Biochem: PKU ~ 2 y/o with PKU, before you r/o Phenylalanine deficiency what dietary changes can you make? Increase tyrosine Essential Fatty acid: Linoleic vs Linolenic — know you can only get it from your diet and Linolenic is cardioprotective. Vitamin A excess Patient with Night blindness -> Vitamin A deficiency Osteomalacia Collagen synthesis question: Osteogenic Imperfecta. This was confusing as it did talk about laxity of the skin [Ehlers Danlos| but the pt has blue sclera, So, I am pretty su OL + BI2 Def Bo def Gastric bypass, what vitamin is deficient = RI? ‘Vegan male pt what he should supplement I went with ~> B12, there was folie acid, zine MG Bitot spot -> Fat soluble vitamin Hartnup Disease — Vitamin B3 and Tryptophan deficiency Taking Isoniazid and now has neuroglia -> Pyridoxine deficiency B12 Deficiency -> Megaloblastic anemia Outer plasma of cell marked for apoptosis. —° Phosphatidylserine ‘Tumor suppressor question, —° RB ané p53 ‘Tumor suppressor p53 works where (graphic) —* GI,S Vit A deficiency: kid with a white thing on his eye Vitamin that causes kidney stones — Vitamin C. A lot of vitamin Qs Vitamin A specially - Keratomalacia etc. CF pt, what vitamin def —> vit D (the only fat soluble in the vignette) CF PT problem with what -° misfolding something photo of Polycystic Kidney disease. —* Autosomal Dominant * Vitamin E presents like B12 without the blood stuff Vitamin D def terminal ileum cannot absorb fat soluble vitamins which form ~ 25, de Nutritional def with neuropathies: know the difference between B12, B6, and Vitamin E deficiency and how they can cause neuropathies or megaloblastic anemia, Dehydrogenases with Thiamine def Duchenne Musculo dystrophy ~ Gower sign Know the pedigree for autosomal dominant disease Flow cytometry ~ lear how to interpret them. NKCs and Toll-like receptor. I can't remember what the exact question was, know its relationship, + NKCs activity is enhanced by IL-2, IL-12, IFN-a, and IFN-B. Experiment, need to extend the life of cells, what could be added? -> Telomerase ‘+ What stays in GO -> Neurons -Cell disease -> decreased mannose-6-phosphatePeroxisomes -> oxidation over VLCFA Anticipation -> Huntington’s X-Linked pedigree Pedigree Father has Polycystic kidney disease, chances that the children get it -> 50% Intellectual disability, delayed development, coarse facial features “Child looks Happy” Reason for infertility in cystic fibrosis Rocker bottom fect -> what other presentations Child finding it difficult to get up, no thigh atrophy -> X-Linked Hyperammonemia, treatment is Lactulose, why > osmotic diuretic Pompe, Cardiomyopathy -> Lysosomal 1,4 glucosidase First time playing sports and unable to continue, myoglobinuria -> myophosphorylase Hurlers > Autosomal recessive Serology for all Hepatitis, IgM and IgG for Hep E are positive > Hepatitis E infection What continues to develop in the brain after baby is born? > myelination, ‘What continues to develop in the lungs after baby is born? -> alveoli Celiac disease in an 8-month-old vs lactose deficiency 6-year-old kiddo, what is still developing? —> Alveoli Newborn what is still happening ~° Brain myelination, NADPH oxidase- constant resp infections and rashes, pt was deficient in NADPH oxidase Meconium aspiration syndrome Patient comes in with Headaches and cbdominal pain, image of PKD ~ Autosomal Dominant FAP colon, inheritance -> Autosomal Dominant Dissociation curve question Melas Pedigree ~* Mitochondrial (graphic) (they described Melas) TIPS procedure allows people the blood to drain into the ~ IVC I got 2 questions with the same answer 1.23 years old has never been able to exercise due to lack of tolerance ~° myophosphorylase (McArdle) Pt with high 14, normal TSH, low free T4, on OCP went with due to —° TRG Boy presents with inability to smell, what failed to develop? — diencephalon patient presents with abdominal mass and aniridia. What gene defect? —>- WTI Bitot spots and dry skin ~ Vitamin A deficiency 2 q's of this asked different Premature baby with respiratory retractions, what is indicated for treatment Phosphatidylcholine, Experiment, need to extend the life of cells, what could be added? ~» Telomerase Experiment q’s Cancer cells with problem in e-cadherin what it can’t do I went with = no adherence to base membrane idk Pt with Alzheimer’s they give the dx ~* impaired proteolytic cleavage.What is most likely to be up regulated in cancer cells? ~ Telomerase Fragile X inheritance. they didn’t give trinucleotide, so I went with = x-link Clarthrin Experiment, impaired action affects function of what? —° MHC Il Kawasaki, they give you a picture SAME pic of NBME. They say an amino acid you give and dilate the vessel due to NO (they give you a graph) = Arginine Graph and they say is an insulin that have a modified AA you have to select the letter I went with — Regular insulin 1 about e7 (HPV) - Rb inhibition. Asking what type of mutation RET is - protooncogene. Prostate adenocarcinoma - what molecule causes apoptosis? Phosphatidylcholine Neonate bleeding - what clotting factor is decreased” Factor 2 (vitamin K def) Multiple biochem diseases (bloom syndrome, inheritance pattem of RB, picture of Gaucher disease. APE site question about process of translation): Helicase - Unwinds DNA template at replication fork. Deficient in Bloom syndrome (BLM gene mutation). Loss of heterozygosity: Ifa patient interits or develops a mutation in a tumor suppressor gene, the wild type allele must be deleied/mutated before cancer develops. This is not true of oncogenes. Retinoblastoma and the “two-hit hypothesis,” Lynch syndrome (HNPCC), Li-Fraumeni syndrome, Retinoblastoma: Loss (whitening) of the red reflex. Important causes in children include retinoblastoma, congenital cataract [Leukocoria] Gaucher disease: AR Most common. Hepatosplenomegaly, pancytopenia, osteoporosis, avascular necrosis of femur, bone crises, Gaucher cells (lipid-laden macrophages resembling crumpled tissue paper). Glucocerebrosidase (-glucosidase); treat with recombinant glicocerebrosidase. aa sickle cell genetic code, finding valine inthe right sequence VWF labs sirl dies of starvation. what will be increased in her body 2 hours after her death. genetic term for ABO compatibility: osteogenesis imperfecta genetic term:abetalipoproteinemia correct symptoms: Autosomal recessive. Mutation in gene that, encodes microsomal transfer protein (47P). Chylomicrons, VLDL, LDL absent. Deficiency in ApoB-48, ApoB-100. Affected infants present with severe fat malabsorption, steatorthea, failure to thrive, Later manifestations include retinitis, pigmentosa, spinocerebellar degeneration due to vitamin E deficiency, progressive ataxia, Intestinal biopsy shows lipid-laden enterocytes Treatment: restriction of long-chain fatty acids, large doses of oral vitamin E, bus that eats BIZ Gait instability and telangiectasias what was the deficiency Vitamin E Vit E deficiency causes ataxic gait Patient comes in with white on comea and asking what the vitamin deficiency, which was vit a, cause was decreased cell turnover in the cornea, Vit D- child that had decreased bone consolidation and chose 25 cholecalciferol vitamin transport system, diagnosis of SCID through x-ray: rnunknee diagnosis acid based question Retinoblastoma what cell eycle ~ G1 -S osteogenesis imperfecta genetic term ‘What does ubiquitin do if it is inhibited ~ Buildup of protein / inhibition of ubiquitin Ped pt with bright red blood’ remnant of the vitelline duct ~ Meckel’s Diverticulum autosomal dominant or X-linked or mitochondrial Patau vs. Edwards vs. Down Syndrome Collagen/Elastin/insulin synthesis and corresponding diseases amino acid derivatives, catecholamine synthesis Kartagener ot Cystic Fibrosis {know CF really well] pleiotropy or polygenie or heteroplasmy Vitamin-E, B12, B3, F- ataxia, Syphilis related neuropathy or parietal cell antibody gluconeogenesis or HMP shunt lysosome or mitochondria or proteasome or intron/exon Vitamins ADEK, MeArdle’s: Which enzyme in this pathway will be deficier Gave Pathway and have to identify where the enzyme acts Diabetic Ketoacidosis ~ Anion Gap Excess TGF-beta — Colloid Wound healing — FBGF Trisomy 13 - Holoprosencephaly, clenched fist, ete. Pellagra and Niacin F pt with Marfan complains of decreased height. What is the cause? Kyphosis ‘What is prevalent on skeletal muscle when you start exercising? GLUT 4 Chromosomes ~ P53 and Rb ~ which phase in the cell cycle?MOA of Acyclovir? DNA polymerase Genetics: Pedigrees given that must be interpreted Mitochondrial X-linked Dominant Autosomal Dominant Indirect ELISA: test Ag or Ab secondary Ab-coupled to color-generating enzyme added to detect Ab-Ag complex Vitamin B12 Homocystinuria: Syx. Marfanoid habitus (lens down/in), Tx. cysteine, B6, B12 Megaloblastic Anemia RBC picture Methylmatonic aciduria: Tx. B12 Vitamin E (tocopherol/tocotrienol): patient with paresthesia + normocytic anemia Weight loss medication (2,4-DNP): decreased H+ gradient in ETC increased heat, no ATP N-acetyl glutamate required cofactor for Urea Cycle Tryptophan hydroxylase required to produce Serotonin (decreased if inhibited) Glycogen storage disorders ‘Von Gierke (G6PD): increased blood lactate, triglycerides, uric acid, hepatomegaly Lysosomal storage disorders Tay-Sachs (def. Hexoaminase A, ine. GM2): cherry red macula, no hepatosplenomegaly Cherry-red spot-on macula: prevent blindness with perinatal retinal exam Familial hypercholesterolemia (AD): éefect in LDL receptor (Apo B-100), tendon xanthomas Xeroderma pigmentosa: defect in nucleotide excision repair, formation of pyrimidine dimers I-Cell disease: defect in N-acetylglucosaminyl-1-phosphotransfersac (dec. M6P) Extracellular secretion of proteins (high plasma), Sx. Coarse facial, clouded comeas Cystic Fibrosis (CFTR, ch.7, deletion Phe508): Dx. Chloride sweat, immunoreactive trypsinogen Defective post-translation folding/glycosylation — protein structure issue Duchenne Muscular Dystrophin (frameshift) deletion in dystrophin (cytoskeleton) ~ proximal muscle weakness (Gower sign) Dilated cardiomyopathy, increased CK + aldolase Myotonic type | (AD): CTG repeat in DMPK gene — cataracts, testicular atrophy, frontal balding, bird’s beak face Down Syndrome (chr. 21): nondisjunciion maternal meiosis 1, endocardial cushion (ostium primum) Inc, nuchal translucency, B-hCG, Inhibin A; Dec. a-fetoprotein, estriol, PAPP-A Knockout mice Vibrio cholera — pathogenesis of infection Bordetella pertussis ~ Gram - coccobacilli E coli Staph aureus Ebola Strep pneumoniaSalmonella — pea soup colored diarthea TRICKSSS ~ Toxic shock, Rickettsia Ricketsi, Cox A, Kawasaki, Staph scalded skin syndrome, scarlet fever, syphilis Trypanosoma brucei ~ know how it looks in blood smear Acylostoma spp - Microcytic anemia Which herpes virus cause GI symptoms? Roseola HPV-8 Pneumocystis jiroveeci Camping in Pacific Northwest drank water week long history of diarrhea -> Giardia ‘Trophozoites are found in a patient's stool sample -> cysts from contaminated water 2 degree burns 3 days ago. What organism? -> S.aureus Linear tracing marks up the skin -> Scabies Patient had acne -> bacterial process under the skin leading to increased sebum. Young woman with UTI showed gram stain (+) -> S, saprophyticus, Prostatitis after a GI/GU procedure -> Enterococcus Air fluid abscess in the lung -> gram negative bacteria vs. s, aureus Camping in Colorado, drank from a lake, have a picture of Giardia the SAME picture of the NBME. DX: Giardia Picture of schistosome DX. Schistosome SAME pic of NBME. 2 questions on —* Scabies Vignette of pseudomonas (they described the ulcer and the bacteria) tx ~* ceftazidime Patient with general GI discomfort and symptoms (vomiting/diarthea) along with periorbital edema and eosinophilia (dead giveaway), what is the bug causing this? — Trichinella spiralis Viral reassortment in a graph Viral conjunctivitis (the vignette was clear it was viral) —> Adenovirus, Question described candida asking what is most likely to be seen on light microscopy/ stain? — Pseudo hyphae and budding yeasts (Candida) 15 y/o with petechiae and fever - Neisseria — DIC ‘man eats licks a turtle what can he get - Salmonella herpes virus that cases GI ulcers herpes virus that cases GI ulcers anthrax picture asked about vector: guy comes back from water rafting got jaundice why? Weil — disease: Spirochete with hook-shaped ends found in water contaminated with animal urine.Leptospirosis—flu-like symptoms, myalgias (classically of calves), jaundice, photophobia with conjunctival suffusion (erythema without exudate). Prevalent among surfers and in tropics (eg, Hawaii). Weil disease (icterohemorthagic leptospirosis) —severe form with jaundice and azotemia from liver and kidney dysfunction, fever, hemorrhage, and anemia bug that eats BIZ Scraped leg which antigen picks up bacterial antigens ~ macrophages take it to the lymph node Pts face with fungal infection losing facial hair ~ put something with Kansis, ‘Treatment for scabies — permethrin Welt of hand infection ~ Scabies Gardnerella infection — Hydrogen Peroxide 2 questions on Gardnerella 30s, 50s, aminoacyl transferase, resistance, beta lactamase, penicillin binding protein Celiac or Whipple sexual transmitted infection (gonorrhea, chlamydia, syphilis, HSV, Hemophilus, vaginosis, Trichomonas) antiviral medication recurrent bacterial/fungus/ viral patient PLACES or SHINE bacteria malaria or mycoplasma Type 1/2/3/4 hypersensitivity, transplant rejection Which vaccines are toxoid vs. live vs. killed lymph node drainage albino or vitiligo or Leukocyte adhesion or Chronic granulomatous or tetrazolium blue test asthma drug or cyclosporine or tacrolimus or other immunosuppressive HIV: progression, associated diseases, treatments, and side effects Sydenham chorea sequela to group A strept infection Toddler with unilateral purulent rhinorchea think foreign body Parapneumonic pleural effusion intussusception ‘Treatment for TB? Rifampin, Isoniazid, Pyrazinamide, Ethambutol Photo of Schistosoma Haematobium egg Pseudomonas and Hot Tub folliculitis Staph Aureus Enterococcus Facealis Pt started on Macrotides having sympioms of diarrhea. What caused the GI symptoms? Activation of motilin M receptors Pregnant pt with yellow fluid in vaginal eanal, cervix closed, everything else normal What is the cause of infection? Ascencing infection Gardnerella Histology was given. The answer was lack of lactobacillus in vagina canal because the normal flora is decreased Peds with a Sandpaper Rash. What is the cause? Kawasaki Disease M pt hunting for bear meat, Answer was TrichinellaEosinophils given in labs and asked what was the cause? Only one parasite in the answers Candida Image was given — IV catheter - What was the morphology’ Candida is a yeast MOA of E-Coli affecting the bladder? Pilus Fungi: Cocco. Mutans ~ What was??? What I couldn’t understand this ~ around 8:30 in second recording Couldn’t understand which arthritis in 18:29 Cryptococeus in HIV Chikungunya- flu like symptoms plus muscle pain and traveled to the Caribbean CMV- transplant patient, immunocompromised also had EBV but went with CMV, kidney transplant patient on immunosuppressant Herpes 6- baby with a maculopapular rash all over and had fever 2 days before that resolved by itself The pic of alveoli that’s in NBME all the time, type that is pneumocyte | and 2, which one would proliferate to help damaged cells so know 2 on the pic Bartonella henslae in child, child spends weekend on farm and lymphadenopathy Poison ivy due to mast cell degranulation Paramyxovirus not anything specific, person febrile and mild fevers and body aches and. pain and no travel Sub-Saharan Africa had a pic of an ovoid, but by sandfly, has diartheal illness, which organism—> went with necatur americanus but wasn’t sure Pneumocystis jirovecci Candida vaginitis and asking for treatment-- went with fluconazole sexually active teen with HIV your response while giving diagnoses ‘man eats licks a turtle what can he get - salmonella herpes virus that causes GI ulcers Mycobacterium Cord factor (serpentine): TNF-alpha + inhibits macrophage immune response (VF) Leprosy: Tuberculoid form less problematic, has Th! response Pregnant patient with TB taking rifampin. Negative pressure room Heamophilus influenza (g-ve cocci-rod): epiglottitis (picture) Vibrio parahaemolyticus (comma, oxidase +, alkaline): oysters, seafood, rice water diarrhea Syphilis: 2 = condyloma lata — painless/moist white lesion (accuminata in HPV) Tinea versicolor (Malassezia): damage melanocytes — hypopigmentation, Dx. KOH cigar butt PCP: opportunistic in HIV — diffuse interstitial, ground glass ~ methenamine silver stain (disc) Candida: disruption of vaginal flora (candida overgrowth) - antibiotic use Nacgleria fowleri: freshwater swimming, cribriform plate ~ meningitis, death Leishmania: Amastigotes in macrophages (picture) — sandfly, kala azar Parasites (know pictures) Strongyloidiasis: larvae in soil penetrate skin, Dx. Larvae in stool Tx. Ivermectin’ Benznidazoles Influenza vaceine (live ~ intranasal, killed ~ injected) Adenovirus: febrile pharyngitis, conjunctivitis — preauricular lymphadenopathy Kaposi sarcoma (HHV8): AIDS pt, ~ endothelial cell neoplasm, spindle shaped tumor cellsRabies: bat bite, Tx. Killed Vaccine + Immunoglobulin - negri bodies (cytoplasmic ~ hippo) Viral hepatitis (councilman bodies) ~ eosinophilic apoptotic globules Meningitis: Neonates: GBS (vagina ~ penicillin), E.coli (K-capsule), Listeria (g+ rod, dairy/deli-4C) Antibiotics: MOAVSE, which induce CYP450 (Macrolides) Capsofungin: inhibit beta glucan Antivirals, HIV drugs Teichoie acid (gram +), LPS (gram -) Dental procedures: S. mutans/mitis ~ tricuspid infective endocarditis Splenectomy: $. pneumonia Toxoplasma: Tx. Pyramidazine + Sulfalazine Trichomonas (trophozoite - strawberry cervix): Tx. Metronidazole STD: colon ulcers ~ HPV (16, 18) UTES, saprophyticus (gram stain), E, Coli (VF = pili, adhesin) ~ EMBigreen sheen Prion disease: sterilize with sodium hydroxide/hypochlorite + autoclave, anti-gravity HIT Urobilirubin process Post partum lady on Apixaban for righ: DVT, now she has left sided leg swelling Girl with strong family bleeding history, bloody nose and menorthagia increased bleeding time increased PTT => von Willebrand disease Black liver on postmortem examination -> UDP-glucuronosyltransferase Steven Johnson mx due to ~* Type 3 hypersensitivity but explained weird AB Rh+ recipient has a coagulative reaction to a O- donor, what anti bodies did he respond to? —* Anti-Kell ‘Typical case of Gilbert syndrome: student stresses duc to final exams and shows jaundice due to unconjugated hyperbilirubinemia, Asked why? Deficiency of UDP sglucuronosyltransferase I change this one too «( UGC- CDR What molecule on the endothelium is responsible for anticoagulation? ‘Thrombomodulin, Children 3 y/o with decreased in ALL cell lines, platelets, RBCs and WBCs, dx? > Aplastic anemia 1 got like 5 q’s on anemia they weren't easy for me A lot of labs values and weird idk Question on a differential characteristic between HbA and HbF? It was not easy (for me) end up choosing related to the — co? I had 2 q°s on this. ‘The other question was Hydroxyurea increase what > HBFHealthy young woman with thrombosis and no other sign or information, Healthy pt > factor V deficiency (is the most common) they give port ¢ too Patient with heavy menses and bleeding problems with family history of bleeding issues, with vignette also including lab values, which disorder? —° von Willebrand disease (know typical lab values!) Vignette with TTP VWF labs S-year boy got diagnosed with Meckels, location of his ectopic tissue? Gastric or pancreatic tissue, lower GI bleed- hematochezia AML diagnoses: Median onset 65 years. Auer rods; myeloperoxidase ® cytoplasmic inclusions seen mostly in APL (formerly M3 AML); circulating myeloblasts on peripheral smear, Risk factors: prior exposure to alkylating chemotherapy, radiation, myeloproliferative disorders, Down syndrome (typically acute megakaryoblast leukemia [formerly M7 AML). APL: (15;17), responds to all-érans retinoic acid (vitamin A) and arsenic trioxide, which induce differentiation of promyelocytes; DIC is a common presentation CML complication: Peak incidence: 4S—85 years; median age: 64 years. Defined by the Philadelphia chromosome (t[9:22], BCR-ABL) and myeloid stem cell proliferation, Presents with dysregulated production of mature and maturing granulocytes (eg, neutrophils, metamyclocytes, myclocytes, basophils) and splenomegaly. May accelerate and transform to AML ot ALL (“blast crisis”). Responds to BCR-ABL tyrosine kinase inhibitors (eg, imatinib) et) = anal hemorrhoids know what lymph nodes are causing the drainage — lymph nodes hemophilia child with AR inheritance iferior mesenteric On a Plane and clotting ~ warfarin inaibiting of gamma carboxylation Basophilic Stippling — Lead Poisoning Pleuro thickening what is the pts job — Asbestos house painter Coagulation cascade and associated defectsCauses of microcytic vs. macrocytic vs. normocyti¢ anemia Heme synthesis, CML or polycythemia vera or myelofibrosis Blood smear - parvovirus B19 or Howell Jolly or Heinz or AML. Warfarin or heparin or von Willebrand or HUS or TTP Blood group ABO classification or Thalassemia or Sickle cell Multiple myeloma cancer drugs and which categories for each / chemo man side effects grade or TNM stage or brain to lung metastasis or colon to liver metastasis or prostate to bone metastasis, pancreatic adenocarcinoma osteoBlastic (unlike other cancers) Hypersegmented Neutrophils, Spherocytes, Pale Blood Cells Hodgkin and Non-Hodgkin's Lymphoma Burkitt's Lymphoma, What is cause of starry sky appearance? Apoptosis Breast tumors related with colon cancer. DNA mismatch repair ‘What is associated with Lynch? CEO — Colon and Ovarian Lynch Syndrome APC Breast ~ p53 SBLA Syndrome by p53 mutation BRCAI and BRCA2 associated with ovarian Nonhomologous repai Pt with Sickle Cell started on Hydroxyurea. What hemoglobin is increase’? Hem F Alpha Thalassemia Minor is only one gene deletion Pt with Spherocytes on blood smear and anemia, What vitamin deficiency would cause this? I choose selenium about prostate carcinoma location - periphery AML diagnoses CML complication genetic term for ABO compatibility anal hemorrhoids know what lymph nedes are causing the drainage hemophilia child with AR inheritance Anemia Microcytie (Iron deficiency, Thalassemia, Lead poisoning, Sideroblastic anemia) Maerocytic (Folate/B12 deficiency, Orotic aciduria) Normoeytic: Nonhemolytic (Anemia of chronic disease, Aplastic anemia) Hemolytic (increased reticulocyte) Intrinsic: Spherocytosis (E), G6PD (Ell), PNH (I), Sickle cell (E) Extrinsic: Microangiopathic, Macroangiopathic WWF disease (AD): Increased BT, increased PTT, negative ristocetin agglutination ALL: Pre-B-cell lymphoma (Tdt+, CD10+), increased lymphoblasts, Pre-T (mediastinal mass) Langerhans cell histiocytosis: edla, Birkbeck granules — lytic bone lesions in children, mastoid Immature cells do not effectively stimulate primary T cells via antigen presentation Clopidogrel: ADP receptor inhibitor, prevents expression of GplIb/Illa — require activation p450 ‘TPA antagonism — causes increased clots Methotrexate: inhibit DHFR (S-phase), S/E: hepatotoxicity, pulmonary fibrosis Hydroxyurea: inhibit ribonucleotide reductase, inerease HDF ‘Trastuzumab: HER-2-nue (c-erbB2) ~ tyrosine kinase receptor S/E: cardiotoxicity Breast CancerImmui Leukemoid reaction: increase WBC, Neutrophils + band cells (left shift) & LAP, Doble bodies ITP: isolated thrombocytopenia, increased BT, anti-Gplb/IIla, increased megakaryocytes nology: Interleukins Transplant rejection Bruton’s agammaglobulinemia Selective IgA deficiency Leukocyte adhesion Azathioprine Bacterial genetics: transformation, trarsduction, conjugation, & transposons. with CDIA positive and the typical scenario —> Hystiocites Vignette with a contaminated saline infusion why the pt has the reaction ~* cytokines. (idk) Tap graph. find the right vaccination recommend: diagnosis of SCID through x-ray: Uncontrolled allergies patch given that needs to be check on for which monoclonal antibody -mab Live v Killed Vaceine ~ CDS with Live and Killed Antibody response ~ Stronger response with Live Location of B and T cells in LN Where is the T cell in the LN? Paracortex Pt with AB+ blood with O-blood given. What is the reason for the transfusion reaction? If MHC Tis not expressed, what is it susceptible to? NK cells will kil it GVHD question What does the oral vaccine induce? Humoral IM vaccine will induce? Cell mediated Leukocyte migration is mediated by which interleukin? IL-8 ‘What caused neutrophils to go to the pustule? Chemotaxis, IL-8 LN Drainage of Kidneys? Para-Aortic Child who is constantly getting sick and had CD4 and macrophage count, CD3 and 56 all low and went with patient having SCID down syndrome reproductive lab Hyperacute (pro-cxisting Ab-type I): widespread thrombosis of graft — ischemia/necrosis Acute (CD8 against donor MHC): vasculitis, interstitial lymphocytic infiltrate Chronic (CD4 respond to recipient APC): parenchymal fibrosis, arteriosclerosis Bronchiolitis obliterans (terminal bronchioles), obliterative intimal thickening (renal) Graft vs. Host — prevent by HLA matching + irradiate/wash thymocytes CGD: NADPH oxidase deficiency Leukocyte Adhesion deficiency: Integrin (CD18), delayed separation of umbilical cord Autoimmune hepatitis: anti-smooth muscle Ab Filgastrim: G-CSF (recovery of bone marrow) Cetuximab: target EGFR, Tx. Stage IV colon cancer, head & neck cancerPHARMOCOLOGY Efficacy (up/down), Potency (left/right), Agonist/ Antagonist (complete, partial) ANS: Gq (HI, al, V1, MI, M3), Gi (M2, a2, D2), Gs (BI, B2, DI, H2, V2) Grapefruit juice = CYP3A4 Methotrexate: S/E. pulmonary fibrosis + liver toxicity Warfarin: toxicity ~ skin necrosis (decreased protein C — hypercoaguable) Tx, FFP Mercury: toxicity Tx. Dimercaprol Ipratropium: Tx. Asthma/COPD (reverse vagal mediated bronchoconstriction) Digoxin: toxicity — diarthea, vision/color problems Sucralfate: protective coat on uleer base ASA allergy - nasal polyps Benzocaine: toxicity causes methemoglobinemia Curare (Tubocurarine, Atracurium, Rocuronium): Non-depolarizing competitive ACh antagonists Reverse blockade with Neostigmine (acetylcholinesterase inhibitor) + Atropine ‘Sweating = Acetylcholine (sympathetic) Tiotropium: acts on muscarinic to dilate in lungs Tx. asthma (reverse vagal bronchoconstriction) Niacin — causes hyperuricemia/gout Phenoxybenzamine: non-competitive antagonist of alpha (epinephrine) B2 on the uterus Female patient presents with amenorrhea and elevated 17-hydroxyprogesterone -> Congenital Adrenal hyperplasia Pain with intercourse, speculum split in two > Uterine didelphys. Prost partum lady on Apixaban for right DVT, now she has left sided leg swelling Male with small testicles, did mention there was normal testosterone -> between 47XXY Vaginal bleeding in 36 week pregnant, dilated cervix 2m -> normal due to cervical dilation Secretory phase of the mensural cycle with tortuous vesicles lines up with progesterone increase after LH surge large, encapsulated mass removed from the patients breast with clean margins and no evidence of infiltration -> Fibroadenoma abdominal plain but no unusual bleeding with two masses noted on the uterus, well identified -> Leiomyoma monthly camps and pelvie pain, primary amenorrhea >> imperforate hymen Prostate examination on a gentleman with new onset urinary retention -> smooth and uniform enlargement of the prostate pain in his feet bilaterally, left hand with a rash Culture shows diplococci-> N. gonorrhea Pain with intercourse, speculum split in two —* Uterine didelphys Ca of endometrium tisk factor ~* estrogen Cervical cancer, what is the strongest predisposition? —° HPVPT with potter it was more than clear, what was the problem in the mom ~* chronic amniotic fluid leakage other options make no sense to me Lump in breast at 3 o'clock where it drains, I went with parasternal idk They described the ovulation period, colloid arteries you have to pick the point in the graph Menopause ine FSH, LH, prolactin no change (arrows) women dies from a cervical cancer. pic of biopsy. what cells are damag women die from a cervical cancer. pic of biopsy. what cells are damaged? Pain during sex, what is the cause?” How to diagnose hypertension in pregnancy? BP > 140/90 mm Hg after 20 weeks of gestation, No preexisting hypertension, No proteinuria or end-organ damage. Hypertension prior to 20 weeks of gestation suggests chronic hypertension. Treatment: antihypertensives (Hydralazine, a-methyldopa, labetalol, nifedipine), deliver at 37-39 weeks. Hypertensive moms love nifedipine. schizoid pregnancy kallsman syndrome sexual active teen with HTV your response while giving diagnoses Combination OCP will increase the risk of — Tubo-ovarian abscess Ovarian cancer Physiologic changes during pregnancy Ovarian hyperthecosis Breech presentation Effects of OCP use Fetal HR-! igh + maternal fever = immediate induction of labor (regardless of G-age) CIN-3 diagnosis - management of CIN-3 Ghon and chlam — no microscopic finding - unable to detect, do NAAT Dyspareunia + menstrual cramp =endometri Engineering strategies to prevent errors Dyspareunia + anterior vaginal mass =urethral diverticulum Vesicovaginal fistula ~ bladder dye test- red, raised granulation on anterior wall Compression of peripheral nerve ~ meralgia paresthesicaPreterm labor < 32weeks management Weakening of abdominal muscle Post-partum urinary retention Complication of preeclampsia ~ PF Inflammatory breast cancer OCP with bicornate uterus Uterine rupture Labor arrest over 4 hours Pain during sex. what is the cause? How to diagnose hypertension in pregnancy? schizoid pregnancy recurrent pregnancy loss with systemic rash and positive test for syp! which layer doesn’t shed during mensuration about prostate carcinoma location: Common in males > 50 years old. Arises most often from posterior lobe (peripheral zone) of prostate gland and is most frequently diagnosed by PSA and subsequent needle core biopsies (transrectal, ultrasound-guided). Histologically graded using Gleason grade, which is based on glandular architecture and correlates closely with metastatic potential. Prostatic acid phosphatase (PAP) and PSA are useful tumor markers (total PSA, with fraction of free PSA). Osteoblastic metastases in bone may develop in late stages, as indicated by lower back pain and serum ALP and PSA. Metastasis to the spine ofien occurs via Batson (vertebral) venous plexus down syndrome reproductive lab girl pregnant 23 wks. starts her period why’? hypothyroidism after pregnancy why: kallsman syndrome sexual active teen with HIV your response while giving diagnoses which layer doesnt shed during mensuration. hypothyroidism cells u see before the follicular rupture: 25 yo M painless mass — seminoma Women urinary incontinence with 8 kids groin area - vaginal prolapse PCOS or menopause Disorders of sexual development: Kallman vs. Turner vs. Aromatase deficiency vs Mullerian agenesis vs. AIS vs. Sa reductase deficieney developmental stage roll, sand, walh, 1un, staits Endometriosis, Leiomyoma, Adenomyosis, Asherman Causes of lower quadrant pain Endometrial glands tortious histology given of uterine gland -gland in proliferative phase. Answer was Progesterone 2. 21-Hydroxylase Def. Q just wanted this diagnosis 3, Progesterone agonist for abortion: Mifepristone 4, M pt with defect in seminiferous tubules. Answer was pt is taking exogenous steroids 5. Pt with hx of radiation therapy and now obviously going through menopause with vaginal dryness, What is the cause of menopause? Primary Ovarian Anovulation6. Pt with a BPH. What is the cause? Obstructive uropathy causing recurrent pyelonephritis and recurrent reflux ‘Most common type of twin: monochorionic di-amniotic Cystic Hygroma (cavernous Iymphangioma of the neck) & Turner XO Pre-eclampsia: proteinuria >300mg, give pt. Mg to prevent seizures PCOS: Hyperinsulinemia/insulin resistance, LH:PSH (2:3) increase androgens theca interna cells Fibrocystic change of breast + epithelial hyperplasia (terminal duct lobule, women >30) 1.5-2x risk of breast cancer: Sclerosing adenosis + intraductal papilloma Superior parathyroid derived from Ath pouch PAX gene: specification of tissues, limb regeneration in capable animals Urachal duct cyst: partial failure of urachus to obliterate — connection w/ bladder Fetal Alcohol syndrome: microcephaly, smooth philtrum, hypertelorism Due to failure of cell migration Leydig cell: LH ~ testosterone (externa genitalia) Sertoli function: FSH, increase inhibin, line seminiferous tubules, produce MIF (internal) Gestational diabetes: BP> 140/90 after 20th week, no proteinuria, no preexisting HTN ‘Tx. a-methyldopa, labetalol, hydralazine, nifedipine Perineural invasion - prostatic carcinoma Sonic hedgehog: base of limbs in zone of polarizing activity ~ pattern along anterior- posterior axis, mutation can cause holoprosencephaly Blue in abdomen ~ endometriosis ‘Anatomy Tips procedure > drains into the TVC Transilluminate non painful swelling of the middle finger pip joint > ganglion cyst Injury with numbness and atrophy of the thenar eminence -> median nerve Double cortex. —* Radial migration Eherl Myer flask — problem with bone resorption Pt with cirrhosis and portal HTTN and they asked you which of the following vessels have the highest pressure in this condition? ~* Rectal superior vein, Only vessel on portal Lump in breast at 3 o'clock where it drains, I went with parasternal idk Knee ligaments. Answer was MCL F pl wilh mass in posterior Uhigh. What muscle is it on? Biceps Femoris Brachial Plexus Diagram. What will a be the defect in a Radial Nerve injury? Wrist drop M pt jumps in the pool and hits his head at the bottom sustaining cervical fracture and cannot move his lower limbs. What will be preserved? Upper extremities F pt and cortex was divided into two layers. What is the defect? Radial Migration Which ligament should be clamped when there is a bleed right and left lobe of the liver? Hepatogastro Ligament Cardio:Hyaline vs Hypertrophic arteriosclerosis, Pale wedge shaped segment of the liver known heart disease -> thrombus Wide Split S2 on inspiration and right heart problem -> Pulmonary hypertension Patient with an acute MI and what heart sound -> $4 Pregnant with mitral area systolic murmur > Mitral Regurgitation S152 Tracing of what appeared to be a mis systolic click -> MVP Left 2 intercostal space murmur in a healthy 21M -> Murmur of HCM Dextroposition of the aorta ~ keep the PDA open. Open heart surgery right ventricle injury Patient with Aortic dissection ascending. What risk factor? —- HTN Pt with afib and suddenly had abdominal pain and had decreased ph, Dx? > Embolism of SMA Patient with family history of sudden cardiac death is experiencing cardiac issues, what is most likely to be seen on echocardiogram? ~ Thickening of IV septum (genetic hypertrophic cardiomyopathy) Hypovolemie Shock arrows Austin flint murmur diagnose HOCM pt young pt what part affected - Myosin HOCM when does it get louder ~ on standing MVA shock what is the SVR VR -ine CO-dee Pulmonary Arerty Pressure-dee — Arrow Question Known Mitral Valve Replacement looks like on CT — Mitral Valve Brachial arch or pouch question/digeorge lipid lowering drug Shock thermoregulation peripheral vasoconstriction in prolonged cold HOCM S4 AS or Dilated $3 AR MR polyarteritis nodosa or temporal arteritis or Kawasaki or Reye; all the vasculitis post-ventricular MI complications CO, SVR, etc arrows in Dilated Cardiomyopathy Pt with papillary muscle rupture and image. What will be seen? Regurg. What will you find if there is MR? Second messenger for Beta Blockers - cAMP ECG and Wide splitting $2? RBBB ‘LECG with ST elevation, just asked what ion channel were effected-> she chose potassium. If potassium ATPase pump stops working, what gets inside and stays outside, increase potassium inside and increased sodium outside PR wave lenghtening and which part of heart affected- AV and SA node (PR interval) AV node (PR segment) Endocardial cushion defect ~ truncus erterious (neural crest derivatives) Hypertrophic cardiomyopathy: Beta-myosin heavy chain, sarcomere proteins, disarray Degree of LVOT obstruction and intensity vary with LV EDVIncrease intensity with decreased preload/afterload, standing/valsalva Associated with Friedreich ataxia V5-V6 lesion: lateral circumflex Atrial fibrillation (irregularly irregular with no p waves) — Tx. IC/IIl for rate control Torsades ~ polymorphic ventricular tachycardia, prolong QT Duc to Class 1A dizopyramide, quinidine, procainamide, Class It Murmurs © AR-high pitched blowing eariy diastolic, L2ICS, wide pulse pressure, head bobbing AS crescendo-decrescendo, loudest at base radiates to carotids, calcification ASD (risk of stroke) ~ pulmonicarea, diastolic rumble PDA - congenital Rubella Buergers (thomboangitis obliterans): intermittent claudication Atherosclerosis: macrophage + LDL a foam cell a fatty streak & SMC proliferation + ECM deposition fibrous plaque (lipid filled intimal plaque} Dissecting aneurysm: patient on BB, add vasodilators Dilated cardiomyopathy: eccentric hypertrophy (added in series), mutation in dystrophin, mitochondrial enzymes, decreased ejection fraction 0 Associated with Hemochromatosis, Chagas, Coxsackie B, Doxorubicin C-ANCA Membranous FSGN Patient comes in with Headaches and bdo pain, image of PKD — Autosomal Dominant Given an antihypertensive medication on a background of renal artery stenosis, decreased in renal function > ACE Hydronephrosis on ultrasound of the kidney, where is the obstruction -> ureter Hospitalized patient with hematuria and a drop in renal function -> ATN Dehydrated diarthea patient -> metabolic acidosis Hyperventilating patient -> respiratory alkalosis Child with enuresis that behavioral modifications have not worked > Imiparamine Patient has had worsening anxiety, what treatment -> -hydroxytryptamine reuptake inhibitor Hypertensive retinopathy -> nicking othe artery Diabetic retinopathy -> retinal angiogenesis photo of Polycystic Kidney disease, —* Autosomal Dominant patient presents with abdomi mass and aniridia What gene defect? —° WTI | had this patient that was losing volume - high ADH - what region in the renal tubule is, impermeable to water? Thick ascending loop vit d and renal questions Psychogenic Polydipsia — what part of kidney are you losing the water ~ medullary or cortex — which is not absorbing water TAL diuretic places of action and side effecis nephritic or nephrotic or white casts or interstitial or kidney stones Acute tubular neeiusis vs, acute inter+. ps6N + Child with perioral edema. What isthe diagnosis? Minimal Change Dz ‘+ SE of ACE inhibitors causes? Oligohydramnios + Potter's + Alport Syndrome + F ptwho drinks very cold water, What will happen to blood flow to skin and rectum? Blood flow will dec to both parts + What isthe LN Drainage of Kidneys? Para-Aortic + Whatiis + What is the second messenger in Nephorgenic DI? cAMP (ADH) + Metabolic acidosis + respiratory compensation: Winters formula (PCO2 = 1.5 [HCO3] + 8 +/-2)0 Anion gap: Na~ (CI + HCO3), normal 8-12 ‘+ Membranous nephropathy: diffuse capillary + GMB thickening (LM), immune complex (1g6/C3), “spike and dome” with subepithelial deposits (EM), antibodies to PLAZ (transmembrane) + Uric acid kidney stone: not visible on ‘ray (radiolucent), thomboid/rosettes ~ arid climate ‘+ Hydronephrosis: distention of renal pelvis/calcyces 8 causes atrophy of cortex/medulla + ADPKD: ch. 16 (PKD1), ch. 4 (PKD2), MRI (can cause subarachnoid hemorrhage/berry aneurysm) + Vesicouretral reflux: chronic pyelonephritis + Thiazide: Tx. Essential HTN ‘+ Na/K pump destroyed in PCT - no reabsorption of H20? + Acute interstitial nephritis: pyuria (eosinophils) 1-2 weeks after drug use (NSAIDs) Endo: + Parathyroid + SIADH + Nephrogenic DI Hyperthyroid — labs * Female patient presents with amenorrhea and elevated 17-hydroxyprogesterone -> Congenital Adrenal hyperplasia + Chronic Renal Failure + low calcium + High PTH — 2X? HYPERPARATHYROIDISM. + PTU effects on a chart blocking peripheral conversion of T4 to T3 ‘+ Patient with short stature -> Resistance to IGH-1 * DiGeorge syndrome and thymic aplasia -> hypercalcemia Pt whit thick pleura, pearly pleura, meation pleura hike 3 times ~* mesothelioma Pt with pearly pleura, ferruginos body exposed to asbesto They showed you a graph with calcium and PTH levels. They put you a point on the raph an asked what is de Dx. The point was were caleium was low and PTH was increased. Dx? ~* 2daty hyperparathyroidism,Graph and they say is an insulin that have a modified AA you have to select the letter I went with — Regular insulin Alpha | and 2 charts from first aid. SLE patient with hypercoagulability hand the most common complication of it recurrent pregnancy loss with systemic rash and positive test for syphilis: SLE girl dies of starvation. what will be increased in her body 2 hours after her death. hypothyroidism after pregnancy why: which layer doesn’t shed during menstration hypothyroidism cells u see before the follicular rupture: lot of endocrine pathways, vit d ete Pt post viral infection with thyroid hormone — TSH normal — Painful thyroid and enlarged ~ Subacute Thyroiditis DiGeorge tetany, absent thymus, shadow on x ray ~ 22q11 Hypocalcemia what pouch is missing ~ Third pharyngeal pouch Diabetic pt ~ Delayed gastric emptying Splinter hemorthages what causes these - Septic emboli MEN 1 - what type of mutation ~ Tumor supp or/ RET protoncogene MEN 1/2 hypeuthyrvid or hypothyroid myoma or rhabdomyoma PTH vs Ca levels endocrine drug metformin, sulfonylurea Addisons or DI or adrenal cortical/medullary signaling pathway of hormones, p53, HOX gene, motif, tumor suppressor genes, oncogenes Islet cell tumors: insulinoma vs. gastrinoma vs. VIPoma, etc. ‘Type | vs. Type 2 diabetes; DKA vs, HHM MG antibodies What is the cause of Myasthenia Gravis? F pt with fever and later develops hyperthyroidism. What is the diagnosis? Subacute Thyroiditis hypothyroidism after pregnancy why hypothyroidism cells u see before the follicular rupture lot of endocrine pathways. vit d ete Elevated C-peptide, Insulin (released from secretory granules in golgi): Sulfonylurea use PTH: increase Ca absorption at bone/kidney (OT), vitamin D, decrease phosphorous (PT) Adrenal Cortex: 21 (increase sex), 17 (increase aldosterone), 11 hydroxylase (increase sex/BP) Addison's disease: no cortisol going to cortex, increase ACTH (hyperpigmentation) © Hyponatremia, Hyperkalemia, Metabolic acidosis (no aldosterone), Hypoglycemia Subacute thyroiditis: tender/painful, granuloma — multinucleated giant cells, ESR inc., Viral flu Grave's disease: scalloping of colloid, IgG stimulate TSH ‘Acromegaly (GH ~IGF-1 from liver) & Tx. Octreotide DM type 2: hyperasmotic coma+ Glucagon: upregulates glycogenolysis + gluconeogenesis ‘+ Increased vitamin D ingestion = decressed PTH + Secondary hypothyroidism a failure of pituitary gland (TSH) + DKA: decrease pH, decrease HCO3, increase H, (decrease CO2 — compensation) + Pheochromocytoma: increased hematocrit (increased EPO) ~ VHL? Neuro Conductive vs Sensorincural hearing loss — Rhine and weber test Brown-Sequard syndrome + PICA vs AICA Homer syndrome Tapping on the patients tooth elicits pain -> Trigeminal Nerve Tongue was deviated and loss of gag reflex, -> IX Left Quadrantopia and pick the place on the brain Foramen spinosum is the meningeal branch of V3 ‘Transilluminate non painful swelling of the middle finger pip joint > ganglion cyst Injury with numbness and atrophy of the thenar eminence -> median nerve Pt with Alzheimer’s they give the dx ~* impaired proteolytic cleavage. They show a neuron and then point something I don’t remember more —* Na voltage channel( the saltatory conduction) Double cortex - failure of neuronal migration ‘Smooth brain - failure of radial migration Neuroanatomy broca area location on brain cadaver narcolepsy on ECG: Excessive daytime sleepiness (despite awakening well-rested) with recurrent episodes of rapid-onset, overwhelming sleepiness > 3 times/week for the last 3 months. Due toorexin (hypocretin) production in lateral hypothalamus and dysregulated sleep-wake cycles. Associated with: Hypnagogic (just before going to sleep) or hypnopompic (just before awakening; get pomped up in the morning) hallucinations. Nocturnal and narcoleptic sleep episodes that start with REM sleep (sleep paralysis). Cataplexy (loss of all muscle tone following strong emotional stimulus, such as laughter), Treatment: good sleep hygiene (scheduled naps, regular sleep schedule), daytime stimulants (eg, amphetamines, modafinil) and/or nighttime sodium oxybate (GHB). reaction of light reflex after damage of damaged optic nerve ~ CN 2 Spinal cord cross section — anterior right was out — deviation of the tongue to the right Hippocampus on cross section Huntington’s caudate and putamen on cross section near front Acetylcholine pt dipped in parasympathetic state acetylcholine didn’t dip how to treat — Atropine ‘Trigeminal jaw pain to eat what is the nerve — Trigeminal Brainstem thick nerve below the optic chiasm right side - Down and out on right side - culomotar nerve (CN Il)ACA angiogram right in front of the brain — Contralateral legs will be paralyzed! Hemiparesis| Ct'scan and just asked what itis and she said meningioma looked li it was coming from meninges Lewy Body dementia — visual hallucinations optic nerve lesion or hemianopsia hematoma epidural/subdural/subarachnoid brain anatomy picture or dorsal cohumn/spinothalamie tract/corticospinal © Know brain structures that correspond to pathology (be able to find substantia nigra and subthalamic nucleus) Sturge Weber or neurofibromatosis or Wilms or tuberous sclerosis Horners (constricted pupil) or uncal herniation (blown pupil) multiple sclerosis, Brain Tumors: Adults vs. Children jons and post-stroke timeline cranial nerve or comeal or pupillary reflex Weber Syndrome Ocular motor symptoms. What is affected? MRI given. Answer was Midbrain F pt with temporal lobectomy. What went with it? Hippocampus Pt with Spinal cord Deficits. Which vitamin is deficient and what is the manifestation? Vitamin € Def — Ataxia Pt with alcoholism. What is affected? Mamillary Bodies Pinealoma — Ditemporal llemianopsia Pt with pain on molar and also when chewing and headaches. Which of the following nerves if affected? Trigeminal Pt with hearing problems everything normal but has jaw issues. Which nerve? Facial CN nucleus + location/exit (label) Lesion underneath sylvian fissure — affects medial geniculate nucleus (hearing) Huntington (CAG): Atrophy of caudate~ hydrocephalus ex vacuo of frontal horns AICA lesion: Lateral Pons © Facial nucleus: paralysis of face, taste from anterior 2/3 of tongue 0 Salivary nucleus: decreased lacrimation, salivation, © Vestibular nucleus: vomiting, vertigo, nystagmus PICA lesion: Lateral Medulla © Wallenburg (nucleus ambiguus, CN IX, X, XI): dysphagia, hoarsness, decreased gag reflex o Trigeminal nucleus: ipsilateral loss of pain and temperature from face Subarachnoid hemorrhage (picture): hyperdense cisterns/sulci, intraventricular blood Ischemic stroke: hippocampus (most vulnerable) + cerebellum © Red neurons (12-48h), Microglia (3-5d), Reactive gliosis (1-2), Glial scar (>2w) Abducens nerve (CN6): exits from superior orbital fissure Wet Macular degeneration: choroidal neovascularization (angiogenesis) - rapid vision loss Natalizumab: can cause PML (JC virus) - destruction of oligodendrocytes, rapidly progressive Medulloblastoma: homowright rosettes (picture) — basophilic nuclei, neuroectodermal ‘tumor © Can compress 4th ventricle (hydrocephalus), drop metastasis to spinal cord - Adults Hyperaccusis: increased sensitivity to certain frequenciesGI Arnold Chiari: cerebellum tonsillar hemia (associated with myelomeningocele) Aphashia (MCA) © 0 Broca: non-fluent aphasia with intact comprehension, impaired repetition 0 Wernicke: fluent aphasia with impaired comprehension & repetition © Superior temporal gyrus (superior visual field defect) © O Arcuste fasciculus: poor repetition, fluent spccch | intact comprehension Multiple Sclerosis: INO, spastic bladder, IgG in CSF — oligoclonal bands (periventricular plaques) Sleep cycle: Awake (beta), N1 (theta), N2 (sleep spindle/K complex), N3 (delte-slow wave), REM © N3:sleep walking, night terrors, bedwetting (Tx. Imipramine, desmopressin) © REM (PPRF): induced by ACh, dreaming, increase 02 use Meckle’s ~ in an elderly patient FAP colon, inheritance -> Autosomal Dominant Colonic Polyp removed 3 years ago what is the appearance now -> Normal Blood flow to the Ascending colon supplied by what vessel? -> Right Colic White creamy fluid on effusion aspiration following esophageal surgery -> thoracic duct injury Gastroduodenal artery is severed, collsteral blood supply -> Gastroepiploic artery Patient with diabetes and vascular disease, where is the greatest risk of an ulcer -> plantar surface of the great toe Pancreatic autoimmune destruction of alpha cells, what's inhibited CT with diverticulosis -> increased pressure and weakness of the colonic wall Mecekels diverticulum -> mesenteric in origin Feeling of food stuck in the throat > Zenkers AB recipient has a coagulative reaction to a O donor, what ani bodies did he respond -> Anti-Kell TIPS - where does it drain? = IVC TIPS procedure allows people the blood to drain into the ~° IVC I got 2 questions with the same answer Blood flow to the Ascending colon supplied by what vessel? — Right Colic Colonic polyp removed 10 years ago, what will be seen now? ~° Normal mucosa Where are the stem cells located in the intestine => Crypts Pt they mentioned that he was having early satiety with a little amount of food and. malaise in general, he used the smoke food machine OCCASIONAL , dx was gastric cancer, they asked what was the most important predisposing factor for his condition? ‘Smoking food on the machine. I change I’t and went with H.pilory :( they give tabaco, spicy foods.Pt with weight loss and thrombophlebitis on one side on foot and then travels to other side on next week, cancer of where ~° Panereas Pt with GERD and more comorbidities and he was receiving drugs and asked which was the effect or MOA of the best drug for his condition? It was as tricky question. Options were not easy, I ended up choosing — decreasing extracellular potassium Image of celiac trunk angiography, asking you (o select one the question what was the artery [choose ~ splenic IDK 5 year boy got diagnosed with meckles. location of his etocpic tissue? herpes virus that cases GL ulcers Cut a polyp out of the colon whats going to happen in colopscopy 6 months later whats its going to look like ~ normal muscosa solid or liquid dysphagia her Causes and treatment of ulcers--gastric, peptic, ete Meckel diverticulum or appendicitis or ovarian tumor or Hirschsprung esophageal varices or Mallory Weiss or Boethave vesicular steatosis or nodular cirrhosis or Ilep A, B,C, D, E, Hep B markers Crohn or UC or Thi or Th2 Causes of upper quadrant pain Gastric Uleers H. Pylori associated with MALT lymphoma. What was the cause of lymphoma? H. Pylori How is Portal HTN treated? TIPs procedure Engorged Vessel in Portal HTN? Splenic Vein Meckel’s Diverticulum Crohn's Disease Bullet lodged in the spleen (NBME image) Annular pancreas: ventral pancreatic bud encircles 2nd part of duodenum Peyers patches (aggregated lymphoid nodules): found in the ileum Above pectinate line: superior rectal vein & IMV a portal vein, internal iliac lymph nodes Below pectinate line: inferior rectal vein & internal pudendal a internal iliac common iliac IVC, superficial inguinal lymph nodes (painful ext. hemorrhoids — pudendal nerve) Barrett's esophagus (picture): glandular metaplasia (intestinal metaplasia) - adenocarcinoma Celiac sprue (picture): blunting of villi, intraepithelial lymphocytes (duodenum/jejunum) 0 HLADQ2/8, anti-endomysial, ant-tissue transglutaminase, anti-gliadi © Decreased Vitamin D, increased TH Colonic polyps — (picture w/ tubular histology): Tubular less malignant, APC/KRAS mutation Aluminum OH antacid: /E. constipation Fas mutation: decreased apoptosis, lymphoproliferative (Hepatosplenomegaly) External anal sphincter: 4th sacral + pudendal nerve Chronic gastritis: increased Gastrin, decreased somatostatin, Dx. Urine pH for H. pylori or hemorrhoid+ Peutz Jagher (AD): hamartomas throughout Gl tract, hyperpigmented mouth, lips ‘+ External hemorrhoids drainage: inferior rectal vein (IVC), superficial inguinal lymph node Pulmonary Sarcoidosis Silicosis Positive pressure changes in aviation ‘+ Tracheal deviation pneumothorax -> Hyperresonant and decreased fremitus Right sided pneumonia -> Increased fremitus and dullness White creamy fluid on effusion aspiration following esophageal surgery -> thoracic duet injury + ARDS -> Increased fluid in the alveoli Pt with recurrent pneumothorax they use a powder in the pleura to decrease the pheumotorax — I went with to fix the pleura I have no clue chorionic bronchitis labs F Pi lifetime smoker lung collapse tracheal deviation ~ Pneumothorax or Atelectasis, Pt with something in the posterior bottom right bronchus — lobe consolidation - aspiration pneumonia ‘Aca gradient acidosis/alkalosis, hhyperresonant or tactile fremitus small cell lung carcinoma or eareinoid or serotonin syndrome hydrostatic or colloid pressure sarcoidosis, Vitamin D, 25-something, 1,25-something, 24,25-something CO? transport ‘Type 2 pneumocytes ‘+. PE and Changes in arterial/blood gas + Mptwith PE. What caused PE? Smoking + Fpton OCPs with PE. What caused PE? What cause it? OCPS ‘+ 2:3 questions Mesothelioma + Free 120-M pt with Radon exposure in basement. What is the cause of the cancer? Radon + Methemoglobinemia + Carbon Monoxide ~ 02 dissociation curve ‘+ Mopt with seizure and later dies - What happened? Aspiration + Hb dissociation curve + Haldane ettect: deoxygenated blood isa better butter tor H+, CO2 leaves tissue and enters RBC and equation is shifted toward HCO3- formation, HCO3 then gets converted back to CO2 in lung and is expired - thus deoxygenation of blood increases it’s ability to carry COZ + Bohr effect: increased CO2 causes a decrease in pH which increases 02 unloading ‘+ Restrictive vs. Obstructive (x-ray findings) + Silicosis ‘+ Breath sounds/percussion/fremitus ‘+ Pneumonias © Lobar: S. pneumonia, consolidation, increased fremitus