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Terms in this set (96)
A shunt between _______________ veins is most likely to relieve esophageal bleeding caused by varices
Splenic and Left renal
In a TIPS procedure, a shunt is placed between __________
Portal vein and hepatic vein
Improper insertion of a catherther in the internal jugular vein will damage which 2 underlying structures
Hilar mass arising from bronchus with cavitation
Squamous cell carcinoma
pancreatic endocrine tunmors
Type of anemia with low iron and low TIBC
Anemia of chronic disease
Low iron, low TIBC and high ferritin.Anemia is first normocytic and becomes microcytic
If there is stenosis of the renal artery, what region of the kidney will have the highest concentration of renin in response to reduction in arcuate artery pressure?
PGE2 is synthesized in?
Eye muscles located in orbital floor
In a patient with multiple rib fractures, the most likely afferent pathway of this patient's chest pain is carried by?
After 20 hours of fasting, what precursor contributes to normal glycemia?
Alanine + Lactate
- hepatic gluconeogenesis
The only fatty acid that can contribute to gluconeogenesis
Odd chain fatty acid (propionyl coA)
Concommitant use of statins + fibrates can cause________
Effect on fetus if maternal TSH increases in pregnancy
Abnormal brain development
Molluscum contagiosum virus
How does Prednisone enhance the response to the B-adrenergic agonist?
Enhances action of agonist at B-adrenergic receptors
What causes oxytocin concentration to increase in labor?
Birth canal reflex
- stretch/ dilation of the cervix and vagina --> Ferguson reflex-->oxytocin release from hypothalamus
Which area of the kidney will be most affected by the administration of an ACEE- Inhibitor?
Most approptiate treatment for effective relief from DVT symptoms
A 2 week old infant with a PDA will have which finding?
Higher than normal left ventricular cardiac output
After receiving 3 units of blood, patient develops SOB. CXR shows bilateral lung infiltrates. Abg shows PO2 of 55mmHg. What caused this condition?
Transfusion related acute lung injury
- due to donor antleukocyte antibodies against recipent neutrophils and pulmonary endothelial cells
An 8 year old with breast development.
Is this normal?
- If less than 8, its precocious
Testicular enlargement before the age of ________ in boys is considered early
Will see pubic hair, axillary hair, body odor
Before 8 in girls, 9 in boys
Which sweat glands have secretions that are associated with characteristic odor of sewat?
Secrete an odorless sweat
Eccrine sweat gland
75 year old woman with Right sided Horners, dysphagia, and difficulty speaking. With decreased pain and te,perature on R face and L body had an occlusion of which artery?
Dysphagia and dysarthria should make you suspect an infarct of?
- in lateral medullary syndrome
Prolonged apnea in a patient under general anesthesia who was induced with sevofluorane and intubated with succinylcholine, caused by?
- makes drug stay longer
Effect of NSAID on:
Increased: LTC4, AA
Decreased: PGH2, PGE2
* NSAIDS don't act on leukotriene pathway
CT of head shows edematous right hemisphere, after patient experienced left arm and leg wekness 16 hours ago. Microscopic exam 1 hour after patient dies will show?
Eosinophilic red neurons
AA reactive increase of a cell line ends in "-cytosis" (e.g., leukocytosis);
Neoplastic increase is referred to as "-emia" (e.g., leukemia).
Why would an anti-idiotypic antibody be inappropriate as a therapeutic agent for the treatment of a patient with multiple myeloma?
Myeloma cells don't have membrane bound surface Immunoglobulin
What is an anti-idiotypic antibody?
When one antibody binds to an idiotope of another antibody it
A patient with 5 day history of shortness of breath and swollen legs.
Has a large AV fistula from 15 years ago, caused by a stab wound to left supraclavicular area 15 years ago. What finding is most likely in this patient?
Increased resting cardiac output
Effect of an AV fistula
Decrease in systemic vascular resistance
Decrease in blood pressure
Decreased effective circulating blood volume
In a partial thyroidectomy, a branch of the thyrocervical trunk is ligated to interrupt supply to the resected specimen. It is most important to also ligate a direct branch ot whoch artery?
External carotid artery
- branch is superior thyroid artery
Blood supply to thyroid
Superior thyroid artery- a branch of the external carotid artery
Inferior thyroid artery-a branch of the thyrocervical trunk
Why is there a larger amount of carbon dioxide in venous blood vs arterial blood samples?
HCO3- in plasma
A 40 year old man with Interstitial pulmonary fibrosis has a greater maximal expiratory flow rate than predicted. What explains these findings?
Increased radial traction on airways
Explain the concept of radial traction
U can think of radial traction as elastic springs that anchor the airway lumen to the lung interstitium (parenchyma) hence helping to keep the airway patent.
In restrictive lung Dzs, u get interstitial fibrosis and this increases radial traction bcos it "adds more elastic springs" between the airway lumen and the interstitium/parenchyma. U basically add "stuff/fibrosis" between the lumen and interstitial and this "stuff" connects the two more strongly... there's always a more complicated explanation, but I think this is easy to follow...
In some obstructive lung Dzs say emphysema (congenital or acquired), u basically have more elastase activity than anti-elastase activity thus the interstitium is broken down thus decreasing the # of elastic springs b/t the airway lumen & interstitium, aka reduced elastic recoil.
Bonus: Such airways are more prone to collapsing during exhalation (increased collapsing pressure) given the decreased radial tension to withstand the increasing collapsing pressures --> expiratory obstruction...
Maternal diabetes is a major risk factor for which obstetric complication?
47 yr old with jaundice. Lab findings include increased serum bilirubin concentration and positive urine bilirubin test. What is associated with the positive bilirubin test?
Bile duct obstruction
1]urobillinogen is produced wen conjugated bilirubin goes into bowel thru bile duct .bacteria convert conj bili to urobilinogen .....so any reason where excess unconjugated billirubin is formed ull get urobillinogen in urine [so u exclude condition like obstructive jaundice and liver injury]
2]in obstructive juandice ull not get urobillinogen at all all u get billirubin in urine becoz u have conjugated billirubin which will leak out from ducts due to obstruction and also conj billiru is water soluble.
If there is compression of C5 and C6 spinal nerves as they exit the spinal canal, weakness of which movements will confirm this diagnosis?
Abduction of upper extremity
- Axillary nerve damage
23 year old with persistent sneezing each year in the spring as she works in her garden. A drug with which mechanism is most likely to be effective to treat her?
Stabilization of mast cell membranes
Beta 2 agonists are used to treat
In a 55 year old with hypertension, a faint bruit is heard over the left abdomen. Captopril radionucleotide scan shows delayed function of the left kidney. Which finding is most likely on abdomninal aortography?
Left renal artery atherosclerosis
66 year old woman with pancreatic cancer comes to office due to 2 day history of black tarry stools. Upper endoscopy shows gastric varices.
Which vein is the most likely source of bleeding in this patient?
Short gastric vein
Drain into the splenic vein
short gastric veins, left gastroepiploic vein, pancreatic veins, inferior mesenteric vein
In an 18 week pregnant woman with palpitations and an elevated serum T4. What test confirms a diagnosis of hyperthyroidism in this patient?
In an MS patient, which drug is most likely to improve spasticity?
- can cause hyperpolarization
75 year old woman with decreased concentration and energy for the past month. For 6 months she has been waking up at 4am and unable to get back to sleep. What is the most likely cause of sleep disturbance in this patient?
An investigatorr studying the regulation of pulmonary lymphatic flow using an animal model. Catheters are implanted into the femoral vein, PA and main lymphatic vessel draining the lungs in anesthesized, intubated and mechanically ventilated animals. Drugs may be injected directly into the pulm onary artery catheter and inspired gas mixtures altered at the ventilator. timed collection of lymph from catheters is used to calculate lymphatic flow, Which intervention will most likely increase flow of pulmonary lymmph in these animals?
IV infusion of 0.9% saline for 5 minutes
Relationship between sample size and confidence interval
Increasing the sample size decreases the width of confidence intervals
Decreasing the sample size increases the width of confidence intervals
In a seated patient were is the needle inserted for a thoracentesis?
9th intercostal space
6, 7, 8 or 9 intercostal space
In treatment of ADHD, a drug with which action is most likely to be useful ?
Stimulation of release of biogenic amine neurotransmitters
If there is an enlargement of the pancreas and dilation of the pancreatic ducts. The most underlying cause if these findings is a gallstone lodged in which location?
Elderly man with dementia needs a feeding tube.
Wife and kids visit him at nursing home frequently. In what way is it most appropriate for the physician to address the issue of a feeding tube?
Encourage family to come to a consensus based on their perception of the patient's wishes
11 year old boy with knee pain after he twisted it 3 weeks ago. PE shows no mass.
X ray shows osteolytic mass that has eroded through cortex and elevated the periosteum. Mass is surrounded by reactive bone in some areas. Biopsy shows atypical cells with hperchromatic pleomorphic nuclei. Also surrounded by eosinophilic matrix. THis tumor is most likely yo spread first to?
What tumor is it?
Most appropriate pharmacotherapy to trat volume overload and pulmonary edema in chronic renal failure
A female newborn with hyaline membrane disease is intubated and mechanically ventilated at O2 stat between 92% and 95%. The primary goal of this treatment is protection of which structure?
(prevents retinal detachment /blindness)
6 months after Strep pneumonia induced pneumonia, CXR shows no abnormalities. Which of the following is produced by the cell type responsible for restitution of near normal lung structure?
- Even with severe pneumonia, there is usually full recovery, only rarely is there scar formation
Chronic Abuse of drug presents as headaches, forgetfullness, clumsiness and falls, broad based ataxic gait.
This patient is 14.
What drug is it?
partial mu agonist, kappa antagonist
A case control study determines what value?
A cohort study determines which value?
Cyclosporine has been used to prevent graft rejection. Graft rejection is most likely prevented by an action of cyclosporine on which of the following steps in T- lymphocyte recognition/activation?
Inhibits IL-2 gene transcription
Five minutes after graft blood vessels are anastomosed to host vessels in a renal transplant, a man develops hemorrhage and thrombotic occlusion of the graft vessels. What is the most likely mediator of this process?
IgG + comnplement
(Hyperacute graft rejection occurs within minutes, Type II hypersensitivity rxn)
(IgG activates complement)
Boy falls and lascerates his lower leg to the subdermal connective tissue. What is the first step in tissue repair process?
Formation of fibrin clot
A 66 year old right handed woman develops spastic left paralysis and weakness of the lower 2/3 of her face on the left. Her lesion is most likely located in?
If the incidence of Tay Sach;s among Askenazi Jews is 1/900, which of the following is the approximate carrier frequency of this mendelian train in the population
60 year old comes to physician due to swlling and pain in her hands in the past 6 months. PE shows joint tenderness and effusion. She asks for ethsoxsalen and UV A light (PUVA) whoch worked well for her sister. THis therapy would be contraindicated in this patient if she were to have which condition?
Porphyria cutanea tarda
- blistering due to photosensitivity + hyperpigmentation upon sun exposure
70 year old woman with recurrent pneumonia, fatigue and WL for 3 months. SerumT4 and TSH are within reference range and serum T3 is low. TSH increases after afministration of TRH. What is the diagnosis?
Euthyroid sick syndrome
What is euthyroid sick syndrome?
Euthyroid sick syndrome is a condition in which serum levels of thyroid hormones are low in clinically euthyroid patients with nonthyroidal systemic illness. Diagnosis is based on excluding hypothyroidism.
80 year old woman can't concentrate her urine above 450mOgmol/kg H2O. She accumulates 450 mOsmol/day of solute which must be excreted by the kidneys. she loses 900 ml of water insensibly and 100 mL of water in sweat and feces. Which of the following best represents the minimum volume of watr that she must ingest in food and drink daily to prevent an increase in plasma osmolality?
A mutation in a gene for a protein that controls traffic of vesicles into the Golgi complex. Electron microscopy will show which finding?
FOXO transcription factor responds to insulin signaling by alterinf transcription of several metabolic genes. FOXO can respond rapidly to changes in insulin signaling because it is reversibly modified. In what ways does insulin signaling regulate FOXO activity?
A 23 year old woman tests positive for spirochetes. Which histologic change is most likely to be seen on a biopsy specimen?
Obliterative endarteritis with lymphocytes and plasma cells
Study to select men ages 65 and older to be used as reference values in a lab. Random selection of which of the following will provide an
estimate of the mean BUN concentration in this group.
500 men from a list of patients to be examined by a urologist
HIV women admitted with epigastric tenderness, abdominal distension and absent bowel sounfs. Lab studies show elevated serum amylase. What drug was she given>
80 year old woman has lost her pep and is feeling funny
Hx og poorly controlled hypertension, and started a new med 2 weeks ago but can't remember the name.
BP is high at 130/85. Serum potasssium is 3mEg/l. WHich drug caused the patient's condition?
- can cause hypokalemic metabolic alkalosis
18 year old comes to physician because of 2 week history of extreme fatigue. PE sows scleral icterus.
Hgb 9, Retic count 22.5%, Erythocyte 2, 3BPG is high, bilirubin is high. THis patient has a deficency of which enzyme in erythrocytes
PFK 1 and Glyceraldehyde-3-phosphate dehydrogenase
35 year old woman has blistering lesions on her face, arms and hands on the sun exposed areas. PE shws fluid filled vesicles and bullae on n face and upper extremities.
Lab findings: Increased AST, ALT, total prphyrin, urine porphyrin.
WHich enzyme deficiency is the cause of this patient's disorder
- She has porphyria cutanea tarda, it is associated with hep C
Ligand of the CCR5 receptor in HIV
What happens to the mixed venous oxygen tension in a person with myocardial ischemia
Mixed venous oxygen saturation
Mixed venous oxygen saturation (SvO2) is the percentage of oxygen bound to hemoglobin in blood returning to the right side of the heart
*****An investigator is studying the efficacy vaccine formulations directed against capsular polysaccharides of N. meningitidis. THe carbohydrates are chemically conjugated to various compounds and injected into lab mice. TIters of IgG are then measured. Which compound ois most likely to induce increased titers of these antibodies whe conjugated to the polysaccharides?
Characterized by chronic inflammation and fibrous thickening of alveolar septa, after URI (bacterial 1 year ago
Usual interstitial pneumonitis
Chromatin negative buccal smear tells you _________
No barr body= male
In a normal appearing female who has never had a period, with a blind ending vagina and no uterus or ovaries. Buccal smear shows chromatic- negative nuclei. What is the most likely diagnosis?
Androgen insensitivity syndrome
How does the rabies virus reach the brain?
Retrogade via nerves
A man drinks alcohol heavily on a weekend. Which cellular changes is most likely to occur in his liver?
- hepatic statosis is macrovesicular fatty change that may be reversible with alcohol cessation
What are essential amino acids?
PVT TIM HALL
For a person on a low fat, low carb diet, what fatty acids should be included in her diet to maintain good nutrition?
A woman with PCOS is at greatest risk of developing which conditions?
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