High Yield Uworld Review 1/29/2018 3:18:00 PM

1. Tumor Cells Become Resistant to drugs through MDR1 gene via P-

Glycoprotein found on the surface of cells. What is the function of this
glycoprotein?
1. ATP dependent transporter

2. Mehthemoglobin is formed when _______ in heme is oxidized to ______

Fe 2+ ; Fe 3+
3. What type of cancer are patients with down syndrome most likely to get
ALL (10-20x fold) / AML
4. In a patient with sickle cell anemia that gets sicker what is the cause and
what type of virus is it
a. Non enveloped single strand DNA virus (parvovirus B19 –
Aplastic Crisis
5. Beta thalesemmia causes high HgbA2 levels and is caused by
a. Defects in beta globin mRNA synthesis (mutation)
6. Which Hepatitis uses reverse transcriptase to integrate their DNA into the
host genome
Hepatitis B
7. Maturing Erythrocytes lose their ability to synthesize heme when they
lose their…
 Mitochondria
8. Increased activity of this intracellular enzyme can make someone more
susceptible to benz(o)pyrene induced lung cancer
a. Microsomal Monooxygenase

9. Which drug receptors are involved in treating chemotherapy induced

nausea
 Dopamine antagonist (metroclopramide) Seratonin 5HT3
receptor (ondansetron) Neurokinin 1 receptor antagonist
(aprepitant) – Prevent Substance P release
10. What cell can produce a glycolysis step without gaining any ATP and
why is it done?
 Erythrocytes can produce 2,3 BPG from 1,3 BPG and this
produces no ATP. 2,3 BPG regulates O2 distribution to
peripheral tissue, in hypoxia more 2,3 BPG is produced
 which decreases hemoglobin affinity for O2 causing ^O2
Delivery
11. TOP 3 CANCERS IN WOMEN (IN ORDER MOST TO LEAST)
 BREAST / LUNG / COLON
12. When Dihydrofolate reductase and DNA Polymerase (DNA SYNTHESIS
S PHASE PROTEINS) WHAT OTHER PROTEIN IS PHOSPHORYLATED to
allow entry from G1S?
 Retinoblastoma (hyperphosphorylated)
13. Which enzyme works in the basophilic (dark staining) region of the
nucleus?
 RNA Polymerase I
14. Vincristine and Vinblastine exert their chemotherapeutic effects
through what mechanism
 Inhibiting microtubule formation during Mitosis (M Phase)
15. Burkitt Lymphoma Chromosome translocation, name, and function?
 t8:14 c-MYC (transcription activator)
16. Haptoglobin binds to hemoglobin so levels would be low in…
 intravascular hemolysis
17. Highly Vascularized tumors usually have upregulation of what 2 genes
 VEGF and FGF 2 (Fibroblast growth factor)
18. Newborn baby with generalized edema and dies and + direct coombs
test what is the disease. If direct coombs test is negative what is the dis?
 Newborn death due to maternal antibodies RH- mother (+)
 Hemoglobin barts due to missing alpha chain (Dir. coombs -)
19. Extramedullary Hematopoesis is most commonly caused by?
 Chronic hemolyisis (ex : B- thalassemia)
20. What Disorder shows CD55 and CD59 Deficiency? And why does it
cause anemia in patients
 Paroxysmal Nocturnal Hemoglibinuria (PNH) and it causes
anemia through complement activation
21. Sickle cell displays what pattern of inheritance
 Autosomal Recessive
22. Patient that gets tired easily, has constipation, and mental status
changes. Construction worker, Most Likely Diagnosis?
 LEAD POISONING (BASOPHILIC STIPLING, LEAD LINES,
WRIST/FOOT DROP)
23. Inheritance pattern of G6PD and Hereditary Spherocytosis
 X-linked Recessive and Autosomal Dominant
24. Polycythemia Vera involves mutation of what enzyme and what is this
enzyme type
 JAK-2 enzyme [STAT pathway] (cytoplasmic tyrosine kinase)
25. Three cardinal findings of Wiskott-Aldrich syndrome?
 Eczema, recurrent infections, thrombocytopenia
26. BCL-2 (+) is seen in what cancer? And what does it do?
 Follicular lymphoma (11:14) and is an inhibitor to apoptosis
27. How does hydroxyurea treat pain crises in patients with sickle cell?
 Hydroxyurea increases HbF
28. What is the most common inherited bleeding disorder? And what
values are increased?
 Von Wildebrand Disease (Autosomal Dom) increased PTT
(Factor 8 dysfx) and increased Bleeding time (vWD dysf)
29. What factors (numbers and what vitamin) does warfarin inhibit
 Vit K ( 2, 7, 9, 10, C, S) Protein C/S  Skin Necrosis
30. Patient with renal disease and excess bleeding would have what blood
time measurement abnormalities
 Normal PT/PTT/Platelet count | Increases bleeding time
31. Anti EGFR theraphy (cetuximab / Pantumumab) is ineffective with
patients that have this mutated enzyme
 KRAS protein
32. t(15;17 translocation) what is the disease and what receptor is
abnormal.
 AML (APML M3 Subtype) Retinoic Acid Receptor
33. In patients with iron excess what enzyme mediates the uptake of iron,
how does it do it, and where is it made?
 Hepcidin , causes downregulation of ferroportin liver causing
decreased intestinal absorbtion, found in parenchymal cells,
34. Digeorge syndrome causes deficiency of MATURE T lymphocytes
leading to poor development of what structure?
 Lymph node paracortex
35. MAIN DIFFERENCE between Dysplasia and Carcinoma
 Dysplasia is reversible
36. Patient with painless cervical lymph node that fluctuates in size. What
is most likely diagnosis, what is the translocation, and what does it do?
 Follicular Lymphoma (14:18) +BCL-2 enzyme (inhibits
apoptosis unapposed cellular growth)
37. Patient Presents w/ Anemia, increase lactate dehydrogenase and
indirect hyperbilirubinemia with a + glycerol lysis test what is the
diagnosis
 Hereditary Spherocytosis (increase risk of aplastic anemia
with parvovirus B19 infection)
38. Patient has normocytic anemia with normal b12 and iron studies.
Decreased reticulocytes and normal granulocytes and platelets. There is
absence of erythroid precursors. What is the Most Likely Disease and
what is one of the major associated conditions
 PureRedCellAphasia (PRCA) associated with thymoma
39. How does desmopressin treat hemophilia A?
 Increase factor VIII(8)
40. Patient has low hemoglobin, low platelets (thromobocytopenia), high
lipid count in bone marrow. What is the most likely diagnosis? What labs
would be elevated in this patient.
 Aplastic Anemia. (high EPO from the kidneys)
41. Von Wil de Brand disease has an (Increased/Decreased) amount of
platelets?
 Neither it presents with a normal amount
42. .t(8:14) seen in what cancer and what is the gene?
 Burkitt Lymphoma (c-MYC)
43. Follicular lymphoma; what translocation and what gene?
 t(14:18) Bcl-2 overexpression
44. patient with recurring blistering in hands and forearms, large blisters
with hyperpigmentation. What diseases is most likely and what is the
enzyme responsible?
 [PORPHYRIA CUTANEA TARDA] Uroporphyrinogen
decarboxylase (excess uroporphyrinogen)
45. Acute myeloid Leukemia. What translation, what gene, and what can
help treat the patients?
 ,t(15:17) MPL/RARa – receptor is unable to signal
differentiation of myeloid precursors with physiologic
 retonoic acid (VIT. A). VIT. A derivitive all-trans retinoic acid
can overcome this and help induce differentiation.
46. Cachexia – a state in which the body begins to waste muscle, apetite
decreases, and patients become anemic are seen in paraneoplastic
conditions (CANCER) what is the main mediator for cachexia
 TNF-a
47. Positive ristocetin test= what are the two possible diagnosis
 Bernard souilee (gp1b) or vWD Disease
48. Patient comes in with anemia, increased indirect bilirubin, and
reticulytosis, “red blood cells without central pallor” What is the diagnosis
and what is the red cell index most specific for this disease
 Spherocytosis (increased MCHC)
49. Selective COX-2 inhibitor
 Celecoxib
50. Patient comes in with arthralgias in hands, pancytopenia (low blood
values (all)) and proteinuria and RBC casts. Whats the most likely
diagnosis
 Systemic Lupus Erythematous (type II hypersensitivity)
51. Patient has anemia, trouble swallowing, beefy red tongue, what is the
diagnosis and what is the treatment?
 Plummer Vinson Syndrome (dysphagia and iron def. anemia)
 Tx: Iron
52. Nitrites are inhaled to turn fe2+ hemoglobin to fe3+methemoglobin to
treat what toxicity?
 Cyanide poisoning.
53. Most common trigger for DIC in pregnancy
 Release of tissue factor from damaged placenta
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Infectious Disease 1/29/2018 3:18:00 PM

1. What 4 drugs are used to treat tubeculosis (hint:)

a. Rifampin – inhibits DNA dep RNA pol (GI, Rash, Red-Orange
sweat Gatorade color)
b. Isoniazid – inhibits mycolic acid synthesis (neurotox – give
vit b6
c. Pyrazinamide – unknown (hepatotox, hyperurecemia)
d. Ethambutol - inhibition of arabinosyl transferase (optic
neuropathy)
2. 3 types of vaginitis, their distuinguishing features, and treatments
a. bacterial (gardnerella vaginosis) KOH – off white – fishy
smell – clue cells [metronidazole x clindamycin]
b. Trichomoniasis (tricomonas vaginallis) thin – yellow green –
mobile organisms on wet mount – vaginal inflammation
[metronidazole]
c. Candida vaginitis – thick cottage cheese – vaginal
inflammation – psuedohyphae [fluconazole]
3. Zidovadine is used to treat? And what is the mechanism of its action?
a. Zidovadine is a nucleotide reverse transcriptase inhibitor
used to treat HIV infection. It completely binds to reverse
transcriptase and is incorporated into the viral DNA as a
thymidine analog. It prevents 3’-5’ phosphodiester bond
formation
4. Most common cause of viral gastroenteritis?
a. Norovirus (calicivirus family)
5. Main cause of Hepatocellular carcinoma in developing countries
a. Hep B virus (use vaccine to treat this problem worldwide)
6. Most common cause of UTI esp. in Elderly. Name the other causes as
well.
a. E. coli
b. Proteus, klebsiella, enterobacter, citrobacter, and
psuedomonas
7. What is the treatment for mucormycosis? And what levels should be
monitored and why
a. Amphoteracin B- binnds to ergosterol and alters cell
membrane permeability. Renal toxicity is the most notorius
side effect, causing hypokalemia and hypomagnesemia –
 two levels that should be monitored when patients are on
this treatment.
8. Patient presents as an unvaccinated immagrant age 8. Has gray exudate
on the pharynx. What is the culture it can be seen on?
a. Cysteine-tellurite agar
b. Cornyebacterium diptheriae
9. Patient presents with bitemporal lobe abnormalities with increased
opening pressure hemorragic lymphocytic pleocytosis and normal glucose
count. What is the most likely organism, what is the drug used to treat
this condition and what does the drug do?
a. VIRAL (HSV) encephalitis
b. Acyclovir – inhibits viral DNA polymerase by incorportaing
into newly replicating viral DNA
10. How is EBV transmitted?
a. Through saliva
11. Patient comes In with previous genital sore which was not painful at
first but now comes in with new painful swelling in his inguinal region.
What is the most likely diagnosis and organism?
a. Lymphogranuloma venereum (chlymidia trachomatis)
12. Where in the vocal cords can HPV also infect?
a. True vocal cords
13. A bacterial specimen is cultured in medium with vancomycin, colistin,
nystatin, and trimethoprim – what is the organism cultured?
a. Neiserria Gonohrrhea
14. Group A strep show resistance to phagocytosis when placed in blood.
What is the main mechainsm for this resistance?
a. Protein M – inhibits phagocytosis and complement activation
b. This is the target for humoral immunity against strep
pyogenes
15. Patient has tampons in vagine, starts to go into shock. What is the
organism responsible and what cells facilitate the shock.
a. Staph Aureus (toxic shock syndrome)
b. Via TSST-1 a superantigen that binds to MHC II and T cell
receptor. (Macrophages release IL-1 and TNF and T cells
release IL -2)
16. Why Do HEP C antibodies not provide effective immunity against HCV?
 a. Antigenic variation in envelope proteins due to no
proofreading 3’ – 5’ exonuclease
17. Patient presents with septic shock, from E.Coli. What bacterial factor is
the most likely cause?
a. LIPID A
b. Releases cytokines and inflammatory mediators that lead to
shock
18. Wool processor comes to emergency room with fever, chest pain,
hemoptysis. What is the organism/disease? And what does this bacteria
produce?
a. Antiphagocytic D-Glutamate capsule
19. How does tertiary syphillis cause aortic regurgitation?
a. Vasa vasorum obliteration (endarterits)
20. If a HIV patient has a HLA – B 5701 positive type then what drug is
counter indicated?
a. Abacavir (NRTI’s)
21. Patient with low CD4 count presents with multiple colonic polyps that
hemmorrhage, biopsy shows spindle cells with blood vessel proliferation.
What is the condition?
a. Kaposi Sarcoma (HHV8)
22. Patient comes in fever headache abdominal pain and a history of 1
week watery diarrhea that has recently become bloody. Phyiscal exam
shows hepatosplenomegaly and several maculopapular lesions on the
chest and abdomen. What is the most likely cause of this?
a. Salmonella typhi – Typhoid fever

23. What two things does isoniazid (with pyridoxine treatment) cause
damage to?
a. Hepatocytes and neurons
24. Patient comes in with a dog bite and his leg is swelling, becomes an
open wound, and has a “mouse like odor”, what is the most likely
organism.
a. Paturella multocida
25. Patient with aids has <50 CD4 count which of his drugs would make
him complain of hyperglycemia?
a. Proetease inhibitor (Navir)
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pshyciatry 1/29/2018 3:18:00 PM

1. tryptophan is a precursor to which neurotransmitter?

a. Serotonin

2. Frontal lobe lesions what are symptoms of right vs left?

a. left – apathy
b. right – disinhibition

3. trycyclic antidepressants (amitriptiline) can cause cardiac arrythmias due

to what mechanism
a. inhibition of fast Na+ channels

4. Difference between serotonin syndrome and Neuroleptic malignant

syndrome and tx for each?
a. Serotonin S – hypperreflexia and clonus and mydriasis
dilated

b. Neuroleptic M. S. – lead pipe rigidity

5. Concerns skinny patients that don’t eat enough food taking bupropion?
a. Seizures

6. First line treatment for anxiety disorder?

a. SSRI / SNRI

7. Patients that have mood swings (bipolar) that are treated with lithium
have a risk to develop?
a. Diabetes insipidus
b. Hypothyroidism
c. Tremor
d. Ebstein Anomaly (baby)
8. BUSIPIRONE is used for ? and has what special property?
a. Used in GAD (Generalized Anxiety Disorder)
b. Has a slow onset (takes 2 weeks to work)

9. What is the drug used for treatment resistant Schizophrenia?

a. Clozapine – check bone marrow for agranulocytosis
10. First gen typical antipsychotics high dose vs low dose. Give name and
effects
a. High – Fluphenazine , Haloperidol , trifluoperazine (more
extrapyramidal side effects)
b. Low – chloropromazine , thioridazine (more anticholinergic,
antihistamine and alpha1 blocking effects)

11. PCP works through what mechanism???

a. NMDA receptor antagonism

12. In treatment resistant atypical depression what is the drug class of

choice?
a. Monoamine Oxidase Inhibitors (phenelezine)

13. Which antibiotic used to treat cellulitis also has MAO inhibiter activity?
a. Linezolid (can cause serotonin syndrome with the use of
paroxetine [ssri]

14. Immediate and long term treatment for panic attacks?

a. Immediate – benzodiazapene
b. Long term – SSRI / SNRI

15. What drug class do you give for nightmares?

a. Osin (alpha blocker) prazosin

16. What drug class used for major depression and specifically OCD can
cause anticholinergic tox if overdosed?
a. Tricyclic antidepressants (amitryptaline)
b. Clomipramine – specifically for OCD

17. What drug is good for reducing reward pathway for alcoholics and
what type of receptor modifier is it?
a. Naltrexone – mu opiod receptor blocker
18. Normal “female” 13 month old baby presents with normal status
initially but shows regression of mental and social function. What is the
most likely diagnosis?
a. Rett Syndrome (MEPC2 gene)

19. What is the first line treatment of delirium and psychosis?

a. Typical antipsychotics such as haloperidol

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 1/29/2018 3:18:00 PM

1. Ovarian torsion (acute pain, nausea, noo blood flow to ovary) involves
what ligament?
1. Infundibulopelvic ligament (suspensory ligament of the ovary)
i. Main risk of torsion is from large adnexal mass

2. Old 50yr old lady presents with heavy and painful menstral bleeding, with
a “uniformly” enlarged uterus. What is the most likely cause?
1. Endometrial tisuue in the myometrium (Adenomyosis)

3. PCOS patients have ______ ovaries

1. Enlarged

4. Young woman Patient presents with dysmenorrhea (painful menses) ,

dyspareunia (painful sex), and or infertility.
1. Endometriosis (endometrial tissue outside the uterus)

5. What is the mechanism of Flutamide and what is it used for?

1. Competitive testosterone receptor inhibitor
2. Used for metastatic prostate cancer

6. Absence of the vas deferens in men with recurrent pnemonia infections

and digital clubbing. What is the most likely disorder?
1. Cystic fibrosis

7. Lymph from the testes drains to?

1. Para aortic nodes

8. Bloody discharge of the nipple (without change to the structure of brest)

is caused most likely by
1. Intraductal papilloma

9. Hypospadias is abnormal closure of?

1. Urethral (urogenital folds)

10. Epispadias is abnormal closure of?

1. Genital tubercle
11. What two proteins does HPV make and what do they do?
1. E6 – inhibits tumor supressor p53
2. E7 – inhibits Rb causing unregulated DNA replication

12. During an episotomy a incision is made at the posterior vaginal

opening through the vaginal and subvaginal mucosa. What structure is
also involved?
1. Perineal Body

13. Protective Factors for Epithelial Ovarian Cancers are based on what?
1. Decreased amounts of ovulation since ovulation causes damage
minor trauma to the ovarian surface increasing risk for
transformation.

14. What artery is ligated in postpartum hemmorrage?

1. Internal illiac

15. Failure to obliterate what structure causes indirect inguinal hernia and
hydrocele?
1. Patent processus vaginalisis

16. A bicornate uterus characterized by an indentation in the center of the

fundus is caused by?
1. Incomplete lateral fusion of the paramesonephric ducts

17. Complete Mole Genotype (most common)

1. 46, (XX)

18. Partial Mole Genotype

1. 69, (XXY)
2. 69, (XXX)

19. Lymph Nodes of the scrotum drain to?

1. Superficial inguinal nodes
20. Turner syndrome (45, X) is caused by?
1. Loss of Paternal Chromosome X

21. This structure is the most vulnurable during a hystrectomy

1. Ureter

22. Connexins code for what?

1. Gap Junctions

23. Kleinfelters cause and genotype?

1. Sex chromosome aneuploidy (47, XXY)

24. Patient presents with amenohrrea, normal secodary sex characteristics

and cyclical abdominal pain. What is the most likely dx?
1. Imperforate hymen, caused by incomplete degenration of the
central portion of the fibrous tissue bands connecting the wall of
the vagina.
2. Contrast this with endometriosis which presents as
dysmennorrhea, dysparenuia, painful defecation

25. Where do the right and left ovarian veins drain to?
1. Right - IVC
2. Left – left renal vein

26. In what structure are the ovarian vessels located in?

1. Infindibulopelvic ligament aka suspensory ligament of the ovary

27. In testicular torsion the gonadal arteries arise from which artery?
1. Abdominal aorta

28. Prostatectomy can cause damage to the prostatic plexus which can
cause ________
1. Erectile Dysfunction
29. Quad screen for pregnancy shows decreased alpha fetal protein,
decreased estriol, increased B-HCG and increased Inhibin A, what is the
most likely disorder of the newborn?
1. Down Syndrome

30. How many days after implantation is BHCG detectable in serum and
urine
1. Serum- 8 days
2. Urine- 14 days

31. WHAT IS THE NUMBER ONE THING YOU MUST DO BEFORE GIVING A
PATIENT ISORETONOIN FOR ACNE TX?
1. Pregnancy Test (isoretonoin is a known teratogen)

32. What is the treatment for lyme disease in a pregnant mother and what
is one of the side effects for the baby?
1. Doxycycline (tetracycline) – teeth staining

Review PICTURES
 1/29/2018 3:18:00 PM

1. Patient presents with renal mass on ultrasound and chromosome 3p

deletion. What is the disease and what gene does it affect
a. Von Hippau Lindau disorder. VHL gene

2. Most likely cause for pyelonephritis?

a. Vesicourethral Reflux

3. Majority of water is reabsorbed where?

a. Proximal tubule

4. Ace inhibitors have what effect on the efferent arteriole?

a. Vasoconstrict

5. Most Renal cell carcinomas arise from?

a. Proximal tubule

6. What drug is given to patients that have calcium oxalate stones?

a. Thiazide diuretics

7. Child comes in with post strep glomernulonephritis what is the most likely
levels of C3 levels?
a. Decreased C3 levels

8. Proximal Ureter’s blood is supplied via? Distal Ureter?

a. Renal A.
b. Superior Vesical A.

9. Abrupt onset of gross hematuria in a patient with family history of sickle

cell is indicative of ?
a. Renal Papillary Necrosis

10. Sirolimus binds to what? To decrease levels of what?

a. Binds to mTOR
b. Decreases levels of IL-2
c. Used in non HLA matched transplants
11. Patient suffers from post op urinary retention what two class of drugs
would be suitable for treatment?
a. Muscarinic antagonist – Bethenicol
b. A blocker (osin’s)

12. What do the Ureteric bud and metanephric mesoderm differentiate into
a. Ureteric Bud – collecting system (collecting tubules and
ducts / major and minor calyces/ renal pelvis/ ureters
b. Metanephric meso – proximal and distal convuluted tubules,
glomeruli, bowmans space.

13. In RPGN (rapid prog. Glomerularnephritis) the crescents are composed

of ?
a. Fibrin

14. Angiotensin converting enzyme (ACE) does what to bradykinin?

a. Inactivates it

15. Tumor lyisis syndrome causes increased uric acid due to increased cell
turnover. What portion of the kidney causes the crystals to be formed and
why?
a. Collecting ducts due to low urine pH

16. Treatment for Renal Cell Carcinoma and what does it do?
a. Aldesleukin (IL-2)
b. Stimulates the growth of CD4 + CD8 cells and activates
NATURAL KILLER CELLS (ANTI – CANCER EFFECT)

17. Biggest Way to alleviate cathether associated UTIs in hospitals?

a. Removal of cathether when not indicated

18. Which Rib can cause damage to the kidney?

a. 12th rib
19. patient comes in with headache from motorcycle trauma. He is
obtunded and only responds to pain. He is given a drug due to fear of
cerebral edema and shortly develops pulmonary edema. What is the drug
a. Mannitol (osmotic diuretic)

20. Lithium impairs what in the renal tubule?

a. ADH in the collecting duct

21. Most pathognomic for pyelonephritis?

a. WBC casts

22. What is a side effect of EPO Stimulating Drugs?

a. Hypertension and thromboembolic events

23. What are the most potent type of diuretics? Used for acute
decompensated heart failure as well.
a. Loop Diuretics
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Respiratory uWorld 1/29/2018 3:18:00 PM

1. A-a gradient measures what? and gives information about?

a. Measures the difference of O2 pressures in Alveoli vs
arteries
b. Gives us information about whether there is a problem with
O2 coming in (normal gradient) or transfer of O2 from
alveoli to arteries

2. Structure of MHC I ?
a. Heavy chain and B2 microglobulin

3. Mycoplasma (atypical “walking” pneumonia) require what to grow?

a. Cholesterol

4. What mutation leads to familial pulmonary hypertension

a. Loss of BMPR2 – smooth muscle proliferation inhibitor

5. Causes for post influenza pneumonia?

a. Strep pneumo , Staph Aureus, H influenza

6. Increased radial traction on airway walls is a hallmark of?

a. Interstitial lung disease leading to fibrosis

7. Spherules in lungs is caused by? And where is this found?

a. Coccidiodes immitis.
b. Southwestern United States (california new mexico Arizona
mexico)

8. Blastomyces Dermatidis – where is it located and what are some feature s

in culture?
a. Doubly refractile wall with single broad-based bud branching
b. Ohio and missisipi river valleys, Great Lakes
c. Found in soil

9. Histoplasma capsulatum – where is it located and what are some

differentiating features in culture
a. Oval yeast cells within macrophages
 b. Ohio and missisipi river valleys, Great Lakes
c. Found in soil bird bat droppings, chicken coops / caves,

10. What accounts for the rubber like properties of elastin?

a. Cross chain interlinks involving lysine

11. Patients comes in with history of celiac disease, 3 cases of pneumonia,

and has anaphylaxis during blood transfusion. What is the patients most
likely disease?
a. Selective IgA def.

12. What two bacteria can survive in hot temperatures do to their ability to
make spores?
a. Bacillus and Clostridyium

13. Sarcoidosis is stimulated by?

a. Th1 cells that release IL2 and IFN-y

14. Define asthma mediators (cytokines)?

a. TH2 – IL5

15. Patients gone to cruize ships or hotels where contaminated water

could be an issue are at greater risk of getting what disease?
a. Legoinella Pneumonia
b. Legionerre disease – mild flu like illness, radiographic
pnuemonia on cxr , GI diarrhea,
c. Most differentiating fact is that this disease causes
hyponatremia with pneumonie like features
d. Grows on selective buffered charcoal extract ****

16. Patients that get recurrent granulomatis infections due to Chronic

Garnulomatis Disease (dysfunciton of NADPH Oxidase) are at increase
risk for infection with what type of bacteria and the names?
a. Catalase positive (can destroy their own hydrogen peroxide)
b. Staph Aur / Burkholderia cepacia / Serratia Massercans /
Nocardia / Aspergillus
17. Whooping cough is caused by? And what type of bacteria is it?
a. Bordatella Pertussis
b. Gram (-) coccobacillus

18. If needle for thoracocentesis is inserted along the upper border of 10th
rib at right mid axillary line, what structure is at greatest risk for
penetration?
a. Right Hepatic Lobe

19. Elastase is found in?

a. Alveolar Macrophages (inhibited by metaleoproteases)
b. Neutrophils (inhibited by a1 antitrypsin)

20. Alpha hemolytic bacteria that causes pneumoniae. What is the name
and virulence factor?
a. Strep pneumoniae – polysacchride capsule

21. Lancet shaped gram + diplococci. What is the organism and what
needs to be inside the vaccine to treat the patients?
a. Strep pneumo,
b. Outer polysachiride covering

22. CD4 th2 cells produce a substance that causes class switching to make
IgE. This substance is?
a. IL – 13 along with IL-4
b. IL -5 made by Th2 cells activates eosiniophils + IgA
switching (proposed mechanism for asthma)

23. Asthmatics with moderate to sever asthma are presecirbed

omalizumab. What does this medication do?
a. Anti IgE antibody

24. In patients with obstructive sleep apnea. Electrical stimulation of what

nerve causes significant relief?
a. Hypoglossal
25. Patient has pneumonia like symptoms but shows only neutrophils and
no bacteria on gram stain, what is the most likely organism?
a. Legonella Pneumophilia – requires silver stain

26. Superior sulcus tumor is also known as ?

a. Pancoast tumor – shoulder pain due to brachial plexus
compression, horner syndrome.

27. Mediastinal masses that lead to puffy face and dilated neck veins can
cause?
a. Superior Vena Cava Syndrome

28. Budding yeast with thicc capsules? What is the species and what is the
main manifestations?
a. Cryptococcus neoformans
b. Cryptococcal pneumonia and meningoencephalitis (seen in
HIV / immunocompromised patients)

29. Fibrotic focus in the lower lobe with ipsilateral hilar adenopathy is
called? And is found in what disease?
a. Ghon complex, found in M. Tuberculosis initial infection

30. Lung cancer showing long slender microvilli, abundant tonofilaments,

and pleural thickinening..
a. Mesothilioma

31. During Pregnancy amniocentesis is performed to measure neonatal

lung maturation. What is the normal ratio?
a. Lecithin (phosphatidylcholine) to sphingomyelin ratio >2

32. IL-12 is required for what?

a. IL 12 is secreted by macrophages to stimulate th1 cells to
release IFN-y to activate macrophages. Absence of IL-12
leads to decreased macrophage activities.

33. Cromylyn is used for asthma by doing what?

 a. Inhbiting mast cell degranulation

34. Patients requires a chest tube for drainage of pleural effusion. Incision
is made in between the 4th and 5th intercostal space. What muscle is most
likely to be damaged?
a. Serratus anterior

35. What drug reduces nicotine cravings and pleasurable side effects?
a. Verenicline (partial agonist at nicotinic ach receptor)

36. IN sarcoidosis granulomas what is the main cell type found in the cell?
a. CD4 + T-helpers

37. Patient with asthma that shows marked eosinophilia should be treated
with what class of drugs?
a. Leukotriene antagonist

38. Patient with respiratory issues come in with thick whalled spirules filled
with endospores. What is the most likely orgnaism?
a. Coccioides immitis (desert areas of US / Mexico)

39. Alcoholic with respiratory distress comes in with encapsulated gram –

bacilli. Sputum color shows pink colored “mucoid” colonies on Mackonkey
agar. What is the organism?
a. Klebsiella Pneumonia

40. Mycobacterium tuberculosis that grows in parrallel chains “serpentine

cords” represents what of the bacteria?
a. Virulence “cord factor” – inactivates neurtrophils, damages
mitochondria, and induces release of tumor necrosis factor

41. Young child presents with epiglotits, fever, respiratory distress. What
is the most likely cause of the infection and what is the bacteria’s major
virulence factor?
a. Haemophilus influenza b (Hib)
b. Major Vir. Factor is polyribosylribitol phosphate
42. What vitamin is necessary for differentiation of epithelial surfaces, and
its deficiency leads to squamos metaplasia to keratinizing epithelium
a. Vitamin A

43. Cold agglutinins (IgM proteins that that cause RBC clumping at cold
temperatures are seen in what bacteria?
a. Mycoplasma Pneumonia (atypical)
b. Infectious Mononucleosis

44. Patient comes in and gets a mucaramine stained broncheoalveolar

fluid. What is the organism and what is being stained?
a. Cryptococcus neoformans
b. Polysaccride capsule (stained with india ink)
c. Red with muciramine

45. Chronic transplant rejection in the lungs leads to fibrosis of ? what

does acute reaction lead to ?
a. Small airways (bronchioles) [Chronic]
b. Vascular Structures [Acute]

46. Child presents with cherry red epiglotis and drooling. What is the most
likely organism causing this presentation?
a. Haemophilus influenzae b

47. Most common type of cancer seen in patients exposed to asbestos?

a. Bronchogenic carcinoma

48. What stimulates neutrophil migration?

a. Leuktriene B4
49.
50.
51.
52.
53.
54.
55.
56.
Neuro U world 1/29/2018 3:18:00 PM

1. Neural injury showing loss of Nissl substance indicates what time after
injury?
a. 12-24 hours

2. Entacopone does what?

a. Decreases the breakdown of levidopa peripherally (inhibits
COMT)

3. What landmark is useful for lumbar punctures?

a. Illiac crest (L3/L4 – L4/L5)

4. Most common adult brain tumor?

a. Glioblastoma

5. P450 inducers?
a. Barbituate, rifampin, carbamezapine, grisosulevin (anti
fungal interferes with microtubules

6. P450 inhibiters?
a. Fluconazole (antifungal), cimetidine (Histamine H2
antagonist) , omezaprole (proton pump inhibitor)

7. Patient with aids and meningioencephalitis what is the most likely bug?
a. Cryptococcus Neoformans

8. Very long chain fatty acids are oxidized in?

a. Peroxisomes

9. Treatment for restless leg syndrome?

a. Pramiprexole, ropinirole (DOPAMINE AGONIST)

10. Initial treatment for staticus epilepticus?

a. Benzodiazapenes (enhanced postsynaptic chloride influx)

11. What two cranial nerves run throught the internal acoustic meatus?
a. 8 – vestibulocochlear
 b. 7 – facial

12. homozygous apolipoprotein E-4 allele leads to what disease?

a. Alzheimers

13. Weakened muscles with scoliosis, difficulty walking. His lower reflexes
are higher his upper reflexes are low (1+). What is the most likely
condition?
a. Syringomyelia

14. Orbital fracture to the oribital floor (direct eye trauma) can do what?
a. Trap the inferior rectus muscle, limited verticle gaze
b. Parasthesia of the upper cheek, upper lip, upper gingiva

15. Narcolepsy patients show decreased amounts of what in spinal fluid?

a. Hypocretin (orexin)

16. What is the mechanism for dysfunction in huntington’s Disease?

a. Hypo acetylated histones aka histone deactylation

17. Treatment for atropine (anticholinergic) overdose?

a. Cholinesterase inhibitors
i. Tertiary amines (physostigmine, galantamine, donepezil,
rivastigmine) cross BBB and reverse peripheral + central
symptoms
ii. Quaternary amines (neostigmine, edrophonium,
pyridostigmine) reverse peripheral symptoms only

18. Glycopyrrolate works via what mechanism?

a. Muscarinic antagonist (selective ~ also hyoscyamine,
propantheline)

19. Pallor or hypopigmentation seen cathecholaminergic brain nuclei is

caused by what enzyme deficiency?
a. Phenaylalanine hydroxylase (PKU)
20. What seizure drug is used to treat status epilepticus “prophylactically”
a. Phenytoin ~ blocks Na+ channels in cortex

21. Ring enhnacind lesions on brain mri is diagnostic for?

a. Toxoplasmosis

22. What junction prevents peripheral dopamine into getting into central
circulation?
a. Tight junctions (BBB)

23. Temporal lobe has what loop relating to vision?

a. Myers loop

24. Treatments for Alzheimer’s Disease?

a. NMDA receptor antagonist ~ memantine
b. Cholinesterase inhibitors ~ donepezil
c. Antioxidants (vit. E)
25. SEIZURE DRUG CHART
 a.

26. Jaw pain and ear involvement. What nerve is the most likely suspec?
a. Mandibular nerve V3

27. What is Ramelteon?

a. Melatonin agonist

28. Parotid gland ttumors can cause _____ nerve disruption causing?
a. Facial ~ facial droop / peripheral nerve palsy

29. Pufferfish toxin (tetrodotoxin) causes what?

a. Impairs Na+ channels preventing influx and depolarization

30. Brain tumor in child with spindle cells mixed with rosenthal fibers
andeosiniphilic bodies?
 a. Pilocytic Astrocytoma

31. Normal pressure hydrocephalus causes wet wobbly and wacky

symptopms in old age patients. What is the mechanism for bladder
intolerance?
a. Stretching of decending cortical fibers

32. What protein allows for reactivation of herpes simplex sores?

a. Kinesin – anterograde
i. Vs dynein (retrograde)

33. Patient who has previous subarachnoid hemmorrage returns with focal
neurological deficit ie weakness in arms/legs. What is the cause for this?
a. Arterial vasospasm due to impaired brain autoregulation

34. Macroscopic changes to the brain in huntington’s Disease?

a. Pronounced atrophy of the caudate nucleus
b. Atrophy of putamen and frontal lobes
c. NMDA receptors bind glutamate causing neuronal death

35. Classic trio for congenital toxoplasmosis?

a. Hydrocephalus, intracranial calcifications, chorioretinitis

36. Premature baby is bleeing into ventricles, what is the most likely
location for this bleed?
a. Germinal matrix (neonatal intraventricular hemorrage)
b. Due to reduced glial support and impaired autoregulation of
BP

37. Isoniazid can cause peripheral neuropathy due to what?

a. Vitamin B6 (pryidoxine deficiency)

38. What is the pathology of Guillan Barre syndrome and cause?

a. Cause – campylobacter jejuni infection causing schwann cell
destruction
b. Pathology – endoneurial inflammation
39. Cause of intranuclear opthalmoplegia?
a. Multiple scleorosis or lesion in MLF

40. Interscalene nerve blocks are used to anesthetize the brachial plexus
but what other nerve struvture can be paralyzed due to its course within
this region?
a. Phrenic nerve

41. Absecense of kinesin would lead to an absence of what?

a. Secretory vesicles in nerve terminal
b. Kinesin is responsible for antereograde transport w/in
neurons

42. Episodic diplopia and ptosis strongly suggests?

a. Myasthenia gravis

43. Most important in making decision for tetanus?

a. History and physical exam

44. Taysachs disease diagnostic finding and enzyme deficiency?

a. Cherry red macula + progressive neurodegeration
b. B – hexosaminidase A def

45. First line treatment of essential tremor?

a. Propanolol

46. Intranuclear opthalmoplegia is a lesion where?

a. In the MLF in the dorsal pons

47. Loss of sensation in the 5th digit represetns damage to what nerve and
what actions of the wrist?
a. Ulnar nerve ~ wrist flexion/adduciton

48. Most common type of encephalitis?

a. Herpes simplex virus type 1
 b. Normal glucose – increased protein – lymphocytes/erythro

49. Neurofibrotmatosis type 1 displays what hereditary pattern?

a. Autosomal dom

50. Young boy with trouble walking and frequent sinus infections?
a. Ataxia teleangiectasia – autosomal recessive
b. Cerebellar atrophy
c. Resulting from a defect in DNA repair genes –ultrasensitive
to ionizing radiation.

51. Rabies virus enters the body through?

a. Muscle acetylcholine receptors

52. Muscle atrophy of type I fibers is what type of dystrophy?

a. Myotonic dystrophy

53. Demylenation affects which constant of conduction ?

a. Length constant

54. Marcus gunn pupil is seen in a lesion where?

a. Optic tract

55. Brain tumor with S-100 positivity what is the most likely dx?
a. Schwanomma

56. Treatment for wilsons disease?

a. D-penicillamine (chelator)
57. SERATONIN / MELANIN / CATHECOLAMINE production

58. Patient with HIV that has ring enhacing lesions, what is the diagnosis
and the treatment?
a. Toxoplasmosis
b. Pyrimethamine + sulfadiazine

59. Lamotrigene serious side effect?

a. Stene johns syndrome or toxic epidermal necrolysis
b. Go to hospital if experiencing skin rash

60. Low transketolase activity is suggestive of what?

a. Thaimine (vit B1) deficiency

61. Child with urine cathecolamines, abdominal mass, and abnormal

occular movements. What is the most likely neoplasm?
a. Neuroblastoma

62. Characteristic finding of HIV associated dementia?

a. Microglial nodule involvement
63. Patient presents with spontaenous lobar hemorrage what is the most
likely cause in an elderly patient
a. Cerebral amyloid angiopathy

64. Patient presents with hypertension and hemorrage of deep brain

structures (basal ganglia, cerebellar nuclei, thalamus, pons). What is the
most likely cause?
a. Charcot bouchard anerysms due to hypertension

65.
66.
67.
68.
69.
70.
71.
72.
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 1/29/2018 3:18:00 PM

1. Third heart sound normal for what conditions?

a. young age <40 and pregnancy

2. Third heart sound abnormal for what conditions?

a. Systolic heart failure
b. Mitral regurgitation

3. Fourth heart sounds abnormal in what condition?

a. Left verntriclular hypertrophy

4. Fourth heart sound normal in what condition?

a. Old age (sound is from blood going into stiff ventricle)

5. NAVEL ([LATERAL] NERVE – ARTERY – VEIN [MEDIAL])

6. Retinal artery occlusion path’?

a. Internal carotid – opthalmic A – retinal A

7. How does AV fistula effect preload and afterload?

a. Increases preload
b. Decreases afterload

8. Where do bacteria adhere to in endocarditis?

a. Fibrin platelet aggregates

9. What sound heard with Mitral regurg is used to assess severity?

a. S3

10. Mid systolic click is ?

a. Mitral valve prolapse

11. Opeinig snap is?

a. Early diastolic sound heard in mitral/tricuspid stenosis

12. WPW syndrome is caused by?

a. Atrioventicular accessory pathway
 b. Basically bypasses the AV node and causes connection to
atria ventricle via bundle of kent

13. What molecule is secreted by vascular endothelial cells that inhibits

platelet function?
a. Prostacyclin

14. What is kussmaul sign? And what is it seen in?

a. A paradoxical increase in JVP during inspiration
b. Seen in constrictive pericarditis

15. Congenital long QT syndrome arises from deficiceny of what?

a. K+ membrane channels

16. Sore throat and abnormal arm jerking/movements, what disease and
what vascular lesion can be seen?
a. Acute rheumatic fever
b. Acute – mitral regurg
c. Chronic – mitral stenosis

17. Which antiarrythmic is used for ischemic tissue preferentially

a. Class 1B lidocaine + mixellitine

18. What beta blocker can you use to treat a patient with COPD that is
having an acute MI
a. Metropolol / atenolol (cardioselective)

19. Saphenous vein is located near?

a. Inferolateral to the Pubic tubercle

20. Dissection of descending aorta effects which artery?

a. Subclavian

21. Damage to the meeting fo the frontal , temporal , parietal, and

sphenoid bones (also known as pyterion) injure what vessel?
a. Middle meningeal (branch of maxillary A)
22. Biggest risk factor for aortic dissection?
a. hypertension

23. during myocardial ischemia the cells swell. Why do they do this?
a. Increase in ca2+

24. Nonbacterial thrombotic endocarditis is caused by what most likely?

a. Advanced malignancy (mucinious adenocarcinomas)
b. Chronic inflammatory syndromes such as anti phospholipid
and SLE

25. Most likely arterys to get artherosclerosis?

a. Abdominal aorta & Coranary Arteries

26. Wide , fixed splitting of S2 indicated?

a. ASD

27. Patient with congeintal heart defect that shows toe clubbing and
cynaosis at 10 years of age but no finger deformity most likely has?
a. Patent ductus arterious

28. Digioxin poisoning signs?

a. Hyperkalemia and visual distrubances

29. Dystrophic vs metastatic calcifiaction of aortic valve?

a. Dystrophic – due to cellular necrosis
b. Metastatic – due to malignant hypercalcemia

30. Sacubitril inhibits? Which causes prolongation of what substance that

increases urinary output and decreases total PVR
a. Neprilysin
b. ANP
31. Patient comes into your office with right sided face and arm swelling
with engrogement of the subcut. Veins on the same side of the neck,
which vein is occluded?
a. Brachiocephalic
b. You think superior vena cava but that would have signs on
both side of the face

32. Patient has reduced lower extremity bp compared to upper and is a

female. What is the most likely condition and what is the abnormality?
a. Turner syndrome
b. Coarctation of the Aorta

33. Vasculitis that demonstrates granuloma formation?

a. Takayasu arteritis
b. Temporal (giant cell) arteritis

34. A left renal vein caught between the SMA and Aorta can cause?
a. Nutcracker effect aka varicocele

35. Ruptured cerebral anyeurysm with spontaneous intracerebral

hemorrage is related to?
a. Coarctation of the aorta

36. Fast to slow (purkinje – Atria muscle – Ventricle muscle – AV node

 PARK AT VENTURE AVENUE

37. Deviation of the infundibular septem is what disease?

a. Tetrology of fallot

38. “Chronic transmural inflammation” in a lifelong smoke at 60 years of

age with a pulsitile abdominal mass is indicative of what?
a. Abdominal aortic anyersm

39. Nitroprusside is a?
a. Short acting venodilatior and arteriodilator
40. Biggest side effects of nitrates?
a. Reflex tachycardia, headaches, cutaneous flushing,
lightheadness, hypotension

41. segmental vasculitis extending into contiguos veins and nerves?

a. Thromboangitis obliterans (bueger disease)

42. Myosin dephosphrylation caused by nitrates leads to cardiac muscle?

a. Relaxation

43. In polyarteritis nodosa which artery is usually spared?

a. Lung vasculature

44. Beta Blocker overdose is treated with ?

a. Glucagon

45. Most common cause of Sudden Cardiac Death in patient post MI?
a. Ventricular Fib

46. Vascular malignanc associated with past arsenic or polyvinly chloride

exposure positive for CD 31
a. Liver Angiosarcoma

47. Endocardial thickenining with dense deposits around the tricuspid and
pulmonary valves is most likely caused by? And what marker can be used
to diagnose?
a. Carcinoid Syndrome
b. Urinary 5-hydroxyindoleacetic acid (5-HIAA)

48. What bacteria cause endocarditis and generated dextrans from

sucrose?
a. Strep viridans

49. Digioxin mechanism of action?

 a. Inhbiits the Na-K-ATAPase Pump that decreases sodium
efflux from cells which in turn decreases Ca2+ efflux leading
to increased cellular contraction

50. In left dominant patient which artery supplies the PDA which supplies
the AV node?
a. Left circumflex

51. Patient with ST elevation in leads I and aVL has an occlusion of?
a. Left circumflex A.

52. Niacins flushing effects are caused by?

a. Prostaglandin release

53. Hypotension when in supine position for pregnant woman is due to

what?
a. Supine hypotension syndrome,
b. decreased venous return due to IVC Compression

54. nitric oxide is synthesized from this amino acid?

a. Arginine

55. Major side effect of non dyhydropyrimidine ca+ channel blockers?

a. constipation

56. which antiarrythmatics increase the QT interval?

a. Class 1A (procainamide, disopyrimide, quinidine)
b. Class III (amiodarone)

57. What cells provide stimuli for atherosclerotic plaque formation

a. Macrophages
b. Platelets
c. Endothelial cells

58. NorEpinephrine effects on BP/HR

a. Alpha 1 action –increase blood pressure
 b. Beta 1 action - increase HR but will see reflex bradycardia
due to a1
c. a1>a2>b1

59. Epinephrine on BP /HR

a. B>A
b. Moderate to High dose
i. Alpha 1 action
1. Increase in BP
2. B1 receptor – increase in HR
3. Wide Pulse Pressure
c. Low dose
i. Beta 2 action predominates – lower BP

60. Dopamine on BP/HR

a. D1 > B > a
b. High Dose
i. Alpha 1 action – increase BP
ii. Beta 1 action – increase HR
c. Moderate dose
i. Beta 1 action – increase HR
d. Low dose
i. D1 – vasodilation of renal
61. Phenylephirine on BP/HR
a. Alpha 1 > alpha 2
i. Increase blood pressure a;pha 1
ii. Reflex bradycardia (decreased HR)
62. Isoproteronol on BP/HR
a. Beta effects only
i. B2 vasodilation (decreased BP)
ii. B1 Tachycardia

63. Dobutamine
a. Beta 1
 Increase HR
64. 3 lead locations for biventricular pacemaker installation
a. right atrium right ventricle (easy to install)
b. left ventricle (hard – need to put in through atrioventricular
groove through the posterior portion of the heart)

65. class III antiarythmatics?

a. Soltalol / amiodarone / dofetilide (block outward potassium
channels)

66. Wide and Fixed splitting of S2 is indicative of ?

a. Atrial septal defect (ASD, etc)

67. Pregnant woman with thromoboemoblisms should be treated with

what to balance the risk between mother and child?
a. Low molecular weight heparin such as enoxaparin

68. Most likely location for atherosclerotic plaques

a. Abdominal aorta

69. Patient drinks alcohol and has an irregularly irregular rhythm what is
the problem? And what is a characteristic ecg finding?
a. Afib – absent p wave

70. Cortisol ptoentiates other hormones effects through which mechanism?

a. Permissiveness

71. Renin release is inhibited by?

a. Beta blockers

72. Hypertrophic cardiomyopathy is caused by mutation of?

a. Beta – myosin heavy chain and myosin binding protein C

73. Injecting NE into a vein causes sever blanching of that vein? Why and
what can be done about this?
a. Due to increased a1 vasoconstrictive effects
b. Treating with a1 blocker (phentolamine)
74. HTN drug that causes lower extremity edema?
a. Amlodipine

75.
76.
77.
78.
79.
80.
81.
82.
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94.
95.
96.
97.
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103.
104.
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Skeletal 1/29/2018 3:18:00 PM

1. Achondroplasia defect in what bone formation and what mutation?

a. Endochondral (long bone formation)
b. Activating mutation in Fibroblast growth factor (FGFR3)

2. Osteogenesis imperfecta defect in what with what pathognemonic

feature?
a. Type I collagen synthesis
b. Blue Sclera – thin collagen and exposure of choroidal A.s

3. Osteopetrosis defect in what. Most likely cause

a. Defect in bone resorption (osteoclast)
b. Most likely cause Carbonic Anhydrase II mutation
i. Leads to loss of the acidic microenvironment needed for
bone resorption

4. Rickets/Osteomalacia defective mineralization of ? and due to?

a. Osteoid
b. Vitamin D def

5. Osteoporosis results in what type of bone and what are the most
common types?
a. Loss of trabecular bone mass resulting in porous bone
b. Senile and postmenopausal

6. Paget Disease of bone. What is the pathologic pattern seen and some
complications and the three stages?
a. Mosaic pattern of lamellar bone
b. High output cardiac failure due to formation of AV shunts in
bone + Osteosarcoma
c. 1. Osteoclastic 2. Mixed osteoclastic/blastic 3. Osteoblastic

7. Osteomyelitis what is it? And the bugs involved? Where does it affect
children vs adults? What is the x ray pattern?
a. Infection of marrow and bone
b. BUGS
 Staph aureus – most common cause
  N. gonnorea – sexually active adults
 Salmonella – sickle cell disease
 Psuedomonas – diabetic/iv drug abuser
 Pasturella – cat/dog scratch/bites
 Mycobacterium tuberculosis – involves infection of
vertebrae (Potts Disease)
c. Adults – Epiphysis
d. Children – Metaphysis

8. Avascular Necrosis what is it and what are the causes?

a. Ischemic necrosis of bone and bone marrow
b. Causes include
i. Trauma
ii. Fracture
iii. Steroids
iv. Sickle cell anemia

9. Thymus is what pharyngeal pouch? And name another organ that is

derived from it?
a. 3rd
b. inferior parathyroid glands

10. mitochondrial diseases display variable clinical expressions due to ?

a. heteroplasmy

11. Osteocytes remain connected to each other by?

a. Gap junctions

12. What are the rotator cuff muscles and what are their actions?
a. SITS / Ab-E-AdE-AdI
b. Supraspinatus (suprascapular N)
i. abduction
c. infraspinatus (suprascapular N)
i. external rotation
d. teres minor (axilalary N)
i. adduction and external rotation
 e. Subscapularis
i. Adduction and internal rotation

13. Defective FAS gene product leads to impairment of what?

a. Extrinsic apoptotic process

14. Tetanus vaccine causes patients to be safe from disease how?

a. Due to circulating antibodies that neutralize bacterial
products

15. Patients taking isoniazid, procainamide, hydralazine can have drug

induced lupus, what puts them at a greater risk to get this disease?
a. Slow liver acytlylation

16. Patient with symetric polyarthritis involving the MCP and PIP joints
with prolonged morning stiffness is suggestive of rheumatoid arthirits,
what is the most specific antibody test?
a. Citrulinated peptides

17. Parvovirus disease casuses what in adults vs children

a. Adults – acute symmetric arthopathy
b. Children – fifth disease (slapped cheek)

18. What are the findings in CREST syndrome and what antibody is seen?
a. limited scleroderma
b. Anti – centromere ab
c. C
i. calcinosis (subcutaneous calcium deposits)
d. R
i. Raynauds phenomenom (hands get cold easy)
e. E
i. Esophogeal dysmotility (heartburn)
f. S
i. Sclerodactyly (thickening of the hands)
g. T
i. Telangiectasias (dilated blood vessels
19. Elderly woman presents with jaw claudication and an episode of
transient vision loss is most likely have what disease and what test
should be done to rule this out?
a. Giant cell (temporal) arteritis
b. ESR or CRP test

20. Reactive arthrithis shows what antigen association?

a. HLA- B27

21. Gas gangrene due to clostridium perfingens has what toxin?

a. Lechtinase which catalyses the splitting of phospholipid
molecules

22. Treatment for woman with osteoporosis and susceptibiility to breast

cancer?
a. SERM – Raloxifene
b. Not Tamoxifen – increases uterine cancer risk

23. What muscle aids in internal rotation and is innervated by the

thoracodorsal nerve?
a. Latissimus dorsi

24. Avascular necrosis of the hip is caused by what 3 things?

a. Sickle cell disease
b. Vessel wall injury (vasculitis)
c. High dose corticosteroid theraphy

25. Polymyositis shows what autoantibody?

a. Jo1 (anti histidyl trna synthetase)

26. Lateral ankle sprain is due to?

a. inversion of a plantarflexed foot and most commonly
involves the anterior talofibular ligament

27. joint location in RA vs osteoarthritis

 a. RA – MCP PCP , wrists
b. Osteo – DIP , knees , hip

28. What motion is required to get up off seat?

a. Hip flexors – iliopsoas

29. Guyan canal is compression of what nerve where and what atrophies?
a. Ulnar
b. Hook of hamate
c. Hypothenar

30. Supracondylar humeral fractures (antereolateral displacement) caused

from outstretched arms can cause injury to what nerve most likely?
a. Radial nerve

31. Patients with Lupus have antibodies directed against anti-smith. What
is the function of anti – smith
a. Removal of introns (funxtions as a snrp)

32. Patient comes in with damaged serratus anterior muscle innervated by

long thoracic nerve. What could be possible causes?
a. Chest tube placement / axillary lyph node dissection

33. Patients with RA most likely have antibodies against?

a. Rheumatoid factor –Fc component of IgG
b. Anti citrulinated antibodies

34. Spinal stenosis is due to hypertrophy of the ?

a. Ligamentum flavum

35. Duchenne muscular dystrophy (psuedohypertrophic calves) is a

mutation of what protein , give name and function.
a. Dystrophin
i. Links component of cytoskeleton (actin) to
transmembrane proteins
36. Young patient with multiple fractures, shitty teeth, small stature,
bluish eyes. What is the disease and the reason for this?
a. Osteogenesis imperfecta (autosomal Dom)
i. Defective osteoid production by osteoblasts
ii. Defective synthesis of type 1 collagen by osteoblasts

37. Osteoporosis can be caused by what drugs?

a. Phenobarbital , carbamezapine, phenytoin
b. Aromatase inhibitors
c. Medroxyprogesterone
d. GnRH agonists
e. Proton Pump inhibitors (decrease Ca2+ absorbtion)
f. Glucocorticoids

38. What potrion of the spinal cord is affected by RA?

a. Cervical spine

39. Hematogenous osteomyelitis most commonly affects the ? of long

bones?
a. Metaphysis (contains low flowing sinusoidal vessels)

40. Thoracic outlet syndrome causes lower trunk brachial plexus

compression due to compression from?
a. Scalene muscles and first rib

41. Patellar fractures cause inability of the knee to do what against

gravity?
a. Extend

42. Main cytokine invovled in Temporal Arteritis?

a. IL-6

43. Lateral epicodyle muscle is involved with?

a. Wrist extension
44. Midshaft fracture of the humerus risks injury to what artery that runs
with the radial N?
a. Deep Brachial A.

45. Where in the butt does superior gluteal nerve injury happen?
a. Superiomedial quadrant of the left buttocks

46. People on their knees a lot get damage to which bursae?

a. Prepatellar

47. Patient falls with arm pronated and extended. Falls when holding a
siblings hand and can no longer move the affected arm without pain.
What is the most likely diagnosis and what ligament is affected?
a. Radial head subluxation (nursemaids elbow)
b. Annular ligament

48.
49.
50.
51.
52.
53.
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55.
56.
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58.
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60.
61.
62.
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64.
65.
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1. Patient shows up to your clinic with lesions demonstrating hyperkeratosis

and parakeratosis and atypical keratinocytes. What is the most likely
cancer this patient will develop?
a. Squamos cell carcinoma

2. What type of inheritance is hair loss caused by?

a. Polygenic

3. 6 month boy comes to ER with poor feeding and irritability and epidermis
that comes off with gentle pressure. What is the most likely cause of this?
a. Staphylococcal scalded skin syndrome
b. “exo” – toxin mediated skin damage

4. terbenafine use and MOA

a. used for tinea corporis
b. squalene epoxidase inhbitor

5. opoids cause what type of IgE mast cell degranulation?

a. Independent

6. Melanoma is of what cell origin?

a. Neural crest

7. Over elastic skin is seen in what disease and is a consequnce of what

defect?
a. Ehler danlos
b. Collagen

8. Patient with perifolicular hemorrages, myalgias, superiosteal hemotomas

and gingivitis is due to a deficeincy of what?
a. Ascorbic acid (vit. C) Scurvy

9. Pellagra is characterized by 3ds? What conezyme is made by the

defiecient nutrient?
a. Dermitits
b. Dementia
 c. Diarrhea
d. Caused by niacin (b3) deficiency
i. Leads to NAD+ deficency
ii. Tryptophan can also be used to make NAD+

10. ACNE is caused by what type of exocrine glands?

a. Holocrine sebaceous glands

11. Signs of graft vs host disease?

a. Diffuse maculopapular rash that has a predilection for palms
and soles that shows deaquamtion. Also damage to liver and
GI tract

12. What is photoaging and why is it happen

a. Penetration of UVA into skin
b. It decreaeses collagen fibiril production
c. Increased crosslinking of collagen

13. In a susceptible child, a rash that starts on the face and goes to the
body or trunk is indicative of what two diseases?
a. Measels (rubeola) [parmyxovirus] or German Measels
(rubella)
i. Rubella (togavirus) also shows postauricular tenderness

14. What factor is responsible for fibroblast migration, proliferation, and

connective tissue synthesis? Also this factor Is overexpressed in
hypertrophic/keloid scarring and fibrosis.
a. TGF-B

15. Vitiligo is a condition associated with autoimmune disease. Affected

skin will demonstrate?
a. Absence of melanocytes in the skin

16. Xeroderma pigmentosa is caused by a defect in what enzyme?

a. Endonuclease
17. A unilateral vesicular rash localized on a single dermatome represents
what? And name a major complication from this
a. Herpes zoster (varicella zoster virus)
b. Post herpetic neuralgia

18. Patient presents with bilatteral elbow lesions. Biopsy shows thin
stratum granulosum and prominent parakeratotic stratum cornerum with
foci of neutrophil accumulation. What is the most likely diagnosis in this
patient?
a. Psoriasis

19. Melanoma shows mutation in what gene? Also what extra

manifestations can also be present?
a. BRAF / can see mets to CNS showing seizures

20. Subcutaneous nodules attached to tendons with family history of

cardiac problems?
a. Xanthoma (hypercholesterol)

21.
22.
23.
24.
25.
26.
27.
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1. CD14?
a. Co receptor for TLR4 on macrophages that recognizes LPS on
the outer membrane of gram (-) bacteria

2. CD18? And disease

a. Integrin
b. Luekocyte adhesion deficiency – characteristic delayed
seperation of umbilical cord , increasesd circulating
neutrophils, reccurrent bacterial infections without pus
formation.

3. CD28
a. Binding site for B7 (APC) on CD4 helper t cell providing 2nd
signal for activation

4. CD40
a. Found on B cell that binds to CD40L on t heloer cells via MHC
class II

5. CD16?
a. Fc receptor for neutrophils. Decreased amount signifies left
shift aka massive release of immature neutrophils seen in
infection / tissue necrosis

6. CD34
a. Hematopoetic stem cell

7. Cell expresses CD 5 and CD 20

a. Chronic lymphocytic leukemia (CLL)
b. B cell express both CD5 and CD20
i. Normally CD5 only expressed in T cells

8. CD15 + CD30
a. Non hodgkin lymphoma (Reed Sternberg Cells)

9.
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13.
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1. Anti inflammatory cyotkines?

a. IL-10 + TGF – B
b. Released by macrophages to signal for resolution and
healing

2. Which interleukin released by macrophages stimulates more neutrophils?

a. IL8

3. Function of IL2?
a. Activates CD8 cells

4. IL4?
a. B cell class switching to IgE / IgG

5. IL5
a. B cell class switching to IgA

6. High Serum IL6 is seen in what disorder?

a. Multiple Myeloma

7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
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25.
26.
27.
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