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Cardio Microbiology & Pathology 1. 22 year male with dental procedure.

Gram + bacteria, which synthesizes from dextrans and sucrose. What allows adherence of the bacteria. **Fibrin Platelet aggregates**: strep viridians cannot bind to a normal heart valve. When a valve is damaged it causes fibrin and platelet aggregation. Subendothelial collagen and glycoaminoglycans are involved in the formation of atherosclerotic plaque 2. Picture of lung infract in the lungs and an patient who is IVDU. What caused the red infarct in the lungs. Patients who are IVDU are susceptible to S. aureus infection. Dont Tri Drugs. Drugs targets tricuspid valve and causes growth of vegetation on the valve. This can lead to breaking off of the vegetation and embolizes in the pulmonary artery. **Tricuspid Valve endocarditis** 3. 8 year old Asian immigrant, throat pain and difficulty breathing. Dies of severe heart failure. Bacteria described is C. diphtheria and the dz is being caused by its exotoxin. **IgG against circulating Protein** this will deactivate toxin (AB toxin) B binds K-antigen of bacterial all bypassing IgA 4. Long term effect of using penicillin for treating pharyngitis in developing countries Pharyngitis can causes heart damage (rheumatic fever) so this would decrease **heart surgeries** Rheumatic fever targets 3 organs, heart, CNS and joints. Joints -> arthritis 5. Normal Variant of Heart defect Foramen ovale 6. Dyspnea occurring in supine position indicates: **Left Ventricular Failure** Blood backup Interstitial edema SOB Edema in Extremities occurs due to Right heart failure, Liver cirrhosis, Vena cava obstruction 7. Picture of mitral valve showing redness. Pt presents with fever, progressive weakness and SOB. Question is asking what precondition (which of the following risk factor) is causing his presenting(current) conditions Rupture of Chordae Tendinae is a result of endocardititis not the cause Previous Valvular Scarring and Inflammation prior damage makes it easier for the bacteria to infect 8. How does S. aureus infect valves.

Myomatous degeneration can affect mitral valve and cause mitral valve prolapsed but endocarditis vegetations are not caused by myxomatous degeneration S. aureus high Blood force endothelial damage exposes fibrin S. aureus attaches to fibrin platelet -Fibrin deposition allow attachement 9. 16 yr old dies of hypertrophic cardiomyopathy. Uncle died at age 20. What would be found histologically B-myosin heavy chain, cardiac cell sarcomere protein defect Defect in Dystrophin & Mitchondrial Dilated Cardiomyopathy Fibrillin-1 Defect Marfans Potassium channel defect prolonged QT interval Torsades de pointe 10. 73 yr old with visceral cancer dies of MI. Autopsy shows non-destructive vegetation. What caused it? Cancer hypercoaguable state Non-bacterial thrombotic endocarditis Lambert Eaton Syndrome 11. 69 yr old female with almost complete occlusion of LAD and chest pain. Why is there no necrosis or scarring downstream of the plaque? Slow growing rate heart senses decrease blood flow creates collateral blood supply supplying downstream 12. 34 yr old w/ harsh systolic murmur dies. Echo shows IV septum hypertrophy. What is causing the left ventricular outflow obstruction Hypertrophy Cardiomyopathy pushes mitral leaflet close to IV septum block aorta Mitral valve cusp and IV septum 13. 22 year old with mid-diastolic rumble, weight loss, syncopy, SOB (dyspnea)echo shows pedunculated mass in the left atrium. This is a myxoma. Question is asking the histological description of a myxoma Coarse filament, branching septate hyphae Fungal endocarditis Gram positive cocci in cluster S. aureus endocardititis 14. Pt 32 yr high fever, SOB, fatigue. Holosystolic murmur. Given a picture of food with janeway lesions. What is the description Microemboli to skin vessels 15. Congenital QT interval leading torsades Presents with sensorineural deafness Jervell and Lange-Nielsen

16. 57 year old male with prior Hx of coronary heart dz. Died 30 minutes after chest pain. What caused his death? MCC V Fib for Sudden Cardiac Arrest 17. Pt with transmural infarction who also have BRADYCARDIA. Which artery is blocked? RCAsupplied nodal cells ichemia causing bradycardia 18. Mutation of K+ channels causes Prolonged QT interval leading to Torsades de pointe Jervel & Lange 19. 85 year pt comes in with amyloid deposition in the right atrium. What is the source of the amyloid? Remember that the amyloid will be made of protein belonging to that specific location Pancreas-amylin amyloidosis Thyroid-calcitonin amyloidosis Pituitary- prolactin amyloidosis CNS-B amyloidosis ANP 20. Pt 64 yrs of age with occlusion of LAD. What substance produced by the endothelial cells prevents platelet aggregation.

Thromboxane A2- enhances platelet aggregation Hageman Factor-involved in intrinsic clotting pathway and activation of fibrinolysis Kallikrein converts kininogen to bradykinin and ACE breaks down bradykinin. ACE inhibitors causes build up of bradykinin and cause dry cough Prostacyclin inhibits platelet aggregation

21. Pt who is obese and has been taking appetite suppressant. Normal BP and HR. Suddenly died in 6 months. What caused her death. Diet suppressants has been known to cause secondary pulmonary HTN. This leads to right ventricular hypertrophy. This prevents the heart from getting adequate blood supply during exertion because of decreased rt ventricle size

22. Pt has hypertrophic cardiomyopathy. What will make his murmur worse. Remember in HCM you have outflow obstruction so anything that worsens obstruction will increase murmur. Valsava decrease venous return decreases Preload increases murmur Standing up increase venous pooling decreases venous return increases murmur 23. 9 yr old pt suffering from swelling and joint pain after an untreated soar throat Rheumatic Fever. Patient dies. What caused her death Mitral Stenosis: can occur because of Rheumatic fever causes fibrosis takes years to occur Renal failure: post strep infection can cause Post Streptococcal Glomerulonephritis NOT FATAL **Severe Myocarditis** causes dilation mitral regurg Heart Failure 24. Picture of dilated left ventricle and pt suffers from exertional dyspnea. What is causing the problem. Is it systolic/diastolic/contractile/outflow obstruction problem Dilated left ventricle decreased actin-myosin attachment decreased contractile forceDecreased ventricular contractile force 25. 10 yr old patient with dyspnea (SOB) Picture of Aschoff bodies. What caused it Bacterial infection Recent travel to Latin America associated with Chagas Dz myocarditis 26. 4 year old with fever, bilateral conjunctivitis, with desquamation skin on the fingertips. What complication can he develop This is the description of Kawasaki disease MCC complication Coronary Aneurysm MI 27. Pt with ST elevation, nocturnal episodes of chest pain. This is a description of prinzmetal angina (not told). Questions is asking which drug can mimic prinzemetal agina Aspirin: inhibits thromboxane A2 prevent platelet aggregation doesnt cause vasospasm

Phentolamine a1 and a2 antagonist cause vasodilation this is opposite of prinzmetal vasospasm Nitroglycerin causes release NO vasodilation of coronary arteries opposite of prinzmetal Amlodipine Ca Channel blocker treats prinzmetal agina Morphine acts in CNS Ergonovine ergot alkaloid constricts vascular smooth muscle 28. 7 yr old with abdominal pain, occult blood, urinalysis reveals protenuria & palpable lesion on lower extremities. What is the likely cause? Memingococcemiaabove symptoms +fever, hypotension +tachycardia Henoch Schonlein Purpura IgA immune complexes deposition 29. 0089. 65 yr old pt with acute ST segment elevation w/chest pain. Pain is sharp increases with swallowing and radiates to the neck. Pt has fever of 101F. What is causing the chest pain at day 4? Transmural Infarction inflammation Fever Day 4 of MI Fibrinous pericarditis Posterior Pericardium pain during swallowing Inferior pericardium involvement pain radiating to the neck Pericardial inflammation overlying the necrotic segment of myocardium A. Thrombosis ischemia angina constant substernal and crushing pain NOT Sharp B. Dressler syndrome fever, pleuritis, leukocytosis, pericardial friction rub and chest x-ray shows pleural effusion autoimmune causes pericardial inflammation 2wk months not 4 days 30. 35 yr old pt with endocardial fibrous deposit thickening of tricuspid and pulmonary valves. What would be elevated in urine? Fibrous intimal thickening of right side of the heard is always due to carcinoid syndrome, which produces 5-hydroxyindoleacetic acid 31. 185. 65 yr old dies. Biopsy of lungs shows alveolar cells containing cytoplasmic granules that turns blue with Prussian blue staining. What was the pt suffering from? Left Ventricular Failure increase hydrostatic pressure increase leakage of iron containing proteins macrophages eat them hemosiderins heart failure cells 32. 1705. 5 yr old child develops cyanosis. It started soon after birth. Child assumes squatting position to feel better. Which embryological event caused his condition? Endocardial cushion defect atrioventricular defect left to right shunt overtime causes Eisenmenger syndrome

Aortic Arch Constriction Coarctation of Aorta presents with BP differences b/w upper and lower extremities **Abnormal neural Crest Migration

33. 1345. 35 yr old pt with 2 wk Hx to nasal congestion has been using topical nasal decongestant since symptoms started. Experience relief for 1 wk then symptoms came back. Pt has Hx of allergic rhinitis. What is the most appropriate management? Stopping the decongestant first causes vasoconstriction decreases mucous improves symptoms 1 wk later decrease Norepi due to negative feedback vasodilation increase mucous secretion 34. 229. 23 yr male with new cardiac murmur with mild proteinuria and microscopic hematuria. Serum creatinine is 2.3 mg/dL. Red cell cast seen in urine. What explains these finding. Young pt with murmur is most like likely due to bacterial endocarditis circulating Immune complexes glomerulonephritis

35. 201. 12 yr old pt with wide, fixed splitting of S2. If the congenital heart disease continues then surgical repair is required to what structure may be required? ASD high left atrial pressure Left to right movement of blood more volume on right side more blood into pulmonary artery laminated medial hypertrophy of muscular pulmonary artery Eisenmenger syndrome irreversible pulmonary vascular sclerosis 36. 35. Pt with Transposition of Great vessels aorta lies anterior to and to the right of the pulmonary artery. What embryological process was supposed to occur to prevent this from happening? Apoptosis 37. 93 38. 41 39. 2124. 34 yr old female with progressive exertional shortness of breath. Echo shows dilated coronary sinus. What explains these findings Pulmonary Hypertension increase Right heart pressure dilation of Coronary Sinus 40. 1944. 65 yr old pt with worsening exertional dyspnea and lower extremity edema. feet get swollen and does go away completely PMH of HTN, MI. Currently taking aspirin and hydrochlorothiazide. What drug should be added to decrease long term mortality?

Pt is suffering from CHF ABD- B for Beta blocker

41. 149. Ianotropic agent, Milrinone, inhibits phosphodiesterase isoenzyme 3. What additional response will it have? Phosphodiesterase isoenzyme increase cAMP increase Calcium contraction of smooth muscle Inhibiting decrease cAMP decrease Calcium vasodilation 42. 46 yr old pt w/murmur. Physical examination reveals bounding femoral pulses and carotid pulsation w/ head bobbing. What murmur does the pt suffers from Mitral Stenosis opening snap w/diastolic rumble Aortic Stenosis crescendo decrescendo w/ ejection click Tricuspid Regurg/Mitral Regurg holosystolic blowing murmur Aortic Regurg bounding femoral and carotid pulsation w/head bobbing 43. Pt w/ intranasal ulcer which fails to heal and oliguria. Pts condition is associated with antibodies against? Glomerular basal membrane goodpastures syndrome Antimitochondrial antibodies primary biliary cirrhosis Wegeners Cytoplasmic anti-neutrophil cytomplasmic antibodies (c-ANCA) neutrophils

44. 42 yr old with malignant HTN 240/150 and papilledema. What is the pathological process Benign HTN hyaline membrane arteriolosclerosis decreases vascular caliber Malignant HTN Smooth muscles hyperplasia onion like concentric thickening

947

Physiological Maneuver Inspiration

Valsave strain phase Abrupt standing Squatting Passive leg raise Hand grip

Change in cardiac parameters Venous return to RH Venous Return to LH Preload Afterload Preload Afterload Preload Afterload

Murmurs that increase Most right sided murmurs

Murmurs that decreases Most left sided murmurs

MVP & HCM ( LV Volume)

Most other murmurs ( Flow through stenosis or regurg Most other murmurs MVP & HCM ( Flow through ( LV Volume) stenosis or regurg AR, MR, VSD HCM ( LV ( LV & aortic Volume) pressure AS ( transvalvular pressure gradient )

45. 67 yr old pt with pneumonia is started on norepi IV. Few hours later the antecubital vein being used for infusion becomes cold hard and pale. Injecting what medication will have the greatest benefits. a. Accidental Norepi in the skin causes vasoconstriction local tissue necrosis b. Calcium Gluconate administered in severe hypocalcemia c. Heparin given in thrombosis situation d. Phentolamine Alpha receptor blocker vasodilation 46. 64 yr old comes for tx for exertional angina. He is prescribed aspirin but that causes shortness of breath. What is the alternative tx for angina? a. You want to decrease platelet aggregation Clopidogrel Blocks ADP receptors, which are required for platelet activation 47. 64 yr old pt with stable angina currently taking atenolol and aspirin. Complains of worsening symptoms and now doc added another drugs. Shows up in ER with BP 100/70 and HR of 38 beats/min/. Which drug was added a. Note that HR has dropped HR dependent on SA node & Ca verapamil blocks Ca decrease HR additive effect with B-blocker (atenolol) 48. Pt has HTN and diabetes. Niacin is added for hyperlipidemia. What adjustment to the current drugs need to be made ID 162

49. Which nitrate has largest bioavailabilty ID 139 50. Pt with restrictive Cardiomyopathy. What physical sign would most likely be detected during physical examination? a. Holosystolic murmur Mitral/Tricuspid Regurg b. Loud P2 seen in pulmonary HTN c. Kussmaul Sign d. S3 Heart sound volume overload Pathological in Dilated Cardiomyopathy e. Systolic Click Mitral valve prolapsed 51. In certain adults, myocytes of cardiac ventricles express mRNA from natriuretic peptides typically synthesized by the atria. This finding is associated with which of the following conditions? a. A-type Natriuretic Peptide is released from atria. B-type Natriuretic Peptide is released from ventricle. They are released when there is volume overload and to correct contractility. Hypertrophy of ventricles increased BNP increased BNP 52. 1616 What is the resistance in a parallel circuit with R1-R4 =2mm hg/mL/min. What is the total peripheral resistance 53. Cardiac Pharm ID 159 2. Nitrates causes vasodilation hypotension tachycardia increase O2 demand. What drug can you give to prevent this b. Metoprolol B-blocker Heart Physio 1. Pt who had MI now has diastolic heart sound in left lateral decubitus postion. What position will increase the sound of murmur a. Valsava and Standing up: makes mitral valve prolapsed heart sound worse because it increase TPR and causes blood to rush into the left atrium instead of the aorta b. End expiration: MI causes stiff vessels or in pt with MI decreases Contractility compensated by increasing Preload S3 heart sound. Expiration increase venous return more blood S3 c. Furosemide diuretic decreases blood volume decrease S3 d. Amy Nitrate vasodilation decrease BP decrease Venous return decrease S3

2. Patient comes in with A-fibb. Question is asking what is controlling Ventricular contraction? a. SA Node discharge rate: does not control V-contraction. SA AVventricular b. AV node refractory period: SA node impulse AV node (refractory period prevents more impulses from depolarizing AV node) 3. What controls coronary blood flow? a. Duration of diastole 4. Patient suffering from paroxysmal supraventricular tachycardia. Carotid massage decreased the HR. What is the mechanism? a. Carotid Massage increase parasymp & decrease sympathetic decrease AV node conduction 5. Dr prescribes Verapamil to pt for hypertension. Why do the drug not have an effect on the skeletal muscle? a. L-type Ca channels not present in skeletal muscle 6. A pregnant woman of 36 wks gestation loses BP when she goes from standing to lying supine. Why? a. Lying supine compresses the IVC Decrease VR Decrease Preload Decreased CO MAP= CO * TPR 7. Pt with atherosclerotic lesion. Drug is given, which causes redistribution of blood flow away from ischemic area myocardial ischemia. What effect does drug have a. Ischemia overtime collateral circulation further growth of plaque arteriolar dilation drug administered vasodilation of all coronary vessel decrease blood flow through collateral myocardial ischemia 8. Pt with Tetralogy of Fallot squats. How does squatting help the patient

9. Pt Korotkoff sounds audible only during expiration. Why? a. Pulsus Paradoxus decrease in BP during Inspiration sounds audible in expiration and then in all respiratory cycle(normally) cardiac tamponade decrease expansion bulging into LV decrease end diastolic volume decrease Stroke Volume decrease CO decrease BP

10. 2100- Pt with prolonged expiration and prominent bilateral wheezes. What will relieve the symptoms? a. Asthma prolonged expiration & bilateral wheezing Gs protein coupled receptor that activated adenylyl cyclase increases cAMP 11. 58 yr old pt with hypokinesia of left ventricle w/reduced ejection fraction. Coronary bypass improves his symptoms and hypokinesia is no longer present and Ejection fraction is now 50% from 35%. This phenomenon is called? a. Ischemic pre-conditioning: repetitive infarcts myocytes develops resistance protection from greater ischemic insults b. Myocardial Stunning: brief ischemic episodes <30minutes. reversible effects. This pt has had it for longer period c. **Hibernating myocardium **: repetitive ischemica reversible loss of contractile function = hibernation 12. 72 yr old pt suffering from long term SOB, recent episode of syncope. Pt is diagnosed with aortic stenosis, pulmonary edema, A-fib with irregular irregular rhythm. NO St segment change. What is causing the patients symptoms of SOB, syncope. a. A-fibb & Aortic Stenosis **Sudden decrease in Left ventricle preload** decrease COsyncope & SOB 13. 1882. Pt suffered from Ischemia myocardial cells increase in size. Why does it happen? a. No O2 No ATP Na/K ATP pump shutdown & Sarcoplasmic Reticulum Ca ATPase fails High Intracelluar Na & Ca & High Extracellular K 14. 23 yr has MAP of 93mm/Hg and when exercising his MAP is 115 mm Hg. A decrease in what causes his increase in MAP. a. Decreasing Systemic vascular resistance

15. 23 yr old runs 5 miles. What do you expect to increase a. Arterial O2 and CO2 and pH are maintained Venous circulation CO2 content body extracts more O2 and produces more CO2 because of increase metabolism

Behavior

1. 54 year old diabetic male who is non-compliant to diabetic tx is avoiding or coming late to doctors appointment. Which defense mechanism is he expressing a. Acting out: means person expressing by action b. Isolation: separating emotions from ideas or events c. Passive aggressive: expressing behavior towards other by passively refusing to meet them. 2. Maternity Blue Lasts 10-14 days Maternity blues Lasts 10-14 days No hallucination, tearful

Post partum Depression Lasts 2wks to 1 yr Depression, anxiety

Postpartum psychosis Lasts 4-6wks Hallucination, confusion

3. Pt age 21 presents with parotitis and eroded enamel. a. Bulimia Nervosa binge eating and vomiting causes tooth enamel erosion and parotitis 4. Pt is 18 year old, freshmen in college. Stop going to class for 2 months is found talking when no one is there. Spends time alone, not seeing his friends a. Brief Psychotic Disorder lasts for < 1 month b. **Schizophreniform has all of the symptoms of schizophrenia but only difference is time 1-6 months Schizophrenia is > 6 months 5. Patients who are intoxicated and require medical attention. What do you do? You cannot leave medical care until you are sober

6. Stop treating me like a child. My father treated me like a child for years and Ive never been confident because of that a. Displacement: shifting feeling and behavior from one person or thing to another another. For example, resident belittles intern. Intern belittles medical student b. **Transference**: reminds you of someone. Patient states that the therapist reminds him of his father. 7. Interview Techniques: Facilitation: encouraging patient to talk more then what happened Empathy: understanding patients difficulties I can imagine how the abuse has changed your perspective on life Reflection: repeating what the patient tell the doctor so you are telling me that you were sexually molested

Confrontation: therapist draws the patients attention to discrepancies in her response although youre telling me that you were disturbed by this trauma, you sound unaffected as youre describing it Support: acknowledging that sexual abuse has been difficult Yes, he really hurt you 8. 23 yr old woman complain of severe leg pain after fianc broke up 3 days ago. Everything else is normal a. Somatization Disorder: Multiple organ Disorder (4 pain, 2 GI, 1 sexual, 1 pseudoneurologic) b. **Conversion**: sudden loss of sensory after stressor 9. Pt with MI is worried of dying. He asking you to pray from him. You two belong to different faiths. What do you say. a. I understand that your beliefs are very important, and I will keep you in my thoughts Immunology 1. Pat presents with cough, night sweats, weighloss. TB. Presence of apical granuloma with central caseous necrosis. Epitheloid cell present. What is the CD Marker present. a. Caseous necrosis seen in Mycobacterium & Fungal infection b. Apical Granuloma 2nd TB Reactivation c. Middle lobe primary TB d. Macrophages epitheloid cells granuloma e. CD 14: CD marker on macrophages 2. T-lymphocytes undergo very high affinity interaction with MHC molecule. Which process will the lymphocyte will now undergo. a. Positive selection: normal affinity b. High Affinity Negative Selection Apoptosis c. Affinity Maturation: is the process of changing Hypervariable region where antigen binds 3. 5 month old patient with low T-cell and low Ig. Failure to thrive. What enzyme should be added? a. Adenine deaminase: adenine deficiencyincreased B & T cell toxicity B & T cell death

4. 43 yr old male presents with muscle weakness in hips and shoulders. Difficulty rising from chairs and combing hair. MHC-I has overexpression of CD8 a. Polymyalgia rheumatica: pain and stiffness in shoulders and hips. No Muscle weakness b. Eaton-Lambert Syndrome: paraneoplastic syndrome AB against Ca Channels decrease Ca release muscles weakness improves with use c. Polymyositis increase MHC I CD8 weakness of hips and shoulder muscles difficulty combing hair 5. Patient with soar throat, anterior and posterior cervical lympadenopathy and splenomegaly. Peripheral smear shows atypical lymphocytes. What are these atypical lymphochytes a. CD 8 + Lymphocytes: EBV infects B-cell intracellular activates CD 8+ lymphocytes 6. 6 month old infant with 1. Otitis Media, 2. chronic diarrhea 3. Failure to thrive 4. Bilateral interstitial opacities 5. Pneumocystis seen on silver stain What is the diagnosis? MCC of Otitis media 1. Strep Pneumo 2. H. influenza 3. Moraxella Agammaglobulinemia: is B-cell defect Recurrent bacterial infections No fungal infections B/c T-cells normal Phaygocytic Defect causes cutaneous abscesses Complement Defect recurrent niessiera infections C5-C9 def Combined ImmunoDef B & T cell defect Bacterial and fungal infections 7. Candida antigen injected into skin of pt with no response. Same done to her mother and created a skin response. What is caused this response in the pts mother? Cell-mediated immunity delayer hypersensitivity Macrophages, CD4 & CD8 responds in cell mediated immunity B-cell are responsible in humoral immunity 8. Functions of Interleukins:

1. IL-1 -promotes Helper T-cells to proliferate 2. IL-3 - promotes growth and differentiation of stem cells 3. IFN-Y- activates macrophages and CD8 cells 4. TGF-B involved in tissue regeneration

9. What promotes non-caseous necrosis in sarcoidosis (name cells and IL) 1. Th-1 Helper cells 2. IFN-Y 3. IL-2

Hematology 1. 469. 23 yr old Pt with pink spider like lesions on oral, nasal mucosa, face and arm and recurrent nose bleeds. Pt suffers from? Von Recklinghausen Dz aka neurofibromatosis type 1 (NF-1) Von Hippel landau Dz retinal hemangioblastoma, kidney,liver, pancrea cyst increase risk of Renal Cell CA Tuberous Sclerosis angiofibromas, visceral cyst, hamartomas, renal angiomyolipomas, cardiac rhabdomyomas **Osler Weber Rendu Syndrome skin and mucoas telangiectasias recurrent severe nosebleeds 2. 5 yr old w/ fever, headache and confusion. Previous Hx of severe penicillin allergic reaction. What drug caused here this problem a. Clindamycin pseudomembranous colitis b. Gentamicin ototoxicity and neurotoxicity c. Metronidazole GI discomfort d. Vancomycin red man syndrome e. Chloramphenicol aplastic anemia

3. 891. Pt with recurrent jaundice, pallor, icterus and splenomegaly. Low Hb, Elevated Lactate dehydrogenase and bilirubin. Lysis of RBC when place in hypotonic solution a. Hypotonic Solution Osmotic Fragility test + Spherocytosis lysis increase risk of pigmented gallstone 4. 1626. 30 yr old male pt complaining of fever, night sweats, and weight loss. Cervical lymphadenopathy noted. Picture of Reed Sternberg cells. What is the Dx a. Burkitts abdominal, cervical or jaw mass Starry Sky Appearance b. Tuberculosis same symptoms caseating granuloma c. Large B cell lymphoma diffuse sheet of large lymphocytes with nuclei . No Reed Sternberg cells d. Multiple Myeloma plasma cell dyscrasia mature and immature plasma cell proliferation osteolytic leason 5. 830. 54 yr old with megaloblastic anemia and ataxia given radio-labeled B12 and IV unlabeled B12. Urine excretion is 16%. What is the likely cause? a. Unlabeled B12 attached to liver receptors prevents radio-labeled B12 from binding increases urinary excretion Dietary B12 Def b. Pernicious Anemia no absorption into blood no excretion in urine (urine excretion <5%) 6. 34 yr old with blue lesion under the finger nails of index finger, which are tender to touch. If lesion is tumor what is the origin Glomous tumor 7. 1941. Pt with obstruction sleep apnea has hematocrit of 57%. Decease O2 delivery to which organ is causing the increase in hematocrit level. Kidney. Bone Marrow: EPO release from kidneys goes to the bone marrow 8. 24 yr old female who fetus died. Spontaneous expulsion is performed. What factor should be monitored to see if DIC is occurring? D-Dimer is not on the list Fibrinogen is being consumed to make fibrin microthrombi schistocytes increased PTT and PT 9. Warfarin induces skin necrosis . What caused the lesion Vit K is needed to Factors 10, 9, 7 & 2 C & S warfarin inhibits epoxide reductase Vit cant recycle bleeding not clotting

AT III targeted by Heparin Decrease Prothrombin to Thrombin decreases Clot formation Protein C Deficiency Wafarin inhibits 10,9,7, 2 C& S people with some Protein C deficiency now get more have severe Protein C deficiency Protein C normal inactivates Factor 5 and 8 leads to thrombosis in skin 10. Pt suffering from MI is giving enoxaparin. What is the MOA of enoxaprin? Enoxaprin is a low molecular heparin binds AT III 11. Pt suffering from SOB, tachypnea and pleuritic chest pain. V/Q mismatch in lower lobe of right lung. PE PE give anticoagulant Warfarin long term management blocks glutamate residue carboxylation Binds tightly to antithrombin Heparin used in acute condition Pulmonary Path 1. How to calculate reid index Mucous gland thickness/ Total thickness (dont include cartilage)

Biochem 1. Pt w/Xeroderma pigmentosum. What is non-functional? 3-5 exonuclease used in DNA repair Absence of Endonuclease causes Xeroderma pigmentosum 2. Pt with Cystic fibrosis. What abnormality is seen in the patient Cystic fibrosis Phenylalanine deletion degradation of protein before it reaches cell surface Abrnomal trafficking of a transmembrane protein **Channel is cAMP mediated using ATP** imp fact

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