Infarction in which coronary artery territory may cause nodal dysfunction?

[Left/Right] coronary artery

Right coronary artery

What artery supplies the sinoatrial and atrioventricular nodes via its branches?

Right coronary artery

Enlargement of which labeled structure in the image is most likely to cause Ortner syndrome?

Left atrium

To which 3 areas of the body is pain referred in a patient with pericarditis?

___

___

___

neck

arms

shoulders

The pericardial space is located between which two layers of the pericardium?

_____ _____

_____

Parietal pericardium
Epicardium

What are the three layers of the pericardium, from outermost to innermost?

[...] pericardium

↓

[...] pericardium

↓

[...]

Fibrous pericardium

↓

Parietal pericardium

↓

Epicardium

Which artery supplies the following?
Posterior 1/3 of the interventricular septum
Posterior 2/3 of the ventricular walls
Posteromedial papillary muscle

_____ _____ artery

Posterior descending artery

What structure is supplied by the right marginal artery?

____ ____

Right ventricle

Which coronary artery gives rise to the posterior descending artery in most people?

[Left/Right] coronary artery

Right coronary artery

In which phase of the cardiac cycle does coronary blood flow to the left ventricle and intraventricular septum peak?

____ ____

Early diastole

What three areas of the heart are supplied by the left anterior descending artery?

Anterior surface of the [left/right] [atrium/ventricle]
Anterolateral ____ muscle
Anterior 2/3 of the ____ ____

Anterior surface of the left ventricle
Anterolateral papillary muscle
Anterior 2/3 of the interventricular septum

What is the most posterior chamber of the heart?

Left atrium

Which coronary artery gives rise to the posterior descending artery in left dominant circulation?

____ ____ artery

Left circumflex artery

Which chamber of the heart is most commonly injured in trauma?

[Left/Right] [atrium/ventricle]

Right ventricle

Which nerve innervates the pericardium?

Phrenic

Which coronary artery is most commonly occluded?

Left anterior descending artery

What two symptoms can enlargement of the left atrium cause as a result of compression of related structures?

[...] from compression of the esophagus
[...] from compression of the left recurrent laryngeal nerve

Dysphagia

Hoarseness

Which chambers of the heart make up the inferior cardiac surface?

[Left/Right] [atrium/ventricle] → 2/3 of the inferior cardiac surface
[Left/Right] [atrium/ventricle] → 1/3 of the inferior cardiac surface

Left ventricle → 2/3 of the inferior cardiac surface
Right ventricle → 1/3 of the inferior cardiac surface

Which blood vessel runs in the left atrioventricular groove and drains into the right atrium?

____ ____

Coronary sinus

In addition to drug therapy, what is the most important step in the management of a STEMI?

_____ therapy

Reperfusion therapy

What are two medications for immediate symptom control in patients with unstable angina?

_____

_____

Nitroglycerin
Morphine

β-blockers are used in chronic heart failure management except in which situation?

A) Stable systolic heart failure
B) Reduced ejection fraction
C) Acute decompensated heart failure
D) Long-term mortality reduction

C) Acute decompensated heart failure

What are the five initial treatments that should be administered to patients with unstable angina or NSTEMI?

[...] (to prevent further clot formation)
[...] therapy
[...]-blockers
[...] (to stabilize atherosclerotic plaques)
[...] inhibitors

Anticoagulation
Antiplatelet therapy
β-blockers
Statins
ACE inhibitors

Could a child have essential fructosuria if neither of the parents do?

[Yes/No]

Yes

What are the two most common ECG findings in patients with acute pericarditis?

Diffuse ST-segment [elevation/depression]
PR-segment [elevation/depression]

Diffuse ST-segment elevation
PR-segment depression

What is the most common cause of acute pericarditis?

____

Idiopathic

What can be caused by autoimmune and connective disorders, infections, cardiac surgery, cardiovascular events, radiation, and renal failure?

____ ____

acute pericarditis

What physical maneuver by the patient commonly relieves the pain associated with acute pericarditis?

Sitting ____
Leaning ____

Sitting up
Leaning forward

What common complication of acute pericarditis is indicated by the yellow arrows?

pericardial effusion

What is the most common auscultatory finding in patients with acute pericarditis?

Pericardial _____ _____

Pericardial friction rub

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)

Colchicine
NSAIDs
Glucocorticoids

How do you treat pericarditis due to uremia? ____

Dialysis

What condition is shown in the CT scan?

Abdominal aortic aneurysm. Note outer dilated calcified aortic wall.

Pain in which 2 parts of the body may be a sign of leaking, dissection, or imminent rupture of an aortic aneurysm?

___

___

Back
Abdomen

What is a congenital condition that increases the risk for development of thoracic aortic aneurysms?

____ ____ disease

connective tissue disease

An elderly man with a long smoking history has abdominal pain and a pulsatile abdominal mass. What is the most likely diagnosis?

Abdominal aortic aneurysm

What might cause a patient with a thoracic aortic aneurysm to develop a murmur?

____ ____ dilatation

Aortic root dilatation

What pathologic process is typically associated with formation of an abdominal aortic aneurysm?

______ disease

Atherosclerotic disease

What pathologic process is typically associated with formation of a thoracic aortic aneurysm?

____ ____ degeneration

Cystic medial degeneration

Syphillis increases the risk of development of what vascular disease?

Obliterative _____ of the _____ _____

Obliterative endarteritis of the vasa vasorum

What are 4 risk factors for development of an abdominal aortic aneurysm?

_____ sex
[Older/Younger]
_____
_____ _____

Male sex
Increased age
Smoking
Family history

Which congenital heart condition increases the risk of development of a thoracic aortic aneurysm?

_____ _____ valve

Bicuspid aortic valve

What acquired condition is an important risk factor for development of a thoracic aortic aneurysm?

____

HTN

____ ____

Aortic dissection

A patient presents with sudden, tearing chest pain.

____ ____

Aortic dissection

What is the treatment for an aortic dissection extending from the ascending aorta to the aortic arch?

_____

Surgery

This is a Stanford type A aortic dissection.

What is the treatment for an aortic dissection confined to the descending aorta?

___-blockers, then ___

β-blockers, then vasodilators

This is a Stanford type B aortic dissection.

What are 3 conditions associated with aortic dissection?

Inherited ______ ______ disorders
______

______ ______ valve

Inherited connective tissue disorders
Hypertension
Bicuspid aortic valve

What are 3 complications that may result from an aortic dissection?

Aortic [...]
Organ [...]
[...]

Aortic rupture
Organ ischemia
Death

What are 2 cardiac complications from a proximal Stanford type A aortic dissection?

____ ____
____ ____ regurgitation

Cardiac tamponade
Acute aortic regurgitation

What is an aortic dissection?

A ______ intimal tear, which forms a false _____ within the aorta

A longitudinal intimal tear, which forms a false lumen within the aorta

What chest X-ray finding do you expect in a patient with aortic dissection?

Widened _____

Widened mediastinum

Where does the fluid accumulate in cerebral edema?

Brain [...]

Brain parenchyma

What are the three causes of cytotoxic cerebral edema?

Early [...]
[...] (endocrine issue)
[...] (can be seen in labs)

Early ischemia
SIADH
Hyperammonemia

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.

Late ischemia
Trauma
Inflammation
Hemorrhage
Tumors

What vitamin deficiency causes the ocular manifestation shown in the image? What are they?

Vitamin ____

____ spots

Vitamin A

Bitot spots

Which vitamin is essential for the differentiation of epithelial cells into specialized tissue?

Vitamin [...]

Vitamin A

All-trans retinoic acid is a treatment for which malignancy?

____ ____ leukemia

Acute promyelocytic leukemia

Which vitamin prevents squamous metaplasia?

Vitamin A

What requirements must be met before prescribing isotretinoin to a female of childbearing age?

A pregnancy test result must be [positive/negative]
The patient must use two forms of contraception because of isotretinoin's [...] properties

A pregnancy test result must be negative
The patient must use two forms of contraception because of isotretinoin's teratogenic properties

What are the teratogenic effects of vitamin A?

____ palate
____ abnormalities

Cleft palate
Cardiac abnormalities

What are the symptoms of acute vitamin A toxicity?
_____
_____
_____
_____ vision due to increased intracranial pressure

Nausea
Vomiting
Vertigo
Blurred vision due to increased intracranial pressure

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?

Chronic vitamin [...] toxicity

Chronic vitamin A toxicity

What vitamin A derivative is a component of visual pigments?

Retinal

What two dietary sources are rich in vitamin A?

____

____ vegetables

Liver

Leafy vegetables

What enzyme pathway becomes primary for converting fructose to fructose-6-phosphate in essential fructosuria? _______

Hexokinase

Analogs of which hormone are used to treat acromegaly?

somatostatin

What is another name for vitamin A?

Retinol

Name two topical uses of vitamin A.

____

____

Wrinkles
Acne

Vitamin A can help with what highly contagious disease caused by a virus?

measles

What are the symptoms of vitamin A deficiency?

____ blindness
Skin that is [...]/[...]
____ eyes
Corneal squamous metaplasia → ____ spots
____ degeneration
____suppression

Night blindness
Skin that is dry/scaly
Dry eyes
Corneal squamous metaplasia → Bitot spots
Corneal degeneration
Immunosuppression

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

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

Decreased catecholamine synthesis due to vitamin C deficiency

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

Tryptophan

Which amino acid and vitamin produces histamine?

____
Vitamin ____

Histidine
Vitamin B₆

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

____
Vitamin ____

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 ____

Vitamin B₆

S-adenosylmethionine is needed to convert ____ to ____

nori to epi

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

Vitamin ____
Vitamin ____

Vitamin B₂
Vitamin B₆

Which two disadvantages are associated with low-molecular-weight heparin compared with unfractionated heparin?

A) Oral use and slow onset
B) Renal clearance and poor reversibility
C) Short half-life and high HIT risk
D) CYP metabolism and teratogenicity

B) Renal clearance and poor reversibility

What two cofactors are needed to produce melatonin from tryptophan?

____
Vitamin ____

BH₄
Vitamin B₆

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

____
Vitamin ____ is the cofactor

GABA
Vitamin B₆ is the cofactor

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

What are the four clinical features of otitis externa?

[...] (often worsened by pulling the pinna or pressing the tragus)
[...] (drainage from the ear canal due to infection/inflammation)
[...]
[...] loss (usually conductive)

Otalgia
Discharge
Pruritus
Hearing loss

What is a dreaded complication of otitis externa in older patients with diabetes?

[...] otitis externa

Malignant otitis externa

Malignant otitis externa is an invasive otitis externa with _____.

osteomyelitis

What are the clinical findings of malignant otitis externa?

[...] (worse pain than with normal otitis externa)
[...] (foul-smelling ear drainage from ongoing infection)
[...] tissue in ear canal

Otalgia
Otorrhea
Granulation tissue in ear canal

malignant otitis externa can lead to what type of palsies? ___ ___

cranial nerve

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?

_____ _____ _____

Primary sclerosing cholangitis

Which 2 autoantibodies are associated with ulcerative colitis?

p-ANCA

MPO-ANCA

Toxic megacolon, fulminant colitis, and perforation are complications that are most commonly associated with which inflammatory bowel disease?

UC

{Crohn disease/Ulcerative colitis} → Transmural inflammation
{Crohn disease/Ulcerative colitis} → Mucosal and submucosal inflammation

Crohns

UC

What 2 conditions can be treated with sulfasalazine?

UC

Crohns

Which inflammatory bowel disease is associated with gallstones and calcium oxalate kidney stones?

Crohns

Which inflammatory bowel disease has creeping fat, skip lesions, cobblestone mucosa, linear ulcers, bowel wall thickening, fissures, and rectal sparing?

Crohns

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

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

[...] side

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

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

The pump is [...]

The pump is dephosphorylated

What is the inheritance pattern of alkaptonuria?

Autosomal recessive

What causes joint pain in a patient with alkaptonuria?

Buildup of ____ acid

homogentisic

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

______ oxidase deficiency

Homogentisate oxidase deficiency

What metabolic pathway is affected in alkaptonuria?

Degradation of ______ to ______

Degradation of tyrosine to fumarate

The activity of what enzyme is decreased in Menkes disease?

____ ____

Lysyl oxidase

this is bc copper is a necessary cofactor

What connective tissue disease is the result of a mutation in the ATP7A gene?

_____ disease

Menkes disease

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?

_____ disease

Menkes disease

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

_____

Collagen

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

Copper levels are low in Menkes disease
Copper levels are high in Wilson disease

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

How can an uncorrected left-to-right shunt lead to Eisenmenger syndrome?

Pathologic vasculature changes lead to _____ hypertension and resultant _____ _____ hypertrophy, causing a new-onset right-to-left shunt

pulmonary

right ventricular

What is the primary reason that testosterone levels are normal in those with cryptorchidism?

_____ cell function is unaffected by the _____ testicular temperature seen in cryptorchidism

Leydig

higher

What is the pathophysiologic mechanism associated with the reduced fertility seen in those with cryptorchidism?

Impaired ______

spermatogenesis

What are the two most common complications seen in patients with cryptorchidism?

Increased risk of _____
_____ _____ tumors

Increased risk of infertility
Germ cell tumors

What are the expected levels of inhibin B, FSH, LH, and testosterone in patients with cryptorchidism?

[...] inhibin B levels
[...] FSH levels
[...] LH levels
[...] testosterone levels if cryptorchidism is unilateral
[...] testosterone levels if cryptorchidism is bilateral

Decreased inhibin B levels
Increased FSH levels
Increased LH levels
Normal testosterone levels if cryptorchidism is unilateral
Decreased testosterone levels if cryptorchidism is bilateral

What is the major risk factor for the development of cryptorchidism? _____

Prematurity

What is the primary treatment method for patients with cryptorchidism?

Most cases resolve [...]
If testicles have not descended by 2 years of age, [...] may be performed

spontaneously

orchiopexy

Where does lactase function in the gastrointestinal tract?

Intestinal _____ _____

brush border

What might be noted on testing of a stool sample obtained from a patient with lactase deficiency?

_____ stool pH

Decreased

What are the causes of secondary lactase deficiency?

Loss of intestinal brush border caused by _____
_____ disease

gastroenteritis

Autoimmune

What would an intestinal biopsy specimen from a patient with hereditary lactose intolerance show?

_____ mucosa

Normal mucosa

What are the clinical features of lactase deficiency?
_____
_____
_____
_____ diarrhea

Flatulence
Bloating
Cramps
Osmotic diarrhea

What is the treatment for lactase deficiency?

Dietary avoidance of ____-containing products
Replacement of lactase in ____

Dietary avoidance of lactose-containing products
Replacement of lactase in pills

Which groups of people tend to be lactase deficient in adulthood because of the absence of a lactase-persistent allele?
[...]
[...]
[...]

Asians
Africans
Native Americans

Lactase breaks down lactose into which monosaccharides?

glucose

galactose

What finding is expected on hydrogen breath testing in a patient with lactase deficiency?

[Increased/Decreased] hydrogen levels

Increased hydrogen levels

why do we see increased hydrogen levels in lactase def? -

Due to increased _____ of undigested lactose by _____ bacteria.

fermentation

colonic

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?

[...] syndrome

Rett syndrome

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?

Rett syndrome is a _____ disorder

Rett syndrome is a sporadic disorder

Why is Rett syndrome almost exclusively seen in females?

Affected males ____ in utero or shortly after birth

die

Between what ages does Rett syndrome usually manifest?

Between ages [...] and [...]

1 and 4

What is the underlying mutation in Rett syndrome?

____ ____ mutation of ____ on the ____ chromosome

De novo mutation of MECP2 on the X chromosome

Karotype analysis reveals a balanced translocation between chromosomes 14 and 21. How will this affect the individual's phenotype?

The individual will be _____

The individual will be unaffected

Balanced translocations, unlike unbalanced translocations, do not cause abnormal _______. There will be no gain or loss of genetic material.

phenotypes

What feature of chromosomes 13, 14, 15, 21, and 22 predisposes them to Robertsonian translocations?

They are [...] chromosomes

They are acrocentric chromosomes.

They have centromeres near their ends.

What are acrocentric chromosomes?

Chromosomes with centromeres near their _____

ends

What is a Robertsonian translocation?

Fusion of the [long/short] arms of two ____ chromosomes at the centromeres.

Fusion of the long arms of two acrocentric chromosomes at the centromeres

Unbalanced translocations can result in ____, ____, and chromosomal ____

Unbalanced translocations can result in miscarriage, stillbirth, and chromosomal imbalances

A pig farmer has bloody diarrhea. He later reports dysuria and sore red knees. What is the diagnosis?

____ ____ from ____ ____ infection

Reactive arthritis from Campylobacter jejuni infection

(This was most likely contracted from infected farm animals)

What findings help identify Campylobacter jejuni as a cause of infection?

[...] or "[...]" shaped with [polar/nonpolar] flagella
Oxidase-[positive/negative]
Grows at [...]°C

Comma or "S" shaped with polar flagella
Oxidase-positive
Grows at 42°C

What are two possible sequelae of Campylobacter jejuni infection?

____ ____
____-____ syndrome

Reactive arthritis
Guillain-Barré syndrome

What are two common modes of transmission for Campylobacter jejuni?

____-____
Ingestion of unpasteurized ____ or undercooked ____

Fecal-oral
Ingestion of unpasteurized milk or undercooked meat

What is the most common heritable cause of intellectual disability?

____ ____ syndrome

Fragile X syndrome

What is the underlying genetic cause of fragile X syndrome?

____ repeats in the ____ gene

Trinucleotide repeats in the FMR1 gene

What heart defect is most likely present in patients with fragile X syndrome?

____ ____ prolapse

Mitral valve prolapse

During embryonic development, when does the trinucleotide repeat expansion that leads to fragile X syndrome occur?

______

Oogenesis

How does the trinucleotide expansion in fragile X syndrome affect gene expression?

Trinucleotide repeats in the _____ gene causes hypermethylation of _____ residues → Decreased expression

Trinucleotide repeats in the FMR1 gene causes hypermethylation of cytosine residues → Decreased expression

What is the mode of inheritance of fragile X syndrome?

X-linked dominant

What are the clinical manifestations of fragile X syndrome when there is a full mutation?

[Long/Short] face
[Large/Small] jaw
[Large/Small], [inverted/everted] ears
[Heart defect]
[Hypermobile/Hypomobile] joints
_____
Postpubertal _____

Long face
Large jaw
Large, everted ears
Mitral valve prolapse
Hypermobile joints
Autism
Postpubertal macroorchidism

What are the clinical manifestations of fragile X syndrome when there is a premutation?

____
____
____ ovarian insufficiency

Ataxia
Tremor
Primary ovarian insufficiency

What symptom often observed in patients with fragile X syndrome and might be confused with Lesch-Nyhan syndrome?

[...]

Self-mutilation

ataxia-telangiectasia

Despite their intellectual disability, patients with Williams syndrome are typically advanced in which skill set?

_____ skills

Verbal skills

What is the probable diagnosis of a child with “elfin” facies, intellectual disability, notable friendliness with strangers, hypercalcemia, and cardiovascular problems?

[...] syndrome

Williams syndrome

Which connective tissue gene is deleted in Williams syndrome?

_____ gene

Elastin gene

What chromosomal abnormality is the cause of Williams syndrome?

[...] of the [long/short] arm of chromosome [...]

Microdeletion of the long arm of chromosome 7

Name two cardiovascular conditions that may be present in patients with Williams syndrome.

____ ____ stenosis
____ ____ stenosis

Supravalvular aortic stenosis
Renal artery stenosis

The enzyme deficient in maple syrup urine disease is dependent on which vitamin to function?

Vitamin ____

Vitamin B₁

What molecule levels increase in the blood in maple syrup urine disease?

____-____, especially those derived from ____

α-ketoacids, especially those derived from leucine

What is the treatment for maple syrup urine disease?

Restrict ____, ____, and ____ in the diet (three amino acids)
Provide ____ supplementation (vitamin)

Restrict isoleucine, leucine, and valine in the diet
Provide thiamine supplementation

What is the inheritance pattern of maple syrup urine disease?

Autosomal recessive

Which amino acids cannot be degraded in maple syrup urine disease? (3)

Leucine
Isoleucine
Valine

What condition should be suspected when a urine sample obtained from a lethargic child smells like burnt sugar?

Maple syrup urine disease

What are the key functions of zinc in the human body?

Involved in the activity of ____ enzymes
Important in the formation of ____ ____

Involved in the activity of 100+ enzymes
Important in the formation of zinc fingers

Deficiency of which micronutrient can predispose an individual to alcoholic cirrhosis?

____

Zinc

What symptoms are associated with a zinc deficiency?

Delayed ____ ____
[Hypergonadism/Hypogonadism]
Reduced adult ____ growth
____
____

Delayed wound healing
Hypogonadism
Reduced adult hair growth
Dysgeusia
Anosmia

What is the diagnosis of the condition shown in the image in a malnourished patient with poor wound healing and impaired taste sensation?

_____ deficiency

Zinc deficiency

Why might a patient with zinc deficiency develop recurrent bacterial and fungal infections?

Zinc deficiency can cause _____

Zinc deficiency can cause immunosuppression

Laboratory testing reveals impaired intestinal zinc absorption. Which dermatologic condition is most likely present?

A) Dermatitis herpetiformis
B) Acrodermatitis enteropathica
C) Seborrheic dermatitis
D) Erythema multiforme

B) Acrodermatitis enteropathica

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

What is the mechanism by which atherosclerotic plaques form?

_____ cell dysfunction leads to _____ -mediated plaque formation via _____ cell formation

Endothelial cell dysfunction leads to macrophage-mediated plaque formation via foam cell formation

Fatty streaks and smooth muscle proliferation contribute to _____ plaques.

fibrous

Rank the following vessels from MOST commonly affected to LEAST commonly affected by atherosclerosis:

• Circle of Willis
• Coronary arteries
• Carotid arteries
• Abdominal aorta
• Popliteal arteries

Abdominal aorta → Coronary arteries → Popliteal arteries → Carotid arteries → Circle of Willis

Atherosclerosis risk increases after menopause because _____ is protective against atherosclerosis

estrogen

How does a patient's risk of atherosclerosis change with increases in HDL and LDL?

High [...] is protective and decreases atherosclerotic risk
High [...] increases atherosclerotic risk

High HDL is protective and decreases atherosclerotic risk
High LDL increases atherosclerotic risk

______ nerve palsy

Oculomotor nerve palsy

What causes the musty odor in phenylketonuria?

Disorder of ____ amino acid metabolism

Disorder of aromatic amino acid metabolism

Name two possible deficiencies that can cause phenylketonuria.

Decreased ____ hydroxylase
Decreased ____ cofactor

phenylalanine

BH₄

Why should a patient with phenylketonuria avoid most artificial sweetners?

Phenylalanine is found in ____

Phenylalanine is found in aspartame

Why are newborns screened for phenylketonuria at 2 to 3 days of age and not earlier?

The result is always normal at birth due to the presence of ____ ____

The result is always normal at birth due to the presence of maternal enzymes

What is the treatment for phenylketonuria?

Decrease dietary ____
Increase dietary ____
Provide ____ supplementation

Decrease dietary phenylalanine
Increase dietary tyrosine
Provide BH₄ supplementation

Which nonessential amino acid becomes essential for patients with phenylketonuria?

tyrosine

An increase in phenylalanine levels due to phenylketonuria leads to the presence of what class of metabolites in urine?

Phenyl _____

Phenyl ketones

What skin condition, apart from decreased pigmentation, can be seen with phenylketonuria? ____

Eczema

Phenylketonuria exhibits what pattern of inheritance?

Autosomal recessive

What findings would be present in a patient who was born to a mother with maternal phenylketonuria?

[Macrocephaly/Microcephaly]
[...] disability
[...] retardation
Congenital [organ] defects

Microcephaly
Intellectual disability
Growth retardation
Congenital heart defects

β-blockers decrease ______ after a myocardial infarction

mortality

How could maternal transmission of syphilis to a neonate be prevented?

By treating the mother with ______ early in pregnancy

penicillin

What fat absorption disorder can lead to steatorrhea, failure to thrive during infancy, retinitis pigmentosa, progressive ataxia, and acanthocytosis?

Abetalipoproteinemia

What three lipoproteins are absent in apolipoprotein B₄₈ and B₁₀₀ deficiency?

Chylomicrons
LDL
VLDL

A patient with abetalipoproteinemia is treated with large doses of oral vitamin E to prevent which complication?

______ degeneration

Spinocerebellar degeneration

What is the inheritance pattern of abetalipoproteinemia?

Autosomal recessive

What is the treatment for apolipoprotein B₄₈ and B₁₀₀ deficiency?

Restricted consumption of [...]-chain fatty acids
Large doses of oral vitamin [...]

Restricted consumption of long-chain fatty acids
Large doses of oral vitamin E

A mutation in what gene results in abetalipoproteinemia?

____ gene

MTP gene

This encodes microsomal transfer protein: ____ gene

MTP

What is the likely finding in an intestinal biopsy specimen obtained from an infant with abetalipoproteinemia?

______-laden enterocytes

Lipid-laden enterocytes

What cellular process allows for a single gene transcript to result in the production of multiple different proteins?

Alternative splicing

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?

Introns

What parts of the gene contain the actual genetic information for coding proteins or functional RNA?

Exons

Provide examples that exhibit alternative splicing.

Brain → _____ receptors
Muscle → _____ variants
Tumor cells → _____ _____ evasion

Brain → Dopamine receptors
Muscle → Tropomyosin variants
Tumor cells → Host defense evasion

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

Accumulation of _____ in the _____

Accumulation of protein in the cytosol

What is the definitive treatment for acromegaly?

Surgical resection of the ______ ______

Surgical resection of the pituitary adenoma

What are three pharmacologic treatment options for acromegaly?

______

______

______ ______

Pegvisomant
Octreotide
Dopamine agonists

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

Type [...] collagen

Type III collagen

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

Hypermobility type

Ehlers-Danlos syndrome is transmitted through what inheritance patterns?

______ ______
______ ______

Autosomal dominant
Autosomal recessive

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

______ synthesis

Collagen synthesis

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

______ aneurysms
______ aneurysms

Berry aneurysms
Aortic aneurysms

What type of specific collagen type that 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?

____ type

Vascular type

A patient has vascular Ehlers-Danlos syndrome due to defective type III collagen. Which gene is most likely mutated?

A) COL1A1
B) COL2A1
C) COL3A1
D) COL4A5

C) COL3A1

What are the two major sources of HDL in the body?

_____

_____ _____

Liver
Small intestine

What is the function of cholesterol ester transfer protein?

Assists in the transfer of cholesterol ______ to other ______ particles

Assists in the transfer of cholesterol esters to other lipoprotein particles

What is the function of hormone-sensitive lipase in lipid transport?

Degrades ______ in adipocytes
Releases ______

Degrades triglycerides in adipocytes
Releases glycerol

What is the function of hepatic lipase in lipid transport?

Degrades _____ still present in _____ and _____ _____

Degrades triglycerides still present in IDL and chylomicron remnants

What enzyme degrades triglycerides present in circulating chylomicrons and VLDL?

_____ _____

Lipoprotein lipase

What is the function of pancreatic lipase in lipid transport?

Degrades _____ obtained from the diet in the _____ intestine

Degrades triglycerides obtained from the diet in the small intestine

What enzyme catalyzes the esterification of the majority of plasma cholesterol and converts nascent HDL to mature HDL?

A) Hormone-sensitive lipase
B) Lipoprotein lipase
C) Lecithin-cholesterol acyltransferase
D) HMG-CoA reductase

C) Lecithin-cholesterol acyltransferase

What is the function of PCSK9 in lipid metabolsim?

Promotes degradation of ____ receptors

LDL

If a drug inhibits PCSK9, how will this affect serum LDL levels?

It will [increase/decrease] serum LDL levels

decrease

What are the three different cell types present in the endocrine pancreas and what do they release?

α endocrine cells → [...]
β endocrine cells → [...]
δ endocrine cells → [...]

α endocrine cells → Glucagon
β endocrine cells → Insulin
δ endocrine cells → Somatostatin

Where are the α, β, and δ endocrine cells located in the Islets of Langerhans?

α endocrine cells → [...]
β endocrine cells → [...]
δ endocrine cells → [...]

α endocrine cells → Peripheral
β endocrine cells → Central
δ endocrine cells → Interspersed

Why do steroids cause neutrophilia?

Steroids inhibit white blood cell ____ → Neutrophilia

Steroids inhibit white blood cell adhesion → Neutrophilia

What provides the stimulus for cortisol secretion?

Hypothalamic _____ stimulates release of pituitary _____

Hypothalamic CRH stimulates release of pituitary ACTH

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
B) Cold agglutinin test
C) Monospot test
D) PPD test

D) PPD test

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
B) Decreased IL-2 production
C) Increased neutrophil chemotaxis
D) Decreased antibody class switching

B) Decreased IL-2 production

What would result from mitral stenosis?

Pulmonary capillary wedge pressure would be [greater/less] than left ventricular end-diastolic pressure

greater

remember that pulmonary capillary wedge pressure is a proxy for LA pressure

What is the normal pressure for the aorta during systole and diastole?

Systole → [...] mmHg
Diastole → [...] mmHg

Systole → 120 mmHg
Diastole → 80 mmHg

What is the normal pressure for the pulmonary artery during systole and diastole?

Systole → [...] mmHg
Diastole → [...] mmHg

Systole → 25 mmHg
Diastole → 8 mmHg

What is the normal pressure for the left ventricle during systole and diastole?

Systole → [...] mmHg
Diastole → < [...] mmHg

Systole → 120 mmHg
Diastole → < 12 mmHg

What is the normal pressure for the right ventricle during systole and diastole?

Systole → [...] mmHg
Diastole → < [...] mmHg

Systole → 25 mmHg
Diastole → < 5 mmHg

What are the normal pressures for the right and left atria?

Right atrium → < [...] mmHg
Left atrium → < [...] mmHg

Right atrium → < 5 mmHg
Left atrium → < 12 mmHg

Which amino acid is most basic?

Arginine

Which basic amino acid has no charge at body pH?

Histidine

What finding in this histology image is characteristic of a carcinoid tumor?

rosette arrangement

The absence of which 2 nerve plexus result in the disease shown in the image below?

_____ plexus
_____ plexus

Auerbach plexus
Meissner plexus

What percentage of carcinoid tumors metastasize?

A) 10%
B) 20%
C) 33%
D) 75%

C) 33%

What 2 medications provide only symptomatic relief in patients with heart failure?

____ diuretics
____ diuretics

Thiazide
Loop diuretics

What 2 medications, used in combination, both relieve symptoms of heart failure and lower associated mortality in select patients?

____

____

Hydralazine
Nitrates

What is the role of the RAAS in the symptomatic presentation of edema in heart failure?

Activation of RAAS → [Increased/Decreased] circulating volume due to ____ and ____ reabsorption in the kidneys → [Increased/Decreased] preload → Edema

Activation of RAAS → Increased circulating volume due to Na⁺ and H₂O reabsorption in the kidneys → Increased preload → Edema

In diastolic dysfunction, what typically happens to ejection fraction (EF) and end-diastolic volume (EDV)?

Preserved EF, normal EDV

What is the effect of increased pulmonary venous pressure, causing fluid transudation into the lungs in patients with heart failure?

_____ _____

Pulmonary edema

What common symptom associated with heart failure is caused by increased venous return from redistribution of blood and reabsorption of peripheral edema?

_____ _____ dyspnea

Paroxysmal nocturnal

Medications in what 4 drug classes are prescribed to reduce mortality in patients with heart failure and reduced ejection fraction?

_____ inhibitors
_____ _____ receptor antagonists
_____ -blockers
_____ receptor antagonists

ACE inhibitors
Angiotensin II receptor antagonists
β-blockers
Aldosterone receptor antagonists

What is the most common cause of right-sided heart failure in the absence of left-sided heart failure?

_____ _____ due to COPD

Cor pulmonale

What is the most common cause of right-sided heart failure?

Left-sided heart failure

What is the major histologic finding in the lungs of patients with left-sided heart failure?

_____-laden macrophages

Hemosiderin-laden macrophages

What is the major effect of right-sided heart failure on liver function?

____

____

Hepatomegaly
Cirrhosis

What is the pathophysiologic mechanism leading to orthopnea in patients with left-sided heart failure?

[Increased/Decreased] venous return to the heart in the _____ position → Pulmonary vascular congestion and shortness of breath

Increased venous return to the heart in the supine position → Pulmonary vascular congestion and shortness of breath

What type of heart failure is associated with decreased contractility, reduced ejection fraction, and increased ventricular end-diastolic volume?

(Systolic or Diastolic) heart failure

Systolic heart failure

What are the 4 most common physical exam findings in patients with heart failure?

____ ____ ____
____ edema
____ heart sound
____ (auscultatory finding)

Jugular venous distention
Pitting edema
S3 heart sound
Rales

Which three physical exam findings are most suggestive of right-sided heart failure?

A) Peripheral edema, JVD, hepatomegaly
B) Pulmonary edema, crackles, S3
C) Cyanosis, clubbing, wheezing
D) Bradycardia, syncope, pulsus paradoxus

A) Peripheral edema, JVD, hepatomegaly

The trachea bifurcates at what level?

T4

A newborn has failure to pass meconium and severe chronic constipation. Which condition should be suspected?

Hirschsprung disease

Which hormones stimulate and inhibit the release of GH respectively?

_____ stimulates growth hormone levels
_____ inhibits growth hormone levels

GHRH

somatostatin

Which cranial nerve innervates the intraocular muscles?

oculomotor

The common carotid bifurcates at what level?

C4

The abdominal aorta bifurcates at what level?

L4

Which three nerve roots innervate the diaphragm and form the phrenic nerve?

C3-C5

Which lymph node cluster is likely to be enlarged in a patient with mastitis or metastasis from breast cancer?

Axillary

What do D cells in the antrum of the stomach secrete?

Somatostatin

Which nerve and artery would you expect to see injured with a fracture at the surgical neck of the humerus?

_____ nerve

_____ _____ artery

Axillary Nerve

Posterior Circumflex Artery

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?

axillary nerve

What general medication is used for long-term prevention or treatment of deep vein thrombosis?

oral direct _______

oral direct anticoagulants

What is the drug of choice for the acute management of deep vein thrombosis?

____ heparin

____ ____ ____ heparin

unfractioned

low molecular weight

What circumstance typically increases venous stasis in a patient?

Prolonged ______

prolonged inactivity

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?

D-dimer

This test has a high sensitivity, but low specificity.

What congenital condition is caused by blockage of the posterior nasal opening and is associated with midface bony abnormalities?

_____ atresia

Choanal atresia

Which two respiratory conditions are not typically associated with digital clubbing?

A) Asthma and COPD
B) Asthma and bronchiectasis
C) COPD and lung cancer
D) Cystic fibrosis and asthma

A) Asthma and COPD

What type of rheumatologic disease is commonly associated with pulmonary hypertension?

A) Crystal arthropathy
B) Connective tissue disease
C) Degenerative joint disease
D) Vasovagal syndrome

B) Connective tissue disease

Nerve?

Muscle?

Diagnosis?

long thoracic

serratus anterior

winged scapula

Osteogenesis imperfecta is caused by a defect in which step of collagen synthesis?

A) Hydroxylation of lysine
B) Cleavage of procollagen
C) Triple helix formation
D) Cross-linking by lysyl oxidase

C) Triple helix formation

Approximately one-third of collagen is composed of which amino acid?

A) Glycine
B) Lysine
C) Proline
D) Hydroxyproline

A) Glycine

In patients with Hirschspring disease, which enzyme is increased in hypertrophied nerve fibers of the lamina propria?

______

Acetylcholinesterase

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 ______

By destruction of lung parenchyma

Which screening test is commonly used to identify primary ciliary dyskinesia, and would be decreased in a positive test?

Nasal ____ ____ measurement

Nasal nitric oxide measurement

What is the most common genetic cause of heritable pulmonary arterial hypertension, inhibiting vascular smooth muscle proliferation?

A) CFTR mutation
B) FBN1 mutation
C) BMPR2 mutation
D) JAK2 mutation

C) BMPR2 mutation

What parasitic infection is typically associated with the development of pulmonary hypertension?

______

Schistosomiasis

Pulmonary pressure is measured in which unit?

A) mmHg
B) dynes/sec/cm⁵
C) mEq/L
D) cm H₂O

D) cm H₂O

What may digital rectal exam reveal in Hirschsprung disease?

A) Bloody stool
B) Squirt sign with empty rectum
C) Hard stool in rectal vault
D) Perianal fistulas

B) Squirt sign with empty rectum

What is the prognosis for a patient diagnosed with idiopathic or heritable pulmonary arterial hypertension?

_____

poor

How does myoglobin's affinity for oxygen compare to that of hemoglobin?

Myoglobin has {{greater/less}} affinity for oxygen

Myoglobin has greater affinity for oxygen

What type of oxygen-carrying molecule consists of a single polypeptide chain with a single heme moiety?

______

Myoglobin

Which form of hemoglobin has the lowest affinity for oxygen?

Highest?

Deoxygenated or oxygenated?

deoxygenated

oxygenated

Hemoglobin can act as a buffer for which ion?

____

H⁺

What are the four polypeptide subunits that form normal adult hemoglobin?

2 ____ subunits
2 ____ subunits

2 alpha subunits
2 beta subunits

How does emphysema alter lung compliance?

increases it

Lung compliance is _____ proportional to alveolar wall stiffness.

inversely

What is the definition of lung compliance?

change in lung ______/change in lung ______

change in lung volume/change in lung pressure

How does the presence of surfactant affect the compliance of the lung? Increases or decreases?

increases

What symptoms occur in a newborn with Hirschsprung disease?

Abdominal ______
______ emesis
Failure to pass ______ within 48 hours

Abdominal distention
Bilious emesis
Failure to pass meconium within 48 hours

What would a rectal suction biopsy show to indicate a diagnosis of Hirschsprung disease?

Absence of _____ cells

ganglion

What will be found proximal to the diseased segment of bowel in Hirschsprung disease?

_____ portion of bowel creating a "_____ _____"

Dilated portion of bowel creating a "transition zone"

What is the mechanism that causes Hirschsprung disease?

Failure of ____ ____ cell migration → Absence of ____ cells and ____ nervous plexuses in distal segment of colon

Failure of neural crest cell migration → Absence of ganglion cells and enteric nervous plexuses in distal segment of colon

There is an increased risk for Hirschsprung disease in individuals with what genetic syndrome?

____ syndrome

down

What loss of function mutations are associated with Hirschsprung disease?

Loss of function mutations in _____

RET

What findings may be present on a CT scan of the sinuses in a patient with cystic fibrosis?

_____ of the sinuses

Opacification of the sinuses

Which medication slows the progression of cystic fibrosis?

_____

Ibuprofen

What is the benefit of prescribing azithromycin for patients with cystic fibrosis?

______ activity

Anti-inflammatory activity

What is the function of aerosolized dornase alfa, albuterol, inhaled hypertonic saline, and chest physiotherapy in the treatment of cystic fibrosis?

Facilitates ______ clearance

Facilitates mucus clearance

What is the earliest manifestation of cystic fibrosis in a newborn?

______ ______

Meconium ileus

What is the reason for subfertility in females with cystic fibrosis?

______
Abnormally [thick/thin] cervical mucus

Amenorrhea
Abnormally thick cervical mucus

What is the cause of infertility in males with cystic fibrosis?

Absence of ___ ___

Absence of vas deferens

What complications occur in the gastrointestinal tract as a result of pancreatic insufficiency and biliary cirrhosis in patients with cystic fibrosis?

Deficiencies of _____-soluble vitamins
_____ with steatorrhea

Deficiencies of fat-soluble vitamins
Malabsorption with steatorrhea

What diagnosis is suggested if a newborn screening test reveals increased immunoreactive trypsinogen?

Cystic fibrosis

Which pathogens most commonly cause recurrent pulmonary infections in cystic fibrosis during childhood versus adulthood?

A) H influenzae in children; S aureus in adults
B) S aureus in children; P aeruginosa in adults
C) P aeruginosa in children; Aspergillus in adults
D) Burkholderia in children; S pneumoniae in adults

B) S aureus in children; P aeruginosa in adults

A patient with cystic fibrosis undergoes chest X-ray imaging. Which finding is most likely present?
A) Lobar consolidation only
B) Reticulonodular pattern
C) Pleural calcifications
D) Cavitary upper lobe lesions

B) Reticulonodular pattern

A patient with cystic fibrosis has a reticulonodular pattern on chest X-ray. Which process most directly explains this finding?
A) Chronic bronchitis and bronchiectasis
B) Pleural fibrosis and calcification
C) Acute pulmonary embolism
D) Alveolar surfactant deficiency

A) Chronic bronchitis and bronchiectasis

Why do patients with cystic fibrosis develop bronchiectasis over time?
A) Pulmonary venous congestion
B) Autoimmune pleural inflammation
C) Primary alveolar collapse
D) Chronic mucus plugging and infections

D) Chronic mucus plugging and infections

Which metabolic disorders may be present in patients with cystic fibrosis?

[Hyperkalemia/Hypokalemia]
Contraction [acidosis/alkalosis]

Hypokalemia
Contraction alkalosis

This is due to extracellular fluid H₂O/Na⁺ loss via sweating and concomitant renal K⁺/H⁺ wasting.

In which organ are fatty acids and amino acids metabolized to ketone bodies?

_____

Liver

What is the mechanism for ketone production in a patient with diabetic ketoacidosis or prolonged starvation?

[...] is depleted for gluconeogenesis → [...] accumulates → Ketone production

Oxaloacetate is depleted for gluconeogenesis → Acetyl-CoA accumulates → Ketone production

How does chronic alcoholic use increase ketone body formation?

Overuse of alcohol results in increased ____ state → Accumulation of ____ → Shunted to ____ → Buildup of ____ → Production of ketones

Overuse of alcohol results in increased NADH state → Accumulation of oxaloacetate → Shunted to malate → Buildup of acetyl-CoA → Production of ketones

Which of the three ketone bodies do not appear on a standard urinalysis?

β-hydroxybutyrate

What is the clinical implication of excess GH in children?

It causes ______ with increased ______ bone growth

It causes gigantism with increased linear bone growth

Red blood cells can only use ____ as an energy source.

glucose

Which ketone gives the fruity smell to the breath of a patient with diabetic ketoacidosis?

Acetone

After absorption of dietary fat and cholesterol in intestinal cells, where are lipids distributed next?

_____

Lymphatics

Which two apolipoproteins are transferred from HDL to chylomicrons and VLDL in circulation?

Apolipoprotein CII
Apolipoprotein E

Apolipoprotein CII is critical in the activation of which enzyme?

_____ lipase

Lipoprotein lipase

A chylomicron remnant binds to a hepatocyte utilizing which apolipoprotein and receptor?

Apolipoprotein ____ on chylomicrons binds to apolipoprotein ____ receptors on hepatocytes

Apolipoprotein E on chylomicrons binds to apolipoprotein E receptors on hepatocytes

Chylomicron remnants are broken down by hepatocytes into cholesterol and triglycerides. What is the next step in lipid transport?

Cholesterol and triglycerides are released into _____ from hepatocytes as _____

Cholesterol and triglycerides are released into circulation from hepatocytes as VLDL

After lipid breakdown via lipoprotein lipase, chylomicrons and VLDL become what respective lipoprotein forms?

Chylomicrons become ____ ____
VLDL becomes ____

Chylomicrons become chylomicron remnants
VLDL becomes IDL

When IDL is delivered to hepatocytes via apolipoprotein E and apolipoprotein E receptors, what lipoprotein is then released from hepatocytes?

LDL

In the final step of lipid transport, LDL particles are taken up by peripheral cells with the help of which apolipoprotein?

Apolipoprotein _____ on LDL binds to LDL receptors on _____ cells

Apolipoprotein B₁₀₀ on LDL binds to LDL receptors on peripheral cells

What 2 lipid-lowering medications are commonly associated with myopathy?

_____

_____

statins

fibrates

What is the key enzyme in ketogenesis that converts HMG-CoA into acetoacetate?
A) HMG-CoA reductase
B) Thiophorase
C) HMG-CoA lyase
D) Acetyl-CoA carboxylase

C) HMG-CoA lyase

Fibrates increase the risk of cholesterol gallstones primarily through inhibition of which enzyme?
A) HMG-CoA reductase
B) Cholesterol 7α-hydroxylase
C) Lipoprotein lipase
D) Hormone-sensitive lipase

B) Cholesterol 7α-hydroxylase

What class of lipid-lowering agents has the greatest effect in decreasing triglycerides?

Fibrates

What drug used in the treatment of heart failure is a recombinant form of BNP? _____

Nesiritide

When the heart is overworked or stretched, it releases ____ to help reduce blood pressure and fluid.

BNP

What stimulates release of BNP?

Increased _____ _____

ventricular tension

Which cells release BNP?

Ventricular ____

Ventricular myocytes

How does hydralazine affect afterload?

decreases afterload

How does nitroglycerin affect preload?

decreases preload

In a patient with chronic hypertension, how does the left ventricle compensate for increased afterload?

Left ventricular wall _____ to decrease wall stress

Left ventricular wall hypertrophies to decrease wall stress

An ECG tracing is shown in the image. What pathology does the presence of the U wave indicate?

_____ or _____

Hypokalemia or Bradycardia

Which pacemaker would take over if the SA node stopped functioning?

AV node

Enlarged P waves on an electrocardiogram may indicate pathology in which part of the heart? _____

Atrium

What neurotransmitters increase and decrease heart rate?

_____ increase heart rate
_____ and _____ decrease heart rate

Catecholamines increase heart rate
Acetylcholine and adenosine decrease heart rate

Which part of the adrenal gland secretes mineralcorticoids (such as aldosterone)?

zona ____

zona glomerulosa

Which part of the adrenal gland secretes glucocorticoids (such as cortisol)?

zona ____

Zona fasciculata

What is the embryologic origin of parafollicular cells?

____ pharyngeal pouch

4th

What are three ways to diagnose acromegaly?

Lack of suppression of serum _____ after oral glucose tolerance tests
_____ mass 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 most common cause of death in gigantism and acromegaly?

____ failure

Heart failure

What 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 _____ _____

Glucose tolerance is impaired due to insulin resistance

What endocrine tumor is associated with niacin deficiency?

Carcinoid tumors

What cell line do carcinoid tumors arise from and what do they secrete?

Carcinoid tumors originate from ____ cells and secrete ____

Carcinoid tumors originate from neuroendocrine cells and secrete 5-HT

Increased urinary 5-HIAA suggests what endocrine tumor?

Carcinoid tumor

What physical exam finding in Cushing syndrome does the image depict?

abdominal striae

What physical exam finding is shown in the image? What condition do you find this in?

Moon face, Cushings syndrome

A CRH stimulation test shows increases in ACTH and cortisol. What diagnosis is suggested?

____ ____

Cushing disease

To confirm that a patient has Cushing disease after suppression with a high-dose dexamethasone test, what do you order?

____ of the ____ gland

MRI of the pituitary gland

What would a high-dose dexamethasone suppression test do to ACTH in Cushing disease?

_____ ACTH

Suppress ACTH

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

CT of the abdomen, pelvis, and chest

What happens to ACTH levels during a high-dose dexamethasone suppression test in a patient with ectopic ACTH production from small cell lung cancer?

There will be no suppression of ACTH

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 _____

Measurement of serum ACTH

What will administration of CRH do to ACTH and cortisol levels in a patient with ectopic ACTH production?

normal ACTH and cortisol

Name some clinical indications for angiotensin II receptor blockers.

____ failure
____ (in a lot of kidney problems)
[Hypertension/Hypotension]
Chronic kidney disease with intolerance to ____ inhibitors

Heart failure
Proteinuria
Hypertension
Chronic kidney disease with intolerance to ACE inhibitors

What are the adverse effects of angiotensin II receptor blockers?

[Hyperkalemia/Hypokalemia]
Decreased ____ function
[Hypertension/Hypotension]
____

Hyperkalemia
Decreased renal function
Hypotension
Teratogenicity

How do angiotensin II receptor blockers affect levels of renin, angiotensin I, and angiotensin II?

[Increased/Decreased] renin levels
[Increased/Decreased] angiotensin I levels
[Increased/Decreased] angiotensin II levels

Increased renin levels
Increased angiotensin I levels
Increased angiotensin II levels

What is the mechanism of action of the -sartan drugs?

Selectively blocks binding of angiotensin II to ___ receptor

Selectively blocks binding of angiotensin II to AT₁ receptor

What is microscopic colitis?

Colonic ____ → Chronic ____ diarrhea

Colonic inflammation → Chronic watery diarrhea

Which gender is more likely to develop microscopic colitis?

Females

What is the likely diagnosis if colonic histology shows a thickened subepithelial collagen band or intraepithelial lymphocytes and inflammatory infiltrate in the lamina propria?

Microscopic colitis

In microscopic colitis, on endoscopy, the mucosa of the colon appears ____.

normal

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

Smooth ER

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?

____ bodies

Nissl bodies

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

Goblet cells
Plasma cells

_____ cells secrete mucus.
_____ cells secrete antibodies.

Goblet
Plasma

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

Rough endoplasmic reticulum

What three factors alter absorption of fat-soluble vitamins?

Bile ____
____ secretions
Presence of intact ____

Bile emulsification
Pancreatic secretions
Presence of intact ileum

Why is toxicity more common with fat-soluble vitamins than with water-soluble vitamins?

Fat-soluble vitamins ____ in fat

Fat-soluble vitamins accumulate in fat

Water-soluble vitamins are eliminated more rapidly.

Malabsorption syndromes, often presenting with chronic steatorrhea, can lead to deficiency of which vitamins?

[...]-soluble vitamins

Fat-soluble vitamins

What four dietary supplements should be added to a vegetarian/vegan diet? (3 vitamins and one mineral)

Vitamin B₂
Vitamin B₁₂
Vitamin D
Iron

High consumption of egg whites can predispose to which vitamin deficiency?

Vitamin B₇

Egg whites contain avidin, which binds to biotin and prevents its absorption.

Consumption of untreated corn is associated with which vitamin deficiency?

Vitamin B₃

What are the three most common adverse effects of ivabradine?

[Hypertension/Hypotension]
[Tachycardia/Bradycardia]
___ phenomena

Hypertension
Bradycardia
Luminous phenomena

What are the two main indications for prescribing ivabradine?

Chronic _______ angina with contraindications for β-blockers
Chronic heart failure with _______ ejection fraction

Chronic stable angina with contraindications for β-blockers
Chronic heart failure with reduced ejection fraction

What is ivabradine's mechanism of action?

Ivabradine selectively inhibits "____ " ____ channels → ____ slow depolarization phase

Ivabradine selectively inhibits "funny" Na⁺ channels → Prolonged slow depolarization phase

Different mutations in the same locus cause the same disease. What is this called?
A) Locus heterogeneity
B) Allelic heterogeneity
C) Incomplete penetrance
D) Heteroplasmy

B) Allelic heterogeneity

Mutations at different genetic loci cause the same phenotype. What is this called?
A) Allelic heterogeneity
B) Locus heterogeneity
C) Incomplete penetrance
D) Heteroplasm

B) Locus heterogeneity

A child inherits both normal and mutated mitochondrial DNA, causing variable mitochondrial disease expression. What is this called?
A) Heteroplasmy
B) Mosaicism
C) Anticipation
D) Pleiotropy

A) Heteroplasmy

A mutated gene is present in multiple family members, but only some show the disease phenotype. What is this called?
A) Variable expressivity
B) Locus heterogeneity
C) Incomplete penetrance
D) Allelic heterogeneity

C) Incomplete penetrance

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

Steroid hormone-producing cells

Hepatocytes

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

Rough endoplasmic reticulum

What is the pathophysiology behind the neurologic findings in vitamin E deficiency?

Demyelination of the posterior columns causes decreased ____ and decreased sensation of ____
Demyelination of the spinocerebellar tracts causes ____

Demyelination of the posterior columns causes decreased proprioception and decreased sensation of vibration
Demyelination of the spinocerebellar tracts causes ataxia

How does vitamin E protect neuronal membranes and red blood cells?

Vitamin E acts as an ______, and is protective against ____ ____ damage

antioxidant

free radical damage

In contrast to vitamin B₁₂ deficiency, vitamin E deficiency will present with the following:

No ____ anemia
No ____ neutrophils
No elevated serum ____ acid levels

No megaloblastic anemia
No hypersegmented neutrophils
No elevated serum methylmalonic acid levels

What is the likely cause of a hemorrhagic stroke in a patient being treated with warfarin who takes a vitamin E supplement?

Excess vitamin E decreases the metabolism of vitamin ____ → Enhanced ____ effects of warfarin → Increased risk of bleeding

Excess vitamin E alters the metabolism of vitamin K → Enhanced anticoagulant effects of warfarin → Increased risk of bleeding

What is a possible complication of excessive vitamin E supplementation in infants?

_____

Enterocolitis

What are the names of the two main forms of vitamin E?

____

____

Tocopherol
Tocotrienol

How may vitamin E deficiency present clinically?

____ (something to do with RBC)
____ anemia
____ weakness
Decreased ____ (neuro thing)
Decreased ____ sensation (neuro thing)
____ (neuro thing)

Acanthocytosis
Hemolytic anemia
Muscle weakness
Decreased proprioception
Decreased vibration sensation
Ataxia

A patient undergoes a pilocarpine sweat test for suspected cystic fibrosis. Which result would most strongly support the diagnosis?

A) Increased sweat chloride
B) Increased sweat glucose
C) Decreased sweat sodium
D) Increased sweat potassium

A) Increased sweat chloride

Why is sweat chloride elevated in cystic fibrosis?

A) Excess aldosterone activity
B) Defective CFTR chloride channels
C) Increased sodium-potassium ATPase activity
D) Autoimmune destruction of sweat glands

B) Defective CFTR chloride channels

What is the diagnostic test most commonly used for cystic fibrosis?

A) Schilling test
B) Nasal nitric oxide test
C) D-xylose absorption test
D) Pilocarpine-induced sweat test

B) Pilocarpine-induced sweat test

The CFTR gene encodes which type of protein?

A) Voltage-gated sodium channel
B) ATP-gated chloride channel
C) Ligand-gated calcium channel
D) Sodium-glucose cotransporter

B) ATP-gated chloride channel

What is the primary function of the CFTR protein in the lungs and gastrointestinal tract?

A) Reabsorbs sodium into epithelial cells
B) Secretes chloride into epithelial secretions
C) Pumps potassium into luninal cells
D) Secretes chloride into luminal secretions

D) Secretes chloride into luminal secretions

What is the primary function of CFTR channels in sweat glands?

A) Secrete bicarbonate
B) Reabsorb chloride
C) Secrete potassium
D) Reabsorb glucose

B) Reabsorb chloride

What genetic defect causes cystic fibrosis?

____ deletion → Defect in the ____ gene on chromosome ____

Phe508 deletion → Defect in the CFTR gene on chromosome 7

What accompanying symptoms can be seen in a patient who has from vision loss due to Leber hereditary optic neuropathy?

Features of ____ dysfunction

Features of neurologic dysfunction

In patients with cystic fibrosis, how does a decrease in Cl^- secretion cause thick mucus production in the lungs and gastrointestinal tract?

Low Cl^- secretion → [High/Low] intracellular Cl^- → Compensatory ____ reabsorption via ____ → Increase in ____ reabsorption → Abnormally thick mucus in lungs and gastrointestinal tract

Low Cl^- secretion → High intracellular Cl^- → Compensatory Na⁺ reabsorption via ENaC → Increase in H₂O reabsorption → Abnormally thick mucus in lungs and gastrointestinal tract

How does the transepithelial potential differ in patients with cystic fibrosis?

It is more [positive/negative] due to high ____ reabsorption

It is more negative due to high Na⁺ reabsorption

What is the sequelae of a Phe508 deletion in patients with cystic fibrosis?

A ___ protein that is retained in the ___ ___ ___

A misfolded protein that is retained in the rough endoplasmic reticulum

In patients with cystic fibrosis, what medication functions to reduce symptoms by opening chloride channels leading to improved chloride transport?

Ivacaftor

What is the mechanism of action of lumacaftor or tezacaftor in patients with cystic fibrosis?

Corrects the ____ of proteins caused by the ____ deletion

Corrects the misfolding of proteins caused by the Phe508 deletion

A patient with cystic fibrosis has severe malnutrition and steatorrhea. What is the treatment?

_____ enzyme replacement

Pancreatic

A patient with cystic fibrosis has recurrent pneumonia. Lung biopsy shows fungal organisms. Which diagnosis is most likely?

A) Cryptococcal pneumonia
B) Histoplasmosis
C) Allergic bronchopulmonary aspergillosis
D) Pneumocystis pneumonia

C) Allergic bronchopulmonary aspergillosis

Which late-stage complication can occur in cystic fibrosis?

A) Endocrine dysfunction
B) Hyperthyroidism
C) Adrenal crisis
D) Pituitary adenoma

A) Endocrine dysfunction

A patient presents with recurrent pulmonary infections, pancreatic insufficiency, and fat-soluble vitamin deficiencies. What is the diagnosis?

Cystic fibrosis

Which late-stage complication can occur in cystic fibrosis?

A) Acute cholecystitis only
B) Biliary cirrhosis
C) Viral hepatitis
D) Hepatic adenoma

B) Biliary cirrhosis

Which late-stage complication can occur in cystic fibrosis?

A) Neurologic disease
B) Renal disease
C) Liver disease
D) Bone marrow failure

C) Liver disease

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 _____

A combination of either lumacaftor or tezacaftor with ivacaftor

B. degeneracy

UUU and UUC both code for phenylalanine.

Degeneracy = multiple codons can code for the same amino acid.

A. allergic bronchopulmonary aspergillosis

Key clues:
Asthma patient
Recurrent wheezing/infiltrates despite antibiotics
Brown mucus plugs/sputum
↑ IgE and eosinophilia
Positive Aspergillus-specific IgE

This patient has the classic triad for allergic bronchopulmonary aspergillosis (ABPA):

• Asthma
• Eosinophilia
• Central/proximal bronchiectasis

A child has steatorrhea, nasal polyps, chronic bronchitis, and nail clubbing. What is the diagnosis?

Cystic fibrosis

What is the underlying cause of cri-du-chat syndrome?

____ arm deletion on chromosome ____

Short arm deletion on chromosome 5

Which chromosome carries the mutation for Wilson disease?

13

Which chromosome carries the mutation for Friedreich ataxia?

9

Which chromosome is affected in Patau syndrome?

13

Which chromosome carries the mutation for Williams syndrome?

7

What is the genetic syndrome associated with high-pitched crying, microcephaly, epicanthal folds, cardiac abnormalities, and intellectual disability?

Cri-du-chat syndrome

What cardiac abnormality is commonly found in patients with cri-du-chat syndrome?

VSD

Which chromosome is affected in Edwards syndrome?

18

Which chromosome is affected in Wilms tumor?

11

Which chromosome carries the BRCA1 mutation and the mutations that result in Li-Fraumeni syndrome and neurofibromatosis type 1?

17

Which chromosome carries the mutation for von Hippel-Lindau disease?

3

Which chromosome carries the mutation for Prader-Willi syndrome?

15

Which chromosome carries the mutation for multiple endocrine neoplasia type 1?

11

Which chromosome carries the mutation for α-thalassemia and other α-globin gene defects?

16

Which chromosome carries the mutation for Marfan syndrome?

15

Which chromosome carries the BRCA2 mutation?

13

Hemochromatosis is a disorder caused by a mutation in which chromosome?

6

Which chromosome carries the mutation for Huntington disease?

4

Which chromosome carries the mutation that predisposes a person to renal cell carcinoma?

3

Which chromosome mutation is associated with familial adenomatous polyposis?

5

Which chromosome carries the mutation for Angelman syndrome?

15

Which chromosome carries the mutation for neurofibromatosis type 2?

22

Which chromosome carries the defect that is responsible for achondroplasia?

4

A patient has a chromosomal defect that results in large, bilateral cystic kidneys. Which genes might be affected?

_____ on chromosome 16
_____ on chromosome 4

PKD1 on chromosome 16
PKD2 on chromosome 4

This is autosomal dominant polycystic kidney disease.

Which chromosome carries the mutation for agammaglobulinemia?

X

Which chromosome carries the mutation for β-globin defects?

11

Which chromosome carries the mutation for retinoblastoma?

13

Which two chromosome mutations are associated with each type of tuberous sclerosis?

TSC1 is associated with chromosome ____
TSC2 is associated with chromosome ____

9

16

An individual presents with severe intellectual disability, laughter at inappropriate times, seizures, and ataxia. What is the diagnosis?

Angelman syndrome

A child is diagnosed with Angelman syndrome due to loss of maternal chromosome 15 gene expression. Which genetic mechanism could cause this disorder?
A) Maternal uniparental disomy
B) Paternal uniparental disomy
C) Paternal deletion of chromosome 15
D) Trisomy 21

B) Paternal uniparental disomy

A child is diagnosed with Prader-Willi syndrome due to loss of paternal chromosome 15 gene expression. Which genetic mechanism could cause this disorder?
A) Maternal uniparental disomy
B) Maternal deletion of chromosome 15
C) Paternal uniparental disomy
D) Deletion of chromosome 5p

A) Maternal uniparental disomy

What type of tissues are typically affected in mitochondrial diseases?

Those with increased ____ requirements

Those with increased energy requirements

Mitochondrial diseases are rare disorders that arise secondary to failure of what process?

____ ____

Oxidative phosphorylation

Name two mitochondrial myopathies.

_____

_____

MELAS
MERRF

What would skeletal tissues affected by a mitochondrial myopathy show under electron microscopy?

Mitochondrial _____ _____

Mitochondrial crystalline inclusions

Leber hereditary optic neuropathy typically presents in what part of the population?

____, ____, ____ adults

Teens, Males, Young Adults

Describe the pathophysiology of Leber hereditary optic neuropathy.

Mutations in complex ____ of the electron transport chain → Neuronal death in ___ and ___ nerve → Subacute permanent bilateral vision loss

Mutations in complex I of the electron transport chain → Neuronal death in retina and optic nerve → Subacute permanent bilateral vision loss

What is the main characteristic of high-output heart failure?

[Increased/Decreased] cardiac output

Increased

What are the 6 causes of high-output heart failure?

Advanced _____ - liver thing
Severe _____ - RBC thing
_____ - endocrine thing
Severe _____ - health thing
Wet _____ - vitamin thing
_____ disease - bone thing

Advanced cirrhosis
Severe anemia
Hyperthyroidism
Severe obesity
Wet beriberi
Paget disease of bone

By what biochemical mechanism does vitamin K promote synthesis of clotting factors II, VII, IX, and X?

Through ___-carboxylation of ___ acid residues

Through γ-carboxylation of glutamic acid residues

Why might a patient develop vitamin K deficiency after prolonged antibiotic use?

Due to destruction of ____ ____

intestinal microbiota

What is genetic imprinting?

One gene copy is [...] while the other is [...] by methylation → Parent-of-origin effects

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.

An individual presents with hyperphagia, intellectual disability, hypogonadism, hypotonia, and obesity. What is the diagnosis?

Prader-Willi syndrome

What are two consequences of vulnerable child syndrome?

The child may miss ____
The child may have excessive ____ visits

The child may miss school
The child may have excessive medical visits

(the parents believe their kid is vulnerable to disease, found freq after a major incident)

Barrett esophagus: Replacement of nonkeratinized stratified ____ epithelium with nonciliated ____ epithelium with ____ cells

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

Barrett esophagus leads to increased risk of what cancer?

____ of the esophagus

Adenocarcinoma

Barrett esophagus

What are the reproductive manifestations of myotonic dystrophy?

Gonadal ___ in men
Reduced ___ in women

Gonadal atrophy in men
Reduced fertility in women

Fragile X syndrome is caused by a trinucleotide repeat expansion of ___.

CGG

What does anticipation refer to in genetic disease?

[Increased/Decreased] disease severity in successive generations
[Earlier/Later] age of onset in successive generations

Increased disease severity in successive generations
Earlier age of onset in successive generations

Huntington disease is caused by a trinucleotide repeat expansion of ____

CAG

Friedreich ataxia is caused by a trinucleotide repeat expansion of ____.

GAA

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

_____ _____

Bottleneck effect

Breastfed neonates are deficient in vitamin K for what two physiologic reasons?

____ ____ does not contain vitamin K
Neonates have ____ intestines

Breast milk does not contain vitamin K
Neonates have sterile intestines

What changes might be seen in the PT, aPTT, and bleeding time in a neonatal hemorrhage due to vitamin K deficiency?

[...] PT
[...] aPTT
[...] bleeding time

Increased PT
Increased aPTT
Normal bleeding time

A male neonate born at home has a spontaneous intracranial hemorrhage. What intervention could likely have prevented this problem?

Injection of vitamin ____

K

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 kind of gifts should physicians politely decline to accept?

Inappropriately _____ or [large/small] gifts
Gifts that may cause _____ or _____ distress to the patient
Any gift that might negatively affect the _____ of care

Inappropriately expensive or large gifts
Gifts that may cause financial or emotional distress to the patient
Any gift that might negatively affect the quality of care

When deciding not to accept a gift from a patient, what is the recommended way to politely decline?

With ____ while politely saying that the gift must be declined and ____ the patient that this will not affect their care or relationship with the physician in any way

gratitude

assuring

Vitamin ___ is synthesized by intestinal microbiota.

K

Name two essential polyunsaturated fatty acids.

_____ acid
_____ acid

Linoleic acid
Linolenic acid

What two products are created from the metabolism of linoleic acid?

____
____

Leukotrienes
Prostaglandins

Linoleic acid is metabolized to _____ acid, which serves as the precursor to leukotrienes and prostaglandins.

arachidonic

Which polyunsaturated fatty acid has been shown to have antihyperlipidemic and cardioprotective effects?

____ acid

Linolenic acid

Name 2 conditions in which bilateral internuclear ophthalmoplegia is seen.

____ ____

____

Multiple sclerosis
Stroke

internuclear ophthalmoplegia:

[Ipsilateral/Contralateral] adduction failure
Nystagmus in [same/opposite] side

Ipsilateral adduction failure
Nystagmus in opposite side

Why is internuclear ophthalmoplegia common in diseases that affect myelin?

Because of the extensive myelination of the ____

MLF

If the right eye is unable to adduct while an individual is trying to look left horizontally, where is the lesion?

_____ medial longitudinal fasciculus

Right medial longitudinal fasciculus

From lateral to medial, what are the 4 deep nuclei of the cerebellum?

Fastigial Emboliform Globose Dentate

Dentate
Emboliform
Globose
Fastigial

Don't eat greasy food

A patient has head tilting, wide gait, and nystagmus. Where in the cerebellum is the lesion likely to be?

[Medial/Lateral] cerebellum

Medial

Ipsilateral proprioceptive information is sent to what structure of the cerebellum?

____ ____ ____

Inferior cerebellar peduncle

Describe the path of outputting information from the cerebellar cortex to the contralateral motor cortex.

Cerebellar cortex via ____ cells → ____ ____ nuclei→ ____ cerebellar peduncle → Contralateral motor cortex

Cerebellar cortex via Purkinje cells → Deep cerebellar nuclei → Superior cerebellar peduncle → Contralateral motor cortex

Voluntary movements are relayed to the cerebullum by the contralateral motor cortex via what structure?

_____ cerebellar peduncle

Middle cerebellar peduncle

To what brain structures do the Purkinje cells of the cerebellum project?

____ ____ nuclei

Deep cerebellar nuclei

What are the output neurons of the cerebellar cortex?

____ cells

Purkinje cells

Recurrent falls to the left side indicate a lesion in which location of the cerebellum?

_____ _____ cerebellum

Left lateral cerebellum

What is the classic CT finding associated with acute pyelonephritis shown in the image?

_____ _____ enlargement

Striated parenchymal enhancement

What is a common histologic finding in kidneys affected by chronic pyelonephritis?

____ casts resembling ____ tissue

Eosinophilic casts resembling thyroid tissue

What finding on urinalysis suggests acute pyelonephritis?

____ ____ cells with or without white blood cell casts

White blood cells with or without white blood cell casts

What disease process is indicated by the findings in the renal biopsy specimen shown in the image?

Acute pyelonephritis

What form of chronic pyelonephritis is associated with a history of Proteus infection?

_____ pyelonephritis

Xanthogranulomatous pyelonephritis

What disease manifests renally as coarse, asymmetric corticomedullary scarring and blunting of calyces?

_____ pyelonephritis

Chronic pyelonephritis

What two conditions commonly lead to chronic pyelonephritis because they predispose individuals to infection?

_____ reflux
Chronic obstruction by _____ stones

Vesicoureteral reflux
Chronic obstruction by kidney stones

What is the likely diagnosis for a patient with fever, chills, nausea, and costovertebral angle tenderness on examination?

______ pyelonephritis

Acute pyelonephritis

What organism most commonly produces the condition demonstrated by the renal biopsy findings shown?

_____ _____

Escherichia coli

What are two common mechanisms for development of acute pyelonephritis?

____ urinary tract infection
____ spread of bacteria to the kidney

Ascending urinary tract infection
Hematogenous spread of bacteria to the kidney

What are five risk factors for acute pyelonephritis?

Urinary tract _____
Indwelling urinary _____
_____ reflux
Diabetes _____
_____ (women)

Urinary tract obstruction
Indwelling urinary catheters
Vesicoureteral reflux
Diabetes mellitus
Pregnancy

______ are the treatment for acute pyelonephritis

Antibiotics

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?

Transfuse the ____
Do not transfuse the ____

Transfuse the daughter
Do not transfuse the mother

A healthcare proxy can refuse emergency treatment for an adult patient, but not for a minor, on the basis of religious beliefs.

Should you accept a sponsorship offered by a drug company in exchange for advertising a new drug?

The offer must be [accepted/rejected]

The offer must be rejected

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?

Gently inform the family that involuntary movement is caused by ____ ____ and that brain death is equivalent to ____
Inform the ____ ____

Gently inform the family that involuntary movement is caused by spinal reflexes and that brain death is equivalent to death
Inform the ethics board

What should you do when a physician colleague arrives at work in an impaired state?

You are ethically and legally ____ to ____ impaired colleagues

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)

How should you respond if your patient wants to try alternative or holistic medicine?

Find out ____ the patient wants this
Inform the patient about known ____ and ____

Find out why the patient wants this
Inform the patient about known benefits and risks

Be supportive and nonjudgemental. You may refer the patient to a naturopath.

What should you do if you find out that your patient is experiencing physical abuse from an intimate partner?

Ensure that patient is ____ and has an ____ plan
Ask ____ questions
Provide ____ of answers in response
Do not push patient to take a step unless required by ____

Ensure that patient is safe and has an emergency plan
Ask open-ended questions
Provide summary of answers in response
Do not push patient to take a step unless required by law

Do not limit treatment because of ____ or ____ constraints.

Do not limit treatment because of financial or time constraints.

What is the best approach when a 7-year-old boy feels responsible for his older sister's death from cancer?

Use _____ terms in discussing his sister's death
_____ him that it was not his fault
Identify/normalize _____ and _____
Encourage healthy _____ strategies

Use concrete terms in discussing his sister's death
Reassure him that it was not his fault
Identify/normalize fears and feelings
Encourage healthy coping strategies

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

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.)

What is an appropriate response if an invasive test is performed on the wrong patient?

Regardless of the result, the physician is obligated to ____ the patient about the mistake

tell

What is an appropriate response if a woman who had a mastectomy says she now feels ugly?

Find out more about ____ the patient feels this way without offering ____ reassuring statements

Find out more about why the patient feels this way without offering falsely reassuring statements

What is the most appropriate next step when a patient is suicidal and has a plan?

Suggest voluntary ______

Suggest voluntary hospitalization

If necessary, the patient can be hospitalized involuntarily.

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?

Explore his ______
Explain that if a patient wants information, you must ______ it
If you believe the patient might harm herself or others, you can ______ it

Explore his reasoning
Explain that if a patient wants information, you must provide it
If you believe the patient might harm herself or others, you can withhold it

How would you help a patient if the patient has difficulty taking medication?

Provide _____ instructions
_____ the regimen
Use the _____ -_____ method

Provide written instructions
Simplify the regimen
Use the teach-back method

How can you help a patient if the patient is not adherent?

Discuss any ______ or ______ obstacles to adherence
Schedule regular ______ -______
Avoid ______ and ______ to other physicians

Discuss any logistical or financial obstacles to adherence
Schedule regular follow-ups
Avoid coercion and referrals to other physicians

What is an appropriate response if a patient is upset with the treatment provided by another physician?

Advise the patient to talk _____ to that physician

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)

What is an appropriate response if a patient is angry about the amount of time spent in the waiting room?

_____ for any inconvenience and _____ the patient's anger
_____ the patient for being patient, but _____ explaining why the delay occurred

Apologize for any inconvenience and acknowledge the patient's anger
Thank the patient for being patient, but avoid explaining why the delay occurred

What is an appropriate response if a patient wants an unnecessary procedure?

Discuss the patient's _____ and _____ for requesting the procedure
Avoid _____ procedures
Do not _____ or _____ the patient to another provider

Discuss the patient's concerns and reasons for requesting the procedure
Avoid unwarranted procedures
Do not discharge or refer the patient to another provider

What is an appropriate response if a patient flirts with you and asks you out on a date?

Explain that romantic relationships with patients are _____ appropriate
Employ a _____

Explain that romantic relationships with patients are never appropriate
Employ a chaperone

(It may be necessary to transfer the patient to another physician)

What is the appropriate response if a pregnant 17-year-old patient requests an abortion?

Certain states require ____ ____ for minors to undergo abortion

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)

How do you proceed when a family member wants information about a patient's prognosis?

Unless the patient gives _____, you should not give the information to family members

Unless the patient gives permission, you should not give the information to family members

For vax skeptics:
Address any ____
Explain ____ and ____ and why vaccinations are recommended
Do not administer any vaccinations without the parent's ____

Address any concerns
Explain risks and benefits and why vaccinations are recommended
Do not administer routine vaccinations without the parent's consent

What should be done when a dependent patient presents with injuries inconsistent with the caregiver's account?

_____ detailed history and exam findings
_____ patient alone if feasible
Contact _____ for assessment
_____ caregiver of your duty to report suspected abuse

Record detailed history and exam findings
Interview patient alone if feasible
Contact authorities for assessment
Inform caregiver of your duty to report suspected abuse

How should you proceed if a patient requests a nonemergent treatment option that is against your personal beliefs?

Provide _____ and _____ information, so the patient can make an informed decision.
Explain that you do not perform the procedure, but offer to _____ them to another physician.

Provide accurate and unbiased information, so the patient can make an informed decision
Explain that you do not perform the procedure, but offer to refer them to another physician

A deficiency in which vitamin results in Wernicke-Korsakoff syndrome?

Vitamin B₁ deficiency

What three symptoms are present in Korsakoff syndrome?

Irreversible _____ loss
_____
_____ changes

Irreversible memory loss
Confabulation
Personality changes

Wernicke-Korsakoff symptoms can be precipitated in a patient with thiamine depletion by administering _____ to a patient before vitamin _____

dextrose

B1

What are the symptoms of Wernicke encephalopathy?
____
____
____
____

Confusion
Ophthalmoplegia
Nystagmus
Ataxia
CorONA beer

What are six common complications of alcohol use disorder?

_____ (organ issue)
_____ (viral issue)
_____ (organ related issue)
[Central/Peripheral] neuropathy
_____ atrophy
Vitamin _____ deficiency

Pancreatitis
Hepatitis
Cirrhosis
Peripheral neuropathy
Testicular atrophy
Vitamin B₁ deficiency

How does naltrexone help patients with alcohol use disorder?

It reduces _____

cravings

How does disulfiram help patients with alcohol use disorder?

It conditions the patient to ______ from alcohol use

It conditions the patient to abstain from alcohol use

Which three medications are commonly prescribed for the management of alcohol use disorder?

_____
_____
_____

Naltrexone
Disulfiram
Acamprosate

Where are the cranial nerve nuclei generally located within the brainstem?

In the ____. This is between ____ and ____ portions of the brainstem.

In the tegmentum. This is between dorsal and ventral portions of the brainstem.

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.

Sulcus limitans. This forms during embryonic development of the alar and basal plates.

What general functions are coordinated by the medial brainstem nuclei?

____ functions

Motor functions

What general functions are coordinated by the lateral brainstem nuclei?

____ functions

Sensory functions

Which cranial nerve nucleus is located in the spinal cord?

Nucleus of cranial nerve XI

Which cranial nerve nuclei are located in the medulla?

Nucleus of cranial nerve [...]
Nucleus of cranial nerve [...]
Nucleus of cranial nerve [...]

Nucleus of cranial nerve IX
Nucleus of cranial nerve X
Nucleus of cranial nerve XII

Which cranial nerve nuclei are located in the pons?

Nucleus of cranial nerve [...]
Nucleus of cranial nerve [...]
Nucleus of cranial nerve [...]
Nucleus of cranial nerve [...]

Nucleus of cranial nerve V
Nucleus of cranial nerve VI
Nucleus of cranial nerve VII
Nucleus of cranial nerve VIII

Which cranial nerve nuclei are located in the midbrain?

Nucleus of cranial nerve [...]
Nucleus of cranial nerve [...]

Nucleus of cranial nerve III
Nucleus of cranial nerve IV

What three general classes of drugs may lead to mydriasis?
______
[Direct/Indirect] ______
[Direct/Indirect] ______

Anticholinergics
Direct sympathomimetics
Indirect sympathomimetics

What four general classes of drugs may lead to miosis?
______
______
______
______

Sympatholytics
Opioids
Parasympathomimetics
Organophosphates

fetal alcholol syndrome

fetal alcholol syndrome:

Impaired migration of ____ and ____ cells

Impaired migration of neuronal and glial cells

What conditions characterize the most severe form of fetal alcohol syndrome?

Heart-lung _____
_____

Heart-lung fistulas
Holoprosencephaly

What limb abnormality is associated with fetal alcohol syndrome?

Limb dislocation

What condition associated with substance use by a pregnant woman is a leading preventable cause of intellectual disability in the United States?

Fetal alcohol syndrome

What craniofacial findings are characteristic of fetal alcohol syndrome?

[Macrocephaly/Microcephaly]
Small palpebral ______
Smooth ______
[Thick/Thin] vermillion border

Microcephaly
Small palpebral fissures
Smooth philtrum
Thin vermillion border

What are the treatment options for performance-type social anxiety disorder?

____-blockers

____

β-blockers
Benzodiazepines

What disorder is agoraphobia commonly associated with?

Panic disorder

What is the fear of leaving the house, using public transportation, and being in big crowds or open spaces known as?

Agoraphobia

Which treatments can be prescribed for social anxiety disorder?

_____
_____
_____ _____ therapy

SSRIs
Venlafaxine
Cognitive behavioral therapy

How do phobias differ from normal fears?

Fear present in pathologic phobias is _____ and _____ for over _____ months

Fear present in pathologic phobias is excessive and persistent for over 6 months

Do individuals with a phobia recognize their excessive fear?

Yes

What is the treatment for a patient with a phobia?

[...] therapy
[...] therapy

Cognitive behavioral therapy
Exposure therapy

What is the definition of performance-type social anxiety disorder?

Anxiety restricted to ____ ____ or ____

Anxiety restricted to public speaking or performing

What are the treatment options for agoraphobia?

_____ _____ therapy
_____

Cognitive behavioral therapy
SSRIs

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?

No. Hallucinations can occur in the context of normal bereavement.

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?

No. This is persistent complex bereavement disorder.

What anomaly in the coagulation cascade causes thrombosis in a patient with factor V Leiden mutation?

Production of a factor V that resists activated protein [...] inhibition

Production of a factor V that resists activated protein C inhibition

What medication may reduce brain damage in acute thrombotic stroke if given within 3 to 4.5 hours of onset?

tPA

What is tPA used for clinically?

_____

Thrombolytic. This activates plasminogen to plasmin.

What is the role of protein S in anticoagulation?

Protein S is a cofactor for protein _____
Inactivates factors _____ and _____

Protein S is a cofactor for protein C
Inactivates factors Va and VIIIa

Name the three endogenous factors that promote anticoagulation.
____ ____
Protein ____
Protein ____

Antithrombin III
Protein C
Protein S

Why is vitamin K administration necessary for neonates soon after birth?

They lack ____ ____ that produce vitamin K

They lack enteric bacteria that produce vitamin K

What drug does inhibition of vitamin K epoxide reductase (leading to less Vitamin K coag function)?

Warfarin

What drug does enhancement of antithrombin III activity?

Heparin

What two medications can be administered to reverse the inhibitory effect of warfarin?

Vitamin _____ (slow reversal)
Fresh frozen _____ or _____ complex concentrate (immediate reversal)

Vitamin K (slow reversal)
Fresh frozen plasma or prothrombin complex concentrate (immediate reversal)

Which coagulation factor has the shortest half life?

Factor VII

Which coagulation factor has the longest half life?

Factor II

Activated forms of which factors are susceptible to inhibition by antithrombin?

Factor [...]
Factor [...]
Factor [...]
Factor [...]
Factor [...]
Factor [...]

Factor II
Factor VII
Factor IX
Factor X
Factor XI
Factor XII

What are the two principal targets of antithrombin?

_____
Factor _____

Thrombin
Factor Xa

Which enzyme is responsible for converting inactive vitamin K-dependent factors to their active forms?

___-___ ______

γ-glutamyl carboxylase

What is the first step in the protein C pathway?

_____-_____ complex activates protein C

Thrombin-thrombomodulin complex activates protein C

How does activated protein C proceed to inactivate factors Va and VIIIa?

Requires protein ____ to ____ factors Va and VIIIa

Requires protein S to cleave factors Va and VIIIa

List, in order, the structures through which sperm must travel to complete ejaculation.

[...] → [...] → [...] → [...] → [...] → [...]

Seminiferous tubules → Epididymis → Vas deferens → Ejaculatory ducts → Urethra → Penis

Are the symptoms and motivation of malingering intentional or unconscious?

Malingering symptoms → [...]
Malingering motivation → [...]

Malingering symptoms → Intentional
Malingering motivation → Intentional

Are the symptoms and motivation of factitious disorder intentional or unconscious?

Factitious disorder symptoms → [...]
Factitious disorder motivation → [...]

Factitious disorder symptoms → Intentional
Factitious disorder motivation → Unconscious

Are the symptoms and motivation of somatic symptom disorders intentional or unconscious?

Somatic symptom disorders symptoms → [...]
Somatic symptom disorders motivation → [...]

Somatic symptom disorders symptoms → Unconscious
Somatic symptom disorders motivation → Unconscious

What are three dermatologic manifestations of sulfa allergy?

_____
_____-_____syndrome

_____sensitivity

Urticaria
Stevens-Johnson syndrome
Photosensitivity

What common allergen is shared by sulfonamides, sulfasalazine, probenecid, furosemide, acetazolamide, celecoxib, thiazides, and sulfonylureas?

Sulfa

What are three hematologic manifestations of sulfa allergy?

____ anemia
____
____

Hemolytic anemia
Thrombocytopenia
Agranulocytosis

What are two genitourinary manifestations of a sulfa allergy?

Increased risk of ____ ____ ____
Acute ____ ____

Increased risk of urinary tract infection
Acute interstitial nephritis

When would ethacrynic acid be used in place of furosemide or other loop diuretics?

Diuresis in patients allergic to ____ drugs

Diuresis in patients allergic to sulfa drugs

Which two cholinomimetic drugs can be used in the treatment of glaucoma?

____

____

Carbachol
Pilocarpine

What is the mechanism of action of bethanechol, carbachol, pilocarpine, and methacholine?

{Direct/Indirect} ______ agonism

Direct cholinergic agonism

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

It is a potent stimulator of sweat, tears, and saliva production via parasympathomimetic action on muscarinic receptors and smooth muscles

What action of pilocarpine makes it useful in the treatment of open-angle glaucoma?

_____ of the _____ muscle

contraction of the ciliary muscle

What action of pilocarpine makes it useful in the treatment of closed-angle glaucoma?

_____ of the _____ _____ muscle

contraction of the pupillary sphincter muscle

Which direct cholinomimetic is used to treat xerostomia commonly associated with Sjögren syndrome?

Pilocarpine

Which three direct cholinomimetic drugs are resistant to degradation by acetylcholinesterase?

_____

_____

_____

Bethanechol

Carbachol

Pilocarpine

What condition- patient with severe eye pain caused by blockage of aqueous humor outflow?

acute angle-closure glaucoma

Relative to the inferior epigastric vessels, where do a direct and an indirect inguinal hernia present?

Direct hernia → [Medially/Laterally]
Indirect hernia → [Medially/Laterally]

Direct hernia → Medially
Indirect hernia → Laterally

From what muscle layer does the external spermatic fascia of the spermatic cord originate?

_____ _____ muscle

External oblique muscle

From which layer does the cremasteric muscle and fascia derive?

____ ____ muscle

Internal oblique muscle

From which layer does the internal spermatic fascia derive?

_____ fascia

Transversalis fascia

What layers comprise the spermatic cord?

_____ _____ fascia
_____ muscle and fascia
_____ _____ fascia

Internal spermatic fascia
Cremasteric muscle and fascia
External spermatic fascia

Through what structure does a direct inguinal hernia protrude?

_____ _____

Abdominal wall

Through which structure does an indirect inguinal hernia protrude?

[Internal/External] inguinal ring

Internal inguinal ring

List the layers of the anterior abdominal wall lateral to the deep inguinal ring, from the parietal peritoneum to the external oblique aponeurosis.

Parietal peritoneum
↓
[...] tissue
↓
[...] fascia
↓
[...] muscle
↓
[...] muscle
↓
External oblique aponeurosis

Parietal peritoneum
↓
Extraperitoneal tissue
↓
Transversalis fascia
↓
Transversus abdominis muscle
↓
Internal oblique muscle
↓
External oblique aponeurosis

How can you confirm a diagnosis of vitamin B₁ deficiency?

Increased ____ ____ activity following vitamin B₁ administration

Increased RBC transketolase activity following vitamin B₁ administration

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?

Impaired [...] breakdown → ATP depletion that is exacerbated by [...] infusion

Impaired glucose breakdown → ATP depletion that is exacerbated by glucose infusion

This occurs in thiamine deficiency

Which regions of the brain are damaged in Wernicke-Korsakoff syndrome as a result of vitamin B₁ deficiency?

_____ bodies _____ gray matter
_____ _____ _____ of the thalamus

Mammillary bodies Periaqueductal gray matter
Medial dorsal nucleus of the thalamus

Why are the heart and brain particularly susceptible to injury in patients with thiamine deficiency?

Highly ____ cells require more ____ to function

Highly aerobic cells require more ATP to function

What is the likely diagnosis for a patient with a known lung malignancy presenting with jugular venous distention and the skin finding shown?

Superior vena cava syndrome. Shown is blanching after fingertip pressure, which is characteristic of facial plethora.

Thiamine is required for the breakdown of ____ and the production of ____.

glucose

ATP

Dry beriberi is characterized by ____ and ____ ____ wasting.

polyneuropathy

symmetric muscle

What is a major complication of wet beriberi caused by vitamin B₁ deficiency?

[High/Low]-output ____ failure

High-output cardiac failure

What is the role of thiamine in the TCA cycle?

It is a cofactor for __-________ ________

It is a cofactor for α-ketoglutarate dehydrogenase

Vitamin B1 (thiamine) is the direct precursor to ________ ________ (TPP), also known as thiamine diphosphate.

thiamine pyrophosphate

What do all these need as a cofactor?

Branched-chain ketoacid dehydrogenase
α-ketoglutarate dehydrogenase
Pyruvate dehydrogenase
Transketolase

thiamine pyrophosphate (TPP)

D. free radical oxidative damage to CNS neurons

This is Wernicke encephalopathy from thiamine deficiency.

When does hCG typically peak during pregnancy?

At [...] to [...] weeks' gestation

At 8 to 10 weeks' gestation

When is hCG first detectable in the blood and urine of a pregnant patient?

Blood → Detectable [...] week(s) after fertilization
Urine → Detectable [...] week(s) after fertilization

Blood → Detectable 1 week(s) after fertilization
Urine → Detectable 2 week(s) after fertilization

What is the difference between embryonic/developmental age and gestational age?

Gestational age is calculated from the _____ _____ _____
Embryonic age is determined from the _____ of _____

Gestational age is calculated from the last menstrual period
Embryonic age is determined from the date of conception

What cell type secretes hCG shortly after conception?

_____

Syncytiotrophoblasts

When does implantation occur in relation to ovulation?

[...] week(s) after ovulation
[...] day(s) after fertilization

1 week(s) after ovulation
6 day(s) after fertilization

When does fertilization occur in relation to ovulation?

Within [...] day(s) of ovulation

Within 1 day(s) of ovulation

Where is the most common area of fertilization in the female reproductive tract?

____ of the ____ tube

Ampulla of the fallopian tube

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

Surgical ____
____ if it is associated with infertility or pain

Surgical ligation
Embolization if it is associated with infertility or pain

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 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 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 pathophysiologic mechanism by which the pathology leads to infertility?

_____ increase in the scrotum impairs _____

Temperature increase in the scrotum impairs spermatogenesis

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

Indicates inferior vena cava obstruction

Which antidepressants are contraindicated for patients who are taking tramadol and why?

____, ____, and ____ inhibitors are contraindicated due to the risk of serotonin syndrome

SSRIs, SNRIs, and MAO inhibitors are contraindicated due to the risk of serotonin syndrome

What 3 kinds of adverse effects may occur with tramadol?

_____-like adverse effects
Lowering of _____ threshold
_____ syndrome

Opioid-like adverse effects
Lowering of seizure threshold
Serotonin syndrome

What is the mechanism of action of tramadol?

Weak ____ agonist
Inhibits the reuptake of ____ and ____

Weak opioid agonist
Inhibits the reuptake of norepinephrine and serotonin

How does malignant carcinoid syndrome cause pellagra?

Tryptophan is shunted primarily toward the synthesis of _____, leaving less tryptophan to synthesize _____

Tryptophan is shunted primarily toward the synthesis of serotonin, leaving less tryptophan to synthesize niacin

Precocious puberty can be diagnosed if secondary sexual characteristics develop before what age?

[...] years for girls
[...] years for boys

8 years for girls
9 years for boys

What mechanism causes short stature in children affected by precocious puberty?

[Increased/Decreased] sex hormone exposure or production → Early skeletal ____ → Premature closure of the ____ plates

Increased sex hormone exposure or production → Early skeletal maturation → Premature closure of the epiphyseal plates

What is the difference in the mechanism of disease for central and peripheral precocious puberty?

Central precocious puberty → Increased ____ secretion
Peripheral precocious puberty → Increased ____ ____ production independent of ____

Central precocious puberty → Increased GnRH secretion
Peripheral precocious puberty → Increased sex hormone production independent of GnRH

What are two causes of central precocious puberty?

____
Central nervous system ____

Idiopathic
Central nervous system tumors

What are two possible oncologic causes of peripheral precoious puberty?

____-secreting ____ tumor
____ cell tumor

Estrogen-secreting ovarian tumor
Leydig cell tumor

What are two congenital conditions that may cause peripheral precocious puberty?

Congenital ____ ____
____-____ syndrome

Congenital adrenal hyperplasia
McCune-Albright syndrome

What is the likely diagnosis of an obese patient presenting with snoring, disrupted sleep, reduced PaO₂, and increased PaCO₂?

____ ____ AKA ____ syndrome

Obesity hypoventilation AKA Pickwickian syndrome

What is the first-line treatment for central sleep apnea?

[Positive/Negative] airway pressure

Positive airway pressure

What test confirms the suspected diagnosis in an obese patient presenting with daytime somnolence, disrupted sleep, and loud snoring?

Sleep study

What is the pathophysiologic mechanism that leads to a high hematocrit in a patient with daytime somnolence, disrupted sleep, and loud snoring?

Increased ___ release secondary to ___ → Increased erythropoiesis

Increased erythropoietin release secondary to hypoxia → Increased erythropoiesis

What anatomic abnormality is commonly associated with obstructive sleep apnea in adults?

Excess ___ tissue

Excess parapharyngeal tissue

What anatomic abnormality is commonly associated with obstructive sleep apnea in children?

___ [hypertrophy/hypotrophy]

Adenotonsillar hypertrophy

What are the two preferred treatment options for obesity hypoventilation syndrome?

Weight [gain/loss]
[Positive/Negative] airway pressure

Weight loss
Positive airway pressure

What is the major difference in the etiology of central sleep apnea compared to obstructive sleep apnea?

Central sleep apnea is due to _____-driven impairment in respiratory effort
Obstructive sleep apnea is due to respiratory efforts against airway _____

Central sleep apnea is due to CNS-driven impairment in respiratory effort
Obstructive sleep apnea is due to respiratory efforts against airway obstruction

What severe complications are commonly seen due to nocturnal hypoxia in sleep apnea?

____ (seen on EKG)
Systemic/pulmonary [hypertension/hypotension]
Sudden ____

Arrhythmias
Systemic/pulmonary hypertension
Sudden death

What happens to a patient's PaCO₂ in the setting of obesity hypoventilation syndrome?

[Increased/Decreased] PaCO₂ is seen during waking and sleeping hours

Increased PaCO₂ is seen during waking and sleeping hours

What would you expect the daytime PaO₂ to be in a patient with sleep apnea?

Normal

What three findings are classically associated with obstructive sleep apnea?

____
Loud ____
Daytime ____

Obesity
Loud snoring
Daytime sleepiness

What is the pathophysiologic mechanism whereby sleep apnea leads to sleep disruption?

Repeated ____ of breathing during sleep → Sleep disruption

Repeated cessation of breathing during sleep → Sleep disruption

What are the three most common causes of central sleep apnea?

___ use
___ injury/toxicity
[Organ] failure

Opioid use
CNS injury/toxicity
Heart failure

What type of sleep apnea can cause a patient with advanced heart failure to oscillate between apnea and hyperpnea during sleep?

[Central/Obstructive] sleep apnea

Central sleep apnea. This is associated with Cheyne-Stokes respirations in some patients, as well as congestive heart failure and central nervous system toxicity.

What five treatment options are commonly recommended in patients with obstructive sleep apnea?

Weight [gain/loss]
_____
_____ devices
_____ nerve stimulation
Upper airway _____

Weight loss
CPAP
Dental devices
Hypoglossal nerve stimulation
Upper airway surgery

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?

Countertransference

What term describes the behavior of a patient projecting feelings about a formative or other important individual, such as a parent, onto a physician?

Transference

What genetic abnormalities are associated with horseshoe kidney?

_____ _____

Chromosomal aneuploidies. Examples include Turner syndrome and trisomies 13, 18, and 21.

A horseshoe kidney gets trapped beneath which artery?

_____ _____ artery

Inferior mesenteric artery

What is the pathophysiology behind the horseshoe kidney?

[Superior/Inferior] poles of both kidneys fuse → Kidneys are trapped under the inferior mesenteric artery during ____ in fetal development

Inferior poles of both kidneys fuse → Kidneys are trapped under the inferior mesenteric artery during ascension in fetal development

What complications may arise in a patient born with a horseshoe kidney?
_____
Renal _____
_____
Increased risk of renal _____ (rare)

Infection
Renal stones
Hydronephrosis
Increased risk of renal cancer (rare)

What vessel is likely blocked in a patient presenting with a left lung mass, headaches, dizziness, and a berry aneurysm on angiography?

Superior vena cava

Superior vena cava syndrome puts a patient at risk for rupture of which arteries?

_____ arteries

Intracranial arteries. These arteries may burst as a result of elevated intracranial pressure.

What has likely occurred in a patient with superior vena cava syndrome who has developed rapid-onset confusion, loss of sensation, and hemiparesis?

Critically [increased/decreased] intracranial pressure → Intracranial bleed

Critically increased intracranial pressure → Intracranial bleed

This is either from a ruptured aneurysm or an intracranial artery.

What are the two most common causes of superior vena cava syndrome?

_____
_____ from indwelling catheters

Malignancy
Thrombosis from indwelling catheters

How urgently should a patient with an indwelling venous catheter, facial edema, and the CT findings shown be treated?

Treat emergently

Thoracodorsal innervates what muscle?

lat

Damage to the long thoracic nerve would affect which arm abductor muscle?

serratus anterior

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

{{c1::Root}} of the brachial plexus

With which artery does the long thoracic nerve travel in the axillary region?

long thoracic artery

What is the most common presentation of cavernous sinus syndrome?

Variable ____
Reduced ____ sensation
____ syndrome
Occasionally reduced ____ sensation

Variable ophthalmoplegia
Reduced corneal sensation
Horner syndrome
Occasionally reduced maxillary sensation

Which arteries pass through the cavernous sinus?

____ ____ arteries

Internal carotid arteries

What 3 underlying conditions may cause cavernous sinus syndrome?

____ tumors
Carotid-cavernous ____
Cavernous sinus ____

Pituitary tumors
Carotid-cavernous fistulae
Cavernous sinus thrombosis

Which 5 cranial nerves may be endangered when a cavernous sinus thrombosis forms?

Cranial nerve [...]
Cranial nerve [...]
Cranial nerve [...]
Cranial nerve [...]
Cranial nerve [...]

Cranial nerve III
Cranial nerve IV
Cranial nerve V₁
Cranial nerve V₂
Cranial nerve VI

What is the pathway of blood from the eye and superficial cortex to the greater venous system?

This is via the _____ _____ to the _____ _____ vein