1. Radiation treatment 6 months ago.

Bilateral patches of atelectasis  caused by Contraction

(Now fibrosis is causing it)
2. Meningitis life-threatening in a kid  treat and fuck consent
3. Longtime diabetes causing autonomic neuropathy---->mechanism of diarrhea? motility
disorder.
4. Improve adherence: followup
5. Patient >50 YO with weight loss, hematuria, and flank pain is RCC until proven otherwise.
Mass in upper portion of kidney.
6. Eccentric hypertrophy results in dilation, concentric hypertrophy results in thickening.
7. Congestive cardiomyopathy would have a decreased EF. Diastolic dysfunction is incorrect
because although in diastolic dysfunction there is preserved EF with impaired relaxation, the
ventricles are not dilated but usually hypertrophied and thicker; the same reason why also
hypertrophic cardiomyopathy and increased myocardial stiffness are incorrect – both may have
a normal to increased EF, but the ventricles would be thick not dilated.
8. A dilated heart is built from eccentric hypertrophy, or in-line (or in-series) building and
enlargements of muscle cells/fibers. In contrast, a thick heart of normal size (not dilated) is
built from concentric hypertrophy, or parallel building and enlargement of muscle cells. This is
a key concept for the boards that is repeatedly tested. Furthermore, this patient doesn’t
necessarily have anything wrong with him. He is a professional athlete and works his heart to
the max, so much so that it has become big, and not in a pathological way, since his EF is still
preserved and actually more than it should be at 75% (normal is ~55-65%).

PTH gets positive feedback from low Ca++ and negative feedback from high Ca+. PTH increases
Ca++, and does so in part by increasing the activity of enzyme 1-alpha-hydroxylase, which converts
vitamin D3 to 1,25-Vitamin D, the active form of vitamin D that increases Ca++ absorption from the
gut. When vitamin D3 isn’t being converted to 1,25-Vitamin D, it’s being shunted to its other pathway
that forms 24,25-Vitamin D.

Bullous pemphigoid: Layer - deep, age - elderly, blisters - tense/firm, oral lesions - rare, Nikolsky's
sign - negative, Immunofluorescence - Basement membrane, target antigen –
hemidesmosome(dermal-epidermal junction), blister content - hemorrhagic

Pemphigus vulgaris: Layer - superficial, age - middle-age (not always), blisters - flaccid, easily
rupture, oral lesions - common, Nikolsky's sign - positive, Immunofluorescence - intraepidermal,
circular, target antigen – desmosme,
blister content - fluid-filled

Low kidney perfusion (from things like renal artery stenosis or fibromuscular dysplasia) leads to
activation of the RAAS cascade and an overall increase in BP/TPR.

Pulmonary artery hypertension (PAH) results from increase in release of endothelin-1. PAH is a
consequent of pulmonary fibrosis. Bosentan is a medication frequently used to treat PAH through
antagonization of the endothelin receptor.

Avoid alpha agonists in Raynaud’s phenomenon.: phenylephrine

Porphyria is a group of disorders that result in defective heme synthesis and the buildup of
uroporphyrin, an intermediate compound. The very beginning of heme synthesis starts with succinyl
CoA and glycine.

Astrocytomas are single lesions that are often in the frontal lobe, presenting with personality changes
therefore, and “butterfly” from lobe to the other through the corpus callosum.

cryoglobulinemia secondary to hepatitis C. And what do cryoglobulins do to the kidney? Cause

nephrotic syndrome by settling in the kidney and causing an immune response. So, whenever you
have circulating immune complexes, that is always a type III hypersensitivity reaction

infect through walking barefoot and can cause pneumonia and gastroenteritis  stool parasite egg,
Necator americanus/Ancylostoma duodenale (sucks blood and passes eggs in stool )  microcytic
anemia) while Strongyloides stercoralis (doesn’t suck blood and passes larvae in stool).

45-year-old man with hypertension not compliant with medications, S4 gallop, thickening of left
ventricular wall. Mechanism of change in cardiac muscle? Transcription factor c-Jun: increased, beta-
myosin heave chain: increased, endothelin: increased

Diphenhydramine: histamine 1 blocker and antimuscarinic 3 (M3) receptors to prevent motion

sickness

Major depression 1st line of treatment → SSRIs(Paroxetine)

Smoker, peripheral edema/congested liver (RHF), distant heart sounds ---> cor pulmonale

As for the loose stools one, it's IBS. Big clue for me at least was relief with defecation. Treatment for
IBS is loperamide.

statins inhibit HMG CoA reductase leading to decrease in cholesterol, the cell will sense it which will
lead to cell signaling to increase the transcription and formation of HMG CoA reductase.

Subacute granulomatous thyroiditis: painful thyroid, and it can present as hyperthyroidism initially

they can drive as long as their seizure disorder is well controlled.

cracked lips and peeling sunburned skin ..... application of petrolatum to his lips may aid in reducing
lip symptoms by which of the following effects of the compound? Barrier

Unable to flex right elbow with decreased sensation to pinprick over right lateral forearm. Brachial
plexus lesion? Musculocutaneous

Parkinson: alpha synuclein

increased creatinine means renal failure> decreased vitamin D  increased PTH--> increased PO4
(PTH cant eliminate it), decreased HCO3

fracture of left ninth and tenth ribs. Organ injured?

- Spleen

Sensation to pinprick absent over lateral aspect of shoulder. Xray of right shoulder shown (fracture of
surgical neck of humerus)? Axillary

HSV tx: acyclovir

CMV: gangiclovir

limiting his daily caloric intake to 2000 calories. In order to maintain the recommended protein intake
56 g daily, a balanced decrease in carbonhydrate and fat is required (30:55) which of the following
best described number of calorie that should be provided by fat in this patient diet each day ?
a) 370
b) 430
c) 510
d) 630
e) 740

56g x 4 cal/g = 224 cal (so he has 2000 - 224 = 1776 left to eat in one day).

So they told us the person must get atleast 56g of protein in that 2000cal diet. So we multiply 56g
into 4 (1gprotein=4cal) and substract it from 2000. We get roughly 1776 calories.
Now they tell us that from that 1776cal, we should maintain the ratio of 30:55 between fat and carb.
But that ratio is BETWEEN fat and carb and not between fat and the TOTAL NO. of calories. To get
that ration we will add 30 and 55 which will no give us 85. And 30:85 is our required ratio between
fat and the left over calories(1776). Now we just have to multiply that ratio to the actual number of
leftover calories(1776) to get the answer.

Involvement of which of the following skin layers is associated with the greatest risk for an
unfavorable prognosis: subcutaneous tissue. the deeper it goes the dangerous it is.

crypts of Lieberkühn are the stem cells in the intestine.

BUN: creatinine > 20:1 suggests pre renal azotemia.

He is in renal failure so pH should be low or at the most normal, acidosis because decrease HCO3,
tachypnea so pCO2 should be low (out C), not BPH (obstruction ---> increased hydrostatic pressure
in BS due to back pressure of urine)

concentric enlargement of the left ventricle. Microscopic examination of the heart shows enlarged
myocardial cells with large nuclei.: Hypertension increases the pressure within the ventricle, and this
pressure overload eventually results in diastolic heart failure, which is associated with concentric
enlargement. Myocardial cells hypertrophy and develop "boxcar nuclei" when having to generate
increased pressure due to hypertension.
Long-standing history of hypertension and Physical examination shows a visible pulsation ( AORTIC
ANEURYSM)

contrast material into cervix. on hysterosalpingogram, contrast material also seen in peritoneal
cavit normal spillage of contrast.

defect in an innate defense mechanism. Decrease gastric hydrogen chloride production. After 2
months, endoscopic biopsy specimens of gastric fundus and body show decreased mucosal thickness
and hyperplasia of enterochromaffin like cell: chronic gastritis

any type of chemo that causes myelosuppression you want to monitor for neutropenia.

immune thrombocytopenia.there is some viral illness that causes the formation of antibodies which
form antibody platelet complex which then is consumed by spleen. increased megakaryocytes
because of platelet deficiency

increased creatinine means renal failure> increased PTH> increased PO4 decreased HCO

Herniated lumbar intervertebral disc asking for most appropriate location for surgical entrance to
neural canal? Thru lamina

radial groove. radial nerve is damaged giving smptoms

ruising on forearms, wrinking, erythematous patches on face, brown macules. Echhymoses in various
stages of healing. CBC and coagulation studies normal: extensive solar elastosis=actinic keratosis

right knee showing fracture of tibia and elevated periosteum and sunburst pattern (So Giant cell
tumor?) Xray shows pul nodules of various sizes, Codman triangle and this leads to diagnosis of
osteosarcoma. aPleomorphic neoplastic cells producing new woven bone

PID inflammation, has surgical resction scarring, macrophages = scarring

Dead space has to do with areas that are ventilated but not perfused (more or less). A shunt is the
opposite-- not ventilated, but perfus

If everything else stays the same, except for the decreased number of measurements (smaller
sample size), the width of the confidence interval will increase. Therefore, when n is reduced from 20
to 4, we can see the mean has a larger value added/subtracted from it, making the interval wider
when n=4 instead of 20.
kidney failure, so there will be defects in reabsorption. This means he isn't absorbing bicarbonate, so
HCO3 will be well below normal Since he is failing to reabsorb bicarb, he will be in metabolic acidosis.
The body tries to make up for this by blowing off volatile acid (CO2; note the high RR of 24 breaths
per minute), so the pCO2 will be below normal (40 is normal). The respiratory compensatory
mechanism for metabolic acidosis (hyperventilating to blow off CO2) is not going to overcompensate
for the primary defect; that is, he is not going to hyperventilate so much that the pH actually ends up
slightly above normal.

Green colonies on blood agar--->all alpha hemolytics. Add recent teeth cleaning to the picture and
you get strep viridans.

History of 6 hrs of fever and shaking chills + leukocytosis suggests you this is an acute inflammatory
reaction.You can see she has nitrites and leukocyte esterase(Gram - bacteria) in urine and flank
pain→ acute pyelonephritis. A Leukemoid reaction is just an acute inflammatory reaction= ↑WBC
count and ↑neutrophils, also ↑leukocyte alkaline phosphatase

the lower the blood: gas coefficient, the faster the induction rate; Low blood solubility

Chloroquine is ineffective on the exoerythrocytic malaria tissue stages

Mechanisms explains the decreased resistance in these colonies? Vancomycin resistant colonies:
plasmid loss

The question states that the brother is healthy; this means he did not get "aa", so we can eliminate
that. This leaves us 3 genotype possibilities, 2 of which involve him receiving an "a" allele from either
mom or dad, while only 1 possibility of him getting "A" from both parents. Thus, 2 out of 3.

infection after the membrane rupture, now the inflammation and the consequent pgs are causing
contractions.

Capsofugin  Decrease gluten expression on fungal cell surface

Myelin basic protein is associated in the synthesis of myelin in CNS and the question describe a
patient with MS, which is an autoimmune demyelinating disease  CD4+ T lymphocytes activated by
myelin basic protein

Cancer of the cecum, found to have metastatic lesion in the right lobe of the liver. Most likely path?

Ileocolic SM portal  right hepatic branch of the portal

SMA drains directly into the portal vein, while the IMV drains into the splenic veins

a 35 year old women comes to the physician bcz of fever n sharp chest pain for 3 days. temp=
101.3. friction rub heard. al the secondary causes of pericarditis is ruled out. most likely cause of
primary pericarditis?viurs coxsackie

12 hours after aspirin suicide attempt. tachypnea. lab findings?

You'll have metabolic acidosis. pH will be low (below 7.35), bicarb will be low (below 24), and pCO2
will be low (below 40) as patient hyperventilates trying to compensate for the metabolic acidosis.
Also of note, this metabolic acidosis will have an increased anion gap, as salicylic acid will nudge
down the normal anions (Cl- and bicarb) a bit.

Cachexia or wasting syndrome is loss of weight, muscle atrophy, fatigue, weakness, and significant
loss of appetite in someone who is not actively trying to lose weight.
Cachexia is seen in patients with cancer, AIDS,coeliac disease,chronic obstructive pulmonary disease,
multiple sclerosis, Rheumatoid arthritis, congestive heart failure, tuberculosis
The inflammatory cytokines involved in wasting diseases are interleukin 6, TNF-alpha, IL1B, and
interferon-gamm

Attachment of bacteria to host surfaces is required for colonization during infection or to initiate
formation of a biofilm. A fimbria is a short pilus that is used to attach the bacterium to a surface

superior mesenteric artery with complete occlusion of middle colic artery. Ischemic changes where?
- Small intestine, ascending colon, and part of the transverse colon
. Gram stain: gram-positive, lancet-shaped diplococci. Vaccine is against which bacterial component?
- Capsular polysaccharide

. Biopsy shows sheet-like infiltrate of pale eosinophilic cells with bean-shaped nuclei. Cells positive for
CD1a. Electron microscopy of cells shows Birbeck granules. Abnormal cell type?
- Langerhans cells

stimulus for her uterine muscle contractions?

- Inflamed maternal decidua release of prostaglandin

error of chromosome segregation occurred during anaphase at which of the following stages of
spermatogenesis in the patient's father?
- Primary spermatocyte

. 34-year-old man with a 3 month history of a progressive rash on his feet. Rash is not itchy or
painful. A photograph of feet is shown. HIV+. In addition to HAART, which of the following
pharmacotherapy is most appropriate?
- Antineoplastic  Kaposi sarcoma

Mechanism of antigenic shift?

- Reassortment

pneumonia, gram negative rods. The identity of these bacteria is confirmed by staining with specific
fluoroscent antibodies. The patient respond therapy with macrolide Ab. Mechanism?
- Inhalation of aerosol from an environmental source (Legionella))

17-hydroxyprogesterone increased. Enzyme deficiency?

- 21-hydroxylase
. 10-day-old male newborn 1-day history red eyes with discharge. Pregnancy uncomplicated but no
prenatal care in third trimester. PE bilateral conjunctival injection with water discharge. Cause?
- Chlamydia trachomatis (gonorrhea occurs earlier and is more purulent)

Sheehan syndrome occurred, so all anterior pituitary hormones (and whatever they induce those are
also down) but aldosterone is up because blood delivery is decreased to juxtaglomerular cells --->
renin ---> ang II ---> incr aldo.prolactin, ACTH TSH decrease and aldosterone up

35-year old man w several episodes of squeezing chest pain gets angiogram... gets IV NE. Question
shows a graph of coronary blood flow with a drop after the NE and then a rise. Which substance
causes increased total coronary blood flow 1-2 mins after NE?
- Adenosine  vasoldilation

Where is hormone released from that causes gallbladder contraction?

- Enteroendocrine cells of the small intestine (CCK)

Barium swallow shows dilated esophagus with beak-like narrowing: loss of neurons in myenteric
plexus; Achalasia: hypertonic lower esophageal sphincter which fails to relax in response to the
esophageal swallowing wave

Plclitaxel: Inhibits microtubule disassembly

Vincristine: polymerization

18-year-old woman get general anesthesia for wisdom teeth extraction. After 5 minutes, gets
hypertonicity of skeletal muscles and increased body temperature. The treatment is a drug that
decreases?
- Malignant hyperthermia: give dantrolene: blocks ryanodine receptorsprevents release of calcium
from the sarcoplasmic reticulum in skeletal muscle

Angiography shows no coronary artery blockage. ECG shows prolonged QT. Decreased activity in
which of following causes this?
- Outward (delayed) rectifying potassium channel

22-year-old nulligravid woman has menses that occur at irregular 26- to 32-day intervals. Height 5 ft
4 in and weighs 187 lb. BMI 32. PE shows mild hirsutism and velvety brown, thickened skin at the
base of the neck and around axillae. Patient has which condition?
- Hyperinsulinemia

HIV patients should be kept on a HAART regimen, which includes 2 NRTIs and one other drug
PI/NNRTI/etc.

4-month-old boy with 1-day respiratory distress. Has progressive weakness and difficulty feeding for
a month. RR 50/min. PE shows enlarged tongue and generalized hypotonia. Increased lactate,
pyruvate, glucose, and uric acid. CXR shows cardiomegaly. Biopsy of skeletal muscle shows increased
glycogen. Enzyme impaired?
- alpha-1,4-Glucosidase Pompes disease

give hparin then warfarin, secodmd day PTT high and PT low why? Long half life factor 2
(prothrombin

Pinealoma: inc release of HCG wich cause precociuos puberty  enlarged lateral and third ventricles,
papilledema, upward gaze

Physical examination shows tenderness to palpation over the L2-3 vertebrae. Serum electrophoresis
shows a monoclonal spike of IgG kappa. A chest x-ray shows cardiomegaly with bilateral pleural and
pericardial effusions. An x-ray of the spine shows a lytic lesion. Echocardiography shows an
echodense thickened left ventricle and poor diastolic compliance. Multiple Myeloma: amyloid
infiltration

3-year-old boy with progressive fever and skin lesions during 24 hours. T 102.9 F, pulse 120, RR 20,
bp 110/60. PE shows large, flaccid, bullous lesions over trunk and abdomen. Another finding in pt?
- Positive nares culture for toxin-producing Staphylococcus aureus

kid has staph scaled skin syndrome. Toxic shock syndrome. Almost everyone has staph aureus
colonized in their nares and it's the only one that fits in this case since they have desquamation of
their skin and fever.

Age of patient + lump is smooth, firm, round, mobile, nontender...most common breast tumor for
this age group and this description is a fibroadenoma. Textbook definition. Cystic would be > 25,
premenstrual pain, multiple, and usually bilateral.

Gastric contents where lungs are ---> pulmonary hypoplasia ----> respiratory distress = failure of
pleuroperitoneal membrane to fuse.

CT shows bilateral hydronephrosis and lymphadenopathy compressing ureters. Tx to improve renal

function?
- Bilateral stents in the ureters

A 63 year old woman comes to the physician b/c of a 2 week history of daily episodes of severe,
lancinating, left-sided facial pain. The pain, which occurs suddenly and lasts 30 to 60 seconds, shoots
from the left ear down along the jawline. The pain is sometimes precipitated by chewing or brushing
teeth. Vital signs are normal. PE shows no abnormalities except for moderate dental caries .
Diagnosis?trigeminal neuralgia

Fourth one isn't prolapse because that prolapse would cause the uterus to squish out of the vagina.
Instead, you feel a bulge on the anterior wall of the vagina with increased abdominal pressure. The
bladder is anterior to the uterine wall, so there's your answer.  cystocele

He is a long time smoker presenting with signs of right heart failure.

Also note that the murmur increases on inspiration which indicates a right side murmur...
COPD leads to pulmonary hypoxic vasoconstriction, that results in right ventricular hypertrophy and
subsequent right heart failure.--> cor pulomonale

only four measurements were made rather than 20, which of the following statements would best
describe the width of the 95% CI with regard the mean blood pressure?
- Larger

66-year-old man with 1-month hx of nonproductive cough and 6 months shortness of breath.
Bilateral end-inspiratory crackles heard. CT chest shows diffuse reticular opacities at periphery and
bases of lungs. Micro exam of biopsy shows patchy interstitial fibrosis, several fibroblastic foci and no
granulomas. Dx?
- Idiopathic pulmonary fibrosis

8-year-old girl is brought to the physician by her mother because of a 3 week history of poor feeding
chronic diarrhea and pale foul smelling stools. Mother says the symptoms began with colicky
abdominal pain following introduction of solid food to the infant's diet. History of gluten sensitivity.
60th percentile for length and 25th percentile for weight. Which cell is dysfunctional?
- Enterocyte

25-year-old woman comes for counseling prior to conception. Has seizure disorder on valproic acid.
Fetus at greatest risk for drug-related adverse effect during which pregnancy stage?
- 3 to 8 weeks

68-year-old man with a 10-month history of shortness of breath and swelling of his feet, family
history of cardiovascular disease. He smoked 2 packs of cigarettes daily for 50 years. Pulse 80/min, rr
24/min, BP 150/80. PE: 3+pitting edema of lower extremities. Diffuse, scattered wheezes are heard
bilaterally on auscultation of the chest. Grade 2/6 pansystolic mumur heard best at lower left sternal
border, which increases on inspiration. Maximal impulse palpated in sub-xiphoid area. S1 and S2
sounds are distant. Liver span 14 cm. Diagnosis?
- Cor pulmonale

7. 48-year-old woman with gradual onset back pain past 2 weeks. No trauma. Doesn't smoke
cigarettes, drink alcohol or use drugs. Hemogram, serologic studies and urinalysis unremarkable.
Xray of spine shows two lytic lesions, in T-10 and L-1. Dx?
- Metastatic carcinoma of the breast

first pharyungeal pouch middle ear cavity and Eustachian tube

third pharyngeal pouch thymus and inferior parathyroid glands

fourth pharyngeal pouch superior PTH glands.

Fifth gland that secretes calcitonin

17-year-old boy in septic shock unresponsive to ADH (vasopressin). Treat is discontinued, and high-
dose dopamine in started. Which receptors are stimulated?
- alpha1-adrenoreceptors

After operation, 65-year-old patient has lung region that is underventilated but well perfused. Which
increases?
- Physiologic shunt

52-year-old with chronic pancreatitis is deficient in which enzymes that causes inability to digest
triglycerides?
- Colipase

32-year-old man with HIV infection follow up examination, has been treated with HAART for the past
6 years HIV plasma viral load has been undetectable. HIV viral load now increase, antiretroviral
resistance suspected. HIV genotype analysis confirms that the virus has resistance mutations, which
of the following most likely mutated?
- Reverse transcriptase and protease (the two targets of HAART therapy, therefore if therapy stopped
working, must be these two target proteins of virus mutated)

19. 58-year-old woman with 6-month shortness of breath and chronic nonproductive cough. 2-year
history difficulty swallowing, joint stiffness, diffuse tightening of skin on face, neck, shoulders, arms,
fingers. Sensitivity to cold weather, turn white. Hx of esophageal reflux. Biopsy showed atrophy of
epidermis and deposition of collagen throughout dermis with loss of dermal appendages. PE
cutaneous ulceration, clawlike flexion deformity, decreased joint mobility. At risk for which pulmonary
disorder?
- Pulmonary hypertension (dx: systemic sclerosis/CREST)

A 68-year-old man comes to the physician because of a 1-month history of light-headedness and
tightness in his chest with exertion. He adds that the pain is worse after arguing with his wife, and
the symptoms resolve with rest. He has a past history of lower gastrointestinal bleeding; evaluation
at that time was negative on upper endoscopy and colonoscopy. His temperature is 37°C (98.6°F),
pulse is 85/min, respirations are 15/min, and blood pressure is 110/75 mm Hg. Physical examination
shows no abnormalities. His hemoglobin concentration is 8.2 g/dL, and hematocrit is 24%. Test of
the stool for occult blood is positive. An ECG shows no abnormalities. Repeat colonoscopy shows no
abnormalities. Which of the following is the most likely cause of this patient's gastrointestinal
symptoms?
- Angiodysplasia

24. A 25-year-old woman comes to the physician because of a 2-year history of intermittent, diffuse,
cramping lower abdominal pain. The pain is usually associated with2 to 6 days of loose, watery
stools, and is typically relieved with defecation. IBD A drug targeting which of the following
mechanisms of action is most appropriate for this patient?
- Accentuation of μ-opioid myenteric plexus receptor

Triamterene (potassium-sparing)

A 70-year-old woman comes to the physician for a routine pelvic examination. During speculum
examination of the vagina and cervix, the Valsalva maneuver causes a bulge of the anterior vaginal
wall. Which of the following is the most likely cause of this finding?
- Cystocele cystocele is ant vaginal wall prolapse, rectocele is post vaginal wall prolapse.

EM biopsy of skin shows tennis racket-shaped bilamellar granule in cytoplasm. Immuno studies show
CD1a antigen expression. Abnormal cells in patient are derived from which cell?
- Dendritic cells
21-year-old man loses 15% total blood volume 2 minute after motor vehicle collision. Finding most
likely?
- Increased sympathetic nerve traffic to sinoatrial node
Low blood volume = low BP = increased sympathetic activity to SA node = higher heart rate.

Hemochromatosis: increase risk of hepatocellular carcinoma

27-year-old man for psychiatric eval sent by employer because he is "very odd." Is a computer repair
specialist and lives alone. Refuses to socialize and has no friends. Extremely preoccupied with science
fiction, occult, afterlife. Personality disorder?
- Schizotypal

. Unable to flex the distal phalanx when proximal interphalangeal joint metacarpophalangeal joints
restratined. Xray normal. Injured structure?
- Flexor digitorum profundus tendon

46-year-old woman with 1-week low-grade fever and joint pain. Has chronic headaches and takes
ibuprofen several times. PE diffuse maculopapular rash. UA 2+ protein, 10-20 WBC and eosinophils.
Renal biopsy would show what?
- Inflammatory infiltrates in the interstitium

the mutant allele should have a lower affinity(higher) km for alcoholdecreased catalyitic efficiency
of K487

45-year-old man bmi 26, total cholesterol 200, HDL 50, triglycerides 550. Which drug to prescribe?
- Fenofibrate - Need a super decrease in TG so fenofibrate

◦ 63-year-old man 2-week sensation of fullness in left upper quadrant. Has lethargy and shortness of
breath. 20-lb weight loss during 3 months. PE shows pallor. Spleen tip palpated. Labs: hb 9,
hct 27%, wbc 4000, serum uric acid 15. Peripheral blood smear numerous erythrocytes with
abnormal shapes and sizes, nucleated erythrocytes and myelocytes. Aspiration of bone marrow
dry tap. Biopry shows thickened bony trabeculae with increased reticulum: myelifibroblast
◦
◦ Neoplasia of mature myeloid cells
▪ most notably megakaryocytes
◦ Most commonly seen in older adults (5th/6th decade)
◦ Result of a JAK2 kinase mutation
◦ Megakaryocyte hyperplasia results in fibrotic obliteration of the bone marrow
result of increased production of PDGFSymptoms
◦ splenomegaly
▪ secondary to extramedullary hematopoiesis
◦ bleeding
▪ megakaryocytes are dysfunctional
◦ thrombosis
platelets can rupture which stimulates coagulation cascade
Peripheral blood smear
◦ tear-drop RBC
▪ membrane is disrupted when RBC passed through fibrosis to leave bone marrow
◦ nucleated RBCs
band granulocytes

1-year-old has numerous infection of skin and oral mucosa since birth. Infections slow to respond to
antibiotic therapy. T 100.4F. PE multiple erythematous lesions of skin some with superficial
ulceration. WBC 21,000 77% segmented neutrophils, 6% bands, 14% lymphocytes and 3%
monocytes. Biopsy shows no neutrophils in dermis or epidermis. Culture of lesion grows
Staphylococcus aureus. DefectiveIt is leukocyte adhesion deficiency, which is caused by a defective
integrin.
(Note that another key association with this condition is delayed separation of the umbilical cord,
because neutrophils are also involved in that process.)

◦ 45 yr old man with SOB on exertion x 6 months, nosebleeds since adolescence, 2 pics: clubbing +
hemorrhagic lesions in tongue, inhaled albuterol doesn't improve his symptoms. Cause of
symptoms?Hereditary hemorrhagic telangiectasia (HHT)
◦ Pathophysiology
▪ hyperemic vessels that blanch with pressure arteriovenous malformation (AMVs) in small
vessels
◦ Genetics
autosomal dominant inheritance
◦ Symptom
▪ recurrent bleeding
epistaxis
gastrointestinal
pulmonary AVMs
◦ Physical exam
▪ skin abnormalities
discolorations
telangiectasias (especially mucosal)
Pulmonary AV shunting
Disease is osler weber rendu

27-year-old primigravid woman at 18 weeks gestation comes to physician for routine prenatal
examination. The uterus consistent in size with 18 week gestation. Ultrasonography shows a male
fetus. The collecting system and pelvis of the left kidney is dilated and the renal cortex appears
compressed. The left and right ureters are not dilated. The right kidney appears normal. Amniotic
fluid volume is normal. Which causing renal finding in this fetus ?
- Incomplete recanalization of proximal ureter

2. An 82 year old woman comes to the physician because of constant severe lower abdominal pain
and fever for 24 hours. Laproscopic examination shows severe diverticulosis and perforated
diverticulitis. In spite of appropriate therapy she dies 2 days later. Her liver autopsy was given
Which of the following is the primary component of the material shown on the hepatic surface >
Fibrin. Perf'd diverticuli = poop in belly = tons of inflammation = fibrin.
36 weeks' gestation with 6-hour history of heavy vaginal bleeding. No prenatal care. Ultrasound
shows placenta over cervical os. Can't stop bleeding and has cesarean. Dx?
- Placenta previa

3. 19-year-old woman is admitted to the hospital for antibiotic treatment of meningococcal

meningitis. She is stabilized. Three days later, her pulse is 120/min, and blood pressure is 60/30 mm
Hg. Physical examination shows bilateral flank tenderness. Serum studies show a sodium
concentration of128 mEq/L, potassium of 5.4 mEq/L, and bicarbonate of 20 mEq/L. Which of the
following is the most appropriate next step to determine the cause of this patient's hypotension?
- Adrenocorticotropic hormone stimulation test

I understand how type 2 pneumos can act as stemcells for type 1 but overall the integrity of
basement membrane would direct type 2s to ensure a normal restoration. ( I think a similar
mechanism works for skin too. You only get a scar if the bm has been breached otherwise the skin
regenerates normally without a scar)

succinylcholine to not give in cholinesterase deficiency because they will have prolonged paralysis
the duration of action of Succ. chol. depends on activity of plasma cholinesterase; if a patient is
homozygous for "atypical" cholinesterase, their paralysis can last for hours.

For the carbs question, I think you use the ratio they gave so fat would be 30/(30+55) which is
around 35%. Then you subtract the protein from 2000 (2000-224 = 1776). 35% of 1776 is around
answer

For the first one, you had to multiply protein grams with 4 and subtract it from 2000(calories
allowed/day). They gave a fat/carb ratio of 30:55. So for the fat calories, you had to multiply the left
over calories with 33/(30+55) or 33/85.

I understand how type 2 pneumos can act as stemcells for type 1 but overall the integrity of
basement membrane would direct type 2s to ensure a normal restoration. ( I think a similar
mechanism works for skin too. You only get a scar if the bm has been breached otherwise the skin
regenerates normally without a scar)

Pt has Cushing Disease (ACTH secreting pituitary adenoma).

Pituitary adenoma --->bitemporal hemianopia (vision loss)
Increase cortisol ---> insulin resistance (weight gain) and compression fractures from decreased
bone formation--> osteoporosis.

20-year-old woman with 2-week fever, shaking chills, headaches, fatigue, and joint and muscle pain.
Spent summer workin as lifeguard in Long Island, New York. Has splenectomy for motor vehicle
collision 6 years ago. T 102.4 F. Peripheral blood smear shows small intraerythrocytic rings.
Polymerase chain reaction for Plasmodium is negative. Causal organism from bite of?
- Tick  negative plasmodium, intraerythrocytic rings  babesia

cancer, cachexia  autophagic vacuoles

14-year-old girl with type 1 diabetes mellitus and 4-hour history of lethargy, confusion, disorientation.
Symptoms gradually developed and she did not take her usual insulin dose during a sleepover. HR
110, RR 24 deep and rapid, bp 95/75. Labs: glucose 450, arterial pH 7.15. ABG?
pCO2/HCO3-/Anion gap
- decreased/decreased/increased

12. Investigator studying vancomycin-resistant strain of Enterococcus faecalis. Ten generations

created. Culture inoculated and resulting bacterial colonies are screened for vancomycin resistance.
Vancomycin-sensitive colonies observed at frequency of one per 100 cells. Mechanism of decreased
vancomycin resistance?
- Plasmid loss

13. Male newborn delivered at 28 weeks, neonatal respiratory distress syndrome, ABG shows
decreased pH, decreased Po2 increased PCO2. A deficiency in which of the following most likely
caused the disorder?
- Dipalmitoylphosphatidylcholine

45-year-old man comes to the physician because of an enlarging face shoulders and trunk and
thinning of his arms and legs. Physical examination shows a large plethoric face, fat pad over the
upper thoracic spine and purple striae on the abdomen. Serum studies show undetectable ACTH and
an increased cortisol concentration. Administration of low dose dexamethasone would most likely
result in which of the following sets of serum findings?
- ACTH no change, cortisol no change

16. 12-year-old boy with mother concerned about enlarged left breast and family history of breast
cancer. Left breast is slightly larger than right, nipple mildly tender. Penis slightly enlarged and pubic
hair curling and beginning to darken at base. Best next step?
- Reassure the mother that physical findings are not uncommon for his age

18. 35-year-old woman with fever and sharp chest pain for 3 days. T 101.3F. Friction rub heard. All
cuases of secondary pericarditis ruled out. Cause of primary pericarditis?
- Virus

20. 35-year-old woman passed out while washing dishes. Began to feel weak and dizzy, husband
shares with nursing staff history of bulimia nervosa, and has been binging more frequently.
Suspected she has been vomiting. Labs of patient?
K+/HCO3-/Anion Gap/pH
- decreased/increased/normal/increased

21. 67-year-old man with 3 months fatigue and shortness of breath. Vitals HR 90, RR 15, bp 150/98.
PE conjunctival pallor. Labs: hb 8.5, hct 26%, MCV 90, RDW 14.4% (N=13-15%), Cr 2.9, Ferritin
144, Iron 24, Transferrin saturation 23% (N=20-50%). Besides iron supplementation, most
appropriate tx?
- Erythropoietin

24. 38-year-old man 1-week shortness of breath with exertion, light palpation of carotid artery shows
upstroke is abnormally brisk and downstroke falls precipitously. Cause of finding?
- Aortic Regurgitation
Case fatality rate=fatalities among cases/all cases of a certain dz

CT shows bilateral hydronephrosis and lymphadenopathy compressing ureters. Tx to improve renal

function?
- Bilateral stents in the ureters

-year-old male with recurrent UTIs, left kidney found small and non functional; right is normal.
Nephrectomy is done, and the picture shown (dilated ureter and renal calyx). Microscopic exam of
kidney will show which?
- Tubular atrophy

In a 25-year-old patient who underwent splenectomy, target cells are seen on peripheral smear.
These cells are seen due to loss of function of which portion of spleen?
- Red pulp

19-year-old man with gastrointestinal bleeding. Laparotomy done and 5-cm blind outpouching on
antimesenteric side of terminal ileum 15 cm from ileocecal valve resected. Pathology shows?
- Heterotopic gastric mucosa  merrckles diverticulum

So they told us the person must get atleast 56g of protein in that 2000cal diet. So we multiply 56g
into 4 (1gprotein=4cal) and substract it from 2000. We get roughly 1776 calories.
Now they tell us that from that 1776cal, we should maintain the ratio of 30:55 between fat and carb.
But that ratio is BETWEEN fat and carb and not between fat and the TOTAL NO. of calories. To get
that ration we will add 30 and 55 which will no give us 85. And 30:85 is our required ratio between
fat and the left over calories(1776). Now we just have to multiply that ratio to the actual number of
leftover calories(1776) to get the answer.

You should modify your mnemonic. The internal carotid artery like the other four run in the lateral
wall. Only the abducent nerve run freely in the middle and that's it's first affected by cavernous sinus
thrombosis.
4. 32-year-old woman has new neuro finding while being tx for acute infection of sphenoid sinus.
Imaging shows cavernous sinus thrombosis on left. Additional finding most likely?
- Inability to abduct the eye

83-year-old with arteriosclerosis undergoes repair of infrarenal abdominal aortic aneurysm. Graft
extends just below the renal arteries to the bifurcation of the aorta. Which organ will lose primary
blood supply and rely on collateral circulation?
- Descending colon

62-year-old with angina pectoris is referred for cardiac catheterization. Patient worried about
hospital-associated infection. Studies show 30% of patients require admission after procedure, and 2
percent of admitted patients acquire hospital infection. Patient's risk for infection overall?
0.3 * 0.02 = 0.006 = 6/1000