Case-Based Flashcards

A patient has a lesion involving the brachium pontis. Which deficit is most likely?

A. Impaired cortical motor planning input to cerebellum
B. Loss of cerebellar output to red nucleus
C. Disruption of vestibular input from medulla
D. Loss of decussating dentatothalamic fibers

______ is given before anticholinesterase to prevent bradycardia and cholinergic crisis

A lesion of the restiform body would most directly disrupt which type of information entering the cerebellum?

A. Cerebellar output to thalamus
B. Corticopontocerebellar fibers
C. Proprioceptive and vestibular input
D. Basal ganglia feedback to cortex

A tumor compresses the major efferent pathway leaving the cerebellum. Which structure is most likely involved?

A. Restiform body
B. Brachium pontis
C. Inferior olive
D. Brachium conjunctivum

A patient has fluctuating ptosis and diplopia that worsen late in the day. On examination, deep tendon reflexes are normal. Which structure is most directly spared, explaining the preserved reflexes?

A. Postsynaptic acetylcholine receptors
B. Muscle spindle afferent limb
C. Neuromuscular junction end plate
D. Extraocular muscle fibers

A patellar tendon tap suddenly stretches the quadriceps. The first receptor that detects this change is the:

A. Golgi tendon organ
B. Pacinian corpuscle
C. Muscle spindle
D. Free nerve ending

The primary sensory fiber mediating the monosynaptic stretch reflex is the:

A. Ib afferent fiber
B. Ia afferent fiber
C. C fiber
D. Group IV autonomic fiber

A reflex hammer strike to the patellar tendon causes quadriceps contraction and hamstring relaxation. Which spinal cord circuit best explains the hamstring response?

A. Direct inhibition by Ia afferents on hamstring alpha motor neurons
B. Activation of an inhibitory interneuron by Ia afferents
C. Presynaptic inhibition of quadriceps afferents
D. Activation of gamma motor neurons to hamstrings

Which disorder would most likely abolish the afferent limb of a deep tendon reflex?

A. Myasthenia gravis
B. Dorsal root ganglion lesion
C. Thymoma
D. Acetylcholinesterase inhibition

A patient with proximal weakness has preserved sensation and normal reflexes. The clinician suspects a disorder of the postsynaptic neuromuscular junction rather than peripheral neuropathy. Which finding best supports that conclusion?

A. Absent muscle spindle discharge
B. Loss of Ia sensory fibers
C. Impaired transmission from motor nerve terminal to muscle
D. Loss of inhibitory interneurons in the spinal cord

A patient has weakness that improves transiently after repeated activation, along with reduced reflexes that may increase after exercise. Which diagnosis is more likely than myasthenia gravis?

A. Lambert-Eaton syndrome
B. Duchenne muscular dystrophy
C. Botulism limited to sensory neurons
D. Multiple sclerosis

A patient is given a medication that causes dry skin, flushed appearance, confusion, and intense thirst. Which mechanism best explains these findings?

A. Nonselective blockade of muscarinic receptors
B. Selective activation of nicotinic receptors
C. Inhibition of acetylcholinesterase activity
D. Selective stimulation of M3 receptors

Pyridostigmine lasts ___-___ hours

A patient presents with acute respiratory distress and generalized weakness. Administration of an acetylcholinesterase inhibitor leads to clinical improvement. Which diagnosis is most likely?

A. Cholinergic crisis
B. Myasthenic crisis
C. Lambert-Eaton syndrome
D. Botulism from impaired ACh release

A patient being treated for myasthenia gravis develops worsening weakness, bradycardia, diaphoresis, and miosis. Which mechanism best explains the patient’s condition?

A. Decreased acetylcholine at the neuromuscular junction
B. Autoimmune destruction of postsynaptic receptors
C. Excess acetylcholine from acetylcholinesterase inhibition
D. Blockade of nicotinic receptors at the NMJ

In myesthenia crisis, symptoms ______ with anticholinesterase drugs

In cholinergic crisis, symptoms ______ with anticholinesterase drugs

Deep branch of the ulnar is what?

Deep branch of the ulnar (C8-T1) innervates ______ eminence muscles

A patient has fluctuating ptosis, diplopia, and fatigable proximal weakness. Initial serology for acetylcholine receptor antibodies is negative, but clinical suspicion for myasthenia gravis remains high. Which antibody should be checked next?

A. Anti-MuSK
B. Anti-dsDNA
C. Anti-centromere
D. Anti-Jo-1

A patient with clinically suspected myasthenia gravis is negative for AChR antibodies and MuSK antibodies. Which antibody is most appropriate to check next?

A. Anti-agrin
B. Anti-LRP4
C. Anti-voltage-gated calcium channel
D. Anti-GQ1b

Which sequence best reflects the normal neuromuscular junction signaling pathway that these MG-related antibodies disrupt?

A. MuSK → agrin → ACh receptor → LRP4
B. Agrin → LRP4 → MuSK → ACh receptor clustering
C. ACh receptor → MuSK → agrin → LRP4
D. LRP4 → agrin → MuSK → acetylcholinesterase

What is 1?

2?

3?

4?

A patient with suspected myasthenia gravis also has arthralgias, photosensitive rash, and proteinuria. Which additional laboratory test is most appropriate to help evaluate an alternative systemic autoimmune diagnosis?

A. ANA
B. Anti-MuSK
C. Anti-LRP4

ANA tests for autoantibodies directed toward ____ material. It is highly sensitive for ____ (SLE)

A patient develops descending paralysis after eating improperly canned food. The toxin cleaves SNARE proteins in cholinergic nerve terminals. Which immediate effect causes the weakness?

A. Less ACh vesicle fusion
B. Fewer muscle ACh receptors
C. More ACh breakdown
D. Less muscle depolarization threshold

Which disorder is most directly caused by impaired presynaptic acetylcholine release rather than loss of postsynaptic receptor function?

A. Botulism
B. Myasthenia gravis
C. Muscular dystrophy
D. Polymyositis

_______ play a role in docking and fusion of synaptic vesicles

The age onset for myasthenia gravis is bimodal, with it occurring at 20-30 in _______ and 60-70 in _______

A patient with myasthenia gravis is started on mycophenolate mofetil for long-term disease control. Which mechanism best explains its therapeutic effect?

A. Blocks muscarinic receptors
B. Inhibits purine synthesis
C. Inhibits acetylcholinesterase
D. Blocks calcium channels

Mycophenolate mofetil improves myasthenia gravis primarily by reducing activity of which cells?

A. Neutrophils and eosinophils
B. B cells and T cells
C. Schwann cells and fibroblasts
D. Platelets and macrophages

A patient taking mycophenolate mofetil develops fatigue and recurrent infections. Which adverse effect best explains both findings?

A. Hemolysis
B. Leukopenia
C. Hypercalcemia
D. Bradycardia

Which adverse-effect set is most consistent with mycophenolate mofetil therapy?

A. Constipation, mydriasis, urinary retention
B. Ototoxicity, nephrotoxicity, gingival hyperplasia
C. GI upset, hepatotoxicity, cytopenias
D. Pulmonary fibrosis, hypothyroidism, edema

A defect in thymic function leads to survival of T cells that react against self-antigens. Which thymic region is most directly impaired?

A. Cortex
B. Medulla
C. Germinal center
D. Red pulp

Which statement best describes the normal organization of T cells within the thymus?

A. Mature T cells dominate cortex
B. Immature T cells reside in cortex
C. Negative selection occurs in cortex
D. Positive selection occurs in medulla

The thymus is primarily composed of which two cell types?

A. Neurons and glial cells
B. Epithelioreticular cells and lymphocytes
C. Fibroblasts and macrophages
D. Chondrocytes and osteocytes

The thymus is derived embryologically from which germ layer?

A. Ectoderm
B. Mesoderm
C. Endoderm
D. Neural crest

The thymus is located in which anatomical region?

A. Posterior mediastinum
B. Upper anterior mediastinum
C. Abdominal cavity
D. Cervical triangle

What is the primary function of the thymus?

A. B-cell antibody production
B. T-cell maturation via antigen presentation
C. Erythrocyte destruction
D. Platelet activation

The _____ muscle protrudes the tongue. Innervated by CN___

In repetitive nerve stimulation testing for suspected myasthenia gravis, stimulation at Erb’s point is used primarily to:

A. Assess thymic output
B. Activate upper trunk fibers
C. Block acetylcholine release
D. Directly test muscle spindles

A patient with myasthenia gravis undergoes repetitive stimulation of the brachial plexus at Erb’s point. Which finding is most consistent with the disease?

A. Increasing CMAP amplitude
B. Decremental CMAP response
C. Absent sensory nerve action potential
D. Conduction block across the plexus

For CMAP testing, Erb’s point is located in which site?

A. Axilla, anterior to pectoralis minor
B. Supraclavicular fossa, posterior to SCM
C. Cubital fossa, medial to biceps tendon
D. Carotid triangle, anterior to SCM

Stimulation at Erb’s point during CMAP testing most directly activates which structure?

A. Lower trunk, C8–T1
B. Upper trunk, C5–C6
C. Lateral cord, C5–C7
D. Long thoracic nerve, C5–C7

Which property of neostigmine best explains why it lacks major central nervous system effects?

A. Rapid renal excretion
B. High protein binding
C. Does not cross the BBB
D. Selective nicotinic blockade

Neostigmine is a ____ amine that inhibits ____

Muller's (smooth muscle) - innvervated by sympathetic nerves via ____ ____

A patient taking neostigmine presents with excessive salivation, muscle weakness, and respiratory distress. Which condition best explains these findings?

A. Cholinergic crisis
B. Myasthenic crisis
C. Serotonin syndrome
D. Neuroleptic malignant syndrome

The germinal centers seen in thymic hyperplasia primarily contain which cell type?

A. T cells
B. Neutrophils
C. B cells
D. Macrophages

In thymic hyperplasia associated with myasthenia gravis, which histologic feature is most characteristic?

A. Follicles with germinal centers
B. Caseating granulomas
C. Fatty infiltration only
D. Reed–Sternberg cells

A patient presents with fluctuating diplopia and ptosis that worsen throughout the day. Why are extraocular muscles affected early in myasthenia gravis?

A. Large motor units and low activity
B. High use and small motor units
C. Increased acetylcholine release
D. Predominant parasympathetic innervation

anti-dsDNA test is used to diagnose / rule out [...]

Which statement best describes the normal structure of the thymus in adulthood?

A. Mostly adipose tissue after involution
B. Predominantly lymphoid follicles
C. Fully replaced by bone marrow
D. Enlarged with active germinal centers

Which cell type is primarily responsible for forming the blood-thymus barrier?

A. Endothelial cells
B. Epithelioreticular cells
C. Macrophages
D. Fibroblasts

Prednisone improves myasthenia gravis primarily through which mechanism?

A. Suppresses immune system
B. Increases ACh release
C. Blocks nicotinic receptors
D. Enhances calcium influx

Which adverse effect is most associated with long-term prednisone use?

A. Hypoglycemia
B. Osteoporosis
C. Hyperkalemia
D. Bradycardia

A patient on chronic prednisone develops weight gain, moon facies, and central obesity. Which condition best explains these findings?

A. Addison disease
B. Hypothyroidism
C. Cushing syndrome
D. Acromegaly

A patient with weight loss, heat intolerance, and proximal muscle weakness is found to have elevated thyroid hormones. What is the mechanism of the muscle weakness?

A. Increased protein catabolism
B. Decreased neuromuscular transmission
C. Autoimmune receptor blockade
D. Reduced calcium release

A patient with fatigue, cold intolerance, and muscle cramps has hypothyroidism. What is the primary mechanism of their muscle weakness?

A. Increased muscle breakdown
B. Decreased metabolism
C. Impaired ACh release
D. Demyelination

MG → mainly type _____ hypersensitivity

Low C3/C4 → think type _____ immune-complex consumption

Which protein acts as the calcium sensor that triggers synaptic vesicle fusion during neurotransmitter release?

A. Synaptotagmin
B. SNARE complex
C. Acetylcholinesterase
D. Voltage-gated sodium channel

Hassall corpuscles in the thymus are best described as which structure?

A. Concentric epithelioreticular layers
B. Clusters of immature lymphocytes
C. Collections of macrophages
D. Vascular endothelial loops

Which mechanism best explains how thymoma or thymic hyperplasia contributes to myasthenia gravis?

A. Reduced calcium entry in motor nerves
B. Autoimmunity against ACh receptors
C. Direct muscle fiber degeneration
D. Increased acetylcholine breakdown

A patient is unable to coordinate horizontal eye movements, with impaired conjugate gaze. Which structure is most likely affected?

A. Optic chiasm
B. Medial longitudinal fasciculus
C. Superior colliculus
D. Vestibular ganglion

A patient with a brainstem lesion develops vomiting after exposure to circulating toxins. Which structure is most likely responsible for detecting these blood-borne substances?

A. Area postrema
B. Substantia nigra
C. Red nucleus
D. Nucleus ambiguus

A patient has difficulty initiating horizontal gaze toward the right. Which structure is most directly responsible for sending signals to the ipsilateral abducens nucleus?

A. Paramedian pontine reticular formation
B. Medial longitudinal fasciculus
C. Superior colliculus
D. Edinger-Westphal nucleus

The paramedian pontine reticular formation (PPRF) integrates input from which combination of sources to coordinate horizontal eye movements?

A. Retina, optic tract, lateral geniculate
B. Cortex, cerebellum, vestibular nuclei
C. Hypothalamus, pituitary, limbic system
D. Basal ganglia, thalamus, amygdala

A patient is unable to adduct the left eye during rightward gaze, but convergence is intact. The right eye shows nystagmus. Which diagnosis best explains these findings?

A. Internuclear ophthalmoplegia
B. Oculomotor nerve palsy
C. Abducens nerve palsy
D. Horner syndrome

Which eye movement is preserved in a patient with a lesion of the MLF and ipsilateral abducens nucleus?

A. Ipsilateral adduction
B. Ipsilateral abduction
C. Contralateral adduction
D. Contralateral abduction

A patient with a pontine lesion cannot move either eye to the left. On rightward gaze, the left eye fails to adduct while the right eye abducts with nystagmus. Which diagnosis best explains these findings?

A. Internuclear ophthalmoplegia
B. One-and-a-half syndrome
C. Abducens nerve palsy
D. Oculomotor nerve palsy

A patient has an absent gag reflex after touching the posterior pharyngeal wall. Which pathway correctly describes the afferent limb of the reflex?

A. CN IX to spinal trigeminal and solitarius nuclei
B. CN X to spinal trigeminal and solitarius nuclei
C. CN IX to nucleus ambiguus
D. CN X to nucleus ambiguus

A medullary lesion disrupts the efferent limb of the gag reflex. Which structure is most directly affected?

A. CN IX fibers to nucleus solitarius
B. CN X fibers from nucleus ambiguus
C. CN V fibers from spinal trigeminal nucleus
D. CN VII fibers from facial nucleus

Medulloblastomas can cause what type of hydrocephalus?

they block what?

A patient with a brain tumor develops persistent vomiting and increased intracranial pressure. Which medication is most appropriate to reduce both inflammation and vomiting?

A. Dexamethasone
B. Ondansetron
C. Metoclopramide
D. Scopolamine

A patient with a posterior fossa tumor is started on dexamethasone for symptomatic relief. Which description best matches this drug?

A. Glucocorticoid that reduces inflammation
B. Muscarinic blocker that prevents motion sickness
C. Dopamine blocker that increases motility
D. Serotonin agonist that stimulates vagal tone

Dexamethasone helps reduce vomiting in a patient with a brain tumor primarily by reducing which process?

A. Vestibular signaling
B. Cerebral edema
C. Gastric acid secretion
D. Acetylcholine release

Which additional effect of dexamethasone makes it useful in patients with intracranial tumors?

A. Reduces nausea
B. Causes sedation
C. Increases appetite only
D. Blocks CN X output

1. Which histologic description is most characteristic of classic medulloblastoma?

A. Large pleomorphic cells with necrosis
B. Small blue cells with rosettes
C. Spindle cells with collagen bundles
D. Foamy macrophages with lipid

A pediatric posterior fossa tumor shows densely packed small cells with hyperchromatic nuclei and minimal cytoplasm. Which additional histologic feature supports medulloblastoma?

A. Homer Wright rosettes
B. Psammoma bodies
C. Reed–Sternberg cells
D. Schaumann bodies

Medulloblastoma most commonly spreads through which pathway?

A. Hematogenous spread
B. Lymphatic drainage
C. Cerebrospinal fluid
D. Direct muscle invasion

“Drop metastases” from medulloblastoma most commonly involve which structure?

A. Cervical spinal cord
B. Cauda equina
C. Optic nerve
D. Cerebral cortex

Cisplatin exerts its anticancer effect primarily through which mechanism?

A. DNA cross-link formation
B. Microtubule stabilization
C. Topoisomerase inhibition
D. Folate antagonism

Which adverse effect is most associated with acute cisplatin toxicity?

A. Nephrotoxicity
B. Neuropathy
C. Bone marrow suppression
D. Nausea and vomiting

Which adverse effect is most associated with delayed cisplatin toxicity?

A. Alopecia
B. Nausea
C. Nephrotoxicity
D. Hyperglycemia

A patient receiving cisplatin later develops numbness in the extremities and cytopenias. Which explanation best accounts for these findings?

A. Acute cholinergic toxicity
B. Delayed toxicity from cisplatin
C. Immediate hypersensitivity reaction
D. Dopamine receptor blockade

Vincristine exerts its anticancer effect primarily through which mechanism?

A. DNA cross-linking
B. Inhibits mitosis
C. Topoisomerase inhibition
D. Antimetabolite activity

Which statement best describes the acute toxicity profile of vincristine?

A. Severe nausea and vomiting
B. Bone marrow suppression
C. No major acute toxicity
D. Nephrotoxicity

Which adverse effect is most associated with delayed toxicity of vincristine?

A. Hypertension
B. Neurotoxicity
C. Hypercalcemia
D. Bradycardia

A patient receiving vincristine develops abdominal distension and decreased bowel sounds. Which delayed toxicity best explains this?

A. Paralytic ileus
B. Acute gastritis
C. Pancreatitis
D. Hepatic failure

Which additional delayed toxicity is associated with vincristine?

A. SIADH
B. Hypoglycemia
C. Polycythemia
D. Hyperkalemia

Lomustine treats brain tumors primarily through which mechanism?

A. DNA cross-link formation
B. Microtubule stabilization
C. Topoisomerase inhibition
D. Folate antagonism

Which adverse effect is most associated with acute lomustine toxicity?

A. Myelosuppression
B. Neuropathy
C. Nausea and vomiting
D. Nephrotoxicity

Which adverse effect is most associated with delayed lomustine toxicity?

A. Alopecia
B. Myelosuppression
C. Hypertension
D. Bradycardia

Chemotherapy can cause a reduction in ____ production leading to ____ marrow depression

In hydrocephalus, increased ventricular pressure can lead to movement of CSF into surrounding brain tissue. What is this process called?

A. Transependymal absorption
B. Axonal transport
C. Osmotic demyelination
D. Retrograde flow

Transependymal absorption of CSF in hydrocephalus most directly leads to which complication?

A. Cerebral edema
B. Hemorrhage
C. Infarction
D. Demyelination

Sympathetic innervation of foregut is from ____-____ via ____ ____ nerve and ____ ganglion

Sympathetic innervation of midgut is from ____-____ via ____ and ____ splanchnic nerve and ____ ____ ganglion

Sympathetic innervation of hindgut is from ____-____ via ____ and ____ splanchnic nerve and ____ ____ ganglion

The pelvic pain line is classically described as passing through which structure?

A. Splenic flexure
B. Middle of sigmoid colon
C. Ileocecal valve
D. Rectosigmoid junction

Visceral pain from a structure above the pelvic pain line most commonly travels with which fibers?

A. Parasympathetics to S2–S4
B. Somatic fibers to pudendal nerve
C. Sympathetics to the respective level
D. Phrenic nerve to C3–C5

Visceral pain from a pelvic organ below the pelvic pain line most commonly travels by which route?

A. Sympathetics to T5–T9
B. Parasympathetics to S2–S4
C. Vagus nerve to medulla
D. Somatic afferents to L1–L2

Stretch and distension from much of the gastrointestinal tract are primarily carried by which nerve?

A. Pudendal nerve
B. Greater splanchnic nerve
C. Vagus nerve
D. Hypogastric nerve

A patient with inflammatory bowel disease develops fatigue and pallor. Laboratory studies show microcytic, hypochromic anemia. Which combination best explains this finding?

A. Iron malabsorption and rectal bleeding
B. Folate excess and hemolysis
C. B12 malabsorption and thrombosis
D. Autoimmune hemolysis and splenic sequestration

Sulfasalazine is used in inflammatory bowel disease primarily because it inhibits which process?

A. Eicosanoid inflammatory mediators
B. DNA cross-link formation
C. Acetylcholine breakdown
D. Histamine release from mast cell

A patient with IBD starts sulfasalazine. Which adverse-effect combination best fits this drug?

A. GI upset, myalgia, arthralgia
B. Nephrotoxicity, ototoxicity, tinnitus
C. Hyperglycemia, tremor, insomnia
D. Bradycardia, miosis, diaphoresis

Which serious toxicity of sulfasalazine would be most concerning on routine blood work?

A. Myelosuppression
B. Hypercalcemia
C. Polycythemia
D. Eosinophilia

Hydrocortisone enema is a _____ to reduce inflammation rectally

Anisocytosis= various [...] of RBC
Poikilocytosis= various [...] of RBC

RDW = size variability of ____.

Thalassemia can cause ______, ______ anemia

[IBD] is associated with primary sclerosing cholangitis

_____ = storage form of iron
_____ = binding capacity of transferrin

Which gross finding is most characteristic of Crohn disease?

A. Cobblestone mucosa
B. Continuous ulceration
C. Loss of haustra
D. Pseudopolyps only

A patient with Crohn disease develops obstructive symptoms due to chronic inflammation. Which gross feature best explains this?

A. Strictures
B. Polyps
C. Diverticula
D. Hemorrhoids

A patient with Crohn disease develops an abnormal connection between the intestine and bladder. Which gross feature does this represent?

A. Stricture
B. Fistula
C. Abscess
D. Adhesion

Which gross finding describes mesenteric fat wrapping around inflamed bowel in Crohn disease?

A. Creeping fat
B. Fat necrosis
C. Lipomatosis
D. Mesenteric edema

Which structural change in Crohn disease most directly contributes to luminal narrowing?

A. Mucosal atrophy
B. Wall thickening
C. Serosal thinning
D. Increased vascularity

what is this showing in Crohns?

Which histologic feature is most characteristic of Crohn disease?

A. Caseating granulomas
B. Non-caseating granulomas
C. Reed–Sternberg cells
D. Psammoma bodies

Which additional microscopic finding is commonly seen in Crohn disease?

A. Crypt abscesses
B. Fat necrosis
C. Fibrous plaques
D. Amyloid deposits

Mesalamine treats inflammatory bowel disease primarily through which mechanism?

A. TNF-alpha inhibition
B. DNA cross-linking
C. Eicosanoid inhibition
D. Microtubule stabilization

Which toxicity profile best fits mesalamine?

A. GI upset, myalgia, arthralgia, myelosuppression
B. Nephrotoxicity, ototoxicity, tinnitus
C. Hyperglycemia, weight gain, hypertension
D. Bradycardia, miosis, diaphoresis

Infliximab is used in Crohn disease primarily because it targets which molecule?

A. Interleukin-2
B. TNF-alpha
C. Acetylcholine
D. Histamine

A patient on infliximab develops a chronic cough and weight loss. Which complication should be most suspected?

A. Tuberculosis reactivation
B. Acute pancreatitis
C. Hyperthyroidism
D. Nephrotic syndrome

Which additional risk is increased with infliximab therapy?

A. Viral clearance
B. Fungal and bacterial infections
C. Bone density
D. Platelet production

Anal wink and bulbocavernosus reflex test ____-____ levels via ____ nerve

Which histologic pattern is most characteristic of meningioma?

A. Whorled pattern of cell growth
B. Small blue cells with rosettes
C. Non-caseating granulomas
D. Pseudopalisading necrosis

Which additional histologic finding is commonly seen in meningioma?

A. Homer Wright rosettes
B. Psammoma bodies
C. Reed–Sternberg cells
D. Councilman bodies

A spinal MRI shows bright cerebrospinal fluid surrounding the cord. Which sequence is most likely being viewed?

A. T1
B. T2
C. Diffusion-weighted
D. Gradient echo

A radiologist wants to look for edema around a spinal cord lesion. Which sequence is generally most useful?

A. T1
B. T2
C. Plain radiograph
D. CT bone windows

A lesion becomes more conspicuous after gadolinium administration. This is typically assessed on:

A. T1 post-contrast
B. T2 without contrast
C. Noncontrast CT
D. Ultrasound Doppler

MRI contrast depends on how hydrogen nuclei relax after being excited by the magnetic field pulse.

• T1 = ______ relaxation
  • how fast protons realign with the main magnetic field
• T2 = ______ relaxation
  • how fast protons lose phase coherence in the transverse plane

______ is an NSAID that ______ inhibits COX-1 and COX-2

A patient with severe chronic kidney disease undergoes MRI with contrast and later develops progressive skin thickening and joint stiffness. Which diagnosis is most likely?

A. Scleroderma
B. Nephrogenic systemic fibrosis
C. Dermatomyositis
D. Psoriasis

1. Which patient is at highest risk for developing complications from gadolinium contrast?

A. Young healthy adult
B. Patient with asthma
C. Patient with chronic kidney disease
D. Patient with hypertension

Gadolinium molecules shorten the spin-lattice relaxation time to make mostly _____ weighted MRI images brighter

A patient has a spinal cord lesion at the T4 level. They report decreased pain and temperature sensation beginning around the 7th intercostal space on the contralateral side. What best explains this finding?

A. Spinothalamic fibers ascend before crossing
B. Spinothalamic fibers descend before crossing
C. Second-order neurons cross after ascending 2–3 levels
D. First-order neurons cross immediately at entry

Back pain may be caused by compression of _______ meningeal nerve

Prednisone side effects?

A. Addisonian symptoms
B. Cushing symptoms
C. Neuroleptic symptoms
D. Cholinergic symptoms

Prednisone is best classified as which type of drug?

A. Short-acting glucocorticoid
B. Long-acting mineralocorticoid
C. Short-acting beta blocker
D. Long-acting muscarinic blocker

Portal hypertension most directly causes splenomegaly through which mechanism?

A. Arterial vasospasm
B. Venous congestion
C. Lymphatic obstruction
D. Autoimmune destruction

A patient with chronic liver disease develops portal hypertension. Which additional finding can contribute to thrombocytopenia in this setting?

A. Splenomegaly
B. Neutropenia from marrow fibrosis
C. Increased platelet production
D. Renal erythropoietin excess

Which finding most directly explains thrombocytopenia in a patient with liver dysfunction?

A. Reduced thrombopoietin production
B. Increased erythropoietin release
C. Excess vitamin K activation
D. Decreased fibrin degradation

A patient with upper gastrointestinal bleeding has vomitus that resembles coffee grounds. What best explains this appearance?

A. Fresh arterial blood
B. Old coagulated blood
C. Bile mixed with mucus
D. Undigested food particles

Azathioprine suppresses proliferation of which cells?

A. Neutrophils and eosinophils
B. Platelets and megakaryocytes
C. B cells and T cells
D. Schwann cells and fibroblasts

The mechanism of azathioprine is best described as:

A. Blocks acetylcholinesterase
B. Inhibits TNF-alpha
C. Blocks muscarinic receptors
D. Inhibits inosinic acid synthesis

A patient on azathioprine develops worsening thrombocytopenia. Which toxicity best explains why the drug exacerbated this patient’s low platelet count?

A. Bone marrow suppression
B. Hepatotoxicity
C. GI disturbance
D. Cushing syndrome

Which adverse-effect set is most characteristic of azathioprine?

A. Nephrotoxicity, ototoxicity, alopecia
B. Hepatotoxicity, marrow suppression, GI disturbance
C. Hyperglycemia, osteoporosis, moon facies
D. Bradycardia, miosis, diaphoresis

Kayser-Fleischer rings are due to copper build up in _____ membrane

A patient with cirrhosis and ascites is started on a diuretic that antagonizes aldosterone signaling in the renal collecting tubule. Which drug best matches this mechanism?

A. Furosemide
B. Hydrochlorothiazide
C. Spironolactone
D. Acetazolamide

A patient with hypertension is prescribed a diuretic that inhibits the Na/Cl cotransporter in the distal convoluted tubule. Which drug was most likely given?

A. Hydrochlorothiazide
B. Spironolactone
C. Amiloride
D. Ethacrynic acid

A patient with systolic heart failure is started on a medication that reduces aldosterone-mediated sodium retention. Which additional condition is this same drug also commonly used to treat?

A. Hypercalcemia
B. Diabetes insipidus
C. Glaucoma
D. Edema

A patient on hydrochlorothiazide develops weakness and laboratory evidence of low serum potassium and elevated bicarbonate. Which acid-base disturbance is most likely present?

A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis

A patient taking spironolactone returns with breast enlargement and tenderness. Which adverse effect best explains this complaint?

A. Ototoxicity
B. Gynecomastia
C. Hyperuricemia
D. Nephrolithiasis

A patient with Wilson disease develops tremor, rigidity, and other extrapyramidal findings. Copper deposition in which brain region best explains these symptoms?

A. Caudate and claustrum
B. Putamen and globus pallidus
C. Amygdala and hippocampus
D. Thalamus and hypothalamus

Which structures together form the lentiform nucleus?

A. Putamen and globus pallidus
B. Caudate and putamen
C. Globus pallidus and caudate
D. Subthalamic nucleus and putamen

Asterixis is aka a _____ tremor, common in hepatic encephalopathies

Liver disease can lead to ______ (low RBC, WBC, and platelets) on CBC

AST/ALT ratio _____ than 1 may indicate acute hepatitis

A patient with chronic liver disease is being taught about plasma protein synthesis. Most globulin proteins are produced in which organ?

A. Spleen
B. Bone marrow
C. Liver
D. Pancreas

A patient with multiple myeloma has markedly increased immunoglobulin production. These proteins are produced directly by which cell type?

A. Kupffer cells
B. Plasma cells
C. Hepatocytes
D. Neutrophils

A patient is being screened for possible hepatobiliary disease, and the physician wants the most sensitive enzyme marker from the list provided. Which test best fits?

A. ALT
B. GGT
C. Albumin
D. Bilirubin

A clinician is looking for the liver enzyme most specific for hepatocellular injury rather than the one that is merely most sensitive. Which laboratory marker best fits?

A. GGT
B. Alkaline phosphatase
C. AST
D. ALT

What can cause macrocytic anemia if not B12 or folate deficiency?

What causes the dark urine?

Grade ___: varices are dilated veins less than 5mm that do not protrude into the lumen.

Grade ___: varices are greater than 5mm in diameter, relatively straight, and protrude into the lumen without causing an obstruction.

Grade ___: varices are larger winding veins causing significant luminal obstruction.

Grade ___: varices cause almost complete obstruction are characterized by cherry red spots that are at great risk of rupture.

A patient’s hepatitis B panel shows positive HBsAg. What is the best interpretation?

A. Active HBV infection
B. Immunity from vaccination only
C. Resolved infection only
D. False-positive core antibody

A patient has positive HBsAb (anti-HBs) and no other positive markers. What does this most strongly suggest?

A. Active infection
B. Immunity
C. Very early window period
D. Chronic viral replication

A hepatitis B marker appears before anti-HBs and indicates exposure to the actual virus rather than vaccination. Which marker is it?

A. HBeAg
B. HBsAg
C. HBcAb
D. HBV DNA only

Which statement is most accurate?

A. HBsAg means immunity after vaccination
B. HBsAb means active infection
C. HBcAb appears before HBsAb
D. HBcAb is produced only after vaccination

HBcAb is the only detectable marker of a _____ HBV infection

A patient with cholestatic liver disease is found to have a positive antimitochondrial antibody. Which diagnosis is most strongly associated with this finding?

A. Lupus
B. Primary biliary cirrhosis
C. Autoimmune chronic active hepatitis
D. Wilson disease

A patient with suspected autoimmune liver disease has a positive anti-smooth muscle antibody. Which condition does this most strongly suggest?

A. Primary biliary cirrhosis
B. Lupus
C. Autoimmune chronic active hepatitis
D. Hemochromatosis

A patient undergoing an autoimmune workup is found to have a positive ANA. Which condition is classically associated with this marker?

A. Lupus
B. Primary biliary cirrhosis
C. Autoimmune chronic active hepatitis
D. Alpha-1 antitrypsin deficiency

Wilson disease → copper buildup → More _____-type reactions → hydroxyl free radicals → tissue damage

Wilson disease is due to a _____ of function mutation in _____ gene on chromosome _____

A patient with Wilson disease is started on a drug that binds copper and increases its removal from the body. Which medication best fits this mechanism?

A. Penicillamine
B. Ursodiol
C. Lactulose
D. Acetazolamide

A patient with Wilson disease begins chelation therapy and soon develops worsening tremor and other neurologic symptoms. Which drug is most classically associated with this problem?

A. Trientine hydrochloride
B. Penicillamine
C. Zinc acetate
D. Prednisone

A clinician wants to treat Wilson disease with a copper-chelating agent that has fewer side effects than penicillamine. Which drug is the best choice?

A. Trientine hydrochloride
B. Spironolactone
C. Hydrochlorothiazide
D. Propranolol

Foods very high in ____ include liver, shell fish, dark chocolate

A patient with Wilson disease is started on penicillamine. Which supplement should be given with this drug to help prevent neurologic worsening?

A. Riboflavin
B. Cyanocobalamin
C. Pyridoxine
D. Folic acid

Penicillamine therapy can produce deficiency of which vitamin?

A. Vitamin B6
B. Vitamin B12
C. Vitamin C
D. Vitamin K

Tretinoin used in acne therapy is best described as which form of vitamin A?

A. Alcohol form
B. Aldehyde form
C. Ester form
D. Acid form

A topical acne medication works by decreasing cohesion of follicular epithelial cells and increasing epidermal cell turnover. Which drug best fits this mechanism?

A. Clindamycin
B. Tretinoin
C. Benzoyl peroxide
D. Spironolactone

A teenager using tretinoin for acne develops peeling skin with redness and irritation. Which adverse effect is most characteristic of this drug?

A. Hyperkalemia
B. Gingival hyperplasia
C. Erythema and dryness
D. Bone marrow suppression

A patient is prescribed topical tretinoin for acne. Which counseling point is most appropriate?

A. Minimize sun exposure
B. Avoid pyridoxine supplements
C. Expect hypokalemia
D. Take with high-fat meals

A patient with Wallenberg syndrome has persistent hiccups. Dysfunction of which structure best explains the generation of hiccup-related circuitry?

A. Midbrain tegmentum
B. Pontine basis
C. Medullary reticular formation
D. Cerebellar vermis

Which combination best describes the basic mechanical events of a hiccup?

A. Vocal fold abduction and tongue retraction
B. Diaphragm relaxation and glottic opening
C. Intercostal paralysis and palate elevation
D. Diaphragm spasm and epiglottic closure

During hiccup-related laryngeal closure, most intrinsic laryngeal muscles are supplied by which nerve?

A. Recurrent laryngeal nerve
B. Superior laryngeal nerve
C. Glossopharyngeal nerve
D. Hypoglossal nerve

Which intrinsic laryngeal muscle is the main exception to recurrent laryngeal innervation, and is innervated by superior laryngeal?

A. Posterior cricoarytenoid
B. Cricothyroid
C. Lateral cricoarytenoid
D. Thyroarytenoid

Fibers contributing to hiccup-related laryngeal motor output arise from which brainstem nucleus?

A. Caudal nucleus ambiguus
B. Dorsal motor nucleus
C. Solitary nucleus
D. Spinal trigeminal nucleus

Quinapril is an ACE inhibitor to treat _______

A patient with difficult-to-control hypertension is started on a drug that acts as an α2 adrenergic agonist in the central nervous system to reduce sympathetic outflow. Which drug was most likely prescribed?

A. Clonidine
B. Prazosin
C. Phenylephrine
D. Propranolol

A patient treated with clonidine for hypertension reports excessive drowsiness during the day. Which adverse effect best explains this complaint?

A. Reflex tachycardia
B. Sedation
C. Hyperkalemia
D. Cough

A groin hernia protrudes through Hesselbach’s triangle. Which type of hernia is this?

A. Femoral hernia
B. Indirect inguinal hernia
C. Direct inguinal hernia
D. Umbilical hernia

Which structure forms the lateral border of Hesselbach’s triangle?

A. Rectus abdominis
B. Inguinal ligament
C. External iliac vein
D. Inferior epigastric vessels

Which structure forms the medial border of Hesselbach’s triangle?

A. Rectus abdominis
B. Inguinal ligament
C. Iliopsoas muscle
D. Femoral artery

The base of Hesselbach’s triangle is formed by which structure?

A. Lacunar ligament
B. Linea alba
C. Pubic crest
D. Inguinal ligament

A patient with type 2 diabetes is started on repaglinide. Which mechanism best explains how this drug increases insulin release?

A. Activates PPAR-γ in adipocytes
B. Inhibits intestinal glucose absorption
C. Closes ATP-sensitive K+ channels
D. Blocks hepatic gluconeogenesis

A patient taking repaglinide for diabetes develops shakiness and gradual weight increase. Which adverse effect pair is most characteristic of this drug?

A. Pancreatitis and diarrhea
B. Hypoglycemia and weight gain
C. Lactic acidosis and nausea
D. Edema and urinary infection

A patient with chronic constipation is started on a laxative made of soluble fiber that increases stool bulk. Which drug best fits this description?

A. Psyllium
B. Senna
C. Lactulose
D. Docusate

A student drinks large amounts of caffeine before an exam. Caffeine primarily acts by antagonizing which receptor type, and one relevant physiologic effect is decreased what?

A. Dopamine receptors; renal blood flow
B. Nicotinic receptors; coronary blood flow
C. Muscarinic receptors; hepatic blood flow
D. Adenosine receptors; cerebral blood flow

Penicillin exerts its antibacterial effect through which mechanism?

A. Inhibition of bacterial cell wall synthesis
B. Inhibition of folate synthesis
C. Inhibition of 30S ribosomal function
D. Disruption of fungal cell membranes

Vagus innervates all the pharyngeal muscles except _______, which is innervated by _______ nerve.

Spinal accessory nerve innervates _____ and _____ muscles

Arises from _______ spinal cord (C1-C5/6)

A patient with lateral medullary (Wallenberg) syndrome has loss of pain, temperature, and crude touch from the contralateral body, with the face spared. Which structure is most likely affected?

A. Spinal trigeminal nucleus
B. Inferior cerebellar peduncle
C. Spinothalamic tract
D. Nucleus ambiguus

A patient with Wallenberg syndrome has ipsilateral loss of pain, temperature, and crude touch from the face with a diminished blink reflex. Which structure is most likely affected?

A. Spinal trigeminal nucleus
B. Vestibular nucleus
C. Hypothalamospinal tract
D. Nucleus solitarius

A patient with a lateral medullary infarct develops ipsilateral ptosis, miosis, and anhidrosis. Which structure is most likely damaged?

A. Nucleus ambiguus
B. Spinothalamic tract
C. Inferior cerebellar peduncle
D. Hypothalamospinal tract

A patient with Wallenberg syndrome has hoarseness, dysphagia, and paralysis of pharyngeal and laryngeal muscles. Which structure is most likely affected?

A. Vestibular nucleus
B. Nucleus ambiguus
C. Spinal trigeminal nucleus
D. Nucleus solitarius

A patient with a lateral medullary lesion has prominent dizziness due to disruption of pathways that normally provide input toward the MLF. Which structure is most likely involved?

A. Hypothalamospinal tract
B. Inferior cerebellar peduncle
C. Vestibular nucleus
D. Spinothalamic tract

A patient with Wallenberg syndrome has ipsilateral appendicular ataxia on finger-to-nose testing. Which structure is most likely affected?

A. Inferior cerebellar peduncle
B. Nucleus ambiguus
C. Spinal trigeminal nucleus
D. Nucleus solitarius

A patient with a lateral medullary infarct is noted to have decreased taste sensation. Which structure is most likely affected?

A. Vestibular nucleus
B. Spinothalamic tract
C. Hypothalamospinal tract
D. Nucleus solitarius

First order neuron of _____ tract synapses in rexed laminae II (substantia gelatinosa)

The AST/ALT ratio is usually _____ than 1 in patients with alcoholic cirrhosis

A patient is suspected of having a recently formed thrombus. Laboratory testing shows elevation of a fibrin degradation product formed after cross-linked fibrin is broken down. Which marker best fits this description?

A. D-dimer
B. Fibrinogen
C. Troponin I
D. Haptoglobin

A serum laboratory assay is reported as difficult to interpret because the sample is markedly lipemic. Which factor is most directly interfering with the test?

A. High serum bilirubin
B. High blood lipids
C. Low serum albumin
D. Low platelet count

A patient presents with severe epigastric pain radiating to the back. Which elevated laboratory value would most strongly support acute pancreatitis?

A. Serum ALT
B. Serum creatinine
C. Serum amylase
D. Serum ammonia

In the early development of atherosclerosis, which arterial layer is primarily affected?

A. Tunica adventitia
B. Tunica media
C. Elastic lamina only
D. Tunica intima

A patient has elevated homocysteine levels that are contributing to endothelial injury and vascular risk. Homocysteine is best described as which of the following?

A. Cholesterol precursor from acetate
B. Amino acid intermediate from methionine
C. Purine metabolite from uric acid
D. Peptide fragment from fibrin

A patient with hyperhomocysteinemia is counseled on vitamin supplementation to improve homocysteine metabolism. Which combination is required for its breakdown?

A. Vitamins A, D, E
B. Vitamins B1, B2, B3
C. Vitamins B6, B12, folate
D. Vitamins C, K, biotin

A clinician orders an erythrocyte sedimentation rate to assess for possible underlying disease. What does the ESR directly measure?

A. How quickly RBCs settle
B. How rapidly platelets clot
C. How much hemoglobin lyses
D. How strongly leukocytes adhere

A patient has an elevated ESR, but no specific diagnosis can be made from that finding alone. Why is this test limited?

A. It measures renal clearance only
B. It detects only bone disease
C. It is a nonspecific marker
D. It reflects platelet number

A patient with untreated hypothyroidism is found to have elevated LDL cholesterol. Which mechanism best explains this association?

A. Increased bile acid synthesis
B. Increased lipoprotein lipase activity
C. Increased hepatic VLDL export
D. Decreased LDL receptor expression

Urinalysis reveals hyaline casts in a patient with suspected renal disease. This finding most directly suggests which associated abnormality?

A. Glycosuria
B. Proteinuria
C. Hematuria
D. Bacteriuria

A patient’s urine microscopy shows oxalate crystals. This finding can point toward abnormalities involving which endocrine structure?

A. Parathyroid glands
B. Adrenal cortex
C. Thyroid follicles
D. Pancreatic islets

A patient with severe hypertension is started on a drug that blocks both α1 receptors and nonselective β receptors. Which drug best fits this mechanism?

A. Metoprolol
B. Amlodipine
C. Labetalol
D. Ezetimibe

A patient taking labetalol for hypertension develops a medication-related adverse effect. Which finding is most consistent with this drug based on the information given?

A. Mild tachycardia
B. Bradycardia
C. Dyslipidemia
D. Angina

A patient with an acute thrombotic occlusion is given a drug to dissolve the clot. Which medication works as a tissue plasminogen activator?

A. Ezetimibe
B. Metoprolol
C. Amlodipine
D. Alteplase

A patient with hypertension is started on a vasodilator that blocks L-type calcium channels and also promotes nitric oxide release. Which drug was most likely prescribed?

A. Labetalol
B. Amlodipine
C. Metoprolol
D. Alteplase

A patient taking amlodipine develops worsening chest pain episodes and a rapid heart rate. Which adverse effect pair is most associated with this drug?

A. Angina and tachycardia
B. Bradycardia and dyslipidemia
C. Sedation and cough
D. Hyperkalemia and gynecomastia

A patient with hypertension is treated with a drug that selectively blocks β1 receptors. Which medication best matches this description?

A. Amlodipine
B. Labetalol
C. Ezetimibe
D. Metoprolol

A patient on metoprolol returns for follow-up. Which adverse effect profile is most characteristic of this medication?

A. Angina and tachycardia
B. Bradycardia and dyslipidemia
C. Mild tachycardia and flushing
D. Hypoglycemia and weight gain

A patient with elevated LDL cholesterol is prescribed a drug that lowers cholesterol by preventing its uptake from the gut. Which drug best fits this mechanism?

A. Alteplase
B. Amlodipine
C. Ezetimibe
D. Metoprolol

Which pairing is incorrect?

A. Labetalol — hypertension treatment
B. Metoprolol — selective β1 blocker
C. Ezetimibe — inhibits intestinal cholesterol absorption
D. Amlodipine — tissue plasminogen activator

A patient with elevated LDL cholesterol is started on a medication that lowers cholesterol by inhibiting HMG-CoA reductase. Which drug was most likely prescribed?

A. Simvastatin
B. Ezetimibe
C. Colestipol
D. Fenofibrate

A patient taking simvastatin develops proximal muscle pain and elevated liver enzymes on follow-up testing. Which adverse effect profile best matches this drug?

A. Sedation and weakness
B. Metabolic acidosis only
C. Myopathy and hepatic dysfunction
D. Lactic acidosis and diarrhea

A patient takes low-dose aspirin daily after a vascular event. Its antiplatelet effect is best explained by irreversible inhibition of which pathway?

A. ADP receptor signaling
B. Thromboxane synthesis via COX-1
C. GPIIb/IIIa receptor binding
D. Vitamin K recycling

A patient with aspirin toxicity develops an acid-base disturbance. Which finding is most characteristic?

A. Respiratory alkalosis only
B. Metabolic alkalosis
C. Respiratory acidosis
D. Metabolic acidosis

A patient with type 2 diabetes is started on a medication that lowers glucose mainly by inhibiting hepatic gluconeogenesis. Which drug best matches this mechanism?

A. Glipizide
B. Metformin
C. Repaglinide
D. Pioglitazone

A patient with chronic kidney disease is being evaluated for diabetes therapy. Which medication should be avoided because of increased risk of lactic acidosis in impaired renal function?

A. Metformin
B. Acarbose
C. Sitagliptin
D. Exenatide

A patient with severe muscle spasticity after spinal cord injury is treated with a GABA_B agonist. Which drug best fits this description?

A. Diazepam
B. Tizanidine
C. Dantrolene
D. Baclofen

baclofen adverse effects?

A. Tachycardia and angina
B. Sedation and weakness
C. Myopathy and hepatitis
D. Hypoglycemia and weight gain

A patient with a dorsal midbrain lesion has impaired ability to move both eyes vertically. Damage to which structure most directly explains this deficit?

A. Abducens nucleus
B. Edinger-Westphal nucleus
C. Rostral interstitial nucleus of the MLF
D. Medial vestibular nucleus

A patient complains of vertical diplopia that worsens when walking down stairs. Dysfunction of which cranial nerve most likely explains this finding?

A. Trochlear nerve
B. Oculomotor nerve
C. Abducens nerve
D. Optic nerve

A patient receiving chemotherapy develops severe nausea and is treated with a drug that blocks 5-HT3 serotonin receptors. Which medication was most likely given?

A. Metoclopramide
B. Scopolamine
C. Promethazine
D. Ondansetron

A patient started on ondansetron for chemotherapy-induced nausea later develops decreased bowel motility. Which adverse effect best matches this drug?

A. Slowed colonic transit
B. Vertical diplopia
C. Hyperkalemia
D. Sedation and weakness

A patient with stable angina takes a medication that is converted to nitric oxide in vascular smooth muscle. The resulting increase in cGMP produces what immediate effect?

A. Increased platelet aggregation
B. Increased intracellular calcium
C. Vascular smooth muscle relaxation
D. Reduced nitric oxide synthesis

A patient uses sublingual nitroglycerin. Which adverse-effect set best matches this drug?

A. Bradycardia, constipation, flushing
B. Orthostatic hypotension, headache, tachycardia
C. Sedation, weakness, ataxia
D. Cough, hyperkalemia, syncope

A hospitalized patient becomes tremulous, agitated, and confused 3 days after stopping heavy alcohol use. Which drug class is first-line because it enhances GABA-A receptor activity?

A. Benzodiazepines
B. Beta blockers
C. Antipsychotics
D. Alpha-2 agonists

A patient with early liver failure has a prolonged PT but a normal PTT. Which explanation best accounts for this pattern?

A. Factor VIII is depleted first
B. Factor XII is the most unstable factor
C. The intrinsic pathway is selectively lost first
D. Factor VII falls first because of its short half-life

A patient in delirium tremens is treated with lorazepam. The therapeutic effect is most directly due to which receptor action?

A. Blockade of NMDA receptors
B. Stimulation of mu opioid receptors
C. Enhancement of GABA-A receptor activity
D. Inhibition of serotonin reuptake

What marker's level rises in 4-6 hours, peaks in 10-24 hours, and returns to normal in 4 days after infarction

What marker's level rises in 3 to 6 hours, peaks at 12 to 24 hours and returns to normal 12 to 48 hours after infarction

Troponin I is present ____ than CK-MB

[CPK-MB or Troponins] are more specific to cardiac muscle injury

Afferent axons from cardiac ischemia refer to ___-___spinal levels

wernickes encephalopathy is ______, but korsakoff syndrome is not

A patient with chronic alcoholism develops macrocytosis and a low platelet count. Deficiency of which vitamins best explains this megaloblastic picture?

A. Folate and vitamin B12
B. Vitamin C and niacin
C. Vitamin D and calcium
D. Vitamin K and biotin

A patient with acute pancreatitis has an elevated serum amylase level. Which pancreatic cell type produces the pancreatic form of this enzyme?

A. Islet beta cells
B. Ductal epithelial cells
C. Centroacinar cells
D. Acinar cells

A patient with suspected heavy alcohol use has an elevated liver enzyme that is also commonly used as a marker of hepatobiliary disease. Which test is most likely elevated?

A. Troponin I
B. Gamma-glutamyl transpeptidase
C. Creatine kinase MB
D. Lactate dehydrogenase

Ethanol depresses central nervous system activity primarily by enhancing signaling through which receptor system?

A. NMDA glutamate receptors
B. Muscarinic M3 receptors
C. GABA-A receptors
D. Nicotinic acetylcholine receptors

A radiotracer is selected because it can be used in myocardial perfusion imaging and is also useful in breast and parathyroid imaging. Which tracer best fits this description?

A. Iodine-131
B. Technetium-99m sestamibi
C. Gallium-67 citrate
D. Fluorine-18 FDG

A patient undergoes a nuclear stress test. What is the main comparison made in this study?

A. Valve motion before and after meals
B. Coronary calcium before and after sleep
C. Heart rhythm at rest and sleep
D. Myocardial blood flow at rest and stress

Funduscopic exam in a patient with longstanding uncontrolled blood pressure shows widening of the retinal arteriolar light reflex. What is the best interpretation?

A. Chronic hypertensive retinopathy
B. Acute papilledema
C. Diabetic neovascularization
D. Central retinal vein occlusion

During a glaucoma screening exam, a clinician notes an optic disc gray crescent. In which population is this finding especially common?

A. East Asians with cataracts
B. White children with amblyopia
C. African-ancestry glaucoma patients
D. Diabetics with macular edema

A patient with chronic alcohol use presents with hepatobiliary abnormalities and macrocytosis. Which combination is most classically associated with this presentation?

A. Low GGT and microcytosis
B. High GGT and megaloblastosis
C. Low amylase and leukocytosis
D. High troponin and neutropenia

______ ______ is a withdrawal symptom of alcoholism that causes convulsions and hallucinations

A patient with dyspepsia is prescribed magnesium hydroxide. In addition to neutralizing gastric acid, this drug is most likely to cause which effect?

A. Strong laxative effect
B. Marked sedation
C. Severe dry mouth
D. Bradycardia

A patient taking aluminum hydroxide for reflux develops a change in bowel habits. Which adverse effect is most characteristic of this drug?

A. Diarrhea
B. Constipation
C. Hematuria
D. Hypoglycemia

A clinician combines magnesium hydroxide with aluminum hydroxide in one antacid preparation. What is the main rationale for this combination?

A. Increase proton pump inhibition
B. Improve antibiotic absorption
C. Balance opposing GI side effects
D. Reduce facial flushing

A patient has chronic facial redness that reliably worsens after drinking alcohol. Which diagnosis best fits this presentation?

A. Acne vulgaris
B. Rosacea
C. Seborrheic dermatitis
D. Contact dermatitis

A patient with peptic symptoms is started on omeprazole. Which mechanism best explains its action?

A. Reversible H2 receptor blockade
B. Irreversible proton pump inhibition
C. Neutralization of luminal acid
D. Stimulation of prostaglandin synthesis

Omeprazole acts directly on which target in gastric parietal cells?

A. Na/K ATPase
B. H+/K+ ATPase
C. Ca2+ ATPase
D. Cl/HCO3 exchanger

A patient with irritable bowel syndrome has crampy abdominal pain from excess gut smooth-muscle activity. Which drug would reduce this by competitively blocking muscarinic M3 receptors?

A. Bethanechol
B. Dicyclomine
C. Metoclopramide
D. Neostigmine

Dicyclomine adverse-effect profile best matches this medication?

A. Bradycardia, diarrhea, salivation
B. Sedation, ataxia, tremor
C. Tachycardia, confusion, urinary retention
D. Hypotension, cough, hyperkalemia

A screening study reports decreased bone mass that is below normal but not low enough to meet the threshold for osteoporosis. Which diagnosis best fits?

A. Osteomalacia
B. Osteopenia
C. Osteopetrosis
D. Osteitis fibrosa

A postmenopausal patient undergoes DEXA scanning. Which T-score is diagnostic of osteoporosis?

A. Greater than -1.0
B. Between -1.0 and -2.5
C. -2.5 or lower
D. +2.5 or higher

A plain radiograph is reviewed for suspected osteoporosis. Why is X-ray an insensitive test early in disease?

A. It requires about 30% bone loss
B. It detects only cartilage loss
C. It overestimates bone density
D. It cannot image trabecular bone

A patient with chronic vitamin D deficiency develops soft, weak bones from impaired mineral deposition. Which diagnosis is most likely?

A. Osteopenia
B. Osteoporosis
C. Osteomalacia
D. Osteopetrosis

Which structural abnormality best distinguishes osteoporosis from osteomalacia?

A. Osteoporosis has decreased mineralization
B. Osteomalacia has decreased bone matrix
C. Osteoporosis has decreased bone matrix
D. Osteomalacia has abnormally dense bone

A child with recurrent fractures is found to have very dense bones on imaging, yet the bones are brittle and weak. Which diagnosis best explains this paradox?

A. Osteomalacia
B. Osteopenia
C. Osteoporosis
D. Osteopetrosis

A patient with acute diarrhea is given an antidiarrheal that activates μ-opioid receptors in the enteric nervous system but does not produce typical central opioid effects at usual doses. Which drug best fits this description?

A. Loperamide
B. Morphine
C. Diphenhydramine
D. Metoclopramide

A patient scores 30 on the Beck Depression Inventory-II. How should this result be classified?

A. Minimal depression
B. Mild depression
C. Moderate depression
D. Severe depression

A patient with suspected high bone remodeling is found to have an elevated alkaline phosphatase level. This lab value is most useful as a marker of which process?

A. Renal filtration
B. Bone turnover
C. Pancreatic secretion
D. Thyroid hormone synthesis

A severely malnourished patient has endocrine adaptation to low caloric intake. Which thyroid hormone change is most expected?

A. Increased T3
B. Increased T4
C. Increased TSH bioactivity
D. Decreased thyroid hormone levels

Active vitamin D is delivered to the intestine to enhance calcium absorption. It does this in part by increasing production of which calcium-binding protein?

A. Ferritin
B. Albumin
C. Osteocalcin
D. Calbindin

Which pairing is correctly matched?

A. Loperamide — crosses BBB readily
B. ALP — marker of liver synthesis only
C. Malnutrition — raises thyroid hormone levels
D. Calcitriol — increases intestinal calbindin

A patient with low vitamin D is being discussed in relation to serotonin synthesis and mood. Which enzyme is most closely linked to the brain serotonin pathway affected by vitamin D?

A. TPH1
B. TPH2
C. DOPA decarboxylase
D. Monoamine oxidase

A patient with suspected lactose malabsorption has a positive hydrogen breath test after lactose ingestion. What best explains the positive result?

A. Renal excretion of lactose
B. Hepatic oxidation of lactose
C. Bacterial metabolism of unabsorbed lactose
D. Pancreatic hydrolysis of lactose

A test report states that a patient’s coefficient of fat absorption is reduced. What does this value represent?

A. Percent of dietary protein absorbed
B. Percent of fat absorbed from a given dose
C. Percent of stool made of fat
D. Percent of bile salts reabsorbed

A patient excretes a larger percentage of a test fat load in the stool than expected. How would this affect the coefficient of fat absorption?

A. It would increase
B. It would stay normal
C. It would decrease
D. It would become unrelated

A patient has steatorrhea after pancreatic insufficiency. Which measurement would best summarize how much of an administered fat load was successfully taken up by the intestine?

A. Lactose breath hydrogen rise
B. Coefficient of fat absorption
C. Serum amylase level
D. Fecal calprotectin level

Normal _____ transit time is 30 min - 6 hours

The bone densities of spine, hip and wrist are commonly evaluated on _____ scan

Celiac is a type _____ (T-cell mediated) hypersensitivity reaction

A patient with chronic diarrhea and weight loss is being evaluated for small-bowel mucosal malabsorption. Which substance is administered in a classic absorption test because it is a monosaccharide that does not require pancreatic enzymes and is excreted in the urine if absorbed normally?

A. Lactose
B. D-xylose
C. Sucrose
D. Maltose

A patient undergoes a D-xylose test. In a normal patient, which result is most expected?

A. High stool concentration
B. High urine level
C. Absent serum level
D. Marked pancreatic enzyme rise

Which combination best describes the classic histology of celiac disease?

A. Villous atrophy, lymphocyte infiltration, crypt hyperplasia
B. Crypt abscesses, granulomas, fissures
C. Fat-laden macrophages, PAS positivity, lymphangiectasia
D. Caseation, fibrosis, eosinophilia

A patient has steatorrhea, but a normal D-xylose test. This pattern argues against small-bowel mucosal disease and instead points more toward which process?

A. Pancreatic exocrine insufficiency
B. Celiac disease
C. Villous atrophy
D. Crypt hyperplasia

A patient with suspected celiac disease is being screened with the preferred initial serologic test. Which antibody is most appropriate?

A. Anti-endomysial IgA
B. Tissue transglutaminase IgA
C. Native gliadin IgG
D. Parietal cell IgA

A patient has a positive serology panel for celiac disease. Which antibody is classically associated with celiac disease and is known for high specificity?

A. Endomysial IgA
B. Anti-dsDNA IgG
C. Anti-mitochondrial IgM
D. Anti-smooth muscle IgG

A patient with suspected celiac disease has testing ordered for deamidated gliadin antibodies. These antibodies are most commonly checked in which immunoglobulin class from the list you provided?

A. IgE and IgG
B. IgM and IgG
C. IgA and IgG
D. IgD and IgG

Celiac disease is associated with antibodies

1. Endomysial (___)
2. Deamidated gliadin (___)
3. Gliadin (___and ___)
4. tissue transglutaminase (___)

A patient develops chronic malabsorption after living in the tropics and is diagnosed with tropical sprue. Which treatment is most appropriate?

A. Gluten-free diet
B. Tetracycline and folic acid
C. Omeprazole and iron
D. Mesalamine and prednisone

A patient is diagnosed with nontropical sprue, also known as celiac disease. Which treatment is most appropriate?

A. Tetracycline and folate
B. Low-fat diet
C. Gluten-free diet
D. Lactose restriction only