What covalent change occurs in Na⁺/K⁺-ATPase when K⁺ is transported into the cell?

The pump is [...]

dephosphorylated

The ATP binding site of Na⁺/K⁺-ATPase is located on which side of the plasma membrane?

Cytosolic side

What is the mechanism of action of cardiac glycosides?

[...] blockade → Decreased activity of [...] antiporter → Increased [[...]] intracellularly → Increase in cardiac contractility

Na⁺/K⁺-ATPase blockade → Decreased activity of Na⁺/Ca²⁺ antiporter → Increased [Ca²⁺] intracellularly → Increase in cardiac contractility

For each ATP consumed, Na⁺/K⁺-ATPase transports how many Na⁺ and K⁺ molecules, and in what direction?

[...] Na⁺ molecules [in/out]
[...] K⁺ molecules [in/out]

3 Na⁺ molecules out
2 K⁺ molecules in

What two cell types are rich in the smooth endoplasmic reticulum?

[...] cells
[...]

Steroid hormone-producing cells
Hepatocytes

Which organelle is resposible for steroid synthesis and detoxification of poisons and drugs?

Smooth endoplasmic reticulum

Which organelle found in the rough endoplasmic reticulum is missing from the smooth endoplasmic reticulum?

Surface ribosomes

Name the enzyme involved in both glycogenolysis and gluconeogenesis that is found in the smooth endoplasmic reticulum.

Glucose-6-phosphatase

Where are cytosolic, peroxisomal, and mitochondrial proteins synthesized?

Free ribosomes

What is the histologic term for the rough endoplasmic reticulum in neurons?

Nissl bodies

Name two cell types that would be rich in the rough endoplasmic reticulum.

Goblet cells
Plasma cells

Which organelle synthesizes secretory proteins and adds N-linked oligosaccharides to proteins?

Rough endoplasmic reticulum

Defects in the ubiquitin-proteasome system have been linked to which neurologic disease?

[...] disease

Parkinson disease

Which barrel-shaped protein complex degrades damaged or ubiquitin-tagged proteins?

Proteasome

What screening test can be used to identify patients with primary ciliary dyskinesia?

Nasal nitric oxide

Nasal nitric oxide would be _____ in primary ciliary dyskinesia

decreased

Where are proteins within Golgi bodies, lysosomes, and the endoplasmic reticulum synthesized?

Rough endoplasmic reticulum

Why would a patient with the finding in the chest X-ray shown be at an increased risk for hearing loss?

[...] of the [...] is dysfunctional

Cilia of the eustachian tube is dysfunctional

Why are patients with primary ciliary dyskinesia likely to be infertile or develop recurrent ectopic pregnancy?

Dysfunctional cilia of the [...] in females
Immotile [...] in males

Dysfunctional cilia of the fallopian tube in females
Immotile spermatozoa in males

What leads to dysfunctional cilia in patients with primary ciliary dyskinesia?

Defect in the [...] → Immotile cilia

dynein arm

Why do patients with primary ciliary dyskinesia develop recurrent infections of the respiratory tract?

Impaired [...] of debris and pathogens → Sinusitis, ear infections, and bronchiectasis

mucociliary clearance

What is the mode of inheritance of primary ciliary dyskinesia?

Autosomal recessive

What is this?

osteogenesis imperfecta

What is the pathophysiology of a disease in a child with poor dentition, blue sclerae, and fractures and bone deformities after minimal trauma?

Decreased production of ______ ______ ______

Decreased production of type I collagen

What medication can help reduce the incidence of fractures in patients with osteogenesis imperfecta? ______

Bisphosphonates

What is the pathophysiology behind opalescent teeth in patients with osteogenesis imperfecta?

Lack of ______ → Teeth that become worn out easily

dentin

How is the most common form of osteogenesis imperfecta inherited?

Autosomal dominant

What is the cause of conductive hearing loss in a child with recurrent fractures and blue sclerae as shown in the image below? ______ ______

Abnormal ossicles

What are the manifestations of osteogenesis imperfecta?

Multiple [...]
[Color] sclerae
[...] imperfections
[...] loss

Multiple fractures
Blue sclerae
Dental imperfections
Hearing loss

What are the most common genetic mutations involved in osteogenesis imperfecta?

______

______

COL1A1
COL1A2

What causes blue sclerae in osteogenesis imperfecta?

______ connective tissue overlying ______ veins

Translucent, choroidal

Which type of collagen is affected in the vascular type of Ehlers-Danlos syndrome? ______ ______ ______

Type III collagen

What is the most common type of Ehlers-Danlos syndrome?

______ type

Hypermobility type

Ehlers-Danlos syndrome is transmitted through what two inheritance patterns?

______ ______

______ ______

Autosomal dominant
Autosomal recessive

Ehlers-Danlos syndrome is due to a defect in what process?

______ ______

Collagen synthesis

What types of aneurysms are commonly associated with Ehlers-Danlos syndrome?

[...] aneurysms
[...] aneurysms

Berry aneurysms
Aortic aneurysms

What type of specific collagen is affected in a patient with easy bruising and findings as shown in the image below?

Type V collagen

Which type of Ehlers-Danlos syndrome has fragile vessels, muscles, and organs prone to rupture? ______ ______.

There is a mutation in type III collagen caused by ______.

Vascular type

COL3A1.

What is this?

Cilia

Cilia consist of microtubules arranged in ___ doublets around ___ central singlets.

9

2

Which cellular structure is shown in the image below?

Basal body

Basal body is located at the ___ of the ___, below the cell membrane.

base

clium

Basal Body constists of ___ ___ ___ without any central microtubules.

9 microtubule triplets

What ATPase protein links the peripheral nine doublets and allows for bending of the cilia by differential sliding of the doublets? ___ ___

Axonemal dynein

What cell junctions allow for coordinated movement of cilia?

___ ___

Gap junctions

What type of cilia act as chemical signal sensors and play a role in signal transduction and control of cell growth?

___ ___

Non-motile cilia

Non-motile cilia is AKA ___ cilia.

primary

Which conditions may occur due to dysgenesis of non-motile cilia?

___ degeneration
___ kidney disease
___ valve prolapse

Retinal degeneration
Polycystic kidney disease
Mitral valve prolapse

Common complications of EDS include aortic and berry aneurysms, mitral valve prolapse, and ___ ___.

organ rupture.

What is the most common enzyme deficiency that leads to homocystinuria?

[...] deficiency

Cystathionine synthase deficiency

Elastin is rich in which three amino acids?

Proline
Glycine
Lysine

What is the function of fibrillin-1?
It is a glycoprotein that forms a sheath around [...] and sequesters [...]

elastin

tgf-b

What enzyme is inhibited by α₁-antitrypsin?

Elastase

Elastase degrades [...]

elastin

In which cellular compartment does cross-linking of elastin by lysyl oxidase occur?

Extracellular space

Name two aortic/vascular pathologies associated with Marfan syndrome.

Aortic root [...] or [...]
[...] of the aorta

Aortic root aneurysm rupture or dissection
Cystic medial necrosis of the aorta

What is arachnodactyly?

[Long/Short], [...] fingers and toes

Long, tapering fingers and toes

arachnodactyly is seen in patients with _____ syndrome or _____.

Marfan

homocystinuria

What valvular abnormality is most commonly associated with Marfan syndrome?

Mitral valve prolapse

How is lens dislocation in Marfan syndrome different from that in homocystinuria?

Lens dislocate [upward/downward] and [...] in Marfan syndrome
Lens dislocate [upward/downward] and [...] in homocystinuria

Lens dislocate upward and temporal in Marfan syndrome
Lens dislocate downward and nasal in homocystinuria

How does Marfan syndrome affect the intellect of a patient?

homocystinuria?

Normal

Decreased

What lung disease can be caused by a deficiency of α₁-antitrypsin?

COPD

A mutation in what gene is responsible for a tall child presenting with arachnodactyly, hypermobile joints, and the deformity in the image?

A mutation in ____ on chromosome ____

FBN1, 15

What is the inheritance pattern of Marfan syndrome?

Autosomal dominant

What protein is abundantly found in the vocal cords, epiglottis, lungs, large arteries, elastic ligaments, skin, and ligamenta flava?

Elastin

Which disease presents with an increased arm to height ratio, pectus deformity, skin hyperelasticity, arachnodactyly, and scoliosis similar to Marfan syndrome?

Homocystinuria

Impaired copper metabolism in Menkes disease ultimately results in a defective production of what protein?

Collagen

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?

Menkes disease

How do serum copper levels differ in Menkes disease when compared with Wilson disease?

Copper levels are [high/low] in Menkes disease
Copper levels are [high/low] in Wilson disease

low

high

The activity of what enzyme is decreased in Menkes disease?

Why?

Lysyl oxidase

Copper is a necessary cofactor

Menkes gene?

ATP7A

impairment at which point is responsible for the pathophysiology of Li-Fraumeni syndrome and cervical cancer?

modulated by what?

The G₁-S checkpoint

p53

What are cyclins?

[...] proteins that activate [...] at appropriate times in the cell cycle when stimulated by [...] factors

Regulatory

CDKs

growth

List the three components of interphase.

[...] phase
[...] phase
[...] phase

G₁ phase
S phase
G₂ phase

Which type of cells divide rapidly with a short G₁ phase, never enter G₀ phase, and are most affected by chemotherapy?

Labile cells

What cells include hepatocytes, periosteal cells, proximal convuluted tubule cells, and lymphocytes.

Stable cells

What cells include hair follicles, skin, bone marrow, gut epithelium, and germ cells?

Labile cells

What cell type, as classified by cell cycle regulation, can enter the G₁ phase of the cell cycle from the G₀ phase when stimulated?

Stable cells

Permanent cells such as neurons, red blood cells, skeletal myocytes, and cardiac myocytes are arrested in which phase of the cell cycle?

G₀ phase

Which phase of the cell cycle has a variable duration?

G₁ phase

Which phase of the cell cycle is usually the shortest?

M phase

During which phase of the cell cycle can a cell enter the G₀ phase?

G₁ phase

When does DNA synthesis occur in the cell cycle?

S phase

What two processes occur during the M phase?

Mitosis
Cytokinesis

Mitosis is the splitting of the _______.

Cytokinesis is the splitting of the _______.

nucleus

cytoplasm

What is the mechanism by which the p53 protein inhibits the progression of the cell cycle from the G₁ phase to the S phase?

Damaged DNA → p53 induces [...] → Inhibits [...] → Hypophosphorylates (activates) [...] protein → Inhibits progression from G₁ phase to S phase

p21

CDK

retinoblastoma

How do growth factors promote the transition of a cell from the G₁ phase to the S phase?

By binding to [...] receptors

tyrosine kinase

What is the result of having a dysfunctional signal recognition particle in the cell?

Accumulation of [...] in the cytosol

protein

Endosomes act as sorting centers for molecules that are destined for what two purposes?

Sending it to lysosomes for [...]
Sending it back to the plasma membrane or Golgi apparatus for [...] use

degradation

further

What is the role of COPII in vesicular trafficking?

[...] transport from the endoplasmic reticulum to the [...]-Golgi apparatus

anterograde

cis

Which vesicular protein is involved in the trafficking of molecules taken into the cell via receptor-mediated endocytosis?

clathrin

In the Golgi apparatus, the addition of what carbohydrate to proteins makes them a target for lysosomes?

Mannose-6-phosphate

What is the role of COPI in vesicular trafficking?

[...] transport from the Golgi apparatus to the Golgi apparatus or from the [...]-Golgi apparatus to the endoplasmic reticulum

Retrograde

cis

What is the prognosis for a child with symptoms similar to but more severe than those of Hurler syndrome, who has elevated plasma lysosomal enzymes?

The condition is usually [...] in childhood

This is [...] disease.

fatal

inclusion-cell

A boy has coarse facial features, gingival hyperplasia, corneal clouding, claw hand, kyphoscoliosis, and high levels of lysosomal enzymes. What is the inheritance pattern?

Autosomal recessive

N-acetylglucosaminyl-1-phosphotransferase problem, what disease.

inclusion-cell disease

What are the three posttranslational modifications that occur in the Golgi apparatus?

Modification of [...] on asparagine
Addition of [...] on serine and threonine
Addition of [...] to proteins

Modification of N-oligosaccharides on asparagine
Addition of O-oligosaccharides on serine and threonine
Addition of mannose-6-phosphate to proteins

Clathrin functions to transport vesicles from the trans-Golgi apparatus to which organelle?

Lysosome

List three locations to which the Golgi apparatus sends proteins and lipids.

______ ______
______
______ ______

Plasma membrane
Lysosomes
Secretory vesicles

The Golgi apparatus acts as a distribution center for what 2 macromolecules?

Proteins
Lipids

Which enzyme system mediates phase I metabolism of drugs in the body?

CYP450

What is the definition of the relapse phase of the transtheoretical model of change?

Patient falls back to previous behavior

What function does the product of TP53 normally perform?

p53 is a transcription factor for _______ → Blocks the transition from _______ phase to _______ phase

p21

g1

s

An S3 heart sound is caused by _______ filling pressures in _______ _______ during rapid ventricular filling phase

increased

early diastole

What 2 heart murmurs have no true isovolumetric phases?

Aortic regurgitation

Mitral regurgitation

Topoisomerase inhibitors used in cancer treatment all cause cell cycle arrest at which two phases?

S

G2

Melanomas have a tumor suppressor gene mutation at CDKN2A. What protein does this gene typically encode?

p16

Is the corpus luteum present during the follicular or luteal phase of the menstrual cycle?

luteal phase

The corpus luteum is formed from the ruptured _______ and produces _______ .

follicle

progesterone

In which phase of the cell cycle does nucleotide excision repair occur?

G1

In which phase of the cell cycle does mismatch repair occur?

S

In which phase of the cell cycle does base excision repair occur?

It occurs throughout the cell cycle

In which phase of the cell cycle do microtubule inhibitors exert their effects?

M

A first-in-human protocol enrolls healthy volunteers and maps effects as a function of dose. This is:
A. Phase 1 trial
B. Phase 2 trial
C. Phase 3 trial
D. Phase 4 trial

A. Phase 1 trial

A study enrolls patients with the target disease to determine whether the drug is efficacious. This is:
A. Phase 4 trial
B. Phase 3 trial
C. Phase 1 trial
D. Phase 2 trial

D. Phase 2 trial

A program expands to much larger numbers of target-disease patients to establish and confirm safety and efficacy. This is:
A. Phase 4 trial
B. Phase 3 trial
C. Phase 1 trial
D. Phase 2 trial

B. Phase 3 trial

Post-approval monitoring begins only after marketing permission is obtained. This corresponds to:
A. Phase 2
B. Phase 1
C. Phase 4
D. Phase 3

C. Phase 4

What 2 sympathetic chain synapses may be compromised in a patient who has Horner syndrome?

lateral horn

superior cervical ganglion

What facial syndrome may occur as a result of spinal cord lesions above T1 or a Pancoast tumor at the stellate ganglion?

Horner Syndrome

horner classic triad

ptosis

anhidrosis

miosis

A hypoplastic nasal bone and an increase in nuchal translucency is present on a fetal ultrasound exam. What is the diagnosis?

down syndrome

Apart from labor contractions and milk letdown, what role does oxytocin play in mood?

regulates it

Down syndrome is most frequently caused by a defect in what process

Meiotic nondisjunction

Females of which age group are at an increased risk of having a child with Down syndrome?

Females of ______ maternal age

advanced

Glucagon stimulates the breakdown of glycogen by which second-messenger system?

cAMP

Is the promoter region upstream or downstream of its gene locus?

Upstream

Lactase breaks down lactose into which two monosaccharides?

Galactose

Glucose

Rank the incidence of the three most common trisomy disorders.

____ syndrome > ____ syndrome > ____ syndrome

Down syndrome > Edwards syndrome > Patau syndrome

What are two functions of oxytocin in the perinatal period?

Increases milk ____
Promotes uterine ____

letdown

contraction

What could cause a person to always use more drugs than intended despite knowing the dangers and trying to cut down on use?

substance use disorder

What disease is suspected if a newborn with evidence of Down syndrome on prenatal screening does not pass meconium after birth but is not vomiting?

Hirschsprung disease

What is the likely cause of sharp, shooting pains that travel down the jaw for several seconds when eating ice cream?

Trigeminal neuralgia

What is the name of the phenomenon by which alleles that increase a species' fitness are more likely to be passed down to offspring?

natural selection

What ophthalmologic finding may be present in a patient with Down syndrome?

Brushfield spots

What organ does glucagon act on to stimulate the breakdown of glycogen?

Liver

What type of hernia is commonly seen in patients with Down syndrome?

umbilical hernia

Which DNA mutation results from an insertion or a deletion of nucleotides that is not divisible by three?

Frameshift mutation

Which enzyme of DNA replication is often upregulated in progenitor cells and tumor cells and downregulated in aging and progeria?

Telomerase

what is this?

duodenal atresia

While breastfeeding, which hormone causes milk letdown in a mother?

Oxytocin

Why are patients with Down syndrome at higher risk of developing Alzheimer disease?

_____ is located on chromosome _____

APP is located on chromosome 21

Mutations of amyloid precursor protein can lead to early-onset _____ _____ .

Alzheimer disease

down syndrome has low levels of what protein?

α-fetoprotein

What is the Wolff-Chaikoff effect?

_____ of the thyroid gland in response to _____ iodine levels

Downregulation of the thyroid gland in response to high iodine levels

What is the most common heritable cause of intellectual disability?

fragile x syndrome

most common cause of genetic intellectual disability?

down syndrome

What is the major difference between necrosis and apoptosis?

Necrosis is associated with local ______ and breakdown of the cellular ______

inflammation

membrane

Duplication of which chromosome results in Klinefelter syndrome?

Chromosome X

Testicular atrophy and infertility in a tall male patient with eunuchoid proportions may indicate which disorder of sex chromosomes?

Klinefelter

A Barr body is an _____ _____ chromosome; found in _____ syndrome in males

inactivated X

Klinefelter

What will an ovarian biopsy show in a patient with Turner syndrome? ____ ____ AKA ____ ____

ovarian dysgenesis AKA streak ovary

Why are females with Turner syndrome more likely to have an X-linked recessive disorder?

They only have 1 ____ chromosome

X

How many Barr bodies are seen when the cells of a patient with Turner syndrome are examined under the microscope?

0

In patients with Turner syndrome due to a meiosis error, in which gamete does the error typically occur?

paternal

Patients with ______ are less likely to develop hypertension than those with pheochromocytoma.

neuroblastoma

What will be elevated on urine and blood analysis of a patient with pheochromocytoma?

Increased ______ in serum and urine
Increased ______ in serum and urine

catecholamines

metanephrines

When managing a pheochromocytoma, why must administration of an α-antagonist precede administration of a β-blocker and surgical resection?

To prevent ______ ______

hypertensive crisis

Which drug should be given preoperatively for resection of a pheochromocytoma? ______

Phenoxybenzamine

Why should β-blockers be used with caution in the treatment of pheochromocytoma and in patients who have recently used cocaine?

β-blockers may cause unopposed ______ -agonism if given alone

α₁

Opioid use can result in depression of which 2 organ systems?

CNS

Respiratory System

The following symptoms may be present in a patient with withdrawal from which psychoactive drug?

Hunger
Sleep disturbances
Severe depression
Restlessness

Cocaine

What two symptoms can be present with benzodiazepine intoxication?

______ depression

______

respiratory depression

ataxia

Which anesthetic class can cause malignant hyperthermia, myocardial depression, and a decrease in cerebral metabolic demand? ______ ______

Inhaled anesthetics

Which drug class is indicated in the treatment of depression and generalized anxiety disorder and can also be used for diabetic neuropathy?

SNRIs

Why are barbiturates contraindicated for patients with a history of alcohol use disorder?

They have an additive _____ depression effect when combined with alcohol

CNS

Trazodone causes _____, which is desirable in the treatment of insomnia

sedation

What psychiatric disorder should be ruled out before a diagnosis of dementia is made?

Depression

What is the most common subtype of depression?

Depression with atypical features

What is the likely diagnosis for an adult with a history of chronic alcohol consumption who is exhibiting anterograde amnesia and confabulation in the emergency department?

______ syndrome

Korsakoff syndrome

What type of amnesia is present in a patient who sustained a head injury and is unable to recall anything that occurred from the time that the injury occurred?

______ amnesia

Anterograde amnesia

What motor protein is responsible for anterograde transport of cargo on microtubules?

Kinesin

HSV, poliovirus, and rabies virus use which molecular motor protein for retrograde transport to reach the cell body?

Dynein

What molecular defect is responsible for dextrocardia, as seen in Kartagener syndrome?

A defect in _____

dynein

One-third of collagen is composed of which amino acid?

Glycine

What cofactor is required for the hydroxylation of proline and lysine residues in collagen?

vitamin C

What two amino acids undergo hydroxylation in collagen synthesis?

proline, lysine

Which two genetic diseases are associated with bronchiectasis?

_____ _____

_____ syndrome

Cystic fibrosis

Karragener

Cystic fibrosis, Kartagener both impair lung clearance of _____.

pathogens

What two conditions classically impair ciliary motility and may lead to bronchiectasis?

chronic _____

_____ syndrome

chronic smoking

kartagener syndrome

What is the mode of inheritance of Kartagener syndrome?

_____ _____

Autosomal recessive

what is this?

fetal alcohol syndrome

What limb abnormality is associated with fetal alcohol syndrome?

dislocation

A child is diagnosed with autism. When does this disorder present, and is it more common in girls or boys?

Autism must present in _____ childhood and is more common in _____

early

boys

A child is unable to read near the level of proficiency for his or her age even after working with a tutor 7 months. What is the most likely diagnosis?

_____ _____ disorder

specific learning disorder

An episode of separation anxiety in older children must last how long for it to be considered a disorder?

_____ _____ or more

4 weeks

At what age can you diagnose a patient with conduct disorder?

before 18

What is intellectual disability?

_____ cognitive deficits that affect memory, reasoning, judgment, abstract thinking, language, and learning

Global

What term describes weight loss, muscle atrophy, and fatigue in the setting of chronic or terminal illness?

Cachexia

In which direction will the tongue deviate with a lesion of the right hypoglossal nerve?

right

Lesion in which cranial nerve may cause weakness in shrugging the shoulder?

cranial nerve 11

Lesion in which cranial nerve, and on what side, may deviate the uvula to the right?

left, cn X

Lesion of which cranial nerve, and on what side, may deviate the jaw to the right?

right, cn V

cn v injury: The jaw deviates toward the same side as the lesion due to unopposed force from the opposite _____ muscle.

pterygoid

The sternocleidomastoid muscle is innervated by the spinal _____ nerve and turns the head to the _____ side.

accessory

contralateral

Dysfunction of what anatomical structure is associated with increased risk of developing otitis media?

_____ _____

Eustachian tube

What complication presenting with erythema and swelling of the postauricular region might arise after an unresolved acute otitis media infection?

_____

Mastoiditis

What is a dreaded complication of mastoiditis?

_____ _____

Brain abscess

What is the most common pathogen associated with otitis externa?

_____

Pseudomonas

What pathology of the ear is associated with water exposure, occlusion, and trauma of the ear canal?

Otitis externa

Otitis externa AKA _____ _____

swimmer's ear

What metabolic pathway is affected in alkaptonuria?

Degradation of _____ to _____

tyrosine

fumarate

What is the inheritance pattern of alkaptonuria?

Autosomal recessive

What causes joint pain in a patient with alkaptonuria?

Buildup of _____ _____.

This is toxic to _____.

homogentisic acid

cartilage

Which benign enzyme deficiency causes arthralgias, darkened sclerae and connective tissues, and urine that turns black on air exposure?

_____ _____ deficiency

Homogentisate oxidase deficiency

What biochemical anomaly explains reduced blood pressure in a patient with scurvy?

Decreased [...] synthesis due to vitamin [...] deficiency

collagen

C

Vitamin C is required to convert dopamine to _____.

norepinephrine

NAD⁺ and NADP⁺ are derived from which amino acid?

Tryptophan

Which amino acid and vitamin produces histamine?

Histidine
Vitamin B₆

What amino acid and cofactor are required to produce porphyrin, the precursor to heme?

Glycine
Vitamin B₆

What amino acid can be used to synthesize creatinine, urea, and nitric oxide?

Arginine

The conversions of phenylalanine to tyrosine and tyrosine to dopa require what cofactor?

BH₄

Thyroxine is derived from which amino acid?

Tyrosine

Melanin is derived from which compound?

Dopa

The conversion of dopa to dopamine requires what cofactor?

Vitamin B₆

Norepinephrine is converted into epinephrine via a methyl group provided by what cofactor?

S-adenosylmethionine

What two cofactors are needed to produce NAD⁺ and NADP⁺ from tryptophan?

Vitamin _____
Vitamin _____

Vitamin B₂
Vitamin B₆

What two cofactors are needed to produce melatonin from tryptophan?

BH₄
Vitamin B₆

What neurotransmitter is produced from glutamate? Mention the required cofactor.

GABA
Vitamin B₆

What is the final common target of the intrinsic and extrinsic pathways of apoptosis?

Activation of ________

caspases

What two seperate mechanisms trigger the extrinsic apoptotic pathway?

[...]-receptor interactions
T_c cells releasing [...] and [...]

Ligand-receptor interactions
T_c cells releasing granzyme B and perforin

What happens to apoptotic bodies after they are formed?

They are [...]

phagocytosed

There are no ______ ______ to electroconvulsive therapy.

absolute contraindications

Name four clinical indications for electroconvulsive therapy.

Acute [...]
Depression with [...]
Refractory [...]
[...]

Acute suicidality
Depression with psychosis
Refractory depression
Catatonia

What is the mechanism of electroconvulsive therapy?

Electroconvulsive therapy induces [...] seizures in patients under anesthesia and neuromuscular blockade

tonic-clonic

What are the adverse effects of electroconvulsive therapy?

[...]
[...]
[...]/[...] amnesia that usually resolves within [...] months

Headache
Disorientation
Anterograde/retrograde amnesia that usually resolves within 6 months

What kind of medical care aims at improving quality of life in patients with serious illnesses despite their prognosis and is often given with curative treatment?

Palliative care

What should be the life expectancy of the patients to be eligible for hospice care?

Less than [...] months

6 months

Which type of medical care focuses on providing comfort and palliation instead of a definitive cure in patients with a prognosis of < 6 months?

[...] care

Hospice care

What intracellular proteins are responsible for facilitating and maintaining protein folding?

[...] proteins

Chaperone proteins

Name the special class of chaperone proteins that prevents protein denaturation at high temperatures in yeast.

[...] proteins

Heat shock proteins

Which part of Medicare provides prescribed drugs?

Part [...]

Part D

Medicare is available to what group of patients?

Patients ≥ [...] years old
Patients < [...] years old with certain disabilities
Patients with [...] disease

Patients ≥ 65 years old
Patients < 65 years old with certain disabilities
Patients with end-stage renal disease

What are the two federal social healthcare programs that originated from amendments to the Social Security Act?

Medicare
Medicaid

What services do part A of Medicare give?

_______ _______

Hospital admissions

What services does part B of Medicare provide?

Basic _______ _______

Basic medical bills

What services does part C of Medicare provide?

Hospital _______
Basic _______ _______

Hospital admissions
Basic medical bills

The yellow-brown pigments, called _______, are due to lipid _______ of polyunsaturated lipids of subcellular membranes

lipofuscin

peroxidation

lipofuscin pigments in various organs is part of the normal ______ process

aging

What is lipofuscin composed of?

Polymers of [...] and [...] complexed with [...]

Polymers of lipids and phospholipids complexed with protein

How is polycythemia further subtyped?

____
____ ____
____ ____
____ ____

Relative
Appropriate absolute
Inappropriate absolute
Polycythemia vera

What changes in red blood cell mass, O2 saturation, and erythropoietin levels do you expect in polycythemia vera?

[...] O2 saturation

[...] red blood cell mass

[...] erythropoietin levels

↓ O2 saturation
↑ red blood cell mass
↓ erythropoietin levels

What levels of red blood cell mass, O₂ saturation, and erythropoietin would be expected in a patient with relative polycythemia?

[...] red blood cell mass
[...] O₂ saturation
[...] erythropoietin levels

Normal red blood cell mass
Normal O₂ saturation
Normal erythropoietin levels

What changes in red blood cell mass, O₂ saturation, and erythropoietin levels do you expect in appropriate absolute causes of polycythemia?

[...] O₂ saturation
[...] red blood cell mass
[...] erythropoietin levels

Dec O₂ saturation
Increased red blood cell mass
Increased erythropoietin levels

What changes in red blood cell mass, O₂ saturation, and erythropoietin levels do you expect in inappropriate absolute causes of polycythemia?

[...] O₂ saturation
[...] red blood cell mass
[...] erythropoietin levels

Normal O₂ saturation
Increased red blood cell mass
Increased erythropoietin levels

How are plasma volume levels affected in absolute polycythemia?

[...] plasma volume levels

Normal plasma volume levels

In what two conditions do you expect to see inappropriate absolute polycythemia?

Exogenous ______ administration from athlete abuse
Certain malignancies with ectopic ______ ______

Exogenous erythropoietin administration from athlete abuse
Certain malignancies with ectopic erythropoietin secretion

In what three conditions may appropriate absolute polycythemia be seen?

[High/Low] altitude
[Organ] disease
Congenital [organ] disease

High altitude
Lung disease
Congenital heart disease

In what conditions are relative polycythemia imminent?

Patients with [...]
[...]

burns

dehydration

Barrett esophagus leads to increased risk of what cancer?

[...] of the esophagus

Adenocarcinoma

Where is a drug with small lipophilic molecules typically distributed?

Tissues

What cardiovascular changes occur on the left side cavities of the heart due to normal aging?

[Increase/Decrease] in the size of the left ventricular cavity
[Increase/Decrease] of the left atrial cavity

Decrease in the size of the left ventricular cavity
Increase of the left atrial cavity

What effect does immunosenescence due to normal aging have on immunity?

[Increases/Decreases] response to new antigens

Decreases

What changes due to normal aging occur with arterial compliance, aortic diameter, heart rate, and the aortic and mitral valves?

[Increase/Decrease] in arterial compliance
[Increase/Decrease] in aortic diameter
[Increase/Decrease] in heart rate
[...] aortic and mitral valves

Decrease in arterial compliance
Increase in aortic diameter
Decrease in heart rate
Calcified aortic and mitral valves

Name three gastrointestinal changes that occur due to normal aging.

[Increase/Decrease] in lower esophageal sphincter tone
[Increase/Decrease] in gastric mucosal protection
[Increase/Decrease] in colonic motility

Decrease in lower esophageal sphincter tone
Decrease in gastric mucosal protection
Decrease in colonic motility

What two changes occur in bone marrow due to normal aging?

[Increase/Decrease] in bone marrow mass
[Increase/Decrease] in bone marrow fat

Decrease in bone marrow mass
Increase in bone marrow fat

What effect does normal aging have on adaptive immunity?

[Increase/Decrease] in naive B cells and T cells
[...] memory B cells and T cells

Decrease in naive B cells and T cells
Preserved memory B cells and T cells

Name three musculoskeletal changes that occur due to normal aging.

[Increase/Decrease] in skeletal muscle mass
[Increase/Decrease] in bone mass
[Thickening/Thinning] of joint cartilage

Decrease in skeletal muscle mass
Decrease in bone mass
Thinning of joint cartilage

What two nervous system changes occur due to normal aging?

[Increase/Decrease] in brain volume
[Increase/Decrease] in cerebral blood flow

Decrease in brain volume
Decrease in cerebral blood flow

Name five skin changes that occur due to normal aging.

[...] and [...] of dermal-epidermal junction
[Increase/Decrease] in dermal collagen
[Increase/Decrease] in elastin
[Increase/Decrease] in sweat glands
[Increase/Decrease] in sebaceous glands

Atrophy and flattening of dermal-epidermal junction
Decrease in dermal collagen
Decrease in elastin
Decrease in sweat glands
Decrease in sebaceous glands

What is a cause of chronological or intrinsic aging of the skin?

Decreased synthesis capacity of dermal [...]

Decreased synthesis capacity of dermal fibroblasts

How does sun exposure contribute to aging?

[...] degrade dermal collagen and elastin
Products of degradation accumulate in the dermis → [...]

Ultraviolet rays degrade dermal collagen and elastin
Products of degradation accumulate in the dermis → Solar elastosis

Name three renal changes that occur due to normal aging.

[Increase/Decrease] in glomerular filtration rate
[Increase/Decrease] in renal blood flow
[Increase/Decrease] in hormonal function

Decrease in glomerular filtration rate
Decrease in renal blood flow
Decrease in hormonal function

How does aging alter the male reproductive system?

Testicular [...]
Prostate [...]
[Faster/Slower] erection/ejaculation
[Longer/Shorter] refractory period

Testicular atrophy
Prostate enlargement
Slower erection/ejaculation
Longer refractory period

Name five vaginal changes that occur due to normal aging.

Vulvovaginal [...]
Vaginal [lengthening/shortening]
Vaginal [thickening/thinning]
Vaginal [wetness/dryness]
[Increase/Decrease] in pH

Vulvovaginal atrophy
Vaginal shortening
Vaginal thinning
Vaginal dryness
Increase in pH

How does aging affect libido?

Libido [increases/decreases] in both genders

decreases

How does aging alter lung and chest wall compliance?

[Increases/Decreases] lung compliance
[Increases/Decreases] chest wall compliance

Increases lung compliance
Decreases chest wall compliance

How does aging alter residual lung volume, V/Q mismatch, and the A-a gradient?

[Increases/Decreases] residual lung volume
[Increases/Decreases] V/Q mismatch
[Increases/Decreases] A-a gradient

Increases residual lung volume
Increases V/Q mismatch
Increases A-a gradient

How does aging alter FEV₁, FVC, and respiratory muscle strength?

[Increases/Decreases] FEV₁
[Increases/Decreases] FVC
[Increases/Decreases] respiratory muscle strength

Decreases FEV₁
Decreases FVC
Decreases respiratory muscle strength

How does total lung capacity change during normal aging?

no change!

How does aging affect ventilatory response to hypoxia/hypercapnia?

[Increased/Decreased] capacity

Decreased

How does aging affect lung mucus clearance?

[Faster/Slower] mucociliary clearance

Slower mucociliary clearance

What is this? ____

It presents with a high bacterial ____ and low cell-mediated ____.

leprosy

load

immunity

Which animals serve as reservoirs of Mycobacterium leprae in the United States?

Aramadillos

Which form of leprosy presents with hypoesthetic, hairless skin nodules?

[...] leprosy

Tuberculoid leprosy

Which form of leprosy presents with diffuse, communicable skin lesions and leonine facies?

[...] leprosy

Lepromatous leprosy

How do you confirm a Mycobacterium leprae infection?

Tissue [...]
Skin [...]

Tissue PCR
Skin biopsy

Compare T-cell responses associated with lepromatous leprosy and tuberculoid leprosy.

Lepromatous leprosy causes a ____ response
Tuberculoid leprosy causes a ____ response

Lepromatous leprosy causes a T_h2 response
Tuberculoid leprosy causes a T_h1-type response

Infection with which mycobacterium leads to a "glove and stocking" loss of sensation?

Mycobacterium leprae

What type of collagen is defective in Alport syndrome?

Type [...] collagen

Type IV collagen

What type of collagen is targeted by autoantibodies in Goodpasture syndrome?

Type [...] collagen

Type IV collagen

Name the most abundant protein in the body, which undergoes extensive posttranslational modification.

[...]

Collagen

Which type of collagen makes up reticulin?

Type [...] collagen

Type III collagen

What cells are responsible for secretion of type IV collagen and wound contraction?

_____

Myofibroblasts

In what structures can type IV collagen be found?

_____ _____
_____

Basement membrane
Lens

What structures are composed of type II collagen?

_____
Nucleus _____
Vitreous _____

Cartilage

pulposus

body

What is going on?

Replacement of [keratinized/nonkeratinized] [simple/stratified] squamous epithelium with [ciliated/nonciliated] [simple/cuboidal/columnar] epithelium with [...] cells

Replacement of nonkeratinized stratified squamous epithelium with nonciliated columnar epithelium with goblet cells

A patient with chronic reflux esophagitis undergoes a workup. Findings on endoscopy are shown. What is the diagnosis?

Barrett esophagus

Barrett esophagus is an example of what kind of pathologic aberration to the normal tissue histology?

Metaplasia

What do the inclusion bodies indicated by the arrow in the image, often seen in those with alcoholic hepatitis, represent?

Mallory bodies

What pathologic findings would be seen in a liver biopsy specimen obtained from a patient with a history of alcoholism, jaundice, hypoalbuminemia, and an elevated INR?

____ around ____ ____

Sclerosis around central vein

What does alcohol cessation lead to in patients with hepatic steatosis?

Possible ____ of the hepatic steatosis

reversal

What pathologic features are seen in a liver biopsy specimen obtained from a patient with hepatic steatosis?

[Macrovesicular/Microvesicular] ____ change

Macrovesicular fatty change

What is the likely diagnosis for a patient whose liver biopsy specimen shows regenerative nodules surrounded by fibrous bands? ____ ____

Alcoholic cirrhosis

What is the likely diagnosis for a patient with elevated liver enzymes and the findings on liver biopsy shown in the image?

hepatic steatosis

What is the definition of gambling disorder?

Persistent, recurrent, problematic gambling that cannot be better explained as a [...] episode

manic

What is the treatment of gambling disorder?

[...]

psychotherapy

At what age does gender identity develop?

About [...] years old

3

Is gender nonconformity a mental disorder?

No

What is the definition of transgender?

When a patient lives their life as a [similar/different] gender than what was assigned at [...]

different

birth

What is definition of gender dysphoria?

A difference between the way an individual [...] gender and the gender assigned at [...]

experiences

birth

Where is a drug made of large charged molecules or plasma protein-bound molecules typically distributed?

_______ _______

Intravascular compartment

Where is a small hydrophilic drug with a medium volume of distribution typically distributed?

_______ _______

Extracellular fluid

After 3 half-lives, what percentage of a drug remains if it was given as a single-dose IV bolus?

[...]% of its original concentration

12.5

Why is the bioavailability of a drug taken orally less than 100%?

Incomplete _______ of the drug
_______-_______ metabolism

Incomplete absorption of the drug
First-pass metabolism

bioavailability of IV drugs is _______ %.

100

After 1 half-life, given constant IV infusion of a drug, how close to steady state is the concentration of the drug?

[...]% of steady state concentration

50

You administer a drug with a volume of distribution of 30 L and a clearance rate of 1.05 L/min. What is the half-life of this drug?

20 minutes

t_1/2 = ( 0.7 × V_d ) / CL

In first-order kinetics, a drug infused at a constant rate takes ___ to ___ half-lives to reach steady state.

4, 5

What is the definition of the half-life of a drug?

The time required to change the amount of drug in the body by ___ as elimination occurs

half

Disease in which three organs could impair drug clearance?

[...]
[...]
[...]

Heart

Kidney

Liver

The half-life of a drug that follows first-order kinetics is 4 hours. How long after discontinuation of the drug until 6.25% of the drug remains?

16 hours

What does clearance of a drug measure and how is it calculated?

Volume of [...] cleared of drug per unit time
CL = ___ × ___

Volume of plasma cleared of drug per unit time
CL = V_d × K_e

What is the embryologic origin of Schwann cells?

___ ___

Neural crest

What are the two main functions of Schwann cells?

___ of axons in the peripheral nervous system
Promotion of axonal ___ after injury

Myelination

regeneration

Schwann cell injury, what disease?

Guillain-Barré syndrome

How many axons does each Schwann cell myelinate?

[...] peripheral nervous system axon

1

What is the cell marker for Schwann cells? ___

s100b

What is indicated by the red arrow in the electron micrograph showing an axon in cross-section?

Myelin

What cell types produce myelin in the central nervous system and the peripheral nervous system?

Central nervous system → [...]
Peripheral nervous system → [...] cells

Oligodendrocytes

Schwann cells

What does myelin do to an axon's space constant, conduction velocity, membrane resistance, and membrane capacitance?

[Increases/Decreases] space constant
[Increases/Decreases] conduction velocity
[Increases/Decreases] membrane resistance
[Increases/Decreases] membrane capacitance

Increases space constant
Increases conduction velocity
Increases membrane resistance
Decreases membrane capacitance

What role does myelin play in neuronal activity?

Myelin forms an ___ sheath around a neuron's axon to [increase/decrease] conduction velocity of action potentials

insulating

increase

How does myelin increase conduction velocity down an axon?

It promotes ___ conduction at the ___ ___ ___ where concentrations of ___ channels are high

It promotes saltatory conduction at the nodes of Ranvier where concentrations of Na⁺ channels are high

Which cranial nerves are myelinated as part of the central nervous system and peripheral nervous system?

Central nervous system → Cranial nerve [...]
Peripheral nervous system → Cranial nerves [...] to [...]

Central nervous system → Cranial nerve II
Peripheral nervous system → Cranial nerves III to XII

What is the name of the phenomenon observed when a population undergoes a sharp reduction in population size, resulting in new allele frequencies? ____ ____

Bottleneck effect

What is the name of the phenomenon by which a dramatic change in allele frequency occurs by change, and not through natural selection? ____ ____

Genetic drift

What are the two major indications for intervention in a patient with a varicocele?

____

____

Pain
Infertility

What is the significance of a patient with a right-sided varicocele that does not resolve when the patient lies supine?

Indicates ____ ____ ____ obstruction

inferior vena cava

What are two major treatment options for patients with a varicocele?

Surgical [...]
[...] if it is associated with infertility or pain

ligation

Embolization

What is the major reason varicoceles are more common on the left side of the body?

The left _____ vein drains into the left _____ vein → [Increased/Decreased] venous pressure

The left gonadal vein drains into the left renal vein → Increased venous pressure

What is the pathophysiologic mechanism by which the pathology leads to infertility?

_____ increase in the scrotum impairs spermatogenesis

temperature

What is the pathophysiologic mechanism associated with the development of a varicocele?

[Increased/Decreased] venous pressure → Dilation of the _____ _____

Increased venous pressure → Dilation of the pampiniform plexus

What are two major ways to clinically diagnose a varicocele?

[...]
Performance of a [standing/sitting] clinical exam with the [...] maneuver → [...] on visual inspection and the "[...]" finding on palpation

Ultrasound
Performance of a standing clinical exam with the Valsalva maneuver → Distention on visual inspection and the "bag of worms" finding on palpation

What is the definitive treatment for acromegaly?

_____ _____ of the _____ _____

Surgical resection of the pituitary adenoma

What are three pharmacologic treatment options for acromegaly?

[...]
[...]
[...] agonists

Pegvisomant
Octreotide
Dopamine agonists

What are three ways to diagnose acromegaly?

Lack of suppression of serum _____ after oral glucose tolerance tests
_____ _____ on MRI
Increased serum _____

Lack of suppression of serum GH after oral glucose tolerance tests
Pituitary mass on MRI
Increased serum IGF-1

What is the clinical implication of excess GH in children?

It causes [...] with increased [...] bone growth

gigantism

linear

What is the most common cause of death in gigantism and acromegaly?

Heart failure

What endocrine disease typically presents with an enlarged tongue with deep furrows, coarsening of facial features with age, deep voice, and frontal bossing?

Acromegaly

How is glucose regulation affected in acromegaly?

Glucose tolerance is impaired due to insulin [...]

resistance

The patient shown in the image has noted difficulty speaking due to tongue enlargement. Based on this symptom and the physical exam findings shown, what is the diagnosis?

acromegaly

What transports ADH and oxytocin from the hypothalamus to the posterior pituitary, where these hormones are stored and released?

Neurophysins

Where in the hypothalamus are the hormones ADH and oxytocin produced?

ADH is produced in the [...] nucleus
Oxytocin is produced in the [...] nucleus

supraoptic

paraventricular

Which region of the hypothalamus regulates parasympathetic activity and induces you to cool off?

[...] nucleus

Anterior nucleus

Which part of the hypothalamus regulates sleep and the circadian rhythm?

[...] nucleus

Suprachiasmatic nucleus

How might a hypothalamic mass compressing the ventromedial nucleus present in a young patient?

Hyperphagia

Which part of the hypothalamus regulates sympathetic activity and makes you to feel warm?

[...] nucleus

Posterior nucleus

What hormone regulates the ventromedial nucleus's function?

_____ stimulates it

Leptin

What area of the hypothalamus induces the sensation of satiety?

_____ nucleus

Ventromedial nucleus

An infant is born with hypoplastic lateral hypothalamic nuclei. How does this condition manifest?

Failure to [...]

Failure to thrive

What 2 hormones regulate the lateral nucleus of the hypothalamus?

[...] stimulates
[...] inhibits

Ghrelin stimulates
Leptin inhibits