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NBME 15 review

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1st Brachial arch

Cartilage: Meckel's (Mandible, Malleus, Mandibular) Muscles: Muscles of mastication (Masseter, medial pterygoids, Mylohyoid) Nerves: CN V2, V3 -Chew Middle ear cavity Eustachian tube Mastoid air cells Cartilage: Reichert's (Stapes, Styloid, Stylohyoid) Muscles:Stapedius, Stylohyoid Nerves:CN 7 -Smile Epithelial lining of palatine tonsil Cartilage: Greater horn of hyoid Muscles: Stylopharyngeus Nerves: CN 9 -Swallow stylishly Dorsal wings -Inferior parathyroids Ventral wings -Thymus 3 structures Thymus, right & left parathyroids


Affinity column chromatography


1st Brachial Pouch 2nd Brachial arch

Method of separating biochemical mixtures -Based on a highly specific interaction such as that between antigen and antibody, enzyme and substrate, or receptor and ligand. Can be used to. 1. Purify and concentrate a substance from a mixture into a buffering solution 2. Reduce the amount of a substance in a mixture 3. Discern what biological compounds bind to a particular substance 4. Purify and concentrate an enzyme solution.



2nd Brachial Pouch 3rd Brachial arch




3rd Brachial Pouch

African American, bilateral hilar adenopathy, righ paratracheal node enlargment, noncaseating granuloma =??? Albinism

sarcoidosis (ethnicity is risk factor)


Congenital deficiency in: Tyrosinase Defective tyrosine transporter ( tyrosine melanin) Can result from lack of migration of neural crest cells Lack of melanin results in risk of skin cancer


4th Brachial Pouch 4th-6th Brachial arches

Dorsal wings -Superior parathyroid Cartilage: Thyroid, cricoid, Muscles: 4 = pharyngeal constrictors 6 = intrinsic muscles of larynx Nerves: 4 = CN X (superior laryngeal branch) -Simply swallow 6 = CN X (recurrent laryngeal branch) -Speak Brief (usually less than 20 seconds), generalized epileptic seizures of sudden onset and termination



Ammonia source in ammonioagenesis

Aspartate & GLUTAMINE donate NH4 ( amonia ) in renal ammoniaagenesis


Absence seizure

Clinically, the impairment of consciousness (absence) Electroencephalography (EEG) shows generalized spike-and-slow wave discharges ~3Hz

acute ischemic injury = kidney findings?

Acute Tubular Necrosis - Muddy Brown Casts with epithelial cells



Occurs within proximal tubular cells Glutamine made in the liver, is received from peritubular capillaries and is metabolized into 1. Alpha-keto glutarate (Metabolized further into two HCO3- ions, which then leave the cell and enter systemic circulation by crossing the basolateral membrane) 2. NH4+ (Secreted into renal tubules)


Bacillus subtilis

Gram-positive, catalase-positive bacterium Rod-shaped Has the ability to form a tough, protective endospore, allowing the organism to tolerate extreme environmental conditions Only known to cause disease in severely immunocompromised patients


Bacteroides fragilis

Gram-negative bacillus bacterium species Involved in 90% of anaerobic peritoneal infections Predominates in bacteremia associated with intraabdominal infections, peritonitis and abscesses following rupture of viscus, and subcutaneous abscesses or burns near the anus


Anabolic steroids

Leads to sex-hormone binding globulin free testosterone -Gynecomastia results Hb concentration causes O content of blood hypoxia oculomotor nerve palsy (NOT Horner's) Posterior 1/3 of tongue ATP is quickly regenerated from creatine phosphate Consider themselves to be socially inept or personally unappealing and avoid social interaction for fear of being ridiculed, humiliated, rejected, or disliked first arch (TreacherCollins)
28. 25.



blast proliferation, eosinophils? Brachial Arches (Pneumonic)

CML (9:22) responds to imatinib When at the golden arches, 1. Chew 2. Smile 3. swallow stylishly or 4. simply swallow 6. speak There is no 5!



aneurysm of PCA? Arches 3 & 4 ATP concentration doesn't fall much dring normal twitches because? Avoidant Personality Disorder

19. 20.



Brachial pouch pneumonic

Ear, tonsils, bottom to top 1(ear) 2(tonsils) 3 dorsal (bottom for inferior thyroid) 3 ventral (to = thymus) 4 (top = superior parathyroids)


baby, respiratory distress, cyanosis, narrow thorax, ears with periauricular skin tags, micrognathia, glossoptosis, mandibular cleft, short palate = which artch?

Broca's aphasia brown-black, mottled, scaly, irregular borders, atypical melanocytes along basilar layer? Carbaminohemoglobin

Nonfluent aphasia with intact comprehension. lentigo maligna (melanoma)



CO bound to hemoglobin -Account for very small amount of CO in blood O content of blood hypoxia


Carbon monoxide poisoning


Carnitine deficiency

Inability to transport LCFA (Long chain fatty acids) into mitochondria Results in toxic accumulation in the cytoplasm Causes weakness, hypotonia, hypoketotic hypoglycemia


Clostridium perfringens

Gram-positive, rod-shaped, anaerobic, sporeforming bacterium Infections show evidence of tissue necrosis, bacteremia, emphysematous cholecystitis, and gas gangrene


Case Control

Two existing groups differing in outcome are identified and compared on the basis of some supposed causal attribute Medical research descriptive study that: 1. Tracks patients with a known exposure given similar treatment 2. Examines their medical records for exposure and outcome Can be retrospective or prospective Usually involves a smaller number of patients than more powerful case-control studies or randomized controlled trials May be consecutive or non-consecutive -Depends on whether all cases presenting to the reporting authors over a period were included, or only a selection May be confounded by selection bias -Limits statements on the causality of correlations observed -Physicians who look at patients with a certain illness and a suspected linked exposure will have a selection bias in that they have drawn their patients from a narrow selection (Their hospital)


Case series

Toxin involved in gas gangrene is known as -toxin -Inserts into the plasma membrane of cells, producing gaps in the membrane that disrupt normal cellular function

CML treatment Complete hydatidiform mole

Imatinib. BCR-ABL 9:22 Caused by a single (90%) or two (10%) sperm combining with an egg which has lost its DNA The genotype is typically 46,XX (diploid)



Complex partial seizure

Often preceded by a seizure aura. -A simple partial seizure. Aura may manifest itself as a feeling of dj vu, jamais vu, fear, euphoria or depersonalization. Seizure aura might also occur as a visual disturbance, such as tunnel vision or a change in the size of objects (macropsia or micropsia). Once consciousness is impaired, the person may display automatisms such as lip smacking, chewing or swallowing. There may also be loss of memory (amnesia) surrounding the seizure event. Person may still be able to perform routine tasks such as walking, although such movements are not purposeful or planned. Witnesses may not recognize that anything is wrong.


cervical cancer drains to? Chloroquine, primaquine MOA Chronic HTN, heavy heart? Chronic myelogenous leukemia (CML)

internal iliac nodes


Chloroquie kills malaria/ Primaquine kills hypnozoites Hypertrophy of heart



Myeloid stem cell proliferation (30-60 year olds) - neutrophils, metamyelocytes, basophils, t(9;22) Low leukocyte alkaline phosphatase (as opposed to leukemoid reaction)


Congentio pharyngocutaneous fistula Cyanide poisoning

Persistence of cleft and pouch fistula between tonsillar area, cleft in lateral neck


O utilization by tissues hypoxia



Pyrimidine analog inhibition of DNA polymerase Leukemia, lymphomas Toxicity: Leukopenia, Thrombocytopenia, Megaloblastic anemia glycine receptor glutamine (and aspartate donate NH4 in agenesis)


DKA, give insulin, increases activity of which enzyme? drug overdose? Dysostosis multiplex


57. 58.

respiratory acidosis Hereditary disease (autosomal recessive) consisting of an error is mucopolysaccharide metabolism Characterized by severe abnormalities in development of skeletal cartilage and bone and mental retardation


defect in ihibitory NT = seizures, floppy baby defect in renal ammoniagenesis, which substrate is source of ammonia production? Density Gradient Centrifuge



Used to separate certain organelles from whole cells for further analysis of specific parts of cells 1. A tissue sample is first homogenised to break the cell membranes and mix up the cell contents. 2. The homogenate is then subjected to repeated centrifugations, each time removing the pellet and increasing the centrifugal force. 3. Finally, purification may be done through equilibrium sedimentation, and the desired layer is extracted for further analysis. Strep Mitis - alpha hemolytic Better buffer for H than oxyhemoglobin -Advantageous that hemoglobin has been deoxygenated by the time it reaches the venous end of the capillaries increased osteoclast, RANKL, decreased osteoblast activity burning pain Numbness, tingling, ED, Urinary incontinence, Vision changes, Dizziness, Muscle weakness *Burning or electric pain*


Ejection Fraction equation elevated verylong-chain FA, phytanic acid, pipecolic acid = absence of? EPO doping = ? Erythropoietin



peroxisomes (causes hypotonia, poor feeding)


EPO will increase RBC's erythroid precursors Its primary effect on red blood cell progenitors and precursors (which are found in the bone marrow in humans) is promoting their survival through protecting these cells from apoptosis Age < 15 Found in acute lymphoblastic leukemia (ALL) TdT+ (Marker of pre-t & pre-b cells) CALLA+ t(12;21) = good prognosis Increased incidence in people with Down Syndrome



Dental procedure, bug? Deoxyhemoglobin


Excess lymphoblasts



DEXA decreased bone density Diabetic neuropathy pain? Diabetic neuropathy symptoms




Lead poisoning Accumulates: Protoporphyrin, -ALA Microcytic anemia, GI and kidney disease. Children-exposure to lead paint -+ mental deterioration Adults-environmental exposure (battery/ ammunition/radiator factory) -+ headache, memory loss, demyelination


54. 55.

Diaphoresis DiGeorge syndrome

Excessive sweating Aberrant development of 3rd & 4th pouches: T-cell deficiency (thymic aplasia) Hypocalcemia (failure of parathyroid development)


Generalized tonic clonic

Generalized seizure that affects the entire brain Divided into two phases, the tonic phase and the clonic phase. Preceded by aura Tonic = skeletal muscles tense Clonic = Rapid contraction and relaxation of muscles


heme biosynthesis pathway

glycine + succ (ALA synthase) 5-ALA (ALA dehydratase) porphobilinogen (PBG deaminase) Hydroxymethylbilane (uro synthase) Urophyrinogen III (Uro decarboxylase) Coproporphyrinogen III (Copro oxidase) protoporphyrinogen IX (proto oxidase) protophorphyrin (IX) ferrochelatase + Fe = HEME Results most commonly from brain injury to the right cerebral hemisphere, causing visual neglect of the left-hand side of space A stroke affecting the right parietal lobe of the brain can lead to neglect for the left side of the visual field, causing a patient with neglect to behave as if the left side of sensory space is nonexistent (although they can still turn left) -Extreme case, a patient with neglect might fail to eat the food on the left half of their plate, even though they complain of being hungry -Someone with neglect is asked to draw a clock, their drawing might show only numbers 12 to 6, or all 12 numbers on one half of the clock face, the other side being distorted or left blank



germline mosaicism Glipizide

produces disease that is not carried by parent's somatic cells Sulfonylurea (stimulates endogenous insulin release) Close K+ channel in -cell membrane = insulin release via Ca2+ influx. Downward displacement or retraction of the tongue Liver and cells of pancreas, induced by insulin Low glucose = hexokinase sequesters glucose in the tissues High glucose = excess glucose is stored in the liver

Hemispatial neglect



glossoptosis Glucokinase




In ER of liver, Glucose-6-P Glucose Deficient in Von Gierke's disease (fasting hypoglycemia, increased glycogen in liver, increased blood lactate, hepatomegaly)

Histone deacetylase

Removes acetyl groups from AA -Allows histones to wrap DNA more tightly Actions are opposite to that of histone acetyltransferase These would affect transcription of DNA!!!!


Glycogen phosphorylase

Rate determining enzyme for glycogenolysis Skeletal component deficient in McArdle's disease - glycogen in muscle, but can't break it down -Painful muscle cramps, myoglobinuria w/ strenuous exercise


Homonymous hemianopsia

Visual field loss that respects the vertical midline, and usually affects both eyes Vascular and neoplastic (malignant or benign tumours) lesions from the optic tract, to visual cortex can cause -If lesion is in optic tract, will be pupillary reflex problem! The more posterior the cerebral lesion, the more symmetric (congruous) symptoms will be 1. Person who has a lesion of the right optic tract will no longer see objects on his left side 2. Person who has a stroke to the right occipital lobe will have the same visual field defect, usually more congruent between the two eyes, and there may be macular sparing


guy with ulcers, what to do to improve symptoms? H1 (Histamine)

stop smoking


Found on smooth muscle, endothelium, and central nervous system tissue Causes: Bronchoconstriction, Bronchial smooth muscle contraction, Vasodilation, Separation of endothelial cells (responsible for hives), Pain and itching due to insect stings; SE = sleep and appetite suppression.


HDL with age in woman?

HDL of a 25 year old vs. 55 year old, high in 25, low in 55 (estrogen)


Homozygous for point mutation (GT->AT) causes skipping of exon 12, mech? How to calculate A-a gradient How to identify a variant protein? Hydronephrosis causes? Hydroxyurea

RNA Splice error



A small molecular inhibitor of bcr-abl tyrosine kinase Treatment of CML (blasts, basophils)


PAO2 - PaO2 (PAO2=150 PaCO2/0.8) immunohistochemistry Increased tubular hydrostatic pressure from blockage





Process of detecting antigens (e.g., proteins) in cells of a tissue section by exploiting the principle of antibodies binding specifically to antigens in biological tissues Inherited lysosomal storage disorder Failure of addition of mannose-6phosphate to lysosome proteins -Enzymes are secreted outside the cell instead of being targeted to the lysosome Presentation: Coarse facial features Clouded corneas Restricted joint movement High plasma levels of lysosomal enzymes

93. 83.

Inhibits ribonucleotide reductase DNA Synthesis (S-phase specific) Melanoma, CML, Sickle cell disease ( HbF) Toxicity: Bone marrow suppression, GI upset

inclusion cell disease (I-cell disease)



Can be acquired (e.g., liver disease) or hereditary (e.g., urea cycle enzyme deficiencies) excess NH4+ depletes aketoglutarate inhibition of TCA cycle Rx: limit protein in diet


incomplete penetrance vs. variable expressivity Insulin increases? Insulin secretion

IP = not all with mutant genotype show mutant phenotype; VE = genotype SAME, phenotype varies glucokinase activity 1. Glucose binds Glut2 receptor on -cells 2. Glucose oxidizes to ATP closes K channels in cell membrane depolarization of cells 3. Depolerizatino opens Ca channels intracellular [Ca ] [name of this card] Receive lymphatics from: All the pelvic viscera Deeper parts of the perineum -membranous and cavernous portions of the urethra Buttock and back of the thigh Cervix! Not: Ovary, testis, or superior half of the rectum Gonads drain to the paraaortic lymph nodes Superior half of the rectum drains to the pararectal lymph nodes



Stone, Bones, and Groans


Hypercalcemia Hypercalciuria (Stones) Hypophosphatemia PTH, Alk Phos, cAMP in urine


Hypokinesis of Posterior Left Ventricle? Hypovolemic/cardiogenic shock

Stenosis of the right coronary artery low-output failure, increased TPR, low CO, cold, clammy (hypovolemic = low volume, no JVD; cardiogenic = poor pumping, backflow, increased JVD) Pao causes %saturation of hemoglobin hypoxia mannose 6 phosphate addition allows enzymes to go to lysosome, but this is defective = abnormal targeting of these enzymes to lysosomes releases NFkB after undergoing phosphorylation
98. 97.


Internal iliac lymph nodes


Hypoxemia I Cell Disease MOA



IkB function?

Internal urethral orifice

Opening of the urinary bladder into the urethra


Irradiated packed RBCs

Destroys DNA in WBCs -Prevents graft vs host disease occurring from transfusion Important if transfusion is from: 1. Close family relation 2. Someone who is immunocompromised (Di George Syndrome, Wiskott Aldrich, and SCID)


long-chain-fattyacids? Lorazepam

LCFA - peroxisomes Facilitates GABAa action by frequency of Cl channel opening Use: Anxiety Spasticity Status epilepticus Detoxification



IB Left Axillary line holosytolic murmur Left sided heart failure signs

Releases NF-B after undergoing phosphorylation Mitral Regurg - Left Axillary line holosystolic murmur Tachypnea (increased rate of breathing) Increased work of breathing (nonspecific signs of respiratory distress) Rales or crackles, heard initially in the lung bases, and when severe, throughout the lung fields -Suggest the development of pulmonary edema (fluid in the alveoli) -Cyanosis which suggests severe hypoxemia, is a late sign of extremely severe pulmonary edema. Unregulated growth of leukocytes in *bone marrow* or in # of circulating leukocytes in blood Marrow failure anemia (RBC), infections (WBC), hemorrhage (platelets) Infiltrates in liver, spleen, and lymph nodes possible



Loss of left vision in both eyes =? Low blood solubility = slow or fast induction? lump in upper neck, mass moves up with swallowing and tongue protusion, uptake of technetium 99m pertechnetate, what type of cells? Lymphoma Lysosomal storage disease

occipital lobe lesion 141) low blood solubility --> rapid induction, low potency thyroid follicles





Discrete tumor masses arising from lymph nodes. Caused by lysosomal dysfunction usually as a consequence of deficiency of a single enzyme required for the metabolism of lipids, glycoproteins (sugar containing proteins) or so-called mucopolysaccharides When a particular lysosomal enzyme exists in too small an amount or is missing altogether, substances accumulate in the cell. In other words, when the lysosome doesn't function normally, excess products destined for breakdown and recycling are stored in the cell.






Type of cytotoxin created by some types of bacteria Is a type of pore forming toxin Get their names by killing ("-cide") leukocytes Associated with increased virulence of certain strains (isolates) of Staphylococcus aureus Cause of necrotic lesions involving the skin or mucosa, including necrotic hemorrhagic pneumonia


Maintenance dose

Cp x CL/F


Lithium induced Nephrogenic DI, where? Loading dose

Collecting tubule


Cp x Vd/Bioavailability


Megaloblastosis (Megaloblastic anemia)

Results from inhibition of DNA synthesis in red blood cell production -Most often due to hypovitaminosis, specifically a deficiency of vitamin B12 and/or folic acid Characterized by: Many large immature and dysfunctional red blood cells (megaloblasts) in the bone marrow Hypersegmented neutrophils (those exhibiting five or more nuclear lobes ("segments"), with up to four lobes being normal)


Nephroblastoma (Wilms tumor)

Most common renal malignancy of early childhood (Age 2-4) Contains embryonic glomerular structure. Presents with huge flank mass / hematuria. Deletion of WT1 on chromosome 11 Can be hypervascular



Activation occurs when it's inhibitor, I-B, is phosphorylated by specific protein kinase (IKK) & degraded hypertrophy


Melanoma ABCDE Mesoblastic nephroma

Asymmetry, Border irregularity, Color variation, Diameter >6 mm, Evolution over time Type of kidney tumor that is usually found before birth by ultrasound or within the first 3 months of life. It contains fibroblastic cells (connective tissue cells), and may spread to the other kidney or to nearby tissue


normal heart weight (450), enlarged at 600g after poorly controlled HTN? Oculomotor palsy from aneurysm? Olanzapine



Posterior Communicating Artery Anuerysm Atypical antipsychotic Use: Schizophrenia - both +ve and -ve Bipolar, OCD, anxiety disorder, depression, mania Fewer extrapyramidal side effects than traditional antipsychotics



metabolic alkalosis with volume contraction metastaic colon cancer spread MOA Michaelis constant (Km) =? micrognathia MOA IKB Myofibroblast

loop diuretic


Hematogenous spread of Liver Tumor from Colon via Portal Venous System Km = 1/2 Vmax


Oligomenorrhea Optic chiasm lesion optic nerve, Chiasm, optic tract Organophosphate poisoning- first antidote Oxytocin

increased estrogen in adipose tissue Bitemporal anopia parietal lesion = optic tract lesion Atropine first/Pralidoxime second

130. 131.


121. 122.

Jaw is undersized lkb --> NF-KB post phosphorylation for IL-1/IL-6 fever induction Cell that is in between a fibroblast and a smooth muscle cell in differentiation Can contract by using smooth muscle type actin-myosin complex, rich in a form of actin called alpha-smooth muscle actin -These cells are then capable of speeding wound repair by contracting the edges of the wound




Stimulates labour Uterine contraction Milk let down Controls uterine hemorrhage Allows the blood to flow readily without the addition of saline burning pain supraspinatus


Packed RBCs with adenine-saline added pain associated with diabetic neuropathy? pain in shoulder, reproduced with resisted abduction at 90, giving thumbs down Pain upper abdomen, refered to shoulder




Diaphram ulceration phrenic nerve


Pain with thumbs down, shoulders up pancreatic cancer associated with? paraesophageal hernia parathyroid adenoma, decreased? Parietal lobe lesion Partial hydatidiform mole

Arm up Thumbs down sign... supraspinatus... depression portion of gastric fundus herniates through the diaphragm calcium concentration in feces Lower quadrantic anopia Occurs when an egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY Partial 1 egg two sperm 69XXY vs paternal complete 46XX 2 sperm no egg Chronic inflammation due to Helicobacter pylori that colonizes the antral mucosa NSAIDs Some studies have found correlations between smoking and ulcer formation Caffeine and coffee, also commonly thought to cause or exacerbate ulcers, have not been found to affect ulcers to any significant exten


Pipecolic acid


Accumulates in Pipecolic acidemia - Very rare autosomal recessive metabolic disorder that is caused by a peroxisomal defect Abnormally deep attachment of the placenta to the myometrium without penetrating it. Placenta grows completely through the endometrium Great risk of haemorrhage during placental removal -Commonly requires surgery to stem the bleeding and fully remove the placenta -In severe forms can often lead to a hysterectomy or be fatal



Placenta accreta


142. 143.


Partial vs complete mole Peptic ulcers



Porphobilinogen deaminase

Acute intermittent porphyria Accumulates: Porphobilinogen, -ALA, uroporphyrin 5 P's 1. Painful abdomen 2. Port wine-colored urine 3. Polyneuropathy 4. Psychological disturbances 5. Precipitated by drugs


Posterior Communicating Artery

Common site ofsaccular (berry) aneurysm. CN III Palsy: Eye is "down and out" with ptosis and pupil dilation Lesions are typically aneurysms, not strokes



Membrane-enclosed organelle involved in catabolism of very long fatty acids (VLFA) & amino acids Irreversible enzyme in Gluconeogenesis A component of Gluconeogenesis Branched chain fatty acid that humans can obtain through the consumption of dairy products, ruminant animal fats, and certain fish Undergoes -oxidation in the peroxisome, where it is converted into pristanic acid by the removal of one carbon
156. 155.


Phosphoenolpyruvate carboxykinase Phosphorylase kinase Phytanic acid

148. 149.

postpartum hemorrhage treated with? Prenatal cocaine effects progestin challenge with withdrawal bleed? protease inhibitors (navirs)


Associated with premature birth, birth defects, attention deficit disorder low estrogen production = estrogen increased in adipose tissue



protein processing (assmebling of virions = cleave of polypeptide products of HIV mRNA into functional parts)


pinpoint pupils, unconscious

heroin OD



Ca+ resorption from Kidney (Inhibits PO4 resorption) Stimulates Vit D. synth (1,25 OH) -Increased Ca+ absorbed from intestine Ca+ release from bone


RTA2 ("proximal", Renal tubular acidosis)

Defect in proximal tubule HC03reabsorption Fanconi's syndrome urine pH < 5.5 hypokalemia risk for hypophosphatemic rickets

serum calcium


Recurrent severe mycobacterial diseases renal failure causes loss of? Right Coronary Artery

INF-gamma receptor defect

RTA4 ("hyperkalemic", Renal tubular acidosis)

Hypoaldosteronism or lack of collecting tubule response to aldosterone Resulting hyperkalemia impairs ammoniagenesis in the proximal tubule buffering capacity and urine pH


1,25-dihydroxycholecalciferol (from decreased conversion via 1a-hydroxylase in PCT) Supplies blood to right ventricle & 25-30% of left ventricle In 85% of patients, gives off posterior descending artery Supplies SA nodal artery in 60% of patients Give off branch to right marginal artery If lungs are clear to auscultation, no LVF. Think RVF!


S. pyogenes (Group A)

The bacteria behind post-streptococcal glomerulonephritis PHaryngitis can results in PHever & glomerulonePHritis



Salmonella enterica

Most cases of salmonellosis are caused by food infected with w/ this bacteria, which often infects cattle and poultry Usually does not need ABs (Only if complicated in people at risk such as infants, small children, the elderly) -Will lead to prolonged fecal excretion of bacteria



RNA splice error Rouleaux formation

skipping of exons

Salmonella post antibiotic? Scaphoid bone

prolonged fecal excretement post antibiotic Most commonly fractured carpel bone, prone to avascular necrosis due to retrograde blood supply Characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness and apathy May simultaneously demonstrate a rich, elaborate and exclusively internal fantasy world


Stacks of red blood cells (RBCs) which form because of the unique discoid shape of the cells in vertebrates Conditions which cause: Infections Multiple myeloma Inflammatory and connective tissue disorders Cancers Occurs in diabetes mellitus (one of the causative factors for microvascular occlusion in diabetic retinopathy)


Schizoid personality disorder


Screening for CD markers? Septic shock

Immunohistochemistry high-output failure, decreased TPR, dilated arterioles, high venous return, hot patient drowsiness


RTA1 ("distal", Renal tubular acidosis)

Defect in collecting tubule's ability to excrete H+ urine pH >5.5 hypokalemia risk for calcium phosphate kidney stones as a result of urine pH and bone resorption



side effect of H1 blocker


Simple partial seizures

Consciousness is not impaired Often precursors to larger seizures, where the abnormal electrical activity spreads to a larger area of (or all of) the brain, usually resulting in a complex partial seizure or a tonic-clonic seizure -In this case they are often known as an aura


stratified sample

NOT random, created to ensure a more representative sample of the population at large (ADHD more likely in boys than girls, therefore assigned differently) Alcohol: Leading cause of birth defects and mental retardation; fetal alcohol syndrome Cocaine: Abnormal fetal development and fetal addiction; placental abruption Smoking: Preterm labor, placental problems, IUGR, ADI-ID


Substance Abuse Teratogens


Slipped-strand mispairing

Denaturation and displacement of the DNA strands, resulting in mispairing of the complementary bases. Can result in either insertions or deletions. Insertions are thought to be selfaccelerating: as repeats grow longer, the probability of subsequent mispairing events increases


Superficial inguinal lymph nodes

Anal canal (below pectenate line) Scrotum Thighs Ends up in these lymph nodes



Southern = DNA Northern = RNA Western = Protein Identifies DNA-binding proteins Upregulates LDL receptors



Southwestern blot Stain Drug effects Staph -toxin


suprasellar mass, hormone excess? Supraspinatus




The major cytotoxic agent released by bacterium Staphylococcus aureus and the first identified member of the pore forming beta-barrel toxin family -Superantigens (TSST-1) induce toxic shock syndrome (TSS), usually from prolonged tampon use. Cause non-specific activation of T-cells resulting in polyclonal T cell activation and massive cytokine release (IFN) -Enterotoxin that is the causative of gastroenteritis that is self-limiting, characterized by vomiting and diarrhea one to six hours after ingestion of the toxin with recovery in eight to 24 hours. Symptoms include nausea, vomiting, diarrhea, and major abdominal pain. -Exfoliative toxins implicated in (SSSS), which occurs most commonly in infants and young children. Protease activity of the exfoliative toxins causes peeling of the skin observed with SSSS. Other -Protein A, an IgG-binding protein, binds to the Fc region of an antibody

Abduction of the arm at the shoulder joint -Main agonist muscle for this movement during the first 10-15 degrees of its arc Can test: Shoulder at 90% Empty can (Wrists pronated)


Staphylococcus aureus


Temporal lobe lesion Transfusion associated GVH

Upper quadrantic anopia Results from transfusion of immunocompetent T cells capable of engrafting and initiating an immune response against recipient antigens The most susceptible patient groups are those who are severely immunocompromised Gamma irradiation abolishes the proliferative activity of the lymphocytes in the donor blood. Fresh frozen plasma and cryoprecipitate do not contain viable lymphocytes and thus do not need to be irradiated




Statin MOA (upregulate what?)

LDL receptors

Treacher Collins Syndrome

1st arch neural crest fails to migrate -Mandibular hypoplasia -Facial abnormalities


Trisomy 21 associated with increased risk of which cancers? Type I error Type I error =



Wernicke's aphasia


Stating there is an effect when none exist saw a difference when none existed = p-value (false positive error) Stating there is not an effect when there is one Tags proteins for destruction by proteosome proteosome for degradation Placed at the postero-lateral angles of the trigonum vesicae, and are usually slit-like in form Porphyria cutanea tarda Accumulates: Uroporphyrin (tea colored urine) Blistering cutaneous photosensitivity. Most common porphyria.
206. 205.

Fluent aphasia with impaired comprehension. Wernicke's area-superior temporal gyrus of temporal lobe. Wordy, but makes no sense


Whole blood

Blood that is unmodified except for the presence of an anticoagulant Usually not used because the extra plasma can contribute to transfusion associated circulatory overload (TACO), a potentially dangerous complication


Type II error Ubiquitin ubiquitin tagged proteins go where? Ureteric orifice




Why deoxyHB can carry CO2 better than OxyHB? Wound healing

DeoxyHB = better buffer



Uroporphyrinogen decarboxylase

1. Inflammatory (immediate) -Platelets, neutrophils, macrophages 2. Proliferative (2-3 days after wound) -Fibroblasts, myofibroblasts, endothelial cells, keratinocytes, macrophages -Granulation tissue depostion, angiogenesis, wound contraction (mediated by myofibroblasts) 3. Remodeling (1 week after wound) -Fibroblasts -Type III collagen replaced by type I collagen


Valproic acid

A wide spectrum seizure medication -1st line for tonic-clonic Not for status epilepticus Zanamavir MOA zanamivir, oseltamivir MOA -ALA dehydratase


Zanamivir MOA - inhibit virion release inhibits virion release


Valproic Acid MOA

inhibits HISTONE ACETYLASE Histones were in DNA transcription error Required fro the hydroxylation of specific purine and lysine residues -If deficient, will cause scurvy --Inadequate hydroxylation of collagen peptides RBCs washed in sterile saline to remove: WBCs Lytic mediators Non-self antigens Most useful in IgA deficient persons who have circulating anti-IgA Abs -Use febrile, urticarial and anaphylactic reactions



Vitamin C


Lead poisoning Accumulates: Protoporphyrin, -ALA Microcytic anemia, GI and kidney disease. Children-exposure to lead paint -+ mental deterioration Adults-environmental exposure (battery/ ammunition/radiator factory) -+ headache, memory loss, demyelination


Washed packed RBCs


-ALA synthase

Sideroblastic anemia