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Functions of respiratory system -gas exchange, host defense, metabolic organ

2. Lung demonstrate a functional unity similar to -kidney
3. Part of upper airway
- -nose, sinuses, larynx, nasal cavity, posterior pharynx, glottis, vocal cords
- -nose to vocal cords

4. Part of lower airway

- -trachea, bronchi, nonrespiratory bronchioles, respiratory bronchioles, alveoli
- -trachea to alveoli

5. Functions of upper airway

- -condition inspired air at room temp 37°C
- -moisten or warm the inspired air
- -humidify air
- -nose: filter, entrap, clear particles >10ųm, sense of smell

6. Air in the lungs -pnuemothorax

7. Fluid in the lungs -pleural effusion

8. Associated with an increase in airway resistance, presented by a combination of either increased mucus, airway
inflammation, and smooth muscle constriction
- emphysema c. respiratory lung disease
- status asthmaticus d. all of the above

9. Exchanging unit of the respiratory airway

- respiratory bronchioles c. tracheal bronchi
- alveoli d. none of the above

10. Synthesizes pulmonary surfactant

- -type II cells

11. Major structural component of the lung that limits distensibility

- -collagen

12. Major contributor to elastic recoil of the lung

- -elastin

13. Gives nourishment to the lung parenchyma

- -bronchial circulation

14. Effects of stimulating parasymapthetic system

- -bronchial constriction
- -blood vessel dilation
- -increase glandular secretion

15. Major muscle of respiration -diaphragm

16. Provides an "anti-stick" function that decreases surface tension -surfactant
17. Major surface-active component in surfactant
- -dipalmitoylphosphatidylcholine (DPPC)
- -major phospholipid is phosphatidylcholine which is 75% of DPPC

18. Total volume of exhaled air, from a maximal inspiration to a maximal exhalation -vital capacity
19. Volume of air in the lung at the end of exhalation during quiet breathing -functional residual capacity
20. Distinguish different types of pulmonary disease -RV/TLC ratio
21. Volume of gas that is moved per unit of time -minute ventilation

22. A. food and water contamination B. blood inoculation


23. Shed in the stool for 2-3 weeks before and 1 week after the onset of jaundice- HAV
24. IV drug use- HCV
25. Superinfection of a chronic carrier of HBV with a new inoculum of HDV- HDV
26. Enterically transmitted; endemic in india- HEV
27. Transmitted vertically- HBV

28. nucleocapsid core protein- HBcAg

29. precore protein- HBeAg
30. envelope glycoprotein- HBsAg
31. transcriptional transactibator- HBV-X protein

32. HBeAg positive, high levels of HBV DNA (1billion IU/ml), normal serum aminotransferases, low risk of liver damage-
Immune tolerance
33. Fluctuating ALT, variable levels of HBV DNA- Immune active/ Immune clearance
34. Llow HBV DNA, HB eAb positive, normal liver function test; resolution- Immune control
35. Presence of HBeAb, high HBV DNA, liver damage may again occur- Immune reactivation/ Immune escapes
36. acetaldehyde and acetic acid- Ethanol
37. glycol-aldehyde, glycolic acid, glyoxylic acid- Ethylene glycol
38. formaldehyde, formic acid- Methanol
39. acetone- Isopropyl alcohol
40. massive intake of solute free fluid- hyponatremia
41. gastric losses, leaky membranes, shifts from extracellular to intracellular- hypokalemia
42. increased cellular uptake- hypophosphatemia
43. phosphorus deficiency- hypomagnesemia
44. extrahepatic biliary atresia; idiopathic sepsis- Neonatal cholestasis
45. prominent activated Kupffer cells and mild portal inflammation- Cholestasis of Sepsis
46. interlobular bile ducts actively destroyed by lymphocytic or plasmacytic inflammation; florid duct lesion - Primary biliary
47. largest ducts- chronic inflammation; scarring- Primary sclerosing cholangitis

48. Mechanism of injury excessive iron

49. lipid peroxidation by iron catalyzed free radical reactions
50. stimulation of collagen formation
51. direct irreversible oxidative damage of iron to DNA

52. Mechanism of injury excessive copper

53. promoting the formation of free radicals
54. binding to sulfhydryl groups of cellular proteins
55. displacing other metals in hepatic metalloenzymes

56. Relatively small at the time of diagnosis- extrahepatic biliary tumors

57. Jaundice, acholic stools, nausea and vomiting and weight loss from biliary obstruction- extrahepatic biliary tumors
58. May cause symptoms only when much of the liver is replaced by tumor- intrahepatic biliary tumor
59. Nonspecific signs and symptoms such as weight loss, pain, anorexia, and ascites- intrahepatic biliary tumor

60. Hereditary hemochromatosis (decreasing order of severity)

liver- A
pancreas- B
heart- C
skin- D
joint synovial linings- E

61. Pathogenesis of hirschsprung disease

62. heterozygous loss of function mutations in receptor tyrosine kinase RET gene
63. normal migration of neural crest cells from cecum ro rectum disrupted
64. lack of meissner submucosal plexus and auerbach myenteric plexus
65. absent coordinated persitaltic contractions
66. bowel dilation proximal to the affected segment

67. Salient features of autoimmune hepatitis except

68. female predominance 70%
69. absence of serologic evidence of viral infection
70. presence of other forms of autoimmune disease - elevated serum IgM

71. Negative result for HBsAg may occur in the ff:

72. no infection
73. Immunization
74. core window period
75. A and C
76. ALL

77. Hepatic artery obstruction- impaired blood flow into the liver
78. Peritoneal sepsis- impaired blood flow into the liver
79. Banti syndrome- impaired blood flow into the liver
80. Cirrhosis most common intrahepatic cause of portal blood flow- impaired blood flow through the liver
81. Passive congestion- impaired blood flow through the liver
82. Hepatic vein thrombosis (budd-chiari syndrome)- hepatic vein outflow obstruction
83. Sinusoidal obstruction syndrome- hepatic vein outflow obstruction
84. Isoniazid- mimicking chronic viral hepatitis
85. Minocyclin- autoimmune-like hepatitis
86. Steatosis- total parenteral nutrition
87. Reye syndrome- aspirin

88. Type 1 DM
89. massive autoimmune attack of the B cells of the pancreas
90. ketoacidosis is common
91. absolute deficiency of insulin

92. Type 2 DM
93. dysfunctional B cells and insulin resistance
94. responsive to oral hypoglycemic drugs
95. inability of B cells to produce appropriate quantities of insulin

96. Which of the following is a characteristic of chronic hepatitis.

A. T cell immunity
- B.) Wrinkled baggy capsule
- C.)Widespread scarring
- D.) Muddy red mushy

97. Which of the ff. Is NOT the Characteristic of Pancreatic Carcinoma?

- a.)60% part of the body
- b.)highly invasive
- c.)Trousseau syndrome
- d.) Serum Carcinoembryonic and CA19-9 antigen.

98. Acute cholecystitis - enlarged & tense; bright red or blotchy, violaceous color
99. Chronic cholecystitis - may be contracted, submucosa and serosa thickened from fibrosis
100. Gangrenous cholecystitis - wall thickened, edematous and hyperemic into a green-black necrotic organ
101. Empyema of gallbladder - contained exudate is mostly pus
102. Trace the probable pathogenesis of acute pancreatitis
103. obstruction and increase intraductal pressure
104. lipase secretion
105. local fat necrosis; injures periacinar myofibroblasts
106. leaky microvasculature
107. ischemic injury to acinar cells

108. Meconium Ileus

- absence of epithelial cystic fibrosis transmembrane conductance regulator (CFTR gene)
- defects in intestinal and pancreatic ductal chloride ion secretion
- interference with bicarbonate, sodium, and water secretion
- pancreatic intaductal concretions
- autodigestion

109. Vasovagal syncope has prodrome of nausea, diaphoresis, and pallor triggered by fear and unpleasant event

- True

110. Headache localized to the back of head, relieved by relaxation

111. Cause of tension headache
112. Headache only in 1 lobe only, throbbing less than a day
113. Recommendation for tension headache
- Go to a dark room and relax
114. "Worst of my life"
- Subarachnoid hemorrhage
115. All of the following questions are about to ask in proximal weaknesses ,except
- Tingling like "pins and needles" sensation
116. All of the following can cause dermatomal sensory loss except
- Cubital Tunnel Syndrome
117. All of the following questions are needed to ask if the patient has loss consciousness except.
A.Does the patient has a history of pulmonary disease?

118. primary headache includes tension headache, migraine and trigeminal autonomic cephalgia

- True
119. vestibular disease
- Inner ear
120. proximal weakness
- difficulty with movements such as combing hair, reaching up to shelf, getting up out of a chair or climbing
121. vasovagal syncope
- prodome of nausea, diaphoresis, and pallor triggered by a fearful or unpleasant event
122. epilepsy, except
- 60-70% of affected patients brain tumor
123. toni-clonic motor activity
- bowel or bowel incontinence, postictal state characterize generalize seizures. tongue biting or bruisibg of limbs.
m.c, in infants and older adults

124. Important component of temporal lobe- Hippocampus, Amygdala, Lower optic radiation
125. Travels up the dorsal column or the spinothalamic tract into the brain stem- Afferent pathway
126. Motor tracts except- exit via dorsal nerve root
127. Afferent pathway except- reflex
128. Correct paired cranial nerves except- T11
129. Makes up the brachial plexus- C5-T1
130. Bulbar palsy is lower motor neuron lesions- true
131. Frontal lobe except - GAIT (other choices: executive function, decision making, restraint of emotions)
133. Postcentral gyrus – SENSORY
134. Functions of parietal lobe except - visual awareness
135. Functions of temporal lobe except – speech
136. Components of temporal lobe except - broca's area
137. Describe, differentiate, functional, Upper motor neurons
138. Components of basal ganglia- Thalamus
139. A key regulator of homeostasis via autonomic and neuroendocrine system- C.Hypothalamus
140. Brain stem consist of except- Diencephalon
141. Lewy bodies-
142. Parkinsons Disease
143. Neurofibrillary tangle- Tau protein
144. No sensory defect- Amyotrophic Lateral Sclerosis
145. Pseudobulbar palsy caused by UMN lesion- TRUE/FALSE
146. Bulbar palsy caused by LMN- TRUE/FALSE
147. Muscle contraction caused by LMN signaled by UMN- TRUE/FALSE

148. Rupturing of bridge veins in formation of epidural hematoma- False

149. Disruption of middle meningeal artery in ASH - False
150. Chronic subdural hematoma is a collection of blood breakdown product that at least 2 to 3 weeks old- True
151. Subarachnoid- meningitis
152. Diagnostic test for brain abscess- CT scan (rapid, precise)

153. Counteract cortisol anti-inflammatory effect - vitamin a

154. Aldosterone stimulation, except - increase intravascular volume.
155. Hyperaldosteronism except - increase plasma acidity
156. Increase vasodilation- Beta 2 -adrenergic receptors
157. Decrease mucosal edema- Alpha -1 receptors
158. Increase vasoconstriction- Alpha -1 receptors
159. Pregnenolone. Steroid
160. Immunosuppresive effect of cortisol
161. Acetylcholine inhibit release of.
162. Sex hormones - anterior pituitary regulation
163. Glucagon - renin-angiotensin system
164. Enkephalins - renin-angiotensin systems
165. Aldosterone - Autonomic
166. Somatostatin - Anterior pituitary
167. Increase gluconeogenesis- Beta 2

168. Anterior of right adrenal

- Inferior vena cava
169. Innervations
- Greater splanchnic nerve
170. Location of adrenal gland
- Atop the kidney
171. The adrenal cortex releases what 3 main hormones
- Aldosterone, cortisol, androgen
172. Adrenal medulla produces what hormones
- Epinephrine, norepinephrine
173. Which part of the adrenal gland releases epinephrine and norepinephrine in response to stress
- Adrenal medulla
174. Venous drainage of the left adrenal gland
- Left renal vein
175. Mesodermal component
- Adrenal cortex
176. Innervations of adrenal medulla
- Postganglionic sympathetic neurons
177. Zona glomerulosa
- Aldosterone
178. Zones of adrenal cortex
- Zona glomerulosa, zona fasiculata, zona reticularis

179. Acute abdomen/ surgical abdomen

- Direct/ Rebound tenderness
180. Pain underneath the diaphragm felt at the tip of the shoulder
- Kehr sign
181. Promotes increased stomach motility
- Gastrin
182. Activated macrophages
- Interferon, TNF, Interleukin
183. Type of pain wherein pathway is through autonomic c type fibers, poorly localized, cramping and gnawing abdominal
- Visceral

184. Unreferred visceral pain located in the foregut

- 2 portion of the duodenum

185. Absent bowel sound in a minute, except

- Ileus
- Hypermagnesemia
- Mesenteric thrombosis
- Narcotic overdose

186. Compute for VLDL: Triglycerides= 450mg/dl

- 90
187. Isoenzyme directly seen in acute myocardial infarction
- CPK 2 (if troponin I is one of the choices then it’s the answer)
188. LDH seen in the liver and mucles
- LDH 5
189. Excellent marker for early heart failure
- BNP (B-type Natriuretic Peptide)
190. Cardiospecific marker
- Troponin I
191. First marker to elevate in AMI
- CPK (if troponin I is one of the choices then it’s the answer)
192. A component of Beck’s Triad
- Muffled heart sounds (systemic hypotension, elevated systemic venous pressure)
193. Pulsus paradoxus is exaggerated increase of systolic pressure during inspiration
- True
194. Decrease pressure in pulsus paradoxus
- At least 10mmHg
195. Cause of acute cardiac tamponade within minutes
- Aortic aneurysm
196. Causes of pericardial effusion
- -all of the above (hypothyroidism, cancer, chemotherapy)
197. Highest density cholesterol
198. Lowest density cholesterol
- Chylomicrons
199. Origin of LDL
200. Reverse cholesterol transport
201. Best way in performing pericardiocentesis
- Ultrasound guided

202. Best done to pericardial effusion

- Pericardiocentesis
203. Man stabbed. Presents with beck’s triad
- Immediate cardiac surgery
204. Lipoprotein A
205. Contraindication for pericardiocentesis
- -none (options were: trauma, myocardial infarction, aortic dissection)

206. Pericardial effusion is the accumulation of a type of fluid in the pericardium of the heart
- True
207. Cardiac tamponade can cause a decrease in
- Cardiac output
208. Probable cause of myedema
- Hypothyroidism

46 year old female with a history of metastatic adenocarcinoma of the breast. 3 days increasing dyspnea with exertion
and generalized weakness. She denies of chest pain, cough/ congestion, any fever/chills. She is currently between
chemotherapeutic courses. Not currently undergoing radiation treatment. She presents awake/alert, not in respiratory
distress while at rest. T 97.7 P 105 BP 110/80 RR 20.
- Gen: WDWn, thin
- CV: tachycardia, RR
- Pulm: lungs clear bilateral, chest wall shows left sided mastectomy
- Neck: no JVD, trachea midline
- Abd: soft, non tender
- Ext: warm, no cyanosis, no edema

209. Possible diagnosis

- Acute pericardial effusion

210. Plasma lipids that is used in diagnosing and management of lipoprotein disorders
- Cholesterol and Triglycerides
211. What is the predominant lipid after taking the blood sample of a 25 year old male who had just binge eating:
Triglycerides= 260 mg/dl, Cholesterol= 136 mg/dl
- Chylomicrons

212. What is your intervention in the situation above

- No treatment
213. A 10 year old boy complains of swollen arms, legs, face and abdomen seen in his pediatrician. His urone is positive for
protein. What is the clinical disease and its etiology
- Nil’s disease
214. Give the best management
- Corticosteroids
215. What glomerular disease best describe “tram tracking” characteristics
- Membranoproliferative glomerulonephropathy
216. Superior edge of pubic symphisis when bladder is empty
- Apex
217. Longer renal vein drains into
- Inferior vena cava

218. Only surface is covered by peritoneum

- Superior surface of the bladder

219. CASE—just read about the two options below

220. MPGN or membranous (not sure)
221. Most common cause of no. 7
222. How many % will progress to ESRD
223. Microscopic findings of no. 7

224. 38 years old hypertensive. What is your impression

225. What is the percentage of progression to ESRD
- 50%
226. Other exam for diagnosis of post streptococcus
227. 25 years recurrent ketoacidosis
- Wilson disease
228. 22 years old mild respiratory infunction with hematuria
- Berger disease
229. Timed urine examination to assess kidney function
- Creatine clearance

230. Noninvasive procedure to identify bladder volume

- Invasive procedure to determine abnormalities of the renal gland
231. This finding is consistent with chronic glomerulonephritis
232. Hallmark renal findings in patients with diabetes mellitus
233. The best treatment for intestinal nephritis

234. Percent of children who recover from post strep

- 80%
235. Cellularity of post strep
- Hypercellular

236. Athlete patient

- Hypertrophic cardiomyopathy
237. Morphology
- Asymmetric septal hypertrophy
238. IV drug user. Diagnosis
- Infective endocarditis
239. Findings
- Mitral and vegetations
240. Test
- Blood culture

241. Marker for acute rheumatic fever

242. Mechanism of pathogenicity

243. Organism most likely seen in the throat swab culture

- Strep viridians

244. 56 year old woman having exertional dyspnea, having 74 bpm, 15cpm, history of cancer. What is your impression
- Restrictive cardiomyopathy
245. Mechanism
- Dysfunction of diastolic filling
246. Morphological characteristic
- Assymetrical hypertrophy
247. 20 year old male rushed to the hospital having difficulty of breathing. Died after 10 minutes with failed resuscitation.
History if iv drug use. What is your impression
- Acute infective endocarditis
248. Soldiers plaque
- Chronic
249. 4 genes coding protein
- Hyper
250. Etiologic agent for caseous
- M. tuberculosis
251. Not likely true about cardiac myxoma
- More commonly seen in left atrium? more commonly seen in the ventricles?
252. Most characteristic lesion in acute rheumatic fever
- Aschoff bodies? MacCallum plaques?
253. Characteristics of “fishmouth/button hole”
- Chronic rheumatic heart disease
254. 20% defect spontaneously in first year of life
255. Most occurring congenital type
256. Common TOF
257. Changes associated with BUO, except
- Inc RBF approx 90 mins
258. Ureteral and tubular pressure are inc for the first 4-5 hours
- Little early vasodialation is seen
259. All
260. None

261. Renal radiograph, exceot

- Film of abdomen

262. Can cause hydronephrosis, except

- Urolithiasis
263. Pregnancy
264. Bladder obstruction
265. UTI
266. None

267. Calculi seen on CT scan, except

- Indinavir

268. Symptoms least specific for bladder outflow obstruction

- Frequency
- Nocturia
- Terminal dribbling
- Decreasing urine stream

269. Factors risk for kidney stone, except

- Overhydration

270. True about post obstructive dieresis

271. True about hypertension

272. Common location of sinusitis in a 23 year old medical student - maxillary sinus
273. patient with bronchial asthma- resorption atelectasis
274. cigarette smoker with excessive pleural adhesion- compression atelectasi????
275. tension pneumothorax- compression atelectasis
276. aspiration of foreign material- resorption atelectasis

277. Synthesis of surfactant begins at?

- 28 weeks AOG. c. 40 weeks AOG
- 25 weeks AOG. d. 36 weeks AOG
278. True about surfactant
- a. produced by type 1 pneumocyte c. decreased in maternal diabetes
- b. increased in cesarean section. d. phospatidyl inositol is the major component

279. Chest radiograph shows "ground glass" appearance - RDS

280. ARDS with no known etiology - Acute interstitial pneumonia

281. True about the pathophysiology of bronchial asthma - lipoxgenase pathway produces leukotrienes
282. Curschman spirals are - whorls of sloughed epithelium

283. Proper way to measure patient’s waist circumference

- with patient sitting down, measure the waist just above the hip bones
- with patient standing, measure the waist just above the hip bone
- excess body fat if waist measures 40 inches in women
- excess body fat if waist measures 35 inches in men

284. Ways to decrease the risk of having hypertension

- regular exercise
- decrease sodium intake
- decrease potassium intake
- both a and b

285. Rapid changes in weight over a few days, suggest changes in body - fluids

286. Mechanisms of weight loss

- decrease food intake
- proper nutrition
- defective nutrient absorption in genito-urinary tract
- decrease metabolic requirements

287. Sense of weariness or loss of energy - fatigue

288. Fatigue is a common symptom of what infection - hepatitis
289. Weight loss with relatively high food intake suggests - diabetes mellitus

290. Normal RDA of salt in the body. 2300mg

- 2000mg
- 2200mg
- 2400mg
- 2600mg
291. Short stature
- Chondrochurva Dwarfism
- Marfan syndrome
- Turner syndrome

292. Long limbs - Marfan syndrome