PAGE= 397 (420 / 910). Diabetes can cause damage to nerves of the internal/external anal sphincters.

Sympathetic fibers from the superior rectal and hypogastric plexuses stimulate and maintain internal anal sphincter contraction.
Its contraction is inhibited by parasympathetic fiber stimulation.
This sphincter is tonically contracted most of the time to prevent leakage of fluid or gas, but is relaxed
upon distention of the rectal ampulla, requiring voluntary contraction of the puborectalis and external anal sphincter.
The pudendal nerve, which carries somatic (motor and sensory) fibers, provides the innervation to the external anal sphincter.
He has fecal incontinence so his external sphincter is damaged, which is innervated by the pudendal n. (S2-S4).
The pelvic splanchnic nerves, which mediate the erection process, are also S2-S4.

PAGE= 425 (448 / 910) Thrombosis or compression of hepatic veins with centrilobular congestion and necrosis --> congestive liver disease
(hepatomegaly, ascites, varices, abdominal pain, liver failure). Absence of JVD. Associated with hypercoagulable states, polycythemia vera,
postpartum state, HCC. May cause nutmeg liver (mottled appearance).

PAGE= 528 (551 / 910) Enzyme B is COX and enzyme C is 5-lipoxygenase. The patient took an NSAID
and blocked COX. By blocking COX (presumably with an NSAID), we leave more of the
substrate arachidonic acid for 5-LOX to ultimately convert into leukotrienes. This is the basis for
aspirin-intolerant-asthma, which is frequently associated with nasal polyps. (Samter's triad).
LTC4 D4 and E4 increase bronchial tone and are made from 5-HPETE.
You would also make more LTB4, which is for neutrophil chemotaxis.

PAGE 384 (407 / 910) Retroperitoneal structures. Her GU procedures and pelvis radiation may have caused fibrosis of the segments
of the ureter that are retroperitoneal, leading to hydronephrosis and hydroureter.

PAGE 428 (451 / 910) Hemochromatosis. This patient has bronze diabetes. Iron accumulation in the
skin is what is causing his skin pigmentation. He also has the other 2 of things of the classic triad;
liver cirrhosis, diabetes, and skin pigmentation. These patients also have hypogonadism and arthralgias
and can suffer from dilated or restrictive cardiomyopathy. HCC is a common cause of death in them.

PAGE 369 (392 / 910) Chronic Kidney Disease. This patient has secondary hyperparathyroidism.
Renal failure causes loss of Calcium and retention of phosphate, which leads to an elevation of PTH.
The patient will also be low in vitamin D since it is activated in the kidney by 1-a-hydroxylase.

To the right is an image from wikipedia search for the lipid bilayer. Then they explain the answer.
Two types of proteins exist in the lipid bilayer: integral and peripheral membrane proteins. Integral membrane proteins traverse the lipid bilayer. That is, they interact extensively
with the hydrophobic region (hydrocarbon region) of the lipid bilayer. Integral membrane proteins interact by nonpolar interactions. Peripheral membrane proteins are usually
attached to surfaces of integral proteins; therefore, they are on both faces of lipid bilayer. Peripheral membrane proteins interact with the hydrophilic polar head groups of the
lipid molecule. Peripheral proteins bind through electrostatic and hydrogen bonds with the head group of the lipid.
 B. Page 59 discusses modes of inheritance.
Chance of affected individual x Chance of father passing allele x Chance of mother passing allele
(2/3) (1/25) (1/4) -- 2/300

He has a 2/3 chance of being heterozygous (not 2/4 b/c we know he for sure doesn't have CF).
1/25 chance in the population.
1/4 chance of a heterozygous couple having a child with CF.

PAGE 611 (634 / 910) Schizotypal Cluster A Personality. The patient has odd thoughts and an eccentric appearance, as well as magical beliefs.

PAGE 703 (726 / 910) HPV. This patient has cervical squamous cell carcinoma and HPV 16 & 18
produce E6 and E7 which inhibit TP53 and pRb, respectively.

PAGE 262 (285 / 910) Clinical Trials. This has 10^2 patients so its phase 2. In addition, they need patients with disease.

PAGE 611 (634 / 910) Borderline Cluster B. Think Cardi B. She has unstable mood and relationships, fear of abandonment, emotional emptiness, and suicidality.
Splitting and dissociative identity disorder are closely linked to Borderline personality disorder.

An abscess would be a walled-off infection. Cirrhosis is usually nodular due to regeneration.

Focal nodular carcinoma would be encricled and not widespread. Hepatitis B also causes cirrhosis and sclerosis.
An infarct would be dark/red not pale.

Metastasis was the most likely answer for this patient. The single most important thing about this gross pathology
is that the disease is multinodular, indicating metastases.

PAGE 177 (200 / 910) Hepatitis C. With her 5 year history, she has chronic HepC. Lymphocytes, plasma cells, and
macrophages define chronic inflammation, while neutrophils are characteristic of acute inflammation. AFP being normal
indicates she does not have HCC. Choice D is for a granuloma.
 Methylation mutes DNA, which also makes the DNA resistant or inaccessible to restriction endonucleases.
Gyrase is prokaryotic topoisomerase 2, which would open DNA up and allow restriction endonucleases to do their job.
Helicase halves DNA, so this would also open DNA and allow restriction endonucleases to do their job.
Ligase links DNA okazaki fragments and is irrelevant. DNase hydrolyzes phosphodiester bonds in the DNA backbone, breaking down DNA, as the name suggests.

Google shows that 10% of patients with Rituximab treatment without chemotherapy or glucocorticoid exposure developed PcP pneumonia, an
opportunistic fungal infection. In addition, 88% developed acute hypoxemic respiratory failure and 53% required ICU admission.

MHC I function is integral to cancer suppression. MHC I displays endogenously synthesized proteins and presents them to CD8+ T cells.
The failure to display MHC I, or MHC I display of non-self (and by extension cancerous) proteins triggers a cellular immune response,
leading to destruction of the cell.

The proteasome is used for the degradation of worn out, senescent, or malformed proteins. As cancer develops, more mutations lead
to increased wrong proteins. Only by expression of the proteasome, or its over-expression, can these mutant proteins be degraded fast
enough to not be displayed by MHC I and lead to the cell being killed. Bortezomib blocks the proteasome, so the mutant proteins are
displayed on the surface, allowing the immune system to recognize and kill pathological cells.

Complement is activated by IgG and IgM. Perforin is used by NK and CD8+ cells to kill their target. Histamine secretion by mast cells is an allergic thing unrelated to this drug.
IL1 secretion causes fever amongst a few other things unrelated to this drug.

PAGE 450 (473 / 910) alpha Thalassemia. This patient and his wife are both carrying alpha thalassemia traits and in Asian people, the cis-alpha
thalassemia deletion is prominent, while the trans deletion is prominent in African Americans. Both parents have alpha thalassemia minima (silent).

Beta thalassemia is prevalent amongst the mediterranean population and hemoglobin electrophoresis would show increased HbA2.

The only possible answers are B and D. But answer B might mislead a patient into thinking they have cancer and
possibly cause unnecessary distress. So getting the resident physician is the easiest way to handle this scenario.

She has endometrial hyperplasia but not cancer. She will have increased cell division so B is the best choice.
Endometrial hyperplasia is due to excess estrogen, a steroid hormone that binds a nuclear transcription factor.

PAGE 526 (549 / 910) Actinic keratosis. Hes a farmer and has excessive sunlight exposure.
40 (63 / 910) Nucleotide excision repair. He has pyrimidine dimers in his DNA.

PAGE 618 (641 / 910) MDMA Ecstasy. This patient has tachycardia, hypertension, and confusion after a party drug use.
MDMA causes euphoria, disinhibition, hyperactivity, bruxism, hypertension, tachycardia, hyperthermia, hyponatremia, and serotonin
syndrome. Withdrawal can lead to depression and anxiety with loss of concentration.
LSD simply causes hallucinogenic effects with some anxiety and psychosis. Ketamine is used for anesthesia. PCP would be another
valid answer since it also causes tachycardia and hypertension but PCP mainly causes violence and impulsivity.

PAGE 700 (723 / 910) Hydatidiform mole. The grapelike structures are the ultrasound presentation of a honeycombed or snowstorm
uterus in a complete mole. There is no fetus (so no fetal parts) which means this is not a partial mole. A is wrong because its only
trophoblast proliferation. There will not be dilated fetal blood vessels. Choice D would be a choriocarcinoma.

Pretty obvious and self-explanatory. This is suspicious and could have been due to parents trying to make child porn.

Under pharmacology of FA you can learn that tetracyclines are related to pill-induced esophagitis, photosensitivity, idiopathic intracranial HTN, and
fanconi syndrome. But in infants it can notably cause teeth discoloration.
 Your answer needs to have the unit of mL O2/min so the only way to do that is to multiply the two numbers into each other, which logically also makes sense.

The answer is D, which is the right spinothalamic tract, for the

left side. A and J are the gracile (legs) fasciculi while B and I are the
cuneate (arms) fasciculi, both of which are part of the dorsal column PAGE 550 (573 / 910) Spinal Cord Tracts. She has lost
for perception, proprioception, and etc of the body. sensation to pain, and pain & temperature are taken up by
the lateral spinothalamic tract of the contralateral limb.
C and H are the lateral corticospinal tracts for motor command of
limbs while E and F are anterior corticospinal tracts for motor
control of proximal muscles, typically of the trunk.

PAGE 703 (726 / 910) Anovulation. When a follicle does not rupture it can form a cyst. This patient is premenopausal in terms of age so
this is the most likely possibility. An ectopic pregnancy does not lead to ovarian cysts. There is increased risk of endometrial cancer and
endometrial hyperplasia due to unopposed estrogen from anovulatory cycles, but not endometriosis (endometrial tissue in other places where
it does not belong is usually due to retrograde flow, metaplastic transformation of multipotent cells, or transportation of endometrial tissue by
the lymphatic system.) so those choices are out. A cyst is benign and pelvic inflammatory disease does not increase risks of an ovarian cyst.

The most common ovarian cyst in a young woman is a follicular cyst, usually due to hyperestrogenism or endometrial hyperplasia.
The theca lutein cyst would be multiple/bilateral and is caused by gonadotropin stimulation and is associated with hydatidiform moles and
choriocarcinoma. PCOS is the other big topic and that patient would present different with multiple cysts.

Of the 100 residents, 10 have decubitus, 5 develop decubitus in year 1, and 10 develop decubitus in year 2 and 3 have healed.
This means at the start of the 2 year period, 10 had it and at the end 22 of the 100 have it. Thus, prevalence is 22% and that is
over the 20% limit. For incidence, since 10 already had decubitus, you start with 90 residents, and over 2 years that would be
180patient-years over the study course. Over the 2 years, there were 15 new ulcers per 180 patient-years so extrapolate that
to 1000 patient-years by multiplying by 1000/180 and multiply by 15 so you get that there are 83.3 new ulcers per 1000pt-yrs.

PAGE 139 (162 / 910) C tetani. This patient has classic symptoms and history of patients with tetanus, which
works by inhibiting GABA/glycine release from Renshaw cells, leading to continuous muscle tetany.

PAGE 559 (582 / 910) Locked-in syndrome. This patient most likely had a stroke of her basilar artery. She has enough comorbidities for the risk of a stroke.
The basilar artery involves the pons, medulla, and lower midbrain, but a majority of the basilar artery passes over the pons and the ocular cranial nerve nuclei
are also around the pons (1-4 above pons, 5-8 at pons).

PAGE 533 (556 / 910) Myelomeningocele. Neuropores failed to fuse at the 4th week. The caudal end is the lower end of the spine,
which is seen in this infant, at L2-L5. Rostral would be towards the head, which would lead to anencephaly.
Would see high AFP in the amniotic fluid and maternal serum, and high AChE in amniotic fluid.

PAGE 759 (782 / 910) Adenocarcinoma of the lung is the most common lung cancer and it is more common in women and nonsmokers.
In addition, adenocarcinoma and large cell carcinoma are the only peripheral ones and large cell has a bad prognosis and is highly
associated with smoking

PAGE 94 (117 / 910) Hypertriglyceridemia. The type 1 and 4 dyslipidemias have high trigylcerides and include a risk of pancreatitis, which is also a potential
issue for alcoholic patients like this man. It seems he has pancreatic insufficiency at this moment. Linoleic, oleic, and pamitic acids are just free fatty acids and
they can be absorbed without pancreatic lipases. Triglycerides need lipases from the liver. Cholesterol is absorbed via bile acids.
 PAGE 749 (772 / 910) ARDS. She had trauma that lead to leakage of protein-rich fluid into her alveoli (exudate) that caused more inflammation
leading to hyaline membranes in her alveoli and noncardiogenic pulmonary edema (so PCWP would be normal).

PAGE 116 (139 / 910) Brutons Agammaglobulinemia. Defect in BTK, bad tyrosine kinase, no mature B cells, so no
germinal centers in lymph nodes and you cant give live vaccines to these patients. This is X-linked.

PAGE 209 (232 / 910) HIV Therapy. Under protease inhibitors there is literally ONE sentence that says
"Ritonavir can "boost" other drug concentrations by inhibiting P450." PI generally cleave polypeptide
products of HIV mRNA, preventing maturation of new viruses. Cushing-like syndrome & nephropathy are
some side effects. Indinavir can cause thrombocytopenia.

https://en.wikipedia.org/wiki/Stellate_ganglion
It causes sympathetic symptoms. Its also slightly clear that some of the other answer choices are all parasympathetic
or unrelated to the sympathetic vs parasympathetic difference. Stellate ganglion blocks help with hyperhydrosis of the hands
and hot flushes & night awakenings in breast cancer survivors or women with menopause. Can also be blocked to for a
coronary artery bypass surgery. Left stellectomy is a treatment for prolonged QT syndrome because the ganglion drives
prolonged QT, but this is advised only in patients on a beta blocker. Stellectomy can cause Horners syndrome.

PAGE 69 (92 / 910) B12 deficiency. 452 (475 / 910) Megaloblastic anemia. 574 (597 / 910) Spinal lesions.
This patient has megaloblastic anemia and peripheral neuropathy due to B12 deficiency, evident by the
multilobular neutrophils on the peripheral smear. B12 deficiency causes SCD; degeneration of the dorsal
columns, corticospinal tracts, and spinocerebellar tracts. These tracts are in the posterior cord.
Posterior cord syndrome is known as posterior spinal artery syndrome and would look like tabes dorsalis.
Hemicord syndrome is Brown-Sequard. Anterior spinal artery cord syndrome has loss of LMN at the lesion
and loss of UMN and spinothalamic tract below the lesion.

Image here shows all --> https://en.wikipedia.org/wiki/Anterior_spinal_artery_syndrome

PAGE 550 (573 / 910) Spinal cord tracts. Fasciculus gracilis. This patient only has lower extremity numbness and spastic paraparesis
with a positive babinski sign bilaterally. Other tracts are fine and upper limbs are fine.

PAGE 170 (193 / 910) VZV. VZV causes chickenpox, encephalitis, and pneumonia and then becomes altent in the dorsal root or trigeminal V1 ganglia.
Adenovirus causes pharyngitis, pneumonia, conjunctivitis, myocarditis, and cystitis, and it is more common in childrens camps.
Influenza virus causes the flu, parainfluenza causes croup, and measles (rubeola) causes cough and conjunctivitis.

PAGE 469 (492 / 910) HIT. This patient was most likely receiving heparin for her right hip replacement. HIT is a development of IgG antibodies
against PF4, leading to thrombosis and thrombocytopenia. ITP would have destruction of platelets in the spleen due to anti Gp2b3a antibodies
so youd see more megakaryocytes but that is unlikely in this scenario. TTP would have loss of ADAMTS13 so youd see large vWF multimers,
but this is unlikely here. Henoch-Schonlein is IgA vasculitis with purpura GI pain and arthralgias after an URI.

PAGE 620 (643 / 910) Typical antipsychotics. Haloperidol (like trifluoperazine and fluphenazine) is a high potency D2 blocker that increases cAMP
and can lead to extrapyramidal symptoms caused by excessive ACh activity. Currently, its been 6 weeks and the patient is now experiencing
acute dystonia and some akathisia, which are treated with benztropine, a muscarinic antagonist used for Parkinson disease as well.
 Integral membrane proteins are found within the plasma membrane and span the whole length across. The inside of the membrane is very
hydrophobic due to the long carbon chains. Extensive hydrophobic interactions between the protein side chain and the lipid tails will help
anchor the protein in the membrane
PAGE 47 (70 / 910) Cell Trafficking. N on asparagine and O on serine are done to secreted proteins. A signal sequence also.
Posttranslational modifications include phosphorylation as well as glycos, hydrox, meth, and acet-ylation as well as ubiquitination.

PAGE 683 (706 / 910) Male sexual response. This patient has erectile dysfunction after the operation.
Erection is a parasympathetic activity carried out by pelvic splanchnic S2-S4 via NO. Emission is sympathetic hypogastric T11-L2 and
expulsion is the visceral somatic pudendal nerve.

PAGE 517 (540 / 910) Neuromuscular junction diseases. This patient has lambert eaton so something is EATing their calcium,
thereby reducing ACh release. Presynaptic calcium channels are being destroyed by autoantibodies. This improves with use.
Choice B is myasthenia gravis, which is grave because no matter how much ACh you have, you do not have the receptors for it
because postsynaptic receptors are destroyed by autoantibodies. Does not improve but worsens with use and is related to thymomas.

PAGE 480 (503 / 910) SITS Muscles. Arm abduction is mainly by the STDS muscles and the first one is supraspinatus, which is also part of the rotator
cuff muscles. She seems to have more pain in her shoulder with internal rotation which is a rotator cuff (subscapularis) function.

The deltoid, trapezius, and serratus anterior are for arm abduction but not as much related to the rotator cuffs and would not have more pain with internal
rotation. The teres minor is another rotator cuff muscle for adduction and external rotation.
 PAGE 340 (363 / 910) Niacin. This med reduces LDL and TG while increasing HDL. It can cause a red, flushed face, which is reduced by NSAID use.
It can also cause hyperglycemia and hyperuricemia. It works by inhibiting hormone-sensitive lipase and reducing hepatic VLDL synthesis.

PAGE 733 and 754 (777 / 910) Lung physical findings. This patient's left lung looks like it is
smaller possibly due to a spontaneous pneumothorax. The empty left lung will be
hyperresonant, have decreased tactile fremitus, and diminished breath sounds.

This is not BCD or E because those would not present in this manner. Adhesive capsulitis is frozen sholder, where the connective tissue around the
glenohumeral joint becomes inflamed and stiff, greatly restricting motion of the shoulder and causing pain.

This patient has subacromial bursitis, where the bursa separating the supraspinatus tendon and acromion is inflamed. Hence, patients present with
supraspinatus type issues of the difficulty with overhead work.

Simple hardy weinberg. They told us a prevalence, so say P2= 1/10,000 thus P=1/100 and Q=99/100 and now we need the heterozygote carrier frequency
which is 2PQ=2/100=1/50.

Dumb, as usual. Even choice D does not sound so good. But yes, changing the
formula would be a fine thing to try so E is the "best" answer here.

She has loss of vitamin D, crystals in the corneas, low phosphate, low potassium, metabolic acidosis, glucosuria, and loss
of amino acids. Most of these are reabsorbed at the PCT so something is wrong with the PCT function. HCO3 is also
reabsorbed at the PCT so F makes sense.
PAGE 645 (668 / 910) Renal tubular acidosis type 2 is a defect in PCT HCO3 reabsorption, which leads to metabolic
acidosis.
PAGE 636 (659 / 910) Renal tubular defects. She may have fanconi that lead to RTA2. Fanconi loses PCT function.

Informed consent should be obtained by a provider who has sufficient knowledge to give an accurate
description of the intervention, the risk and benefits, alternative treatments and to answer all of the
patient's questions.

PAGE 269 (292 / 910) Statistical distribution. In a normal, Gaussian distribution, mean=mode=median and here that is 3.8 for the normal intelligence level.
For disease at an age under 9 pretty much encompasses everyone, so 99%. The middle is 3.8 for your mean on the gaussian curve, + - 1 SD is 2 and 5.6 if we
round, then + - 2 SD is 0.2 and 7.4. Now + - 3 SD is 0 and 9.2 years. That is closer to 99% than 95% so there was confusion but 99% is correct apparently.
 PAGE 313 (336 / 910) Normal Cardiac pressures. Pressure in the LV is way too high.

PAGE 412 (435 / 910) Celiac disease/sprue. Gluten enteropathy. Loss of fat soluble vitamins. She most likely has Vit D
deficiency so her Calcium is low. So she will release more PTH and lose phosphate to try and increase Calcium.

PAGE 763 (786 / 910) Ipratropium - competitively blocks muscarinic receptors, preventing bronchoconstriction.
Cromolyn is rarely used and prevents mast cell degeneration. Montelukast and zafirlukast block leukotriene synthesis for aspirin-induced or exercise-induced
asthma. A and B are unrelated to asthma.

PAGE 394 (417 / 910) Celiac trunk. First of all, the choices A-D make no sense for the splenic artery, which is the 3rd branch of the celiac trunk.
Now, the tail of the pancreas is right by the spleen so that is probably the right answer, although no one really talks about the pancreatic blood
supply when the celiac trunk is discussed. But remember, the celiac trunk is for foregut supply and the pancreas is from the foregut. The spleen
arises in the mesentery of the stomach and is thus mesodermal, but has foregut supply. So if anything, the spleen should not be getting blood
from the celiac trunk but its unique in this manner. In addition, the head of the pancreas is supplied by the pancreaticoduodenal arteries of the
celiac trunk's common hepatic branch. The tail of the pancreas and the splenic vessels are in the splenorenal ligament.

PAGE 505 (528 / 910) Ganglion cyst.

PAGE 587 (610 / 910) Cavernous sinus. Many people felt it was E because of the air
in the center of the eye, but even if that were the case, it does not explain the double
vision. In fact, none of the choices besides C even explain double vision.

PAGE 167 (190 / 910) Viral structure. Loss of the envelope, either by heating or the use of ether/organic solvents, will lead to a loss of viral
infectivity because it will not be able to combine with our lipid membrane, so the genome wont enter our cells.

PAGE 643 (666 / 910) Acid Base. Laxative use is similar to having diarrhea, which causes a normal anion gap metabolic
acidosis. Hyperchloremia, Addison, RTA, diarrhea, acetazolamide, spironolactone, and saline are under HARDASS.

Not entirely sure where to find all the details of ions and pH for laxative abuse. ASNJournals describes that laxative abuse
causes hypokalemia which raises extracellular HCO3 so your cells lose HCO3 and only choice D has both things low.
 PAGE 412 (435 / 910) Celiac disease. None of the other answer choices cause iron deficiency (normal Fe 50-170, ferritin 15-200).
Also, she lost vitamin D due to steatorrhea (its a fat soluble vitamin) and now has some osteopenia.

PAGE 302 (325 / 910) Splitting. First of all, heart sounds are from closure not opening. Secondly, we are talking about the left sternal border.
S1 is from the closure of the mitral and tricuspid valves, while S2 is the sound of the aortic and pulmonic valves. So this must be the mitral.

PAGE 264 (287 / 910) Specificity = TN/(TN+FP). This test gave 20 false positives out of 100 people, and only 15 true negatives out of 50 men.
Specificity also equals 1-FPrate, and here the FP rate seems 20% so 100%-20%=80%.

The three criteria for causality are: 1) empirical association (i.e. strength of association; a change in
independent variable correlates or is associated with a change in dependent variable), 2) time order
(i.e. temporal relationship; the independent variable must come before change in the dependent variable,
or plainly stated, cause must come before effect). and 3) nonspuriousness (i.e. dose-response gradient;
the relationship between 2 variables is due to a direct relationship between the two, not because of the
actions of changes in a third variable... this can be evinced by a dose-dependent response).

PAGE 245 (268 / 910) Autonomic drugs.

The only possible answers are C or D because
this has nothing to do with the DOPA path.
This patient has organophosphate poisoning, so
his AChE is not working and he has excess ACh
activity, causing DUMBBELSS and the nictonic
and CNS effects. He needs atropine for the muscarinic
effects and pralidoxime for the nicotinic effects.

PAGE 426 (449 / 910) Physiological neonatal jaundice. The baby has immature UDP Gluc so she has high unconjugated
bilirubin and is presenting with jaundice. Phototherapy isomerizes unconjugated bilirubin to a water-soluble form.

PAGE 693 (716 / 910) Androgens. Androstenediol is a potent estrogen. Androstenedione would be a possible correct answer.
 Normoblast: An immature red blood cell containing hemoglobin and a pyknotic nucleus and normally
present in bone marrow but appearing in the blood in many anemias — compare erythroblast.
The other answer choices are not RBC.

PAGE 372 (395 / 910) SIADH. Small cell carcinoma can lead to paraneoplastic ADH secretion and this patient has SIADH. The patient will have
euvolemic hyponatremia with continued Na+ excretion. Urine osmolality > serum osmolality and patients have hypoosmotic volume expansion.
Fluid restriction is first line therapy, and ADH antagonists can help (conivaptan, tolvaptan, demeclocycline). Fluid restriction severely increases
serum osmolality but does not change urine osmolality in central or nephrogenic DI. Water restriction causes euvolemic hyponatremia in SIADH.

This question got a lot of people confused and many also chose lymphatic flow.
This patient has diastolic HTN, which is related to filling pressures of the heart. But their systolic BP is presumably normal.
Systolic BP is determined by Cardiac Output and diastolic BP is determined by arterioles which before the capillary.
Hence, precapillary resistance.

PAGE 541 (564 / 910) Cerebellum. Ataxia and right side intention tremor. Cerebellar lesions are ipsilateral!

Donepezil, rivastigmine, and galantamine are treatments for Alzheimer's disease.

Riluzole is for Lou Gehrig (ALS). Selegilene is a MAO B inhibitor for Parkinsons.

PAGE 262 (285 / 910) Observational studies. This is looking at patients "receiving care" which is happening right now, not in the past or future.

PAGE 528 (551 / 910) Arachidonic acid pathways. This patient probably has asthma.
763 (786 / 910) Asthma drugs. He might have been given inhaled corticosteroids or an antileukotriene, both of which inhibit some product of arachidonate.

PAGE 47 (70 / 910) Signal Recognition Particle. The SRP sends proteins from the cytosol to the RER, so the receptor for the SRP must be on RER.

PAGE 311 (334 / 910) ECG Tracings. The distance between QRS complexes is continuously about 6 boxes, so rate is unaffected.
This is a 3rd degree block where the atria and ventricles are beating independently of each other and the RR is equivalent all along.
The 2nd QRS complex is SUPER narrow, and others are also narrow, which means theyre depolarizing thanks to bundle of His.
PAGE 528 (551 / 910) Arachidonic Acid Pathways. TXA2 increases platelet aggregation and vascular tone, and his acute chest pain is probably
related to increased vascular tone (hypertension). LB4 is just for neutrophil chemotaxis. LC4 LD4 and LE4 are for increased bronchial tone which
would be something asthmatic.

Gotta treat your patients with compassion and understand what theyre going through, not judge or scold them.
Then educating the patient may be a possible step but the patient probably already got that education upon
diagnosis or knows already. Parents are unnecessary here and so is E.

PAGE 716 (739 / 910) PDE-5 inhibitors.

Medications like viagra increasin NO for increased blood flow into the corpus cavernosum,
which is supplied by the deep artery.

PAGE 151 (174 / 910) Zoonotic bacteria. Coxiella burnetti is an intracellular gram neg bug and in sketchy its Curly Q the Ram. Sheep/lamb are related to
this bug and the cow in the image shows hepatomegaly. It causes a presentation similar to pneumonia and it causes hepatitis. Doxy and
hydroxychloroquine are the 2 treatments.
B anthracis causes pulmonary anthrax in woolsorters. Chlamydia psittaci is in parrots and causes atypical pneumonia.
Francisella tularensis is in rabbits and causes granulomas with caseating necrosis and is treated with aminoglycosides.
Rickettsia causes headache, fever, and rash including palms and soles; tx doxy or chloramphenicol in pregnancy.

PAGE 680 (703 / 910) Female anatomy. The perineal body will be damaged and after that comes the external anal sphincter.

PAGE 102 (125 / 910) Regulatory T Lymphocytes. FOXP3 is found on regulatory T cells, which maintain immune tolerance by suppressing
CD4 and CD8 T cell effectors. They have CD3, 4, 25, and FOXP3. IPEX is a disease with a mutation in FOXP3 leading to autoimmunity.

PAGE 113 (136 / 910) Type 4 HS. The kid probably has a reaction to something like poison ivy or oaks from the woods. His
symptoms are of contact dermatitis. Clearly the patient is responding to something with T cells not an antibody/antigen thing so
it cant be types 1-3. Also, answer A is more related to asthma.

PAGE 543 (566 / 910) Cerebral Cortex. The primary motor cortex is in front of the central sulcus, and the primary somatosensory cortex is after it.

PAGE 94 (117 / 910) Familial Dyslipidemias. This patient has Type 1, which is hyperchylomicronemia. Chylomicrons are high in type 1 and 3,
both of which are autosomal recessive, but type 3 is high in VLDL and has atherosclerosis, while type 1 and 4 are high in TG and have pancreatitis.
Type 1 is a deficiency in LL or its cofactor apoC2.

PAGE 337 (360 / 910) Cardiac Myxoma.

The only diastolic murmurs are D-ARMS, aortic regurg and mitral stenosis. This patient does not seem to have either issues though.
She has fainted many times over the past 5 months and the facial weakness that resolved was probably due to a tiny benign stroke.
For the murmur to become more loud when she rises from a prone position means that the murmur is louder with lesser blood in the
LV, which makes most sense with choice D. The overall picture falls into place because a myxoma would cause a murmur and fainting.
PAGE 84 (107 / 910) Homocystinuria. She has the symptoms. Since you cannot make homocystein into cystathionine, you end up making more
methionine instead.

Patient has polycythemia vera, as evidenced by erythrocytosis, granulocytosis, and headaches & diziness.
EPO is decreased due to erythrocytosis. Decreased LAP would indicate CML, not PV.

PAGE 80 (103 / 910) Galactosemia. This patient has GUT deficiency as evidenced by the jaundice and reducing substances after
feeding breast milk. Galactokinase deficiency would be much less severe and both galactosurias cause cataracts, which was not given.
Fructokinase def is benign and aldolase B deficiency fits this scenario as well but is not an answer choice, nor did the patient have juice.

Cholera is from water. Legionnaires is related to water. Lyme comes from ticks and so does Rocky mountain.
Meningococcal meningitis can be spread to others within a college campus and stuff and close contacts are given rifampin.
 PAGE 244 (267 / 910) G protein second messengers. PAGE 358 (381 / 910) Signaling pathways of endocrine hormones.
Clearly, epinephrine is the only non-endocrine thing here generally speaking. So by logic, "pick 1 that is least like the others," epinephrine
makes the most sense to pick.

All the cholesterol derivative -sone hormones use an intracellular receptor (B, C, E, F). Insulin and growth factors use tyrosine kinase receptors,
while thyroid hormone is a different thing and doesnt count here. But TRH uses IP2 Gq, and TSH uses cAMP Gs.

Beta1 blockers reduce HR. Alpha1 blockers would reduce vasoconstriction, reducing BP. Labetalol and carvedilol are the only nonselective alpha and beta
blockers so they have a modified suffix instead of -olol. Patients on these 2 meds can experience orthostatic hypotension.

Phentolamine and phenoxybenzamine are nonselective alpha blockers, while prazosin is a alpha1 blocker also used for PTSD. The non-zelective n-z includes
propranolol which blocks both b1 and b2. Albuterol (salmeterol, terbutaline) is a direct sympathomimetic that affects B2>B1, used for acute asthma.

This is most likely a case scenario of the mother undergoing eclampsia related issues so she is hypertensive, leading to fetal
heart decelerations. Inotropic effects on the fetal heart are rare and nothing causes that generally speaking.

Once pancreatic enzyme supplements are begun, there should not be fat in the stool anymore.

PAGE 239 (262 / 910) Bioavailability. Area under the curve talks about overall drug exposure and how high the ascending portion of the graph
goes tells you about the absorption, which is related to bioavailability.

PAGE 114 (137 / 910) Transfusion reactions. This patient had an immediate response to the transfusion and now has fever and hypotension.
This is acute hemolytic transfusion reaction due to ABO incompatibility. Blood type O people have antibodies against A and B.

PAGE 634 (657 / 910) Nephron Transport Physiology.

At the DCT, PTH helps reuptake
calcium, so the DCT is the reason for hypercalcemia in
this patient with hyperPTHism.

In the PCT, PTH works to inhibit the Na/PO4 channel

leading to more PO4 excretion.

PAGE 360 (383 / 910). In summary-

No Aldosterone = Lose Na+, Keep K+ & H+.
Keeping H+ means losing HCO3-.
Losing HCO3- means keeping Cl- via
basolateral HCO3/Cl exchanger found in PCT.
Metabolic acidosis.
Low Na and HCO3. High K, Cl, and H.
Think - Lose NaHCO3, Keep, HKCl.
No Cortisol = Anorexia, hypoglycemia, low BP.

A diabetic mother that did not control her diabetes will have high insulin. The sugar crosses the placenta and causes the neonate
to make more insulin too because insulin itself cannot cross the placenta. Insulin shuts down gluconeogenesis and causes glycogenesis.
B) Decreased glycogen concentration- I don't know the glycogen concentration compared to an adult patient, but a decrease in glycogen
concentration would indicate glycogen/glucose release, which would not be a hypoglycemic state. C) Decreased glycogen synthase
activity- decreased glycogen synthase activity indicates energy catabolism, and would lead to higher serum glucose levels. D) Decreased
serum insulin concentration- decreased serum insulin would lead to higher levels of glucose in serum. E) Increased serum insulin-like
growth factor- IGF does not bind nearly as well to insulin receptors as insulin does, and so would have to be in extremely high
concentrations to have this effect. IGF is associated with somatic growth and muscle development.
 PAGE 327 (350 / 910) Hypertrophic Obstructive Cardiomyopathy. Mutations in myosin binding protein C and beta myosin heavy chain lead to autosomal
dominant HOCM. Can die of sudden cardiac death due to ventricular arrhythmia. S4 due to noncompliant ventricles and systolic murmur that intensifies
with decreased blood volume such as with standing.

PAGE 340 (363 / 910) Statins. Statins and fibrates both have increased risk of myopathy.

Patient with bilateral renal artery bruits and hypertension will for sure have activation of RAS system and therefore increase in angiotensin.

Although pheochromocytoma and consequent elevated catecholamines can increase blood pressure, symptoms are typically episodic and renal bruits are not
likely to be heard. Elevated levels of serotonin can also cause hypertension, but we would also expect to see flushing; also, there is nothing in the stem to
indicate patient is taking SSRIs or something else that could predispose her to elevated levels of serotonin. Elevated levels of thyroid hormone could also give
patient hypertension, but we would also expect other signs of hyperthyroidism (tremors, weight loss, etc.). EPO would elevate in chronic issues of hypoxia.

PAGE 709 (732 / 910) Breast Cancer. When its ER/PR+ then there is amplification/overexpression of HER2 c-erbB2, an EGF receptor.

PAGE 516 (539 / 910) SLE. Patients with SLE are associated with early complement deficiencies (C1q, C2, C4), which leads to decreased
ability to clear immune complexes. This leads to organ damage due to a type 3 hypersensitivity and some type 2 reactions.

Normal isotonic saline is 0.9% and this animal is getting 5% hypertonic saline. So there will be
more solutes in the ECF, which will cause fluid to osmose from inside to outside. So now, the
inside of the cell will have less volume and more solute concentration (osmolality).

The outside of the cell just received more solute so the solute concentration will go up and since
the ICF exited into the ECF, volume also increased outside.

PAGE 661 (684 / 910) Acetazolamide. The book does not mention this medication lowering CSF
production in patients with idiopathic intracranial HTN but it does mention that this med treats IIHTN.
https://emedicine.medscape.com/article/1214410-medication#3
Acetazolamide is a nonbacteriostatic sulfonamide and a potent CA inhibitor that is effective in diminishing
fluid secretion. It lowers ICP by decreasing production of CSF. Inhibition of CA results in a drop in sodium
ion transport across the choroidal epithelium. Reduction of CSF production occurs within hours.

PAGE 270 (293 / 910) Confidence Interval. The average is 113, and 95% CI is from 110-116. The 99% CI must include more numbers and only B does that.
The 95% CI includes 1.96SD (or 2SD) so that means with the average being 113,113-->116 is 2SD, thus SD must be 1.5 and the 99%CI uses Z=2.58 or 2.5 so
now its gonna be a bigger CI of 2.5+(1.5)=4.5 and now its gonna range as 113 +/- 4.5, which is 108 to 118.

Mean = average +/- Z(SE) and Z is 2 for 95% and 2.58 for 99% CI.

Choice A would be a different issue, but insulin generally causes glycogen synthesis.
Catecholamine receptors are irrelevant in this case but generally, epinephrine beta1 effects cause muscle glycogen breakdown.
Decreased insulin receptors would cause diabetes, hyperglycemia. As would insulin inactivation.
This patient probably is unable to make glucagon for some reason.

Having a cleft palate is not associated with a specific genetic disorder. Its more a thing that just happens with some genetic disorders.
PAGE 155 (178 / 910) Candida albicans. This is Candida vaginosis. It cannot be gardnerella since that requires pH > 4.5 and candida usually
has a normal pH close to 4. Also, the photomicrograph shows you pseudohyphae. So treatment will be with an -azole.

He is 65, so in the USA, he is considered eligible for disability.

Giving him the permit makes sense but he still needs to work
out because he would gain weight and his osteoporosis would
only get worse.

This patient clearly had drugs at a party and is now presenting with symptoms of some drug he took.
He didnt overdose but its probably some hallucinogen so it would be good to know what he had in case
treatment is needed for any symptoms.

PAGE 459 (482 / 910) Immune Thrombocytopenic Purpura. This 5yo had a viral infection most likely, and now has
antibodies to Gp2b3a. He will have megakaryocytes and low platelets, as is evident. His bone marrow has good
production so the issue is not that he is not producing enough RBC/platelets, thus they must be getting killed elsewhere.
Choice A would indicate DIC but then they would have to show schistocytes or give a reason he could have DIC, such
as gram - sepsis or some malignancy.

PAGE 422 (445 / 910) Liver Cirrhosis. This patient has physical exam symptoms of a patient with liver cirrhosis, possibly due to his excessive
alcohol consumption. He is now presenting with symptoms of excess estrogen because his liver cannot get rid of it.

PAGE 383 (406 / 910) Duodenal atresia. This patient has bilious vomiting in the first few days of life, which means his duodenum failed to
recanalize, leading to duodenal atresia. He would have the double bubble xray and this is associated with down syndrome as well.

PAGE 317 (340 / 910) ASD. Fixed wide splitting of S2 is generally a giveaway for ASD. Also, the systolic murmur here is just due to
pulmonic regurgitation. You can also hear a diastolic rumble due to excess flow through the tricuspid valve.
 Page 164 (187 / 910) discusses nematodes.
Strongyloides stercoralis penetrates the skin from soil and then you see rhabtidiform larvae in feces.
Intestinal biopsy would show eggs and adult parasites. Can cause ileocecal valve and biliary obstruction.

Wikipedia tells you labile cells are ones that always multiply throughout life.
Stable, permanent, and terminal cells are all generally the same thing; they do not divide anymore.
Transitional cells would be changing in some way.

656 (679 / 910)

This patient has prerenal azotemia due to the hypotension, and you conserve Na to maintain volume.
After they fixed his volume, the Na will no longer be retained so youll see a lot of Na excretion.

711 (734 / 910)

Testicular "germ cell" tumors.
All testicular neoplasms are germ cell tumors.
This biopsy looks like you see "fried egg" cells in the cytoplasm, which is indicative of the most common one, seminoma.

508 (531 / 910) PAGET = Picture-frame bone

Paget disease of bone. AV shunts; HF
Patients have lytic osteoclastic, mixed, and sclerotic osteoblastic phases. Grown skull
Treat with bisphosphonates. Ear narrowing
ALP will be high due to osteoblasts but Ca, Phosphate, and PTH are normal. Triangle (Codman; Osteosarcoma)

480 (503 / 910)

The supraspinatus is the most common rotator cuff injury, but that would not allow the patient to abduct their arm the first 30 degrees at all.
External rotation is by the Infraspinatus, usually due to pitching injury, which requires sudden forceful internal rotation.

This is directly from Goljan

I) Hypovolemic shock may occur due to loss of plasma from the burn surface.
Loss of protein from the plasma loss may result in generalized pitting edema. II) Infection of the wound site and sepsis may occur.
(a) Sepsis due to Pseudomonas aeruginosa is the most common cause of infection in burn patients.
(b) Other pathogens include methicillin-resistant S. aureus and Candida species.
(3) Curling ulcers may occur in the proximal duodenum.
(4) Hypermetabolic syndrome may occur if >40% of the body surface is burned.

The wife has not exhibited lack of mental capacity or any psychosis so her wish must be maintained and then if anything escalates, the police would get involved.

609 (632 / 910)

Panic disorder can present as any kind of difficulty but one thing to remember is that patients will hyperventilate.
Hyperventilation causes you to lose your PCO2.
 359 (382 / 910)
This patient has cushing disease. The ACTH must be coming from the pituitary, because it responded to the dexamethasone suppression test.
Had the ACTH been coming from small cell lung cancer, it would not respond to dexamethasone suppression or CRH stimulation.
If her cushing was due to an adrenal adenoma, her ACTH would be low to begin with.

162 (185 / 910)

This is probably the most bullshit question ever. It is so simple, that it is hard.
Malaria can impair hepatic gluconeogenesis and can also consume glucose for its own metabolic demands.
The blood smear is showing the trophozoite ring forms within RBC.

https://malariaworld.org/blog/glucose-and-malaria

Page 220 discusses transudates and page 328 discusses heart failure.
She probably has mitral regurgitation due to RHD, her diastolic murmur.
You can hear crackles in the lower lung fields so she has pulmonary edema.
Her systolic ejection murmur can be aortic stenosis. It sounds like the patient has heart failure, which causes transudates.

432 (455 / 910)

The best medication for her would be omeprazole, a proton pump inhibitor.

PAGE 529 (552 / 910) Ibuprofen. Nsaid's of this group reversibly inhibit COX1 and COX2 and block prostaglandin synthesis.
Indomethacin is in this group too and its used to close a PDA. Adverse effects of losing prostaglandins include gastric ulcers
since prostaglandins protect gastric mucosa. But this patient has an elevated BUN and creatinine because NSAIDs also cause
interstitial nephritis, renal ischemia (PDA--Prostaglandins dilate afferent arteriole) and aplastic anemia.

The puborectalis muscle, which is one of the muscles that comprise the pelvic floor and
plays an important role in both fecal continence and defecation, is tonically contracted
and maintains the anorectal angle at rest.

PAGE 382 (405 / 910) Gastroschisis. Protrusion of intestinal contents without a cover is open like the opening in the letter G.
When its closed in some cover, or "sealed" its an omphalo"seal" and closed like the letter O.
 PAGE 491 (514 / 910) Common Peroneal. The common peroneal nerve is very superficial and right by the fibular on the lateral side of the leg.
The common peroneal is for PED (evert and dorsiflex) and sensation of the laeteral leg and dorsal foot via superficial peroneal.

https://en.wikipedia.org/wiki/Accessory_spleen
Pretty much NBME bullshit. But in all reality, its the only viable answer choice considering everything was ok post-splenectomy.
Then all of a sudden everything was being killed again as if the patient had a spleen once again.

PAGE 113 (136 / 910) Serum Sickness. SS is a type 3 HS due to antibodies to foreign proteins, leading to antibody antigen complexes and complement
activation causing inflammatory damage. You note fever, arthralgia, lymphadenopathym, and you run out of complement.

PAGE 512 (535 / 910) Rheumatoid Arthritis. RA is also a type 3 HS with IgM against IgG Fc region.

The rhombencephalon would be on the actual fetus so just get rid of (D). The "black hole" that the fetus is floating in is the gestational sac so get rid of (C).
Now I am no ultrasound expert but I know that the amniotic cavity eventually expands to fuse with the chorion thereby eliminating the chorionic cavity (B).
In terms of where the amniotic cavity is shown in this image, I am not sure, so maybe someone can help but this leaves the yolk sac which typically
appears within the gestational sac around 5.5 weeks.

PAGE 570 (593 / 910) Pituitary adenoma. The most likely type is a prolactinoma of lactotrophs.
Somatotroph = GH would have acromegaly.
Corticotroph = ACTH would have Cushing.
Thyrotroph = TSH would have hyperthyroidism.
Gonadotroph = FSH/LH would have dysfunctional HPO axis.
 PAGE 163 (186 / 910) Leishmania spp. Kala azar includes spiking fevers, hepatosplenomegaly, and pancytopenia. The others do not cause pancytopenia.
This mans fever is super high and his history of travel to the middle east, organic farming, and physical exam all fit this.

PAGE 475 (498 / 910) Alkylating Agents. Lomustine is a nitrosurea that cross links DNA and can cross the BBB to enter the CNS so
it is used for brain tumors. Cyclophosphamide is a nitrogen mustard that cross links Guanines and is used for solid tumors,
leukemia, lymphomas, and rheumatic disease like SLE or granulomatosis with polyangiitis but adverse effects include SIADH and
hemorrhagic cystitis (avoid with mesna). Another alkylating agent that cross link DNA includes busulfan, while procarbazine has an
unknown mechanism and is used for brain tumors.

PAGE 273 (296 / 910) Surrogate Decision Maker.

Since has has no relatives or children, it falls down to any "other relative" and this
neighbor is basically the only thing this patient has. The neighbor's words will be
checked by any further possible investigation and life support will not be initiated. The
patient has nothing or person to live for and prognosis is bad with anoxic brain injury.

PAGE 376 (399 / 910) MEN syndrome. This patient has oral ganglioneuromatosis, mucosal neuromas are only seen in 2B.
The pectus excavatum is specific for marfan, a habitus associated with the RET oncogene. This is MEN 2B.

Coloboma is an eye abnormality that occurs before birth. They're missing pieces of tissue in structures that form the eye.
Colobomas affecting the iris, which result in a "keyhole" appearance of the pupil, generally do not lead to vision loss.
Colobomas involving the retina result in vision loss in specific parts of the visual field.
Large retinal colobomas or those affecting the optic nerve can cause low vision, which
means vision loss that cannot be completely corrected with glasses or contact lenses.

D. NMDA receptors are the only ones from this list that uses calcium.
Remember memantine, the Alzheimer's drug, is an NMDA antagonist that prevents excitotoxicity by blocking Calcium entry!

PAGE 432 (455 / 910) GI Pharmacology.

This patient had NSAIDs for RA but then got gastric burning because B= Misoprostol, which is a PGE analog, and that is
NSAIDs get rid of prostaglandin synthesis so the gastric ulceration is what this patient needed. He will continue taking the
possible. He is now on another drug that wont affect PGE synthesis NSAID but the misoprostol prevents the NSAID
but it somehow caused diarrhea. induced peptic ulcers, that is its main function. It is
used off label for labor. The side effect this has
A = Acetylcholine blocker so muscarinic antagonist against M3, such is diarrhea and abortion.
as atropine. Atropine side effects do not include diarrhea, instead it
would cause constipation if anything.
C= Histamine blocker so an H2 blocker like cimetedine, but its S/E
includes antiandrogenic effects and confusion, which other H2
blockers dont cause.
D= Gastrin blocker but there is no such medicine.
E= Omeprazole which many would think would be a good idea but
remember, the goal is to treat his RA not his gastric burning. His
gastric burning is not due to excess acid production, but rather it was
a side effect of NSAID use.

PAGE 656 (679 / 910) Azotemia and PAGE 328 (351 / 910) Heart Failure.
This patient has unmanaged CHF, which is leading to more RAAS due to low CO, and that leads to
more renal Na and H2O reabsorption, hence the low urine output. Due to low renal blood flow, his
BUN/Cr ratio should be high and his FE(Na) should be low since he is reabsorbing it all due to RAAS.
Choice D has a high BUN/Cr ratio and a low urine Na, which falls into place with prerenal azotemia.
Prerenal because the issue isnt renal, its something else (low RBF).

PAGE 550 (573 / 910) Spinal Cord Tracts. This patients spinothalamic tract needs to be
This is about sensation of pain, so its definitely not anesthetized and those sensations are ipsilateral
AB FE which are all for the dorsal column, a sensory tract in the spinal cord, then they decussate. This is a spinal
for proprioception. C and G is your descending tract for cord image.
motor activity, so it definitely cannot be that either. That
leaves you down to H and D which are your In the brain the sensations are received contrallaterally
spinothalamic tract, the one that senses pain and after the decussated fibers ascend to the
temperature. Since this patient feels it on the right side, contralateral VPL in the thalamus.
you anesthetize H, because the spinothalamic tract
decussates in the spinal cord unlike the dorsal column
and Lateral corticospinal tract which both decussate
at the medulla in the brain.
 PAGE 331 (354 / 910) Hypovolemic Shock. This patient has been knocked out in a desert for 24 hours, so he is definitely VERY dehydrated.
A lot of people thought the answer was D due to CNS injury but this is not going to be any of the other stuff. Its simple. He is dehydrated, so
he will have high SVR and low PCWP and CO. He needs IV fluids. Simple.

PAGE 59 (82 / 910) Mitochondrial disease

The question stem is describing a mitochondrial disease, which commonly present with lactic acidosis.
There is an increase in anaerobic forms of energy production (glycolysis). The mitochondria are faulty,
so they can’t use the end product of glycolysis (pyruvate) in TCA. Instead pyruvate is shunted over and
is used by LDH (lactate dehydrogenase) to generate lactate.
The description of mitochondria in the subsarcolemmal regions is describing ragged red fibers.

PAGE 154 (177 / 910) Tinea. The physical exam is describing scaly rings of ringworm infection, which has central clearing like a "target."
The lack of lymphadenopathy cancels out cat-scratch disease, a fucked up answer choice but a smart one to put in the choices too.
Tinea corporis can be acquired from pets or farm animals.

PAGE 748 (771 / 910) Pneumoconioses. The pleural plaques are a give away for asbestosis, specially
considering his presentation and work history. Pneumoconioses present with occupational history and
lung findings unrelated to some kind of sickness like pneumonia.

Pneumoconioses are restrictive lung diseases, which present with a normal FEV1/FVC ratio but a lower
FVC since the lung is restricted. The DLCO decreases for the same reason as well.

PAGE 682 (705 / 910) Female Reproductive Histology. The Vulva to Ectocervice have squamous epithelium because it gets damaged and sheds.
Then the squamocolumnar junction leads into the endocervix which has columnar epithelium up to the fallopian tubes. The ovary is cuboidal
because it breaks and rebuilds.
Choices C, D, and E would have squamous epithelium. The endometrial lining depends on where on her menstrual cycle she is and it would have
glands and glycogen.

PAGE 536 (559 / 910) Myelin. FA does not teach about myelin in relation to capacitance and resistance, but it does discuss
conduction velocity with respect to length and time constants. In general, myelin speeds up nerve conduction by reducing
the capacitance and increasing the resistance. A capacitor is a device that stores electrical charge, like a battery. If you
reduce capacitance, you reduce how much electricity is stored, so the impulse gets transmitted rather than stored. Loss of
myelin increases capacitance and causes the action potential to get stored rather than transferred.

V=IR tells you that R=V/I which is voltage divided by current. Increasing resistance lowers the current but raises the voltage of impulses.

PAGE 365 (388 / 910) Hypothyroidism. Antithyroid peroxidase antibodies are seen in hashimoto.
Hashimoto has hurthle cells and lymphoid aggregates with germinal centers, so E is the answer.
A= Riedel with fibrosis and inflammation due to IgG4 systemic disease like autoimmune pancreatitis, etc.
B=
C= Possibly de Quervain with granulomatous inflammation.
D=

PAGE 319 (342 / 910) Hypertension. This patient clearly has hypertensive emergency since she
has end organ damage of her renal arteries as evident in the angiogram. The image is just like
the one in FA, with the "string of beads" appearance of the renal artery and you can note
microaneurysms. Pretty straight forward question.
 PAGE 265 (288 / 910) Attributable risk. They used the word attributable in the question so you kow you're looking for AR.
This is simply incidence in exposed minus incidence in unexposed. So (30/1000)= 3% incidence in exposed and 30/3000 is a 1% incidence in unexposed.
so in 10,000, 3% would be 300, and 1% would be 100, so 300-100=200. Incidence does not change with the size of the population.

PAGE 741 (764 / 910) Respiratory Flow-Volume curves. This patient has an obstructive defect due to a
fixed obstructor (mass). Inspiratory flow rate has to be lower so that knocks out half the options. Expiration
also has to be slower so that leaves only C or H. The person can neither breathe in nor out quickly/well.

FEV1/FVC is low in obstructive issues. FVC also will be low for this patient, which is hard to explain but
basically this patient's tidal volume is really low due to the abnormal breathing but the ERV & IRV are
unchanged. So the decrease in TV decreases FVC.

PAGE 662 (685 / 910) Potassium-sparing diuretics. Spironolactone causes endocrine effects including gynecomastia and antiandrogen effects.

Easy interpretation. Y axis is increasing amounts of Y being added. But X is not being bound.
Thus, X and Y do not share any epitopes in common. If they shared epitopes, the line would be
increasing because more X would be bound to the Y.

PAGE 537 (560 / 910) Neurotransmitters. Serotonin is low in depression, and Fluoxetine is an SSRI that increases serotonin concentratios.
Serotonin is synthesized in the Raphe nucleus of the medulla.

PAGE 239 (262 / 910) Dosage Calculations. They are being mean by messing up the units, Liters and mL. 1L=1000mL. So .09L is actually
90mL/hr/kg and maintenance dose is calculated by (Cp x CL x tau)/F and we are told this medication is given once a day so tau is 1.

The next messed up unit is hours and days. So 24hr = 1 day, thus the 90mL/hr/kg x 24hrs/day= 2160mL/kg/day.
The next messd up unit is micrograms and mg, so 1000microg = 1mg. So 12microg/mL divided by 1000 microg/mg= .012mg/mL.
Lastly we have to choose mg but we have kg so
Multiply (2160 mL/kg/day)(.012 mg/mL)=25.92 and the closest answer is 28.8 so they might have rounded something.

The way PEEP works, there is no negative intrapleural pressure in the system since it is no
longer needed so everything will be positive. Rude to ask this question.

PAGE 759 (782 / 910) Lung Cancer. His serum calcium is elevated most likely due to PTHrP being released by the squamous cell carcinoma he has.
Squamous cell carcinoma of the lung is a non-small cell carcinoma that is central, has cavitation, is associated iwth smoking, and causes hypercalcemia.
You would note PTHrP and histology would show keratin pearls and intercellular bridges.

This has to do with Intention-to-treat analysis. Essentially, when participants are non-adherent
but the data shouldn't be lost. They just undergo another statistical model to account for their
changes. Here is a nice video--> https://www.youtube.com/watch?v=Kps3VzbykFQ&t=7s

PAGE 530 (553 / 910) Gout Drugs. Acute gout drugs include NSAIDs, glucocorticoids, and Colchicine. Since he has NSAID induced respiratory
distress, we must go with one of the other two choices. Allopurinol, as well as probenecid, pegloticase, and febuxostat are for chronic gout treatment
in a preventive manner. They can exacerbate acute attacks so theyre avoided in acute cases.
PAGE 340 (363 / 910) Lipid lowering agents. This patient has high TG and gemfibrozile is a fibrate that activates PPARa to induce HDL synthesis
and reduce TG. That would be perfect for this patient.
A= Statin HMG CoA reductase inhibitor for reducing LDL.
B & C= Bile acid resin to stop reabsorbing bile, so you use up LDL to make more bile.
D= A medication that prevents cholesterol absorption at small intestine brush border.

None of the other answer choices are pediatric vaccinations.

Children are vaccinated against HepB at birth and more times within the first year so this baby would need that.
https://www.hepb.org/prevention-and-diagnosis/vaccination/guidelines/

PAGE 429 (452 / 910) Cholecystitis. This patient will exhibit the murphy sign, choice A. She has gall bladder pain after
eating fatty meals, which causes the gall bladder to contract. She most likely has calculous cholecystitis, gallstone in the
cystic duct.

PAGE 51 (74 / 910) Osteogenesis imperfecta. Rib fractures without any mention of abuse or trauma is pretty much choice D.
The other choices dont affect bone as much or in this manner. Rickets would cause bowing of bones.

Badly worded answer choice but the others wouldnt cause this either. Its sort of like she got a DVT and she
most likely has atrial fibrillation also, hence the several acute palpitations.

PAGE 111 (134 / 910) Vaccination. Only RIP Always (rabies, influenza, polio salk, and hepA) use an inactivated vaccine.
HBV, HPV, acell Pertussis, Neisseria, strep pneumo, and haem B use subunits. Toxoid is for colstridium tetani and c diphtheriae.
The others all have live attentuated vaccines.

PAGE 411 (434 / 910) Ulcer complications. This patient has an extensive smoking history and heavy drinking habit. His rebound gaurding and
pneumoperitoneum (free air under diaphragm, aka the abdominal cavity) are a sign of duodenal (anterior > posterior) perforation.

Prostate cancer spreads via the prostatic venous

plexus, which goes to the vertebral venous plexus
PAGE 712 (735 / 910) Prostatic venous plexus. and runs up the entire spinal column to connect
I have this note in my PDF from uworld. with the brain via a valveless system, allowing
bidirectional flow to regulate intracranial pressure.
This explains the propensity of tumors to metastasize
to the brain and why prostate cancer can metastasize
to the lower back.

PAGE 651 (674 / 910) Kidney Stones. This patients pH >7 and the only stones that precipitate at higher pH are phosphate related stones.
Calcium phosphate and MAP (or AMP) stones and that would be answer D. The others all precipitate at a pH < 7.
 PAGE 475 (498 / 910) Cyclophosphamide. It is one of the alkylating agents that cross links DNA, particularly at guanine.
It has many side effects including myelosuppression, SIADH, and fanconi. Hemorrhagic cystitis and bladder cancer can be
avoided via concurrent use of mesna. Of all the choices, granulocytes would be dividing the most so that will be depleted.

PAGE 471 (494 / 910) Clopidogrel. This and other "grel" medications as well as ticlopidine are
ADP receptor inhibitors which irreversibly block ADP P2Y12 receptors to prevent the expression of
gp2b/3a on the platelet surface. It helps decrease thrombotic strokes and treats acute coronary syndrome.
Ticlopidine can cause neutropenia, while any of them can lead to TTP.

Of all the choices, the liver is the only organ that can regenerate with minimal scarring.

PAGE 465 (488 / 910) CML. CML would have very low LAP because of low activity in malignant neutrophils.
But in benign neutrophilia (leukemoid reaction) there would be high LAP due to more leukocytes responding
to various stressors.

PAGE 155 (178 / 910) Mucor and Rhizopus spp. This patient has diabetic ketoacidosis and her physical exam has all the classic finidings that lead
to Mucormycosis, which affects her population and leukemics. Spores proliferate in blood vessels and enter the cribriform plate to reach the brain.
THey cause frontal lobe abscess, cavernous sinus thrombosis, facial pain, black necrotic eschar on face, and possibly cranial nerve involvement.

This is a very fucked up question. The patient does not have jaundice, because he is nonicteric. His skin is yellow because his family eats
mostly a plant based diet and he has excess carotene in him. Its an orange-red pigment found in carrots and many other plants
Note the question asks to improve his appearance, not his condition, because his condition is fine. He is growing well and has fine vitals.

PAGE 480 (503 / 910) Rotator cuff muscles. The subscapularis is on the anterior side of the scapula, and it pulls the scapula medially.

PAGE 163 (186 / 910) Leishmania. This patient has an insect bite that lead to pancytopenia, which is only possibly by Leishmania, transmitted by the sandfly.
The black fly is for the female black fly that causes river blindness via onchocerca volvulus.
The deer fly (as well as the horse and mango flies) cause Loa loa infections.
The tsetse fly is for trypanosoma brucei (brutsetse) and causes african sleeping sickness, no pancytopenia.

PAGE 162 (185 / 910) Babesia/Borrelia.

152 (175 / 910) Anaplasma. Anaplasma is under Rickettsial diseases and vector-borne illnesses.
This question is easy if you simply consider which of these pairs can even be together and Babesia and Borrelia (Lyme disease)
are both transmitted by the Ixodes tick. Anaplasma is simply tick-borne and its main feature is that granulocytes will have morulae.

https://www.cdc.gov/anaplasmosis/index.html Anaplasmosis has fever, headache, and myalgias and is also found in the Ixodes tick.
 PAGE 653 (676 / 910) Urinary Incontinence. This patient has stress incontinence, where you may have leakage with coughs. Pessaries
should help, as well as Kegel exercises for the levator ani muscles. Alpha agonists can also help them by contracting the IUS.

Urgency incontinence has detrusor overactivity, which causes bladder emptying, so these patients always need to urinate as soon as there
is any urine in the bladder. Treatment for them is with antimuscarinics like oxybutynin.

Overflow has detrusor underactivity, so they cannot empty their bladder and it overfills, so they need M2 muscarinic agonists like
bethanechol, or an alpha blocker if the issue is obstruction from BPH.

PAGE 524 (547 / 910) Hairy leukoplakia vs Thrush vs Leukoplakia. This patient has a precancerous lesion, which is plain leukoplakia, a
squamous cell carcinoma. Hairy oral leukoplakia is associated with EBV and immunosuppression. Thrush is also found in immunocompromised
and candida and often associated with use of oral corticosteroids.

Squamous cell carcinoma is related to depth of cancer.

PAGE 354 (377 / 910) Congenital Adrenal Hyperplasias. This patient has 21hydroxylase deficiency, which is most common. It could
also be 11b hydroxylase deficiency. Both have 46,XX females with virilization.

PAGE 696 (719 / 910) Disorders of Sex Development

A= Androgen Insensitivity Syndrome; 46,XY but female external genitalia and no uterus or fallopian tubes. Has no pubic hair, compared to
Mullerian agenesis, which is 46,XX and has a similar phenotype but with pubic hair.
The other choices do not really have much basis.

PAGE 209 (232 / 910) HIV Therapy. The mainstay of HIV treatment is an NRTI or NNRTI which both stop viral DNA
synthesis. NRTI competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain. NNRTI
bind reverse transcriptase at another site and do the same as well.

PAGE 523 (546 / 910) Strawberry Hemangioma. This is a 3 month old baby with a benign capillary
hemangioma that grows then regresses spontaneously by age 5-8yrs. Remember "strawberry shortcake"
to recall that the strawberry is for babies.

Cherry hemangiomas occur in adults and does not regress.