. It most commonly occurs due to a fixed atherosclerotic plaque obstructing >70% of the coronary artery lumen that limits blood flow during exertion.
STEMI involves transmural (full-thickness) infarction of the myocardial wall, and usually results from acute atherosclerotic plaque rupture w/ the devel of overlying Cardiovascular (CV) Pathology (Path) 18
thrombus that fully occludes the coronary artery lumen. It classically presents w/ sudden-onset substernal chest pain that's not relieved by rest or short-acting nitrates.
ECG demonstrates STE in the affected leads w/ subseq devel of Q waves.
Prinzmetal (variant) angina is Chx by episodic, transient atks of coronary vasospasm (at rest and at night), producing temporary transmural myocardial ischemia w/ ST- Cardiovascular (CV) Pathology (Path) 2
segment elevation. Possible triggers are cigarette smoking, cocaine/amphetamines, and dihydroergotamine/triptans. Tx includes tobacco/Rx cessation and vasodilator Thx
(eg, nitrates, CCBs).
Gradually developing myocardial ischemia encourages the formation and maturation of collateral vessels and is most likely to occur in the setting of a slow-growing, Cardiovascular (CV) Pathology (Path) 8
stable atherosclerotic plaque. An unstable atherosclerotic plaque (eg, that w/ active inflammation, a lipid-rich core, a/o a thin fibrous cap) is more likely to rupture,
resulting in the abrupt onset of ischemia/infarction that precludes the development of viable collateral vessels.
Loss of cardiomyocyte contractility occurs w/i 60 2nds after the onset of total ischemia. When ischemia lasts less than 30 min, restoration of blood flow leads to reversible Cardiovascular (CV) Pathology (Path) 18
contractile dysfxn (myocardial stunning), w/ contractility gradually returning to normal over the next several hrs to days. However, after about 30 min of total ischemia,
ischemic injury becomes irreversible.
The gallbladder fxns to actively absorb water from bile. Gallbladder hypomotility causes the bile to become concentrated, promoting precipitation and accumulation of Cardiovascular (CV) Pathology (Path) 8
particulate material. This forms a viscous biliary sludge that can cause transient BDO (biliary colic) and promote cholesterol gallstone formation.
Janeway lesions are nontender, macular, and erythematous lesions typically located on the palms and soles of pts w/ acute IE and are the result of septic embolization from Cardiovascular (CV) Pathology (Path) 15
valvular vegetations.
CV MFx of lupus include accelerated atherosclerosis, small-vessel necrotizing vasculitis, pericarditis, and Libman-Sacks endocarditis (small, sterile vegetations on both Cardiovascular (CV) Pathology (Path) 7
sides of the valve). Renal involvement classically MFx as DPGN, which is Chx by diffuse thickening of the glomerular capillary walls w/ "wire-loop" structures on LM.
DCM results from direct dmg to cardiomyocytes leading to myocardial contractile dysfxn (systolic dysfxn), volume overload, and ventricular dilation. Viral myocarditis is Cardiovascular (CV) Pathology (Path) 8
a common cause of DCM and should be suspected in young pts who develop HF following a SSx viral prodrome.
Acute acalculous cholecystitis is an acute inflammation of the gallbladder in the absence of gallstones. It typically occurs in critically ill pts (eg, those w/ sepsis, severe Cardiovascular (CV) Pathology (Path) 5
burns, trauma, immunosuppression) due to gallbladder stasis and ischemia. CFx may be subtle and include fever, RUQ pain, and leukocytosis.
HCM is a common cause of SCD in young adults. Histologic features incl cardiomyocyte hypertrophy and myofiber disarray w/ ↑ interstitial fibrosis. The structural Cardiovascular (CV) Pathology (Path) 9
disarray creates a substrate for ventricular arrhythmia (e.g. v-tach, VF) that can lead to SCD.
HCM is Chx by asymmetric (eg, septal) LVH that can result in SCD. AD mutations affecting the cardiac sarcomere genes (eg, cardiac β-myosin heavy chain gene and Cardiovascular (CV) Pathology (Path) 9
myosin-binding protein C gene) are responsible for the majority of cases.
HCM is characterised by asymmetric ventricular septal hypertrophy and dynamic LVOT obstr. ↓ in LV blood volume, via manoeuvres or conditions that ↓ preload (e.g. Cardiovascular (CV) Pathology (Path) 9
abrupt standing, Valsalva strain phase) or afterload, worsen LVOT obstr and ↑ the intensity of the HCM murmur.
Gallstone ileus is a mech bowel obstr caused when a large gallstone erodes into the intestinal lumen. Pneumobilia (air in the biliary tract) is a common finding. Cardiovascular (CV) Pathology (Path) 1
Wolff-Parkinson-White syndrome is characterized by symptomatic paroxysmal supraventricular tachycardia (eg, atrioventricular reentrant tachycardia) due to the Cardiovascular (CV) Pathology (Path) 2
presence of an accessory conduction pathway. During normal sinus rhythm, the presence of this accessory pathway causes ventricular preexcitation, which can be
identified on ECG by the triad of a shortened PR interval, early upslope of the QRS complex (delta Wave), and a widened QRS interval.
Jervell and Lange-Nielsen syndrome is an AR disorder Chx by profound bilateral sensorineural hearing loss and congenital LQTS, which predisposes to ventricular Cardiovascular (CV) Pathology (Path) 4
arrhythmias and SCD. This condition occurs 2° to mutations in genes that encode voltage-gated K channels.
Cardiovascular (CV) Pathology (Path) 1
RCM can be caused by infiltrative diseases (e.g. amyloidosis, sarcoidosis, hemochromatosis) and often results in diastolic HF due to ventricular hypertrophy w/ impaired Cardiovascular (CV) Pathology (Path) 1
ventricular filling. Cardiac amyloidosis is characterised histologically by areas of myocardium infiltrated by an amorphous and acellular pink material (amyloid).
Acute-onset, sharp, and pleuritic chest pain that ↓ w/ leaning forward is char of acute pericarditis. Fibrinous/serofibrinous pericarditis is the most common form of Cardiovascular (CV) Pathology (Path) 5
pericarditis and a pericardial friction rub is the most specific physical finding. Viral pericarditis is often preceded by a URI.
Common AEx of non-DHP CCBs (eg, diltiazem, verapamil) include constipation, bradycardia, AV conduction block ((-) chronotropic effect), and worsening of HF in pts Cardiovascular (CV) Pathology (Path) 2
w/ ↓ LV fxn ((-) inotropic effect).
Digoxin tox presents w/ nonspecific GI (e.g. anorexia, nausea, vomiting) and neuro (e.g. fatigue, confusion, weakness) SSx. Changes in colour vision are a more specific, Cardiovascular (CV) Pathology (Path) 4
but rarer, finding. Life-threatening ventricular arrhythmias are the most serious complication.
ANP and BNP are released from the atria and ventricles, respectively, in response to myocardial wall stretch due to intravascular volume expansion. These endogenous Cardiovascular (CV) Pathology (Path) 1
hormones promote ↑ GFR, natriuresis. and diuresis.
For class I antiarrhythmics, Na+-channel-binding strength is IC > IA > IB. Use dependence describes the phenomenon in which higher HRs lead to ↑ Na+ channel Cardiovascular (CV) Pathology (Path) 12
blockade due to cumulative blocking effects over multiple cardiac cycles. Class IC antiarrhythmics demonstrate the most use dependence due to their slow dissociation
from the receptor, and class IB drugs have the least use dependence as they rapidly dissociate.
Most statins are metabolized by cytochrome P450 3A4, w/ the exception of pravastatin. Concomitant administration of Rx that inhibit statin metabolism (eg, macrolides) Cardiovascular (CV) Pathology (Path) 3
is a/w ↑ incidence of statin-induced myopathy and rhabdomyolysis. ARF is a possible sequela of rhabdomyolysis.
Simvastatin decreases hepatic cholesterol production, while cholestyramine increases hepatic cholesterol and bile acid synthesis. Combination therapy results in a Cardiovascular (CV) Pathology (Path) 1
synergistic reduction in plasma LDL level.
Asthma is Chx by chronic airway inflammation, which leads to airway remodeling, airway hyperresponsiveness, and bronchoconstriction. Corticosteroids ↓ airway Cardiovascular (CV) Pathology (Path) 12
inflammation and are used for both chronic asthma Mx (inhaled administration) and acute exacerbations (systemic administration).
In 90% of individuals, occlusion of the RCA can result in transmural ischemia of the inferior wall of the LV, producing ST elevation in leads II, III, and aVF as well as Cardiovascular (CV) Pathology (Path) 9
possible sinus node dysfxn. Occlusion of the proximal LAD would be expected to result in anteroseptal transmural ischemia, w/ ST elevations in leads V1-V4. Occlusion
of the LCX would produce transmural ischemia of the lateral wall of the LV, w/ ST elevations mainly in V5 and V6, and possibly also in I and aVL.
Anovulation is a common cause of infertility. Menotropin (human menopausal gonadotropin) is a treatment option that acts like FSH and triggers the formation of a Cardiovascular (CV) Pathology (Path) 3
dominant ovarian follicle. Ovulation is then induced by administration of human chorionic gonadotropin, which mimics the LH surge.
Leuprolide is a GnRH agonist that causes a transient ↑ in pituitary LH secretion, which leads to a rise in testosterone lvls. However, continuous use of leuprolide Cardiovascular (CV) Pathology (Path) 5
suppresses LH release and leads to a ↓ in testosterone production.
QID Topic
231 Pituitary adenoma
232 Diabetes insipidus
236 Menopause
240 von Willebrand disease
241 Hypopituitarism
242 Craniopharyngiomas
300 Azoles
442 Hydrocele
443 Colorectal cancer
444 Colorectal cancer
446 Colorectal cancer
447 Carcinoid tumors
448 Carcinoid tumors
449 Appendicitis
451 Colorectal cancer
452 Lynch syndrome
453 Colonic polyps
460 Acute pancreatitis
462 Acute pancreatitis
463 Acute pancreatitis
464 Acute pancreatitis
466 Coronary artery disease
469 Atherosclerosis
473 Giant cell arteritis
474 Peripheral vascular disease
475 Takayasu arteritis
506 Alpha1 antitrypsin
deficiency
809 Radiation injury
878 Urinary tract obstruction
939 G6PD anemia inheritance
pattern
947 Antiarrhythmic drugs
1040 Thiazides
1439 Resting membrane potential The AP results from changes in the membrane permeability to K and Na ions. Depol results from massive influx of Na thru v-gated Na channels. Repol occurs due to
and action potential
1852 Aging
1882 Amenorrhea
2074 Diabetes mellitus
2075 Botulism
7568 Ischemic stroke
7616 Thalassemia
7666 Pulsus paradoxus
7667 Metabolic acidosis
8296 Multiple myeloma
8458 Primary hypertension
8610 Rhesus alloimmunization
11636 Meta analysis
11640 Actinomycosis
14789 Ovarian vein thrombosis
14964 Internuclear
ophthalmoplegia
14978 Anoxic brain injury
14980 COPD
Educational Objective System Subject Repeats
Pituitary tumours can present w/ h/a, bitemporal hemianopsia, and hypopituitarism; the most common hormonally active (fxnal) adenomas are PL-secreting adenomas Cardiovascular (CV) Pathology (Path) 8
(PRL-omas). PRL-omas can cause galactorrhoea and amenorrhoea in women. In men, they often present w/ hypogonadism.
Pts w/ DI are unable to concentrate their urine in response to dehydration. Following desmopressin admin during the water deprivation test, urine osmolality ↑ to normal Cardiovascular (CV) Pathology (Path) 4
lvls in CDI but doesn't change in complete NDI.
Menopause occurs on average at age 51 and is Dx retrospectively after 12 mos of amenorrhea. An ↑ serum FSH level confirms the Dx. Cardiovascular (CV) Pathology (Path) 1
The vWF enhances clotting thru both augmentation of platelet binding and stabilisation of FVIII. Pts w/ vWD are defic in fxnal vWF and present w/ ↑ bruisability and Cardiovascular (CV) Pathology (Path) 7
prolonged mucosal bleeding. DDAVP can alleviate bleeding thru endothelial release of vWF.
High oestrogen lvls during preg cause enlargement of the pit gland w/o a proportional ↑ in blood supply. Peripartum hypotension can cause ischemic necrosis of the pit Cardiovascular (CV) Pathology (Path) 2
leading to panhypopituitarism (Sheehan syndrome). Pts commonly develop failure of lactation due to defic of PRL.
The ant. pit is formed from an out-pouching of the pharyngeal roof and is called Rathke's pouch. The post. pit gland arises from an extension of the hypothal neurons. Cardiovascular (CV) Pathology (Path) 2
Craniopharyngiomas are tumours arising from Rathke's pouch remnants in the ant. pit. They char have 3 components: solid, cystic, and calcified. They present during
childhood, usually, w/ mass effect and visual deficits.
Azoles inhibit the synthesis of ergosterol by the fungal cytochrome P450 enzymes. They also suppress the human P450 system, resulting in many drug-drug interactions. Cardiovascular (CV) Pathology (Path) 1
Communicating hydroceles and IIHs are caused by an incomplete obliteration of the processus vaginalis. The resultant connection b/w the scrotum and abdominal cavity Cardiovascular (CV) Pathology (Path) 2
can allow for fluid leakage (hydrocele) or the passage of abdominal contents (IIH).
The adenoma to carcinoma seq is a series of gene muts that leads to the devel of CAC. TP53 TSG mut is part of the final step in the seq and leads to malignant Cardiovascular (CV) Pathology (Path) 15
transformation of pre-existing large adenomatous polyps.
The size of adenomatous polyps determines their malignant potential. Adenomas <1 cm are unlikely to undergo malignant transformation, whereas those >4 cm are very Cardiovascular (CV) Pathology (Path) 15
likely to progress to AC. KRAS proto-oncogene mutation facilitates the growth of adenomas by causing uncontrolled cell proliferation.
Prognosis of CRAC is directly related to the stage of the tumour (not to the grade!). Cardiovascular (CV) Pathology (Path) 15
Carcinoid tumours are composed of islands or sheets of uniform cells w/ eosinophilic cytoplasm and oval-to-round stippled nuclei. These tumours are often derived from Cardiovascular (CV) Pathology (Path) 4
neuroendocrine cells in the GI tract. Appendiceal carcinoids typically have a benign course but may cause appendicitis or, rarely, carcinoid syndrome (e.g. w/ liver mets).
Carcinoid tumors confined to the intestine don't cause carcinoid syndrome as their secretory products are meta by the liver before entering the syst circulation. In contrast, Cardiovascular (CV) Pathology (Path) 4
intestinal carcinoids that met to the liver and extraintestinal (e.g. bronchial) carcinoids release vasoactive substances that avoid 1st-pass meta, resulting in carcinoid
syndrome (e.g. flushing, diarrhea, bronchospasm).
obstr of the lumen of the appendix is the 1st event in pathogenesis of acute appendicitis. Fecaliths, hyperplastic lymphoid follicles, foreign bodies, or tumours may cause Cardiovascular (CV) Pathology (Path) 5
the obstr. RLQ abdo pain, nausea, vomiting, diarrhoea, and fever are the typical MFxs of acute appendicitis.
Mutation of the APC TSG is the 1st step in the classic adenoma-to-carcinoma sequence; it is found in most cases of sporadic colon ca and in all pts w/ FAP. The Cardiovascular (CV) Pathology (Path) 15
microsatellite instability pathway is Chx by mutations in DNA mismatch repair genes and is implicated in the development of HNPCC (Lynch syndrome).
HNPCC, or Lynch syndrome, leads to occurrence of colonic ACs at a young age (age <50) along w/ a predisposition for extraintestinal malignancies. Mutations of DNA Cardiovascular (CV) Pathology (Path) 1
mismatch repair genes are responsible for HNPCC.
Adenomatous polyps are either tubular, villous, or tubulovillous, depending on their histologic appearance. Villous adenomas tend to be larger, sessile, and more severely Cardiovascular (CV) Pathology (Path) 2
dysplastic than tubular adenomas. Villous adenomas can cause a secretory diarrhea from ↑ mucin production; pts may develop hypoproteinemia and hypokalemia.
The dorsal pancreatic bud forms the majority of pancreatic tissue (body, tail, and most of the head). The ventral pancreatic bud is a precursor of the uncinate process, Cardiovascular (CV) Pathology (Path) 9
inf/post portion of the head, and major pancreatic duct (of Wirsung). Failure of the dorsal and ventral pancreatic buds to fuse leads to pancreas divisum. In this condition,
the pancreatic ductal systems remain separate, w/ the accessory duct draining the majority of the pancreas.
In AIP the pancreas is grossly oedematous. Focal areas of fat necrosis, Ca2+ deposition, and interstitial oedema are seen on LM. In ANP (hemorrhagic), chalky-white Cardiovascular (CV) Pathology (Path) 9
areas of fat necrosis interspersed w/ hemorrhage are seen on macroscopic Ex.
Eighty percent of acute pancreatitis cases are caused by gallstones and chronic Alcism. Less common causes account for the other 20%. Inherited or acquired Cardiovascular (CV) Pathology (Path) 9
hypertriglyceridemia can cause acute pancreatitis if the serum lvl of TGs exceeds 1000 mg/dL.
Pancreatic zymogens are normally converted into their active form by trypsin in the duodenal lumen. Premature cleavage of trypsinogen to trypsin w/i the pancreas leads Cardiovascular (CV) Pathology (Path) 9
to uncontrolled activation of these zymogens, causing pancreatic autodigestion and acute pancreatitis.
VSMCs are the only cells w/i the atherosclerotic plaque capable of synthesizing structurally important collagen isoforms and other matrix components. Progressive Cardiovascular (CV) Pathology (Path) 4
enlargement of the plaque results in remodeling of the ECM and VSMC death, promoting development of vulnerable plaques w/ an ↑ propensity for rupture.
The likelihood of plaque rupture is related to plaque stability rather than plaque size or the degree of luminal narrowing. Plaque stability largely depends on the mech Cardiovascular (CV) Pathology (Path) 8
strength of the fibrous cap. Inflammatory macrophages in the intima may ↓ plaque stability by secreting metalloproteinases, which degrade ECM proteins (e.g. collagen).
GCA is char by granulomatous inflammation of the media and predominantly involves medium to smaller branches of the carotid artery, esp. the temporal artery. The Cardiovascular (CV) Pathology (Path) 5
resulting SSx respond promptly to GC therapy.
Thromboangiitis obliterans (Buerger disease) is a segmental, inflammatory vasculitis that affects the small- and medium-sized arteries and veins of the distal extremities Cardiovascular (CV) Pathology (Path) 4
w/ inflammatory, intraluminal thrombi and sparing of the vessel wall. It is usually seen in young, heavy smokers, and can Px w/ digital ischemia and ulceration, extremity
claudication, Raynaud phenomenon, and superficial thrombophlebitis.
Takayasu arteritis is a chronic, large-artery vasculitis that 1arily involves the aorta and its branches. It presents w/ constitutional (e.g. fever, weight loss) and arterio- Cardiovascular (CV) Pathology (Path) 1
occlusive (e.g. claudication, BP discrepancies, pulse deficits) findings in pts age <40. Histopathology shows granulomatous inflammation of the vascular media.
Alveolar fluid contains neutral proteases (e.g. elastases) that're derived from alveolar macrophages and infiltrating neutrophils. These proteases can cause destruction of Cardiovascular (CV) Pathology (Path) 8
terminal lung parenchyma (e.g. emphysema) when secreted in excess or if left unchecked by defic antiprotease activity.
KI competitively inhibs thyroid uptake of radioactive I- isotopes and is often admin following nuclear accidents to protect the thyroid and prevent devel of radiation- Cardiovascular (CV) Pathology (Path) 1
induced thyroid carcinoma.
Inadequate canalization of the ureteropelvic junction, the connection site between the kidney and the ureter, is the most common cause of unilateral fetal hydronephrosis. Cardiovascular (CV) Pathology (Path) 4
G6PD defic has an XLR inheritance. HS follows an AD inheritance pattern. Cardiovascular (CV) Pathology (Path) 1
Class III antiarrhythmic drugs (e.g. amiodarone, sotalol, dofetilide) predominantly block K+ channels and inhib the outward K+ currents during phase 3 of the cardiac AP, Cardiovascular (CV) Pathology (Path) 12
thereby prolonging repol and total AP duration.
Thiazide diuretics increase calcium absorption in the distal convoluted tubules within the nephron. Thiazides are associated with increased bone mineral density and are Cardiovascular (CV) Pathology (Path) 3
recommended for treatment of hypertension in patients at risk for osteoporosis. Loop diuretics increase urinary calcium loss.
Cardiovascular (CV) Pathology (Path) 5
closure of v-gated Na channels and opening of v-gated K channels. K ion permeance is highest during the repol phase of the AP.
Digoxin is a cardiac glycoside that's predominantly cleared by the kidneys. Elderly pts typically exhibit age-related renal insufficiency, even in the presence of normal Cardiovascular (CV) Pathology (Path) 8
creatinine lvls. The dose of digoxin must be ↓ in these pts to prevent tox.
Pts w/ Müllerian aplasia (ie, Mayer-Rokitansky-Küster-Hauser syndrome) have no upper vagina (eg, short vagina) and variable uterine development. These pts are 46,XX Cardiovascular (CV) Pathology (Path) 2
females w/ normal ovaries and 2° sexual Chx.
HbA1c is produced by NEG of the Hb molecule. A HbA1c assay provides an estimate of chronic glycaemic control over the life span of circulating erythrocytes (~3mos). Cardiovascular (CV) Pathology (Path) 31
However, rapid erythrocyte turnover (e.g. hemolytic anaemia) can give a misleadingly low HbA1c in relation to glycaemic status.
Bot tox blocks the presynaptic exocytosis of ACh vesicles, causing impaired musc and nico NT; it char Px as a symmetric, desc paralysis that 1st MFx w/ CN abns, often Cardiovascular (CV) Pathology (Path) 4
following consumption of home-canned foods.
The ventral posterior lateral nucleus (receives input from the spinothalamic tract and dorsal columns) and ventral posterior medial nucleus (receives input from the Cardiovascular (CV) Pathology (Path) 19
trigeminal pathway) of the thalamus send somatosensory projections to the cortex via thalamocortical fibers. Damage to these nuclei results in complete contralateral
sensory loss.
B thalassemia results in hypochromic, microcytic anemia due to decreased ß globin chain synthesis. Unpaired a chains precipitate within red cells and cause membrane Cardiovascular (CV) Pathology (Path) 3
damage, leading to ineffective erythropoiesis and extravascular hemolysis.
Asthma and COPD exacerbation are the most frequent causes of PP in the absence of significant pericardial disease. β-adrenergic agonists control acute asthma and COPD Cardiovascular (CV) Pathology (Path) 2
exacerbations by causing bronchial smooth muscle relaxation via ↑ intracellular cAMP.
Lactic acidosis in septic shock results from tissue hypoxia, which impairs oxidative phosphorylation and causes shunting of pyruvate to lactate following glycolysis. Cardiovascular (CV) Pathology (Path) 4
Hepatic hypoperfusion also contributes to the build-up of lactic acid as the liver is the 1° site of lactate clearance.
MM is a/w ↑ circulating paraproteins (monoclonal Igs), which causes erythrocytes to stack like coins (rouleaux formation). Pts classically have normocytic anemia, Cardiovascular (CV) Pathology (Path) 9
hypercalcemia, bone pain, and renal insufficiency.
Chronic HTN can result in HTN nephrosclerosis (HN), which is characterised by compensatory medial hypertrophy and fibrointimal proliferation; endothelial dmg from ↑ Cardiovascular (CV) Pathology (Path) 14
systemic pressure also leads to hyaline arteriolosclerosis. The narrowed arteriolar lumens cause a progr ↓ in renal blood flow, resulting in glomerular ischemia and fibrosis
(glomerulosclerosis).
W/ maternal blood types A or B, HDFN very rarely occurs b/c materal Abs (anti-A or anti-B) are of the IgM type and can't cross the placenta. In contrast, mothers w/ Cardiovascular (CV) Pathology (Path) 2
blood type O also produce IgG Abs (anti-A and anti-B), which can cross the placenta and cause fetal hemolysis.
A meta-analysis groups results of several trials to ↑ statistical power and provide an overall pooled effect estimate. Cardiovascular (CV) Pathology (Path) 1
Pulm actinomycosis develops most commonly following aspiration and can be confused w/ lung abscess, malignancy, or Tb. Micro findings incl filamentous, branching, Cardiovascular (CV) Pathology (Path) 2
gram (+) bacteria and sulphur granules.
Venous stasis and hypercoagulability from pregnancy in addition to endothelial damage from delivery can cause ovarian vein thrombosis in the puerperium. Symptoms Cardiovascular (CV) Pathology (Path) 1
include fever and localized abdominal or flank pain. Most thrombosis is right-sided and can extend to the inferior vena cava; however, left ovarian vein thrombosis can
extend to the left renal vein.
INO is a disorder of impaired horizontal gaze caused by a lesion in the MLF. The affected eye (ipsilateral to the lesion) is unable to adduct while the contralateral eye is Cardiovascular (CV) Pathology (Path) 1
able to abduct (often w/ assoc nystagmus). Convergence and the pupillary light reflex are preserved b/c these pathways bypass the MLF.
The upper midbrain contains neural structures (e.g. CNII, pretectal nuclei, EWN, CNIII) that mediate the direct and consensual pupillary light reflex. Cardiovascular (CV) Pathology (Path) 1
Supplemental O2 admin in pts w/ COPD can lead to ↑ CO2 retention (O2-induced hypercapnia), resulting in confusion and depressed consciousness. The major cause is Cardiovascular (CV) Pathology (Path) 16
reversal of hypoxic pulm vasoconstriction, which ↑ physiologic dead space as blood is shunted away from well-ventilated alveoli.
QID Topic
14989 Pulmonary embolism
14992 Endocarditis
14993 Embryologic derivatives
14997 Acute intracerebral
hemorrhage
14998 Traumatic brain injury
14999 Facial nerve
15000 Leukocytoclastic vasculitis
15195 Gastroesophageal reflux
disease
15196 Gastroesophageal reflux
disease
15198 Esophageal cancer
15542 Vibrio vulnificus
15554 Opioids
15555 Acute lymphoblastic
leukemia
15559 Normal child development
15839 Toxic shock syndrome
15840 Hypertrophic
cardiomyopathy
15885 Parasomnias
15886 Acute heart failure
15891 Sick sinus syndrome
33 Bicuspid aortic valve
42 Myocardial infarction
75 Carcinoid tumors
85 Long QT syndrome
90 Acute pericarditis
93 Dilated cardiomyopathy
96 Hypertrophic
cardiomyopathy
97 Cardiac tamponade
186 Dyslipidemia
187 Dyslipidemia
189 Acute pancreatitis
193 COPD
194 Asthma
195 Theophylline
196 Antihistamines
198 Motion sickness
200 Myocardial infarction
201 Necrosis
204 Aging
227 Diabetes insipidus
233 Primary polydipsia
234 Pituitary adenoma
235 Hyperprolactinemia
237 Infertility
238 Cryptorchidism
243 Antipsychotics
244 Pituitary adenoma
246 Growth hormone
293 Coccidioidomycosis
Educational Objective System Subject Repeats
V/Q scanning can be useful for Dx PE. A large perfusion defect w/o ventilation defect is the characteristic (+) test result. Cardiovascular (CV) Pathology (Path) 13
During the normal cardiac cycle, central aortic pressure is higher than RV pressure during systole and diastole. Consequently, an intracardiac fistula b/w the aortic root Cardiovascular (CV) Pathology (Path) 15
and RV will most likely demonstrate a left-to-right cardiac shunt as blood continuously flows from the aortic root (high pressure) to the RV (low pressure).
The spleen is a large, wedge-shaped lymphatic organ that is situated in the post sup portion of the left abdo cavity. It is derived from mesoderm in the dorsal mesentery Cardiovascular (CV) Pathology (Path) 2
during embryonic development.
The locus coeruleus is a paired brainstem nucleus located in the posterior rostral pons near the lateral floor of the 4th ventricle and fxns as the principal site for NE Cardiovascular (CV) Pathology (Path) 1
synthesis in the brain. It projects to virtually all parts of the CNS and helps control mood, arousal (reticular activating system), sleep-wake states, cognition, and
autonomic fxn.
Smell occurs when odorants bind to nasal chemoreceptors that relay signals via the olfactory nerve through the cribriform plate to the olfactory bulb, which then projects Cardiovascular (CV) Pathology (Path) 5
to the primary olfactory cortex in the medial temporal lobe. Head trauma can tear olfactory nerve rootlets as they cross the cribriform plate, causing anosmia. Anosmia is
often associated with ageusia (loss of taste).
Hyperacusis (↑ sensitivity to sound) is an indication of dmg to the facial nerve (CN VII) close to its origin from the brainstem. Cardiovascular (CV) Pathology (Path) 3
CSVV is a/w Rx (e.g. penicillins, cephalosporins) use and typically presents w/ palpable purpura in the lower extremities. Char histopath findings incl marked Cardiovascular (CV) Pathology (Path) 1
perivascular inflammation of the small blood vessels w/ fibrinoid necrosis and a predominance of neutrophils and fragmented neutrophilic nuclei (LCV).
Mx of GERD incl dietary and LSMs (e.g. weight loss, tobacco avoidance) and Rx such as H2 receptor antags (e.g. ranitidine) or PPIs (e.g. pantoprazole, omeprazole). Cardiovascular (CV) Pathology (Path) 7
PPIs irrev inhib the H/K ATPase on parietal cells, thereby ↓ gastric acid secr.
Pregnant women often develop GERD due to ↑ lvls of estrogen and progesterone, which relax the smooth muscle of the LES. Later in pregnancy, GERD can also develop Cardiovascular (CV) Pathology (Path) 7
when the gravid uterus presses on the stomach and leads to an altered LES angle or ↑ gastric pressure.
Oesophageal SCC presents mostly in the proximal 2/3 of the oesophagus and freq mets to the mediastinal LNs. Histo char shows sheets of pleomorphic squamous cells w/ Cardiovascular (CV) Pathology (Path) 4
keratin pearls and intercellular bridges.
V. vulnificus is a curved, gram (-), free-living bacterium that grows in marine environments. Transmission 1arily occurs due to the consumption of raw seafood (e.g. Cardiovascular (CV) Pathology (Path) 1
oysters) or wound contamination. MFxs are often mild, but individuals w/ liver disease or Fe overload are at very high risk of severe, fulminant infection (e.g. sepsis,
necrotising fasciitis).
Acute opioid OD is characterised by altered lvl of consciousness, pinpoint pupils, and central resp depression. Pts are expected to have acute resp acidosis (low pH, high Cardiovascular (CV) Pathology (Path) 13
PaCO2) due to hypoventilation. Serum HCO3- is typically near normal as there isn't time for meta compensation in the acute setting.
ALL is marked by a high conc of circulating lymphoblasts. Flow cytometry can be used to distinguish b/w B-cell (CD19-expressing) and T-cell (CD3-expressing) Cardiovascular (CV) Pathology (Path) 3
lineages. T-cell ALL usually arises in teens or individuals in their 20s and often presents w/ a large mediastinal mass.
Short attn span and varying degrees of hyperactivity and impulsivity are commonly seen in children under age 4. ADHD shouldn't be Dx until age 4-5. Cardiovascular (CV) Pathology (Path) 2
Toxic shock syndrome is typically associated with the prolonged use of tampons or wound packing, which allows Staphylococcus aureus to replicate locally and release Cardiovascular (CV) Pathology (Path) 2
pyrogenic toxic superantigens (eg, toxic shock syndrome toxin-1) into the blood. Superantigens bind to the MHC-II complex of antigen-presenting cells without
processing and nonspecifically activate T cells. This leads to a dramatic release of inflammatory cytokines, which causes the manifestations of the disease (eg,
hypotension; high fever; organ failure; diffuse, erythematous rash).
Many pts w/ HCM have poor cardiac reserve (e.g. exercise intolerance) due to LVOT obstruction. This outflow obstruction is worsened by ↓ LV blood volume. β blockers Cardiovascular (CV) Pathology (Path) 9
↓ HR and LV contractility to ↑ LV blood volume, ↓ LVOT obstruction, and improve SSx.
REM sleep is characterized by dreaming and voluntary muscle paralysis, and occurs more often during the final third of the night. Nightmares occur during REM sleep Cardiovascular (CV) Pathology (Path) 2
and can be differentiated from sleep terrors, a non-REM parasomnia characterized by incomplete arousals and lack of recall of dream content.
SV is the absolute volume of blood ejected from the LV w/ each contraction and is calculated by subtracting LV ESV from LV EDV. EF is the relative volume of blood Cardiovascular (CV) Pathology (Path) 7
ejected from the LV w/ each contraction; it is calculated by dividing SV by LV EDV. CO, the volume of blood ejected into the aorta per unit time, is estimated by
multiplying SV by HR.
aSSx LV systolic dysfxn is a common stage in the progr of HF. Neurohormonal mechs, incl the SNS and RAAS, help maintain the aSSx period by ↑ volume retention and Cardiovascular (CV) Pathology (Path) 2
peri resistance to maintain organ perfusion. Although these mechs are beneficial in the short term, they're ultimately deleterious, ↑ hemodynamic stress and cardiac
remodelling that eventually lead to DHF.
AS is the most common complication of bicuspid AVs. Pts w/ bicuspid AVs develop clinically significant AS on average around age 50. In comparison, senile calcific Cardiovascular (CV) Pathophysiology 1
stenosis of normal AVs generally becomes SSx age >65. (Patp)
After the onset of severe ischemia leading to MI, early signs of coag necrosis don't become apparent on LM until 4hrs after the onset of MI. Cardiovascular (CV) Pathophysiology 18
(Patp)
Carcinoid syndrome typically presents w/ episodic flushing, secretory diarrhoea, and wheezing. It can lead to pathognomonic plaque-like deposits of fibrous tissue on the Cardiovascular (CV) Pathophysiology 4
right-sided endocardium, causing TR and right-sided HF. ↑ 24-hr urinary 5-HIAA can confirm the Dx. (Patp)
Unprovoked syncope in a previously aSSx young person may result from a congenital LQTS. The 2 most important congenital syndromes w/ QT prolongation — RWS Cardiovascular (CV) Pathophysiology 4
and JLNS — are thought to result from muts in a K+ channel protein that contributes to the delayed rectifier current (IK) of the cardiac AP. (Patp)
In contrast to angina, the chest pain of pericarditis is sharp and pleuritic and may be exacerbated by swallowing or coughing. PIP occurs b/w 2 and 4 days following a Cardiovascular (CV) Pathophysiology 5
transmural MI. PIP is an inflammatory rxn to cardiac muscle necrosis that occurs in the adjacent pericardium. (Patp)
Dilation of the LV cavity commonly occurs in response to systolic dysfxn (eg, ischemic heart disease, DCM) or certain types of valvular disease (ie, AR, MR). Chronic Cardiovascular (CV) Pathophysiology 8
volume overload causes progressive eccentric hypertrophy that eventually leads to ↓ ventricular contractility and DHF. (Patp)
HCM is caused by genetic mutations affecting structural proteins of the cardiac sarcomere (eg, β-myosin heavy chain, myosin-binding protein C) and is one of the most Cardiovascular (CV) Pathophysiology 9
common causes of SCD in young adults. Histologically, it is Chx by cardiomyocyte hypertrophy w/ haphazard cellular arrangement and interstitial fibrosis. (Patp)
CT typically presents w/ hypotension w/ PP, ↑ JVP, and muffled heart sounds (HS; Beck's triad). PP refers to an abn exaggerated ↓ in SBP >10mmHg on inspiration, and Cardiovascular (CV) Pathophysiology 2
is a common finding in pts w/ pericardial effusion w/ CT. (Patp)
BABRs inhib the enterohepatic circulation of BAs. This leads to diversion of hepatic chol to synthesis of new BAs, ↑ uptake of chol from the circulation, and ↓ blood Cardiovascular (CV) Pathophysiology 11
LDL lvls. However, BABRs ↑ hepatic production of TGs and can cause hypertriglyceridaemia. (Patp)
Gemfibrozil (and other fibrates) can ↓ chol sol and promote gallstone formation by ↓ BA synth. Caution should be used when prescribing fibrate therapy to pts w/ Cardiovascular (CV) Pathophysiology 11
underlying gallbladder disease. (Patp)
In pts w/ severe hypertriglyceridaemia, pancreatic lipases can cause toxic lvls of FFAs to be released w/i the pancreatic tissue, leading to acute pancreatitis. Fibrates (e.g. Cardiovascular (CV) Pathophysiology 9
fenofibrate) are the most effective agents for the Tx of hypertriglyceridaemia. (Patp)
Ipratropium, an anticholinergic agent and derivative of atropine, treats obstructive lung disease by blocking acetylcholine at muscarinic receptors, which prevents Cardiovascular (CV) Pathophysiology 16
bronchoconstriction and reduces mucus secretion from tracheobronchial submucosal glands. (Patp)
Cromolyn and nedocromil are mast cell-stabilizing agents that inhibit mast cell degranulation independent of the triggering stimulus. They are less effective than inhaled Cardiovascular (CV) Pathophysiology 12
glucocorticoids and are considered second-line treatments for allergic rhinitis and bronchial asthma. (Patp)
Seizures are the major cause of morbidity and mortality from theophylline intoxication. Tachyarrhythmias are the other major concern. Cardiovascular (CV) Pathophysiology 2
(Patp)
In addn to blocking H receptors, 1st-gen antihistamines (e.g. chlorpheniramine, diphenhydramine) have antimuscarinic, anti-α adrenergic, and anti-5-HT-ergic properties. Cardiovascular (CV) Pathophysiology 3
Anticholinergic effects on the ocular ciliary muscles impair accommodation and cause blurring of vision for close objects. (Patp)
Antimusc agents and antihists w/ antimusc action are most effective for motion sickness prevention. Cardiovascular (CV) Pathophysiology 1
(Patp)
Mitochondrial vacuolization is typically a sign of irreversible cell injury, signifying that the involved mitochondria are permanently unable to generate ATP. Cardiovascular (CV) Pathophysiology 18
(Patp)
Irreversible ischemic injury to brain tissue causes tissue digestion by hydrolytic enzymes (liquefactive necrosis). The infarcted CNS tissue is eventually replaced w/ a Cardiovascular (CV) Pathophysiology 3
cystic astroglial scar. In other organs, lethal ischemic injury results in coag necrosis. (Patp)
Normal morphological changes in the aging heart incl a ↓ in LV chamber apex-to-base dimension, devel of a sigmoid-shaped ventricular septum, myocardial atrophy w/ ↑ Cardiovascular (CV) Pathophysiology 8
collagen deposition, and accumulation of cytoplasmic lipofuscin pigment w/i cardiomyocytes. (Patp)
Injury to the hypothal or post pit (e.g. head trauma, transsphenoidal neuroSx, suprasellar masses) can result in CDI. Dmg to the post pit gland typically causes transient DI, Cardiovascular (CV) Pathophysiology 4
whereas dmg to the hypothal nuclei often causes permanent DI. (Patp)
1° (psychogenic) polydipsia is characterised by excessive intake of free water, leading to hyponatraemia and production of large volumes of dilute urine. Water restriction Cardiovascular (CV) Pathophysiology 1
normalises serum Na+ lvls and ↑ urine osmolality. (Patp)
Large PRL-secreting pituitary tumours can compress the optic chiasm, causing bitemporal hemianopsia. In addn, ↑ PRL lvls suppress release of GnRH, leading to ↓ LH Cardiovascular (CV) Pathophysiology 8
secretion and subseq impaired testosterone production in men. (Patp)
The release of PRL is under inhib control by DA secretion from the hypothal. Disruption of DA-ergic pathways or blockade of DA D2 receptors can cause Cardiovascular (CV) Pathophysiology 1
hyperprolactinaemia. (Patp)
LH stims the release of testo from the Leydig cells of the testes; FSH stims the release of inhibin B from the Sertoli cells in the seminiferous tubules. Testo and inhibin B Cardiovascular (CV) Pathophysiology 3
induce (-) fb on LH and FSH prod, respectively. (Patp)
Inhibin B is prod by the Sertoli cells and is the phys inhib of FSH secretion. LH conc is controlled 1°ly by testo fb. Cardiovascular (CV) Pathophysiology 2
(Patp)
The secretion of PRL is controlled by the inhib effect of hypothal DA. Risperidone and other antipsychs cause hyperprolactinaemia by blocking D2 receptors on Cardiovascular (CV) Pathophysiology 9
lactotrophs. ↑ PRL leads to amenorrhoea (inhib of GnRH release), galactorrhoea, and breast soreness. (Patp)
Hyperprolactinaemia suppresses secretion of GnRH, which leads to ↓ oestrogen in women. Low oestrogen lvls are a RF for accelerated bone loss. Cardiovascular (CV) Pathophysiology 8
(Patp)
Gigantism is caused by excess GH during childhood and is characterised by accelerated linear growth, prognathism, and bone enlargement of the hands and feet. GH Cardiovascular (CV) Pathophysiology 2
excess after closure of the epiphysial growth plates causes acromegaly. GH has direct effects on target tissues and indirect effects mediated by IGF-1 secretion from the (Patp)
liver.
C. immitis infection can be aSSx or it can cause pulm disease ranging from a flulike illness to chronic pneumonia. It causes disseminated disease in immsup pts. Spherules Cardiovascular (CV) Pathophysiology 2
containing endospores are found in tissue samples. (Patp)
QID Topic Educational Objective System Subject Repeats
296 Antibiotic resistance The main groups of antifungal Rx are polyenes, azoles, echinocandins, and pyrimidines. Polyene antifungals (eg, amphotericin B, nystatin) act by binding ergosterol in the Cardiovascular (CV) Pathophysiology 8
fungal cell membrane. (Patp)
726 Primary hypertension Fenoldopam is a selective peripheral dopamine-1 receptor agonist. It is given IV to ↓ BP in HTE, especially in pts w/ renal insufficiency. Fenoldopam causes arteriolar Cardiovascular (CV) Pathophysiology 14
dilation, ↑ renal perfusion, and promotes diuresis and natriuresis. (Patp)
751 Rheumatoid arthritis Methotrexate is the preferred disease-modifying treatment for patients with moderate to severe rheumatoid arthritis. Significant adverse effects include stomatitis, bone Cardiovascular (CV) Pathophysiology 9
marrow suppression, and liver function abnormalities. (Patp)
843 Cystic fibrosis Cystic fibrosis (CF) is most commonly due to a 3-base pair deletion in the CF transmembrane conductance regulator (CFTR) gene at amino acid position 508 (ΔF508). Cardiovascular (CV) Pathophysiology 11
This mutation impairs post translational processing of CFTR, resulting in shunting of CFTR toward the proteasome, with complete absence of the protein on the cell (Patp)
surface. Elevated sweat chloride concentrations are found in most patients with CF.
943 Antiarrhythmic drugs Adenosine causes hyperpolarization of the nodal PM to briefly block conduction through the AV node, and it is effective in the initial Tx of PSVT. Common AEx include Cardiovascular (CV) Pathophysiology 12
flushing, chest burning (due to bronchospasm), hypotension, and high-grade AV block. (Patp)
944 Antiarrhythmic drugs Amiodarone (and other class III and class IA antiarrhythmic agents) causes lengthening of the cardiac AP, which MFx as QT interval prolongation on ECG. QT Cardiovascular (CV) Pathophysiology 12
prolongation caused by amiodarone, in contrast to other Rx, is a/w a very low risk of TdP. (Patp)
945 Antiarrhythmic drugs Lidocaine is a class IB antiarrhythmic Rx that tends to bind to inactivated Na channels and rapidly dissociates. As a result, it is effective in suppressing ventricular Cardiovascular (CV) Pathophysiology 12
tachyarrhythmias induced by rapidly depolarizing and ischemic myocardium. (Patp)
952 Pulmonary arterial Pulmonary arterial hypertension (PAH) typically affects young women and can be familial. It is characterized by luminal narrowing of the pulmonary arteries and Cardiovascular (CV) Pathophysiology 8
hypertension arterioles, with medial hypertrophy, intimal fibrosis, and the eventual development of plexiform lesions. Bosentan is a competitive antagonist of endothelin receptors used (Patp)
for the treatment of PAH.
1532 Rubella The CRS is predominantly Chx by neonatal defects of the head (microcephaly, mental retardation), eyes (cataracts), ears (deafness), and heart/CV system (PDA, Cardiovascular (CV) Pathophysiology 3
peripheral pulmonic stenosis). To ↓ the incidence of this syndrome, the CDC currently recommends the vax of children and non-pregnant females of childbearing age w/ (Patp)
live, attenuated rubella virus vax.
1578 Antiarrhythmic drugs The class IA antiarrhythmics (quinidine, procainamide, and disopyramide) are Na+ channel-blocking agents that depress phase 0 depol. They also prolong repol due to Cardiovascular (CV) Pathophysiology 12
moderate K+ channel-blocking activity, ↑ AP duration in cardiac myocytes. (Patp)
2070 Niemann-Pick In NPD, sphingomyelinase defic causes accumulation of the lipid sphingomyelin. CFx incl hepatosplenomegaly, neuro regression, and a cherry-red macular spot in Cardiovascular (CV) Pathophysiology 2
infancy. (Patp)
2071 Cervical cancer Human papillomavirus (HPV) infection, especially with strain 16 or 18, is the strongest risk factor for development of cervical dysplasia and invasive cervical carcinoma. Cardiovascular (CV) Pathophysiology 3
HIV coinfection allows HPV infection to persist and enhances expression of HPV oncogenes, increasing the risk for cervical dysplasia/cancer. (Patp)
2096 Brain tumors The hypothalamus is a key region responsible for homeostasis. The VMN mediates satiety; lesions of this area of the hypothalamus can result in hyperphagia and obesity. Cardiovascular (CV) Pathophysiology 10
(Patp)
2099 Central venous catheter The common cardinal veins of the developing embryo drain directly into the sinus venosus. These cardinal veins ultimately give rise to the SVC and other constituents of Cardiovascular (CV) Pathophysiology 2
the systemic venous circulation. (Patp)
2100 Trigeminal nerve CNV3 exits the skull thru the foramen ovale and innervates the muscles of mastication, incl the masseter, the medial and lateral pterygoids, and the temporalis muscles. Cardiovascular (CV) Pathophysiology 3
(Patp)
2105 Mismatch repair Lynch syndrome is an AD disease caused by abnormal nucleotide mismatch repair. The mismatch repair system involves several genes, including MSH2 and MLH1, Cardiovascular (CV) Pathophysiology 1
which code for components of the human MutS and MutL homologs. Mutations in these 2 genes account for around 90% of cases of Lynch syndrome. (Patp)
2106 Releasing factors RFs recog stop codons (e.g. UAA, UAG, and UGA) and terminate protein synthesis. They facilitate release of the polypeptide chain from the ribosome and dissolution of Cardiovascular (CV) Pathophysiology 1
the ribosome-mRNA complex. (Patp)
2107 TATA box mutations The TATA box is a promoter region that binds TFs and RNA polymerase II during the initiation of transcription. It is located approximately 25 bases upstream from the Cardiovascular (CV) Pathophysiology 1
beginning of the coding region. (Patp)
2108 Transcription DNA-binding proteins incl TFs (Myc, CREB), steroid receptors (cort, aldo, progest), TH receptor, fat-sol vit receptors (vit D, retinoic acid), and DNA transcription and Cardiovascular (CV) Pathophysiology 7
replication proteins. (Patp)
2109 Mischarged tRNA The seq of AAs in a growing polypeptide chain is dictated by the interaction of the mRNA codon w/ the tRNA anticodon. tRNA that's mischarged w/ the incorrect AA Cardiovascular (CV) Pathophysiology 1
(and not corrected by AA-tRNA synthetase proofreading) will incorporate the wrong AA into the growing polypeptide chain. (Patp)
2117 Splice site mutation Splicing is performed by spliceosomes, which remove introns containing GU at the 5' splice site and AG at the 3' splice site. Splice site mutations may result in Cardiovascular (CV) Pathophysiology 1
inappropriate removal of exons and retention of introns, leading to the formation of dysfunctional proteins. (Patp)
2124 Prion disease Western blotting is used to identify proteins, Northern blotting identifies specific RNA sequences, and Southern blotting identifies specific DNA sequences in an unknown Cardiovascular (CV) Pathophysiology 3
sample. (Patp)
11797 Hyperthyroidism Postop hypoparathyroidism w/ resultant hypocalcaemia is a common complication of thyroidectomy due to inadvertent injury or removal of the PT glands. Postop Cardiovascular (CV) Pathophysiology 8
supplementation w/ oral Ca2+ and vitD can be used to Tx and prevent postop hypocalcaemia. (Patp)
11833 Orbital fracture Fractures to the orbital floor commonly result from direct frontal trauma to the orbit. The infraorbital nerve runs along the orbital floor in a groove in the maxilla before Cardiovascular (CV) Pathophysiology 2
exiting the skull just inferior to the orbit. Dmg can result in paraesthesia of the upper cheek, upper lip, and upper gingiva. In addn, the IR muscle can also become (Patp)
entrapped, limiting vertical gaze.
11849 Panic disorder PD is characterised by recurrent, unexpected panic atks and should be considered in young, healthy adults who come to the ED w/ unexplained chest pain. Cardiovascular (CV) Pathophysiology 4
(Patp)
11851 Bipolar disorder BD-I is Dx in pts w/ >1 episodes of mania. Manic episodes are characterised by ↑/irritable mood, impulsivity, hyperactivity, ↓ need for sleep, pressure speech, and Cardiovascular (CV) Pathophysiology 7
grandiosity and may occur w/ psych features. (Patp)
13979 Ovarian cancer Telomerase is an RNA-dependent DNA polymerase that synthesizes telomeric DNA sequences that can replace the lost chromosomal ends of the telomeres. Cancer cells Cardiovascular (CV) Pathophysiology 9
typically contain increased telomerase activity to allow for continued proliferation. (Patp)
14959 COPD Neutrophils, macrophages, and CD8+ T lymphocytes are the 1° mediators of disease in COPD. They secrete enzymes and proteases that cause and perpetuate both the Cardiovascular (CV) Pathophysiology 16
alveolar destruction of emphysema and the mucus hypersecretion found in chronic bronchitis. (Patp)
14966 Spinal anatomy The optimal location for needle insertion during a LP is the L3/L4 or L4/L5 space as this is well below the spinal cord termination site (L1 in adults). The L4 vertebral Cardiovascular (CV) Pathophysiology 1
body lies on a line drawn b/w the highest points of the iliac crests. (Patp)
15001 Idiopathic intracranial Idiopathic intracranial HTN (pseudotumor cerebri) Px in young obese women w/ daily h/a (which worsens during Valsalva), bilaterally symmetric papilledema, and Cardiovascular (CV) Pathophysiology 1
hypertension transient visual disturbances. ↑ ICP compresses the optic nerves, resulting in impaired axoplasmic flow and optic disc edema. (Patp)
15180 Study designs A RCT is an experiment in which participants are randomly allocated to >2 groups to Ax the effect of specific interventions (eg, Tx). Cardiovascular (CV) Pathophysiology 6
(Patp)
15199 Esophageal cancer OAC usually occurs in the distal oesophagus due to underlying Barrett oesophagus. Long-standing GORD is the most important RF. Obesity, smoking, use of Rx that Cardiovascular (CV) Pathophysiology 4
lower oesophageal sphincter pressure, and consumption of foods containing nitroso compounds also ↑ the risk. (Patp)
15241 Gout Patients undergoing solid organ transplantation are at increased risk of gout due to medications that impair renal clearance of uric acid. Cyclosporine is particularly Cardiovascular (CV) Pathophysiology 11
associated with gout in the post transplantation period due to decreased uric acid excretion. (Patp)
15269 Atrial myxoma Myxomas are the most common 1° cardiac neoplasm, and approx. 80% originate in the LA. Pts may have systemic embolisation (e.g. stroke) or SSx MV obstr that may Cardiovascular (CV) Pathophysiology 3
be worse w/ certain body positions. Histopathologic Ex reveals amorphous ECM w/ scattered stellate or globular myxoma cells w/i abundant mucopolysaccharide ground (Patp)
substance.
15310 Progressive multifocal Pts w/ advanced AIDS can have reactivation of JC virus, which causes PML. This condition usually presents w/ slowly progr confusion, ataxia, and motor deficits. Brain Cardiovascular (CV) Pathophysiology 1
leukoencephalopathy MRI reveals multifocal areas of white matter demyelination w/ no mass effect or enhancement. (Patp)
15354 Hepatitis C Chronic HCV infec is Tx w/ DAA Rx such as ledipasvir and sofosbuvir. These Rx target spec HCV enzymes (e.g. protease, NS5A, RNA pol), which inhibs viral Cardiovascular (CV) Pathophysiology 4
replication and assembly. Tx w/ DAAs results in cure in >97% of pts. (Patp)
15528 Psychosis In addn to (+) psychotic SSx (e.g. delusions, hallucinations, disorganisation), pts w/ schizophrenia freq exhibit (-) SSx such as flat affect (i.e. lack of facial expression). (-) Cardiovascular (CV) Pathophysiology 6
SSx typically persist b/w acute psychotic episodes and are more resistant to Tx. (Patp)
15574 Chronic kidney disease CKD can cause hyperphosphataemia due to impaired renal excretion of P. ↑ blood PO43- triggers the release of FGF-23, which lowers calcitriol production and intestinal Cardiovascular (CV) Pathophysiology 8
Ca2+absorption. The resulting hypocalcaemia, along w/ hyperphosphataemia, leads to 2° HPT. (Patp)
15650 Acne vulgaris Acne typically arises in adolescents and young adults due to adrenarche-associated enlargement in sebaceous glands with subsequent increases in sebum production. Cardiovascular (CV) Pathophysiology 3
Follicles clogged with sebum provide the anaerobic, lipid-rich environment necessary for the proliferation of Propionibacterium acnes, the skin commensal responsible for (Patp)
acne lesions.
15651 Depression Somatic SSx of depression (weight loss, low energy, sleep disturbance) are less reliable indicators of MDD in pts w/ advanced medical illness. Focusing on non-somatic Cardiovascular (CV) Pathophysiology 8
SSx, such as loss of interest, anhedonia, worthlessness, excessive guilt, and suicidality, can assist in Dx comorbid depression in these pts. (Patp)
15693 Chagas disease Chagas disease is a protozoal illness that's endemic to Latin America. Pts in rural areas are at greatest risk when their houses harbor the vector (Triatome bug) in adobe Cardiovascular (CV) Pathophysiology 1
walls or thatched roofs. Acute infections are often aSSx, but pts can develop Chagas cardiomyopathy (e.g. HF, ventricular arrhythmias, ventricular aneurysms) several (Patp)
decades later.
15729 Multiple myeloma MM is a/w the clonal proliferation of plasma cells in the bone marrow. This prevents normal B cell lymphogenesis and incr. the risk of bacterial infection due to decr. Cardiovascular (CV) Pathophysiology 9
production of normal Igs. (Patp)
16596 Radiculopathy Motor and sensory deficits across multi peri upper extremity nerves (e.g. radial and median) indicate a lesion in the brachial plexus prox. to the formation of the terminal Cardiovascular (CV) Pathophysiology 3
branches. In the absence of Hx of trauma or malignancy, the most likely cause is nerve root compression due to cervical spondylosis (cervical radiculopathy). (Patp)
1014 West Nile virus infection WNV is harbored in birds and transmitted to humans by mosquitos. Most pts are aSSx, but the virus can cause an influenza-like illness or neuroinvasive disease w/ Cardiovascular (CV) Pharmacology 2
meningitis, encephalitis, and flaccid paralysis. (Phar)
1080 Toxoplasmosis Pregnant women should avoid raw or undercooked meat in order to prevent infection w/ Toxoplasma gondii, an intracellular parasite that can spread across the placenta to Cardiovascular (CV) Pharmacology 5
the fetus. Congenital toxoplasmosis is typically Chx by retinal lesions, hydrocephalus, jaundice, and HSM. (Phar)
1082 Sjogren syndrome SS is an AI disorder char by inflammation of exocrineglands. Bx of the labial salivaryglands shows periductal lymphocytic infiltrates (focal lymphocytic sialadenitis), Cardiovascular (CV) Pharmacology 2
often w/ germinal centres; the glandular tissue is typically atrophic and fibrotic. (Phar)
1118 Sjogren syndrome SS is an AI disorder char by lymphocytic inflammation in exocrine glands (e.g. lacrimal, salivary glands). It presents w/ dry eyes (keratoconjunctivitis sicca) and dry Cardiovascular (CV) Pharmacology 2
mouth (xerostomia). Chronic B-cell proliferation in pts w/ SS ↑ the risk of devel NHL. (Phar)
QID Topic Educational Objective System Subject Repeats
1164 Central pontine Osmotic demyelination syndrome results from overly rapid correction of chronic hyponatremia. Clinical features include quadriplegia, pseudobulbar palsy, and reduced Cardiovascular (CV) Pharmacology 2
myelinolysis level of consciousness. MRI demonstrates focal demyelination of the pons. (Phar)
1166 Wilson disease WD is a/w Cu accumulation in the liver, brain, and cornea. It commonly presents in childhood or adolescence w/ abn LFTs a/o neuropsych SSx. Psych SSx may predate Cardiovascular (CV) Pharmacology 5
other MFxs and incl personality changes, depression, mania, a/o psychosis. (Phar)
11836 Polymyositis and Dermatomyositis is characterised by proximal muscle weakness resembling polymyositis, w/ addnal inflammatory features affecting the skin (e.g. heliotrope rash, Gottron Cardiovascular (CV) Pharmacology 5
dermatomyositis papules). In both conditions, involvement of striated muscle in the oropharynx and heart can lead to dysphagia, pulm aspiration, and myocarditis. (Phar)
11844 Benzodiazepines Flumazenil is a benzo receptor antagonist. It can reverse the sedative effects of benzos related to overdose and procedural sedation. Cardiovascular (CV) Pharmacology 6
(Phar)
11925 Antidepressants Antidepressants (e.g. SSRIs) take 4-6wks to achieve max clinical effect. Cardiovascular (CV) Pharmacology 4
(Phar)
1196 Fetal alcohol syndrome Typical features of fetal alcohol syndrome include facial dysmorphism (short palpebral fissures, thin upper lip, smooth philtrum), growth retardation, neurological Cardiovascular (CV) Pharmacology 1
abnormalities, and behavioral difficulties. (Phar)
1200 Myasthenia gravis MG is characterised by auto-Abs against post-synaptic nAChRs at the NMJ, which result in receptor degradation. Pts typically have extraocular, bulbar, and facial Cardiovascular (CV) Pharmacology 10
weakness that worsens w/ activity. In severe cases, the resp muscles may be affected, leading to hypoventilation and resp failure. (Phar)
1252 Peripheral neuropathy Ulnar neuropathy is Chx by numbness of the 4th and 5th digits, pain, and weakness. It is most commonly caused by compressive injury, leading to tissue ischemia and Cardiovascular (CV) Pharmacology 3
demyelination (Schwann cell injury). A nerve conduction study can help differentiate demyelinating vs axonal neuropathies; demyelination causes slowed or blocked (Phar)
nerve conduction velocity whereas axonal injury leads to a ↓ in signal strength.
1342 Inhalants Inhalant intox is characterised by immediate onset of euphoria, lethargy, ataxia, a/o LOC f/b rapid recovery w/i 45mins. Perioral and perinasal dermatitis (i.e. 'glue Cardiovascular (CV) Pharmacology 1
sniffer's rash') may be seen in chronic users. (Phar)
1343 Cocaine Cocaine intox can produce psychotic SSx (e.g. paranoid delusions), euphoria, and agitation. Physical SSx indicating sympathetic stim (e.g. tachycardia, diaphoresis, Cardiovascular (CV) Pharmacology 3
mydriasis) can assist in diffiating cocaine intox from 1° psychiatric disorders. (Phar)
1344 SLE SLE is an autoimmune disease characterised by the formation of ANA (e.g. anti-DNA Abs). Lupus nephritis occurs 1arily due to the formation of ICs containing DNA Cardiovascular (CV) Pharmacology 7
and anti-DNA in the circulation. These are deposited in the glomerulus where they result in complement activation, recruitment of inflammatory cells, and renal injury (Phar)
(HS-III).
136 Rheumatoid arthritis Joint destruction in RA is char by synovial hyperplasia, an inflammatory infiltrate, and synovial angiogenesis. The joint space often becomes replaced by pannus, an Cardiovascular (CV) Pharmacology 9
invasive mass composed of fibroblast-like synovial cells, granulation tissue, and inflammatory cells that can erode into the articular cartilage and underlying bone. (Phar)
1364 Rheumatoid arthritis RA is char by synovial hyperplasia w/ inflammatory infiltrates. The accelerated meta rate of the inflamed synovium causes local hypoxia, which leads to synovial Cardiovascular (CV) Pharmacology 9
angiogenesis. As the disease progresses, the joint space is replaced by a rheumatoid pannus (an invasive mass of fibroblast-like synovial cells, granulation tissue, and (Phar)
inflammatory cells) which can destroy the articular cartilage and underlying subchondral bone.
1367 Bone tumor ES is the 2nd most common malignant bone tumor of childhood (after OS). It most commonly involves the lower extremity and pelvis and often metastasizes to the lungs. Cardiovascular (CV) Pharmacology 3
Histopathology is Chx by uniform, small, round, cells; fibrous septae; and patches of necrosis and hemorrhage. (Phar)
137 Bone tumor OS is the most common 1° bone tumour in children and young adults and typically arises near the metaphyses of long bones. Pts usually have slowly worsening pain and Cardiovascular (CV) Pharmacology 3
soft-tissue swelling. XR typically reveals a lytic bone lesion, and Bx classically shows pleomorphic, spindle-shaped tumour cells that generate osteoid and thin trabeculae (Phar)
of neoplastic bone.
138 Neural tube defects MTX and other vit B9 antagonists adversely affect rapidly dividing cells (e.g. epithelial cells, stem cells, neural tube cells) by limiting the production of precursors Cardiovascular (CV) Pharmacology 4
essential to DNA synthesis and repair. If used in the 1st trimester of pregnancy, these drugs can cause major congenital abnormalities (e.g. CV abnormalities, NTDs). (Phar)
139 Brain tumors Ependymomas originate from the ependymal cells that line the ventricular system and the central canal of the spinal cord. Ventricular ependymomas can block the flow of Cardiovascular (CV) Pharmacology 10
CSF thru the interventricular foramina, causing SSx of ↑ ICP (e.g. h/a, papilloedema) due to obstr (noncommunicating) hydrocephalus. (Phar)
140 Insomnia Age-related sleep changes may be reported as insomnia and must be diffiated from 1° sleep disorders and other disorders. Normal changes incl ↓ total sleep time, ↑ night- Cardiovascular (CV) Pharmacology 3
time awakenings, sleepiness earlier in the evening w/ earlier morning awakening, and ↑ daytime napping. (Phar)
141 Bone tumor OS is the most common 1° bone malignancy in children and young adults. It occurs most frequently at the metaphyses of long bones and Px w/ local pain and swelling. Cardiovascular (CV) Pharmacology 3
Most cases are a/w sporadic or inherited mutations in RB1 (HRb) and TP53 (LFS). (Phar)
142 Cerebral aneurysm An expanding aneurysm in the cavernous portion of the ICA is most likely to initially cause h/a and diplopia (ipsilateral lateral rectus weakness) due to compressing or Cardiovascular (CV) Pharmacology 1
stretching of the abducens nerve (CN VI) as it runs next to the ICA in the cavernous sinus. Other commonly affected nerves include the oculomotor nerve (CN III), (Phar)
trochlear nerve (CN IV), and the V1 and V2 branches of the trigeminal nerve (CN V).
143 Frontotemporal dementia The frontal lobes are involved in personality, language, motor fxns, and executive fxns (e.g. abstraction). Frontal lobe fxn may be Dx by testing abstraction ability (e.g. Cardiovascular (CV) Pharmacology 2
asking about the similarities b/w 2 related objects) on the MSE. (Phar)
1444 Acute heart failure Pts w/ DHF have ↑ LV EDP and ↓ CO that's most often 1arily due to LV dysfxn. RA pressure (i.e. CVP) is also ↑ in advanced HF due to volume overload; RHF (most Cardiovascular (CV) Pharmacology 7
often occurring 2° to LHF) can also contribute to ↑ RA pressure. (Phar)
145 Chronic heart failure The ventricular myocardium secretes BNP in response to the ventricular stretch and strain that typically occurs w/ volume overload. BNP, along w/ ANP secreted by the Cardiovascular (CV) Pharmacology 12
atrial myocardium, stimulates vasodilation and salt and water excretion to help relieve volume overload. (Phar)
147 Gastroparesis Diabetic gastroparesis results from the destruction of enteric neurons due to chronic hyperglycaemia, leading to impaired relaxation and disordered and ineffective Cardiovascular (CV) Pharmacology 2
peristalsis. This causes delayed gastric emptying, which presents as postprandialfullness, regurgof undigested food, nausea, and vomiting. (Phar)
14780 Brain tumors GBM is an aggressive 1° brain neoplasm that generally Px w/ slowly worsening h/a, seizure, a/o focal neuro issues. Most cases are a/w oncogenic mutations that increase Cardiovascular (CV) Pharmacology 10
EGFR expression on the tumor cells, leading to ↑ transduction of growth signals that promote cellular survival and proliferation. (Phar)
148 Hip fracture The greater trochanter of the femur serves as the site of insertion for the gluteus medius muscle, which is responsible for hip abduction and stabilisation of the pelvis Cardiovascular (CV) Pharmacology 2
during ambulation. Fractures of the greater trochanter (e.g. fragility fracture from a fall) can disrupt the integrity of the gluteus medius tendon and result in lat. hip pain w/ (Phar)
gait instability and weakness of hip abduction.
14844 Lipoma Lipomas are common, benign tumours that arise from the subcutaneous fat and present as soft, mobile masses that're stable or enlarge slowly over time. The Dx is usually Cardiovascular (CV) Pharmacology 1
made clinically, but histopath shows well-diffiated, matureadipocytes w/ a fibrous capsule. (Phar)
149 Osteomyelitis M. tuberculosisspondylitis (Pott's disease) is usually the result of heme seeding of vertebrae from 1° pulm infection. MFxs typically arise mos or yrs later (due to Cardiovascular (CV) Pharmacology 4
reactivation) and incl chronic, progr back pain, fever, and radiographic evidence of vertebral bone destruction and fluid collection. (Phar)
150 Diabetic neuropathy DM is the most common cause of peri polyneuropathy in adults. Common findings incl numbness and paraesthesias in a stocking-glove distribution and ↓ proprioception Cardiovascular (CV) Pharmacology 1
due to degen of large-fibre sensory axons. (Phar)
1505 Diabetic retinopathy Chronic hyperglycemia in patients with diabetes can lead to increased permeability and arteriolar obstruction in retinal vessels. The resulting ischemia stimulates Cardiovascular (CV) Pharmacology 1
production of vascular endothelial growth factor and other angiogenic factors, leading to neovascularization (proliferative diabetic retinopathy). Complications include (Phar)
retinal hemorrhage, retinal detachment, and vision loss.
1506 Diabetic foot Neuropathic foot ulcers can occur in diabetic pts when loss of pain sensation and proprioception delays recognition of injury due to trauma, friction, or sustained pressure Cardiovascular (CV) Pharmacology 2
(on plantar surface of foot bones). The risk is greatest in pts w/ longstanding DM who have poor glycaemic control. (Phar)
1507 Paget disease of bone PDB is Chx by disordered bone formation. Involvement of long bones can lead to bone pain, bowing, fracture, or arthritis of adjacent joints. Serum ALP is ↑ due to ↑ Cardiovascular (CV) Pharmacology 4
production of new bone, but Ca and P levels remain normal. (Phar)
1508 Traumatic brain injury DAI is a type of TBI that results from disruption of the white matter tracts. Microscopically, DAI is visible as widespread axonal swelling, most pronounced at the gray- Cardiovascular (CV) Pharmacology 5
white matter jxn, w/ accumulation of transport proteins (eg, amyloid precursor, α synuclein) at the site of injury. (Phar)
1509 Migraine Migraines are an episodic neurological disorder that results in severe, unilateral, throbbing headaches often associated with photophobia, phonophobia, and Cardiovascular (CV) Pharmacology 3
nausea/vomiting. Migraines typically last 4-72 hours, and up to 25% of patients also develop an aura (focal, reversible neurologic symptoms that precede or accompany (Phar)
the headache).
153 Migraine Migraine is an episodic disorder characterised by severe, often unilateral h/a, commonly a/w nausea and sensitivity to light and sound. Tx is divided into abortive therapy Cardiovascular (CV) Pharmacology 3
(e.g. mild analgesics, triptans, antiemetics, ergotamines) for acute SSx and preventive therapy (e.g. β blockers, TCAs, anticonvulsants [topiramate, valproate]) to ↓ the freq (Phar)
of h/a.
154 Long QT syndrome Congenital LQTS is commonly caused by a mutation that slows the delayed rectifier K current that repolarizes the cardiomyocyte AP. Certain Rx (eg, macrolide Abx, Cardiovascular (CV) Pharmacology 4
antipsychotics, antiemetics) also slow the K repolarization current and prolong the QT interval. Excessive QT prolongation can trigger serious cardiac arrhythmia (ie, (Phar)
TdP), resulting in syncope or SCD.
155 Erythema multiforme EM is a target-shaped, inflammatory skin lesion that typically arises in the setting of infection, particularly w/ HSV or M. pneumoniae. It's caused by the deposition of Cardiovascular (CV) Pharmacology 2
infectious Ags in keratinocytes, leading to a strong cell-mediated (e.g. Tc-cell) immune response. (Phar)
15515 Paget disease of bone PDB is char by excessive and disordered bone formation. It commonly affects the skull, long bones, and vertebral column. The ↑ formation of new bone is a/w an ↑ serum Cardiovascular (CV) Pharmacology 4
ALP lvl. Radiographs shows lytic or mixed lytic-sclerotic lesions, thickening of cortical and trabecular bone, and bony deformities. (Phar)
156 Panic disorder PD consists of recurrent and unexpected panic atks characterised by an abrupt surge of anxiety and distressing cardiopulm/neuro SSx. Agoraphobia, a common comorbid Cardiovascular (CV) Pharmacology 4
disorder, results in anxiety about and avoidance of situations where pts may feel trapped and helpless in the event of a panic atk (e.g. crowds, enclosed spaces, public (Phar)
transportation.
1565 Delirium Delirium is characterised by the acute onset of fluctuating disturbance in attn and gen cognition (e.g. altered lvl of consciousness, disorientation, hallucinations). Common Cardiovascular (CV) Pharmacology 4
Rx that may precipitate delirium in high-risk pops (e.g. elderly pts) incl sedative-hypnotics, benzos, opioids, and anticholinergic Rx. (Phar)
159 Sciatic neuropathy Sciatic neuropathy is a common complication of hip fracture a/o arthroplasty b/c of the proximity of the sciatic nerve to the hip joint. Injury to the sciatic nerve in the Cardiovascular (CV) Pharmacology 2
pelvis causes neuro deficits across the sciatic nerve (knee flexion), common peroneal nerve (dorsiflexion, numbness of the calf and dorsal foot), and tibial nerve (plantar (Phar)
flexion, ankle reflex).
160 Chemotherapy induced CTx-induced nausea and vomiting is mediated by peri and central mechs. It can be Tx w/ 5-HT receptor antagonists (e.g. ondansetron) to prevent 5-HT stim of afferent Cardiovascular (CV) Pharmacology 1
nausea and vomiting vagal fibres in the bowel wall (peri cause) and NK-1 receptor antagonists (e.g. aprepitant) to prevent the effects of substance P in the brainstem (central cause). (Phar)
161 Median nerve injury The median nerve is most commonly injured w/i the carpal tunnel, leading to pain and numbness in the first 3 digits and lateral half of the 4th, as well as weakness of Cardiovascular (CV) Pharmacology 1
thumb flexion and opposition. More proximal injury (in the forearm) additionally causes ↓ sensation over the thenar eminence and weakness of flexion in the wrist and (Phar)
2nd and 3rd digits.
1780 Tricuspid regurgitation Severe TR can lead to right-sided HF, evidenced by JVD, hepatomegaly, lower extremity edema, and the absence of pulm edema. Permanent PM placement can cause TR Cardiovascular (CV) Pharmacology 3
b/c the RV lead passes through the TV orifice and can disrupt valve closure. (Phar)
1828 Bipolar disorder Manic episodes are characterized by euphoric/irritable mood, impulsivity, hyperactivity, decreased need for sleep. pressured speech, racing thoughts, and grandiosity. Cardiovascular (CV) Pharmacology 7
They may occur with or without psychotic features. (Phar)
QID Topic Educational Objective System Subject Repeats
1836 Illness anxiety disorder IAD is characterised by excessive concern about having a serious, un-Dx disease, despite few or no SSx and (-) medical workup. Cardiovascular (CV) Pharmacology 1
(Phar)
1944 Parasomnias Sleepwalking, a common non-REM parasomnia of childhood, occurs during slow-wave sleep (stage N3), which is characterized by delta Waves on EEG. Sleepwalking Cardiovascular (CV) Pharmacology 2
typically occurs during the first half of the night, when slow-wave sleep is most prominent. (Phar)
1947 Ischemic stroke The ACA supplies the medial aspects of the frontal and parietal lobes, which contain the UMNs responsible for contralateral lower extremity motor control. TE occlusion Cardiovascular (CV) Pharmacology 19
of the ACA Chx results in contralateral lower extremity weakness w/ hyperreflexia. (Phar)
1948 Transient ischemic attack TIAs are transient episodes of focal neuro impairment that occur due to local brain ischemia; tissue infarction doesn't occur, and brain imaging is normal. Pts w/ TIA are at Cardiovascular (CV) Pharmacology 1
↑ risk of future stroke; 2° prevention incls antiplatelet agents (e.g. aspirin, clopidogrel), statins, and LSMs (e.g. tobacco cessation, exercise) to ↓ future risk. (Phar)
2002 Diabetes mellitus SGLT2 inhibs (e.g. canagliflozin, dapagliflozin) ↓ renal reabsorption of Glc and Na+, leading to lower BSLs. The ↓ reabsorption of Na+ and Glc also induces osmotic Cardiovascular (CV) Pharmacology 31
diuresis, which causes a ↓ in BP. Excess urinary Glc also leads to an ↑ risk for GUTIs. (Phar)
2005 Testicular cancer A painless, solid scrotal mass should be considered testicular cancer until proven otherwise. Examination generally reveals a solid, firm, or fixed nodule in the tunica Cardiovascular (CV) Pharmacology 4
albuginea that is ovoid in shape and painless to palpation. Testicular tumors do not transilluminate. (Phar)
2006 BCL 2 CLL is a/w overexpression of BCL-2, an anti-apoptotic protein, on the mitochondrial membrane. Tx w/ a BCL inhib causes ca cell death by promoting cyt c release from Cardiovascular (CV) Pharmacology 1
the mitochondria, which subseq activates caspases. (Phar)
315 Testicular cancer Most cases of testicular cancer are either seminomatous or nonseminomatous germ cell tumors. Nonseminomatous germ cell tumors are composed of partially Cardiovascular (CV) Pharmacology 4
differentiated germ cells, which often retain the ability to secrete human chorionic growth hormone and alpha-fetoprotein (serum tumor markers). Serum lactate (Phar)
dehydrogenase, a marker of tissue injury and cell turnover, is also frequently increased.
38 Aortic aneurysm TAAs are usually aSSx until they grow large enough to compress surrounding structures or cause rupture. The most common SSx presentation is chest or back pain, but Cardiovascular (CV) Pharmacology 6
compression of nearby structures can cause dysphagia, hoarseness, cough, or dyspnoea. (Phar)
551 Aortic aneurysm Ruptured AAA is a Sx emergency that usually Px w/ the acute onset of severe abdominal and back pain in pts w/ appropriate RFx (eg, advanced age, smoking, Cardiovascular (CV) Pharmacology 6
atherosclerosis). Accompanying syncope, hypotension, and shock may occur quickly (intraperitoneal rupture) or may be delayed (retroperitoneal rupture). (Phar)
577 Diabetes mellitus Phys insulin secretion can be approx. by a combo of long-acting and rapid-acting insulin analogues. Long-acting preps (e.g. glargine) are released from the injection site Cardiovascular (CV) Pharmacology 31
slowly throughout the day and replicate basal insulin secretion. Boluses of a rapid-acting insulin (e.g. lispro) w/ quick absorption are given w/ meals to control (Phar)
postprandial Glc ↑.
625 Diabetes mellitus SUs inhib the ATP-sensitive K+ channel on the pancreatic β cell membrane, inducing depol and L-type Ca2+ channel opening. The ↑ Ca2+ influx stims β cell insulin Cardiovascular (CV) Pharmacology 31
release independent of BGCs. SUs stim insulin secretion, even when BSLs are normal, which can lead to hypoglycaemia. (Phar)
645 Aortic dissection The most common SSx of acute AD is sudden onset of severe, sharp or tearing chest and back pain. Complications include stroke, AR, and myocardial ischemia. In Cardiovascular (CV) Pharmacology 6
addition, a dissection can extend into the pericardium, resulting in tamponade w/ ↓ CO and shock. (Phar)
6811 Aortic dissection Marfan syndrome involves a deleterious mut in fibrillin that mainly affects the structural integrity of the CV and MSK systems. Aortic root disease predisposes to AD, Cardiovascular (CV) Pharmacology 6
which can present w/ sudden-onset chest or back pain, acute AR, and HF. Common histologic findings in aortic disease incl fragmentation and loss of the elastic lamellae (Phar)
w/ fibrosis and CMD.
686 Aortic dissection CMD (necrosis) is the classic histologic finding in AD, as it weakens the aortic wall and allows a small intimal tear to readily propagate. Collagen, elastin, and smooth Cardiovascular (CV) Pharmacology 6
muscle are replaced by a basophilic mucoid ECM w/ elastic tissue fragmentation and cystic collections of mucopolysaccharide. (Phar)
689 Biologic agents Monoclonal antibodies (mAbs) are not eliminated by hepatic or renal clearance. Therefore, no dose adjustment is necessary with impaired hepatic/renal function or use of Cardiovascular (CV) Pharmacology 2
cytochrome P450 inducers or inhibitors. (Phar)
691 Focal nodular hyperplasia FNH is a benign liver tumor marked by a central stellate scar containing an abnormally large artery. It usually arises in young women and most cases are aSSx and found Cardiovascular (CV) Pharmacology 1
incidentally. (Phar)
693 Vitamin B12 deficiency Vit B12 is an essential cofactor in the recycling of 5MTHF to THF, which is req for AA, purine, and thymidine synth. Defic 1arily affect HPO cell maturation and is Cardiovascular (CV) Pharmacology 9
marked by incr nuclear-cytoplasmic ratio, leading to macrocytic RBCs and hyperseg neutrophils; incr apoptosis often also leads to anemia and mild (Phar)
thrombocytopenia/leukopenia.
697 Diabetes mellitus GLP-1 regulates Glc by slowing gastric emptying, suppressing glucagon secretion, and ↑ Glc-dependent insulin release. DPP-4 inhibs (e.g. sitagliptin, saxagliptin) ↓ the Cardiovascular (CV) Pharmacology 31
breakdown of GLP-1 and improve glycaemic control in pts w/ DM-2. B/c the effect on insulin is Glc-dependent, these Rx have a low risk of hypoglycaemia. (Phar)
711 Lichen planus LP presents w/ pruritic, purple/pink, polygonal papules and plaques that can affect the flexural surfaces of the wrists and ankles, along w/ the nails, oral mucous Cardiovascular (CV) Pharmacology 1
membranes, and genitalia. Histo findings incl hyperkeratosis, lymphocytic infiltrates at the DEJ, thickened stratum granulosum w/ sawtooth rete ridges, and eosinophilic (Phar)
colloid bodies in the papillary dermis.
713 DIC Acute DIC is a consumptive coagulopathy linked to severe trauma. Widespread formation of microvascular thrombi leads to consumption of platelets, coagulation factors, Cardiovascular (CV) Pharmacology 5
and fibrinogen. Subsequent activation of anticoagulant proteins leads to low protein C/S; fibrinolysis ↑ D-dimer. Most pts have bleeding complications (eg, oozing from (Phar)
venipuncture/catheter sites) and EOD to the lungs or kidneys.
7640 DIC DIC is marked by widespread activation of the coag cascade, leading to excessive FIIa production and formation of microthrombi. Subseq conversion of plasminogen to Cardiovascular (CV) Pharmacology 5
plasmin results in incr fibrinolysis to clear the thrombi. LFx show a consumption of CFs (prolonged PT/PTT) and platelets (thrombocytopenia) and SSx of excessive (Phar)
fibrinolysis (e.g. incr D-dimer).
778 Aortic regurgitation A large, acute pulmonary embolism causes a rapid increase in right ventricular (RV) pressure that leads to RV cavity enlargement and RV dysfunction. Thickening of the Cardiovascular (CV) Pharmacology 8
RV wall is not seen in acute pulmonary embolism, as there is no time for compensatory hypertrophy to occur in response to the increased pressure load. (Phar)
780 von Willebrand disease vWD is the most common inherited bleeding disorder and is usually transmitted in an AD fashion. SSx pts typically Px w/ easy bruising and mucosal bleeding. LFx will Cardiovascular (CV) Pharmacology 7
show normal platelets, normal PT, and either normal or prolonged PTT due to low levels of factor VIII. (Phar)
781 Tinea Tinea pedis is a superficial infection of the epidermis caused by dermatophytes (e.g. T. rubrum). It most often presents as a pruritic, erythematous rash b/w the toes that Cardiovascular (CV) Pharmacology 4
freq extends along the sole. KOH micro of skin scrapings shows branching hyphae. Tx options incl a variety of topical antifungals (e.g. clotrimazole), but not nystatin. (Phar)
823 Melanoma Melanoma lesions often have multiple color variations. The different colors represent different activities within the tumor. Whitish/gray areas occur when cytotoxic T Cardiovascular (CV) Pharmacology 6
cells recognize tumor antigens and destroy malignant cells, leading to melanocyte regression. Red areas arise due to vessel ectasia and local inflammation, whereas brown (Phar)
or black areas are generally due to advancing malignant melanocytes.
8289 Melanoma Melanoma is often Dx when immunostaining of Bx samples reveals multi melanocyte markers (e.g. S-100, HMB-45, MART-1). Cardiovascular (CV) Pharmacology 6
(Phar)
8291 Melanoma PD-1 is a checkpoint inhibitor that downregulates the Tc cell response. Neoplastic cells often exploit this receptor via the overexpression of PD-L1. PD-1 receptor Cardiovascular (CV) Pharmacology 6
inhibitors (eg, Pembrolizumab) restore the T cell response, allowing Tc cells to invade the tumor and induce apoptosis of neoplastic cells. (Phar)
8869 Hypokalemia Hypokalaemia can result from the intracellular shift of K+, which can occur due toβ-adrenergic hyperactivity (e.g. β2agonists, endogenous EPI release), ↑ insulin lvls, ↑ Cardiovascular (CV) Pharmacology 2
extracellular pH, or ↑ cell production (e.g. acute leukaemia). (Phar)
898 Constipation Dyssynergic defecation occurs when the puborectalis muscle or the int. or ext. anal sphincter fails to relax during defecation, leading to chronic constipation. Dyssynergic Cardiovascular (CV) Pharmacology 3
defecation is usually considered a fxnal disorder and occurs more commonly in the elderly but may also occur w/ certain neuro disorders (e.g. PD, MS) or trauma. (Phar)
899 Constipation The pelvic splanchnic nerves (S2-S4) provide parasympathetic innervation to the bowel and bladder, and their impairment in CES can cause constipation and difficulty Cardiovascular (CV) Pharmacology 3
urinating. Other SSx of CES incl radicular LBP and leg weakness (sciatic nerve) as well as saddle anaesthesia (pudendal, ilioinguinal nerves). (Phar)
900 Psoriasis Psoriasis is a common inflammatory skin disorder characterised by hyperkeratosis (overgrowth of the stratum corneum) and epidermal hyperplasia. Plaque psoriasis is the Cardiovascular (CV) Pharmacology 5
most common form and presents w/ chronic, well-demarcated, erythematous plaques w/ a thick, silver scale. (Phar)
901 Lice infestation Pediculus humanus capitis (ie, head lice) infestation is common in school children and adults who come into close contact w/ infested individuals. Transmission is usually Cardiovascular (CV) Pharmacology 2
by direct contact. The eggs (nits) are attached to the hair shaft and can be identified on inspection. Head lice do not carry infection, but the bite can induce a pruritic (Phar)
allergic rxn. 1st-line Tx includes topical pediculicides (eg, permethrin, ivermectin).
948 Thyroid cancer Foll neoplasms typically present as slowly enlarging, painless thyroid nodules. diff b/w a foll adenoma and FTC isn't possible using only FNA results. Histo evidence of Cardiovascular (CV) Pharmacology 6
invasion of the tumour capsule a/o surrounding blood vessels is needed to Dx FTC. (Phar)
949 Adrenal insufficiency Primary adrenal insufficiency (PAI) is characterized by weight loss, abdominal pain, fatigue, and hyperpigmentation. Physiologic stress in patients with PAI can trigger Cardiovascular (CV) Pharmacology 5
acute adrenal crisis (eg, fever, shock, mental status changes). Autoimmune adrenalitis is the most common cause of PAI and leads to bilateral adrenal atrophy. (Phar)
144 Lactose intolerance The small bowel mucosa of pts w/ 1° lactase defic is normal on histo Ex. Cardiovascular (CV) Physiology 3
(Phys)
157 Nitrates Isosorbide dinitrate has a low bioavailability due to extensive 1st-pass hepatic metabolism prior to release in systemic circulation. Sublingual NG is absorbed directly from Cardiovascular (CV) Physiology 7
oral mucosa into the venous circulation and has a higher bioavailability. (Phys)
183 Dyslipidemia Niacin is used in the Tx of hyperlipidemia. It ↑ HDL lvls and ↓ LDL lvls and triglycerides. Niacin causes cutaneous flushing, which is mediated by prostaglandins and can Cardiovascular (CV) Physiology 11
be diminished by preTx w/ aspirin. (Phys)
205 Primary hypertension Concentric hypertrophy is characterised by uniform thickening of the ventricular wall and narrowing of the ventricular cavity due to ↑ afterload (e.g. chronic HTN, AS). Cardiovascular (CV) Physiology 14
Eccentric hypertrophy is characterised by ↓ ventricular wall thickness w/ an assoc ↑ in chamber size due to volume overload. (Phys)
456 Acute pancreatitis Multi inhib mechs exist to prevent premature activation of trypsinogen before it reaches the duodenal lumen, incl cleavage inactivation of trypsin by trypsin itself and Cardiovascular (CV) Physiology 9
production of trypsin inhibs (e.g. SPINK1). Gene muts that render trypsin insensitive to cleavage inactivation cause hereditary pancreatitis. (Phys)
951 Huntington disease HD is an AD neurodegen disease that leads to the accumulation of abn, toxic huntingtin protein in neural cells. Inhib GABAergic neurons in the caudate nuclei are most Cardiovascular (CV) Physiology 5
susceptible, and their loss is responsible for the ChFx of HD (e.g. chorea, behavioural abns). (Phys)
1510 Alzheimer disease A chronically progressive pre-senile dementia with cortical atrophy but no other radiological or laboratory abnormalities permits a clinical diagnosis of Alzheimer's Cardiovascular (CV) Physiology 7
disease (AD), which is a diagnosis of exclusion. Current AD-specific therapies include cholinesterase inhibitors (Donepezil), antioxidants (vitamin E), and NMDA (Phys)
receptor antagonists (e.g. memantine).
1511 Benzodiazepines Benzos bind GABAA receptors, resulting in an ↑ freq of Cl- channel opening in the presence of GABA. Indications for prescribing incl short-term Tx of anxiety disorders Cardiovascular (CV) Physiology 6
and AWS. (Phys)
1512 Beta blocker poisoning Pts who have OD'd on β blockers should be Tx w/ glucagon, which ↑ HR and contractility independent of adrenergic receptors. Glucagon activates GPCRs on cardiac Cardiovascular (CV) Physiology 1
myocytes, causing activation of adenylate cyclase and ↑ intracellular cAMP. The result is Ca2+ release from intracellular stores and ↑ SA node firing. (Phys)
1513 Lung abscess Patients with alcoholism are at increased risk for lung abscess due to the aspiration of oral flora during periods of unconsciousness. Lung abscesses tend to be Cardiovascular (CV) Physiology 4
polymicrobial; they are usually composed of anaerobic oral flora (Bacteroides, Prevotella, Fusobacterium, and Peptostreptococcus) and aerobic bacteria. Clindamycin (Phys)
provides coverage against both anaerobic and aerobic organisms and has been traditionally used in the treatment of lung abscess.
1515 Warfarin Most available rodenticides contain brodifacoum, a long-acting 4-hydroxycoumarin derivative. A pt who has ingested a quantity of rodenticide sufficient to cause Cardiovascular (CV) Physiology 2
coagulopathy and abnormal bleeding (similar to warfarin toxicity) requires immediate Tx w/ FFP in addition to vitamin K. (Phys)
QID Topic Educational Objective System Subject Repeats
1516 Sexual differentiation The SRY gene on the Y chromosome codes for the TDF, which differentiates the primitive gonads into testes. Sertoli cells produce AMH, which causes regression of the Cardiovascular (CV) Physiology 2
Mullerian ducts and suppresses female internal reproductive organ development. Leydig cells produce testosterone, differentiating Wolffian ducts into internal male (Phys)
reproductive organs. DHT is required for differentiation of the external male genitalia.
1517 Gout Gout results from the deposition of monosodium urate crystals in the joints and soft tissues. Under polarized light, urate crystals appear needle-shaped and negatively Cardiovascular (CV) Physiology 11
birefringent. Conditions that increase uric acid production or decrease uric acid clearance can increase the risk of gout. (Phys)
1518 Pseudogout Synovial fluid analysis showing rhomboid-shaped Ca-PPi crystals is Dx of pseudogout. These crystals are (+) birefringent under pol light. The knee joint is involved in Cardiovascular (CV) Physiology 1
>50% of cases. (Phys)
1528 Obstructive sleep apnea OSA is due to relaxation of oropharyngeal muscle tone w/ occlusion of the upper airway. SSx incl daytime sleepiness, h/a, and depression. Complications incl HTN and Cardiovascular (CV) Physiology 4
PAH, RHF, and an ↑ risk for cardiac events. (Phys)
1529 Viral genetics Recombination refers to gene exchange that occurs through the crossing over of 2 ds DNA molecules. Reassortment describes the mixing of genome segments in Cardiovascular (CV) Physiology 4
segmented viruses that infect the same host cell. (Phys)
1530 Viral genetics Phenotypically mixing refers to coinfection of a host cell by 2 viral strains, resulting in progeny virions that contain nucleocapsid proteins from 1 strain and the unchanged Cardiovascular (CV) Physiology 4
parental genome of the other strain. B/c there's no change in underlying viral genomes (no genetic exchange), the next gen of virions revert to their original, unmixed (Phys)
phenotypes.
1531 HIV ART during preg ↓ the risk of perinatal transmission of HIV to 1-2% and is recommended for all preg women w/ HIV. Cardiovascular (CV) Physiology 11
(Phys)
1557 Bursitis A bursa is a fluid-filled synovial sac that serves to alleviate pressure from bony prominences and ↓ friction b/w muscles and tendons. Acute trauma or chronic repetitive Cardiovascular (CV) Physiology 1
pressure can cause injury, leading to localized pain and tenderness. Prepatellar bursitis causes anterior knee pain and is usually due to repetitive or prolonged kneeling. (Phys)
1589 Pulmonary gas exchange Gas exchange b/w the alv and pulm cap blood depends on both Q and D. The exchange of O2 and CO2 in a normal individual at rest is Q-limited, so alv and cap partial Cardiovascular (CV) Physiology 1
pressures are equal. Situations in which O2 exchange becomes D-limited (e.g. emphysema, PF) cause a large gradient b/w alv and cap PO2; PCO2 is less affected due to (Phys)
the greater DC of CO2.
1591 Hypovolemia Regardless of the pt's hydration status, the majority of water reabsorption in the nephron occurs in the PCT passively w/ the reabsorption of solutes. Cardiovascular (CV) Physiology 1
(Phys)
1609 Respiratory physiology Both perfusion and ventilation are highest in the base of the lung and lowest in the apex; however, the variability in perfusion is greater than that in ventilation. This Cardiovascular (CV) Physiology 8
causes the ventilation/perfusion ratio to follow the opposite gradient: it is lowest in the base and highest in the apex. (Phys)
1621 Herpes zoster 1ary VZV infection (chickenpox) occurs most commonly in childhood. Subseq, the virus migrates to the sensory ganglia, where it lies dormant for decaded. Over time, Cardiovascular (CV) Physiology 4
waning cell-mediated immunity allows reactivation of the virus, which spreads down a single nerve to cause a painful, erythematous, vesicular rash in a derm distribution. (Phys)
1622 Herpes zoster A unilateral vesicular rash localized on a single dermatome in an older patient is most likely herpes zoster. Postherpetic neuralgia is the most common neurologic Cardiovascular (CV) Physiology 4
complication of varicella zoster virus infection. (Phys)
1624 Filtration fraction The GFR can be estimated by the insulin or creatinine clearance, while the RPF is calculated using the PAH clearance. The FF (FF = GFR / RPF) is the fraction of the Cardiovascular (CV) Physiology 2
RPF that's filtered across the glom caps into BS. It's usually equal to 20% in healthy individuals. (Phys)
1625 Renal blood flow The RBF refers to the volume of blood that flows thru the kidney per unit time and can be calculated by dividing the RPF by (1 - Hct). Cardiovascular (CV) Physiology 1
(Phys)
1652 Pulmonary embolism PE is common in hosp and and postop pts, and classically Px w/ sud-on SOB and pleuritic chest pain. It causes hypoxemia due to V/Q mismatch; PaCO2 is usually normal Cardiovascular (CV) Physiology 13
or decr. (Phys)
1653 Acute heart failure LHF is common following MI affecting the LV. The resulting accumulation of oedema in the pulm interstitium makes the lungs heavy and stiff, restricting inspiratory Cardiovascular (CV) Physiology 7
expansion and ↓ lung compliance. (Phys)
1661 Cytomegalovirus The Monospot test is positive in most cases of Epstein-Barr virus-associated mononucleosis. In immunocompetent patients with a heterophile antibody-negative Cardiovascular (CV) Physiology 9
mononucleosis-like syndrome, the most likely diagnosis is cytomegalovirus infection. (Phys)
1782 Dose response curves The changes in the log dose-response curve expected for the effect of a reversible competitive antagonist added to a full agonist are: 1) a parallel shift to the right in the Cardiovascular (CV) Physiology 4
log-dose response curve, illustrating an increase in the ED50, and 2) no change in the maximum effect (Emax). Competitive=change ED50=shift right; (Phys)
noncompetitive=change Emax=shift down.
1931 Renal cell carcinoma The most common renal malignancy is CCC, which arises from renal PCT cells. Rounded or polygonal cells w/ abundant clear cytoplasm are seen on LM. 'Clear cells' are Cardiovascular (CV) Physiology 8
gen those w/ a high glycogen or lipid content that dissolves during routine tissue prep. (Phys)
1973 Bartonella Bartonella henselae causes cat-scratch disease, bacillary angiomatosis, and culture-negative endocarditis. Cat-scratch disease is characterized by low fever, Cardiovascular (CV) Physiology 2
lymphadenopathy, and a self-limited course. (Phys)
1974 Dysfunctional uterine Anovulation is common in the 1st several yrs after menarche and the last few yrs before menopause. It MFx w/ marked menstrual cycle variability. Cardiovascular (CV) Physiology 1
bleeding, anovulation (Phys)
1975 Lambert-Eaton myasthenic LEMS is a NM disorder char by auto-Abs against presynaptic v-gated Ca2+channels. It causes progr prox. muscle weakness and ↓ DTRs that improve w/ exercise (post- Cardiovascular (CV) Physiology 2
syndrome exercise facilitation); CN involvement and autonomic SSx may also occur. LEMS is strongly a/w SCLC. (Phys)
1976 Androgenic steroids Androgenic steroidabuse may lead to erythrocytosis, testicularatrophy, acne, and virilisation in women (e.g. clitoromegaly, hirsutism). Cardiovascular (CV) Physiology 2
(Phys)
1977 Inhibin Sertoli cells produce inhibin in response to FSH from the anterior pituitary. Inhibin suppresses FSH production in the pituitary. Sertoli cells also facilitate spermatogenesis Cardiovascular (CV) Physiology 1
w/i the seminiferous tubules. Impaired Sertoli cell fxn would lead to ↓ production of inhibin, ↑ FSH lvls, and impaired fertility. (Phys)
1978 Factor VII deficiency A normal BT indicates adequate platelet hemostatic fxn. A normal aPTT indicates an intact intrinsic coag system. Prolonged PT in the setting of normal aPTT indicates a Cardiovascular (CV) Physiology 1
defect in the extrinsic coag system at a step that's not shared w/ the intrinsic system. (Phys)
1983 Malaria RBCs filled w/ multiple, small rings suggest Plasmodium infection (malaria). Erythrocytic forms of this parasite may be Tx w/ antimalarials such as chloroquine (in non- Cardiovascular (CV) Physiology 5
resistant areas), atovaquone-proguanil, and artemisinins. Primaquine is req to kill P. vivax and P. ovale liver hypnozoites. (Phys)
2009 Bacterial vaginosis Bacterial vaginosis is a/w a grayish-white vaginal d/c w/ a "fishy" odor. The etiology involves an overgrowth of Gardnerella vaginalis, an anaerobic Gram-variable rod. Cardiovascular (CV) Physiology 3
Clue cells (squamous epithelial cells covered w/ bacterial organisms) are seen on wet mount microscopy or cytology. (Phys)
2055 Atrial fibrillation AF occurs due to irregular, chaotic electrical activity w/i the atria and Px w/ absent P waves, irregularly irregular R-R intervals, and narrow QRS complexes. The AV node Cardiovascular (CV) Physiology 5
refractory period regulates the number of atrial impulses that reach the ventricle and determines the ventricular contraction rate in conditions where the atria undergo rapid (Phys)
depolarization.
8293 Anticoagulants Both UFH and LMWH can bind to ATIII to ↑ its activity against FXa. Only UFH is able to bind to both ATIII and FIIa to allow ATIII to inactivate FIIa. Cardiovascular (CV) Physiology 8
(Phys)
8546 Pertussis B. pertussis, a small, gram (-) coccobacillus, can cause outbreaks of whooping cough in un-vax individuals. Infected infants and children gen develop mucoid rhinorrhoea Cardiovascular (CV) Physiology 3
f/b severe, paroxysmal cough that may be a/w an inspiratory whoop and vomiting. The bacterium is largely non-invasive and secretes several exotoxins that severely dmg (Phys)
ciliated resp epithelium.
8563 Myocardial infarction RV infarction (right-sided HF) can lead to shock via impaired forward blood flow to the left heart, which ↓ left-sided preload (↓ PCWP) and ↓ CO. The ↓ RV output also ↑ Cardiovascular (CV) Physiology 18
RA and CVP. (Phys)
11745 Gastroesophageal reflux New-onset odynophagia in the setting of chronic GORD should raise suspicion for erosive oesophagitis w/ oesophageal ulcers. Dx is made by upper endoscopy. Cardiovascular (CV) Physiology 7
disease (Phys)
12187 Urticaria A # of Rx, incl opioids, radiocontrast agents, and some Abx (e.g. vancomycin), can trigger IgE-independent mast cell degran. Common SSx incl diffuse itching and pain, Cardiovascular (CV) Physiology 2
bronchospasm, and localized swelling (urticaria). (Phys)
14743 Triglyceride metabolism HSL is found in adipose tissue, where it fxns to drive the breakdown of stored TGs into FFAs and glycerol. During times of starvation, this enzyme provides substrates for Cardiovascular (CV) Physiology 2
hepatic GNG and ketone body formation. (Phys)
14745 Beta oxidation Cytosolic acetyl-CoA carboxylase converts acetyl-CoA to malonyl-CoA during the rate-limiting step of de novo fatty acid synthesis. Malonyl-CoA also inhibits the action Cardiovascular (CV) Physiology 3
of mitochondrial carnitine acyltransferase, thereby inhibiting beta-oxidation of newly formed fatty acids. (Phys)
14976 Hypercalcemia Multiple myeloma is associated with increased bone resorption due to the production of tumor related cytokines. This results in elevated serum calcium levels, which Cardiovascular (CV) Physiology 5
reduce parathyroid hormone (PTH) production. Low PTH decreases renal calcium reabsorption (hypercalciuria), and, in combination with renal insufficiency, reduces (Phys)
1,25-dihydroxyvitamin D synthesis.
15391 Urinary tract obstruction Urinary tract obstruction causes reflux of urine into the renal tubules and increased tubular hydrostatic pressure. The intraglomerular capillary hydrostatic pressure is Cardiovascular (CV) Physiology 4
unchanged, resulting in a decreased hydrostatic pressure gradient across the glomerular capillary wall and a reduction in glomerular filtration. Oncotic pressure is (Phys)
maintained by large plasma proteins which are not filtered across the glomerular capillary basement membrane; it is unaffected by a urinary tract obstruction.
15516 Renal artery stenosis RAS (e.g. severe HTN, abdo bruits) causes decr renal art perfusion, which activates the RAAS. Incr secretion of renin leads to incr production of AT-I and AT-II, which Cardiovascular (CV) Physiology 9
causes incr TPR and incr syst BP. Incr aldo secretion causes incr renal Na+ reabs and K+ and H+ excretion, resulting in relative hypokalemia and meta alk. (Phys)
15526 Atheroembolism Atheroembolic disease typically occurs after an invasive vascular procedure due to mech dislodgement of atherosclerotic plaque, resulting in the showering of chol-rich Cardiovascular (CV) Physiology 2
microemboli into the circulation. Needle-shaped chol clefts in affected vessels are Dx. Commonly involved organs incl the kidneys (e.g. AKI), skin (e.g. blue toe (Phys)
syndrome, livedo reticularis), GIT (e.g. bleeding, infarction), and CNS (e.g. stroke, amaurosis fugax).
15534 Psychosis Brief psychotic disorder is characterised by >1 psychotic SSx lasting >1day and <1mos w/ full return to previous lvls of fxning. Onset is typically sudden and a/w a Cardiovascular (CV) Physiology 6
stressor. (Phys)
1061 Diabetes mellitus Smoking cess is by far the most effective preventive intervention in almost all pts, and this is esp true in those w/ DM. Dermatology (DE) Biochemistry 31
(Bioc)
1064 Prerenal azotemia Hypovolaemia results in a ↓ renal plasma flow (RPF) and GFR. This leads to compensatory efferent arteriolar vasoconstriction, which raises the filtration fraction and Dermatology (DE) Biochemistry 6
maintains GFR at near-normal lvls. As RPF continues to decline, ↑ glomerular oncotic pressure will eventually overwhelm the compensatory ↑ in hydrostatic pressure, (Bioc)
leading to a precipitous drop in GFR and ARF.
1244 Matching Matching is used in case-control studies in order to control confounding. Matching variables should always be the potential confounders of the study (eg, age, race). Cases Dermatology (DE) Biochemistry 1
and controls are then selected based on the matching variables so that both groups have a similar distribution in accordance w/ the variables. (Bioc)
1245 Predictive values NPV is the probability of not having a disease when the test result is (-). The NPV will vary w/ the pretest probability of a disease. A pt w/ a high probability of having a Dermatology (DE) Biochemistry 3
disease will have a low NPV w/ a (-) test, but a pt w/ a low probability of having a disease will have a high NPV w/ a (-) test. (Bioc)
1247 Quantitative diagnostic tests The cutoff value of a quantitative Dx test determines whether a given result is interpreted as (+) or (-). Lowering the cutoff point typically causes more pts w/ the disease Dermatology (DE) Biochemistry 1
to test (+), ↓ the number of FNs and ↑ test sensitivity. Consequently, more pts w/o the disease will also test (+), resulting in an ↑ number of FPs and ↓ specificity. (Bioc)
QID Topic Educational Objective System Subject Repeats
2038 Penicillin Clavulanic acid, sulbactam, and tazobactam are β-lactamase inhibs. Concurrent admin of clavulanate w/ amoxicillin expands amoxicillin's spectrum of activity to incl Dermatology (DE) Biochemistry 2
strains of β-lactamase synthesising bacteria that're resistant to amoxicillin alone. (Bioc)
12276 Paroxysmal nocturnal PNH is due to a gene defect that leads to uncontrolled complement-mediated hemolysis. The classic triad incls hemolytic anaemia (hemoglobinuria), pancytopaenia, and Dermatology (DE) Biochemistry 2
hemoglobinuria thrombosis at atypical sites. Chronic hemolysis can cause Fe deposition in the kidney (hemosiderosis). (Bioc)
1960 Beta oxidation Carnitine deficiency impairs FA transport from the cytoplasm into mitochondria, preventing β-oxidation of FAs into acetyl-CoA. This leads to cardiac and skeletal Dermatology (DE) Embryology 3
myocyte injury (lack of ATP from TCA) and impaired ketone body production by the liver during fasting periods. (Embr)
883 Chronic heart failure ↓ CO in HF triggers neuroendo compensatory mechanisms to maintain organ perfusion; however, the compensatory mechanisms are maladaptive over the long term. ↑ Dermatology (DE) Genetics (Gene) 12
sympathetic output and activation of the RAAS stimulate vasoconstriction and volume retention, compounding the hemodynamic stress on an already failing heart and
creating a vicious cycle of decompensation.
1476 Methemoglobinemia HbM-emia causes dusky discoloration of the skin (similar to cyanosis), and b/c HbM is unable to carry O2, a state of fxnal anemia is induced. However, the blood PO2 Dermatology (DE) Genetics (Gene) 1
will be unchanged as it's a measure of O2 dissolved in plasma and is unrelated to Hb fxn.
1725 Hypoparathyroidism Hypocalcaemia can cause muscle cramps, perioral paraesthesias, hypotension, and neuromuscular hyperexcitability. Injury to the PT glands during thyroid Sx is a Dermatology (DE) Genetics (Gene) 1
common cause of hypoparathyroidism and acute hypocalcaemia.
588 Severe combined The 2nd most common cause of SCID is AR defic of ADA, an enzyme necessary for the elimination of excess adenosine w/i cells. Tox lvls of adenosine accum w/i Dermatology (DE) Histology (Hist) 3
immunodeficiency disease lymphocytes in this condition, leading to lymphocyte cell death and resultant cellular and humoral ID. Tx is presently being researched using retroviral vectors to "infect"
pt stem cells w/ the gene coding for ADA.
1133 Peripheral vascular disease SSx Mx PVD includes a graded exercise program and cilostazol. Cilostazol is a PDEI that inhibs platelet aggregation and acts as a direct arterial vasodilator. Pts w/ PVD Dermatology (DE) Immunology 4
should also receive an antiplatelet agent (aspirin or clopidogrel) for 2° prevention of CAD and stroke. (Immu)
1613 Carbon monoxide Carbon monoxide (CO) binds to hemoglobin with much higher affinity than oxygen, thereby preventing oxygen binding to hemoglobin. It also reduces oxygen unloading Dermatology (DE) Immunology 2
poisoning from hemoglobin in the tissues. CO poisoning increases carboxyhemoglobin concentrations but does not affect the partial pressure of oxygen and does not precipitate (Immu)
methemoglobinemia.
16862 Odontogenic infections Sjogren syndrome is characterised by autoimmune inflammation of exocrine glands (e.g. salivary, lacrimal, vaginal). Pts typically have severe dry mouth (xerostomia) due Dermatology (DE) Immunology 1
to ↓ saliva production, which can lead to an ↑ rate of dental caries and other oral infections (e.g. thrush) b/c of the loss of protective factors in saliva. Bx of the salivary (Immu)
glands shows a lymphocytic infiltrate, often w/ germinal centres.
16895 Epididymitis Epididymitis presents with acute testicular pain, tenderness, and pyuria. It is caused by retrograde passage of organisms from the urethra into the ejaculatory duct and vas Dermatology (DE) Immunology 1
deferens. The microbiology is largely influenced by patient age: epididymitis in young men is usually due to sexually acquired infections (eg, Chlamydia trachomatis, (Immu)
Neisseria gonorrhoeae), whereas in older men (age >35) it is usually due to gram-negative colonic flora.
104 Blastomycosis Dimorphic fungi grow as moulds at 25-30°C and as yeast at body temp (35-37°C). Med important dimorphic fungi incl Sporothrix, Coccidioides, Histoplasma, Dermatology (DE) Microbiology 3
Blastomyces, and Paracoccidioides species. (Micr)
270 Aortic stenosis In pts w/ chronic AS and concentric LVH, atrial contraction contributes significantly to LV filling. Loss of atrial contraction due to AF can ↓ LV preload and CO Dermatology (DE) Microbiology 8
sufficiently to cause systemic hypotension. ↓ forward filling of the LV can also result in backup of blood in the LA and pulm veins, leading to acute pulm edema. (Micr)
680 Congenital anomalies of The urachus is a remnant of the allantois that connects the bladder with the yolk sac during fetal development. Failure of the urachus to obliterate at birth results in a Dermatology (DE) Microbiology 3
kidney and urinary tract patent urachus, which can facilitate discharge of urine from the umbilicus. (Micr)
973 Amenorrhea FHA results from loss of pulsatile GnRH release from the hypothal and is caused by weight loss, strenuous exercise, systemic illness, or abn eating habits. Loss of cyclic Dermatology (DE) Microbiology 2
Gn release leads to a ↓ in LH and FSH secretion from the pituitary, which in turn causes low circulating oestrogen lvls. (Micr)
974 Pheochromocytoma PCC is a tumour arising from the chromaffin cells of the AM characterised by excess production of catecholamines. CFx incl episodic HTN, diaphoresis, and palpitations. Dermatology (DE) Microbiology 4
Micro Ex of the tumour cells shows electron-dense, membrane-bound secretory granules, and IHC is (+) for synaptophysin, chromogranin, and neuron-specific enolase. (Micr)
1313 Brain tumors Medulloblastoma is the 2nd most common brain neoplasm of childhood. It is located in the cerebellum, often at the vermis, and consists of sheets of small, blue cells. Like Dermatology (DE) Microbiology 10
other "PNET" tumors, medulloblastomas are poorly differentiated and have a bad prognosis. (Micr)
1553 DNA structure & function X-inact occurs in genetically normal females and results in conversion of the inact X chrom into compact heterochrom (Barr body). Heterochrom is condensed chromatin Dermatology (DE) Microbiology 2
composed of heavily meth DNA in tight a/w deacet histones. It has a low lvl of transcriptional activity. In contrast, euchrom is loosely arranged and exhibits a high lvl of (Micr)
transcriptional activity.
1669 Guillain-Barre syndrome GBS represents a group of imm-med polyneuropathies that're thought to be caused by molecular mimicry, leading to demyelination of the peri nerves. Up to 1/3 of GBS Dermatology (DE) Microbiology 3
cases are preceded by a C. jejuni infection, which is a common cause of acute diarrheal illness. (Micr)
1898 Coronary artery disease Clopidogrel irreversibly blocks the P2Y12 component of ADP receptors on the platelet surface and prevents platelet aggregation. Clopidogrel is as effective as aspirin in Dermatology (DE) Microbiology 4
the prevention of CV events in pts w/ coronary heart disease. (Micr)
8858 Mental status examination Quick clinical tests to Ax attn and conc incl counting down from 100 by intervals of 3 or 7, reciting the mos of the yr in reverse order, and spelling 'world' backwards. Dermatology (DE) Microbiology 1
(Micr)
10168 Seafood poisoning Pufferfish poisoning is caused by tetrodotoxin, a neurotoxin produced by microorganisms a/w the fish. Tetrodotoxin binds to v-gated Na channels in nerve and cardiac Dermatology (DE) Microbiology 1
tissue, preventing Na influx and depol. (Micr)
13911 Postpartum hemorrhage Postpartum hemorrhage is an obstetrical emergency. Bilateral ligation of the internal iliac artery can decrease uterine blood flow and control postpartum hemorrhage that Dermatology (DE) Microbiology 1
is unresponsive to medical management (eg, uterine massage, uterotonic medications). (Micr)
15339 HIV Tenofovir is a NRTI that's a common component of HIV therapy. This drug is gen well tolerated but may occasionally cause dmg to the PCT of the kidney, leading to Dermatology (DE) Microbiology 11
AKI a/o PCT impairment (e.g. phosphoruria, glucosuria, water retention). Bx typically reveals a normal glomerulus and renal interstitium but dmg to the PCT. (Micr)
15431 Prerenal azotemia Hypovolemia triggers a variety of compensatory mechanisms to improve tissue perfusion. These include activation of the renin-angiotensin-aldosterone system (resulting Dermatology (DE) Microbiology 6
in increased aldosterone and endothelin release), increased vasopressin release, and increased sympathetic tone. (Micr)
15448 Rhabdomyolysis Rhabdomyolysis is characterised by the release of intracellular muscle contents (e.g. Mb, electrolytes) due to myocyte injury; it's common w/ crush injuries, seizures, or Dermatology (DE) Microbiology 2
drug use (e.g. statins). heme pigment (released from Mb after degradation in the kidney) is toxic to tubular cells and can cause ATN. (+) blood on urine dipstick in the (Micr)
absence of RBCs on microscopic UA suggests Mburia.
15579 Cell cycle CDKs 4/6 regulate the movement of cells from G1 → S phase. Ca often have muts that enhance the activity or downstream effects of CDK 4/6, which contribute to Dermatology (DE) Microbiology 2
unregulated cellular growth. Inhibs to CDK 4/6 can be used to Tx certain forms of ca. However, they can inhib cellular replication in other rapidly dividing cells such as (Micr)
the heme cells in the bone marrow (e.g. neutropaenia, anaemia, or thrombocytopaenia).
17230 Group B streptococcal Streptococcus agalactiae (GBS), one of the most common causes of early neonatal sepsis, is typically identified by the presence of a narrow zone of β-hemolysis when Dermatology (DE) Microbiology 2
infection plated on blood agar. It is also identified by the production of CAMP factor, which enhances β-hemolysis by particular strains of Staphylococcus aureus. (Micr)
467 Atherosclerosis Fatty streaks are the earliest lesions of atherosclerosis and can be seen as early as the 2nd decade of life. They appear as a collection of lipid-laden macrophages (foam Dermatology (DE) Pathology (Path) 8
cells) in the intima that can eventually progress to atherosclerotic plaques.
826 Patient confidentiality Under the HIPAA, physicians may disclose pt information to friends and family members in emergency situations or when the pt is otherwise incapacitated, depending on Dermatology (DE) Pathology (Path) 5
what is in the best interest of the pt. Otherwise, pt information may be disclosed only when the pt gives explicit permission or does not object when given a reasonable
opportunity.
827 Iron deficiency anemia Hepcidin is a polypeptide synthesized by the liver that acts as the central regulator of iron homeostasis. High iron levels and inflammatory conditions increase the Dermatology (DE) Pathology (Path) 7
synthesis of hepcidin; hypoxia and increased erythropoiesis act to lower hepcidin levels. Low hepcidin levels increase intestinal iron absorption and stimulate iron release
by macrophages.
876 Acute interstitial nephritis Fever, maculopapular rash, and ARF occurring 1-3wks after beginning a new Rx (e.g. Abx, PPIs) is highly suggestive of AIN. peri eosinophilia, sterile pyuria, Dermatology (DE) Pathology (Path) 2
eosinophiluria, and WBC casts may also be seen. Histo reveals leucocyte infiltration and oedema of the renal interstitium.
935 Hereditary spherocytosis HS results from red cell cytoskeleton abns, most commonly in the proteins spectrin and ankyrin. ↑ osmotic fragility on acidified glycerol lysis testing confirms the Dx. Dermatology (DE) Pathology (Path) 3
hemolytic anaemia, jaundice, and splenomegaly are classic MFxs. Complications incl pigmented gallstones and aplastic crises from PVB19 infection.
936 Sickle cell HU ↑ HbF synthesis by an unknown mech. HU is reserved for pts w/ freq pain crises. Gardos channel blockers hinder the efflux of K+ and water from the cell, preventing Dermatology (DE) Pathology (Path) 13
dehydration of erythrocytes and ↓ the polymerisation of HbS.
1042 Second messengers After a ligand binds to a G protein-coupled receptor that activates phospholipase C, membrane phospholipids are broken down into diacylglycerol (DAG) and inositol Dermatology (DE) Pathology (Path) 2
triphosphate (IP3). Protein kinase C is subsequently activated by DAG and calcium; the latter is released from the endoplasmic reticulum under the influence of IP3.
1105 Multiple myeloma MM should be suspected in elderly pts w/ any combo of hypercalcaemia, normocytic anaemia, bone pain, ↑ γ gap, or renal failure. Renal failure is commonly caused by Dermatology (DE) Pathology (Path) 9
light chain cast nephropathy; large, waxy, eosinophilic casts composed of BJ proteins are seen in the tubular lumen.
1108 Breast cancer Invasive breast carcinoma typically presents as an irregularly shaped, adherent breast mass, most commonly in the upper outer quadrant. Malignant infiltration of Dermatology (DE) Pathology (Path) 7
suspensory ligaments of the breast can cause skin retractions.
1110 Guillain-Barre syndrome GBS is an acute demyelinating polyneuropathy. It's thought to be due to molecular mimicry and is commonly preceded by a viral URI or gastroenteritis. Segmental Dermatology (DE) Pathology (Path) 3
demyelination of the peri nerves and an endoneurial inflammatory infiltrate are seen on LM.
1111 Peripheral neuropathy Diabetic peri neuropathy is characterised by numbness and paraesthesia in a stocking-and-glove distribution. It results from nonenzymatic glycosylation of proteins, Dermatology (DE) Pathology (Path) 3
leading to hyalinisation of endoneurial arteries and ischemic nerve dmg. In addn, accumulation of toxic substances w/i neurons results in deranged meta and ↑ oxidative
stress.
1112 Cranial nerve palsy Diabetic mononeuropathy often involves CNIII. It's caused by predominantly central ischemia, which affects the somatic nerve fibres but spares peri parasympathetic Dermatology (DE) Pathology (Path) 9
fibres. SSx incl ptosis, a 'down and out' gaze, and normal light and accommodation reflexes.
1113 Vitamin C deficiency Ascorbic acid (vitamin C) is a cofactor in the hydroxylation of proline and lysine residues and is important in the synthesis of collagen. Deficiency (scurvy) is Dermatology (DE) Pathology (Path) 3
characterized by microvascular bleeding, gingivitis, and impaired wound healing.
1114 Vitamin K deficiency Vitamin K deficiency results in impaired clotting factor carboxylation. Newborns are at risk for vitamin K deficiency due to poor transplacental transfer of vitamin K and Dermatology (DE) Pathology (Path) 2
low content in breast milk. All newborns should receive vitamin K prophylaxis to prevent bleeding complications.
1115 Biotin deficiency Biotin acts as a CO2 carrier on the surface of carboxylase enzymes and is an essential cofactor for numerous rxns, including the conversion of pyruvate to OA and FA Dermatology (DE) Pathology (Path) 1
metabolism. Excess ingestion of avidin, found in egg whites, has been a/w biotin deficiency. This condition Px w/ mental status changes, myalgias, anorexia, macular
dermatitis, and lactic acidosis.
1116 Niacin deficiency Niacin (vitamin B2) can be synthesized endogenously from tryptophan and is an essential component of nicotinamide adenine dinucleotide (NAD) and nicotinamide Dermatology (DE) Pathology (Path) 3
adenine dinucleotide phosphate (NADP). A deficiency of this vitamin results in pellagra, which is characterized by dermatitis, diarrhea, and dementia.
1117 Vitamin D toxicity Excessive vit D intake can lead to hypercalcemia and cause AMS, muscle weakness, constipation, and polyuria/polydipsia. Activated macrophages in sarcoidosis and Dermatology (DE) Pathology (Path) 1
other gran diseases express 1α-hydroxylase, leading to excess prod of 1,25-OH2 vit D and hypercalcemia.
QID Topic Educational Objective System Subject Repeats
1314 CNS lymphoma 1° CNS lymphomas occur in immunosuppressed pts, such as those suffering from AIDS. These tumors arise from B cells and are universally a/w EBV. They are high- Dermatology (DE) Pathology (Path) 2
grade tumors w/ a poor prognosis.
1867 Iron deficiency anemia Anemia in a woman of childbearing age is most commonly caused by iron deficiency secondary to menstrual blood loss. Iron deficiency is associated with decreased Dermatology (DE) Pathology (Path) 7
serum ferritin, increased total iron-binding capacity (transferrin), and microcytic, hypochromic red blood cells.
1878 Varicocele Pressure in the left renal vein may become ↑ due to compression where the vein crosses the aorta beneath the SMA. This "nutcracker effect" can cause hematuria and Dermatology (DE) Pathology (Path) 1
flank pain. Pressure can also be ↑ in the left gonadal vein, leading to formation of a varicocele.
1937 Anticholinergics Anticholtox is characterised by fever; confusion; cutaneous flushing; dry oral mucosa; and dilated, poorly reactive pupils. TCAs, particularly amitriptyline, have strong Dermatology (DE) Pathology (Path) 3
anticholinergic effects.
1993 Alpha1 antitrypsin Emphysema most commonly results from chronic smoking but can also occur in genetically predisposed individuals w/ AATD. Pts w/ emphysema have a ↓ FEV1/FVC Dermatology (DE) Pathology (Path) 8
deficiency ratio, ↑ TLC, and ↓ DLCO.
2065 Menstrual cycle The secretory phase of the menstrual cycle occurs b/w ovulation and menses, from days 15-28 of the normal menstrual cycle. Progesterone released by the CL causes the Dermatology (DE) Pathology (Path) 2
uterine glands to coil and secrete glycogen-rich mucus in preparation for embryo implantation. The endometrial stroma becomes edematous and completely traversed by
tortuous spiral arteries that extend from the deeper layers to the uterine lumen.
7649 Polycystic ovary disease Patients with polycystic ovary syndrome who desire fertility can be treated with clomiphene. Clomiphene is an estrogen receptor modulator that decreases negative Dermatology (DE) Pathology (Path) 4
feedback inhibition on the hypothalamus by circulating estrogen, thereby increasing gonadotropin production.
7707 Aspiration pneumonia Elderly pts w/ dementia or hemiparesis may have dysphagia, which is a RF for aspiration pneumonia. Dependent lung consolidation is commonly seen in aspiration Dermatology (DE) Pathology (Path) 2
pneumonia.
8334 Cirrhosis Portal HTN, as seen in ALD, produces splenomegaly by causing congestion of blood w/i the spleen, which produces expansion of the red pulp. Dermatology (DE) Pathology (Path) 7
11502 Visual pathway Injury to Meyer's loop in the temporal lobe results in contralateral superior quadrantanopia. Dermatology (DE) Pathology (Path) 5
11662 Clostridium difficile Clostridium difficile requires additional contact precautions, including handwashing w/ soap and water, a gown for any pt contact, and nonsterile gloves that should be Dermatology (DE) Pathology (Path) 7
infection changed after contact w/ contaminated secretions. Alc-based hand sanitizers do not kill the bacterial spores.
11738 Ischemic stroke WD refers to the process of axonal degeneration and breakdown of the myelin sheath that occurs distal to a site of injury. Axonal regeneration does not occur in the CNS Dermatology (DE) Pathology (Path) 19
due to the persistence of myelin debris, secretion of neuronal inhibitory factors, and development of dense glial scarring.
11852 Social anxiety disorder SAD involves excessive fear of scrutiny or embarrassment in social or performance situations, resulting in significant distress and fxnal impairment. Dermatology (DE) Pathology (Path) 2
14984 Aortic dissection The intimal tear in Stanford type A AD (involving the ascending aorta) usually originates in the sinotubular jxn whereas the intimal flap in Stanford type B AD usually Dermatology (DE) Pathology (Path) 6
starts near the origin of the left SCA. Dissections can propagate distally to the thoracoabdominal aorta.
15361 Hepatitis B HBV has a partially dsDNA genome and contains a viral DNA polymerase w/ reverse transcriptase activity. Reverse transcriptase serves a crucial step in viral replication; Dermatology (DE) Pathology (Path) 14
it converts transcribed (+) sense ssRNA into the partially dsDNA genome of viral progeny.
15373 Renal cell carcinoma RCC may present w/ a combo of hematuria, abdo mass, or flank pain; however, this triad occurs together in <10% of cases. Pathology demonstrates rounded, polygonal Dermatology (DE) Pathology (Path) 8
cells w/ a clear cytoplasm and eccentric nuclei. RFs incl smoking, toxin exposure, and certain hereditary disorders (e.g. VHL syndrome).
15374 Hepatitis B Immunization against hepatitis B virus uses recombinant HBsAg to generate anti-HBs antibodies. These antibodies prevent infection by binding to the envelope of Dermatology (DE) Pathology (Path) 14
circulating virus and inhibiting viral entry.
15408 Pulmonary stenosis PV stenosis causes a crescendo-decrescendo systolic murmur (best heard at the left upper sternal border) and delays closure of the PV, resulting in widened splitting of S2. Dermatology (DE) Pathology (Path) 1
Inspiration ↑ blood flow to the right side of the heart, causing ↑ intensity of the murmur and even later closure of the PV.
15441 Acute diarrhea Rotavirus is a common cause of self-limited childhood diarrhoea in un-vax individuals. It infects villous enterocytes in the duodenum and prox. jejunum and results in Dermatology (DE) Pathology (Path) 13
villous blunting, proliferation of secretory crypt cells, and a loss of brush border enzymes; this results in water diarrhoea w/o faecal leucocytes.
15550 Renal calculi Urine sediment in acute ureterolithiasis typically shows free RBCs (hematuria) and crystals consistent w/ the type of stone. US can reveal ureteral and calyceal dilation Dermatology (DE) Pathology (Path) 7
(hydronephrosis), but small stones themselves may not be visible.
15675 Hand, foot, mouth disease HFMD (oral ulceration and extremity rash) and herpangina (oral ulcerations w/o rash) are the most common MFxs of enteroviral infection. Rare but serious complications Dermatology (DE) Pathology (Path) 2
of infection incl myocarditis and CNS disease (e.g. aseptic meningitis).
15695 Schistosomiasis Schistosomiasis is a parasitic blood fluke infection that is associated with bathing in freshwater contaminated with cercariae from infected snails. Patients often are Dermatology (DE) Pathology (Path) 2
asymptomatic for months or years but may eventually develop eosinophilic granulomatous inflammation in the liver, spleen, gastrointestinal tract, or genitourinary
system. One common manifestation of genitourinary schistosomiasis is painless terminal hematuria; eggs can often be identified in the urine or on biopsy.
16395 Chronic lymphocytic CLL is a chronic LPD marked by the progressive accumulation of mature B cells. Most pts are aSSx for yrs but eventually develop anemia, thrombocytopenia, a/o Dermatology (DE) Pathology (Path) 1
leukemia neutropenia. The Dx is generally made when CBC reveals dramatic leukocytosis, and FC subsequently shows a clonal population of leukocytes w/ typical B-cell markers
such as CD19, CD20, and CD23.
16865 Lyme disease Early disseminated Lyme disease can have cardiac involvement (Lyme carditis) that most commonly MFx w/ varying degrees of AV conduction block. Pts may be aSSx, Dermatology (DE) Pathology (Path) 3
but those w/ complete AV conduction block are likely to have dyspnea, lightheadedness, or syncope.
17062 Sick sinus syndrome SSS results from degeneration (usually age-related) of the SA node, leading to impaired conduction and ↓ CO w/ SSx of dyspnea, fatigue, lightheadedness, presyncope, Dermatology (DE) Pathology (Path) 2
and syncope. ECG typically demonstrates bradycardia w/ sinus pauses (delayed P waves), sinus arrest (dropped P waves), and jxnal escape beats.
874 Vesicoureteral reflux VUR is caused by retrograde urine flow from the bladder into the ureter. The hydrostatic pressure of refluxing urine along w/ infections due to ascending bacteria causes Dermatology (DE) Pathophysiology 1
inflammation. The compound papillae in the upper and lower poles of the kidney are most susceptible to reflux-induced dmg, which appears as dilated calyces w/ (Patp)
overlying renal cortical scarring.
1477 RNA structure & function The nucleolus is a dense intranuclear body visible by light and electron microscopy that functions as the primary site of ribosome synthesis and assembly. All ribosomal Dermatology (DE) Pathophysiology 2
RNA except 5S rRNA is transcribed in the nucleolus. (Patp)
1860 Aplastic anemia AA is most commonly due to a toxic effect or AI response causing apoptosis of pluripotent stem cells (pancytopenia). Bone marrow Bx reveals hypocellularity w/ an Dermatology (DE) Pathophysiology 3
abundance of fat cells. (Patp)
8904 Cell cycle Nondisjxn is the failure of chrom pairs to separate properly during cell division. This could be due to a failure of homologous chroms to separate in meiosis I or a failure Dermatology (DE) Pathophysiology 2
of sister chromatids to separate during meiosis II or mitosis. (Patp)
15379 Coronary artery disease Stable angina results from fixed coronary artery stenosis that limits blood flow to downstream myocardium, preventing the myocardial O2 supply from ↑ during exertion. Dermatology (DE) Pathophysiology 4
Dobutamine mimics the effects of exercise and ↑ myocardial O2 demand; it can be used during stress testing to provoke areas of ischemic myocardium, which can be (Patp)
recognized on imaging by a localized and transient ↓ in contractility (ie, wall motion defect).
836 Sarcoidosis Sarcoidosis often presents in young AA women w/ the insidious onset of resp SSx (e.g. cough, dyspnoea, chest pain) accompanied by fatigue, fever, and weight loss. The Dermatology (DE) Pharmacology 7
char histopath feature is NCGs, which consist of aggregates of epithelioid macrophages and multinucleated giant cells. (Phar)
1214 Urinalysis ADH acts on the medullary segment of the CD to ↑ urea and water reabsorption, allowing for the production of max concentrated urine. Dermatology (DE) Pharmacology 2
(Phar)
1641 Toxoplasmosis The finding of multi ring-enhancing lesions in an HIV pt is most likely due to toxoplasmosis. Dermatology (DE) Pharmacology 5
(Phar)
1726 Myasthenia gravis Progressively weakening diaphragmatic contractions during max voluntary ventilation w/ intact phrenic nerve stim indicate NMJ pathology (e.g. MG) a/o abnormally Dermatology (DE) Pharmacology 10
rapid diaphragmatic muscle fatigue (e.g. restrictive lung or chest wall disease). (Phar)
7585 CNS lymphoma Primary central nervous system lymphoma is typically composed of B-lymphocytes. Dermatology (DE) Pharmacology 2
(Phar)
8569 Peptic ulcer disease Helicobacter pylori is a common cause of peptic ulcers. Duodenal ulcers are a/w heavy colonization in the gastric antrum, whereas colonization in the gastric corpus is a/w Dermatology (DE) Pharmacology 10
gastric ulcers. (Phar)
1633 Anticholinergics Physostigmine is a AChEI w/ a 3° NH4+ structure that can reverse both the CNS and PNS SSx of anticholinergic tox. Neostigmine, edrophonium, and pyridostigmine Ear, Nose & Throat Anatomy (Anat) 3
have a 4° NH4+ structure that limits CNS penetration. (EN)
1686 GFR The concs of PAH, creatinine, inulin, and urea ↑ as fluid runs along the PCT, while the concs of HCO3-, Glc, and AAs ↓. Ear, Nose & Throat Anatomy (Anat) 6
(EN)
1698 Burkitt lymphoma The EBV genome is ID'd in approx. 50% of systemic B-cell lymphomas and almost all 1° CNS lymphomas occurring in the setting of HIV infection. A high mitotic index Ear, Nose & Throat Anatomy (Anat) 3
is typical of Burkitt lymphoma. (EN)
1814 Ulnar nerve neuropathy Ulnar nerve injury most commonly occurs at the elbow (eg, compression due to resting arm on a hard surface while using a computer) and usually Px w/ discomfort and Ear, Nose & Throat Anatomy (Anat) 2
sensory loss/paresthesia in the 5th digit, medial half of the 4th digit, and the hypothenar eminence. In severe cases, pts can also have weakness on wrist flexion and (EN)
adduction (ie, ulnar deviation) along w/ finger weakness/clumsiness.
8631 Obstructive sleep apnea OSA, the most common sleep-related breathing disorder, is characterized by recurrent obstruction of the upper airways. Relaxation of the oropharyngeal a/o soft palate Ear, Nose & Throat Anatomy (Anat) 4
musculature during sleep results in a fxnal collapse of the airway, producing periods of ↓ (hypopnea) or absent (apnea) airflow despite continued breathing efforts. (EN)
8703 Beta blockers β1 adrenergic receptors are found in cardiac tissue and on renal JGA cells, but not in vascular smooth muscle. Selective blockade of the β1 receptor (e.g. w/ atenolol) leads Ear, Nose & Throat Anatomy (Anat) 3
to ↓ cAMP lvls in cardiac and renal tissue w/o significantly affecting cAMP lvls in vascular smooth muscle. (EN)
11783 Meningitis Listeria is a relatively common foodborne illness a/w outbreaks after the consumption of contaminated food, particularly processed meats and dairy products. Healthy pts Ear, Nose & Throat Anatomy (Anat) 17
may develop gastroenteritis; pts w/ impaired cell-mediated immunity are at risk for invasive infection (e.g. sepsis, meningoencephalitis) and listeriosis in preg is a/w (EN)
adverse foetal outcomes (e.g. foetal death, premature birth).
1740 Measles Measles Px w/ fever, cough, rhinorrhea, and conjunctivitis f/b a maculopapular rash that starts on the face and spreads downwards. Koplik spots are pathognomonic for Ear, Nose & Throat Embryology 3
measles and Chx by tiny white or blue-gray lesions on the buccal mucosa. (EN) (Embr)
15028 Opioids Opioid intox presents w/ miosis, depressed mental status, ↓ RR, ↓ bowel sounds, and hypotension. Of these, ↓ RR is the best predictor of intox and is also a freq cause of Ear, Nose & Throat Embryology 13
mortality. (EN) (Embr)
1102 Acute urate nephropathy Tumor lysis syndrome occurs when tumors with a high cell turnover are treated with chemotherapy. The lysis of tumor cells causes intracellular ions, such as potassium Ear, Nose & Throat Microbiology 1
and phosphorous, and uric acid (metabolite of tumor nucleic acid) to be released into serum. Uric acid is soluble at physiologic pH, but it can precipitate in the normally (EN) (Micr)
acidic environment of distal tubules and collecting ducts. The prevention of tumor lysis syndrome includes urine alkalinization and hydration, as high urine flow and high
pH along the nephron prevents crystallization and precipitation of uric acid.
1373 Tuberculosis Isoniazid is an antimycobacterial agent that specifically inhibits the synthesis of mycolic acids, which are essential components of the unique mycobacterial peptidoglycan Ear, Nose & Throat Microbiology 18
cell wall. Without mycolic acids, the mycobacteria lose their acid-fastness and become unable to synthesize new cell walls or multiply. (EN) (Micr)
8342 Esophageal varices Acute Mx of variceal hemorrhage req rapid lowering of portal pressure. Somatostatin and octreotide (a long-acting somatostatin analogue) inhib the release of hormones Ear, Nose & Throat Microbiology 2
that induce splanchnic vasodilation, indirectly causing splanchnic vasoconstriction and ↓ portal blood flow. (EN) (Micr)
QID Topic Educational Objective System Subject Repeats
308 Systemic sclerosis Systemic sclerosis may result in oesophageal dysmotility and incompetence of the LOS due to atrophy and fibrous replacement of the oesophageal muscularis. This can Ear, Nose & Throat Pathophysiology 3
cause GORD w/ an ↑ risk of Barrett oesophagus and stricture formation. (EN) (Patp)
11628 Advance directives A health care proxy is a person legally designated to make medical decisions in the event the patient loses decision-making capacity. The proxy overrules all other Ear, Nose & Throat Pathophysiology 3
possible surrogate decision makers, including family members. (EN) (Patp)
1195 Acute diarrhea Shigellosis is an infectious disease that can be caused by a variety of Shigella species; S. sonnei is the most common cause of shigellosis in industrialised nations. Shigella Ear, Nose & Throat Pharmacology 13
invades the GI mucosa by gaining access to microfold cells in ileal Peyer patches thru endocytosis. Shigella subseq lyses the endosome and spreads laterally into other (EN) (Phar)
epithelial cells, causing cell death and ulceration w/ hemorrhage and diarrhoea.
1345 Sensitivity and specificity The degree of overlap b/w the healthy and the diseased population curves limits the maximum combined sensitivity and specificity of a quantitative Dx test. The degree to Ear, Nose & Throat Pharmacology 4
which sensitivity or specificity is affected depends on the chosen cutoff value. (EN) (Phar)
8589 NSAIDs Cyclooxygenase-2 (COX-2) is an inducible enzyme upregulated during inflammation by interleukin-1 and TNF-α. Selective COX-2 inhibitors (eg, celecoxib) decrease Ear, Nose & Throat Physiology 4
inflammation by inhibiting COX-2 production of pro-inflammatory arachidonic acid metabolites. Because they do not affect COX-1, they have minimal gastroduodenal (EN) (Phys)
toxicity.
206 Coronary blood flow During ventricular systole, the coronary vessels supplying the LV are compressed by the surrounding muscle. As a result, the majority of LV blood flow occurs during Endocrine, Diabetes & Anatomy (Anat) 9
diastole. The systolic ↓ in coronary blood flow is greatest in the subendocardial region, making this portion of the LV most prone to ischemia and infarction. Metabolism (ES)
1747 Lyme disease The characteristic cutaneous lesion in Borrelia burgdorferi infection (Lyme disease) is erythema migrans, which begins as an erythematous macule at the site of an Ixodes Endocrine, Diabetes & Anatomy (Anat) 3
tick bite. The erythema spreads outward, often leaving a zone of central clearing ("bull's-eye" rash). Metabolism (ES)
1144 Diphtheria Diphtheria toxin is an AB exotoxin that ribosylates and inactivates EF-2. This action inhibits protein synthesis and ultimately leads to cell death. Endocrine, Diabetes & Behavioral 6
Metabolism (ES) Science (Beha)
602 Contraception The absolute c/i to the use of OCPs are: prior Hx of TE event or stroke, Hx of an oestrogen-dependent tumour, women over age 35yrs who smoke heavily, Endocrine, Diabetes & Biochemistry 3
hypertriglyceridaemia, decompensated or active liver disease (would impair steroid meta), preg. Metabolism (ES) (Bioc)
846 Cystic fibrosis In CF, impairment of the CFTR protein ↓ Cl- secretion and ↑ Na+ absorption by the resp epithelia, resulting in dehydrated mucus. When saline is applied to the nasal Endocrine, Diabetes & Biochemistry 11
mucosa, the ↑ Na+ absorption in pts w/ CF causes a more (-) nasal transepithelial potential diff, which can be used to Dx CF. Metabolism (ES) (Bioc)
847 Cystic fibrosis ΔF508 is the most common mutation in the CFTR protein in pts w/ CF. This mutation leads to protein misfolding and failure of glycosylation, f/b proteasome-mediated Endocrine, Diabetes & Biochemistry 11
degradation and significantly ↓ number of transmembrane CFTR proteins. Metabolism (ES) (Bioc)
934 Hereditary spherocytosis In spherocytosis, MCHC is incr due to mild dehydration of the RBC. Markers of hemolysis are often evident and incl incr LDH, reticulocytosis, and decr haptoglobin. Endocrine, Diabetes & Biochemistry 3
Metabolism (ES) (Bioc)
989 Mitral regurgitation In pts w/ MR, LV afterload is determined by the balance of resistance b/w forward flow (aortic pressure) and regurgitant flow (LA pressure). A ↓ in SVR ↑ the ratio of Endocrine, Diabetes & Biochemistry 6
forward to regurgltant blood flow and improves CO. Metabolism (ES) (Bioc)
994 ACE inhibitors Angioedema is a rare and serious AE of ACEI therapy. ACEI ↑ bradykinin lvls, which ↑ vascular permeability and lead to angioedema. SSx include tongue, lips, or eyelid Endocrine, Diabetes & Biochemistry 7
swelling and, less frequently, laryngeal oedema and difficulty breathing. ACEI should be discontinued in affected pts. Metabolism (ES) (Bioc)
997 HIV The chemokine receptor CCR5 is a coreceptor that enables the HIV virus to enter cells. Blockade of CCR5 by chemokine receptor antagonists prevents viral entry into Endocrine, Diabetes & Biochemistry 11
host cells. Metabolism (ES) (Bioc)
998 Sexual differentiation 5α-reductase converts testo to DHT, which mediates devel of the ext genitalia in the male fetus. Male neonates w/ 5α-reductase defic are born w/ feminized ext genitalia Endocrine, Diabetes & Biochemistry 2
that typically masculinize at puberty. A small phallus and hypospadias are common. Metabolism (ES) (Bioc)
1010 Immunizations The Hib vax consists of a CPS conjugated to a carrier protein (TT protein or OMP of N. meningitidis). Protein conjugation causes a T cell-mediated immune response Endocrine, Diabetes & Biochemistry 4
leading to long-term immunity thru production of memory B-lymphocytes. Metabolism (ES) (Bioc)
1019 Febrile neutropenia Ecthyma gangrenosum is a cutaneous necrotic disease with a strong association with Pseudomonas aeruginosa bacteremia. It occurs from perivascular invasion and Endocrine, Diabetes & Biochemistry 4
release of tissue-destructive exotoxins, causing vascular destruction and insufficient blood flow to patches of skin that become edematous and subsequently necrose. Metabolism (ES) (Bioc)
Pseudomonas infections are common in patients who are neutropenic, are hospitalized, have burns, or have indwelling catheters.
1022 Cholera V. cholerae and ETEC cause a purely toxin-mediated watery diarrhoea. The toxins secreted by these organisms modify electrolyte handling by enterocytes but don't cause Endocrine, Diabetes & Biochemistry 2
cell death; therefore, no erythrocytes or leucocytes are typically noted on stool micro. Metabolism (ES) (Bioc)
1023 Cholera V. cholerae must survive the acidic environment of the stomach to reach the small intestine and cause disease. B/c the organism is easily destroyed by acid, a high burden Endocrine, Diabetes & Biochemistry 2
of organisms must be ingested to cause infection. However, conditions that ↓ gastric acidity (e.g. antacid use) ↓ the minimum infectious dose of V. cholerae by multi Metabolism (ES) (Bioc)
orders of magnitude.
1030 Sarcoidosis Hypercalcaemia in sarcoidosis is caused by PTH-independent formation of 1,25-dihydroxyvit D by activated macrophages. This leads to ↑ intestinal absorption of Ca2+. Endocrine, Diabetes & Biochemistry 7
Metabolism (ES) (Bioc)
1031 Diabetic ketoacidosis Most pts w/ DKA have normal to ↑ serum K+ lvls despite a total body K+ deficit. Replacement of K+ is a crucial step in the Mx of pts w/ DKA. Endocrine, Diabetes & Biochemistry 6
Metabolism (ES) (Bioc)
1032 Multiple endocrine MEN-1 consists of HPT (e.g. hypercalcaemia, constipation, kidney stones), pit tumours, and PETs (e.g. gastrinoma). The genetic defect involves muts of the MEN1gene. Endocrine, Diabetes & Biochemistry 5
neoplasia Metabolism (ES) (Bioc)
1034 Paget disease of bone Bone pain and elevated alkaline phosphatase level in an elderly patient can occur with osteoblast metastases and Paget disease of bone (PDB). Biopsy showing a mosaic Endocrine, Diabetes & Biochemistry 4
pattern of lamellar bone is diagnostic for PDB. The initial phase in PDB is characterized by an increase in osteoclastic activity. Metabolism (ES) (Bioc)
1063 Human papillomavirus Human papillomavirus (HPV) infection causes cutaneous and genital warts as well as benign and malignant intraepithelial neoplasia. Koilocytosis is a hallmark sign of Endocrine, Diabetes & Biochemistry 4
HPV infection. Koilocytes are pyknotic, superficial or immature squamous cells with a dense, irregularly staining cytoplasm and perinuclear halo-like clearing. Metabolism (ES) (Bioc)
1066 LDH and glycolysis Under anaerobic conditions, NADH transfers electrons to pyruvate to form lactate and regenerate NAD*. NAD+ is required to convert glyceraldehyde-3-phosphate to 1-3- Endocrine, Diabetes & Biochemistry 1
bisphosphoglycerate in glycolysis. Metabolism (ES) (Bioc)
1067 Pyruvate kinase deficiency PKD causes HA due to failure of glycolysis and resultant failure to generate sufficient ATP to maintain erythrocyte structure. In this case, splenic hyperplasia results from Endocrine, Diabetes & Biochemistry 1
incr. work of the splenic parenchyma, which must remove these deformed erythrocytes from the circulation. Metabolism (ES) (Bioc)
1069 Citric acid cycle GTP is synthesised by succinyl-CoA synthetase during the conversion of succinyl-CoA to succinate in the TCA cycle. During GNG, PEPCK uses GTP to synthesise PEP Endocrine, Diabetes & Biochemistry 1
from OA. Metabolism (ES) (Bioc)
1070 Glycogen storage disease Acid maltase (a-glucosidase) deficiency presents in early infancy with cardiomegaly, macroglossia, and profound muscular hypotonia. Abnormal glycogen accumulation Endocrine, Diabetes & Biochemistry 3
within lysosomal vesicles is seen on muscle biopsy. Metabolism (ES) (Bioc)
1073 Urethritis N. gonorrhoeae has high antigenic variability of its surface molecules (e.g. porins, Opa proteins), which prevents the formation of protective immunity and leads to Endocrine, Diabetes & Biochemistry 4
susceptibility to repeat infection. Metabolism (ES) (Bioc)
1119 Hyperphosphatemia Glucose-6-phosphate dehydrogenase is the rate-limiting enzyme in the pentose phosphate pathway, the major source of cellular NADPH. This molecule is necessary for Endocrine, Diabetes & Biochemistry 1
reducing glutathione (protects red blood cells from oxidative damage) and for the biosynthesis of cholesterol, fatty acids, and steroids. Metabolism (ES) (Bioc)
1121 Fructose metabolism Dietary fructose is phosphorylated in the liver to F1P and is rapidly metabolized b/c it bypasses PFK-1, the major RLE of glycolysis. Other sugars (e.g. Glc, Gal, Endocrine, Diabetes & Biochemistry 4
mannose) enter glycolysis prior to PFK-1 and as a result are metabolized more slowly. Metabolism (ES) (Bioc)
1334 Odds ratio A case-control study is used to compare the exposure status of people w/ the disease (ie, cases) to the exposure status of people w/o the disease (ie, controls). The main Endocrine, Diabetes & Biochemistry 2
measure of association is the OR. Metabolism (ES) (Bioc)
1335 Validity and reliability A precise/reliable test is reproducible in that it gives similar results on repeat measurements. Reliability is maximal when random error is minimal. Endocrine, Diabetes & Biochemistry 1
Metabolism (ES) (Bioc)
1336 Confounding, effect Effect modification is present when the effect of the main exposure on the outcome is modified by the presence of another variable. Effect modification is not a bias. Endocrine, Diabetes & Biochemistry 3
modification, bias, errors Metabolism (ES) (Bioc)
1370 Neurofibromatosis NF-I is a single-gene AD disorder. It occurs due to mut of the NF1 gene located on chrom 17. Café-au-lait spots, multiple neurofibromas, and Lisch nodules are the most Endocrine, Diabetes & Biochemistry 3
common SSx. Metabolism (ES) (Bioc)
1379 Syphilis Pts w/ early syphilis (e.g. chancre) often have false (-) initial serologic testing. Direct visualisation of the organism (T. pallidum) by dark-field micro or fluorescent Ab Endocrine, Diabetes & Biochemistry 9
testing is the gold standard for Dx but isn't widely available. Metabolism (ES) (Bioc)
1383 Cholecystitis CCK is the hormone responsible for gallbladder contraction. It’s made in the duodenum and jejunum in response to FAs and AAs. Endocrine, Diabetes & Biochemistry 5
Metabolism (ES) (Bioc)
1484 Acute diarrhea Campylobacter infection is a common cause of GE and is typically acquired from contaminated food (eg, undercooked poultry) or domesticated animals (eg, household Endocrine, Diabetes & Biochemistry 13
dogs). MFx usually include fever, cramping abdominal pain, and watery diarrhea that may be bloody. Stool studies typically show blood and leukocytes. Campylobacter Metabolism (ES) (Bioc)
infection is a/w GBS.
1501 Aging Crit shortening in telomere length can signal for programmed cell death. Telomerase is a reverse transcriptase (RNA-dependent DNA polymerase) that lengthens Endocrine, Diabetes & Biochemistry 8
telomeres by adding TTAGGG repeats to the 3' end of chroms. SCs have long telomeres due to high telomerase activity, allowing them to proliferate indefinitely in a Metabolism (ES) (Bioc)
controlled manner.
1720 Diastolic dysfunction Na nitroprusside is a short-acting agent that causes balanced vasodilation of the veins and arteries to ↓ both LV preload and afterload. The balanced vasodilation allows for Endocrine, Diabetes & Biochemistry 4
maintenance of SV and CO at a ↓ LV pressure (↓ cardiac work). Metabolism (ES) (Bioc)
1886 Otitis externa The vagus nerve provides cutaneous sensation to the posterior external auditory canal via its small auricular branch. Sensation to the rest of the canal is from the Endocrine, Diabetes & Biochemistry 2
mandibular division of the trigeminal nerve. Metabolism (ES) (Bioc)
1887 Cranial nerve palsy Lesions of the glossopharyngeal nerve result in loss of the gag reflex (afferent limb); loss of sensation in the upper pharynx, posterior tongue, tonsils, and middle ear Endocrine, Diabetes & Biochemistry 9
cavity; and loss of taste sensation on the posterior 3rd of the tongue. Metabolism (ES) (Bioc)
1888 Urinary tract infection hemorrhagic cystitis during therapy w/ cyclophosphamide or ifosfamide is caused by the urinary excretion of the tox metabolite acrolein. It can be prevented by aggressive Endocrine, Diabetes & Biochemistry 12
hydration, bladder irrigation, and admin of mesna, a sulfhydryl compound that binds acrolein in the urine. Metabolism (ES) (Bioc)
1889 Nausea and vomiting Ondansetron inhibits serotonin (5-HT3) receptors and is used primarily to treat nausea and vomiting following chemotherapy, 5-HT3 receptors are located peripherally in Endocrine, Diabetes & Biochemistry 2
the presynaptic nerve terminals of the vagus nerve in the gastrointestinal tract. These receptors are also present centrally in the chemoreceptor trigger zone and the solitary Metabolism (ES) (Bioc)
nucleus and tract.
1989 Polycystic kidney disease In its most severe phenotype, autosomal recessive polycystic kidney disease can be detected on prenatal sonogram along with oligohydramnios. Potter sequence (flattened Endocrine, Diabetes & Biochemistry 3
facies, limb deformities, pulmonary hypoplasia) is caused by oligohydramnios and is associated with high mortality. Metabolism (ES) (Bioc)
1990 Urinary tract obstruction The ureters run in close proximity to the pelvic LNs and the uterine artery in the female pelvis, which predisposes them to injury during pelvic surgery. Endocrine, Diabetes & Biochemistry 4
Metabolism (ES) (Bioc)
QID Topic
1991 Pituitary adenoma
2016 Neuronal physiology
2064 Obstructive sleep apnea
2066 Normal pregnancy
11917 Factitious disorder
11918 Rheumatoid arthritis
11950 Brain herniation
1013 Tetanus
543 COPD
763 Community acquired
pneumonia
771 Meningitis
1407 Dysthymia
1789 Drug structure and
properties
8424 Osteoarthritis
191 Asthma
220 Pulmonary arterial
hypertension
221 Mitral regurgitation
225 Tetralogy of Fallot
579 Lung nodule
585 Cell mediated immunity
768 Community acquired
pneumonia
769 Meningitis
782 Reactive arthritis
848 Cystic fibrosis
927 Diabetic nephropathy
931 Urinary tract infection
980 Adrenal insufficiency
986 Polymyositis and
dermatomyositis
1011 Tetanus
1012 Epiglottitis
1262 Odds ratio
1658 Respiratory physiology
1659 Mitral stenosis
1660 Cytomegalovirus
1839 Accuracy and precision
1844 Osteoarthritis
1901 Mullerian anomalies
1921 Hemolytic uremic
syndrome
1996 Cushing syndrome
2080 Thiazides
2081 Aldosterone antagonists
7651 von Willebrand disease
8531 Bladder cancer
17236 Tinea
17246 Cryptococcal infections
210 Atrioventricular canal
defect
212 Atherosclerosis
Educational Objective System Subject Repeats
Prolactinomas are the most common hormonally active pituitary adenomas. The excess prolactin produced by these tumors can cause galactorrhea and amenorrhea in Endocrine, Diabetes & Biochemistry 8
premenopausal women. With a large mass, visual changes and headaches may occur due to compression of the optic chiasm. Metabolism (ES) (Bioc)
Kinesin is a microtubule-associated, ATP-powered motor protein that facilitates the anterograde transport of neurotransmitter-containing secretory vesicles down axons to Endocrine, Diabetes & Biochemistry 3
synaptic terminals. Metabolism (ES) (Bioc)
OSA presents in obese individuals w/ excessive daytime sleepiness and SSx of nocturnal upper airway obstr (e.g. snoring, gasping). The condition is a/w systemic HTN. Endocrine, Diabetes & Biochemistry 4
Prolonged, un-Tx OSA can also cause PAH and RHF. Metabolism (ES) (Bioc)
In pregnancy, progesterone is secreted by the corpus luteum and later by the placenta. Although PRL secretion ↑ as pregnancy progresses, high progesterone lvls inhibit Endocrine, Diabetes & Biochemistry 2
lactation by preventing binding of PRL to receptors on alveolar cells in the breast. Metabolism (ES) (Bioc)
Factitious disorder involves the conscious and deceptive feigning or self-production of physical or psychological SSx to obtain attn and medical care from health care Endocrine, Diabetes & Biochemistry 1
personnel. Metabolism (ES) (Bioc)
Long-standing RA can affect the cervical spine, causing vertebral misalignment (subluxation) that can affect the atlantoaxial joint. Extension of the neck during Endocrine, Diabetes & Biochemistry 9
endotracheal intubation can worsen the subluxation, leading to acute compression of the spinal cord a/o vertebral arteries. Metabolism (ES) (Bioc)
Expanding space occupying lesions w/i the temporal lobe can cause ↑ ICP w/ transtentorial herniation of the uncus. Uncal herniation often compresses the ipsilateral Endocrine, Diabetes & Biochemistry 2
CNIII as it exits the midbrain, resulting in CNIII palsy w/ a fixed pupil (e.g. due to preganglionic parasympathetic fibre dmg). Metabolism (ES) (Bioc)
Neonatal tetanus can be prevented by hygienic delivery and umbilical cord care and universal immunisation of women who're preg or may become preg. Immunised Endocrine, Diabetes & Biostatistics 5
mothers provide passive immunity via transplacental IgG, protecting infants until they receive active immunisation (vax) around age 2mos. Metabolism (ES) (Bios)
COPD is a combo of emphysema and chronic bronchitis and commonly presents w/ progr dyspnoea and recurrent URIs. Bronchial obstr and alveolar destruction cause air Endocrine, Diabetes & Embryology 16
trapping that MFx on PFT as ↓ FEV1, FVC, and FEV1/FVC ratio. RV and TLC are ↑. Metabolism (ES) (Embr)
The 1° VF of S. pneumoniae is a PSC that inhibs opsonisation and phagocytosis. The PSC of the most virulent strains is targeted by the PCV, which confers immunity Endocrine, Diabetes & Embryology 21
against those subtypes. Metabolism (ES) (Embr)
N. meningitidis is transmitted 1arily by aerosolized droplets and subseq colonizes the nasopharyngeal epithelium. Penetration of the epithelium can lead to bloodstream Endocrine, Diabetes & Embryology 17
infection. Spread to the meninges occurs via transcellular penetration of the cerebral cap endothelium or entry at the choroid plexus. Metabolism (ES) (Embr)
The DSM-5 Dx of dysthymia is characterised by chronic depressed mood and at least 2 other depressive SSx lasting for at least 2yrs. Endocrine, Diabetes & Genetics (Gene) 1
Metabolism (ES)
While the kidney is the primary site of elimination of most drugs, the liver is the main site of biotransformation of these agents in preparation for elimination. Drugs that Endocrine, Diabetes & Genetics (Gene) 3
are more lipophilic (high Va good penetration into CNS) are preferentially processed by the liver into more polar compounds for easier elimination in the bile and urine. Metabolism (ES)
Liver disease (e.g., cirrhosis) or the concomitant use of other drugs may limit or enhance the clearance of drugs metabolized in the liver.
OA is char by progr fissuring and erosion of articular cartilage. RFs incl advancing age, obesity, joint trauma, and repetitive stress. Pts may have mild effusion and Endocrine, Diabetes & Histology (Hist) 2
crepitus on PEx, but SSx of synovitis (e.g. redness, warmth) are less prominent than in the classic inflammatory arthritic disorders. Metabolism (ES)
Improper administration of inhaled glucocorticoids for the treatment of asthma can lead to adverse effects, including oropharyngeal candidiasis and dysphonia. Using a Endocrine, Diabetes & Pathology (Path) 12
spacer during administration and rinsing the mouth after each use can help prevent these adverse effects. Metabolism (ES)
Left-sided HF can cause 2° PAH via ↑ left-sided diastolic filling pressures transmitting backward to the pulm veins, resulting in pulm venous congestion. Over time, pulm Endocrine, Diabetes & Pathology (Path) 8
arterial remodelling (medial hypertrophy and intimal thickening w/ fibrosis) can occur, but not to the extent that occurs in (1°) PAH. Metabolism (ES)
DHF is a common cause of 2° (fxnal) MV regurgitation. ↑ LV EDV causes dilation of the MV annulus and restricted movement of the chordae tendineae w/ subsequent Endocrine, Diabetes & Pathology (Path) 6
regurgitation. Tx w/ diuretics and vasodilators can improve HF-induced MR. Metabolism (ES)
In pts w/ TOF, the degree of RVOT obstr is the major determinant of the degree of R-L intracardiac shunting and resulting cyanosis. Endocrine, Diabetes & Pathology (Path) 3
Metabolism (ES)
Hamartomas are the most common benign lung tumours. They present as aSSx perily located 'coin lesion' in pts 50-60 y/o. These tumours are composed of disorganised Endocrine, Diabetes & Pathology (Path) 1
cartilage, fibrous, and adipose tissue. Metabolism (ES)
The process of (-) selection in T cell maturation is essential for eliminating T cells that bind to self MHC or self Ags w/ overly high affinity. This process occurs in the Endocrine, Diabetes & Pathology (Path) 5
TM. If these cells were permitted to survive, they would likely induce immune and inflam rxns against self Ags leading to AI disease. Metabolism (ES)
S. pneumoniae vax ↓ the risk of invasive disease and is recommended for young pts and the elderly. The PCPSV is an unconjugated vax that induces a T-cell-independent Endocrine, Diabetes & Pathology (Path) 21
humoral immune response. In contrast, the PCCV contains polysaccharide material attached to a protein Ag, which creates a robust T-cell-mediated humoral immune Metabolism (ES)
response.
Bacterial meningitis causes an incr in CSF neutrophil count and protein conc as well as decr in CSF Glc. S. pneumoniae is a leading cause of CAP, OM, and meningitis in Endocrine, Diabetes & Pathology (Path) 17
adults. S. pneumoniae appears on Gram stain as lancet-shaped, Gram (+) cocci in pairs. Metabolism (ES)
The classic triad of ReA is nongonococcal urethritis, conjunctivitis, and arthritis. It's an HLA-B27-assoc. arthropathy that occurs w/i several wks following a GU or Endocrine, Diabetes & Pathology (Path) 2
enteric infection. It belongs to the group of SNSAs (incl. AS) and can cause SI in about 20% of cases. Metabolism (ES)
Recurrent sinopulm infections and exocrine gland atrophy in a young Caucasian are suggestive of CF. CF can lead to pancreatic insufficiency, fat malabsorption, and a Endocrine, Diabetes & Pathology (Path) 11
defic of vits A, D, E, and K. VitA maintains orderly diff of specialised epithelia, incl the mucus-secreting columnar epithelia of the ocular conjunctiva, resp and urinary Metabolism (ES)
tracts, and pancreatic and other exocrine ducts. Avitaminosis A can cause squamous metaplasia of such epithelia to a keratinising epithelium.
NGS is characterised by GBM thickening, ↑ mesangial matrix deposition, and formation of Kimmelstiel-Wilson (KW) nodules. It's most common caused by diabetic Endocrine, Diabetes & Pathology (Path) 4
nephropathy and indicates irreversible glomerular dmg w/ a rapid decline in kidney fxn. Metabolism (ES)
Pyuria and bacteriuria are found in both upper and lower UTIs. However, WBC casts only form in the renal tubules and are pathognomonic for acute pyelonephritis Endocrine, Diabetes & Pathology (Path) 12
(APN) when accompanied by SSx of acute UTI. Metabolism (ES)
Pts w/ AI aren't able to ↑ GC production in response to acute stress (e.g. illness, Sx). Adrenal crisis is characterised by severe hypotension, abdo pain, vomiting, weakness, Endocrine, Diabetes & Pathology (Path) 5
and fever. In addn to aggressive fluid resuscitation, Tx req immediate GC supplementation. Metabolism (ES)
DM is char by prox. muscle weakness (similar to PM) and dermal MFxs (e.g. heliotrope rash, Gottron papules). Lab testing shows ↑ muscle enzymes (e.g. CK) and auto- Endocrine, Diabetes & Pathology (Path) 5
Abs (e.g. antinuclear, anti-Jo-1). Initial Tx incl systemic GCs and eval for potential underlying malignancy. Metabolism (ES)
Tetanospasmin is a neuro-exotoxin released by C. tetani. The toxin blocks the release of glycine and GABA from the spinal inhib interneurons that regulate the LMNs. Endocrine, Diabetes & Pathology (Path) 5
These disinhib motor neurons cause ↑ activation of muscles, leading to spasms and hyperreflexia. Metabolism (ES)
Rapidly progressing fever, severe sore throat, drooling and progressive airway obstruction potentially accompanied by stridor are the presenting symptoms of acute Endocrine, Diabetes & Pathology (Path) 2
epiglottitis. This illness is most commonly caused by H. influenzae type b, but the Hib vaccine has dropped the incidence of this disease considerably. H. influenzae type b Metabolism (ES)
can still cause disease in unimmunized or improperly immunized patients as well as fully immunized patients in some cases.
The odds ratio (OR) is a measure of the strength of an association between an exposure and an outcome. Specifically, it represents the odds that an outcome occurred in Endocrine, Diabetes & Pathology (Path) 2
the presence of a particular exposure compared with the odds that the outcome occurred in the absence of that exposure. In a standard contingency table, OR = ad/bc. Metabolism (ES)
During physical ex, there's incr skeletal muscle CO2 production that incr the CO2 content of venous blood. Art O2 and CO2 content remains constant via incr in alv vent Endocrine, Diabetes & Pathology (Path) 8
and gas exchange efficiency. Venous O2 content remains constant or is decr due to incr O2 extraction by the tissues that matches or exceeds the rate of O2 delivery (i.e. Metabolism (ES)
O2 consumption during ex is limited by CO).
Under normal circumstances, PCWP closely reflects LA and LV EDP. MS leads to an ↑ in the LA pressure that is reflected as ↑ PCWP during pulm artery catheterization. Endocrine, Diabetes & Pathology (Path) 7
LV filling may be normal, resulting in an ↑ pressure gradient b/w the LA and LV during diastole. Metabolism (ES)
Cytomegalovirus (CMV) is typically associated with subclinical infection in the immunocompetent, with the occasional individual developing a mononucleosis-like Endocrine, Diabetes & Pathology (Path) 9
syndrome that is heterophile antibody (Monospot) negative. In the immunocompromised, primary or reactivated CMV infection can result in severe retinitis, pneumonia, Metabolism (ES)
esophagitis, colitis, or hepatitis.
A precise tool is one that consistently provides very similar or the same value when measuring a fixed quantity. An accurate tool is one that provides a measurement Endocrine, Diabetes & Pathology (Path) 1
identical or similar to the actual value (as reflected in a gold standard measurement). Metabolism (ES)
OA of the hands is char by osteophyte formation leading to hard bony enlargement of the dist. IPJs (Heberden nodes) and prox. IPJs (Bouchard nodes). Brief morning Endocrine, Diabetes & Pathology (Path) 2
stiffness may be present. Metabolism (ES)
In females, the paramesonephric ducts fuse to form the fallopian tubes, uterus, cervix, and upper vagina. Disruptions of this process can lead to a variety of Müllerian tract Endocrine, Diabetes & Pathology (Path) 1
anomalies, and renal anomalies are a common comorbidity. Incomplete lateral fusion of the paramesonephric ducts results in a bicornuate uterus Chx by an indentation in Metabolism (ES)
the center of the fundus.
HUS MFx w/ AKI, MAHA, and thrombocytopenia. Char lab abns incl decr Hb and platelet count and incr BT, LDH, bilirubin, BUN, and creat. Endocrine, Diabetes & Pathology (Path) 3
Metabolism (ES)
PNP hypercortisolism, most commonly caused by SCLC, is due to ectopic ACTH secretion. CFx incl HTN, hyperglycaemia, oedema, and hyperpigmentation. Unlike non- Endocrine, Diabetes & Pathology (Path) 5
PNP CS, central obesity is uncommon. Metabolism (ES)
TZDs effectively incr renal Ca2+ reabs. In pts w/ recurrent Ca2+ nephrolith, TZDs can help prevent stone formation by decr urine Ca2+ excretion. Endocrine, Diabetes & Pathology (Path) 3
Metabolism (ES)
All diuretics except for the K-sparing class cause K loss by ↑ Na delivery to the late distal tubule and cortical collecting duct, where aldosterone-induced Na reabsorption Endocrine, Diabetes & Pathology (Path) 3
occurs at the expense of K. K-sparing diuretics (eg, spironolactone, amiloride) act on the late distal tubule and cortical collecting duct to antagonize the effects of Metabolism (ES)
aldosterone.
Pts w/ vWD often Px w/ a lifelong Hx of mucosal bleeding, incl gingival bleeding, epistaxis, a/o menorrhagia. These pts have normal platelet lvls but typically have a Endocrine, Diabetes & Pathology (Path) 7
prolonged BT due to impaired platelet fxning. Metabolism (ES)
Urothelial (transitional cell) bladder ca typically affects the elderly and presents w/ gross hematuria. A Hx of smoking or occup exposure to rubber, plastics, aromatic Endocrine, Diabetes & Pathology (Path) 4
amine-containing dyes, textiles, or leather ↑ the risk. Metabolism (ES)
Tinea corporis presents with round or ovoid lesions with a raised, scaly border and central clearing. Trichophyton rubrum is the most common cause and infects Endocrine, Diabetes & Pathology (Path) 4
keratinized matter in the stratum corneum of the superficial epidermis but does not invade the dermis and subcutaneous tissues. Metabolism (ES)
Cryptococcus neoformans is a round/oval yeast w/ a thick PSC. It is a common cause of meningoencephalitis (eg, h/a, vomiting, confusion, seizure) in pts w/ unTx AIDS. Endocrine, Diabetes & Pathology (Path) 3
The yeast can frequently be visualized in the CSF by India ink or silver stain. Metabolism (ES)
A complete AV canal defect is comprised of an ASD, a VSD, and a common AV valve. It's the most common congenital cardiac anomaly a/w Down syndrome. Endocrine, Diabetes & Pathophysiology 1
Metabolism (ES) (Patp)
Familial hypercholesterolemia, one of the most common autosomal dominant disorders, is the result of heterozygous or homozygous LDL receptor gene mutations, which Endocrine, Diabetes & Pathophysiology 8
cause hepatocyte under expression of functional LDL receptors. This condition can lead to accelerated atherosclerosis and early-onset coronary artery disease. Metabolism (ES) (Patp)
QID Topic Educational Objective System Subject Repeats
213 Dyslipidemia Xanthelasmas, a type of xanthoma, are yellowish macules/papules found on the med. eyelids. They're dermal accumulations of macrophages containing cholesterol and Endocrine, Diabetes & Pathophysiology 11
TGs, and are generally a/w a 1° or 2° hyperlipidaemia or dyslipidaemia. An LDL receptor abn is the most common cause. Metabolism (ES) (Patp)
214 Myocardial infarction VF is the most common mech of SCD due to AMI. It results from arrhythmogenic foci triggered by electrical instability in the ischemic myocardium. Endocrine, Diabetes & Pathophysiology 18
Metabolism (ES) (Patp)
218 Pulmonary arterial PAH should be suspected in young and otherwise healthy pts w/ fatigue, progr dyspnoea, atypical chest pain, or unexplained syncope. Long-standing PAH leads to Endocrine, Diabetes & Pathophysiology 8
hypertension hypertrophy a/o dilation of the RV (cor pulmonale). Metabolism (ES) (Patp)
223 Atrial septal defect The foramen ovale is patent in approximately 25% of normal adults. Although the foramen ovale usually remains fxnally closed, transient ↑ of RA pressure above LA Endocrine, Diabetes & Pathophysiology 2
pressure can produce a right-to-left shunt, leading to paradoxical embolism of venous clots into the arterial circulation. Metabolism (ES) (Patp)
224 Ventricular septal defect VSD typically presents in the neonatal period after pulm vascular resistance has declined. The clinical Px depends on the size of the defect, which ranges from an aSSx Endocrine, Diabetes & Pathophysiology 2
holosystolic murmur (small VSD) to HF (large VSD). Metabolism (ES) (Patp)
226 Tetralogy of Fallot In pts w/ TOF, squatting during a Tet spell ↑ SVR and ↓ right-to-left shunting, thereby ↑ pulm blood flow and improving O2ation status. Endocrine, Diabetes & Pathophysiology 3
Metabolism (ES) (Patp)
454 Colorectal cancer Adenomatous polyps contain dysplastic mucosa and are premalignant. Regular screening w/ timely excision of polyps is effective for prevention of CAC. Studies have Endocrine, Diabetes & Pathophysiology 15
linked ↑ activity of COX-2 to some forms of CAC and suggest that regular aspirin use ↓ adenomatous polyp formation. Metabolism (ES) (Patp)
547 COPD Hyperplasia of the submucosal bronchial glands is the major contributor to bronchial wall thickening in chronic bronchitis. The Reid index is the ratio of the thickness of Endocrine, Diabetes & Pathophysiology 16
the submucosal bronchial glands to the thickness of the bronchial wall b/w the epithelial BM and the bronchial cartilage. Higher values correlate w/ ↑ duration and Metabolism (ES) (Patp)
severity of chronic bronchitis.
582 Lung cancer SCLC is strongly a/w smoking and is usually centrally located. Histopath shows small, round or oval cells w/ scant cytoplasm and large, hyperchromatic (blue) nuclei; Endocrine, Diabetes & Pathophysiology 9
abundant mitoses are also usually seen. IHC stains are freq (+) for neuroendocrine markers (e.g. chromogranin, synaptophysin, NCAM (CD56)). Metabolism (ES) (Patp)
601 Selective serotonin reuptake SSRIs have improved tolerability and a better AE profile compared w/ TCAs and MAOIs but are a/w sexual dysfxn. Physicians should routinely inquire about sexual Endocrine, Diabetes & Pathophysiology 3
inhibitors dysfxn b/c it's a relatively common AE of SSRIs that may lead to non-adherence. Metabolism (ES) (Patp)
608 Breast cancer Selective ER modulators (eg, tamoxifen, raloxifene) are competitive inhibitors of estrogen binding to ERs. They can have agonist or antagonist effects depending on the Endocrine, Diabetes & Pathophysiology 7
specific tissue. Tamoxifen has an estrogenic effect on the uterus and can cause endometrial hyperplasia and ca. Metabolism (ES) (Patp)
609 Klinefelter syndrome KFS (47,XXY) causes infertility characterised by 1° hypogonadism (↑ FSH and LH, low testosterone) and azoospermia. Other findings incl long lower extremities; small, Endocrine, Diabetes & Pathophysiology 3
firm testes; and gynecomastia. Metabolism (ES) (Patp)
610 Abortion Progesterone is necessary for implantation and maintenance of pregnancy. Mifepristone is a progesterone antagonist that is used w/ misoprostol (a PGE1 agonist) to Endocrine, Diabetes & Pathophysiology 3
terminate a 1st-trimester pregnancy. Metabolism (ES) (Patp)
611 Aromatase inhibitors Oestrogen is the main hormone responsible for the growth and devel of ER(+) breast tumours. Aromatase inhibs (e.g. anastrozole, letrozole, exemestane) ↓ the synthesis Endocrine, Diabetes & Pathophysiology 1
of oestrogen from androgens, suppressing oestrogen lvls and slowing progr of ER(+) tumours. Metabolism (ES) (Patp)
612 Neuroendocrine tumors Glucagonoma presents w/ hyperglycaemia (often as newly Dx DM) and necrolytic migratory erythema (blistering erythematous plaques w/ central clearing) affecting the Endocrine, Diabetes & Pathophysiology 1
groin, face, and extremities. The Dx is made by detecting ↑ glucagon lvls. Metabolism (ES) (Patp)
623 Alzheimer disease Early-onset familial AD is a/w 3 gene muts: APP (chrom 21), presenilin 1, and presenilin 2. Late-onset familial AD is a/w apoE4 genotype. Endocrine, Diabetes & Pathophysiology 7
Metabolism (ES) (Patp)
631 Wernicke-Korsakoff WE is a complication of thiamine deficiency Chx by encephalopathy, ataxia, and oculomotor dysfxn. It occurs most commonly in pts w/ chronic Alc abuse and may be Endocrine, Diabetes & Pathophysiology 5
syndrome precipitated by infusion of Glc-containing fluids. Neuroimaging reveals focal hemorrhage or atrophy of the mammillary bodies. Metabolism (ES) (Patp)
656 Osteoporosis Regular exercise leads to increased peak bone mass, a reduced rate of bone loss, and a decreased risk of osteoporosis. Endocrine, Diabetes & Pathophysiology 10
Metabolism (ES) (Patp)
698 Churg-Strauss syndrome Eosinophilic GPA (CSS) is a small to medium vessel vasculitis char by late-onset asthma, rhinosinusitis, and eosinophilia. Mononeuritis multiplex due to involvement of Endocrine, Diabetes & Pathophysiology 1
the epineural vessels of peri nerves is common. Metabolism (ES) (Patp)
764 Community acquired S. pneumoniae are gram (+), α-hemolytic, optochin-sen, bile-soluble diplococci. Viridans group streptococci are also α-hemolytic, but they're optochin-res and bile Endocrine, Diabetes & Pathophysiology 21
pneumonia insoluble. S. pyogenes (GAS) appear as gram (+) cocci in chains w/ bacitracin susceptibility. Metabolism (ES) (Patp)
765 Asplenia The spleen acts as both a blood filter capable of removing circulating pathogens and as a major site of opsonising Ab synthesis. Asplenic pts are prone to infections caused Endocrine, Diabetes & Pathophysiology 2
by encapsulated organisms such as S. pneumoniae, H. influenzae, and N. meningitidis. Metabolism (ES) (Patp)
793 Prostacyclins Prostacyclin (prostaglandin I2) is synthesized from prostaglandin H2 by prostacyclin synthase in vascular endothelial cells. Once secreted, it inhibits platelet aggregation Endocrine, Diabetes & Pathophysiology 1
and causes vasodilation to oppose the fxns of thromboxane A2 and help maintain vascular homeostasis. Metabolism (ES) (Patp)
849 Cystic fibrosis CFTR gene mutations are the most common cause of congenital bilateral absence of the vas deferens (CBAVD). Patients with CBAVD have azoospermia and infertility Endocrine, Diabetes & Pathophysiology 11
but normal levels of FSH, LH, and testosterone. Elevated sweat chloride levels are diagnostic of cystic fibrosis. Metabolism (ES) (Patp)
921 Contraception All hormone-containing contraceptives prevent pregnancy through the actions of progestins. The main mechanism of contraceptives with systemically active progestins Endocrine, Diabetes & Pathophysiology 3
(eg, combined hormonal oral contraceptives) is inhibiting ovulation by decreasing FSH and LH synthesis in the anterior pituitary. Metabolism (ES) (Patp)
922 Brain tumors Synaptophysin is a protein found in presynaptic vesicles of neurons, neuroendocrine, neuroectodermal cells. CNS tumours of neuronal origin freq stain (+) for Endocrine, Diabetes & Pathophysiology 10
synaptophysin on IHC. Neoplasms of glial origin (astrocytomas, ependymomas, and oligodendrogliomas) stain for GFAP. Metabolism (ES) (Patp)
924 Reye syndrome Reye syndrome occurs in children w/ febrile illness Tx w/ salicylates (aspirin). It consists of hepatic failure and encephalopathy. The char histo finding is microvesicular Endocrine, Diabetes & Pathophysiology 1
steatosis of hepatocytes w/o inflammation and cerebral oedema. Metabolism (ES) (Patp)
925 Down syndrome DS is most commonly caused by maternal meiotic nondisjxn, a process by which the fetus receives 3 full copies of chromosome 21. Dysmorphic features (eg, flat facial Endocrine, Diabetes & Pathophysiology 6
profile, protruding tongue, small ears, upslanting palpebral fissures) and cardiac defects (eg, endocardial cushion defects) are Chx. Metabolism (ES) (Patp)
926 Xeroderma pigmentosum Xeroderma pigmentosum develops due to a defect in nucleotide excision repair. This disease is characterized by increased sensitivity to ultraviolet radiation and a high Endocrine, Diabetes & Pathophysiology 2
incidence of cutaneous malignancy. Metabolism (ES) (Patp)
928 Acute kidney injury ATN is caused by renal ischemia and is characterised by oliguria, ↑ serum creatinine, and muddy brown casts. Ischemic injury predominantly affects the renal medulla, Endocrine, Diabetes & Pathophysiology 5
which has a relatively low blood supply. The terminal (straight) portion of the proximal tubules and the thick ascending limb of the LOH are the most commonly involved Metabolism (ES) (Patp)
portions of the nephron due to their high meta rate and location w/i the medulla.
929 Acute kidney injury ATN is characterised by tubular injury due to renal ischemia or direct cytotoxicity. The course of the disease can be broken into 3 stages: initiation (initial insult), Endocrine, Diabetes & Pathophysiology 5
maintenance (oliguric renal failure), and recovery. During the recovery period, GFR improves prior to restoration of renal tubular resorptive capacity, so transient polyuria Metabolism (ES) (Patp)
and electrolyte wasting (e.g. hypokalaemia) can occur.
930 Acute kidney injury Ethylene glycol ingestion causes ATN w/ vacuolar degen and ballooning of the PCT cells. Typical clinical findings incl AMS, ARF, high AGMA, ↑ osmolar gap, and Endocrine, Diabetes & Pathophysiology 5
Ca2+-oxalate crystals in the urine. Metabolism (ES) (Patp)
932 Hereditary spherocytosis HS results from red cell cytoskeleton abns, most commonly spectrin and ankyrin. hemolytic anaemia, jaundice, and splenomegaly are classic MFxs. Spherocytes are seen Endocrine, Diabetes & Pathophysiology 3
on peri blood smear. Metabolism (ES) (Patp)
981 Diabetes mellitus In the polyol pathway, aldose reductase converts Glc into sorbitol, which is slowly meta into fructose by SDH. Chronic hyperglycaemia overwhelms this pathway, causing Endocrine, Diabetes & Pathophysiology 31
intracellular sorbitol accumulation and ↑ osmotic/oxidative stress. This accelerates cataract devel in pts w/ DM, and contributes to the path of diabetic retinopathy, Metabolism (ES) (Patp)
neuropathy, and nephropathy.
985 Aortic stenosis The murmur of valvular AS is typically an ejection or midsystolic murmur of crescendo-decrescendo configuration w/ max intensity over the right 2nd ICS and radiation Endocrine, Diabetes & Pathophysiology 8
to neck and carotid arteries. The most common cause of AS in elderly pts (age >70) is degen calcification of the AV leaflets. Metabolism (ES) (Patp)
988 von Willebrand disease Pts w/ SSx vWD can be Tx w/ DDAVP, a syntheticADH analogue that has no vasoconstrictive effects. DDAVP transiently ↑ vWF and FVIII release from endothelial cell Endocrine, Diabetes & Pathophysiology 7
storage thru indirect mechs; it can be used prophylactically prior to procedures or to Tx minor bleeding. Metabolism (ES) (Patp)
1163 Melanoma Melanoma often has an early horizontal growth phase w/ low mets potential f/b a nodular, vertical growth phase w/ a significantly ↑ risk of mets. Depth of invasion Endocrine, Diabetes & Pathophysiology 6
(Breslow thickness) is the most important prognostic indicator in malignant melanoma. Metabolism (ES) (Patp)
1326 Bias Recall bias results from study participants' inaccurate recall of past exposure and occurs most often in retrospective studies such as case-control studies. People who have Endocrine, Diabetes & Pathophysiology 4
experienced an adverse event are more likely to recall RFx than those who have not experienced an adverse event. Metabolism (ES) (Patp)
1327 P-value and confidence A result is considered statistically significant if the 95% CI does not cross the null value, which corresponds to a p-value <0.05. Endocrine, Diabetes & Pathophysiology 2
interval Metabolism (ES) (Patp)
1328 Bias Observer bias occurs when the investigator's evaluation is affected by preconceived expectations or prior knowledge, typically leading to overestimation of the disease Endocrine, Diabetes & Pathophysiology 4
association or Tx effects. This type of bias can be ↓ by conducting a blinded study in which observers are unaware of study details and pt Chx that could unduly influence Metabolism (ES) (Patp)
them.
1561 Parvovirus Erythema infectiosum (5th disease) is caused by PVB19 and Px w/ a nonspecific prodrome (eg, malaise, fever, congestion) f/b a classic "slapped-cheek" facial rash and a Endocrine, Diabetes & Pathophysiology 3
lacy, reticular body rash. Parvovirus is highly tropic for erythroid precursor cells and replicates predominantly in the bone marrow. Metabolism (ES) (Patp)
1656 Para-aminohippuric acid PAH is 1arily secreted into the nephron by the PCT, but some is also freely filtered by the glom. PAH isn't reabsorbed by any portion of the nephron. Therefore, tubular Endocrine, Diabetes & Pathophysiology 1
fluid conc of PAH is lowest in BS. Metabolism (ES) (Patp)
1845 Normal pregnancy β-hCG is produced by the syncytiotrophoblast after implantation, which generally occurs 6-7 days after fertilization at the earliest. β-hCG typically is detectable in the Endocrine, Diabetes & Pathophysiology 2
maternal serum approximately 8 days after fertilization, whereas it is detectable in the urine 14 days after fertilization. Therefore, a serum pregnancy test will be (+) before Metabolism (ES) (Patp)
a urine pregnancy test.
1866 Iron deficiency anemia Hypochromic, microcytic anemia is most commonly due to Fe deficiency. Blood loss, especially occult loss from the GI tract, must be r/o in a pt w/ IDA. Endocrine, Diabetes & Pathophysiology 7
Metabolism (ES) (Patp)
1979 Syringomyelia The combo of fixed segmental loss of upper extremity pain and temp sensations, upper extremity LMN SSx, a/o lower extremity UMN SSx in the setting of scoliosis Endocrine, Diabetes & Pathophysiology 2
suggests syringomyelia. Metabolism (ES) (Patp)
14818 Human papillomavirus Human papillomavirus (HPV) oncogenicity relies on the inhibitory effects of viral proteins E6 and E7 on cell cycle regulatory proteins p53 and Rb. This allows cells Endocrine, Diabetes & Pathophysiology 4
infected with HPV to undergo unchecked cellular proliferation and evasion of apoptosis, promoting genomic instability and malignant transformation. Metabolism (ES) (Patp)
14930 Vitamin B12 deficiency Pernicious anaemia is an AI disease characterised by CD4+cell-mediated destruction of parietal cells. As parietal cells are destroyed, their ability to secrete HCl ↓, Endocrine, Diabetes & Pathophysiology 9
resulting in an ↑ intraluminal pH that leads to upregulation of gastrin secretion. Pts also develop vitB12 defic as a result of ↓ IF secretion. Metabolism (ES) (Patp)
14985 Ischemic stroke PICA occlusion causes lateral medullary (Wallenberg) syndrome, Chx by vertigo/nystagmus, ipsilateral cerebellar signs, loss of pain/temperature sensation in the Endocrine, Diabetes & Pathophysiology 19
ipsilateral face and contralateral body, bulbar weakness, and ipsilateral Horner syndrome. This condition can occur in the setting of cervical spine trauma w/ dissection of Metabolism (ES) (Patp)
the vertebral artery.
QID Topic Educational Objective System Subject Repeats
14995 Mosaicism Mosaicism is defined as the presence of multiple, genetically different cell lines w/i the body. It can result from several processes, including chromosomal nondisjunction Endocrine, Diabetes & Pathophysiology 1
or a mutation during the 1st stages of embryonic development. Somatic mosaicism results in a mixture of normal and mutated somatic cells, often leading to a milder form Metabolism (ES) (Patp)
of the disease.
15016 Niacin deficiency Niacin is a precursor for nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP), two important cofactors for many Endocrine, Diabetes & Pathophysiology 3
dehydrogenase and reductase enzymes. Niacin deficiency results in pellagra (ie, diarrhea, dementia, and dermatitis). Metabolism (ES) (Patp)
15105 Atrial flutter Atrial flutter demonstrates rapid and regular atrial activity in a saw-toothed pattern (flutter or F waves) on ECG. Typical atrial flutter is caused by a large re-entrant circuit Endocrine, Diabetes & Pathophysiology 1
that traverses the cavotricuspid isthmus of the RA, which is the target site for radiofrequency ablation. Metabolism (ES) (Patp)
163 Nitrates The main AEx seen w/ nitrate Thx include h/a and cutaneous flushing along w/ lightheadedness and hypotension due to systemic vasodilation. Endocrine, Diabetes & Pharmacology 7
Metabolism (ES) (Phar)
166 Nitrates Using nitrates together w/ PDEIs used for ED and pulm HTN causes a profound systemic hypotension b/c they both ↑ intracellular cGMP which causes vascular smooth Endocrine, Diabetes & Pharmacology 7
muscle relaxation. Their use together is absolutely c/i. Metabolism (ES) (Phar)
167 Calcium channel blocker Contraction initiation in cardiac and SMCs is dependent on extracellular Ca influx through L-type Ca channels, which can be prevented by CCBs (eg, verapamil). Skeletal Endocrine, Diabetes & Pharmacology 3
muscle is resistant to CCBs, as Ca release by the SR is triggered by a mechanical interaction b/w L-type and RyR Ca channels. Metabolism (ES) (Phar)
209 Congenital cardiac defects Increased blood oxygen saturation between 2 right-sided vessels or chambers indicates the presence of a left-to-right shunt. If the abnormal oxygen increase occurs Endocrine, Diabetes & Pharmacology 2
between the right atrium and the right ventricle, a ventricular septal defect (VSD) is likely present. Small VSDs produce a holosystolic murmur that is loudest over the Metabolism (ES) (Phar)
lower left sternal border.
548 Asthma An excess of Th2 cell activity relative to Th1 cell activity may underlie the pathogenesis of asthma. In the asthma sensitization phase, inhaled antigens stimulate Th2 cells Endocrine, Diabetes & Pharmacology 12
to secrete IL-4 and IL-13, which together promote B-lymphocyte class switching for IgE synthesis, leading to mast cell priming. Th2 cells also secrete IL-5, which Metabolism (ES) (Phar)
activates eosinophils.
549 Asthma Paroxysmal breathlessness and wheezing in a young pt that're unrelated to ingestion of aspirin, pulm infection, inhalation of irritants, a/o exercise should raise a strong Endocrine, Diabetes & Pharmacology 12
suspicion for atopic (extrinsic) asthma. Classic sputum findings incl eosinophils and Charcot-Leyden crystals. Eosinophils are recruited and activated by IL-5 secreted by Metabolism (ES) (Phar)
Th2 type T cells.
584 Primary immunodeficiency Chronic granulomatous disease is an X-linked disorder resulting from deficiency of NADPH oxidase, the enzyme responsible for formation of reactive oxygen species in Endocrine, Diabetes & Pharmacology 7
disorder phagosomes. Neutrophils affected by this disorder are unable to kill catalase-producing organisms, resulting in recurrent bacterial and fungal infections that frequently Metabolism (ES) (Phar)
involve the lungs, skin, and lymph nodes.
599 Tricyclic antidepressants TCA OD can cause fatal cardiac arrhythmias and refractory hypotension due to inhib of fast Na+ channels in cardiac myocytes. Endocrine, Diabetes & Pharmacology 1
Metabolism (ES) (Phar)
600 Urinary retention TCAs have strong antichol properties. Potential AEs incl confusion, constipation, and urinary retention. These Rx should be used w/ caution in elderly pts. Endocrine, Diabetes & Pharmacology 4
Metabolism (ES) (Phar)
604 Ovarian cancer The pathogenesis of epithelial ovarian ca is linked to the frequency of trauma and repair at the ovarian surface. OCPs, multiparity, and breastfeeding are protective by ↓ Endocrine, Diabetes & Pharmacology 9
the frequency of ovulation. RFx include BRCA mutation, nulliparity, and infertility. Metabolism (ES) (Phar)
606 Kallmann syndrome In KS, there's an absence of GnRH secretory neurons in the hypothal due to defective migration from the olfactory placode. These pts have central hypogonadism and Endocrine, Diabetes & Pharmacology 1
anosmia, and often present w/ delayed puberty. Metabolism (ES) (Phar)
607 Cryptorchidism In undescended testes, the seminiferous tubules atrophy if uncorrected due to higher body temperatures, resulting in decreased fertility and increased risk for malignancy. Endocrine, Diabetes & Pharmacology 2
Orchiopexy (surgical placement of the testes in the scrotal sac) can minimize damage and decrease risk for testicular cancer. Metabolism (ES) (Phar)
622 Down syndrome Pts w/ trisomy 21 (DS) have 3 copies of the amyloid precursor protein gene located on chrom 21. This ↑ amyloid-β accumulation in the brain, placing these pts at high risk Endocrine, Diabetes & Pharmacology 6
for developing early-onset AD. Metabolism (ES) (Phar)
626 Alzheimer disease AD is characterised by ↓ lvls of ACh in the nucleus basalis of Meynert and the hippocampus, caused by ↓ activity of choline acetyltransferase. Endocrine, Diabetes & Pharmacology 7
Metabolism (ES) (Phar)
637 Diabetes mellitus SGLT2 inhibs (e.g. canagliflozin, dapagliflozin) ↓ renal reabsorption of Glc, leading to urinary Glc loss and ↓ BSLs. In pts w/ CKD, these Rx are less effective. Therefore, Endocrine, Diabetes & Pharmacology 31
serum creatinine should be measured prior to therapy. Metabolism (ES) (Phar)
658 Vitamin D deficiency Rickets is char by an excess of un-mineralised osteoid matrix and epiphyseal cartilage due to vitD defic. CFx incl frontal bossing, craniotabes, CCJ deformity ('rachitic Endocrine, Diabetes & Pharmacology 4
rosary'), and bowed legs. Metabolism (ES) (Phar)
712 Urinary tract infection S. saprophyticus is responsible for almost half of all UTIs in sexually active young women. S. saprophyticus belongs to coag (-) staphylococci (CoNS) and is unique Endocrine, Diabetes & Pharmacology 12
among these b/c it's resistant to novobiocin. Metabolism (ES) (Phar)
767 Endocarditis Enterococcus is a component of the normal colonic and urogenital flora and is capable of growing in hypertonic saline and bile. It is γ-hemolytic, catalase (-), and Endocrine, Diabetes & Pharmacology 15
pyrrolidonyl arylamidase (+). GU instrumentation or catheterization has been a/w enterococcal endocarditis. Metabolism (ES) (Phar)
772 Meningitis N. meningitidis can cause sepsis and circulatory collapse in previously healthy young individuals. LOS, a VF in the pathogens outer membrane, is the major underlying Endocrine, Diabetes & Pharmacology 17
cause of disease severity. Metabolism (ES) (Phar)
850 Cystic fibrosis In a young Caucasian pt, the combo of recurrent resp infecs w/ P. aeruginosa, diarrhea, and FTT suggests a Dx of CF. CF causes steatorrhea and FTT due to malabs 2° to Endocrine, Diabetes & Pharmacology 11
PI, which can be corrected by pancr enzyme supp. Metabolism (ES) (Phar)
920 Chronic venous Chronically ↑ venous pressure in the ↓ extremities can lead to incompetent venous valves and venous dilation (varicose veins). Venous congestion and tissue ischemia can Endocrine, Diabetes & Pharmacology 3
insufficiency result in venous stasis dermatitis. Metabolism (ES) (Phar)
1213 Keratin as a marker Keratin is a marker of epithelial cell origin. Endocrine, Diabetes & Pharmacology 1
Metabolism (ES) (Phar)
1324 Predictive values Various parameters are used to evaluate the accuracy and usefulness of Dx tests. PPVs and NPVs are influenced by disease prevalence in the target population; sensitivity, Endocrine, Diabetes & Pharmacology 3
specificity, and likelihood ratios are not prevalence-dependent. Metabolism (ES) (Phar)
1492 Defense mechanisms Projection is an immature defence mech involving the misattribution of 1's unacceptable feelings or thoughts to another person who doesn't actually have them. Endocrine, Diabetes & Pharmacology 8
Metabolism (ES) (Phar)
1655 Pulmonary arterial The pulm vasc bed is unique in that tissue hypoxia results in a vasocon response. Such hypoxic vasocon occurs in the small muscular pulm arteries to divert blood flow Endocrine, Diabetes & Pharmacology 8
hypertension away from undervent lung regions and toward well-vent lung areas to mini V/Q mismatch, leading to more efficient overall gas exchange. Metabolism (ES) (Phar)
1673 Gastrectomy IF is a gp that's normally secreted by parietal cells in the stomach and is necessary for the absorption of vitB12 in the ileum. Pts who have undergone a total gastrectomy Endocrine, Diabetes & Pharmacology 1
req lifelong vitB12 supplementation due to inability to produce IF. Metabolism (ES) (Phar)
1945 Ischemic hepatitis Organ susceptibility to infarction after occlusion of a feeding artery is ranked from greatest to least as follows: CNS, myocardium, kidney, spleen, and liver. The presence Endocrine, Diabetes & Pharmacology 1
of a dual a/o collateral blood supply (as seen in the liver, which is supplied by the hepatic artery and portal vein) enables an organ to tolerate arterial occlusion better than Metabolism (ES) (Phar)
those w/ end-arterial circulations.
1984 Community acquired The green discolouration of pus or sputum seen during common bacterial infections is due to the presence of MPO, a blue-green hem-based enzyme that’s released from Endocrine, Diabetes & Pharmacology 21
pneumonia neutrophil azurophilic granules and forms HOCl (bleach). Metabolism (ES) (Phar)
11565 Diuretics and electrolyte TZD and loopDs cause significant volume depletion, activating the RAAS, which can lead to hypokalemia and meta alk. TZDs are more likely to cause hyponatremia and Endocrine, Diabetes & Pharmacology 1
imbalance hypercalcemia; loop diuretics cause hypocalcemia. Metabolism (ES) (Phar)
11634 Penetrating abdominal Occlusion of the portal triad can be used to distinguish the source of RUQ bleeding. If the bleeding subsides following occlusion, the source is likely to be the hepatic Endocrine, Diabetes & Pharmacology 1
trauma artery or portal vein. If hepatic bleeding persists after occlusion, the IVC or hepatic veins are likely to be injured. Metabolism (ES) (Phar)
11657 Primary hypertension Health promotion, according to the WHO, is "the process of enabling people to ↑ control over their health and its determinants, and thereby improve their health." Endocrine, Diabetes & Pharmacology 14
Metabolism (ES) (Phar)
11664 Urinary incontinence Patients with multiple sclerosis often develop a spastic bladder a few weeks after developing an acute lesion of the spinal cord. These patients present clinically with Endocrine, Diabetes & Pharmacology 7
increased urinary frequency and urge incontinence. Urodynamic studies show the presence of bladder hypertonia. Metabolism (ES) (Phar)
14136 Mitochondrial disorders Mitochondrial dysfxn freq Px w/ myopathy, NS dysfxn, lactic acidosis, and ragged red fibers on muscle Bx. Mitochondrial myopathies due to mtDNA muts are inherited Endocrine, Diabetes & Pharmacology 4
solely in a maternal fashion (i.e. maternal inheritence). Therefore, transmission occurs only thru affected females and never thru males. Metabolism (ES) (Phar)
14919 Immunotherapy The binding of PD-1 to 1 of its ligands (PD-L1) downregs the immune response by inhib Tc cells. Many types of ca evade immunodetection by incr. expression of PD-L1 Endocrine, Diabetes & Pharmacology 2
on their surface. mAbs against PD-1 upreg the T cell response and promote tumor cell apoptosis. Metabolism (ES) (Phar)
14952 Spinal stenosis Spinal stenosis occurs most commonly in the lumbar region and presents w/ posture-dependent lower extremity pain, numbness/paraesthesia, and weakness. The most Endocrine, Diabetes & Pharmacology 1
common cause is degen arthritis of the spine, which results in narrowing of the spinal canal due to intervertebral disc herniation, ligamentum flavum hypertrophy, and Metabolism (ES) (Phar)
osteophyte formation affecting the facet joints.
15303 Histoplasmosis Histoplasma capsulatum replicates w/i macrophages and often spreads from the lungs thru the pulm lymphatics to the RES (e.g. spleen, liver). Most healthy individuals Endocrine, Diabetes & Pharmacology 4
quickly contain the infection w/i granulomas and don't become ill; a minority develop self-limited pneumonia. Over time, the granulomas at the initial sites of infection Metabolism (ES) (Phar)
calcify and may be seen incidentally on radiographic imaging.
15770 Arbovirus Arboviruses, small RNA viruses transmitted by biting arthropods, are the most common cause of encephalitis outbreaks in the US. B/c no vax are currently available, Endocrine, Diabetes & Pharmacology 1
prevention 1arily involves eliminating the vector arthropods (e.g. infected mosquitoes). Metabolism (ES) (Phar)
15876 Hypertrophic HCM typically involves interventricular septal hypertrophy that obstructs LV outflow and creates a systolic murmur that ↓ in intensity w/ maneuvers that ↑ LV blood Endocrine, Diabetes & Pharmacology 9
cardiomyopathy volume (eg, hand grip, passive leg elevation). HCM is Chx by ↑ LV muscle mass w/ a small LV cavity, preserved EF, and impaired LV relaxation leading to diastolic Metabolism (ES) (Phar)
dysfxn.
15881 Gonococcal infection N. gonorrhoeae is spread sexually by GU secretions and can be prevented by the consistent use of condoms. GUIs are often aSSx, which ↑ the risk of spread thru the Endocrine, Diabetes & Pharmacology 3
bloodstream, leading to disseminated gonococcal infection. Pts w/ disseminated disease typically present w/ the triad of polyarthralgia, tenosynovitis, and dermatitis or Metabolism (ES) (Phar)
purulent arthritis.
16324 Ehrlichiosis and Ehrlichia chaffeensis is harbored in white-tailed deer and transmitted to humans by tick bite. It replicates in vacuoles w/i monocytes and forms mulberry-shaped, Endocrine, Diabetes & Pharmacology 1
anaplasmosis intraleukocytic inclusions (morulae). MFx usually include nonspecific SSx (eg, fever, chills, myalgia), maculopapular rash, and significant laboratory abnormalities, Metabolism (ES) (Phar)
particularly lymphopenia.
216 Marfan syndrome CV lesions are the most life-threatening complications a/w MFS. Early-onset CMD of the aorta predisposes to AD, the most common COD in these pts. Endocrine, Diabetes & Physiology 2
Metabolism (ES) (Phys)
217 Myocardial infarction Rupture of the LV free wall is a catastrophic mechanical complication of anterior wall MI that usually occurs w/i the 1st 5-14 days after MI. Rupture leads to Endocrine, Diabetes & Physiology 18
hemopericardium and CT, causing profound hypotension and shock w/ rapid progression to PEA and death. Metabolism (ES) (Phys)
641 Hypopituitarism Suppression of the HPA axis by GC therapy is the most common cause of AI. In these pts, adrenal crisis can be precipitated by stressful situations (e.g. infections, Sx) if Endocrine, Diabetes & Physiology 2
the GC dose isn't ↑ appropriately. Metabolism (ES) (Phys)
QID Topic Educational Objective System Subject Repeats
770 Bacterial gene transfer S. pneumoniae is able to undergo transformation, which allows the bacterium to take up exogenous DNA fragments and express the encoded proteins. Thru this method, Endocrine, Diabetes & Physiology 1
strains of S. pneumoniae that don't form a capsule can acq the genes that code for the capsule and therefore gain virulence. Metabolism (ES) (Phys)
821 Drug induced liver injury Common AEs of HMG-CoA reductase inhibs (statins) include muscle and liver tox. Hepatic transaminases should be checked prior to initiating therapy and repeated if Endocrine, Diabetes & Physiology 2
SSx of hepatic injury occur. Metabolism (ES) (Phys)
954 Renal cell carcinoma CCC is the most common type of RCC and originates from the epithelial cells of the proximal renal tubules. Gross pathology typically demonstrates a sphere-like mass Endocrine, Diabetes & Physiology 8
composed of golden-yellow cells (due to high lipid content) w/ areas of necrotic cells and focal hemorrhage. Metabolism (ES) (Phys)
983 Acanthosis nigricans AN presents w/ thickening and hyperpigmentation of skin in the flexural areas. The lesions have a classic 'velvety' texture. AN is commonly a/w insulin-resistant states (e. Endocrine, Diabetes & Physiology 1
g. DM, acromegaly, obesity) and GI malignancies. Metabolism (ES) (Phys)
990 Mitral regurgitation Pts w/ severe MR develop left-sided volume overload w/ an S3 gallop due to the large volume of regurgitant flow re-entering the ventricle during mid-diastole. The Endocrine, Diabetes & Physiology 6
absence of an S3 gallop excludes severe chronic MR. Metabolism (ES) (Phys)
991 Mitral regurgitation LV systole corresponds to the time of passive filling of the LA (atrial diastole). MR leads to markedly ↑ LA pressure during this period, creating the char early and large V Endocrine, Diabetes & Physiology 6
wave on LA pressure tracing. Metabolism (ES) (Phys)
992 Mitral valve prolapse MVP is most often caused by defects in connective tissue proteins that predispose to myxomatous degen of the mitral leaflets and chordae tendineae. Cardiac auscultation Endocrine, Diabetes & Physiology 1
typically reveals a MC f/b a MR murmur; the click and murmur occur later in systole or disappear completely w/ manoeuvres (e.g. squatting) that ↑ LV EDV. Metabolism (ES) (Phys)
1009 Septic arthritis H. influenzae is a gram (-) coccobacillus that req both X factor (hematin) and V factor (NAD+) to grow. Hib has an antiphagocytic PSC, which allows it to spread Endocrine, Diabetes & Physiology 4
hematogenously and cause invasive disease such as septic arthritis and meningitis. Metabolism (ES) (Phys)
1065 GFR Selective vasoconstriction of the efferent arteriole (up to certain extent) ↑ hydrostatic pressure in the glom caps, and therefore ↑ the GFR. As efferent arteriolar Endocrine, Diabetes & Physiology 6
constriction continues to ↑, the GFR begins to ↓ due to a flow-mediated rise in oncotic pressure in the glom caps. The FF always ↑ w/ ↑ efferent arteriole constriction. Metabolism (ES) (Phys)
1325 Power and sample size Power (1 - β) is the probability of rejecting a null hypothesis when it is truly false. It is typically set at 80% and depends on sample size and difference b/w outcomes. Endocrine, Diabetes & Physiology 3
Metabolism (ES) (Phys)
1355 Hemolytic uremic Schistocytes suggest MAHA (eg, HUS, TTP), DIC or mechanical damage (eg, prosthetic valve). In childhood, HUS is often preceded by bloody diarrhea. Coagulation Endocrine, Diabetes & Physiology 3
syndrome studies (PT and PTT) are normal in HUS-TTP but abnormal in DIC. Metabolism (ES) (Phys)
1540 Escherichia coli During bacterial DNA replication, DNA polymerase I functions to remove RNA primers (via 5' to 3' exonuclease activity) and replace them with DNA (via 5' to 3' Endocrine, Diabetes & Physiology 1
polymerase activity). DNA polymerase I is the only bacterial DNA polymerase that possesses 5' to 3' exonuclease activity. Metabolism (ES) (Phys)
1562 Sickle cell In patients with sickle cell anemia and other chronic hemolytic disorders, the most common viral cause of an aplastic crisis is infection of erythroid progenitor cells with Endocrine, Diabetes & Physiology 13
parvovirus B19, a nonenveloped single-stranded DNA virus. Metabolism (ES) (Phys)
1615 Chronic pancreatitis Diarrhoea, weight loss, and epigastric calcifications in a pt w/ chronic alcoholism suggest chronic pancreatitis w/ resulting pancreatic exocrine insufficiency and Endocrine, Diabetes & Physiology 3
malabsorption. Metabolism (ES) (Phys)
1768 Orbital fracture Blunt trauma to the globe can cause orbital blowout fractures. These fractures most commonly involve the medial or inferior orbital walls due to the thin bone bordering Endocrine, Diabetes & Physiology 2
the ethmoid and maxillary sinuses. Metabolism (ES) (Phys)
6803 Psychosis Schizophreniform disorder is characterised by psychotic SSx (delusions, hallucinations, disorganised speech and behaviour, (-) SSx) lasting >1mos and <6mos. Endocrine, Diabetes & Physiology 6
Metabolism (ES) (Phys)
11660 Leukocytosis LR is a benign leucocytosis (>50k/mm3) that occurs in response to an underlying condition such as severe infection/hemorrhage, malignancy (e.g. leukaemia), or acute Endocrine, Diabetes & Physiology 1
hemolysis. LAP lvls are normal or ↑. peri smear can show ↑ bands, early mature neutrophil precursors (e.g. myelocytes), and granules (e.g. Dohle bodies) in the Metabolism (ES) (Phys)
neutrophils.
14988 Seizures Seizures can be classified as focal (partial) if they originate from a localized region of one cerebral hemisphere or generalized if they involve both hemispheres at onset. Endocrine, Diabetes & Physiology 8
The MFx of focal seizure depend on the brain region in which seizure activity is occurring. Focal seizure can be subclassified as simple if consciousness is preserved or Metabolism (ES) (Phys)
complex if there is LOC.
15308 Bartonella Bacillary angiomatosis is 1arily seen in pts w/ advanced AIDS. It's caused by the gram (-) bacterium B. henselae, which is typically transmitted by a cat scratch. Pts Endocrine, Diabetes & Physiology 2
usually develop highly vascular, violaceous, cutaneous lesions over wks or mos. Histo of the lesions reveals large endothelial cells forming small vascular channels w/ a Metabolism (ES) (Phys)
surrounding inflammatory infiltrate.
1056 Cervicitis Neisseria gonorrhoeae and Chlamydia trachomatis cause mucopurulent cervicitis, which can progress to PID if unTx. PID can cause scarring of the fallopian tubes, Female Reproductive & Anatomy (Anat) 1
leading to ectopic pregnancy and infertility. Breast (FR)
1632 Respiratory physiology Min vent is equal to the product of TV and RR and incl dead space vent. Alv vent is equal to the product of RR and the diff b/w TV and dead space volume. Female Reproductive & Anatomy (Anat) 8
Breast (FR)
1739 Rubella In a susceptible child, a febrile maculopapular rash that begins on the face and spreads to the trunk and extremities is suggestive of rubeola (measles) or rubella (German Female Reproductive & Anatomy (Anat) 3
measles). The additional finding of postauricular lymphadenopathy indicates that rubella is the most likely etiology. Breast (FR)
8390 Turner syndrome Common MFx of TS include 1° amenorrhea, short stature, a high arched palate, and widely spaced nipples. 1° amenorrhea occurs in these pts due to in utero degeneration Female Reproductive & Anatomy (Anat) 8
of the ovarian follicles (gonadal dysgenesis). Breast (FR)
11781 Costochondritis Costosternal syndrome (costochondritis) usually occurs after repetitive activity and is characterised by pain that is reproducible w/ palpation and worsened w/ movement Female Reproductive & Anatomy (Anat) 1
or changes in position. Breast (FR)
11820 Sciatic neuropathy The piriformis passes through the greater sciatic foramen and is involved w/ external hip rotation. Muscle injury or hypertrophy can compress the sciatic nerve in the Female Reproductive & Anatomy (Anat) 2
foramen, causing piriformis syndrome. Breast (FR)
11823 Sinoatrial node The SA node consists of specialized PM cells located at the jxn of the RA and SVC. It is the site of earliest electrical activation in pts w/ sinus rhythm. Female Reproductive & Anatomy (Anat) 1
Breast (FR)
11885 Rotator cuff The RC muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) all insert onto the humeral head, allowing them to stabilise the shoulder joint and move the Female Reproductive & Anatomy (Anat) 3
arm at the shoulder. An infraspinatus injury would result in shoulder pain and weak, painful ext. rotation of the arm against resistance. Breast (FR)
11901 Appendicitis The teniae coli are 3 separate smooth muscle ribbons that travel longitudinally on the outside of the colon and converge at the root of the vermiform appendix. If the Female Reproductive & Anatomy (Anat) 5
appendix cannot be identified by palpation during an appendectomy, it can be located by following the teniae coli to their origin at the cecal base. Breast (FR)
11908 Attention deficit Stim Rx are a 1st-line Tx for ADHD. They work by ↑ the availability of NE and DA in the prefrontal cortex. Female Reproductive & Anatomy (Anat) 5
hyperactivity disorder Breast (FR)
11920 Rett syndrome Rett syndrome is characterised by loss of speech and motor skill, deceleration of head growth, and stereotypically purposeless hand movements after a period of normal Female Reproductive & Anatomy (Anat) 1
devel. It affects mainly girls and is a/w muts in the MECP2 gene. Breast (FR)
12512 Intraductal papilloma Intraductal papilloma is a proliferation of papillary cells in a cyst wall or duct that may contain focal atypia. It is the most common cause of bloody nipple discharge and Female Reproductive & Anatomy (Anat) 1
typically presents without breast masses or skin changes. Breast (FR)
1809 Chronic pancreatitis Chronic pancreatitis often presents w/ epigastric pain and pancreatic exocrine insufficiency resulting in fat malabsorption/steatorrhoea. On abdo CT scan, the pancreas can Female Reproductive & Embryology 3
be ID'd by its head in close a/w the 2nd part of the duodenum; its body overlying the aorta, left kidney, and renal vessels; and its tail lying w/i the splenorenal ligament. Breast (FR) (Embr)
1831 Infectious mononucleosis EBV causes IM in teens and young adults. It's also a/w a # of malignant conditions, incl Burkitt lymphoma and NPC. Female Reproductive & Embryology 5
Breast (FR) (Embr)
256 Mitral stenosis Rheumatic MS is characterised by diffuse fibrous thickening and distortion of the MV leaflets along w/ commissural fusion at the leaflet edges. Pts often present w/ a Female Reproductive & Genetics (Gene) 7
diastolic murmur, dyspnoea, and fatigue and are at ↑ risk of AF and TE (e.g. stroke). Breast (FR)
339 Oncogenes and tumor p53 is a TSG that controls cell division and apoptosis. It's inactivated in many tumours. Female Reproductive & Genetics (Gene) 1
suppressor genes Breast (FR)
1810 Anesthesia A pudendal nerve block is performed by injecting an anesthetic intravaginally, medial to the ischial spine, through the sacrospinous ligament. This provides anesthesia to Female Reproductive & Genetics (Gene) 9
most of the perineum. Breast (FR)
1830 Apoptosis Apoptosis can occur through either the intrinsic (mitochondria-mediated) pathway or the extrinsic (receptor-initiated) pathway. Both pathways converge in the activation Female Reproductive & Genetics (Gene) 4
of caspases. Caspases are proteolytic enzymes that cleave cellular proteins. Breast (FR)
7489 Constrictive pericarditis Calcification and thickening of the pericardium are common features of constrictive pericarditis on CT. CFx include slowly progressive dyspnea, peripheral edema, and Female Reproductive & Genetics (Gene) 2
ascites. Breast (FR)
12225 Radial neuropathy Supracondylar humeral fractures commonly occur after hyperextension of the elbow as a result of a FOOSH. The radial nerve runs along the anterolateral aspect of the Female Reproductive & Genetics (Gene) 3
elbow and is the structure most likely to be injured w/ anterolateral displacement of the prox. fracture fragment. The brachial artery runs w/ the median nerve on the Breast (FR)
anteromedial aspect of the elbow and will usually be spared in these pts (e.g. intact radial pulse).
12298 Normal child development Although children understand the concept of gender by age 4, it's normal for them to explore activities culturally a/w the opposite gender. In contrast, gender dysphoria is Female Reproductive & Genetics (Gene) 2
Dx when there's marked distress a/w a prolonged and intense feeling that 1 is a diff gender from 1's birth sex. Breast (FR)
1957 Community acquired On posteroanterior chest x-ray, the right middle lobe is seen adjacent to the right border of the heart, which is primarily formed by the right atrium. Consolidation in the Female Reproductive & Histology (Hist) 21
pneumonia right middle lobe can obscure the X-ray silhouette of the right heart border. Breast (FR)
11888 Anesthesia A femoral nerve block at the inguinal crease will anesthetize the skin and muscles of the anterior thigh (eg, quadriceps), femur, and knee. Female Reproductive & Histology (Hist) 9
Breast (FR)
11890 Thoracic outlet syndrome Thoracic outlet syndrome (TOS) is most often caused by compression of the brachial plexus as it passes through the scalene triangle, the space bordered by the anterior Female Reproductive & Histology (Hist) 1
and middle scalene muscles and the first rib. Symptoms typically include upper extremity numbness, tingling, and weakness that worsen with repetitive overhead arm Breast (FR)
movements. The presence of an anomalous cervical rib is a risk factor for TOS.
110 Febrile neutropenia Candida albicans is the most common cause of opportunistic mycosis. It can affect any organ and cause gen candidaemia. Yeasts and pseudohyphae on LM and a (+) germ Female Reproductive & Microbiology 4
tube test are Dx of Candida albicans infection. Breast (FR) (Micr)
1008 Haemophilus influenzae Haemophilus influenzae is a "blood-loving" organism that requires X (hematin) and V (NAD+) factors for growth. This can be accomplished by growing H influenzae in Female Reproductive & Microbiology 2
the presence of Staphylococcus aureus and demonstrating the "satellite phenomenon," whereby H influenzae grow only near the β-hemolytic S aureus colonies that Breast (FR) (Micr)
produce the needed X and V factors.
1549 Transamination Transamination reactions typically occur between an amino acid and an a-keto acid. The amino group from the amino acid is transferred to the a-keto acid, and the a-keto Female Reproductive & Microbiology 1
acid in turn becomes an amino acid. Pyridoxal phosphate (active vitamin B ) serves as a cofactor in amino acid transamination and decarboxylation reactions. Breast (FR) (Micr)
1929 Aging Photoaging is a product of excess exposure to ultraviolet A wavelengths and is characterized by epidermal atrophy with flattening of rete ridges. In addition, there is Female Reproductive & Microbiology 8
decreased collagen fibril production and increased degradation of collagen and elastin in the dermis. Breast (FR) (Micr)
1932 Hepatitis A Acute hepatitis due to most hepatotropic viruses causes hepatocyte ballooning degen and apoptosis w/ mononuclear cell infiltrations. Female Reproductive & Microbiology 4
Breast (FR) (Micr)
QID Topic
11765 Thrombotic
thrombocytopenic purpura
11802 Ubiquitin proteasome
pathway
11961 Language disorder
127 Intestinal phase
333 Meniere disease
1015 Tetanus
1057 Hypoglycemia
1109 Ductal carcinoma in situ
1158 Fibroadenoma breast
1837 Breast cancer
1917 Folic acid deficiency
1928 Extramedullary
hematopoiesis
1992 Peptic ulcer disease
2056 Chronic heart failure
11652 Urinary incontinence
11858 Superficial inguinal ring
11929 Ankle trauma
578 Dose response curves
869 Hemangioma
1027 Vitamin D deficiency
2094 Etoposide
2095 Antiretroviral therapy
11926 Wolff-Parkinson-White
syndrome
581 Lung cancer
583 Hypersensitivity reactions
879 Retroperitoneal hematoma
1447 Respiratory physiology
207 Chronic heart failure
208 Diastolic dysfunction
215 Myocardial infarction
258 Mitral stenosis
299 Adverse drug reaction
1317 Neuroblastoma
1560 Respiratory physiology
1899 Brachial plexus
1986 Urethritis
129 Hypertrophic pyloric
stenosis
291 Histoplasmosis
292 Histoplasmosis
303 Zenker diverticulum
417 Hemochromatosis
418 Copper excretion
838 Sarcoidosis
1525 Heme metabolism
1537 Viral genetics
1706 Falls
Educational Objective System Subject Repeats
TTP results from impaired fxn of the vWF-cleaving protease ADAMTS13, resulting in uncleaved vWF multimers that are significantly more prothrombotic and cause Female Reproductive & Microbiology 3
diffuse microvascular thrombosis, MAHA, and thrombocytopenia. Breast (FR) (Micr)
An essential step in the activation of the cellular immune response to a virus is the breakdown of intracellular viral proteins by the ubiquitin proteasome pathway. This Female Reproductive & Microbiology 2
pathway is initiated by ubiquitin ligases, which recognize specific protein substrates and attach a ubiquitin tag. The target proteins are then degraded by a proteasome into Breast (FR) (Micr)
peptide fragments, which are coupled with major histocompatibility complex class proteins and presented on the cell surface for surveillance by cytotoxic CD8+
lymphocytes.
At age 2, children should have a vocab of 50-200 words and be using 2-word phrases. Parents' concerns about delayed milestones should be validated; they should be Female Reproductive & Microbiology 1
reassured that children often catch up but may need help. Further eval and regular monitoring are req. Breast (FR) (Micr)
The cephalic and gastric phases stim gastric acid secr, while intestinal influences tend to ↓ gastric acid secr. Female Reproductive & Pathology (Path) 1
Breast (FR)
Ménière disease is Chx by tinnitus, vertigo, and sensorineural hearing loss. Its pathogenesis is related to an ↑ volume and pressure of endolymph in the vestibular Female Reproductive & Pathology (Path) 1
apparatus. Breast (FR)
Tet is a CDx that should be suspected in pts who have Chx SSx (e.g. lockjaw, muscle pain/spasms, difficulty swallowing), particularly if they are unlikely to be Female Reproductive & Pathology (Path) 5
adequately vax or have an antecedent cutaneous injury. Breast (FR)
Ox meta of Glc in pancreatic β cells generates ATP. ATP-induced closure of the ATP-sens K channels leads to membrane depol and subseq insulin release. Female Reproductive & Pathology (Path) 6
Breast (FR)
Ductal carcinoma in situ is characterized by ducts distended by pleomorphic cells with prominent central necrosis that do not penetrate the basement membrane. It is the Female Reproductive & Pathology (Path) 1
precursor to invasive ductal carcinoma, the most common type of breast cancer. Breast (FR)
Fibroadenomas are the most common benign tumor of the breast. They are characterized histologically by a cellular or myxoid stroma that encircles and sometimes Female Reproductive & Pathology (Path) 1
compresses epithelium lined glandular and cystic spaces. Breast (FR)
ER or PR (+) in breast ca indicates expected sensitivity to tamoxifen and aromatase inhibitor Tx. HER2 overexpression in breast ca suggests a more aggressive tumor that Female Reproductive & Pathology (Path) 7
typically responds to Thx w/ the anti-HER2 mAb trastuzumab. Breast (FR)
Vit B9 inhibs the synth of NAs, particularly the formation of dTMP. This leads to defective DNA synth that char causes incr. apoptosis of HPO cells and megaloblastic Female Reproductive & Pathology (Path) 1
anemia. Thymidine supplementation bypasses the enzyme and can decr. erythroid cell apoptosis. Breast (FR)
The presence of erythroid precursors in organs such as the liver and spleen is indicative of EMH, a condition characterised by EPO-stim, hyperplastic marrow cell Female Reproductive & Pathology (Path) 1
invasion of EM organs. EMH is most freq caused by severe chronic hemolytic anaemias, such as β-thalassaemia. Breast (FR)
Acute Helicobacter pylori infection initially causes nonatrophic antral gastritis and an ↑ risk for duodenal ulcers. Chronic infection results in patchy, multifocal, atrophic Female Reproductive & Pathology (Path) 10
gastritis w/ loss of parietal cells and G cells in the gastric body; this is a/w ↓ acid secretion and an ↑ risk of gastric ulcers, GAC, and MALT lymphoma. Breast (FR)
Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are secreted by atrial and ventricular cardiomyocytes in response to myocardial stretching induced by Female Reproductive & Pathology (Path) 12
hypervolemia. These natriuretic peptides inhibit the renin-angiotensin-aldosterone system and stimulate peripheral vasodilation and increased urinary excretion of sodium Breast (FR)
and water. Neprilysin inhibitors (eg. sacubitril) prevent the degradation of ANP and BNP, enhancing their beneficial effects in heart failure.
Diabetic autonomic neuropathy is common in type 1 diabetics and can cause overflow incontinence due to inability to sense a full bladder and incomplete emptying. PVR Female Reproductive & Pathology (Path) 7
testing w/ US or catheterization can confirm inadequate bladder emptying. Breast (FR)
The superficial and deep inguinal rings are physiologic openings in the external abdominal oblique aponeurosis and the transversalis fascia, respectively. Surgical repair of Female Reproductive & Pathology (Path) 1
an undescended testicle lodged in the inguinal canal involves reducing the testis through the superficial inguinal ring and fixing it in the scrotum (orchiopexy). Breast (FR)
Lat. ankle sprain is due to inversion of a plantar-flexed foot and most commonly involves the ant. talofibular ligament. Stronger forces can cause joint instability by Female Reproductive & Pathology (Path) 1
injuring addnal ligaments. Breast (FR)
Cortisol exerts a permissive effect on many hormones to help improve the response to a variety of stressors. For example, cortisol increases vascular and bronchial smooth Female Reproductive & Pathophysiology 4
muscle reactivity to catecholamines and increases glucose release by the liver in response to glucagon. Breast (FR) (Patp)
Superficial infantile hemangiomas (i.e. strawberry/cap hemangiomas) are benign vascular tumours of childhood. They appear during the 1st wks of life, initially grow Female Reproductive & Pathophysiology 6
rapidly, and typically regress by the time the child is 5-9yrs old. These tumours are composed of blood-filled caps separated by CT. Breast (FR) (Patp)
Malabsorption caused by coeliac disease can lead to vitD defic. Pts have ↓ serum P, ↑ serum PTH (2° HPT), and low (or normal) serum Ca2+. Female Reproductive & Pathophysiology 4
Breast (FR) (Patp)
Etoposide is a CTx agent that inhibs the sealing activity of topoisomerase II. Tx w/ etoposide causes chrom breaks to accumulate in dividing cells, ultimately causing cell Female Reproductive & Pathophysiology 1
death. Breast (FR) (Patp)
ZDT is an NRTI used to prevent maternal to foetal transmission of HIV during labour (when the mother isn't virally suppressed). It's a thymidine analogue that doesn't Female Reproductive & Pathophysiology 7
have the normal 3'-OH group found on thymidine. B/c new nucleotides are added to growing DNA chains only at the 3'-OH group, the addn of ZDT into DNA results in Breast (FR) (Patp)
chain termination.
WPW pattern is characterised by a shortened PR interval, widening of the QRS complex, and slurred initial upstroke of the QRS complex (δ wave). It's caused by an Female Reproductive & Pathophysiology 2
accessory pathway that bypasses the AV node, causing preexcitation of the ventricles. Pts w/ WPW pattern can develop SSx arrhythmia (e.g. AV re-entrant tachycardia) Breast (FR) (Patp)
due to re-entry of electrical impulses thru the accessory conduction pathway.
Adenocarcinoma is the most common 1° lung ca in the gen pop, women, and non-smokers. EGFR muts and ALK gene rearrangements are seen more commonly in non- Female Reproductive & Pharmacology 9
smokers and thought to contribute to disease formation in this subgroup. Adenocarcinoma is typically located perily and may be a/w clubbing or hypertrophic Breast (FR) (Phar)
osteoarthropathy (HOA).
Wheal-and-flare lesions usually result from allergic (type 1 hypersensitivity) reactions. On initial exposure, an allergen (eg, insect venom) promotes antibody class Female Reproductive & Pharmacology 4
switching to IgE. Subsequent exposure promotes cross-linking of IgE on basophils and mast cells, resulting in degranulation and release of multiple vasoactive mediators, Breast (FR) (Phar)
including histamine.
Retroperitoneal hematoma is a common complication of abdo and pelvic trauma. The pancreas is a retroperitoneal organ, and pancreatic injury is freq a source of Female Reproductive & Pharmacology 1
retroperitoneal bleeding. Breast (FR) (Phar)
The binding of O2 to hemoglobin increases the affinity for binding of subsequent O2 molecules (cooperative binding). In the lungs, the binding of O2 to hemoglobin Female Reproductive & Pharmacology 8
drives the release of H+ and CO2 from hemoglobin (Haldane effect). In the peripheral tissues, high concentrations of CO2 and H+ facilitate O2 unloading from Breast (FR) (Phar)
hemoglobin (Bohr effect).
Alveolar hemosiderin-laden macrophages indicate alveolar hemorrhage. They most commonly result from chronic ↑ of pulm capillary hydrostatic pressure in the setting Female Reproductive & Physiology 12
of left-sided HF. Breast (FR) (Phys)
HF w/ preserved EF is Chx by diastolic dysfunctlon, which frequently occurs in the setting of prolonged systemic HTN due to concentric LVH. Pts w/ longstanding HTN Female Reproductive & Physiology 4
have ↑ SVR. Breast (FR) (Phys)
LV free-wall rupture is an uncommon but devastating mech complication of transmural MI that occurs w/i 5 days or up to 2wks following the event. Rupture leads to Female Reproductive & Physiology 18
cardiac tamponade that causes hypotension and shock w/ rapid progr to cardiac arrest. Autopsy typically reveals a slit-like tear at the site of infarction in the LV wall. Breast (FR) (Phys)
Isolated MS causes ↑ upstream pressures in the LA and pulm veins and arteries. LV EDP is normal or ↓ due to obstr of blood flow thru the stenotic valve. An ↑ LV EDP Female Reproductive & Physiology 7
suggests addnal downstream pathology (e.g. AV disease, LV failure). Breast (FR) (Phys)
Hypokalaemia and hypomagnesaemia are common electrolyte disturbances in pts undergoing Tx w/ amphotericin B and reflect an ↑ in DCT membrane permeability. Female Reproductive & Physiology 2
Breast (FR) (Phys)
Opsoclonus-myoclonus is a PNP syndrome a/w neuroblastoma, the most common extracranial solid neoplasm in children. The tumour typically arises from the neural Female Reproductive & Physiology 1
crest cells of the adrenal medulla and presents w/ an abdo mass and ↑ catecholamine breakdown products. Breast (FR) (Phys)
Panic atks are typically accomp by hypervent, leading to hypocapnia. CBF is directly related to PaCO2; therefore, hypocapnia can lead to decr CBF and SSx of cerebral Female Reproductive & Physiology 8
hypoperfusion (e.g. blurred vision, dizziness, lightheadedness). Breast (FR) (Phys)
The lower trunk of the brachial plexus carries nerve fibers from the C8 and T1 spinal levels that are responsible for innervating all of the intrinsic muscles of the hand (via Female Reproductive & Physiology 6
the median and ulnar nerves). Sudden upward stretching on the arm at the shoulder can damage the lower trunk, resulting in finger clumsiness w/ total claw hand Breast (FR) (Phys)
deformity.
Neisseria can be isolated by culture on selective media such as the Thayer-Martin VCN (vancomycin/colistin/nystatin) medium, which inhibs growth of contaminants Female Reproductive & Physiology 4
such as gram (+) organisms, gram (-) organisms other than Neisseria, and fungi. Breast (FR) (Phys)
Congenital pyloric stenosis arises 2° to hypertrophy of the pyloric muscularis mucosae. Gastrointestinal & Anatomy (Anat) 1
Nutrition (GI)
H. capsulatum is endemic to the Ohio and Mississippi River valleys and is found 1arily in soil contaminated w/ bird or bat droppings. It exists in tissues as an ovoid/round Gastrointestinal & Anatomy (Anat) 4
yeast predominantly w/i the intracellular space of macrophages. Immcom pts are often aSSx but can infreq develop subacute pneumonia w/ hilar and mediastinal LAD. Nutrition (GI)
H. capsulatum is a dimorphic fungus that exists as a small, ovoid yeast at tissue temps. It replicates w/i macrophages and spreads thru the lymphatic and RES. Immcom Gastrointestinal & Anatomy (Anat) 4
pts usually have an aSSx pulm infection, but those who are immsup (e.g. advanced AIDS) can develop disseminated disease to the liver, spleen, and bone marrow. Nutrition (GI)
Diminished relaxation of cricopharyngeal muscles during swallowing results in ↑ intraluminal pressure in the oropharynx. This may eventually cause the mucosa to Gastrointestinal & Anatomy (Anat) 1
herniate thru a zone of muscle weakness in the post. hypopharynx, forming a Zenker (false) diverticulum, which presents in elderly pts w/ oropharyngeal dysphagia, Nutrition (GI)
halitosis, regurg, and recurrent aspiration.
HFE protein mutations are the most common cause of 1° hemochromatosis. Inactivation of the HFE protein results in ↓ hepcidin synthesis by hepatocytes and ↑ DMT1 Gastrointestinal & Anatomy (Anat) 4
expression by enterocytes, leading to Fe overload. Pts w/ hemochromatosis are at an ↑ risk for liver cirrhosis and HCC. Nutrition (GI)
Absorbed Cu is used to form ceruloplasmin, which accounts for 90-95% of circulating Cu. Senescent ceruloplasmin and the unabsorbed Cu are secreted into bile and Gastrointestinal & Anatomy (Anat) 1
excreted in stool, which is the 1° route for Cu elimination. Nutrition (GI)
Sarcoidosis is characterized by noncaseating granulomas due to dysregulated cell-mediated immunity. Activated antigen-presenting cells produce IL-12, which stimulates Gastrointestinal & Anatomy (Anat) 7
the differentiation of Th1-type CD4+ cells. Th1 cells produce IL-2 and interferon-y, which stimulate Th1 cell proliferation and macrophage activation, respectively. Nutrition (GI)
Heme oxygenase concerts heme to biliverdin, a pigment that causes the greenish color to develop in bruises several days after an injury. Gastrointestinal & Anatomy (Anat) 2
Nutrition (GI)
Viruses with segmented genomes (eg, orthomyxoviruses, rotaviruses) are capable of genetic shifts through reassortment. Reassortment (genetic shift) involves exchange Gastrointestinal & Anatomy (Anat) 4
of entire genomic segments, a far more dramatic process than the point mutations responsible for genetic drift. Nutrition (GI)
Superior gluteal nerve injury results in weakness and paralysis of the gluteus medius, gluteus minimus, and tensor fasciae latae muscles. This causes the pelvis to tilt Gastrointestinal & Anatomy (Anat) 1
downward toward the contralateral side ((+) Trendelenburg SSx). Pts will also lean toward the ipsilateral side when walking to help stabilise the pelvis (gluteus medius Nutrition (GI)
gait).
QID Topic Educational Objective System Subject Repeats
1738 Bronchiolitis Viral bronchiolitis is most commonly caused by RSV and presents w/ low-grade fever, cough, tachypnoea, and ↑ work of breathing. Ex shows diffuse wheezes and Gastrointestinal & Anatomy (Anat) 1
crackles. Nutrition (GI)
1744 Antiretroviral therapy NNRTIs are ARV drugs that don't req activation via intracellular phosphorylation. The more common NNRTIs incl nevirapine and efavirenz. Gastrointestinal & Anatomy (Anat) 7
Nutrition (GI)
1832 Non-Hodgkin lymphoma Overexpression of bcl-2 leads to ↑ secretion of Bcl-2 protein, which inhibits apoptosis and promotes survival of tumor cells. This overexpression occurs in follicular Gastrointestinal & Anatomy (Anat) 6
lymphoma 2° to translocation of the bcl-2 oncogene from chromosome 18 to the Ig heavy chain locus on chromosome 14 [t(14:18)]. Nutrition (GI)
1875 Bladder cancer The obturator nerve is the only major nerve that exits the pelvis through the obturator foramen. Nerve injury typically results from compression (eg, due to pelvic trauma, Gastrointestinal & Anatomy (Anat) 4
Sx, or tumor) and Px w/ weakness on thigh adduction and sensory loss over the distal medial thigh. Nutrition (GI)
8547 Growth hormone Acromegaly is caused by excessive production of GH, usually due to a pit somatotroph adenoma. MSK MFxs incl bony hypertrophy (e.g. frontal bossing; enlarged jaw, Gastrointestinal & Anatomy (Anat) 2
hands, and feet) and OA. LVH is often common in acromegaly and may progress to HF. Nutrition (GI)
8574 Patient confidentiality It is unethical to discuss any information regarding a pt's Dx and Tx w/ another individual, including a physician who is not involved in the pt's care. Likewise, the Gastrointestinal & Anatomy (Anat) 5
physician should neither confirm nor deny whether the person of interest is, in fact, a pt. Nutrition (GI)
8587 DNA methylation Genomic imprinting refers to the phenomenon in which an offspring's genes are expressed in a parent-specific manner. Genomic imprinting is caused by DNA meth, an Gastrointestinal & Anatomy (Anat) 1
epigenetic process in which genes can be silenced by attaching methyl groups to cytosine residues in the DNA molecules. Nutrition (GI)
8669 Alternative splicing Alt splicing is a process where the exons of a gene are reconnected in multi ways during PTP. This creates diff mRNA seqs and subseq, diff protein isoforms. It's a normal Gastrointestinal & Anatomy (Anat) 1
phenomenon in eukaryotes that greatly incr. the biodiversity of proteins encoded by the genome. Nutrition (GI)
10583 Tumor lysis syndrome TLS can develop during CTx for ca w/ rapid cell turnover (e.g. poorly diffiated lymphomas and leukaemias), substantial tumour burden, or high sensitivity to CTx. It's Gastrointestinal & Anatomy (Anat) 1
characterised by hyperphosphataemia, hypocalcaemia, hyperkalaemia, and hyperuricaemia. Prevention often involves hydration and the use of hypouricaemic agents such Nutrition (GI)
as allopurinol or rasburicase.
11753 Specific phobia Exposure-based cognitive-behavioral therapy, in which patients are systematically confronted with their feared objects or situations, is the most effective long-term Gastrointestinal & Anatomy (Anat) 1
treatment for specific phobia. Nutrition (GI)
11760 Depression Major depressive disorder (MDD) with psychotic features is a severe subtype of unipolar major depression characterized by symptoms meeting the criteria for MDD and Gastrointestinal & Anatomy (Anat) 8
the presence of delusions and/or hallucinations. Nutrition (GI)
11771 Complementary and Physicians should routinely ask their pts about the use of herbal preps and nutritional supplements and advise them on the quality, safety, and efficacy of these products. Gastrointestinal & Anatomy (Anat) 1
alternative medicine Nutrition (GI)
11775 Catheter related The presence of central vascular catheter and receipt of parenteral nutrition are RFs for candidaemia. Candida display a morphology of branching pseudohyphae w/ Gastrointestinal & Anatomy (Anat) 3
bloodstream infection blastoconidia. Nutrition (GI)
11782 Polymyositis and Polymyositis and dermatomyositis are characterized by symmetric proximal muscle weakness and are associated with antinuclear and anti-tRNA synthetase (anti-Jo-1) Gastrointestinal & Anatomy (Anat) 5
dermatomyositis autoantibodies. Biopsy in polymyositis shows patchy endomysial inflammatory infiltrate (ie, direct invasion of individual muscle fibers), whereas dermatomyositis causes Nutrition (GI)
perifascicular inflammation (ie, localized around blood vessels and the septa between muscle fascicles).
11795 Erythema multiforme EM is a cell-mediated inflammatory disorder of the skin characterised by erythematous papules that evolve into target lesions. It's most commonly a/w HSV. Gastrointestinal & Anatomy (Anat) 2
Nutrition (GI)
11817 Visual pathway Damage to the left temporal hemiretina will disrupt the transmission of visual information along the ipsilateral optic nerve, lateral optic chiasm, optic tract, lateral Gastrointestinal & Anatomy (Anat) 5
geniculate body, optic radiations, and 1° visual cortex. Nutrition (GI)
11839 Cocaine Cocaine withdrawal is characterised by the devel of acute depression accompanied by fatigue, hypersomnia, hyperphagia, and vivid dreams. Gastrointestinal & Anatomy (Anat) 3
Nutrition (GI)
11840 Prostate cancer The skeletal system is a common site of metastasis due to hematogenous seeding. Cancers of the pelvis, including the prostate, spread to the lumbosacral spine via the Gastrointestinal & Anatomy (Anat) 5
vertebral venous plexus, which in turn communicates with a number of venous networks, including the prostatic venous plexus. Nutrition (GI)
11850 Medical errors Communication failures b/w physicians during pt handoffs are a major cause of medical errors and can be ↓ by use of a standardized handoff process including systematic Gastrointestinal & Anatomy (Anat) 8
sign-out notes. Nutrition (GI)
14837 Lysosomal storage disorder Protein targeting is the process by which proteins with different intra- and extracellular fates reach their destination. Proteins destined for the lysosome require Gastrointestinal & Anatomy (Anat) 1
phosphorylation of specific mannose residues to ensure proper transit through the Golgi apparatus. Nutrition (GI)
14880 Alzheimer disease Inappropriate processing of amyloid precursor protein down the β- and γ-secretase pathway results in the production of β-amyloid. Insufficient clearance of β-amyloid can Gastrointestinal & Anatomy (Anat) 7
result in formation of extracellular amyloid plaques, which are neurotoxic and thought to play a key role in the pathogenesis of AD. Nutrition (GI)
17004 HSV infection HSV is a common, STI marked by the formation of painful genital ulcers. Tzanck smear can reveal the char cytopathic effects of the virus, incl multinucleated giant cells, Gastrointestinal & Anatomy (Anat) 9
ground-glass opacities, acantholytic cells, keratinocyte ballooning, and nuclear moulding. Nutrition (GI)
17005 Febrile neutropenia Chemotherapy-assoc neutropaenic fever is most often caused by endogenous commensal bacteria that have translocated across dmgd mucosal sites. Gastrointestinal & Anatomy (Anat) 4
Nutrition (GI)
67 Guillain-Barre syndrome GBS is an acute, demyelinating polyneuropathy thought to be caused by molecular mimicry. Abs formed against infectious agents cross-react w/ myelin and Schwann Gastrointestinal & Biochemistry 3
cells, leading to immune-mediated demyelination. LM shows segmental demyelination and an endoneurial inflammatory infiltrate composed of lymphocytes and Nutrition (GI) (Bioc)
macrophages.
70 Gallstone disease Black pigment stones arise from conditions that ↑ the amount of unconjugated bilirubin in bile, which promotes Ca2+ bilirubinate precipitation. This may occur in the Gastrointestinal & Biochemistry 8
setting of chronic hemolysis (e.g. SCA, β-thalassaemia, HS) and ↑ enterohepatic cycling of bilirubin (e.g. ileal disease). Nutrition (GI) (Bioc)
755 Poststreptococcal GN is a/w prior streptococcal pharyngeal or skin infection; acute RF is a/w prior streptococcal pharyngitis but not skin infection. Streptococci are catalase (-), Gastrointestinal & Biochemistry 8
glomerulonephritis staphylococci are catalase (+). Streptococcus pyogenes (GAS) is β-hemolytic, bacitracin-susceptible, and pyrrolidonyl arylamidase (+). Streptococcus pneumoniae is bile- Nutrition (GI) (Bioc)
soluble and optochin-susceptible.
790 Polymyositis and Polymyositis causes symmetric proximal muscle weakness. Muscle biopsy reveals inflammation, necrosis, and regeneration of muscle fibers. Over-expression of major Gastrointestinal & Biochemistry 5
dermatomyositis histocompatibility complex class I proteins on the sarcolemma leads to infiltration with CD8+ T lymphocytes and myocyte damage. Nutrition (GI) (Bioc)
1068 Wernicke-Korsakoff Pyruvate dehydrogenase and a-ketoglutarate dehydrogenase require thiamine as a cofactor. Administration of glucose to thiamine-deficient patients (eg, alcoholics) can Gastrointestinal & Biochemistry 5
syndrome result in Wernicke encephalopathy (eg, acute confusion, ophthalmoplegia, and ataxia) due to increased thiamine demand. Nutrition (GI) (Bioc)
1071 Meningococci The Thayer-Martin medium is used to isolate pathogenic Neisseria species such as N. meningitidis and N. gonorrhoeae. It's a chocolate sheep blood agar that contains Gastrointestinal & Biochemistry 1
vancomycin to inhib the growth of gram (+) organisms; colistin and trimethoprim to inhib gram (-) bacteria (other than pathogenic Neisseria); and nystatin to inhib yeasts. Nutrition (GI) (Bioc)
1072 Gonococcal infection Gonococci use their pili to mediate adherence to the mucosal epithelium. Through Ag variation, each gonococcus can modify the pilus protein expressed, thereby avoiding Gastrointestinal & Biochemistry 3
host defenses (to some degree) and making vax directed against the pilus protein difficult. Nutrition (GI) (Bioc)
1074 Pelvic inflammatory disease PID is most frequently caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Severe or inadequately Tx PID can result in fallopian tube scarring, which in turn Gastrointestinal & Biochemistry 2
can lead to infertility. Tx must always include coverage of both organisms w/ a 3rd-generation cephalosporin (eg, ceftriaxone) as well as azithromycin or doxycycline. Nutrition (GI) (Bioc)
1332 Study designs In a cross-sectional study, exposure and outcome are measured simultaneously at a particular point in time ("snapshot study"). In other study designs, a certain time period Gastrointestinal & Biochemistry 6
separates the exposure from the outcome. Nutrition (GI) (Bioc)
1475 Cyanide poisoning Nitrites are ox agents that're effective in Tx CN- pois due to their ability to induce HbM-emia. HbM contains Fe3+ rather than Fe2+. CN- binds to Fe3+ more avidly than Gastrointestinal & Biochemistry 2
to mitochondrial cytochrome enzymes, diminishing CN-'s toxic effect. Nutrition (GI) (Bioc)
1479 DNA replication DNA synth can occur only in the 5' --> 3' direction. Okazaki fragments are short stretches of newly synth DNA that're separated by RNA primers. They're formed by the Gastrointestinal & Biochemistry 3
discontinuous synth of DNA on the lagging strand during replication. Nutrition (GI) (Bioc)
1485 Cirrhosis ↑ AST and ALT are indicators of hepatocellular dmg, and ↑ ALP and GGT indicate biliary injury. Serum albumin lvls, bilirubin lvls, and PT are reflective of liver fxn and Gastrointestinal & Biochemistry 7
are of greatest prognostic significance in pts w/ cirrhosis. Nutrition (GI) (Bioc)
1807 Congenital anomalies of The metanephros (metanephric blastema) gives rise to the glomeruli, Bowman's space, proximal tubules, the loop of Henle, and distal convoluted tubules. The ureteric bud Gastrointestinal & Biochemistry 3
kidney and urinary tract becomes the collecting system of the kidney, including the collecting tubules and ducts, major and minor calyces, renal pelvis, and the ureters. Nutrition (GI) (Bioc)
2028 Dose response curves Phenoxybenzamine is an irreversible α1 and α2 adrenergic antagonist that effectively ↓ the arterial vasoconstriction induced by NE. B/c phenoxybenzamine is an Gastrointestinal & Biochemistry 4
irreversible antagonist, even very high concentrations of NE, such as those seen in pheochromocytoma, can't overcome its effects. Nutrition (GI) (Bioc)
8425 COPD Smoking is the strongest RF for COPD and is responsible for accelerated decline in FEV1 in pts w/ COPD. Smoking cessation will slow the accelerated decline in FEV1, Gastrointestinal & Biochemistry 16
but FEV1 won't return to the lvl it would've been had the pt never smoked. Nutrition (GI) (Bioc)
8578 Traumatic brain injury Pts w/ OFC injury often experience personality changes, disinhib, and irritability 2° to impairment of the behavioural and emotional mod systems. Gastrointestinal & Biochemistry 5
Nutrition (GI) (Bioc)
1169 Psoriasis Psoriasis is characterised by hyperkeratosis and confluent parakeratosis of the stratum corneum, and epidermal hyperplasia (acanthosis) w/ elongated rete ridges. Gastrointestinal & Biostatistics 5
Neutrophilic foci in the stratum corneum and epidermis may coalesce to form microabscesses (Munro microabscesses). Nutrition (GI) (Bios)
318 Aging Dystrophic calcification occurs in dmgd or necrotic tissue in the setting of normal Ca lvls; metastatic calcification occurs in normal tissue in the setting of hypercalcemia. Gastrointestinal & Embryology 8
Nutrition (GI) (Embr)
319 Apoptosis Cytochrome c is a mitochondrial enzyme that activates caspases and indirectly brings about cell death through intrinsic pathway apoptosis. Gastrointestinal & Embryology 4
Nutrition (GI) (Embr)
321 Apoptosis The Fas receptor acts to initiate the extrinsic pathway of apoptosis. Mutations involving the Fas receptor or Fas ligand can prevent apoptosis of autoreactive lymphocytes, Gastrointestinal & Embryology 4
thereby increasing the risk of autoimmune disorders such as systemic lupus erythematosus. Nutrition (GI) (Embr)
322 Apoptosis Progesterone is the 1° hormone responsible for stimulating the endometrium so that it is suitable for implantation. Progesterone withdrawal causes endometrial cells to Gastrointestinal & Embryology 4
undergo apoptosis, resulting in menstrual bleeding. Nutrition (GI) (Embr)
328 Zollinger-Ellison syndrome Pts w/ ZES develop PUD and parietal cell hyperplasia w/ gastric fold enlargement due to gastrin hypersecretion. Gastrointestinal & Embryology 3
Nutrition (GI) (Embr)
329 Zollinger-Ellison syndrome ZES is caused by gastrinomas located in the small intestine/pancreas and Px w/ peptic ulcers (especially distal duodenal ulcers), heartburn, and diarrhea. Pts typically have Gastrointestinal & Embryology 3
↑ gastrin lvls that rise in response to exogenous secretin administration. In contrast, secretin inhibits release of gastrin from normal gastric G cells. Nutrition (GI) (Embr)
330 Mastocytosis Systemic mastocytosis is characterised by the abn proliferation of mast cells and ↑ hist release. Hist causes hypersecretion of GA by parietal cells in the stomach as well as Gastrointestinal & Embryology 1
a variety of other SSx (e.g. hypotension, flushing, pruritus). Nutrition (GI) (Embr)
437 Mesenteric ischemia CMI is Chx by atherosclerosis of the mesenteric arteries, resulting in diminished blood flow to the intestine after meals. This causes postprandial epigastric pain (intestinal Gastrointestinal & Embryology 1
angina) w/ associated food aversion/weight loss. Its pathogenesis is similar to angina pectoris. Nutrition (GI) (Embr)
QID Topic Educational Objective System Subject Repeats
438 Diverticular disease Colonic diverticula often involve the sigmoid colon and develop due to exaggerated contractions of colonic smooth muscle segments. This results in ↑ intraluminal Gastrointestinal & Embryology 3
pressure, causing outpouching of the mucosa and submucosa through the muscularis (false diverticula). Individuals (typically age >60) may be aSSx or have hematochezia Nutrition (GI) (Embr)
or diverticulitis.
2022 Polycythemia In response to tissue hypoxia, specialised interstitial cells in the RM and RC release EPO to stim the bone marrow to ↑ RBC production and improve the O2-carrying Gastrointestinal & Embryology 5
capacity of the blood. This response, known as 2° polycythemia, is an expected finding in diseases or conditions that cause significant chronic hypoxaemia (e.g. COPD). Nutrition (GI) (Embr)
11803 Hypertensive retinopathy Severe hypertension in retinal precapillary arterioles causes endothelial disruption, leakage of plasma into the arteriolar wall, and fibrinous necrosis. The necrotic vessels Gastrointestinal & Embryology 1
can then bleed into the nerve fiber layer, which can be seen on examination as dot- or flame-shaped hemorrhages. Nutrition (GI) (Embr)
11962 Urinary tract infection Enterococcus is an important cause of urinary tract infections. These organisms are gram-positive cocci in pairs and chains and, when grown on blood agar, they do not Gastrointestinal & Embryology 12
cause hemolysis (gamma hemolytic). Nutrition (GI) (Embr)
12198 Depression Most available antidepressants target the neurotransmission of 5-HT or NE, or both. Inhib of 5-HT reuptake by blocking the 5-HT transporter is the 1° MOA of SSRIs. Gastrointestinal & Embryology 8
Nutrition (GI) (Embr)
124 Esophageal cancer Major RFx for esophageal SCC include smoking, excessive Alc consumption, and intake of foods containing N-nitroso compounds. Gastrointestinal & Histology (Hist) 4
Nutrition (GI)
324 Tuberculosis T-helper subtype 1 cells release interferon-gamma leading to the activation of macrophages, a process critical for control of Mycobacterium tuberculosis infection. Gastrointestinal & Histology (Hist) 18
Activated macrophages form mature phagolysosomes that destroy phagocytosed mycobacteria and can differentiate into epithelioid and Langhans giant cells to wall off Nutrition (GI)
extracellular mycobacteria within caseating granulomas. Interferon-γ, IL-12, and TNF-α are critical cytokines for the formation and maintenance of granulomas.
15024 Turner syndrome IVF using a donated ovum is the most promising means of achieving pregnancy in a woman w/ TS. Pregnancy can occasionally occur spontaneously in some pts w/ TS, Gastrointestinal & Histology (Hist) 8
but the risk of spontaneous abortion, DS and TS are all ↑ in such cases. Nutrition (GI)
1467 Acute promyelocytic The presence of rod-shaped intracytoplasmic inclusions known as Auer rods is char of many forms of AML. The M3 variant of AML, APML, is a/w the cytogenetic abn t Gastrointestinal & Immunology 3
leukemia (15;17). Nutrition (GI) (Immu)
1597 LV volume and pressure Ventricular pressure and volume curves allow 1 to ID the phases of the cardiac cycle and to determine the exact time of opening and closure of the cardiac valves. The AV Gastrointestinal & Immunology 1
opens when LVP exceeds the central aortic pressure at the end of isovolumetric contraction. Nutrition (GI) (Immu)
47 Hepatitis B Infants born to HBeAg-positive mothers have a high risk of acquiring perinatal hepatitis B virus (HBV) infection. Infected neonates have high levels of HBV replication Gastrointestinal & Microbiology 14
and are at high risk for chronic infection, but are usually asymptomatic or have only mildly elevated liver function tests. Nutrition (GI) (Micr)
62 Echinococcosis Echinococcus granulosus is the most common cause of hydatid cysts. Spilling of cyst contents can cause anaphylactic shock. Surgical manipulation should be performed Gastrointestinal & Microbiology 1
with caution. Nutrition (GI) (Micr)
278 Colorectal cancer CEA lvls are ↑ in colon ca but are also ↑ in a number of other conditions (eg, pancreatic ca, COPD, cirrhosis). CEA cannot be used to Dx colon ca, but it is helpful for Gastrointestinal & Microbiology 15
detecting residual disease and recurrence. Nutrition (GI) (Micr)
283 Parkinson disease Selegiline is an inhib of MAO-B and can prevent MPTP-induced dmg of DA-ergic neurons. Selegiline is used clinically to delay the progr of Parkinson disease. Many Gastrointestinal & Microbiology 7
neurologists favour the use of combos of selegiline, anticholinergics, and amantadine until they no longer provide control of SSx. Only then is L-DOPA/carbidopa Nutrition (GI) (Micr)
introduced.
372 Insomnia Benzos, antihists, and sedating antideps should be avoided in the Tx of insomnia in elderly pts due to their AEs. Ramelteon, a melatonin agonist, has a lower AE burden Gastrointestinal & Microbiology 3
than other sedative-hypnotic agents and is effective in ↓ time to sleep onset in the elderly. Nutrition (GI) (Micr)
386 Gilbert syndrome Gilbert syndrome is the likely Dx in pts w/ no apparent liver disease who have mild unconjugated hyperbilirubinaemia that appears provoked by 1 of the classic triggers. Gastrointestinal & Microbiology 1
Nutrition (GI) (Micr)
388 Kernicterus CNS is an AR disorder of bilirubin meta caused by a genetic lack of the UGT enzyme needed to catalyse bile glucuronidation. Unconjugated hyperbilirubinaemia Gastrointestinal & Microbiology 1
develops in these infants, causing kernicterus and often death. Nutrition (GI) (Micr)
644 Congenital adrenal 11β-hydroxylase defic typically results in excessive adrenal androgen and MC (11-deoxycorticosterone) production. Genetically female infants are born w/ ambiguous Gastrointestinal & Microbiology 6
hyperplasia genitalia, and affected individuals develop HTN and hypokalaemia early in life. Nutrition (GI) (Micr)
1098 Anorexia nervosa AN is an eating disorder characterised by low body weight, intense fear of becoming fat, and distorted body image. Med complications due to starvation in AN incl Gastrointestinal & Microbiology 3
bradycardia, hypotension, osteoporosis, and amenorrhoea. Nutrition (GI) (Micr)
1100 Vitamin A toxicity Vit A overuse can result in intracranial HTN, skin changes, and HSM. Gastrointestinal & Microbiology 1
Nutrition (GI) (Micr)
1136 Matrix metalloproteinase Metalloproteinases are Zn-containing enzymes that degrade the ECM. They participate in normal tissue remodeling and in tumor invasion through the BM and CT. Gastrointestinal & Microbiology 1
Nutrition (GI) (Micr)
1397 Porphyria cutanea tarda Enzyme defics of the early steps in porphyrin synth cause neuropsych MFx w/o photosens, whereas late step derangements lead to photosens. Photosens MFx as vesicle Gastrointestinal & Microbiology 1
and blister formation on sun-exposed areas as well as edema, pruritus, pain, and erythema. Nutrition (GI) (Micr)
1398 ALA synthase AIP atks are due to the accum of ALA and PBG, resulting from inher PBG deaminase defic combo w/ ALA synthase induction (typically due to certain Rx, Alc use, or a Gastrointestinal & Microbiology 1
low-calorie diet). Mx w/ Glc or hemin inhibs ALA synthase activity. Nutrition (GI) (Micr)
1400 Organic acidemias Propionyl-CoA is derived from the metabolism of valine, isoleucine, methionine, threonine, and odd-chain FAs. Congenital defx of propionyl-CoA carboxylase, the Gastrointestinal & Microbiology 1
enzyme responsible for the conversion of propionyl-CoA to methylmalonyl-CoA, leads to the development of propionic acidemia. The condition Px w/ lethargy, poor Nutrition (GI) (Micr)
feeding, vomiting, and hypotonia 1-2 wks after birth.
1422 Mushroom poisoning Activation of mAChRs by ACh or cholinergic agonists results in peripheral vasodilation due to synthesis of NO in endothelial cells, which leads to vascular smooth Gastrointestinal & Microbiology 2
muscle relaxation (e.g. hypotension). mAChR activation in other sites causes smooth muscle contraction. Nutrition (GI) (Micr)
6510 Defense mechanisms Passive aggression is the expression of angry feelings in a non-confrontational manner. Gastrointestinal & Microbiology 8
Nutrition (GI) (Micr)
6731 Decision making capacity Pts who are temporarily incapacitated should not be allowed to make important health care decisions. Acutely intoxicated pts should be reAx when sober. Gastrointestinal & Microbiology 5
Nutrition (GI) (Micr)
7573 Congenital adrenal Males w/ classic, non-salt-wasting 21-hydroxylasedefic present at age 2-4yrs w/ early virilisation, ↑ linear growth, and ↑ lvls of 17-hydroxyprogesterone and androgens. Gastrointestinal & Microbiology 6
hyperplasia Females w/ classic 21-hydroxylase defic (+/- salt-wasting) present w/ ambiguous genitalia at birth. Nutrition (GI) (Micr)
7642 Gout Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line therapy for treating acute gouty arthritis. They inhibit cyclooxygenase and exert a broad anti-inflammatory Gastrointestinal & Microbiology 11
effect that includes inhibition of neutrophils. When NSAIDs are contraindicated (eg, peptic ulcer disease, renal impairment), colchicine is useful in the acute management Nutrition (GI) (Micr)
of gout as it inhibits neutrophil chemotaxis and phagocytosis by preventing microtubule formation.
8873 Torticollis Acute EPS (e.g. dystonia, akathisia, parkinsonism) are due to D2 blockade in the nigrostriatal pathway. High-potency FGAs (e.g. haloperidol, fluphenazine) strongly Gastrointestinal & Microbiology 2
block D2 receptors and are most likely to cause EPS. Nutrition (GI) (Micr)
15049 Viral genetics Influenza epidemics and pandemics are typically caused by reassortment of the RNA segments coding for HA or NA proteins (major antigenic shifts). This process can Gastrointestinal & Microbiology 4
occur b/w human and animal strains of influenza A virus in avian or swine hosts. Nutrition (GI) (Micr)
15144 Perforated viscus Pneumoperitoneum is air or gas in the peritoneal cavity; it can be seen as free air under the diaphragm in an upright CXR. The most common cause is a perforated Gastrointestinal & Microbiology 1
duodenal ulcer, but perforation can occur anywhere along the GIT (or female repro). subseq peritonitis can lead to diffuse abdo pain w/ rebound and guarding, sometimes Nutrition (GI) (Micr)
w/ referred shoulder pain due to diaphragmatic irritation.
54 Hepatitis E HEV is an unenveloped, ssRNA virus spread thru the faecal-oral route. The most concerning feature of hepE infection is the high mortality rate observed in infected preg Gastrointestinal & Pathology (Path) 1
women Nutrition (GI)
56 Hemangioma Cavernous hemangioma is the most common benign liver tumour. Microscopically, these tumours consist of cavernous, blood-filled vascular spaces of variable size lined Gastrointestinal & Pathology (Path) 6
by a single epithelial layer. The Bx of a suspected hemangioma is not advisable, as the procedure has been known to cause fatal hemorrhage and is of low Dx yield. Nutrition (GI)
57 Hepatocellular cancer AFP is a serum tumour marker that's often moderately ↑ in pts w/ chronic viral hepatitis. However, it can be strikingly ↑ in those w/ HCC, and a sudden rise can be a sign Gastrointestinal & Pathology (Path) 5
that a pt w/ chronic liver disease is harbouring HCC. Nutrition (GI)
59 Hepatocellular carcinoma Both HBV and HCV infections ↑ the risk of HCC due to chronic hepatic inflammation and cell turnover. HBV is also carcinogenic due to the production of oncogenic Gastrointestinal & Pathology (Path) 1
proteins and the insertion of the HBV genome into the host chrom. Nutrition (GI)
71 Gallstone disease Brown pigment gallstones are composed of Ca salts of unconjugated bilirubin and arise 2° to bacterial or helminthic infection of the biliary tract. β-glucuronidase released Gastrointestinal & Pathology (Path) 8
by injured hepatocytes and bacteria hydrolyzes bilirubin glucuronides to unconjugated bilirubin. The liver fluke Clonorchis sinensis has a high prevalence in East Asian Nutrition (GI)
countries and is a common cause of pigment stones.
79 Gallstone disease ↑ chol concs ↑ the likelihood of chol precipitation and gallstone formation. High lvls of bile salts and PC ↑ chol solubility and ↓ the risk of gallstones. Gastrointestinal & Pathology (Path) 8
Nutrition (GI)
81 Cholecystitis Acute cholecystitis is most often caused by gallstones obstructing the cystic duct. The diagnosis can be made by identifying signs of gallbladder inflammation (eg, wall Gastrointestinal & Pathology (Path) 5
thickening, pericholecystic fluid) on ultrasonography. When ultrasound is inconclusive, nuclear medicine hepatobiliary scanning (ie, cholescintigraphy) can be used to Nutrition (GI)
assess cystic duct patency and make the diagnosis.
87 Long QT syndrome Congenital LQTS is most often caused by genetic muts in a K+ channel protein that contributes to the outward-rectifying K+ current. A ↓ in the outward K+ current leads Gastrointestinal & Pathology (Path) 4
to prolongation of AP duration and QT interval. This prolongation predisposes to the devel of life-threatening ventricular arrhythmias (e.g. TdP) that can cause Nutrition (GI)
palpitations, syncope, seizures, or SCD.
88 Porcelain gallbladder Porcelain gallbladder is a potential MFx of chronic cholecystitis and is often found in a/w multi gallstones. It's due to dystrophic intramural deposition of Ca2+ salts in the Gastrointestinal & Pathology (Path) 1
setting of chronic inflammation. Porcelain gallbladder is a/w an ↑ risk of adenocarcinoma of the gallbladder. Nutrition (GI)
99 Constrictive pericarditis In constrictive pericarditis, normal pericardium is replaced by dense, rigid pericardial tissue that restricts ventricular filling, leading to low CO and progr right-sided HF. Gastrointestinal & Pathology (Path) 2
PEx findings in such pts incl ↑ JVP, pericardial knock, pulsus paradoxus, and a paradoxical ↑ in JVP w/ inspiration (Kussmaul sign). Nutrition (GI)
100 Biliary excretory function A moderately ↑ ALP of unclear etiology should be f/u w/ GGT. Gastrointestinal & Pathology (Path) 1
Nutrition (GI)
122 Blastomycosis B. dermatitidis can cause pulm disease in the immcom host. Dissemination (most commonly to skin and bones) occurs in immsup individuals. Gastrointestinal & Pathology (Path) 3
Nutrition (GI)
125 Vitamin B12 deficiency Pernicious anemia is an autoimmune disorder caused by the cell-mediated destruction of parietal cells in the superficial upper glandular layer of the gastric body and Gastrointestinal & Pathology (Path) 9
fundus. Parietal cells are responsible for the secretion of hydrochloric acid and intrinsic factor, a glycoprotein involved in the absorption of B12. Deficiency leads to Nutrition (GI)
megaloblastic anemia and neurologic dysfunction.
128 Ovarian cancer A Krukenberg tumor is a gastric tumor that has metastasized to the ovary and can present with unintentional weight loss, epigastric pain, and adnexal masses. Gastrointestinal & Pathology (Path) 9
Histologically, the metastatic tumor cells have large amounts of mucin with apically displaced nuclei, resulting in a signet ring appearance. Nutrition (GI)
QID Topic Educational Objective System Subject Repeats
130 Submucosal glands of Gastric acid is neutralised by HCO3- from the submucosal glands of the duodenum (Brunner glands) and from pancreatic duct secretions. Chronic overproduction of Gastrointestinal & Pathology (Path) 1
Brunner gastric acid can lead to hyperplasia of the submucosal glands. Nutrition (GI)
131 Peptic ulcer disease Duodenal ulcers aren't a/w an ↑ risk of carcinoma in the same location. In contrast, ulcers located in the oesophagus, stomach (gastric), and colon may be malignant, and Gastrointestinal & Pathology (Path) 10
Bx is req. Nutrition (GI)
132 Whipple disease Caused by the gram (+) actinomycete Tropheryma whippelii, Whipple disease is a rare systemic illness that involves the small intestine, joints, and CNS. Classic Gastrointestinal & Pathology (Path) 2
histologic findings incl small intestine mucosa containing enlarged, foamy macrophages packed w/ both rod-shaped bacilli and PAS (+), diastase-resistant granules. Nutrition (GI)
190 Gout Gout occurs in the setting of hyperuricemia and causes an inflammatory arthritis characterized by negative birefringent, needle-shaped crystals visible on joint fluid Gastrointestinal & Pathology (Path) 11
microscopy. Most diuretics (eg, hydrochlorothiazide, furosemide) can cause hyperuricemia and trigger gout flares by causing relative volume depletion, which decreases Nutrition (GI)
the fractional excretion of uric acid.
253 Endocarditis MVP w/ MR is the most common predisposing condition for native valve IE in developed nations. Rheumatic heart disease remains a freq cause of IE in devel nations. Gastrointestinal & Pathology (Path) 15
Nutrition (GI)
255 Endocarditis NBTE (marantic endocarditis) is a form of non-infectious endocarditis characterised by valvular deposition of sterile platelet-rich thrombi. It likely results from valvular Gastrointestinal & Pathology (Path) 15
dmg due to inflammatory cytokines in the setting of an underlying hypercoagulable state, and it's most commonly seen w/ advanced malignancy (esp. mucinous AC) or Nutrition (GI)
SLE.
257 Mitral stenosis The best and most reliable auscultatory indicator of the degree of MS is the A2-OS interval. A shorter interval indicates more severe stenosis. Other auscultatory findings Gastrointestinal & Pathology (Path) 7
can incl a diastolic rumbling murmur w/ presystolic accentuation due to LA contraction. Nutrition (GI)
280 Turner syndrome Streak ovaries, amenorrhea, and infertility are the gynecologic complications of TS. In addition, pts w/ TS usually have short stature, webbed neck, shield chest, and low Gastrointestinal & Pathology (Path) 8
posterior hairline. Bicuspid AV is the most common cardiac comorbidity. Nutrition (GI)
281 Colorectal cancer CAC is the most common GI malignancy. Right-sided lesions are more likely to bleed and cause IDA; left-sided lesions tend to present w/ obstructing SSx (e.g. altered Gastrointestinal & Pathology (Path) 15
bowel habits, constipation, abdo distension, nausea, and vomiting). Nutrition (GI)
282 Polycystic ovary disease PCOS is a/w oligomenorrhea, hirsutism, and polycystic ovaries. Disruption in intraovarian steroidogenesis causes anovulatory cycles and results in chronic estrogen Gastrointestinal & Pathology (Path) 4
stimulation w/ ↓ progesterone secretion, placing PCOS pts at risk for endometrial hyperplasia/carcinoma. Nutrition (GI)
284 Antipsychotics DIP is an EPS caused by Rx that block D2 receptors (e.g. antipsychs). Mx strategies incl ↓ or discontinuing the offending Rx and Tx w/ an antichol Rx. Gastrointestinal & Pathology (Path) 9
Nutrition (GI)
286 Parkinson disease Long-term Tx of PD w/ levodopa can be complicated by periodic and sometimes unpredictable fluctuations in motor fxn. This "on-off" phenomenon is thought to be a Gastrointestinal & Pathology (Path) 7
consequence of progressive nigrostriatal neurodegeneration leading to a ↓ therapeutic window for levodopa. Nutrition (GI)
287 Parkinson disease PD is typically Tx w/ L-DOPA (immediate precursor of DA), which crosses the BBB. L-DOPA is admin w/ DDCIs (e.g. carbidopa) and sometimes COMTIs (e.g. Gastrointestinal & Pathology (Path) 7
entacapone) to ↓ the peri meta of L-DOPA, resulting in ↑ L-DOPA bioavailability to the brain. Nutrition (GI)
304 Diffuse esophageal spasm DOS is characterised by periodic, simultaneous, and non-peristaltic contractions of the oesophagus due to impaired inhib innervation w/i the oesophageal myenteric Gastrointestinal & Pathology (Path) 1
plexus. Pts typically present w/ liquid/solid dysphagia and chest pain due to inefficient propulsion of food into the stomach. Nutrition (GI)
305 Mallory-Weiss syndrome Mallory-Weiss tears account for about 10% of cases of upper GI hemorrhage. They occur due to ↑ intraluminal gastric pressure due to retching, vomiting, or other Gastrointestinal & Pathology (Path) 2
abdominal straining. Nutrition (GI)
307 Esophagitis Infec esophagitis is common in pts w/ HIV. The most common cause is C. albicans, although CMV and HSV are also freq implicated. Dx is based on endoscopic and Gastrointestinal & Pathology (Path) 3
micro findings. Nutrition (GI)
326 Lung abscess Abscess formation is largely driven by neutrophil recruitment and activation leading to the release of cytotoxic granules that kill bacteria but also cause liquefying Gastrointestinal & Pathology (Path) 4
necrosis of surround tissue. Nutrition (GI)
327 Superior mesenteric artery SMA syndrome occurs when the transverse portion of the duodenum is entrapped b/w the SMA and aorta, causing SSx of partial intestinal obstr. This syndrome occurs Gastrointestinal & Pathology (Path) 1
syndrome when the aortomesenteric angle critically ↓, 2° to diminished mesenteric fat, pronounced lordosis, or Sx correction of scoliosis. Nutrition (GI)
331 Gastric cancer There are 2 morphological variants of GAC. The intestinal type forms a solid mass that projects into the stomach lumen and is composed of glandular-forming cuboidal or Gastrointestinal & Pathology (Path) 1
columnar cells. In contrast, diffuse carcinoma (linitis plastica) infiltrates the stomach wall and displays signet-ring cells on LM. Nutrition (GI)
358 Gestational trophoblastic Choriocarcinoma is a malignant form of gestational trophoblastic disease composed of anaplastic cytotrophoblasts and syncytiotrophoblasts w/o villi. It often Px as Gastrointestinal & Pathology (Path) 3
disease dyspnea/hemoptysis due to pulm metastasis from hematogenous spread. Nutrition (GI)
362 Turner syndrome TS (45,X) MFx in the neonate w/ lymphedema and cystic hygromas. Short stature, 1° amenorrhea, and aortic anomalies are the other important CFx. Gastrointestinal & Pathology (Path) 8
Nutrition (GI)
364 Prostate cancer CFx that suggest a malignant cause of back pain incl occurrence at night, not relieved w/ rest or analgesics, advanced age, and systemic SSx. Common malignancies w/ a Gastrointestinal & Pathology (Path) 5
propensity for bony mets incl prostate, breast, kidney, thyroid, and lung. Nutrition (GI)
366 Klinefelter syndrome 47,XXY is the most common genotype causing KS. Pts Px w/ tall stature; small, firm testes; azoospermia; and gynecomastia. Mild intellectual disability is seen in some Gastrointestinal & Pathology (Path) 3
pts, and the severity generally ↑ w/ each additional X chromosome. Nutrition (GI)
367 Fragile X syndrome FXS, an XL disorder, is the most common cause of inherited intellectual disability. The pathogenesis involves an unstable expansion of TNRs (CGG) in the FMR1 gene. Gastrointestinal & Pathology (Path) 3
Key physical findings include dysmorphic facial features (e.g. large jaw, protruding ears, long face) and macroorchidism. Nutrition (GI)
368 Li-Fraumeni syndrome LFS is caused by an AD mut in the TSG TP53. Leukaemia, sarcomas, and tumours of the breast, bran, and adrenal cortex are most common. Gastrointestinal & Pathology (Path) 1
Nutrition (GI)
370 Child abuse Abusive head trauma can be caused by vigorous shaking of an infant and results in SDH (due to tearing of bridging veins) and retinal hemorrhages. Additional red flags Gastrointestinal & Pathology (Path) 2
are injuries inconsistent w/ Hx or developmental age. Nutrition (GI)
393 Hepatitis A Acute hepA is a self-limited infection that typically presents acutely w/ prodromal SSx (e.g. fever, malaise, anorexia, nausea/vomiting, RUQ pain) followed by SSx of Gastrointestinal & Pathology (Path) 4
cholestasis (e.g. jaundice, pruritus, dark-coloured urine, clay-coloured stool). Nutrition (GI)
394 Hepatitis B HepB infection causes the hepatocellular cytoplasm to fill w/ HBsAg. These inclusions are highly specific for hepB infection and have a finely granular, pale eosinophilic, Gastrointestinal & Pathology (Path) 14
ground-glass appearance. Nutrition (GI)
400 Hepatitis B The HBV replicated via the following seq: dsDNA → (+)RNA template → partially dsDNA progeny. Although it's a DNA virus, HBV uses reverse transcriptase to Gastrointestinal & Pathology (Path) 14
generate new viral DNA from a (+)-sense RNA template. Nutrition (GI)
401 Hepatitis B HBV doesn't have a cytotox effect itself; however, the presence of viral HBsAg and HBcAg on the cell surface stim the host's CD8+Tc lymphocytes to destroy infected Gastrointestinal & Pathology (Path) 14
hepatocytes. Nutrition (GI)
403 Hepatitis B Individuals who are successfully immunized against HBV develop protective anti-HBs Ab. Individuals who recover from hepatitis B infection, however, have anti-HBs as Gastrointestinal & Pathology (Path) 14
well as anti-HBc Abs. The presence of circulating HBsAg indicates active infection. Nutrition (GI)
404 Hepatitis B Vertical transmission of hepB from preg females to the unborn child can occur in women w/ active hepB infection. The presence of HBeAg (a marker of viral replication Gastrointestinal & Pathology (Path) 14
and ↑ infectivity) in the mother greatly ↑ the risk of vertical transmission of the virus. B/c of this concern, the newborns of all mothers w/ active hepB are passively Nutrition (GI)
immunised at birth w/ HBIG, f/b active immunisation w/ recombinant HBV vax.
405 Hepatitis B If HBeAg persists for several months and host anti-HBeAg remain at low or undetectable levels, suspect chronic hepatitis B infection with high infectivity. Gastrointestinal & Pathology (Path) 14
Nutrition (GI)
406 Hepatitis B The presence of anti-HBc and anti-HBs antibodies in the serum without detectable viral antigens indicates recovery from acute hepatitis B infection. In contrast, patients Gastrointestinal & Pathology (Path) 14
vaccinated against hepatitis B will have anti-HBs antibodies without detectable levels of anti-HBc. Chronic hepatitis B is indicated by persistent levels of HBsAg and Nutrition (GI)
HBV DNA in the serum.
407 Glomerular disorders MG is a common cause of nephrotic syndrome in adults and can occur in a/w solid malignancy, viral hepatitis, and SLE. IC deposition in the subepithelial portion of the Gastrointestinal & Pathology (Path) 9
glomerular cap wall causes diffuse thickening of the GBM (w/o ↑ cellularity); these deposits have a 'spike and dome' appearance when stained w/ silver stains. Nutrition (GI)
409 Glomerular disorders MCD is the most common cause of nephrotic syndrome in children. Classic MFxs incl proteinuria, hypoalbuminaemia, and oedema that're usually reversible w/ Gastrointestinal & Pathology (Path) 9
corticosteroids. The principal lesion is a diffuse foot process effacement that can be seen on EM. LM and IF are normal. Nutrition (GI)
410 Glomerular disorders MCD is cause by immune dysregulation and overproduction of glomerular permeability factor, which dmgs podocytes and ↓ the anionic properties of the GBM. This Gastrointestinal & Pathology (Path) 9
results in selective loss of albumin in the urine, in contrast to the nonselective proteinuria in other forms of nephrotic syndrome. Nutrition (GI)
411 Hepatitis B The main modes of transmission of HBV incl sexual (among both heterosex partners and MSM) and percutaneous (e.g. IVDU, needlestick accidents, blood transfusions). Gastrointestinal & Pathology (Path) 14
The risk of sexual transmission of HCV is low. Nutrition (GI)
413 Hepatitis B The most common outcome in HBV-infected adults (>95%) is acute hepatitis w/ mild or subclinical SSx that eventually completely resolve. Gastrointestinal & Pathology (Path) 14
Nutrition (GI)
414 Hemochromatosis Physiologic Fe loss through menstruation and pregnancy slows the progression of hemochromatosis in women. Gastrointestinal & Pathology (Path) 4
Nutrition (GI)
415 Hemochromatosis HH is most commonly caused by a missense mut in the HFE gene, resulting in excessive intestinal Fe absorption and organ dmg (e.g. cirrhosis, DM, cardiomyopathy, Gastrointestinal & Pathology (Path) 4
arthropathy) due to Fe accumulation w/i parenchymal tissues. Nutrition (GI)
416 Hemochromatosis Hereditary hemochromatosis is an autosomal recessive disease characterized by abnormally high intestinal iron absorption. Common manifestations include liver disease, Gastrointestinal & Pathology (Path) 4
skin hyperpigmentation, diabetes mellitus, arthropathy, and cardiac enlargement with conduction abnormalities or heart failure. Nutrition (GI)
420 Wilson disease The Kayser-Fleischer ring is an ophthalmologic finding most strongly associated with Wilson's disease. It is seen most frequently in patients with neuropsychiatric Gastrointestinal & Pathology (Path) 5
complications. Basal ganglia atrophy is typically present in these patients. Nutrition (GI)
421 Alpha1 antitrypsin AAT is a serum protein that, thru the inhib of neutrophil elastase, ↓ tissue dmg caused by inflammation. Histo, AATD can demonstrate reddish-pink globules on PAS Gastrointestinal & Pathology (Path) 8
deficiency stain; these globules represent un-secreted, polymerised AAT in the periportal hepatocytes. Nutrition (GI)
424 Primary biliary cholangitis PBC is a chronic liver disease characterised by autoimmune destruction of the intrahepatic bile ducts and cholestasis (↑ ALP). The condition is most common in middle- Gastrointestinal & Pathology (Path) 4
aged women, w/ severe pruritus (esp. at night) often 1 of the 1st reported SSx. Nutrition (GI)
426 Primary biliary cholangitis PBC is a chronic autoimmune liver disease characterised by destruction of intrahepatic, interlobular bile ducts by granulomatous inflammation. The disease typically Gastrointestinal & Pathology (Path) 4
presents insidiously w/ pruritus and fatigue in middle-aged women. Pts may eventually develop SSx of cholestasis (e.g. jaundice, pale stool, dark urine) and Nutrition (GI)
hypercholaemia (e.g. xanthelasma).
427 Inflammatory bowel disease CD typically Px w/ prolonged diarrhea and abdominal pain. Constitutional SSx (eg, low-grade fever, fatigue), malabsorption, and weight loss are also common. Gastrointestinal & Pathology (Path) 9
Transmural inflammation of the bowel wall may result in the formation of fistulas (eg, enteroenteric, enterocutaneous), abscesses, and fibrotic strictures. Nutrition (GI)
428 Inflammatory bowel disease NCGs are a hallmark of CD and can help distinguish it from UC, which does not form granulomas. Histopathology in CD also demonstrates transmural inflammation, Gastrointestinal & Pathology (Path) 9
distortion of the normal architecture, and Paneth cell metaplasia. Nutrition (GI)
QID Topic Educational Objective System Subject Repeats
429 Inflammatory bowel disease Granulomas are characterised by a large # of epithelioid macrophages that may fuse together to form multinucleated cells (Langhans giant cells) surrounded by a band of Gastrointestinal & Pathology (Path) 9
lymphocytes. Granuloma formation involves chronic Th1 and macrophage activation in response to a difficult-to-eradicate Ag. Nutrition (GI)
430 Inflammatory bowel disease CD is an IBD characterised by patchy inflammation that can occur throughout the entire GIT. Gross path demonstrates skip lesions, cobble-stoning of the mucosa, bowel Gastrointestinal & Pathology (Path) 9
wall thickening, and creeping fat. Nutrition (GI)
431 Inflammatory bowel disease CD is a/w oxalate kidney stones. Impaired BA absorption in the terminal ileum leads to loss of BAs in faeces w/ subseq fat malabsorption. Intestinal lipids then bind Gastrointestinal & Pathology (Path) 9
Ca2+ions, and the resulting soap complex is excreted. Free oxalate (normally bound by Ca2+ to form an unabsorbable complex) is absorbed and forms urinary calculi Nutrition (GI)
(enteric oxaluria).
432 Inflammatory bowel disease CD is characterised by patchy, transmural inflammation of the GIT. It can affect any part of the tract from the mouth to the anus. Complications incl strictures (due to Gastrointestinal & Pathology (Path) 9
bowel wall oedema, fibrosis, and thickening of the muscularis mucosae), fistulas (due to penetration of ulcers thru the intestinal wall), and abscesses. Nutrition (GI)
434 Colorectal cancer IBD, especially ulcerative pancolitis, is a/w a significant risk for CRC. Compared w/ sporadic CRC, colitis-associated CRC is more likely to occur at a younger age, is Gastrointestinal & Pathology (Path) 15
typically more aggressive w/ a higher histopathologic grade, often evolves from flat (nonpolypoid) lesions, and is frequently multifocal. Pts should be monitored regularly Nutrition (GI)
via colonoscopy w/ random Bx.
435 Gallstone disease Pts w/ CD affecting the terminal ileum (most common site of involvement) are prone to devel gallstones. ↓ BA reabsorption by the inflamed terminal ileum promotes chol Gastrointestinal & Pathology (Path) 8
supersaturation of the bile, resulting in gallstone formation. Nutrition (GI)
436 Colonic ischemia The splenic flexure and RSJ lie b/w regions of perfusion of major arteries. These 'watershed' areas are susceptible to ischemic dmg during hypotensive states, esp. in ps w/ Gastrointestinal & Pathology (Path) 1
underlying arterial insufficiency. Nutrition (GI)
439 Intussusception Intussusception most often occurs in children younger than 2 y/o and in the region of the ICV. It MFx w/ intermittent, severe, colicky abdo pain, 'currant jelly' stools, and Gastrointestinal & Pathology (Path) 1
sometimes a palpable mass in the RLQ. Nutrition (GI)
440 Groin hernias FHs can present w/ groin discomfort and a tender bulge on the upper thigh inf. to theinguinal ligament, lat. to thepubic tubercle and lacunar ligament. The structure that Gastrointestinal & Pathology (Path) 3
lies immediately lat. to the hernia w/i the femoral sheath is the femoral vein. Incarceration and strangulation are common complications of FHs. Nutrition (GI)
471 Peripheral vascular disease Intermittent claudication describes muscle pain that's reproducibly caused by exercise and relieved by rest; it occurs due to atherosclerotic stenoses (lipid-filled intimal Gastrointestinal & Pathology (Path) 4
plaques) in the large arteries that prevent sufficient blood flow to exercising muscle. The lower extremities are most commonly affected; however, proximal lesions (i.e. Nutrition (GI)
aortoiliac occlusion) can cause gluteal claudication a/o impotence.
586 Cell mediated immunity Immature T-lymphocytes express both the CD4 and CD8 cell surface Ags in addn to a complete TCR or a pro-TCR. These lymphocytes exist in the TC where they Gastrointestinal & Pathology (Path) 5
undergo (+) selection and in the TM where they undergo (-) selection. Nutrition (GI)
881 Huntington disease Hypo-acetylated histones bind tightly to DNA and prevent transcription of genes in their associated regions. Alteration of gene expression in HD occurs in part due to Gastrointestinal & Pathology (Path) 5
deacetylation of histones. This prevents the transcription of certain genes that code for neurotrophic factors, contributing to neuronal cell death. Nutrition (GI)
1143 Diphtheria Diphtheria exotoxin inhibs host cell protein synthesis by catalysing the ADP-ribosylation of host cell EF-2. Gastrointestinal & Pathology (Path) 6
Nutrition (GI)
1396 Maple syrup urine disease BCKD req several coenzymes: Thiamine. Lipoate, Coenzyme A, FAD, NAD (mnemonic: Tender Loving Care Fore Nancy). Some pts w/ MSUD improve w/ high-dose Gastrointestinal & Pathology (Path) 2
vitB1 Tx, but most req lifelong restriction of leucine, isoleucine, valine. Nutrition (GI)
1423 Urinary retention Cholinomimetics are indicated in non-obstr urinary retention, paralytic ileus, and glaucoma. Their AEs incl nausea, vomiting, abdo cramps, diarrhoea, dyspnoea, and ↑ Gastrointestinal & Pathology (Path) 4
secretions (sweating, lacrimation, and salivation). Nutrition (GI)
1547 Lac operon The lac operon is regulated by 2 distinct mechs: (-) by binding of the repressor protein to the operator locus and (+) by cAMP-CAP binding upstream from the promoter Gastrointestinal & Pathology (Path) 2
region. Constitutive expression of the structure genes of the lac operon occurs w/ muts that impair the binding of the repressor protein (Lac I) to its regulatory sequences in Nutrition (GI)
the operator region.
1603 Community acquired Irritation of the parietal pleura will cause sharp pain, which is worse on inspiration. Pain arising from the mediastinal or diaphragmatic pleura will be carried by the Gastrointestinal & Pathology (Path) 21
pneumonia phrenic nerve and referred to the C3 C5 distribution. Nutrition (GI)
1604 Parkinson disease The BBB is formed by tight jxns b/w nonfenestrated capillary endothelial cells that prevent the paracellular passage of fluid and solutes. This barrier only permits the Gastrointestinal & Pathology (Path) 7
passage of substances from the blood to the brain via transcellular movement across the endothelial plasma membrane, which is limited by diffusion or carrier-mediated Nutrition (GI)
transport.
1701 Hearing loss Prolonged exposure to loud noises causes hearing loss due to damage to the stereociliated hair cells of the organ of Corti. Gastrointestinal & Pathology (Path) 2
Nutrition (GI)
1783 Route of administration & F refers to the fraction of admin drug that reaches the syst circulation in a chem unchanged form. F for a drug admin by a non-IV route is always less than 1. It can be Gastrointestinal & Pathology (Path) 2
bioavailability determined by examining a graph of plasma conc vs time then applying the formula: F = (AUC oral x dose IV) / (AUC IV x dose oral). Nutrition (GI)
1806 Visual pathway CNII carries the afferent limb of the pupillary light reflex pathway, which activates the efferent limb bilaterally and causes both direct and consensual pupillary Gastrointestinal & Pathology (Path) 5
constriction. Unilateral CNII lesions (e.g. demyelination due to optic neuritis) can result in impaired pupillary constriction bilaterally when light enters the eye ipsilateral Nutrition (GI)
to the lesion. When light enters the contralateral eye, pupillary constriction occurs normally in both eyes.
1863 Autosomal recessive The prob that an AR disease will be transmitted to a child can be calculated based on the maternal and paternal pedigrees. An unaffected individual (w/ unaffected Gastrointestinal & Pathology (Path) 5
inheritance parents) who has a sibling affected by an AR condition has a 2/3 chance of being a carrier for that condition. Nutrition (GI)
1918 Vitamin B12 deficiency Atrophic gastritis can result in profound hypochlorhydria, inadequate IF production, vitB12 defic, and ↑ MMA lvls. The reticulocyte count ↑ dramatically once vitB12 Gastrointestinal & Pathology (Path) 9
replacement therapy is initiated in an individual w/ pernicious anaemia. Hb and erythrocyte count lvls rise more gradually and take up to 8wks to normalise. Nutrition (GI)
1927 Muscle structure & Postural skeletal muscles such as the soleus and paraspinal muscles contain predominantly Type I slow twitch, red muscle fibers that derive ATP primarily from oxidative Gastrointestinal & Pathology (Path) 8
physiology (aerobic) metabolism. Nutrition (GI)
7214 Dyslipidemia Familial dysbetalipoproteinemia (type III hyperlipoproteinemia) is an autosomal recessive disorder characterized by elevated cholesterol and triglyceride levels. It is Gastrointestinal & Pathology (Path) 11
caused by defects in ApoE3 and ApoE4, leading to decreased clearance of chylomicrons and VLDL remnants. Patients can develop eruptive and palmar xanthomas and Nutrition (GI)
premature atherosclerosis.
7215 Pemphigus vulgaris PV is an autoimmune bullous disease characterised by auto-Abs directed against desmosomal proteins (e.g. desmoglein). It presents w/ painful flaccid bullae and erosions Gastrointestinal & Pathology (Path) 1
affecting the skin and mucosal membranes. The bullae spread laterally w/ pressure and new blisters may form w/ gentle rubbing. Nutrition (GI)
7228 Anaphylaxis Anaphylaxis is the result of widespread mast cell and basophil degranulation and the release of preformed inflammatory mediators, including histamine and tryptase. Gastrointestinal & Pathology (Path) 3
Tryptase is relatively specific to mast cells and can be used as a marker for mast cell activation. Nutrition (GI)
7229 Anaphylaxis The high-affinity IgE receptor (FCERI) is found on the surface of mast cells and basophils and normally binds the Fc portion of circulating IgE antibodies. Cross-linking Gastrointestinal & Pathology (Path) 3
of multiple membrane bound IgE antibodies by a multivalent antigen results in aggregation of the FcERI receptors, causing degranulation and the release of preformed Nutrition (GI)
mediators (eg, histamine, tryptase) that initiate an allergic response.
7710 Aortic regurgitation AR causes a high-pitched, blowing, diastolic murmur w/ a decrescendo intensity pattern. The murmur of AR due to aortic root dilation is best heard at the right upper Gastrointestinal & Pathology (Path) 8
sternal border, whereas the murmur of AR due to valvular pathology is best heard at the left 3rd ICS. Nutrition (GI)
9920 Skin and soft tissue Granulomatous inflammation is a form of chronic inflammation characterised by aggregates of activated macrophages that assume an epithelioid appearance. Persistent Gastrointestinal & Pathology (Path) 8
infections granulomatous inflammation w/ subseq fibrosis can cause organ dysfxn, which is seen in a # of granulomatous diseases. Nutrition (GI)
11548 Vertigo Vertigo is a sensation of excessive motion compared to physical reality. It is most commonly due to dysfxn w/i the vestibular system. Gastrointestinal & Pathology (Path) 1
Nutrition (GI)
12062 Autosomal recessive The Hardy-Weinberg equation can be used to estimate carrier frequency, disease frequency, and frequency of different genotypes if at least 1 of these values is known. Gastrointestinal & Pathology (Path) 5
inheritance Nutrition (GI)
14873 Chronic kidney disease CKD causes disordered mineralisation and bone meta that usually presents w/ hyperphosphataemia, 2° hyperparathyroidism, and ↓ calcitriol lvls. Pts can be aSSx or Gastrointestinal & Pathology (Path) 8
develop weakness, bone pain, and fractures. Nutrition (GI)
14878 Hemorrhagic stroke Spontaneous deep intracerebral hemorrhage is typically caused by hypertensive vasculopathy involving the small, penetrating branches of the major cerebral arteries. The Gastrointestinal & Pathology (Path) 3
most frequently affected locations include the BG (putamen), cerebellar nuclei, thalamus, and pons. The putamen is supplied by the lenticulostriate arteries, which are Nutrition (GI)
deep, small vessel branches off the MCAs.
14879 Seizures The 1° somatosensory cortex (postcentral gyrus) is responsible for processing all somatic sensory input from the contralateral side of the body. A focal onset seizure Gastrointestinal & Pathology (Path) 8
originating in this region of the cerebral cortex often results in contralateral sensory disturbance (e.g. numbness, paraesthesia). Nutrition (GI)
14891 Ischemic stroke Gerstmann syndrome results from damage to the angular gyrus of the dominant parietal lobe and is Chx by agraphia (inability to write), acalculia (inability to carry out Gastrointestinal & Pathology (Path) 19
mathematical calculations), finger agnosia (inability to identify individual fingers on the hand), and left-right disorientation. Nutrition (GI)
14892 High altitude illness People traveling to elevations >2500 m (8000 ft) can develop high-altitude illness, characterized by hypobaric hypoxia with the potential to develop life-threatening Gastrointestinal & Pathology (Path) 3
cerebral and/or pulmonary edema. Key adaptive responses to hypoxemia include hyperventilation to increase blood oxygenation and increased synthesis of 2,3- Nutrition (GI)
bisphosphoglycerate in erythrocytes (facilitating oxygen offloading into peripheral tissues).
14900 Spinal cord injury Brown-Séquard syndrome results from hemisection of the spinal cord. It is Chx by ipsilateral spastic paralysis (due to corticospinal tract injury), ipsilateral loss of Gastrointestinal & Pathology (Path) 1
tactile/vibratory/position sensation (dorsal columns), and contralateral loss of pain and temperature sensation (spinothalamic tract) below the level of injury. Nutrition (GI)
14907 Subclavian steal syndrome Subclavian steal syndrome occurs due to severe stenosis of the proximal SCA, which leads to reversal in blood flow from the contralateral vertebral artery to the ipsilateral Gastrointestinal & Pathology (Path) 1
vertebral artery. Pts may have SSx related to arm ischemia in the affected extremity (eg, exercise-induced fatigue, pain, paresthesias) or vertebrobasilar insufficiency (eg, Nutrition (GI)
dizziness, vertigo).
15011 ACE inhibitors Fetopathy due to ACEIs or ARBs results from blockade of AT-II, which is necessary for normal renal development. Use of these antiHTN Rx during pregnancy can result Gastrointestinal & Pathology (Path) 7
in fetal anuria, oligohydramnios, pulm hypoplasia, limb contractures, and calvarium defects. Nutrition (GI)
15012 Transcription The TATA and CAAT boxes are promoters of transcription in eukaryotic cells and are located approximately 25 and 75 bases upstream from the transcription start site, Gastrointestinal & Pathology (Path) 7
respectively. They promote initiation of transcription by serving as binding sites for transcription factors and RNA polymerase II. Nutrition (GI)
15018 Polymerase chain reaction Reverse transcription polymerase chain reaction (RT-PCR) is used to detect and quantify levels of mRNA in a sample. It uses reverse transcription to create a Gastrointestinal & Pathology (Path) 2
complementary DNA template that is then amplified using the standard PCR procedure. RT-PCR can be used to diagnose chronic myelogenous leukemia by identifying Nutrition (GI)
an mRNA transcript containing both BCR and ABL exons in affected cells.
15020 Hemangioma Cavernous hemangiomas are vascular malformations composed of abnly dilated capillaries separated by thin connective tissue septa. The lack of structural support gives Gastrointestinal & Pathology (Path) 6
them a tendency to bleed, and those that occur in the brain can present w/ neurologic deficits and seizures. Nutrition (GI)
15021 SIADH Small cell lung cancer is a neuroendocrine malignancy associated with several paraneoplastic syndromes. It is the most common cause of syndrome of inappropriate Gastrointestinal & Pathology (Path) 3
antidiuretic hormone (SIADH) due to ectopic secretion of antidiuretic hormone. SIADH is characterized by hyponatremia, decreased serum osmolality, and urine Nutrition (GI)
osmolality >100 mOsm/kg H2O.
15535 Psychosis Antipsych Rx are 1st-line Rx for schizophrenia. Their 1° MOA is D2 receptor antagonism. Gastrointestinal & Pathology (Path) 6
Nutrition (GI)
QID Topic Educational Objective System Subject Repeats
15603 Anemia of chronic disease EPO is produced 1arily by peritubular fibroblast cells in the RC in response to ↓ renal O2 delivery (e.g. ↓ blood Hb content). EPO acts on erythrocyte precursor cells in the Gastrointestinal & Pathology (Path) 2
bone marrow to stim RBC production. Pts w/ CKD have inflammatory dmg to renal EPO-producing cells and often develop normocytic anaemia due to insufficient EPO. Nutrition (GI)
16070 Acute heart failure Congestive hepatopathy is a common complication of RHF. Patchy hemorrhage and necrosis predominantly affect the centrilobular regions (zone 3) where hepatic Gastrointestinal & Pathology (Path) 7
congestion is most prominent. The centrilobular necrosis, combo w/ relatively normal-appearing periportal regions (zone 1), creates an overall heterogenous appearance Nutrition (GI)
sometimes referred to as 'nutmeg liver'.
77 Hypertrophic In pts w/ HCM, dynamic LVOT obstr is due to abn systolic anterior motion of the anterior leaflet of the MV toward a hypertrophied IV septum. Gastrointestinal & Pathophysiology 9
cardiomyopathy Nutrition (GI) (Patp)
78 Gallstone disease The absence of normal enteral stim in pts receiving TPN leads to ↓ CCK release, biliary stasis, and ↑ risk of gallstones. Resection of the ileum can also ↑ the risk of Gastrointestinal & Pathophysiology 8
gallstones due to disruption of normal enterohepatic circulation of the BAs. Nutrition (GI) (Patp)
80 Cholecystitis Acute calculous cholecystitis is an acute inflammation of the gallbladder initiated by gallstone obstruction of the cystic duct. Subsequent steps in pathogenesis include Gastrointestinal & Pathophysiology 5
mucosal disruption by lysolecithins, bile salt irritation of the luminal epithelium, PG release w/ transmural inflammation, gallbladder hypomotility, ↑ intraluminal pressure Nutrition (GI) (Patp)
causing ischemia, and bacterial invasion.
101 Cirrhosis Hyperestrinism in liver cirrhosis likely arises due to ↑ in androstenedione production, androgen aromatisation, and sex hormone-binding globulin (SHBG) conc Gastrointestinal & Pathophysiology 7
(preferentially binds testosterone). Impaired oestrogen meta by the liver may also be a contributing factor. A ↓ free testosterone/oestrogen ratio leads to gynaecomastia, Nutrition (GI) (Patp)
testicular atrophy, ↓ body hair, and spider angiomata.
102 Hereditary DJS is a benign disorder characterised by defective hepatic excretion of bilirubin glucuronides across the canalicular membrane, resulting in direct hyperbilirubinaemia Gastrointestinal & Pathophysiology 1
hyperbilirubinemia and jaundice. Grossly, the liver appears black due to impaired excretion of EPI metabolites, which histo appear as dense pigments w/i lysosomes. Nutrition (GI) (Patp)
133 Whipple disease The glycoprotein in the cell walls of the actinomycete Tropheryma whippelii colours magenta w/ PAS and is diastase-resistant, making this stain an excellent choice in Gastrointestinal & Pathophysiology 2
evaluating tissue for Whipple disease. Nutrition (GI) (Patp)
134 Lactose intolerance LI presents w/ flatulence, crampy abdo pain, and watery diarrhoea after dairy product consumption. It can be acq by inflammatory/infectious conditions that injure the Gastrointestinal & Pathophysiology 3
mucosal brush border of the small intestine where lactase is expressed. Studies can show ↑ breath H+ content, ↓ stool pH, and ↑ stool osmolality. Nutrition (GI) (Patp)
279 Anal fissure Anal fissures are longitudinal tears in the mucosa. They're usually due to passage of hard stool in pts w/ chronic constipation. Most fissures occur at the posterior midline, Gastrointestinal & Pathophysiology 1
likely due to ↓ blood flow in this area. Fissures in other areas may be due to less common causes. Nutrition (GI) (Patp)
306 Barrett esophagus Barrett esophagus is a metaplastic condition in which the normal squamous epithelium of the distal esophagus is replaced by intestinal-type columnar epithelium. It occurs Gastrointestinal & Pathophysiology 2
most often in longstanding acid reflux and is associated with an increased risk of adenocarcinoma. Nutrition (GI) (Patp)
317 Atrophy Pathologic atrophy can be caused by ↓ physical workload, loss of innervation, ↓ blood supply, inadequate nutrition, absent endo stimulation, aging, or mechanical Gastrointestinal & Pathophysiology 1
pressure. Nutrition (GI) (Patp)
323 Aging Lipofuscin is the product of lipid peroxidation, accumulating in aging cells (esp. in pts w/ malnutrition and cachexia). Gastrointestinal & Pathophysiology 8
Nutrition (GI) (Patp)
363 Systemic sclerosis CREST syndrome (limited scleroderma) MFx w/ calcinosis, Raynaud's phenomenon, oesophageal dysmotility, sclerodactyly, and telangiectasias. Anti-centromere Abs are Gastrointestinal & Pathophysiology 3
found in about 40% of pts w/ CREST syndrome. Anti-DNA topoisomerase I (Scl-70) Abs are highly specific for systemic sclerosis. Nutrition (GI) (Patp)
365 Prenatal care The maternal serum quadruple screen is performed to Ax risk of congenital defects in fetuses. Accurate dating is important for determining whether levels of AFP and Gastrointestinal & Pathophysiology 1
other analytes are abnormal for gestational age. Pts w/ a Hx of irregular menses are at risk for inaccurate pregnancy dating. Nutrition (GI) (Patp)
369 von Willebrand disease Following endothelial dmg, vWF binds GPIb receptors on platelets to mediate platelet adherence. The RCoA measures platelet agglutination via binding of GPIb Gastrointestinal & Pathophysiology 7
receptors to vWF; it'll be abn in vWF defic but will correct w/ the addn of normal (vWF-containing) plasma. Nutrition (GI) (Patp)
375 Antiepileptics Phenytoin meta depends on the fxn of hepatic P450 oxidases and is dose-dependent. Drugs that induce hepatic microsomal enzymes (phenobarbital, carbamazepine, and Gastrointestinal & Pathophysiology 3
rifampin) enhance phenytoin meta and ↓ its serum conc. You should know all of the commonly-prescribed Rx that're meta by the P450 system, and you should know Nutrition (GI) (Patp)
which drugs induce or inhib the fxn of these enzymes.
391 Hepatitis B Acute hepB infection can cause a serum sickness-like syndrome w/ joint pain, LAD, and a pruritic urticarial rash. Other features may incl RUQ pain, hepatomegaly, and ↑ Gastrointestinal & Pathophysiology 14
hepatic TA lvls. Nutrition (GI) (Patp)
396 Acute liver failure Inhaled anesthetics, such as halothane, can be associated with a highly lethal fulminant hepatitis that cannot be distinguished histologically from acute viral hepatitis. Gastrointestinal & Pathophysiology 2
Patients have significantly elevated aminotransferase levels due to massive hepatocellular injury and a prolonged prothrombin time due to failure of hepatic synthetic Nutrition (GI) (Patp)
function.
402 Hepatitis B Replication of the hepatitis B genome occurs w/i a newly synthesized capsid through the action of reverse transcriptase on an RNA template. The mature capsid contains Gastrointestinal & Pathophysiology 14
partially ds circular DNA and reverse transcriptase. Nutrition (GI) (Patp)
408 Glomerular disorders MCD is the most common cause of nephrotic syndrome in children. Systemic T-cell dysfxn leads to the production of glomerular permeability factor, which causes Gastrointestinal & Pathophysiology 9
podocyte foot process fusion and ↓ the anionic properties of the GBM. The loss of (-) charge leads to selective albuminuria. Nutrition (GI) (Patp)
412 Hepatitis C The HCV is genetically unstable b/c it lacks proofreading 3’ → 5’ exonuclease activity in its RNA pol. Its env GP seqs also contain an HVR prone to freq genetic mut. Gastrointestinal & Pathophysiology 4
Nutrition (GI) (Patp)
433 Toxic megacolon Toxic megacolon is a well-recognised complication of UC. Pts typically present w/ abdo pain/distension, bloody diarrhoea, fever, and SSx of shock. Plain abdo XR is the Gastrointestinal & Pathophysiology 1
preferred Dx imaging study. Barium contrast studies and colonoscopy are c/i due to the risk of perforation. Nutrition (GI) (Patp)
441 Groin hernias The inf. epigastric vessels are useful as a landmark during lap hernia repair to classify the type of IH. IIHs protrude thru the DIR into the inguinal canal lat. to theinf. Gastrointestinal & Pathophysiology 3
epigastric vessels. In contrast, DIHs protrude thru Hesselbach's triangle med. to theinf. epigastric vessels. Nutrition (GI) (Patp)
828 Homocysteine ↑ lvls of plasma homocysteine are an independent RFx for thrombotic events. Homocysteine can be metabolized to methionine via remethylation or to cystathionine via Gastrointestinal & Pathophysiology 2
transsulfuration. Hyperhomocysteinemia is most commonly due to genetic mutations in critical enzymes or deficiencies of vitamin B12, vitamin B6, and folate. Nutrition (GI) (Patp)
1581 Hypovolemic shock Intravenous fluids increase the intravascular and left ventricular end-diastolic volumes. The increase in preload stretches the myocardium and increases the end-diastolic Gastrointestinal & Pathophysiology 1
sarcomere length, leading to an increase in stroke volume and cardiac output by the Frank-Starling mechanism. Nutrition (GI) (Patp)
1605 Portal hypertension The portal vein can be ID'd on cross-sectional scans lying med. to (or just w/i) the right lobe of the liver and ant. to the IVC. The pressure in the portal system is ↑ in liver Gastrointestinal & Pathophysiology 1
cirrhosis. Nutrition (GI) (Patp)
1662 Infectious mononucleosis EBV commonly infects B cells, stim them to proliferate continuously ('transformation' or 'immortalisation'). EBV is an oncogenic virus that promotes polyclonal B cell Gastrointestinal & Pathophysiology 5
proliferation and heterophile Ab production. The heterophile Ab test is sensitive and highly specific for EBV infection. Nutrition (GI) (Patp)
1907 Ovarian cancer Epithelial ovarian cancer is the most common ovarian malignancy. Histologic findings include anaplasia of epithelial cells with invasion into the stroma, along with Gastrointestinal & Pathophysiology 9
multiple papillary formations with cellular atypia. Epithelial ovarian tumors produce CA-125, which can be used as a serum marker for this condition. Nutrition (GI) (Patp)
11591 Physician patient Physicians should ask pts their preferred form of address. When in doubt, pts should be addressed formally unless they indicate otherwise when asked. Gastrointestinal & Pathophysiology 11
communication Nutrition (GI) (Patp)
11860 Cardiac catheterization The optimal site for obtaining vascular access in the lower extremity during cardiac catheterization is the common femoral artery below the inguinal ligament. Gastrointestinal & Pathophysiology 2
Cannulation above the inguinal ligament can significantly ↑ the risk of retroperitoneal hemorrhage. Nutrition (GI) (Patp)
12047 Coronary artery disease The inferior epigastric artery is 1 of 2 branches of the external iliac artery and takes off immediately proximal to the inguinal ligament. It provides blood supply to the Gastrointestinal & Pathophysiology 4
lower anterior abdominal wall as it runs superiorly and medially up the abdomen. Nutrition (GI) (Patp)
12068 Coronary blood flow Coronary dominance is determined by the coronary artery supplying the PDA. The PDA originates from the RCA in approximately 70%-80% of pts (right dominant), Gastrointestinal & Pathophysiology 9
both the RCA and LCX in 10%-20% (codominant), and the LCX in 5%-10% (left dominant). The dominant coronary artery supplies blood to the AV node via the AV Nutrition (GI) (Patp)
nodal artery.
15652 Diastolic dysfunction Prolonged systemic HTN leads to concentric LVH via the addition of myocardial contractile fibers in parallel. The thickening of the LV walls ↓ LV compliance, leading Gastrointestinal & Pathophysiology 4
to impaired diastolic filling and HF w/ preserved EF. In response to ↓ CO, the kidneys activate the RAAS, stimulating Na retention and vasoconstriction that worsens Nutrition (GI) (Patp)
volume overload and can lead to DHF.
164 Hypertrophic The dynamic LVOT obstruction that occurs in HCM worsens w/ ↓ LV volume, which can be caused by ↓ in cardiac preload a/o afterload. Therefore, Rx that ↓ venous Gastrointestinal & Pharmacology 9
cardiomyopathy return or SVR (DHP CCBs, NG) should generally be avoided. Nutrition (GI) (Phar)
165 Nitrates Pts taking daily maintenance nitrates need to have a nitrate-free period every day to avoid tolerance to the Rx. Gastrointestinal & Pharmacology 7
Nutrition (GI) (Phar)
175 Hyperaldosteronism Aldo excess will cause HTN, hypokalemia, meta alk, and depressed renin. Alt, hypoaldo-ism is the cause of RTA-IV. Aldo antags such as spironolactone or eplerenone Gastrointestinal & Pharmacology 5
can be used as med therapy for Conn syndrome. Nutrition (GI) (Phar)
309 Gastroesophageal reflux Metaplasia is the substitution of one differentiated cell type for another due to the presence of an adverse environmental stimulus. It is often seen in the bronchi of chronic Gastrointestinal & Pharmacology 7
disease cigarette smokers (substitution of columnar for stratified squamous cells) and the distal esophagus of patients with chronic gastroesophageal reflux (substitution of Nutrition (GI) (Phar)
stratified squamous with columnar cells). Metaplasia can lead to dysplasia and malignant transformation.
808 Hypothyroidism Hypothyroid myopathy presents w/ myalgias, prox. muscle weakness, ↑ CK lvls, and delayed relaxation of DTRs. The Dx can be confirmed w/ an ↑ TSH lvl. Other Gastrointestinal & Pharmacology 13
common causes of myopathy w/ ↑ CK lvls incl inflammatory myopathies, muscular dystrophies, and HMG-CoA reductase inhibs. Nutrition (GI) (Phar)
865 Myocardial infarction Fibrinolytic Thx for acute STEMI is a reasonable reperfusion technique for pts w/ no c/i to thrombolysis. Fibrinolytic agents such as alteplase bind to fibrin in the Gastrointestinal & Pharmacology 18
thrombus (clot) and activate plasmin, which leads to thrombolysis. The most common AEx of thrombolysis is hemorrhage (eg, GI, intracerebral). Nutrition (GI) (Phar)
1258 Normal distribution In a normal (bell-shaped) distribution: 68% of all values are w/i 1 SD from the mean; 95% of all values are w/i 2 SDs from the mean; 99.7% of all values are w/i 3 SDs Gastrointestinal & Pharmacology 3
from the mean. Nutrition (GI) (Phar)
1290 Defense mechanisms In displacement, emotions are transferred from the person causing the (-) emotions to a more neutral, less threatening person or object. Gastrointestinal & Pharmacology 8
Nutrition (GI) (Phar)
1709 Acyclovir IV acyclovir can cause crystalline nephropathy if adequate hydration isn't also provided. Gastrointestinal & Pharmacology 4
Nutrition (GI) (Phar)
1766 Ischemic stroke The ACAs supply the medial portions of the 2 hemispheres (frontal and parietal lobes). Occlusion can cause contralateral motor and sensory deficits of the lower Gastrointestinal & Pharmacology 19
extremities, behavioral changes, and urinary incontinence. Nutrition (GI) (Phar)
1778 Tetralogy of Fallot TOF results from anterior and cephalad deviation of the infundibular septum during embryologic development, resulting in a malaligned VSD w/ an overriding aorta. As a Gastrointestinal & Pharmacology 3
result. the pt has RV outflow obstruction (resulting in a systolic murmur) and squats to ↑ the peripheral SVR (afterload) and ↓ right-to-left shunting across the VSD. Nutrition (GI) (Phar)
1817 Thyroid cancer The ext branch of the sup laryngeal nerve is at risk of injury during thyroidectomy due to its prox to the sup thyroid art and vein. This nerve innervs the cricothyroid Gastrointestinal & Pharmacology 6
muscle. Nutrition (GI) (Phar)
6705 Emancipated minor Minors can consent for medical Tx in certain circumstances, including legal emancipation (eg, parent, married), emergency care, and specific conditions (eg, STI, Gastrointestinal & Pharmacology 1
pregnancy, substance abuse). Nutrition (GI) (Phar)
QID Topic
7584 Toxoplasmosis
10401 Study designs
10999 Intraventricular hemorrhage Neonatal IVH usually originates from the fragile germinal matrix in infants born before 32wks gestation a/o w/ birth weight <1.5kg (3lbs 5oz). It's a common
complication of prematurity that can lead to long-term neurodevel impairment.
11661 Spasticity
11739 Alcohol use disorder
14872 Tracheoesophageal fistula
14877 Brain tumors
14890 Sickle cell
15244 Lymphedema
126 Stress gastric ulcer
1251 Mucocutaneous candidiasis Nystatin is a polyene antifungal and the Rx of choice for oropharyngeal candidiasis in pts w/o advanced immunodeficiency. It acts by binding to ergosterol in the fungal
cell membrane, causing the formation of pores and leakage of fungal cell contents. Nystatin is not absorbed from the GIT and is administered as an oral "swish and
swallow" agent.
1319 Duchenne dystrophy
1358 Traumatic hemolytic
anemia
1546 Sunburn
1926 Methotrexate
1938 Allergic rhinitis
1971 Lyme disease
11830 Gallstone disease
1432 Urea cycle
8456 Renal artery stenosis
11515 Airway emergency
11847 Prostate cancer
995 Coronary blood flow
996 Coronary blood flow
1028 Osteoporosis
1248 Sensitivity, specificity,
positive predictive value
PPV, negative predictive
value NPV
1419 Active transport
1424 Glaucoma
1428 Sympathomimetic agents
1434 Parvovirus
1435 Epstein Barr virus
1436 Influenza
1437 Cellular transports
1482 Genetic code
2035 Femoral fracture
2037 Bacterial vaginosis
2044 Meningitis
11595 Impaired colleague
11916 Separation anxiety disorder SAD consists of excessive and distressing anxiety (>4wks in children, >6mos in adults) due to separation from attachment figures. Children w/ this disorder often
experience physical SSx and nightmares.
11930 Erectile dysfunction
12066 Nitrates
12278 Erectile dysfunction
1190 Typhoid
633 Diabetes mellitus
701 Asbestos
1412 Defense mechanisms
1418 Respiratory acidosis
Educational Objective System Subject Repeats
In patients with HIV, the presence of multiple ring-enhancing lesions with mass effect is most often indicative of toxoplasmosis, followed by primary central nervous Gastrointestinal & Pharmacology 5
system lymphoma. Nutrition (GI) (Phar)
In a crossover study, subjects are randomly allocated to a sequence of 2 or more Tx given consecutively. A washout (no Tx) period is often added b/w Tx intervals to limit Gastrointestinal & Pharmacology 6
the confounding effects of prior Tx. Nutrition (GI) (Phar)
Gastrointestinal & Pharmacology 1
Nutrition (GI) (Phar)
Baclofen, an agonist at the GABA-B receptor, is effective as monoThx for the Tx of spasticity 2° to both brain and spinal cord disease, including MS. Tizanidine, an α-2 Gastrointestinal & Pharmacology 1
adrenergic agonist, is also effective and commonly used. Nutrition (GI) (Phar)
The opioid antagonist naltrexone is a 1st-line Rx for mod-to-severe alcohol use disorder, and works by preventing the reinforcing effects of alcohol use. Gastrointestinal & Pharmacology 3
Nutrition (GI) (Phar)
TEF/EA results from failure of the primitive foregut to appropriately divide into separate trachea and esophageal structures. Infants Px shortly after birth w/ excessive Gastrointestinal & Pharmacology 1
secretions and choking/cyanosis during feeds. Nutrition (GI) (Phar)
The cerebellar hemispheres are responsible for motor planning and coordination of the ipsilateral extremities via their connections w/ the lateral descending motor Gastrointestinal & Pharmacology 10
systems. Consequently, cerebellar hemisphere lesions typically result in ipsilateral dysdiadochokinesia, limb dysmetria, a/o intention tremor. Nutrition (GI) (Phar)
Sickle cell disease is the result of a missense mutation that causes valine to replace glutamic acid at position 6 in the hemoglobin beta-globin chain. RNA contains the Gastrointestinal & Pharmacology 13
pyrimidine base uracil, whereas DNA contains the base thymidine. Nutrition (GI) (Phar)
Chronic lymphedema is most commonly caused by an acquired disruption of lymphatic drainage (eg, due to malignancy or lymphadenectomy), and typically presents with Gastrointestinal & Pharmacology 1
swelling and thickened skin in one or more extremities. Treatment is usually conservative and involves compression bandages and physiotherapy; diuretics are ineffective Nutrition (GI) (Phar)
and contraindicated.
Stress-related mucosal disease is usually caused by local ischemia in the setting of severe physiologic stress (e.g. shock, extensive burns, sepsis, severe trauma). Ulcers Gastrointestinal & Physiology 1
arising in the setting of severe trauma/burns are call Curling ulcers. Ulcers arising from intracranial injury are caused by direct vagal stim and are called Cushing ulcers. Nutrition (GI) (Phys)
Gastrointestinal & Physiology 3
Nutrition (GI) (Phys)
DMD is an XLR myopathy that MFx w/ prox. muscle weakness and enlargement of the calf muscles in boys age 2-5. It most often results from frameshift deletions Gastrointestinal & Physiology 2
affecting the dystrophin gene. Dystrophin provides a stabilising interaction b/w the sarcolemma and the intracellular contraction apparatus, and disruption of the protein Nutrition (GI) (Phys)
results in membrane dmg and myonecrosis.
RBC fragments, burr cells, and helmet cells are a/w either MAHA or mech red cell destruction. In pts w/ prosthetic valves, RBCs are exposed to excessive shear and Gastrointestinal & Physiology 2
turbulence in the circulation, causing dmg from mech trauma. Nutrition (GI) (Phys)
Pyrimidine dimers are formed in DNA as a result of ultraviolet light exposure. They are recognized by a specific endonuclease complex that initiates the process of repair Gastrointestinal & Physiology 1
by nicking the damaged strand on both sides of the pyrimidine dimer. The damaged segment is then excised, and replacement DNA is synthesized by DNA polymerase. Nutrition (GI) (Phys)
MTX is a vitB9 antagonist used to Tx ectopic preg. It competitively inhibs the enzyme DHFR, which catalyses the synthesis of THF. DHFR inhib causes the intermediate Gastrointestinal & Physiology 2
DHF to accumulate intracellularly. Nutrition (GI) (Phys)
First-generation antihistamines are nonspecific and interact with multiple receptors, including the muscarinic receptor. This leads to anticholinergic effects (eg, fever, Gastrointestinal & Physiology 2
flushing, mydriasis, urinary retention, tachycardia, altered mental status). Nutrition (GI) (Phys)
Early Lyme disease causes flu-like symptoms and erythema chronicum migrans. The second stage of Lyme disease may involve atrioventricular block and facial palsy. Gastrointestinal & Physiology 3
Late Lyme disease can cause chronic asymmetric large joint arthritis and encephalopathy. Lyme disease is easily treated with doxycycline or penicillin-type antibiotics Nutrition (GI) (Phys)
(eg, ceftriaxone).
Medical therapy to dissolve cholesterol gallstones is an option in patients refusing cholecystectomy or with high surgical risk. Hydrophilic bile acids (eg, ursodeoxycholic General Principles (GP) Anatomy (Anat) 8
acid) improve cholesterol solubility by reducing the amount of cholesterol secreted into the bile and increasing biliary bile acid concentration.
Ornithine transport into mitochondria is necessary for proper fxn of the urea cycle, which is the major disposal pathway for waste N generated by catabolism of AAs. Urea General Principles (GP) Behavioral 3
cycle defects typically cause neuro dmg due to the accumulation of NH3. Protein restriction improves this condition by ↓ the amount of AA turnover. Science (Beha)
In unilateral RAS, the narrowed renal artery causes hypoperfusion of the affected kidney w/ subseq ischemic dmg (e.g. tubular atrophy, interstitial ischemia, glomerular General Principles (GP) Behavioral 9
crowding). In contrast, the contralateral kidney is exposed to high BP and typically shows changes of HTN nephrosclerosis (e.g. arteriolar wall thickening due to hyaline Science (Beha)
or hyperplastic arteriolosclerosis).
Cricothyrotomy is indicated when an emergency airway is required and orotracheal or nasotracheal intubation is either unsuccessful or contraindicated. The General Principles (GP) Behavioral 1
cricothyrotomy incision passes through the superficial cervical fascia, pretracheal fascia, and the cricothyroid membrane. Science (Beha)
Imaging of bone mets assists in ca Dx. Bone mets are characterised as osteolytic or osteoblastic. Bony pain in an older man w/ osteoblastic lesions on imaging is highly General Principles (GP) Behavioral 5
suspicious for prostate ca. Science (Beha)
The high systolic intraventricular pressure and wall stress of the LV prevent myocardial perfusion during systole; therefore, the majority of LV myocardial perfusion General Principles (GP) Biochemistry 9
occurs during diastole. Shorter duration of diastole is the major limiting factor for coronary blood supply to the LV myocardium during periods of tachycardia (e.g. (Bioc)
exercise).
↑ in resting blood flow to ischemic myocardium are primarily mediated by locally-acting substances (eg, adenosine, NO) that trigger coronary arteriolar vasodilation. Rx General Principles (GP) Biochemistry 9
arteriolar vasodilators (eg, adenosine, dipyridamole) mimic the vasodilation that occurs w/ exercise and may cause redistribution of blood flow from ischemic to (Bioc)
nonischemic areas of myocardium, so-called coronary steal.
Patients with osteoporosis have low bone mass, resulting in increased susceptibility to fragility fractures (ie, those occurring with minimal or no trauma). In primary General Principles (GP) Biochemistry 10
osteoporosis (not caused by a medical disorder), serum calcium, phosphorus, and parathyroid hormone levels are typically normal. (Bioc)
The PPV of a test answers the question: If the test result is (+), what is the probability that a pt has the disease? PPV = TPs / (TPs + FPs). General Principles (GP) Biochemistry 4
(Bioc)
Parietal cells release H ions into the gastric lumen by means of the H/K ATPase, which reqs hydrolysis of ATP and is therefore an active transport mech. Omeprazole and General Principles (GP) Biochemistry 1
other PPIs suppress the activity of the gastric parietal cell H/K ATPase leading to an ↑ in the pH of the gastric lumen. (Bioc)
OAG is Chx by progressive loss of peripheral vision from ↑ IOP. Timolol and other nonselective β blockers work by diminishing the secretion of aqueous humor by the General Principles (GP) Biochemistry 3
ciliary epithelium. Acetazolamide, a CAI, also ↓ aqueous humor secretion by the ciliary epithelium. PGF2α (eg, latanoprost, travoprost) and cholinomimetics (eg, (Bioc)
pilocarpine, carbachol) ↓ IOP by ↑ the outflow of aqueous humor.
NE stim cardiac β1 adrenoceptors, which ↑ cAMP concentration w/i cardiac myocytes and leads to ↑ contractility, conduction, and HR. Peripheral vasoconstriction occurs General Principles (GP) Biochemistry 5
via stim of α1 adrenoreceptors in vascular smooth muscle cells and activation of an IP3 signalling pathway. (Bioc)
Infection w/ PVB19 (a nonenveloped ss DNA virus) can cause arthralgia +/- rash in adults. An infected fetus may develop hydrops fetalis (severe anemia, HF, pleural General Principles (GP) Biochemistry 3
effusions, pericardial effusions, and ascites). (Bioc)
The initial attachment of the virion envelope or capsid surface proteins to the complementary host cell surface receptors is essential to viral tropism for specific tissues and General Principles (GP) Biochemistry 1
invasion of cells. Many viruses bind to normal host cell plasma membrane receptors to enter host cells. Known host cell receptor and virion/virion protein binding (Bioc)
specificities include: CD4 with HIV gp120, CD21 with Epstein-Barr virus gp350, and erythrocyte P antigen with parvovirus B19.
Alc-based disinfectants kill enveloped viruses (eg, influenza) by dissolving their outer lipid envelope. Nonenveloped viruses are less susceptible to some Alc-based General Principles (GP) Biochemistry 5
disinfectants b/c they have no lipid envelope to target. (Bioc)
Carrier-mediated transport includes facilitated diffusion and active transport. Movement of substrate across the cell membrane by these mechanisms depends on the General Principles (GP) Biochemistry 2
presence of carrier proteins that can become saturated at high substrate concentrations. (Bioc)
Translation of the mRNA template proceeds in the 5' to 3' direction. B/c complementary sequences align in antiparallel fashion, during translation tRNA anticodons will General Principles (GP) Biochemistry 1
be oriented in the opposite 3' to 5' direction. Stop codons (UAA, UAG, and UGA) halt protein synthesis by binding a RF; they do not add AAs to the polypeptide chain. (Bioc)
The med. FCX artery and its branches provide the majority of the blood supply to the femoral head and neck. Injury to these vessels due to a displaced femoral neck General Principles (GP) Biochemistry 1
fracture can cause ON of the femoral head. (Bioc)
Bacterial vaginosis is a vaginal infection diagnosed by the presence of clue cells and a positive amine "whiff" test with potassium hydroxide (KOH). The pathogenesis General Principles (GP) Biochemistry 3
involves a loss of lactobacilli in the normal vaginal flora and overgrowth of Gardnerella vaginalis. It is treated with clindamycin or metronidazole. (Bioc)
Fever; meningeal SSx (e.g. h/a, neck stiffness); and CSF that shows lymphocytic pleocytosis, a modestly incr protein lvl, and normal Glc are suggestive of aseptic General Principles (GP) Biochemistry 17
meningitis. Enteroviruses are the most common cause of aseptic meningitis. (Bioc)
Physicians are ethically and legally obligated to report impaired colleagues in a timely manner. Reporting protects pt safety and can assist the impaired physician in General Principles (GP) Biochemistry 1
receiving appropriate evaluation and Tx. (Bioc)
General Principles (GP) Biochemistry 1
(Bioc)
The prostatic plexus lies within the fascia of the prostate and innervates the corpus cavernosa of the penis, which facilitates penile erection. As a result, prostatectomy or General Principles (GP) Biochemistry 3
injury to the prostatic plexus can cause erectile dysfunction. (Bioc)
Nitrates are primarily venodilators and increase peripheral venous capacitance, thereby reducing cardiac preload and left ventricular end-diastolic volume and pressure. General Principles (GP) Biochemistry 7
Nitrates also have a modest effect on arteriolar dilation and cause a decrease in systemic vascular resistance and cardiac afterload. (Bioc)
Premature ejaculation is characterised by recurrent episodes of early ejaculation accompanied by a sense of lack of control. Eval of any sexual disorder req taking careful General Principles (GP) Biochemistry 3
med and substance use Hx and Ax psychosocial stressors and comorbid psych conditions. (Bioc)
Typhoid fever is caused by S. typhi or paratyphi and presents w/ escalating fever, f/b abdo pain, formation of rose spots on the chest/abdo, and hemorrhagic enteritis w/ General Principles (GP) Biostatistics 2
possible bowel perforation. Humans are the only reservoir; transmission is faecal-oral and 1arily occurs due to ingestion of food or water contaminated w/ faeces. (Bios)
TZDs (e.g. pioglitazone) can cause fluid retention, leading to peri oedema and weight gain. The excess fluid can potentially exacerbate underlying CHF. General Principles (GP) Genetics (Gene) 31
Asbestos-related pleural disease is characterised by pleural plaques (focal pleural thickening, typically w/ calcifications). Common occup exposures incl shipbuilding, General Principles (GP) Genetics (Gene) 5
insulation manufacturing and application, and drywall application. Most affected pts remain aSSx for 20-30yrs following initial exposure.
Suppression is a mature defence mech involving a conscious choice not to dwell on a particular thought or feeling. General Principles (GP) Genetics (Gene) 8
Resp acid Px w/ a low pH and a high PaCO2. HCO3- initially remains w/i the normal range, but becomes incr over hrs to dys as renal comp develops. General Principles (GP) Genetics (Gene) 1
QID Topic
1438 Body fluid distribution
1472 Mutations
1486 tRNA wobble
1487 Hypokalemia
1610 Respiratory physiology
1727 Thyroid cancer
1790 Drug metabolism and
clearance
1970 Parvovirus
2015 Mitochondrial disorders
2025 Hyperthyroidism
2027 Essential tremor
2029 Primary hypertension
2030 Urethritis
2031 Syphilis
2033 ITP
2042 Multiple myeloma
7791 Cephalosporins
8328 Renal calculi
11904 Epistaxis
11913 Transplant rejection
11914 Alcohol use disorder
11960 Attention deficit
hyperactivity disorder
12263 Osteomyelitis
1417 Macular degeneration
1473 Hemoglobin properties
542 Hypothyroidism
746 Dyslipidemia
1756 Ischemic stroke
11674 Physician patient
communication
12299 Uterine fibroids
1592 Cholecystitis
297 Aspergillosis
1801 Behavioural responses
852 Atheroembolism
1365 Power and sample size
1707 Peripheral neuropathy
1708 Herpes zoster
1710 Foscarnet
1711 Cytomegalovirus
1712 Acyclovir
1713 Cytomegalovirus
1714 Cytomegalovirus
1715 Influenza
1716 Influenza
1869 Iron deficiency anemia
2112 mRNA processing and
regulation
8523 Pleural effusion
11567 Iron deficiency anemia
11678 Medical errors
Educational Objective System Subject Repeats
Volume contraction and expansion can be divided into isosmotic, hyposmotic, and hyperosmotic states. Hyperosmotic volume contraction is caused by a loss of free water General Principles (GP) Genetics (Gene) 1
(w/ retention of electrolytes). It can occur in pts w/ DI or as a result of ↓ fluid intake/excessive sweating.
Deletion or addn of a # of bases that's not divisible by 3 in the coding region of a gene will cause a frameshift mut. Frameshift muts alter the reading frame of the genetic General Principles (GP) Genetics (Gene) 3
code, resulting in the formation of nonfxnal proteins.
The genetic code is considered "degenerate" because more than 1 codon can code for a particular amino acid. Some of this degeneracy is explained by the wobble General Principles (GP) Genetics (Gene) 1
hypothesis, which states that the first 2 nucleotide positions on the mRNA codon require traditional (Watson-Crick) base pairing, whereas the third "wobble" nucleotide
position may undergo less stringent (nontraditional) base pairing.
Thiazide diuretics decrease intravascular fluid volume, which stimulates aldosterone secretion and leads to increased excretion of potassium and hydrogen ions in the General Principles (GP) Genetics (Gene) 2
urine. This results in hypokalemia and metabolic alkalosis.
The pO2 in the LA and LV is lower than that in the pulm caps due to mixing of oxy blood from the pulm veins w/ deoxy blood from the bronchial circulation and General Principles (GP) Genetics (Gene) 8
thebesian veins.
PTC is the most common type of thyroid ca. ChFx on histopath incl large cells w/ nuclei containing finely disperse chromatin, giving an empty or ground-glass General Principles (GP) Genetics (Gene) 6
appearance (Orphan Annie eye), and intranuclear inclusions or grooves.
In first-order kinetics, a constant fraction (or proportion) of drug is metabolized per unit of time, so the amount metabolized changes based on the serum concentration. In General Principles (GP) Genetics (Gene) 2
zero-order kinetics, a constant amount of drug is metabolized per unit of time, independent of serum levels.
PVB19 causes erythema infectiosum (5th disease) in children and arthritis in adults. PV arthritis can mimic RA but is usually self-resolving. General Principles (GP) Genetics (Gene) 3
The presence of lactic acidosis and ragged skeletal muscle fibers histologically suggests a mitochondrial myopathy. Variable clinical expressions in affected family General Principles (GP) Genetics (Gene) 4
members can occur due to heteroplasmy, which is the coexistence of distinct versions of mitochondrial genomes in an individual cell.
Hyperthyroidism causes a hyperadrenergic state Chx by HTN, palpitations/tachycardia, sweating, heat intolerance, tremor, and hyperreflexia. β blockers can relieve these General Principles (GP) Genetics (Gene) 8
SSx. Exophthalmos in Graves disease is due to an immune-mediated ↑ in orbital soft tissue mass and does not improve w/ β blockers.
Essential tremor is the most common movement disorder. Pts experience a slowly progr, symmetric postural a/o kinetic tremor that most commonly affects the upper General Principles (GP) Genetics (Gene) 1
extremities. Essential tremor is often inherited in an AD fashion (referred to as familial tremor). 1st-line Tx is the nonspecific β-adrenergic antagonist propranolol.
β blockers inhibit release of renin from renal juxtaglomerular cells through antagonism of β1 receptors on these cells. Inhibition of renin release prevents activation of the General Principles (GP) Genetics (Gene) 14
RAA pathway, which results in ↓ vasoconstriction and ↓ renal Na and water retention.
Gonorrhoea can cause urethritis (dysuria and purulent urethral d/c). The NAAT is the Dx tool of choice. Gram stain showing gram (-), intracellular diplococci is also Dx. General Principles (GP) Genetics (Gene) 4
Dual therapy w/ ceftriaxone and azithromycin is the 1st-line Tx due to concerns about resistance and chlamydia coinfection.
Penicillins, structurally similar to D-alanine-D-alanine, inhibit transpeptidase by binding covalently to its active site. The result is failed synthesis of the bacterial General Principles (GP) Genetics (Gene) 9
peptidoglycan cell wall.
Autoimmune platelet destruction is a common cause of thrombocytopaenia and should be suspected in pts w/ ecchymoses, petechiae, mucosal bleeding, and no other obvi General Principles (GP) Genetics (Gene) 1
causes of thrombocytopaenia (e.g. Rx, bone marrow failure).
The finding of a high peak in the γ-globulin region on SPEP usually represents an M protein consisting of an overproduced monoclonal Ig. MM causes an M protein peak General Principles (GP) Genetics (Gene) 9
on SPEP as well as anaemia (weakness), lytic bone lesions (back pain, path fractures), and renal insufficiency (related to amyloid deposition and hypercalcaemia).
Penicillins and cephalosporins fxn by irreversible binding to PBPs such as transpeptidases. General Principles (GP) Genetics (Gene) 2
Staghorn calculi are large renal stones that take on the shape of the renal calyces. They're composed 1arily of struvite (MgNH4PO4) and are a/w recurrent upper UTIs by General Principles (GP) Genetics (Gene) 7
urease-producing organisms (e.g. Proteus, Klebsiella). Hydrolysis of urea yields NH3, which alkalinises the urine and facilitates precipitation of struvite crystals.
Epistaxis is commonly caused by irritation of the highly vascular mucosa at the anterior nasal septum. The anterior nasal septum contains the Kiesselbach plexus. The General Principles (GP) Genetics (Gene) 1
anterior ethmoidal, sphenopalatine, and superior labial arteries anastomose in this region.
Sirolimus binds to the immunophilin FKBP in the cytoplasm, forming a complex that binds and inhibits mTOR (mammalian target of rapamycin). Inhibition of mTOR General Principles (GP) Genetics (Gene) 4
signaling blocks IL-2 signal transduction and prevents cell cycle progression and lymphocyte proliferation.
Behavioural change often happens in 5 distinct stages: precontemplation (denial of the problem), contemplation (acceptance of the problem and thinking about change), General Principles (GP) Genetics (Gene) 3
prep (planning to make a change in the near future), action (putting active changes into place), and maintenance (maintaining change over the long term).
↓ appetite and insomnia are the most common AEs of psychostimulant Rx used to Tx ADHD. They're usually mild and can be Mx w/o stopping the Rx. General Principles (GP) Genetics (Gene) 5
Vertebral osteomyelitis should be suspected in patients with new or worsening back pain, fever, and recent endocarditis or bacteremia (especially Staphylococcus aureus). General Principles (GP) Genetics (Gene) 4
It should also be suspected if there are new neurologic findings and fever with or without back pain. MRI of the spine is preferred for diagnosis.
A scotoma is a visual field defect that occurs due to a pathologic process that involves parts of the retina or the optic nerve resulting in a discrete area of altered vision General Principles (GP) Histology (Hist) 2
surrounded by zones of normal vision. Lesions of the macula cause central scotomas.
The individual subunits of the Hb molecule are structurally analogous to Mb. If separated, the monomeric subunits will demo a hyperbolic O2 dissociation curve similar to General Principles (GP) Histology (Hist) 4
that of Mb.
Hypothyroidism and NDI are the most common AEs of long-term lithium therapy. Serum TSH and renal fxn (BUN and creatinine) should be monitored routinely. General Principles (GP) Immunology 13
(Immu)
Tx w/ statins causes hepatocytes to ↑ their LDL receptor density, leading to ↑ uptake of circulating LDL. General Principles (GP) Immunology 11
(Immu)
Upper motor neuron lesions (ie, internal capsule stroke) cause contralateral weakness with clasp knife spastic rigidity, hyperreflexia, and a positive Babinski sign. These General Principles (GP) Immunology 19
lesions damage the pyramidal motor system (eg, corticospinal tracts), which runs from the precentral gyrus (primary motor cortex) through the internal capsule to the (Immu)
brainstem and spinal cord.
Physicians should remain alert to pts w/ a low level of literacy as this can often impair communication and result in low-quality medical care and poor adherence. General Principles (GP) Immunology 11
Alternate learning methods (eg, visual resources) should be used to address this challenge. (Immu)
Subserosal leiomyomas (fibroids) often cause irregular uterine enlargement, resulting in pelvic pressure. Fibroids arising from the posterior subserosal surface of the General Principles (GP) Immunology 1
uterus can cause constipation due to pressure on the colon. (Immu)
Gallstone ileus results from passage of a large gallstone thru a cholecystenteric fistula into the small bowel, where it ultimately causes obstr at the ileum. Pts typically General Principles (GP) Microbiology 5
present w/ SSx of SBO, and an AXR may reveal gas w/i thegallbladderandbiliary tree. (Micr)
Amphotericin B binds the ergosterol of fungal cell membranes to exert its antifungal effects. However, it also binds chol to some degree, causing tox to human tissues. General Principles (GP) Pathology (Path) 5
The most important AEs of amphotericin B are nephrotox, hypokalaemia, and hypomagnesaemia.
Classical conditioning involves a neutral stim being repeatedly paired w/ a non-neutral stim that elicits a reflexive, unconditioned response. Over time, the formerly General Principles (GP) Pathology (Path) 1
neutral stim is able to evoke a conditioned response by itself in absence of the non-neutral stim.
Invasive vascular procedures can be complicated by atheroembolic disease, which may involve the kidneys, GIT, CNS, and the skin. LM show a partially or completely General Principles (GP) Pharmacology 2
obstructed arterial lumen w/ needle-shaped chol clefts w/i the atheromatous embolus. (Phar)
A study's power ↑ as its sample size ↑. Therefore, the larger the sample, the greater the ability of a study to detect a difference when one truly exists. General Principles (GP) Pharmacology 3
(Phar)
Injections given in the superomedial part of the buttock risk injury to the sup. gluteal nerve. Injections into the superomedial, inferomedial, and inferolateral regions of the General Principles (GP) Pharmacology 3
buttock risk injury to the sciatic nerve. The superolateral quadrant of the buttock is a relatively safe site for intragluteal injections, although the anterolateral gluteal region (Phar)
is preferred.
Acyclovir, the acyclovir prodrug valacyclovir, famciclovir, and ganciclovir are all nucleoside analogues that require both herpes viral and cellular kinases for conversion General Principles (GP) Pharmacology 4
to their active nucleoside triphosphate form. Cidofovir is a nucleoside monophosphate (ie, a nucleotide) that requires only cellular kinases for activation. (Phar)
Foscarnet is an analogue of PPi that can chelate Ca2+ and promote nephrotox renal Mg wasting. These tox can result in hypocalcaemia and hypomagnesaemia, which can General Principles (GP) Pharmacology 1
cause seizures. (Phar)
Of all the antiviral agents that bind and inhib DNA polymerase in herpesvirus and reverse transcriptase in HIV, the PPi analogue foscarnet is 1 of few that don't req General Principles (GP) Pharmacology 9
intracellular activation by viral or cellular kinases. (Phar)
Monophosphorylation of acyclovir by a viral thymidine kinase is the 1st (and RLS) step in conversion of acyclovir to its active triphosphate form. Acyclovir and related General Principles (GP) Pharmacology 4
drugs (e.g. famciclovir, valaciclovir) are more effective against HSV and VZV than CMV and EBV. (Phar)
CMV retinitis is the most common cause of ocular disease in pts w/ unTx AIDS who have CD4 counts <50/mm3. Dx is made by funduscopy, which typically reveals General Principles (GP) Pharmacology 9
yellow-white, fluffy retinal lesions near the retinal vessels w/ associated hemorrhage. Tx w/ ganciclovir is required to prevent blindness. (Phar)
1st-line therapy for CMV colitis and retinitis is ganciclovir. This Rx inhibs viral synthesis by blocking CMV DNA polymerase. However, ganciclovir also blocks host General Principles (GP) Pharmacology 9
DNA polymerase to a lesser degree, which can lead to heme AEs such as neutropaenia, anaemia, and thrombocytopaenia. (Phar)
Oseltamivir is a neuraminidase inhib useful in the Tx and prevention of both influenza A and B virus infections. This Rx impairs the release of newly formed virions from General Principles (GP) Pharmacology 5
infected host cells and impairs viral penetration of mucous secretions that overlie the resp epithelium. (Phar)
Major adaptive immune mechs that prevent reinfection w/ the influenza virus incl anti-hemagglutinin Abs. General Principles (GP) Pharmacology 5
(Phar)
↑ bone marrow EPO results in an accelerated release of immature RBCs (reticulocytes) into the bloodstream. Reticulocytes contain bluish cytoplasm and reticular General Principles (GP) Pharmacology 7
precipitates of residual ribosomal RNA. (Phar)
When mRNA is first transcribed from DNA, it is in an unprocessed form called pre-mRNA or heterogeneous nuclear mRNA (hnRNA). Several processing steps are General Principles (GP) Pharmacology 1
required before finalized mRNA molecules can leave the nucleus, including 5'-capping, poly A tail addition, and intron splicing. Cytoplasmic P bodies play an important (Phar)
role in mRNA translation regulation and mRNA degradation.
Fluid in the pleural space acts to insulate sound vibrations that originate in the airways; therefore, pleural effusion causes ↓ tactile fremitus and ↓ intensity of breath General Principles (GP) Pharmacology 4
sounds. The high density of pleural fluid compared to normal lung tissue also causes dullness to percussion. (Phar)
Pica is the compulsive consumption of a non-nutritive a/o non-staple food. It's common in preg and is often a/w IDA and other forms of nutritional defic. General Principles (GP) Pharmacology 7
(Phar)
Sleep deprivation in physicians often causes cognitive impairment, resulting in medical errors. Although mandated resident work-hr limitations are in place, it is the General Principles (GP) Pharmacology 8
responsibility of all physicians to self-regulate their workloads to promote pt safety. (Phar)
QID Topic Educational Objective System Subject Repeats
11740 Multiple myeloma In MM, neoplastic plasma cells synthesise large amount of monoclonal Ig or Ig fragments. These cells are particularly susceptible to proteasome inhib due to the large General Principles (GP) Pharmacology 9
amount of proteins that they manufacture. The resulting accumulation of tox intracellular and pro-apoptotic proteins ↑ cellular apoptosis. (Phar)
15941 Chronic heart failure LHF leads to chronically ↑ pulm venous and capillary pressures, w/ resulting pulm oedema and extravasation of RBCs into the alveolar parenchyma. The Fe from RBCs is General Principles (GP) Pharmacology 12
taken up by alveolar macrophages and stored as hemosiderin, appearing as brown pigment on histopathology. (Phar)
757 Rheumatic fever Acute rheumatic fever is an autoimmune reaction following an untreated group A streptococcal pharyngitis. Anti-group A Streptococcus antibodies (eg, anti-M protein, General Principles (GP) Physiology 5
anti-N-acetyl-β-D glucosamine) cross-react and attack cardiac and central nervous system antigens. (Phys)
1378 Leprosy The lepromin skin test will be (+) w/ Tb leprosy as they exhibit a strong CD4+ Th1 cell-mediated immune response to M. leprae. Pts w/ lepromatous leprosy will test (-) General Principles (GP) Physiology 2
due to their weak Th1 cell-mediated immune response. (Phys)
1616 Respiratory mucosa Most inhaled particles that lodge in the bronchial tree are removed via prox transport by ciliated epithelial cells (mucociliary clearance). Mucus-secreting cells are present General Principles (GP) Physiology 4
to the lvl of the larger bronchioles, after which club cells become the prominent secretory cell type. (Phys)
12024 Roseola infantum HHV-6 infection (roseola) classically presents w/ fever for 3-5days f/b a truncal rash. It's also the most common cause of febrile seizures. General Principles (GP) Physiology 1
(Phys)
1631 Diabetes insipidus NPs are carrier proteins for Oxy and ADH. Oxy and ADH are carried by unique NPs from their site of prod in the cell bodies of the PVN and SON to their site of release Hematology & Anatomy (Anat) 4
in the axon terminals of the post pit. Point muts in NP-II underlie most cases of HHDI, a disorder resulting from insuff ADH release into the syst circulation. Oncology (HO)
346 Embryology, Meckel A # of ectopic tissues are found in Meckel diverticulum - most commonly, gastric epithelium. Gastric mucosa is present in 80% of cases of SSx Meckel diverticulum. Hematology & Biochemistry 1
Gastric acid production leads to ulceration and subsequent bleeding. Oncology (HO) (Bioc)
868 Cherry angioma Cherry hemangiomas are small, red, cutaneous papules common in aging adults. They don't regress spontaneously and typically ↑ in # w/ age. LM of these lesions shows Hematology & Biochemistry 1
proliferation of caps and post-cap venules in the papillary dermis. Oncology (HO) (Bioc)
1020 Skin and soft tissue Hot tub folliculitis is a superficial and self-limited Pseudomonas aeruginosa infection of the hair follicles that tends to occur in minor outbreaks following exposure to a Hematology & Biochemistry 8
infections pool or spa in which the chemicals have not been maintained at appropriate concentrations. Pseudomonas are gram negative, oxidase-positive, nonlactose-fermenting, Oncology (HO) (Bioc)
motile rods that produce green pigment.
1029 Hypothyroidism 1° hypoTH-ism is char by ↓ T4 lvls and ↑ TSH. T3 is 1°ly prod by conversion from T4 in peri tissues; serum lvls widely fluctuate due to its short ½ life, and can often be Hematology & Biochemistry 13
w/I the normal range in pts w/ hypoTH-ism. Oncology (HO) (Bioc)
1035 Multiple endocrine MEN-2B is characterised by MTC, PCCs, mucosal neuromas, and Marfanoid habitus. HPT isn't a feature of this syndrome. Hematology & Biochemistry 5
neoplasia Oncology (HO) (Bioc)
1036 Gluconeogenesis In a fasting state, glucagon and EPI bind to transmembrane receptors and prevent hypoglycaemia by ↑ hepatic glycogenolysis and GNG. Prolonged fasting ↑ the secretion Hematology & Biochemistry 4
of cortisol, a steroid hormone that binds to an intracellular receptor and acts to ↑ transcription of enzymes involved in GNG, lipolysis, and proteolysis. Oncology (HO) (Bioc)
1037 Vitamin D deficiency Sunlight exposure catalyzes conversion of 7-dehydrochol to vit D3 in the skin. Subseq 25-hydroxylation in the liver and 1-hydroxylation in the kidneys prod 1,25-OH2 vit Hematology & Biochemistry 4
D, the active form. Inadequate exposure to sunlight can lead to vit D defic. Oncology (HO) (Bioc)
1240 Risk Risk is the probability of developing a disease over a certain period of time. To calculate this probability, divide the number of affected subjects by the total number of Hematology & Biochemistry 6
subjects in the corresponding exposure group. Oncology (HO) (Bioc)
1241 Risk The attributable risk percent (ARP) in the exposed represents the excess risk in the exposed population that can be attributed to the risk factor. It can be easily derived Hematology & Biochemistry 6
from the relative risk (RR) using the formula: ARP exposed = 100 [(RR - 1)/RR). Oncology (HO) (Bioc)
1242 Risk, rate, prevalence, and Prevalence equals the incidence rate multiplied by the average disease duration. Changing disease prevalence in a steady-state population w/ a constant incidence rate Hematology & Biochemistry 3
incidence means that there is an additional factor affecting the duration of the condition. A factor that prolongs disease duration (eg, improved quality of care) will ↑ disease Oncology (HO) (Bioc)
prevalence, as affected pts survive longer.
1243 Confounding, effect In prospective studies, disproportionate loss to f/u b/w the exposed and unexposed groups creates the potential for attrition bias, which is a form of selection bias. As a Hematology & Biochemistry 3
modification, bias, errors result, investigators generally try to achieve high pt f/u rates in prospective studies. Oncology (HO) (Bioc)
1337 Risk The concept of accumulation effect can be applied to disease pathogenesis and exposure to risk modifiers. Cumulative exposure to a RFx or risk reducer must sometimes Hematology & Biochemistry 6
occur for prolonged periods before a clinically significant effect is detected. Oncology (HO) (Bioc)
1338 Central tendency (mean, The median is the value that is located in the precise center of an ordered dataset. It separates the right half of the data from the left half. Hematology & Biochemistry 2
median, mode, outliers) Oncology (HO) (Bioc)
1384 Myasthenia gravis Exacerbation of MG in a pt Tx w/ long-acting AChEIs (e.g. pyridostigmine) occurs due to myasthenic or cholinergic crisis. The edrophonium (Tensilon) test helps to Hematology & Biochemistry 10
diffiate these 2 conditions. Clinical improvement after edrophonium admin indicates that the pt is under-Tx (myasthenic crisis). Oncology (HO) (Bioc)
1385 Anticholinergics Anticholinergic agents (e.g. atropine, scopolamine) competitively inhib ACh at the mAChR. The effects can be memorised w/ the mnemonic, 'blind as a bat, mad as a Hematology & Biochemistry 3
hatter, red as a beat, hot as a hare, dry as a bone, full as a flask, and fast as a fiddle,' and can be reversed by AChEIs (physostigmine). Oncology (HO) (Bioc)
1387 Organophosphate poisoning OPs inhibit AChE in both muscarinic and nicotinic cholinergic synapses, leading to ↓ ACh degradation and over-stim of the corresponding receptors. Atropine reverses Hematology & Biochemistry 2
muscarinic effects but doesn't prevent the devel of nicotinic effects such as muscle paralysis. Pralidoxime is a AChE-reactivating agent that allows for degradation of Oncology (HO) (Bioc)
excess ACh and Tx both the muscarinic and nicotinic effects of OPs.
1413 Benzodiazepines When benzos are used in the Tx of anxiety, drug selection should consider the Rx's duration of action. Short- to intermediate-acting benzos (e.g. lorazepam) are pref in Hematology & Biochemistry 6
situations in which prolonged AEs of sedation and cognitive impairment must be minimalised. Oncology (HO) (Bioc)
1415 GFR The net filtration pressure is calculated by the following equation: NFP = (Pc- Pi) - (πc- πi). Hematology & Biochemistry 6
Oncology (HO) (Bioc)
1416 Cellular transports Transport of Glc into the cells of most tissues occurs by means of fac diffusion. Glc moves from areas of high conc to areas of low conc w/ the help of transmembrane Hematology & Biochemistry 2
GLUT. These carrier proteins are stereoselective and have pref for D-Glc. Oncology (HO) (Bioc)
1455 Clostridial myonecrosis Clostridium perfringens causes late-onset food poisoning and clostridial myonecrosis (gas gangrene). The food poisoning is toxin-mediated, late-onset, and causes Hematology & Biochemistry 3
transient watery diarrhea. Oncology (HO) (Bioc)
1456 Clostridial myonecrosis Lecithinase, also known as alpha toxin, is the main toxin produced by Clostridium perfringens. Its function is to degrade lecithin, a component of cellular phospholipid Hematology & Biochemistry 3
membranes, leading to membrane destruction, cell death, and widespread necrosis and hemolysis. Oncology (HO) (Bioc)
1470 HSV infection 1° HSV-1 infection in children causes gingivostomatitis (vesicular lesions on the lips and hard palate). HSV-1 and other herpesviruses are enveloped dsDNA viruses. Hematology & Biochemistry 9
Oncology (HO) (Bioc)
1838 X-linked X-linked agammaglobulinemia is characterized by low or absent circulating CD19+ and CD20+ B cells and pan-hypogammaglobulinemia. Affected patients have Hematology & Biochemistry 2
agammaglobulinemia increased susceptibility to pyogenic bacteria, enteroviruses, and Giardia lamblia due to the absence of opsonizing and neutralizing antibodies. Oncology (HO) (Bioc)
1847 Tuberculosis INH can be directly hepatotox, causing acute, mild hepatic dysfxn in 10-20% of pts and frank hepatitis (fever, anorexia, and nausea, sometimes progressing to hepatic Hematology & Biochemistry 18
failure) in a small % of pts. Oncology (HO) (Bioc)
1905 Septic arthritis A high synovial fluid leucocyte count (>100k/mm3) and absent crystals on micro Ex strongly suggest bacterial joint infection. SA req Abx Tx to prevent joint destruction, Hematology & Biochemistry 4
OM, and sepsis. Oncology (HO) (Bioc)
2032 Hemophiliacs Hemophilia is an XLR coagulopathy that Px w/ IM hemorrhage, hemarthrosis, and delayed bleeding after procedures. LFx show PTT prolongation; other tests of Hematology & Biochemistry 2
hemostatic fxn are generally normal. Oncology (HO) (Bioc)
2043 Malaria Chloroquine is the TOC for uncomplicated malaria contracted in a chloroquine-sen geographic region. It eliminates susceptible erythrocytic forms of all Plasmodium Hematology & Biochemistry 5
species. Primaquine is added in the Tx of infections w/ P. vivax and P. ovale to eradicate the intrahepatic stages (hypnozoites) of these malarial species, which are Oncology (HO) (Bioc)
responsible for relapses.
8276 Trigeminal nerve Infarcts involving the anterior portion of the medial pons can produce dysarthria and contralateral hemiparesis/lower facial palsy due to disruption of the ipsilateral Hematology & Biochemistry 3
corticospinal and corticobulbar tracts. The trigeminal nerve arises at the level of the middle cerebellar peduncle at the lateral aspect of the mid-pons. Oncology (HO) (Bioc)
11816 Lateral epicondylitis Lat. epicondylitis (i.e. tennis elbow) is characterised by overuse of wrist extensor muscles (e.g. extensor carpi radialis, extensor digitorum), leading to angiofibroblastic Hematology & Biochemistry 1
tendinosis at their attachment on the lat. epicondyle. Oncology (HO) (Bioc)
15301 Histoplasmosis TNF-α inhibs are a/w impairments to the cell-mediated immune response and ↑ the risk of infection w/ intracellular bacteria and granulomatous fungi (e.g. Histoplasma Hematology & Biochemistry 4
capsulatum). Histoplasma replicates w/i the intracellular space of macrophages and can spread from the lungs to the LNs and the RES (liver, spleen, bone marrow). Oncology (HO) (Bioc)
1203 Peroneal neuropathy The common peroneal nerve is susceptible to injury at the lateral neck of the fibula caused by compression or fracture. Pts often have weakness on foot dorsiflexion ('foot Hematology & Biostatistics 3
drop') and eversion, as well as toe extension. Sensory loss typically occurs over the lateral leg and dorsolateral foot. Oncology (HO) (Bios)
1206 Craniopharyngiomas Craniopharyngiomas are suprasellar tumours found in children and composed of calcified cysts containing chol crystals. They arise from remnants of Rathke's pouch, an Hematology & Biostatistics 2
embryonic precursor of the anterior pituitary. Oncology (HO) (Bios)
1474 Respiratory physiology The majority of CO2 produced in the tissues is transported to the lungs as HCO3-. W/i RBCs, the enzyme CA forms HCO3- from CO2 and water. The excess HCO3- is Hematology & Genetics (Gene) 8
then transferred out of RBCs into the plasma via exchange w/ Cl-. This exchange is known as 'Cl- shift' and is the principal cause of high RBC Cl- content in venous Oncology (HO)
blood.
1599 Chronic heart failure The ↓ CO in HF leads to ↓ renal perfusion and conseq stim of the RAAS in a maladaptive effort to maintain effective BV. Inactive AT-I is converted into active AT-II by Hematology & Genetics (Gene) 12
endothelial-bound ACE in the lungs. Oncology (HO)
1788 Serum drug levels and half- The half-life (t[½]) is a measure of how quickly a drug with first-order kinetics is eliminated from the body. A drug is almost completely eliminated after 5 half-life Hematology & Genetics (Gene) 3
life intervals. The half-life can be calculated from the drug's volume of distribution (Vd) and clearance rate (CL) using the equation: t[½] = (0.7 x Vd) / CL. Oncology (HO)
2039 Melanoma The most common metastatic tumors to the brain are lung cancer, renal cancer, and melanoma. Melanoma is a malignancy of melanocytes, which are embryologically Hematology & Genetics (Gene) 6
derived from neural crest cells. Oncology (HO)
2040 Cluster headache CHs cause severe, episodic, unilateral periorbital and temporal pain a/w ipsilateral autonomic SSx (e.g. lacrimation, nasal congestion, miosis, conjunctival injection). The Hematology & Genetics (Gene) 1
h/a typically last 15-180min and tend to occur in clusters (often at the same time each day). Males are affected more commonly than females. Oncology (HO)
2041 Acute promyelocytic APML can present w/ persistent infection and coagulopathy causing hemorrhagic SSx. Bone marrow Bx classically reveals promyelocytes w/ intracytoplasmic Auer rods. Hematology & Genetics (Gene) 3
leukemia APML is a/w a t(15;17) chrom translocation that causes fusion of the RARA gene and PML gene. Oncology (HO)
2086 GFR At normal plasma concs of Glc, the renal tubules reabsorb the entire filtered load of Glc as this is below the max tubular reabsorption ability (TmG). At higher plasma Hematology & Genetics (Gene) 6
concs, Glc is excreted when the filtered amount exceeds the TmG. Oncology (HO)
2087 Excretion rate Inulin clearance can be used to estimate the GFR and to calculate the TFR of a freely filtered substance when the plasma conc of the substance is known. If the substance Hematology & Genetics (Gene) 1
is subseq reabsorbed from the nephron lumen, then the net RER of the substance will be equal to its TFR minus the total TRR. Oncology (HO)
11912 Adolescent adherence Adolescents have low Tx adherence rates due to issues w/ autonomy, rebellion against authority, ↑ self-consciousness, and a lack of understanding of potential risks. Peer Hematology & Genetics (Gene) 1
behaviour has a strong influence on adherence due to adolescents' desire to fit in w/ their social groups. Oncology (HO)
QID Topic Educational Objective System Subject Repeats
12019 Urinary incontinence Stress urinary incontinence is defined as involuntary urine loss with increased intraabdominal pressure. Pelvic floor strengthening (eg, Kegel exercises) targets the levator Hematology & Genetics (Gene) 7
ani to improve support around the urethra and bladder. Oncology (HO)
537 Antipsychotics Antipsychotic Rx work by blocking DA-2 receptors in the mesolimbic DA pathway. DA-2 receptor blockade in the tuberoinfundibular pathway can result in galactorrhea Hematology & Immunology 9
and amenorrhea. Oncology (HO) (Immu)
545 Asthma Eosinophils have bilobed nuclei and numerous eosinophilic granules in the cytoplasm and are important in allergic disease and defence against parasitic infection. The Hematology & Immunology 12
eosinophilic granules predominantly contain MBP, which, once release, acts as a potent anti-helminthic toxin. MBP also dmgs epithelial and endothelial cells and is a Oncology (HO) (Immu)
major cause of chronic lung dmg in asthma.
559 Respiratory mucosa The pneumoconioses are diseases resulting from the inhalation of fine dust particles that reach the resp bronchioles and alv. Particles that lodge in this region are normally Hematology & Immunology 4
cleared by alv macrophages. High particulate burden can cause the excessive release of cytokines from macrophages, resulting in progr PF. Oncology (HO) (Immu)
1134 Myocardial infarction In the fibrinolytic pathway, tPA converts plasminogen to plasmin, which then breaks down fibrin clot. The administration of a tPA analogue (eg, alteplase, tenecteplase, Hematology & Immunology 18
streptokinase) triggers fibrinolysis and can restore myocardial perfusion in pts w/ STEMI who cannot undergo timely PCI. Oncology (HO) (Immu)
1598 Cardiac physiology In cardiac pacemaker cells, phase 0 depol is mediated by an inward flux of Ca2+. This differs from phase 0 of cardiomyocytes and Purkinje cells, which results from an Hematology & Immunology 6
inward Na+ current. Oncology (HO) (Immu)
1683 Hypothyroidism TSH from the ant pit stims the thyroid to prod T4 and a small amount of T3. T4 is converted in peri tissues to T3 (active form) and rT3 (inactive form). TSH secretion is Hematology & Immunology 13
under (-) fb by TH on the hypothal and pit. Oncology (HO) (Immu)
8261 Delirium Delirium is a reversible, acute-onset confusional state characterised by a fluctuating lvl of consciousness w/ deficits in attn, memory, and executive fxn. In contrast, Hematology & Immunology 4
dementia has a gradual onset, is irreversible, and doesn't involve fluctuations in consciousness. Oncology (HO) (Immu)
8480 Syphilis The Jarisch-Herxheimer reaction is an acute inflammatory reaction that occurs within hours of treatment for spirochetal (eg, syphilis) infections. The rapid lysis of Hematology & Immunology 9
spirochetes releases inflammatory bacterial lipoproteins into the circulation and causes acute fevers, rigors, and myalgias. Oncology (HO) (Immu)
8532 Prerenal azotemia Blood volume loss can cause prerenal or intrinsic ARF. Prerenal ARF is a/w normal nephron fxn (e.g. low urine Na+ lvl, low fractionated Na+ excretion, high urine Hematology & Immunology 6
osmolarity, and a high BUN/creatinine ratio), whereas intrinsic ARF features diminished renal resorptive capacity (e.g. lower urine osmolarity, higher urinary Na+, Oncology (HO) (Immu)
normal serum BUN/creatinine ratio).
12048 Retinal artery occlusion RAO is a cause of acute, painless, monocular vision loss. It is usually caused by TE complications of atherosclerosis traveling from the ICA and through the ophthalmic Hematology & Immunology 1
artery. Oncology (HO) (Immu)
15466 Head and neck cancers Most OPCs (e.g. tonsil, base of tongue) are caused by HPV infection. HPV-16 is particularly likely to cause malignant transformation. Hematology & Immunology 1
Oncology (HO) (Immu)
896 Gout Colchicine is used for treatment of acute gouty arthritis in patients who cannot take nonsteroidal anti inflammatory drugs. It inhibits leukocyte migration and phagocytosis Hematology & Microbiology 11
by blocking tubulin polymerization. Significant side effects of colchicine include nausea and diarrhea. Oncology (HO) (Micr)
957 HSV infection Viral infections of the CNS are usually characterised by ↑ protein, normal Glc, and an ↑ WBC count w/ a lymphocytic predominance. Pts w/ herpes encephalitis also Hematology & Microbiology 9
usually have ↑ erythrocytes in the CSF due to hemorrhagic inflammation of the temporal lobes. Oncology (HO) (Micr)
1097 Measles VitA can be beneficial in the Tx of measles infection by ↓ comorbidities (e.g. ocular complications, diarrhoea, pneumonia), recovery time, and length of hospital stay. Hematology & Microbiology 3
Oncology (HO) (Micr)
1375 Mycobacterium avium MAC infections are common in pts w/ advanced AIDS. The bacterium often spreads thru the bloodstream and RES and causes nonspecific SSx (e.g. fever, fatigue, weight Hematology & Microbiology 1
intracellulare complex loss, diarrhoea), LAD, and HSM. Dx is often made on blood culture or bone marrow aspirate (intracellular acid-fast bacteria that aren't M. tuberculosis). Oncology (HO) (Micr)
1496 Conversion disorder Conversion disorder is Chx by neuro SSx and Ex findings that are incompatible w/ a known neuro disease. Pts do not consciously produce the SSx like in factitious Hematology & Microbiology 1
disorder or malingering, and the condition may cause significant distress/impairment. Oncology (HO) (Micr)
26 Renal vein thrombosis Nephrotic syndrome is a hypercoagulable state. Sudden-onset abdominal or flank pain, hematuria, and left-sided varicoceles suggest RVT, a well-known complication of Hematology & Pathology (Path) 1
nephrotic syndrome. Loss of anticoagulant factors, especially AT-III, is responsible for the thrombotic and TE complications of nephrotic syndrome. Oncology (HO)
58 Hepatocellular cancer High lvls of dietary aflatoxin exposure is a/w a G:C → T:A transversion in codon 249 of the p53 gene, a mut thought to greatly ↑ the risk of devel HCC. Hematology & Pathology (Path) 5
Oncology (HO)
69 Gallstones and pregnancy Estrogen-induced cholesterol hypersecretion and progesterone-induced gallbladder hypomotility are responsible for the ↑ incidence of cholelithiasis in women who are Hematology & Pathology (Path) 1
pregnant or using oral contraceptives. Oncology (HO)
294 Coccidioidomycosis C. immitis is a dimorphic fungus endemic to the SW US. It exists in the environment as a mould (w/ hyphae) that forms spores. These spores are inhaled and turn into Hematology & Pathology (Path) 2
spherules in the lungs. Oncology (HO)
313 Peptic ulcer disease Most gastric ulcers arise along the lesser curvature of the stomach, usually at the transitional zone b/w the gastric corpus (body) and antrum. The left and right gastric Hematology & Pathology (Path) 10
arteries run along the lesser curvature and are likely to be penetrated by ulcers, causing gastric bleeding. Oncology (HO)
314 Peripheral vascular disease Phenotypically mixing refers to coinfection of a host cell by 2 viral strains, resulting in progeny virions that contain nucleocapsid proteins from 1 strain and the unchanged Hematology & Pathology (Path) 4
parental genome of the other strain. B/c there's no change in underlying viral genomes (no genetic exchange), the next gen of virions revert to their original, unmixed Oncology (HO)
phenotypes.
336 Vitamin C deficiency Vitamin C is necessary for the hydroxylation of proline and lysine residues in pro-collagen. Vitamin C deficiency (scurvy) is most often seen in severely malnourished Hematology & Pathology (Path) 3
individuals and leads to capillary bleeding, poor wound healing, and periodontal disease. In children, bony deformities and subperiosteal hemorrhages are also Chx. Oncology (HO)
341 Patent ductus arteriosus PDA is common in preterm infants and presents w/ a continuous murmur, widened PPs, and SSx of CV strain. Indomethacin or ibuprofen therapy can inhib PGE2 Hematology & Pathology (Path) 4
synthesis and accelerate closure. Oncology (HO)
345 Intestinal atresia Intestinal atresia distal to the duodenum occurs due to vascular accidents in utero. "Apple-peel" atresia occurs when the superior mesenteric artery is obstructed. The result Hematology & Pathology (Path) 1
is a blind-ending proximal jejunum; a length of absent bowel and mesentery: and, finally, a terminal ileum spiraled around an ileocolic vessel. Oncology (HO)
395 Cirrhosis Cirrhosis is Chx by diffuse hepatic fibrosis w/ replacement of the normal lobular architecture by fibrous-lined parenchymal nodules. Chronic viral hepatitis (eg, hepatitis B Hematology & Pathology (Path) 7
and C), Alc, hemochromatosis. and NAFLD are the most common causes of cirrhosis in the United States. Oncology (HO)
423 Alpha1 antitrypsin AAT is a serine protease inhib that regulates the activity of elastase in the lung. Inherited defic of AAT leads to alveolar destruction and panacinar emphysema; in addn, Hematology & Pathology (Path) 8
deficiency accumulation of improperly folded AAT proteins in hepatocytes can leads to liver dysfxn and cirrhosis in some pts. Oncology (HO)
465 Atherosclerosis Atherosclerosis is initiated by repetitive endothelial cell injury, which leads to a chronic inflammatory state in the underlying intima of large elastic arteries as well as in Hematology & Pathology (Path) 8
large- and medium-sized muscular arteries. Oncology (HO)
615 Histiocytosis Langerhans cells are dendritic cells found in the skin that act as professional antigen presenting cells. These cells are derived from the myeloid cell line and they possess Hematology & Pathology (Path) 1
characteristic racquet shaped intracytoplasmic granules known as Birbeck granules. Oncology (HO)
710 Skin and soft tissue Protein A is a virulence factor found in the PGCW of S. aureus that binds to the Fc portion of IgG, leading to impaired complement activation, opsonisation, and Hematology & Pathology (Path) 8
infections phagocytosis. Oncology (HO)
742 Priapism Trazodone is a highly sedating antidepressant commonly used to Tx insomnia. Priapism is a rare but serious AE. Hematology & Pathology (Path) 1
Oncology (HO)
789 Blood transfusion Acute hemolytic transfusion reaction is a antibody-mediated (type II) hypersensitivity reaction caused by pre-existing anti-ABO antibodies that bind antigens on Hematology & Pathology (Path) 2
transfused donor erythrocytes. Subsequent complement activation results in erythrocyte lysis, vasodilation, and symptoms of shock. Common findings include fever, Oncology (HO)
hypotension, chest and back pain, and hemoglobinuria.
829 Hematopoietic drugs Vits B12 and B9 defic cause similar heme pictures. However, neuro dysfxn is only seen in pts w/ vitB12 defic. If megaloblastic anaemia due to vitB12 defic is mistakenly Hematology & Pathology (Path) 1
Tx w/ vitB9 alone, the neuro dysfxn can worsen. Oncology (HO)
872 Urinary tract infection Suppression of endogenous flora, colonization of the distal urethra by pathogenic gram-negative rods, and attachment of these pathogens to the bladder mucosa are the Hematology & Pathology (Path) 12
stages of pathogenesis in lower urinary tract infections. Anatomic or functional vesicoureteral reflux is almost always necessary for the development of acute Oncology (HO)
pyelonephritis.
873 Renal artery stenosis Marked unilateral kidney atrophy is suggestive of renal artery stenosis. It occurs in elderly individuals due to atherosclerotic narrowing of the renal artery and is often seen Hematology & Pathology (Path) 9
in association with other atherosclerotic risk factors or diseases (eg, chronic mesenteric ischemia, coronary artery disease, peripheral vascular disease). Hypertension and Oncology (HO)
abdominal and flank bruits are often present.
875 Renal papillary necrosis RPN classically presents w/ gross hematuria, acute flank pain, and passage of tissue fragments in urine. It's most commonly seen in pts w/ SCD or trait, DM, analgesic Hematology & Pathology (Path) 1
nephropathy, or severe OPN. Oncology (HO)
889 Diabetes mellitus Long-acting insulin analogues (e.g. degludec, detemir, glargine) have an extended duration of action w/o a noticeable peak in activity and are typically given once daily to Hematology & Pathology (Path) 31
mimic basal insulin secretion. Rapid-acting insulins (e.g. aspart, lispro, glulisine) are quickly absorbed from the injection site and are given at mealtimes to replicate Oncology (HO)
postprandial insulin secretion.
891 Anesthesia Following intravenous administration, a highly lipophilic drug will be rapidly distributed to organs with high blood flow (eg, brain, liver, kidneys, lungs). The drug is then Hematology & Pathology (Path) 9
redistributed to tissues with relatively lower blood flow (eg, skeletal muscle, fat, bone). This accounts for the short duration of action of many commonly used anesthetics, Oncology (HO)
such as propofol.
893 Anesthesia Almost all volatile anaesthetics ↑ cerebral blood flow. It's an undesirable effect as it results in ↑ ICP. Other important effects of inhalation anaesthetics are myocardial Hematology & Pathology (Path) 9
depression, hypotension, resp depression, and ↓ renal fxn. Oncology (HO)
894 Malignant hyperthermia Malignant hyperthermia occurs after admin of inhalation anaesthetics a/o SCh to genetically susceptible individuals. It's Tx w/ dantrolene that blocks RyR and prevents Hematology & Pathology (Path) 1
release of Ca2+ into the cytoplasm of skeletal muscle fibres. Oncology (HO)
895 Anesthesia Propofol and other highly lipophilic drugs readily diffuse across membranes, quickly accumulating in tissues receiving high blood flow; this accounts for their rapid onset Hematology & Pathology (Path) 9
of action. These compounds are subseq redistributed to organs receiving less blood flow, which explains their short duration of action. Oncology (HO)
941 Sickle cell Patients with sickle cell disease become functionally asplenic within the first few years of life due to repeated microinfarction of splenic vascular beds. This dramatically Hematology & Pathology (Path) 13
increases the risk for fulminant infections with encapsulated bacterial organisms, particularly Streptococcus pneumoniae. Patients with sickle cell disease are also at Oncology (HO)
increased risk for other bacterial infections, most notably salmonella osteomyelitis.
1039 Hypercalcemia Ca-sensing receptors are GPCRs that regulate the secretion of PTH in response to changes in circulating Ca levels. FHH is a benign AD disorder caused by defective Ca- Hematology & Pathology (Path) 5
sensing receptors in the parathyroid gland and kidneys. Oncology (HO)
1075 Calcium and glycogen Synchronization of glycogen degradation with skeletal muscle contraction occurs due to release of sarcoplasmic calcium following neuromuscular stimulation. Increased Hematology & Pathology (Path) 1
phosphorylase intracellular calcium causes activation of phosphorylase kinase, stimulating glycogen phosphorylase to increase glycogenolysis. Oncology (HO)
1083 Glycogen storage disease Glycogen serves as a source of Glc during fasting and as an energy store that can be mobilised quickly during strenuous muscle contraction. Myophosphorylase defic Hematology & Pathology (Path) 3
(McArdle disease or GSD-V) causes failure of muscle glycogenolysis, resulting in ↓ exercise tolerance, muscle pain and cramping, and myoglobinuria w/ physical Oncology (HO)
activity).
QID Topic Educational Objective System Subject Repeats
1084 Gluconeogenesis Acetyl-CoA stims GNG by ↑ the activity of PC when acetyl-CoA is abundant. This regulatory step allows pyruvate to be shunted toward acetyl-CoA production when Hematology & Pathology (Path) 4
acetyl-CoA lvls are low, preventing the cell from becoming depleted of energy. Oncology (HO)
1086 G6PD deficiency The PPP consists of an ox (irrev.) branch and a nonox (rev.) branch, and each can fxn independently based on cellular reqs. Transketolase, an enzyme of the nonox Hematology & Pathology (Path) 5
branch, is responsible in part for the interconversion of R5P (nucleotide precursor) and F6P (glycolytic intermediate). Oncology (HO)
1088 G6PD deficiency G6PD defic causes HA and jaundice 2ary to incr. ox stress due to the lack of NADPH. Glutathione reductase defic has a similar clin conseq as its absence results in an Hematology & Pathology (Path) 5
inability to utilize NADPH to red glutathione. Oncology (HO)
1160 Dermatitis herpetiformis DH is characterised by erythematous pruritic papules, vesicles, and bullae that appear bilaterally and symmetrically on the extensor surfaces. DH is strongly a/w coeliac Hematology & Pathology (Path) 1
disease. Oncology (HO)
1286 Sensitivity and specificity Specificity is the number of TNs divided by the total number of subjects confirmed as not having the disease. TNs = (Specificity) * (Number of pts confirmed w/o the Hematology & Pathology (Path) 4
disease). FPs = (1 - Specificity) * (Number of pts confirmed w/o the disease). Oncology (HO)
1293 Professional disagreements When treating patients who have been referred for specialty care or a second opinion, it is imperative to not undermine the patient's relationship with the primary Hematology & Pathology (Path) 1
among providers physician. A physician should avoid making negative comments about the quality of care rendered by that practitioner unless practices are imminently dangerous or far Oncology (HO)
outside acceptable standards of care.
1294 Carbon monoxide CO binds heme Fe in Hb w/ an affinity much greater than O2, generating HbCO. Remaining binding sites on HbCO have an incr. affinity for O2 that causes the O2 Hematology & Pathology (Path) 2
poisoning dissociation curve to shift to the left, impeding O2 delivery to tissues. Oncology (HO)
1295 Sickle cell HbS aggregates in the deoxy state. HbS polymers form fibrous strands that decr. RBC membrane flex and promote sickling. Sickling occurs under conditions a/w anoxia Hematology & Pathology (Path) 13
incl. low pH and high lvls of 2,3-BPG. These inflex erythrocytes predispose to microvascular occlusion and microinfarcts. Oncology (HO)
1296 Sickle cell Hemoglobin S (HbS) contains valine in place of glutamic acid at the sixth amino acid position of the beta globin chain. This promotes hydrophobic interaction among Hb Hematology & Pathology (Path) 13
molecules and results in HbS polymerization and erythrocyte sickling. Oncology (HO)
1297 Beta-thalassemia HbF contains gamma-globin instead of beta-globin. Pts w/ homozygotic beta-thalassemia (beta-thalassemia major) are aSSx at birth due to the presence of gamma-globins Hematology & Pathology (Path) 1
and HbF. Switching to HbA production and the cessation of gamma-globin synth precips the SSx of beta-thalassemia. Oncology (HO)
1298 Ehlers-Danlos syndrome Ehlers-Danlos syndrome (EDS) is a heritable connective tissue disease associated with abnormal collagen formation. EDS usually manifests clinically as overflexible Hematology & Pathology (Path) 1
(hypermobile) joints, overelastic (hyperelastic) skin, and fragile tissue susceptible to bruising, wounding, and hemarthrosis. Oncology (HO)
1403 Alpha agonists α-adrenergic agonists ↑ SBP and DBP by stimulating α1-adrenoreceptors in the vascular walls, causing vasoconstriction. The ↑ systemic BP then causes a reflexive ↑ in Hematology & Pathology (Path) 1
vagal tone, resulting in ↓ HR and slowed AV node conduction. Oncology (HO)
1404 Cardiogenic shock Dobutamine is a β adrenergic agonist w/ predominant activity on β1 receptors. It causes an ↑ in HR and cardiac contractility, leading to an ↑ in myocardial O2 Hematology & Pathology (Path) 1
consumption. Oncology (HO)
1405 Nonallergic rhinitis Topical preparations of α-adrenergic agonists cause vasoconstriction of the nasal mucosa vessels and are used as decongestants. Overuse of these Rx causes (-) feedback, Hematology & Pathology (Path) 1
resulting in ↓ NE synthesis and release from nerve endings, which ↓ their effect (ie, tachyphylaxis). Oncology (HO)
1406 Body dysmorphic disorder BDD involves fixation on a perceived defect in appearance and repetitive behaviours in response to the fixation. It can present w/ absent insight/delusional beliefs and Hematology & Pathology (Path) 1
result in significant psychosocial dysfxn. Oncology (HO)
1426 Sympathomimetic agents Low-dose dopamine infusion stimulates Di receptors in the renal and mesenteric vasculature, resulting in vasodilation and increased blood flow to these sites. Increasing Hematology & Pathology (Path) 5
doses of dopamine stimulate B, and a receptors, resulting in increased cardiac output and elevated systemic vascular resistance. At the higher end of the dose range, the Oncology (HO)
increase in afterload can result in decreased cardiac output.
1569 Phenylketonuria BH4 is a cofactor used by hydroxylase enzymes in the synthesis of tyrosine, DA, and 5-HT. PKU can result from BH4 defx due to dihydropteridine reductase defx. Hematology & Pathology (Path) 5
Intellectual disability is the hallmark of this condition and results in NT (e.g. 5-HT) defx and hyperphenylalaninemia. Tx involves a low phenylalanine diet and BH4 Oncology (HO)
supplementation.
1570 Phenylketonuria BH2 reductase defic (DHBRD) results in impaired BH4 lvls. BH4 is an important cofactor for both phenylalanine hydroxylase and tyrosine hydroxylase. Although Hematology & Pathology (Path) 5
phenylalanine lvls can be corrected w/ dietary restriction, downstream defic of DA, NE, EPI, and 5-HT lead to progr neuro deterioration. Oncology (HO)
1571 Alkaptonuria Alkaptonuria is an AR disorder in which the lack of homogentisic acid dioxygenase blocks the metabolism of tyrosine, leading to an accumulation of homogentisic acid. Hematology & Pathology (Path) 2
CFx include a black urine color when exposed to air, a blue-black pigmentation on the face, and ochronotic arthropathy. Oncology (HO)
1572 Alkaptonuria Alkaptonuria is an autosomal-recessive disorder caused by a deficiency of homogentisic acid dioxygenase, an enzyme involved in tyrosine metabolism. Excess Hematology & Pathology (Path) 2
homogentisic acid causes diffuse blue-black deposits in connective tissues. Adults have sclerae and ear cartilage hyperpigmentation along with osteoarthropathy of the Oncology (HO)
spine and large joints.
1580 Cardiac physiology Pressure-volume loops represent the relationship b/w pressure and volume in the LV during systole and diastole. An ↑ in the circulating volume ↑ preload (LV EDV) and Hematology & Pathology (Path) 6
causes a rightward widening of the pressure-volume loop. Oncology (HO)
1626 Heart sounds The 3rd heart sound (S3) is a low-frequency sound occurring during early diastole after S2. LV gallops (S3 a/o S4) are best heard w/ the bell of the stethoscope over the Hematology & Pathology (Path) 1
cardiac apex while the pt is in the left lateral decubitus position at end expiration. Oncology (HO)
1627 Muscle structure & During skeletal muscle contraction, calcium is released from the sarcoplasmic reticulum and binds troponin C, thereby allowing the binding of actin to myosin. Hematology & Pathology (Path) 8
physiology Oncology (HO)
1629 Estrogen synthesis LH stimulates the theca interna cells of the ovarian follicle to produce androgens. Aromatase w/i the follicle's granulosa cells subsequently converts these androgens to Hematology & Pathology (Path) 1
estradiol under FSH stimulation. The theca externa cells serve as a CT support structure for the follicle. Oncology (HO)
1630 SIADH ADH and Oxt are synthesised w/i neurons found in the PVN and SON and are released into the circulation from axon terminals in the posterior pituitary. NPs are involved Hematology & Pathology (Path) 3
in the post-translational processing and stabilisation of Oxt and ADH w/i neurosecretory vesicles during transport to the posterior pituitary. Oncology (HO)
1717 Interstitial lung disease Decr in the slope of the curve depicting LV vs distending pressure indicates decr lung compliance (the hallmark of PF). Hematology & Pathology (Path) 8
Oncology (HO)
1718 GFR Acuteureteral constriction or obstr ↓ the GFR and FF. Hematology & Pathology (Path) 6
Oncology (HO)
1724 Diabetes mellitus Proinsulin is cleaved into mature insulin and C-peptide, which are co-secreted from pancreatic β cells in equimolar amounts. Circulating lvls of C-peptide can be used as a Hematology & Pathology (Path) 31
marker of endogenous insulin secretion. SUs and meglitinides ↓ blood Glc by stim pancreatic insulin secretion; hypoglycaemia due to these agents is a/w ↑ C-peptide lvls. Oncology (HO)
1754 Radial neuropathy Radial nerve injury can occur w/ repetitive pressure/trauma at the axilla (eg, improperly fitted crutches). Findings include weakness of the forearm, hand, and fingers Hematology & Pathology (Path) 3
extensors (eg, wrist drop, absent triceps reflex) and sensory loss over the posterior arm and forearm, dorsolateral hand, and dorsal thumb. More distal lesions spare the Oncology (HO)
triceps brachii.
1755 Thyroid cancer The recurrent laryngeal nerve travels in close proximity to the inferior thyroid artery and can be injured during thyroid surgery, resulting in vocal cord paralysis (eg, Hematology & Pathology (Path) 6
hoarseness). Oncology (HO)
1757 Oogenesis 1° oocytes are completely developed in female embryos by the 5th month of gestation, at which point they are arrested in prophase of meiosis I. Normal menstrual cycle Hematology & Pathology (Path) 1
hormones stimulate the 1° oocyte to resume differentiation. Prior to fertilization, 2° oocytes are arrested in metaphase of meiosis II. Oncology (HO)
1758 Wilson disease WD can cause cystic degen of the putamen as well as dmg to other BG structures. The putamen is located medial to the insula and lateral to the GP on coronal sections. Hematology & Pathology (Path) 5
Oncology (HO)
1759 Huntington disease The head of the caudate lies in the inferolateral wall of the frontal horn of the lateral ventricle. It is separated from the GP and putamen by the IC. Atrophy of the caudate Hematology & Pathology (Path) 5
nuclei w/ enlargement of the lateral ventricles is Chx of HD and can be observed on neuroimaging. Oncology (HO)
1760 Pharyngeal arches The development of derivatives of the 1st (e.g. CN V, mandible, maxilla, zygoma, incus, malleus) and 2nd (e.g. CN VII, stapes, styloid process, lesser horn of hyoid) Hematology & Pathology (Path) 1
pharyngeal arches can be disrupted in genetic disorders (e.g. TCS), resulting in hypoplasia of the mandibular and zygomatic bones. Oncology (HO)
1761 Radiculopathy Sciatica is a nonspecific term for low back pain that radiates down the leg due to compression of the lumbosacral nerve roots (eg, from vertebral disc herniation). The S1 Hematology & Pathology (Path) 3
nerve root is commonly involved, resulting in pain/sensory loss down the posterior thigh and calf to the lateral aspect of the foot. Pts may also have weakness on thigh Oncology (HO)
extension, knee flexion, and foot plantarflexion w/ an absent ankle jerk reflex.
1762 Cauda equina syndrome Saddle anesthesia and loss of the anocutaneous reflex are SSx of CES, which is a/w damage to the S2 through S4 nerve roots. Hematology & Pathology (Path) 1
Oncology (HO)
1785 Drug metabolism and Cytochrome P450 enzymes found in the liver are responsible for the majority of drug metabolism. Polymorphisms occurring in the genes coding for these enzymes result Hematology & Pathology (Path) 2
clearance in various phenotypes that differ in their rates of metabolism; individual differences in phenotype alter treatment efficacy and drug toxicity. Oncology (HO)
1786 Pharmacogenomics Isoniazid is metabolized by acetylation. The speed with which a patient is able to acetylate drugs depends on whether they are genetically "fast" or "slow" acetylators. The Hematology & Pathology (Path) 1
presence of fast and slow acetylators within the same population results in a bimodal distribution of the speed of isoniazid metabolism. Slow acetylators are at increased Oncology (HO)
risk of adverse side effects.
1787 Route of administration & Bioavailability is the fraction of an administered drug that reaches the systemic circulation unchanged. Drugs administered orally enter the portal circulation and are Hematology & Pathology (Path) 2
bioavailability subject to first-pass metabolism. Rectal administration is capable of partially bypassing first-pass metabolism as a proportion of rectal blood flow enters the systemic Oncology (HO)
circulation directly. Drugs that undergo extensive first-pass metabolism have increased bioavailability when administered rectally.
1792 Rb protein Proliferation signals activate CDK4, resulting in hyperphosphorylation of the Rb protein. B/c hyperphosphorylated Rb is inactive, cells are allowed to transition Hematology & Pathology (Path) 1
unchecked from the G1 phase to the S phase in the cell cycle. Oncology (HO)
1793 Turner syndrome GH binds to cell surface receptors, leading to intracellular activation of the JAK-STAT pathway. Cytokines (e.g. IFN) and hematopoietic GFs (e.g. EPO, G-CSF) also use Hematology & Pathology (Path) 8
this pathway. Oncology (HO)
1794 HIV HIV pol gene mutations are responsible for acquired resistance to RTIs, PIs, and integrase strand transfer inhibitors. Mutations of the env gene enable escape from host- Hematology & Pathology (Path) 11
neutralizing Abs. Oncology (HO)
1796 HIV Pts w/ HIV have much higher rates of lymphoma than the general population. Many cases are due to underlying EBV infection. Hematology & Pathology (Path) 11
Oncology (HO)
1797 Hair loss Androgenetic alopecia is the most common cause of hair loss in both males and females. The pattern and severity of the baldness depend on both hormonal (circulating Hematology & Pathology (Path) 2
androgens) and genetic factors and vary between males and females. The condition is polygenic with variable expressivity. Oncology (HO)
1798 Hair loss Androgenetic alopecia causes hair loss primarily at the anterior scalp and vertex. It shows polygenic inheritance, with dihydrotestosterone (DHT) being the primary Hematology & Pathology (Path) 2
pathogenic factor. 5-a-reductase inhibitors decrease the conversion of testosterone to DHT and are effective for treating the condition. Oncology (HO)
1842 Community acquired The most common cause of CAP in both HIV-infected and HIV-uninfected individuals is S. pneumoniae. Risk of invasive pneumococcal disease is significantly ↑ in pts Hematology & Pathology (Path) 21
pneumonia w/ HIV regardless of CD4 count. Oncology (HO)
1848 Teratogens Although tetracyclines are the 1st-line Tx for Lyme disease, they are c/i in pregnancy due to the potential for fetal tooth discoloration. Amoxicillin should be given instead Hematology & Pathology (Path) 2
for Tx of Lyme disease in pregnant women. Oncology (HO)
QID Topic Educational Objective System Subject Repeats
1859 Pure red cell aplasia PRCA is a rare form of marrow failure Chx by severe hypoplasia of marrow erythroid elements in the setting of normal GPO and TPO. PRCA is a/w thymoma, Hematology & Pathology (Path) 1
lymphocytic leukemias, and PVB19 infection. Oncology (HO)
1861 X-linked inheritance Given phenotypically normal parents, the probability that a female sibling of a male affected by an X linked recessive disease will give birth to an affected child is 1/8. Hematology & Pathology (Path) 2
Oncology (HO)
1864 Autosomal recessive The probability that a child of parents from 2 populations with different mutant allele carrier frequencies will inherit an autosomal recessive disease is 25% multiplied by Hematology & Pathology (Path) 5
inheritance the carrier frequencies. Oncology (HO)
1865 Vitamin B12 deficiency defic of vitB12 is a/w both megaloblastic anaemia and neuro dysfxn, while vitB9 defic is a/w megaloblastic anaemia alone. Mod improvement in the Hb lvl often occurs Hematology & Pathology (Path) 9
when a defic in vitB12 is Tx w/ vitB9, or vice versa. Tx of vitB12 defic w/ vitB9 alone can actually worsen neuro dysfxn. Oncology (HO)
1872 Septic shock Tumor necrosis factor-α is released from activated macrophages and is one of the most important mediators of the systemic inflammatory response in sepsis. Other Hematology & Pathology (Path) 6
cytokines responsible for inducing the systemic inflammatory response include IL-1 and IL-6. Oncology (HO)
1873 Inflammation Leukotriene B, stimulates neutrophil migration to sites of inflammation. Other important chemotactic agents include 5-HETE (leukotriene precursor), complement Hematology & Pathology (Path) 3
component C5a, and IL-8. Oncology (HO)
1879 Vitamin E deficiency VitE defic can occur in individuals w/ fat malabsorption. defic of this fat-soluble vit is a/w ↑ susceptibility of the neuronal and erythrocyte membranes to oxidative stress. Hematology & Pathology (Path) 2
Clinical MFxs incl ataxia, impaired proprioception and vibratory sensation, and hemolytic anaemia. Oncology (HO)
1880 TCA cycle Vit B2 is a precursor of the coenzymes FMN and FAD. FAD participates in the TCA cycle and ETC by acting as an electron acceptor for succinate dehydrogenase Hematology & Pathology (Path) 2
(complex II), which converts succinate into fumarate. Oncology (HO)
1911 ACE inhibitors In the kidney, angiotensin II preferentially constricts the efferent arteriole, thereby maintaining the glomerular filtration rate (GFR) within normal range. ACE-inhibitors Hematology & Pathology (Path) 7
promote efferent arteriolar dilation, causing GFR reduction. Oncology (HO)
1923 Meningitis Abs against the PSC of N. meningitidis provide immunity against this pathogen. Quadrivalent MCVs contain capsular PSs from major serotypes (A, C, Y, and W) of N. Hematology & Pathology (Path) 17
meningitidis. Serotype B vax use recomb proteins. Oncology (HO)
1941 Fibronectin Adhesion of cells to the ECM involves integrin-mediated binding to fibronectin, collagen, and laminin. diffial expression of integrin subtypes affects adhesion properties Hematology & Pathology (Path) 1
of individual cells, and has been found to correlate w/ malignant behaviour in a # of tumours. Oncology (HO)
1953 Inherited thrombophilia 1-9% of Caucasians worldwide are heterozyg carriers of FV Leiden, which is modded to resist activated protein C. The resulting hypercoagulable state predisposes to Hematology & Pathology (Path) 2
DVT, which are the source of most PE. Oncology (HO)
1954 Pulmonary embolism Saddle PE straddles the bifurcation of the main pulm artery. VTE (i.e. PE or DVT) arises due to the Virchow triad of endothelial injury, venous stasis, and a Hematology & Pathology (Path) 13
hypercoagulable state. Malignancy causes a hypercoagulable state and is a strong RF for VTE. Oncology (HO)
1963 Beta oxidation Impaired β-oxidation of FAs causes hypoglycaemia after prolonged fasting and insufficient lvls of ketone bodies. MCAD catalyses the 1st step in the β-oxidation pathway Hematology & Pathology (Path) 3
and is the most commonly defic enzyme. Oncology (HO)
1964 Triglyceride metabolism Glycerol produced by the degradation of TGs in adipose tissue can be used by glycerol kinase in the liver and kidney to synthesize Glc during GNG. Hematology & Pathology (Path) 2
Oncology (HO)
2084 Diabetic ketoacidosis The kidneys compensate for meta acidosis by completely reabsorbing filtered HCO3- and excreting excess H+ in the urine. Most of the excreted H+ is buffered by Hematology & Pathology (Path) 6
H2PO4- and NH4+, which allows for large amounts of acid to be excreted w/o precipitously dropping the pH. Oncology (HO)
2085 Coronary blood flow Myocardial oxygen extraction exceeds that of any other tissue or organ; therefore, the cardiac venous blood in the coronary sinus is the most deoxygenated blood in the Hematology & Pathology (Path) 9
body. Due to the high degree of oxygen extraction, increases in myocardial oxygen demand can only be met by an increase in coronary blood flow. Oncology (HO)
2092 Steroid hormones The initial step in the synthesis of steroid hormones is the conversion of cholesterol to pregnenolone in the mitochondria. The remainder of steroidogenesis occurs in the Hematology & Pathology (Path) 1
smooth endoplasmic reticulum. Steroid-producing cells contain a well-developed smooth endoplasmic reticulum. Oncology (HO)
2093 Transcription Primase is a DNA-dependent RNA polymerase that incorporates short RNA primers into replicating DNA. Hematology & Pathology (Path) 7
Oncology (HO)
6530 Defense mechanisms Transference is the unconscious shifting of emotions a/w a significant person from 1's past to a person in the present. Hematology & Pathology (Path) 8
Oncology (HO)
7643 Breast cancer Cytokeratin is a commonly used IHC marker of epithelial cell carcinomas. Hematology & Pathology (Path) 7
Oncology (HO)
8281 Cranial nerve palsy CNIII is most susceptible to injury from ipsilateral PComA aneurysms. Aneurysmal compression of CNIII produces mydriasis (due to superficial parasympathetic fibre Hematology & Pathology (Path) 9
dmg) w/ diplopia, ptosis, and down and out deviation of the ipsilateral eye (due to somatic efferent fibre injury). Oncology (HO)
8540 Implantable cardioverter LV leads in biventricular PMs course through the coronary sinus, which resides in the AV groove on the posterior aspect of the heart. Hematology & Pathology (Path) 1
defibrillator Oncology (HO)
8559 Pulmonary embolism Pts being weaned from mech vent typically breathe at low TVs, w/ a comp incr in RR to maintain min vent. B/c at low TVs a higher proportion of each breath is Hematology & Pathology (Path) 13
composed of dead space, this type of breathing leads to an incr in wasted vent (inefficient breathing). Oncology (HO)
8591 Urinary incontinence Urge incontinence, or OBS, is caused by uninhib bladder contractions (detrusor instability). It results in a sense of urgency accompanied by an involuntary loss of urine. If Hematology & Pathology (Path) 7
beha therapy alone is unsuccessful, Rx therapy w/ an antimusc drug (targeting M3 receptors) can help improve SSx. Oncology (HO)
11456 Lesser omentum The lesser omentum is a double layer of peritoneum that extends from the liver to the lesser curvature of the stomach and the beginning of the duodenum. It's divided into Hematology & Pathology (Path) 1
the hepatogastric and hepatoduodenal ligaments. Oncology (HO)
11625 Patient confidentiality The HIPAA protects health information by requiring verbal or written authorization for release of information. Family members who contact the physician for information Hematology & Pathology (Path) 5
about their relative should not be given any information about the pt w/o the pt's consent. Oncology (HO)
11750 Translation Short non-coding RNA sequences (eg, microRNA and small interfering RNA) induce posttranscriptional gene silencing by base-pairing with complementary sequences Hematology & Pathology (Path) 1
within target mRNA molecules. Oncology (HO)
11754 HSV infection The finding of multiple painful genital ulcers and constitutional SSx in a sexually active pt is highly suggestive of 1° genital HSV infection. Dx can be established by PCR Hematology & Pathology (Path) 9
testing, direct fluorescence Ab testing, viral culture, or Tzanck smear. Oncology (HO)
11864 Urinary tract infection Escherichia coli are lactose-fermenting, indole-positive gram-negative rods that are an important cause of urinary tract infection in women. Hematology & Pathology (Path) 12
Oncology (HO)
11869 Hemorrhoids External hemorrhoids, which originate below the dentate line, are covered by modded squamous epithelium and have cutaneous (somatic) nervous innervation from the Hematology & Pathology (Path) 2
inf. rectal nerve, a branch of the pudendal nerve. Oncology (HO)
12049 Myocardial infarction The dominant RCA perfuses both the inferior wall of the LV and the majority of the RV. Proximal occlusion can cause RV MI, which Px w/ hypotension (↓ CO) and Hematology & Pathology (Path) 18
distended jugular veins (↑ CVPs). The lungs will be clear on auscultation and XR (lack of pulm edema) unless concomitant left-sided HF is also present. Oncology (HO)
14772 Amniotic fluid embolism AFE is a rare and catastrophic pregnancy complication that results from amniotic fluid entering the maternal circulation. Common signs of AFE include hypoxia, Hematology & Pathology (Path) 1
hypotensive shock, and DIC. Fetal squamous cells are seen in the pulm vasculature during histologic evaluation. Oncology (HO)
14816 Chancroid Chancroid, due to Haemophilus ducreyi, Px as deep, painful (you "do cry" w/ H ducreyi) ulcers w/ ragged borders that are a/w a gray exudate and inguinal LAD. Dx is Hematology & Pathology (Path) 1
established by Gram stain and culture of the organism from a scraping of the ulcer base. Oncology (HO)
15120 Myocarditis Acute myocarditis is most commonly caused by a viral infection (e.g. coxsackievirus, adenovirus, influenza). It often resolves w/o noticeable SSx, but pts can develop Hematology & Pathology (Path) 1
serious complications, incl decompensated HF due to DCM or SCD due to ventricular arrhythmia. Histopathology typically demonstrates myofibrillary necrosis w/ Oncology (HO)
inflammatory mononuclear infiltrate.
15228 Haemophilus influenzae Most COPD exacerbations are caused by infection w/ an upper resp pathogen. The leading bacterial cause is H. influenzae and the leading viral cause is rhinovirus. Hematology & Pathology (Path) 2
Oncology (HO)
15278 Colorectal cancer Most hepatic neoplasms are due to mets from a distant site. CRC is the most common cause of hepatic mets due to direct blood flow from the colon (and superior rectum) Hematology & Pathology (Path) 15
to the liver via the portal venous circulation. Oncology (HO)
15460 Aminoglycoside Aminoglycosides are filtered across the glomerulus and concentrate in the renal tubules, leading to PCT injury and ATN. This is visualised histo as focal tubular epithelial Hematology & Pathology (Path) 3
necrosis, often w/ extensive granular casts that obstruct the tubular lumen and lead to rupture of the BM. Oncology (HO)
15467 NSAIDs Pts w/ intravascular volume depletion (e.g. CHF, diarrhoea, excessive diuresis) and CKD depend on renal PG production to dilate the afferent glomerular arteriole and Hematology & Pathology (Path) 4
maintain the GFR. NSAIDs inhib PG synthesis, which cause prerenal azotaemia in at-risk pts. Oncology (HO)
15545 Athlete's heart Athlete's heart refers to physiologic cardiac adaptations that improve cardiac fxn in response to high-lvl endurance training. There's predominant eccentric hypertrophy w/ Hematology & Pathology (Path) 1
a smaller component of concentric hypertrophy, leading to an overall ↑ in LV mass, enlarged LV cavity size, ↑ LV wall thickness, and ↓ resting HR. Oncology (HO)
15562 Autism spectrum disorders Pts w/ milder forms of ASD freq have normal language and cognitive devel. ChFx incl deficits in social communication and reciprocal social interactions, restricted Hematology & Pathology (Path) 2
interests, and behavioural rigidity that become more apparent as social and academic demands ↑. Oncology (HO)
15635 Aortic aneurysm AAA is focal dilation of the abdominal aorta above normal (or >3 cm in diameter). It is generally aSSx until aneurysm rupture, which is frequently fatal. RFx include age Hematology & Pathology (Path) 6
>65, smoking, and male sex. Oncology (HO)
15645 Asbestos Mesothelioma is a neoplasm arising from mesothelial cells and is strongly associated with asbestos exposure. In early mesothelioma, multiple nodules form on the parietal Hematology & Pathology (Path) 5
pleura and gradually encase the lung parenchyma. Immunohistochemistry is important for diagnosis; nearly all mesotheliomas stain positive for cytokeratins and many Oncology (HO)
also stain positive for calretinin.
16441 Intestinal helminth parasites Ascaris lumbricoides is transmitted via contaminated food or water. Eggs hatch into larvae in the small intestine, penetrate the intestinal wall, and migrate across the lung Hematology & Pathology (Path) 3
into the alveoli. Larvae are subsequently coughed up and swallowed into the GIT, where they mature to adult worms. Most pts are aSSx, but some develop early pulm Oncology (HO)
MFx (Loeffler syndrome) or later GI SSx.
425 Primary biliary cholangitis PBC is a chronic AI liver disease Chx by lymphocytic infiltrates and destruction of small and mid-sized intrahepatic bile ducts. Similar findings are seen in hepatic Hematology & Pathophysiology 4
GVHD, highlighting the immunologic etiology of the disorder. Oncology (HO) (Patp)
890 Anesthesia The MAC is a measure of potency of an inhaled anaesthetic. It's the conc of the anaesthetic in the alveoli that renders 50% of pts unresponsive to painful stimuli (ED50). Hematology & Pathophysiology 9
Potency is inversely proportional to the MAC: the lower the MAC, the more potent the anaesthetic. Oncology (HO) (Patp)
897 Gout Colchicine inhibits tubulin polymerization into microtubules and can be used for acute treatment and prophylaxis of gout. Important side effects of colchicine include Hematology & Pathophysiology 11
nausea, abdominal pain, and diarrhea. Oncology (HO) (Patp)
1156 Dyslipidemia Xanthomas are suggestive of hyperlipidaemia, esp. when present in conjunction w/ a FHx of early cardiac death. Hematology & Pathophysiology 11
Oncology (HO) (Patp)
1291 Advance directives The admission process should include discussion of ADs and code status to ensure that medical personnel adhere to the pt's specific wishes in the event that the pt Hematology & Pathophysiology 3
becomes incapacitated. Oncology (HO) (Patp)
QID Topic Educational Objective System Subject Repeats
1292 Requests to withhold Patients have the right to have information withheld from them regarding their medical condition. Physicians must respect their wish not to know, but should also explore Hematology & Pathophysiology 1
information the patient concerns to better understand their preferences and maximize their involvement in subsequent medical decision making. Oncology (HO) (Patp)
1339 Normal distribution In general, in a (+)ly skewed distribution, the mean is the most shifted in the (+) direction (to the right), followed by the median and then the mode. In such a situation, the Hematology & Pathophysiology 3
median often reflects a central tendency better than the mean does. Oncology (HO) (Patp)
1851 Infection control Spore-forming bacteria can survive boiling temps. Bacillus and Clostridium species are common pathogenic spore-forming bacteria. Hematology & Pathophysiology 3
Oncology (HO) (Patp)
1855 Inflammatory bowel disease CD typically presents w/ the insidious onset of abdo pain, diarrhoea, and constitutional SSx (e.g. weight loss, fever). Pts are prone to devel fistulas/abscesses as the lesions Hematology & Pathophysiology 9
affect the entire thickness of the bowel wall. Perianal disease (e.g. skin tags, fissures) is also common. Oncology (HO) (Patp)
1877 Ureter injury The ureters pass posterior to the ovarian (gonadal) vessels within the retroperitoneum and cross anterior to the common/external iliac arteries to reach the true pelvis. Hematology & Pathophysiology 3
Within the true pelvis, the ureters lie anterior to the internal iliac artery and posterior to the uterine artery. Oncology (HO) (Patp)
1903 Fetal circulation The most highly oxygenated blood in the fetus is carried by the umbilical vein, which empties directly into the inferior vena cava via the ductus venosus. Hematology & Pathophysiology 1
Oncology (HO) (Patp)
1940 Coronary blood flow The inferior wall of the LV forms most of the inferior (diaphragmatic) surface of the heart and is supplied by the PDA. In 85%-90% of individuals, the PDA derives from Hematology & Pathophysiology 9
the RCA (right dominant coronary circulation). Oncology (HO) (Patp)
2097 Testicular cancer Lymph from the testes drains through lymph channels directly back to the para-aortic lymph nodes. In contrast, lymph from the scrotum drains to the superficial inguinal Hematology & Pathophysiology 4
lymph nodes. Oncology (HO) (Patp)
2098 Spleen rupture The spleen is of mesodermal origin (the dorsal mesentery). Although it is supplied by the splenic artery (a branch of the major foregut vessel, the celiac trunk), It is not a Hematology & Pathophysiology 2
foregut derivative. Oncology (HO) (Patp)
2133 Bulimia nervosa BN is characterised by recurrent episodes of binge eating f/b compensatory behaviours to prevent weight gain (e.g. fasting, exercising, vomiting, using laxatives). In Hematology & Pathophysiology 4
contrast to pts w/ AN, BN pts are normal weight to overweight. Oncology (HO) (Patp)
11624 Patient confidentiality Physicians must be cautious about discussing protected pt health information in public places, including public settings w/i the hospital, even w/ other medical personnel. Hematology & Pathophysiology 5
Conversations regarding pts should be deferred to a later time when a more private setting can be arranged. Oncology (HO) (Patp)
14983 Myocardial infarction Papillary muscle rupture is a life-threatening complication that typically occurs 3-5 days after MI and presents w/ acute MR and pulm edema. The posteromedial papillary Hematology & Pathophysiology 18
muscle is supplied solely by the PDA, making it susceptible to ischemic rupture. Oncology (HO) (Patp)
15133 Myelofibrosis PMF is an MPD a/w the clonal expansion of megakaryocytes. Bone marrow fibrosis accounts for most of the major MFxs, incl HSM, cytopaenias, and blood smear Hematology & Pathophysiology 3
evidence of dacrocytes. Bone marrow aspiration is usually dry, but bone marrow Bx will show marked fibrosis w/ occasional clusters of atypical megakaryocytes. Oncology (HO) (Patp)
15134 Gynecomastia 5-α reductase inhibs (e.g. finasteride, dutasteride) are used in the Tx of BPH. These Rx block the conversion of testosterone to DHT; the excess testosterone is then Hematology & Pathophysiology 3
available for conversion to oestrogens (e.g. oestradiol) by aromatase, which can lead to gynecomastia. Oncology (HO) (Patp)
15248 Hypothyroidism Thyrotoxicosis, whether due to endogenous hyperthyroidism or over-replacement with thyroid hormone in patients with hypothyroidism, causes a hyperadrenergic state Hematology & Pathophysiology 13
that can lead to atrial fibrillation, high-output heart failure, and worsening of angina pectoris. Oncology (HO) (Patp)
16287 Primary hypertension Concentric LVH involves uniform thickening of the LV walls w/ ↓ in LV cavity size and most commonly results from prolonged systemic HTN. It can progress to HTN Hematology & Pathophysiology 14
heart disease w/ impaired diastolic filling and HF w/ preserved EF. Histopathology demonstrates transverse thickening of cardiomyocytes w/ prominent hyperchromatic Oncology (HO) (Patp)
nuclei and interstitial fibrosis.
16442 Hand, foot, mouth disease HFMD is a common childhood illness characterised by painful, vesicular mouth lesions; ulcers on the extremities; and low-grade fever. It's caused by the ingestion and Hematology & Pathophysiology 2
subseq dissemination of an enterovirus (e.g. Coxsackievirus). Oncology (HO) (Patp)
16705 Pulmonary embolism Transcatheter aortic valve implantation (TAVI) allows for minimally invasive management of severe aortic stenosis in elderly patients who are unable to tolerate open Hematology & Pathophysiology 13
surgical valve replacement. Paravalvular aortic regurgitation is a common complication of TAVI, resulting from improper sealing of the prosthetic valve to the native Oncology (HO) (Patp)
aortic valve annulus.
219 Fat embolism FES most commonly results from the release of fat globules from bone marrow following a long-bone or pelvic fracture. The fat globules form inflammatory aggregates Hematology & Pharmacology 2
that cause microvessel obstr and systemic inflammation leading to the triad of resp distress, neuro dysfxn, and petechial rash that characterises the condition. Oncology (HO) (Phar)
709 Toxic shock syndrome Superantigens (eg, toxic shock syndrome toxin) interact with major histocompatibility complex molecules on antigen-presenting cells and the variable region of the T Hematology & Pharmacology 2
lymphocyte receptor to cause nonspecific, widespread activation of T cells. This results in the release of interleukin (IL)-2 from the T cells and IL-1 and tumor necrosis Oncology (HO) (Phar)
factor from macrophages. This immune cascade is responsible for the manifestations of toxic shock syndrome.
714 Endocarditis Staphylococcus epidermidis, a Gram (+) coccus that grows in clusters, is a skin commensal that is a common cause of infection in pts w/ prosthetic devices such as Hematology & Pharmacology 15
artificial joints or heart valves. Unlike S aureus, S epidermidis is coagulase (-). Unlike S saprophyticus (another coagulase (-) staphylococci species), S epidermidis is Oncology (HO) (Phar)
susceptible to novobiocin.
892 Drug induced liver injury Halogenated inhaled anaesthetics (e.g. halothane, enflurane, isoflurane, sevoflurane, desflurane) are meta by the hepatic CYP450 system by which they're converted to Hematology & Pharmacology 2
reactive intermediates that can cause hepatocellular dmg (halothane hepatitis). Pts often present w/ acute hepatitis days after Rx exposure, and liver Bx may show Oncology (HO) (Phar)
centrilobular hepatic necrosis.
942 Paroxysmal nocturnal The triad of HA, hypercoag, and pancytopenia suggests PNH. PNH results from an acq mut in the PIGA gene that causes absence of the GPI anchor and assoc defic of Hematology & Pharmacology 2
hemoglobinuria CD55 and CD59 complement inhib proteins. Oncology (HO) (Phar)
1077 2,3-bisphosphoglycerate 2,3-BPG decr Hb's affinity for O2. Therefore, in the presence of decr blood O2 conc., higher 2,3-BPG lvls w/i erythrocytes enable incr O2 delivery in the peri tissues. 2,3- Hematology & Pharmacology 1
metabolism BPG is produced from 1,3-BPG by the enzyme BPG mutase. This rxn bypasses an ATP-generating step of glycolysis, causing no net gain in ATP. Oncology (HO) (Phar)
1078 Glycogen storage disease Debranching enzyme defic (Cori disease) leads to accumulation of glycogen w/ abnly short outer chains (limit dextrins) due to the inability to degrade α-1,6-glycosidic Hematology & Pharmacology 3
branch points. Pts present w/ hypoglycaemia, ketoacidosis, hepatomegaly, and muscle weakness and hypotonia. Oncology (HO) (Phar)
1079 Fructose 2,6 bisphosphate F-2,6-BP activates PFK-1 (↑ glycolysis) and inhibs F-1,6-BPase (↓ GNG). F-2,6-BP conc is regulated by a bifxnal enzyme complex: PFK-2 ↑ F-2,6-BP lvls in response to Hematology & Pharmacology 1
insulin, and F-2,6-BPase ↓ F-2,6-BP lvls in response to glucagon. Oncology (HO) (Phar)
1087 G6PD deficiency G6PD is the RLE of the PPP. G6PD defic is a common XLR disorder resulting in episodes of HA during times of incr. ox stress (e.g. use of antimalarials/sulfonamide, Hematology & Pharmacology 5
infections). Oncology (HO) (Phar)
1090 Toxoplasmosis Congenital toxoplasmosis is a transplacental infection (acq in utero). Its classic triad includes hydrocephalus, intracranial calcifications, and chorioretinitis. Expecting Hematology & Pharmacology 5
mothers should avoid cat feces to help prevent exposure to Toxoplasma. Oncology (HO) (Phar)
1257 Anticoagulants Warfarin is an oral anticoagulant that inhibits the carboxylation of vitamin K-dependent coagulation factors II, VII, IX, and X. It is used in AF, DVT, and pulm TE. Hematology & Pharmacology 8
PT/INR should be monitored regularly during Tx w/ warfarin. aPTT is used for monitoring UFH. Oncology (HO) (Phar)
1628 Glucose clearance Glc is normally filtered at the glom and completely reabsorbed by the PCT. Inhib of Na+-coupled, carrier-mediated transport of Glc by the PCT would cause the Glc Hematology & Pharmacology 1
clearance to approach the value of the GFR, which is typically estimated by calculating the clearance of inulin. Oncology (HO) (Phar)
1784 Drug structure and Characteristics of a drug such as high molecular weight, high plasma protein binding, high charge, and hydrophilicity tend to trap the drug in the plasma compartment Hematology & Pharmacology 3
properties resulting in a low Vd (3-5 L). Oncology (HO) (Phar)
1816 Aspiration pneumonia Due to gravity, supine patients typically aspirate into the posterior segments of the upper lobes and superior segments of the lower lobes. Patients who are upright tend to Hematology & Pharmacology 2
aspirate into the basilar segments of the lower lobes. Aspirated material is more likely to travel down the right main bronchus. Oncology (HO) (Phar)
1818 Peroneal neuropathy Trauma/sustained pressure to the neck of the fibula can injure the common peroneal nerve, causing weakness on foot dorsiflexion and eversion and impaired sensation Hematology & Pharmacology 3
over the lateral shin and dorsal foot, and b/w the 1st and 2nd toes. Oncology (HO) (Phar)
1819 Carpal tunnel syndrome CTS occurs due to compression a/o inflammation of the median nerve in the carpel tunnel and typically results in sensory loss over the palm and anterior aspect of the 1st Hematology & Pharmacology 3
3.5 digits w/ thenar atrophy and impairment of thumb flexion/opposition. In the forearm, the median nerve courses b/w the humeral and ulnar heads of the pronator teres Oncology (HO) (Phar)
muscle and b/w the FDS and FDP muscles.
1857 Anticoagulants Enoxaparin is a low-molecular-weight heparin (LMWH) that functions like heparin in that it binds and activates antithrombin III (AT III). Activated AT III binds to factor Hematology & Pharmacology 8
Xa and stops factor Xa from converting prothrombin to thrombin. Due to its fewer number of molecules, LMWH acts primarily on factor Xa, not thrombin. Oncology (HO) (Phar)
1890 Methotrexate Folinic acid (leucovorin) can reverse the tox of MTX in non-ca cells in the GI mucosa and bone marrow if admin at the appropriate time. Leucovorin serves as a reduced Hematology & Pharmacology 2
form of vitB9 that doesn’t req the action of DHFR. Oncology (HO) (Phar)
1892 Chemotherapy The human MDR1 gene codes for P-gp, a transmembrane ATP-dependent efflux pump protein that has a broad specificity for hydrophobic compounds. This protein can Hematology & Pharmacology 3
both ↓ the influx of drugs into the cytosol and can ↑ efflux from the cytosol, thereby preventing the action of CTx agents. Oncology (HO) (Phar)
1893 Trisomy 13 Patau syndrome (trisomy 13) usually occurs secondary to meiotic nondisjunction in mothers of advanced maternal age. Key physical findings reflect defective prechordal Hematology & Pharmacology 1
mesoderm fusion resulting in midline defects (eg, holoprosencephaly, microphthalmia, cleft lip/palate, omphalocele) as well as polydactyly and cutis aplasia. Oncology (HO) (Phar)
1894 Trisomy 18 Trisomy 18, or ES, is most commonly the result of meiotic nondisjxn due to advanced maternal age. Key findings include fetal growth retardation, hypertonia (clenched Hematology & Pharmacology 1
hands w/ overlapping fingers), rocker bottom feet, and cardiac/GI/renal defects. Oncology (HO) (Phar)
2018 VIPoma VIPomas are pancr islet cell tumors that hypersecr VIP, which ↑ intestinal Cl loss into the stool and causes excess losses of the accomp water, Na, and K. VIP also inhibs Hematology & Pharmacology 1
gastric acid secr. SS inhibs the secr of VIP and is used to Tx the SSx of VIPoma. Oncology (HO) (Phar)
2132 Obsessive compulsive OCD is characterised by persistent, intrusive thoughts leading to repetitive, ritualistic behaviours. SSRIs are considered 1st-line Tx for OCD and exert their effects by Hematology & Pharmacology 2
disorder inhib 5-HT reuptake. Oncology (HO) (Phar)
8542 Seborrheic keratosis SKs are pigmented macules or plaques w/ a greasy surface and well-demarcated borders. Rapid onset of numerous lesions is an indicator of internal malignancy (Leser- Hematology & Pharmacology 2
Trelat sign), esp. GAC. Oncology (HO) (Phar)
11584 Suicide Access to firearms greatly ↑ the risk of completed suicide. Eval of a pt's access to guns is a key part of suicide risk Ax. Other interventions to ↓ suicide risk incl ↓ stress, ↑ Hematology & Pharmacology 1
psychosocial support, Tx psych illness and substance use, and Mx pain. Oncology (HO) (Phar)
11585 Necrotizing enterocolitis NEC is 1 of the most common GI emergencies affecting newborns. It's characterised by bacterial invasion and ischemic necrosis of the bowel wall, and is a/w prematurity Hematology & Pharmacology 1
and initiation of enteral feeding. Abdo XR showing pneumatosis intestinalis (i.e. air in the bowel wall confirms the Dx. Oncology (HO) (Phar)
11728 Cytomegalovirus The most common eye-related complication of congenital CMV infection is chorioretinitis. Hematology & Pharmacology 9
Oncology (HO) (Phar)
11731 Drug interaction The Beers criteria identify drugs that should be used with caution in geriatric patients. Common drugs to avoid include anticholinergics (eg, first-generation Hematology & Pharmacology 2
antihistamines), alpha blockers, tricyclic antidepressants, benzodiazepines (and other sedating medications), antipsychotics, most antiarrhythmics, and skeletal muscle Oncology (HO) (Phar)
relaxants.
14848 Lead poisoning Lead poisoning can cause neurologic, gastrointestinal, renal, and hematologic complications. Although symptoms can be vague, lead poisoning should be suspected if Hematology & Pharmacology 4
these symptoms arise while residing in a home built before 1978. Diagnosis is made by measuring the patient's blood lead level. Oncology (HO) (Phar)
QID Topic Educational Objective System Subject Repeats
14956 Renal calculi Formation of uric acid kidney stones is promoted by low urine pH, which favours formation of insoluble uric acid over soluble urate ion. GI HCO3- loss due to chronic Hematology & Pharmacology 7
diarrhoea leads to chronic meta acidosis and production of acidic urine, promoting formation of uric acid stones. Oncology (HO) (Phar)
15299 Clostridium difficile C. difficile commonly Px w/ diarrhea and abdo pain; hosp and Abx use ↑ the risk of contracting the disease. A NAAT is considered the most sens method for Dx of C. Hematology & Pharmacology 7
infection difficile infec in pts w/ CFx. Oncology (HO) (Phar)
15489 Toxic alcohols Ethylene glycol and methanol are toxic alcohols that cause AGMA and an ↑ osmolar gap. Toxicity occurs after metabolization by alcohol dehydrogenase; fomepizole is a Hematology & Pharmacology 1
competitive inhibitor of alcohol dehydrogenase and is used for the Tx of acute poisoning. Oncology (HO) (Phar)
15706 Malaria Malaria is Dx when intraerythrocytic diamond ring-shaped parasites are seen on peri blood smear. This disease should be suspected in travellers to endemic regions who Hematology & Pharmacology 5
develop a febrile illness. Oncology (HO) (Phar)
15821 Bulimia nervosa Hypokalaemia in an otherwise healthy young adult w/ a normal BMI and preoccup w/ body size is concerning for self-induced vomiting a/w BN. Common PEx findings Hematology & Pharmacology 4
in BN incl tachycardia, hypotension, painless parotid gland swelling, calluses or scarring on the dorsum of the hand, and erosion of dental enamel. Oncology (HO) (Phar)
787 Cell mediated immunity NK cells recognize and kill cells w/ decr. MHC-I Ag cell surface expression, such as virus-infected cells and tumor cells. They're large lymphocytes that contain perforins Hematology & Physiology 5
and granzymes in cytoplasmic granules. NK cells kill target cells by inducing apoptosis. Oncology (HO) (Phys)
1062 Dilated cardiomyopathy Anthracycline CTx agents (e.g. doxorubicin, daunorubicin) cause cardiotox mainly thru the formation of anthracycline-topoisomerase II DNA cleavage complexes that Hematology & Physiology 8
affect healthy cardiomyocytes. The cardiotox is dependent on the cumulative dose of anthracycline received, and it manifests as DCM. Oncology (HO) (Phys)
1545 Xeroderma pigmentosum Xeroderma pigmentosum is an autosomal recessive disorder characterized by defective nucleotide excision repair often caused by a deficiency in UV-specific Hematology & Physiology 2
endonuclease. Affected children usually have severe photosensitivity, hyperpigmentation in sun-exposed areas, and a greatly increased risk for skin cancer. Oncology (HO) (Phys)
1654 Polycythemia Erythrocytosis is defined as a Hct lvl >52% in men and >48% in women. Measurement of RBC mass is necessary to distinguish absolute from relative erythrocytosis. A Hematology & Physiology 5
normal RBC mass indicates plasma volume contraction as the cause of polycythemia. Oncology (HO) (Phys)
15307 HIV Pts w/ advanced HIV and low CD4 counts are at risk for opportunistic infections and req antimicrobial prophylaxis. P. jiroveci pneumonia prophylaxis w/ TMP-SMX is Hematology & Physiology 11
indicated when CD4 count is <200/mm3. Oncology (HO) (Phys)
15323 Pulmonary embolism Massive PE can lead to SCD due to a sudden loss of CO. Less commonly, SCD may result from cardiac arrhythmia triggered by RV strain and ischemia. Hematology & Physiology 13
Oncology (HO) (Phys)
1471 Influenza The tissue tropism of viruses is 1arily mediated by viral surface glycoproteins that bind to specific host cell receptors. muts to viral surface glycoproteins can alter tissue Infectious Diseases Biochemistry 5
tropism and cause noninfective viruses to become infectious. (ID) (Bioc)
1469 Hypothyroidism Congenital hypoTH-ism is usually aSSx at birth. After maternal T4 wanes, infants develop constipation, lethargy, hypotonia, macroglossia, an umbi hernia, and a large ant Infectious Diseases Genetics (Gene) 13
fontanelle. (ID)
483 Granulomatosis with The histopath features of oesophageal SCC incl solid nests of neoplastic squamous cells w/ abundant eosinophilic cytoplasm and distinct borders. Areas of keratinisation Infectious Diseases Histology (Hist) 2
polyangiitis and the presence of intercellular bridges are also char. Pts typically present w/ progr solid and eventually liquid dysphagia and weight loss. (ID)
112 Mucocutaneous candidiasis Oral thrush is caused by Candida albicans infection and usually presents as white, plaque-like oropharyngeal lesions that're easily scraped off w/ a tongue depressor. Most Infectious Diseases Immunology 3
cases arise in those who have disruptions to normal flora due to Abx or impairments in cell-mediated immunity from chemotherapy, inhaled corticosteroids, or HIV. (ID) (Immu)
Young, otherwise healthy pts w/ thrush should be tested for HIV, particularly if they have HIV RFs or other SSx of the virus.
380 Antiepileptics Lamotrigine can be used to Tx partial and gen seizures and works by blocking v-gated Na+ channels. SJS and TEN are rare, life-threatening AEs characterised by flu-like Infectious Diseases Immunology 3
SSx f/b widespread mucocutaneous epidermal necrosis. (ID) (Immu)
676 Lung cancer Tumors located in the lung apex (superior sulcus) are called Pancoast tumors. Invasion of surrounding structures can lead to ipsilateral Horner syndrome, rib destruction, Infectious Diseases Immunology 9
atrophy of hand muscles, and pain in the distribution of C8, T1, and T2 nerve roots. (ID) (Immu)
739 Parkinson disease DA agonists have a chem structure similar to the NT DA and directly stim DA receptors. The 2 classes of DA agonists are ergot compounds (e.g. bromocriptine) and non- Infectious Diseases Immunology 7
ergot compounds (e.g. pramipexole, ropinirole). (ID) (Immu)
760 Skin and soft tissue S. aureus is the most common cause of skin and soft-tissue abscess (e.g. furuncle). Tx of the abscess w/ incision and drainage and Abx can eliminate the local infection but Infectious Diseases Immunology 8
infections doesn't eliminate colonisation of the anterior nares and skin. Therefore, recurrent infections are common. (ID) (Immu)
1466 Acute myeloid leukemia APML is the M3 variant of acute myelogenous leukemia. It affects adult pts and may Px w/ DIC. The cytogenetic abnormality t(15;17) leads to formation of the Infectious Diseases Immunology 3
PML/RARα fusion gene, which is unable to signal for proper cellular differentiation, unlike the normal RAR. (ID) (Immu)
15177 Syphilis Histopathologic examination of syphilitic lesions classically demonstrates a proliferative endarteritis with a surrounding plasma cell infiltrate. Most of the manifestations Infectious Diseases Immunology 9
of syphilis are due to localized tissue ischemia resulting from endarteritis. (ID) (Immu)
15490 Diabetic nephropathy In diabetic nephropathy, early adaptive changes in the kidney cause a transient increase in glomerular filtration (hyperfiltration). As diabetic nephropathy progresses, Infectious Diseases Immunology 4
glomerular filtration falls, with a concurrent increase in urine albumin loss. (ID) (Immu)
15509 Acute diarrhea Children w/ watery diarrhea should be Tx w/ oral rehydr solns containing hypotonic, equimolar concs of Na and Glc to help prevent dehydr and electrolyte abns. Infectious Diseases Immunology 13
(ID) (Immu)
44 Myocardial infarction Hibernating myocardium refers to the presence of LV systolic dysfxn due to ↓ coronary blood flow at rest that's partially or completely reversible by coronary Infectious Diseases Microbiology 18
revascularisation. (ID) (Micr)
45 Hepatitis C Genetic variations created during HCV replication result in marked variety in the Agic structure of HCV envelope proteins. The production of host Abs lags behind that of Infectious Diseases Microbiology 4
new mutant HCV strains, preventing infected individuals from mounting an effective immune response. (ID) (Micr)
46 Hepatitis D HDV is a replication-defective RNA virus that's capable of causing infection only in the setting of coinfection w/ HBV. HBV provides HBsAg for the HDV envelope. Infectious Diseases Microbiology 2
(ID) (Micr)
48 Hepatitis D The HBsAg of HBV must coat the HDAg of HDV before it can infect hepatocytes and multiply. Infectious Diseases Microbiology 2
(ID) (Micr)
105 Tinea Pityriasis versicolor (tinea versicolor) is a superficial skin infection caused by Malassezia species. It causes erythematous, hyper- or hypopigmented macules and patches. Infectious Diseases Microbiology 4
Malassezia forms spores and hyphae, producing the characteristic "spaghetti and meatballs" appearance on KOH preparation light microscopy. (ID) (Micr)
106 Aspergillosis Immsup pts are at risk for A. fumigatus infection. This fungus produces thin, septate hyphae w/ acute V-shaped branching. It causes invasive aspergillosis, aspergillomas, Infectious Diseases Microbiology 5
and allergic pulm aspergillosis. (ID) (Micr)
107 Mucormycosis Mucormycosis is an opportunistic infection caused by Rhizopus, Mucor, and Absidia species. The classic clinical picture is paranasal sinus involvement in a diabetic or Infectious Diseases Microbiology 3
immsup pt. The fungi form broad non-septate hyphae that branch at right angles. (ID) (Micr)
109 Aspergillosis A. fumigatus causes a wide spectrum of disease. It can be an opportunistic infection in immsup and neutropaenic pts (invasive pulm aspergillosis). Aspergillosis can be Infectious Diseases Microbiology 5
colonising (aspergilloma) when it forms a fungus ball w/i a pre-existing lung cavity. It can also cause a lung HSR in allergic bronchopulm aspergillosis in individuals w/ (ID) (Micr)
asthma.
111 Mucocutaneous candidiasis Abx suppress the normal vaginal flora and facilitate Candida overgrowth. Abx use is the most common cause of Candida vaginitis. Other potential causes include Infectious Diseases Microbiology 3
pregnancy, systemic corticosteroid use, DM, and immunosuppression. (ID) (Micr)
271 Diastolic dysfunction A low-freq, late diastolic sound on cardiac auscultation that immediately precedes S1 is most often S4. An abn S4 can be heard in pts w/ ↓ ventricular compliance (e.g. Infectious Diseases Microbiology 4
HTN heart disease, AS, HCM) due to a sudden rise in EDP w/ atrial contraction. (ID) (Micr)
277 Holoprosencephaly A developmental field defect describes multiple malformations that occur 2° to an embryonic disturbance in an adjoining group of cells. HPE is a developmental field Infectious Diseases Microbiology 1
defect Chx by a spectrum of fetal anomalies due to incomplete division of the forebrain (prosencephalon). (ID) (Micr)
373 Insomnia NonBZD Rx (eg, zolpidem, zaleplon, eszopiclone) stimulate specific subtypes of GABA-A receptors. As a result, nonBZDs are primarily hypnotics and do not produce Infectious Diseases Microbiology 3
the anxiolytic, muscle relaxant, or anticonvulsant effects a/w BZDs. (ID) (Micr)
374 Alcohol withdrawal AWS should be considered in hospitalised pts who develop tremulousness, agitation, and ↑ HR and BP w/i 48hrs following admission. Benzos act as a substitute for the Infectious Diseases Microbiology 2
effects of alcohol on GABA receptors, preventing AWS from occurring. (ID) (Micr)
376 Benzodiazepines 1st-gen H1 receptor antagonists, incl diphenhydramine and chlorpheniramine, can cause significant sedation, esp. when used w/ other Rx that caused CNS depression Infectious Diseases Microbiology 6
(such as benzos). (ID) (Micr)
377 Seizures SE is a single seizure lasting >5min or the occurrence of multi discrete seizures w/ incomplete recovery of consciousness b/w episodes. The initial Tx incls IV lorazepam Infectious Diseases Microbiology 8
and phenytoin given concurrently. Phenytoin is a long-acting anticonvulsant that inhibs neuronal high-freq firing by ↓ the ability of Na+ channels to recover from (ID) (Micr)
inactivation.
378 Trigeminal neuralgia CNV neuralgia presents w/ brief episodes of sudden and severe 'electric shock-like' or 'stabbing' pain in the distribution of CNV (particularly V2 and V3). Carbamazepine Infectious Diseases Microbiology 2
is the DOC. (ID) (Micr)
379 Seizures Broad-spectrum anticonvulsants (e.g. levetiracetam, valproic acid) Tx both focal and gen onset seizures, whereas narrow-spectrum anticonvulsants (e.g. carbamazepine, Infectious Diseases Microbiology 8
phenytoin) are 1arily used only for focal onset seizures. B/c the seizures in JME are usually gen onset (i.e. affect both cerebral hemispheres at onset), Tx is w/ a broad- (ID) (Micr)
spectrum agent such as valproic acid.
390 Cholestasis Cholestatic liver disease can cause malabsorption and nutritional defic of fat-soluble vits. Infectious Diseases Microbiology 1
(ID) (Micr)
532 DRESS syndrome DRESS syndrome typically occurs 2-8wks after exposure to high-risk drugs such as anticonvulsants (e.g. phenytoin, carbamazepine), allopurinol, sulphonamides (e.g. Infectious Diseases Microbiology 1
sulfasalazine), and Abx (e.g. minocycline, vancomycin). Pts typically develop fever, gen LAD, facial oedema, diffuse skin rash, eosinophilia, and internal organ dysfxn. (ID) (Micr)
560 Wiskott-Aldrich syndrome The WAS consists of the triad of eczema, thrombocytopenia, and combined B-lymphocyte and T-lymphocyte defic. Onset of disease is early in life w/ thrombocytopenia Infectious Diseases Microbiology 1
present at birth and eczema and repeated infections, particularly by encapsulated organisms, following at 6-12 mos of age. (ID) (Micr)
651 Hyperthyroidism Pretibial myxoedema and Graves ophthalmopathy are specific features of GD. They're caused by an autoimmune response directed against the TSH receptor that results in Infectious Diseases Microbiology 8
the accumulation of GAGs w/i the affected tissues. (ID) (Micr)
677 Asbestos Malignant mesothelioma is a rare neoplasm typically arising from the pleura. It's strongly a/w asbestos exposure and presents w/ progr dyspnoea, cough, and chest pain. Infectious Diseases Microbiology 5
Unilateral pleural thickening or plaque formation is seen on imaging; pleural effusions are also common and may be hemorrhagic. Histopathology reveals tumour cells w/ (ID) (Micr)
numerous long, slender microvilli and abundant tonofilaments.
678 Lung cancer SCLC is the most aggressive type of lung ca and is commonly a/w PNP syndromes (e.g. SIADH, Cushing syndrome). It's thought to have a neuroendocrine origin; tumour Infectious Diseases Microbiology 9
cells express neuroendocrine markers (e.g. neural cell adhesion molecule (NCAM; CD56), chromogranin, synaptophysin) and contain neurosecretory granules in the (ID) (Micr)
cytoplasm.
722 Loop diuretics Ototox 2ary to loopDs usually occurs w/ higher dosages, pre-existing CKD, rapid IV admin, or when used in combo w/ other ototox agents (aminoglycosides, salicylates, Infectious Diseases Microbiology 3
and cisplatin). Hearing impairment is usually rev but may be permanent in some cases. (ID) (Micr)
723 Aldosterone antagonists MRBs (e.g. spironolactone, eplerenone) improve survival in pts w/ CHF and ↓ LV EF. They shouldn't be used in pts w/ hyperkalaemia or renal failure. Infectious Diseases Microbiology 3
(ID) (Micr)
QID Topic Educational Objective System Subject Repeats
725 Mannitol Mannitol is an osmoD that works by incr plasma or tubular fluid osmolality. Incr plasma and fluid osmolality causes extraction of water from the interstitial space into the Infectious Diseases Microbiology 1
vasc space or tubular lumen, w/ subseq diuresis. In the brain, water redistribution from the tissues into the plasma helps decr edema and ICP in the setting of cerebral (ID) (Micr)
edema. 1 of the more severe tox of aggressive osmoDs is pulm edema.
727 Renin angiotensin ACEIs block the effect of ACE, decr AT-II and aldo lvls. By decr AT-II lvls, ACEIs directly interrupt (-) fb loops, thereby incr renin and AT-I lvls. ACE is also Infectious Diseases Microbiology 1
aldosterone system responsible for the breakdown of bradykinin; ACEIs therefore incr bradykinin lvls. (ID) (Micr)
728 Angiotensin receptor ARBs work by blocking ATII-1 receptors, inhib the effects of ATII. This results in arterial vasodilation and ↓ aldosterone secretion. The resulting fall in BP ↑ renin, ATI, Infectious Diseases Microbiology 1
blockers and ATII lvls. ARBs don't affect the activity of ACE, and therefore they don't affect bradykinin degradation and don't cause cough. (ID) (Micr)
736 Achondroplasia Unlike the process of intramembranous ossification that forms flat bones, endochondral ossification proceeds along a cartilage template and is responsible for the Infectious Diseases Microbiology 2
formation of long bones. Achondroplasia is characterized by an exaggerated inhibition of chondrocyte proliferation in the growth plates of long bones and manifests with (ID) (Micr)
proximal limb shortening, midface hypoplasia, and macrocephaly.
953 Renal cell carcinoma Sporadic and hereditary (a/w vHL disease) RCCs are a/w mutations involving the VHL gene on chromosome 3p. The VHL gene is a tumor suppressor that inhibits Infectious Diseases Microbiology 8
hypoxia-inducible factors; mutations lead to constitutive activation of these proteins, resulting in the activation of multiple angiogenic and tumorigenic growth factors (eg, (ID) (Micr)
VEG-F, PDG-F).
963 Central pontine Rapid correction of chronic hyponatraemia may led to osmotic demyelination syndrome (i.e. central pontine myelinolysis). It typically MFx 2-6days after the osmotic Infectious Diseases Microbiology 2
myelinolysis insult w/ spastic quadriplegia, pseudobulbar palsy, and locked-in syndrome. (ID) (Micr)
968 Diabetes mellitus TZDs lower blood Glc by ↓ insulin resistance. TZDs activate PPAR-γ, a nuclear receptor that alters the transcription of genes involved in Glc and lipid meta. Infectious Diseases Microbiology 31
(ID) (Micr)
972 Adrenal insufficiency Pts w/ DM-1 are at ↑ risk for other autoimmune endocrinopathies, incl PAI (Addison disease). Electrolyte abns in PAI incl hyponatraemia, hyperkalaemia, Infectious Diseases Microbiology 5
hyperchloraemia, and NAGMA. (ID) (Micr)
976 Cushing syndrome Long-term use of supraphysiologic doses of GCs cause suppression of the HPA axis, which in turn leads to bilateral AC atrophy involving the ZF and ZR. Sudden Infectious Diseases Microbiology 5
cessation of the exogenous corticosteroids can precipitate adrenal crisis. (ID) (Micr)
977 Hyperaldosteronism 1° MC excess (hyperaldosteronism) causes ↑ renal Na+ reabsorption, leading to HTN, hypokalaemia, and meta alkalosis. PHA is freq caused by adrenal adenoma or Infectious Diseases Microbiology 5
bilateral hyperplasia. (ID) (Micr)
1004 Community acquired L. pneumophila has a propensity to affect older adults w/ chronic lung disease who smoke. It causes Legionnaires' disease which is characterised by high fever, diarrhoea, Infectious Diseases Microbiology 21
pneumonia h/a, and confusion. L. pneumophila is a gram (-) rod that's typically not detected on Gram stain but can be Dx by PCR of an LRT sample or detection of Legionella Ag in (ID) (Micr)
the urine.
1007 Epiglottitis PRP is a capsule and major VF for Hib. Hib is the most common cause of epiglottitis, which presents w/ fever, stridor, and dyspnoea. Infectious Diseases Microbiology 2
(ID) (Micr)
1024 Hypercalcemia Serum calcium >13 mg/dL is suggestive of an underlying malignancy. Secretion of parathyroid hormone-related protein (PTHrP), which closely resembles parathyroid Infectious Diseases Microbiology 5
hormone at the bioactive amino-terminal region, is a frequent cause of malignancy-related hypercalcemia and is commonly seen with squamous cell carcinomas (eg, lung, (ID) (Micr)
neck).
1025 Chronic kidney disease CKD usually causes hyperphosphataemia (binds serum Ca2+) and low 1,25-dihydroxyvit D (↓ intestinal Ca2+ absorption and Ca2+ release from bone). The resulting Infectious Diseases Microbiology 8
hypocalcaemia stims release of PTH, causing 2° hyperparathyroidism. (ID) (Micr)
1026 Hypercalcemia TZDs cause hypercalcaemia by ↑ the DCT reabsorption of Ca2+. The ↑ circulating Ca2+ lvls result in suppression of PTH, which distinguishes this effect from HPT. Infectious Diseases Microbiology 5
(ID) (Micr)
1045 Gluconeogenesis After 12-18hrs of fasting, GNG becomes the principal source of blood Glc. GNG uses many glycolytic enzymes, but hexokinase, PFK, and PK need to be bypassed as Infectious Diseases Microbiology 4
they're unidirectional. The initial steps of GNG involve the conversion of pyruvate to OA and OA to PEP by PC and PEPCK, respectively. (ID) (Micr)
1092 Acute pericarditis Pericarditis is the most common CV MFx a/w SLE. It presents w/ sharp pleuritic chest pain that is relieved by sitting up and leaning forward. Infectious Diseases Microbiology 5
(ID) (Micr)
1093 Barrett esophagus Squamous metaplasia is a reversible, adaptive response to chronic irritation, such as smoking. The normal columnar epithelium is replaced by squamous epithelium, Infectious Diseases Microbiology 2
which is more resistance to irritation but has ↓ mucociliary clearance. Metaplasia also occurs w/ Barrett oesophagus, in which oesophageal squamous epithelium is (ID) (Micr)
replaced by columnar epithelium in response to chronic acid exposure.
1094 Herpes zoster HZ (shingles) develops due to reactivation of VZV in the DRG (sensory neurons). It presents w/ a painful vesicular rash in a dermatomal distribution. Intranuclear Infectious Diseases Microbiology 4
inclusions in keratinocytes and multinucleated giant cells are seen on LM. (ID) (Micr)
1099 Dilated cardiomyopathy Thiamine deficiency causes beriberi and Wernicke-Korsakoff syndrome. Dry beriberi is characterized by symmetrical peripheral neuropathy; wet beriberi includes the Infectious Diseases Microbiology 8
addition of high-output congestive heart failure. (ID) (Micr)
1101 NSAIDs Analgesic nephropathy is a form of CKD caused by prolonged, heavy intake of NSAIDs a/o acetaminophen. Path chars incl CIN and RPN. Infectious Diseases Microbiology 4
(ID) (Micr)
1103 Polycystic kidney disease ADPKD MFx in pts 40-50 y/o w/ enlarged kidneys, HTN, and ARF. In newborns, the kidneys are of normal size, and the cysts are too small to be detected on abdo US. Infectious Diseases Microbiology 3
As the cysts enlarge, they compress the renal parenchyma and cause SSx. (ID) (Micr)
1135 Breast cancer Hereditary breast ca is most commonly a/w muts in BRCA1 and BRCA2. These TSGs are involved in DNA repair, and their mut ↑ the risk of devel breast and ovarian ca. Infectious Diseases Microbiology 7
(ID) (Micr)
1137 Non-Hodgkin lymphoma Analgesic nephropathy is a form of CKD caused by prolonged, heavy intake of NSAIDs a/o acetaminophen. Path char incl CIN and RPN. Infectious Diseases Microbiology 6
(ID) (Micr)
1138 Anticoagulants Protamine sulphate binds to heparin, causing chem inactivation. VitK and FFP can be used to reverse warfarin effects. Infectious Diseases Microbiology 8
(ID) (Micr)
1139 Anticoagulants Warfarin inhibits proteins C and S (natural anticoagulants present in blood), which can lead to skin necrosis, particularly in pts w/ protein C or S deficiency. This Infectious Diseases Microbiology 8
complication is usually seen in the 1st few days of warfarin Thx. (ID) (Micr)
1141 Penicillin β-lactamase inhibs (e.g. clavulanic acid, sulbactam, tazobactam) prevent β-lactamase from inactivating penicillin class drugs, which extends the spectrum of their activity. Infectious Diseases Microbiology 2
(ID) (Micr)
1142 Diphtheria Toxigenic strains of C. diphtheria produce diphtheria toxin, which irreversibly inhibs host protein synthesis due to ADP-ribosylation of EF-2. Local effects incl Infectious Diseases Microbiology 6
pseudomembranous pharyngitis; systemic effects incl potentially life-threatening myocarditis and neuritis. Immunisation w/ diphtheria toxoid generates protective (ID) (Micr)
circulating IgG against the exotoxin B subunit.
1154 Bullous pemphigoid BP is characterised by auto-Abs against hemidesmosomes along the BM of the DEJ. This causes the entire epidermis to separate from the dermis, forming tense, Infectious Diseases Microbiology 1
subepidermal blisters. (ID) (Micr)
1223 Risk, rate, prevalence, and Incident cases represent new cases Dx in a given period of time. Prevalent cases are the total number of cases (both old and new) at a particular point in time. Any Tx that Infectious Diseases Microbiology 3
incidence prolongs survival but does not cure the disease will ↑ prevalence due to an ↑ in the number of afflicted (but still living) individuals over time. (ID) (Micr)
1225 Normal distribution In a normal (bell-shaped) distribution curve, 68% of observations lie w/i 1 SD of the mean, 95% of observations lie w/i 2 SDs of the mean, and 99.7% of observations lie Infectious Diseases Microbiology 3
w/i 3 SDs of the mean. (ID) (Micr)
1310 Opioids Chronic opioid use leads to the devel of tolerance to analgesic effects and most AEs, w/ the exception of constipation and miosis. To prevent bowel complications, it's Infectious Diseases Microbiology 13
recommended that pts be Tx prophylactically w/ adequate fluid intake and daily laxatives. (ID) (Micr)
1315 Brain tumors Germinomas are the most common pineal gland tumor and Px w/ obstructive hydrocephalus and dorsal midbrain (Parinaud) syndrome. Germinomas in the suprasellar Infectious Diseases Microbiology 10
region cause endocrinopathies due to pituitary/hypothalamic dysfxn. (ID) (Micr)
1316 Pituitary adenoma PRL-omas are the most common pit adenoma and can cause galactorrhoea, menstrual irregularities, and infertility in premenopausal women. Large pit adenomas can Infectious Diseases Microbiology 8
cause h/a from mass effect and BTH from compression of the optic chiasm. (ID) (Micr)
1374 Antibiotic resistance The aminoglycoside streptomycin inhibs protein synthesis by inactivating the 30S (small) ribosomal subunit. ↓ activity of bacterial catalase-peroxidase is a mech of Infectious Diseases Microbiology 8
mycobacterial resistance to INH. Structural alteration of enzymes involved in RNA synthesis (DNA-dependent RNA polymerase) is the mech thru which organisms (ID) (Micr)
become resistant to rifampin.
1377 Leprosy The severity of leprosy, a systemic illness caused by Mycobacterium leprae, depends on the strength of the cell-mediated immune (CMI) response, with tuberculoid Infectious Diseases Microbiology 2
leprosy representing the milder form intact Th1 CMI response) and lepromatous leprosy, the more severe form (weak CMI response). (ID) (Micr)
1389 Hypoglycemia Uptake of Glc by skel muscle is mediated by GLUT4, which is translocated to the cell membrane in response to insulin and muscle contraction. Hypoglycemia can be Infectious Diseases Microbiology 6
precip by exercise in pts w/ insulin-Tx DM due to the persistent effects of exog insulin. (ID) (Micr)
1390 Diabetes mellitus Phosphorylation of serine and threonine residues of IR and IRS by serine kinase leads to insulin resistance. This type of phosphorylation can be induced by TNF-α, Infectious Diseases Microbiology 31
catecholamines, GCs, and glucagon. (ID) (Micr)
1391 Metabolic syndrome Visceral obesity as measured by waist circumference or waist-to-hip ratio is an important predictor of insulin resistance. Infectious Diseases Microbiology 2
(ID) (Micr)
1393 Homocysteine Homocystinuria is most commonly caused by a defect in cystathionine synthase, resulting in an inability to form cysteine from homocysteine. Cysteine becomes essential Infectious Diseases Microbiology 2
in affected pts, and homocysteine buildup leads to ↑ methionine. Homocysteine is prothrombotic, resulting in premature TE events (e.g. atherosclerosis, ACS) in these pts. (ID) (Micr)
1394 Niacin deficiency Hartnup disease is caused by impaired transport of neutral AAs in the small intestine and PCT of the kidney. SSx incl pellagra-like skin eruptions and cerebellar ataxia, Infectious Diseases Microbiology 3
which occur as a result of vitB3 defic. The Dx can be confirmed thru detection of excessive amounts of neutral AAs in the urine. (ID) (Micr)
1409 Bipolar disorder The anticonvulsant valproate has mood-stabilising properties and is an effective maintenance Tx for BD. Other maintenance options for BD incl lithium, lamotrigine, and Infectious Diseases Microbiology 7
quetiapine. (ID) (Micr)
1411 Defense mechanisms Splitting is a defence mech that involves organising experiences of the self or others into extremes to keep (+) and (-) aspects separated. It's commonly seen in pts w/ Infectious Diseases Microbiology 8
BPD. (ID) (Micr)
1461 Botulism Botulinum neurotoxin produced by Clostridium botulinum prevents the release of acetylcholine from presynaptic nerve terminals. The toxin impairs peripheral muscarinic Infectious Diseases Microbiology 4
and nicotinic neurotransmission, causing both autonomic symptoms (eg, fixed pupillary dilation, dry mouth) and skeletal muscle weakness (eg, diplopia, dysphagia, (ID) (Micr)
respiratory depression). Its effects at the neuromuscular junction can be seen on electromyography as a decrease in muscle response following stimulation of a motor
nerve.
1462 Botulism Infant bot is freq due to honey consumption. More than 12% of honey samples contain low # of C. botulinum spores. Whereas infant bot results from consuming C. Infectious Diseases Microbiology 4
botulinum spores, adult bot results from consuming preformed tox, typically in canned food. SSx of infant bot incl constipation, mild weakness, lethargy, and poor (ID) (Micr)
feeding.
1463 Botulism C. botulinum is a spore-forming, Gram (+), anaerobic bacillus that synth bot tox, which prevents the presynaptic release of ACh from the nerve terminal at the NMJ. Bot Infectious Diseases Microbiology 4
tox can be used to Tx focal dystonia and other disorders of abn muscle contraction. (ID) (Micr)
QID Topic Educational Objective System Subject Repeats
1465 Acute promyelocytic The cytogenetic defect t(15;17) is a/w APML. A translocation involving the RARα gene from chromosome 17 and the PML gene on chromosome 15 leads to the Infectious Diseases Microbiology 3
leukemia formation of PML/RARα, a fusion gene whose product inhibits differentiation of myeloblasts and triggers the development of APML. (ID) (Micr)
1495 Interviewing technique Open-ended questions are the most effective way to begin a medical interview. Once the patient provides an initial history, the physician can use closed-ended and follow- Infectious Diseases Microbiology 1
up questions to clarify certain points and fill gaps in the history. (ID) (Micr)
1497 Exonuclease In prokaryotes, DNA polymerase I has 5' to 3' exonuclease activity in addition to 5' to 3' polymerase and 3 to 5' exonuclease activities. This 5' to 3' exonuclease activity Infectious Diseases Microbiology 2
functions to remove the RNA primer created by RNA primase and repair damaged DNA sequences. (ID) (Micr)
1498 Exonuclease All 3 prokaryotic DNA polymerases can remove mismatched nucleotides via their 3 to 5 exonuclease ("proofreading") activity. Only DNA polymerase i has 5' to 3' Infectious Diseases Microbiology 2
exonuclease activity. which is used to remove the RNA primer synthesized by RNA primase. (ID) (Micr)
1499 DNA replication Bloom syndrome is a rare autosomal recessive condition caused by mutations in the BLM gene encoding helicase, an enzyme that unwinds the double helix during DNA Infectious Diseases Microbiology 3
replication. Patients typically present with growth retardation, facial anomalies, photosensitive skin rash, and immunodeficiency due to chromosomal instability and (ID) (Micr)
breakage.
1550 Phenylketonuria Deficiency of the enzyme phenylalanine hydroxylase or its cofactor BH4 causes accumulation of phenylalanine in body fluids and the CNS. Homozygous infants are Infectious Diseases Microbiology 5
normal at birth but gradually develop severe intellectual disability and seizures if left unTx. Hypopigmentation of the skin, hair, eyes, and catecholaminergic brain nuclei (ID) (Micr)
is also frequently seen.
1574 SLE Procainamide and hydralazine have the highest risk of causing DILE, which is Chx by the development of lupus-like SSx in addition to (+) ANA and anti-histone Abs. Infectious Diseases Microbiology 7
Unlike w/ SLE, anti-dsDNA Abs are rarely seen. (ID) (Micr)
1593 Obesity hypoventilation OHS is char by chronic fatigue, dyspnea, difficulty conc, and evidence of hypovent (PaCO2 >45 mmHg while awake). It's 1 of the important causes of hypoxemia w/ a Infectious Diseases Microbiology 1
syndrome normal A-a O2 gradient. (ID) (Micr)
1594 Iron deficiency anemia The 3 variables that affect the total oxygen content of blood are hemoglobin concentration, oxygen saturation of hemoglobin (SaO2), and the partial pressure of oxygen Infectious Diseases Microbiology 7
dissolved in blood (PaO2). Anemia is characterized by decreased hemoglobin concentration in the setting of normal SaO2 and PaO2. (ID) (Micr)
1595 Pulmonary blood flow The circulatory system is a continuous circuit, and therefore the volume output of the left ventricle must closely match the output of the right ventricle. This balance is Infectious Diseases Microbiology 2
necessary to maintain continuous blood flow through the body and exists both at rest and during exercise. (ID) (Micr)
1596 Cardiac physiology The Fick principle can be applied to calculate CO using the rate of O2 consumption and the AV O2 content difference: Infectious Diseases Microbiology 6
CO = rate of O2 consumption / AV O2 content difference (ID) (Micr)
1668 Reactive arthritis Reactive arthritis is a spondyloarthropathy associated with HLA-B27 that can occur following infection with Chlamydia, Campylobacter, Salmonella, Shigella, or Infectious Diseases Microbiology 2
Yersinia. It presents with sterile arthritis due to deposition of immune complexes. (ID) (Micr)
1670 Peptic ulcer disease H. pylori antral gastritis is a/w the formation of duodenal ulcers due to ↑ gastric acid production. This ↑ in acidity is caused by unchecked gastrin production due to the Infectious Diseases Microbiology 10
destruction of somatostatin-secreting cells in the gastric antrum. (ID) (Micr)
1672 Peptic ulcer disease H. pylori produces the enzyme urease, which splits urea into CO2 and NH3+ and neutralises the local acidic gastric pH. Active infection can be confirmed thru rapid Infectious Diseases Microbiology 10
urease testing, in which gastric mucosa is evaluated in the presence of urea and a pH indicator. Evidence of alkalinisation (due to NH3+ formation) is confirmatory. (ID) (Micr)
1678 Immotile cilia syndrome Kartagener syndrome is a form of primary ciliary dyskinesia characterized by the triad of situs inversus, chronic sinusitis, and bronchiectasis. It occurs due to mutations Infectious Diseases Microbiology 1
that impair the structure or function of cilia. Cystic fibrosis also causes chronic respiratory infections, but it is not associated with situs inversus. (ID) (Micr)
1722 Cardiac pressure range Right-sided pressures in the heart are lower than left-sided pressures due to lower resistance in the pulm vasculature. RV diastolic pressure is similar to RA/CVP (1-6 mm Infectious Diseases Microbiology 1
Hg), whereas pulm artery diastolic pressure is slightly higher (6-12 mm Hg) due to resistance to flow in the pulm circulation. (ID) (Micr)
1723 Blood transfusion Citrate anticoagulants in high-volume blood transfusion can chelate plasma calcium, leading to hypocalcemia which causes peripheral neuromuscular excitability (eg, Infectious Diseases Microbiology 2
paresthesia, muscle spasms). This is most common with very rapid transfusion rates, but it can also be seen at lower rates in patients with hepatic insufficiency because (ID) (Micr)
citrate is metabolized by the liver.
1779 Gastroesophageal reflux The oesophagus is located b/w the trachea and the vertebral bodies in the sup. thorax. It's typically collapsed w/ no visible lumen on CT images of the chest. Infectious Diseases Microbiology 7
disease (ID) (Micr)
1895 Down syndrome DS (trisomy 21) is a/w ↓ maternal serum AFP and ↑ nuchal translucency. Duodenal atresia is the most common GI complication in these pts. Infectious Diseases Microbiology 6
(ID) (Micr)
1908 Vitamin B12 deficiency Vit B12 is obtained thru the diet solely from animal sources, which places strict vegans at risk for dietary defic. This defic takes yrs to develop due to the large hepatic Infectious Diseases Microbiology 9
B12 reserve, and Px w/ megaloblastic anemia and potentially irrev. neuro deficits (e.g. paresthesias, weakness, ataxic gait). (ID) (Micr)
1912 Sickle cell The major chronic path changes in the spleens of pts w/ SCA result from repetitive splenic infarctions caused by splenic microvessel occlusion. Fibrosis, brownish Infectious Diseases Microbiology 13
discolouration, and eventual autosplenectomy ultimately result. (ID) (Micr)
1949 Breast cancer Peau d'orange is an erythematous, itchy breast rash w/ skin texture changes that resemble an orange peel. It's the key derm Px of inflam breast ca and is caused by ca cells Infectious Diseases Microbiology 7
spreading to the dermal lymphatic spaces and obstr lymphatic drainage. (ID) (Micr)
1952 Ecchymosis Ecchymoses freq indicate a deep hemorrhage (hematoma) due to bony fracture, ligamentous rupture, or muscular injury. They don't blanch under pressure as the RBCs Infectious Diseases Microbiology 1
aren't contained w/i the vasculature. Ecchymoses often pass thru an evolution of colour change (blue or red to brown, green, and yellow), which can be used to estimate (ID) (Micr)
the age of the injury.
2110 Poly A tail The poly-A tail isn't transcribed from DNA; instead, it's added as a PTM downstream of the consensus seq (AAUAAA) located near the 3' end of the mRNA molecule. Infectious Diseases Microbiology 1
This tail protects mRNA from degradation w/i the cytoplasm after it exits the nucleus. (ID) (Micr)
2111 Southern blotting Southern blotting is a technique used to identify DNA mutations. It involves restriction endonuclease digestion of sample DNA, gel electrophoresis, and gene Infectious Diseases Microbiology 1
identification w/ a labeled DNA probe. (ID) (Micr)
6547 Physician patient Physicians should respond to disclosure of past sexual abuse w/ empathy and concern. Clearly acknowledging the trauma and communicating willingness to discuss it Infectious Diseases Microbiology 11
communication when the pt is ready will help strengthen the physician-pt relationship. (ID) (Micr)
6643 Female genital tract The uterine mucosa is covered by endometrium, and abnormal implantation of endometrial glands/stroma is referred to as endometriosis. The ovary is covered by a simple Infectious Diseases Microbiology 1
histology cuboidal epithelium involved in surface repair of defects from ovulation. Endometriosis commonly affects the ovary and results in infertility. (ID) (Micr)
6781 Myasthenia gravis MG is an AI disease that causes a ↓ in the # of fxnal AChRs w/i the NMJ. This ↓ the # of postsynaptic cation channels that can open in response to ACh, which ↓ the Infectious Diseases Microbiology 10
amplitude of motor end plate potential and prevents muscle fiber depol. (ID) (Micr)
7650 Mitral regurgitation MR results in a blowing, holosystolic murmur heard best over the cardiac apex w/ radiation to the axilla. RHD is a very common cause of MR in underdeveloped Infectious Diseases Microbiology 6
countries. (ID) (Micr)
8533 Torsades de pointes TdP refers to polymorphic ventricular tachycardia that occurs in the setting of a congenital or acquired prolonged QT interval. TdP is most commonly precipitated by Rx Infectious Diseases Microbiology 1
that prolong the QT interval such as certain antiarrhythmics (sotalol, quinidine), antipsychotics (haloperidol), and Abx (macrolides, fluoroquinolones). (ID) (Micr)
8565 Melanoma BRAF is a PK involved in activation of signalling pathways for melanocyte proliferation; the BRAF V600E mut is seen in 40-60% of pts w/ melanoma. Infectious Diseases Microbiology 6
(ID) (Micr)
11377 Hepatic encephalopathy Hyperammonemia in advanced liver failure occurs as a direct result of the cirrhotic liver's inability to metabolize nitrogenous waste products. Ammonia crosses the blood- Infectious Diseases Microbiology 2
brain barrier and causes excess glutamine to accumulate within astrocytes. This decreases the amount of glutamine available for conversion to glutamate in the neurons, (ID) (Micr)
resulting in disruption of excitatory neurotransmission.
11395 Radial head subluxation Radial head subluxation (i.e. nursemaid's elbow) is the displacement of the annular ligament into the RHJ, classically resulting from sudden axial traction (e.g. pulling) on Infectious Diseases Microbiology 1
the arm of a child age <5. Although most patients don't have any obvious swelling or deformity, they avoid moving the arm due to pain and hold it w/ the elbow flexed (ID) (Micr)
and forearm pronated.
11459 Polycythemia PV is an MPD characterised by uncontrolled erythrocyte production. Virtually all pts w/ PV have a mut in JAK2, a non-receptor (cytoplasmic) tyrosine kinase a/w the Infectious Diseases Microbiology 5
EPO receptor. (ID) (Micr)
11514 Acute heart failure The CXR in ADHF typically shows prominent pulm vessels; patchy, bilateral airspace opacification; and blunting of the costophrenic angles due to pleural effusions. Infectious Diseases Microbiology 7
(ID) (Micr)
11524 Scaphoid fracture A FOOSH may cause fracture of the scaphoid bone. Ex shows tenderness in the anatomical snuffbox. The scaphoid bone is vulnerable to AVN due to its tenuous blood Infectious Diseases Microbiology 1
supply. (ID) (Micr)
11540 Necrotizing soft tissue Necrotizing fasciitis is a severe infection of the subcutaneous tissue and deep fascia that is a surgical emergency. The infection is often polymicrobial, but monomicrobial Infectious Diseases Microbiology 1
infections cases due to Streptococcus pyogenes (group A strep) can also occur. S pyogenes is a pyrrolidonyl arylamidase (PYR)-positive, beta-hemolytic, Gram-positive cocci that (ID) (Micr)
grows in chains.
11547 Skin and soft tissue Pseudomonas aeruginosa is a major pathogen in burn patients. Only a few specific penicillins (eg. ticarcillin, piperacillin) and cephalosporins (eg, ceftazidime, cefepime) Infectious Diseases Microbiology 8
infections have activity against it. Certain aminoglycosides, fluoroquinolones (eg, ciprofloxacin, levofloxacin), and carbapenems (eg, imipenem, meropenem) are also effective. (ID) (Micr)
11596 Clostridium difficile C. difficile infec can be Tx w/ oral vancomycin or fidaxomicin. Fidaxomicin is a macrocyclic Abx that inhibs RNA pol. It’s bactericidal against C. difficile. Infectious Diseases Microbiology 7
infection (ID) (Micr)
11604 Physician patient Physicians may become frustrated w/ a pt who's hopeless about Tx, often compelling them to refer the pt to a specialist. Empathising w/ the pt's frustration over past Tx Infectious Diseases Microbiology 11
communication failures can help build the physician-pt relationship. (ID) (Micr)
11633 Somatic symptom disorder SSD is best Mx w/ regularly scheduled medical visits that aren't contingent on having active SSx. Unnecessary Dx testing and specialist referrals should be avoided. Infectious Diseases Microbiology 1
(ID) (Micr)
11637 Osteoporosis Long-term acid suppression with proton pump inhibitors may be associated with an increased risk of osteoporotic fractures, possibly due to decreased calcium absorption. Infectious Diseases Microbiology 10
Other medications associated with an increased risk of osteoporosis include glucocorticoids, aromatase inhibitors, and anticonvulsants that induce cytochrome P450. (ID) (Micr)
11650 Urinary incontinence Patients with multiple sclerosis most commonly develop urge incontinence due to loss of central nervous system inhibition of detrusor contraction in the bladder. As the Infectious Diseases Microbiology 7
disease progresses, the bladder can become atonic and dilated, leading to overflow incontinence. (ID) (Micr)
11670 Urinary tract infection Urinary tract infections (UTIs) are common in hospitalized patients with indwelling urinary catheters. The risk for UTI can be reduced by avoiding unnecessary Infectious Diseases Microbiology 12
catheterization, using sterile technique when inserting the catheter, and removing the catheter as soon as possible. (ID) (Micr)
11709 Patient safety Health care providers working on a team should employ closed-loop communication, in which team members repeat back the information received to ensure that the Infectious Diseases Microbiology 1
correct information has been conveyed. This highly effective form of communication ↓ the risk of medical errors in the health care setting. (ID) (Micr)
11729 Osteoporosis Bisphosphonates have a chemical structure similar to that of pyrophosphate and attach to hydroxyapatite binding sites on bony surfaces to inhibit bone resorption by Infectious Diseases Microbiology 10
osteoclasts. (ID) (Micr)
11766 Antibiotic resistance ESBLs can be produced by gram (-) bacteria, rendering cephalosporins and other β-lactam Abx inactive. These genes can be transmitted b/w organisms thru plasmid Infectious Diseases Microbiology 8
conjugation. (ID) (Micr)
QID Topic Educational Objective System Subject Repeats
11822 Acyclovir The most effective Tx for HSV encephalitis is IV acyclovir; whose MOA is complete inhib of the viral DNA polymerase (synthesises viral DNA). Infectious Diseases Microbiology 4
(ID) (Micr)
11859 Central venous catheter The femoral triangle (lateral to medial) consists of the femoral nerve, femoral artery, femoral vein, and deep inguinal nodes/lymphatic vessels. Cannulation of the femoral Infectious Diseases Microbiology 2
vein should occur approximately 1 cm below the inguinal ligament and just medial to the femoral artery pulsation. (ID) (Micr)
11927 SLE SLE is char by loss of immune self-tolerance w/ production of auto-Abs against nuclear Ags. Binding of auto-Abs to self Ags leads to deposition of ICs in tissues and Infectious Diseases Microbiology 7
consumption of complement. (ID) (Micr)
12708 Placenta accreta Postpartum hemorrhage is an obstetric emergency and can result from abnormal placentation. Prior uterine surgery can impair decidualization, resulting in myometrial Infectious Diseases Microbiology 1
invasion by villous tissue and a placenta that is abnormally adherent to the myometrium (placenta accreta). (ID) (Micr)
14903 Vitamin B12 deficiency Neuro damage a/w vitamin B12 deficiency classically includes SCD of the dorsal columns (loss of position and vibration sensation, (+) Romberg sign) and lateral Infectious Diseases Microbiology 9
corticospinal tracts (spastic paresis). (ID) (Micr)
14916 Malabsorption Crohn disease with ileal resection or extensive ileal involvement can cause bile acid malabsorption, which may lead to impaired absorption of fat-soluble vitamins (A, D, Infectious Diseases Microbiology 4
E, K). Vitamin K deficiency can result in impaired coagulation with easy bruising, large hematoma formation in deep tissues and joints (eg, hemarthrosis) after minor (ID) (Micr)
trauma, and prolonged bleeding after surgery.
15027 Immunology principles A radioimmunoassay uses specific antibodies and a fixed quantity of radiolabeled antigen to determine the amount of antigen present in an unknown sample. This is done Infectious Diseases Microbiology 2
by measuring the amount of radiolabeled antigen displaced from the antibodies in the system. (ID) (Micr)
15034 Hypothyroidism Prolactin production is regulated primarily by inhibitory effects of hypothalamic dopaminergic pathways. However, prolactin secretion is stimulated by thyrotropin- Infectious Diseases Microbiology 13
releasing hormone (TRH). In patients with primary hypothyroidism, the increased production of TRH by the hypothalamus can lead to hyperprolactinemia. (ID) (Micr)
15057 Probability theory The multiplication law of probability states that the probability of 2 or more independent events occurring together can be calculated by multiplying the individual Infectious Diseases Microbiology 2
probabilities of each event. The multiplication law of probability can be extended to complementary events (1 - probability of event) in the same manner. (ID) (Micr)
15066 Dilated cardiomyopathy AD mutations in the TTN gene, which encodes for the sarcomere protein titin, are the most common cause of familial DCM. Infectious Diseases Microbiology 8
(ID) (Micr)
15067 Benzodiazepines Benzo withdrawal is characterised by anxiety, tremor, insomnia, and sympathetic hyperactivity (e.g. diaphoresis, palpitations). Severe benzo withdrawal may also be Infectious Diseases Microbiology 6
accompanied by psychosis, seizures, or death. (ID) (Micr)
15068 Scabies Scabies is a human mite infection associated with a pruritic papular rash with excoriations and burrows. Patients with impaired cell-mediated immunity (eg, HIV) often Infectious Diseases Microbiology 2
develop a very high mite burden. Treatment with topical permethrin and/or ivermectin is generally curative. (ID) (Micr)
15069 Septic shock Septic shock causes widespread arteriolar vasodilation, which leads to a decrease in systemic vascular resistance and a compensatory increase in cardiac output. Central Infectious Diseases Microbiology 6
venous pressure and pulmonary capillary wedge pressure are also decreased due to pooling of blood in the dilated veins Increased flow rates through the peripheral (ID) (Micr)
capillaries lead to incomplete oxygen extraction by the tissues and high mixed venous oxygen saturation.
15075 Diabetes mellitus GLP-1 is secreted by intestinal L cells in response to food intake and regulates Glc lvls by slowing gastric emptying, suppressing glucagon secretion, and ↑ Glc-dependent Infectious Diseases Microbiology 31
insulin release. GLP-1 agonists are parenteral anti-DM agents that can improve glycaemic control w/ low risk of hypoglycaemia. They're also a/w significant weight loss (ID) (Micr)
unlike many other anti-DM agents.
15076 Rheumatoid arthritis The pathogenesis of rheumatoid arthritis involves early activation of CD4+ T cells (especially Th1 and Th17 subsets) with release of cytokines such as tumor necrosis Infectious Diseases Microbiology 9
factor-alpha and IL-1 that cause destruction of cartilage and bone. Monoclonal antibodies that inhibit tumor necrosis factor-alpha or IL-1 receptors can slow progression (ID) (Micr)
of the disease.
15077 Atrial fibrillation AF is recognized by an irregularly irregular rhythm w/ variable R-R intervals and absence of P waves on ECG. The development of AF most commonly involves ectopic Infectious Diseases Microbiology 5
electrical foci in the pulm veins that trigger fibrillatory conduction in abnormal (remodeled) atrial tissue. (ID) (Micr)
15113 Bradycardia Conduction impairment is common w/ acute inferior wall MI. Sinus bradycardia often occurs due to nodal ischaemia and an ↑ in vagal tone triggered by infarction of Infectious Diseases Microbiology 1
myocardial tissue; the ↑ vagal tone can be counteracted by the antichol effects of atropine. (ID) (Micr)
15125 Benign prostatic BPH is a/w stromal and glandular growth in the periurethral and transitional zone of the prostate. The hyperplastic cells are supported by the formation of new blood Infectious Diseases Microbiology 6
hyperplasia vessels, which are friable and prone to bleeding. Therefore, BPH is often a/w microscopic or gross hematuria. (ID) (Micr)
15169 Interstitial lung disease Bleomycin is an antineoplastic agent that binds to Fe and O2 molecules to create free radicals that cause DNA strand breaks. The most clinically important AE of Infectious Diseases Microbiology 8
bleomycin is lung tox, usually MFxing as PF. Pts develop dyspnoea and NPC, and PFT shows a restrictive pattern w/ ↓ DLCO. (ID) (Micr)
15205 Achalasia Achalasia is caused by loss of inhib gang cells in the dist esoph wall and is char by the absence of esoph peristalsis and incomplete relaxation of a hypertonic LES. Bot tox Infectious Diseases Microbiology 3
prevents ACh release into the NM synapse, resulting in inhib of ACh-ergic neurons and LES relaxation. (ID) (Micr)
15210 Diverticular disease Colonic diverticulosis refers to multi sac-like outpouchings w/i the sigmoid colon. Complications incl diverticular bleeding and diverticulitis. RFs for diverticulosis incl a Infectious Diseases Microbiology 3
diet high in red meat and fat and low in fibre, as well as obesity, physical inactivity, and smoking. (ID) (Micr)
15215 Toxoplasmosis T. gondii is an intracellular parasite that's typically transmitted to humans after accidental ingestion of contaminated cat feces (e.g. cat handling, litter box). Most initial Infectious Diseases Microbiology 5
cases are aSSx. However, the organism establishes a latent infection that can reactivate in the setting of severe immsup, particularly adv AIDS. Pts usually develop (ID) (Micr)
encephalitis w/ multi ring-enhancing lesions.
15230 Osteoporosis Long-term use of GnRH agonists (e.g. leuprolide) suppresses pituitary LH release and leads to the ↓ production of testosterone. The lower lvls of circulation testosterone Infectious Diseases Microbiology 10
produce a clinical effect similar to that of Sx orchiectomy and can lead to accelerated bone loss and ↑ risk for osteoporosis. (ID) (Micr)
15243 Myocardial infarction MI that causes ischemia of the papillary muscle or nearby LV wall can result in acute MR w/ development of a new systolic murmur. Timely restoration of blood flow can Infectious Diseases Microbiology 18
improve papillary muscle dysfxn and lead to resolution of the regurgitation. (ID) (Micr)
15255 Hypothyroidism Central hypothyroidism is characterised by low serum TSH and T4 lvls and is due to HP dysfxn. Sheehan syndrome is ischemic necrosis of the pituitary gland and is Infectious Diseases Microbiology 13
typically caused by systemic hypotension during delivery. In addn to central hypothyroidism, pts may also develop defic of other pituitary hormones (e.g. ACTH, PRL, (ID) (Micr)
Gn).
15325 Lice infestation Phthirus pubis is the human pubic louse. It is transmitted sexually via skin-to-skin contact and causes intense pruritus. Louse and nits can often be visualized on Ex, which Infectious Diseases Microbiology 2
is Dx. Tx w/ topical permethrin is generally curative. (ID) (Micr)
15400 Aortic stenosis Concentric LVH involves thickening of the ventricular walls and ↓ in the ventricular cavity size. It occurs via the addition of myocardial contractile fibers in parallel in Infectious Diseases Microbiology 8
response to chronic pressure overload. AS and prolonged systemic HTN are common causes of concentric LVH. (ID) (Micr)
15407 Cardiac catheterization To access the left side of the heart, CVCs must cross the interatrial septum at the site of the foramen ovale. Entry into the LA allows for direct measurement of LA Infectious Diseases Microbiology 2
pressure and for access to arrhythmogenic foci on the LA myocardium or pulm veins. (ID) (Micr)
15419 Acute diarrhea Nontyphoidal Salmonella is a leading cause of foodborne gastroenteritis. Most cases are marked by 3-4days of self-limited fever, nausea, vomiting, and watery diarrhoea. Infectious Diseases Microbiology 13
A minority of individuals develop subseq invasive disease w/ spread to the long bones (osteomyelitis), vasculature (mycotic aneurysm), or heart (endocarditis). Risk of (ID) (Micr)
invasion is greatest in those w/ SCD or impaired immunity or at the extremes of age.
15436 Foodborne illness Staphylococcal foodborne illness is due to the consumption of a preformed enterotoxin in contaminated food. Most cases can be prevented by washing hands thoroughly Infectious Diseases Microbiology 2
prior to food prep (prevents contamination) and ensuring proper refrigerated storage (prevents bacterial proliferation/enterotoxin production). (ID) (Micr)
15453 Prerenal azotemia Cardiorenal syndrome is due to hemodynamic alterations related to a low cardiac output state and maladaptive neurohormonal changes. Low cardiac output results in renal Infectious Diseases Microbiology 6
hypoperfusion, leading to activation of the renin-angiotensin-aldosterone system, antidiuretic hormone release, and increased sympathetic nervous system activity. The (ID) (Micr)
resultant increase in sodium and water reabsorption and systemic vasoconstriction have detrimental effects on left ventricular systolic function, further worsening cardiac
output and renal perfusion.
15457 Acute kidney injury Surgeries complicated by significant blood loss or those req the use of cardiopulm bypass or clamping of the aorta can cause sustained renal hypoperfusion and result in Infectious Diseases Microbiology 5
ATN. ATN presents w/ oliguria, ↑ serum creatinine, and BUN/creatinine ratio <20:1. UA is characterised by muddy brown granular casts composed of sloughed renal (ID) (Micr)
tubular epithelial cells.
15491 Septic shock The initial Mx of septic shock req RFR to replace intravasc volume and restore adequate EOP. This is best accomplished w/ IV boluses of isotonic crystalloid in the form Infectious Diseases Microbiology 6
of 0.9% (normal) saline or lactated Ringer solution b/c these solutions remain in the ECS. (ID) (Micr)
15518 Renal artery stenosis Fibromuscular dysplasia (FMD) is characterised by abn tissue growth w/i arterial walls, resulting in stenotic and tortuous arteries that can cause tissue ischemia and are Infectious Diseases Microbiology 9
prone to aneurysm formation. Path typically demonstrates alternating fibromuscular webs and aneurysmal dilation w/ absent internal elastic lamina (string-of-beads (ID) (Micr)
appearance). Renovascular HTN occurs due to RAS and activation of the RAAS.
15543 Renal calculi Struvite stones are typically seen in pts w/ recurrent upper UTI by urease-producing organisms (e.g. Proteus, Klebsiella). Hydrolysis of urea yields NH3, which alkalinises Infectious Diseases Microbiology 7
the urine and facilitates precipitation of MgNH4PO4. UA shows hematuria and ↑ urine pH. (ID) (Micr)
15549 Hyperparathyroidism Most kidney stones are made of Ca2+ salts and are idiopathic, but conditions that ↑ renal Ca2+ excretion can ↑ the risk of stones. Hyperparathyroidism is a common cause Infectious Diseases Microbiology 2
of recurrent kidney stones and is typically a/w mild hypercalcaemia and hypophosphataemia. (ID) (Micr)
15557 Attention deficit ADHD often persists into adulthood. Adults w/ ADHD are less overtly hyperactive but experience chronic problems w/ distractibility, disorganisation, and impulsivity Infectious Diseases Microbiology 5
hyperactivity disorder that cause significant social and occup impairment. (ID) (Micr)
15565 Renal infarction Renal infarctions are most commonly caused by cardioembolic disease; AF is the greatest RF. CFx incl flank pain, nausea, vomiting, low-grade fever, and HTN (due to Infectious Diseases Microbiology 2
renin release from hypoxic tissue). Gross path demonstrates sharply demarcated, yellow-white, wedge-shaped areas w/ surrounding hyperaemia. (ID) (Micr)
15566 Chronic kidney disease In chronic kidney disease, reduced excretion of phosphate can cause hyperphosphatemia. This induces hypocalcemia directly by binding free calcium and depositing in Infectious Diseases Microbiology 8
tissues, and indirectly by triggering fibroblast growth factor 23 secretion (decreases calcitriol production and intestinal calcium absorption). The resulting hypocalcemia (ID) (Micr)
can manifest as neuromuscular excitability (eg, carpal spasm).
15578 Severe combined ADA inhib/absence is highly lymphocytotox. Rx that block ADA are used to Tx lymphocyte-derived ca. Inherited gene muts in ADA lead to the AR disease of SCID. Infectious Diseases Microbiology 3
immunodeficiency disease (ID) (Micr)
15588 Anemia of chronic disease Erythropoietin (EPO) is produced by peritubular fibroblast cells in the renal cortex in response to decreased renal oxygen delivery. EPO acts on erythrocyte precursors in Infectious Diseases Microbiology 2
the bone marrow to increase red blood cell production. Patients with chronic kidney disease often have damage to renal EPO-producing cells, which results in normocytic (ID) (Micr)
anemia.
60 Metastatic liver disease Malignant hepatic lesions most often represent mets from another 1° site (e.g. breast, lung, colon); 1° liver neoplasms (e.g. HCC) are much less common. Infectious Diseases Pathology (Path) 1
(ID)
472 Primary hypertension HTE is severely ↑ BP (typically >180/120 mm Hg) w/ evidence of end-organ dmg. In the kidneys, this can MFx as malignant nephrosclerosis, Chx by fibrinoid necrosis Infectious Diseases Pathology (Path) 14
and hyperplastic arteriolosclerosis ("onion-skin" appearance). A MAHA can occur due to erythrocyte fragmentation and platelet consumption at the narrowed arteriolar (ID)
lumen.
1676 Carotid sinus The carotid sinus is a dilation of the ICA located just above the bifurcation of the CCA. The carotid sinus reflex has an afferent limb that arises from the baroreceptors in Infectious Diseases Pathology (Path) 1
hypersensitivity the carotid sinus and travels to the vagal nucleus and medullary centers via the glossopharyngeal nerve (CN IX); the efferent limb carries parasympathetic impulses via the (ID)
vagus nerve (CN X).
QID Topic Educational Objective System Subject Repeats
1958 CT abdomen The IVC is formed by the union of the right and left common iliac veins at the lvl of L4-L5. The renal arteries and veins lie at the lvl of L1. The IVC returns venous blood Infectious Diseases Pathology (Path) 1
to the heart from the ↓ extremities, portal system, and abdominal and pelvic viscera. (ID)
8290 Blunt aortic injury Traumatic aortic rupture is most often caused by the rapid deceleration that occurs in MVCs. The most common site of injury is the aortic isthmus, which is tethered by Infectious Diseases Pathology (Path) 1
the ligamentum arteriosum and is relatively fixed and immobile compared to the adjacent descending aorta. (ID)
14855 Nuclear factor kappa B Nuclear factor-kappa B (NF-kB) is a transcription factor with a critical role in the immune response to infection. NF-kB is normally present in the cytoplasm in a latent, Infectious Diseases Pathology (Path) 1
inactive state bound to its inhibitor protein, IKB. Extracellular substances such as lipopolysaccharide can initiate a signal cascade that results in the destruction of IKB and (ID)
translocation of free NF-kB to the nucleus.
14921 Colorectal cancer Activating mutations of the KRAS gene lead to constitutive activation of the EGFR pathway, promoting ↑ cell proliferation and growth. Tumors harboring these mutations Infectious Diseases Pathology (Path) 15
are resistant to Tx w/ anti-EGFR drugs (eg, cetuximab, panitumumab). (ID)
15438 COPD Emphysema consists of alveolar destruction and enlargement that results from a combo of inflammation and leucocyte infiltration, ↑ protease activity, and oxidative stress, Infectious Diseases Pathology (Path) 16
usually in response to exposure to cig smoke. In severe disease, large air spaces known as subpleural blebs can form in the lung apices. (ID)
61 Hepatocellular cancer Universal vaccination of children against HBV would likely cause a steep decline in the worldwide incidence of hepatocellular carcinoma. Infectious Diseases Pathophysiology 5
(ID) (Patp)
724 Gynecomastia Spironolactone is an aldo antag commony used to Tx HF. It has significant antiandrogenic effects and can cause gynecomastia, decr libido, and impotence. Eplerenone is a Infectious Diseases Pathophysiology 3
more selective aldo antag w/ fever AEs. (ID) (Patp)
1799 X-linked inheritance In XLR inheritance, 1) affected males will always produce unaffected sons and carrier daughters, and 2) carrier females have a 50% chance of producing affected sons and Infectious Diseases Pathophysiology 2
carrier daughters. G6PD defic follows this inheritance pattern and causes acute HA in response to ox drugs. (ID) (Patp)
14870 Abortion Septic abortion typically Px w/ fever, abdominal pain, uterine tenderness, a/o foul-smelling d/c after pregnancy termination. Common offending pathogens include Infectious Diseases Pathophysiology 3
Staphylococcus aureus and Escherichia coli due to seeding of the uterine cavity during instrumentation. (ID) (Patp)
273 Generalized anxiety Buspirone is an NBA used to Tx GAD. It has a slow onset of action, lacks muscle relaxant or anticon properties, and carries no risk of dependence. Infectious Diseases Pharmacology 4
disorder (ID) (Phar)
274 Generalized anxiety SSRIs and SNRIs are 1st-line Rx for GAD. BZDs should be limited to short-term use while antidepressants take effect and avoided in pts w/ a Hx of substance abuse. Infectious Diseases Pharmacology 4
disorder (ID) (Phar)
275 Seizures Older children w/ absence seizures may also develop gen onset tonic-clonic or myoclonic seizures. Although ethosuximide is effective against isolated absence seizures, it Infectious Diseases Pharmacology 8
isn't effective for tonic-clonic seizures. Valproic acid is a broad-spectrum antiepileptic that Tx both types of seizures. (ID) (Phar)
276 Seizures Absence seizures are a type of gen epilepsy characterised by brief staring spells w/ momentary loss of awareness f/b an abrupt return to full consciousness. A classic 3-Hz Infectious Diseases Pharmacology 8
spike-wave is seen on EEG; the Tx is ethosuximide. (ID) (Phar)
643 Congenital adrenal 17α-hydroxylase defic impairs the synthesis of androgens, oestrogens, and cortisol but doesn't inhib MC production. Boys appear phenotypically female at birth, but girls Infectious Diseases Pharmacology 6
hyperplasia develop normal genitalia. Pts typically present w/ hypogonadism, HTN, and hypokalaemia. (ID) (Phar)
819 Opioids Opiate analgesics ↓ pain by binding to μ receptors and inhib synaptic activity in the CNS. Activation of presynaptic μ receptors on the 1° afferent neuron leads to closure Infectious Diseases Pharmacology 13
of v-gated Ca2+ channels and ↓ excitatory NT release. Binding to μ receptors on the postsynaptic membrane causes opening of K+ channels and membrane hyperpol. (ID) (Phar)
959 Prion disease CJD is a prion disease characterised by rapidly progr dementia, myoclonus, and death w/i a yr of SSx onset. Histopath shows widespread neuronal loss w/ small, uniform Infectious Diseases Pharmacology 3
vacuoles in the grey matter of the brain (e.g. spongiform encephalopathy). (ID) (Phar)
1000 Metabolic alkalosis Metabolic alkalosis is characterized by a high arterial blood pH, HCO3, and pCO2. Vomiting/nasogastric suctioning and thiazide/loop diuretic use cause volume and Cl Infectious Diseases Pharmacology 1
depletion, resulting in metabolic alkalosis that is saline-responsive. In contrast, hyperaldosteronism leads to metabolic alkalosis that is saline-unresponsive. Determining (ID) (Phar)
the patient's volume status and measuring the urinary chloride concentration can help to identify the cause of metabolic alkalosis.
1091 Cancer anorexia cachexia TNF-a is thought to mediate PNP cachexia in humans by suppressing appetite and ↑ BMR. Infectious Diseases Pharmacology 2
syndrome (ID) (Phar)
1104 Acute kidney injury Most pts w/ ATN experience tubular re-epithelialisation and regain renal fxn. However, when ATN is a/w multiorgan failure, renal fxn may be permanently impaired; in Infectious Diseases Pharmacology 5
such pts, foci of interstitial scarring can be seen on LM. (ID) (Phar)
1198 Physician patient Delivering bad news effectively requires determining the pt's perception of the situation, providing appropriate details in an empathic manner, and allowing the pt time to Infectious Diseases Pharmacology 11
communication react emotionally and express concerns. Empathic, supportive communication should be directed at understanding the pt's wishes and beliefs while maintaining cultural (ID) (Phar)
and religious sensitivity.
1226 Confounding, effect Confounding occurs when the exposure-disease relationship is muddled by the effect of an extraneous factor a/w both exposure and disease. Confounding bias can result Infectious Diseases Pharmacology 3
modification, bias, errors in the false association of an exposure w/ a disease. (ID) (Phar)
1228 Number needed to treat The NNT is the number of pts that need to be Tx w/ a Rx to avoid an additional (-) outcome. NNT is calculated by dividing 1 by the ARR (the difference b/w the control Infectious Diseases Pharmacology 2
and experimental group event rates). Lower NNT values represent more beneficial Tx. (ID) (Phar)
1309 Opioids Naloxone is a pure opioid receptor antagonist used to Tx opioid intox or OD. Although it binds to μ, κ, and δ opioid receptors, it has the greatest affinity for μ receptors Infectious Diseases Pharmacology 13
(which mediate opioid-induced bradycardia and resp depression), making it an ideal agent for Tx opioid intox. (ID) (Phar)
1312 Opioids Opioid analgesics can cause contraction of smooth muscles in the sphincter of Oddi, leading to ↑ pressures in the CBD and the gallbladder. Infectious Diseases Pharmacology 13
(ID) (Phar)
1488 G6PD deficiency G6PD defic is an XL disorder of the hexose monophosphate (PPP) pathway. In affected individuals, the amount of NADPH produced in RBCs is low, which impairs Infectious Diseases Pharmacology 5
glutathione-mediated inactivation of free radicals. hemolytic episodes are induced by infections, Rx, and other oxidants. (ID) (Phar)
1551 Phenylketonuria PKU results from an inability to convert phenylalanine to tyrosine by the phenylalanine hydroxylase system, making tyrosine an essential AA in these pts. Classic CFx of Infectious Diseases Pharmacology 5
unTx PKU include intellectual disability, seizures, light pigmentation, and a “musty” odor. (ID) (Phar)
1642 Giardia Giardia lamblia is the most common enteric parasite in the United States and Canada and is a common cause of diarrhea in campers/hikers. Iodine-stained stool smear Infectious Diseases Pharmacology 2
classically shows pear-shaped, flagellated trophozoites or ellipsoidal cysts w/ smooth, well-defined walls and 2+ nuclei. Metronidazole is the Tx of choice. (ID) (Phar)
1643 Rubella Maternal rubella infection produces a low-grade fever, a maculopapular rash w/ cephalocaudal progression, and posterior auricular and suboccipital LAD. Most adult Infectious Diseases Pharmacology 3
women pts develop polyarthritis and polyarthralgia as sequelae. CRS is a/w sensorineural deafness, cataracts, and cardiac malformations (PDA). (ID) (Phar)
1644 Cytomegalovirus In a transplant pt, pneumonia w/ intranuclear and cytoplasmic inclusion bodies histo points to opportunistic infection w/ CMV, an enveloped virus that contains a dsDNA Infectious Diseases Pharmacology 9
genome. (ID) (Phar)
1645 Glomerular disorders Frothy or foamy urine may be caused by proteinuria. Heavy proteinuria, as in nephrotic syndrome, can cause regional or generalized interstitial edema because the Infectious Diseases Pharmacology 9
decrease in serum albumin and total protein concentrations lowers the plasma oncotic pressure and increases net plasma filtration in capillary beds. (ID) (Phar)
1647 ARDS ARDS is caused by injury of the pulm epithelium a/o endothelium, and occurs most often due to sepsis or pneumonia. Cytokines recruit neutrophils to the lung tissue, Infectious Diseases Pharmacology 3
which cause cap dmg and leakage of protein-rich fluid into the alveoli. Later, cellular proliferation and collagen deposition occurs, and in some pts, this leads to (ID) (Phar)
irreversible PF.
1648 Folic acid The underlying biochemical feature of megaloblastosis is a defect in DNA synthesis. In chronic Alcics, megaloblastic macrocytic anemia can result from a nutritional Infectious Diseases Pharmacology 1
deficiency of vitamin B12 or of folate, which impairs synthesis of purine and pyrimidine bases. (ID) (Phar)
1674 Nephron osmolarity ADH acts 1arily on the CDs, ↑ their permeability to water. In the absence of ADH, the tubular fluid is most concentrated at the junction b/w the desc. and asc. limbs of the Infectious Diseases Pharmacology 2
LOH and most dilute in the CDs. (ID) (Phar)
1675 Nephron osmolarity Dehydration stim ADH secretion. ADH acts on the CDs, ↑ their permeability to water. Thus, in the presence of ADH, the CDs contain the most concentrated fluid in the Infectious Diseases Pharmacology 2
nephron, while the DCT contains the most dilute fluid. (ID) (Phar)
1774 Clavicle fracture The clavicle is commonly fractured in children after a fall on an outstretched arm. In a distal clavicle fracture, the deltoid muscle and the weight of the arm cause Infectious Diseases Pharmacology 1
inferolateral displacement of the distal fragment, whereas the sternocleidomastoid and trapezius muscles cause superomedial displacement of the proximal fragment. (ID) (Phar)
1959 Psoas abscess The psoas muscle originates from the ant. surface of the transverse processes and lat. surface of the vertebral bodies and fxns 1arily as a hip flexor. Psoas abscess may Infectious Diseases Pharmacology 2
form due to direct spread of infection from an adjacent structure (e.g. vertebral bodies, appendix, hip joint) or from heme seeding from a distant site. (ID) (Phar)
1965 Acute lymphoblastic 6-MP is mainly degraded in the liver by XO. Allopurinol, an XO inhib, can ↑ the conc of 6-MP significantly. Both 6-MP and 6-TG are prodrugs that req activation by Infectious Diseases Pharmacology 3
leukemia HGPRT. (ID) (Phar)
2019 Cystic fibrosis Pts w/ CF produce eccrine sweat w/ higher-than-normal concs of Na+ and Cl-. Exposure to high temp or exercise can lead to hyponatraemia and hypochloraemia due to Infectious Diseases Pharmacology 11
excessive NaCl loss thru sweat; therefore, salt supplementation is recommended. (ID) (Phar)
8288 Wernicke-Korsakoff WE is a complication of vitB1 defic and is characterised by CNIII dysfxn, encephalopathy, and ataxia. Chronic defic results in Korsakoff syndrome (e.g. anterograde and Infectious Diseases Pharmacology 5
syndrome retrograde amnesia, confabulation, apathy). VitB1 is involved in Glc meta, and areas of the brain w/ high meta demands are particularly susceptible; the mammillary (ID) (Phar)
bodies are most commonly affected.
8371 Cytomegalovirus CMV is a common cause of colitis in pts w/ advanced AIDS. It is the 2nd most common CMV reactivation disease in this population (CMV retinitis is the most common). Infectious Diseases Pharmacology 9
Pts w/ CMV colitis often have abdominal pain, fever, diarrhea, and weight loss. Colonoscopy usually shows erythema, erosions, and ulcerations; colonic Bx typically (ID) (Phar)
reveals large cells w/ prominent basophilic intranuclear inclusions.
8538 Cryptosporidiosis Cryptosporidium is a common cause of self-lim diarrhea in immcom hosts, but may cause life-thr diarrhea in immsup pts (e.g. adv AIDS). Dx is usually made when Infectious Diseases Pharmacology 1
oocysts are visualized w/ modded acid-fast stain in stool or Bx (oocysts lining the brush-border). (ID) (Phar)
8593 Narcolepsy Tx for narcolepsy incls psychostims (e.g. modafinil) for daytime sleepiness. Infectious Diseases Pharmacology 3
(ID) (Phar)
11590 Scabies Scabies is a highly contagious disease that presents with an intensely pruritic rash (usually worse at night) in the flexor surfaces of the wrist, lateral surfaces of the fingers, Infectious Diseases Pharmacology 2
and the finger webs. Patients usually have excoriations with small, crusted, red papules scattered around the affected areas. Diagnosis is confirmed by skin scrapings from (ID) (Phar)
excoriated lesions that show mites, ova, and feces under light microscopy.
11626 Advance directives Advance directives take precedence over the wishes of family members. Physicians should respect patient autonomy and adhere to patients' wishes as outlined in advance Infectious Diseases Pharmacology 3
directives. (ID) (Phar)
15107 Cancer anorexia cachexia The ubiquitin-proteasome pathway mediates targeted protein degradation, which allows for rapid disposal of unneeded intracellular proteins. In ca-related cachexia, high Infectious Diseases Pharmacology 2
syndrome lvls of pro-inflammatory cytokines lead to ↑ ubiquitination of sarcomeric muscle proteins, which in turn leads to extensive skeletal muscle loss. (ID) (Phar)
15347 HIV Most cases of AIDS worldwide are caused by HIV-1. However, AIDS can also be caused by infection w/ HIV-2, which is endemic to West Africa. HIV-2 infection is a/w Infectious Diseases Pharmacology 11
lower viral loads, less risk of transmission, and a slower progr to AIDS. The Dx is often suspected when HIV tests are incongruent ((+) screening serology but (ID) (Phar)
indeterminate Western blot and (-) plasma HIV-1 RNA). Confirmation can be made using HIV-1/HIV-2 immunodiff assay (IDA).
QID Topic Educational Objective System Subject Repeats
16855 Heart block 3rd-degree (complete) AV block involves dysfxn of the AV node, resulting in total lack of communication b/w the atria and ventricles. On ECG, there's dissociation of P Infectious Diseases Pharmacology 2
waves and QRS complexes, w/ P waves marching out at the intrinsic rate of the SA node and QRS complexes at the intrinsic rate of the His bundle or ventricles (escape (ID) (Phar)
rhythm).
839 Sarcoidosis Sarcoidosis is a systemic inflammatory disorder characterised by NCGs in a variety of tissues. Most pts develop liver involvement, which typically MFx as aSSx Male Reproductive Anatomy (Anat) 7
hepatomegaly w/ mild LFT abns. Liver Bx freq demonstrates scattered NCGs. (MR)
1737 Laryngotracheobronchitis Brassy, barking cough; dyspnoea, and recent Hx of URI in a child are suggestive of viral laryngotracheitis (croup). The most common cause of croup is parainfluenza Male Reproductive Anatomy (Anat) 1
virus. (MR)
1827 Non-Hodgkin lymphoma Benign LN enlargement in response to Ag stim is a/w a polyclonal proliferation of lymphocytes. A monoclonal lymphocytic proliferation is strong evidence of Male Reproductive Anatomy (Anat) 6
malignancy. (MR)
2021 Polycythemia Renal cortical cells sense hypoxia and respond by synthesizing and releasing EPO. EPO stimulates the production of erythrocytes in the bone marrow. Male Reproductive Anatomy (Anat) 5
(MR)
8326 Gastroparesis Erythromycin stims upper GI motility by acting as an ag on motilin receptors in the muscularis externa. Therefore, it can be used to Tx gastroparesis (i.e. delayed gastric Male Reproductive Anatomy (Anat) 2
emptying), a condition that freq occurs in pts w/ long standing DM. (MR)
11658 Dengue fever The Aedes aegypti mosquitoes can transmit the viruses that cause DF and chikungunya. Classic DF Px as an acute febrile illness w/ h/a, retro-orbital pain, and joint and Male Reproductive Anatomy (Anat) 2
muscle pain. Chikungunya is a febrile illness w/ flu-like SSx, prominent polyarthralgias, and diffuse macular rash. (MR)
11747 Personality disorders BPD is characterised by a persistent pattern of unstable relationships, mood lability, and impulsivity. Individuals w/ this disorder may exhibit suicidal ideation or Male Reproductive Anatomy (Anat) 6
behaviour in the context of an interpersonal crisis in which they feel rejected or abandoned. (MR)
11762 Adjustment disorders Eval of depressive SSx occurring in response to psychosocial stressors must take into account the severity, duration, and degree of fxnal impairment. Mild or brief sadness Male Reproductive Anatomy (Anat) 2
w/o significant interference in psychosocial fxning is consistent w/ normal sadness. (MR)
11800 Health insurance A HMO is an insurance plan w/ low monthly premiums, low copayments and deductibles, and low total cost for the pt. HMOs ↓ utilization by confining pts to a limited Male Reproductive Anatomy (Anat) 3
panel of providers, requiring referral from a PCP prior to specialist consultations, and denying payment for services that do not meet established guidelines. (MR)
419 Wilson disease WD is an AR condition Chx by excessive Cu deposition into tissues (eg, liver, basal ganglia, cornea). It typically Px in young adults w/ liver disease, neuropsych SSx (eg, Male Reproductive Embryology 5
gait disturbance, dysarthria, depression, personality changes), and Kayser-Fleischer rings on slit lamp Ex. (MR) (Embr)
1427 Anaphylaxis Anaphylactic shock is characterised by vasodilation, ↑ vascular permeability, and bronchoconstriction. EPI counteracts these physiological mechs and is the DOC for the Male Reproductive Embryology 3
Tx of anaphylaxis. (MR) (Embr)
1449 Diphtheria The 1° Tx for diphtheria is diphtheria antitoxin (passive immunization), which inactivates circulating toxin. Abx should also be administered to ↓ continued production of Male Reproductive Embryology 6
toxin. (MR) (Embr)
1870 Carcinogens Most chem carcinogens enter the body in an inactive state (i.e. as pro-carcinogens). These pro-carcinogens are converted into active metabolites by the CYP450 oxidase Male Reproductive Embryology 1
system. Individual susceptibility to chem carcinogens depends on the activity of these P450 enzymes, which is genetically determined. (MR) (Embr)
343 Biliary atresia Biliaryatresia, or obstr of extrahepatic bile ducts, presents w/ jaundice, dark urine, and acholic stools in the 1st 2mos of life due to conjugated hyperbilirubinaemia. Bx Male Reproductive Genetics (Gene) 1
reveals intrahepatic bile duct proliferation, portal tract oedema, and fibrosis. (MR)
807 Hypothyroidism The thyroid releases TH (T3 and T4) in response to TSH from the pituitary, which is regulated by TRH from the hypothal. TH suppresses the secretion of TSH and TRH Male Reproductive Genetics (Gene) 13
via (-) feedback, and small changes in TH lvls cause large changes in TSH. Serum TSH is the most sensitive test for 1° hypothyroidism. (MR)
580 Asbestos Pts w/ a long Hx of asbestos exposure are at risk for devel asbestosis, pleural disease, and malignancies such as bronchogenic carcinoma and mesothelioma. Bronchogenic Male Reproductive Pathology (Path) 5
carcinoma is the most common malignancy in this pop, although mesothelioma is more specific for asbestos exposure. (MR)
624 Alzheimer disease Amyloid is an abnormally folded (insoluble) extracellular protein that has apple-green birefringence when stained w/ Congo red and viewed under polarized light. AD is Male Reproductive Pathology (Path) 7
a/w β-amyloid deposits in the brain parenchyma (neuritic plaques) and walls of cerebral vessels (amyloid angiopathy). (MR)
664 Hemiballismus The STN plays an important role in the modulation of BG output. Damage to this structure (eg, due to lacunar stroke) may result in contralateral hemiballism, Chx by Male Reproductive Pathology (Path) 1
wild, involuntary, large-amplitude, flinging movements of the proximal limbs (eg, arm a/o leg) on one side of the body. (MR)
1055 Septic arthritis Septic arthritis in a young, sexually active adult should raise suspicion for disseminated N. gonorrhoeae infection. Pts may also have the triad of polyarthritis, a Male Reproductive Pathology (Path) 4
vesiculopustular skin rash, and tenosynovitis. N. gonorrhoeae is a gram (-) diplococci that's usually ID'd by micro, culture, or NAAT. (MR)
8351 Renal cell carcinoma RCC tends to invade the renal vein; IVC obstr can occur by intraluminal extension of the tumour. obstr of the IVC produces symmetric bilateral extremity oedema, often Male Reproductive Pathology (Path) 8
a/w prominent devel of venous collaterals in the abdo wall. (MR)
15560 Attention deficit Dx of ADHD req evidence of inattentive a/o hyperactive/impulsive SSx for >6mos in >2 settings (e.g. home, school, after-school program). Teacher evals can assist in Male Reproductive Pathology (Path) 5
hyperactivity disorder Dx. (MR)
15804 Grief Preschool children haven't developed an understanding of the finality of death, which typically occurs around age 7. They may have magical thoughts that death is Male Reproductive Pathology (Path) 3
temporary or reversible and believe that other people's grief is their fault. (MR)
15828 Anorexia nervosa AN is characterised by a distorted body image and fear of weight gain despite significantly low body weight. Pts may restrict their food intake a/o binge and purge. The Male Reproductive Pathology (Path) 3
key in distinguishing AN from BN is abnly low body weight. (MR)
657 Osteoporosis Initially in OP, bone loss predominantly affects trabecular bone, leading to trabecular thinning and perforation w/ loss of interconnecting bridges. Over time, cortical bone, Male Reproductive Pharmacology 10
which composes most of the appendicular skeleton, also becomes involved. (MR) (Phar)
8930 Bell's palsy In addn to unilateral CNVII paralysis, pts w/ Bell's palsy may experience ↓ tearing, hyperacusis, a/o loss of taste sensation over the anterior 2/3 of the tongue. Male Reproductive Pharmacology 1
(MR) (Phar)
1902 Duodenum and superior The 3rd part of the duodenum courses horizontally across the abdo aorta and IVC at the lvl of the 3rd lumbar vertebra. The SMVs lie ant. to the duodenum at this location. Male Reproductive Physiology 1
mesenteric artery (MR) (Phys)
8468 Primary hypertension Hyperplastic arteriosclerosis ("onion-skinning") and fibrinoid necrosis of the renal arterioles are typical morphologic findings in hypertensive (malignant) nephrosclerosis. Male Reproductive Physiology 14
End-organ damage can be prevented by treatment of high blood pressure with antihypertensives. (MR) (Phys)
11635 Intimate partner violence Pts experiencing intimate partner violence should be approached in a supportive, nonjudgmental, open-ended manner. A thorough safety Ax and development of an Miscellaneous Anatomy (Anat) 1
emergency safety plan are essential. (Multisystem) (MS)
11531 Cranial nerve palsy Lesions involving CNIII cause ptosis, a downward and laterally deviated eye, impaired pupillary constriction and accommodation, and diagonal diplopia. The most Miscellaneous Behavioral 9
dreaded cause of CNIII palsy is an enlarging intracranial aneurysm. (Multisystem) (MS) Science (Beha)
11532 Pituitary adenoma All adult cells and tissues can be traced back to the 3 1° germ layers: ectoderm, mesoderm, and endoderm. The ectoderm gives rise to the surface ectoderm, neural tube, Miscellaneous Behavioral 8
and neural crest. (Multisystem) (MS) Science (Beha)
11533 Foreign body aspiration The internal laryngeal nerve mediates the afferent limb of the cough reflex above the vocal cords. Foreign bodies (eg, fish bones) can become lodged in the piriform recess Miscellaneous Behavioral 1
and may cause damage to the nerve, impairing the cough reflex. (Multisystem) (MS) Science (Beha)
11534 Psoas abscess Psoas abscess presents w/ fever, back or flank pain, an inguinal mass, and difficulty walking. Inflammation of the psoas muscle leads to pain w/ extension at the hip (i.e. Miscellaneous Behavioral 2
psoas sign). Psoas abscess can develop due to heme or lymphatic seeding from a distant site, particularly in pts w/ DM, IVDU, and immsup (e.g. HIV infection). (Multisystem) (MS) Science (Beha)
11535 Collagen types Type I collagen is the most prevalent collagen in the human body and is the 1° collagen in mature scars. Miscellaneous Behavioral 1
(Multisystem) (MS) Science (Beha)
11536 Smoking cessation Varenicline is a partial agonist of nicotinic acetylcholine receptors. It can assist patients with cessation of tobacco use by reducing withdrawal cravings and attenuating the Miscellaneous Behavioral 1
rewarding effects of nicotine. (Multisystem) (MS) Science (Beha)
11537 Rheumatoid arthritis Rheumatoid arthritis is characterized by symmetric polyarthritis (involving the metacarpophalangeal and proximal interphalangeal joints) with prolonged morning Miscellaneous Behavioral 9
stiffness and associated fatigue. Antibodies to citrullinated peptides/proteins have a high specificity for the condition. (Multisystem) (MS) Science (Beha)
11550 Strongyloides S. stercoralis infec begins following skin penetration by filariform (infec) larva and can be Dx by finding rhabditiform (noninfec) larvae in the stool. Rhabditiform larvae Miscellaneous Behavioral 1
can mature into filariform larva in the human HIT, precip an autoinfec cycle that occurs entirely w/i the affected indiv. This can result in a hyperinfec syndrome char by (Multisystem) (MS) Science (Beha)
massive dissem of the organism, leading to MOD and septic shock.
11602 Attack rate The attack rate is the ratio of the number of people who contract an illness divided by the number of people who are at risk of contracting that illness. Miscellaneous Behavioral 1
(Multisystem) (MS) Science (Beha)
311 Esophageal cancer The histopathologic features of esophageal SCC include solid nests of neoplastic squamous cells w/ abundant eosinophilic cytoplasm and distinct borders. Areas of Miscellaneous Biochemistry 4
keratinization and the presence of intercellular bridges are also Chx. Pts typically Px w/ progressive solid and eventually liquid dysphagia and weight loss. (Multisystem) (MS) (Bioc)
1122 Hereditary fructose Aldolase B defic causes HFI. This disease MFx after intro of fructose into the diet w/ vomiting and hypoglycaemia about 20-30min after fructose ingestion. These infants Miscellaneous Biochemistry 1
intolerance can present w/ FTT, jaundice, and hepatomegaly. (Multisystem) (MS) (Bioc)
1502 Cardiac tamponade The combo of JVD, hypotension, and muffled heart sounds is highly suggestive of cardiac tamponade. Tachycardia and pulsus paradoxus are also freq seen w/ tamponade. Miscellaneous Biochemistry 2
Lung Ex is normal, which can help distinguish cardiac tamponade from tension PTX. (Multisystem) (MS) (Bioc)
1504 Primary immunodeficiency Chronic granulomatous disease (CGD) results from a genetic defect in NADPH oxidase. Normally, NADPH oxidase participates in the killing of microbes within Miscellaneous Biochemistry 7
disorder neutrophil and macrophage phagolysosomes. Patients with CGD develop recurrent bacterial and fungal infections that are predominantly caused by 5 catalase-positive (Multisystem) (MS) (Bioc)
organisms: Staphylococcus aureus, Burkholderia cepacia, Serratia marcescens, Nocardia, and Aspergillus.
252 Endocarditis The most likely cause of fever and fatigue w/ new-onset cardiac murmur is IE. DPGN 2° to circulating IC deposition may complicate IE and can result in acute renal Miscellaneous Embryology 15
insufficiency. (Multisystem) (MS) (Embr)
34 DiGeorge syndrome Chromosome 22q11.2 microdeletion results in DGS (cardiac anomalies, hypoplastic or absent thymus, and hypocalcemia) and VCFS (cleft palate, cardiac anomalies, Miscellaneous Genetics (Gene) 2
dysmorphic facies). FISH is the "gold standard" for detecting a microdeletion. (Multisystem) (MS)
1420 Autonomic nervous system The SNS typically regulates visceral fxn via 2-neuron signal transmission involving cholinergic preganglionic neurons and adrenergic postganglionic neurons. Eccrine Miscellaneous Genetics (Gene) 3
sweat glands and the AMs are exceptions to this rule as they're both innervated by cholinergic neurons. The PSNS uses both preganglionic and postganglionic cholinergic (Multisystem) (MS)
neurons.
1728 Thyroid cancer MTC is a NET that arises from parafollicular calcitonin-secreting C cells. It's char by nests or sheets of polygonal or spindle-shaped cells w/ extracellular amyloid deposits Miscellaneous Genetics (Gene) 6
derived from calcitonin. (Multisystem) (MS)
1822 Embryologic derivatives The 1st AA gives rise to a portion of the maxillary artery, and the 2nd AA gives rise to the stapedial artery, which typically regresses in humans. The 5th AA completely Miscellaneous Genetics (Gene) 2
regresses, leaving no structures or vestiges in the adult. The 3rd AA forms the CCAs and proximal ICAs. The 4th AA gives rise to part of the true AA and a portion of the (Multisystem) (MS)
SCAs. The 6th AA gives rise to the pulm arteries and the ductus arteriosus.
1823 Patent ductus arteriosus The ductus arteriosus is derived from the sixth embryonic aortic arch. A patent ductus arteriosus (PDA) causes left-to-right shunting of blood that can be heard as a Miscellaneous Genetics (Gene) 4
continuous murmur over the left infraclavicular region. Indomethacin (a PGE2 synthesis inhibitor) can be used to close a PDA in premature infants, but surgical ligation is (Multisystem) (MS)
often necessary in older patients.
QID Topic Educational Objective System Subject Repeats
1824 Potter sequence Potter sequence results from a renal anomaly that causes decreased fetal urine output leading to oligohydramnios. The lack of amniotic fluid causes compression of the Miscellaneous Genetics (Gene) 1
fetus (characteristic facies and limb abnormalities) and pulmonary hypoplasia, which is the most common cause of death in affected infants. (Multisystem) (MS)
8283 Asthma IgE-binding monoclonal antibodies (eg, omalizumab) are effective in treating asthma that remains uncontrolled despite optimal therapy with bronchodilators and inhaled Miscellaneous Genetics (Gene) 12
corticosteroids. IgE-binding monoclonal antibodies reduce airway inflammation by blocking the binding of IgE to the IgE receptors on mast cells and preventing the (Multisystem) (MS)
release of proinflammatory substances, including histamine and leukotrienes.
6 Tuberous sclerosis Renal angiomyolipoma is a benign tumor composed of blood vessels, smooth muscle, and fat. Bilateral renal angiomyolipomas are associated with tuberous sclerosis, an Miscellaneous Pathology (Path) 1
autosomal dominant condition. (Multisystem) (MS)
285 Parkinson disease Adding carbidopa can ↓ most of the peri AEs of L-DOPA. However, behavioural changes from L-DOPA can actually worsen w/ addn of carbidopa b/c more DA becomes Miscellaneous Pathology (Path) 7
available to the brain. (Multisystem) (MS)
862 Bronchiectasis Digital clubbing is often a/w prolonged hypoxia. It can be found in pts w/ large-cell lung ca, TB, CF, and suppurative lung diseases such as empyema, bronchiectasis, and Miscellaneous Pathology (Path) 2
chronic lung abscesses. (Multisystem) (MS)
1753 Rhogam (anti-D IgG) Anti-Rh Ig consists of IgG anti-D Abs that opsonize Rh+ fetal erythrocytes, promoting clearance by maternal RES macrophages and preventing maternal Rh sensitization. Miscellaneous Pathology (Path) 1
It's routinely admin to Rh(-) women at 28 wks gestation and immediately postpartum. (Multisystem) (MS)
11955 Renal cell carcinoma Classic SSx of RCC incl hematuria, an abdo mass, flank pain, and weight loss. Hypercalcaemia and erythrocytosis are common PNP syndromes a/w RCC. Miscellaneous Pathology (Path) 8
(Multisystem) (MS)
21 Ischemic stroke Occlusion of the MCA typically results in contralateral hemiparesis and hemisensory loss of the face and upper limb w/ relative preservation of lower limb fxn. If the Nervous (NS) Anatomy (Anat) 19
occluded MCA is in the dom (usually left) hemisphere, aphasia may also occur.
566 Hyper-IgM syndrome Hyper-IgM syndrome results from defective Ig class switching due to a defect in CD40L-CD40 interaction. Absence of the CD40L is the most common cause and is Nervous (NS) Anatomy (Anat) 1
inherited in an XLR pattern. CFx incl. recurrent sinopulm, GI, and opport infections.
635 Gastrointestinal hormones Reduced gallbladder contractility, due to decreased cholecystokinin secretion, is responsible for biliary stones in patients with somatostatinoma. Nervous (NS) Anatomy (Anat) 2
1149 Acute diarrhea EHEC O157:H7 infec is a common cause of bloody diarrhea and can lead to HUS. It’s a/w consumption of undercooked ground beef and elabs a Shiga-like tox capable of Nervous (NS) Anatomy (Anat) 13
inhib protein synth in colonic mucosal cells and renal endothelial cells. This particular strain of E. coli is unable to ferment sorbitol and doesn’t prod a glucuronidase.
1150 Pertussis B. anthracis oedema factor is an adenylate cyclase that ↑ intracellular cAMP, leading to neutrophil and macrophage dysfxn and tissue oedema. This MOA is similar to that Nervous (NS) Anatomy (Anat) 3
of adenylate cyclase toxin, produced by B. pertussis.
1261 Power and sample size The power of a study indicates the probability of seeing a difference when there is one. The formula is Power = 1- β, where β is the type II error rate. Nervous (NS) Anatomy (Anat) 3
1306 SLE DILE is Chx by abrupt onset of lupus SSx (eg, fever, arthralgias, pleuritis) w/ (+) anti-histone Abs. It has been linked to Rx metabolized by N-acetylation in the liver (eg, Nervous (NS) Anatomy (Anat) 7
procainamide, hydralazine, INH). Genetically predisposed individuals who are slow acetylators are at greater risk for developing DILE.
1452 Listeria L. monocytogenes is a facultative, intracellular, gram (+) rod that produces a very narrow zone of β hemolysis on blood agar, shows tumbling motility at room temp, and Nervous (NS) Anatomy (Anat) 1
can grow at refrigerated temps. Intracellular pathogens such as Listeria are largely eliminated by the cell-mediated immune response (e.g. T-cells, macrophages,
cytokines). Pts w/ impaired cell-mediated immunity are at risk for invasive Listeria infections.
1453 Meningitis Listeriosis is most commonly transmitted thru food ingestions and can cause meningitis in immsup adults. Listeria is a Gram (+) rod w/ tumbling motility. It grows well in Nervous (NS) Anatomy (Anat) 17
cold temps and can therefore contaminate refrigerated food.
1635 Teratogens Isotretinoin is used to Tx severe acne w/ significant scarring. Pregnancy is an absolute c/i due to the risk of teratogenicity. Sexually active women should be advised to use Nervous (NS) Anatomy (Anat) 2
2 forms of contraception and take monthly pregnancy tests.
1636 Chronic myeloid leukemia CML and LR can have presentations similar to leucocytosis; however, LAP lvl is normal or ↑ in an LR but ↓ in CML. The definitive Dx of CML req demonstration of the Nervous (NS) Anatomy (Anat) 2
Philadelphia chrom t(9;22) or BCR-ABL fusion gene or mRNA.
1639 Acute lymphoblastic Precursor B-ALL and precursor T-ALL can only be distinguished by immunophenotyping. The lymphoblasts in precursor B-ALL are TdT+, CD10+, and CD19+, whereas Nervous (NS) Anatomy (Anat) 3
leukemia the lymphoblasts in precursor T-ALL express T-cell markers (e.g. CD2, CD3, CD4, CD5, CD7, and CD8), TdT, and CD1a.
1685 Flow/resistance The total resistance for a group of vessels arranged in parallel is equal to one divided by the sum of the inverse values for resistance of each of the contributing vessels as Nervous (NS) Anatomy (Anat) 1
follows: 1/TPR = 1/R1+1/R2 + 1/R3 + ... 1/Rn. Total body circulation can be best described as a parallel circuit, whereas circulation in an individual organ is often best
described by a series arrangement.
1687 GFR ↑ in the cap hydrostatic pressure or the BS oncotic pressure will ↑ GFR, while ↑ in cap oncotic pressure or BS hydrostatic pressure will ↓ GFR. The FF can be calculated Nervous (NS) Anatomy (Anat) 6
by dividing the GFR by the RPF. ↑ in GFR or ↓ in RPF will ↑ the FF.
1689 Renal artery stenosis Blood flow is directly proportional to the vessel radius raised to the fourth power. Resistance to blood flow is inversely proportional to the vessel radius raised to the Nervous (NS) Anatomy (Anat) 9
fourth power.
1690 Physical exercise Exercising muscles can receive up to 85% of the total CO during periods of strenuous activity. Although sympathetic discharge during exercise causes ↑ CO and Nervous (NS) Anatomy (Anat) 2
splanchnic vasoconstriction, there's only a modest ↑ in mean BP as vasodilation w/i active skeletal muscles significantly ↓ the total SVR.
1692 Cardiac output and venous MI causes a sharp ↓ in CO due to loss of fxn of a zone of myocardium. On a cardiac fxn curve, MI would ↓ both the slope and the maximal height of the line. Nervous (NS) Anatomy (Anat) 2
return
1693 Cardiac output and venous A chronic AV shunt would ↑ CO b/c of ↑ sympathetic stimulation to the heart, ↓ TPR, and ↑ venous return. It would also cause the venous return curve to shift to the right Nervous (NS) Anatomy (Anat) 2
return b/c the circulating blood volume is ↑ through renal retention of fluids and b/c venous pooling is ↓ by the ↑ sympathetic tone.
1694 Hodgkin lymphoma The presence of RS cells on LN Bx is Dx of classic Hodgkin lymphoma. RS cells have abundant cytoplasm, bilobed or double nuclei, and inclusion-like eosinophilic Nervous (NS) Anatomy (Anat) 2
nucleoli.
1696 Non-Hodgkin lymphoma Rituximab is a mAb directed against the CD20 Ag. Its intro has improved the prognosis of some lymphomas. Nervous (NS) Anatomy (Anat) 6
1703 Hydrocephalus CSF flows from the third ventricle to the fourth ventricle via the cerebral aqueduct of Sylvius. Obstruction at this level can cause dilated lateral and third ventricles with a Nervous (NS) Anatomy (Anat) 4
normal-sized fourth ventricle. Obstruction at the foramen of Monro would cause enlargement of only the affected lateral ventricle, while obstruction at the foramen of
Magendie and Luschka causes enlargement of all 4 ventricles.
1735 Muscle structure & During the skeletal muscle contraction cycle, ATP binding to myosin causes release of the myosin head from its binding site on the actin filament. Nervous (NS) Anatomy (Anat) 8
physiology
1741 HIV In the HIV replication cycle, polyprotein precursors are encoded by the structural genes gag, pol, and env. Only the env gene polyprotein product (gp160) is glycosylated. Nervous (NS) Anatomy (Anat) 11
This polyprotein is subseq cleaved in the GA to form the envelope glycoproteins gp120 and gp41.
1743 Lipodystrophy HAART for HIV is commonly a/w body fat redistribution. Subcutaneous lipoatrophy involving the face and extremities is a/w NRTIs (esp. stavudine and zidovudine) and Nervous (NS) Anatomy (Anat) 1
PIs. Central fat accumulation in the trunk and viscera can occur w/ any HAART regimen.
1748 Community acquired All organisms in the Mycoplasma genus, incl U. urealyticum, lack peptidoglycan cell walls and are therefore resistant to agents that target the cell wall such as penicillins, Nervous (NS) Anatomy (Anat) 21
pneumonia cephalosporins, carbapenems, and vancomycin. Mycoplasma infections can be Tx w/ anti-ribosomal agents (e.g. tetracyclines, macrolides).
1749 Actinomycosis Actinomyces species are gram (+), branching, filamentous bacteria that may cause cervicofacial infections when introduced to the submucosa during mech trauma (e.g. Nervous (NS) Anatomy (Anat) 2
tooth extraction). MFxs incl a slowly enlarging, nonpainful, chronic mandibular mass that evolves into multi abscesses and sinus tracts draining yellow-orange sulphur
granules.
1802 Rectus muscle and Valsalva The Valsalva maneuver ↑ vagal tone and can be used to abolish PSVT. The rectus abdominis is the most important muscle in achieving the ↑ IAP and ITP of the Valsalva Nervous (NS) Anatomy (Anat) 1
maneuver.
1813 Nausea and vomiting The vomiting reflex is initiated by the chemoreceptor trigger zone (ie, area postrema) and nucleus tractus solitarius within the dorsal medulla at the caudal end of the Nervous (NS) Anatomy (Anat) 2
fourth ventricle. The area postrema does not have a well-developed blood brain barrier, allowing it to be activated directly by emetogenic substances (eg, drugs, toxins) or
indirectly by ascending afferents from the bowel wall (eg, chemotherapy-induced release of serotonin).
1815 Gastrointestinal hemorrhage The hindgut encompasses the dist. 1/3 of the transverse colon, the desc. colon, the sigmoid colon, and the rectum. These structures receive their main arterial blood supply Nervous (NS) Anatomy (Anat) 1
from the IMA.
1829 Burkitt lymphoma Burkitt lymphoma is Chx by aggressive rapid growth and a "starry sky" microscopic appearance. Translocation of the c-Myc oncogene on the long arm of chromosome 8 Nervous (NS) Anatomy (Anat) 3
w/ the Ig heavy chain region on chromosome 14 produces a nuclear phosphoprotein (c-Myc) that fxns as a transcription activator.
1834 Colorectal cancer Most tumors possess multiple cytogenetic abnormalities. Activation of POCs results in stimulation of cellular proliferation. Inactivation of anti-oncogenes eliminates Nervous (NS) Anatomy (Anat) 15
oversight of the cell cycle.
1846 Corticosteroids Osteoporosis is a common cause of fragility fractures, which occur in the absence of significant trauma. Chronic, systemic use of glucocorticoids such as prednisone Nervous (NS) Anatomy (Anat) 3
promotes osteoporosis and increases the risk of fractures.
1930 Aplastic anemia The triad of low Hb, thrombocytopaenia, and absent HPO cells in the bone marrow is consistent w/ AA. A compensatory ↑ in circulating EPO lvls would be expected in Nervous (NS) Anatomy (Anat) 3
individuals w/ AA and normal renal fxn.
1933 Hodgkin lymphoma RS cells are large binucleated cells w/ an 'owl's eyes' appearance that appear on a background of lymphocytic infiltrates. RS cells must be present histopath in order to Nervous (NS) Anatomy (Anat) 2
make the Dx of HL.
1955 Acute heart failure Acute pulm oedema is a common conseq of AMI affecting the LV. ↑ hydrostatic pressure in the pulm venous system leads to engorged alveolar caps w/ transudation of Nervous (NS) Anatomy (Anat) 7
fluid into the alveoli, appearing as acellular pink material on histo. hemosiderin-laden macrophages are indicative of chronic lung congestion and aren't present acutely.
2020 Thalassemia Beta-thalassemia is caused by muts that result in defective transcription, processing, and translation of beta-globin mRNA. This leads to defic of the beta-globin chains req Nervous (NS) Anatomy (Anat) 3
for normal Hb synth.
2024 Chronic heart failure Rx that have been shown to improve long-term survival in pts w/ HF due to LV systolic dysfxn include β blockers, ACEIs, ARBs, and aldosterone antagonists. Nervous (NS) Anatomy (Anat) 12
2076 Organophosphate poisoning OPs are AChEIs that are widely used as pesticides in agriculture. They inhib the breakdown of ACh, leading to a state of cholinergic excess. SSx of OP poisoning include Nervous (NS) Anatomy (Anat) 2
salivation, lacrimation, diaphoresis, bradycardia, and bronchospasm.
2077 Beta blockers β blockers are used in the Tx of essential tremor. Propranolol, a nonselective β blocker, is the most commonly used therapy and prevents the interaction of EPI and NE w/ Nervous (NS) Anatomy (Anat) 3
β1 and β2 receptors to relieve tremor SSx. However, inhib of pulm β2 receptors in pts w/ underlying reactive airway disease can cause bronchoconstriction, leading to
cough, wheeze, and dyspnoea.
2125 Transcription Northern blots detect target mRNA in a sample and can be used to Ax the degree of gene transcription. Nervous (NS) Anatomy (Anat) 7
2126 Polymerase chain reaction PCR is used to amp small fragments of DNA (e.g. genes, exons, NCRs) by repeated replication. It req primers that're complementary to the regions of DNA flanking the Nervous (NS) Anatomy (Anat) 2
segment of interest. Thermostable DNA polymerase, dNTPs, and a source DNA template strand are also necessary.
2127 Southwestern blot Southwestern blotting is used to detect DNA-binding proteins such as transcription factors, nucleases, and histones. Nervous (NS) Anatomy (Anat) 1
2129 Psychosis DD is characterised by >1 delusions for >1mos in the absence of other psychotic SSx. Behaviour isn't obvi bizarre, and fxning isn't significantly impaired apart from the Nervous (NS) Anatomy (Anat) 6
direct impact of the delusions.
QID Topic Educational Objective System Subject Repeats
8329 Community acquired Mycoplasma pneumoniae is a leading cause of atypical pneumonia. B/c this pathogen lacks a cell wall, it does not show up on Gram stain and cannot be treated w/ β- Nervous (NS) Anatomy (Anat) 21
pneumonia lactam Abx. PSIs (eg, macrolides, tetracycline) are the Tx of choice.
8522 COPD In COPD, air-trapping leads to an incr in RV and TLC, as well as an incr in the RV/TLC ratio. Airway obstr causes a decr in FVC, FEV1, and the FEV1/FVC ratio. Nervous (NS) Anatomy (Anat) 16
8564 Myocardial infarction Severe systemic hypotension (eg, shock) is most likely to cause ischemia 1st in areas of high metabolic demand (eg, hippocampus) or watershed zones, which are areas Nervous (NS) Anatomy (Anat) 18
that are supplied by the distal branches of two different major arteries. Commonly affected areas in the colon include the splenic flexure and RSJ.
8592 Community acquired L. pneumophila is a facultative intracellular gram (-) bacillus that can cause a systemic infection. SSx freq incl high fever, cough, confusion, and diarrhoea. The most Nervous (NS) Anatomy (Anat) 21
pneumonia common lab abn seen w/ Legionella pneumonia is hyponatraemia, and sputum Gram stain often shows many neutrophils but few or no organisms.
8594 Interstitial lung disease The work of breathing is minimised in pts w/ ↑ elastic resistance (e.g. PF) when their RR is high and TV is low (fast, shallow breaths). In contrast, pts w/ diseases that ↑ Nervous (NS) Anatomy (Anat) 8
airflow resistance (e.g. asthma, COPD) breathe at a lower RR and higher TV (slow, deep breaths) to minimise the work of breathing.
8636 Muscle structure & The muscle spindle system is a feedback system that monitors and maintains muscle length, while the Golgi tendon system is a feedback system that monitors and Nervous (NS) Anatomy (Anat) 8
physiology maintains muscle force. GTOs are exquisitely sensitive to increases in muscle tension but are relatively insensitive to passive stretch.
8701 Linkage disequilibrium Two allele loci are said to be in linkage disequilibrium when a pair of alleles are inherited together in the same gamete (haplotype) more often or less often than would be Nervous (NS) Anatomy (Anat) 1
expected given random pairing. This most often occurs when the genes are in close physical proximity on the same chromosome.
11609 Myocardial infarction Leads I and aVL correspond to the lateral limb leads on ECG. Therefore, ST elevation or Q waves in these leads are indicative of infarction involving the lateral aspect of Nervous (NS) Anatomy (Anat) 18
the left ventricle, which is supplied by the left circumflex artery.
11663 Parkinson disease Nigrostriatal degen in Parkinson disease ↓ activity of the thalamus and its projections to the cortex, resulting in bradykinesia and rigidity. Pts w/ medically intractable SSx Nervous (NS) Anatomy (Anat) 7
of Parkinson disease may benefit from high-freq deep brain stimulation of the globus pallidus internus (GPi) or subthalamic nucleus (STN) as it promotes thalamo-cortical
disinhib w/ improved mobility.
11681 Medical errors Avoiding the use of unsafe abbreviations and trailing zeros in Rx orders can help ↓ the incidence of Rx errors. Nervous (NS) Anatomy (Anat) 8
11685 Animal and human bite P. multocida is a cause of soft-tissue infection that develops w/i 24hrs following a dog or cat bite. Mx incls wound care and Abx targeted against this organism. Nervous (NS) Anatomy (Anat) 1
injuries
11742 Child and adolescent mental Adolescence often involves some degree of moodiness, intense self-consciousness, and transient emotional outbursts. Ax of severity, persistence, and degree of social and Nervous (NS) Anatomy (Anat) 1
health academic impairment can help diffiate normal adolescent behaviour from behavioural changes during further evaluation.
11744 Antiretroviral therapy Abacavir HSR occurs in 2-8% of pts and is strongly a/w the HLA-B*57:01 allele. Nervous (NS) Anatomy (Anat) 7
11769 Hemangioma Cavernous hemangiomas are vascular malformations that occur most commonly w/i the brain parenchyma; they carry an ↑ risk of intracerebral hemorrhage and seizure. Nervous (NS) Anatomy (Anat) 6
11772 Pertussis Pertussis should be considered in any adult who hasn't had updated vax boosters. The clinical presentation is a paroxysmal cough lasting >2wks that's a/w post-tussive Nervous (NS) Anatomy (Anat) 3
emesis or inspiratory whoop after a severe coughing episode.
11777 Compartment syndrome Acute compartment syndrome (ACS) is caused by increased pressure within fascial compartments of the limbs, leading to impaired perfusion. ACS can cause severe pain, Nervous (NS) Anatomy (Anat) 2
myonecrosis, and nerve injury. The anterior compartment of the leg, which contains the deep peroneal (fibular) nerve, is the most common site of ACS.
11779 Aspergillosis Pts w/ profound and prolonged neutropenia are at especially high risk for viral and fungal infections. The most common fungal causes are Aspergillus and Candida Nervous (NS) Anatomy (Anat) 5
species. Invasive pulm aspergillosis Px w/ some combination of fever, chest pain, cough, dyspnea, and hemoptysis.
11804 Neuroleptic malignant NMS is a life-threatening rxn to antipsychotic Rx characterised by diffuse muscle rigidity, hyperthermia, autonomic instability, and altered sensorium. The antipsychotic Nervous (NS) Anatomy (Anat) 2
syndrome should be stopped and supportive care provided; dantrolene, a RyR blocker that inhibs Ca2+ release from the SR, is an effective antidote.
11952 Polymyositis and Dermatomyositis is characterized by proximal muscle weakness resembling polymyositis, with additional inflammatory features involving the skin (heliotrope rash, Nervous (NS) Anatomy (Anat) 5
dermatomyositis Gottron papules). Both dermatomyositis and polymyositis may occur alone or as a paraneoplastic syndrome associated with an underlying adenocarcinoma (eg, ovary,
lung, pancreas).
11995 Sideroblastic anemia INH inhibs vit B6 PK, leading to vit B6 defic. Vit B6's active form is the cofactor for delta-ALA synthase, the enzyme that catalyzes the RLS of heme synth. Inhib of this Nervous (NS) Anatomy (Anat) 1
step can result in sideroblastic anemia.
12007 Lymphatic drainage Lymphatic drainage of the rectum prox. to the anal dentate line occurs via the inf. mesenteric and int. iliac LNs. Areas distal to the dentate line drain 1arily into the Nervous (NS) Anatomy (Anat) 2
inguinal nodes.
12008 Septic arthritis Synovitis is char by pain, erythema, swelling, and ↓ ROM in a joint. Acute synovitis may represent serious path (e.g. SA), esp. if accompanied by fever or leucocytosis; it Nervous (NS) Anatomy (Anat) 4
should be eval urgently w/ synovial fluid analysis.
12023 Rheumatoid arthritis RA causes progr joint destruction involving the hands, wrists, elbows, and knees. Cervical spine involvement can lead to spinal instability and cord compression. Nervous (NS) Anatomy (Anat) 9
12025 Perineal lacerations The perineal body is a fibromuscular tissue between the urogenital and anal triangle. A midline episiotomy is a vertical incision from the posterior vaginal opening to the Nervous (NS) Anatomy (Anat) 1
perineal body. It transects the vaginal submucosal tissue but not the external anal sphincter or the rectal mucosa.
12029 Depersonalization disorder D/DD is a dissociative disorder involving recurrent episodes of feeling detached from 1's body or surroundings a/o feelings of unreality. Nervous (NS) Anatomy (Anat) 1
12030 Obsessive compulsive OCD is characterised by persistent, unwanted thoughts (obsessions) and repetitive, time-consuming rituals (compulsions) that the individual feels driven to perform to Nervous (NS) Anatomy (Anat) 2
disorder alleviate anxiety.
12031 Conduct disorder Conduct disorder involves a persistent pattern of violating major societal norms or the rights of others. Behaviors include aggression toward people and animals, Nervous (NS) Anatomy (Anat) 1
deceitfulness or theft, destruction of property, and serious violation of rules.
12035 Substance use disorders Physicians have a responsibility to ID SSx of potential drug-seeking behaviour and prescription drug misuse. This involves being alert to red flags (e.g. lost or stolen Rx, Nervous (NS) Anatomy (Anat) 1
pain inconsistent w/ PEx) and attempting to clarify Rx Hx by using prescription drug-monitoring programs or other info sources.
12083 Glaucoma Glaucoma is a form of optic neuropathy characterized by increased intraocular pressure associated with increased production or decreased outflow of aqueous humor. Nervous (NS) Anatomy (Anat) 3
Topical prostaglandins (eg, latanoprost) increase outflow of aqueous via the uveoscleral pathway and are the preferred treatment for open-angle glaucoma.
12084 Atrial fibrillation AF is a/w ↑ risk of systemic TE. The LA appendage is the most common site of thrombus formation. Nervous (NS) Anatomy (Anat) 5
12119 Obstructive sleep apnea Neuromuscular weakness of the oropharynx is involved in the pathophysiology of obstructive sleep apnea. Electrical stimulation of the hypoglossal nerve increases the Nervous (NS) Anatomy (Anat) 4
diameter of the oropharyngeal airway and decreases the frequency of apneic events.
12155 Primary hypertension PRA is a measure of the amount of ATI generated per unit of time. It provides a useful Ax of the RAA axis. Factors that ↑ PRA incl low Na+ intake and anti-HTN Rx Nervous (NS) Anatomy (Anat) 14
such as diuretics (e.g. hydrochlorothiazide), ACEIs, and ARBs (e.g. valsartan).
12226 Human papillomavirus Human papillomavirus infection of basal cervical cells can progress to premalignant and cancerous lesions. Cervical intraepithelial neoplasia refers to atypical squamous Nervous (NS) Anatomy (Anat) 4
cells and is classified as low grade squamous intraepithelial lesions (if extending <1/3 of the epithelium) or high-grade squamous intraepithelial lesions (if extending
beyond). Basement membrane breach signifies invasive disease.
12227 Q fever Q fever is a zoonotic infection that occurs in farm workers exposed to waste from cattle and sheep. Its causative agent is Coxiella burnetii. A patient with exposure to Nervous (NS) Anatomy (Anat) 1
waste from farm animals who develops a nonspecific illness (myalgias, fatigue, fever (>10 days), retroorbital headache) with a normal leukocyte count, thrombocytopenia,
and increased liver enzymes should be evaluated for acute Q fever infection.
14898 Facial nerve The facial nerve (CN VII) exits the stylomastoid foramen and courses through the substance of the parotid gland, where it divides into its 5 terminal branches that Nervous (NS) Anatomy (Anat) 3
innervate the muscles of facial expression. Malignant tumors of the parotid gland often compress and disrupt the facial nerve and its branches, causing ipsilateral facial
droop.
15158 Pulmonary arterial Pulm HTN can occur due to a 1° change in the pulm arteries (i.e. PAH) or it can be 2° to a separate disease process such as LHF (r/o by normal PCWP). Endothelin Nervous (NS) Anatomy (Anat) 8
hypertension receptor antagonists (e.g. bonsetan, ambrisentan) ↓ pulm arterial pressure and improve dyspnoea in pts w/ PAH.
15646 Acne vulgaris RFs for acne incl ↑ androgen lvls; obstr of pilosebaceous glands by oil-based hair products; and mech irritation of skin follicles. Sports participation freq triggers acne due Nervous (NS) Anatomy (Anat) 3
to the use of tight-fitting clothing and protective gear.
15705 Malaria Mefloquine chemoprophylaxis for malaria must be continued for 4wks after return from an endemic region to ensure the elimination of hepatic schizonts (which develop Nervous (NS) Anatomy (Anat) 5
in the liver over 8-30days).
15727 Lung cancer Melanoma is a highly aggressive malignancy that often mets early in the disease course. Pts may be aSSx for yrs prior to onset of met MFxs. Dx is gen made when a Nervous (NS) Anatomy (Anat) 9
histopath sample shows cellular atypia w/ cells containing brown pigment (melanin granules); immunostaining for melanin/melanoma markers (e.g. S-100, HMB-45) is
gen (+).
15765 Hemophilias hemophilia A is an XL disorder a/w a defic of FVIII. Emicizumab — a bispecific, mAb — mimics the activity of FVIII by binding to both FIXa and FX, bringing them Nervous (NS) Anatomy (Anat) 1
into close proximity to allow for FX activation.
8323 HSV infection Pts infected w/ HSV develop a lifelong latent infection of the sensory ganglion. Periodic viral replication can lead to SSx that flare and resolve over time. Nervous (NS) Behavioral 9
Science (Beha)
64 Wernicke-Korsakoff Oculomotor dysfxn, ataxia, and confusion form the triad of WE. Most of these SSx usually resolve after vitB1 administration. Korsakoff syndrome is a complication of Nervous (NS) Biochemistry 5
syndrome WE, the hallmarks of which are permanent memory loss and confabulation. (Bioc)
598 Depression MAOIs are particularly useful in pts w/ Tx-resistant MDD w/ atypical features. ↑ appetite and sleep, leaden paralysis, rejection sensitivity, and mood reactivity are Nervous (NS) Biochemistry 8
hallmarks of the atypical subtype. (Bioc)
1048 Aminoglycoside Aminoglycoside (e.g. gentamicin) resistance is most commonly due to Abx-modding enzymes. These enzymes add chem groups to the Abx, which diminishes its ability Nervous (NS) Biochemistry 3
to bind to the 16S rRNA w/i the 30S ribosomal subunit. (Bioc)
1120 Fructose metabolism Unlike HFI (aldolase B deficiency) and classic galactosemia (GALT deficiency), essential fructosuria (fructokinase deficiency) is a benign disorder. Although affected pts Nervous (NS) Biochemistry 4
are aSSx, their urine will test (+) for a reducing sugar due to the presence of unmetabolized fructose. (Bioc)
1340 Comparing 2 means The two-sample t test is a statistical method commonly employed to compare the means of 2 groups of subjects. Nervous (NS) Biochemistry 1
(Bioc)
1341 Probability theory If events are independent, the probability that all events will turn out the same is the product of the separate probabilities for each event. The probability of at least 1 event Nervous (NS) Biochemistry 2
turning out differently is given as 1 - P(all events being the same). (Bioc)
1369 Vestibular schwannoma Vestibular schwannomas arise from CNVIII and are usually located at the CPA. These tumours can cause a range of SSx by dmging CNVIII (unsteadiness and ipsilateral Nervous (NS) Biochemistry 3
sensorineural hearing loss w/ tinnitus), CNV (ipsilateral facial paraesthesia and ↓ corneal reflex), and CNVII (ipsilateral facial paresis). Bilateral acoustic neuromas are (Bioc)
a/w NF-2.
1372 Tuberculosis Isoniazid is structurally similar to vitB6. As a result, this Abx ↑ the urinary excretion of vitB6 — often causing a frank defic of vitB6 — and competes for vitB6-binding Nervous (NS) Biochemistry 18
sites, leading to the defective synthesis of NTs like GABA. Isoniazid-induce neuropathy can usually be prevented w/ vitB6 supplementation. (Bioc)
1480 DNA replication DNA replication occurs in the 5'+3' direction on both strands. In contrast to the continuous synthesis of the leading strand, lagging strand synthesis occurs discontinuously Nervous (NS) Biochemistry 3
and is composed of short stretches of RNA primer plus newly synthesized DNA segments (Okazaki fragments). As a result, lagging strand synthesis requires the repetitive (Bioc)
action of DNA primase and DNA ligase.
QID Topic Educational Objective System Subject Repeats
1483 Fragile X syndrome FXS is caused by an ↑ # of CGG TNRs on the FMR1 gene on the long arm of the X chrom. This leads to hypermethylation and inactivation of FMR1. Nervous (NS) Biochemistry 3
(Bioc)
1500 Eukaryotic DNA replication Multiple origins of replication make eukaryotic DNA replication quick and effective despite the large size and complexity of the genome compared to that of prokaryotic Nervous (NS) Biochemistry 1
organisms. (Bioc)
1998 von Willebrand disease vWD is the most common inherited bleeding disorder. It has an AD pattern of inheritance and variable penetrance. Absence of vWF leads to impaired platelet fxn Nervous (NS) Biochemistry 7
(prolonged BT) and coagulation pathway abnormalities due to ↓ factor VIII activity (prolonged PTT). (Bioc)
2036 Adenomyosis Adenomyosis is the presence of endometrial glandular tissue w/i the myometrium. Menorrhagia and dysmenorrhea are common Px SSx. Pts have a uniformly enlarged Nervous (NS) Biochemistry 1
uterus w/ normal-appearing endometrial tissue on Bx. (Bioc)
2067 Diffusion Diffusion speed across a semipermeable membrane ↑ w/ higher molecular concgradients, larger membrane SAs, and ↑ solubility of the diffusing substance. Diffusion Nervous (NS) Biochemistry 1
speed ↓ w/ ↑ membrane thickness, smaller pore size, higher molecular weights, and lower temps. (Bioc)
8385 Physician patient In nonemergent settings, trained language interpreters should be used to ensure optimal medical care; this applies to deaf pts using ASL. Nervous (NS) Biochemistry 11
communication (Bioc)
8524 Acute heart failure Acute cardiogenic pulm oedema results from ↑ pulm venous pressure. The alveolar capillaries become engorged w/ blood and there's a transudation of fluid plasma across Nervous (NS) Biochemistry 7
the alveolar-capillary membrane, appearing as pink, acellular material w/i the alveoli. (Bioc)
496 Aortic dissection HTN is the single most important RF for the devel of intimal tears leading to AD. HTN, smoking, DM, and hypercholaemia are all major RFs for atherosclerosis, which Nervous (NS) Embryology 6
predisposes more to AA formation than AD. (Embr)
502 Respiratory mucosa Bronchi have a ciliated pseudostratified columnar epithelium with mucin-secreting goblet cells and submucosal mucoserous glands. The airway epithelium gradually Nervous (NS) Embryology 4
changes to ciliated simple cuboidal by the level of the terminal bronchioles. Bronchioles lack glands and cartilage, and the number of goblet cells decreases distally, (Embr)
ending before the terminal bronchioles. Ciliated epithelium persists up to the respiratory bronchioles.
1534 Immunizations Inactivated (killed or component) viral vaccines primarily generate a humoral immune response against extracellular viral antigens, preventing viral entry into the cell. In Nervous (NS) Embryology 4
contrast, live attenuated viral vaccines can generate a strong cell-mediated immune response that can kill virally-infected cells, in addition to providing humoral immunity. (Embr)
1691 Left atrial enlargement CV dysphagia can result from external compression of the esophagus by a dilated and posteriorly displaced LA in pts w/ RHD and MS/MR. Nervous (NS) Embryology 1
(Embr)
8702 Daptomycin Daptomycin is a lipopeptide Abx w/ activity limited to gram (+) organisms, incl MRSA. It causes depol of bacterial cellular membrane and inhib of DNA, RNA, and Nervous (NS) Embryology 1
protein synthesis. Daptomycin is a/w ↑ CPK lvls and an ↑ incidence of myopathy. (Embr)
15637 Personality disorders ASPD involves a pattern of violating the rights of others, engaging in unlawful behaviours (e.g. physical aggression, illegal occups), and lacking remorse for Nervous (NS) Embryology 6
transgressions. Individuals must be age >18 for Dx and have a Hx of CD prior to age 15. (Embr)
344 Malrotation Intestinal malrotation results when the midgut undergoes incomplete embryological counterclockwise rotation. It can Px as intestinal obstruction (due to compression by Nervous (NS) Genetics (Gene) 1
the adhesive bands) and midgut volvulus (intestinal ischemia due to twisting around the blood vessels).
357 Ectopic pregnancy An ectopic pregnancy is Chx by implantation outside of the uterus. Uterine curettage would reveal decidual changes in the endometrium due to progesterone secretion but Nervous (NS) Genetics (Gene) 1
no embryonic or trophoblastic tissue (eg, no villi).
590 Lung cancer Adenocarcinoma, the most common pulm malignancy, is characterised histopathologically by invasive glandular cells w/ abundant cytoplasm and eccentrically placed Nervous (NS) Genetics (Gene) 9
nuclei; mucin production is common. Imaging typically demonstrates a discrete mass or pneumonia-like consolidation at the periphery of the lung.
591 Superior vena cava Intrathoracic spread of bronchogenic carcinoma may lead to compression of the SVC, causing impaired venous return from the upper part of the body. SSx incl dyspnoea, Nervous (NS) Genetics (Gene) 1
syndrome facial swelling, and dilated collateral veins in the upper trunk.
596 Primary immunodeficiency CGD is most commonly due to an XL mut affecting NADPH oxidase. Defic of this enzyme leads to an inability of neutrophils to form the ox burst necessary to kill Nervous (NS) Genetics (Gene) 7
disorder organisms in their phagolysosomes. CGD can be Dx by absence of the normal blue and fluorescent green pigment produced by the NBT test and DHR FC test,
respectively.
840 Neonatal respiratory Use of concentrated O2 therapy for NRDS may be complicated by retinopathy of prematurity. This abn retinal neovascularisation is a major cause of blindness in Nervous (NS) Genetics (Gene) 5
distress syndrome developed nations.
1307 Cyanide poisoning Cyanide toxicity can occur in pts Tx w/ nitroprusside. Cyanide toxicity Px w/ altered mental status, seizures, CV collapse, lactic acidosis, and bright red venous blood. Nervous (NS) Genetics (Gene) 2
Antidotal Tx of cyanide toxicity can be achieved by 3 different strategies: direct binding of cyanide ions (hydroxocobalamin), induction of methemoglobinemia (Na
nitrite), and use of detoxifying sulfur donors (Na thiosulfate).
1421 Autonomic nervous system The ANS utilises 3 types of signal pathways: cAMP, IP3, and ion channels. nAChRs are ligand-gated ion channels that open after binding ACh. This results in an Nervous (NS) Genetics (Gene) 3
immediate influx of Na+ and Ca2+ into the cell and an outflux of K+ from the cell.
1808 Benign prostatic The prostate is located between the pubic symphysis and the anal canal and is visible on inferior sections of the pelvis on CT scan. Benign prostatic hyperplasia is a Nervous (NS) Genetics (Gene) 6
hyperplasia common, age-related condition that causes urinary symptoms (eg, hesitancy, straining, incomplete voiding). It can be medically treated with a-adrenergic blockers and 5-a
reductase inhibitors.
1536 Influenza IFN-alpha and -beta are produced by most human cells in response to viral infections. The production of alpha and beta IFNs helps suppress viral replication by halting Nervous (NS) Histology (Hist) 5
protein synth and promoting apoptosis of infected cells, limiting the ability of viruses to spread thru the tissues.
1922 Kawasaki disease Kawasaki disease is a vasculitis of medium-sized arteries that presents w/ persistent fever for >5days, bilateral conjunctivitis, cervical LAD, and mucocutaneous Nervous (NS) Histology (Hist) 1
involvement. Coronary artery aneurysms are a serious complication of Kawasaki disease.
1936 Primary biliary cholangitis A yellowish eyelid papule or plaque containing lipid-laden macrophages is most likely xanthelasma. Xanthelasma may occur in a/w 1° or 2° hyperlipidaemia. Cholestatic Nervous (NS) Histology (Hist) 4
conditions such as PBC are a potential cause of hypercholesterolaemia leading to xanthelasma.
113 Febrile neutropenia Local defense against Candida is performed by T cells, whereas systemic infection is prevented by neutrophils. For this reason, localized candidiasis is common in Nervous (NS) Microbiology 4
patients who have HIV, but neutropenic individuals are more likely to have the systemic form of the disease. (Micr)
116 Cryptococcal infections Meningoencephalitis is the most common presentation of C. neoformans infection. It occurs in immsup pts and can be Dx by India ink staining of the CSF. Cryptococcal Nervous (NS) Microbiology 3
pneumonia is Dx by mucicarmine staining of lung tissue and bronchoalveolar washings. (Micr)
118 Cryptococcal infections C. neoformans is the only pathogenic fungus that has a PSC. The capsule appears red on mucicarmine stain and as a clear unstained zone w/ India ink. Nervous (NS) Microbiology 3
(Micr)
735 Precocious puberty Sex hormones promote both growth and epiphyseal plate closure; hence, precocious puberty may result in a shorter stature, despite an initial growth spurt. Gigantism is Nervous (NS) Microbiology 1
caused by excessive pituitary production of GH; these pts achieve enormous heights b/c, unlike excessive sex steroids, excessive IGF-1 doesn't lead to premature closure (Micr)
of the epiphysis.
737 Achondroplasia Achondroplasia is an AD disorder that results in a GOF mut in the FGFR3 gene. Most individuals affected by AD disorders are heterozyg and have a 50% chance of Nervous (NS) Microbiology 2
transmitting the mut to their offspring. (Micr)
738 Osteogenesis imperfecta OI results from defective synthesis of type I collagen by osteoblasts. CFx incl a Hx of MTFs, blue sclerae, and small, malformed teeth. In most pts, OI is transmitted by Nervous (NS) Microbiology 1
AD inheritance. (Micr)
907 Febrile seizure Febrile seizures are the most common neuro disorder affecting children and are benign sequelae of fever. Children who experience a febrile seizure are at risk for Nervous (NS) Microbiology 1
recurrence but have a low risk of developing epilepsy. Supportive care (eg, antipyretics) can improve pt comfort during fever but does not prevent future seizures. (Micr)
1005 Community acquired L. pneumophila commonly contaminates natural bodies of water, municipal water supplies, and water-based cooling systems. The organism is inhaled in aerosolised water Nervous (NS) Microbiology 21
pneumonia and establishes infection via the pulm route. Dx is gen made by urine Ag testing, Ag stain, or culture on buffered charcoal yeast extract agar supplemented w/ L-cysteine (Micr)
and Fe.
1038 Vitamin D deficiency In CKD, conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D is impaired. In addition, failure of glomerular and tubular fxn results in PO4 retention and Nervous (NS) Microbiology 4
hypocalcemia. This leads to a compensatory rise in PTH (2° HPT) that can Px w/ weakness, muscle and joint pain, defective bone mineralization, and ↑ fracture risk. (Micr)
1140 Anticoagulants Rifampin, phenobarbital, and phenytoin are potent enhancers of the CYP450 pathway; concurrent use of warfarin w/ these Rx results in ↓ efficacy of warfarin. In contrast, Nervous (NS) Microbiology 8
cimetidine, amiodarone, and TMP-SMX inhib warfarin meta, ↑ the risk of bleeding. (Micr)
1392 Metabolic syndrome DM-2 is due to insulin resistance and relative insulin defic. Chronically ↑ FFA lvls contribute to insulin resistance by impairing insulin-dependent Glc uptake and ↑ Nervous (NS) Microbiology 2
hepatic GNG. (Micr)
1399 Acute intermittent AIP is an AD condition caused by PBG deaminase defic. Most pts remain aSSx, but a minority Px w/ acute atks char by abdo pain and vomiting, peri neuropathy, Nervous (NS) Microbiology 1
porphyria neuropsych SSx, and reddish-brown urine. Tx consists of IV Glc or heme preps, which downreg ALA synthase activity. (Micr)
1401 Metabolic acidosis Methylmalonic acidemia is an organic acidemia due to complete or partial defx of methylmalonyl-CoA mutase. Complete defx classically Px w/ lethargy, vomiting, and Nervous (NS) Microbiology 4
tachypnea in a newborn. LTx shows hyperammonemia, ketotic hypoglycemia, and metabolic acidosis. The Dx is confirmed by ↑ urine methylmalonic acid and propionic (Micr)
acid.
1402 Orthostatic hypotension Orthostatic hypotension is a frequent cause of light-headedness and syncope and is defined as a ↓ in SBP (>20mmHg) or DBP (>10mmHg) on standing from the supine Nervous (NS) Microbiology 1
position. Rx (α1-adrenergic antagonists, diuretics), volume depletion, and autonomic dysfxn are common causes of orthostatic hypotension. (Micr)
1552 Lac operon Bacterial mRNA can be polycistronic, meaning that 1 mRNA codes for several proteins. An example of polycistronic mRNA is the bacterial lac operon, which codes for Nervous (NS) Microbiology 2
the proteins necessary for lactose metabolism by E. coli; the transcription and translation of these bacterial proteins is regulated by a single promoter, operator, and set of (Micr)
regulatory elements.
1573 Homocystinuria Homocystinuria is most commonly caused by cystathionine synthase deficiency. Affected individuals have marfanoid habitus, ectopia lentis, and developmental delay. Nervous (NS) Microbiology 1
Significant morbidity and mortality are due primarily to TE. Many pts w/ homocystinuria respond dramatically to pyridoxine (vitamin B6) supplementation. (Micr)
1601 Neurofibromatosis NF-I (vRD) is an AD disorder caused by muts in the NF1 TSG. Pts Chx develop numerous cutaneous neurofibromas comprised mostly of Schwann cells, which are Nervous (NS) Microbiology 3
embryologically derived from the neural crest. (Micr)
1853 Developmental milestones By age 3, a child is expected to play imaginatively in parallel w/ others, speak in simple sentences, copy a circle, use utensils, and ride a tricycle. Nervous (NS) Microbiology 1
(Micr)
1906 Beta 2 agonists Isoproterenol is a β1 and β2 adrenergic receptor agonist that causes ↑ myocardial contractility and ↓ SVR. Nervous (NS) Microbiology 1
(Micr)
1966 Chemotherapy MTX and 5-FU both effectively inhib thymidylate formation, but the CTx effect of MTX is overcome by N5-formyl-THF (folinic acid, leucovorin) supplementation. Nervous (NS) Microbiology 3
(Micr)
1997 Neuronal physiology Kinesin is a microtubule-associated motor protein that fxns in the anterograde transport of materials and organelles w/i cells. Reactivation of latent HSV requires Nervous (NS) Microbiology 3
anterograde transport of viral particles from neuronal cell bodies in the sensory ganglia to the skin and oral mucosa. (Micr)
2082 Antiarrhythmic drugs β blockers ↓ AV nodal conduction, leading to an ↑ AV nodal refractory period. This correlates to PR interval prolongation on an ECG. Nervous (NS) Microbiology 12
(Micr)
QID Topic
2083 Resting membrane potential Changes in membrane potential occur in response to changes in neuronal membrane permeability to various cellular ions. The more permeable the membrane becomes for Nervous (NS)
and action potential
8324 Myasthenia gravis
11862 Bacterial vaginosis
14905 Syphilis
15580 Laboratory techniques
15587 Pituitary adenoma
4 Subarachnoid hemorrhage
14 Hydrocephalus
15 Hydrocephalus
16 Normal pressure
hydrocephalus
17 Normal pressure
hydrocephalus
18 Ischemic stroke
19 Ischemic stroke
20 Ischemic stroke
22 Ischemic stroke
23 Ischemic stroke
63 Liver abscess
65 Vitamin B12 deficiency
66 Vitamin B12 deficiency
177 Calcium channel blocker
347 Meckel diverticulum
397 Alcoholic liver disease
468 Atherosclerosis
492 von Hippel-Lindau disease
493 Hereditary hemorrhagic
telangiectasia
494 Hepatocellular cancer
495 Syphilis
497 Chronic venous
insufficiency
498 Thrombophlebitis
499 Pulmonary embolism
500 Respiratory mucosa
501 Neonatal respiratory
distress syndrome
503 Respiratory physiology
504 Neonatal respiratory
distress syndrome
505 Human papillomavirus
592 Lung cancer
593 Poststreptococcal
glomerulonephritis
594 Heart transplantation
595 Transplant rejection
597 Monoamine oxidase
inhibitors
613 Zollinger-Ellison syndrome ZES is caused by gastrin-secreting tumors (gastrinomas) involving the small intestine or pancreas. Pts typically have peptic ulcers (often beyond the duodenal bulb),
614 Ataxia telangiectasia
632 Wernicke-Korsakoff
syndrome
634 Diabetes mellitus
636 Pheochromocytoma
647 Brain tumors
671 Antibiotic resistance
Educational Objective System Subject Repeats
Microbiology 5
a cellular ion, the more that ion’s equilibrium potential contributes to the total membrane potential. (Micr)
MG is an AI disorder caused by an autoAb-mediated atk on the ACh receptors of the postsynaptic NMJ, leading to a ↓ number of ACh receptors. It is Chx by fatigable Nervous (NS) Microbiology 10
weakness of the skeletal muscles; resp failure can occur due to diaphragmatic weakness. (Micr)
Bacterial vaginosis is caused by a disruption of the vaginal bacteria flora and is Chx by a "fishy-smelling," thin, grayish vaginal d/c and clue cells on wet mount Nervous (NS) Microbiology 3
microscopy. Metronidazole and clindamycin are the preferred Tx options. (Micr)
The Romberg test is a test of proprioception in which pts are observed for unsteadiness as they stand w/ their feet close together, arms to the sides, and eyes closed. Failure Nervous (NS) Microbiology 9
to maintain this posture indicates sensory ataxia, which may be caused by defects in the posterior column or peri nerves (e.g. tabes dorsalis, vitB12 defic). (Micr)
FISH can Id specific chrom translocations, duplications, or deletions using a complementary ssDNA segment that's tagged w/ a radiotracer. FISH is rapid, highly sens and Nervous (NS) Microbiology 1
spec, and can be used on tissues w/ low mitotic rates. However, the targeted chrom abn must be somewhat large in order to be Id. (Micr)
Galactorrhoea is abn secretion of breast milk not a/w preg or breastfeeding. It's most commonly due to excess PRL, as seen in PRL-secreting pituitary adenomas. PRL is Nervous (NS) Microbiology 8
under (-) regulation by hypothal DA-ergic neurons, and DA agonists can be sued to Tx hyperprolactinaemia. (Micr)
Intracranial BAs of the COW are often seen in pts w/ ADPKD; when ruptured, they cause SAH that presents w/ sudden onset of 'thunderclap h/a'. Nervous (NS) Pathology (Path) 4
Hydrocephalus is an enlargement of the ventricles (+/- ↑ pressure) caused by either neuronal volume loss (eg, hydrocephalus ex-vacuo) or excessive CSF accumulation Nervous (NS) Pathology (Path) 4
(due to flow obstruction or impaired absorption). Neurodegenerative diseases (eg, AIDS dementia) can be a/w hydrocephalus ex-vacuo due to significant cortical atrophy,
which allows the ventricles to expand while maintaining normal pressure.
Symmetrical enlargement of the ventriculi is Chx of communicating hydrocephalus. Communicating hydrocephalus usually occurs 2° to dysfxn or obliteration of Nervous (NS) Pathology (Path) 4
subarachnoid villi. This dysfxn is usually a sequelae of meningeal infection (including tuberculosis meningitis) or SAH/IVH.
NPH presents w/ progr gait difficulties, cognitive disturbances, and urinary incontinence. It's a form of communicating hydrocephalus characterised by ventriculomegaly Nervous (NS) Pathology (Path) 2
w/o persistent ↑ in ICP. Brain imaging reveals ventricular enlargement out of proportion to sulci enlargement.
NPH occurs due to ↓ CSF absorption, resulting in ventriculomegaly w/ normal ICP. This causes stretching of the descending cortical fibers (corona radiata) from the Nervous (NS) Pathology (Path) 2
frontal lobe and contributes to the classic triad of SSx (ie, dementia, gait abnormalities, urinary incontinence). Loss of cortical inhibition of the sacral micturition center
leads to urge incontinence.
Global cerebral ischemia is typically precipitated by systemic hypotension (e.g. cardiac arrest). The cells most susceptible to ischemia are the CA1 pyramidal neurons of Nervous (NS) Pathology (Path) 19
the hippocampus. Other areas of the brain that are damaged early in the course of global cerebral ischemia incl the cerebellar Purkinje cells and the pyramidal neurons of
the neocortex.
Inadequate blood supply to the brain (e.g. arterial thrombosis or embolism) leads to ischemic stroke. The 1st microscopic changes are typically seen 12-24hrs after Nervous (NS) Pathology (Path) 19
irreversible ischemic injury and incl intense eosinophilic staining of the neuronal cytoplasm (red neurons) and nuclear fragmentation.
Microglia are the predominant cell in the necrotic area 3-7 days after the onset of ischemia and phagocytize the fragments of neurons, myelin, and necrotic debris. Nervous (NS) Pathology (Path) 19
Lacunar infarcts are small ischemic infarcts (<15mm in diameter) involving the deep brain structures (e.g. basal ganglia, pons) and subcortical white matter (e.g. internal Nervous (NS) Pathology (Path) 19
capsule, corona radiata). They're most often due to lipohyalinosis, microatheroma formation, and hardening/thickening of the vessel wall (HTN arteriolar sclerosis), which
predisposes to thrombotic vessel occlusion.
Sustained cerebral hypoperfusion (eg, hypotension, shock) may cause global cerebral ischemia and watershed infarction. These watershed zones are located at the borders Nervous (NS) Pathology (Path) 19
b/w areas perfused by the ACAs, MCAs, and PCAs and typically appear as symmetric, bilateral wedge-shaped strips of necrosis over the cerebral convexity, parallel and
adjacent to the interhemispheric fissure.
S. aureus can cause hepatic abscesses via heme seeding of the liver. Enteric bacteria (e.g. E. coli, Klebsiella, and enterococci) can cause hepatic abscesses by asc the Nervous (NS) Pathology (Path) 1
biliary tract (i.e. asc cholangitis), portal vein pyemia, or direct invasion from an adjacent area (e.g. cholecystitis).
Vit B12 defx often Px w/ megaloblastic anemia (impaired DNA synthesis) and neuro deficits (impaired myelin synthesis). Chx neuro findings include SCD of the dorsal Nervous (NS) Pathology (Path) 9
columns and lateral corticospinal tract. ↑ in methylmalonic acid and homocysteine lvls occur due to ↓ metabolism of these molecules.
Myelopathy a/w vitB12 defic is called SCD. 'combo' refers to myelin degen of both the ascending (dorsal columns) and descending (corticospinal tract) pathways. Loss of Nervous (NS) Pathology (Path) 9
position and vibration sensation, sensory ataxia, and spastic paresis are common MFxs.
Amlodipine is a DHP CCB commonly used as monoThx or in combination w/ other agents for Tx of HTN. Major AEx include h/a, flushing, dizziness, and peripheral Nervous (NS) Pathology (Path) 3
edema.
The omphalomesenteric (vitelline) duct normally obliterates during the 7th wk of embryonic development. Both enterocysts and Meckel diverticula result from a failure of Nervous (NS) Pathology (Path) 3
obliteration involving the vitelline duct.
The pathogenesis of Alc-induced hepatic steatosis appears related primarily to a ↓ in FFA oxidation 2° to excess NADH production by the 2 major Alc metabolism Nervous (NS) Pathology (Path) 1
enzymes, Alc dehydrogenase and aldehyde dehydrogenase.
During the development of atherosclerotic plaque (atheroma), activated macrophages, platelets, and endothelial cells release GFs (eg, PDGF) that stimulate recruitment of Nervous (NS) Pathology (Path) 8
SMCs from the arterial wall media and their subsequent proliferation in the intima.
A cerebellar hemangioblastoma in a/w congenital cysts of the kidneys, liver, a/o pancreas is highly suggestive of vHL disease, a rare AD condition. Nervous (NS) Pathology (Path) 1
Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasia) is an AD condition marked by the presence of telangiectasias in the skin as well as the mucous Nervous (NS) Pathology (Path) 1
membranes of the lips, oronasopharynx, resp tract, GIT, and urinary tract. Rupture of these telangiectasias may cause epistaxis, GI bleeding, or hematuria.
Hepatic angiosarcoma is a/w exposure to carcinogens such as arsenic, thorotrast, and polyvinyl chloride. Tumour cells express CD31, an endothelial cell marker. Nervous (NS) Pathology (Path) 5
Tertiary syphilis can result in thoracic aortic aneurysm. If the aneurysm compresses adjacent structures and dilates the aortic valve ring, a murmur and mediastinal Nervous (NS) Pathology (Path) 9
widening might be present. The pathogenesis begins with vasa vasorum endarteritis and obliteration, resulting in inflammation, ischemia, and weakening of the aortic
adventitia. Fluorescent treponemal antibody absorption testing is specific for syphilis.
Varicose veins are dilated, tortuous veins most commonly found in the superficial veins of the leg. They're caused by chronically ↑ intraluminal pressure a/o loss of tensile Nervous (NS) Pathology (Path) 3
strength in the vessel wall, leading to incompetence to the venous valves. Common complications incl oedema, stasis dermatitis, skin ulcerations, poor wound healing, and
infections.
A PNPS of hypercoagulability may be seen in some pts w/ ca, especially ACs of the pancreas, colon, or lung. Superficial venous thromboses may therefore appear in one Nervous (NS) Pathology (Path) 1
site and then resolve, only to recur in another site. This is known as Trousseau syndrome (migratory superficial thrombophlebitis), an indication of visceral ca.
V/Q scans use radiotracers to compare the ventilation and blood perfusion of each area of the lung. V/Q mismatch w/ perfusion defects are often indicative of a PE, which Nervous (NS) Pathology (Path) 13
are most commonly caused by DVT in the lower extremities that embolises to the pulm vasculature.
Type II pneumocytes have 2 important functions: regeneration of the alveolar lining following injury and surfactant production. Nervous (NS) Pathology (Path) 4
The lamellar bodies of type II pneumocytes store and release pulm surfactant into the fluid layer lining the inner surfaces of alveoli. The major fxn of surfactant is to ↓ Nervous (NS) Pathology (Path) 5
surface tension in this fluid layer, and so a surfactant defic can cause alveolar atelectasis, as seen in NRDS.
The airway resistance at each lvl of the LRT is inv related to the TCSA of all the airways at that lvl. Airway resistance is high in the trachea and reaches a peak in the Nervous (NS) Pathology (Path) 8
medium-sized bronchi, where TCSA is at a mini. Airway resistance then progr decr as TCSA incr thru the smaller bronchioles, term bronchioles, and alv.
Phospholipids, including dipalmitoyl phosphatidylcholine, are a major component of pulmonary surfactant. The amniotic fluid lecithin (phosphatidylcholine) to Nervous (NS) Pathology (Path) 5
sphingomyelin ratio (L/S ratio) is measured in order to assess fetal lung maturity. The fetal lungs are considered mature when they are producing adequate surfactant to
yield an L/S ratio greater than 2.
HPV is a small DNA virus w/ a tropism for stratified squamous epithelium, which protectively lines anatomical areas that undergo frequent friction and abrasion, Nervous (NS) Pathology (Path) 4
including the true vocal cords, cervix, and anus. Infants can acquire resp papillomatosis via passage through an HPV-infected birth canal.
Pancoast tumours are NSCLCs (e.g. SCC, AC) that arise near the superior sulcus. Pts may develop ipsilateral shoulder pain, upper limb paraesthesias, and areflexic arm Nervous (NS) Pathology (Path) 9
weakness due to involvement of the brachial plexus. Horner's syndrome (e.g. ipsilateral partial ptosis, miosis, anhidrosis) can also occur due to involvement of the cervical
sympathetic ganglia.
Poststreptococcal glomerulonephritis is the most common cause of nephritic syndrome (eg, hematuria, edema, hypertension) in children, typically occurring 2-4 weeks Nervous (NS) Pathology (Path) 8
after a streptococcal infection (eg, impetigo, cellulitis, pharyngitis). It is caused by a type III (immune-complex-mediated) hypersensitivity reaction resulting from
nephritogenic strains of group A β-hemolytic Streptococcus.
Acute cardiac transplant rejection occurs wks following transplantation and is primarily a cell-mediated process. On histopathologic analysis of an endomyocardial Bx, a Nervous (NS) Pathology (Path) 1
dense mononuclear lymphocytic infiltrate w/ cardiac myocyte dmg will be visualized. Tx w/ immunosuppressive Rx is aimed primarily at preventing this form of
rejection.
Hyperacute rejection is caused by preformed Abs in the recipient that recognize and attack donor Ags (ie, type II HS). These are often anti-ABO blood group or anti-HLA Nervous (NS) Pathology (Path) 4
Abs. Vascular injury and capillary thrombotic occlusion lead to rapid ischemic necrosis of the renal graft, often evidenced by gross cyanosis and mottling immediately
following graft perfusion.
MAO is a mitochondrial enzyme that breaks down MA NTs (e.g. DA, NE, 5-HT). Tyramine-induced HTC can occur in pts taking MAOIs who consume foods containing Nervous (NS) Pathology (Path) 1
high amounts of tyramine (e.g. aged cheeses, cured meats, draft beer).
Nervous (NS) Pathology (Path) 3
abdominal pain/acid reflux, and diarrhea. The condition is frequently a/w MEN-1.
Cerebellar ataxia, telangiectasias, and ↑ risk of sinopulm infections constitute a Chx triad of AT. This illness exhibits AR inheritance, and the defect is in a gene that codes Nervous (NS) Pathology (Path) 2
for the ATM gene which plays a role in DNA break repair. The immune defx primarily MFx as an IgA defx and predisposes to infections of the upper and lower airways.
Chronic vit B1 defx impairs Glc utilization in the CNS. This occurs due to ↓ activity of the enzymes that use B1 as a cofactor (e.g. PDH, α-KG dehydrogenase, Nervous (NS) Pathology (Path) 5
transketolase). B1 defx can be Dx if baseline erythrocyte transketolase activity is low but ↑ after addition of B1-PPi.
DKA is initially Tx w/ an IV infusion of regular insulin, which allows for rapid adjustments in dose based on BSLs. When given subcutaneously, regular insulin starts Nervous (NS) Pathology (Path) 31
working w/i 30min, peaks in 2-4hrs, and lasts 5-8hrs.
Cortisol ↑ the conversion of NE to EPI in the AM by ↑ the expression of PNMT. Nervous (NS) Pathology (Path) 4
GBM is the most common 1° cerebral neoplasm of adults that's typically located w/i the cerebral hemispheres and may cross the midline ('butterfly glioma'). These Nervous (NS) Pathology (Path) 10
tumours are highly malignant and grossly contain areas of necrosis and hemorrhage.
The mech of vancomycin resistance in organisms such as VRE is a substitution of D-lactate in the place of D-alanine during the process of PGCW synthesis. This Nervous (NS) Pathology (Path) 8
prevents the binding of vancomycin to its usual D-ala-D-ala binding site in the cell wall.
QID Topic Educational Objective System Subject Repeats
672 Foodborne illness Staphylococcal food pois is mediated by the ingestion of a preformed, heat-stable enterotox that induces rap-on (<6 hrs) nausea and vomiting. Most cases arise due to Nervous (NS) Pathology (Path) 2
improper food handling and storage. Common culprit foods incl eggs, dairy prods, and mayonnaise-based salads.
673 Endocarditis Initial empiric Tx of coagulase (-) staphylococcal infection should include vancomycin due to widespread methicillin resistance, esp. in nosocomial infections. If Nervous (NS) Pathology (Path) 15
susceptibility results indicate a methicillin-susceptible isolate, vancomycin can be switched to nafcillin or oxacillin.
674 Osteomyelitis Hematogenous osteomyelitis is predominantly a disease of children that most frequently affects the long bones. Staphylococcus aureus is implicated in most cases Nervous (NS) Pathology (Path) 4
secondary to a bacteremic event. Streptococcus pyogenes (group A streptococcus) is the second most common cause of hematogenous osteomyelitis.
675 Lung cancer The phrenic nerve arises from the C3-C5 segments of the spinal cord and innervates the ipsilateral hemidiaphragm. Intrathoracic spread of lung ca may affect the phrenic Nervous (NS) Pathology (Path) 9
nerve, causing hiccups and diaphragmatic paralysis w/ dyspnoea. Brachial plexus involvement can cause pain in the distribution of the C8, T1, and T2 nerve roots.
Involvement of the recurrent laryngeal nerve may cause hoarseness.
749 NSAIDs ASA is an NSAID that irreversibly inhibs COX-1 and -2 enzymes via acetylation. In contrast, other NSAIDs (e.g. diclofenac, ibuprofen, indomethacin) reversibly inhib Nervous (NS) Pathology (Path) 4
COX-1 and -2.
794 Ankylosing spondylitis The seronegative spondyloarthropathies include ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and arthritis associated with inflammatory bowel disease. Nervous (NS) Pathology (Path) 2
Individuals expressing HLA B27 are at increased risk for the seronegative spondyloarthropathies.
871 Traumatic hemolytic Schistocytes (helmet cells) are fragmented erythrocytes. They occur 2° to mech trauma from MAHAs or prosthetic cardiac valves. Intravascular hemolytic anaemias are Nervous (NS) Pathology (Path) 2
anemia characterised by ↓ serum haptoglobin lvls as well as ↑ LDH and bilirubin.
880 Urethral injury Injury to the posterior urethra is associated with pelvic fractures, and the anterior urethra is most commonly damaged in straddle injuries. Inability to void with a full Nervous (NS) Pathology (Path) 1
bladder sensation, a high-riding boggy prostate, and blood at the urethral meatus are suggestive of urethral injury, particularly in the presence of a pelvic fracture. If
urethral injury is suspected, placement of a Foley catheter is contraindicated.
902 Gout Nonsteroidal anti-inflammatory drugs are the first-line treatment for acute gouty arthritis. They inhibit cyclooxygenase and therefore decrease prostaglandin synthesis and Nervous (NS) Pathology (Path) 11
exert a broad anti-inflammatory effect that includes inhibition of neutrophils.
906 Constipation PEG is an osmotic laxative. Diarrhea a/w lactase defic is also osmotic and occurs due to accum of nonabs lactose in the intestinal lumen. MgOH (and other Mg-containing Nervous (NS) Pathology (Path) 3
compounds, such as Mg citrate) is another osmotic laxative that’s often used, although its efficacy is Q-able and there’s not enough evidence to support its widespread use.
908 Fibromyalgia Fibromyalgia occurs most commonly in women age 20-55 and presents with diffuse musculoskeletal pain, fatigue, and neuropsychiatric disturbances. It is characterized Nervous (NS) Pathology (Path) 1
by abnormal central processing of painful stimuli. Although initially painful, aerobic exercise helps to improve pain and functioning in these patients.
910 Fetal hemoglobin HbF is the predominant Hb type in the 2nd and 3rd trims of preg and during the 1st few mos after birth. HbF consists of 2 alpha and 2 gamma protein subunits (a2g2) and Nervous (NS) Pathology (Path) 1
has a high affinity for O2, which facilitates O2 transport across the placenta to the fetus. HbA (a2b2) is the major Hb in adults.
911 Cervical cancer Consistent use of barrier contraceptives is extremely important for preventing STIs, including HPV. Pts infected w/ carcinogenic strains of HPV (ie, 16, 18, and 31) are at Nervous (NS) Pathology (Path) 3
risk of SCC of the cervix.
912 Alcohol withdrawal Tremulousness is typically 1 of the earliest SSx of alcohol withdrawal. Other common SSx incl GI distress, agitation, anxiety, and autonomic disturbance. DT is the most Nervous (NS) Pathology (Path) 2
severe MFx of alcohol withdrawal and typically begins 48-96hrs after the last drink.
913 Necrosis Liquefactive necrosis is characterised by complete digestion and removal of necrotic tissue w/ formation of a cystic cavity. Irreversible ischemic CNS injury is typically Nervous (NS) Pathology (Path) 3
f/b liquefactive necrosis due to the release of lysosomal enzymes from inflammatory cells and dmgd neurons.
915 Alcohol use disorder Folic acid deficiency anemia commonly occurs in Alcism. It is a megaloblastic anemia that can develop w/i wks. PBS shows macrocytosis, ovalocytosis, and neutrophils Nervous (NS) Pathology (Path) 3
w/ hypersegmented nuclei.
916 Keloid Keloids result from excessive collagen formation during the remodeling phase of wound healing. They present as raised, painful, and pruritic nodules that grow beyond Nervous (NS) Pathology (Path) 2
the wound borders.
917 SLE SLE is an autoimmune disorder that occurs most commonly in women. heme abns are common; auto-Abs against blood cell Ags (i.e. HS-II) can cause pancytopaenia (i.e. Nervous (NS) Pathology (Path) 7
anaemia, thrombocytopaenia, leucopoenia). In contrast, lupus nephritis is caused by IC deposition (i.e. HS-III) in the glomeruli.
918 Atopic dermatitis AD (eczema) is a common, chronic inflammatory disorder caused by impairment of the skin's barrier fxn. Eczema presents w/ pruritus and erythematous papules and Nervous (NS) Pathology (Path) 2
plaques and is a/w other atopic diseases, such as allergic rhinitis and asthma.
919 Sarcoidosis Sarcoidosis commonly presents w/ hilar adenopathy, pulm infiltrates, and skin (e.g. erythema nodosum) and ocular findings. Biopsy shows NCGs composed of epithelioid Nervous (NS) Pathology (Path) 7
cells (activated macrophages) and giant multinucleated cells. Oral glucocorticoids are the Tx of choice for significant disease.
1058 Diabetes mellitus Insulin release by pancreatic β cells is stim by ↑ Glc meta and ATP production. Glucokinase fxns as a Glc sensor in pancreatic β cells by controlling the rate of Glc entry Nervous (NS) Pathology (Path) 31
into the glycolytic pathway. muts in the glucokinase gene lead to a state in which higher Glc lvls are req to stim insulin secretion and are a cause of MODY.
1059 Diabetes mellitus Pts w/ non-coronary atherosclerotic disease, DM, or CKD are at the same risk of CV events (e.g. MI, stroke) as pts w/ known CAD. CAD is the most common COD in pts Nervous (NS) Pathology (Path) 31
w/ DM.
1060 Diabetes mellitus AI insulitis w/ progr β cell loss is the most common cause of DM-1. IRaccompanied by relative insulin defic is the main cause of DM-2. Nervous (NS) Pathology (Path) 31
1151 Otitis media Nontypeable strains of Haemophilus influenzae are part of the normal upper respiratory tract flora and are a common cause of acute otitis media, sinusitis, and bronchitis. Nervous (NS) Pathology (Path) 1
Because nontypeable strains do not form a polysaccharide capsule, immunity is not conferred by vaccination with the H influenzae type b vaccine.
1152 Meningitis The Hib vax induces anticapsular Abs that facilitate complement-mediated phagocytosis of the bacterium. The vax series has drastically ↓ the incidence of invasive Nervous (NS) Pathology (Path) 17
disease caused by Hib, such as meningitis, bacteremia, pneumonia, and epiglottitis.
1153 Folate antimetabolites TMP, MTX, and pyrimethamine inhib DHFR. TMP restricts bacterial growth thru this process, and works particularly well in conjunction w/ sulphonamide, which inhibs Nervous (NS) Pathology (Path) 1
an earlier step in the bacterial vitB9 pathway.
1259 Study designs Selection of control subjects in case-control studies is intended to provide an accurate estimation of exposure frequency among the non-diseased general population. Cases Nervous (NS) Pathology (Path) 6
and controls should be selected based on disease status, not exposure status.
1260 Prospective cohort study Prospective cohort studies are organized by selecting a group of individuals (i.e., cohort), determining their exposure status, and then following them over time for Nervous (NS) Pathology (Path) 1
development of the disease of interest.
1263 Prevalence and incidence According to 2019 estimates, the most common cancers (excluding basal and squamous cell skin cancer) in women by order of incidence are breast, lung, and colorectal Nervous (NS) Pathology (Path) 3
cancer. In terms of mortality, lung cancer claims the most lives, followed by breast and colorectal cancer.
1264 Risk The RR represents the risk of an outcome in the exposed divided by the risk of that outcome in the unexposed. Applying the correct formula for RR calculations depends Nervous (NS) Pathology (Path) 6
on the proper formatting of a 2x2 (contingency) table.
1267 Correlation coefficient The correlation coefficient (r) ranges from -1 to +1 and describes the strength and polarity of a linear association. Nervous (NS) Pathology (Path) 1
1268 Urinary retention Postop urinary retention, w/ incomplete bladder emptying, is a common complication thought to involve decr micturition reflex activity, decr contractility of the bladder Nervous (NS) Pathology (Path) 4
detrusor, a/o incr vesical sphincter tone. This condition may be Tx w/ a musc ag (bethanechol) or an alpha1 blocking drug.
1304 Malabsorption The duodenal brush border enzyme EntP activates trypsin from its inactive precursor, trypsinogen. Trypsin degrades complex polypeps to dipeps, tripeps, and AAs while Nervous (NS) Pathology (Path) 4
activating other pancr enzymes. EntP defic impairs both protein and fat abs, leading to diarrhea, FTT, and hypoproteinemia.
1305 Primary hypertension Direct arteriolar vasodilators ↓ BP but trigger reflex sympathetic activation and stimulate the RAA axis. This results in tachycardia and edema. To counteract such Nervous (NS) Pathology (Path) 14
compensatory effects, these agents are often given in combination w/ sympatholytics and diuretics.
1904 Generalized anxiety Serotonin-releasing neurons in the CNS are located in the raphe nuclei. These neurons disseminate widely to synapse on numerous structures in the CNS. Antidepressants Nervous (NS) Pathology (Path) 4
disorder such as SSRIs, SNRIs, and TCAs inhib serotonin reuptake at these synapses.
1962 Ketone utilization When glycogen stores are depleted during fasting, ketone bodies are produced in the liver and can be used as an energy source in the mitochondria of peri tissues. The Nervous (NS) Pathology (Path) 1
brain preferentially uses Glc, but will utilise ketones for most of its energy needs during prolonged starvation. Erythrocytes lack mitochondria and are unable to use
ketones.
6554 Atrial fibrillation Palpitations refer to a subjective sensation/awareness of the heartbeat due to rapid arrhythmias or forceful ventricular contractions. AF is the most common cause of an Nervous (NS) Pathology (Path) 5
irregularly irregular rhythm and is detected on ECG by an absence of organized P waves and varying R-R intervals.
7490 Diabetic ketoacidosis meta acidosis is characterised by a ↓ in serum pH and serum HCO3-. PaCO2 will also ↓ as a result of resp compensation for 1° meta acidosis. Nervous (NS) Pathology (Path) 6
7492 Diabetic ketoacidosis The Tx of choice for DKA is IV normal saline and insulin. These therapies ↑ serum HCO3- and Na+ and ↓ serum Glc, osmolality, and K+. Nervous (NS) Pathology (Path) 6
8859 Atrial myxoma Myxomas are the most common 1° cardiac neoplasm and usually arise w/i the LA. The tumours typically cause position-dependent obstr of the MV, leading to a mid- Nervous (NS) Pathology (Path) 3
diastolic murmur and SSx of ↓ CO (e.g. dyspnoea, syncope). Constitutional SSx (e.g. fever, weight loss) may also be present. Histologically, the tumours demonstrate
scattered cells w/i a mucopolysaccharide stroma and abn blood vessels w/ hemorrhaging.
11462 Visual pathway Lesions of the occipital cortex (e.g. PCA occlusion) can produce contralateral homonymous hemianopia w/ macular sparing. Nervous (NS) Pathology (Path) 5
11568 Accessory nipple Accessory nipples are the most common congenital breast anomaly resulting from failed regression of the mammary ridge in utero. They are usually asymptomatic but can Nervous (NS) Pathology (Path) 1
become tender along with breast tissue during times of hormonal fluctuation.
11574 Benign prostatic 5-α reductase inhibitors (eg, finasteride, dutasteride) block the conversion of testosterone to DHT in the prostate. These Rx ↓ prostate volume in pts w/ BPH and relieve Nervous (NS) Pathology (Path) 6
hyperplasia the fixed component of bladder outlet obstruction.
11576 Opioids When abuse of prescription opioids is suspected, physicians should 1st engage pts in a non-judgemental, collaborative discussion to understand the reasons for the misuse. Nervous (NS) Pathology (Path) 13
11627 Decision making capacity Parents' authority to make medical decisions for their children can be challenged in cases in which a child is at significant risk for harm. Physicians are justified in Nervous (NS) Pathology (Path) 5
obtaining a court injunction to proceed w/ life-saving medical Tx of the child.
11631 Study designs The unit of analysis in ecological studies is populations rather than individuals. Nervous (NS) Pathology (Path) 6
11632 Risk, rate, prevalence, and Incidence corresponds to the number of new cases of a disease in a certain population at risk over a given time period. Prevalence is the total number of cases in the Nervous (NS) Pathology (Path) 3
incidence population over a given period.
11843 Panic disorder PD involves recurrent, unexpected panic atks characterised by an abrupt surge of fear accompanied by physical and cognitive SSx. Individuals experience persistent worry Nervous (NS) Pathology (Path) 4
about future atks and typically restrict their activities as a result.
12011 Osgood-Schlatter disease The quadriceps muscle group is connected to the patella, which is attached to the tibial tubercle by the patellar ligament. Repetitive quadriceps contraction (e.g. jumping) Nervous (NS) Pathology (Path) 1
in adolescents can result in OSD, which is characterised by focal ant. knee pain and swelling due to chronic avulsion of the tibial tubercle.
12175 Anterior abdominal wall Horizontal transection of the rectus abdominis muscle must be performed w/ great caution as the inf. epigastric arteries enter this muscle at the lvl of the arcuate line. The Nervous (NS) Pathology (Path) 1
inf. epigastric arteries below the arcuate line are susceptible to injury (e.g. hematoma) due to lack of a supporting post. rectus sheath.
12252 Small intestinal bacterial Gastric bypass Sx can cause SIBO due to excessive bacterial proliferation in the blind-ended gastroduodenal segment. SIBO results in defic of most vits (B12, A, D, and Nervous (NS) Pathology (Path) 1
overgrowth E) and Fe, but ↑ production of vitB9 and vitK.
QID Topic Educational Objective System Subject Repeats
12283 Immunizations PCVs are strongly immunogenic in infancy due to both B and T cell recruitment. They provide higher, longer-lasting Ab titers relative to PPSVs. The PPSV is poorly Nervous (NS) Pathology (Path) 4
immunogenic in infants due to their relatively immature humoral Ab response.
15638 Personality disorders SPD consists of a persistent pattern of social detachment, preference for solitary activities, and constricted range of affect in social interactions. Nervous (NS) Pathology (Path) 6
15659 Antipsychotics SGAs block 5-HT2A receptors and have lower binding affinity at DA D2 receptor sites, which is a/w a lower risk of EPS. Nervous (NS) Pathology (Path) 9
15667 Delirium Delirium is freq a/w psychotic SSx. It's diffiated from 1° psychotic disorders by fluctuating lvls of consciousness, impaired attn, and disorientation. Delirium can occur Nervous (NS) Pathology (Path) 4
post-op a/o in a/w underlying med illnesses or the intro of certain Rx.
15678 Pleural effusion A pleural effusion is a collection of fluid b/w the visceral pleura that lines the lungs and the parietal pleura that lines the thoracic cavity. The fluid acts to insulate Nervous (NS) Pathology (Path) 4
vibrations and sounds that originate in the airways of the lung; therefore, tactile fremitus and breath sounds are ↓ over a pleural effusion. Dullness to percussion is also
present.
15683 Pleural effusion Transudative pleural effusions result from ↑ intracapillary pressure (e.g. HF) and exudative effusions develop from inflammatory disruption of the vascular membrane. Nervous (NS) Pathology (Path) 4
Transudative pleural effusions have low fluid/serum ratios of total protein and LDH and low absolute lvls of LDH compared to exudative effusions.
15702 Leishmaniasis Leishmania species are obligate intracellular protozoa that mature in macrophages and can be identified on biopsy by the presence of rod-shaped kinetoplasts. They are Nervous (NS) Pathology (Path) 1
transmitted to humans by infected sand flies and cause the clinical syndrome of cutaneous leishmaniasis, characterized by a chronic, pinkish papule that evolves into a
nodule or plaque.
587 Gonococcal infection IgA protease is produced by N. meningitidis, N. gonorrhoeae, S. pneumoniae, and H. influenzae. This enzyme cleaves secretory IgA at its hinge region, rendering it Nervous (NS) Pathophysiology 3
ineffective. Secretory IgA exists on mucosal surfaces and in secretions and acts to bind and inhib the action of pili as well as other cell surface Ags that normally mediate (Patp)
mucosal adherence and subseq penetration.
966 Multiple sclerosis MS is an autoimmune demyelinating disease that results from oligodendrocyte depletion. W/i the lesions, inflammatory infiltrates of lymphocytes and macrophages are Nervous (NS) Pathophysiology 6
seen surrounding oligodendrocytes and myelin sheaths. Oligoclonal bands are highly sensitive but nonspecific in pts w/ MS. (Patp)
969 Diabetes mellitus DM-1 typically presents sub-acutely w/ polyuria and polydipsia accompanied by fatigue and weight loss. The Dx can be confirmed w/ an FBG or HbA1c measurement. Nervous (NS) Pathophysiology 31
(Patp)
1167 Contact dermatitis Acute ACD is caused by an HS-IV (delayed) rxn to an Ag on the skin surface. Gross findings incl erythematous, papulovesicular, weeping lesions. Histo is characterised Nervous (NS) Pathophysiology 2
by spongiosis, an accumulation of oedema fluid in the intercellular spaces of the epidermis. W/ chronic exposure, lesions become less oedematous, w/ thickening of the (Patp)
stratum spinosum and stratum corneum.
1657 Physical exercise The cardioresp response to exercise includes ↑ HR, CO, and RR in order to balance the ↑ total tissue O2 consumption and CO2 production. These coordinated adaptations Nervous (NS) Pathophysiology 2
result in relatively constant ABG values whereas venous O2 is ↓ and venous CO2 is ↑. (Patp)
1854 Pericardial effusion PP refers to an exaggerated drop (>10 mm Hg) in SBP during inspiration. It is most commonly seen in pts w/ CT but can also occur in severe asthma, COPD, Nervous (NS) Pathophysiology 1
hypovolemic shock, and constrictive pericarditis. (Patp)
1920 Henoch-Schonlein purpura HSP gen affects young children and is classically preceded by an URI. This IgA-mediated HS (leucocytoclastic) vasculitis commonly causes abdo pain, joint pain, lower Nervous (NS) Pathophysiology 3
extremity palpable purpura and hematuria. (Patp)
1934 Lead poisoning Coarse erythrocyte basophilic stippling and microcytic hypochromic anemia are common PBS findings in Pb poisoning. High-risk groups include young children Nervous (NS) Pathophysiology 4
ingesting paint chips and industrial workers inhaling particulate Pb. (Patp)
2061 Filtration fraction The FF is the fraction of plasma flowing through the glomeruli that is filtered across the glomerular capillaries into Bowman's space (FF = GFR/RPF). RPF can be Nervous (NS) Pathophysiology 2
determined from RBF by multiplying the RBF by (1 – Hct). (Patp)
2062 Tricuspid regurgitation A holosystolic murmur that ↑ in intensity on inspiration most likely represents TR. The other holosystolic murmurs (which are 2° to MR or a VSD) do not typically ↑ in Nervous (NS) Pathophysiology 3
intensity during inspiration. (Patp)
8352 Renal cell carcinoma RCC causes a variety of PNP syndromes incl erythrocytosis (due to excessive EPO production) and hypercalcaemia (due to PTHrP). Nervous (NS) Pathophysiology 8
(Patp)
11793 Cirrhosis Tx for HE incl lactulose (↑ conversion of NH3 to NH4) and rifaximin (↓ intraluminal NH3 prod). Nervous (NS) Pathophysiology 7
(Patp)
14899 Cavernous sinus thrombosis Infection of the medial face, sinuses (ethmoidal or sphenoidal), or teeth may spread through the valveless facial venous system into the cavernous sinus, resulting in Nervous (NS) Pathophysiology 1
cavernous sinus thrombosis. Pts typically Px w/ h/a, fever, proptosis, and ipsilateral deficits in CNs III, IV, VI, and V (ophthalmic and maxillary branches). (Patp)
15600 Chronic kidney disease CKD can cause hyperPO4-emia due to decr renal excretion of P. Dietary P restriction is recommended, but oral PO4 binders are often needed. Sevelamer is a Nervous (NS) Pathophysiology 8
nonabsorbable anion-exchange resin that binds intestinal PO4 to decr absorption. (Patp)
15612 Skin and soft tissue The most common cause of nonpurulent cellulitis is beta-hemolytic streptococci, particularly group A streptococcus. The most common cause of purulent cellulitis is Nervous (NS) Pathophysiology 8
infections Staphylococcus aureus. (Patp)
15648 Acne vulgaris Acne vulgaris is an inflammatory disorder of pilosebaceous follicles. Contributing factors incl hyperkeratinisation and obstr of follicles; sebaceous gland enlargement w/ ↑ Nervous (NS) Pathophysiology 3
secretion of sebum; colonisation and proliferation in the gland by P. (C.) acnes; and follicular and perifollicular inflammation. (Patp)
146 Nitrates Nitrates (via conversion to NO) activate guanylate cyclase and ↑ intracellular lvls of cGMP. ↑ lvls of cGMP lead to myosin light-chain dephosphorylation, resulting in Nervous (NS) Pharmacology 7
vascular smooth muscle relaxation. (Phar)
173 Primary hypertension α1-blockers such as doxazosin, prazosin, and terazosin are useful for the Tx of both BPH and HTN. Pts w/ CAD and HF along w/ HTN will benefit from cardioselective Nervous (NS) Pharmacology 14
β-blockers. Hydrochlorothiazide is presently the 1st-line Rx for the Tx of essential HTN in the gen pop. (Phar)
249 Aortic regurgitation AR causes a decrescendo diastolic murmur w/ maximal intensity occurring just after closure of the AV, when the pressure gradient b/w the aorta and LV is the highest. Nervous (NS) Pharmacology 8
The pressure tracing for AR is Chx by loss of the aortic dicrotic notch, steep diastolic decline in aortic pressure, and high-peaking systolic pressures. (Phar)
250 Endocarditis Microemboli from the valvular vegetations of BE are the most common cause of subungual splinter hemorrhages. The presence of these lesions necessitates careful Nervous (NS) Pharmacology 15
cardiac auscultation to detect a possible new-onset regurgitant murmur. (Phar)
259 Mitral stenosis Cardiac auscultation in pts w/ MS reveals a loud 1st heart sound, an early diastolic OS after the 2nd heart sound, and a low-pitched diastolic rumble best heard at the Nervous (NS) Pharmacology 7
cardiac apex. The OS is caused by the sudden opening of the MV leaflets when the LV pressure falls below the LA pressure at the beginning of diastole. (Phar)
262 Aortic regurgitation In chronic AR, persistent LV volume overload triggers eccentric hypertrophy, which causes a compensatory ↑ in SV to maintain CO. This compensatory mech allows for Nervous (NS) Pharmacology 8
a relatively long aSSx in most pts; however, LV dysfxn eventually occurs, leading to HF. (Phar)
264 Aortic regurgitation Chronic aortic regurgitation (AR) causes a reduction in diastolic blood pressure and a compensatory increase in left ventricular stroke volume. These changes create a Nervous (NS) Pharmacology 8
high-amplitude, rapid rise-rapid fall pulsation (ie, widened pulse pressure) and the other characteristic findings of AR (eg, head bobbing. "pistol-shot" femoral pulses). (Phar)
265 Rheumatic fever The 1° cause of morbidity in ARF is HF from severe pancarditis. MS develops yrs or decades after the original illness. Joint involvement is usually transient. Nervous (NS) Pharmacology 5
(Phar)
351 Abetalipoproteinemia Abetalipoproteinaemia is an inherited inability to synthesise apoB, an important component of chylomicrons and VLDL. Lipids absorbed by the small intestine can't be Nervous (NS) Pharmacology 1
transported into the blood and accumulate in the intestinal epithelium, resulting in enterocytes w/ clear or foamy cytoplasm. (Phar)
352 Meckel diverticulum Meckel diverticulum is a remnant of the omphalomesenteric (vitelline) duct. It is connected to the ileum and is located 2 ft proximal to the ICV. It often contains acid- Nervous (NS) Pharmacology 3
secreting ectopic gastric tissue, which may cause ulceration of the adjacent mucosa and lower GI bleeding (melena/hematochezia). Meckel diverticulum is a true (Phar)
diverticulum and consists of all parts of the intestinal wall.
353 Meckel diverticulum Meckel diverticulum results from failed obliteration of the vitelline duct and usually Px w/ spontaneous but painless lower GI bleeding. (99m)Tc-pertechnetate localizes Nervous (NS) Pharmacology 3
ectopic gastric mucosa, and its ↑ uptake is Dx for Meckel diverticulum. (Phar)
354 Hirschsprung disease Hirschsprung disease is a result of abnormal migration of neural crest cells during embryogenesis. These cells are the precursors of ganglion cells of intestinal wall plexi. Nervous (NS) Pharmacology 2
Since neural crest cells migrate caudally, the rectum is always affected in Hirschsprung disease. (Phar)
355 Hirschsprung disease Submucosal (Meissner) and myenteric (Auerbach) autonomic plexi are absent in the affected segment of the bowel in HD. The submucosa of the narrowed area is the Nervous (NS) Pharmacology 2
most superficial layer where the absence of ganglion cells can be seen. (Phar)
356 Endometriosis Endometriosis refers to the presence of endometrial glands and stroma outside the uterus. It may be asymptomatic or present with dysmenorrhea, dyspareunia, and/or Nervous (NS) Pharmacology 1
infertility. (Phar)
508 ARDS ARDS is characterised by hypoxia and bilateral pulm infiltrates and is a/w pneumonia, sepsis, trauma, and pancreatitis. The assoc pulm oedema is noncardiogenic in Nervous (NS) Pharmacology 3
nature, so the PCWP will be w/i the normal range (6-12mmHg). (Phar)
509 COPD The flow-volume loop for COPD is Chx by ↑ RV and TLC, as well as a "scooped-out" expiratory pattern due to ↓ expiratory flow rates. Both airway narrowing due to Nervous (NS) Pharmacology 16
chronic bronchitis and ↓ elasticity due to emphysematous destruction of interalveolar walls are responsible for the hyperinflation and airflow limitation. (Phar)
659 Hyperparathyroidism ↑ bone resorption in PHPT leads to osteoporosis 1arily involving the cortical bone of the appendicular skeleton. The cortical thinning appears radiologically as Nervous (NS) Pharmacology 2
subperiosteal erosions. More advanced disease can present as osteitis fibrosa cystica (i.e. granular decalcification of the skull, osteolytic cysts, and brown tumours). (Phar)
660 Huntington disease HD is an AD neurodegen disorder that MFx w/ chorea (e.g. involuntary, jerky, fidgety movements) and behavioural abns (e.g. aggressiveness, depression). Char Nervous (NS) Pharmacology 5
neuroimaging findings incl atrophy of the caudate nuclei which results in enlargement of the frontal horns of the lateral ventricles. (Phar)
703 Vitamin E deficiency VitE is a lipid-soluble vit that has antioxidative properties. Neuro SSx of vitE defic closely mimic FA and incl ataxia (due to degen of spinocerebellar tracts), loss of Nervous (NS) Pharmacology 2
position and vibration sense (due to degen of the dorsal columns), and loss of DTR (due to peri nerve degen). (Phar)
776 Antiphospholipid syndrome GN, a photosensitive skin rash, and arthralgias in a young woman are suggestive of SLE. Up to 30% of pts w/ SLE have antiphospholipid Abs, which can cause Nervous (NS) Pharmacology 1
paradoxical aPTT prolongation and a false (+) RPR/VDRL. Pts w/ antiphospholipid Abs are at risk for venous and arterial TE and unexplained, recurrent preg loss. (Phar)
851 Renal infarction Renal infarction presents w/ flank pain, hematuria, ↑ LDH, and a wedge-shaped kidney lesion on CT scan. The most common cause of renal infarction is systemic TE, Nervous (NS) Pharmacology 2
often due to thrombus formation during AF. The brain and kidneys are more likely than other organs to suffer embolic infarctions b/c they are perfused at a higher rate. (Phar)
853 Benign prostatic Benign prostatic hyperplasia leads to progressive bladder outlet obstruction. Over time, increased urinary pressures can cause hydronephrosis and renal parenchymal Nervous (NS) Pharmacology 6
hyperplasia atrophy with scarring. This can progress to chronic kidney disease. (Phar)
854 Renal calculi Hypercalciuria is the most common RFx for Ca (Ca oxalate and Ca PO4) kidney stones in adults; contributing factors may include ↑ GI absorption, ↑ mobilization of Ca Nervous (NS) Pharmacology 7
from bone, or ↓ renal tubular Ca reabsorption. However, most pts remain normocalcemic due to regulation of plasma Ca levels by vitamin D and PTH. (Phar)
855 Cystinuria Cystinuria results from defective dibasic AA transport in intestinal and PCT epithelial cells. It most often presents w/ recurrent stone formation at a young age due to ↓ Nervous (NS) Pharmacology 2
reabsorption of cysteine from the urine. UA shows pathognomonic hexagonal cystine crystals, and the Na+ cyanide-nitroprusside test can be used to detect excess cystine (Phar)
in the urine.
856 Cystinuria Cystinuria is an autosomal recessive disorder caused by defective transportation of cystine, ornithine, arginine, and lysine across the intestinal and renal tubular Nervous (NS) Pharmacology 2
epithelium. Recurrent nephrolithiasis is the only clinical manifestation. Urinalysis shows pathognomonic hexagonal cystine crystals. (Phar)
QID Topic Educational Objective System Subject Repeats
866 Muscle structure & Transverse tubules (T-tubules) are invaginations of the sarcolemma that transmit depolarization signals to the sarcoplasmic reticulum to trigger the release of calcium and Nervous (NS) Pharmacology 8
physiology induce muscle contraction. The uniform distribution of T-tubules in striated muscle fibers ensures that each myofibril contracts at the same time, which is necessary for (Phar)
efficient contraction.
1197 Treatment adherence Physicians should use a nonjudgmental, pt-centered approach in discussing Tx nonadherence. Acknowledging the difficulty of taking Rx regularly can strengthen the Nervous (NS) Pharmacology 5
therapeutic alliance, potentially improving pt receptiveness to educational efforts. (Phar)
1199 Urinary tract infection Pseudomonas aeruginosa is an oxidase (+), non-lactose-fermenting, Gram (-) organism. It is a common cause of UTIs in pts w/ indwelling bladder catheters. Nervous (NS) Pharmacology 12
(Phar)
1308 Opioids Neonatal abstinence syndrome presents with neurologic, gastrointestinal, and autonomic symptoms. Tremors, irritability, diarrhea, and poor feeding are classic findings. Nervous (NS) Pharmacology 13
Opiate replacement therapy is the treatment of choice; the dose is titrated to the patient's symptoms, and the patient is then slowly weaned. (Phar)
1320 Duchenne dystrophy DMD MFx w/ prox. muscle weakness and atrophy. True hypertrophy of the dist. muscle is noted early in the disease as dist. muscles compensate for weak prox. ones. Nervous (NS) Pharmacology 2
Muscle fibres of the dist. extremities are later replaced by fat and CT (pseudohypertrophy). (Phar)
1321 Lambert-Eaton myasthenic LEMS is characterised by Abs against presynaptic v-gated Ca2+ channels. Pts develop progr proximal muscle weakness w/ ↓/absent reflexes that predominantly involves Nervous (NS) Pharmacology 2
syndrome the lower extremities. The syndrome is often a/w malignancy, particularly SCLC. (Phar)
1322 Myotonic dystrophy MMD is an AD disorder. It is caused by an ↑ number of TNRs on MPK gene. Sustained muscle contraction (myotonia), along w/ weakness and atrophy, is common. Nervous (NS) Pharmacology 1
Cataracts are seen in almost all pts. Frontal balding and gonadal atrophy are other common features. (Phar)
1323 Prevalence and incidence The cumulative incidence of a disease is the number of new cases of a disease over a specific period divided by the total population at risk at the beginning of the study Nervous (NS) Pharmacology 3
(ie, the proportion of at-risk individuals who contract the disease over the specified period). (Phar)
1359 DIC DIC commonly occurs in the setting of sepsis and is characterised by widespread activation of the coag cascade w/ formation of microthrombi. Lab results reveal Nervous (NS) Pharmacology 5
prolonged PT/PTT, thrombocytopaenia, and low fibrinogen (i.e. a consumptive coagulopathy), and pts usually have SSx of bleeding (e.g. oozing from venepuncture sites). (Phar)
1360 P-value and confidence The SD reflects the spread of individual values in a normal distribution (ie, it measures the variability of the observations w/i a single sample). The standard error of the Nervous (NS) Pharmacology 2
interval mean reflects the variability of means (ie, variance b/w the means of different samples) and helps estimate the true mean of the underlying population. (Phar)
1362 Bias The main purpose of blinding is to prevent pt or researcher expectancy from interfering w/ an outcome. Nervous (NS) Pharmacology 4
(Phar)
1368 Neurofibromatosis Bilateral acoustic neuromas are a/w NF-2, an AD condition caused by mut of the NF-2 gene on chrom 22. Nervous (NS) Pharmacology 3
(Phar)
1442 Protein structure Integral membrane proteins contain transmembrane domains composed of α helices w/ hydrophobic AA residues (e.g. alanine, valine, leucine, isoleucine, phenylalanine, Nervous (NS) Pharmacology 1
tryptophan, methionine, proline, glycine). These transmembrane domains help anchor the protein to the phospholipid bilayer of the cell membrane. (Phar)
1564 Acute diarrhea Norovirus is the most common cause of viral GE. Outbreaks (eg, schools, cruise ships, nursing homes) are common, and SSx include vomiting and watery diarrhea. Nervous (NS) Pharmacology 13
(Phar)
1777 Humerus fracture The deep brachial (profunda brachii) artery and radial nerve run together along the post. aspect of thehumerus. Midshaft fractures of the humerus risk injury to these Nervous (NS) Pharmacology 1
structures. (Phar)
1946 Fat embolism FES should be strongly suspected in a pt w/ severe long-bone a/o pelvic fractures who develops acute-onset neuro abns, hypoxaemia, and a petechial rash. Occlusion of Nervous (NS) Pharmacology 2
the pulm microvessels by fat globules is an early histo finding of this syndrome. (Phar)
2000 Shoulder dislocation Flattening of the deltoid muscle w/ acromialprominence after a shoulder injury suggests an ant. humerus dislocation. This injury most commonly results from a blow to an Nervous (NS) Pharmacology 1
ext. rotated and abducted arm. There's often assoc axillary nerve injury, resulting in deltoid paralysis and loss of sensation over the lat. shoulder. (Phar)
8476 Appendicitis Intra-abdo infecs are polymicro, w/ B. fragilis and E.coli being the most prominent organisms isolated. Nervous (NS) Pharmacology 5
(Phar)
8481 GI surgery Fe abs occurs predom in the duodenum and prox jejunum. Bypass of this segment of small bowel by gastrojejunostomy results in IDA that can be corrected w/ Rx Fe Nervous (NS) Pharmacology 1
supp. Malabs of vits B12, B9, fat-sol vits (esp vit D), and Ca may also be obs following gastric bypass procedures. (Phar)
10362 Ubiquitin proteasome Ubiquitin is a protein that undergoes ATP-dependent attachment to other proteins, labeling them for degradation. These modified proteins enter the proteasome and are Nervous (NS) Pharmacology 2
pathway degraded into small peptides. Impairment of the ubiquitin-proteasome system can contribute to the development of neurodegen disorders, including PD and AD. (Phar)
11458 Hearing loss In conductive hearing loss, bone conduction will be greater than air conduction (abnormal Rinne test), and the Weber test will lateralize to the affected ear. In Nervous (NS) Pharmacology 2
sensorineural hearing loss, air conduction will be greater than bone conduction (normal Rinne test), and the Weber test will lateralize to the unaffected ear. (Phar)
11665 Melanocytic nevus Compound naevi are benign proliferations of melanocytes that involve both the dermis and epidermis. The lesions appear as slightly raised papules w/ uniform Nervous (NS) Pharmacology 1
pigmentation and symmetrical sharp borders. (Phar)
11676 Tuberculosis IGRAs test for LTBI by measuring the amount of IFN-γ released by T lymphocytes when exposed to Ags unique to M. tuberculosis. Nervous (NS) Pharmacology 18
(Phar)
11680 Treatment adherence Effective d/c planning requires collaboration of multiple disciplines (physician, nurse, social worker). A social worker can be instrumental in Ax whether the pt has Nervous (NS) Pharmacology 5
adequate family or caregiver support at home. (Phar)
12504 Labor management Gap junctions facilitate communication and coordination b/w cells and play an important role in labor contractions. Connexins are proteins that assemble into gap Nervous (NS) Pharmacology 1
junctions and their density ↑ in the uterus before delivery in response to rising estrogen levels. (Phar)
14850 Transcription Zn-finger motifs are composed of chains of AAs bound together around a Zn atom via linkages w/ cysteine and histidine residues. They recognise specific DNA seqs and Nervous (NS) Pharmacology 7
are used by many TFs to bind DNA and alter activity of target genes. Intracellular receptors that bind steroids, TH, and fat-soluble vits act directly as TFs and contain Zn- (Phar)
finger binding domains.
15684 Cutaneous larva migrans Hookworm infections are transmitted via direct contact between human skin and contaminated soil/sand (eg, walking barefoot). Dermal penetration is often characterized Nervous (NS) Pharmacology 1
by an intensely pruritic papule that may form serpiginous tracks due to the subcutaneous migration of hookworm larvae. (Phar)
15766 Infectious mononucleosis Reactive (atypical) lymphocytes are activated, pathogen-specific cytotoxic T cells or natural killer cells that form in response to certain intracellular infections. In contrast Nervous (NS) Pharmacology 5
to normal lymphocytes, reactive lymphocytes are large, scalloped, and have abundant cytoplasm. Reactive lymphocytosis is a diagnostic feature of infectious (Phar)
mononucleosis.
775 Serum sickness Serum sickness is a type III hypersensitivity reaction to nonhuman proteins characterized by vasculitis resulting from tissue deposition of circulating immune complexes. Nervous (NS) Physiology 1
Clinical findings include fever, pruritic skin rash, arthralgias, and low serum C3 and C4 complement levels. (Phys)
1318 Carpal tunnel syndrome CTS is a peri neuropathy characterised by pain/paraesthesias in a median nerve distribution (palmar surface of the 1st 3 digits and radial half of the 4th digit), weakness on Nervous (NS) Physiology 3
thumb abduction/opposition, thenar atrophy, and a (+) Tinel a/o Phalen test. It's caused by median nerve compression at the transverse carpal ligament. (Phys)
1361 Sensitivity and specificity The sensitivity of a test refers to its ability to correctly identify those w/ the disease. A highly sensitive test should always be considered over a highly specific test when Nervous (NS) Physiology 4
screening for life threatening diseases, where identification of every person w/ the disease is important. (Phys)
1380 Syphilis Syphilis is caused by the spirochete T. pallidum. Confirmation of the Dx req 2 forms of serologic testing to prevent false (+) results. Non-treponemal tests (e.g. RPR, Nervous (NS) Physiology 9
VDRL) evaluate for anticardiolipin Abs (nonspecific); treponemal tests evaluate for Abs targeted against T. pallidum. (Phys)
1493 Depression Postpartum mood disturbances incl postpartum blues, postpartum depression, and, rarely, postpartum psychosis. The most common disturbance, postpartum blues, is a Nervous (NS) Physiology 8
benign self-limited condition that begins several days postpartum and resolves w/i 14days w/o intervention. (Phys)
2007 Hepatitis C IVDU is a major RF for HBV and HCV viral infection. Acute viral hepatitis is marked by panlobular inflammation and hepatocyte necrosis and ballooning. Tc cell- Nervous (NS) Physiology 4
mediated signals also cause hepatocyte apoptosis w/ the formation of intensely eosinophilic Councilman bodies. (Phys)
8573 Macular degeneration Wet age-related macular degeneration is characterized by retinal neovascularization due to increased vascular endothelial growth factor (VEGF) levels. Patients typically Nervous (NS) Physiology 2
have acute vision loss and metamorphopsia with funduscopy showing a grayish-green subretinal membrane and/or subretinal hemorrhage. Treatment includes smoking (Phys)
cessation and VEGF inhibitor therapy (eg, ranibizumab, bevacizumab).
11682 Treatment adherence Pts' misunderstanding of Rx use can result in Rx errors, including potential overdose, toxicity, and withdrawal. Physicians must Ax the pt's understanding and provide Nervous (NS) Physiology 5
targeted education to address misconceptions. (Phys)
11755 Substance-induced Stimulant intoxication can present with paranoid ideation and must be differentiated from primary psychiatric disorders. Physical signs of stimulant intoxication include Nervous (NS) Physiology 1
psychotic disorder mydriasis, tachycardia, hypertension, and diaphoresis. (Phys)
8557 Pulmonary embolism PE causes dead space vent, which leads to hypoxemia due to the conseq V/Q mismatch. Ophthalmology (OP) Anatomy (Anat) 13
11551 Narcolepsy Hypocretin-1 (orexin-A) and hypocretin-2 (orexin-B) are neuropeptides produced in the lateral hypothal that promote wakefulness and inhib REM sleep-related Ophthalmology (OP) Microbiology 3
phenomena. Most pts who have narcolepsy w/ cataplexy have undetectable lvls of hypocretin-1 in their CSF. (Micr)
398 Hepatitis A Transmission of the HAV occurs thru the fecal-oral route and is common in areas w/ overcrowding and poor sanitation. Outbreaks freq result from contam water or food, Ophthalmology (OP) Pathology (Path) 4
and raw or steamed shellfish is a common culprit in the US.
863 Brown adipose tissue BAT is found in newborns and in hibernating mammals. BACs contain several intracytoplasmic fat droplets and many more mitochondria than WACs. They fxn to prod Ophthalmology (OP) Pathology (Path) 1
heat by uncoupling ox phos w/ the protein thermogenin.
11675 Babesiosis Babesiosis should be considered in pts w/ febrile illness who reside in geographic areas where they're exposed to Ixodes ticks. Dx can be established w/ the ID of Ophthalmology (OP) Pathology (Path) 2
intraerythrocytic organisms on peri blood smear.
15668 Schizophrenia 2nd-gen antipsychotics are a/w a lower risk of EPS AEs compared w/ 1st-gen antipsychotics but may cause metabolic AEs. Ophthalmology (OP) Pathology (Path) 4
360 Bladder cancer Urothelial (transitional cell) carcinoma is the most common type of bladder ca. Tumor stage is the most important factor for determining prognosis and is based on the Ophthalmology (OP) Pathophysiology 4
depth of invasion into the bladder wall and the degree of spread to other tissues. Tumor invasion into the muscular layer of the bladder wall carries an unfavorable (Patp)
prognosis.
1356 DIC DIC is a common complication of gram (-) bacterial sepsis due to activation of the coag cascade by bacterial endotoxins, which leads to the formation of microthrombi. Ophthalmology (OP) Pathophysiology 5
peri smear shows fragmented erythrocytes (schistocytes) and thrombocytopaenia. Lab tests show ↓ fibrinogen lvls and prolonged PT and PTT. (Patp)
12257 Gaucher disease Gaucher disease is an AR lysosomal storage disorder that's characterised by β-glucocerebrosidase defic and presents w/ pancytopaenia and HSM. Glucocerebroside Ophthalmology (OP) Pathophysiology 1
accumulation leads to distended macrophages w/ a 'wrinkled tissue paper' appearance, aka Gaucher cells. (Patp)
1363 Hawthorne effect The Hawthorne effect (observer effect) is the tendency of study subjects to change their behavior as a result of their awareness that they are being studied. Ophthalmology (OP) Pharmacology 1
(Phar)
1646 Cor pulmonale Peripheral edema results from the accumulation of fluid in the interstitial spaces. Factors that promote edema include elevated capillary hydrostatic pressure, decreased Ophthalmology (OP) Pharmacology 1
plasma oncotic pressure, sodium and water retention, and impaired lymphatic drainage. In chronic heart failure, increased lymphatic drainage initially offsets factors (Phar)
favoring edema, whereas acute changes (eg, venous thrombosis, heart failure decompensation) are more likely to produce edema.
QID Topic Educational Objective System Subject Repeats
7721 Aortic stenosis A bicuspid AV is a common cause of AS in the United States. The classic auscultatory finding in pts w/ AS is a harsh, crescendo-decrescendo systolic ejection murmur Ophthalmology (OP) Pharmacology 8
heard best in the right 2nd ICS w/ radiation to the carotids. (Phar)
11841 Gout Xanthine oxidase (XO) catalyzes 1 of 2 major azathioprine-inactivating pathways. Allopurinol competitively inhibits XO, which results in increased conversion of Ophthalmology (OP) Pharmacology 11
azathioprine to its active metabolite. (Phar)
1454 Meningitis Ampicillin is the treatment of choice for Listeria, which is not sensitive to cephalosporins. Listeria most commonly causes disease in those with deficient cell-mediated Poisoning & Biochemistry 17
immunity, such as young infants or immunocompromised patients. Environmental (Bioc)
Exposure (PO)
8482 Androgenic steroids Androgens stimulate follicular epidermal hyperproliferation and excessive sebum production, thereby promoting acne development. Anabolic steroid misuse is a known Poisoning & Biochemistry 2
cause of acne, especially in competitive athletes. Environmental (Bioc)
Exposure (PO)
11949 Umbilical hernia Umbilical hernias are caused by a defect in the linea alba and Px as protrusions at the umbilicus that are soft, reducible, and benign. They can occur in isolation or in a/w Poisoning & Pathology (Path) 1
other conditions, such as DS. Environmental
Exposure (PO)
1544 Base excision repair BER is used to correct single-base DNA defects induced spontaneously or by exogenous chemicals. In this process, glycosylases remove the defective base, and the Poisoning & Pathophysiology 1
corresponding empty sugar-P site is cleaved and removed by the action of endonuclease and lyase. DNA pol then replaces the missing nucleotide, and ligase seals the final Environmental (Patp)
remaining nick. Exposure (PO)
172 Chronic heart failure Milrinone is a PDE-3 inhib that ↓ the degradation of cAMP to provide 2 beneficial effects for treating systolic HF. Ca2+ influx into cardiomyocytes is ↑, which ↑ cardiac Poisoning & Pharmacology 12
contractility. In addn, Ca2+-myosin light chain kinase interaction is ↓, which causes vasodilation and ↓ cardiac preload and afterload. Environmental (Phar)
Exposure (PO)
708 Amyotrophic lateral ALS causes both UMN and LMN lesions. Loss of neurons of the anterior horns of the spinal cord (LMN lesion) causes muscle weakness and atrophy. Demyelination of Poisoning & Pharmacology 2
sclerosis the lateral corticospinal tract (UMN lesion) leads to spasticity and hyperreflexia. Environmental (Phar)
Exposure (PO)
841 Neonatal respiratory Dipalmitoyl phosphatidylcholine (lecithin, L) and phosphatidylglycerol are major constituents of surfactant. Fetal lung lecithin production increases sharply after 30 Poisoning & Pharmacology 5
distress syndrome weeks gestation, and phosphatidylglycerol production increases at 36 weeks gestation. The amniotic fluid sphingomyelin (S) level should remain approximately constant Environmental (Phar)
during the third trimester. An L/S ratio > 2.0 indicates adequate surfactant production to avoid neonatal hyaline membrane disease. Exposure (PO)
1254 Antiepileptics Gingival hyperplasia is a common side effect of phenytoin and is sometimes reversible when phenytoin is withdrawn. Phenytoin causes increased expression of platelet- Poisoning & Pharmacology 3
derived growth factor (PDGF). When gingival macrophages are exposed to increased amounts of PDGF, they stimulate proliferation of gingival cells and alveolar bone. Environmental (Phar)
Phenytoin toxicity mainly affects the cerebellum and vestibular system, causing ataxia and nystagmus. Exposure (PO)
1448 Hemoglobin properties 2,3-BPG normally forms ionic bonds w/ the beta subunits of deoxy HbA, facilitating O2 release in the peri tissues. Muts that result in loss of the 2,3-BPG binding pocket's Poisoning & Pharmacology 4
(+) charge cause HbA to resemble HbF, which binds O2 w/ a higher affinity due to its inability to interact w/ 2,3-BPG. Environmental (Phar)
Exposure (PO)
15235 Pulmonary arterial Pulmonary arterial hypertension results from endothelial dysfunction that leads to an increase in vasoconstrictive, proproliferative mediators (eg, endothelin, thromboxane Poisoning & Pharmacology 8
hypertension A2) and a decrease in vasodilative, antiproliferative mediators (eg, nitric oxide, prostacyclin). The relative imbalance in these mediators leads to vasoconstriction and Environmental (Phar)
intimal-wall thickening with a consequent increase in pulmonary vascular resistance. Exposure (PO)
337 Down syndrome DS is the most common chromosomal anomaly. It is a/w low lvls of maternal serum AFP and estriol and ↑ lvls of β-hCG and inhibin A. ↑ AFP lvls are seen in multiple Pregnancy, Childbirth Embryology 6
gestation, open NT defects, and abdominal wall defects. & Puerperium (PR) (Embr)
1772 Rib fracture The left kidney lies immediately deep to the tip of the 12th rib. Pregnancy, Childbirth Embryology 1
& Puerperium (PR) (Embr)
8406 Alzheimer disease Alzheimer dementia typically Px insidiously w/ memory loss (especially of recent events), executive dysfxn, and visuospatial impairment. Classic histopathologic findings Pregnancy, Childbirth Embryology 7
include amyloid plaques (central amyloid β core surrounded by dystrophic neurites) and NFTs (aggregates of hyperphosphorylated τ protein). & Puerperium (PR) (Embr)
312 Peptic ulcer disease The gastroduodenal artery lies along the post. wall of the duodenal bulb and is likely to be eroded by post. duodenal ulcers. Ulceration into the gastroduodenal artery can Pregnancy, Childbirth Genetics (Gene) 10
be a source of life-threatening hemorrhage. & Puerperium (PR)
1688 PAH clearance PAH is freely filtered from the blood in the glom caps to the tubular fluid in BS. It's also secreted from the blood into the tubular fluid by the cells of the PCT by a carrier Pregnancy, Childbirth Genetics (Gene) 1
protein-mediatedprocess. The secretion of PAH can be saturated at high blood concs. & Puerperium (PR)
1825 Cervical cancer Dysplasia is characterized by disruption of organized epithelial cell differentiation with marked cellular pleomorphism. Although high-grade dysplasia (involving most or Pregnancy, Childbirth Genetics (Gene) 3
the entire epithelial layer) often progresses to invasive cancer, low-grade dysplasia (involving a small portion of epithelium) typically spontaneously regresses. Invasive & Puerperium (PR)
cancer occurs when the abnormal cells penetrate the basement membrane.
334 Carcinoid tumors Carcinoid syndrome may accomp extraintestinal mets of GI carcinoid tumors. Octreotide is a synth SS analog used to control the SSx of carcinoid syndrome. Pregnancy, Childbirth Histology (Hist) 4
& Puerperium (PR)
1464 Tetanus Tet is caused by infection w/ toxigenic strains of the anaerobic bacterium C. tetani. Transmission typically occurs when spores are inoculated into the skin via a puncture Pregnancy, Childbirth Microbiology 5
wound. The bacteria germinate, replicate locally, and elaborate tetanospasmin (TT). The tox spreads in a retrograde fashion thru the LMNs to the spinal cord, where it & Puerperium (PR) (Micr)
blocks inhib interneurons and causes spasmodic muscle contraction (e.g. trismus, risus sardonicus).
1575 Antiarrhythmic drugs Sotalol has both β adrenergic-blocking and class III antiarrhythmic (K+ channel-blocking) properties and is occasionally used in Tx of AF. Major AEs of sotalol include Pregnancy, Childbirth Microbiology 12
bradycardia, proarrhythmia, and most commonly TdP due to QT interval prolongation. & Puerperium (PR) (Micr)
1440 Resting membrane potential When a specific ion channel opens, the respective ions will flow across the membrane in a direction that brings the resting membrane potential closer to that ion's Pregnancy, Childbirth Pathology (Path) 5
and action potential equilibrium potential. & Puerperium (PR)
1914 Multiple endocrine MEN-2B is char by MTC, PCC, marfanoid habitus, and oral and intestinal mucosal neuromas. Pregnancy, Childbirth Pathology (Path) 5
neoplasia & Puerperium (PR)
8325 Community acquired The virulence of S. pneumoniae is predominantly due to its PSC, which impedes phagocytosis and complement binding. Pregnancy, Childbirth Pathology (Path) 21
pneumonia & Puerperium (PR)
11891 Radiculopathy The C5-C6 spinal nerves mediate the biceps and brachioradialis reflexes. Pregnancy, Childbirth Pathology (Path) 3
& Puerperium (PR)
68 Gallstone disease Fibrate Rx (e.g. fenofibrate, gemfibrozil) inhib cholesterol 7α-hydroxylase, which catalyzes the RLS in the synthesis of BAs. The ↓ BA production results in ↓ cholesterol Pregnancy, Childbirth Pathophysiology 8
solubility in bile and favors the formation of cholesterol gallstones. & Puerperium (PR) (Patp)
335 SIDS The AEs of 2nd-hand smoke exposure incl an ↑ risk of low birth weight, asthma, middle ear disease, and SIDS. Up to 1/2 of all SIDS cases are due to tobacco exposure, Pregnancy, Childbirth Pathophysiology 1
likely from impaired arousal and abn CV responses to stimuli. & Puerperium (PR) (Patp)
342 Osteonecrosis ON (AVN) occurs due to impaired blood supply to a segment of bone. The femoral head is the most common location. Common causes incl SCD, GC therapy, vasculitis, Pregnancy, Childbirth Pathophysiology 1
and alcoholism. & Puerperium (PR) (Patp)
791 Myasthenia gravis MG is caused by circulating Abs directed against AChR of the NMJ. Auto-Ab binding leads to receptor degradation, producing fluctuating weakness that worsens over Pregnancy, Childbirth Pathophysiology 10
the course of the day and most commonly affects the extraocular muscles (e.g. ptosis, diplopia). Most pts also have thymic abns (e.g. thymoma). & Puerperium (PR) (Patp)
792 Cell mediated immunity Eosinophils play a role in host defense during multicellular parasitic infection. When stimulated by antibodies bound to a parasitic organism, they destroy the parasite via Pregnancy, Childbirth Pathophysiology 5
antibody-dependent cell mediated cytotoxicity with enzymes from their cytoplasmic granules. Another function of eosinophils is regulation of type I hypersensitivity & Puerperium (PR) (Patp)
reactions.
955 Syphilis Tabes dorsalis, a later form of neurosyphilis, causes progr degen of the dorsal columns and dorsal roots of the spinal cord. MFxs incl loss of proprioception and vibratory Pregnancy, Childbirth Pathophysiology 9
sensation, severe lancinating pains, and sensory ataxia (e.g. wide-based gait, (+) Romberg sign). Many pts also have Argyll Robertson pupils. & Puerperium (PR) (Patp)
11919 Chronic pancreatitis The short gastric veins drain blood from the gastric fundus into the splenic vein. Pancreatic inflammation (e.g. pancreatitis, pancreatic ca) can cause a blood clot w/i the Pregnancy, Childbirth Pathophysiology 3
splenic vein, which can ↑ pressure in the short gastric veins and lead to gastric varices only in the fundus. & Puerperium (PR) (Patp)
507 ARDS Pancreatitis is a major RF for ARDS as it results in the release of large amounts of inflammatory cytokines and pancreatic enzymes, which leads to activation of Pregnancy, Childbirth Pharmacology 3
neutrophils in the alveolar tissues. During the initial phase, interstitial and intra-alveolar oedema, inflammation, and fibrin deposition cause the alveoli to become lined w/ & Puerperium (PR) (Phar)
waxy hyaline membranes.
1255 Diabetic foot Piperacillin-tazobactam is a combo of extended-spectrum penicillin w/ β-lactamase inhib. It's effective against most gram (-) enteric rods (incl P. aeruginosa) and against Pregnancy, Childbirth Pharmacology 2
B. fragilis. & Puerperium (PR) (Phar)
1490 Mullerian inhibitory factor The embryonic testis secretes testosterone and MIF. MIF is responsible for regression of the paramesonephric (Mullerian) ducts that normally give rise to the internal Pregnancy, Childbirth Pharmacology 1
genitalia in the female fetus. Testosterone mediates development of male internal genitalia and DHT mediates development of the external genitalia. & Puerperium (PR) (Phar)
1568 HSV infection Herpetic gingivostomatitis is a severe vesicular or ulcerative disease following 1° infection w/ HSV-1. Involvement of the gingiva, tongue, palate, and pharynx along w/ Pregnancy, Childbirth Pharmacology 9
systemic SSx (e.g. fever, malaise) is common. In contrast, reactivation of a latent herpes infection in the CNV ganglia gen results in mild perioral vesicles. & Puerperium (PR) (Phar)
1775 Cranial nerve palsy The oculomotor nerve (CN III), ophthalmic nerve (CN V1) branches, trochlear nerve (CN IV), abducens nerve (CN VI), and superior ophthalmic vein enter the orbit via Pregnancy, Childbirth Pharmacology 9
the superior orbital fissure. & Puerperium (PR) (Phar)
12262 Anxiety The DDx of anxiety incls medical conditions and substance-induced aetiologies (e.g. intox, withdrawal). 1° anxiety disorders aren't Dx when anxiety is caused by the phys Pregnancy, Childbirth Pharmacology 1
effects of a medical condition (e.g. hyperthyroidism) or drug. & Puerperium (PR) (Phar)
1987 Diabetic nephropathy Moderately ↑ albuminuria (urine albumin 30-300mg/day) is the earliest MFx of diabetic nephropathy (DN). Screening for DN is best achieved using an albumin-specific Pregnancy, Childbirth Physiology 4
urine assay (regular dipstick UA has low sensitivity). & Puerperium (PR) (Phys)
8330 High altitude illness At high altitude, the low PiO2 leads to hypoxemia w/ consequent hyperventilation and respiratory alkalosis. The hypoxemia and alkalemia can cause SSx of altitude Pregnancy, Childbirth Physiology 3
sickness (eg, h/a, fatigue, lightheadedness). The kidneys respond by creating a compensatory metabolic acidosis and by ↑ EPO secretion. & Puerperium (PR) (Phys)
513 Alpha1 antitrypsin AAT is the major serum inhib of neutrophil elastase. AATD typically causes early-onset panacinar emphysema, predominantly affecting the lower lung lobes. Psychiatric, Anatomy (Anat) 8
deficiency Behavioural &
Substance Abuse (PS)
248 SIADH SIADH is characterised by low plasma Na+ and osmolality, inappropriately concentrated urine, and clinically normal volume status (euvolaemic hyponatraemia). An Psychiatric, Behavioral 3
important cause of SIADH is a PNP effect 2° to SCLC. Behavioural & Science (Beha)
Substance Abuse (PS)
511 Alpha1 antitrypsin The major serum inhibitor of extracellular elastase is AAT; pts w/ AATD typically develop early-onset panacinar emphysema due to unchecked elastase activity. Psychiatric, Behavioral 8
deficiency Exposure to tobacco smoke dramatically accelerates the development of emphysema in pts w/ AATD and should be avoided. Behavioural & Science (Beha)
Substance Abuse (PS)
QID Topic Educational Objective System Subject Repeats
518 Neuronal physiology The changes in the body of a neuron after the axon has been severed are called axonal rxn. This process reflects an ↑ protein synthesis that facilitates axon repair. Psychiatric, Behavioral 3
Enlarged, rounded cells w/ perily located nuclei and dispersed finely granular Nissl substance are seen. Behavioural & Science (Beha)
Substance Abuse (PS)
573 Hyperaldosteronism PH is caused by excessive aldosterone secretion, typically as a result of bilateral nodular hyperplasia of the ZG or an aldosterone-producing adrenal adenoma. Clinical Psychiatric, Behavioral 5
findings incl HTN, low PRA, hypokalaemia, and meta alkalosis. Behavioural & Science (Beha)
Substance Abuse (PS)
576 Neonatal respiratory Both maternal and fetal cortisol help to accelerate fetal lung maturation by stimulating surfactant production. Betamethasone or dexamethasone is administered to Psychiatric, Behavioral 5
distress syndrome pregnant women at risk of premature delivery to prevent neonatal respiratory distress syndrome. Behavioural & Science (Beha)
Substance Abuse (PS)
707 Amyotrophic lateral UMN dmg leads to spastic paralysis, hyperreflexia, and an upgoing plantar reflex (Babinski sign) due to loss of descending inhib over LMNs in the anterior horn. Psychiatric, Behavioral 2
sclerosis Conversely, LMN lesions cause flaccid paralysis, hypotonia, hyporeflexia, muscle atrophy, and fasciculations. Behavioural & Science (Beha)
Substance Abuse (PS)
870 Achalasia Achalasia is caused by ↓ # of inhib ganglion cells in the oesophageal wall. Oesophageal manometry in achalasia shows ↓ amplitude of peristalsis in the mid oesophagus, Psychiatric, Behavioral 3
w/ ↑ tone and incomplete relaxation at the LOS. Behavioural & Science (Beha)
Substance Abuse (PS)
970 Gestational diabetes Maternal hyperglycaemia causes ↑ transplacental Glc delivery to the infant, foetal hyperglycaemia, and, ultimately, β cell hyperplasia. The resulting hyperinsulinaemia Psychiatric, Behavioral 2
caused by islet cell hyperplasia is a/w foetal macrosomia and hypoglycaemia after delivery. Behavioural & Science (Beha)
Substance Abuse (PS)
1046 PDH and ketogenic amino PDH complex defic is an inherited inborn error of meta causing lactic acidosis and neuro defects. Pts are unable to convert pyruvate to acetyl-CoA, resulting in a shunting Psychiatric, Behavioral 1
acids of pyruvate to lactic acid. In these pts, meta of exclusively ketogenic AAs (e.g. lysine, leucine) can provide energy in the form of acetyl-CoA w/o ↑ lactate production. Behavioural & Science (Beha)
Substance Abuse (PS)
1165 Urticaria Urticaria is a transient HS disorder characterised by pruritic erythematous plaques that arise suddenly and resolve over hrs. They're most often caused by IgE-mediated Psychiatric, Behavioral 2
degranulation of mast cells, leading to ↑ permeability of the microvasculature w/ oedema of the superficial dermis. Behavioural & Science (Beha)
Substance Abuse (PS)
1182 Selective IgA deficiency Selective IgA deficiency is the most common primary immune deficiency and can present with recurrent sinopulmonary and gastrointestinal infections as well as Psychiatric, Behavioral 1
autoimmune disease. Patients with severe IgA deficiency can have anaphylaxis during transfusion of blood products that contain small amounts of IgA. Behavioural & Science (Beha)
Substance Abuse (PS)
1234 Professional conduct Physicians are ethically obligated to inform pts of medical errors, regardless of whether harm has occurred. Disclosure should be timely and accompanied by an Psychiatric, Behavioral 3
explanation of what happened and an apology. Behavioural & Science (Beha)
Substance Abuse (PS)
1287 Number needed to treat The NNH represents the number of people who must be Tx before 1 additional adverse event occurs. In order to calculate NNH, the absolute risk ↑ b/w the Tx and control Psychiatric, Behavioral 2
groups must be known: NNH = 1 / Absolute risk ↑. Behavioural & Science (Beha)
Substance Abuse (PS)
1288 Sensitivity, specificity, PPV represents the probability of truly having a disease given a (+) test result. It ↑ w/ ↑ disease prevalence and ↓ w/ ↓ disease prevalence. Psychiatric, Behavioral 4
positive predictive value Behavioural & Science (Beha)
PPV, negative predictive Substance Abuse (PS)
value NPV
1289 Predictive values Negative predictive value (NPV) represents the probability of not having a disease given a negative test result. NPV is inversely proportional to the prevalence of a Psychiatric, Behavioral 3
disease. When a patient has characteristics similar to the overall population (eg, age, sex, risk factor status), the disease prevalence is a valid estimate of the pretest Behavioural & Science (Beha)
probability of disease. Substance Abuse (PS)
1346 Lung cancer B/w 1950 and 2000, rising rates of tobacco use resulted in an ↑ in female lung ca incidence and mortality. Lung ca is currently the most common cause of ca death in both Psychiatric, Behavioral 9
women and men in the US. Behavioural & Science (Beha)
Substance Abuse (PS)
1347 Opioids Methadone is a potent, long-acting opioid agonist used in the maintenance Tx of opioid use disorder. Its prolonged effects suppress withdrawal SSx and cravings. Psychiatric, Behavioral 13
Behavioural & Science (Beha)
Substance Abuse (PS)
1348 Phencyclidine PCP is a hallucinogen that causes dissociative SSx, agitation, hallucinations, and violent behaviour. Ataxia, nystagmus, and memory loss are other distinguishing SSx of Psychiatric, Behavioral 2
PCP abuse. Behavioural & Science (Beha)
Substance Abuse (PS)
1350 Cannabis Marijuana contains tetrahydrocannabinol, which stims cannabinoid receptors to produce a mild euphoria w/ inappropriate laughter, ↑ appetite, slowed rxn time/motor Psychiatric, Behavioral 1
speed, and cognitive impairment. Tachycardia and conjunctival injection are the 2 most immediate physical SSx of marijuana use. Behavioural & Science (Beha)
Substance Abuse (PS)
1351 Irritable bowel syndrome Diphenoxylate is an opioid antidiarrheal drug that binds μ opiate receptors in the gut to slow motility. Overuse can lead to euphoria and physical dependence. To Psychiatric, Behavioral 1
discourage abuse, diphenoxylate is combo w/ atropine, which induces AEs if taken in high doses. Behavioural & Science (Beha)
Substance Abuse (PS)
1352 Cirrhosis Vit K-dependent CFs (II, VII, IX, and X) are synth in the liver. FVII has the shortest 1/2-life of the CFs. Failure of the PT to correct w/ vit K supp indicates FVII defic, Psychiatric, Behavioral 7
which is often due to underlying liver disease. Behavioural & Science (Beha)
Substance Abuse (PS)
1353 Atrial fibrillation Pts started on warfarin develop a transient hypercoag state due to the short 1/2-life of protein C. This hypercoag is further exaggerated by pre-existing protein C defic and Psychiatric, Behavioral 5
can result in thrombotic occlusion of the microvasc w/ skin necrosis. Behavioural & Science (Beha)
Substance Abuse (PS)
1429 Autonomic nervous system Inhib of uterine contractions (tocolysis) is a result of β2 adrenergic receptor stim. α1 receptor stim causes contraction of the ocular pupillary dilator muscle, resulting in Psychiatric, Behavioral 3
mydriasis (pupillary dilation). Behavioural & Science (Beha)
Substance Abuse (PS)
1430 TCA cycle Alanine is the major AA responsible for transferring N to the liver for disposal. During the catabolism of proteins, amino groups are transferred to α-KG to form Psychiatric, Behavioral 2
glutamate. Glutamate is then processed in the liver to form urea, the 1° disposal form of N in humans. Free NH3 is also excreted into the urine by the kidney for regulation Behavioural & Science (Beha)
of acid-base status. Substance Abuse (PS)
1431 Urea cycle Pts w/ urea cycle disorders typically have discrete episodes of vomiting, tachypnoea, and confusion/coma 2° to hyperammonaemia (a meta emergency). OTC defic is the Psychiatric, Behavioral 3
most common disorder of the urea cycle and is characterised by hyperammonaemia and ↑ urinary orotic acid. Behavioural & Science (Beha)
Substance Abuse (PS)
1433 Upper respiratory tract For a purified RNA molecule to induce viral protein synthesis in a host cell, it must be able to act directly as mRNA using the host's intracellular machinery for Psychiatric, Behavioral 2
infections translation. Therefore, in general, purified (+) sense ssRNA can be infectious; (-) sense ssRNA or dsRNA is not. Behavioural & Science (Beha)
Substance Abuse (PS)
1458 Clostridium difficile Abx disrupt the normal intestinal flora and which can allow for overgrowth of Clostridium difficile, an anaerobic, Gram (+), spore-forming bacillus. C difficile produces 2 Psychiatric, Behavioral 7
infection toxins that penetrate colonic epithelial cells leading to watery diarrhea, abdominal cramping, and colitis. The presence of a pseudomembrane (exudate on colonic mucosa Behavioural & Science (Beha)
consisting of fibrin and inflammatory cells) is highly suggestive of C difficile infection. Substance Abuse (PS)
1459 Clostridium difficile C. difficile toxs A and B exert their effects by disrupting the actin CSK structure and intracellular signaling. Although the toxs have overlapping effects, tox A causes Psychiatric, Behavioral 7
infection relatively more intestinal inflam and fluid secretion, and tox B is more cytotox. Behavioural & Science (Beha)
Substance Abuse (PS)
1729 Thyroid cancer MTC is a NET that arises from calcitonin-secreting C (parafollicular) cells. It's often seen in the context of MEN-2 (A and B), although the majority of cases are sporadic. Psychiatric, Behavioral 6
Both sporadic and familial MTCs are a/w muts in the RETproto-oncogene. Behavioural & Science (Beha)
Substance Abuse (PS)
1781 Dose response curves Efficacy is a measure of the maximum pharmacodynamic effect achievable with a drug. Potency refers to the dose of drug that is required to produce a given effect. Drugs Psychiatric, Behavioral 4
that bind their receptors with a higher affinity or are better able to gain access to their target tissues will have greater potency (lower ED50). Behavioural & Science (Beha)
Substance Abuse (PS)
1843 Diabetes mellitus Cleavage of proinsulin in pancreatic β-cell secretory granules yields insulin and C-peptide, which are stored in the granules until they’re secreted in equimolar amounts. Psychiatric, Behavioral 31
Behavioural & Science (Beha)
Substance Abuse (PS)
2045 CABG The great saphenous vein is a superficial vein of the leg that originates on the medial side of the foot, courses anterior to the medial malleolus, and then travels up the Psychiatric, Behavioral 1
medial aspect of the leg and thigh. It drains into the femoral vein w/i the region of the femoral triangle, a few cm inferolateral to the pubic tubercle. Behavioural & Science (Beha)
Substance Abuse (PS)
2046 Knee trauma The PCL prevents posterior displacement of the tibia relative to the femur. It originates from the anterolateral surface of the medial femoral condyle and inserts into the Psychiatric, Behavioral 4
posterior intercondylar area of the tibia. Its integrity can be tested in the clinical setting by using the posterior drawer test. Behavioural & Science (Beha)
Substance Abuse (PS)
2047 Knee trauma The PCL prevents post. displacement of the tibia relative to the femur when the knee is flexed. It attaches to the post. part of the intercondylar area of the tibia and the ant. Psychiatric, Behavioral 4
part of the lat. surface of the med. epicondyle of the femur. Behavioural & Science (Beha)
Substance Abuse (PS)
2048 Pleiotropy Pleiotropy describes instances where multiple phenotypic manifestations result from a single genetic mutation. Most syndromic genetic illnesses exhibit pleiotropy. Psychiatric, Behavioral 1
Behavioural & Science (Beha)
Substance Abuse (PS)
2049 Pancreatic secretion Duodenal S-cells secr secretin in response to ↑ H concs. Secretin ↑ pancr HCO3 secr. The Cl content of pancr secrs ↓ in proportion to HCO3 conc ↑. Psychiatric, Behavioral 1
Behavioural & Science (Beha)
Substance Abuse (PS)
2050 Antiarrhythmic drugs Class IV antiarrhythmics (eg, verapamil, diltiazem) are commonly used to prevent recurrent nodal arrhythmias (eg, PSVT). They work by blocking Ca channels in slow- Psychiatric, Behavioral 12
response cardiac tissues, slowing phase 4 (spontaneous depolarization) and phase 0 (upstroke). This ↓ impulse conduction velocity in the SA and AV nodes. Behavioural & Science (Beha)
Substance Abuse (PS)
QID Topic Educational Objective System Subject Repeats
2051 Cardiac AP The cardiac myocyte AP consists of rapid depolarization (phase 0), initial rapid repolarization (phase 1), plateau (phase 2), late rapid repolarization (phase 3), and resting Psychiatric, Behavioral 1
potential (phase 4). The AP is a/w ↑ membrane permeability to Na and Ca and ↓ permeability to K. Behavioural & Science (Beha)
Substance Abuse (PS)
2053 Cardiac physiology The phase 4 slow depolarization in cardiac PM cells occurs due to the closure of repolarizing K channels, the slow influx of Na through funny channels, and the opening Psychiatric, Behavioral 6
of T-type Ca channels. ACh and adenosine ↓ the rate of spontaneous depolarization in cardiac PM cells by prolonging phase 4. Behavioural & Science (Beha)
Substance Abuse (PS)
2063 Hypoglycemia Severe hypoglycaemia w/ LOC is typically Tx w/ IM glucagon in the non-med setting and w/ IV dextrose in the med setting. Psychiatric, Behavioral 6
Behavioural & Science (Beha)
Substance Abuse (PS)
2122 Protein synthesis The nucleolus is the site of ribosomal subunit maturation and assembly. RNA polymerase I functions exclusively within the nucleolus to transcribe the 45S pre-rRNA Psychiatric, Behavioral 2
gene, which codes for most of the ribosomal RNA components (18S, 5.8S, and 28S rRNAs). Behavioural & Science (Beha)
Substance Abuse (PS)
2123 Sickle cell Sickle cell anemia is an autosomal recessive hemoglobinopathy. In order for a child to have sickle cell disease, both parents must be carriers. Hemoglobin electrophoresis Psychiatric, Behavioral 13
can be used to determine the carrier status of a prospective parent who has no history of sickle cell anemia. Behavioural & Science (Beha)
Substance Abuse (PS)
7752 Chronic heart failure S3 is a low-freq sound occurring immediately after S2 that's commonly a/w ↑ ventricular ESV. S3 freq occurs in the setting of MR and systolic HF (e.g. DCM). Psychiatric, Behavioral 12
Behavioural & Science (Beha)
Substance Abuse (PS)
8295 Clostridium difficile Clostridium difficile infection is associated with white, patchy pseudomembranes on the bowel mucosa. These pseudomembranes consist of a neutrophil-predominant Psychiatric, Behavioral 7
infection inflammatory infiltrate, fibrin, bacteria, and necrotic epithelium. Patients may develop a nonobstructive colonic dilation known as toxic megacolon, which can lead to Behavioural & Science (Beha)
colonic perforation. Substance Abuse (PS)
8878 Rabies Rabies virus has a bullet-shaped envelope w/ knob-like GP that bind to nAChRs. Once transmission occurs (usually due to a bite wound from an infected animal), the Psychiatric, Behavioral 2
virus replicates locally in muscle tissue for several dys or wks before spreading in a retrograde fashion thru the peri nerve axons to the CNS. Behavioural & Science (Beha)
Substance Abuse (PS)
8893 Serotonin syndrome SS is characterised by a triad of autonomic instability, AMS, and NM irritability. It may develop when a MAOI antidep or a non-antidep w/ MAOI activity (e.g. linezolid) Psychiatric, Behavioral 2
is combo w/ a 5-HT-ergic Rx such as a SSRI, SNRI, or TCA. Behavioural & Science (Beha)
Substance Abuse (PS)
8943 Gestational diabetes hPL ↑ maternal IR during the 2nd and 3rd trimesters, leading to a rise in serum Glc that helps provide adequate nutrition to the growing fetus. Gestational diabetes occurs Psychiatric, Behavioral 2
when the compensatory rise in maternal insulin secretion is inadequate to prevent serum Glc lvls from reaching excessively high lvls. Behavioural & Science (Beha)
Substance Abuse (PS)
8954 Echocardiography The LA forms the majority of the posterior surface of the heart and resides adjacent to the esophagus. Enlargement of the LA can compress the esophagus and cause Psychiatric, Behavioral 2
dysphagia. Behavioural & Science (Beha)
Substance Abuse (PS)
9814 Echocardiography The descending thoracic aorta lies posterior to the esophagus and the LA. This position permits clear visualization of the descending aorta by TEE, allowing for the Psychiatric, Behavioral 2
detection of abnormalities such as dissection or aneurysm. Behavioural & Science (Beha)
Substance Abuse (PS)
10398 Imperforate hymen Imperforate hymen is caused by incomplete degeneration of the central portion of the fibrous tissue band connecting the walls of the vagina. Adolescent patients typically Psychiatric, Behavioral 1
present with primary amenorrhea, normal secondary sexual characteristics, and cyclic abdominal or pelvic pain due to accumulation of menstrual blood in the vagina and Behavioural & Science (Beha)
uterus (eg, hematocolpos). Substance Abuse (PS)
10449 Obesity Leptin is a protein hormone produced by adipocytes in proportion to the quantity of fat stored. Leptin acts on the arcuate nucleus of the hypothalamus to inhib production Psychiatric, Behavioral 2
of NPY (↓ appetite) and stim production of α-MSH (↑ satiety). Muts in the leptin gene or receptor result in hyperphagia and profound obesity. Behavioural & Science (Beha)
Substance Abuse (PS)
10452 Health insurance Capitation is an arrangement in which a payor pays a fixed, predetermined fee to provide all the services required by a patient. Payors may negotiate a capitated contract Psychiatric, Behavioral 3
with an insurance company that then pays the providers, or a large medical group may negotiate directly with the payor. Behavioural & Science (Beha)
Substance Abuse (PS)
10458 Elder abuse & neglect Clinicians have a legal and ethical obligation to report elder abuse, neglect, and exploitation. If there is reason to suspect possible mistreatment, the patient should be Psychiatric, Behavioral 1
interviewed alone to avoid intimidation by potential perpetrators. Behavioural & Science (Beha)
Substance Abuse (PS)
10465 Migraine Migraine h/a are unilateral, have a pulsating or throbbing quality, and are a/w photophobia, phonophobia, and nausea. Triptans are 5-HT1B/5-HT1D agonists used as Psychiatric, Behavioral 3
abortive therapy during an acute migraine. β blockers, antidepressants (e.g. amitriptyline and venlafaxine), and anticonvulsants (e.g. valproate and topiramate) are Behavioural & Science (Beha)
commonly used for migraine prophylaxis. Substance Abuse (PS)
10581 Schistosomiasis Humans acquire schistosomiasis via contact w/ freshwater sources that contain snails infected w/ Schistosoma larvae. S japonicum and S mansoni cause intestinal and Psychiatric, Behavioral 2
hepatic schistosomiasis, and S haematobium causes urinary schistosomiasis. Behavioural & Science (Beha)
Substance Abuse (PS)
11586 Community acquired Klebsiella is an encapsulated, lactose-fermenting, gram (-) bacillus that appears mucoid in culture. It causes pneumonia in individuals w/ impaired host defences, esp. pts Psychiatric, Behavioral 21
pneumonia w/ alcoholism. Klebsiella pneumonia is characterised by tissue necrosis and early abscess formation w/ production of thick, mucoid, blood-tinged sputum (currant jelly Behavioural & Science (Beha)
sputum). Substance Abuse (PS)
11587 Beneficence The EMTALA was enacted by Congress to prevent hospitals from inappropriately transferring, discharging, or refusing to Tx indigent pts. All pts who Px to the ED must Psychiatric, Behavioral 1
receive an appropriate screening medical Ex and stabilization of their condition, regardless of ability to pay. Behavioural & Science (Beha)
Substance Abuse (PS)
11592 End of life care Pts w/ advanced metastatic ca or other terminal illnesses and a life expectancy of <6 months should be evaluated for hospice care. Psychiatric, Behavioral 2
Behavioural & Science (Beha)
Substance Abuse (PS)
11593 Restless leg syndrome RLS is characterised by an uncomfortable sensation in the legs accompanied by an urge to move them. It's worse at rest and when falling asleep. DA agonists are the Psychiatric, Behavioral 1
preferred Rx for Tx. Behavioural & Science (Beha)
Substance Abuse (PS)
11594 Treatment adherence IDing and Mx non-adherence is critical to improving outcomes for many chronic conditions, incl HTN. Creating an alliance by validating the pt's perspective and using an Psychiatric, Behavioral 5
open-ended, non-judgemental question is the most effective way to initiate a discussion. Behavioural & Science (Beha)
Substance Abuse (PS)
11603 Physician patient When confronting an angry patient, the physician should use a non-defensive, empathic approach that acknowledges the patient's anger and attempts to build a Psychiatric, Behavioral 11
communication collaborative physician-patient relationship. Behavioural & Science (Beha)
Substance Abuse (PS)
11605 Physician patient Empiric Abx therapy for pts w/ uncomplicated URIs is c/i. Pts requesting Abx prescriptions should be educated in a non-judgemental manner about the lack of efficacy Psychiatric, Behavioral 11
communication and AEs of Abx therapy. Behavioural & Science (Beha)
Substance Abuse (PS)
11606 Abortion Physicians are not required to provide medical services that are against their personal beliefs. In such cases, the physician should provide referral to providers who will Psychiatric, Behavioral 3
perform the requested procedure. Behavioural & Science (Beha)
Substance Abuse (PS)
11607 Ethical principles in Romantic and sexual relationships w/ current pts as well as former psych pts are always unethical. Relationships w/ former non-psych pts may be acceptable provided the Psychiatric, Behavioral 3
healthcare physician-pt relationship is terminated well beforehand. Behavioural & Science (Beha)
Substance Abuse (PS)
11617 Terminal illness Pts faced w/ terminal illness may experience stages of grief, including denial, anger, bargaining, depression, and acceptance. Denial that does not impair relationships or Psychiatric, Behavioral 1
interfere w/ pt care should not be confronted. Behavioural & Science (Beha)
Substance Abuse (PS)
11618 Informed consent Physicians must ensure the appropriate use of medical interpreters to promote adequate pt understanding and participation in the decision-making process. This is Psychiatric, Behavioral 3
particularly important during the informed consent process. Behavioural & Science (Beha)
Substance Abuse (PS)
11619 Medical errors Physicians should disclose Rx errors and provide an apology in a timely fashion regardless of whether harm has occurred. Psychiatric, Behavioral 8
Behavioural & Science (Beha)
Substance Abuse (PS)
11622 Medical errors Root cause analysis is a quality improvement measure that identifies what, how, and why a preventable adverse outcome occurred. The first step involves collecting data Psychiatric, Behavioral 8
mainly through interviewing multiple individuals involved in the steps leading to the outcome. Behavioural & Science (Beha)
Substance Abuse (PS)
11629 Decision making capacity In the absence of an AD and designated health care proxy, a family member of an incapacitated pt should be contacted to act as a surrogate decision maker, followed by a Psychiatric, Behavioral 5
person who cares about and knows the pt's wishes. In an emergency, the physician can Tx an incapacitated pt w/o obtaining consent. Behavioural & Science (Beha)
Substance Abuse (PS)
11732 HIV HIV-assoc dementia should be suspected in pts w/ AIDS who have progr cognitive decline. The char histopath finding is microglial nodules (groups of activated Psychiatric, Behavioral 11
microglia/macrophages around small areas of necrosis) and multinucleated giant cells. Behavioural & Science (Beha)
Substance Abuse (PS)
11737 Traumatic brain injury Damage to the brainstem at/below the level of the red nucleus (eg, midbrain tegmentum, pons) typically results in decerebrate (extensor) posturing. In contrast, damage to Psychiatric, Behavioral 5
neural structures above the red nucleus (eg, cerebral hemispheres, IC) typically results in decorticate (flexor) posturing. Behavioural & Science (Beha)
Substance Abuse (PS)
11743 Bipolar disorder Patients who experience major depressive and hypomanic episodes are diagnosed with bipolar II disorder. In contrast to manic episodes, hypomanic episodes are less Psychiatric, Behavioral 7
severe, do not involve psychosis, and cause a lesser degree of functional impairment. Behavioural & Science (Beha)
Substance Abuse (PS)
QID Topic Educational Objective System Subject Repeats
11746 Oppositional defiant ODD is a behavioural disorder of childhood characterised by argumentative and defiant behaviour toward authority figures. It doesn't involve the more severe violations Psychiatric, Behavioral 1
disorder of the basic rights of others seen in CD. Behavioural & Science (Beha)
Substance Abuse (PS)
11751 Acute parotitis Acute bacterial parotitis occurs more commonly in elderly postoperative patients who are intubated or dehydrated. Staphylococcus aureus is the most common bacterial Psychiatric, Behavioral 1
etiology. Diagnosis can be confirmed by imaging and an elevated serum amylase level (with a normal serum lipase level and no evidence of pancreatitis). Behavioural & Science (Beha)
Substance Abuse (PS)
11756 Personality disorders STPD is characterised by a long-standing pattern of eccentric behaviour, odd beliefs, perceptual distortions, and social anxiety despite familiarity. Psychiatric, Behavioral 6
Behavioural & Science (Beha)
Substance Abuse (PS)
11758 Thrombotic 1° TMA syndromes share common clinical and path features and result in platelet activation and diffuse microthrombosis in arterioles and caps. TMA syndromes present Psychiatric, Behavioral 3
thrombocytopenic purpura w/ hemolytic anaemia w/ schistocytes, thrombocytopaenia, and organ injury (e.g. brain, kidneys, heart). Behavioural & Science (Beha)
Substance Abuse (PS)
11759 Vestibular schwannoma Acoustic neuromas are Schwann cell-derived tumours that typically arise from the vestibular portion of CNVIII and are commonly located at the CPA (b/w the cerebellum Psychiatric, Behavioral 3
and lateral pons). Pts usually present w/ unilateral sensorineural hearing loss and tinnitus. Behavioural & Science (Beha)
Substance Abuse (PS)
11773 Multiple sclerosis The pathogenesis of MS involves an AI response (T cell and Ab mediated) targeting oligodendrocytes and myelin in the CNS, leading to slowed nerve conduction w/ Psychiatric, Behavioral 6
neuro deficits. Behavioural & Science (Beha)
Substance Abuse (PS)
11784 Ovarian cancer Teratomas are the most common subtype of germ cell tumor. Ovarian teratomas occur most frequently in females age 10-30. They are divided into mature (cell lines of >1 Psychiatric, Behavioral 9
germ layer, commonly including hair, teeth, and skin) and immature types. Behavioural & Science (Beha)
Substance Abuse (PS)
11785 Hip fracture MAS is char by the triad of fibrous dysplasia of the bone, endocrine abns, and café-au-lait spots. The condition results from an activating mut in the G Psychiatric, Behavioral 2
protein/cAMP/adenylate cyclase signalling pathway. Behavioural & Science (Beha)
Substance Abuse (PS)
11787 Testicular torsion Testicular torsion is due to twisting of the testis around the spermatic cord (containing the gonadal artery), which can eventually lead to ischemia. The gonadal arteries Psychiatric, Behavioral 1
arise from the abdominal aorta. The right gonadal vein drains directly into the inferior vena cava while the left gonadal vein drains into the left renal vein. Behavioural & Science (Beha)
Substance Abuse (PS)
11789 Knee trauma Patella fractures are most commonly due to a direct impact to the anterior aspect of the knee. Signs include an acutely swollen knee, focal patella tenderness, inability to Psychiatric, Behavioral 4
extend the knee against gravity, and a palpable gap in the extensor mechanism. Behavioural & Science (Beha)
Substance Abuse (PS)
11792 Hypocalcemia Postop hypocalcemia is common after thyroid Sx, due to inadvertent removal or dmg to the PT glands. The acute drop in PTH lvl results in ↓ Ca and PO4 resorption from Psychiatric, Behavioral 1
bone and ↓ Ca reabs by the kidneys. Behavioural & Science (Beha)
Substance Abuse (PS)
11796 Temporomandibular Temporomandibular disorder is a/w dysfxn of the TMJ and hypersensitivity of the mandibular nerve (CN V3). This can result in pathologic contraction of the pterygoid Psychiatric, Behavioral 1
disorders muscles (eg, jaw pain/dysfxn) and the tensor tympani in the middle ear (eg, ear pain, muffled hearing). Behavioural & Science (Beha)
Substance Abuse (PS)
11807 Brachial plexus The latissimus dorsi is a large thoracolumbar muscle that originates from the iliac crest and lumbar fascia to the spinous processes of T7-12 and lower ribs, and inserts at Psychiatric, Behavioral 6
the bicipital groove of thehumerus. It's innervated by the TDN. 1° fxns incl extension, adduction, and med. rotation of the humerus. Behavioural & Science (Beha)
Substance Abuse (PS)
11809 Capsaicin Topical capsaicin causes defxnalisation of afferent pain fibres and depletion of substance P. Initial application results in a burning and stinging sensation, but chronic Psychiatric, Behavioral 1
exposure leads to ↓ pain transmission. Behavioural & Science (Beha)
Substance Abuse (PS)
11810 Axillary nerve injury Injury to the axillary nerve most commonly occurs in the setting of shoulder trauma (e.g. anterior dislocation, humeral fracture) and presents w/ sensory loss over the Psychiatric, Behavioral 1
lateral shoulder and weakness on shoulder abduction (due to denervation of the deltoid muscle). Behavioural & Science (Beha)
Substance Abuse (PS)
11814 Carpal tunnel syndrome The CT is formed by the carpal bones and the transverse carpal ligament (flexor retinaculum). CTS results from compression of the median nerve as it passes thru the CT Psychiatric, Behavioral 3
w/ 9 flexor tendons. Longitudinal incision of the transverse carpal ligament can ↓ pressure w/i the CT, improving pts' SSx. Behavioural & Science (Beha)
Substance Abuse (PS)
11824 Venous thromboembolism Rivaroxaban is an oral anticoag that directly inhibs FXa. It's used in VTE and AF. Psychiatric, Behavioral 2
Behavioural & Science (Beha)
Substance Abuse (PS)
11825 Attention deficit ADHD is Chx by a pattern of inattention a/o hyperactivity/impulsivity that interferes w/ fxning in >2 settings. Psychiatric, Behavioral 5
hyperactivity disorder Behavioural & Science (Beha)
Substance Abuse (PS)
11828 Autism spectrum disorders ASD is characterised by impaired social communication/interactions and restricted, repetitive interests or behaviours. It can occur +/- language and intellectual Psychiatric, Behavioral 2
impairment. Behavioural & Science (Beha)
Substance Abuse (PS)
11829 Keloid TGF-β is critical for fibroblast migration, proliferation, and CT synthesis. ↑ TGF-β activity is responsible for the hypertrophic/keloid scarring and fibrosis of the lung, Psychiatric, Behavioral 2
liver, and kidney that occur w/ chronic inflammation. Behavioural & Science (Beha)
Substance Abuse (PS)
11838 Chronic heart failure Neprilysin is responsible for the breakdown of the natriuretic peptides and AT-II; therefore, inhibition of neprilysin ↑ the activity of these peptides. For Tx of HF, Psychiatric, Behavioral 12
neprilysin inhibition is combined w/ AT-II receptor blockade to optimize the (+) effects of the natriuretic peptides (eg, vasodilation, diuresis) while blocking the (-) effects Behavioural & Science (Beha)
of AT-II (eg, vasoconstriction, fluid retention). Substance Abuse (PS)
11846 Spleen rupture Any abdo process (e.g. ruptured spleen, peritonitis, hemoperitoneum) irritating the phrenic nerve sensory fibres around the diaphragm can cause referred pain to the C3- Psychiatric, Behavioral 2
C5 shoulder region (Kehr sign). Behavioural & Science (Beha)
Substance Abuse (PS)
11848 Resting membrane potential A Rx that binds to and activates GABA-A receptors (or enhances their activity) will ↑ the conductance of Cl ions, leading to ↑ passive transport of Cl into the cell interior. Psychiatric, Behavioral 5
and action potential This causes the membrane potential to become hyperpolarized (more (-) than the RMP) by approaching or reaching the equilibrium potential for Cl. Behavioural & Science (Beha)
Substance Abuse (PS)
11854 Hepatocellular cancer The celiac trunk is the first main branch of the abdominal aorta; it provides oxygenated blood to the spleen, stomach, liver, abdominal esophagus, and parts of the Psychiatric, Behavioral 5
duodenum and pancreas. The proper hepatic artery branches off the common hepatic artery from the celiac trunk and provides arterial blood supply to the liver. Behavioural & Science (Beha)
Substance Abuse (PS)
11866 Appendicitis The iliohypogastric nerve provides sensation to the suprapubic and gluteal regions and motor fxn to the anterolateral abdominal wall muscles. Abdominal Sx (eg, Psychiatric, Behavioral 5
appendectomy) can damage the nerve and cause ↓ sensation a/o burning pain at the suprapubic region. Behavioural & Science (Beha)
Substance Abuse (PS)
11870 Cranial nerve palsy The spinal accessory nerve is vulnerable to injury in the posterior triangle of the neck. Injury results in weakness of the trapezius muscle, which Px w/ drooping of the Psychiatric, Behavioral 9
shoulder, impaired abduction of the arm above horizontal (due to weakness in rotating the glenoid upward), and winging of the scapula. Behavioural & Science (Beha)
Substance Abuse (PS)
11874 Pulmonary embolism The lungs are supplied by dual circulation from both the pulmonary and bronchial arteries. This collateral circulation can help protect against lung infarction due to Psychiatric, Behavioral 13
pulmonary artery occlusion (ie, pulmonary embolism), as the bronchial circulation can continue to provide blood to the lung parenchyma. Behavioural & Science (Beha)
Substance Abuse (PS)
11875 Appendicitis Appendicitis causes dull visceral pain at the umbilicus due to afferent pain fibres entering at the T10 lvl in the spinal cord. progr inflammation in the appendix irritates the Psychiatric, Behavioral 5
parietal peritoneum and abdo wall to cause more severe somatic pain shifting from the umbilicus to McBurney's point (2/3 of the distance from the umbilicus to the Behavioural & Science (Beha)
ASIS). Substance Abuse (PS)
11899 Pulmonary blood flow PAOP is measured at the distal tip of the pulm artery catheter after an inflated balloon occludes blood flow through a pulm artery branch. It closely corresponds to LA and Psychiatric, Behavioral 2
LV EDP. Behavioural & Science (Beha)
Substance Abuse (PS)
15242 Aortic regurgitation AR causes a rapid fall in aortic pressure during diastole w/ an ↑ in LV EDV and a compensatory ↑ in SV. These hemodynamic changes create Chx pressure changes, Psychiatric, Behavioral 8
including ↓ aortic diastolic pressure, ↑ aortic systolic pressure, and ↑ LV diastolic and systolic pressures. Behavioural & Science (Beha)
Substance Abuse (PS)
15252 Stress cardiomyopathy Stress-induced (takotsubo) cardiomyopathy is characterised by hypokinesis of the mid and apical segments and hyperkinesis of the basal segments of the LV, resulting in Psychiatric, Behavioral 1
systolic dysfxn. The condition is likely caused by a surge of catecholamines in the setting of physical or emotional stress. It usually affects postmenopausal women and Behavioural & Science (Beha)
resolves on its own w/i several wks. Substance Abuse (PS)
15253 Dilated cardiomyopathy Peripartum cardiomyopathy is a relatively uncommon cause of DCM that may be related to impaired fxn of angiogenic GFs. DCM involves compensatory eccentric Psychiatric, Behavioral 8
hypertrophy, which ↑ ventricular compliance and also allows for temporary maintenance of CO. Over time, ovewhelming wall stress leads to LV failure w/ ↓ EF and SSx Behavioural & Science (Beha)
HF. Substance Abuse (PS)
15283 Hyperthyroidism Exogenous hyperthyroidism is characterised by ↑ free T4, suppressed TSH, and low/undetectable TG. It can occur w/ surreptitious levothyroxine abuse, use of animal- Psychiatric, Behavioral 8
sourced thyroid supplements, and erroneous dosing of thyroid replacement therapy. Over time, the lack of TSH stim causes the thyroid follicles to become atrophic Behavioural & Science (Beha)
Substance Abuse (PS)
15284 Peptic ulcer disease Peptic ulcers are most commonly caused by Helicobacter pylori infection or NSAID use. NSAIDs inhibit COX-1, leading to ↑ gastric acid formation, ↓ mucosal Psychiatric, Behavioral 10
bicarbonate production, and ↓ mucosal blood flow, which promote mucosal injury and ulcer formation. Behavioural & Science (Beha)
Substance Abuse (PS)
15285 Colorectal cancer FAP is an AD disorder caused by germline mutation to the TSG adenomatous polyposis coli. Pts w/ FAP develop hundred or thousands of colonic polyps; lifetime risk of Psychiatric, Behavioral 15
colon ca is close to 100%. Behavioural & Science (Beha)
Substance Abuse (PS)
QID Topic Educational Objective System Subject Repeats
15286 Familial adenomatous FAP is an AD hereditary disorder that results in the formation of innumerable colonic polyps and a nearly 100% risk of CRC. It arises due to germline mut to the TSG Psychiatric, Behavioral 1
polyposis APC. Behavioural & Science (Beha)
Substance Abuse (PS)
15327 Meningitis N. fowleri is a free-living, motile protozoan that lives in warm water. Exposure can result in 1° amoebic encephalitis (PAM), which is characterised by acute fever, h/a, Psychiatric, Behavioral 17
confusion, and neck stiffness. The Dx is confirmed when motile trophozoites are seen in CSF wet mount. Nearly all pts die. Behavioural & Science (Beha)
Substance Abuse (PS)
15328 Multiple endocrine MEN-2 is caused by germline activating muts in the RET proto-oncogene and freq results in both MTC and PCC. In pts w/ un-Dx PCC, induction of anaesthesia (e.g. prep Psychiatric, Behavioral 5
neoplasia for thyroidectomy) can precipitate a catecholamine surge, leading to HTN crisis, flash pulm oedema, and AF. Behavioural & Science (Beha)
Substance Abuse (PS)
15348 Interstitial lung disease Histologic findings of idiopathic pulmonary fibrosis include patchy lymphoplasmacytic infiltrates, focal fibroblastic proliferation with dense fibrosis, honeycombing, and Psychiatric, Behavioral 8
hyperplasia of type 2 pneumocytes. Therapies are directed at slowing the progression of fibrosis by inhibiting transforming growth factor β and other fibrogenic growth Behavioural & Science (Beha)
factors (eg, PDGF, fibroblastic growth factor, and VEGF). Substance Abuse (PS)
15349 Multiple myeloma MM should be suspected in elderly pts who have any combo of osteolytic lesions, hypercalcemia, anemia, or AKI. Renal disease is most commonly caused by LC cast Psychiatric, Behavioral 9
nephropathy, in which free LCs form obstr casts in the renal tubules. Monoclonal paraproteins aren't detected by urine dipstick (which detects only albumin), but both spot Behavioural & Science (Beha)
and 24 hr protein concs will be incr. Substance Abuse (PS)
15357 Asthma Bronchodilators induce bronchial smooth muscle relaxation to relieve airway spasm and bronchoconstriction in pts w/ asthma. Bronchodilation is most commonly Psychiatric, Behavioral 12
accomplished w/ β2 receptor agonists (e.g. albuterol), which fxn by ↑ cAMP lvls in bronchial smooth muscle. Behavioural & Science (Beha)
Substance Abuse (PS)
15358 Phrenic nerve injury The right phrenic nerve courses along the pericardium overlying the right side of the heart and is at risk for injury during procedures in or near the RA (eg, radiofrequency Psychiatric, Behavioral 1
ablation). Right phrenic nerve injury is typically recognized by elevation of the right hemidiaphragm. Behavioural & Science (Beha)
Substance Abuse (PS)
15384 Bladder cancer Major RFs for urothelial ca of the bladder incl age >60, cigarette smoking, and occup exposure to rubber, plastics, or aromatic amine-containing dyes. Cyclophosphamide Psychiatric, Behavioral 4
therapy also ↑ the risk. Behavioural & Science (Beha)
Substance Abuse (PS)
15410 Pulmonary arterial Pulm HTN can be recognized on PEx by a loud pulmonic component of S2 and an accentuated, palpable impulse at the left stemal border (left parasternal lift due to RV Psychiatric, Behavioral 8
hypertension heave). Behavioural & Science (Beha)
Substance Abuse (PS)
15416 Urinary tract obstruction AUR is characterised by anuria and bladder distension, and can result in hydronephrosis and AKI. A palpable, distended bladder is present on Ex, and abdo and flank pain Psychiatric, Behavioral 4
may be present. The most common cause of urinary retention is bladder outlet obstr (urethral compression) due to BPH. Behavioural & Science (Beha)
Substance Abuse (PS)
15447 Rhabdomyolysis Rhabdomyolysis usually presents w/ myalgia, proximal muscle weakness, and dark urine (Mburia) in the setting of trauma, sepsis, or overexertion. AKI occurs due to Psychiatric, Behavioral 2
heme pigment-mediated tubular injury, leading to ATN. Urine microscopy typically reveals granular, muddy brown casts. Behavioural & Science (Beha)
Substance Abuse (PS)
15481 Amoebiasis Entamoeba histolytica is an amoeba that causes colitis characterised by ulcers w/ undermining edges (i.e. flask-shaped) that may contain cysts and trophozoites. Psychiatric, Behavioral 1
Trophozoites can occasionally (~1%) invade the colonic wall and disseminate thru the blood to the liver, brain, or lungs. Amoebic hepatic abscess is the most common Behavioural & Science (Beha)
extraintestinal MFx. Substance Abuse (PS)
15482 COPD Chronic obstructive pulmonary disease causes air trapping and hyperinflation; consequently, these patients breathe at higher baseline lung volumes (higher functional Psychiatric, Behavioral 16
residual capacity). The volume of air in the lungs that is not respired (residual volume) increases substantially, as does the fraction of air in the lungs that is not involved in Behavioural & Science (Beha)
respiration (residual volume/total lung capacity ratio). Substance Abuse (PS)
15493 Septic shock Septic shock can Px w/ either hyper- or hypothermia. The initial disturbance is peripheral vasodilation leading to ↓ SVR, ↓ CVP and ↓ PCWP. A compensatory ↑ in Psychiatric, Behavioral 6
sympathetic drive causes an ↑ in CO; the resulting high flow rates lead to incomplete O2 extraction in the tissues, resulting in high mixed venous O2 saturation. Behavioural & Science (Beha)
Substance Abuse (PS)
15500 Defense mechanisms Countertransference consists of a provider's response (e.g. attitudes, thoughts, feelings, behaviours) toward a pt based on past personal relationships. Countertransference Psychiatric, Behavioral 8
can be (+) or (-), conscious or unconscious; if unrecognised, it may have detrimental effects on pt care. Behavioural & Science (Beha)
Substance Abuse (PS)
15501 Intestinal helminth parasites Hookworms are transmitted when human skin comes into contact w/ soil contaminated w/ human faeces. The larvae penetrate the skin, travel to the lungs, are coughed up, Psychiatric, Behavioral 3
and then subseq swallowed. Adult hookworms live in the small intestine and feed on human blood. Therefore, chronic IDA (microcytic anaemia) is the greatest Behavioural & Science (Beha)
complication. Substance Abuse (PS)
15602 Chronic kidney disease Chronic kidney disease is commonly associated with normocytic anemia due to reduced production of erythropoietin by the kidneys. Erythropoietin signal transduction is Psychiatric, Behavioral 8
primarily mediated by the Janus kinase 2/signal transducers and activators of transcription (JAK2/STAT) pathway, which promotes erythrocyte precursor survival. Behavioural & Science (Beha)
Substance Abuse (PS)
15607 Schizophrenia (+) SSx of schizophrenia (e.g. delusions, hallucinations) are a/w ↑ activity of DA in the mesolimbic pathway. Antipsychotics work by antagonising DA receptors in this Psychiatric, Behavioral 4
pathway. Behavioural & Science (Beha)
Substance Abuse (PS)
15613 Membranous nephropathy MN is a common cause of nephrotic syndrome in adults. EM of the glomerular capillary demonstrates irregular, subepithelial, electron-dense immune deposits on the Psychiatric, Behavioral 2
GBM w/ moderate effacement of the podocyte foot processes; IF microscopy demonstrates a diffuse granular pattern of IgG along the capillary loops. Behavioural & Science (Beha)
Substance Abuse (PS)
15615 Antibiotic resistance MRSA is resistant to most β-lactam Rx (e.g. oxacillin, methicillin, cephalosporins) due to the acquisition of a mobile genetic element that contains the mecA gene. This Psychiatric, Behavioral 8
gene encodes for a specialised PBP that has low affinity for β-lactam Abx. Tx of MRSA therefore req a non-β-lactam Rx such as TMP-SMX, clindamycin, doxycycline, Behavioural & Science (Beha)
or vancomycin. Substance Abuse (PS)
15644 Skin and soft tissue BI is a superficial infection by S. aureus that's most common in young children. It's characterised by a blistering skin rash w/ tan- to honey-coloured crusts. The blistering Psychiatric, Behavioral 8
infections in BI is caused by exfoliative toxin A, which targets desmoglein 1 in epidermal cellular junctions and causes a loss of cell adhesion. Behavioural & Science (Beha)
Substance Abuse (PS)
15701 Depression Depression-related cognitive impairment refers to cognitive impairment that occurs in the context of MDD, which may be mistaken for mild cognitive impairment or Psychiatric, Behavioral 8
dementia. Behavioural & Science (Beha)
Substance Abuse (PS)
15730 Multiple myeloma MM is a plasma cell malignancy that replicates in the bone marrow and causes osteolytic bone lesions, bone destruction, hypercalcaemia, and path fractures. Histopath Psychiatric, Behavioral 9
will show replacement of the normal bone marrow w/ plasma cells and blasts. Behavioural & Science (Beha)
Substance Abuse (PS)
15732 Social anxiety disorder SAD is characterised by anxiety and fear of scrutiny in social situations and can result in marked social-occup impairment. Preferred pharmacotherapy is Rx that inhibs 5- Psychiatric, Behavioral 2
HT reuptake (e.g. SSRIs or SNRIs). Behavioural & Science (Beha)
Substance Abuse (PS)
1021 Pulmonary embolism Pulm infarcts are typically hemorrhagic (red) and wedge-shaped in the periphery of the lung. IVDUs are at ↑ risk of TV endocarditis, which can cause multi septic pulm Psychiatric, Biochemistry 13
infarcts due to embolisation of TV vegetation fragments. Behavioural & (Bioc)
Substance Abuse (PS)
15523 Myelofibrosis PMF is a chronic MPD a/w bone marrow fibrosis. EMH leads to marked expansion of the splenic red pulp w/ HPO progenitor cells and results in massive splenomegaly. Psychiatric, Pathophysiology 3
Pts also usually have hepatomegaly, cytopenias, and PBS abns (e.g. dacrocytes, nucleated RBCs, immature granulocytes). Behavioural & (Patp)
Substance Abuse (PS)
15609 Psychosis Huntington Disease is an autosomal dominant, progressive neurodegenerative disorder characterized by chorea, psychiatric symptoms, and dementia. Psychiatric Psychiatric, Pathophysiology 6
symptoms may occur early in the disease course and include irritability, anxiety, apathy, depression, and psychosis. Behavioural & (Patp)
Substance Abuse (PS)
15762 Impulse control disorders IED is characterised by recurrent episodes of explosive verbal or physical aggression. The aggressive behaviours are impulsive and grossly out of proportion to the Psychiatric, Pathophysiology 1
provocation. Behavioural & (Patp)
Substance Abuse (PS)
222 Atrial septal defect Wide, fixed splitting of the 2nd heart sound is a Chx auscultatory finding in pts w/ ASD. A hemodynamically significant ASD can produce chronic pulm HTN as a result Psychiatric, Pharmacology 2
of left-to-right intracardiac shunting. Eisenmenger syndrome is the late-onset reversal of a left-to-right shunt due to pulm vascular sclerosis resulting from chronic pulm Behavioural & (Phar)
HTN. Closure of the ASD may be required to prevent irreversible pulm vascular sclerosis and a permanent Eisenmenger syndrome. Substance Abuse (PS)
247 Pituitary apoplexy Acute pit hemorrhage (pit apoplexy) is char by severe h/a, BTH (compression of the optic chiasm), and ophthalmoplegia (compression of CNIII). It usually occurs in a Psychiatric, Pharmacology 1
pre-existing pit adenoma. Pit apoplexy is a med emergency that req urgent Tx w/ GCs to prevent acute adrenal crisis and circulatory collapse. Behavioural & (Phar)
Substance Abuse (PS)
261 Mitral stenosis LA enlargement can sometimes cause left recurrent laryngeal nerve impingement. Neurapraxia resulting in left vocal cord paresis and hoarseness may result. Psychiatric, Pharmacology 7
Behavioural & (Phar)
Substance Abuse (PS)
348 Malabsorption Malabsorption is a syndrome of impaired intestinal digestion and absorption. Fats are typically the most severely affected macronutrient in gen malabsorption, and testing Psychiatric, Pharmacology 4
the stool for fat (e.g. w/ Sudan III stain) is the most sensitive strategy for screening for malabsorptive disorders. Behavioural & (Phar)
Substance Abuse (PS)
349 Celiac disease Celiac disease (gluten-sens enteropathy) classically Px b/w age 6-24 mos w/ abdo pain, diarrhea, vomiting, and weight loss. Duodenal Bx reveals crypt hyperplasia, Psychiatric, Pharmacology 2
villous atrophy, and intraepithelial lymphocyte infiltration. Tx w/ a gluten-free diet resolves SSx and normalizes sero and histo. Behavioural & (Phar)
Substance Abuse (PS)
350 Celiac disease Celiac disease is caused by an immune-mediated rxn to gluten and can Px w/ bloating, diarrhea, and flatulence, as well as short stature and weight loss. Screening tests Psychiatric, Pharmacology 2
show an ↑ level of IgA against tissue transglutaminase. Duodenal Bx is confirmatory, showing villus flattening and intraepithelial lymphocyte infiltration. Behavioural & (Phar)
Substance Abuse (PS)
510 COPD The path of centriacinar emphysema a/w chronic, heavy smoking predominantly involves the release of proteases, esp. elastase, from infiltrating neutrophils and alveolar Psychiatric, Pharmacology 16
macrophages. Behavioural & (Phar)
Substance Abuse (PS)
QID Topic Educational Objective System Subject Repeats
512 Pneumothorax PSP occurs in pts w/o pre-existing pulm disease when a large change in the alveolar or intrapleural pressure results in a break in the visceral (e.g. ruptured superficial Psychiatric, Pharmacology 2
bleb) pleura and air trapping b/w the pleural spaces. Behavioural & (Phar)
Substance Abuse (PS)
515 Ischemic stroke Neurons that sustain irreversible ischemic injury begin to develop char histopath changes 12-24hrs after the inciting event. These changes incl shrinkage of the cell body, Psychiatric, Pharmacology 19
pyknosis of the nucleus, loss of Nissl bodies, and cytoplasmic eosinophilia (red neurons). Behavioural & (Phar)
Substance Abuse (PS)
516 Ischemic stroke CNS injury is a/w astrocyte hypertrophy and proliferation (gliosis). This process leads to the formation of a glial scar, which compensates for the volume loss that occurs Psychiatric, Pharmacology 19
after neuronal death. Behavioural & (Phar)
Substance Abuse (PS)
519 Brain herniation Transtentorial (ie, uncal) herniation is a complication of an ipsilateral mass lesion, such as a hemorrhage or brain tumor. The 1st sign of uncal herniation is a fixed and Psychiatric, Pharmacology 2
dilated pupil on the side of the lesion. Ipsilateral paralysis of oculomotor muscles, contralateral or ipsilateral hemiparesis, and contralateral homonymous hemianopsia w/ Behavioural & (Phar)
macular sparing may also occur. Substance Abuse (PS)
520 Neural tube defects Failure of neural tube closure at 4 wks gestation results in NTDs. 1st trimester use of valproate is a significant RF for NTDs, but periconceptional vit B9 supplementation Psychiatric, Pharmacology 4
↓ this risk. Behavioural & (Phar)
Substance Abuse (PS)
572 Transplant rejection Organ rejection can be hyperacute, acute, or chronic. Acute rejection most often occurs within weeks or up to 6 months after transplant and is predominantly cell- Psychiatric, Pharmacology 4
mediated, involving sensitization of host T lymphocytes against donor MHC antigens. There is typically graft dysfunction with histology showing a dense, mononuclear Behavioural & (Phar)
(ie, lymphocytic) infiltrate. Substance Abuse (PS)
574 Corticosteroids GCs are predominantly catabolic, causing muscle weakness, skin thinning, impaired wound healing, osteoporosis, and immsup. However, they also cause ↑ hepatic Psychiatric, Pharmacology 3
synthesis of GNG and glycogenic proteins to ↑ Glc availability. This, along w/ peri antagonism of insulin, contributes to the devel of hyperglycaemia. Behavioural & (Phar)
Substance Abuse (PS)
575 Corticosteroids The acute effects of corticosteroids on the WBC incl an ↑ neutrophil count and ↓ lymphocyte, monocyte, basophil, and eosinophil counts. The ↑ in the neutrophil count Psychiatric, Pharmacology 3
results from 'demargination' of neutrophils previously attached to the vessel wall. Behavioural & (Phar)
Substance Abuse (PS)
704 Friedreich ataxia FA is Chx by cerebellar ataxia (spinocerebellar tract degeneration) and loss of position/vibration sensation (dorsal column/DRG degeneration), kyphoscoliosis, and HCM. Psychiatric, Pharmacology 2
Foot abnormalities and DM are also common. Behavioural & (Phar)
Substance Abuse (PS)
706 Ataxia telangiectasia AT is an AR disorder resulting from a defect in DNA-repair genes. The DNA of these pts is hypersensitive to ionizing radiation. MFx include cerebellar ataxia, Psychiatric, Pharmacology 2
oculocutaneous telangiectasias, repeated sinopulm infections, and an ↑ incidence of malignancy. Behavioural & (Phar)
Substance Abuse (PS)
773 Complement deficiency Deficiency of the complement factors that form the membrane attack complex (i.e., C5b-C9) results in recurrent infections by Neisseria species. Psychiatric, Pharmacology 1
Behavioural & (Phar)
Substance Abuse (PS)
774 Myasthenia gravis Myasthenia gravis results from an autoimmune type II (antibody-mediated) hypersensitivity reaction against skeletal myocyte surface acetylcholine receptors. Psychiatric, Pharmacology 10
Goodpasture syndrome similarly involves autoantibodies against basement membrane collagen in the renal glomeruli and lung alveoli. Behavioural & (Phar)
Substance Abuse (PS)
937 G6PD deficiency hemolytic anaemia is a possible AE of dapsone and is most significant in pts defic for G6PD. G6PD defic anaemia is characterised by episodes of hemolytic anaemia Psychiatric, Pharmacology 5
precipitated by oxidative stress (drugs, infections). peri smear typically shows bite cells and Heinz bodies (req special prep). Behavioural & (Phar)
Substance Abuse (PS)
1193 Septic shock Gram (-) sepsis is caused by the release of LPSs from bacterial cells during cell division or bacteriolysis. Lipid A is the toxic component of LPSs and induces the Psychiatric, Pharmacology 6
widespread release of IL-1 and TNF-α from activated macrophages. These cytokines cause the SSx of septic shock (eg, fever, hypotension, organ dysfunction). Behavioural & (Phar)
Substance Abuse (PS)
1256 Trigeminal neuralgia The first-line treatment for trigeminal neuralgia is carbamazepine, a neuroleptic medication that inhibits neuronal high-frequency firing by reducing the ability of sodium Psychiatric, Pharmacology 2
channels to recover from inactivation. Carbamazepine can cause bone marrow suppression; therefore, complete blood cell counts should be monitored periodically. Behavioural & (Phar)
Substance Abuse (PS)
1443 Hemoglobin properties Pso refers to the partial pressure of oxygen at which hemoglobin is 50% saturated. Hemoglobins with high oxygen affinity have a decreased P50 that is represented by a Psychiatric, Pharmacology 4
leftward shift of the oxygen dissociation curve. The reduced ability to release oxygen within the peripheral tissues leads to renal hypoxia, increased erythropoietin Behavioural & (Phar)
synthesis, and compensatory erythrocytosis. Substance Abuse (PS)
1868 Osteoporosis Selective estrogen receptor modulators exhibit estrogen antagonist and agonist properties in a tissue-specific manner. Raloxifene has estrogen agonist activity on bone, Psychiatric, Pharmacology 10
which decreases bone resorption and improves bone density. Raloxifene has an estrogen antagonist effect on breast tissue and can decrease the risk of breast cancer; it also Behavioural & (Phar)
acts as an estrogen antagonist in the uterus, and does not increase the risk of endometrial cancer. Substance Abuse (PS)
2001 Asthma Intermittent resp SSx in a pts w/ a normal CXR, sputum eosinophils, and ↓ FEV1 suggest asthma. Common asthma triggers incl exercise, cold air, resp infection, and Psychiatric, Pharmacology 12
exposure to inhaled allergens (e.g. dust mites, cockroaches, pet dander, mould, pollen). Behavioural & (Phar)
Substance Abuse (PS)
2088 ADH and urea clearance ADH and DDAVP cause a V2receptor-mediated ↑ in water and urea permeability at the inner medullary CD. The resulting rise in urea reabsorption (↓ urea clearance) Psychiatric, Pharmacology 1
enhances the medullary osmotic gradient, allowing the production of max concentrated urine. Behavioural & (Phar)
Substance Abuse (PS)
2089 Hyperaldosteronism ↑ serum aldolvls can MFx w/ HTN, hypokalaemia, and muscle weakness. ↑ lvls of both renin and aldoare indicative of 2° hyperaldosteronism, which can be caused by Psychiatric, Pharmacology 5
renovascular disease and renin-secreting tumours. Behavioural & (Phar)
Substance Abuse (PS)
8259 Atelectasis An obstr lesion in a mainstem bronchus can prevent ventilation of an entire lung, leading to obstr atelectasis and complete lung collapse. ChFx on CXR incl unilateral Psychiatric, Pharmacology 1
pulm opacification and deviation of the mediastinum toward the opacified lung. Behavioural & (Phar)
Substance Abuse (PS)
8327 Acute diarrhea Campylobacter jejuni is an oxidase-positive, curved, gram-negative rod that is a leading cause of gastroenteritis. The pathogen is a zoonotic organism most commonly Psychiatric, Pharmacology 13
contracted by consuming contaminated, undercooked poultry. Cases are marked by fever, abdominal pain, and diarrhea that may be bloody. Behavioural & (Phar)
Substance Abuse (PS)
11577 Opioids In the US, the majority of overdose deaths are caused by opioids, incl prescription analgesics and heroin. Psychiatric, Pharmacology 13
Behavioural & (Phar)
Substance Abuse (PS)
13907 Multifactorial inheritance Many freq encountered diseases (e.g. HTN, spinal bifida) display multifactorial inheritance, which involves the complex interaction of numerous genetic and Psychiatric, Pharmacology 1
environmental factors to determine phenotypically expression. Although the exact inheritance risk can't be determined, the closer a relative is to the affected person, the Behavioural & (Phar)
more likely the relative is to develop the trait. Substance Abuse (PS)
15254 Dilated cardiomyopathy DCM results from 1° myocardial dysfxn leading to eccentric remodelling of the LV. Pts can develop LV mural thrombus and are at risk for SCD due to ventricular Psychiatric, Pharmacology 8
arrhythmia. Familial DCM is typically inherited in an AD pattern, and most commonly results from truncating muts of the TTN gene that codes for the sarcomere protein Behavioural & (Phar)
titin. Substance Abuse (PS)
15397 Aortic regurgitation Eccentric ventricular hypertrophy results in a dilated cavity w/ relatively thin ventricular walls due to the addition of myocardial contractile fibers in series in response to Psychiatric, Pharmacology 8
chronic volume overload. Chronic AR can result from aortic root dilation and is a common cause of eccentric hypertrophy. Behavioural & (Phar)
Substance Abuse (PS)
15606 Malaria P. vivax is the most common cause of malaria in non-African countries. It's transmitted by the female Anopheles mosquito and is a/w a latent liver phase that must be Tx Psychiatric, Pharmacology 5
(w/ primaquine) independently of the erythrocytic phase to fully eliminate the organism. Behavioural & (Phar)
Substance Abuse (PS)
844 Cystic fibrosis Meconium ileus is a distal SBO due to abnly dehydrated meconium in a pt w/ CF. Persistent, Tx-resistant infectious pneumonias, bronchiectasis, and cor pulmonale Pulmonary & Critical Anatomy (Anat) 11
account for most deaths due to CF. Care (PU)
1535 Immunizations The live attenuated oral (Sabin) poliovirus vaccine produces a stronger mucosal secretory IgA immune response than does the inactivated poliovirus (Salk) vaccine. This Pulmonary & Critical Anatomy (Anat) 4
increase in mucosal IgA offers immune protection at the site of viral entry by inhibiting attachment to intestinal epithelial cells. Care (PU)
1695 Non-Hodgkin lymphoma Follicular lymphoma is characterised by aggregates of packed follicles that obscure the normal LN architecture. 90% of pts w/ follicular lymphoma have the t(14;18) Pulmonary & Critical Anatomy (Anat) 6
translocation, which causes overexpression of the anti-apoptotic BCL-2 protein. Care (PU)
1745 Antiretroviral therapy Fusion inhibs (e.g. enfuvirtide) bind the HIV transmembrane glycoprotein gp41 and prevent it from approx. the viral and host cellular membranes, which prevents HIV Pulmonary & Critical Anatomy (Anat) 7
penetration into new host cells. Care (PU)
11741 Trastuzumab Human epidermal growth factor receptor 2 (HER2) is a tyrosine kinase receptor that is overexpressed in 20% of breast cancer patients. In such patients, HER2 blockade Pulmonary & Critical Anatomy (Anat) 1
with the monoclonal antibody trastuzumab downregulates cellular proliferation and promotes apoptosis. Care (PU)
11845 Theophylline Theophylline is an adenosine receptor antagonist and indirect adrenergic agent with a narrow therapeutic index. It is predominantly metabolized by the hepatic Pulmonary & Critical Anatomy (Anat) 2
cytochrome oxidases. Inhibition of these enzymes by concurrent illness (eg, infection with fever) or ingestion of certain drugs or substances (eg, ciprofloxacin) can raise Care (PU)
serum theophylline concentrations and cause toxicity (eg, seizures, cardiac arrhythmias).
1249 Bipolar disorder Lithium and the anticons valproate, carbamazepine, and lamotrigine are mood-stabilising agents used in BD. Valproate is commonly used in the Tx of gen as well as Pulmonary & Critical Biochemistry 7
myoclonic seizures. Care (PU) (Bioc)
1386 Glaucoma Atropine is indicated for the Tx of bradycardia as it ↓ vagal influence on the SA and AV nodes. A common AE is ↑ IOP. It may precipitate acute CAG in susceptible Pulmonary & Critical Biochemistry 3
individuals. Care (PU) (Bioc)
482 Henoch-Schonlein purpura Small vessel leucocytoclastic angiitis a/w IgA and C3 deposition is typical of HSP. HSP is most common in children 3 to 11 y/o and is most often related to a recent Pulmonary & Critical Embryology 3
infection. Most children present w/ palpable skin lesions, +/- abdo pain and arthralgias. Although usually self-limiting, pts afflicted w/ HSP should be observed carefully Care (PU) (Embr)
b/c glomerulonephritis and even ESRD are possible complications.
550 Respiratory alkalosis An acute V/Q mismatch (e.g. due to PE or pneumonia) causes hypoxaemia and triggers hyperventilation. B/c the removal of CO2 is directly dependent on ventilation but Pulmonary & Critical Embryology 1
the absorption of O2 is capped by the high baseline sat of Hb, the hyperventilation response typically leads to resp alkalosis (low PaCO2) w/ persistent hypoxaemia. Care (PU) (Embr)
QID Topic Educational Objective System Subject Repeats
800 Henoch-Schonlein purpura Henoch-Schönlein purpura is an IgA-mediated type III hypersensitivity reaction in children that generally follows infection. Deposition of circulating IgA-containing Pulmonary & Critical Embryology 3
immune complexes in small vessels results in systemic vasculitis. Common manifestations include palpable lower-extremity purpura, abdominal pain, arthralgias, and Care (PU) (Embr)
hematuria.
1833 Anaplasia Undifferentiated (anaplastic) tumors bear no resemblance to the tissue of origin. They are composed of pleomorphic cells w/ large, hyperchromatic nuclei that grow in a Pulmonary & Critical Embryology 1
disorganized fashion. Anaplastic tumors may also contain numerous, abnormal mitoses and giant tumor cells. Care (PU) (Embr)
802 Latex allergy IL-4 is produced by the Th2 subset of Th cells. It facilitates proliferation of B cells and Th2 lymphocytes and stims Ab isotype switching to IgE which mediates HS-1 Pulmonary & Critical Genetics (Gene) 1
(allergic) rxns. Care (PU)
805 Cell mediated immunity IL-12 stimulates the differentiation of naive Th0 cells into Th1 cells. Pts w/ IL-12 receptor deficiency are susceptible to severe mycobacterial infections due to the Pulmonary & Critical Genetics (Gene) 5
inability to mount a strong cell-mediated granulomatous immune response; therefore, they require Tx w/ IFN-γ. Care (PU)
1791 Retinoblastoma (Rb) The Rb TSG encodes the Rb protein, which regulates the cell cycle. Active (hypophosphorylated) Rb protein prevents damaged cells from proceeding past the G1 to S Pulmonary & Critical Genetics (Gene) 1
protein checkpoint, while the inactive (hyperphosphorylated) Rb protein allows the damaged cell to enter mitosis. Abnormal phosphorylation of Rb protein results in its Care (PU)
inactivation.
478 Hyperaldosteronism Hypersecreting AC tumours can have fxnality resembling the outer (aldosterone/Conn syndrome), middle (cortisol/Cushing syndrome), or inner (androgens/hirsutism and Pulmonary & Critical Histology (Hist) 5
virilisation) layers of the AC. Care (PU)
480 Primary hypertension Isolated systolic HTN (ISH; SBP >140mmHg w/ DBP <90mmHg) is due to age-related stiffness and ↓ in compliance of the aorta and major peri arteries. Pulmonary & Critical Histology (Hist) 14
Care (PU)
524 Subarachnoid hemorrhage The most common complication of aneurysmal SAH is vasospasm, which typically occurs 3-12days after the initial insult and can cause delayed cerebral ischemia (e.g. Pulmonary & Critical Histology (Hist) 4
sudden change in mental status, new focal neuro deficits). The CT scan usually remains unchanged, unlike w/ rebleeding. Care (PU)
301 Antibiotic resistance Echinocandins (e.g. caspofungin, micafungin) are antifungal Rx that inhib synthesis of the polysaccharide glucan, an essential component of the fungal cell wall. Pulmonary & Critical Immunology 8
Care (PU) (Immu)
526 Neural tube defects NTDs most often occur when the neural folds fail to fuse in the region of the ant or post neuropores. Persistent communication b/w the spinal canal and the amniotic Pulmonary & Critical Immunology 4
cavity allows leakage of AFP and AChE into the amnionic fluid, leading to ↑ lvls of AFP and AChE that can be detected on amniocentesis. Care (PU) (Immu)
534 Antipsychotics Akathisia is an EPS of antipsychRx characterised by inner restlessness and an inability to sit or stand in 1 position. Tx involves a ↓ in the antipsychdose, if possible, or the Pulmonary & Critical Immunology 9
addn of a β blocker or benzo. Care (PU) (Immu)
544 COPD COPD involves components of chronic bronchitis and emphysema. Bronchial airway obstr from chronic bronchitis and ↓ alveolar elasticity from emphysema result in air- Pulmonary & Critical Immunology 16
trapping and lung hyperinflation. The FRC is ↑, as are RV and TLC. Care (PU) (Immu)
797 Nutrition, protein Metabolism of 1 g of protein or carbohydrate produces 4 Calories of energy; metabolism of 1 g of fat produces 9 Calories. Pulmonary & Critical Immunology 1
Care (PU) (Immu)
967 Multiple sclerosis MS is an immune-mediated disorder of the CNS characterised by focal demyelination (plaques). Histo, plaques contain foci of perivenular inflammatory infiltrates made Pulmonary & Critical Immunology 6
up 1arily of autoreactive T lymphocytes and macrophages. Patchy demyelination occurs f/b astrocyte hyperplasia (glial scarring). Care (PU) (Immu)
1130 Anticoagulants Heparin is commonly used for the prevention of DVT in non-ambulatory pts or those undergoing elective Sx, esp. hip and knee Sx. Heparin ↑ the effect of the naturally Pulmonary & Critical Immunology 8
occurring anticoag ATIII. Care (PU) (Immu)
1131 Anticoagulants HIT is Tx w/ DTIs such as argatroban. Both HMWH and LMWH should be avoided in these pts. Pulmonary & Critical Immunology 8
Care (PU) (Immu)
1218 ACE inhibitors ACEIs and ARBs ↓ the risk of CKD in pts w/ HTN and DM. ACEIs ↑ lvls of bradykinin and can cause nonproductive cough, an effect not see w/ ARBs. Pulmonary & Critical Immunology 7
Care (PU) (Immu)
1220 Gout Colchicine is a 2nd-line agent for treating acute gouty arthritis. It inhibits tubulin polymerization and microtubule formation in leukocytes, ↓ neutrophil chemotaxis and Pulmonary & Critical Immunology 11
emigration to sites inflamed by tissue deposition of monosodium urate crystals. GI mucosal fxn is also impaired by microtubule disruption, leading to diarrhea and, less Care (PU) (Immu)
commonly, nausea, vomiting, and abdominal pain.
1441 Resting membrane potential The resting membrane potential is the difference in the electrical charges across the cell membrane under steady-state conditions. The ions that are most permeable to the Pulmonary & Critical Immunology 5
and action potential cell membrane make the largest contribution to the resting membrane potential. In general, a high potassium efflux and some sodium influx are responsible for the value Care (PU) (Immu)
of the resting potential, which is typically about -70 mV.
1611 Interstitial lung disease ILD is a/w decr LVs and incr lung elastic recoil caused by fibrotic interstitial tissue. The incr elastic recoil results in incr radial traction (outward pulling) on the airways, Pulmonary & Critical Immunology 8
leading to incr exp flow rates when corrected for the low LV. Care (PU) (Immu)
1763 Radial neuropathy Injury to the radial nerve during its passage thru the supinator canal may occur due to repetitive pronation/supination of the forearm, direct trauma, or subluxation of the Pulmonary & Critical Immunology 3
radius. Pts typically have weakness during finger and thumb extension ('finger drop') w/o wrist drop or sensory deficits. Care (PU) (Immu)
1800 Autosomal recessive AR disorders affect 25% of offspring of aSSx heterozygous carrier parents. Classical galactosemia is the most common and severe galactosemic disorder and Px w/i days Pulmonary & Critical Immunology 5
inheritance of birth w/ jaundice, vomiting, and hepatomegaly. Care (PU) (Immu)
103 Hepatic encephalopathy HE is caused by ↑ lvls of NH3 and other neurotox in the circulation that lead to ↑ inhib neurotransmission and impaired excitatory NT release. HE is freq precipitated by a Pulmonary & Critical Microbiology 2
stressor (e.g. GI bleeding, infection) that ↑ blood NH3lvls. Care (PU) (Micr)
108 Mucormycosis Facial pain, headache, and black necrotic eschar in the nasal cavity in a pt w/ DKA are highly suggestive of mucormycosis. Histo Ex of the affected tissue is necessary to Pulmonary & Critical Microbiology 3
confirm the Dx. The fungi show broad non-septate hyphae w/ right-angle branching. Tx consists of Sx debridement and antifungal therapy. Care (PU) (Micr)
114 Meningitis C. neoformans is a yeast w/ a thick PSC that's found 1arily in soil contaminated by bird droppings. Inhalation of the pathogen into the lungs leads to (a usually aSSx) 1ary Pulmonary & Critical Microbiology 17
infection. In pts who're immsup (e.g. adv AIDS), the pathogen can spread thru the bloodstream to other organs, particularly the CNS. Care (PU) (Micr)
117 Meningitis Pts w/ suspected cryptococcal meningitis can be Dx using India ink staining of the CSF. Tx w/ amphotericin B and flucytosine is req at 1st, f/b long-term fluconazole Pulmonary & Critical Microbiology 17
maint therapy. Care (PU) (Micr)
119 Meningitis C. neoformans causes ME in pts w/ unTx AIDS. Dx can be made by detecting the PSC in CSF using the latex agglutination test. India ink staining of CSF is also used for Pulmonary & Critical Microbiology 17
Dx and can demo round or oval budding yeast. Care (PU) (Micr)
120 Normal flora Expectorated sputum cultures are often contaminated by normal oral flora. The growth of C. albicans, a normal commensal of the GIT and skin, almost always indicates Pulmonary & Critical Microbiology 1
oral contamination rather than true pulm infection. Care (PU) (Micr)
121 Blastomycosis B. dermatitidis is a dimorphic fungus seen in tissue as round or oval yeasts w/ thick walls and broad-based budding. It's endemic in the SE US (states east of the Pulmonary & Critical Microbiology 3
Mississippi River). The lungs are the 1° site of involvement, and the skin and bone are the major sites of dissemination. Care (PU) (Micr)
266 Rheumatic fever Interstitial myocardial granulomas (Aschoff bodies) are found in carditis due to acute RF, which develops after an un-Tx GAS pharyngeal infection. Aschoff bodies Pulmonary & Critical Microbiology 5
contain plump macrophages w/ abundant cytoplasm and central, slender ribbons of chromatin (Anitschkow, or caterpillar cells). Care (PU) (Micr)
267 Rheumatic fever Sydenham chorea presents w/ involuntary, rapid, irregular jerking movements involving the face, arms, and legs. It occurs mos after group A streptococcal infection and is Pulmonary & Critical Microbiology 5
one of the major clinical MFx of acute RF. Pts w/ this condition carry a high risk of chronic valvular disease. Care (PU) (Micr)
268 Aortic stenosis Calcific degeneration of the trileaflet AV is the most common cause of AS in developed nations. AS is Chx by progressive AV leaflet thickening and calcification, leading Pulmonary & Critical Microbiology 8
to restricted leaflet excursion and mobility. AS murmur is usually a harsh ejection-type systolic murmur heard best at the base of the heart in the "aortic area" (2nd right Care (PU) (Micr)
ICS) w/ radiation to the carotid arteries.
269 Aortic stenosis The murmur of AS is a systolic ejection-type, crescendo-decrescendo murmur that starts after the 1st heart sound and typically ends before the A2 component of the 2nd Pulmonary & Critical Microbiology 8
heart sound. The intensity of the murmur is proportional to the magnitude of the LV to aorta pressure gradient during systole. Care (PU) (Micr)
665 Friedreich ataxia FA is an AR condition that presents during childhood/adolescence w/ progr gait ataxia (due to degen of the spinocerebellar tracts) and impaired joint and vibration sense Pulmonary & Critical Microbiology 2
(due to degen of the posterior columns and DRG). Other features incl HCM (most common cause of death), skeletal abns (e.g. kyphoscoliosis, pes cavus), and DM. Care (PU) (Micr)
730 ACE inhibitors ACEIs can cause significant 1st-dose hypotension in pts w/ volume depletion (eg, from diuretic use) or HF. To ↓ the risk of 1st-dose hypotension, ACEI Thx should be Pulmonary & Critical Microbiology 7
initiated at low dosages. Care (PU) (Micr)
731 ACE inhibitors Pts w/ bilateral RAS have decr renal perfusion (due to atherosclerotic blockage) and are dependent upon AT-II-induced eff vasocon to maint GFR. ACEIs block AT-II- Pulmonary & Critical Microbiology 7
mediated vasocon, which can decr syst BP and decr renal perfusion. In addn, ACEIs cause dilation of the eff art, leading to a decr in GFR and RFF. Care (PU) (Micr)
734 Hyperkalemia ACEIs block the conversion of AT-I to AT-Il, thereby ↓ vasoconstriction and aldosterone secretion. ↓ aldosterone leads to K retention, which can cause hyperkalemia, Pulmonary & Critical Microbiology 1
especially in pts w/ renal insufficiency and in those taking other Rx that ↑ K lvls (eg, ARBs, MRBs). Care (PU) (Micr)
958 Measles SSPE is a rare complication of measles infection that occurs several yrs after apparent recovery from initial infection. Oligoclonal bands of measles virus Abs are found in Pulmonary & Critical Microbiology 3
the CSF of these pts. Care (PU) (Micr)
960 Prion disease Prion diseases are rapidly progr neurodegen disorders caused by the accumulation an abnly folded protein w/i the brain. Prion proteins are normally found in an α helix Pulmonary & Critical Microbiology 3
form; a conformation change into a β-sheet form confers resistance to proteases and can trigger similar conformational changes in other normally folded proteins. Char Care (PU) (Micr)
micro findings incl spongiform degen of the grey matter w/ vacuolisation of neurons, gliosis, and cyst formation.
961 Giant cell arteritis Polymyalgia rheumatica occurs in more than 1/2 of pts w/ temporal arteritis. It's characterised by neck, torso, shoulder, and pelvic girdle pain and morning stiffness. Pulmonary & Critical Microbiology 5
Fatigue, fever, and weight loss may also occur. Monocular vision loss is a common complication of temporal arteritis. Care (PU) (Micr)
962 Giant cell arteritis ESR and CRP have very high sensitivity for GCA. Pts w/ suspected GCA who have an ↑ ESR or CRP lvl should be referred for temporal artery Bx to confirm the Dx. Pulmonary & Critical Microbiology 5
Care (PU) (Micr)
964 Multiple sclerosis MS is Chx by episodic, progressive neuro deficits involving multiple anatomic regions w/i the CNS. Demyelinating plaques are commonly seen as hyperintense lesions on Pulmonary & Critical Microbiology 6
T2-weighted MRI of the brain and spinal cord. Common MFx include optic neuritis, INO, sensory deficits, and fatigue, which may worsen w/ heat exposure. Care (PU) (Micr)
999 Aromatase deficiency Aromatase converts androgens into estrogens in the ovaries, testes, placenta, and other peripheral tissues. Placental aromatase deficiency causes accumulation of Pulmonary & Critical Microbiology 1
androgens during pregnancy, resulting in ambiguous external genitalia in female infants and maternal virilization. Care (PU) (Micr)
1215 Cushing syndrome ACTH is the major trophic hormone of the ZF and ZR, whereas the ZG is 1arily regulated by ATII. Excess production of ACTH causes ↑ cortisol synthesis w/i the ZF Pulmonary & Critical Microbiology 5
(Cushing's MFxs) and ↑ androgen production w/i the ZR (irregular menstruation, hirsutism is women). Care (PU) (Micr)
1216 Sympathomimetic agents Blanching of a vein into which NE is being infused together w/ induration and pallor of the tissues surrounding the IV site are signs of NE extravasation and resulting Pulmonary & Critical Microbiology 5
vasoconstriction. Tissue necrosis is best prevented by local injection of an α1 blocking drug, such as phentolamine. Care (PU) (Micr)
1217 Phencyclidine PCP is 1arily an NMDA receptor antagonist, w/ lesser effects on the reuptake inhib of biogenic amines and other receptors. It can have dissociative and anaesthetic effects Pulmonary & Critical Microbiology 2
but may also cause psychosis and severe agitation, leading to violent trauma. Ataxia, horizontal and vertical nystagmus, and memory loss can also be present. Care (PU) (Micr)
1576 Antiarrhythmic drugs Class III antiarrhythmic Rx (amiodarone, sotalol, dofetilide) predominantly block K channels and inhibit the outward K currents during phase 3 of the cardiac AP, thereby Pulmonary & Critical Microbiology 12
prolonging repolarization and total AP duration. Care (PU) (Micr)
1649 Vitamin A deficiency VitA defic causes night blindness and hyperkeratosis. defic of this fat-soluble vit can develop in pts w/ biliary disorders, exocrine PI, or intestinal malabsorption. Pulmonary & Critical Microbiology 1
Care (PU) (Micr)
QID Topic Educational Objective System Subject Repeats
1666 Tuberculosis The CGs of TB are almost always surrounded by large epithelioid macrophages w/ pale pink granular cytoplasm. CD14 is a surface marker spec. to the monocyte- Pulmonary & Critical Microbiology 18
macrophage cell lineage. Care (PU) (Micr)
1667 Down syndrome Trisomy 21 is detectable by cytogenetic karyotype analysis and is the most common genetic cause of congenital intellectual disability. Patients with Down Syndrome are Pulmonary & Critical Microbiology 6
at increased risk of developing acute lymphoblastic leukemia and acute megakaryoblastic leukemia. Care (PU) (Micr)
1677 Aneuploidy Common findings in DS include cognitive impairment, facial dysmorphism, and cardiac defects; 95% of cases are caused by the presence of an extra chromosome 21 Pulmonary & Critical Microbiology 1
(trisomy) resulting from nondisjunction. Unbalanced Robertsonian translocations or mosaicism are less common causes. Care (PU) (Micr)
1679 Angioedema Angioedema can be hereditary (AD) or acq (a/w ACEI Tx). In HAE, low C1 esterase inhib activity leads to ↑ in bradykinin activity. ACEI shouldn't be used in these pts. Pulmonary & Critical Microbiology 2
Care (PU) (Micr)
1767 Knee trauma The ACL can be damaged by sudden changes in direction or awkward landings (eg, excessive internal rotation or valgus stress) during sports activity. ACL tears are Pulmonary & Critical Microbiology 4
typically a/w rapid-onset hemarthrosis. PEx shows anterior laxity of the tibia relative to the femur (eg, Lachman test, anterior drawer test). Care (PU) (Micr)
8257 Lithium Li-induced DI is the result of Li's antag effect on the action of ADH on principal cells w/i the CD system. Pulmonary & Critical Microbiology 2
Care (PU) (Micr)
9989 Otitis externa Pseudomonas aeruginosa is a non lactose-fermenting, oxidase (+), motile, Gram (-) rod. It is the most common cause of MOE, a serious infection of the ear seen in elderly Pulmonary & Critical Microbiology 2
diabetic pts. MOE Px w/ exquisite ear pain and drainage, and granulation tissue is often seen w/i the ear canal. Care (PU) (Micr)
10993 Arginine in NO production Nitric oxide is synthesized from arginine by nitric oxide synthase. As a precursor of nitric oxide, arginine supplementation may play an adjunct role in the treatment of Pulmonary & Critical Microbiology 1
conditions that improve with vasodilation, such as stable angina. Care (PU) (Micr)
11630 Informed consent Informed consent should be obtained by a provider who has sufficient knowledge to give an accurate description of the intervention, the risks and benefits of Tx, and Pulmonary & Critical Microbiology 3
available alternative Tx and to answer all of the pt's questions. Care (PU) (Micr)
11638 Urinary incontinence Stress incontinence is due to loss of pelvic floor support and incompetence of the urethral sphincter. Increased abdominal pressure (eg, coughing, sneezing, or vigorous Pulmonary & Critical Microbiology 7
effort) greater than the urethral sphincter pressure can cause brief involuntary urine loss, which is virtually diagnostic of stress incontinence. Care (PU) (Micr)
13402 Obesity Obesity, particularly morbid, central obesity, can cause a pattern of extrinsic restrictive PFTs. The most common indicator of obesity-related disease is a ↓ in ERV and Pulmonary & Critical Microbiology 2
FRC, but FEV1, FVC, and TLC are also typically ↓. Care (PU) (Micr)
14840 Metabolic acidosis Acidosis stimulates renal ammoniagenesis, a process by which renal tubular epithelial cells metabolize glutamine to glutamate, generating ammonium that is excreted in Pulmonary & Critical Microbiology 4
the urine and bicarbonate that is absorbed into the blood. This process is responsible for the vast majority of renal acid excretion in chronic acidotic states. Care (PU) (Micr)
14925 Enzyme kinetics Competitive inhibitors compete with substrate for active binding sites on enzymes. Additional substrate is required to achieve the same rate of reaction, increasing the Pulmonary & Critical Microbiology 1
measured value of the Michaelis constant (Km). Competitive inhibitors do not affect enzyme function; therefore, maximal velocity (Vmax) is unchanged in their presence. Care (PU) (Micr)
197 Antihistamines 1st-gen antihistamines can cause significant AEs due to blockade of cholinergic, α-adrenergic, and 5-HT-ergic pathways. They should be avoided in older pts w/ cognitive Pulmonary & Critical Pathology (Path) 3
or fxnal impairments. Care (PU)
310 Gastroesophageal reflux GERD is caused primarily by GEJ incompetence and can be a/w extraesophageal SSx (eg, nocturnal cough) in the absence of heartburn. Acidic gastric contents irritate the Pulmonary & Critical Pathology (Path) 7
disease esophageal mucosa, leading to Chx histologic findings that include basal zone hyperplasia, elongation of the lamina propria papillae, and scattered eosinophils. Care (PU)
476 Renal artery stenosis RAS is most often due to atherosclerosis. It can cause severe, refractory HTN due to activation of the RAAS. Over time, renal atrophy may occur due to chronic O2 and Pulmonary & Critical Pathology (Path) 9
nutrient deprivation. Histologic Ex may show crowded glomeruli, tubulointerstitial atrophy and fibrosis, and focal inflammatory infiltrates. Care (PU)
479 Hypertensive nephropathy Homogeneous deposition of eosinophilic hyaline material in the intima and media of small arteries and arterioles characterises hyaline arteriolosclerosis. This is typically Pulmonary & Critical Pathology (Path) 1
produced by un-Tx or poorly controlled HTN a/o DM. Care (PU)
484 Polyarteritis nodosa PAN is segmental, transmural, necrotizing inflammation of medium- to small-sized arteries. Renal artery involvement is often prominent. Vessels of the kidneys, heart, Pulmonary & Critical Pathology (Path) 2
liver, and gastrointestinal tract are most commonly involved in resulting ischemia, infarction, or hemorrhage. Cutaneous manifestations occur in up to one-third of Care (PU)
patients, and include palpable purpura. The lung is very rarely involved.
485 Giant cell arteritis GCA is char by granulomatous inflammation of the media, w/ fragmentation of the internal elastic lamina of medium and small branches of the carotid artery. Irreversible Pulmonary & Critical Pathology (Path) 5
blindness is a severe complication of GCA, and pts w/ suspected GCA req immediate GC therapy. Care (PU)
486 Aortic aneurysm Myxomatous changes w/ pooling of proteoglycans in the media layer of large arteries are found in CMD, which predisposes to the devel of ADs and AAs. Medial degen is Pulmonary & Critical Pathology (Path) 6
freq seen in younger individuals w/ Marfan syndrome. Care (PU)
490 Hemangioma Cutaneous, strawberry-type capillary hemangiomas are common, benign, congenital tumors, which are composed of unencapsulated aggregates of closely packed, thin- Pulmonary & Critical Pathology (Path) 6
walled capillaries. Initially, strawberry hemangiomas grow in proportion to the growth of the child, before eventually regressing. In 75-95% of cases, the vascular tumor Care (PU)
will regress completely by age 7.
491 Glomus tumor A benign glomus tumour (glomangioma) can produce a very tender, small (a few mm in diameter), red-blue lesion under the nail bed. This type of tumour originates from Pulmonary & Critical Pathology (Path) 1
the modded SMCs that control the thermoregulatory fxns of dermal glomus bodies. Care (PU)
525 Ischemic stroke Several mos to yrs after ischemic brain infarction, the necrotic area appears as a cystic cavity surrounded by a wall composed of dense fibers formed by astrocytic Pulmonary & Critical Pathology (Path) 19
processes (glial scar). Care (PU)
529 Epidural hematoma EDH is an accumulation of blood b/w the bone and dura mater. It typically occurs due to a tear of the MMA a/w fracture of the pterion region of the skull (often involving Pulmonary & Critical Pathology (Path) 2
the temporal bone). Pts char have transient LOC f/b a lucid interval before ↑ ICP leads to neuro deterioration. Care (PU)
531 Neural tube defects Valproate ↓ levels of folic acid and ↑ the risk of NTDs (eg, meningocele, myelomeningocele). Pulmonary & Critical Pathology (Path) 4
Care (PU)
533 Seizures Ethosuximide, the 1st-line Tx for absence seizures, prevents neuronal burst firing by blocking thalamic T-type Ca2+ channels. Phenytoin, carbamazepine, and valproic Pulmonary & Critical Pathology (Path) 8
acid inhib neuronal high-freq firing by ↓ the ability of Na+ channels to recover from inactivation. Care (PU)
535 Antipsychotics Tardive dyskinesia consists of abnormal involuntary movements of the mouth, tongue, face, extremities, or trunk associated with prolonged exposure to antipsychotics. Pulmonary & Critical Pathology (Path) 9
Characteristic movements include lip smacking, facial grimacing, tongue protrusions, and choreoathetoid movements of the head, limbs, and trunk. Care (PU)
552 Pulmonary embolism The risk of VTE (i.e. PE or DVT) in hospitalised pts can be greatly ↓ w/ the admin of prophylactic anticoags, usually w/ LMWH. Pulmonary & Critical Pathology (Path) 13
Care (PU)
553 Pulmonary arterial Hereditary PAH develops in 2 steps. An abn BMPR2 gene predisposes affected individuals to excessive endothelial and SMC proliferation. An insult (e.g. infection, Pulmonary & Critical Pathology (Path) 8
hypertension drugs) is thought to then activate the disease process, resulting in vascular remodelling, ↑ pulm vascular resistance, and progr PAH. Care (PU)
554 Community acquired Lobar pneumonia is marked by the cytokine-mediated accumulation of neutrophils and proteinaceous material in the alveoli. Over several days, the proteinaceous material Pulmonary & Critical Pathology (Path) 21
pneumonia becomes fibrinous, neutrophils are replaced by macrophages, and macrophages digest the fibrinous exudate, thereby restoring normal lung histology. Care (PU)
555 Lung abscess Lung abscess usually occurs in individuals w/ episodes of impaired consciousness (e.g. alcohol/drug abuse, dementia) or ↓ ability to swallow (e.g. oesophageal strictures). Pulmonary & Critical Pathology (Path) 4
They're gen caused by aspiration of anaerobic and aerobic bacteria from the oral cavity into the LRT. Care (PU)
564 Immunoglobulins The carboxy terminal of the Fc portion of the heavy immunoglobulin chains represents the site that binds to the Fc receptors on neutrophils and macrophages. Antibody Pulmonary & Critical Pathology (Path) 2
bound to antigen is able to signal for the phagocytosis of that antigen by a conformational change of the Fc region allowing binding to the Fc receptor on phagocytes. This Care (PU)
leads to subsequent phagocytosis of the organism / antibody complex and subsequent destruction of the organism.
565 Immunoglobulins The CCC begins w/ binding of the C1 complement component to either 2 molecules of IgG or to 2 molecules of IgM. B/c IgM circulates in pentameric form, it's a much Pulmonary & Critical Pathology (Path) 2
better activator of the complement system. The C1 molecule binds to the Fc region of the heavy Ig chain in the region near the hinge point. Care (PU)
648 Glioblastoma (Multiforme) GBM is the most common 1° brain tumour in adults. Areas of necrosis and hemorrhage are seen on gross Ex. LM showing pseudopalisading tumour cells around areas of Pulmonary & Critical Pathology (Path) 1
necrosis is Dx. Care (PU)
649 Brain tumors Pilocytic astrocytomas are the most common brain tumors in children. They frequently arise in the cerebellum and can be differentiated from medulloblastomas by the Pulmonary & Critical Pathology (Path) 10
presence of both cystic and solid components on imaging. Care (PU)
650 Hyperthyroidism Graves ophthalmopathy is caused by stimulation of orbital fibroblasts by thyrotropin receptor antibodies and cytokines released by activated T-cells. Excess deposition of Pulmonary & Critical Pathology (Path) 8
extracellular glycosaminoglycans and inflammatory infiltration lead to expansion of extraocular Muscles and retro orbital tissues. Glucocorticoids improve Graves Care (PU)
ophthalmopathy by decreasing the severity of inflammation and reducing the excess extraocular volume.
653 Amiodarone Amiodarone is 40% iodine by weight. It can cause hypothyroidism due to ↓ production of thyroid hormone. Amiodarone can also cause hyperthyroidism due to ↑ thyroid Pulmonary & Critical Pathology (Path) 1
hormone synthesis or destructive thyroiditis w/ release of preformed thyroid hormone. Care (PU)
666 Hyperthyroidism Agranulocytosis is a serious complication of antithyroid drugs (e.g. methimazole, PTU) that results from drug-induced granulocyte destruction and conseq neutropaenia. Pulmonary & Critical Pathology (Path) 8
Initial MFxs often incl fever, sore throat, and oral ulcerations. If drug-induced agranulocytosis is suspected, the drug should be discontinued immediately and a CBC w/ Care (PU)
diffial should be obtained to help confirm the Dx.
668 Paget disease of bone Osteoclasts originate from hematopoietic progenitor cells. Macrophage colony-stimulating factor and receptor for activated nuclear factor kappa-B ligand (RANK-L) play Pulmonary & Critical Pathology (Path) 4
an important role in osteoclast differentiation. Paget's disease of bone is characterized by increased numbers of abnormal osteoclasts, excessive bone turnover and Care (PU)
disorganized bone remodeling.
669 Osteoporosis The receptor activator of nuclear factor kappa B (RANKY/RANK ligand (RANK-L) interaction is essential for the formation and differentiation of osteoclasts. Pulmonary & Critical Pathology (Path) 10
Osteoprotegerin blocks binding of RANK-L to RANK and reduces formation of mature osteoclasts. Low estrogen states cause osteoporosis by decreasing osteoprotegerin Care (PU)
production, increasing RANK-L production, and increasing RANK expression in osteoclast precursors.
795 Ankylosing spondylitis Ankylosing spondylitis is characterized by stiffness and fusion of axial joints (ankylosis) and inflammation at the site of insertion of tendons into bone (enthesitis). Pulmonary & Critical Pathology (Path) 2
Involvement of the thoracic spine and costovertebral and costosternal junctions can limit chest wall expansion, leading to hypoventilation. Care (PU)
796 Rheumatoid arthritis Rheumatoid arthritis results from an immune response directed against autoantigens in the joints. Infiltrating CD4+ T cells secrete cytokines that promote inflammatory Pulmonary & Critical Pathology (Path) 9
synovitis. They also stimulate B cells to produce rheumatoid factor (IgM antibody specific for Fc component of IgG) and anti citrullinated protein antibodies that Care (PU)
contribute to chronic inflammation and joint destruction.
798 Myasthenia gravis Myasthenia gravis is associated with abnormalities of the thymus (e.g. thymoma, thymic hyperplasia). The thymus and inferior parathyroid glands arise from the 3rd Pulmonary & Critical Pathology (Path) 10
pharyngeal pouch. Care (PU)
799 Rough ER protein synthesis The rough endoplasmic reticulum (RER) is covered with ribosomes and is involved in the transfer of proteins to the cell membrane and extracellular space. The RER is Pulmonary & Critical Pathology (Path) 1
well developed in protein secreting cells. The smooth ER lacks surface ribosomes and functions in lipid synthesis, carbohydrate metabolism, and detoxification of harmful Care (PU)
substances.
803 Tetanus Clostridium tetani produces the neurotoxin tetanospasmin, which blocks inhibitory neurotransmission in the spinal cord and leads to tonic muscular contraction. Tetanus is Pulmonary & Critical Pathology (Path) 5
prevented by immunization with an inactivated toxoid that triggers the production of antitoxin antibodies (active immunity). Care (PU)
806 Ectopic thyroid The thyroid gland is formed from evagination of the pharyngeal epithelium and desc to the lower neck. Due to failure of migration, the thyroid can reside anywhere along Pulmonary & Critical Pathology (Path) 1
the thyroglossal duct's usual path, incl the tongue (lingual thyroid). Care (PU)
QID Topic Educational Objective System Subject Repeats
820 Drug induced myopathy The 1° side effects of statins include myopathy and hepatitis. Fibrates such as gemfibrozil can impair hepatic clearance of statins, ↑ the risk of severe myopathy. Pulmonary & Critical Pathology (Path) 3
Care (PU)
825 Dyslipidemia Familial chylomicronaemia syndrome (HLP-I) freq presents in childhood w/ recurrent episodes of acute pancreatitis. Pts w/ this disorder aren't usually at ↑ risk for Pulmonary & Critical Pathology (Path) 11
premature CAD. Eruptive skin xanthomas may be present in hypertriglyceridaemia, but tendon xanthomas and xanthelasmas are 1arily seen w/ hypercholesterolaemia. Care (PU)
877 Tinea Terbinafine is used for treatment of dermatophytosis. It inhibits synthesis of fungal membrane ergosterol by suppressing the enzyme squalene epoxidase. Pulmonary & Critical Pathology (Path) 4
Care (PU)
975 Cushing syndrome CS caused by a pit adenoma or ectopic (PNP) ACTH secretion is a/w ↑ ACTH lvls. High-dose dexamethasone suppresses ACTH and cortisol secretion when CS is caused Pulmonary & Critical Pathology (Path) 5
by a pit adenoma (CD) but not when it's caused by ectopic ACTH secretion (e.g. SCLC). Care (PU)
984 Benzodiazepines Benzos act by binding to the benzo binding site, which allosterically mods the binding of GABA, resulting in an ↑ freq of Cl- ion channel opening. The influx of Cl- ions Pulmonary & Critical Pathology (Path) 6
into the neurons causes neuronal hyperpol and inhib of the AP. Care (PU)
1041 Second messengers PKA is responsible for the intracellular effects of the G protein-mediated adenylate cyclase 2nd messenger system. Hormone receptors that use this system incl the TSH, Pulmonary & Critical Pathology (Path) 2
glucagon, and PTH receptors. Care (PU)
1147 Acute diarrhea Shiga-like tox (Vero cytotox), prod by EHEC, are nearly identical to the Shiga tox prod by S. dysenteriae. They inhib the 60S ribosomal subunit in human cells, thereby Pulmonary & Critical Pathology (Path) 13
blocking protein synth by preventing binding of tRNA. Care (PU)
1219 Wilson disease WD (hepatolenticular degen) is an AR condition of excess Cu leading to toxic accumulation in the liver, basal ganglia, and cornea. Chelation Thx w/ D-penicillamine is Pulmonary & Critical Pathology (Path) 5
indicated to remove excess loosely bound serum Cu. Care (PU)
1221 Positive predictive value (+) and (-) predictive values depend on disease prevalence in the tested pop. The sens and spec of a Dx test aren’t affected by disease prevalence. Pulmonary & Critical Pathology (Path) 1
Care (PU)
1222 Bias Lead-time bias occurs when a new test Dx a condition earlier than conventional studies, causing an apparent ↑ in survival time despite no improvement in overall Pulmonary & Critical Pathology (Path) 4
mortality. Long-term mortality rates, not survival times, should be considered for measuring the effect of early screening and Tx. Care (PU)
1579 Cardiac physiology An ↑ in effective SV or EF is depicted on the LV pressure-volume relationship by widening of the loop w/ a shift in the isovolumic relaxation line to the left (indicating Pulmonary & Critical Pathology (Path) 6
less residual blood volume in the ventricle at end-systole). Care (PU)
1876 Peroneal neuropathy The common peroneal nerve is vulnerable to injury where it courses around the neck of the fibula. Fibular neck fractures can injure this nerve, causing weakness of Pulmonary & Critical Pathology (Path) 3
dorsiflexion (deep peroneal nerve) and eversion (superficial peroneal nerve) of the foot as well as loss of sensation over the dorsum of the foot. Care (PU)
1881 Fragile X syndrome FXS is an XL disorder that Px w/ a long, narrow face, a prominent chin and forehead, and large testes. Pts often have developmental delay and neuropsych findings that Pulmonary & Critical Pathology (Path) 3
overlap w/ anxiety disorders, autism, and ADHD. Care (PU)
1925 Sickle cell Dactylitis (painful swelling of the hands and feet) is a common presentation of sickle cell disease (SCD) in young children. It is one of many vasoocclusive manifestations Pulmonary & Critical Pathology (Path) 13
of SCD. Sickling episodes result in hemolysis, which leads to increased indirect bilirubin and lactate dehydrogenase and decreased levels of haptoglobin. Care (PU)
2101 Enhancer sequence Enhancers and silencers may be located upstream, downstream, or within a transcribed gene; these gene sequences function to increase and decrease the rate of Pulmonary & Critical Pathology (Path) 1
transcription, respectively. In contrast, promoter regions are typically located 25 or 75 bases upstream from their associated genes and function to initiate transcription. Care (PU)
2102 Mutations A frameshift mutation occurs with the deletion/addition of a number of bases not divisible by 3 in the coding region of a gene. Frameshift mutations alter the reading Pulmonary & Critical Pathology (Path) 3
frame of the genetic code, dramatically changing the protein structure and often resulting in the formation of a premature stop codon. Care (PU)
2116 tRNA structure Transfer RNA (tRNA) is a small, noncoding form of RNA that contains chemically modified bases (eg, dihydrouridine, ribothymidine, pseudouridine). tRNA has a CCA Pulmonary & Critical Pathology (Path) 1
sequence at its 3'-end that is used as a recognition sequence by proteins. The 3' terminal hydroxyl group of the CCA tail serves as the amino acid binding site. Care (PU)
7648 Polycystic ovary disease Polycystic ovary syndrome is characterized by elevated LH levels, excess androgen production, and insulin resistance. Clinical features include obesity, menstrual Pulmonary & Critical Pathology (Path) 4
irregularities, hirsutism, enlarged ovaries, and an increased risk of diabetes mellitus and endometrial hyperplasia. Care (PU)
12293 Tourette syndrome Tourette syndrome is a common childhood neuropsych disorder characterised by both vocal and multi motor tics. These tics char wax and wane, can be suppressed Pulmonary & Critical Pathology (Path) 1
temporarily, and are preceded by a premonitory urge. Care (PU)
15061 COPD Most COPD exacerbations are triggered by viral or bacterial URIs, w/ rhinovirus, influenza virus, H. influenzae, M. catarrhalis, and S. pneumoniae being among the most Pulmonary & Critical Pathology (Path) 16
common causes. Care (PU)
15070 Informed consent The process of informed consent involves understanding a pt's knowledge about Tx, responding to specific concerns, and discussing the risks and benefits of Tx and the Pulmonary & Critical Pathology (Path) 3
risks of refusing Tx. Care (PU)
15212 Chikungunya fever Chikungunya is an α-virus spread by mosquitos to humans in tropical and subtropical areas. Initial MFx incl self-limited fever, severe polyarthralgia, and rash. Relapsed Pulmonary & Critical Pathology (Path) 1
or chronic arthralgias, polyarthritis (e.g. wrist, fingers, ankles), or tenosynovitis occur in >50% of infected individuals. Care (PU)
15429 Prerenal azotemia Hypovolemia (eg, excessive diuresis) can cause AKI due to ↓ RBF (prerenal azotemia). Urine Na and fractional excretion of Na levels are low, and the BUN/creatinine Pulmonary & Critical Pathology (Path) 6
ratio is ↑. In severe cases, ATN can occur and cause an intrinsic renal injury pattern (ie, high urine Na, normal BUN/creatinine ratio) w/ muddy brown casts on UA. Care (PU)
302 Achalasia Chagas disease is caused by a chronic infection by Trypanosoma cruzi and causes secondary achalasia due to destruction of the submucosal (Meissner) and myenteric Pulmonary & Critical Pathophysiology 3
(Auerbach) plexus. Other manifestations can include nonischemic cardiomyopathy and megacolon. Care (PU) (Patp)
399 Hepatitis A HAV infection is most commonly silent or subclinical ('anicteric') in young children but can also present as an acute, self-limited illness characterised by jaundice, Pulmonary & Critical Pathophysiology 4
malaise, fatigue, anorexia, nausea, vomiting, RUQ pain, or an aversion to smoking. Care (PU) (Patp)
487 Aortic aneurysm AAA is a/w RFs (e.g. age >60, smoking, HTN, male sex, FHx) that lead to chronic transmural inflammation and ECM degradation w/i the wall of the aorta. This leads to Pulmonary & Critical Pathophysiology 6
weakening and progr expansion of the aortic wall, resulting in aneurysm formation, typically below the renal arteries. Care (PU) (Patp)
488 Aortic dissection AD classically presents w/ severe retrosternal pain that radiates to the back. This condition develops when overwhelming hemodynamic stress leads to tearing of the aortic Pulmonary & Critical Pathophysiology 6
intima w/ blood subseq dissecting thru the aortic media. The resulting intramural hematoma can extend both proximally and distally and can compress major arterial Care (PU) (Patp)
branches and impair blood flow.
489 Inherited thrombophilia Inherited causes of hypercoagulability should be considered in pts younger than age 50 who present w/ thrombosis and no obvi explanation for an acq prothrombotic state. Pulmonary & Critical Pathophysiology 2
The FV Leiden mut, which causes FVa resistance to inactivation by activated protein C, may account for approx. 20% of cases of atypical venous thrombosis. Care (PU) (Patp)
521 Subarachnoid hemorrhage SAH Px w/ a generalized, excruciating h/a. It is classically described by pts as "the worst h/a of my life." SAH usually occurs due to rupture of saccular (berry) aneurysms Pulmonary & Critical Pathophysiology 4
or AVMs. Berry aneurysms of the COW are a/w AD PKD. Care (PU) (Patp)
522 Hemorrhagic stroke Deep intraparenchymal hemorrhage is most commonly caused by HTN vasculopathy of the small penetrating branches of the cerebral arteries (Charcot-Bouchard Pulmonary & Critical Pathophysiology 3
aneurysm rupture). This is in contrast to rupture of saccular aneurysms, which tyrupture of saccular aneurysms, which typically cause SAH. Care (PU) (Patp)
523 Hemorrhage stroke Cerebral amyloid angiopathy is the most common cause of spontaneous lobar hemorrhage, particularly in the elderly. The most common sites of hemorrhage include the Pulmonary & Critical Pathophysiology 1
occipital and parietal lobes. Care (PU) (Patp)
527 Syringomyelia Syringomyelia is characterised by the formation of a cavity (syrinx) in the cervical region of the spinal cord. The syrinx dmgs the ventral white commissure, leading to Pulmonary & Critical Pathophysiology 2
bilateral loss of pain and temp sensation that's limited to the affected lvls (typically the arms and hands); distal sensation is preserved. Destruction of the motor neurons in Care (PU) (Patp)
the ventral horns (due to extension of the syrinx) results in flaccid paralysis and atrophy of the intrinsic muscles of the hand.
528 Chiari malformation Chiari malformations are congenital disorders that result from underdevelopment of the posterior fossa, causing parts of the cerebellum and medulla to herniate through Pulmonary & Critical Pathophysiology 1
the foramen magnum. Chiari-I is relatively benign and Px during adulthood w/ occipital h/a and cerebellar dysfxn. Chiari-II is a more severe form that affects neonates Care (PU) (Patp)
and is often a/w lumbar myelomeningocele and hydrocephalus.
530 Subdural hematoma SDH occurs due to the rupture of cortical bridging veins. In young pts, it results from a fall or MVA and MFx w/ gradual onset of h/a and confusion. In elderly pts it may Pulmonary & Critical Pathophysiology 1
occur after a minor trauma and present w/ a variety of neuro SSx. You should know how to recognise this on CT scan. Care (PU) (Patp)
661 Huntington disease An increased number of trinucleotide repeats on the HTT gene is associated with Huntington disease. The larger the number of repeats, the earlier the onset of the disease. Pulmonary & Critical Pathophysiology 5
Trinucleotide expansion occurs more frequently during paternal transmission, causing a genetic phenomenon called anticipation. Care (PU) (Patp)
663 Dystonia Dystonia is a syndrome of prolonged, repetitive muscle contractions. This condition may be the result of impaired fxn of the basal ganglia. Cervical dystonia (spasmodic Pulmonary & Critical Pathophysiology 1
torticollis), blepharospasm, and writer's cramp are the most common types of focal dystonia. Care (PU) (Patp)
670 Hypercalcemia PTH causes ↑ bone resorption, ↑ serum Ca lvls, and ↑ renal PO4 excretion. Chron high lvls of PTH ↑ the risk of OP. However, intermittent admin of recomb PTH analogs Pulmonary & Critical Pathophysiology 5
(e.g. teriparatide) induces a greater ↑ in osteoblast activity in proportion to osteoclast activity and a net ↑ in bone formation. Care (PU) (Patp)
804 SLE ANAs are found in almost all pts w/ SLE but are also found in many other AI disorders and have low specificity. Anti-dsDNA Abs and anti-Smith Abs have lower Pulmonary & Critical Pathophysiology 7
sensitivity but higher specificity. Care (PU) (Patp)
1460 Clostridium difficile In the absence of normal intestinal microbial flora (as may be the case after a course of antibiotics), Clostridium difficile can overgrow and produce enterotoxin (toxin A) Pulmonary & Critical Pathophysiology 7
infection and cytotoxin (toxin B). Clinical disease resulting from C difficile overgrowth can range from transient diarrhea to severe pseudomembranous colitis. Care (PU) (Patp)
1585 Coronary blood flow Coronary autoregulation allows coronary blood flow to be 1arily driven by myocardial O2 demand over a wide range of perfusion pressures (60-140mmHg). It's mostly Pulmonary & Critical Pathophysiology 9
accomplished by alterations in vascular resistance via release of adenosine and NO in response to myocardial hypoxia. Care (PU) (Patp)
1910 Anorexia nervosa Distorted bodyimage, inadequatediet, dryskin, and lanugo hair in a female suggest AN. Anorexic females commonly have impaired GnRH release from the hypothal, Pulmonary & Critical Pathophysiology 3
leading to low lvls of LH, FSH, and oestrogen (fxnal hypothal amenorrhoea). Care (PU) (Patp)
1919 Hemolytic uremic HUS is a common cause of ARF in children. It's characterised by the triad of MAHA, thrombocytopaenia, and AKI. Most cases develop following a diarrhoeal illness Pulmonary & Critical Pathophysiology 3
syndrome caused by Shiga toxin-producing organisms (e.g. E. coli O157:H7, S. dysenteriae). Care (PU) (Patp)
1939 Hypospadia and epispadia In males, incomplete fusion of the urethral (urogenital) folds results in hypospadias, an abnormal opening of the urethra proximal to the glans penis along the ventral shaft Pulmonary & Critical Pathophysiology 1
of the penis. Care (PU) (Patp)
1942 Hemangioma The key GFs that promote angiogenesis in neoplastic and granulation tissue are VEGF and FGF. Pro-inflammatory cytokines (e.g. IL-1, IFN-γ) can indirectly promote Pulmonary & Critical Pathophysiology 6
angiogenesis thru ↑ VEGF expression. The laminin in BMs may pose a physical barrier to the sprouting of new blood vessels. Care (PU) (Patp)
1985 Non-Hodgkin lymphoma Follicular lymphoma is an NHL of follicular B-lymphocytes. Pts w/ follicular lymphoma char have a translocation b/w chroms 14 and 18 which causes bcl-2 Pulmonary & Critical Pathophysiology 6
overexpression. Bcl-2 is considered a protooncogene b/c it has anti-apoptotic effects. Care (PU) (Patp)
7558 Endocarditis Vegetations are caused by bacterial colonization and growth on a sterile fibrin-platelet nidus that forms on the damaged/disrupted endothelial surface of the valvular Pulmonary & Critical Pathophysiology 15
apparatus. Care (PU) (Patp)
7614 Thalassemia The Kozak consensus sequence occurs on eukaryotic mRNA and is defined by the following sequence: (gcc)gccRccAUGG, in which R is either adenine or guanine. This Pulmonary & Critical Pathophysiology 3
sequence helps initiate translation at the methionine start codon (AUG). Care (PU) (Patp)
8260 Ventricular septal defect A VSD is a/w a low-pitched, holosystolic murmur at the mid to ↓ left sternal border. It accentuates during maneuvers that ↑ afterload (eg, handgrip maneuver). A small Pulmonary & Critical Pathophysiology 2
VSD is usually aSSx and produces a louder murmur due to higher interventricular pressure gradient. Care (PU) (Patp)
8262 Post-traumatic stress PTSD is characterised by intrusive thoughts, nightmares, flashbacks, avoidance of trauma reminders, hypervigilance, and sleep disturbance lasting >1mos. Pulmonary & Critical Pathophysiology 3
disorder Care (PU) (Patp)
QID Topic Educational Objective System Subject Repeats
11774 Hemorrhagic stroke Acute lesions to the cerebellar vermis typically cause truncal and gait ataxia due to impaired modulation of the medial-descending motor systems. Involvement of the Pulmonary & Critical Pathophysiology 3
lower vermis and the flocculonodular lobe also causes vertigo/nystagmus due to dysregulation of the vestibular nuclear complex. Care (PU) (Patp)
11900 Ureter injury The ureter can be injured during hysterectomy due to its close proximity to the uterine structures. The distal ureter may be severed during ligation of the uterine vessels Pulmonary & Critical Pathophysiology 3
because the ureter passes inferior and lateral to the uterine artery at the level of the internal cervical os prior to entering the bladder (eg, "water under the bridge"). Care (PU) (Patp)
12082 Hemorrhoids hemorrhoids results from abn distension of a portion of the anal AV plexus. The vascular components of internal hemorrhoids drain into the sup. rectal vein, which subseq Pulmonary & Critical Pathophysiology 2
drains into the IMV. Band ligation of hemorrhoids cuts off their blood supply, causing them to degen. Care (PU) (Patp)
12141 Post-traumatic stress First-line treatment for post-traumatic stress disorder includes trauma-focused cognitive-behavioral therapy and antidepressant medication. Selective serotonin reuptake Pulmonary & Critical Pathophysiology 3
disorder inhibitors have the best evidence for efficacy. Care (PU) (Patp)
12184 Mitral regurgitation Regurg flow into the LA in acute MR leads to ↑ LA pressure and ↑ LV EDV (preload). The low-resistance pathway also ↓ LV afterload w/ a resulting ↑ in EF but overall Pulmonary & Critical Pathophysiology 6
↓ in forward SV. ↑ LA pressure and ↓ CO result in pulm oedema and severe hypotension, respectively. Care (PU) (Patp)
14847 Erythropoietin ESAs can substantially improve anemia SSx, avoiding the need for blood transfusions in CKD and dialysis pts. However, ESAs are a/w incr risk for HTN and TE events. Pulmonary & Critical Pathophysiology 1
Care (PU) (Patp)
14922 Short bowel syndrome SBS typically occurs in pts w/ massive small bowel resection a/o Crohn disease due to loss of intestinal absorptive surface area and a ↓ in intestinal transit time. Pts Pulmonary & Critical Pathophysiology 1
usually present w/ postprandial voluminous diarrhoea and weight loss due to malabsorption. Loss of fxnal distal ileum may result in vitB12 defic. Care (PU) (Patp)
15155 Pneumocystis pneumonia Pneumocystis pneumonia is common in patients with advanced HIV and usually presents with slowly worsening cough and dyspnea, hypoxia, and bilateral interstitial Pulmonary & Critical Pathophysiology 2
infiltrates. Diagnosis requires visualizing the organism in respiratory secretions using special stains (eg, silver stain). First-line treatment is trimethoprim- Care (PU) (Patp)
sulfamethoxazole.
15156 Dilated cardiomyopathy Trastuzumab is a mAb that blocks HER2 to disrupt malignant cell signalling and encourage apoptosis. B/c HER2 helps preserve cardiomyocyte fxn, trastuzumab can Pulmonary & Critical Pathophysiology 8
cause cardiotox that manifests as a ↓ in myocardial contractility w/o cardiomyocyte destruction or myocardial fibrosis. Care (PU) (Patp)
15206 Esophagitis HSV esophagitis is most common in those w/ impaired cell-mediated immunity. Endoscopy typically reveals small vesicles and "punched-out" ulcers. Findings on Bx Pulmonary & Critical Pathophysiology 3
usually include multinucleated giant cells and eosinophilic intranuclear inclusions (Cowdry type A inclusion bodies). Acyclovir is the Tx of choice. Care (PU) (Patp)
15233 Immunotherapy Ca cells avoid immune recognition by overexpression PD-L1, which binds to the PD-1 receptor on Tc cells and inhibs their response (T-cell exhaustion). mAbs that block Pulmonary & Critical Pathophysiology 2
PD-L1 and PD-1 are effective against ca that express high lvls of neo-Ags on their surface b/c these tumours are particularly susceptible to immune recognition by Tc Care (PU) (Patp)
cells.
15276 Colorectal cancer Tumour stage (degree of invasion/spread) is the most important prognostic determinant for CRC. Tumours confined to the BM and lamina propria are early stage and have Pulmonary & Critical Pathophysiology 15
the best prognosis. Outcomes gen deteriorate as the stage advances: spread of tumour into the muscularis propria → regional LNs → distant sites. Care (PU) (Patp)
15335 HIV R5 strains (macrophage-tropic) of HIV attach to the host CD4 receptor and CCR5 chemokine coreceptor; CCR5 inhibs such as maraviroc can be used in the Tx of R5 Pulmonary & Critical Pathophysiology 11
virus. X4 strains (T lymphotropic) of HIV bind to the CD4 receptor and CXCR4 chemokine receptor; X4 virus can't be Tx w/ CCR5 inhibs. Care (PU) (Patp)
15370 Acute interstitial nephritis AIN is a common cause of renal dysfxn; up to 75% of cases are due to Rx incl NSAIDs, Abx, diuretics, and PPIs. Presenting features incl fever, rash, and eosinophilia. Pulmonary & Critical Pathophysiology 2
UA often demonstrates pyuria and WBC casts w/ ↑ urine eosinophils. Care (PU) (Patp)
15420 Alpha1 antitrypsin Pts w/ advanced emphysema typically have chronic CO2 retention leading to chronic resp acid w/ meta comp (high PaCO2, comp high HCO3-, slightly acidic pH), often Pulmonary & Critical Pathophysiology 8
deficiency accompanied by hypoxaemia (PaO2 <75mmHg on room air). Care (PU) (Patp)
15430 Prerenal azotemia Compensatory mechanisms for hypovolemia include activation of the renin-angiotensin-aldosterone system and increased antidiuretic hormone release. This results in Pulmonary & Critical Pathophysiology 6
increased renal sodium, chloride, water, and urea reabsorption with increased potassium excretion. Care (PU) (Patp)
15611 Asbestos Asbestosis is a pneumoconiosis that occurs w/ inhalation of asbestos fibres, most commonly in pts w/ occup exposure (e.g. insulation installation, shipbuilding, pipe Pulmonary & Critical Pathophysiology 5
work). Histopath demonstrates diffuse interstitial fibrosis and ferruginous asbestos bodies (translucent fibres coated w/ a golden Fe-containing material). Pleural disease Care (PU) (Patp)
(e.g. plaques, benign effusions) is common.
168 Calcium channel blocker CCBs inhib the L-type Ca2+ channel on vascular smooth muscle and cardiac cells. DHPs (e.g. nifedipine, amlodipine) primarily affect peripheral arteries and cause Pulmonary & Critical Pharmacology 3
vasodilation. Non-DHPs (e.g. verapamil, diltiazem) affect the myocardium and can cause bradycardia and slowed AV conduction. Care (PU) (Phar)
169 Subarachnoid hemorrhage Delayed cerebral ischemia due to cerebral vasospasm usually presents 3-12days after the initial SAH w/ an acute change in mental status a/o new focal neuro deficits. Pulmonary & Critical Pharmacology 4
Nimodipine, a selective CCB, improves outcomes in pts w/ cerebral vasospasm by inducing cerebral vasodilation and ↓ Ca2+-dependent excitotoxicity. Care (PU) (Phar)
170 Digoxin Digoxin toxicity typically presents with cardiac arrhythmias and nonspecific gastrointestinal (nausea, vomiting), neurological (confusion, weakness), and visual Pulmonary & Critical Pharmacology 4
symptoms. Elevated potassium is another sign of digoxin toxicity and is caused by inhibition of Na-K-ATPase pumps. Care (PU) (Phar)
171 Digoxin Digoxin directly inhibs the Na-K-ATPase pump in myocardial cells, leading to a ↓ in Na+ efflux and an ↑ in intracellular Na+ lvls. This ↓ the forward activity of the NCX, Pulmonary & Critical Pharmacology 4
causing ↑ intracellular Ca2+ concentration and improved myocyte contractility. Care (PU) (Phar)
903 Gout Chronic uric acid-lowering therapy is recommended for patients with gout who have frequent gouty attacks, uric acid kidney stones, tophi, or chronic joint destruction Pulmonary & Critical Pharmacology 11
from gout. Xanthine oxidase inhibitors are the preferred treatment. Care (PU) (Phar)
1194 Urinary tract infection Escherichia coli is the most common cause of UTI in both healthy adults and elderly pts. E coli is a part of the normal GI flora, and special adhesive proteins (fimbriae) Pulmonary & Critical Pharmacology 12
allow some strains to colonize and ascend the urinary tract. This can result in UTI, pyelonephritis, or bacteremia and sepsis following access to the bloodstream. UTIs are Care (PU) (Phar)
the most common cause of E coli bacteremia.
1212 Osteocyte connections Osteocytes have long intracanalicular processes that extend through the ossified bone matrix. These cytoplasmic processes send signals to and exchange nutrients and Pulmonary & Critical Pharmacology 1
waste products with the osteocytes within neighboring lamellae via gap junctions. Osteocytes can sense mechanical stresses and send signals to modulate the activity of Care (PU) (Phar)
surface osteoblasts, thereby helping to regulate bony remodeling.
1446 Hemoglobin properties A left shift of the Hb O2 dissociation curve indicates ↑ Hb O2 affinity and can be caused by ↑ pH, ↓ 2,3-BPG, and ↓ temperature. Leftward shifts of the curve inhibit the Pulmonary & Critical Pharmacology 4
release of O2 w/i peripheral tissues. Care (PU) (Phar)
1523 Lead poisoning Young children who reside in homes built before 1978 are at significant risk for Pb toxicity. Pb directly inhibits ferrochelatase and δ-ALA dehydratase, resulting in Pulmonary & Critical Pharmacology 4
anemia, ALA accumulation, and ↑ Zn protoporphyrin levels. Neurotoxicity is also a significant long-term complication. Care (PU) (Phar)
2128 Schizophrenia The Dx of schizophrenia req >2 of the following 5 SSx: delusions, hallucinations, disorganised speech, grossly disorganised behaviour, and (-) SSx. The total impairment Pulmonary & Critical Pharmacology 4
duration must be >6mos. Care (PU) (Phar)
8754 Turner syndrome TS is a/w congenital anomalies of the aorta, and the most common defect is a bicuspid AV. A nonstenotic bicuspid AV can MFx as an early systolic, high-frequency click Pulmonary & Critical Pharmacology 8
over the right 2nd interspace. Bicuspid AVs are at risk for stenosis, insufficiency, and infection. Care (PU) (Phar)
11752 Health insurance Medicare is a federal socialized medical insurance program that covers individuals age 65 and older who have a work Hx and younger individuals w/ disabilities. Pulmonary & Critical Pharmacology 3
Care (PU) (Phar)
15126 Benign prostatic BPH can ↑ resistance to urine flow in the urethra and lead to incomplete bladder emptying during micturition. The residual urine can act as a growth medium for Pulmonary & Critical Pharmacology 6
hyperplasia pathogenic bacteria and ↑ the risk for UTI. Care (PU) (Phar)
481 Polyarteritis nodosa PAN is a multisystem vasculitis char by episodic ischemic SSx in various organs w/ sparing of the lungs. Bx shows segmental, transmural inflammation w/ fibrinoid Pulmonary & Critical Physiology 2
necrosis. PAN is commonly a/w hepB. Care (PU) (Phys)
536 Neuroleptic malignant NMS is an AE to antipsych Rx characterised by severe 'lead-pipe' rigidity, hyperthermia, sympathetic hyperactivity, and mental status changes. NMS is characterised by Pulmonary & Critical Physiology 2
syndrome severe rigidity rather than the NM irritability (e.g. hyperreflexia, myoclonus) seen in SS. Care (PU) (Phys)
1357 DIC The most common trigger for DIC in preg is release of tissue factor (thromboplastin) from an injured placenta (e.g. placental abruption) into the maternal circulation. DIC Pulmonary & Critical Physiology 5
presents w/ bleeding from incision sites, IV line sites, and mucosal surfaces due to rapid consumption of clotting factors and platelets. Care (PU) (Phys)
1414 Opioids Opioid withdrawal is marked by mydriasis, abdo pain, diarrhoea, piloerection, lacrimation, and yawning. It's gen non-life-threatening, unlike withdrawal from alcohol and Pulmonary & Critical Physiology 13
benzos. Care (PU) (Phys)
1494 Personality disorders APD is a maladaptive pattern of behaviour characterised by social inhib, feelings of inadequacy, and fear of embarrassment and rejection. Pulmonary & Critical Physiology 6
Care (PU) (Phys)
1514 Metronidazole Metronidazole is used to Tx trichomonal vaginitis and bacterial vaginosis. It can cause disulfiram like effects (eg, abdominal cramps, nausea, headache) when combined Pulmonary & Critical Physiology 1
w/ Alc due to acetaldehyde accumulation. Care (PU) (Phys)
1521 Facial nerve The stapedius muscle is innervated by the stapedius nerve (a branch of CNVII). Paralysis of the stapedius muscle results in hyperacusis (e.g. ↑ sensitivity to sound). Pulmonary & Critical Physiology 3
Care (PU) (Phys)
1522 Trigeminal nerve General sensation from the anterior 2/3 of the tongue is carried by the mandibular division of the trigeminal nerve. Gustatory innervation of the anterior 2/3 of the tongue Pulmonary & Critical Physiology 3
is provided by the chorda tympani branch of the facial nerve. Care (PU) (Phys)
1526 Narcolepsy Narcolepsy is a chronic sleep disorder characterised by excessive daytime sleepiness, cataplexy, and REM sleep-related phenomena (i.e. hypnagogic/hypnopompic Pulmonary & Critical Physiology 3
hallucinations, sleep paralysis). Care (PU) (Phys)
1527 Defense mechanisms Rxn formation is a defence mech that involves replacing unacceptable feelings and impulses w/ their extreme opposites. Pulmonary & Critical Physiology 8
Care (PU) (Phys)
1541 DNA structure & function Nucleosomes are composed of DNA wrapped around a core of 8 histone proteins (2 molecules each of H2A, H2B, H3, and H4). H1 histone is located outside of this Pulmonary & Critical Physiology 2
histone core and helps package nucleosomes into more compact structures by binding and linking the DNA b/w adjacent nucleosomes. Care (PU) (Phys)
1542 Mitochondrial disorders Mitochondrial DNA (mtDNA) is the most common non-nuclear DNA found in eukaryotic cells. It resembles prokaryotic DNA and is maternally derived. Mutations Pulmonary & Critical Physiology 4
involving mtDNA or nuclear DNA that codes for mitochondrial proteins can cause a variety of mitochondrial disorders, including Leigh syndrome and MELAS. Care (PU) (Phys)
1543 Radiation therapy Exposure to ionizing radiation, including therapeutic and palliative radiation therapy, induces DNA damage through DNA double-strand fractures and the formation of Pulmonary & Critical Physiology 1
oxygen free radicals. Care (PU) (Phys)
1548 Urea cycle Arginase is a urea cycle enzyme that produces urea and ornithine from arginine. Arginase deficiency results in progressive spastic diplegia, growth delay, and abnormal Pulmonary & Critical Physiology 3
movements. Treatment includes an arginine-free, low-protein diet. Care (PU) (Phys)
1563 Upper respiratory tract Adenovirus is a self-limiting, yr-round infection that causes the acute onset of fever, cough, congestion, pharyngitis, and conjunctivitis. This pharyngoconjunctival disease Pulmonary & Critical Physiology 2
infections can occur in outbreaks among those living in close quarters (eg, camp dormitories, military barracks). Care (PU) (Phys)
1582 Cardiac physiology The cardiac AP conduction speed is slowest in the AV node and fastest in the Purkinje system. Conduction speed of the atrial muscle is faster than that of the ventricular Pulmonary & Critical Physiology 6
muscle. Care (PU) (Phys)
1583 Cystic fibrosis CF is an AR disease caused by muts in the CFTR gene. The CFTR protein is a transmembrane ATP-gated Cl- channel. Defects in CFTR result in thick, plugging mucous Pulmonary & Critical Physiology 11
and incr Na+ and Cl- lvls in sweat. Care (PU) (Phys)
1584 Carotid baroreceptors Carotid sinus massage leads to an ↑ in PSNS tone causing temporary inhib of SA node activity, slowing of conduction thru the AV node, and prolongation of the AV node Pulmonary & Critical Physiology 1
refractory period. It's a useful vagal manoeuvre for termination of PSVT. Care (PU) (Phys)
QID Topic Educational Objective System Subject Repeats
1586 Mitral stenosis The classic cardiac auscultation findings in MV stenosis include an OS f/b a diastolic rumbling murmur that is heard best over the apex of the heart. On the ventricular Pulmonary & Critical Physiology 7
pressure-volume loop, MV opening occurs at the point b/w isovolumetric relaxation and diastolic filling. Care (PU) (Phys)
1587 AV fistula and P/V curves AV shunts can be congenital or acquired; acquired forms can result from medical interventions or penetrating injuries. AV shunts ↑ preload and ↓ afterload by routing Pulmonary & Critical Physiology 1
blood directly from the arterial system to the venous system, bypassing the arterioles. High-volume AV shunts can eventually result in high-output cardiac failure. Care (PU) (Phys)
1590 Asthma Asthma is characterized by reversible airway obstruction, and lung function tests may be normal between exacerbations. Bronchoprovocation can be used to aid diagnosis Pulmonary & Critical Physiology 12
in patients with normal spirometry; methacholine is administered and followed by serial spirometry. Patients with asthma demonstrate hyperresponsivity to the stimulus, Care (PU) (Phys)
leading to FEV1 reductions at lower doses than in those without asthma.
1650 Acute respiratory failure There're 5 major causes of hypoxemia (low PaO2): alv hypovent, low PiO2, V/Q mismatch, diffusion impairment, and R-L shunting. The A-a gradient is normal w/ alv Pulmonary & Critical Physiology 1
hypovent and low PiO2, which helps distinguish these causes from other causes of hypoxemia. Care (PU) (Phys)
1980 SCA mutation Exertional dyspnea, pneumonia resulting in life-thr ACS, and recurrent abdo and bone pain are CFx of SCA. SCA results from a point mut that causes valine to substitute Pulmonary & Critical Physiology 1
for glutamic acid in the 6th position of the beta-globin chain of Hb. Care (PU) (Phys)
1981 West Nile virus infection West Nile virus is a single-strand flavivirus transmitted by mosquitoes, most commonly in the summer. Most infections are asymptomatic or may present with a flu-like Pulmonary & Critical Physiology 2
illness (West Nile fever), often with a maculopapular or morbilliform rash. Neuroinvasive disease manifests as meningitis, encephalitis, or asymmetric flaccid paralysis; Care (PU) (Phys)
patients may have parkinsonian features.
7601 Sickle cell An MCV >110μm3 is highly suggestive of megaloblastic anaemia, such as that caused by vitB9 or vitB12 defic. Pts w/ chronic hemolytic anaemia have ↑ vitb9 req due to Pulmonary & Critical Physiology 13
↑ erythrocyte turnover and are predisposed to devel macrocytosis. Care (PU) (Phys)
7660 von Willebrand disease vWF fxns as a promoter of platelet adhesion at sites of vasc injury by binding platelet GPs to SEC on injured blood vessel walls. It also acts as a protective carrier protein Pulmonary & Critical Physiology 7
for circulating FVIII. Care (PU) (Phys)
7661 Pulsus paradoxus PP is defined by a ↓ in SBP of >10 mm Hg w/ inspiration. It is most commonly seen in pts w/ CT but can also occur in severe asthma, COPD, and constrictive pericarditis. Pulmonary & Critical Physiology 2
Care (PU) (Phys)
12100 Dandy-Walker syndrome DWM is a developmental anomaly Chx by hypoplasia/absence of the cerebellar vermis and cystic dilation of the 4th ventricle w/ posterior fossa enlargement. Pts often Px Pulmonary & Critical Physiology 1
during infancy w/ developmental delay and progressive skull enlargement. Other features may include cerebellar dysfxn and NCH. Care (PU) (Phys)
15240 Aortic stenosis Angina often occurs in AS even in the absence of obstr CAD. It results from ↑ myocardial O2 demand due to an ↑ in LV mass (i.e. concentric hypertrophy) and ventricular Pulmonary & Critical Physiology 8
wall stress. Care (PU) (Phys)
2 Congenital anomalies of In horseshoe kidney, the kidneys are fused at the poles. The isthmus of the horseshoe kidney usually lies anterior to the aorta and posterior to the inferior mesenteric artery Renal, Urinary & Anatomy (Anat) 3
kidney and urinary tract (IMA). During fetal development, the IMA limits the ascent of the horseshoe kidney. Electrolytes (RE)
1680 Graft versus host disease Graft-versus-host disease can occur following transplantation of organs rich in lymphocytes (eg. liver). T lymphocytes found in the donor organ become sensitized against Renal, Urinary & Anatomy (Anat) 1
the MHC antigens of the recipient and subsequently attack the host's tissues. The skin, liver, and gastrointestinal tract are most frequently affected. Electrolytes (RE)
1700 Ovarian cancer The suspensory ligament of the ovary contains the ovarian artery, vein, lymphatics, and nerves. The ovarian artery is the major blood supply to the ovary and must be Renal, Urinary & Anatomy (Anat) 9
ligated during an oophorectomy to prevent heavy bleeding. Electrolytes (RE)
1804 Rotator cuff The most commonly injured structure in RCS is the tendon of the supraspinatus muscle. B/c the supraspinatus is an abductor of the humerus, injury to its tendon causes Renal, Urinary & Anatomy (Anat) 3
pain on abduction of the arm. Electrolytes (RE)
10962 Polycythemia PV is a clonal MPD characterised by an ↑ RBC mass, ↑ plasma volume, and low EPO lvls. PV can be diffiated from 2° polycythemia by the presence of leucocytosis, Renal, Urinary & Anatomy (Anat) 5
thrombocytosis, a/o splenomegaly. The majority of pts w/ PV have a JAK2 mut rendering HSCs more sensitive to GFs. Electrolytes (RE)
11708 Cytomegalovirus CMV oesophagitis can occur in transplant pts and usually presents w/ odynophagia or dysphagia that can be accompanied by fever or burning chest pain. Endoscopy Renal, Urinary & Anatomy (Anat) 9
typically shows linear and shallow ulcerations in the lower oesophagus, and histo usually shows enlarged cells w/ intranuclear inclusions. Electrolytes (RE)
2017 Lymphoedema Axillary LN dissection is an RF for the devel of chronic lymphoedema involving the ipsilateral arm. Chronic lymphoedema predisposes to the devel of angiosarcoma Renal, Urinary & Biochemistry 1
(Stewart-Treves syndrome). Electrolytes (RE) (Bioc)
11939 Medial collateral ligament The medial collateral ligament resists force that pushes the knee medially. Increased laxity of the knee with the valgus stress test indicates injury to the medial collateral Renal, Urinary & Biochemistry 1
injury ligament. Electrolytes (RE) (Bioc)
652 Testicular cancer Human chorionic gonadotropin (hCG) has a structure similar to TSH. Patients with testicular germ cell tumors or gestational trophoblastic disease may develop very high Renal, Urinary & Embryology 4
serum hCG concentrations, which can stimulate TSH receptors and cause paraneoplastic hyperthyroidism. Electrolytes (RE) (Embr)
837 Sarcoidosis Sarcoidosis is a CD4+ T-cell mediated disease, in which large # of CD4+ lymphocytes release IFN-γ and TNF-α to drive macrophage activation and granuloma formation. Renal, Urinary & Embryology 7
BAL fluid in pulm sarcoidosis demonstrates a lymphocytic predominance w/ a high CD4+/CD8+ ratio. Electrolytes (RE) (Embr)
1736 Community acquired Influenza infection alters the resp epithelium and can ↑ the risk of 2° bacterial pneumonia. The leading pathogens are S. pneumoniae, S. aureus, and H. influenzae. The Renal, Urinary & Embryology 21
pneumonia elderly are affected most commonly, but S. aureus can cause 2° pneumonia in young, previously healthy pts. Electrolytes (RE) (Embr)
1752 Hand injury The lunate bone is the more med. (ulnar) of the 2 prox. carpal bones that articulate w/ the radius. A FOOSH can cause dislocation of the lunate bone w/ resulting Renal, Urinary & Embryology 1
compression of the median nerve (e.g. wrist pain, numbness in the 1st 3.5 digits). Electrolytes (RE) (Embr)
1915 Multiple endocrine MEN-1 syndrome is characterised by tumours of the pituitary, PT gland, and pancreas (the '3 Ps'). Renal, Urinary & Embryology 5
neoplasia Electrolytes (RE) (Embr)
904 Aging Presbyopia and skin wrinkles are age-related changes. Presbyopia occurs due to denaturation of structural proteins within the lens, leading to loss of lens elasticity which Renal, Urinary & Genetics (Gene) 8
can result in improved vision in patients with mild myopia. Decreased synthesis and increased breakdown of collagen and elastin contribute to the development of skin Electrolytes (RE)
wrinkles.
8 Poststreptococcal Poststreptococcal glomerulonephritis is most common in children and presents with nephritic syndrome (eg, renal failure, hypertension, hematuria with red blood cell Renal, Urinary & Histology (Hist) 8
glomerulonephritis casts) 2-4 weeks after an infection with group A β-hemolytic Streptococcus. Immunofluorescence microscopy shows granular deposits of IgG, IgM, and C3 in the Electrolytes (RE)
mesangium and basement membranes.
9 Anti GBM disease Anti-glomerular basement membrane (GBM) antibodies react with collagen type IV, causing rapidly progressive glomerulonephritis with glomerular crescent formation Renal, Urinary & Histology (Hist) 2
on light microscopy. Immunofluorescence demonstrating linear deposits of IgG and C3 along the GBM is characteristic. Electrolytes (RE)
27 Poststreptococcal Poststreptococcal glomerulonephritis is an immune complex-mediated disease that occurs 2-4 weeks after group A β-hemolytic Streptococcus infection. Immune Renal, Urinary & Histology (Hist) 8
glomerulonephritis complexes composed of IgG, IgM, and C3 are deposited along the glomerular basement membrane and are visible on electron microscopy as large, dome-shaped, Electrolytes (RE)
subepithelial, electron-dense deposits.
546 COPD Thickened bronchial walls, lymphocytic infiltration, mucous gland enlargement, and patchy squamous metaplasia of the bronchial mucosa are features of chronic Renal, Urinary & Immunology 16
bronchitis. Tobacco smoking is the leading cause of chronic bronchitis. Electrolytes (RE) (Immu)
567 Major histocompatibility MHC class II is expressed on the surface of antigen presenting cells (APC) and presents extracellular antigens to T cells after extracellular protein is degraded within Renal, Urinary & Immunology 1
class acidified lysosomes. Failure to acidify lysosomes would lead to deficient expression of MHC class II-antigen complexes with subsequent impaired interaction between Electrolytes (RE) (Immu)
APCs and T cells.
744 Warfarin reversal Both vitK and FFP are used for reversing warfarin-induced anticoag. FFP rapidly reverses warfarin's effects whereas vitK req time for clotting factor re-synthesis. Renal, Urinary & Immunology 1
Electrolytes (RE) (Immu)
747 Drug induced myopathy Statins inhib the intracellular RLS of chol biosynthesis via competitive inhib of HMG-CoA reductase. This leads to enhanced hepatic LDL receptor recycling and ↑ LDL Renal, Urinary & Immunology 3
clearance from the circulation. Statin-induced myopathy (e.g. myalgia, ↑ CK) is the most common complication of statin use. Electrolytes (RE) (Immu)
758 Skin and soft tissue ARF and PSGN are post-infectious complications of GAS (S pyogenes) infections. PSGN can follow either streptococcal skin infection (impetigo) or streptococcal Renal, Urinary & Immunology 8
infections pharyngitis, whereas ARF is classically associated only w/ streptococcal pharyngitis. Electrolytes (RE) (Immu)
11786 Gynecomastia Gynecomastia is the devel of glandular breast tissue in males and is commonly seen in men receiving androgen deprivation therapy for prostate ca. Tamoxifen inhibs the Renal, Urinary & Immunology 3
effect of oestrogen on breast tissue and can ↓ the risk of gynecomastia in these pts. Electrolytes (RE) (Immu)
1096 Diabetes insipidus The asc. limb of the LOH is impermeable to water regardless of serum ADH lvls. Reabsorption of electrolytes by the Na+/K+/2Cl-cotransporter occurs in the thick asc. Renal, Urinary & Microbiology 4
limb and contributes to formation of the corticomedullary conc gradient. Electrolytes (RE) (Micr)
1146 Acute diarrhea Enterohemorrhagic Escherichia coli (EHEC) is primarily contracted after eating undercooked ground beef. EHEC produces Shiga toxin, which causes hemorrhagic colitis Renal, Urinary & Microbiology 13
and can lead to hemolytic uremic syndrome (HUS). HUS is characterized by acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia; children age Electrolytes (RE) (Micr)
<10 are at greatest risk.
8541 Interstitial lung disease Histologic findings of IPF are most prominent in the lung periphery and incl a heterogeneous mix of chronic inflammation and patchy interstitial fibrosis, focal fibroblast Renal, Urinary & Microbiology 8
proliferation, and formation of fibrotic cystic spaces in a honeycomb pattern. Electrolytes (RE) (Micr)
11812 Synapse V-gated Na channels are important for the generation and propagation of APs. When the AP reaches the axon terminal, v-gated Ca channels open and allow the influx of Renal, Urinary & Microbiology 1
Ca, which is essential for the fusion and release of NT vesicles into the synaptic cleft. Electrolytes (RE) (Micr)
1 Poststreptococcal PSGN presents most commonly in children w/ hematuria, HTN, and periorbital oedema. RBC casts and mild proteinuria may be present on UA, and serum creatinine may Renal, Urinary & Pathology (Path) 8
glomerulonephritis be ↑. Electrolytes (RE)
3 Polycystic kidney disease ADPKD is caused by muts in the polycystin genes (PKD1, PKD2), which result in cystic enlargement of the kidneys and progr renal dysfxn. CFx incl HTN, abdo/flank Renal, Urinary & Pathology (Path) 3
pain, and gross hematuria; extrarenal MFxs incl liver cysts and intracranial aneurysms. Electrolytes (RE)
7 Anti GBM disease Goodpasture syndrome is caused by auto-Abs against the α 3 chain of type IV collagen in GBM and ABMs (anti-GBM Abs). Pts typically present w/ RPGN (nephritic Renal, Urinary & Pathology (Path) 2
syndrome) and alveolar hemorrhage (SOB, hemoptysis). Electrolytes (RE)
10 Glomerular disorders IgA nephropathy (Berger disease) freq presents as recurrent, self-limited, painless hematuria w/i 5 days of an URI. Kidney biopsy will show mesangial IgA deposits on IF. Renal, Urinary & Pathology (Path) 9
In contrast, PSGN is seen 1-3wks after streptococcal pharyngitis and is usually not recurrent. Electrolytes (RE)
11 Poststreptococcal PSGN is an IC-deposition disease that occurs 2-4wks after exposure to GAS (β-hemolytic) species (e.g. pharyngitis, skin infection). LM shows enlarged, hypercellular Renal, Urinary & Pathology (Path) 8
glomerulonephritis glomeruli. IF demonstrates a 'lumpy-bumpy' granular deposits of IgG and C3 on the GBM, and subepithelial, electron-dense deposits are seen on EM. Electrolytes (RE)
12 Poststreptococcal PSGN is the most common cause of nephritic syndrome in children. LM demonstrates enlarged, hypercellular glomeruli. Lab findings in PSGN incl ↑ anti-streptococcal Renal, Urinary & Pathology (Path) 8
glomerulonephritis Abs (e.g. ASO, anti-DNase B) and ↓ C3 and total complement lvls. C4 lvls are usually normal. Electrolytes (RE)
13 Granulomatosis with Pauci-immune rapidly progressive glomerulonephritis frequently occurs as a manifestation of antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (eg, Renal, Urinary & Pathology (Path) 2
polyangiitis granulomatosis with polyangiitis, microscopic polyangiitis). It is characterized by glomerular crescent formation without immunoglobulin or complement deposits. Electrolytes (RE)
24 Glomerular disorders Crescent formation on LM is Dx for RPGN. Crescents consist of glomerular parietal cells, lymphocytes, and macrophages along w/ abundant fibrin deposition. Crescents Renal, Urinary & Pathology (Path) 9
eventually become fibrotic, disrupting glomerular fxn and causing irreversible renal injury. Electrolytes (RE)
25 Poststreptococcal PSGN presents w/ oedema, HTN, and hematuria after a streptococcal infection. Most children recover completely, but adult pts have a relatively poor prognosis and Renal, Urinary & Pathology (Path) 8
glomerulonephritis higher risk of chronic HTN and renal insufficiency. Electrolytes (RE)
QID Topic
28 Glomerular disorders
178 Digoxin
211 Embolic stroke
229 Infertility
382 Mitochondrial diseases,
inheritance
383 Cystic fibrosis
384 Renal artery occlusion
385 snRNP function
455 Colorectal cancer
810 Subacute thyroiditis
811 Hypothyroidism
814 Pheochromocytoma
816 Serotonin syndrome
817 Opioids
818 Opioids
832 Gestational trophoblastic
disease - complete mole
833 Gestational trophoblastic
disease
834 Congenital adrenal
hyperplasia
835 Alzheimer disease
884 Thoracentesis
885 Diabetes mellitus
886 Diabetes mellitus
887 Diabetes mellitus
888 Hypoglycemia
905 Retinoblastoma
979 Adrenal insufficiency
1016 Professional conduct
1049 Endocarditis
1052 Endocarditis
1053 Meningitis
1054 Meningitis
1663 Infectious mononucleosis
1849 Warfarin
1850 Peptic ulcer disease
1862 Phenylketonuria
1913 Bulimia nervosa
1916 Aphasia
2072 Actinic keratoses
2073 Severe combined
immunodeficiency disease
2131 Generalized anxiety
disorder
6739 Physician patient
communication
7226 Protein synthesis
7227 Lesch-Nyhan syndrome
7570 Primary immunodeficiency SCID is caused by a genetic defect in T cell development, leading to loss of both cellular and humoral immunity. Pts Px in infancy w/ recurrent bacterial, viral, fungal, and Renal, Urinary &
disorder opport infections as well as FTT and chronic diarrhea.
7571 Hypersensitivity reactions
7623 Selective serotonin reuptake Cyproheptadine is an antihist w/ anti-5HT-ergic properties that can be used as an antidote in severe cases of SS that don't respond to supportive measures.
inhibitors
Educational Objective System Subject Repeats
MCD is the most common childhood nephrotic syndrome. ↑ glomerular cap permeability causes massive protein (e.g. albumin) loss in the urine. Hypoalbuminaemia ↓ Renal, Urinary & Pathology (Path) 9
plasma oncotic pressure, which causes a fluid shift into the interstitial space, resulting in oedema. Low oncotic pressure also triggers ↑ LP production in the liver (i.e. Electrolytes (RE)
hyperlipidaemia).
Digoxin is used for ventricular rate control in AF as it ↓ AV nodal conduction by ↑ parasympathetic vagal tone. Digoxin is also used in HF due to its (+) inotropic effect. Renal, Urinary & Pathology (Path) 4
These effects are accomplished via inhib of the Na-K-ATPase pump. Electrolytes (RE)
Paradoxical embolism occurs when a thrombus from the venous system crosses into the arterial circulation via an abnormal connection b/w the right and left cardiac Renal, Urinary & Pathology (Path) 1
chambers (eg, PFO, ASD, or VSD). Atrial left-to-right shunts cause wide and fixed splitting of S2 and can facilitate paradoxical embolism due to periods of transient Electrolytes (RE)
shunt reversal (eg, during straining or coughing).
Pulsatile administration of GnRH stimulates FSH and LH release and is useful for the Tx of infertility. Nonpulsatile (constant) infusion of GnRH, or a long-acting analog, Renal, Urinary & Pathology (Path) 3
suppresses FSH and LH release and subsequently suppresses gonadal fxn. Electrolytes (RE)
Red ragged muscle fibers are seen in mitochondrial diseases. Muscle fibers have this appearance b/c abnormal mitochondria accumulate under the sarcolemma. Renal, Urinary & Pathology (Path) 1
Mitochondrial diseases show maternal inheritance. Electrolytes (RE)
The most common gastrointestinal disorder in patients with cystic fibrosis is pancreatic insufficiency. Mutations in the cystic fibrosis transmembrane conductance Renal, Urinary & Pathology (Path) 11
regulator gene lead to thick, viscous secretions in the lumens of the pancreas, resulting in obstruction, inflammation, and subsequent fibrosis. Clinical manifestations Electrolytes (RE)
include steatorrhea, failure to thrive, and deficiency of fat-soluble vitamins.
Central RAO Px w/ sudden, painless, and permanent monocular blindness. Funduscopic Ex reveals a pale retina and a "cherry-red" macula. Renal, Urinary & Pathology (Path) 1
Electrolytes (RE)
Small nuclear RNA (SARNA) is synthesized by RNA polymerase II in the nucleus and complexes with specific proteins to form small nuclear ribonucleoproteins Renal, Urinary & Pathology (Path) 1
(snRNPs). SnRNPs are an essential component of spliceosomes, which remove introns from pre-mRNA to form mature mRNA. Patients with systemic lupus Electrolytes (RE)
erythematosus can have autoantibodies directed against snRNPs (eg, anti-Smith antibody).
Right-sided colon ca usually grow as exophytic masses and present w/ occult bleeding and SSx of IDA. Left-sided colon ca tend to infiltrate the intestinal wall and Renal, Urinary & Pathology (Path) 15
encircle the lumen, causing constipation and SSx of intestinal obstr. Rectosigmoid involvement often causes hematochezia. Electrolytes (RE)
SGT (de Quervain) is char by painful thyroid enlargement and usually follows a viral illness. Bx shows a mixed inflammatory infiltrate w/ macrophages and Renal, Urinary & Pathology (Path) 1
multinucleated giant cells. Electrolytes (RE)
Chronic lymphocytic (Hashimoto) thyroiditis is the most common cause of hypothyroidism. Histopath char shows an intense lymphocytic infiltrate, often w/ germinal Renal, Urinary & Pathology (Path) 13
centres. Residual follicles may be surrounded by Hürthle cells (large oxyphilic cells filled w/ granular cytoplasm). Electrolytes (RE)
Neural crests are embryological structures composed of parallel strips of cells arising from the ectoderm at the margin of the neural tube. Structures derived from neural Renal, Urinary & Pathology (Path) 4
crest cells include Schwann cells, odontoblasts, melanocytes, enterochromaffin cells, spinal membranes, adrenal medulla/ganglia, laryngeal cartilage, and tracheal Electrolytes (RE)
cartilage.
Co-admin of SSRIs and MAOIs can produce excessive synaptic 5-HT lvls 2° to ↓ reuptake and ↓ degradation of 5-HT, potentially causing SS. To avoid this risk, a 2-wk Renal, Urinary & Pathology (Path) 2
washout period after discontinuing a MAOI and before initiating SSRI therapy is req to allow sufficient time for MAO regen. Electrolytes (RE)
Buprenorphine is a partial opioid receptor agonist that binds w/ high affinity but has low intrinsic activity. In pts on long-term opioid therapy, buprenorphine can displace Renal, Urinary & Pathology (Path) 13
other opioids and precipitate withdrawal. Electrolytes (RE)
β-endorphin is 1 endogenous opioid peptide that is derived from POMC. POMC is a polypeptide precursor that goes thru enzymatic cleavage and modification to produce Renal, Urinary & Pathology (Path) 13
not only β-endorphins, but also ACTH and MSH. The fact that β-endorphin and ACTH are derived from the same precursor suggests that there may be a close Electrolytes (RE)
physiological relationship b/w the stress axis and the opioid system.
A complete mole is composed of multiple cystic edematous hydropic villi as a result of trophoblast proliferation. Serial measurements of B-hCG should be performed Renal, Urinary & Pathology (Path) 1
following evacuation of a hydatidiform mole. Persistently elevated or rising levels may signify the development of an invasive mole or choriocarcinoma. Electrolytes (RE)
A partial mole will have a triploid karyotype (eg, 69,XXX or XXY) and contain fetal tissue w/ some edematous villi w/ focal trophoblastic proliferation, and normal- Renal, Urinary & Pathology (Path) 3
appearing villi. Pts Px w/ vaginal bleeding, and prior miscarriage is a RFx. Electrolytes (RE)
The most common form of CAH is 21-hydroxylase defic. Genetically female infants typically have ambiguous genitalia (virilisation) at birth, whereas males have Renal, Urinary & Pathology (Path) 6
phenotypically normal genitalia, w/ salt-wasting or precocious puberty appearing later. ↑ 17-hydroxyprogesterone is Dx. Electrolytes (RE)
The hippocampus is the area of the brain demonstrating the greatest degree of atrophy in AD. Hippocampal atrophy on MRI is highly suggestive of the Dx. Renal, Urinary & Pathology (Path) 7
Electrolytes (RE)
Thoracentesis should be performed below the 6th rib in the midclavicular line, the 8th rib along the midaxillary line, or the 10th rib along the paravertebral line in order to Renal, Urinary & Pathology (Path) 2
minimize the risk of lung injury. Insertion of a needle lower than 9th rib increases the risk of penetrating abdominal structures. The needle should also be inserted along Electrolytes (RE)
the upper border of the rib to prevent injury to the intercostal vessels.
In hyperglycemic states, aldose reductase converts Glc to sorbitol at a rate faster than sorbitol can be metabolized. Sorbitol accumulates in certain cells such as lens cells, Renal, Urinary & Pathology (Path) 31
causing an influx of water and resulting in osmotic cellular injury. Depletion of NADPH by aldose reductase also ↑ oxidative stress, which accelerates development of Electrolytes (RE)
cataracts and diabetic microvascular complications (e.g. neuropathy, retinopathy).
GLUT-4 is an insulin-sensitive Glc transporter expressed in skeletal muscle cells and adipocytes that translocates to the plasma membrane in response to ↑ insulin lvls. Renal, Urinary & Pathology (Path) 31
Electrolytes (RE)
Pancreatic islet amyloid deposition is char of DM-2. A strong linkage w/ HLA-II gene makeup, pancreatic islet infiltration w/ leucocytes (insulitis), and Abs against islet Renal, Urinary & Pathology (Path) 31
Ags are freq seen in DM-1. Electrolytes (RE)
Glucagon ↑ serum Glc by ↑ hepatic glycogenolysis and GNG. Glucagon also stims insulin secretion from the pancreas. Unlike EPI, glucagon has an insignificant effect on Renal, Urinary & Pathology (Path) 6
Glc homeostasis in the skeletal muscle, adipose tissue, and RC. Electrolytes (RE)
Familial retinoblastoma occurs as a result of mutations of each of the two Rb genes ("two hits"). These patients have an increased risk of secondary tumors, especially Renal, Urinary & Pathology (Path) 1
osteosarcomas, later in life. Electrolytes (RE)
Meningococcal septicaemia can cause bilateral hemorrhagic infarction of the adrenal glands, leading to acute adrenal crisis (WFS). Renal, Urinary & Pathology (Path) 5
Electrolytes (RE)
Physicians are ethically obligated to question orders that raise concern about potential harm to pts. Issues should initially be discussed directly w/ the physician who made Renal, Urinary & Pathology (Path) 3
the order and not involve ancillary staff. Electrolytes (RE)
Streptococcus gallolyticus (formerly S bovis) endocarditis and bacteremia are a/w GI lesions (colon ca) in ~25% of cases. When S gallolyticus is cultured in the blood, Renal, Urinary & Pathology (Path) 15
workup for colonic malignancy w/ colonoscopy is essential. Electrolytes (RE)
Viridans streptococci are normal inhabitants of the oral cavity and are a cause of transient bacteremia after dental procedures in healthy and diseased individuals. In pts w/ Renal, Urinary & Pathology (Path) 15
pre-existing valvular lesions, viridans streptococci can adhere to fibrin-platelet aggregates and establish infection that leads to endocarditis. Electrolytes (RE)
Rifampin is the most frequently used agent for chemoprophylaxis of meningococcal disease. Persons with exposure to the respiratory secretions of a patient with Renal, Urinary & Pathology (Path) 17
meningococcal disease require chemoprophylaxis. Vaccination is an important public health strategy but is not useful for post exposure prophylaxis. Electrolytes (RE)
Pili are the 1ary VF that allow N. meningitidis to initially attach to and colonize the nasopharyngeal epithelial surface. Pili undergo significant Ag variation, which makes Renal, Urinary & Pathology (Path) 17
them a difficult vax target. Electrolytes (RE)
Typical clinical and laboratory features of Epstein-Barr virus (EBV) mononucleosis include fever, pharyngitis, lymphadenopathy, splenomegaly, and atypical Renal, Urinary & Pathology (Path) 5
lymphocytosis. EBV is generally transmitted from an asymptomatic virus shedder to a susceptible individual through saliva transfer (eg, kissing). Electrolytes (RE)
St John's wort induces CYP450 hepatic microsomal enzymes. As a result, a wide variety of drugs that're meta by these enzymes, such as warfarin, will have lower plasma Renal, Urinary & Pathology (Path) 2
concs and ↓ efficacy. Electrolytes (RE)
Most duodenal PUs are caused by H. pylori infec. The most effective method to prevent disease recurrence is to eradicate the infec w/ Abx (e.g. tetracycline, Renal, Urinary & Pathology (Path) 10
metronidazole), typically in combo w/ PPIs (e.g. omeprazole) and, often, bismuth subsalicylate (quad therapy). Electrolytes (RE)
Intellectual disability, gait or posture abn, eczema, and a musty body odor in a toddler are SSx of PKU. Most infants w/ PKU are born to 2 heterozyg carrier parents. The Renal, Urinary & Pathology (Path) 5
prob that heterozyg carrier parents will transmit an AR disease such as PKU to a child is 1/4. Electrolytes (RE)
BN is characterised by episodes of binge eating and compensatory weight-↓ behaviours. SSx of self-induced vomiting incl hypokalaemia, meta alkalosis, parotid gland Renal, Urinary & Pathology (Path) 4
enlargement, dorsal hand calluses, and dental erosion. Electrolytes (RE)
A lesion in Wernicke's area can cause receptive aphasia, which is characterised by well-articulated, nonsensical speech paired w/ a lack of language comprehension Renal, Urinary & Pathology (Path) 2
(Wernicke-Word salad). Wernicke's area is located in the auditory assoc cortex w/i the posterior portion of the superior temporal gyrus in the dom temporal lobe. The Electrolytes (RE)
MCA supplies Broca's area (superior division) and Wernicke's area (inferior division).
AKs are small (usually <1cm), erythematous epidermal lesions w/ adherent scale that're the result of chronic sun exposure. Histo findings incl keratinocyte atypia, Renal, Urinary & Pathology (Path) 2
hyperkeratosis, and parakeratosis. A small % of AKs progress to invasive SCC; therefore, freq monitoring is necessary. Electrolytes (RE)
SCID is char by combo T and B cell dysfxn. It's a life-thr condition that Px in infancy w/ severe bacterial and viral infections; mucocutaneous candidiasis; persistent Renal, Urinary & Pathology (Path) 3
diarrhea; and FTT. LFx incl. absent T cells and hypoGg-emia. The thymic shadow isn't usually present due to severe T cell deficiency. Electrolytes (RE)
GAD involves excessive uncontrollable worry about multi issues w/ a SSx duration of >6mos. assoc SSx incl restlessness, muscle tension, fatigue, sleep disturbance, Renal, Urinary & Pathology (Path) 4
irritability, and difficulty concentrating. Electrolytes (RE)
Pts have the right to refuse to receive medical information. Physicians must understand and respect the beliefs of cultures that value beneficence and nonmaleficence over Renal, Urinary & Pathology (Path) 11
autonomy. In these cultures, family members may be expected to make medical decisions to avoid perceived harm, disrespect, or mental distress caused by direct Electrolytes (RE)
disclosure to the pt.
Orotic aciduria is a rare AR disorder of de novo pyrimidine synthesis that occurs due to a defect in UMP synthase. Children typically present w/ physical and mental Renal, Urinary & Pathology (Path) 2
retardation, megaloblastic anaemia, and large amounts of urinary orotic acid. Uridine supplementation can improve SSx as uridine is converted to UMP via nucleoside Electrolytes (RE)
kinases.
LNS is an XLR disorder caused by a defect in HGPRT. This results in failure of the purine salvage pathway, leading to ↑ degradation of hypoxanthine and guanine to uric Renal, Urinary & Pathology (Path) 1
acid. De novo purine synthesis must ↑ to replace the lost bases, necessitating an ↑ in PRPP amidotransferase activity. Electrolytes (RE)
Pathology (Path) 7
Electrolytes (RE)
The candidal Ag skin test Ax the activity of T cell-mediated imm thru the recruitment of macrophages and CD4+ and CD8+ T lymphocytes in a HS-IV rxn. Anergy, or Renal, Urinary & Pathology (Path) 4
failure to respond to candida Ag testing, is typical in pts w/ SCID. Electrolytes (RE)
Renal, Urinary & Pathology (Path) 3
Electrolytes (RE)
QID Topic Educational Objective System Subject Repeats
7624 Gout Gout occurs with increased frequency in patients with activating mutations involving phosphoribosyl pyrophosphate synthetase due to increased production and Renal, Urinary & Pathology (Path) 11
degradation of purines. Electrolytes (RE)
11608 Grief Transient behavioural disturbances are common in children after the death of a loved 1. Hallucinations of recently deceased relatives are part of a normal grief rxn and Renal, Urinary & Pathology (Path) 3
may not be indicative of major psychiatric illness. Electrolytes (RE)
11806 Serum drug levels and half- The half-life (t[½]) of a drug is the time required to lower its concentration by 50%. The volume of distribution (Vd) refers to how well the drug distributes into tissues Renal, Urinary & Pathology (Path) 3
life compared to plasma; the higher the Vd, the greater the drug distribution into the tissues. The drug concentration (mg/L) is equal to drug dose (mg) divided by Vd (L). Electrolytes (RE)
11977 Learning disorders Learning disorders are characterised by difficulties w/ key academic skills (reading, writing, or math), resulting in performance well below expectations for age. Providers Renal, Urinary & Pathology (Path) 1
should consider a possible learning disorder in any school-aged child w/ behavioural, academic, or social difficulties at school. Electrolytes (RE)
12081 Aortic aneurysm The SMA and IMA are the 2 main vessels supplying the small and large intestines. They're connected by a pair of anastomoses: the marginal artery of Drummond, which Renal, Urinary & Pathology (Path) 6
is the principal anastomosis, and the inconsistently present arc of Riolan (mesenteric meandering artery). Electrolytes (RE)
14797 Sympathomimetic agents Dobutamine is a β-adrenergic agonist w/ predominant activity on β1 receptors and weak activity on β2 and α receptors. Stimulation of β2 receptors leads to an ↑ Renal, Urinary & Pathology (Path) 5
production of cAMP and ↑ cytosolic Ca concentration. This facilitates the interaction b/w actin and myosin, resulting in ↑ myocardial contractility. Electrolytes (RE)
14798 Urinary incontinence A common SSx during pregnancy is stress urinary incontinence, which occurs due to ↑ IAP from the gravid uterus that exceeds the pressure point that maintains closure of Renal, Urinary & Pathology (Path) 7
the urethral valve. Pregnancy hormones ↓ urethral tone and relax the pelvic floor muscles (levator ani, coccygeus), which maintain closure of the urethral valve. Electrolytes (RE)
15172 Myasthenia gravis MG is caused by auto-Abs against postsynaptic nAChRs, leading to fewer fxnal AChRs and fatigable muscle weakness. Non-depolarising neuromuscular blocking agents Renal, Urinary & Pathology (Path) 10
(e.g. vecuronium) are competitive antagonists of AChRs; due to the depletion of receptors, pts w/ MG are extremely sensitive to these agents and very small doses can Electrolytes (RE)
induce paralysis and impair airway protection.
15176 Prevalence and incidence Unlike period prevalence, point prevalence considers only the number of disease cases that are active at a specific point in time. Renal, Urinary & Pathology (Path) 3
Electrolytes (RE)
15186 Study designs A case-control study is an observational study design; it begins w/ selecting individuals who have the outcome ("cases") and individuals who do not have the outcome Renal, Urinary & Pathology (Path) 6
("controls") and then retrospectively comparing their Hx of exposure to RFx. Electrolytes (RE)
15200 Hiatal hernia HHs occur when contents of the abdo cavity herniate thru the diaphragm at the oesophageal hiatus into the thoracic cavity. Sliding HHs occur due to laxity of the phreno- Renal, Urinary & Pathology (Path) 1
oesophageal membrane, leading to herniation of the GOJ and prox. stomach, whereas para-oesophageal hernias occur due to defects in the membrane, resulting in the Electrolytes (RE)
gastric fundus herniation.
15217 Diverticular disease Diverticulitis is characterised by inflammation of colonic diverticula. Pts have abdo pain, nausea, vomiting, and changes in bowel habits. Low-grade fever and Renal, Urinary & Pathology (Path) 3
leucocytosis are common, and PEx may demonstrate a tender mass in the LLQ. Electrolytes (RE)
15218 Cystic fibrosis In pts w/ CF, pathogenic bacteria colonise the resp tract early in the disease course. The leading pathogen in adults is P. aeruginosa, which forms a thick biofilm to prevent Renal, Urinary & Pathology (Path) 11
its full elimination from the body. Electrolytes (RE)
15225 Community acquired Acute phase reactants (APRs) are proteins whose serum concentrations change by 225% during periods of inflammation. Procalcitonin is a unique APR that can rise or Renal, Urinary & Pathology (Path) 21
pneumonia fall depending on the etiology of the infection; elevated levels correlate with a bacterial source, whereas low levels indicate a viral source. Electrolytes (RE)
15227 Community acquired Alveolar consolidation occurs when the alveoli become filled w/ fluid (e.g. inflammatory exudate in bacterial pneumonia). The ↑ compactness of the alveolar fluid Renal, Urinary & Pathology (Path) 21
pneumonia (compared to air) causes sound to travel faster and more efficiently, resulting in bronchophony, ↑ tactile fremitus (vibration), and ↑ intensity of breath sounds over the Electrolytes (RE)
affected area. Dullness to percussion is also present.
15229 Osteoporosis The NFκB (RANK)/RANK-L interaction is essential for the formation and diff of osteoclasts. OPG blocks binding of RANK-L to RANK and ↓ formation of mature Renal, Urinary & Pathology (Path) 10
osteoclasts, leading to ↓ bone resorption. Denosumab is a mAb used in the Tx of postmenopausal osteoporosis that works in a manner similar to OPG. Electrolytes (RE)
15247 Chronic venous SD is characterised by chronic erythema, fibrosis, and reddish-brown discolouration due to deposition of hemosiderin (from breakdown of extravasated RBCs). SSx are Renal, Urinary & Pathology (Path) 3
insufficiency typically bilateral, and usually worse at or above the ankles. Complications incl poor wound healing, weeping, and ulceration. Electrolytes (RE)
15250 Hypothyroidism HypoTH-ism causes ↓ expression of LDL receptors in the liver, leading to ↓ clearance of LDL and ↑ blood LDL lvls. It also causes hyperTG-emia due to ↓ expression of Renal, Urinary & Pathology (Path) 13
LPL. The AEs of hypoTH-ism on lipid lvls can ↑ the risk of coronary atherosclerosis. Electrolytes (RE)
15259 Atrial myxoma Myxomas are the most common 1° cardiac neoplasm and approx. 80% originate in the LA. Pts may present w/ SSx MV obstr that may worsen w/ certain body positions, Renal, Urinary & Pathology (Path) 3
constitutional findings (e.g. fever, weight loss), or systemic embolisation (e.g. stroke, mesenteric ischemia, acute limb ischemia). Electrolytes (RE)
15270 Acute pericarditis Fibrinous pericarditis is the most common type of pericarditis and is Chx by pericardial inflammation w/ a serous, fibrin-containing exudate in the pericardial space. Renal, Urinary & Pathology (Path) 5
Pleuritic chest pain and a triphasic friction rub are frequently seen. Common causes include viral infection, MI, uremia, and rheumatologic disease (eg, SLE, RA). Electrolytes (RE)
15271 Acute pericarditis Viral infection is thought to be the most common cause of acute pericarditis. It causes a fibrinous or serofibrinous pericarditis that is often Chx by pleuritic chest pain, a Renal, Urinary & Pathology (Path) 5
friction rub on cardiac auscultation, diffuse ST elevation on ECG, and mild to moderate-sized pericardial effusion. Electrolytes (RE)
15288 Nonalcoholic fatty liver Stellate (Ito) cells are the primary cells involved in hepatic fibrosis. In response to hepatic injury, the stellate cells are activated and transform into myofibroblasts capable Renal, Urinary & Pathology (Path) 1
disease of proliferating, promoting chemotaxis, and producing large quantities of collagen. Collagen stains blue with Masson trichrome stain. Electrolytes (RE)
15346 Heparin induced HIT and thrombosis results from the production of IgG Abs against complexes of heparin and platelet factor 4. The Fc component of these Abs binds to platelets, resulting Renal, Urinary & Pathology (Path) 1
thrombocytopenia in widespread platelet activation and a prothrombotic state. Electrolytes (RE)
15353 Multiple myeloma MM is a plasma cell malignancy a/w purely radiolucent (osteolytic) bone lesions due to the stim of osteoclasts and the inhib of osteoblasts. Myeloma cells stim osteoclast Renal, Urinary & Pathology (Path) 9
devel by secreting RANKL and destroying OPG, which incr RANK activity and results in osteoclast diff. Electrolytes (RE)
15355 Asthma occup asthma is characterised by airway inflammation, bronchial hyperreactivity, and a variable airflow obstr triggered by workplace exposure. Exposure can be immu Renal, Urinary & Pathology (Path) 12
(atopic), due to exposure to a workplace aeroallergen causing a Th2-mediated IgE formation, or non-immu, due to exposure to workplace irritants that lead to denudation Electrolytes (RE)
of the bronchial mucosa.
15619 Adjustment disorders Adjustment disorder involves emotional or behavioural SSx occurring w/i 3mos of an ID-able stressor. The Dx is indicated when the pt has significant distress and Renal, Urinary & Pathology (Path) 2
impairment but doesn't meet full criteria for another mental disorder. Electrolytes (RE)
813 Hypothyroidism TPO catalyzes the ox of I- to iodine, the iodination of TG tyrosine residues, and the iodotyrosine coupling rxn that forms T3 and T4. Abs against TPO are present in >90% Renal, Urinary & Pathophysiology 13
of pts w/ CLT (Hashimoto). Electrolytes (RE) (Patp)
815 Hypothyroidism An ↑ in oestrogen activity, as seen in preg or postmenopausal ORT, ↑ the lvl of TBG. This leads to an ↑ in total TH lvls, but feedback control maintains normal lvls of free Renal, Urinary & Pathophysiology 13
(biologically active) TH. Electrolytes (RE) (Patp)
831 Colorectal cancer Regulation of the Ras-MAPK signal transduction pathway requires a balance b/w active (GTP-bound) and inactive (GDP-bound) Ras proteins. RAS gene muts, which Renal, Urinary & Pathophysiology 15
result in constitutively activated Ras proteins, are implicated in the development of malignant tumors. Electrolytes (RE) (Patp)
956 HSV infection HSV-1 encephalitis is a potentially fatal complication from 1ary infection or reactivation of latent disease. NS invasion leads to necrosis of the temp lobe, which can result Renal, Urinary & Pathophysiology 9
in aphasia and personality changes in addn to classic features of encephalitis (e.g. h/a, fever, AMS, seizure). Electrolytes (RE) (Patp)
978 Congenital adrenal Pts w/ classic, salt-wasting 21-hydroxylase defic have defic cortisol and aldosterone synthesis combo w/ adrenal androgen overproduction. Male infants have normal Renal, Urinary & Pathophysiology 6
hyperplasia genitalia and present 1-2wks after birth w/ vomiting, hypotension, hyponatraemia, and hyperkalaemia. Females present at birth w/ ambiguous genitalia. Electrolytes (RE) (Patp)
1050 Endocarditis Viridans streptococci produce dextrans that aid them in colonizing host surfaces, such as dental enamel and heart valves. These organisms cause subacute BE, classically Renal, Urinary & Pathophysiology 15
in pts w/ pre-existing cardiac valvular defects after dental manipulation. Electrolytes (RE) (Patp)
1577 Antiarrhythmic drugs Class IC antiarrhythmic agents (flecainide) block the fast Na+ channels responsible for ventricular depol (phase 0), prolonging QRS duration w/ little effect on the QT Renal, Urinary & Pathophysiology 12
interval. Class IA and class III agents cause the most QT prolongation. Electrolytes (RE) (Patp)
1841 Peptic ulcer disease PPIs (e.g. omeprazole, lansoprazole) block the final common pathway of gastric acid secr from parietal cells, which is stim by ACh, hist, and gastrin. Renal, Urinary & Pathophysiology 10
Electrolytes (RE) (Patp)
7569 Ischemic stroke Lacunar infarctions are the result of small vessel occlusion (eg, due to lipohyalinosis and microatheroma formation) in the penetrating vessels supplying the deep brain Renal, Urinary & Pathophysiology 19
structures. Uncontrolled hypertension and diabetes mellitus are major risk factors for this condition. Electrolytes (RE) (Patp)
11038 Scarlet fever Scarlet fever is characterised by fever, pharyngitis, sandpaper-like rash, circumoral pallor, and a strawberry tongue. It's caused by strains of GAS that produce pyrogenic Renal, Urinary & Pathophysiology 1
exotoxins. Scarlet fever can predispose to acute RF and GN. Electrolytes (RE) (Patp)
11040 Psoriasis First-line treatment options for localized psoriasis include high-potency topical corticosteroids and vitamin D analogs. Vitamin D analogs inhibit T-cell and keratinocyte Renal, Urinary & Pathophysiology 5
proliferation and stimulate keratinocyte differentiation. Corticosteroids also have anti-inflammatory and antiproliferative properties; their mechanism of action is Electrolytes (RE) (Patp)
complementary to the vitamin D analogs.
11064 Circadian rhythm The suprachiasmatic nucleus regulates circadian rhythms by processing light info from the retina and modulating body temp and the production of hormones (e.g. cortisol, Renal, Urinary & Pathophysiology 1
melatonin). Dyssynchrony b/w the local environment (e.g. daylight hrs, sleep schedules) and internal circadian rhythms can cause insomnia and daytime sleepiness (i.e. jet Electrolytes (RE) (Patp)
lag). Melatonin supplementation is recommended for the Tx of insomnia associated w/ jet lag.
11464 Infection control Alcohols fxn by disorganising the lipid structure in membranes, causing them to be leaky, and by denaturing cellular proteins. They're bactericidal, tuberculocidal, Renal, Urinary & Pathophysiology 3
fungicidal, and virucidal, but don't destroy bacterial spores. Electrolytes (RE) (Patp)
11516 Visual pathway An aneurysm of the ICA can laterally impinge on the optic chiasm. This can cause ipsilateral nasal hemianopia by dmging uncrossed CNII fibres from the temporal Renal, Urinary & Pathophysiology 5
portion of the retina. Electrolytes (RE) (Patp)
12101 Dyslipidemia Fibrates lower TG lvls by activating PPAR-α, which leads to ↓ hepatic VLDL production and ↑ LPL activity. Fish oil supplements containing high concentrations of ω-3 Renal, Urinary & Pathophysiology 11
FAs ↓ TGs by ↓ production of VLDL and apoB. Electrolytes (RE) (Patp)
15193 Pneumocystis pneumonia Pneumocystis pneumonia is an atypical fungal infection seen primarily in those with impaired cell mediated immunity (eg, advanced AIDS). Manifestations often include Renal, Urinary & Pathophysiology 2
slowly worsening pulmonary symptoms, hypoxia, and bilateral interstitial infiltrates on chest x-ray. The cystic organism can be Visualized using silver stain of respiratory Electrolytes (RE) (Patp)
secretions.
15207 Esophagitis EOO is a Th2 cell-mediated disorder leading to eosinophilic infiltration of the oesophageal mucosa. It occurs most commonly in males w/ a Hx of atopic conditions and Renal, Urinary & Pathophysiology 3
typically presents w/ solid food dysphagia, reflux, and occasionally food impaction. Electrolytes (RE) (Patp)
15208 Brain abscess A single brain abscess is usually caused by direct spread of a contiguous infection. Temporal lobe abscess is usually a result of OM that has spread to the mastoid air cells, Renal, Urinary & Pathophysiology 1
while frontal lobe abscess is usually due to ethmoid or frontal sinusitis. Multiple brain abscesses typically indicate hematogenous dissemination of a distant infection (eg, Electrolytes (RE) (Patp)
endocarditis, empyema).
15209 Meningitis Pneumococcal meningitis is associated with massive cerebrospinal fluid inflammatory cytokine release in response to bacterial cell wall components. Treatment with Renal, Urinary & Pathophysiology 17
dexamethasone prior to antibiotic therapy has been shown to reduce inflammation and decrease the risk of adverse outcomes (eg, seizures, focal neurologic deficits) and Electrolytes (RE) (Patp)
death. Other forms of bacterial meningitis do not seem to benefit from glucocorticoid treatment.
15221 Osteoporosis Rx-induced oesophagitis is a common AE of BPs. BPs are also a/w ↑ risk of osteonecrosis of the jaw and atypical femoral fractures. Renal, Urinary & Pathophysiology 10
Electrolytes (RE) (Patp)
QID Topic Educational Objective System Subject Repeats
15239 Aortic stenosis AS most commonly results from age-related CAVD. The early pathogenesis of CAVD closely mimics that of arterial atherosclerosis. In the later stages, fibroblasts Renal, Urinary & Pathophysiology 8
diffiate into osteoblast-like cells and deposit bone matrix, leading to progr valvular calcification and stenosis. Electrolytes (RE) (Patp)
15289 Clostridial myonecrosis Clostridium septicum is a spore-forming, exotoxin-producing, Gram (+) organism that is the most common cause of spontaneous gas gangrene (eg, rapid-onset pain, Renal, Urinary & Pathophysiology 3
hemorrhagic bullae, tissue crepitus). Underlying colonic malignancy is the greatest RFx for infection. Electrolytes (RE) (Patp)
151 Angina Pharmacologic nitrates (e.g. nitroglycerin, isosorbide mononitrate, isosorbide dinitrate) are meta to NO and S-nitrothiols in vascular smooth muscle cells, leading to an ↑ Renal, Urinary & Pharmacology 1
in cGMP that stims vasodilation. Large veins are predominantly affected, leading to ↑ venous capacitance and ↓ venous return (preload), which ↓ LV wall stress and Electrolytes (RE) (Phar)
myocardial O2 demand to relieve anginal SSx.
152 Nitrates Sublingual nitroglycerin is used for rapid SSx relief in pts w/ stable angina. The 1° anti-ischaemic effect of nitrates is mediated by venodilation w/ a ↓ in LV EDV and Renal, Urinary & Pharmacology 7
wall stress, resulting in ↓ myocardial O2 demand and relief of angina SSx. Electrolytes (RE) (Phar)
681 Interstitial lung disease PF presents w/ gradual-onset progr dyspnoea, non-productive cough, fatigue, eventual weight loss, and bilateral reticulonodular opacities on CXR. PFTs reveal a Renal, Urinary & Pharmacology 8
restrictive pattern. Pts w/ RA can develop interstitial lung diseases, both from the pulm MFxs of the disease itself and from certain therapies (e.g. methotrexate, Electrolytes (RE) (Phar)
cyclophosphamide, sulfasalazine).
682 Penetrating thoracic trauma The LV forms the apex of the heart and can reach as far as the 5th ICS at the left MCL. All other chambers of the heart lie medial to the left MCL. The lungs overlap Renal, Urinary & Pharmacology 2
much of the anterior surface of the heart. Electrolytes (RE) (Phar)
683 Polycystic ovary disease Male-pattern hair growth in a woman is called hirsutism; the most common cause is PCOS. Combo OCPs can Tx hirsutism by suppressing pituitary LH secretion and Renal, Urinary & Pharmacology 4
subseq ↓ ovarian androgen production. Electrolytes (RE) (Phar)
685 Benign prostatic Finasteride is a 5-α-reductase inhib that suppresses peri conversion of testosterone to DHT. It's used for Tx of BPH and androgenetic alopecia. Renal, Urinary & Pharmacology 6
hyperplasia Electrolytes (RE) (Phar)
687 Anesthesia The onset of action of a gas anaesthetic depends on its solubility in the blood (blood/gas partition coefficient). Drugs w/ high blood/gas partition coefficients are more Renal, Urinary & Pharmacology 9
soluble in the blood, demonstrate slower equilibrium w/ the brain, and have longer onset times. Electrolytes (RE) (Phar)
688 Anesthesia The arteriovenous concentration gradient reflects the overall tissue solubility of an anesthetic. Anesthetics with high tissue solubility are characterized by large Renal, Urinary & Pharmacology 9
arteriovenous concentration gradients and slower onsets of action. Electrolytes (RE) (Phar)
690 Allergic rhinitis HS-I rxns are an allergic response triggered by the binding of previously recognized Ag to IgE Abs on mast cells. In the early phase of the response, histamine, already Renal, Urinary & Pharmacology 2
stored in preformed granules in mast cells, is the 1st chemical mediator released. Once released, histamine stimulates smooth muscle contraction (bronchoconstriction), ↑ Electrolytes (RE) (Phar)
vascular permeability (edema), and ↑ mucus secretion.
692 Asthma Bronchial challenge testing is a highly sensitive but nonspecific measure that can help excl a Dx of asthma. A provocative stim (typically aerosolised methacholine) is Renal, Urinary & Pharmacology 12
admin at ↑ concs to induce bronchoconstriction. Pts w/ asthma are hyperresponsive to this stim and experience a decline in FEV1 at lower doses than non-asthmatics. Electrolytes (RE) (Phar)
694 Bronchiectasis Primary ciliary dyskinesia results from an autosomal recessive mutation in the proteins responsible for normal flagellar and ciliary structure and function (eg, dynein, Renal, Urinary & Pharmacology 2
assembly proteins). Clinical manifestations include situs inversus, chronic sinusitis, bronchiectasis, and infertility. Electrolytes (RE) (Phar)
695 Aspergillosis ABPA due to A. fumigatus may complicate asthma. ABPA can result in transient recurrent pulm infiltrates and eventual prox. bronchiectasis. Renal, Urinary & Pharmacology 5
Electrolytes (RE) (Phar)
696 Interstitial lung disease IPFis characterised by patchy interstitial inflammation intermixed w/ areas of dense fibrosis and normal lung, focal fibroblastic proliferation, and a honeycomb pattern Renal, Urinary & Pharmacology 8
most prominent in the periphery. Repetitive injury and disordered healing are implicated as potential causes; lung injury results in focal loss of type 1 pneumocytes and Electrolytes (RE) (Phar)
hyperplasia of type 2 pneumocytes.
1148 Acute diarrhea Traveller's diarrhoea is most freq due to ETEC. This pathogen produces plasmid-encoded, heat-labile (LT, choleragen-like) and heat-stable (ST) enterotoxins. LT activates Renal, Urinary & Pharmacology 13
adenylate cyclase, leading to ↑ intracellular cAMP; ST activates guanylate cyclase leading to ↑ intracellular cGMP. Both cause water and electrolyte loss and watery Electrolytes (RE) (Phar)
diarrhoea.
1211 Ovarian cancer Granulosa cell tumors are sex-cord stromal tumors of the ovary that secrete estrogen and can cause endometrial hyperplasia. Call-Exner bodies (cells arranged in a Renal, Urinary & Pharmacology 9
microfollicular or rosette pattern) are seen on microscopy. On gross pathology, the tumor appears yellow due to the lipid content in theca cells. Electrolytes (RE) (Phar)
1425 Sympathomimetic agents EPI ↑ SBP (α1 + β1) and HR (β1), and either ↑ or ↓ DBP depending on the dose (either α1 or β2 predominates). PreTx w/ propranolol eliminates the β effects of EPI Renal, Urinary & Pharmacology 5
(vasodilation and tachycardia), leaving only the α effect (vasoconstriction). Electrolytes (RE) (Phar)
1533 Rabies In the US, bats are the main source of rabies (only transmitted by mammals). Agitation and spasms progressing to coma w/i wks of exposure is strongly suggestive of Renal, Urinary & Pharmacology 2
rabies encephalitis. Prophylactic vax is recommended for individuals at high risk for exposure to rabid animals or their tissues. The approved rabies vax consist of various Electrolytes (RE) (Phar)
rhabdovirus strains grown in tissue cell culture and then inactivated.
2003 Breastfeeding The breast milk content of vits D and K is typically insuff for the nutr needs of the newborn. Vit K is given parenterally to all newborns at birth to prevent HDN. Renal, Urinary & Pharmacology 1
Exclusively breastfed infants req vit D supp due to lack of sunlight exposure and to prevent rickets. Electrolytes (RE) (Phar)
2113 Spinal muscular dystrophy snRNPs are important components of the spliceosome, a molecule which removes introns from pre-mRNA during processing w/i the nucleus. SMA is a disorder caused Renal, Urinary & Pharmacology 1
by muts in the SMN1 gene, resulting in impaired assembly of snRNPs in LMNS. Infants often have flaccid paralysis due to degen of ant horn cells in the spinal cord. Electrolytes (RE) (Phar)
8249 Serum drug levels and half- During continuous infusion of a drug metabolized by first-order kinetics, the steady state concentration is reached in 4 to 5 half-lives. Renal, Urinary & Pharmacology 3
life Electrolytes (RE) (Phar)
8884 Scrotum Due to its intra-abdominal origin, lymphatic drainage of the testis is to the para-aortic lymph nodes. In contrast, lymph drainage from the scrotum goes into the superficial Renal, Urinary & Pharmacology 1
inguinal lymph nodes. Electrolytes (RE) (Phar)
11761 Depression Suicide risk Ax incls consideration of both RFs and protective factors. A Hx of a previous suicide attempt is the strongest single RF for further attempts and completed Renal, Urinary & Pharmacology 8
suicide. Electrolytes (RE) (Phar)
11945 Vulvovaginitis Trichomonas vaginitis is caused by a motile protozoan which can be seen on wet mount microscopy of vaginal d/c. It Px w/ yellow-green vaginal d/c and vaginal burning Renal, Urinary & Pharmacology 1
and is sexually transmitted. Electrolytes (RE) (Phar)
14967 Aging Aging is a/w steady decr in chest wall compliance but incr in lung compliance due to a loss of elastic recoil. This results in a marked incr in RV, a decr in FVC, and Renal, Urinary & Pharmacology 8
relatively unchanged TLC. Electrolytes (RE) (Phar)
15246 Asplenia Target cells form when erythrocytes have decr cell volume (e.g. thalassemia, Fe defic) or excessive membrane (e.g. OLD, postsplenectomy). Pts who undergo Renal, Urinary & Pharmacology 2
splenectomy usually develop target cells b/c the spleen is the 1ary organ that prunes excessive RBC membrane. Electrolytes (RE) (Phar)
15312 HIV Initial HIV infection is often a/w mononucleosis-like SSx (eg, fever, LAD, sore throat) 2-4 wks after transmission. Important Dx clues are oropharyngeal ulcers and a Renal, Urinary & Pharmacology 11
diffuse maculopapular rash. As the humoral Ab response is not fully activated early in infection, LFx typically show HIV in the serum ((+) viral load and p24 Ag) but (-) Electrolytes (RE) (Phar)
HIV serology.
684 Prostate cancer Flutamide is a nonsteroid anti-androgen that acts as a competitive inhibitor of testosterone receptors. It is used in combination w/ long-acting GnRH agonists for the Tx of Renal, Urinary & Physiology 5
prostate ca. Electrolytes (RE) (Phys)
1017 Anthrax Bacillus anthracis is a large, sporulating, gram-positive rod that is encased in an antiphagocytic polypeptide capsule composed of D-glutamic acid. Inhalation of B Renal, Urinary & Physiology 1
anthracis spores can cause pulmonary anthrax, which is usually characterized by nonspecific symptoms followed by hemorrhagic mediastinitis, shock, and death. Electrolytes (RE) (Phys)
1043 Lactic acidosis In the presence of oxygen, Pyruvate produced during glycolysis is converted by Pyruvate dehydrogenase to acetyl coenzyme A, which is subsequently metabolized by Renal, Urinary & Physiology 1
oxidative phosphorylation. However, if inadequate oxygen is present in the tissues, pyruvate is converted to lactate by lactate dehydrogenase, leading to lactic acidosis. Electrolytes (RE) (Phys)
1161 Seborrheic keratosis SK is a common epidermal tumour that presents as a tan or brown, round lesion w/ a well-demarcated border and 'stuck-on' appearance. Micro Ex shows small cells Renal, Urinary & Physiology 2
resembling basal cells, w/ pigmentation, hyperkeratosis, and keratin-containing cysts. Rapid onset of numerous lesions is often a/w internal malignancy (Leser-Trelat Electrolytes (RE) (Phys)
sign).
1354 Uremic platelet dysfunction abn bleeding in pts w/ uraemia is due to a qualitative platelet disorder that causes prolonged BT w/ normal platelet count, PT, and aPTT. Renal, Urinary & Physiology 1
Electrolytes (RE) (Phys)
1524 Heme metabolism Maturing erythrocytes lose their ability to synthesize heme when they lose their mitochondria, which are necessary for the 1st and final 3 steps of heme synthesis. Renal, Urinary & Physiology 2
Electrolytes (RE) (Phys)
1554 Mutations DMD Px w/ progr prox muscle weakness in young boys due to incr muscle fiber degen. It's caused by frameshift muts (most common) or nonsense muts in the dystrophin Renal, Urinary & Physiology 3
gene that lead to the formation of a truncated, defective protein. Nonsense muts intro premature stop codons (e.g. UAA, UAG, UGA) in the coding seq of mRNA. Electrolytes (RE) (Phys)
1555 Aminoglycoside Aminoglycosides inhibit genetic code reading and protein synthesis by binding to the prokaryotic 30S ribosomal subunit. Renal, Urinary & Physiology 3
Electrolytes (RE) (Phys)
1556 Congenital cardiac defects Li is commonly used to Tx bipolar disorder. Its use during pregnancy is a/w Ebstein's anomaly, which is Chx by apical displacement of the TV leaflets, ↓ RV volume, and Renal, Urinary & Physiology 2
atrialization of the RV. Electrolytes (RE) (Phys)
1559 Traumatic brain injury Carbon dioxide is a potent vasodilator of cerebral vasculature. Tachypnea causes hypocapnia and cerebral vasoconstriction, thereby decreasing cerebral blood volume and Renal, Urinary & Physiology 5
intracranial pressure. Electrolytes (RE) (Phys)
1588 COPD COPD causes air trapping and hyperinflation; conseq, these pts breathe at higher baseline LVs (higher FRC). The absolute volume of air in the lungs that's not respired Renal, Urinary & Physiology 16
(RV) incr substantially, as does the fraction of air in the lungs that's not involved in resp (RV/TLC ratio). Electrolytes (RE) (Phys)
1607 Pulmonary embolism The IVC courses through the abdomen and inferior thorax in a location anterior to the right half of the vertebral bodies. The renal veins join the IVC at the lvl of L1/L2, Renal, Urinary & Physiology 13
and the common iliac veins merge to become the IVC at the lvl of L5. IVC filters are placed in pts w/ DVT who have c/i to anticoagulation Thx. Electrolytes (RE) (Phys)
1608 Diabetic ketoacidosis Normal BGLs are maint by the opp effects of insulin and glucagon. Glucagon stims hepatic glycogenolysis and GNG, whereas insulin ↑ peri Glc uptake and inhibs Renal, Urinary & Physiology 6
lipolysis and KA formation. Insulin also suppresses glucagon release. Electrolytes (RE) (Phys)
1617 HSV infection 1° infection w/ HSV-2 typically Px w/ fever and a painful vesicular genital rash. HSV-2 primarily infects the sacral DRG and can be reactivated to cause recurrent genital Renal, Urinary & Physiology 9
lesions. Electrolytes (RE) (Phys)
1618 HSV infection A new-onset genital vesicular rash w/ a (+) Tzanck smear in a previously aSSx pt is suggestive of 1° genital HSV infection due to HSV-2. Recurrences of genital herpes Renal, Urinary & Physiology 9
can be ↓ thru daily Tx w/ oral valacyclovir, acyclovir, or famciclovir. Condom use can help prevent a 1° genital HSV infection but doesn't prevent reactivation of latent Electrolytes (RE) (Phys)
infection.
1619 Acyclovir Antiviral drugs currently recommended for the Tx of 1° genital herpes incl the nucleoside analogues (e.g. acyclovir). These are incorporated into newly replicating viral Renal, Urinary & Physiology 4
DNA and ultimately terminate viral DNA chain synthesis. Electrolytes (RE) (Phys)
1651 COPD PaCO2 is the major stim of resp in healthy individuals; even a slight incr in PaCO2 stims cChRs and triggers incr vent. In pts w/ COPD, the response to PaCO2 is blunted Renal, Urinary & Physiology 16
and hypoxemia can contribute to resp drive. pChRs are 1arily responsible for sensing PaO2 and can be suppressed w/ O2 admin. Electrolytes (RE) (Phys)
1982 Malabsorption PSs must be degraded to MSs by pancreatic and brush border amylases before they can be absorbed. MSs can be absorbed directly. D-xylose is a MS whose absorption Renal, Urinary & Physiology 4
isn't affected by exocrine PI, and can be used to diffiate b/w pancreatic vs. mucosal causes of malabsorption. Electrolytes (RE) (Phys)
QID Topic Educational Objective System Subject Repeats
1988 Preeclampsia Preeclampsia is defined as hypertension onset after 20 weeks gestation plus proteinuria or signs of end-organ damage. End-organ damage is due to endothelial damage Renal, Urinary & Physiology 1
secondary to the release of inflammatory factors from abnormal placentation. Electrolytes (RE) (Phys)
2008 Ovarian cancer Sertoli-Leydig cell tumors of the ovary arise from the sex cord stroma and secrete testosterone. Typical features include a large ovarian mass and signs of virilization. Renal, Urinary & Physiology 9
Tubular structures lined by round Sertoli cells and surrounded by a fibrous stroma are seen on pathology. Electrolytes (RE) (Phys)
2010 Brachial plexus The radial nerve provides sensory innervation to the skin of the posterior arm, forearm, and dorsal lateral hand and provides motor innervation to all of the extensor Renal, Urinary & Physiology 6
muscles of the upper limb below the shoulder. Damage to the proximal radial nerve (eg, at the axilla or midshaft humerus) may result in wrist drop. Electrolytes (RE) (Phys)
2011 Muscle structure and Ca efflux from cardiac cells prior to relaxation is primarily mediated via an Na/Ca exchange pump and SR Ca-ATPase pump. Renal, Urinary & Physiology 1
physiology Electrolytes (RE) (Phys)
2012 Pelvic inflammatory disease Ruptured ectopic pregnancy can cause abdominal pain, vaginal bleeding, and hemodynamic instability. PID is most commonly caused by Neisseria gonorrhoeae or Renal, Urinary & Physiology 2
Chlamydia trachomatis and significantly ↑ the risk of ectopic pregnancy. Electrolytes (RE) (Phys)
2013 Cranial nerve palsy CNIV innervates the SO muscle, which causes the eye to intort (internally rotate) and depress while adducted. CNIV palsy is typically traumatic or idiopathic and presents Renal, Urinary & Physiology 9
w/ vertical diplopia that worsens when the affected eye looks down and toward the nose (e.g. walking downstairs, up-close reading). Pts may compensate by tucking the Electrolytes (RE) (Phys)
chin and tilting the head away from the affected eye.
2014 Neuromuscular junction ACh release from presynaptic terminal vesicles at the NMJ depends upon the influx of extracellular Ca into the presynaptic terminal. Ca influx into the nerve terminal Renal, Urinary & Physiology 1
occurs following neuronal depol and opening of v-gated Ca channels. Electrolytes (RE) (Phys)
6792 Myasthenia gravis The Tx of MG involves the use of an AChEI, immsups, and possible thymectomy. AChEIs may cause AEs related to muscarinic overstim, which can be ameliorated by Renal, Urinary & Physiology 10
the use of an antimusc agent such as glycopyrrolate, hyoscyamine, or propantheline. Electrolytes (RE) (Phys)
8881 Torticollis Congenital torticollis is typically noted by 2 to 4 weeks of age, after which the child prefers to hold the head tilted to one side. It is most commonly the result of Renal, Urinary & Physiology 2
malposition of the head in utero or birth trauma. Most cases resolve with conservative therapy and stretching exercises. Electrolytes (RE) (Phys)
15273 Vasospastic angina Vasospastic angina involves hyperreactivity of coronary artery smooth muscle. Pts are usually young (age <50) and w/o significant RFx for CAD; they experience Renal, Urinary & Physiology 2
recurrent episodes of chest discomfort that typically occur during rest or sleep and resolve w/i 15 min. Electrolytes (RE) (Phys)
15291 Thyroglossal duct cyst Thyroglossal duct cysts form from epithelial remnants of the thyroglossal duct along the path of thyroid descent. They present as midline masses that rise with swallowing Renal, Urinary & Physiology 1
or tongue protrusion. Electrolytes (RE) (Phys)
15324 Rocky mountain spotted RMSF is a tick-borne illness due to Rickettsia rickettsii, a weakly gram (-), obligate intracellular organism that has an affinity for vascular endothelial cells. Pts usually Renal, Urinary & Physiology 1
fever have non-specific SSx (e.g. fever, malaise, myalgia) f/b a macular-petechial rash that begins on the ankles and wrists and spreads to the centre of the body as well as to the Electrolytes (RE) (Phys)
palms and soles. Urgent Tx w/ doxycycline, an inhib of bacterial protein synthesis, is req.
16978 Sickle cell PVB19 infection can cause transient aplastic crisis, particularly in those w/ underlying Hb disorders such as SCA. Pts develop SSx anaemia (e.g. exertional dyspnoea, Renal, Urinary & Physiology 13
fatigue, low Hct) due to inhib of erythropoiesis by the virus. Bone marrow Ex will show giant pronormoblasts w/ glassy, intranuclear viral inclusions. Electrolytes (RE) (Phys)
1491 RNA structure & function The 3' CCA tail of tRNA serves as the amino acid binding site. Aminoacyl tRNA synthetase is the enzyme responsible for "loading" the appropriate amino acid to the 3' Rheumatology, Anatomy (Anat) 2
terminal hydroxyl group of the CCA tail. Orthopedics & Sports
(RH)
1634 Chronic heart failure Neurohormones (e.g. NE, ATII, and aldosterone) play a large role in the deleterious cardiac remodelling that occurs in HF w/ ↓ EF. ACEIs, ARBs, MRBs, and β blockers Rheumatology, Anatomy (Anat) 12
↓ mortality in these pts by ↓ neurohormonal-mediated cardiac remodelling. Orthopedics & Sports
(RH)
1638 Acute myeloid leukemia The finding of Auer rods (linear purple-red inclusions w/i immature myeloid precursors) is helpful in making the Dx of AML. Auer rods are not found in ALL. In CML, Rheumatology, Anatomy (Anat) 3
there are more mature cells and fewer blasts. Orthopedics & Sports
(RH)
1640 Nasopharyngeal carcinoma NPC is endemic in southern China due genetic and dietary factors that promote nasopharyngeal epithelial pre-malignant lesions. In almost all cases, malignant Rheumatology, Anatomy (Anat) 1
transformation occurs due to infection of pre-malignant cells w/ EBV and the subseq expression of oncogenic viral proteins. Orthopedics & Sports
(RH)
1682 Humoral immunity The 1ary imm response to a new Ag initially results in plasma cells that only produce IgM. Isotype switching later occurs in the germinal centers of LNs and req Rheumatology, Anatomy (Anat) 1
interaction of the CD40 receptor on B cells w/ the CD40L (CD154) expressed by activated T cells. IgG is the main serum Ig of the 2ary response. Orthopedics & Sports
(RH)
1697 Burkitt lymphoma Histo, Burkitt lymphoma has a 'starry sky' appearance due to the presence of macrophages and apoptotic bodies in a sea of medium-sized lymphocytes. The rates of Rheumatology, Anatomy (Anat) 3
mitosis and apoptosis in the cancerous tissue are high. Almost all cases of Burkitt lymphoma are a/w translocations of the c-Myc gene on chrom 8, usually onto the Ig Orthopedics & Sports
heavy chain region of chrom 14 [t(8;14)]. (RH)
1702 Ulnar nerve neuropathy The ulnar nerve can be injured at the med. epicondyle of the humerus ('funny bone') or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist. Pts Rheumatology, Anatomy (Anat) 2
often have sensory loss over the med. 1.5 digits and hypothenar eminence, and weakness on wrist flexion/adduction, finger abduction/adduction, and flexion of the 4th/5th Orthopedics & Sports
digits. The hypothenar eminence may flatten due to muscle atrophy. (RH)
1704 Brachial plexus The musculocutaneous nerve innervates the major forearm flexors (e.g. biceps brachii, brachialis) and coracobrachialis (flexes and adducts the arm) and provides sensory Rheumatology, Anatomy (Anat) 6
innervation to the lateral forearm. It's derived from the upper trunk of the brachial plexus (C5-C7) and can be injured by trauma or strenuous upper extremity exercise. Orthopedics & Sports
(RH)
1730 Aortic regurgitation AR causes an ↑ in total SV w/ abrupt distension and rapid falloff of peripheral arterial pulses, resulting in a wide PP. This leads to bounding peripheral pulses and head Rheumatology, Anatomy (Anat) 8
bobbing w/ each heartbeat. Orthopedics & Sports
(RH)
1732 Mallory-Weiss syndrome A MW tear is a tear in the gastric mucosa near the GOJ. It typically results from repetitive forceful vomiting, which can also cause meta alkalosis. Rheumatology, Anatomy (Anat) 2
Orthopedics & Sports
(RH)
1733 Chronic kidney disease Pts w/ CKD may develop renal osteodystrophy from 2° hyperparathyroidism (caused by hyperphosphataemia and hypocalcaemia). Rheumatology, Anatomy (Anat) 8
Orthopedics & Sports
(RH)
1803 Rotator cuff The supraspinatus muscle assists in abduction of the arm and stabilisation of the GHJ. The supraspinatus tendon is vulnerable to injury due to impingement b/w the Rheumatology, Anatomy (Anat) 3
acromion and the head of the humerus. Supraspinatus tendinopathy is the most common cause of RCS. Orthopedics & Sports
(RH)
1812 Cleft lip and cleft palate Cleft lip results when the maxillary prominence fails to fuse with the intermaxillary segment during the fifth-sixth week of embryonic development. Cleft palate occurs Rheumatology, Anatomy (Anat) 1
when the palatine shelves fail to fuse with one another or with the primary palate. Cleft lip and palate can occur together or in isolation. Orthopedics & Sports
(RH)
1885 Epidural hematoma The MMA is a branch of the maxillary artery, which enters the skull at the foramen spinosum and courses intracranially deep to the pterion (where the frontal, parietal, Rheumatology, Anatomy (Anat) 2
temporal, and sphenoid bones meet). Skull fractures at this site may cause laceration of this vessel, leading to an EDH. Orthopedics & Sports
(RH)
1924 Hydrocephalus Hydrocephalus in infants presents with macrocephaly and poor feeding. Imaging studies showing enlarged ventricles are characteristic. Untreated hydrocephalus leads to Rheumatology, Anatomy (Anat) 4
spasticity due to stretching of the periventricular pyramidal tracts, developmental delays, and seizures. Orthopedics & Sports
(RH)
1956 Myocardial infarction Ion pump failure due to ATP defic during cardiac ischemia causes intracellular accumulation of Na+ and Ca2+. The ↑ intracellular solute conc draws free water into the Rheumatology, Anatomy (Anat) 18
cell, causing the cellular and mitochondrial swelling that's observed histologically. Orthopedics & Sports
(RH)
1968 Chemotherapy Neurotox is the dose-limiting AE of vincristine therapy. This tox results from failure of microtubule polymerisation in neuronal axons. Other notable AEs classically a/w Rheumatology, Anatomy (Anat) 3
CTx agents incl PF and flagellate skin discolouration w/ bleomycin use; CHF w/ doxorubicin; and hemorrhagic cystitis w/ cyclophosphamide. Orthopedics & Sports
(RH)
1969 Urethritis Urethritis in a young man is most likely to be due to Neisseria gonorrhoeae or Chlamydia trachomatis, both of which cause dysuria and mucopurulent urethral discharge. Rheumatology, Anatomy (Anat) 4
The standard Tx for suspected gonococcal urethritis presumes infection by both organisms. Therefore, ceftriaxone is given for N gonorrhoeae, and doxycycline or Orthopedics & Sports
azithromycin is given for C trachomatis. (RH)
7621 Selective serotonin reuptake SS is characterised by AMS, autonomic hyperactivity, and NM excitation (e.g. hyperreflexia, clonus). Causes incl high doses a/o combos of 5-HT-ergic drugs (e.g. SSRI Rheumatology, Anatomy (Anat) 3
inhibitors and MAOI). Tryptophan is a precursor for 5-HT. Orthopedics & Sports
(RH)
8579 Professional conduct It is ethically problematic for physicians to accept expensive gifts as they may influence or appear to influence physician behavior. These gifts should be declined after Rheumatology, Anatomy (Anat) 3
expressing appreciation for the gesture. Orthopedics & Sports
(RH)
8670 Chronic myeloid leukemia Some pts w/ NSCLC harbour a chrom rearrangement that creates a fusion gene b/w EML4 and ALK. This results in a constitutive active tyrosine kinase that causes Rheumatology, Anatomy (Anat) 2
malignancy. Orthopedics & Sports
(RH)
8671 Catheter related The most important steps for prevention of CVC infections are as follows: Rheumatology, Anatomy (Anat) 3
bloodstream infection Proper hand hygiene Orthopedics & Sports
Full barrier precautions during insertion (RH)
Chlorhexidine skin disinfection
Avoidance of the femoral insertion site
Removal of the catheter when it is no longer needed
8710 Kaposi sarcoma Kaposi's sarcoma usually involves the skin and GI tract and is common in HIV patients not on antiretroviral therapy. Endoscopy reveals characteristic lesions, which Rheumatology, Anatomy (Anat) 2
range from reddish/violet flat maculopapular lesions to raised hemorrhagic nodules or polypoid masses. Biopsy can show spindle cells, neovascularization, and Orthopedics & Sports
extravasated red blood cells. (RH)
11659 Dengue fever Dengue viruses are ssRNA viruses w/ 4 diff serotypes. 1° (1st) infection can be aSSx or cause a self-limited disease in most adults. 2° infection is due to infection w/ a diff Rheumatology, Anatomy (Anat) 2
viral serotype and usually causes more severe illness. Orthopedics & Sports
(RH)
QID Topic Educational Objective System Subject Repeats
11679 Polypharmacy Falls are a common problem in elderly nursing home patients. Optimal management includes a careful medication review with the goal of limiting the use of agents Rheumatology, Anatomy (Anat) 1
associated with increased fall risk. Orthopedics & Sports
(RH)
11683 Antihistamines Review of Rx to determine if any are unnecessary or causing AEx is essential in providing high-quality pt care. The cumulative anticholinergic burden of multiple Rx is Rheumatology, Anatomy (Anat) 3
especially problematic in the elderly. Orthopedics & Sports
(RH)
11684 Babesiosis Babesiosis and Lyme disease are transmitted by the Ixodes tick and occur in similar geographic regions. Coinfection is common. Rheumatology, Anatomy (Anat) 2
Orthopedics & Sports
(RH)
11727 Treatment adherence A d/c checklist detailing Rx changes and f/u appointments can significantly facilitate a pt's transition from the hospital and improve adherence to outPt Tx. Individuals Rheumatology, Anatomy (Anat) 5
who experience a smooth transition from the inPt to the outPt setting are at ↓ risk for early rehospitalization. Orthopedics & Sports
(RH)
11776 Dyslipidemia Ezetimibe ↓ intestinal absorption of chol. As a result, the amount of dietary chol reaching the liver ↓. To compensate, the liver ↑ LDL receptor expression, which draws Rheumatology, Anatomy (Anat) 11
chol out of the circulation. Orthopedics & Sports
(RH)
11778 Atherosclerosis Atherosclerosis is a PPx process involving endothelial cell dysfxn, and it develops most rapidly in areas w/ bends and branch points that encourage turbulent blood flow. Rheumatology, Anatomy (Anat) 8
The lower abdo aorta and coronary arteries are the vascular beds most susceptible to atherosclerosis; they tend to develop atherosclerosis earliest in life and have the Orthopedics & Sports
highest overall atherosclerotic burden. (RH)
11799 Angioedema C1INH defic causes ↑ cleavage of C2 and C4 and results in inappropriate activation of the complement cascade. C1INH also blocks kallikrein-induced conversion of Rheumatology, Anatomy (Anat) 2
kininogen to bradykinin, a potent vasodilator a/w angioedema. Orthopedics & Sports
(RH)
11801 Neurocysticercosis Neurocysticercosis is a relatively common cause of seizures in pts from Central and South America and should be considered in pts w/ suggestive SSx and imaging (e.g. Rheumatology, Anatomy (Anat) 1
cystic brain lesion) and char epidemiological RFs. Orthopedics & Sports
(RH)
11819 Antibiotic resistance Aminoglycosides work by interfering w/ the 30S ribosomal subunit and causing the cell to misread mRNA, thereby halting protein synthesis. An important mech of Rheumatology, Anatomy (Anat) 8
resistance is the methylation of the aminoglycoside-binding portion of the ribosome, which inhibs the ability of aminoglycoside to interfere w/ protein translation. Orthopedics & Sports
(RH)
11855 Drug interaction Calcineurin inhib nephrotox w/ resultant impairment of renal fxn is the most significant AE of cyclosporine. CYP3A is responsible for cyclosporine meta in the small Rheumatology, Anatomy (Anat) 2
intestine and liver. Grapefruit juice inhibs this enzyme and incr the nephrotox of cyclosporine by incr circulating drug lvls (pharmacokinetic interaction). Orthopedics & Sports
(RH)
12073 Panic disorder Rx of PD incls SSRIs and benzos. SSRIs are often preferred to benzos due to the lack of phys dependence and abuse potential. Rheumatology, Anatomy (Anat) 4
Orthopedics & Sports
(RH)
15553 Renal artery stenosis Unilateral RAS causes hypoperfusion and activation of the RAAS. ATII causes arteriolar vasoconstriction and ↑ aldo and ADH synthesis. The resultant HTN helps ↓ the Rheumatology, Anatomy (Anat) 9
decline in GFR in the affected kidney, but causes a pressure natriuresis w/ ↑ Na+excretion in the unaffected kidney. Orthopedics & Sports
(RH)
15660 Plague Bubonic plaque is a zoonotic infection that causes febrile illness w/ regional inflammatory LAD (buboes). The underlying pathogen is Y. pestis, a gram (-) coccobacillus Rheumatology, Anatomy (Anat) 1
that exhibits bipolar staining (resembling a close safety pin). The major environmental reservoir is rodents, and transmission usually occurs via rodent flea bite. Orthopedics & Sports
(RH)
361 Polyhydramnios Polyhydramnios (excessive accumulation of amniotic fluid) presents with increased abdominal circumference out of proportion to gestational age. The etiology is Rheumatology, Biochemistry 1
decreased fetal swallowing or increased fetal urination. Fetal anomalies associated with impaired swallowing include gastrointestinal obstruction (eg, duodenal, Orthopedics & Sports (Bioc)
esophageal, or intestinal atresia) and anencephaly. (RH)
1250 Venous thromboembolism Heparins are ideal anticoagulants for most patients with thromboembolic disease in pregnancy as they do not cross the placenta and therefore the risk of fetal bleeding or Rheumatology, Biochemistry 2
teratogenicity is low. Low molecular weight heparin (eg, enoxaparin) is the preferred therapy, with patients transitioned to unfractionated heparin at term. Orthopedics & Sports (Bioc)
(RH)
1503 Diabetes mellitus Neonates born to mothers with poorly controlled diabetes during pregnancy are exposed to high maternal glucose levels in utero, resulting in excessive fetal insulin Rheumatology, Biochemistry 31
production and islet hyperplasia. Fetal hyperinsulinemia persists for several days following birth and predisposes the infant to transient hypoglycemia. Orthopedics & Sports (Bioc)
(RH)
2090 Diabetic ketoacidosis Diabetic ketoacidosis (DKA) is characterized by polydipsia, polyuria, and a fruity odor to the breath and/or urine. DKA is associated with elevated anion gap metabolic Rheumatology, Biochemistry 6
acidosis that is usually accompanied by compensatory respiratory alkalosis. This combination yields a low pH, low serum bicarbonate, and low PaCO2. Orthopedics & Sports (Bioc)
(RH)
2091 Transcription Homeobox genes encode DNA-binding TFs that play an important role in the segmental organization of the embryo along the cranio-caudal axis. Rheumatology, Biochemistry 7
Orthopedics & Sports (Bioc)
(RH)
756 Pharyngitis The major virulence factor of S. pyogenes is M protein, an α-helical coiled-coil protein that shares structural homology w/ tropomyosin and myosin. It extends from the Rheumatology, Embryology 2
cell wall and prevents phagocytosis, inhibs complement binding, and mediates bacterial adherence. Abs against M protein form shortly after acute infection and may Orthopedics & Sports (Embr)
cross-react w/ epitopes on myosin, leading to rheumatic carditis. (RH)
1935 Gluconeogenesis Ethanol inhibs GNG and can cause hypoglycaemia once hepatic glycogen stores are depleted. Rheumatology, Genetics (Gene) 4
Orthopedics & Sports
(RH)
1159 Vitiligo Vitiligo is a common condition characterised by the loss of epidermal melanocytes. It occurs more commonly in pts w/ autoimmune disorders (e.g. autoimmune Rheumatology, Histology (Hist) 1
thyroiditis, DM-1) and results in well-defined, variably sized patches of hypopigmentation. Orthopedics & Sports
(RH)
1734 Muscle structure & The H band is the region of the sarcomere that contains only thick (myosin) filaments. The H band is the part of the Aband (which is on either side of the M line) where Rheumatology, Histology (Hist) 8
physiology thick filaments have no overlapping thin (actin) filaments. Orthopedics & Sports
(RH)
298 Mucormycosis Amphotericin B is a polyene antifungal drug notorious for its renal tox. Severe hypokalaemia and hypomagnesaemia are commonly seen during therapy and often req Rheumatology, Immunology 3
daily supplementation. Orthopedics & Sports (Immu)
(RH)
538 Antipsychotics FGAs can be classified according to high or low potency and have char AE profiles. Low-potency antipsychs are more likely to cause sedation, antichol AEs, and Rheumatology, Immunology 9
orthostatic hypotension. High-potency antipsychs are more likely to cause EPS (e.g. dystonia, akathisia, parkinsonism). Orthopedics & Sports (Immu)
(RH)
741 Antidepressants Sexual dysfxn is seen in up to 50% of pts Tx w/ SSRIs. Bupropion, an NDRI, is a 1st-line Tx for MDD and doesn't cause sexual dysfxn. Rheumatology, Immunology 4
Orthopedics & Sports (Immu)
(RH)
752 Rheumatoid arthritis The foundation of management for rheumatoid arthritis is disease-modifying antirheumatic drugs, which alleviate pain and inflammation and reduce long-term joint Rheumatology, Immunology 9
destruction. However, the response to treatment may take several weeks. Nonsteroidal anti-inflammatory drugs and glucocorticoids can provide rapid symptom relief in Orthopedics & Sports (Immu)
the interim. (RH)
754 Osteomyelitis heme OM is most common in children and usually affects the metaphysis of long bones due to the slower blood flow and cap fenestrae in this region. W/o proper Tx, the Rheumatology, Immunology 4
infection can progress to chronic suppurative OM. Orthopedics & Sports (Immu)
(RH)
646 Cushing syndrome In Cushing syndrome due to an ACTH-secreting pituitary adenoma (Cushing disease), ACTH is high and cortisol production can be suppressed by high-dose, but not low- Rheumatology, Microbiology 5
dose, dexamethasone. In pts w/ ectopic ACTH production (e.g. from malignant tumours), cortisol and ACTH production aren't suppressed by low- or high-dose Orthopedics & Sports (Micr)
dexamethasone. (RH)
1395 Maple syrup urine disease MSUD classically presents w/ irritability, dystonia, poor feeding, and a 'maple syrup' scent to the pt's urine w/i the 1st few days of life. Dietary restriction of BCAAs (e.g. Rheumatology, Microbiology 2
leucine, isoleucine, valine) is the hallmark of Tx. Orthopedics & Sports (Micr)
(RH)
8857 Tricuspid regurgitation IE in IVDUs commonly affects the TV, often leading to septic pulm emboli. Pts can have an early- or holo-systolic murmur of TR, which is best auscultated in the 4th or Rheumatology, Microbiology 3
5th ICS at the left lower sternal border. Orthopedics & Sports (Micr)
(RH)
11868 Giant cell arteritis Cell-mediated immunity is the primary mechanism underlying giant cell arteritis. The production of cytokines, in particular interleukin-6, is an important driver of this Rheumatology, Microbiology 5
process and closely correlates with the severity of symptoms. Orthopedics & Sports (Micr)
(RH)
239 Pituitary adenoma In pts w/ PRL-oma, high lvls of circulating PRL suppress GnRH secretion from the hypothal, leading to ↓ secretion of LH and subseq hypogonadism, anovulation, and Rheumatology, Pathology (Path) 8
amenorrhoea. The resulting oestrogen defic can cause osteoporosis w/ an ↑ risk for fragility fractures, and lead to vaginal dryness and atrophy. Orthopedics & Sports
(RH)
316 Autoimmune hemolytic Fe overload (hemosiderosis) is a common and serious complication of chronic hemolytic anaemia and freq blood transfusions. hemosiderin accumulation is the cardinal Rheumatology, Pathology (Path) 1
anemia histo finding. Chelation therapy is indicated to ↓ parenchymal Fe deposition. Orthopedics & Sports
(RH)
340 Acute liver failure The P450 microsomal oxidase system plays an important role in detoxification. In CCl4 pois, however, it produces free radicals that start a vicious cycle of hepatic injury. Rheumatology, Pathology (Path) 2
Orthopedics & Sports
(RH)
450 Colonic polyps Adenomatous and serrated polyps (i.e. sessile serrated polyp, traditional serrated adenoma) are neoplastic polyps that have malignancy potential. ↑ polyp size is the most Rheumatology, Pathology (Path) 2
important RF for ca; villous histology and high-grade dysplasia are addnal RFs. Orthopedics & Sports
(RH)
QID Topic Educational Objective System Subject Repeats
457 Acute pancreatitis After gallstones, Alc abuse is the 2nd most common cause of acute pancreatitis. Macrocytosis and an AST:ALT ratio >2 are indirect indicators of chronic Alc Rheumatology, Pathology (Path) 9
consumption. Alc-related macrocytosis can occur independently of folate deficiency. Orthopedics & Sports
(RH)
461 Acute pancreatitis Annular pancreas, or pancreatic tissue encircling the desc duodenum, is caused by failure of the ventral pancreatic bud to properly migrate and fuse w/ the dorsal bud Rheumatology, Pathology (Path) 9
during the 7th and 8th wk of fetal development. Annular pancreas is usually aSSx but may Px w/ duodenal obstruction or pancreatitis. Orthopedics & Sports
(RH)
629 Cerebellar degeneration PNP syndromes can occur due to the production of hormone-like substances from tumour cells. They can also result from immune rxns against tumour cells that cross- Rheumatology, Pathology (Path) 1
react w/ normal cells, causing dysfxn a/o dmg to healthy organs and tissues. Neuro PNP syndromes (e.g. PNP cerebellar degen) are an autoimmune phenomenon. Orthopedics & Sports
(RH)
630 Mitochondrial disorders Mitochondrial diseases are Chx by exclusively-maternal inheritance. The variable severity of these diseases is explained by the random distribution of normal and mutated Rheumatology, Pathology (Path) 4
mitochondria b/w daughter cells during mitosis; as a result, some cells may have completely healthy mitochondria, while other cells contain mitochondria affected by Orthopedics & Sports
genetic mutation (heteroplasmy). MELAS is a mitochondrial syndrome. (RH)
667 Bone remodeling Bone-specific alkaline phosphatase levels correlate with osteoblast activity. Other markers of osteoblast activity include N-terminal propeptide of type 1 procollagen, Rheumatology, Pathology (Path) 1
which is released during post translation cleavage of type 1 procollagen. Orthopedics & Sports
(RH)
702 Silicosis In silicosis, internalised silica particles impair macrophage fxn by disrupting phagocytosis and promoting apoptosis. This ↑ the risk of mycobacteria infection (particularly Rheumatology, Pathology (Path) 2
M. tuberculosis). Orthopedics & Sports
(RH)
721 Loop diuretics Furosemide is a loop diuretic that works by inhib Na+-K+-2Cl- symporters in the LOH effectively causing ↑ Na+, Cl-, and fluid excretion. Addnally, loop diuretics also Rheumatology, Pathology (Path) 3
stim PG release. By stim renal PG release, loop diuretics also ↑ RBF leading to ↑ GFR and enhanced drug delivery. Thus concurrent use of NSAIDs w/ loop diuretics can Orthopedics & Sports
result in a ↓ diuretic response. (RH)
914 Multiple myeloma Amyloid light-chain amyloidosis is a/w MM and other monoclonal plasma cell dyscrasias due to the deposition of insoluble Ig light-chain fibrils in major organs (e.g. Rheumatology, Pathology (Path) 9
kidneys, heart, neuro system). A bone marrow sample w/ >10% plasma cells is strongly suggestive of MM. Orthopedics & Sports
(RH)
940 Sickle cell Pts /w SCT are typically aSSx and have relative protection from malaria caused by P. falciparum. These pts usually have normal Hb, reticulocyte, and RBC index values. Rheumatology, Pathology (Path) 13
Life expectancy is the same as that of the gen pop. Orthopedics & Sports
(RH)
1265 Morbidity and mortality Case-fatality rate is calculated by dividing the number of fatal cases of a disease or condition by the total number of people w/ that disease or condition. Rheumatology, Pathology (Path) 1
rates Orthopedics & Sports
(RH)
1266 Urinary tract infection The average (or mean) of a dataset of values is the sum of the values divided by the total number of values. Rheumatology, Pathology (Path) 12
Orthopedics & Sports
(RH)
1451 Diphtheria Diphtheria toxin and pseudomonal exotoxin A act by ribosylating and inactivating EF-2, inhibiting host cell protein synthesis and causing cell death. Rheumatology, Pathology (Path) 6
Orthopedics & Sports
(RH)
1771 Penetrating thoracic trauma The RV composes most of the heart's anterior surface. A deep, penetrating injury at the left sternal border in the 4th ICS would puncture the RV. Rheumatology, Pathology (Path) 2
Orthopedics & Sports
(RH)
1835 Kaposi sarcoma Kaposi sarcoma typically presents as blue-violet or brownish skin plaques on the extremities and mucous membranes of HIV (+) pts. This tumour arises from primitive Rheumatology, Pathology (Path) 2
mesenchymal cells and is strongly a/w HHV-8. Orthopedics & Sports
(RH)
1874 Inflammatory bowel disease Chronic inflammation is associated with increased circulating pro-inflammatory cytokines (eg, IL-1, IL-6, tumor necrosis factor-alpha), which stimulates the liver to Rheumatology, Pathology (Path) 9
release acute-phase reactants (eg, C reactive protein, fibrinogen). The presence of acute-phase reactants increases the erythrocyte sedimentation rate, a nonspecific marker Orthopedics & Sports
for inflammation. (RH)
1896 Down syndrome Unbalanced Robertsonian translocations account for a minority of DS cases. Karyotyping shows 46 chromosomes w/ a translocation b/w 2 acrocentric nonhomologous Rheumatology, Pathology (Path) 6
chromosomes [eg, 46, XX, t(14;21)]. Orthopedics & Sports
(RH)
1900 Gestational trophoblastic 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 the Rheumatology, Pathology (Path) 3
disease Chx 46, XX genotype. Orthopedics & Sports
(RH)
7556 Endocarditis Chronic valvular inflammation and scarring a/w RHD predispose to an ↑ risk of IE, which is Chx by valvular vegetations w/ destruction of the underlying cardiac tissue. Rheumatology, Pathology (Path) 15
Orthopedics & Sports
(RH)
11653 Kidney transplantation Acute renal allograft rejection can be an antibody-or cell-mediated process. Acute cellular rejection is associated with diffuse lymphocytic infiltration of the renal Rheumatology, Pathology (Path) 1
vasculature (endotheliitis), tubules, and interstitium. Orthopedics & Sports
(RH)
11798 Seizures IV benzos (e.g. lorazepam) are the initial DOC for SE. They work by enhancing the effect of GABA at the GABA-A receptor, leading to ↑ Cl- influx and suppression of Rheumatology, Pathology (Path) 8
AP firing. Orthopedics & Sports
(RH)
11818 Urinary retention The bladder is extraperitoneal. In placement of a suprapubic cystostomy, the trocar and cannula will pierce the layers of the abdominal wall but will not enter the Rheumatology, Pathology (Path) 4
peritoneum. Orthopedics & Sports
(RH)
11821 Ovarian cancer Vomiting is a reflex regulated mainly by 5 receptors, incl M1 muscarinic, D2 DA-ergic, H1 histaminic, 5-HT3 5-HT-ergic, and NK1 receptors. 5-HT3 and NK1 receptor Rheumatology, Pathology (Path) 9
antagonists are particularly useful for CTx-induced vomiting. Orthopedics & Sports
(RH)
12255 Meningitis The classic triad of fever, stiff neck, and AMS should raise suspicion for acute bacterial meningitis. Eval req prompt blood cultures, empiric Abx, and LP w/ CSF analysis. Rheumatology, Pathology (Path) 17
Orthopedics & Sports
(RH)
15596 Diabetes mellitus Insulin has both renal and hepatic clearance. In pts w/ adv CKD and DM, ↓ renal clearance of insulin can lead to SSx hypoglycemia if exog insulin doses aren't adjusted Rheumatology, Pathology (Path) 31
based on the change in renal fxn. Orthopedics & Sports
(RH)
15597 Hypertrophic Pts w/ HCM may be aSSx and often have a FHx of HCM or SCD. Findings consistent w/ HCM incl an overall ↑ in LV mass, ↓ LV cavity size w/ impaired diastolic fxn, Rheumatology, Pathology (Path) 9
cardiomyopathy LVH predominantly affecting the septum, and normal or ↑ LV EF. Orthopedics & Sports
(RH)
15627 Post-traumatic stress Acute stress disorder is characterised by intrusive experiences (flashbacks, nightmares), arousal (poor conc, restless sleep), dissociative SSx, and avoidance of traumatic Rheumatology, Pathology (Path) 3
disorder reminders, as well as mood disturbances in response to a life-threatening trauma. SSx last b/w 3days and 1mos. Orthopedics & Sports
(RH)
15629 IgA nephropathy IgA nephropathy is characterised as recurrent hematuria that occurs spontaneously or w/i 5-7days of an URI or pharyngeal infection (synpharyngitic hematuria). Unlike Rheumatology, Pathology (Path) 1
other causes of IC-mediated nephritic syndromes (e.g. PSGN), IgA nephropathy is a/w normal serum complement lvls. Orthopedics & Sports
(RH)
15636 Glomerular disorders MCD is the most common cause of nephrotic syndrome in children. It's often idiopathic but may be triggered by drugs, immunisations, or malignancy. LM shows normal Rheumatology, Pathology (Path) 9
glomeruli, w/ no Ig or complement deposits on IF staining. However, EM shows diffuse podocyte foot process effacement and fusion. Orthopedics & Sports
(RH)
15665 Leptospirosis Leptospirosis is a zoonotic infection caused by the motile spirochete Leptospira. Transmission primarily occurs when humans come into contact w/ water contaminated w/ Rheumatology, Pathology (Path) 1
animal urine during outdoor recreational or occupational activities. Pts classically have a mild, self-limited, flu-like illness but may develop more serious complications Orthopedics & Sports
such as renal or hepatic failure. (RH)
15666 Psoriasis Psoriasis is characterised on histo by hyperkeratosis and confluent parakeratosis of the stratum corneum (producing the char silvery scales seen on gross Ex), diffuse Rheumatology, Pathology (Path) 5
epidermal hyperplasia w/ elongated and clubbed rete ridges (corresponding to the typical erythematous plaques), and dilated caps in the dermal papillae. Orthopedics & Sports
(RH)
15677 Pleural effusion Transudative effusions are typically caused by alterations in hydrostatic or oncotic pressure (e.g. HF, cirrhosis, nephrotic syndrome), whereas exudative effusions typically Rheumatology, Pathology (Path) 4
result from inflammation and conseq ↑ vascular membrane permeability (e.g. infection, malignancy, rheumatologic disease). Exudative effusions are characterised by a Orthopedics & Sports
high ratio of pleural fluid to serum total protein (>0.5) or LDH (>0.6), or high absolute lvls of LDH. (RH)
15696 Ichthyoses Ichthyosis vulgaris is characterized by dermal xerosis (dryness) and scaling that primarily affect the trunk and extensor surfaces of the extremities. It is caused by Rheumatology, Pathology (Path) 1
mutations of the filaggrin gene, resulting in epidermal hyperplasia, defective desquamation, and loss of the normal barrier function. Orthopedics & Sports
(RH)
295 Sporotrichosis Sporothrix schenckii is a dimorphic fungus that causes a subcutaneous mycosis. It is often transmitted by a thorn prick. The disease manifests with nodules that spread Rheumatology, Pathophysiology 1
along lymphatics. Orthopedics & Sports (Patp)
(RH)
640 Adrenal insufficiency Admin of metyrapone will cause a ↓ in cortisol synthesis via inhib of 11-β-hydroxylase. In pts w/ an intact HPA axis, this will cause a reactive ↑ in ACTH, 11- Rheumatology, Pathophysiology 5
deoxycortisol, and urinary 17-hydroxycorticosteroid lvls. Orthopedics & Sports (Patp)
(RH)
700 Silicosis Silicosis is characterised by dyspnoea and productive cough occurring yrs after inhalational exposure to crystalline silica. Histo, it's characterised by birefringent silicate Rheumatology, Pathophysiology 2
particles w/i dense, whorled collagenous nodules surrounded by dust-laden macrophages. Radiography typically demonstrates numerous small, rounded nodules Orthopedics & Sports (Patp)
predominant in the upper lobes; calcification of the rim of hilar LNs (eggshell calcification) may also be seen. (RH)
QID Topic Educational Objective System Subject Repeats
740 Antidepressants Bupropion is a 1st-lineantidep that isn't a/w sexual AEs or weight gain. However, it's a/w an ↑ seizure risk at high doses and is c/i in pts w/ seizure disorders, AN, and BN. Rheumatology, Pathophysiology 4
Orthopedics & Sports (Patp)
(RH)
748 Antiplatelet therapy GI mucosal injury and bleeding are the most common side effects of aspirin. These are due primarily to COX-1 inhib, which results in impaired PG-dependent GI mucosal Rheumatology, Pathophysiology 1
defence and ↓ platelet aggregation. Orthopedics & Sports (Patp)
(RH)
753 Biologic agents Tumor necrosis factor-alpha (TNF-α) inhibitors impair cell-mediated immunity. All patients beginning treatment with TNF-α inhibitors should be evaluated for latent Rheumatology, Pathophysiology 2
tuberculosis. Orthopedics & Sports (Patp)
(RH)
867 Systemic sclerosis PAH is a common complication of systemic sclerosis, likely resulting from proliferation of T cells w/ release of cytokines (e.g. TGF-β) and conseq progr thickening and Rheumatology, Pathophysiology 3
occlusion of the small and medium-sized pulm arteries/arterioles. Pts typically have progr dyspnoea and a loud pulm component of S2 and may develop SSx of right-sided Orthopedics & Sports (Patp)
HF (e.g. hepatomegaly, peri oedema). (RH)
982 Actinic keratoses AK develops on chronically sun-exposed areas of the skin in predisposed individuals. The lesions consist of erythematous papules w/ a central scale and a rough Rheumatology, Pathophysiology 2
'sandpaper-like' texture. AKs are considered premalignant lesions and have the potential to progress to SCC. Orthopedics & Sports (Patp)
(RH)
987 Hemophiliacs Bleeding after a tooth extraction and Hx of hemarthrosis are suggestive of hemophilia. ↓ lvls of FVIII or IX lead to failure to convert prothrombin into thrombin and defic Rheumatology, Pathophysiology 2
thrombus formation. The addition of thrombin to the blood of a pt w/ hemophilia results in clotting. Orthopedics & Sports (Patp)
(RH)
1450 Diphtheria Lysogenic bacteriophages are responsible for converting non-pathogenic Corynebacterium into toxigenic Corynebacterium. Toxigenic strains elaborate the diphtheria Rheumatology, Pathophysiology 6
exotoxin, which causes pseudomembranous pharyngitis and potentially life-threatening systemic effects (e.g. myocarditis, neuritis). Orthopedics & Sports (Patp)
(RH)
1600 Aldosterone antagonists Aldo is a component of the RAAS that acts on the principal and intercalated cells of the renal CDs to cause resorption of Na+ and water and loss of K+ and H+ ions. Aldo Rheumatology, Pathophysiology 3
receptor antags (e.g. spironolactone, eplerenone) inhib these effects. Orthopedics & Sports (Patp)
(RH)
8802 Supine hypotension Pregnant women > 20 wks gestation can experience compression of the IVC by the gravid uterus while in the supine position. This ↓ venous return and CO, which can Rheumatology, Pathophysiology 1
result in hypotension and syncope. Orthopedics & Sports (Patp)
(RH)
11646 Antiemetics 5-HT3 receptor antags are useful for the Tx of visc nausea due to GI insults, such as GE, ChTx, and gen anes. Antihists and antichols are recom for vestibular nausea. DA Rheumatology, Pathophysiology 1
antags are useful for nausea a/w migraine. Orthopedics & Sports (Patp)
(RH)
11770 Cholesteatoma Cholesteatomas are collections of squamous cell debris that form a mass behind the TM. Cholesteatomas can be congenital or may occur as an acquired 1° lesion or Rheumatology, Pathophysiology 1
following infection, trauma, or Sx of the middle ear. They can cause hearing loss due to erosion into auditory ossicles. Orthopedics & Sports (Patp)
(RH)
11805 Pharyngitis Opsonization occurs when host proteins such as Igs or complement bind to foreign cells such as bacteria and coat the surface, enhancing phagocytosis. The most important Rheumatology, Pathophysiology 2
opsonins (coating proteins) are IgG and complement C3b. Orthopedics & Sports (Patp)
(RH)
14677 Compartment syndrome As an antioxidant, superoxide dismutase neutralizes reactive oxygen species, preventing cell injury. In a pathologic state such as post-ischemic reperfusion, oxidative Rheumatology, Pathophysiology 2
stress is high and reactive oxygen species production exceeds the neutralizing capability of antioxidants, leading to increased cell damage and death. Orthopedics & Sports (Patp)
(RH)
716 Staphylococcal scalded skin The staphylococcal scalded skin syndrome occurs in infants and children due to the production of the exotoxin exfoliatin by Staphylococcus species. It causes widespread Rheumatology, Pharmacology 1
syndrome epidermal sloughing. especially with gentle pressure (Nikolsky's sign). Orthopedics & Sports (Phar)
(RH)
718 Loop diuretics LoopDs act by inhib the Na+K+2Cl- cotransporter in the thick asc limb of the LOH, incr Na+, Cl-, and water excretion. They're the most potent diuretics and are used as Rheumatology, Pharmacology 3
1st-line therapy for rapid relief of SSx in pts w/ acute DHF. Orthopedics & Sports (Phar)
(RH)
719 Acetazolamide CA is found in high conc in the PCT and is responsible for catalyzing rxns necessary for NaHCO3 reabs. Acetazolamide is a diuretic that works by inhib CA, which Rheumatology, Pharmacology 1
effectively blocks NaHCO3 and water reabs in the PCTs resulting in urinary HCO3- wasting. CAIs are also used to relieve IOP in open-angle and angle-closure glaucoma. Orthopedics & Sports (Phar)
(RH)
720 Thiazides TZDs work by blocking Na+Cl- symporters in the DCTs, causing enhanced Na+, Cl-, and water excretion. Since only a small amount of filtered Na+ reaches the DCTs, Rheumatology, Pharmacology 3
TZD aren't as efficacious as loopDs. Unlike loopDs, TZDs can cause hypercalcemia. Orthopedics & Sports (Phar)
(RH)
858 Renal calculi Urine supersaturation is the main mech underlying all types of renal stones. Low fluid intake ↑ the conc of stone-forming agents, thereby promoting stone formation. All Rheumatology, Pharmacology 7
pts w/ nephrolithiasis should be advised to maintain adequate fluid intake. Orthopedics & Sports (Phar)
(RH)
859 Renal calculi Renal calculi occur due to an imbalance of factors that facilitate or inhib stone formation. ↑ urinary concs of Ca2+, oxalate, and uric acid promote salt crystallisation, Rheumatology, Pharmacology 7
whereas ↑ urinary citrate conc and high fluid intake prevent calculi formation. Orthopedics & Sports (Phar)
(RH)
860 Renal cell carcinoma CCC is the most common subtype of RCC and is composed of large, rounded, or polygonal cells w/ clear cytoplasm. These tumours are often detected incidentally at an Rheumatology, Pharmacology 8
advanced stage; the lung is the most common site for mets, f/b osteolytic bone and liver. Orthopedics & Sports (Phar)
(RH)
861 Antiretroviral therapy PIs are HIV ARV Rx that inhib cleavage of the polypeptide precursor into mature viral proteins. Their AEs as a class incl. hyperglycaemia, lipodystrophy, and drug-drug Rheumatology, Pharmacology 7
interactions due to inhib of CYP450. Orthopedics & Sports (Phar)
(RH)
993 Chronic cough Cough is a very well recognized AEx of ACEI Thx. Cough 2° to ACEI Thx is Chx as dry, nonproductive, and persistent. The mechanism behind ACEI induced cough is Rheumatology, Pharmacology 1
accumulation of bradykinin, substance P, or prostaglandins. b/c ARBs do not affect ACE activity, they theoretically should not cause cough. Orthopedics & Sports (Phar)
(RH)
1168 Psoriasis Common complications of psoriasis incl psoriatic arthritis, nail changes, and uveitis. Rheumatology, Pharmacology 5
Orthopedics & Sports (Phar)
(RH)
1253 Myocardial infarction β blockers are used in AMI to ↓ morbidity and mortality by ↓ CO and myocardial O2 demand. Non-cardioselective β blockers (e.g. propranolol, nadolol) can trigger Rheumatology, Pharmacology 18
bronchospasm in pts w/ underlying asthma and COPD. Cardioselective β blockers (e.g. metoprolol) predominantly affect β1 receptors and are preferred in such pts. Orthopedics & Sports (Phar)
(RH)
1773 Esophageal varices PVT causes portal HTN, splenomegaly, and varicosities at portocaval anastomoses. It does not cause histologic changes to the hepatic parenchyma. Ascites is uncommon Rheumatology, Pharmacology 2
as the obstruction is presinusoidal; ascites typically only develops in conditions that cause sinusoidal HTN. Orthopedics & Sports (Phar)
(RH)
1795 Anal cancer HPV types 16 and 18 are strongly a/w anal and cervical SCC. HIV infection ↑ the prevalence of HPV infection and the risk of anal carcinoma; this risk is further Rheumatology, Pharmacology 1
augmented in MSM. Orthopedics & Sports (Phar)
(RH)
1897 Hydrocele A communicating hydrocele results when serous fluid accumulates within the tunica vaginalis in the setting of a patent processus vaginalis. It presents as a painless Rheumatology, Pharmacology 2
swelling that transilluminates on examination. Orthopedics & Sports (Phar)
(RH)
7792 Antibiotic resistance A change in the structure of PBPs that prevents cephalosporin binding is 1 mech of bacterial resistance to cephalosporins. Rheumatology, Pharmacology 8
Orthopedics & Sports (Phar)
(RH)
10930 Cranial nerve palsy The pupillary light reflex is assessed by shining light in an eye and observing the response in that eye (direct) and the opposite eye (consensual). The optic nerve (CN II) is Rheumatology, Pharmacology 9
responsible for the afferent limb of the pupillary reflex, and the oculomotor nerve (CN III) is responsible for the efferent limb. Orthopedics & Sports (Phar)
(RH)
11564 Chronic kidney disease When the GFR is normal, relatively large ↓ in GFR result in only small ↑ in serum creatinine. Conversely, when the GFR is significantly ↓, small decrements in GFR Rheumatology, Pharmacology 8
produce relatively large changes in serum creatinine. A good rule of thumb is that every time GFR halves, serum creatinine doubles. Orthopedics & Sports (Phar)
(RH)
11749 Personality disorders Individuals w/ PPD exhibit a lifelong pattern of pervasive suspicion and distrust. Unlike pts w/ psychotic disorders, they don't have fixed delusions and other psychotic Rheumatology, Pharmacology 6
SSx. Orthopedics & Sports (Phar)
(RH)
628 Frontotemporal dementia FTD is a/w pronounced atrophy of the prefrontal cortex w/ later degen of the anterior temporal cortex. It MFx initially w/ changes in personality, social behaviour, and Rheumatology, Physiology 2
language that progress over time to a more global dementia w/ obvi neurocognitive deficits. Orthopedics & Sports (Phys)
(RH)
638 Diabetes mellitus SUs inhib the ATP-sensitive K+ channel on the pancreatic β cell membrane, inducing depol and L-type Ca2+ channel opening. The ↑ Ca2+ influx stims β cell insulin Rheumatology, Physiology 31
release independent of BGCs. SUs can induce hypoglycaemia b/c they stim insulin secretion even when BSLs are normal. Orthopedics & Sports (Phys)
(RH)
639 Diabetes mellitus Metformin inhibs hepatic GNG and ↑ peri Glc utilisation. Lactic acidosis is a rare complication of metformin therapy, but its risk is ↑ in pts w/ underlying renal Rheumatology, Physiology 31
insufficiency. Orthopedics & Sports (Phys)
(RH)
824 Dyslipidemia Although low HDL concentration is a/w ↑ CV risk, the use of Rx to ↑ HDL lvls does not improve CV outcomes. HMG-CoA reductase inhibitors (statins) ↓ total Rheumatology, Physiology 11
cholesterol and LDL lvls. Statins are the most effective lipid-↓ing Rx for 1° and 2° prevention of CV events, regardless of baseline lipid lvls. Orthopedics & Sports (Phys)
(RH)
QID Topic Educational Objective System Subject Repeats
1381 Menstrual cycle Of all hormones influencing the menstrual cycle (LH, FSH, estrogen, progesterone), progesterone ↑ the most in concentration after ovulation. During the latter half of the Rheumatology, Physiology 2
menstrual cycle, the CL secretes high levels of progesterone, which thickens the endometrium and prepares it to receive and nourish a blastocyst. Orthopedics & Sports (Phys)
(RH)
1382 Multiple sclerosis The speed of conduction down an axon depends on 2 constants: the length constant and the time constant (i.e. velocity = length / time). Myelination ↑ the length constant Rheumatology, Physiology 6
and ↓ the time constant, both of which improve axonal conduction speed. Demyelination thus impairs stim transmission. Orthopedics & Sports (Phys)
(RH)
1558 Hypoglycemia Nonselective β blockers exacerbate hypoglycaemia and mask hypoglycaemic SSx mediated by NE/EPI. Rheumatology, Physiology 6
Orthopedics & Sports (Phys)
(RH)
1664 Giardia G. lamblia causes injury to the duodenal and jejunal mucosa by adhering to the intestinal brush border and releasing molecules that induce a mucosal inflammatory Rheumatology, Physiology 2
response. Secretory IgA, which impairs adherence, is the major component of adaptive immunity against G. lamblia infection. Conditions causing IgA defic predispose pts Orthopedics & Sports (Phys)
to chronic giardiasis. (RH)
1665 Inflammatory bowel disease Of the cytokines released in the setting of tissue injury, IL-10 plays important anti-inflammatory and immunomodulatory roles, especially in the pathogenesis of Rheumatology, Physiology 9
inflammatory bowel disease. IL-10 attenuates the immune response through the inhibition of Th1 cytokines, reduction of major histocompatibility complex class Il Orthopedics & Sports (Phys)
expression, and suppression of activated macrophages and dendritic cells. (RH)
1858 Aplastic anemia AA causes pancytopaenia as the bone marrow is replaced by fat cells and marrow stroma. The absence of splenomegaly on PEx is char. A bone marrow Bx can be Rheumatology, Physiology 3
extremely useful in making the Dx. Orthopedics & Sports (Phys)
(RH)
7592 Sickle cell SCD is characterised by repeated splenic infarctions that ultimately result in splenic atrophy and fibrosis, a process that's typically complete by late Rheumatology, Physiology 13
childhood/adolescence. After autosplenectomy, pts are predisposed to infections w/ encapsulated bacterial organisms. Orthopedics & Sports (Phys)
(RH)
8266 Coronary blood flow The coronary sinus communicates freely w/ the RA and will become dilated 2° to any factor that causes ↑ RA pressure. The most common cause is pulm HTN, leading to Rheumatology, Physiology 9
↑ right heart pressures. Orthopedics & Sports (Phys)
(RH)
784 Transplant rejection Chronic renal allograft rejection manifests months to years after a transplant and presents with worsening hypertension and a gradual decline in renal function. It involves Social Sciences (SS) Behavioral 4
a chronic, antibody mediated response against donor antigens and leads to obliterative vascular wall thickening, tubular atrophy, and interstitial fibrosis. The process is Science (Beha)
usually irreversible and eventually leads to graft failure.
1107 Klinefelter syndrome Patients with Klinefelter syndrome (47, XXY) have primary hypogonadism characterized by low testosterone and elevated gonadotropin (FSH, LH) levels. In addition, Social Sciences (SS) Behavioral 3
elevated estradiol results in the common finding of gynecomastia. Science (Beha)
1123 Fructose metabolism Essential fructosuria is a benign disorder of fructose metabolism caused by fructokinase deficiency. In pts w/ essential fructosuria, some of the dietary fructose load is Social Sciences (SS) Behavioral 4
converted by hexokinase to F6P, which can then enter glycolysis; this pathway is not significant in normal individuals. Science (Beha)
1124 Galactosemia Class galactosemia results from deficiency of GALT. CFx include vomiting, lethargy, jaundice, and E. coli sepsis. Cessation of breastfeeding and switching to soy milk- Social Sciences (SS) Behavioral 2
based formula is recommended. Science (Beha)
1125 Lactose intolerance Secondary lactase deficiency can occur after inflammatory (eg, celiac disease) or infectious (eg. giardiasis) processes damage the microvilli of the small intestines. Social Sciences (SS) Behavioral 3
Clinical presentation includes abdominal distension and cramping, flatulence, and diarrhea. Science (Beha)
1126 Fructose metabolism Aldolase B defic, or HFI, leads to accumulation of the tox metabolite F1P. Pts have hypoglycaemia and vomiting when fructose or sucrose is consumed. Tx involves strict Social Sciences (SS) Behavioral 4
removal of both carbs from the diet. Science (Beha)
1128 Galactosemia Lenticular accumulation of galactitol in the lenses of pts w/ galactosemia can cause osmotic dmg and development of cataracts. Cataracts may be the only MFx of Social Sciences (SS) Behavioral 2
galactokinase deficiency. Science (Beha)
1129 Iron deficiency anemia PVS is characterised by dysphagia (oesophageal web formation) and IDA. Findings a/w ID incl koilonychia (spoon-shaped nails) and a shiny red tongue. Most SSx Social Sciences (SS) Behavioral 7
resolve following Fe supplementation. Science (Beha)
1145 Urinary tract infection Urinary tract infections are most common in women and are typically caused by enteric pathogens. Escherichia coli is the leading pathogen. Social Sciences (SS) Behavioral 12
Science (Beha)
1179 End of life care When pts are unable to make end-of-life decisions for themselves and no written ADs exist, responsibility for those decisions falls to the NOK. However, all surrogate Social Sciences (SS) Behavioral 2
medical decisions, including NOK decisions, must be based on the best estimation of what the pt would have wanted. Science (Beha)
1181 Patient confidentiality Pt confidentiality is strongly protected because pts must feel free to disclose details of all aspects of their lives so that physicians can provide optimal care. Exceptions to Social Sciences (SS) Behavioral 5
pt confidentiality include suspected child, disabled person, or elder abuse; knife or gunshot wounds; Dx of a reportable communicable disease; and pts at risk of physically Science (Beha)
harming themselves or others.
1235 Ethical principles in Pts have the right to make decisions about their healthcare. However, based on the principle of non-maleficence, the prescription of Rx likely to do more harm than good Social Sciences (SS) Behavioral 3
healthcare should be avoided, even if requested by pts. Science (Beha)
1237 Central tendency (mean, An outlier is defined as an extreme and unusual observed value in a dataset. It can affect measures of central tendency (mean, median, mode) as well as measures of Social Sciences (SS) Behavioral 2
median, mode, outliers) dispersion (SD, variance). Modes tend to be resistant to outliers. Science (Beha)
1239 Statistical tests A 2x2 table is normally used to record the presence or absence of exposure and disease in research. Rows and columns represent the different levels for each categorical Social Sciences (SS) Behavioral 2
(ie, exposure and disease) variable. The chi-square test for independence is used to evaluate the association b/w 2 categorical variables. Science (Beha)
2054 Pacemaker potential Cardiac pacemaker impulse generation normally occurs in the SA node, which has the fastest firing rate of all conductive cells. The cells in other areas of the conduction Social Sciences (SS) Behavioral 1
system (eg, AV node, bundle of His, and Purkinje fibers) may serve as pacemakers if normal impulse conduction is impaired. Science (Beha)
2057 Metabolic acidosis Normally, meta acidosis is partially compensated for by resp alkalosis. When the steady-state PaCO2 persists above the range given by the Winter formula (PaCO2 = [1.5 Social Sciences (SS) Behavioral 4
* HCO3-] + 8 +/- 2), the pt has a superimposed resp acidosis (resp failure). Science (Beha)
2058 High altitude illness At high altitude, the low PiO2 leads to hypoxemia that triggers hypervent w/ incr exhalation of CO2 and resulting resp alk. The kidneys comp by incr HCO3- excretion to Social Sciences (SS) Behavioral 3
help normalize pH. Hypoxemia persists, but phys adjustments take place to improve O2 use. Science (Beha)
2059 Pulmonary embolism The combo of ac-on dyspnea, calf swelling, and Hx of prolonged immobility is strongly suggestive of PE. PE typically Px w/ hypoxemia due to V/Q mismatch and resp Social Sciences (SS) Behavioral 13
alk (hypocapnia) due to hypervent. Science (Beha)
7487 Jugular venous pulse On JVP tracings, the 1st peak is the a wave, which is generated by atrial contraction. This is notably absent in pts w/ AF. Social Sciences (SS) Behavioral 1
Science (Beha)
7733 S4 The 4th heart sound (S4) is a low frequency sound heard at the end of diastole just before S1. It is due to ↓ LV compliance and is often a/w RCM and LVH. Social Sciences (SS) Behavioral 1
Science (Beha)
7767 Patent ductus arteriosus PDA is characterised by a continuous murmur heard best in the left infraclavicular region w/ max intensity at S2. A small PDA is often aSSx and is usually detected Social Sciences (SS) Behavioral 4
incidentally during routine cardiac auscultation. It occurs most commonly in pts born prematurely and those w/ cyanotic congenital heart disease. Science (Beha)
8457 Renal artery stenosis Renal artery stenosis causing significant renal hypoperfusion will result in a decreased glomerular filtration rate and activation of the renin-angiotensin-aldosterone Social Sciences (SS) Behavioral 9
system. This leads to increased renin release by modified smooth muscle (juxtaglomerular) cells in the walls of afferent glomerular arterioles. Chronic renal hypoperfusion Science (Beha)
can cause hyperplasia of the juxtaglomerular apparatus.
10086 Erectile dysfunction Psychogenic causes of erectile dysfunction include performance anxiety, depression, sexual trauma, relationship problems, and stress. Important clues include sudden- Social Sciences (SS) Behavioral 3
onset and normal nocturnal erections. Science (Beha)
10289 Antiretroviral therapy Integration of HIV dsDNA into the host cell's chrom is necessary to induce viral gene expression and prevent degradation of the viral genome. Raltegravir is an integrase Social Sciences (SS) Behavioral 7
inhib that disrupts HIV genome integration, preventing synthesis of viral mRNA. Science (Beha)
10290 Primary immunodeficiency Inherited defects involving the interferon-y signaling pathway result in disseminated mycobacterial disease in infancy or early childhood. Patients require lifelong Social Sciences (SS) Behavioral 7
disorder treatment with antimycobacterial agents. Science (Beha)
10399 Multiple gestation Dizygotic twins occur due to fertilization of 2 oocytes by 2 different sperm, can be different genders, and almost always have 2 chorions and 2 amnions (eg, Social Sciences (SS) Behavioral 1
dichorionic/diamniotic). In contrast, monozygotic twins arise from the fertilization of a single oocyte, are the same gender, and can be dichorionic/diamniotic (days 0-4), Science (Beha)
monochorionic/diamniotic (days 4-8), monochorionic/monoamniotic (days 8-12), or monochorionic/monoamniotic conjoined twins (> 13 days).
10463 Electrical injury Although lightning injuries are rare, they are a/w a 25% fatality rate. Two-3rds of lightning-related deaths occur w/i the 1st hr after injury, w/ fatal arrhythmias and resp Social Sciences (SS) Behavioral 1
failure as the most common causes. Pts w/ minor cutaneous involvement may still have major internal injury after lightning strikes and high-voltage electrical contact. Science (Beha)
10464 Contraception After vasectomy, viable sperm remain in the portion of the vas deferens distal to the ligation. Pts can still have viable sperm in the ejaculate for 3 mos and at least 20 Social Sciences (SS) Behavioral 3
ejaculations. Science (Beha)
10468 Anesthesia SCh can cause significant K+ release and life-threatening arrhythmias in pts at high risk for hyperkalaemia, incl those w/ burns, myopathies, crush injuries, and Social Sciences (SS) Behavioral 9
denervating injuries or disease. Science (Beha)
10488 Mushroom poisoning Amatoxins are found in a variety of poisonous mushrooms (eg, Amanita phalloides, known as death cap) and are potent inhibitors of RNA polymerase II (halting mRNA Social Sciences (SS) Behavioral 2
synthesis). Science (Beha)
10507 Statistical tests A t-test is used to compare the difference b/w the means of 2 groups. ANOVA compares the difference b/w the means of 2 or more groups. Results from a t-test and Social Sciences (SS) Behavioral 2
ANOVA test will be equivalent when comparing the difference b/w the means of 2 groups. Science (Beha)
10508 Cranial nerve palsy Lesions of the JF can result in JF (Vernet) syndrome, which is characterised by the dysfxn of CNs IX, X, and XI. SSx incl dysphagia, hoarseness, loss of gag reflex on the Social Sciences (SS) Behavioral 9
ipsilateral side, and deviation of the uvula toward the normal side. Science (Beha)
10509 Drug structure and The suffix of a biological agent indicates whether a medication is a monoclonal antibody (mab), a receptor molecule (cept), or a kinase inhibitor (nib). Monoclonal Social Sciences (SS) Behavioral 3
properties antibodies also include in their names the type of target (eg, bacterial or immune system) and their origin (eg, human or mouse). Science (Beha)
10510 Tay-Sachs Tay-Sachs disease is an autosomal recessive disorder caused by B-hexosaminidase A deficiency, which results in GM2 ganglioside accumulation. Key clinical features Social Sciences (SS) Behavioral 1
include progressive neurodegeneration and a cherry-red macular spot. In contrast to patients with Niemann-Pick disease, those with Tay Sachs disease have no Science (Beha)
hepatosplenomegaly.
10532 Cytokines IL-2 is produced by Th cells and stims the growth of CD4+ and CD8+ T cells and B cells. IL-2 also activates NK cells and monocytes. The incr. activity of T cells and Social Sciences (SS) Behavioral 1
NK cells is thought to be responsible for IL-2's anti-ca effect on met melanoma and RCC. Science (Beha)
10533 Hypoglycemia Hypoglycaemia is char by tremor, diaphoresis, and confusion in a/w a low BGL and resolution of SSx when the BGL is corrected. Hypoglycaemia w/ ↑ insulin and low C- Social Sciences (SS) Behavioral 6
peptide lvls suggests exogenous insulin injection, whereas ↑ C-peptide suggests an insulin secretagogue or insulin-secreting tumour. Science (Beha)
10534 Primary immunodeficiency DGS causes an extreme defic in the # of mature T lymphocytes, leading to poor development of the LN paracortex. In contrast, aGg-emia causes an absence of B cells, Social Sciences (SS) Behavioral 7
disorder preventing 1ary lymphoid follicles and germinal centers from forming in the LN cortex. Science (Beha)
QID Topic Educational Objective System Subject Repeats
10542 Staphylococci Staphylococcus epidermidis is a common cause of foreign body infections due to its ability to produce adherent biofilms. Social Sciences (SS) Behavioral 1
Science (Beha)
10545 Intestinal helminth parasites E. vermicularis infection (enterobiasis) occurs most freq in school-age children and presents w/ perianal pruritus. Dx is made by the Scotch tape test. Albendazole is the Social Sciences (SS) Behavioral 3
1st-line Tx, w/ pyrantel pamoate as an alt agent preferred in preg pts. Science (Beha)
10659 Chronic heart failure The ↓ CO in HF triggers compensatory activation of the SNS and RAAS, resulting in vasoconstriction (↑ afterload), fluid retention (↑ preload), and deleterious cardiac Social Sciences (SS) Behavioral 12
remodelling. These mechs perpetuate a downward spiral of cardiac deterioration, leading to SSx DHF. Science (Beha)
11518 Groin hernias DIHs occur most commonly in older men due to weakness of the transversalis fascia. They protrude med. to theinf. epigastric vessels into the Hesselbach's triangle and Social Sciences (SS) Behavioral 3
pass only thru the SIR w/ no direct route to the scrotum. Science (Beha)
11549 Antiarrhythmic drugs Class 10 antiarrhythmics such as flecainide are potent sodium channel blockers that have increased effect at faster heart rates (use-dependence). This makes them more Social Sciences (SS) Behavioral 12
effective at treating tachyarrhythmias, but can also cause prolonged QRS duration (a proarrhythmic effect) at higher heart rates. Science (Beha)
11668 Medical errors Risk of wrong-site surgery can be reduced by requiring "dual identifiers" (usually a nurse and physician) to independently confirm that they have the correct patient, site, Social Sciences (SS) Behavioral 8
and procedure. Checks must be truly independent to ensure patient safety. Science (Beha)
11757 Bipolar disorder Pts experiencing a major depressive episode should be carefully screened for past manic episodes to r/o BD. Antidepressant monotherapy should be avoided in pts w/ BD Social Sciences (SS) Behavioral 7
due to the risk of precipitating mania. Science (Beha)
14111 Transcription Alt splicing is a process by which a single gene can code for various unique proteins by selectively incl or excl diff DNA coding regions (exons) into mature mRNA. Social Sciences (SS) Behavioral 7
Science (Beha)