UWORLD Notes by Subject (Main Division) [Usmle Grassroots]

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Question

Id Main Division Sub Division Notes

654 Anatomy Cardiovascular System

A laterally directed chest wall stab wound at the fifth intercostal space along the midclavicular line. The structure injured would be the *Left Lung*

1699 Anatomy Cardiovascular System A puncture wound at the left sternal border in the fourth intercostal space will injure the *Right Ventricle*

1805 Anatomy Cardiovascular System

The aorta and superior mesenteric artery can compress the left renal vein. The increase pressure in the left renal vein causes retrograde blood flow to the testes and dialtion of the pampiniform plexus ==> *VARICOCELE*

1813 Anatomy Cardiovascular System

A skull fracture at the junction of the frontal, pariatal, temporal and sphenoid bones (pterion) risks lacerating the middle meningeal artery and causing epidural hematoma. The MMA is a branch of *Maxillary Artery*

1871 Anatomy Cardiovascular System

In most poeple with right coronary dominance, Inducible ischemia of the inferior surface of the heart would probably be due to occlusion of *Right coronary artery*

1967 Anatomy Cardiovascular System For graft purposes, the Great Saphenous Vein can accessed at a site *Just inferolateral to the pubic tubercle* 2023 Anatomy Cardiovascular System The Superior Venecava is derived from the common cardinal veins.

2130 Anatomy Cardiovascular System

A high speed motor vehicle accident that leads to injury of aorta would most liley ruptur that ismthus (just after subclavian artery) of the aorta. Pt usually dies before reaching hospital. If they do reach they present with non specific chest and abdominal pain.

7646 Anatomy Cardiovascular System

Left ventricular leads in biventricular pacemaker course through the coronary sinus, which resides in the *Atrioventricular Groove* on the post aspect of the heart.

8294 Anatomy Cardiovascular System

IV drug users can have righ sided endocarditis involving the *TriCuspid Vavle* most often due Staph Aureus infection. This often presents as an early systolic murmur best heard over the left lower sternal border due to tricuspid regurgitation.

8332 Anatomy Cardiovascular System

Pt undergoes transesophageal echocardiography. The ultrasound probe is placed in the mid-esophagus facing "anteriorly". The cardiac chamber closest to the probe is *Left Atrium*

8333 Anatomy Cardiovascular System Transesophageal echo probe facing posteriorly would interrogate the *Descending Aorta*

11764 Anatomy Cardiovascular System

While cannulating the Right Common Femoral artery for cardiac catherization, the physician penetrates the arterial wall above the right ingiunal ligament. Soon after pt becomes cold, and

hypotensive. Bleeding is susupected. Most likely location is *Retroperitoneal Space*

[CFA cannulation shud be below inguinal ligament] 11780 Anatomy Cardiovascular System

Pulmonary capillary wedge pressure (measured via a swan-ganz catheter into the pulmonary artery) closely reflectsend-diastolic pressure in *Left Atrium* and the Left Ventricle.

11956 Anatomy Cardiovascular System

Radiofreqyency ablation of the AV node in a pt with arrhythmia is achieved at the *Interatrial septum near the opening of the

coronary sinus* 1106 Anatomy Dermatology

Pt with inflamatory acne. The glands involved release secretions by *Holocrine* manner.

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1686 Anatomy Ear, Nose & Throat (ENT) The recurrent laryngeal nerve is in close proximity to the inferior thyroid artery and can accidently damaged during inferior thyroid artery ligation during a thyroidectomy.

1698 Anatomy Ear, Nose & Throat (ENT)

Blunt trauma to the globe can cause orbital blowout fractures. These fractures most commonly involve the medial or inferior orbital walls due to thin bone bordering the ethmoid and *Maxillart* sinuses.

1814 Anatomy Ear, Nose & Throat (ENT)

Pt who faints after otoscope exam has experience vasovagal syncope due to stimulation of post ext auditory canal. *Vagus Nerve is affected*

11783 Anatomy Ear, Nose & Throat (ENT)

Pt with epistaxis. Silver nitrate cautery is performed and bleeding stops. Cautery was most likely applied to *Nasal Septum*

[Most bleeds happen here in Kiesselback's plexus] 1747 Anatomy Endocrine, Diabetes & Metabolism

A nerby nerve injury while ligating an artery entering the superior pole of the thyroid lobe(superior thyroid artery) would most likely deninnervate the *Cricothyroid Muscle* which is innevated by the external branch of the superior laryngeal neerve.

1632 Anatomy Female Reproductive System & Breast

*The suspensory ligament of ovary* must be ligated during removal of ovaries to prevent bleeding. It carries the ovarian artery. It also known as the infundibulopelvic ligament. Note that the Cardinal Ligament (transverse cervical ligament) holds the uterine artery and needs to be ligated in a hysterectomy.

1739 Anatomy Female Reproductive System & Breast A *pudendal nerve* block is performed by injecting an anesthetic intravaginally, medial to the ischial spine, through the sacrospinous ligament. This provides anesthesia to most of the perineum.

8390 Anatomy Female Reproductive System & Breast

16 year old female with pelvic pain every 28 days and resolves in a day or two with fully developed 2ndry sexual characteristic. She has a palpable mass anterior to the rectum. Serum Beta-hCG is negative. Most likely Dx is *Imperforate hymen*

11781 Anatomy Female Reproductive System & Breast

Pt with right sided back pain and voiding is normal after a

hysterectomy probably has an injured *Ureter* during the surgery. Voiding is normal becuase other ureter is functionl.

11820 Anatomy Female Reproductive System & Breast Exercise to strengthen pelvic floor targets *Levantor Ani Muscle* 11823 Anatomy Female Reproductive System & Breast

To help with delivery, a vertica; midline incision is made at the post vaginal opening through the vaginal and subvaginal mucosa. The structure most likely involved in this incision is the *Perineal Body*

11908 Anatomy Female Reproductive System & Breast

Woman who delivers twins and has postpartum hemorrhage and surgery is started. To control her bleeding, bilateral ligation of *Internal Iliac* arteries is preformed and this would preserve her fertility due to the dual supply of the uterus from the ovarian arteries.

129 Anatomy Gastrointestinal & Nutrition

submucosal glands that have alkaline secretions in Gi endoscopy probably are the Submucosal (Brunner) glands which can be found at the *First part Duodenum* (ampulla of vater) and the Pylorus.

292 Anatomy Gastrointestinal & Nutrition

A peptic ulcer localized PROXimally on the lesser curvature probably penetrated the *Left gastric Artery* which is a branch of the celiac trunk.

303 Anatomy Gastrointestinal & Nutrition

Laparotomy shows decreased angle between superior mesenteric artery and aorta. The structure most likley obstructed is

*Transverse portion of duodenum* [Superior mesenteric artery syndrome]

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1832 Anatomy Gastrointestinal & Nutrition A mass in the third portion of the duodenum that is infiltrating beyond guy wall carrys the risk of compromising the *Superior Mesenteric Artery*

8587 Anatomy Gastrointestinal & Nutrition

Obese pt is interested in adjustable gastric band. In order to encircle the stomach, the band must pass thru the *Lesser Omentum*

(Hepatoduodenal ligamnet+hepatogastric ligament)

10583 Anatomy Gastrointestinal & Nutrition

Pt was stabbed in RUQ. He is bleeding. Brisk, n"onpulsatile" bleeding is seen emanating from behind the lover. The surgeon occludes the "hepatoduodenal ligament", but the pt continues to hemorrhage. Most likley source of bleeding is *Inferior Vene cava* [Pringle maneuver, hepatoduodenal ligament includes the portal triad of hepatic artery, ven and comon bile duct][the nonpulsatile nature of bleed make it not from an artery]

11771 Anatomy Gastrointestinal & Nutrition

External Hemorrhoids originate below the dentate the line. They have cutanoeous (somatic) innervation from the inferior rectal nerve which is a branch of the *Pudendal Nerve*

11775 Anatomy Gastrointestinal & Nutrition The somatic pain in appendicitis that shifts from the umbilicus to Mcbirney point is due to *Inflammation of parietal peritoneum* 11782 Anatomy Gastrointestinal & Nutrition *Teniae coli* are used to locate the appendix.

11817 Anatomy Gastrointestinal & Nutrition

Pt has mass in the middle third of the rectum extending to

rectosigmoid junction. It was resected. The lymph nodes that shud be assessed are the *Internal Iliac lymph nodes*

(lymph drianage of rectum proximal to the anal dentate line occurs via inferior mesenteric and internal iliac nodes, while distal to dentate line drain into inguinal nodes)

11840 Anatomy Gastrointestinal & Nutrition

Internal hemorhoids is characterized by painless bleeding,

mucosal lesnions above the dentate line on anoscopy. Constipation can lead to it. The venous component is drained into Superior rectal veins wich drian into The *Inferior Mesenteric Vein* which drains into the splenic vein which drains into the hepatic portal vein.

839 Anatomy Male Reproductive System

Pelvic fracture in a male can result in urethral injury leading to inability to void despite full bladder sensation. The most commonly injured site is the *membraneous urthera* which is right after the prostatic urethra. Both membranoeous and prostatic are part of the post urethra.

1737 Anatomy Male Reproductive System

In a pt with BPH who is given Finasteride that acts on *The prostate* (below the bladder on CT)

(5-alpha reductase inhibitor)

8326 Anatomy Male Reproductive System The scrotum is drained by the superficial inguinal lymph nodes. 11658 Anatomy Male Reproductive System Gonadal arteries originate from the abdominal aorta!

11762 Anatomy Male Reproductive System

Undescended testes that can be felt medial to the mid-inguinal point have to only be passed through the Superficial inguinal ring which is formed by the *External oblique muscle aponeurosis*

513 Anatomy Nervous System

Pt that presents with amenorrhea and notes that her breasts have become engorged. She is taking an antipyschotic drug. She probably has galactorhea in which the dopaminergic athway disturbance responsible is the the *Tuberoinfundibular*. It connects the Hypothalamus to ant pit and is responsible for dopamine-dependent prolactin tonic inhibition. The drug she is on blocks dopain in that pathway.

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566 Anatomy Nervous System

Pancoast tumors are non-small cell lung cancers that arise near the superior sulcus. Pts may develop ipsilateral shoulder pain, upper limb parethesias and areflexic arm weakness due to involv of brachial plexus. Horner syndrome (ipsilateral partial ptosos, miosis, anhydrosis) can occur due to invlove of cervical sympathetic *Autnomic Ganglia*

635 Anatomy Nervous System

Old pt with long standing HTN who presents for involuntary movements, "Threw remote control across the room" P,E shows Large amplitude flinging movements affecting proximal muscles of upper extremity. Pt most likely has injury to *Subthalamic Nucleus* 1452 Anatomy Nervous System

Symptoms of hyeracusis (high sensitivity to everday sounds) accompanied by ear pain and difficulty hearing is due to damage to the stapedius muscle wich is innervated by the stapedius nerve which a branch of the *Facial nerve*

1687 Anatomy Nervous System

Pt with initial resistance to passive extension followed by sudden release has Clasp-knife Spasticity which is seen in upper motor neuron lesion due to lack of inhibition on spinal stretch reflex arch. Pts with *INTERNAL CAPSULE* stroke have pure motor weakness affecting contralateral limbs and lower face.

1696 Anatomy Nervous System Embolism to ACA would impared ability to *Climb stairs* 1741 Anatomy Nervous System

Vomiting from sysetmic chemotherapy is triggered by chemoreceptor trigger zone located on the *Dorsal surfce of Medulla at the caudal end of 4th Ventricle* (Area postrema) 1742 Anatomy Nervous System Pt with nerve injury and prsents with foot slapping the ground with each step (steppage gait) has *Common peroneal nerve injury*

1749 Anatomy Nervous System

Injury to median nerve at the wrist is manfiested by diminished sensation in first 3 digits with preserved sensation along the thenar eminence. The median nerves courses between the *Flexor

digitorum superficialis and Flexor digitorum Profundus*

1815 Anatomy Nervous System CN IX resection would lead to loss of sensation over the *Tonsils* 1829 Anatomy Nervous System

Pt who falls from tree and tries to break fall ny grabbing tree branch will likely suffer from *Lower trunk injury of Brachial Plexus*. He will be unable to perform fine finger movements with hand (Lower trunk supplies median and ulnar)

1846 Anatomy Nervous System Occlusion to the *Middle cerebral Artery* can cause both Wernicke and Broca's aphasia. 1933 Anatomy Nervous System

Pt with diplopia and has problems walking down stairs and trouble reading probably has a lesion to the trochlear nerve which is responsible for depression of adducted eye.

2024 Anatomy Nervous System

jaw deviation to right on opening mouth, difficulty chewing food suggest CN V3 Injury (Mandibuar) It passes through *foramen ovale*.

2076 Anatomy Nervous System

loss of touch, temperature, and vibratory sensations indiacte damage to spinothalamic and dorsal column tracts. These two both project into the Ventral Post. Lateral Nucleus of Thalamus. Also if pt experiences diminished sensation over right side of face, then his trigeminal pathway is damaged. The trigemical pathway is also received by the thalamus at the Ventral Post. Medial Nucleus. So damage to *Venral Post Thalamus* can trigger all above sensory loss involving 3 paths.

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2077 Anatomy Nervous System

fluid filled cavities in the deep structures of the brain arise from lacune formation due to occlsuin of small penetrating arteries that supply the structures. These lacunar infarcts are cause by LIPOHYALINOSIS (hyaline thickening of vascular wall) & Microatheromas (athersclerotic accumulation of lipid-laden macrophages on intimal layer of penetrating arteries. These predispose to *Small-Vesel Occlusion*

2127 Anatomy Nervous System The most common finding in *PCA* territory infarction is Contralateral Hemianopia.

8522 Anatomy Nervous System The vagus and spinal accessory nerve exit through the *Jugular Foramen*

8564 Anatomy Nervous System

Premature neonate with decreased level of conscousnes and hypotonia. She is weak, has prominent scalp veins and tense fontanels. Ultrasound shows blood in the lateral ventricles. Source of ventricles is *Germinal Matrix*

(This interventricular hemorrhage in a premature neonate)

8592 Anatomy Nervous System Pt with homonymous hemianopia with macular sparing could have occlusion of *PCA* 8594 Anatomy Nervous System Injury to meyer's loop in the temporal lope results in contralateral superior quadantanopia.

8636 Anatomy Nervous System

Pt with right nasal hemianopsia who has an interal carotic artery aneurysm. Most likely portion of visual pathway that is dirupted is the *right peri chiasm*

[review optic lesions]

11742 Anatomy Nervous System

Orbital floor fractures can impair the infraorbital nerve which is a continuation of the maxilaary nerve and result in numbness and paresthesia in the uppercheeck, UPPER LIP, and upper gingiva. This can also impair inferior rectus muscle amd impair superior gaze

11744 Anatomy Nervous System

The three trunks of the brachial plexus pass between the middle and anterior scalene muscles (scalene triangle). Interscalene nerve block (anesthesia) in this arrea would also affect the Phrenic Nerve and hence affect the *Diaphragm* causing transient

ipsilateral diaphragmatic paralysis. (Phrenic nerve roots pass thru the interscalene sheath)

11777 Anatomy Nervous System

The Quadraceps tendon is supplied by the femoral nerve. The femoral nerve can be blocked best in the *Inguinal Crease* at the lateral borde of the femoral artery.

11952 Anatomy Nervous System Postpartumn fecal incontinence can be caused by injury to *Pedundal Nerve*

1535 Anatomy Pulmonary & Critical Care

The *Phrenic Nerve* carries paim fibers form the Diaphragmatic and Mediastinal Pleura. Irritation of pleura at either area will produce sharp pain worsened by "inspiration" that will be referred to the c3-c5 distribution at the "base of the neck and over the shoulder".

1695 Anatomy Pulmonary & Critical Care

Stab wound immediately above the clavicle and lateral to the manubrium can puncture the *Pleura* and cause pneumothorax, tension pneumothorax or hemothorax.

1745 Anatomy Pulmonary & Critical Care Pts who is supine will aspirate into the *Post segment of the upper lobe* and the Superior segment of the lower lobes of the right lung 8703 Anatomy Pulmonary & Critical Care

Pt with a fish bone lodged in the left piriform recess would impair his internal laryngeal nerve which is a branch of superior laryngeal nerve (CN X) and hence would impair his *Cough Reflex*

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11845 Anatomy Pulmonary & Critical Care In Obstructive Sleep Apnea. Electric stimulation of *Hypoglossal nerve* help the pt

1680 Anatomy Renal, Urinary Systems & Electrolytes

The "proximal" part of the ureter is supplied by the *Renal Artery*. The middle part is highly variable receiving supply from the

gonadal artery, the common iliac, and uterine arteries. The distal part (close to bladder) is supplied by Superior Vesical artery, which is a branch of the internal iliac.

1700 Anatomy Renal, Urinary Systems & Electrolytes A fracture of the elft 12th rib can cause laceration to *Left Kidney* 10962 Anatomy Renal, Urinary Systems & Electrolytes Pt leaking urine with coughing (stress incontinence) is due *to Urethral sphincter dysfunction* 11708 Anatomy Renal, Urinary Systems & Electrolytes In suprapubic cystostomy, besides the bladder, the structure most likely penetrated by the trocar and cannula is the *Anterior

Abdominal Aponeurosis* 1491 Anatomy Rheumatology/Orthopedics & Sports

A gardner who comes in with knee pain with no visible erythema or abrasions. He spends hours on on his knees while working. The bursae most likely affected in this pt is *Prepatellar*

[Prepatellar Bursitis][a.ka "housemaids knee] 1634 Anatomy Rheumatology/Orthopedics & Sports

Pt with sensory loss over the medial 1 and 1/2 digits and hypothenar eminence indicate ulnar nerve injury which often occurs at *Hook of Hamate*

1697 Anatomy Rheumatology/Orthopedics & Sports An anterior translation of the tibia relative to the femur on stability testing indicates an inury to the *Anterior Cruciate Ligament*

1702 Anatomy Rheumatology/Orthopedics & Sports

CHild Pt who falls on his outstretched arms and fractures his clavicle. What causes the medial fragment of the fractured bone to be displaced superiorly is the *Sternocleidomastoid muscle* while the lateral portion would be pulled inferiorly by the wieght of the arm and the pectoralis major muscle.

1704 Anatomy Rheumatology/Orthopedics & Sports

Pt who falls on his can hands and cant extend wrist. Mid humoral shaft fracture is detected. Artery is injured is *Deep Brachial Artery (Profunda brachi)*

(Runs along the radial nerve)

1730 Anatomy Rheumatology/Orthopedics & Sports The most important structure in the Valsalva Meneuver is *Rectum Abdmonis Muscle* which can be seen anterioly on a CT scan. 1812 Anatomy Rheumatology/Orthopedics & Sports

Mastectomy with axillary lymph node removal can injur the long thoracic nerve and henc injury seratius anterior and lead to winged scapula.

1956 Anatomy Rheumatology/Orthopedics & Sports In a pt with a femoral neck fracture. The injury that would lead to osteonecrosis most likley involves the *Medial Cicrumflex* Artery. 7621 Anatomy Rheumatology/Orthopedics & Sports

Psoas major muscle contributes to hip flexion which is an action taken when sitting up from a supine position without using the hand.

8671 Anatomy Rheumatology/Orthopedics & Sports

Pt presents because of right lower abdominal and groin pain and difficulty walking. He is on warfarin. His abdominal CT (image) shows retroperitoneal hematoma lying anterior to psoas muscle. Additional expected finding would be *Loss of sensation on the ant aspect of right thigh*

[Femoral nerve compressed due to bleeding from warfarin use] 11659 Anatomy Rheumatology/Orthopedics & Sports pt with a comminuted patella fracture would be unable to *Extend the knee against gravity* 11683 Anatomy Rheumatology/Orthopedics & Sports In Carpal Tunnel Syndroem, Incicision of the *Transverse Carpal Ligament* (Flexor retinaculum) would improve symptoms. 11727 Anatomy Rheumatology/Orthopedics & Sports The *Piriformis muscle* passes through the greater sicatic formaen and occupies most of its volume.

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11778 Anatomy Rheumatology/Orthopedics & Sports

15 year old boy presents with right arm numbness. He plays baseball. He has had fluctuating tingling and numbness involving the right shoulder arm and hand. Also he felt dull pain in right little finger and hand. He has a cervical rib. Exam shows decreased sensation over emdial 2 fingers and hypothenar eminence. The structure contributing to this pts condition is *Scalene Muscle* (Thoracid outlet syndrome, compression of brachial plexus)

11819 Anatomy Rheumatology/Orthopedics & Sports

13 yr old boy comes with right knee pain. It started as a mild ache in lower part of knee then worsened and now causes him to limp. Pain is relieved with rest and reproduced when knee is

straightened. Evaluation reveals avulsion of 2ndry ossification center of tibia due to repetitive muscle contraction and traction of bone. Most likely insertion site of involved muscle tendon is *Tibial Tuberosity*

[Osgood-Schiatter Disease] 11629 Behavioral science Gastrointestinal & Nutrition

If a hypertensive and diabetic patient is using herbs to lose weight, explain to them that these are poorly regulated and have potential health risks.

8456 Behavioral science General Principles Providing care to all company employees in exchange for a set monthly fee is *Capitation*

11534 Behavioral science Miscellaneous (Multisystem)

Pt with many diseases including neurocognitive disorder, in order to achieve drug adherence, you should *Involve a social worker in discharge planning*

-Note: Checklist wont work since pt's cognition is impaired. 11550 Behavioral science Miscellaneous (Multisystem) Pt who is becoming an outpatient and has complex medication regimens should be given a *Hospital discharge checklist*

247 Behavioral science Psychiatric/Behavioral & Substance Abuse

Buspirone is an nonbenzodiazepine anxiolytic used to treat Generalized Anxiety disorder. It has a SLOW ONSET. It lacks muscle relaxant or anticonvulsant properyes and carries no risk of dependence. It is a partial agonist of 5HT (1a)

248 Behavioral science Psychiatric/Behavioral & Substance Abuse

SSRI's & SNRI's are first line medication in generalized anxiety disorder. Benzos should be limited to short term use and for pts who respond poorly to antidepressants.

520 Behavioral science Psychiatric/Behavioral & Substance Abuse

Pt has been receiving treatment for mood swings and sleep problems. Now the pt has constipation, dry skin, and hair loss. Also she has weight gain despite regular diet. BP is 110/70. Pt appears tired but exam is otherwise normal. Most likely responsible drug is *Lithium*

[Hypothyroidism due to lithium used in bipolar disorder]

574 Behavioral science Psychiatric/Behavioral & Substance Abuse

Following amitriptyline overdose (TCA). There is QRS widening and QTc prolongation. And Death occurs. Deat is related to *Sodium Chanel inhibition*

[Fast Na chanel inhibition resulting in conduction defects and arrythmias]

707 Behavioral science Psychiatric/Behavioral & Substance Abuse

Pt with painful erection for more than 4 hours. Past med history is sig for treatment-resistent depression, OCD, and insomnia. Drug most likley used is *Trazadone*

[Priapism, rare side effect of trazadone]

1165 Behavioral science Psychiatric/Behavioral & Substance Abuse

Pt smoked unknown substance. He displays uncoordinated jerky movements of extremities and assualts someone. He appears immune to pain. In the ER he has visual hallucinations and

alternates between agitation and sedation. He is hyptertensive and tachycardic and has vertical nystagmus. Later, he doesnt

remember anything that happened. MOA of drug is

*N-Methyl-D-aspartate receptor Antagonism* (NMDA Antagonist) [This is PCP]

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1287 Behavioral science Psychiatric/Behavioral & Substance Abuse

Methadone which is used in Heroin Addicts (Opiate) during withdrawal phase, it is beneficial due to *Long Half-Life* and can therefore suppress cravings and withdrawal symptoms for >24 hrs. It is a full Mu-opiod receptor agonist (not partial)

The partial agonist is "Buprenorphine" also used. (Usually alone with Nalaxone which is an opoid anatagonist)

1288 Behavioral science Psychiatric/Behavioral & Substance Abuse

PCP is a hallucinogen that causes agitation, halluciantions, violent behavior. Distinguishing factors of abuse are are Ataxia,

Nystagmus, and Memory loss

1352 Behavioral science Psychiatric/Behavioral & Substance Abuse

Pt who requires benzodiazepam with least imapaired judjement or daytime fatigue should be given one with a short T1/2 and least hepatic metabolism like *Lorazepam*

[LOT benzos, lorazepam, oxazepam,temazepam][Undergo direct glucuronidation]

1429 Behavioral science Psychiatric/Behavioral & Substance Abuse Young man who says that his parents who are about to get a divorce are angry at him. His defense mechanism is *Projection* 2047 Behavioral science Psychiatric/Behavioral & Substance Abuse

Pt with mood symptoms and history of psychotic symptoms for more than 4 weeks in absence of moods symptoms suggests *Schizoaffective Disorder*

2049 Behavioral science Psychiatric/Behavioral & Substance Abuse Use SSRI'S to treat OCD.

2053 Behavioral science Psychiatric/Behavioral & Substance Abuse Shifting of emotions assciated with a significant person from the past to a person in the presentis called *Transference*

7752 Behavioral science Psychiatric/Behavioral & Substance Abuse

Patients with frontal lobe injury often experience executive

dysfunction and personality changes secondary to impairement of the ogranizational, restraint, and motivational systems. Changes in social behavior can manifest in variable ways with *Left* sided lesions more often associated with "Apathy" and right-sided lesions with disinhibition.

8954 Behavioral science Psychiatric/Behavioral & Substance Abuse Majority of overdose deaths are related to *Opioids* 9814 Behavioral science Psychiatric/Behavioral & Substance Abuse Access to firearms increases risks for suicide.

10581 Behavioral science Psychiatric/Behavioral & Substance Abuse Pt with somatic symptom disorder should be *Scheduled regular outpatient office visits* 10785 Behavioral science Psychiatric/Behavioral & Substance Abuse Stimulus conrtol therapy in Tx of insomnia involves leaving the bedroom if unable to fall asleep within 20 minutes. 11594 Behavioral science Psychiatric/Behavioral & Substance Abuse

Suspicion and distrust, feeling of being exploited, together with histroy of repetitive conflict suggests *paranoid personality disorder*

11603 Behavioral science Psychiatric/Behavioral & Substance Abuse Fear of Elevators is treated with *Behavioral Therapy*

11605 Behavioral science Psychiatric/Behavioral & Substance Abuse Pts who has pyschotic symptoms has been staying up late for exams probably has *Substance Induced Psychotic disorder* 11743 Behavioral science Psychiatric/Behavioral & Substance Abuse

Use clozapine in treatment resistent schizophrenia.

(Agranulocytosis, seizures and metabolic syndrome are side effects)

11746 Behavioral science Psychiatric/Behavioral & Substance Abuse Depression, Fatigue, Hypersomnia, Hyperphagia, and Vivid dreams are characteristic of *Cocaine Withdrawal*

11756 Behavioral science Psychiatric/Behavioral & Substance Abuse

Pt with recurrent episodes of chest ain, ,tachycardia, shortness of breath, sweating, and tremulousness in a young otherwise healthy pt with normal ECG. Best next step in management is

*Benzodiazepine* [Panic Disorder]

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11807 Behavioral science Psychiatric/Behavioral & Substance Abuse

Pts who is bulimic (bulimia nervosa) (Binging, exercise, normal weight, self induced vomiting proven by pharyngeal erythema, hypokalemia, and increased amylase)can be given an SSRI such as *Fluoxetine*

11809 Behavioral science Psychiatric/Behavioral & Substance Abuse Methylphenidate used in ADHD has a side effect of *Decrease Appetite and Weight loss* 11810 Behavioral science Psychiatric/Behavioral & Substance Abuse

A child at age 2 with only 40 words of vocabularly should be *Assessed further*

(Normal is 50-100 words at age 2)

11838 Behavioral science Psychiatric/Behavioral & Substance Abuse Use *SRRI's* in panic disoder in pt who presents camly and normal vital signs. 11854 Behavioral science Psychiatric/Behavioral & Substance Abuse srri's used in depression *Block Serotonin Receptor*

11866 Behavioral science Psychiatric/Behavioral & Substance Abuse

Dont confuse *Anxiety to due medical condition* as in

Hyperthyroidsim with generalized anxiety disorder. Weightloss, tachycardia, warm moist skin, tremor along with anxiety suggest hyperthyroidism.

11899 Behavioral science Psychiatric/Behavioral & Substance Abuse Delirium can be treated with first gen antipsychotic such as *Haloperidol* in addition to treating the underlying cause. 2057 Behavioral science Social Sciences (Ethics/Legal/Professional) A pregnant minor is entitled to consent to prenatal care. Not an elective termination however. 10290 Behavioral science Social Sciences (Ethics/Legal/Professional) The requirement for hospice care referal is *Prognosis of less or equal to six months* 10399 Behavioral science Social Sciences (Ethics/Legal/Professional) Physicians must report impaired collegues in a timely manner. 11668 Behavioral science Social Sciences (Ethics/Legal/Professional) a health insurance plan with low monthly premieums is *Health Maintenance Organization*

1064 Biochemistry Dermatology

Pallegra which is due to niacin (ViB3, precursor to NAD) deficiency is characterized by Dermatitis (skin rash on sun exposed), Diarrhea, and Dementia (irritable, hostile, dioriented). Niacin is obtained from diet or synthesized in body from

*Tryptophan*. Therefore, Tryptophan is the precursor for the compensatory pathway for NAD synthesis.

1244 Biochemistry Dermatology Ehlers Danlos Syndrome which presents with hyperextensible skin, easy bruising, hypermobile joints is a defect in collagen synthesis. 1245 Biochemistry Dermatology

Ehler-Danlos Synrome can be caused by procollagen peptidase deficiency which results in impaired *cleavage of terminal propeptides* Where? --> Extracellular space.

1247 Biochemistry Dermatology

Signs of scurvy such as bleeding gums , ecchymoses and corkscrew hairs implicate vit C deficiency. Vit C is required in postranslational hydroxylation of proline and lysin residues by hydroxylases in collagen synthesis. It happens in the Rough Endoplasmic reticulum

1334 Biochemistry Dermatology

12 yr old is evaluated for ataxia acompanied by episodic

erythematous and puritic skin lesions and loose stools. Lab shows loss of neutral aromatic amino acids in urine. The pt symptoms would most likley respond to to supplementation with *Niacin Vit B3* [Hartnup dsiease, defective intestinal and renal absorption of tryptophan. Ttryptophan is a precursor to Nicotinic acid, serotonin, and melatonin.]

[Tryptophan, phenylalanine and tyrosine are all aromatic aa][note:Pallegra?]

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2037 Biochemistry Dermatology

tRNA containts chemically modified bases such as dihydrouridine, ribothymidine, and pseudouridine. It has a *CCA* sequence at the its 3'-end that is used a recognition sequence by proteins. The 3' terminal hydroxyl group of the CCA tail serves as the aa binding site.

602 Biochemistry Endocrine, Diabetes & Metabolism

Pituitary resection decreases ACTH which decreases Cortisol, decrease in cortisol decreases expression of

*PHENYLETHANOL-N-METHYLTRANSFERASE* which the enzyme that converts Norepi into Epi. Therefore, putituwary resection leads to decreased EPI production.

847 Biochemistry Endocrine, Diabetes & Metabolism

Cells that express more glucose transporters as insulin levels increase are *skeletal muscle cells* and adipocytes.

Cell that have constant glucose transporter expression even as insulin level increases are *Renal tunular cells* also brain, intestine, RBC, and Liver

934 Biochemistry Endocrine, Diabetes & Metabolism Sorbitol produced by aldolase reductase is normally metabolized to *Fructose* 997 Biochemistry Endocrine, Diabetes & Metabolism

Oxaloacetate---> Phosphoenolpyruvate (catalyzed by PEP carboxykinase) is the 2nd commited step in gluconeogenesis which predominates in starvation states.

998 Biochemistry Endocrine, Diabetes & Metabolism

Pts with pyruvate dehydrogenase deficiency should be on a ketogenic diet. Soley Ketogenic aminoacids include *lysine* and leucine.

1010 Biochemistry Endocrine, Diabetes & Metabolism

Insuline resistance by the pancreatic cells i sstimulated by increased ATP production. *Glucokinase* functions as a glucose sensor in pancreatic beta cells by controlling the rate of glucose entry into the glycolytic pathway. Mutations in the *glucokinase* gene are a cause of maturity-onset diabetes of the young. 1019 Biochemistry Endocrine, Diabetes & Metabolism

Pt has absent lactate dehydrogenase activity in muscles. In this pt, strenuous exercise leads to inhibition of glycolysis in skeletal muscles due to intracellular depletion of *NAD+*

1021 Biochemistry Endocrine, Diabetes & Metabolism

Homeless pt with signs of wernicke encephalopathy after admin of glucose without thiamine supplemenation would have an impaired *Alpha ketoglutarate to Succinly CoA reaction*

[Thiamine is needed for alpha ketogluyerate dehydrogenase][Also needed for other dehydrogenases and transketolase]

1022 Biochemistry Endocrine, Diabetes & Metabolism A direct source of energy in the TCA cycle is in the conversion of succinylcoA into Succinate thus yeilding GTP.

1031 Biochemistry Endocrine, Diabetes & Metabolism

Increasing fructose-2,6-bisphosphate promotes glycoloysis (insulin like effect) and inhibits Gluconeogensis. Inhibiting

Gluconeogenesis means less alanine and other glucuneogenic substrates are converted to glucos.

1034 Biochemistry Endocrine, Diabetes & Metabolism

During fasting, maintenance of pt blood glucise is facilitated by hepatic conversion of pyruvate into glucose. The substance that is an allosteric activator of the first step of this process is

*Acetyl-CoA* [Gluconeogenesis]

1063 Biochemistry Endocrine, Diabetes & Metabolism

Pt presents with myalgias, anorexia, and skin rash. He has been consuming raw white eggs for several months. P.E shows macular dermatitis of extremities. A water soluble vit def is suspected. The biochemical conversions that most likely uses the def vit as a cofactor are *Pyruvate to Oxaloacetate*

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1070 Biochemistry Endocrine, Diabetes & Metabolism

Pt with hereditary defect in fructose metabolism. He is

asymtomatic however. This pt is still able to metabolize fructose due to compensatory activity of *Hexokinase*

[Essential fructose uea]

1073 Biochemistry Endocrine, Diabetes & Metabolism In Aldolase deficiency, remove *Sucrose* from Diet. 1119 Biochemistry Endocrine, Diabetes & Metabolism

Reactions of the pentos phosphate pathway (HMP shunt) occur in the cytoplasm. Therefore this includes activity of enzyme

*Transketolase* 1121 Biochemistry Endocrine, Diabetes & Metabolism

Insulin increases intracellular glycogen stores and decreases hepatic glucose release into blood (gluconeogenesis), it does so by activating *Protein Phosphatase-1*

1370 Biochemistry Endocrine, Diabetes & Metabolism

*Orinithine Transcarbamoylase* deficiency is the mcc urea cycle disorder. The high NH3 causes neurologic abnormalities. Typical tell tale sign is high urine OROTIC ACID. becasue with no OTC, carbamoyl phosphate is converted to orotic acid in pyrmidine synthesis.

1501 Biochemistry Endocrine, Diabetes & Metabolism

Pt with Phenylalanemia who is place on dietary requirements and supplemented with tyrosine and presents with normal

phenylalanine levels but with axial hypotonia and microcephaly. Also, prolactin is elevated. The enzyme missing in this pt *Dihydrobiopterin reductase*

(Involved in converting tyrosine to DOPA, hence high prolacin)

1990 Biochemistry Endocrine, Diabetes & Metabolism

An autosomal recessive diroder of Sphingomyelinase deficiency. Most consistent with this condition is *Neurodegenration and Hepatosplenomegaly*

[Neiman-Pick disease. aslo foamy macrophages and cherry-red macular spot]

2066 Biochemistry Endocrine, Diabetes & Metabolism

Pt with orotic acid urea and normal ammonia levels could have a defect of UMP synthase (hereditary orotic aciduria)

Supplementation with *URIDINE* helps this pt.

11917 Biochemistry Endocrine, Diabetes & Metabolism

*Hormone Sensitive Lipase* is found in adipose tissue, it catalyzes the mobilization of stored triglycerides into free fatty acids and glycerol. The liver can further oxidize FFA to acetyl-coA and then further metabolized into Ketoen Bodies.

This can be seen during Starvation. 11918 Biochemistry Endocrine, Diabetes & Metabolism

In an animal that well fed with CHD's. beta-oxidation of fatty acids is inhibited via *Malonyl-coA* which inhibits carnitine

acyltransferase from shuttling acyl groups into the mitochondria.

11950 Biochemistry Endocrine, Diabetes & Metabolism

Zinc finger mtoif are composed of chains of aminoacids bound together around a zinc atom via linkage with cystein and histidine residues. Intracellular receptors that bind steroids, *Thyroid Hormones*, and fat-soluble vitamins act directly as transcription factors and conatin zinc biding domains.

67 Biochemistry Gastrointestinal & Nutrition Gallstones caused by the use of fibrates for dyslipidemia are caasued by decreased activity of 7-lpha-hydroxylase. 790 Biochemistry Gastrointestinal & Nutrition Under normal cirumstances the Ras protein is activated only when boud to *GTP* 1068 Biochemistry Gastrointestinal & Nutrition The substance with the fastest rate of metablosim in the glycotic pathway is *Fructose-1-phosphate* 1072 Biochemistry Gastrointestinal & Nutrition Lactose intolerance is due to absence of enzyme lactase which converts Galactosyl-B-1,4-glucose (LACTOSE) into Galactose.

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1251 Biochemistry Gastrointestinal & Nutrition In the duodenum, Enteropeptidase convert Trypsinogen to the active form trypisn. Pt with impaired enteropeptidase will fail to form *Trypsin*

1475 Biochemistry Gastrointestinal & Nutrition

Pt who presents with difficulty swallowing and is found to have an mass in esophagus. He is a hunter and put sodium nitrite in his meat. Analysis of biopsy sample show Cytosin Demaination. This damage is usually repaired (Base Excision Repair) by this enzymatic sequence; *Glycosylase, Endonuclease, Lyase, Polymerase, Ligase*

1807 Biochemistry Gastrointestinal & Nutrition

Chronic alcoholic pt with angular stomatitis, cheilitis, glossitis and a "low riboflavin" probably has riboflavin (B2) deficeincy. Riboflavin can become FMN (flavin mononucleotide) then FAD (dinucleotide) which act as coenzymes in reactions thru acceptance of electrons (ETC (complex2)& Krebs). FAD is a component of *Succinate Dehydrogenase*

8425 Biochemistry Gastrointestinal & Nutrition Mutations in Leptin gene or receptor will lead to *Hyperphagia and Obesity*

8482 Biochemistry Gastrointestinal & Nutrition

Pt with Abdominal pain who ingested mmushrooms, he is

jaundiced with tender palpable liver and elevated liver enzymes and bilirubin most likey has Amatoxin that binds to DNA-dependent RNA polymerase type 2 and halts *mRNA synthesis*

995 Biochemistry General Principles

After a ligand binds to a G protein-coupled receptor that activates phopholipase C, membrane phospholipids are broken down to DAG and IP3. *Protein Kinase C* is subsequently activated by DAG and Ca.

996 Biochemistry General Principles

If lactic acid is accumulatimg that means there is increased activity of Lactate dehydrogensae and DECREASED activity of *Pyruvate Dehydrogensae*

1028 Biochemistry General Principles

The rate of glycogenolysis within myocytes increases several x100 during active skeletal muscle contraction. The substance that synchronizes these two processes is *Ca2+*

1248 Biochemistry General Principles Collagen made by fibroblasts has Glycine as every third amino acid (GLY-X-Y) it is thefefore the most abundant.

1424 Biochemistry General Principles

Certain tRNA molecules can recognize multiple different codons coding for the same amino acid, a phenomenon explained by the *Wobble hypothesis*

{Genetic code is Degenerate] 1434 Biochemistry General Principles

E.coli with enzyme-mediated nucleotide removal in the " 5' to 3' direction " is done by *DNA polymerase 1*

[Other 3 have 3' to 5' exonucelease activity][DNA p1 Removes the RNA Primer]

1437 Biochemistry General Principles

The factor that makes eukayotic DNA replication quick and effective despite large size and complexity of genome is *Multiple origins of replication*

2035 Biochemistry General Principles mRNA *Interaction with P bodies* occurs only in the CYtoplasm. 868 Biochemistry Hematology & Oncology

A new born baby has fetal HB prdominantly (alpha 2 gamma 2) which changes to adult Hb (alpha 2 Beta 2) within the next six months.

1035 Biochemistry Hematology & Oncology Synthesis of ribose from fructose-6phosphate can be done using *Transketolase*. 1036 Biochemistry Hematology & Oncology G6PD converts glucose-6-phosphate to 6-phosphogluconate

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1337 Biochemistry Hematology & Oncology

Pt comes due to recurrent blistering on back of hands and

forearms for several years. P.E shows vesicles and erosion on the dorsum of both hands. Most likely deficient enzyme in this pt is *Uroporphyrinogen Decarboxylase*

[Porphria Cutaneo Tarda] 1338 Biochemistry Hematology & Oncology

Pt with neurologic symptoms (tingling, difficulty concentrating) and recurrent episodes of nonspecific abdominal pain likely has acute intermitten porphyria. (PBG deaminase def) This attack is helped with infusion of heme which downregulates hepatic *ALA synthase* 1386 Biochemistry Hematology & Oncology Oxygen binding to Hb involves the release of *Protons*[H+ is released]

1413 Biochemistry Hematology & Oncology

In an experiment where scientist were able to separate hemoglobin tetramers into individual alpha and beta subunits. If a solution is created that contains only monomeric beta-hemoglobin subunits and the o2 dissociation curve is measure, it would be have a *very high affinity (P50%=1)* The beta subunit is almost identical to Myoglobin which has a stong affinity to O2 (p50%=1) vs p50%=26 of HbA.

1419 Biochemistry Hematology & Oncology

Differences between synthesis of 2 daughter DNA strands include *The joining of DNA fragments by ligase*

This is beacuse the leading strand is less affected by ligase compared to the lagging strand which has okazaki fragments that must be constantly ligated by ligase.

1456 Biochemistry Hematology & Oncology

The change in color of a bruise from blue to green is explained by activity of *Heme Oxygenase*

[Biliverdin is Green, Bilirubin is yellow]

1470 Biochemistry Hematology & Oncology Both HbS and HbC result from *Misense Mutations* 1487 Biochemistry Hematology & Oncology

Duchenne Muscular Dystrophy can also results from None-sense Mutations (premature stop codon)

[Usually from deletions (frameshift) thu]

1847 Biochemistry Hematology & Oncology

In an experiment where folate is deprived. Provision of *Thymidine* would reduce erythroid precuros cell apoptosis. [Folate def inhibits formation of dTMP, Thymidine supplementation can increase dTMP and hence reduce erythroid precursor cell apotosis]

1471 Biochemistry Infectious Diseases Bacterial *DNA polymerase 1* removes RNA primers during DNA replication.

64 Biochemistry Nervous System

Pt presents for exertional dysnpnea and fatigability. On P.E her gait is unstable when her eyes are closed and tehre is impaired vibratory sensation in the lower extremities. There is marked Pallor in conjunctiva, nail beds, and palms. The lab test that would

confirm Dx is *Serum Methylmalonic acid* [Vit B12 Def]

598 Biochemistry Nervous System

Wernicke syndrome manifests with opthalmoplegia, ataxia, & confusion. There is foci of hemorrhage and necrosis in the "mamillary bodies" and periaqueductal gray matter om autopsy. Diagnosis involves measuring *Eythrocyte Transketolase activity* It occurs due to chronic Thiamine (B1) def commonly in alcoholics. 1335 Biochemistry Nervous System

Hypertonicity, muslce rigidity and sugar smelling diapers are signs for maple syrup urine disease and branched chain amino acids such as leucine, isoleucine and valine should be restricted.

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1371 Biochemistry Nervous System

Infant with lethargy vomiting and seizures. Lab shows high ammonium levels. Liver biopsy suggest impaired formation of N-acetylgutamate as the cause. The reaction impaired in this pt would be *Conversion of CO2+NH3 into Carbamoyl-Phosphate* {N-acetylglutamate activates carbamoyl phosphate synthase 1 which is th enzyme that converts co2+NH3 into Carbamoyl phosphate]

1372 Biochemistry Nervous System

Pt with inherited condition wich imapirs transport of ornithine from cytosol to mitochondria. Restric *proteins* from diet to improve condition.

1480 Biochemistry Nervous System High Arginine in plasma and CNS suggest arginase deficiency which works to convert arginine into *Urea* in the urea cycle. 1500 Biochemistry Nervous System

Pt with imapaired Tetrahydrobiopetrin synthesis would have phenylketonurea and would therefore have deificency of *Serotonin*

2036 Biochemistry Nervous System

Pt with mutation in Protein involved in the assembly of small nuclear ribonucleoproteins (snRNP's) in motor neurons. Pt will have impaired function of *Spliceosomes*

2067 Biochemistry Nervous System

In lesch-Nyhan syndrome, there is increased activity of *PRPP Amidotransferase* due to compensatory increase in Denovo Purine Synthesis.

8524 Biochemistry Nervous System

Infant with normal development in first few month then progressive neurologic deterioration. P.E shows macrocephaly and an

abnormal startle reflex with acoustic stimuli. Funduscopy shows a bright red fovea centralis. (chery red macula spot)Pt most likley has accumulation of *GM2 ganglioside*

[Tay-Sachs] 1454 Biochemistry Poisoning & Environmental Exposure

Infant with language regression and anemia probably has lead posioning and probably has an inhoiibited *ALA Dehydratase enzyme* plus ferrochelatase inhibition.

1249 Biochemistry Pulmonary & Critical Care

The stretch and recoil property of elastin is mediated by *Interchain cross-links involving lysine*

[involves lysyl oxidase]

1989 Biochemistry Renal, Urinary Systems & Electrolytes

18 year old male with progressive skin rash. He has long standing history of intermittent burning sensation in his palms and soles that is exacerbated bt stres and fatigue. Burning is severe after

exercise. He sweats very little. Lab test reveals undetectable levels of alpha-galactosidase A. Pt is at greatest risk for *Renal Failure* [Fabry Disease, X-linked alpha-galactosidase A def]

11939 Biochemistry Renal, Urinary Systems & Electrolytes Pt with anion ga metabolic acidosis would rewuire renal metabolism of *Glutamine* for maximizing acid excretion pt. 361 Biochemistry Rheumatology/Orthopedics & Sports SnRNA has the function of *removal of introns from RNA transcripts*

1250 Biochemistry Rheumatology/Orthopedics & Sports

an elstin associated glycoprotein defecct that is abundant in the lens, periosteium, and aortic media refers to *Marfan Syndrome* an autosomal dominant disease with a defect in FBN1 gene coding for fibrillin glycoproten that forms around elastin.

2090 Biochemistry Rheumatology/Orthopedics & Sports

Mutation in PRPP synthetase (enzyme in purine denova synthesis) can lead to hyperuricemia due increased production of purines. Thus increasing the risk for Gout Which affects *Joints*

2091 Biochemistry Rheumatology/Orthopedics & Sports

Negatively Birefringent crystals under polarized light indicates Gouty Arthritis, for which the inflamatory response is mediated by *NEUTROPHILS*

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8802 Biochemistry Rheumatology/Orthopedics & Sports

Pt with signs of RA. Serum autoantibodies with "high specificity" for this pt condition are most likely to react with *Citrullinated peptides*

[ant-CCP]

1175 Biostatistics Biostatistics & Epidemiology Absolute risk reduction = Event rate in the control group - event rate in the Tx group 1178 Biostatistics Biostatistics & Epidemiology Check other calculations in choices.

1187 Biostatistics Biostatistics & Epidemiology

A trend in whoch there is a rising prevalence but stable incidence is due to prolonged duration of disease (*IMPROVED QUALITY OF CARE* for e.g)

1188 Biostatistics Biostatistics & Epidemiology Disproportionate loss of follow up btw exposed and control leads to attrition bias which is a form of *Selection Bias* 1189 Biostatistics Biostatistics & Epidemiology

Matching involves grouping patients with similar characteristics in both the control and treaetment (case) group. It is done to control confounding bias.

1272 Biostatistics Biostatistics & Epidemiology

Statistical power *1-Beta* represents a study's ability to detect a difference when one exists. Basically the ability to reject the null hypothesis when its truly false.

1303 Biostatistics Biostatistics & Epidemiology

A study's power increases as its *Sample Size* increase. Therefore, the larger the sample size, the larger the ability of a study to detect a difference when one truly exists.

10570 Biostatistics Biostatistics & Epidemiology When the unit of analysis in a study is "Populations" and not individuals, then it is an *Ecological Study* 1174 Biostatistics Cardiovascular System Number Needed to Treat is 1/Absolute Risk Reduction.(ARR is: conrol rate - Tx rate) 1301 Biostatistics Cardiovascular System Blinding prevents observer bias.

1190 Biostatistics General Principles

*Negative Predictive Value* is the probability of being free of disease. Answers the question: What are the chances that I really do not have cancer?

1233 Biostatistics Pulmonary & Critical Care Know how to calculate Sen, Spec, PPV, NPV (QUICKLY) 1208 Biostatistics Rheumatology/Orthopedics & Sports Case-fatality rate is calculated by dividing the number of fatal cases by the total number of people with the disease.

35 Embryology Cardiovascular System

Cyanosis in transposition of the great vessels is classic. This condition is due to failure of Septation. Failure of the

aorticopulmonary septum to spiral. It can be conducive to life only if accomanied by another condition that allows mixing of blood. E.g Patent ductus arteriosus which presents with machine like murmur. 202 Embryology Cardiovascular System

Pt with signs of a stroke and echocardiogram shows bubbles on left heart when agitated saline is inserted has an Patent Foramen Ovale due to *Incomplete fusion of atrial septum primum and secundum*

1705 Embryology Cardiovascular System Teratology of Fallor results from *Deviation of Infundibular Septum* 1750 Embryology Cardiovascular System

The common carotid artery which is palpatrd along the inner side of the sternocleidomastoid muscle is derived from the 3rd

pharyngeal aortic arch.

1740 Embryology Ear, Nose & Throat (ENT) a uni lateral cleft lip is caused bt failure of *Fusion on the maxillary prominence and intermaxillary segment* 543 Embryology Endocrine, Diabetes & Metabolism

Pt with absent thymic shadow and narrowing of aortic arch on xray probably has DiFeorge syndrome and lacks a thymus due to failure of *Third pharyngeal Pouch* to develop.

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1809 Embryology Female Reproductive System & Breast

*Vaginal Agenesis* is characterized by short vagina and rudimentary uterus and Amenorrhea with normal 2ndry sex characteristics and normal wieght and stature. It is a.k.a Mullerian Aplasia or MRKH syndrome. It often presents with urologic issues as as unilateral renal agensis.

320 Embryology Gastrointestinal & Nutrition Pt with Imperforate Ausu often have *Urinary tract Abnormalities* accompanying the condition. 321 Embryology Gastrointestinal & Nutrition Meckels diverticulum is an example of ECTOPY.

330 Embryology Gastrointestinal & Nutrition If neural crest migation to the intestine is interrupted by the final week (12 week) of migration, The *Rectum* would be affected. 437 Embryology Gastrointestinal & Nutrition The ventral pancreatic primordium gives rise to the *Main ppancreatic duct*

11803 Embryology Gastrointestinal & Nutrition

New born Pt with down syndrome who has reducible midline abdominal protrusion covered by skin probably has an uncomplicated umblical hernia due to *Incomplete Closure of Umbilical Ring*

419 Embryology Male Reproductive System A patent processus vaginalis causes a communicating hydrocele. It can also cause an *Indirect Inguinal Hernia*

1449 Embryology Male Reproductive System

If Leydig cells are working in a male (46xy) and Sertoli cells are not then the fetus will have female and male internal genitalia and male external genitalia. Why? becuase sertoli cells produce MIF which inhibits female internal gonad differentiation.

252 Embryology Miscellaneous (Multisystem)

Fetus that has closely set eyes, middline mass cosistent with a proboscis, fused cerebral hemispheres, and an absent forebrain fissure has Holoprosencephaly whicha type of *Malformation* 496 Embryology Nervous System

Vitamine supplementation prevents neural tube defects in pregant women. For exampel those defects involving the pos neural folds such as meningocele and meningomyelocele.

502 Embryology Nervous System Acetylcholinestrase in the amniotic fluid indicates a neural tube defect in which there is a *Failure of Fusion* 8702 Embryology Nervous System

The anterior pituitary is derived from *Surface Ectoderm* (Rathke's pouch)

-Check Table 337 Embryology Pregnancy, Childbirth & Puerperium

Pregnant pt on anti-convulsants who presents with

polyhydroamnios, fetus probably has *Anencephaly* due to antiepileptic medication whic is a risk factor for neural tube defects.

1833 Embryology Pulmonary & Critical Care High blood oxygen in a fetus can be found in the inferior venecava. 652 Embryology Renal, Urinary Systems & Electrolytes urine discharge from the umbilicus is caused by a persistent allantois remnant. 837 Embryology Renal, Urinary Systems & Electrolytes The mcc of unilateral fetal hydronephrosis is inadequate canalization of *UretroPelvic Junction*

1752 Embryology Renal, Urinary Systems & Electrolytes

Neoborn who has tachypnea and hypoxia. He has a flattened nose and bilateral club feet. He dies one hour later. To be found during autopsy is *Renal Agenesis*

[Potter sequence of pulmonary hypoplasia, falttened facies, and limb deformity due to Oligohydroamnios due urinary tract anomaly]

1915 Embryology Renal, Urinary Systems & Electrolytes

Ultrasound of fetus with bilaterally enlarged fetal kidneys with diffuse small cysts and oligohydroamnios has Autosomal recessive polycystic kidney disease (ARPKD) and is the oligohydroamnios can lead to Potters sequence which is Flattened facies, Limb deformity, and "Pulmnary Hypoplasia" and therefore the baby can be born with *Respiratory Disress*

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756 Embryology Rheumatology/Orthopedics & Sports Both the thymus and *Inferior parathyroid* originate from the 3rd pharyngeal pouch.

1684 Embryology Rheumatology/Orthopedics & Sports

Infant with flaccid lower extremity and absent ankle reflexes bilaterally and with poorly developed lumbar spine and sacrum (agenesis) has Caudal Regression Syndrome which is related to mother *Uncontrolled Diabetes* during pregnancy.

11835 Genetics Biostatistics & Epidemiology Good Question On Hardy Wieiberg analysis

882 Genetics Cardiovascular System

Majority of Down syndrome have trisomy 21 that happens as a result of *Chromosomal nondisjunction* during the 1st meitic division of the ovum. Incidence increases with maternal age. Only about 4 percent of down syndroem is caused by Robertsonian Translocation.

1476 Genetics Dermatology Pt with xeroderma pigmentosum have a defect in *Endonucelease* enzyme. 256 Genetics Female Reproductive System & Breast Pt with signs of Turner Syndrome is likey to have *Bicuspid Aortic Valve* 8556 Genetics Female Reproductive System & Breast Turner syndrome pt can become pregnant but with oocyte donation.

8283 Genetics Gastrointestinal & Nutrition Differences in halotype frequencies in a population can be as a result of *Linkage Disequilibrium*

1438 Genetics General Principles

A protein that has reverse transcriptase activity that functions to add TTAGGG repeat to the 3'end of chromosomes. The cell type with this protein is most likely *Epidermal Basal cells*

[Temlomerase protein on stem cells]

1462 Genetics General Principles

The acqusition of a new viral surface rotein is often all that is necessary for a virus to infect a new type of host cell. This is an example of *Phenotype Mixing* Here there is no change in parental genome and tehrefore, subsequent progeny will revert to having only original host attacking properties.

1469 Genetics General Principles

Viruses with segmented genomes can undergo genetic shift through reassortment. Such viruses inclide orthomyxoviruses (influenza) and *RotaViruses*

1728 Genetics General Principles *Classic Galactosemia* is autosomal recessive.

1970 Genetics General Principles

The occurence of multiple, seemingly unrelated phenotypic manifestation, often in different organs system as a result of a single genetic defect is termed *Pleiotropy*

[Vignette example is Homocysteinurea, manifesting with pitting edema (from DVT), caved in chest wall (marfinoid habitus), DVT, singlegene mut in cystathionine beeta-synthase enzyme]

2015 Genetics General Principles The homeobox genes code for proteins that are *Transcription regulators* 2025 Genetics General Principles Enhancers can be *Located upstream, downstream or within introns of the gene* 2029 Genetics General Principles Releasing factor 1 recognizes stop codons.

2030 Genetics General Principles Mutations in promotor regions such as TATA box can likely affect *Transcription Initiation* 2033 Genetics General Principles The poly A tail at the *3' end of RNA* is not transcriped from DNA template and was a post transcription modification. 8328 Genetics General Principles In Trisomy 21, chromosomal nondisjunction occurs in *Meiosis 1* 11904 Genetics General Principles Spina Bifida has a *Multifactorial* Inheritance pattern

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11913 Genetics General Principles *Alternative Splicing* is a process by which a single gene can code for various unique proteins by selectively including or excluding different DNA coding regions (Exons) into mature mRNA. 1474 Genetics Hematology & Oncology External Beam Radio therapy kills cancer cells through *Double-strand DNA breaks*

2087 Genetics Hematology & Oncology In beta thalassemia there is *Microcytosis* 11907 Genetics Infectious Diseases

Virus that develop a trait (due to culturing with another viruse) and their subsequent progeny continue to have the trait. Mechanism that explains this is *Reassortment*

(Recombination is if progency acquires completely new trait) 807 Genetics Male Reproductive System

Recurrent pneumonia, Azoospermia, Digital clubbing, No vas deferens are signs of Cystic Fibrosis. It can be diagnosed with measuring *Chloride level in the sweat*

701 Genetics Miscellaneous (Multisystem)

Husband short with a large head and prominent forehead. Wife is normal. They are concerned about unborn child's height. Best response is *Rsik of short stature in child is 50%*

(Achondrolasia is autosomal dominant, father must heterozygous (otherwise be dead), mom is unaffected therefore 50%)

591 Genetics Nervous System

Young man who is aysmptomatic and found to be homozygous for the apolipoprotein E-4 allele. In the future he most likely to suffer from *Alzheimer's dementia*

[Late onset familial Alzheimer's disease]

[Eary onset is assoc with 1) Amyloid precursor protein on chrom 21. 2) Presenilin 1 gene on chrom 14. 3) Presenilin 2 gene on chrom 1.]

1307 Genetics Nervous System

Pt with Fleshy, dome shaped lesions plus cafe-au-lait spots probably has cutaneous neurofibromas which is a hallmark of NF-1 which exhibits an inheritance pattenr of *Single Gene Autosomal Dominant*

-The NF-1 gene is on chromosome 17.

1421 Genetics Nervous System CGG Trinucleotid repeats is characteristic of Fragile X syndrome. Symptoms results from *Gene methylation* of FMR1 gene. 955 Genetics Pregnancy, Childbirth & Puerperium Pt with Clitromegally and High Androgen levels with Maternal Virilization probably has *Aromatase Deficiency* 1688 Genetics Pregnancy, Childbirth & Puerperium An ovulated oocyte is at *Metaphase of Meiosis 2*

1830 Genetics Pregnancy, Childbirth & Puerperium

A complete mole usually results when an empty ovum is fertilized by a haploid sperm. Subsequent duplication of the paternal genetic complement (23X) results in characteristic *46,XX* genotype 904 Genetics Renal, Urinary Systems & Electrolytes

Pt with painless hematuria, right sided renal mass, cytoology of malignant cells with chromosome 3p deletion. No significant family history. Findings indicate Sporadic Renal cell carcinoma which is due to deletion of VHL gene on chromosome 3.

1935 Genetics Rheumatology/Orthopedics & Sports

Presence of ragged skeletal muscle fibers and lactic acidosis is suugestive of mitochondrial myopathy. Heteoroplasmy is

responsible for variable expressiion of mitochonndrial disease in those affected. Heteroplasmy is having both mutated and wild mitochondrial Genomes in one individual, severity of disease depends on ratio of these.

8711 Histology Cardiovascular System Scar tissue in the heart is Type 1 Collagen, Just like tendons, ligaments, bone and blood vessels are type 1. 8424 Histology Endocrine, Diabetes & Metabolism

The adrenam medulla is demaracted from the cortex and is composed of Chromaffin cells with a deeply basophilic (blue) cytoplasm. The medulla is stimulated by Acetycholine.

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127 Histology Female Reproductive System & Breast

Tumor of cells heavely loaded with mucus that has metastasized to the ovaries suggests adenocarcinoma of the *Stomach* Classicly they are mucin-producing signet-ring neoplastic cells in ovarian stroma. (Krukenberg tumor)

1957 Histology Female Reproductive System & Breast

Pt with heavy and painful menstrual bleeding with uniformly

enlarged uterus has Adenomyosis, which is *Endometrial tissue in the Myometrium*

11890 Histology Female Reproductive System & Breast Revise breast neoplasia!

367 Histology Gastrointestinal & Nutrition

*Hep B* infection causes hepatocellular cytoplasm to to fill wih surface hep b antigen. The inclusions are (finely

granular,homogenous, pale pink), dull eosnophilic,ground glass apearance. Commonly transmitted sexually or in "IV drug users" 889 Histology Hematology & Oncology

Hemolytic anemia signs with blood smear showing spherocytes (no cetral pallor) indicates spherocytosis which is *RBC cell

memberane cytoskeleton abnormality* 483 Histology Infectious Diseases

The *True vocal cords* have stratified squamous epithelium. These can be affected by HPV which is a DNA virus casuing warty growth (papillomas) on the true vocal cords.

20 Histology Nervous System

Pt with 1 week history of hemiplegia, expressive ahagia and CT that shows hypodensity in his brain probably had an ischemic brain infarct. Histologic finding after stainling for lIPIDS would produce cells marked densely for lipids which are the

*MICROGLIA* and the lipids are from breakdown prduucts that were phagocytosed.

1536 Histology Nervous System The Blood brain barrier has Tight Junctions (Zonula Occludens) 1922 Histology Nervous System

Kinesin & dynein are *Microtublar* motor proteins responsible for rapid axonal transport.Kinesin acts in Anterograde transpor, Dynein in Retrograde.

1936 Histology Nervous System

A toxic insult that targets protein KInesin will affect *Secretory vesicles in nerve terminals* and will make them absent from tissue histological examination.

478 Histology Pulmonary & Critical Care *Type 2 Pneumocytes* have the ability to proliferate in response to cell injury. They can regenerate!

480 Histology Pulmonary & Critical Care

The epithelium of the bronchi is psuedostratified ciliated epithelium with goblet cells and submucosal mucoserous glands and cartilage. Bronchioles, terminal bronchiols and respiratory bronchioles lack goblet cells, glands, & cartilage. The terminal brocnhioles have ciliated simple cubioidal. So CILIA is last to disappear moving distally.

488 Histology Pulmonary & Critical Care smoking induced emphysema is contributed to by neutrophils. 524 Histology Pulmonary & Critical Care

Pt with tickened bronchial walls, lymphocytic infiltration, mucous gland enlargement, and patchy squamous metaplasia of bronchial wall mucosa are features of Chronic Bronchitis. Smoking is a leading cause of that. Smoking is *Behavioral contributor*

8 Histology Renal, Urinary Systems & Electrolytes In PSGN there is deposition of IgG, IgM, an *C3*, thus producing a star-sky appearance on immunolfourescent microscopy. 1159 Histology Rheumatology/Orthopedics & Sports Osteocytes are connected to each other by *Gap Junctions* 1734 Histology Rheumatology/Orthopedics & Sports Antibodeis against Actin would be against the Z-line since it contains only actin

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556 Immunology Allergy & Immunology

Pt stung by a bee displaying edematous and erythematous plaque with evanescent borders and mild central pallor. This is a local allergic reaction (type 1 hypersensitivity) leading to the release of *HISTAMINE*, heparin, leukotrienes, and prostaglandins that are responisble for the increased vascular permeability leading to the presentation.

743 Immunology Allergy & Immunology

The classic triad of Urethritis, Conjunctivitis, and Mono- or Oligoarticular arthritis indicates "Reactive Arthritis" which is a seronegative (RF -ve) spondyloarthropathy (HLA-B27). Symptoms usually present 1-4 weeks after a primary infection causing

urethritis (dysurea). Skin finding include a vesicular rash on palms & soles, circinate balanitis, and *SACROiLiiTiS* (inflammation of sacroiliac joint)

965 Immunology Allergy & Immunology

We conjugate the H. Influenza capsular polysaccharide together with diptheria toxoid in the vaccine because this combination *Increases Immunogenicity*.

2068 Immunology Allergy & Immunology Histamine and *Tryptase* are elevated in Anaphylaxis.

2069 Immunology Allergy & Immunology Mast cell degranulation is triggered by *Receptor aggregation* during High affinity IgE receptor activation.

1133 Immunology Dermatology

Pt presents with highly Pruritic (itchy) erythematous rash consisting of papules, vesicle and bulla following exposure to wilderness (Elctrician working in unmaintained woody area). Cells responsible for tissue damage are *T cells*

[Poison IVY dermatitis, type 4 hypersen] 1613 Immunology Dermatology

Symptoms of Maculopapular Rash (skin) and multiple intestinal ulcers (GI) after Liver transplant (or bone marrow) suggest Graft-versus-Host disease which is characterized by *Graft T cell sensitization against Host MHC antigen.*

2078 Immunology Dermatology

Pts with history of otitis media, chronic diarhea who on on exa have pneumocystis probably have SCID. (Otitis meedia is from bacteria and that reuires Humoral immunity) (pneumocystits requires t cells) Thefere *Combined Immune deficiency* 373 Immunology Gastrointestinal & Nutrition

Imigrant pt who is otherwise healthy and labfinding yiled Positive Anti-Hepatiitis A IgG. He was never vaccinated against hep A. Thi slab finidng suggest him having an *Anicteric viral infection as a toddler*

589 Immunology Gastrointestinal & Nutrition

Secretory IgA exists as a dimer with J chain in the middle and a secretory piece that kind of cross links the dimer, it functions to prevent IgA dimer degradation in mucosal membranes. Secretory IgA is present in mucus, tear, and *Colostrum*. (Note: the serum form is a monomer)

745 Immunology Gastrointestinal & Nutrition NK cells kill cells that do not express MHC class 1 antigen.

1467 Immunology Gastrointestinal & Nutrition

The live attenuated oral (Sabine) poliovirus vaccine produces stronger mucosal sectretory igA immune resposne than Salk killed vaccine. Secretory IgA maybe refered to as *Duodenal Luminal IgA*. Remember the route of entry of the virus is thru the intestinal epithelial cells.

1596 Immunology Gastrointestinal & Nutrition Immune mechanism against Giradia involves CD4+ T helper cells and *Secretory IgA Production* 8539 Immunology Gastrointestinal & Nutrition

The molecule involved in mediating the accumulation of pus is *IL-8*

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