Instructions for Side by Side Printing
- Print the notecards
- Fold each page in half along the solid vertical line
- Cut out the notecards by cutting along each horizontal dotted line
- Optional: Glue, tape or staple the ends of each notecard together
Day 1
front 1 Infarction in which coronary artery territory may cause nodal dysfunction? [Left/Right] coronary artery | back 1 Right coronary artery |
front 2 What artery supplies the sinoatrial and atrioventricular nodes via its branches? | back 2 Right coronary artery |
front 3  Enlargement of which labeled structure in the image is most likely to cause Ortner syndrome? | back 3 Left atrium |
front 4 To which 3 areas of the body is pain referred in a patient with pericarditis? ___ ___ ___ | back 4 neck arms shoulders |
front 5 The pericardial space is located between which two layers of the pericardium? _____ _____ _____ | back 5 Parietal pericardium |
front 6 What are the three layers of the pericardium, from outermost to innermost? [...] pericardium ↓ [...] pericardium ↓ [...] | back 6 Fibrous pericardium ↓ Parietal pericardium ↓ Epicardium |
front 7 Which artery supplies the following? _____ _____ artery | back 7 Posterior descending artery |
front 8 What structure is supplied by the right marginal artery? ____ ____ | back 8 Right ventricle |
front 9 Which coronary artery gives rise to the posterior descending artery
in most people? | back 9 Right coronary artery |
front 10 In which phase of the cardiac cycle does coronary blood flow to the left ventricle and intraventricular septum peak? ____ ____ | back 10 Early diastole |
front 11 What three areas of the heart are supplied by the left anterior
descending artery? | back 11 Anterior surface of the left ventricle |
front 12 What is the most posterior chamber of the heart? | back 12 Left atrium |
front 13 Which coronary artery gives rise to the posterior descending artery in left dominant circulation? ____ ____ artery | back 13 Left circumflex artery |
front 14 Which chamber of the heart is most commonly injured in trauma? | back 14 Right ventricle |
front 15 Which nerve innervates the pericardium? | back 15 Phrenic |
front 16 Which coronary artery is most commonly occluded? | back 16 Left anterior descending artery |
front 17 What two symptoms can enlargement of the
left atrium cause as a result of compression of
related structures? | back 17 Dysphagia Hoarseness |
front 18 Which chambers of the heart make up the inferior cardiac
surface? | back 18 Left ventricle → 2/3 of the inferior cardiac surface |
front 19 Which blood vessel runs in the left atrioventricular groove and drains into the right atrium? ____ ____ | back 19 Coronary sinus |
front 20 In addition to drug therapy, what is the most important step in the
management of a STEMI? | back 20 Reperfusion therapy |
front 21 What are two medications for immediate symptom control in patients with unstable angina? _____ _____ | back 21 Nitroglycerin |
front 22 β-blockers are used in chronic heart failure management except in which situation? A) Stable systolic heart failure | back 22 C) Acute decompensated heart failure |
front 23 What are the five initial treatments that should be administered to
patients with unstable angina or NSTEMI? | back 23 Anticoagulation |
front 24 Could a child have essential fructosuria if neither of the parents
do? | back 24 Yes |
front 25 What are the two most common ECG findings in patients with acute
pericarditis? | back 25 Diffuse ST-segment elevation |
front 26 What is the most common cause of acute pericarditis? ____ | back 26 Idiopathic |
front 27 What can be caused by autoimmune and connective disorders, infections, cardiac surgery, cardiovascular events, radiation, and renal failure? ____ ____ | back 27 acute pericarditis |
front 28 What physical maneuver by the patient commonly
relieves the pain associated with acute
pericarditis? | back 28 Sitting up |
front 29  What common complication of acute pericarditis is indicated by the yellow arrows? | back 29 pericardial effusion |
front 30 What is the most common auscultatory finding in patients with acute pericarditis? Pericardial _____ _____ | back 30 Pericardial friction rub |
front 31 Name three pharmacologic treatments for acute pericarditis. ____ (Reduces inflammation and lowers recurrence risk) ____ (First-line pain and inflammation treatment) ____ (Used if refractory, autoimmune-related, or NSAIDs contraindicated) | back 31 Colchicine |
front 32 How do you treat pericarditis due to uremia? ____ | back 32 Dialysis |
front 33  What condition is shown in the CT scan? | back 33 Abdominal aortic aneurysm. Note outer dilated calcified aortic wall. |
front 34 Pain in which 2 parts of the body may be a sign of leaking, dissection, or imminent rupture of an aortic aneurysm? ___ ___ | back 34 Back |
front 35 What is a congenital condition that increases the risk for
development of thoracic aortic aneurysms? | back 35 connective tissue disease |
front 36 An elderly man with a long smoking history has abdominal pain and a pulsatile abdominal mass. What is the most likely diagnosis? | back 36 Abdominal aortic aneurysm |
front 37 What might cause a patient with a thoracic aortic aneurysm to develop a murmur? ____ ____ dilatation | back 37 Aortic root dilatation |
front 38 What pathologic process is typically associated with formation of an abdominal aortic aneurysm? ______ disease | back 38 Atherosclerotic disease |
front 39 What pathologic process is typically associated with formation of a thoracic aortic aneurysm? ____ ____ degeneration | back 39 Cystic medial degeneration |
front 40 Syphillis increases the risk of development of what vascular disease? Obliterative _____ of the _____ _____ | back 40 Obliterative endarteritis of the vasa vasorum |
front 41 What are 4 risk factors for development of an abdominal
aortic aneurysm? | back 41 Male sex |
front 42 Which congenital heart condition increases the risk of development of a thoracic aortic aneurysm? _____ _____ valve | back 42 Bicuspid aortic valve |
front 43 What acquired condition is an important risk factor for development of a thoracic aortic aneurysm? ____ | back 43 HTN |
front 44  ____ ____ | back 44 Aortic dissection |
front 45 A patient presents with sudden, tearing chest pain. ____ ____ | back 45 Aortic dissection |
front 46 What is the treatment for an aortic dissection extending from the ascending aorta to the aortic arch? _____ | back 46 Surgery This is a Stanford type A aortic dissection. |
front 47 What is the treatment for an aortic dissection confined to the
descending aorta? | back 47 β-blockers, then vasodilators This is a Stanford type B aortic dissection. |
front 48 What are 3 conditions associated with aortic
dissection? ______ ______ valve | back 48 Inherited connective tissue disorders |
front 49 What are 3 complications that may result from an aortic
dissection? | back 49 Aortic rupture |
front 50 What are 2 cardiac complications from a
proximal Stanford type A aortic dissection? | back 50 Cardiac tamponade |
front 51 What is an aortic dissection? | back 51 A longitudinal intimal tear, which forms a false lumen within the aorta |
front 52 What chest X-ray finding do you expect in a patient with aortic dissection? Widened _____ | back 52 Widened mediastinum |
front 53 Where does the fluid accumulate in cerebral edema?
| back 53 Brain parenchyma |
front 54 What are the three causes of cytotoxic cerebral
edema? | back 54 Early ischemia |
front 55 What are the five causes of vasogenic cerebral edema? ____ ischemia _____: Brain injury damages capillaries and the BBB → plasma fluid leaks into brain tissue. _____: Make vessels more permeable → fluid escapes into the extracellular space. _____: Blood irritates and damages surrounding tissue/vessels → BBB disruption and swelling. _____: Release factors like VEGF and disrupt local vessels → leaky capillaries around the mass. | back 55 Late ischemia |
front 56  What vitamin deficiency causes the ocular manifestation shown in the image? What are they? Vitamin ____ ____ spots | back 56 Vitamin A Bitot spots |
front 57 Which vitamin is essential for the differentiation of
epithelial cells into specialized tissue?
| back 57 Vitamin A |
front 58
All-trans retinoic acid is a treatment for which
malignancy? | back 58 Acute promyelocytic leukemia |
front 59 Which vitamin prevents squamous metaplasia? | back 59 Vitamin A |
front 60 What requirements must be met before prescribing
isotretinoin to a female of childbearing
age? | back 60 A pregnancy test result must be negative |
front 61 What are the teratogenic effects of vitamin A? | back 61 Cleft palate |
front 62 What are the symptoms of acute vitamin A
toxicity? | back 62 Nausea |
front 63 What is the diagnosis for a person who eats a lot of spinach
and liver, presenting with hair loss, dry skin,
joint pain, hepatomegaly and intracranial
hypertension? | back 63 Chronic vitamin A toxicity |
front 64 What vitamin A derivative is a component of visual pigments? | back 64 Retinal |
front 65 What two dietary sources are rich in vitamin A? ____ ____ vegetables | back 65 Liver Leafy vegetables |
front 66 What enzyme pathway becomes primary for converting fructose to fructose-6-phosphate in essential fructosuria? _______ | back 66 Hexokinase |
front 67 Analogs of which hormone are used to treat acromegaly? | back 67 somatostatin |
front 68 What is another name for vitamin A? | back 68 Retinol |
front 69 Name two topical uses of vitamin A. ____ ____ | back 69 Wrinkles |
front 70 Vitamin A can help with what highly contagious disease caused by a virus? | back 70 measles |
front 71 What are the symptoms of vitamin A deficiency?
| back 71 Night blindness |
front 72 What biochemical anomaly explains reduced blood
pressure in a patient with scurvy? | back 72 Decreased catecholamine synthesis due to vitamin C deficiency |
front 73 NAD+ and NADP+ are derived from which amino acid? | back 73 Tryptophan |
front 74 Which amino acid and vitamin produces histamine? | back 74 Histidine |
front 75 What amino acid and cofactor are required to produce
porphyrin, the precursor to heme?
| back 75 Glycine |
front 76 What amino acid can be used to synthesize creatinine, urea, and nitric oxide? | back 76 Arginine |
front 77 The conversions of phenylalanine to tyrosine and tyrosine to dopa require what cofactor? | back 77 BH4 |
front 78 Thyroxine is derived from which amino acid? ____ | back 78 Tyrosine |
front 79 Melanin is derived from which compound? ____ | back 79 Dopa |
front 80 The conversion of dopa to dopamine requires what cofactor? | back 80 Vitamin B6 |
front 81 S-adenosylmethionine is needed to convert ____ to ____ | back 81 nori to epi |
front 82 What two cofactors are needed to produce
NAD+ and NADP+
from tryptophan? | back 82 Vitamin B2 |
front 83 Which two disadvantages are associated with low-molecular-weight heparin compared with unfractionated heparin? A) Oral use and slow onset | back 83 B) Renal clearance and poor reversibility |
front 84 What two cofactors are needed to produce
melatonin from tryptophan? | back 84 BH4 |
front 85 What neurotransmitter is produced from
glutamate? Mention the required cofactor. | back 85 GABA |
front 86 What is the most common pathogen associated with otitis externa? _____ | back 86 Pseudomonas |
front 87 What pathology of the ear is associated with water exposure, occlusion, and trauma of the ear canal? | back 87 Otitis externa |
front 88 What are the four clinical features of otitis externa? | back 88 Otalgia |
front 89 What is a dreaded complication of otitis externa in older patients
with diabetes? | back 89 Malignant otitis externa |
front 90 Malignant otitis externa is an invasive otitis externa with _____. | back 90 osteomyelitis |
front 91 What are the clinical findings of malignant otitis externa? | back 91 Otalgia |
front 92 malignant otitis externa can lead to what type of palsies? ___ ___ | back 92 cranial nerve |
front 93 What is the likely diagnosis for a patient with known ulcerative colitis presenting with jaundice, pale stools, and an ERCP showing beading of bile ducts? _____ _____ _____ | back 93 Primary sclerosing cholangitis |
front 94 Which 2 autoantibodies are associated with ulcerative colitis? | back 94 p-ANCA MPO-ANCA |
front 95 Toxic megacolon, fulminant colitis, and perforation are complications that are most commonly associated with which inflammatory bowel disease? | back 95 UC |
front 96 {Crohn disease/Ulcerative colitis} → Transmural
inflammation | back 96 Crohns UC |
front 97 What 2 conditions can be treated with sulfasalazine? | back 97 UC Crohns |
front 98 Which inflammatory bowel disease is associated with gallstones and calcium oxalate kidney stones? | back 98 Crohns |
front 99 Which inflammatory bowel disease has creeping fat, skip lesions, cobblestone mucosa, linear ulcers, bowel wall thickening, fissures, and rectal sparing? | back 99 Crohns |
front 100 For each ATP consumed, Na+/K+-ATPase transports
how many Na+ and K+ molecules, and in what
direction? | back 100 3 Na+ molecules out |
front 101 The ATP binding site of Na+/K+-ATPase is located on which side of the plasma membrane? [...] side | back 101 Cytosolic side |
front 102 What is the mechanism of action of cardiac glycosides? [...] blockade → Decreased activity of [...] antiporter → Increased [[...]] intracellularly → Increase in cardiac contractility | back 102 Na+/K+-ATPase blockade → Decreased activity of Na+/Ca2+ antiporter → Increased [Ca2+] intracellularly → Increase in cardiac contractility |
front 103 What covalent change occurs in Na+/K+-ATPase
when K+ is transported into the cell? | back 103 The pump is dephosphorylated |
front 104 What is the inheritance pattern of alkaptonuria? | back 104 Autosomal recessive |
front 105 What causes joint pain in a patient with alkaptonuria? Buildup of ____ acid | back 105 homogentisic |
front 106 Which benign enzyme deficiency causes arthralgias, darkened sclerae and connective tissues, and urine that turns black on air exposure? ______ oxidase deficiency | back 106 Homogentisate oxidase deficiency |
front 107 What metabolic pathway is affected in
alkaptonuria? | back 107 Degradation of tyrosine to fumarate |
front 108 The activity of what enzyme is decreased in Menkes disease? ____ ____ | back 108 Lysyl oxidase this is bc copper is a necessary cofactor |
front 109 What connective tissue disease is the result of a mutation in the
ATP7A gene? | back 109 Menkes disease |
front 110 What is the diagnosis for a child who has brittle,
"kinky" hair, hypotonia, delays in growth and
development, and an increased risk for cerebral
aneurysms? | back 110 Menkes disease |
front 111 Impaired copper metabolism in Menkes disease ultimately results in a defective production of what protein? _____ | back 111 Collagen |
front 112 How do serum copper levels differ in Menkes disease when compared
with Wilson disease? | back 112 Copper levels are low in Menkes disease |
front 113 Defects in the ubiquitin-proteasome system have been
linked to which neurologic disease? | back 113 Parkinson disease |
front 114 Which barrel-shaped protein complex degrades damaged or ubiquitin-tagged proteins? _____ | back 114 Proteasome |
front 115 How can an uncorrected left-to-right shunt lead to Eisenmenger
syndrome? | back 115 pulmonary right ventricular |
front 116 What is the primary reason that testosterone levels
are normal in those with cryptorchidism? | back 116 Leydig higher |
front 117 What is the pathophysiologic mechanism associated with the
reduced fertility seen in those with
cryptorchidism? | back 117 spermatogenesis |
front 118 What are the two most common complications seen in patients with
cryptorchidism? | back 118 Increased risk of infertility |
front 119 What are the expected levels of inhibin B, FSH, LH, and testosterone
in patients with cryptorchidism? | back 119 Decreased inhibin B levels |
front 120 What is the major risk factor for the development of cryptorchidism? _____ | back 120 Prematurity |
front 121 What is the primary treatment method for patients with
cryptorchidism? | back 121 spontaneously orchiopexy |
front 122 Where does lactase function in the gastrointestinal tract? | back 122 brush border |
front 123 What might be noted on testing of a stool sample obtained from a
patient with lactase deficiency? | back 123 Decreased |
front 124 What are the causes of secondary lactase deficiency? | back 124 gastroenteritis Autoimmune |
front 125 What would an intestinal biopsy specimen from a patient with hereditary lactose intolerance show? _____ mucosa | back 125 Normal mucosa |
front 126 What are the clinical features of lactase deficiency? | back 126 Flatulence |
front 127 What is the treatment for lactase deficiency? | back 127 Dietary avoidance of lactose-containing products |
front 128 Which groups of people tend to be lactase deficient
in adulthood because of the absence of a lactase-persistent
allele? | back 128 Asians |
front 129 Lactase breaks down lactose into which monosaccharides? | back 129 glucose galactose |
front 130 What finding is expected on hydrogen breath testing in a patient with
lactase deficiency? | back 130 Increased hydrogen levels |
front 131 why do we see increased hydrogen levels in lactase def? - Due to increased _____ of undigested lactose by _____ bacteria. | back 131 fermentation colonic |
front 132 A patient between ages 1 and 4 presents with stereotypical
hand-wringing, seizures, intellectual disability, and regression in
verbal, cognitive, and motor skills. What is the
diagnosis? | back 132 Rett syndrome |
front 133 The mother of a child with Rett syndrome is pregnant with another
child and inquires about the inheritance of the disease. How would you
respond? | back 133 Rett syndrome is a sporadic disorder |
front 134 Why is Rett syndrome almost exclusively seen in females? | back 134 die |
front 135 Between what ages does Rett syndrome usually manifest? | back 135 1 and 4 |
front 136 What is the underlying mutation in Rett syndrome? ____ ____ mutation of ____ on the ____ chromosome | back 136 De novo mutation of MECP2 on the X chromosome |
front 137 Karotype analysis reveals a balanced translocation between
chromosomes 14 and 21. How will this affect the individual's
phenotype? | back 137 The individual will be unaffected |
front 138 Balanced translocations, unlike unbalanced translocations, do not cause abnormal _______. There will be no gain or loss of genetic material. | back 138 phenotypes |
front 139 What feature of chromosomes 13, 14, 15, 21, and 22 predisposes them
to Robertsonian translocations? | back 139 They are acrocentric chromosomes. They have centromeres near their ends. |
front 140 What are acrocentric chromosomes? | back 140 ends |
front 141 What is a Robertsonian translocation? | back 141 Fusion of the long arms of two acrocentric chromosomes at the centromeres |
front 142 Unbalanced translocations can result in ____, ____, and chromosomal ____ | back 142 Unbalanced translocations can result in miscarriage, stillbirth, and chromosomal imbalances |
front 143 A pig farmer has bloody diarrhea. He later reports dysuria and sore red knees. What is the diagnosis? ____ ____ from ____ ____ infection | back 143 Reactive arthritis from Campylobacter jejuni infection (This was most likely contracted from infected farm animals) |
front 144 What findings help identify Campylobacter jejuni as a cause
of infection? | back 144 Comma or "S" shaped with polar
flagella |
front 145 What are two possible sequelae of Campylobacter jejuni
infection? | back 145 Reactive arthritis |
front 146 What are two common modes of transmission for Campylobacter
jejuni? | back 146 Fecal-oral |
front 147 What is the most common heritable cause of intellectual
disability? | back 147 Fragile X syndrome |
front 148 What is the underlying genetic cause of fragile X syndrome? | back 148 Trinucleotide repeats in the FMR1 gene |
front 149 What heart defect is most likely present in patients with fragile X syndrome? ____ ____ prolapse | back 149 Mitral valve prolapse |
front 150 During embryonic development, when does the trinucleotide repeat expansion that leads to fragile X syndrome occur? ______ | back 150 Oogenesis |
front 151 How does the trinucleotide expansion in fragile X
syndrome affect gene expression? | back 151 Trinucleotide repeats in the FMR1 gene causes hypermethylation of cytosine residues → Decreased expression |
front 152 What is the mode of inheritance of fragile X syndrome? | back 152 X-linked dominant |
front 153 What are the clinical manifestations of fragile X syndrome when there
is a full mutation? | back 153 Long face |
front 154 What are the clinical manifestations of fragile X syndrome when there is a premutation? ____ | back 154 Ataxia |
front 155 What symptom often observed in patients with fragile X
syndrome and might be confused with Lesch-Nyhan
syndrome? | back 155 Self-mutilation |
front 156  | back 156 ataxia-telangiectasia |
front 157 Despite their intellectual disability, patients with Williams
syndrome are typically advanced in which skill set? | back 157 Verbal skills |
front 158 What is the probable diagnosis of a child with “elfin”
facies, intellectual disability, notable
friendliness with strangers,
hypercalcemia, and cardiovascular
problems? | back 158 Williams syndrome |
front 159 Which connective tissue gene is deleted in Williams syndrome? _____ gene | back 159 Elastin gene |
front 160 What chromosomal abnormality is the cause of Williams syndrome? | back 160 Microdeletion of the long arm of chromosome 7 |
front 161 Name two cardiovascular conditions that may be present in patients
with Williams syndrome. | back 161 Supravalvular aortic stenosis |
front 162 The enzyme deficient in maple syrup urine disease is
dependent on which vitamin to function? | back 162 Vitamin B1 |
front 163 What molecule levels increase in the blood in maple syrup urine disease? ____-____, especially those derived from ____ | back 163 α-ketoacids, especially those derived from leucine |
front 164 What is the treatment for maple syrup urine disease? | back 164 Restrict isoleucine, leucine, and valine in the diet |
front 165 What is the inheritance pattern of maple syrup urine disease? | back 165 Autosomal recessive |
front 166 Which amino acids cannot be degraded in maple syrup urine disease? (3) | back 166 Leucine |
front 167 What condition should be suspected when a urine sample obtained from a lethargic child smells like burnt sugar? | back 167 Maple syrup urine disease |
front 168 What are the key functions of zinc in the human body? | back 168 Involved in the activity of 100+ enzymes |
front 169 Deficiency of which micronutrient can predispose an individual to alcoholic cirrhosis? ____ | back 169 Zinc |
front 170 What symptoms are associated with a zinc deficiency? Delayed ____ ____
| back 170 Delayed wound healing |
front 171  What is the diagnosis of the condition shown in the image in a malnourished patient with poor wound healing and impaired taste sensation? _____ deficiency | back 171 Zinc deficiency |
front 172 Why might a patient with zinc deficiency develop recurrent bacterial
and fungal infections? | back 172 Zinc deficiency can cause immunosuppression |
front 173 Laboratory testing reveals impaired intestinal zinc absorption. Which dermatologic condition is most likely present? A) Dermatitis herpetiformis | back 173 B) Acrodermatitis enteropathica |
front 174 What intracellular proteins are responsible for
facilitating and maintaining protein
folding? | back 174 Chaperone proteins |
front 175 Name the special class of chaperone proteins that prevents
protein denaturation at high temperatures
in yeast. | back 175 Heat shock proteins |
front 176 What is the mechanism by which atherosclerotic
plaques form? | back 176 Endothelial cell dysfunction leads to macrophage-mediated plaque formation via foam cell formation |
front 177 Fatty streaks and smooth muscle proliferation contribute to _____ plaques. | back 177 fibrous |
front 178 Rank the following vessels from MOST commonly affected to LEAST commonly affected by atherosclerosis:
| back 178 Abdominal aorta → Coronary arteries → Popliteal arteries → Carotid arteries → Circle of Willis |
front 179 Atherosclerosis risk increases after menopause because _____ is protective against atherosclerosis | back 179 estrogen |
front 180 How does a patient's risk of atherosclerosis change with increases in
HDL and LDL? | back 180 High HDL is protective and decreases atherosclerotic risk |
front 181  ______ nerve palsy | back 181 Oculomotor nerve palsy |
front 182 What causes the musty odor in phenylketonuria? | back 182 Disorder of aromatic amino acid metabolism |
front 183 Name two possible deficiencies that can cause phenylketonuria. | back 183 phenylalanine BH4 |
front 184 Why should a patient with phenylketonuria avoid most
artificial sweetners? | back 184 Phenylalanine is found in aspartame |
front 185 Why are newborns screened for phenylketonuria at 2 to 3 days of age
and not earlier? | back 185 The result is always normal at birth due to the presence of maternal enzymes |
front 186 What is the treatment for phenylketonuria? | back 186 Decrease dietary phenylalanine |
front 187 Which nonessential amino acid becomes essential for patients with phenylketonuria? | back 187 tyrosine |
front 188 An increase in phenylalanine levels due to phenylketonuria leads to the presence of what class of metabolites in urine? Phenyl _____ | back 188 Phenyl ketones |
front 189 What skin condition, apart from decreased pigmentation, can be seen with phenylketonuria? ____ | back 189 Eczema |
front 190 Phenylketonuria exhibits what pattern of inheritance? | back 190 Autosomal recessive |
front 191 What findings would be present in a patient who was born to a mother
with maternal phenylketonuria? | back 191 Microcephaly |
front 192 β-blockers decrease ______ after a myocardial infarction | back 192 mortality |
front 193 How could maternal transmission of
syphilis to a neonate be prevented? | back 193 penicillin |
front 194 What fat absorption disorder can lead to steatorrhea, failure to thrive during infancy, retinitis pigmentosa, progressive ataxia, and acanthocytosis? | back 194 Abetalipoproteinemia |
front 195 What three lipoproteins are absent in apolipoprotein B48 and B100 deficiency? | back 195 Chylomicrons |
front 196 A patient with abetalipoproteinemia is treated with large doses of oral vitamin E to prevent which complication? ______ degeneration | back 196 Spinocerebellar degeneration |
front 197 What is the inheritance pattern of abetalipoproteinemia? | back 197 Autosomal recessive |
front 198 What is the treatment for apolipoprotein B48 and
B100 deficiency? | back 198 Restricted consumption of long-chain fatty acids |
front 199 A mutation in what gene results in abetalipoproteinemia? ____ gene | back 199 MTP gene |
front 200 This encodes microsomal transfer protein: ____ gene | back 200 MTP |
front 201 What is the likely finding in an intestinal biopsy specimen obtained from an infant with abetalipoproteinemia? ______-laden enterocytes | back 201 Lipid-laden enterocytes |
front 202 What cellular process allows for a single gene transcript to result in the production of multiple different proteins? | back 202 Alternative splicing |
front 203 What is the name of the intervening segments of DNA within a gene that does not code for protein, but have a role in regulating gene expression? | back 203 Introns |
front 204 What parts of the gene contain the actual genetic information for coding proteins or functional RNA? | back 204 Exons |
front 205 Provide examples that exhibit alternative
splicing. | back 205 Brain → Dopamine receptors |
front 206 What is the result of having a dysfunctional signal
recognition particle in the cell? | back 206 Accumulation of protein in the cytosol |
front 207 What is the definitive treatment for acromegaly? | back 207 Surgical resection of the pituitary adenoma |
front 208 What are three pharmacologic treatment options for acromegaly? ______ ______ ______ ______ | back 208 Pegvisomant |
front 209 Which type of collagen is affected in the vascular type of
Ehlers-Danlos syndrome? | back 209 Type III collagen |
front 210 What is the most common type of Ehlers-Danlos syndrome? | back 210 Hypermobility type |
front 211 Ehlers-Danlos syndrome is transmitted through what inheritance
patterns? | back 211 Autosomal dominant |
front 212 Ehlers-Danlos syndrome is due to a defect in what process? | back 212 Collagen synthesis |
front 213 What types of aneurysms are commonly associated with Ehlers-Danlos
syndrome? | back 213 Berry aneurysms |
front 214  What type of specific collagen type that is affected in a patient with easy bruising and findings as shown in the image below? | back 214 Type V collagen |
front 215 Which type of Ehlers-Danlos syndrome has fragile vessels, muscles,
and organs prone to rupture? | back 215 Vascular type |
front 216 A patient has vascular Ehlers-Danlos syndrome due to defective type III collagen. Which gene is most likely mutated? A) COL1A1 | back 216 C) COL3A1 |
front 217 What are the two major sources of HDL in the body? _____ _____ _____ | back 217 Liver |
front 218 What is the function of cholesterol ester transfer
protein? | back 218 Assists in the transfer of cholesterol esters to other lipoprotein particles |
front 219 What is the function of hormone-sensitive lipase in
lipid transport? | back 219 Degrades triglycerides in adipocytes |
front 220 What is the function of hepatic lipase in
lipid transport? | back 220 Degrades triglycerides still present in IDL and chylomicron remnants |
front 221 What enzyme degrades triglycerides present in circulating chylomicrons and VLDL? _____ _____ | back 221 Lipoprotein lipase |
front 222 What is the function of pancreatic lipase in lipid
transport? | back 222 Degrades triglycerides obtained from the diet in the small intestine |
front 223 What enzyme catalyzes the esterification of the majority of plasma cholesterol and converts nascent HDL to mature HDL? A) Hormone-sensitive lipase | back 223 C) Lecithin-cholesterol acyltransferase |
front 224 What is the function of PCSK9 in lipid metabolsim? | back 224 LDL |
front 225 If a drug inhibits PCSK9, how will this affect serum
LDL levels? | back 225 decrease |
front 226 What are the three different cell types present in the endocrine
pancreas and what do they release? | back 226 α endocrine cells → Glucagon |
front 227 Where are the α, β, and δ endocrine cells located in the Islets of
Langerhans? | back 227 α endocrine cells → Peripheral |
front 228 Why do steroids cause
neutrophilia? | back 228 Steroids inhibit white blood cell adhesion → Neutrophilia |
front 229 What provides the stimulus for cortisol secretion? | back 229 Hypothalamic CRH stimulates release of pituitary ACTH |
front 230 A patient with latent tuberculosis or candidiasis is started on long-term high-dose glucocorticoids. Which screening test should be performed before beginning therapy? A) RPR | back 230 D) PPD test |
front 231 A patient with latent tuberculosis begins high-dose glucocorticoid therapy and later develops reactivation of infection. Which mechanism best explains this risk? A) Increased IL-2 production | back 231 B) Decreased IL-2 production |
front 232 What would result from mitral stenosis? | back 232 greater remember that pulmonary capillary wedge pressure is a proxy for LA pressure |
front 233 What is the normal pressure for the aorta during
systole and diastole? | back 233 Systole → 120 mmHg |
front 234 What is the normal pressure for the pulmonary artery
during systole and diastole? | back 234 Systole → 25 mmHg |
front 235 What is the normal pressure for the left ventricle
during systole and diastole? | back 235 Systole → 120 mmHg |
front 236 What is the normal pressure for the right ventricle during systole
and diastole? | back 236 Systole → 25 mmHg |
front 237 What are the normal pressures for the right and left
atria? | back 237 Right atrium → < 5 mmHg |
front 238 Which amino acid is most basic? | back 238 Arginine |
front 239 Which basic amino acid has no charge at body pH? | back 239 Histidine |
front 240  What finding in this histology image is characteristic of a carcinoid tumor? | back 240 rosette arrangement |
front 241  The absence of which 2 nerve plexus result in the disease shown in the image below? _____ plexus | back 241 Auerbach plexus |
front 242 What percentage of carcinoid tumors metastasize? A) 10% | back 242 C) 33% |
front 243 What 2 medications provide only symptomatic relief in patients with heart failure? ____ diuretics | back 243 Thiazide |
front 244 What 2 medications, used in combination, both relieve symptoms of heart failure and lower associated mortality in select patients? ____ ____ | back 244 Hydralazine |
front 245 What is the role of the RAAS in the symptomatic presentation of edema
in heart failure? | back 245 Activation of RAAS → Increased circulating volume due to Na+ and H2O reabsorption in the kidneys → Increased preload → Edema |
front 246 In diastolic dysfunction, what typically happens to ejection fraction (EF) and end-diastolic volume (EDV)? | back 246 Preserved EF, normal EDV |
front 247 What is the effect of increased pulmonary venous pressure, causing fluid transudation into the lungs in patients with heart failure? _____ _____ | back 247 Pulmonary edema |
front 248 What common symptom associated with heart failure is caused by increased venous return from redistribution of blood and reabsorption of peripheral edema? _____ _____ dyspnea | back 248 Paroxysmal nocturnal |
front 249 Medications in what 4 drug classes are prescribed to reduce
mortality in patients with heart failure and reduced
ejection fraction? | back 249 ACE inhibitors |
front 250 What is the most common cause of right-sided heart failure in the
absence of left-sided heart failure? | back 250 Cor pulmonale |
front 251 What is the most common cause of right-sided heart failure? | back 251 Left-sided heart failure |
front 252 What is the major histologic finding in the lungs of patients with left-sided heart failure? _____-laden macrophages | back 252 Hemosiderin-laden macrophages |
front 253 What is the major effect of right-sided heart failure on liver function? ____ ____ | back 253 Hepatomegaly |
front 254 What is the pathophysiologic mechanism leading to orthopnea
in patients with left-sided heart failure?
| back 254 Increased venous return to the heart in the supine position → Pulmonary vascular congestion and shortness of breath |
front 255 What type of heart failure is associated with decreased contractility, reduced ejection fraction, and increased ventricular end-diastolic volume? (Systolic or Diastolic) heart failure | back 255 Systolic heart failure |
front 256 What are the 4 most common physical exam findings in patients with
heart failure? | back 256 Jugular venous distention |
front 257 Which three physical exam findings are most suggestive of right-sided heart failure? A) Peripheral edema, JVD, hepatomegaly | back 257 A) Peripheral edema, JVD, hepatomegaly |
front 258 The trachea bifurcates at what level? | back 258 T4 |
front 259 A newborn has failure to pass meconium and severe chronic constipation. Which condition should be suspected? | back 259 Hirschsprung disease |
front 260 Which hormones stimulate and inhibit the release of GH
respectively? | back 260 GHRH somatostatin |
front 261 Which cranial nerve innervates the intraocular muscles? | back 261 oculomotor |
front 262 The common carotid bifurcates at what level? | back 262 C4 |
front 263 The abdominal aorta bifurcates at what level? | back 263 L4 |
front 264 Which three nerve roots innervate the diaphragm and form the phrenic nerve? | back 264 C3-C5 |
front 265 Which lymph node cluster is likely to be enlarged in a patient with mastitis or metastasis from breast cancer? | back 265 Axillary |
front 266 What do D cells in the antrum of the stomach secrete? | back 266 Somatostatin |
front 267 Which nerve and artery would you expect to see injured with a fracture at the surgical neck of the humerus? _____ nerve _____ _____ artery | back 267 Axillary Nerve Posterior Circumflex Artery |
front 268 Which nerve injury presents with a flattened deltoid, loss of sensation over the deltoid and lateral arm, and failure to abduct the arm from a resting position? | back 268 axillary nerve |
front 269 What general medication is used for long-term prevention or treatment of deep vein thrombosis? oral direct _______ | back 269 oral direct anticoagulants |
front 270 What is the drug of choice for the acute management of deep vein thrombosis? ____ heparin ____ ____ ____ heparin | back 270 unfractioned low molecular weight |
front 271 What circumstance typically increases venous stasis
in a patient? | back 271 prolonged inactivity |
front 272 What laboratory test is typically used to rule out deep vein thrombosis in a patient at low or moderate risk of developing deep vein thrombosis? | back 272 D-dimer This test has a high sensitivity, but low specificity. |
front 273 What congenital condition is caused by blockage of the posterior nasal opening and is associated with midface bony abnormalities? _____ atresia | back 273 Choanal atresia |
front 274 Which two respiratory conditions are not typically associated with digital clubbing? A) Asthma and COPD | back 274 A) Asthma and COPD |
front 275 What type of rheumatologic disease is commonly associated with pulmonary hypertension? A) Crystal arthropathy | back 275 B) Connective tissue disease |
front 276  Nerve? Muscle? Diagnosis? | back 276 long thoracic serratus anterior winged scapula |
front 277 Osteogenesis imperfecta is caused by a defect in which step of collagen synthesis? A) Hydroxylation of lysine | back 277 C) Triple helix formation |
front 278 Approximately one-third of collagen is composed of which amino acid? A) Glycine | back 278 A) Glycine |
front 279 In patients with Hirschspring disease, which enzyme is increased in hypertrophied nerve fibers of the lamina propria? ______ | back 279 Acetylcholinesterase |
front 280 What is the pathophysiologic mechanism that ultimately leads to development of pulmonary hypertension in patients with a chronic history of emphysema? By destruction of lung ______ | back 280 By destruction of lung parenchyma |
front 281 Which screening test is commonly used to identify primary ciliary dyskinesia, and would be decreased in a positive test? Nasal ____ ____ measurement | back 281 Nasal nitric oxide measurement |
front 282 What is the most common genetic cause of heritable pulmonary arterial hypertension, inhibiting vascular smooth muscle proliferation? A) CFTR mutation | back 282 C) BMPR2 mutation |
front 283 What parasitic infection is typically associated with the development of pulmonary hypertension? ______ | back 283 Schistosomiasis |
front 284 Pulmonary pressure is measured in which unit? A) mmHg | back 284 D) cm H₂O |
front 285 What may digital rectal exam reveal in Hirschsprung disease? A) Bloody stool | back 285 B) Squirt sign with empty rectum |
front 286 What is the prognosis for a patient diagnosed with idiopathic or heritable pulmonary arterial hypertension? _____ | back 286 poor |
front 287 How does myoglobin's affinity for oxygen compare to that of hemoglobin? Myoglobin has {{greater/less}} affinity for oxygen | back 287 Myoglobin has greater affinity for oxygen |
front 288 What type of oxygen-carrying molecule consists of a single polypeptide chain with a single heme moiety? ______ | back 288 Myoglobin |
front 289 Which form of hemoglobin has the lowest affinity for oxygen? Highest? Deoxygenated or oxygenated? | back 289 deoxygenated oxygenated |
front 290 Hemoglobin can act as a buffer for which ion? ____ | back 290 H+ |
front 291 What are the four polypeptide subunits that form normal adult
hemoglobin? | back 291 2 alpha subunits |
front 292 How does emphysema alter lung compliance? | back 292 increases it |
front 293 Lung compliance is _____ proportional to alveolar wall stiffness. | back 293 inversely |
front 294 What is the definition of lung compliance? | back 294 change in lung volume/change in lung pressure |
front 295 How does the presence of surfactant affect the compliance of the lung? Increases or decreases? | back 295 increases |
front 296 What symptoms occur in a newborn with Hirschsprung disease? | back 296 Abdominal distention |
front 297 What would a rectal suction biopsy show to indicate a
diagnosis of Hirschsprung disease?
| back 297 ganglion |
front 298 What will be found proximal to the diseased segment of
bowel in Hirschsprung disease? | back 298 Dilated portion of bowel creating a "transition zone" |
front 299 What is the mechanism that causes Hirschsprung disease? | back 299 Failure of neural crest cell migration → Absence of ganglion cells and enteric nervous plexuses in distal segment of colon |
front 300 There is an increased risk for Hirschsprung disease
in individuals with what genetic syndrome? | back 300 down |
front 301 What loss of function mutations are associated with
Hirschsprung disease? | back 301 RET |
front 302 What findings may be present on a CT scan of the
sinuses in a patient with cystic
fibrosis? | back 302 Opacification of the sinuses |
front 303 Which medication slows the progression of cystic fibrosis? _____ | back 303 Ibuprofen |
front 304 What is the benefit of prescribing azithromycin for
patients with cystic fibrosis? | back 304 Anti-inflammatory activity |
front 305 What is the function of aerosolized dornase alfa, albuterol,
inhaled hypertonic saline, and chest physiotherapy in the
treatment of cystic fibrosis? | back 305 Facilitates mucus clearance |
front 306 What is the earliest manifestation of cystic fibrosis in a newborn? ______ ______ | back 306 Meconium ileus |
front 307 What is the reason for subfertility in
females with cystic fibrosis?
| back 307 Amenorrhea |
front 308 What is the cause of infertility in males with cystic fibrosis? Absence of ___ ___ | back 308 Absence of vas deferens |
front 309 What complications occur in the gastrointestinal tract as a result of
pancreatic insufficiency and biliary cirrhosis in
patients with cystic fibrosis? | back 309 Deficiencies of fat-soluble vitamins |
front 310 What diagnosis is suggested if a newborn screening test reveals increased immunoreactive trypsinogen? | back 310 Cystic fibrosis |
front 311 Which pathogens most commonly cause recurrent pulmonary infections in cystic fibrosis during childhood versus adulthood? A) H influenzae in children; S aureus in adults | back 311 B) S aureus in children; P aeruginosa in adults |
front 312 A patient with cystic fibrosis undergoes chest X-ray imaging. Which
finding is most likely present? | back 312 B) Reticulonodular pattern |
front 313 A patient with cystic fibrosis has a
reticulonodular pattern on chest
X-ray. Which process most directly explains this finding? | back 313 A) Chronic bronchitis and bronchiectasis |
front 314 Why do patients with cystic fibrosis develop
bronchiectasis over time? | back 314 D) Chronic mucus plugging and infections |
front 315 Which metabolic disorders may be present in patients with cystic
fibrosis? | back 315 Hypokalemia This is due to extracellular fluid H2O/Na+ loss via sweating and concomitant renal K+/H+ wasting. |
front 316 In which organ are fatty acids and amino acids metabolized to ketone bodies? _____ | back 316 Liver |
front 317 What is the mechanism for ketone production in a
patient with diabetic ketoacidosis or
prolonged starvation? | back 317 Oxaloacetate is depleted for gluconeogenesis → Acetyl-CoA accumulates → Ketone production |
front 318 How does chronic alcoholic use increase ketone body formation? | back 318 Overuse of alcohol results in increased NADH state → Accumulation of oxaloacetate → Shunted to malate → Buildup of acetyl-CoA → Production of ketones |
front 319 Which of the three ketone bodies do not appear on a standard urinalysis? | back 319 β-hydroxybutyrate |
front 320 What is the clinical implication of excess GH in children? It causes ______ with increased ______ bone growth | back 320 It causes gigantism with increased linear bone growth |
front 321 Red blood cells can only use ____ as an energy source. | back 321 glucose |
front 322 Which ketone gives the fruity smell to the breath of a patient with diabetic ketoacidosis? | back 322 Acetone |
front 323 After absorption of dietary fat and cholesterol in intestinal cells, where are lipids distributed next? _____ | back 323 Lymphatics |
front 324 Which two apolipoproteins are transferred from HDL to chylomicrons and VLDL in circulation? | back 324 Apolipoprotein CII |
front 325 Apolipoprotein CII is critical in the activation of which enzyme? _____ lipase | back 325 Lipoprotein lipase |
front 326 A chylomicron remnant binds to a
hepatocyte utilizing which apolipoprotein and
receptor? | back 326 Apolipoprotein E on chylomicrons binds to apolipoprotein E receptors on hepatocytes |
front 327
Chylomicron remnants are broken down by
hepatocytes into cholesterol and
triglycerides. What is the next step in lipid
transport? | back 327 Cholesterol and triglycerides are released into circulation from hepatocytes as VLDL |
front 328 After lipid breakdown via lipoprotein lipase, chylomicrons and VLDL
become what respective lipoprotein forms? | back 328 Chylomicrons become chylomicron remnants |
front 329 When IDL is delivered to hepatocytes via apolipoprotein E and apolipoprotein E receptors, what lipoprotein is then released from hepatocytes? | back 329 LDL |
front 330 In the final step of lipid transport, LDL particles
are taken up by peripheral cells with the help of
which apolipoprotein? | back 330 Apolipoprotein B100 on LDL binds to LDL receptors on peripheral cells |
front 331 What 2 lipid-lowering medications are commonly associated with myopathy? _____ _____ | back 331 statins fibrates |
front 332 What is the key enzyme in ketogenesis that converts
HMG-CoA into acetoacetate? | back 332 C) HMG-CoA lyase |
front 333
Fibrates increase the risk of cholesterol
gallstones primarily through inhibition of
which enzyme? | back 333 B) Cholesterol 7α-hydroxylase |
front 334 What class of lipid-lowering agents has the greatest effect in decreasing triglycerides? | back 334 Fibrates |
front 335 What drug used in the treatment of heart failure is a recombinant form of BNP? _____ | back 335 Nesiritide |
front 336 When the heart is overworked or stretched, it releases ____ to help reduce blood pressure and fluid. | back 336 BNP |
front 337 What stimulates release of BNP? Increased _____ _____ | back 337 ventricular tension |
front 338 Which cells release BNP? Ventricular ____ | back 338 Ventricular myocytes |
front 339 How does hydralazine affect afterload? | back 339 decreases afterload |
front 340 How does nitroglycerin affect preload? | back 340 decreases preload |
front 341 In a patient with chronic hypertension, how does the left ventricle compensate for increased afterload? Left ventricular wall _____ to decrease wall stress | back 341 Left ventricular wall hypertrophies to decrease wall stress |
front 342  An ECG tracing is shown in the image. What pathology does the presence of the U wave indicate? _____ or _____ | back 342 Hypokalemia or Bradycardia |
front 343 Which pacemaker would take over if the SA node stopped functioning? | back 343 AV node |
front 344 Enlarged P waves on an electrocardiogram may indicate pathology in which part of the heart? _____ | back 344 Atrium |
front 345 What neurotransmitters increase and decrease heart rate? _____ increase heart rate | back 345 Catecholamines increase heart rate |
front 346 Which part of the adrenal gland secretes mineralcorticoids (such as aldosterone)? zona ____ | back 346 zona glomerulosa |
front 347 Which part of the adrenal gland secretes glucocorticoids (such as cortisol)? zona ____ | back 347 Zona fasciculata |
front 348 What is the embryologic origin of parafollicular cells? ____ pharyngeal pouch | back 348 4th |
front 349 What are three ways to diagnose acromegaly? | back 349 Lack of suppression of serum GH after oral glucose tolerance
tests |
front 350 What is the most common cause of death in gigantism and acromegaly? ____ failure | back 350 Heart failure |
front 351 What disease typically presents with an enlarged tongue with deep furrows, coarsening of facial features with age, deep voice, and frontal bossing? | back 351 Acromegaly |
front 352 How is glucose regulation affected in
acromegaly? | back 352 Glucose tolerance is impaired due to insulin resistance |
front 353 What endocrine tumor is associated with niacin deficiency? | back 353 Carcinoid tumors |
front 354 What cell line do carcinoid tumors arise from and what do they
secrete? | back 354 Carcinoid tumors originate from neuroendocrine cells and secrete 5-HT |
front 355 Increased urinary 5-HIAA suggests what endocrine tumor? | back 355 Carcinoid tumor |
front 356  What physical exam finding in Cushing syndrome does the image depict? | back 356 abdominal striae |
front 357  What physical exam finding is shown in the image? What condition do you find this in? | back 357 Moon face, Cushings syndrome |
front 358 A CRH stimulation test shows increases in ACTH and cortisol. What diagnosis is suggested? ____ ____ | back 358 Cushing disease |
front 359 To confirm that a patient has Cushing disease after suppression with a high-dose dexamethasone test, what do you order? ____ of the ____ gland | back 359 MRI of the pituitary gland |
front 360 What would a high-dose dexamethasone suppression test do to ACTH in Cushing disease? _____ ACTH | back 360 Suppress ACTH |
front 361 When a patient is found to have ectopic ACTH secretion causing Cushing syndrome, what diagnostic test can done to confirm the diagnosis? _____ of the abdomen, pelvis, and chest | back 361 CT of the abdomen, pelvis, and chest |
front 362 What happens to ACTH levels during a high-dose dexamethasone suppression test in a patient with ectopic ACTH production from small cell lung cancer? | back 362 There will be no suppression of ACTH |
front 363 A 24-hour urine test reveals a high free cortisol level in a patient suspected of having Cushing syndrome. What diagnostic test should be ordered next? Measurement of serum _____ | back 363 Measurement of serum ACTH |
front 364 What will administration of CRH do to ACTH and cortisol levels in a patient with ectopic ACTH production? | back 364 normal ACTH and cortisol |
front 365 Name some clinical indications for angiotensin II receptor
blockers. | back 365 Heart failure |
front 366 What are the adverse effects of angiotensin II receptor
blockers? | back 366 Hyperkalemia |
front 367 How do angiotensin II receptor blockers affect
levels of renin, angiotensin I, and angiotensin II? | back 367 Increased renin levels |
front 368 What is the mechanism of action of the -sartan drugs? | back 368 Selectively blocks binding of angiotensin II to AT1 receptor |
front 369 What is microscopic colitis? | back 369 Colonic inflammation → Chronic watery diarrhea |
front 370 Which gender is more likely to develop microscopic colitis? | back 370 Females |
front 371 What is the likely diagnosis if colonic histology shows a thickened subepithelial collagen band or intraepithelial lymphocytes and inflammatory infiltrate in the lamina propria? | back 371 Microscopic colitis |
front 372 In microscopic colitis, on endoscopy, the mucosa of the colon appears ____. | back 372 normal |
front 373 Which organelle is resposible for steroid synthesis and detoxification of poisons and drugs? | back 373 Smooth ER |
front 374 Which organelle found in the rough endoplasmic reticulum is missing from the smooth endoplasmic reticulum? _____ _____ | back 374 Surface ribosomes |
front 375 Name the enzyme involved in both glycogenolysis and gluconeogenesis that is found in the smooth endoplasmic reticulum. | back 375 Glucose-6-phosphatase |
front 376 Where are cytosolic, peroxisomal, and mitochondrial proteins synthesized? ____ ____ | back 376 Free ribosomes |
front 377 What is the histologic term for the rough endoplasmic reticulum in neurons? ____ bodies | back 377 Nissl bodies |
front 378 Name two cell types that would be rich in the rough endoplasmic reticulum. | back 378 Goblet cells |
front 379 _____ cells secrete mucus. | back 379 Goblet |
front 380 Which organelle synthesizes secretory proteins and adds N-linked oligosaccharides to proteins? | back 380 Rough endoplasmic reticulum |
front 381 What three factors alter absorption of fat-soluble vitamins? | back 381 Bile emulsification |
front 382 Why is toxicity more common with fat-soluble vitamins than with
water-soluble vitamins? | back 382 Fat-soluble vitamins accumulate in fat Water-soluble vitamins are eliminated more rapidly. |
front 383 Malabsorption syndromes, often presenting with chronic steatorrhea,
can lead to deficiency of which vitamins? | back 383 Fat-soluble vitamins |
front 384 What four dietary supplements should be added to a vegetarian/vegan diet? (3 vitamins and one mineral) | back 384 Vitamin B2 |
front 385 High consumption of egg whites can predispose to which vitamin deficiency? | back 385 Vitamin B7 Egg whites contain avidin, which binds to biotin and prevents its
absorption. |
front 386 Consumption of untreated corn is associated with which vitamin deficiency? | back 386 Vitamin B3 |
front 387 What are the three most common adverse effects of
ivabradine? | back 387 Hypertension |
front 388 What are the two main indications for prescribing
ivabradine? | back 388 Chronic stable angina with contraindications for
β-blockers |
front 389 What is ivabradine's mechanism of action? | back 389 Ivabradine selectively inhibits "funny" Na+ channels → Prolonged slow depolarization phase |
front 390 Different mutations in the same locus cause the
same disease. What is this called? | back 390 B) Allelic heterogeneity |
front 391 Mutations at different genetic loci cause the
same phenotype. What is this called? | back 391 B) Locus heterogeneity |
front 392 A child inherits both normal and mutated mitochondrial
DNA, causing variable mitochondrial disease
expression. What is this called? | back 392 A) Heteroplasmy |
front 393 A mutated gene is present in multiple family
members, but only some show the disease
phenotype. What is this called? | back 393 C) Incomplete penetrance |
front 394 What two cell types are rich in the smooth endoplasmic reticulum? | back 394 Steroid hormone-producing cells Hepatocytes |
front 395 Where are proteins within Golgi bodies, lysosomes, and the endoplasmic reticulum synthesized? | back 395 Rough endoplasmic reticulum |
front 396 What is the pathophysiology behind the neurologic findings in
vitamin E deficiency? | back 396 Demyelination of the posterior columns causes decreased
proprioception and decreased sensation of vibration |
front 397 How does vitamin E protect neuronal membranes and red blood
cells? | back 397 antioxidant free radical damage |
front 398 In contrast to vitamin B12 deficiency, vitamin E
deficiency will present with the following: | back 398 No megaloblastic anemia |
front 399 What is the likely cause of a hemorrhagic stroke in
a patient being treated with warfarin who takes a
vitamin E supplement? | back 399 Excess vitamin E alters the metabolism of vitamin K → Enhanced anticoagulant effects of warfarin → Increased risk of bleeding |
front 400 What is a possible complication of excessive vitamin E supplementation in infants? _____ | back 400 Enterocolitis |
front 401 What are the names of the two main forms of vitamin E? ____ ____ | back 401 Tocopherol |
front 402 How may vitamin E deficiency present clinically? | back 402 Acanthocytosis |
front 403 A patient undergoes a pilocarpine sweat test for suspected cystic fibrosis. Which result would most strongly support the diagnosis? A) Increased sweat chloride | back 403 A) Increased sweat chloride |
front 404 Why is sweat chloride elevated in cystic fibrosis? A) Excess aldosterone activity | back 404 B) Defective CFTR chloride channels |
front 405 What is the diagnostic test most commonly used for cystic fibrosis? A) Schilling test | back 405 B) Pilocarpine-induced sweat test |
front 406 The CFTR gene encodes which type of protein? A) Voltage-gated sodium channel | back 406 B) ATP-gated chloride channel |
front 407 What is the primary function of the CFTR protein in the lungs and gastrointestinal tract? A) Reabsorbs sodium into epithelial cells | back 407 D) Secretes chloride into luminal secretions |
front 408 What is the primary function of CFTR channels in sweat glands? A) Secrete bicarbonate | back 408 B) Reabsorb chloride |
front 409 What genetic defect causes cystic fibrosis? | back 409 Phe508 deletion → Defect in the CFTR gene on chromosome 7 |
front 410 What accompanying symptoms can be seen in a patient who has from
vision loss due to Leber hereditary optic
neuropathy? | back 410 Features of neurologic dysfunction |
front 411 In patients with cystic fibrosis, how does a decrease in
Cl- secretion cause thick mucus production in the lungs and
gastrointestinal tract? | back 411 Low Cl- secretion → High intracellular Cl- → Compensatory Na+ reabsorption via ENaC → Increase in H2O reabsorption → Abnormally thick mucus in lungs and gastrointestinal tract |
front 412 How does the transepithelial potential differ in patients with cystic
fibrosis? | back 412 It is more negative due to high Na+ reabsorption |
front 413 What is the sequelae of a Phe508
deletion in patients with cystic fibrosis? | back 413 A misfolded protein that is retained in the rough endoplasmic reticulum |
front 414 In patients with cystic fibrosis, what medication functions to reduce symptoms by opening chloride channels leading to improved chloride transport? | back 414 Ivacaftor |
front 415 What is the mechanism of action of lumacaftor or
tezacaftor in patients with cystic fibrosis? | back 415 Corrects the misfolding of proteins caused by the Phe508 deletion |
front 416 A patient with cystic fibrosis has severe
malnutrition and steatorrhea. What is the
treatment? | back 416 Pancreatic |
front 417 A patient with cystic fibrosis has recurrent pneumonia. Lung biopsy shows fungal organisms. Which diagnosis is most likely? A) Cryptococcal pneumonia | back 417 C) Allergic bronchopulmonary aspergillosis |
front 418 Which late-stage complication can occur in cystic fibrosis? A) Endocrine dysfunction | back 418 A) Endocrine dysfunction |
front 419 A patient presents with recurrent pulmonary infections, pancreatic insufficiency, and fat-soluble vitamin deficiencies. What is the diagnosis? | back 419 Cystic fibrosis |
front 420 Which late-stage complication can occur in cystic fibrosis? A) Acute cholecystitis only | back 420 B) Biliary cirrhosis |
front 421 Which late-stage complication can occur in cystic fibrosis? A) Neurologic disease | back 421 C) Liver disease |
front 422 A combination of which two medications corrects misfolded proteins and improves their transport to the cell surface in cystic fibrosis? A combination of either _____ or _____ with _____ | back 422 A combination of either lumacaftor or tezacaftor with ivacaftor |
front 423  | back 423 B. degeneracy UUU and UUC both code for phenylalanine. Degeneracy = multiple codons can code for the same amino acid. |
front 424  | back 424 A. allergic bronchopulmonary aspergillosis Key clues: |
front 425  | back 425 This patient has the classic triad for allergic bronchopulmonary aspergillosis (ABPA):
|
front 426 A child has steatorrhea, nasal polyps, chronic bronchitis, and nail clubbing. What is the diagnosis? | back 426 Cystic fibrosis |
front 427 What is the underlying cause of cri-du-chat syndrome? | back 427 Short arm deletion on chromosome 5 |
front 428 Which chromosome carries the mutation for Wilson disease? | back 428 13 |
front 429 Which chromosome carries the mutation for Friedreich ataxia? | back 429 9 |
front 430 Which chromosome is affected in Patau syndrome? | back 430 13 |
front 431 Which chromosome carries the mutation for Williams syndrome? | back 431 7 |
front 432 What is the genetic syndrome associated with high-pitched crying, microcephaly, epicanthal folds, cardiac abnormalities, and intellectual disability? | back 432 Cri-du-chat syndrome |
front 433 What cardiac abnormality is commonly found in patients with cri-du-chat syndrome? | back 433 VSD |
front 434 Which chromosome is affected in Edwards syndrome? | back 434 18 |
front 435 Which chromosome is affected in Wilms tumor? | back 435 11 |
front 436 Which chromosome carries the BRCA1 mutation and the mutations that result in Li-Fraumeni syndrome and neurofibromatosis type 1? | back 436 17 |
front 437 Which chromosome carries the mutation for von Hippel-Lindau disease? | back 437 3 |
front 438 Which chromosome carries the mutation for Prader-Willi syndrome? | back 438 15 |
front 439 Which chromosome carries the mutation for multiple endocrine neoplasia type 1? | back 439 11 |
front 440 Which chromosome carries the mutation for α-thalassemia and other α-globin gene defects? | back 440 16 |
front 441 Which chromosome carries the mutation for Marfan syndrome? | back 441 15 |
front 442 Which chromosome carries the BRCA2 mutation? | back 442 13 |
front 443 Hemochromatosis is a disorder caused by a mutation in which chromosome? | back 443 6 |
front 444 Which chromosome carries the mutation for Huntington disease? | back 444 4 |
front 445 Which chromosome carries the mutation that predisposes a person to renal cell carcinoma? | back 445 3 |
front 446 Which chromosome mutation is associated with familial adenomatous polyposis? | back 446 5 |
front 447 Which chromosome carries the mutation for Angelman syndrome? | back 447 15 |
front 448 Which chromosome carries the mutation for neurofibromatosis type 2? | back 448 22 |
front 449 Which chromosome carries the defect that is responsible for achondroplasia? | back 449 4 |
front 450 A patient has a chromosomal defect that results in large,
bilateral cystic kidneys. Which genes might be
affected? | back 450
PKD1 on chromosome 16 This is autosomal dominant polycystic kidney disease. |
front 451 Which chromosome carries the mutation for agammaglobulinemia? | back 451 X |
front 452 Which chromosome carries the mutation for β-globin defects? | back 452 11 |
front 453 Which chromosome carries the mutation for retinoblastoma? | back 453 13 |
front 454 Which two chromosome mutations are associated with each type of
tuberous sclerosis? | back 454 9 16 |
front 455 An individual presents with severe intellectual disability, laughter at inappropriate times, seizures, and ataxia. What is the diagnosis? | back 455 Angelman syndrome |
front 456 A child is diagnosed with Angelman syndrome due to loss of
maternal chromosome 15 gene
expression. Which genetic mechanism could cause this
disorder? | back 456 B) Paternal uniparental disomy |
front 457 A child is diagnosed with Prader-Willi syndrome due to loss of
paternal chromosome 15 gene expression. Which
genetic mechanism could cause this disorder? | back 457 A) Maternal uniparental disomy |
front 458 What type of tissues are typically affected in
mitochondrial diseases? | back 458 Those with increased energy requirements |
front 459 Mitochondrial diseases are rare disorders that arise secondary to failure of what process? ____ ____ | back 459 Oxidative phosphorylation |
front 460 Name two mitochondrial myopathies. _____ _____ | back 460 MELAS |
front 461 What would skeletal tissues affected by a mitochondrial
myopathy show under electron microscopy? | back 461 Mitochondrial crystalline inclusions |
front 462 Leber hereditary optic neuropathy typically presents in what part of the population? ____, ____, ____ adults | back 462 Teens, Males, Young Adults |
front 463 Describe the pathophysiology of Leber hereditary optic
neuropathy. | back 463 Mutations in complex I of the electron transport chain → Neuronal death in retina and optic nerve → Subacute permanent bilateral vision loss |
front 464 What is the main characteristic of high-output heart failure? | back 464 Increased |
front 465 What are the 6 causes of high-output heart failure?
| back 465 Advanced cirrhosis |
front 466 By what biochemical mechanism does vitamin K
promote synthesis of clotting factors II, VII, IX, and X?
| back 466 Through γ-carboxylation of glutamic acid residues |
front 467 Why might a patient develop vitamin K deficiency after prolonged
antibiotic use? | back 467 intestinal microbiota |
front 468 What is genetic imprinting? | back 468 One gene copy is expressed while the other is silenced by methylation → Parent-of-origin effects The expressed copy may be mutated, unexpressed, or deleted. |
front 469 An individual presents with hyperphagia, intellectual disability, hypogonadism, hypotonia, and obesity. What is the diagnosis? | back 469 Prader-Willi syndrome |
front 470 What are two consequences of vulnerable child
syndrome? | back 470 The child may miss school (the parents believe their kid is vulnerable to disease, found freq after a major incident) |
front 471 Barrett esophagus: Replacement of nonkeratinized stratified ____ epithelium with nonciliated ____ epithelium with ____ cells | back 471 Replacement of nonkeratinized stratified squamous epithelium with nonciliated columnar epithelium with goblet cells |
front 472 Barrett esophagus leads to increased risk of what cancer? | back 472 Adenocarcinoma |
front 473  | back 473 Barrett esophagus |
front 474 What are the reproductive manifestations of myotonic
dystrophy? | back 474 Gonadal atrophy in men |
front 475 Fragile X syndrome is caused by a trinucleotide repeat expansion of ___. | back 475 CGG |
front 476 What does anticipation refer to in genetic
disease? | back 476 Increased disease severity in successive generations |
front 477 Huntington disease is caused by a trinucleotide repeat expansion of ____ | back 477 CAG |
front 478 Friedreich ataxia is caused by a trinucleotide repeat expansion of ____. | back 478 GAA |
front 479 What is the name of the phenomenon by which a dramatic change in allele frequency occurs by change, and not through natural selection? | back 479 Genetic drift |
front 480 What is the name of the phenomenon observed when a population undergoes a sharp reduction in population size, resulting in new allele frequencies? _____ _____ | back 480 Bottleneck effect |
front 481
Breastfed neonates are deficient in
vitamin K for what two physiologic reasons? | back 481 Breast milk does not contain vitamin K |
front 482 What changes might be seen in the PT, aPTT, and bleeding time in a
neonatal hemorrhage due to vitamin K deficiency?
| back 482 Increased PT |
front 483 A male neonate born at home has a spontaneous intracranial
hemorrhage. What intervention could likely have prevented
this problem? | back 483 K |
front 484  A patient with chronic reflux esophagitis undergoes a workup. Findings on endoscopy are shown. What is the diagnosis? | back 484 Barrett esophagus |
front 485 Barrett esophagus is an example of what kind of pathologic aberration to the normal tissue histology? ______ | back 485 Metaplasia |
front 486 What kind of gifts should physicians politely decline to
accept? | back 486 Inappropriately expensive or large gifts |
front 487 When deciding not to accept a gift from a patient, what is the
recommended way to politely decline? | back 487 gratitude assuring |
front 488 Vitamin ___ is synthesized by intestinal microbiota. | back 488 K |
front 489 Name two essential polyunsaturated fatty acids. _____ acid | back 489 Linoleic acid |
front 490 What two products are created from the metabolism of linoleic acid? ____ | back 490 Leukotrienes |
front 491 Linoleic acid is metabolized to _____ acid, which serves as the precursor to leukotrienes and prostaglandins. | back 491 arachidonic |
front 492 Which polyunsaturated fatty acid has been shown to have antihyperlipidemic and cardioprotective effects? ____ acid | back 492 Linolenic acid |
front 493 Name 2 conditions in which bilateral internuclear ophthalmoplegia is seen. ____ ____ ____ | back 493 Multiple sclerosis |
front 494
internuclear ophthalmoplegia: | back 494 Ipsilateral adduction failure |
front 495 Why is internuclear ophthalmoplegia common in
diseases that affect myelin? | back 495 MLF |
front 496 If the right eye is unable to adduct while an individual is trying to look left horizontally, where is the lesion? _____ medial longitudinal fasciculus | back 496 Right medial longitudinal fasciculus |
front 497 From lateral to medial, what are the 4 deep nuclei of the cerebellum? Fastigial Emboliform Globose Dentate | back 497 Dentate Don't eat greasy food |
front 498 A patient has head tilting, wide gait, and
nystagmus. Where in the cerebellum is the lesion likely to
be? | back 498 Medial |
front 499 Ipsilateral proprioceptive information is sent to what structure of the cerebellum? ____ ____ ____ | back 499 Inferior cerebellar peduncle |
front 500 Describe the path of outputting information from the
cerebellar cortex to the contralateral
motor cortex. | back 500 Cerebellar cortex via Purkinje cells → Deep cerebellar nuclei → Superior cerebellar peduncle → Contralateral motor cortex |
front 501 Voluntary movements are relayed to the cerebullum by the contralateral motor cortex via what structure? _____ cerebellar peduncle | back 501 Middle cerebellar peduncle |
front 502 To what brain structures do the Purkinje cells of the cerebellum project? ____ ____ nuclei | back 502 Deep cerebellar nuclei |
front 503 What are the output neurons of the cerebellar cortex? ____ cells | back 503 Purkinje cells |
front 504 Recurrent falls to the left side indicate a lesion in which location of the cerebellum? _____ _____ cerebellum | back 504 Left lateral cerebellum |
front 505  What is the classic CT finding associated with acute pyelonephritis shown in the image? _____ _____ enlargement | back 505 Striated parenchymal enhancement |
front 506  What is a common histologic finding in kidneys affected by chronic pyelonephritis? ____ casts resembling ____ tissue | back 506 Eosinophilic casts resembling thyroid tissue |
front 507 What finding on urinalysis suggests acute
pyelonephritis? | back 507 White blood cells with or without white blood cell casts |
front 508  What disease process is indicated by the findings in the renal biopsy specimen shown in the image? | back 508 Acute pyelonephritis |
front 509 What form of chronic pyelonephritis is associated
with a history of Proteus infection? | back 509 Xanthogranulomatous pyelonephritis |
front 510 What disease manifests renally as coarse, asymmetric corticomedullary scarring and blunting of calyces? _____ pyelonephritis | back 510 Chronic pyelonephritis |
front 511 What two conditions commonly lead to chronic
pyelonephritis because they predispose individuals to
infection? | back 511 Vesicoureteral reflux |
front 512 What is the likely diagnosis for a patient with fever, chills, nausea, and costovertebral angle tenderness on examination? ______ pyelonephritis | back 512 Acute pyelonephritis |
front 513  What organism most commonly produces the condition demonstrated by the renal biopsy findings shown? _____ _____ | back 513 Escherichia coli |
front 514 What are two common mechanisms for development of acute
pyelonephritis? | back 514 Ascending urinary tract infection |
front 515 What are five risk factors for acute pyelonephritis? | back 515 Urinary tract obstruction |
front 516 ______ are the treatment for acute pyelonephritis | back 516 Antibiotics |
front 517 What do you do if both a woman and her 13-year-old daughter require a
blood transfusion in an emergency, but the father refuses to give
consent, saying both are Jehovah’s Witnesses? | back 517 Transfuse the daughter A healthcare proxy can refuse emergency treatment for an adult patient, but not for a minor, on the basis of religious beliefs. |
front 518 Should you accept a sponsorship offered by a drug company in exchange
for advertising a new drug? | back 518 The offer must be rejected |
front 519 How do you respond when a brain-dead patient's family insists that
life support be maintained because the patient is still moving
when touched? | back 519 Gently inform the family that involuntary movement is caused by
spinal reflexes and that brain death is equivalent to
death |
front 520 What should you do when a physician colleague
arrives at work in an impaired state? | back 520 You are ethically and legally obliged to report impaired colleagues (Seek guidance in making the report because applicable laws and requirements vary by state and institution) |
front 521 How should you respond if your patient wants to try alternative or
holistic medicine? | back 521 Find out why the patient wants this Be supportive and nonjudgemental. You may refer the patient to a naturopath. |
front 522 What should you do if you find out that your patient is experiencing
physical abuse from an intimate partner? | back 522 Ensure that patient is safe and has an emergency plan |
front 523 Do not limit treatment because of ____ or ____ constraints. | back 523 Do not limit treatment because of financial or time constraints. |
front 524 What is the best approach when a 7-year-old boy feels responsible for
his older sister's death from cancer? | back 524 Use concrete terms in discussing his sister's death |
front 525 How should you respond when a 15-year-old pregnant patient wants to keep the baby, but the patient's parents want you to tell her to give the baby up for adoption? The _____ has the right to make choices regarding the baby | back 525 The patient has the right to make choices regarding the baby (Physicians should discuss infant care and adoption as needed and encourage open family discussion.) |
front 526 What is an appropriate response if an invasive test is performed on
the wrong patient? | back 526 tell |
front 527 What is an appropriate response if a woman who had a
mastectomy says she now feels ugly?
| back 527 Find out more about why the patient feels this way without offering falsely reassuring statements |
front 528 What is the most appropriate next step when a patient is
suicidal and has a plan? | back 528 Suggest voluntary hospitalization If necessary, the patient can be hospitalized involuntarily. |
front 529 A patient’s son asks you not to tell his mother the results of a test
if the prognosis is poor because she won't be able to cope with it.
How do you respond? | back 529 Explore his reasoning |
front 530 How would you help a patient if the patient has difficulty
taking medication? | back 530 Provide written instructions |
front 531 How can you help a patient if the patient is not adherent? | back 531 Discuss any logistical or financial obstacles to
adherence |
front 532 What is an appropriate response if a patient is upset with the
treatment provided by another physician? | back 532 Advise the patient to talk directly to that physician (If the problem is with a staff member in your office, tell the patient that you will speak to the person) |
front 533 What is an appropriate response if a patient is angry about the
amount of time spent in the waiting room? | back 533 Apologize for any inconvenience and acknowledge the patient's
anger |
front 534 What is an appropriate response if a patient wants an unnecessary
procedure? | back 534 Discuss the patient's concerns and reasons for requesting the
procedure |
front 535 What is an appropriate response if a patient flirts with you and asks
you out on a date? | back 535 Explain that romantic relationships with patients are never
appropriate (It may be necessary to transfer the patient to another physician) |
front 536 What is the appropriate response if a pregnant 17-year-old patient
requests an abortion? | back 536 Certain states require parental consent for minors to undergo abortion (Unless there are medical concerns, physicians should not attempt to influence the patient's decision) |
front 537 How do you proceed when a family member wants information about a
patient's prognosis? | back 537 Unless the patient gives permission, you should not give the information to family members |
front 538
For vax skeptics: | back 538 Address any concerns |
front 539 What should be done when a dependent patient presents with injuries
inconsistent with the caregiver's account? | back 539 Record detailed history and exam findings |
front 540 How should you proceed if a patient requests a nonemergent treatment
option that is against your personal beliefs? | back 540 Provide accurate and unbiased information, so the patient can make an
informed decision |
front 541 A deficiency in which vitamin results in Wernicke-Korsakoff syndrome? | back 541 Vitamin B1 deficiency |
front 542 What three symptoms are present in Korsakoff syndrome? | back 542 Irreversible memory loss |
front 543 Wernicke-Korsakoff symptoms can be precipitated in a patient with thiamine depletion by administering _____ to a patient before vitamin _____ | back 543 dextrose B1 |
front 544 What are the symptoms of Wernicke encephalopathy? | back 544
Confusion |
front 545 What are six common complications of alcohol use disorder? | back 545 Pancreatitis |
front 546 How does naltrexone help patients with alcohol use disorder? It reduces _____ | back 546 cravings |
front 547 How does disulfiram help patients with alcohol use
disorder? | back 547 It conditions the patient to abstain from alcohol use |
front 548 Which three medications are commonly prescribed for the management of
alcohol use disorder? | back 548 Naltrexone |
front 549 Where are the cranial nerve nuclei generally located within the
brainstem? | back 549 In the tegmentum. This is between dorsal and ventral portions of the brainstem. |
front 550 What is the longitudinal groove that separates the sensory and motor areas of the spinal cord and brainstem? ____ ____. This forms during embryonic development of the ____ and
____ plates. | back 550 Sulcus limitans. This forms during embryonic development of the alar and basal plates. |
front 551 What general functions are coordinated by the medial brainstem nuclei? ____ functions | back 551 Motor functions |
front 552 What general functions are coordinated by the lateral brainstem nuclei? ____ functions | back 552 Sensory functions |
front 553 Which cranial nerve nucleus is located in the spinal cord? | back 553 Nucleus of cranial nerve XI |
front 554 Which cranial nerve nuclei are located in the
medulla? | back 554 Nucleus of cranial nerve IX |
front 555 Which cranial nerve nuclei are located in the
pons? | back 555 Nucleus of cranial nerve V |
front 556 Which cranial nerve nuclei are located in the
midbrain? | back 556 Nucleus of cranial nerve III |
front 557 What three general classes of drugs may lead to
mydriasis? | back 557 Anticholinergics |
front 558 What four general classes of drugs may lead to miosis? | back 558 Sympatholytics |
front 559  | back 559 fetal alcholol syndrome |
front 560 fetal alcholol syndrome: Impaired migration of ____ and ____ cells | back 560 Impaired migration of neuronal and glial cells |
front 561 What conditions characterize the most severe form of fetal alcohol
syndrome? | back 561 Heart-lung fistulas |
front 562 What limb abnormality is associated with fetal alcohol syndrome? | back 562 Limb dislocation |
front 563 What condition associated with substance use by a pregnant woman is a leading preventable cause of intellectual disability in the United States? | back 563 Fetal alcohol syndrome |
front 564 What craniofacial findings are characteristic of fetal alcohol
syndrome? | back 564 Microcephaly |
front 565 What are the treatment options for performance-type social anxiety disorder? ____-blockers ____ | back 565 β-blockers |
front 566 What disorder is agoraphobia commonly associated with? | back 566 Panic disorder |
front 567 What is the fear of leaving the house, using public transportation, and being in big crowds or open spaces known as? | back 567 Agoraphobia |
front 568 Which treatments can be prescribed for social anxiety
disorder? | back 568 SSRIs |
front 569 How do phobias differ from normal fears? | back 569 Fear present in pathologic phobias is excessive and persistent for over 6 months |
front 570 Do individuals with a phobia recognize their excessive fear? | back 570 Yes |
front 571 What is the treatment for a patient with a
phobia? | back 571 Cognitive behavioral therapy |
front 572 What is the definition of performance-type social anxiety
disorder? | back 572 Anxiety restricted to public speaking or performing |
front 573 What are the treatment options for agoraphobia?
| back 573 Cognitive behavioral therapy |
front 574 A boy hears his mother's voice during the year after her death. He has no depressive or psychotic symptoms. Does he have a disorder? | back 574 No. Hallucinations can occur in the context of normal bereavement. |
front 575 Since his wife died 2 years ago, a man has been severely depressed. He has not been eating or bathing regularly and has not kept up with household tasks. Is this grief normal? | back 575 No. This is persistent complex bereavement disorder. |
front 576 What anomaly in the coagulation cascade causes
thrombosis in a patient with factor V Leiden
mutation? | back 576 Production of a factor V that resists activated protein C inhibition |
front 577 What medication may reduce brain damage in acute thrombotic stroke if given within 3 to 4.5 hours of onset? | back 577 tPA |
front 578 What is tPA used for clinically? _____ | back 578 Thrombolytic. This activates plasminogen to plasmin. |
front 579 What is the role of protein S in anticoagulation? | back 579 Protein S is a cofactor for protein C |
front 580 Name the three endogenous factors that promote
anticoagulation. | back 580 Antithrombin III |
front 581 Why is vitamin K administration necessary for
neonates soon after birth? | back 581 They lack enteric bacteria that produce vitamin K |
front 582 What drug does inhibition of vitamin K epoxide reductase (leading to less Vitamin K coag function)? | back 582 Warfarin |
front 583 What drug does enhancement of antithrombin III activity? | back 583 Heparin |
front 584 What two medications can be administered to reverse the
inhibitory effect of warfarin? | back 584 Vitamin K (slow reversal) |
front 585 Which coagulation factor has the shortest half life? | back 585 Factor VII |
front 586 Which coagulation factor has the longest half life? | back 586 Factor II |
front 587 Activated forms of which factors are susceptible to
inhibition by antithrombin? | back 587 Factor II |
front 588 What are the two principal targets of
antithrombin? | back 588 Thrombin |
front 589 Which enzyme is responsible for converting inactive vitamin K-dependent factors to their active forms? ___-___ ______ | back 589 γ-glutamyl carboxylase |
front 590 What is the first step in the protein C pathway? | back 590 Thrombin-thrombomodulin complex activates protein C |
front 591 How does activated protein C proceed to inactivate
factors Va and VIIIa? | back 591 Requires protein S to cleave factors Va and VIIIa |
front 592 List, in order, the structures through which sperm must travel to
complete ejaculation. | back 592 Seminiferous tubules → Epididymis → Vas deferens → Ejaculatory ducts → Urethra → Penis |
front 593 Are the symptoms and motivation of malingering
intentional or unconscious? | back 593 Malingering symptoms → Intentional |
front 594 Are the symptoms and motivation of factitious
disorder intentional or unconscious? | back 594 Factitious disorder symptoms → Intentional |
front 595 Are the symptoms and motivation of somatic symptom disorders
intentional or unconscious? | back 595 Somatic symptom disorders symptoms → Unconscious |
front 596 What are three dermatologic manifestations of sulfa
allergy? _____sensitivity | back 596 Urticaria |
front 597 What common allergen is shared by sulfonamides, sulfasalazine, probenecid, furosemide, acetazolamide, celecoxib, thiazides, and sulfonylureas? | back 597 Sulfa |
front 598 What are three hematologic manifestations of
sulfa allergy? | back 598 Hemolytic anemia |
front 599 What are two genitourinary manifestations of a
sulfa allergy? | back 599 Increased risk of urinary tract infection |
front 600 When would ethacrynic acid be used in place of furosemide or other loop diuretics? Diuresis in patients allergic to ____ drugs | back 600 Diuresis in patients allergic to sulfa drugs |
front 601 Which two cholinomimetic drugs can be used in the treatment of glaucoma? ____ ____ | back 601 Carbachol |
front 602 What is the mechanism of action of bethanechol, carbachol, pilocarpine, and methacholine? {Direct/Indirect} ______ agonism | back 602 Direct cholinergic agonism |
front 603 Why is pilocarpine useful in the treatment of patients with dry eyes and dry mouth? It is a potent stimulator of sweat, tears, and saliva production via _____ action on muscarinic receptors and smooth muscles | back 603 It is a potent stimulator of sweat, tears, and saliva production via parasympathomimetic action on muscarinic receptors and smooth muscles |
front 604 What action of pilocarpine makes it useful in the treatment of open-angle glaucoma? _____ of the _____ muscle | back 604 contraction of the ciliary muscle |
front 605 What action of pilocarpine makes it useful in the treatment of closed-angle glaucoma? _____ of the _____ _____ muscle | back 605 contraction of the pupillary sphincter muscle |
front 606 Which direct cholinomimetic is used to treat xerostomia commonly associated with Sjögren syndrome? | back 606 Pilocarpine |
front 607 Which three direct cholinomimetic drugs are resistant to degradation by acetylcholinesterase? _____ _____ _____ | back 607 Bethanechol Carbachol Pilocarpine |
front 608 What condition- patient with severe eye pain caused by blockage of aqueous humor outflow? | back 608 acute angle-closure glaucoma |
front 609 Relative to the inferior epigastric vessels, where
do a direct and an indirect inguinal hernia present? | back 609 Direct hernia → Medially |
front 610 From what muscle layer does the external
spermatic fascia of the spermatic cord originate?
| back 610 External oblique muscle |
front 611 From which layer does the cremasteric muscle and fascia derive? ____ ____ muscle | back 611 Internal oblique muscle |
front 612 From which layer does the internal spermatic fascia derive? _____ fascia | back 612 Transversalis fascia |
front 613 What layers comprise the spermatic cord? | back 613 Internal spermatic fascia |
front 614 Through what structure does a direct inguinal hernia protrude? _____ _____ | back 614 Abdominal wall |
front 615 Through which structure does an indirect
inguinal hernia protrude?
| back 615 Internal inguinal ring |
front 616 List the layers of the anterior abdominal wall lateral to the deep
inguinal ring, from the parietal peritoneum to the external oblique aponeurosis. | back 616 Parietal peritoneum |
front 617 How can you confirm a diagnosis of vitamin B1 deficiency?
| back 617 Increased RBC transketolase activity following vitamin B1 administration |
front 618 In the emergency department, a man with a history of
alcoholism requests a drink and receives
orange juice. He is later found in an obtunded state. What
is the cause of the change in status? | back 618 Impaired glucose breakdown → ATP depletion that is exacerbated by glucose infusion This occurs in thiamine deficiency |
front 619 Which regions of the brain are damaged in Wernicke-Korsakoff syndrome
as a result of vitamin B1 deficiency? | back 619 Mammillary bodies Periaqueductal gray matter |
front 620 Why are the heart and brain
particularly susceptible to injury in patients with thiamine deficiency? | back 620 Highly aerobic cells require more ATP to function |
front 621  What is the likely diagnosis for a patient with a known lung malignancy presenting with jugular venous distention and the skin finding shown? | back 621 Superior vena cava syndrome. Shown is blanching after fingertip pressure, which is characteristic of facial plethora. |
front 622 Thiamine is required for the breakdown of ____ and the production of ____. | back 622 glucose ATP |
front 623 Dry beriberi is characterized by ____ and ____ ____ wasting. | back 623 polyneuropathy symmetric muscle |
front 624 What is a major complication of wet beriberi caused
by vitamin B1 deficiency? | back 624 High-output cardiac failure |
front 625 What is the role of thiamine in the TCA cycle?
| back 625 It is a cofactor for α-ketoglutarate dehydrogenase |
front 626 Vitamin B1 (thiamine) is the direct precursor to ________ ________ (TPP), also known as thiamine diphosphate. | back 626 thiamine pyrophosphate |
front 627 What do all these need as a cofactor? Branched-chain ketoacid dehydrogenase | back 627 thiamine pyrophosphate (TPP) |
front 628  | back 628 D. free radical oxidative damage to CNS neurons This is Wernicke encephalopathy from thiamine deficiency. |
front 629 When does hCG typically peak during pregnancy? | back 629 At 8 to 10 weeks' gestation |
front 630 When is hCG first detectable in the blood and urine of a pregnant patient? | back 630 Blood → Detectable 1 week(s) after fertilization |
front 631 What is the difference between embryonic/developmental age and
gestational age? | back 631 Gestational age is calculated from the last menstrual
period |
front 632 What cell type secretes hCG shortly after conception? | back 632 Syncytiotrophoblasts |
front 633 When does implantation occur in relation to ovulation? | back 633 1 week(s) after ovulation |
front 634 When does fertilization occur in relation to ovulation? | back 634 Within 1 day(s) of ovulation |
front 635 Where is the most common area of fertilization in the female
reproductive tract? | back 635 Ampulla of the fallopian tube |
front 636 What are two major treatment options for patients with a varicocele? | back 636 Surgical ligation |
front 637 What is the major reason varicoceles are more common on the
left side of the body? | back 637 The left gonadal vein drains into the left renal vein → Increased venous pressure |
front 638 What is the pathophysiologic mechanism associated with the
development of a varicocele? | back 638 Increased venous pressure → Dilation of the pampiniform plexus |
front 639 What are two major ways to clinically diagnose a varicocele? | back 639 Ultrasound |
front 640  What is the pathophysiologic mechanism by which the pathology leads to infertility? _____ increase in the scrotum impairs _____ | back 640 Temperature increase in the scrotum impairs spermatogenesis |
front 641 What are the two major indications for
intervention in a patient with a varicocele? | back 641 Pain |
front 642 What is the significance of a patient with a right-sided
varicocele that does not resolve
when the patient lies supine?
| back 642 Indicates inferior vena cava obstruction |
front 643 Which antidepressants are contraindicated for patients who are taking
tramadol and why? | back 643 SSRIs, SNRIs, and MAO inhibitors are contraindicated due to the risk of serotonin syndrome |
front 644 What 3 kinds of adverse effects may
occur with tramadol? | back 644 Opioid-like adverse effects |
front 645 What is the mechanism of action of tramadol? | back 645 Weak opioid agonist |
front 646 How does malignant carcinoid syndrome cause pellagra? | back 646 Tryptophan is shunted primarily toward the synthesis of serotonin, leaving less tryptophan to synthesize niacin |
front 647 Precocious puberty can be diagnosed if secondary sexual
characteristics develop before what age? | back 647 8 years for girls |
front 648 What mechanism causes short stature in children affected by
precocious puberty? | back 648 Increased sex hormone exposure or production → Early skeletal maturation → Premature closure of the epiphyseal plates |
front 649 What is the difference in the mechanism of disease for
central and peripheral precocious puberty?
| back 649 Central precocious puberty → Increased GnRH secretion |
front 650 What are two causes of central precocious puberty?
| back 650 Idiopathic |
front 651 What are two possible oncologic causes of peripheral
precoious puberty?
| back 651 Estrogen-secreting ovarian tumor |
front 652 What are two congenital conditions that may cause
peripheral precocious puberty?
| back 652 Congenital adrenal hyperplasia |
front 653 What is the likely diagnosis of an obese patient presenting with snoring, disrupted sleep, reduced PaO2, and increased PaCO2? ____ ____ AKA ____ syndrome | back 653 Obesity hypoventilation AKA Pickwickian syndrome |
front 654 What is the first-line treatment for central sleep apnea? | back 654 Positive airway pressure |
front 655 What test confirms the suspected diagnosis in an obese patient presenting with daytime somnolence, disrupted sleep, and loud snoring? | back 655 Sleep study |
front 656 What is the pathophysiologic mechanism that leads to a high
hematocrit in a patient with daytime somnolence,
disrupted sleep, and loud snoring?
| back 656 Increased erythropoietin release secondary to hypoxia → Increased erythropoiesis |
front 657 What anatomic abnormality is commonly associated with obstructive
sleep apnea in adults? | back 657 Excess parapharyngeal tissue |
front 658 What anatomic abnormality is commonly associated with obstructive
sleep apnea in children?
| back 658 Adenotonsillar hypertrophy |
front 659 What are the two preferred treatment options for obesity
hypoventilation syndrome? | back 659 Weight loss |
front 660 What is the major difference in the etiology of central sleep apnea
compared to obstructive sleep apnea? | back 660 Central sleep apnea is due to CNS-driven impairment in respiratory
effort |
front 661 What severe complications are commonly seen due to nocturnal
hypoxia in sleep apnea? | back 661 Arrhythmias |
front 662 What happens to a patient's PaCO2 in the setting of
obesity hypoventilation syndrome? | back 662 Increased PaCO2 is seen during waking and sleeping hours |
front 663 What would you expect the daytime PaO2 to be in a patient with sleep apnea? | back 663 Normal |
front 664 What three findings are classically associated with
obstructive sleep apnea?
| back 664 Obesity |
front 665 What is the pathophysiologic mechanism whereby sleep apnea leads to
sleep disruption? | back 665 Repeated cessation of breathing during sleep → Sleep disruption |
front 666 What are the three most common causes of central sleep apnea? | back 666 Opioid use |
front 667 What type of sleep apnea can cause a patient with advanced heart
failure to oscillate between apnea and hyperpnea during sleep? | back 667 Central sleep apnea. This is associated with Cheyne-Stokes respirations in some patients, as well as congestive heart failure and central nervous system toxicity. |
front 668 What five treatment options are commonly recommended in patients with
obstructive sleep apnea? | back 668 Weight loss |
front 669 What term describes the behavior of a physician projecting feelings about a formative or other important individual, such as a younger sibling, onto a patient? | back 669 Countertransference |
front 670 What term describes the behavior of a patient projecting feelings about a formative or other important individual, such as a parent, onto a physician? | back 670 Transference |
front 671 What genetic abnormalities are associated with horseshoe kidney? _____ _____ | back 671 Chromosomal aneuploidies. Examples include Turner syndrome and trisomies 13, 18, and 21. |
front 672 A horseshoe kidney gets trapped beneath which artery? | back 672 Inferior mesenteric artery |
front 673 What is the pathophysiology behind the horseshoe kidney? | back 673 Inferior poles of both kidneys fuse → Kidneys are trapped under the inferior mesenteric artery during ascension in fetal development |
front 674 What complications may arise in a patient born with a horseshoe
kidney? | back 674 Infection |
front 675 What vessel is likely blocked in a patient presenting with a left lung mass, headaches, dizziness, and a berry aneurysm on angiography? | back 675 Superior vena cava |
front 676 Superior vena cava syndrome puts a patient at risk for rupture of
which arteries? | back 676 Intracranial arteries. These arteries may burst as a result of elevated intracranial pressure. |
front 677 What has likely occurred in a patient with superior vena cava
syndrome who has developed rapid-onset confusion, loss of
sensation, and hemiparesis?
| back 677 Critically increased intracranial pressure → Intracranial bleed This is either from a ruptured aneurysm or an intracranial artery. |
front 678 What are the two most common causes of superior vena cava syndrome? | back 678 Malignancy |
front 679  How urgently should a patient with an indwelling venous catheter, facial edema, and the CT findings shown be treated? | back 679 Treat emergently |
front 680 Thoracodorsal innervates what muscle? | back 680 lat |
front 681 Damage to the long thoracic nerve would affect which arm abductor muscle? | back 681 serratus anterior |
front 682 A patient has a lesion on the long thoracic nerve and presents with a winged scapula. Where is the lesion located in the brachial plexus? _____ of the brachial plexus | back 682 {{c1::Root}} of the brachial plexus |
front 683 With which artery does the long thoracic nerve travel in the axillary region? | back 683 long thoracic artery |
front 684 What is the most common presentation of cavernous sinus syndrome? | back 684 Variable ophthalmoplegia |
front 685 Which arteries pass through the cavernous sinus? | back 685 Internal carotid arteries |
front 686 What 3 underlying conditions may cause cavernous sinus syndrome? | back 686 Pituitary tumors |
front 687 Which 5 cranial nerves may be endangered when a cavernous sinus
thrombosis forms? | back 687 Cranial nerve III |
front 688 What is the pathway of blood from the eye and superficial
cortex to the greater venous system?
| back 688 This is via the cavernous sinus to the internal jugular vein |
front 689 The cavernous sinus is a collection of venous sinuses surrounding what structure? ______ gland | back 689 Pituitary gland |
front 690 How is a detectable signal produced in an ELISA? | back 690 An {{c1::antibody}} linked to an enzyme reacts with an added {{c1::substrate}} to produce the detectable signal |
front 691 What is an ELISA used to detect? | back 691 Specific antibodies or antigens in a blood sample |
front 692 ELISA is _____ specific than a Western blot | back 692 ELISA is less specific than a Western blot |
front 693 Which immunologic test is commonly used to screen for HIV infection? | back 693 ELISA |
front 694 Which collagen type production is impaired in osteogenesis imperfecta? | back 694 type 1 |
front 695 What cells are responsible for secretion of type IV collagen and wound contraction? ______ | back 695 Myofibroblasts |
front 696 Which type of collagen makes up reticulin? | back 696 type 3 |
front 697 What type of collagen is targeted by autoantibodies in Goodpasture syndrome? | back 697 type 4 |
front 698 Name the most abundant protein in the body, which undergoes extensive posttranslational modification. | back 698 Collagen |
front 699 Who is in charge of medical decision-making if a patient's
ventilator-assisted support information is absent?
| back 699 Surrogate decision-makers. This is either patient determined or legally determined. |
front 700 What steps are necessary if the decision is made to withhold or
withdraw life support from a patient? | back 700 Palliative care This is via primary care physician discussions. |
front 701 What measures are prohibited under the DNR order? | back 701 Performing CPR Patients may still consider other life-sustaining measures. |
front 702 How can problems arise in an oral advance directive? | back 702 Arise from variance in interpretation |
front 703 What is an advance directive? | back 703 Oral or written instructions given by a patient in anticipation of a need to make important medical decisions |
front 704 What is a written advance directive? | back 704 A document that details specific interventions the patient is willing to accept or reject while receiving treatment for a critical or life-threatening illness |
front 705 Which type of advance directive has more flexibility than a living will? _____ _____ of _____ | back 705 Medical power of attorney |
front 706 Medical power of attorney may be revoked by a patient at any time if _____ -_____ capacity is intact. | back 706 decision-making |
front 707 What is medical power of attorney? | back 707 Designation of someone by the patient as legally authorized to make medical decisions if the patient loses decision-making capacity |
front 708 Name the three methods by which patients can establish advance directives. | back 708 Oral advance directive |
front 709 What four factors would make an oral advance directive more valid? | back 709 The patient was informed |
front 710 What are five notable exceptions to patient confidentiality? | back 710 Patients with suicidal/homicidal ideation |
front 711 What are the general principles that guide exceptions to patient confidentiality? | back 711 Potential of harm to self or others is imminent and
serious |
front 712 In what common situation may a patient voluntarily waive the right to confidentiality? | back 712 To comply with insurance company requests |
front 713 Is a minor's assent necessary even if their consent is not? | back 713 Yes |
front 714 What circumstances make a minor legally emancipated?
| back 714 Married |
front 715 Under what special circumstances is parental notification not
required for care of a minor < 18 years of age? | back 715 Treatment of sexually transmitted infections |
front 716 What ethical principle has been balanced against beneficence when a patient with cancer is treated with drugs causing multiple adverse effects? | back 716 Nonmaleficence |
front 717 Which core ethical principle of medicine dictates that all patients must be treated fairly and equitably? | back 717 Justice |
front 718 Which core ethical principle allows a patient with cancer who has decision-making capacity to refuse life-prolonging treatment? | back 718 Autonomy |
front 719 Does the core principle of justice dictate that all patients always be treated equally? | back 719 No. Patients sometimes need to be triaged according to disease severity. |
front 720 What core ethical principle traditionally supersedes beneficence when a patient has decision-making capacity? | back 720 Autonomy |
front 721 Who has the power to determine a patient's legal competence to make an informed healthcare-related decision? | back 721 Judge |
front 722 Who determines a patient's capacity to make an informed healthcare-related decision? | back 722 Physician |
front 723 If a patient loses capacity, can the previous decisions made with full capacity be revoked? ____ | back 723 No |
front 724 Are intellectual disabilities and mental illness exclusion criteria for informed decision-making? ____ | back 724 No. The exception is if the condition presently impairs the ability to make healthcare decisions. |
front 725 With regard to age, how do you determine decision-making capacity?
| back 725 Age ≥ 18 years Legally emancipated |
front 726 Which two metal storage diseases can result
in free radical injury?
| back 726 Wilson disease Hemochromatosis |
front 727
Free radical damage by carbon
tetrachloride leads to what pathologic processes? | back 727 Fatty changes in the liver Centrilobular necrosis in the liver |
front 728 What type of free radical injury is of greatest concern in a patient who has recently undergone thrombolysis for acute limb ischemia? ____ injury | back 728 Reperfusion injury |
front 729  Cardiac tamponade: Diastolic pressures in all four chambers would be ______ | back 729 equilibrated |
front 730 What are the two ECG abnormalities you would expect in patients with
cardiac tamponade? | back 730 Low-voltage QRS amplitude Electrical alternans |
front 731 What is the triad of symptoms commonly seen in patients with cardiac
tamponade? AKA Beck's triad ____ ____ heart sounds | back 731 hypotension JVD Muffled heart sounds |
front 732 What is the finding of a decrease in systolic blood pressure by more than 10 mmHg during inspiration called? | back 732 Pulsus paradoxus |
front 733 What pathology causes compression of the heart by fluid, such as an effusion, resulting in decreased cardiac output? | back 733 Cardiac tamponade |
front 734 What are the most common causes of pulsus paradoxus? | back 734 Constrictive pericarditis |
front 735  ____ ____ | back 735 Pericardial effusion The ECG reveals electrical alternans, which is caused by a "swinging" movement of the heart in a large effusion. |
front 736  Red arrow → ____ cells | back 736 Red arrow → Anitschkow cells |
front 737 How does the heart murmur of rheumatic heart disease change with time? | back 737 Early disease → Mitral regurgitation |
front 738 What type of hypersensitivity reaction is responsible for rheumatic
fever and what is the pathophysiologic mechanism associated with it? | back 738 Type II hypersensitivity reaction in which antibodies to M protein cross-react with self-antigens. This is known as molecular mimicry. |
front 739 Which heart valves are preferentially affected in rheumatic heart disease? | back 739 Mitral valve > Aortic valve >> Tricuspid valve High-pressure valves are most affected |
front 740 What antibiotic serves as both treatment and prophylaxis for rheumatic fever? _____ | back 740 Penicillin |
front 741 What two antibody titers are commonly elevated in patients with rheumatic fever? A. Anti-dsDNA and anti-Smith | back 741 C. Anti-DNase B and anti-streptolysin O |
front 742 What are the five major criteria for the diagnosis of rheumatic fever? ____ pain | back 742 Joint pain |
front 743  ____ ____ | back 743 Erythema marginatum |
front 744 Rheumatic fever is a result of pharyngeal infection with what organism? Group ___ ___ This is a ___-hemolytic organism. | back 744 Group A streptococci This is a β-hemolytic organism |
front 745 What distinguishes cDNA from
nuclear dsDNA? | back 745 introns |
front 746 In molecular cloning, cDNA
fragments are inserted into
bacterial plasmids. What
gene do these bacterial plasmids contain?
| back 746 Antibiotic resistance gene |
front 747 What enzyme is used to synthesize cDNA from mRNA in molecular cloning? _____ _____ | back 747 Reverse transcriptase |
front 748 Which best describes molecular cloning? A. Sequencing all chromosomes | back 748 B. Producing recombinant DNA in bacteria |
front 749 What is ranolazine used to treat? ____ ____ | back 749 refractory angina |
front 750 What is the mechanism of action of ranolazine? | back 750 Inhibition of the late phase of the inward Na+ current → Decrease in diastolic wall tension and oxygen consumption It does not affect heart rate or blood pressure. |