EOs PDF

QID Topic Educational Objective System Subject Repeats
1 Poststreptococcal PSGN presents most commonly in children w/ hematuria, HTN, and periorbital oedema. RBC casts and mild proteinuria may be present on UA, and serum creatinine may be ↑. Renal, Urinary & Electrolytes Pathology (Path) 8
glomerulonephritis (RE) RE Path
2 Congenital anomalies of kidney In horseshoe kidney, the kidneys are fused at the poles. The isthmus of the horseshoe kidney usually lies anterior to the aorta and posterior to the inferior mesenteric artery (IMA). During fetal Renal, Urinary & Electrolytes Anatomy (Anat) 3
and urinary tract development, the IMA limits the ascent of the horseshoe kidney. (RE) RE Anat
3 Polycystic kidney disease ADPKD is caused by muts in the polycystin genes (PKD1, PKD2), which result in cystic enlargement of the kidneys and progr renal dysfxn. CFx incl HTN, abdo/flank pain, and gross hematuria; Renal, Urinary & Electrolytes Pathology (Path) 3
extrarenal MFxs incl liver cysts and intracranial aneurysms. (RE) RE Path
4 Subarachnoid hemorrhage Intracranial BAs of the COW are often seen in pts w/ ADPKD; when ruptured, they cause SAH that presents w/ sudden onset of 'thunderclap h/a'. Nervous (NS) Pathology (Path) 4 NS Path
6 Tuberous sclerosis Renal angiomyolipoma is a benign tumor composed of blood vessels, smooth muscle, and fat. Bilateral renal angiomyolipomas are associated with tuberous sclerosis, an autosomal dominant condition. Miscellaneous (Multisystem) Pathology (Path) 1
(MS) MS Path
7 Anti GBM disease Goodpasture syndrome is caused by auto-Abs against the α 3 chain of type IV collagen in GBM and ABMs (anti-GBM Abs). Pts typically present w/ RPGN (nephritic syndrome) and alveolar hemorrhage Renal, Urinary & Electrolytes Pathology (Path) 2
(SOB, hemoptysis). (RE) RE Path
8 Poststreptococcal Poststreptococcal glomerulonephritis is most common in children and presents with nephritic syndrome (eg, renal failure, hypertension, hematuria with red blood cell casts) 2-4 weeks after an infection Renal, Urinary & Electrolytes Histology (Hist) 8
glomerulonephritis with group A β-hemolytic Streptococcus. Immunofluorescence microscopy shows granular deposits of IgG, IgM, and C3 in the mesangium and basement membranes. (RE) RE Hist
9 Anti GBM disease Anti-glomerular basement membrane (GBM) antibodies react with collagen type IV, causing rapidly progressive glomerulonephritis with glomerular crescent formation on light microscopy. Renal, Urinary & Electrolytes Histology (Hist) 2
Immunofluorescence demonstrating linear deposits of IgG and C3 along the GBM is characteristic. (RE) RE Hist
10 Glomerular disorders IgA nephropathy (Berger disease) freq presents as recurrent, self-limited, painless hematuria w/i 5 days of an URI. Kidney biopsy will show mesangial IgA deposits on IF. In contrast, PSGN is seen 1- Renal, Urinary & Electrolytes Pathology (Path) 9
3wks after streptococcal pharyngitis and is usually not recurrent. (RE) RE Path
11 Poststreptococcal PSGN is an IC-deposition disease that occurs 2-4wks after exposure to GAS (β-hemolytic) species (e.g. pharyngitis, skin infection). LM shows enlarged, hypercellular glomeruli. IF demonstrates a Renal, Urinary & Electrolytes Pathology (Path) 8
glomerulonephritis 'lumpy-bumpy' granular deposits of IgG and C3 on the GBM, and subepithelial, electron-dense deposits are seen on EM. (RE) RE Path
12 Poststreptococcal PSGN is the most common cause of nephritic syndrome in children. LM demonstrates enlarged, hypercellular glomeruli. Lab findings in PSGN incl ↑ anti-streptococcal Abs (e.g. ASO, anti-DNase B) and Renal, Urinary & Electrolytes Pathology (Path) 8
glomerulonephritis ↓ C3 and total complement lvls. C4 lvls are usually normal. (RE) RE Path
13 Granulomatosis with polyangiitis Pauci-immune rapidly progressive glomerulonephritis frequently occurs as a manifestation of antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (eg, granulomatosis with polyangiitis, Renal, Urinary & Electrolytes Pathology (Path) 2
microscopic polyangiitis). It is characterized by glomerular crescent formation without immunoglobulin or complement deposits. (RE) RE Path
14 Hydrocephalus Hydrocephalus is an enlargement of the ventricles (+/- ↑ pressure) caused by either neuronal volume loss (eg, hydrocephalus ex-vacuo) or excessive CSF accumulation (due to flow obstruction or Nervous (NS) Pathology (Path) 4
impaired absorption). Neurodegenerative diseases (eg, AIDS dementia) can be a/w hydrocephalus ex-vacuo due to significant cortical atrophy, which allows the ventricles to expand while maintaining
normal pressure. NS Path
15 Hydrocephalus Symmetrical enlargement of the ventriculi is Chx of communicating hydrocephalus. Communicating hydrocephalus usually occurs 2° to dysfxn or obliteration of subarachnoid villi. This dysfxn is usually Nervous (NS) Pathology (Path) 4
a sequelae of meningeal infection (including tuberculosis meningitis) or SAH/IVH. NS Path
16 Normal pressure hydrocephalus NPH presents w/ progr gait difficulties, cognitive disturbances, and urinary incontinence. It's a form of communicating hydrocephalus characterised by ventriculomegaly w/o persistent ↑ in ICP. Brain Nervous (NS) Pathology (Path) 2
imaging reveals ventricular enlargement out of proportion to sulci enlargement. NS Path
17 Normal pressure hydrocephalus NPH occurs due to ↓ CSF absorption, resulting in ventriculomegaly w/ normal ICP. This causes stretching of the descending cortical fibers (corona radiata) from the frontal lobe and contributes to the Nervous (NS) Pathology (Path) 2
classic triad of SSx (ie, dementia, gait abnormalities, urinary incontinence). Loss of cortical inhibition of the sacral micturition center leads to urge incontinence. NS Path
18 Ischemic stroke Global cerebral ischemia is typically precipitated by systemic hypotension (e.g. cardiac arrest). The cells most susceptible to ischemia are the CA1 pyramidal neurons of the hippocampus. Other areas of Nervous (NS) Pathology (Path) 19
the brain that are damaged early in the course of global cerebral ischemia incl the cerebellar Purkinje cells and the pyramidal neurons of the neocortex. NS Path
19 Ischemic stroke Inadequate blood supply to the brain (e.g. arterial thrombosis or embolism) leads to ischemic stroke. The 1st microscopic changes are typically seen 12-24hrs after irreversible ischemic injury and incl Nervous (NS) Pathology (Path) 19
intense eosinophilic staining of the neuronal cytoplasm (red neurons) and nuclear fragmentation. NS Path
20 Ischemic stroke Microglia are the predominant cell in the necrotic area 3-7 days after the onset of ischemia and phagocytize the fragments of neurons, myelin, and necrotic debris. Nervous (NS) Pathology (Path) 19 NS Path
21 Ischemic stroke Occlusion of the MCA typically results in contralateral hemiparesis and hemisensory loss of the face and upper limb w/ relative preservation of lower limb fxn. If the occluded MCA is in the dom (usually Nervous (NS) Anatomy (Anat) 19
left) hemisphere, aphasia may also occur. NS Anat
22 Ischemic stroke Lacunar infarcts are small ischemic infarcts (<15mm in diameter) involving the deep brain structures (e.g. basal ganglia, pons) and subcortical white matter (e.g. internal capsule, corona radiata). They're Nervous (NS) Pathology (Path) 19
most often due to lipohyalinosis, microatheroma formation, and hardening/thickening of the vessel wall (HTN arteriolar sclerosis), which predisposes to thrombotic vessel occlusion. NS Path
23 Ischemic stroke Sustained cerebral hypoperfusion (eg, hypotension, shock) may cause global cerebral ischemia and watershed infarction. These watershed zones are located at the borders b/w areas perfused by the ACAs, Nervous (NS) Pathology (Path) 19
MCAs, and PCAs and typically appear as symmetric, bilateral wedge-shaped strips of necrosis over the cerebral convexity, parallel and adjacent to the interhemispheric fissure. NS Path
24 Glomerular disorders Crescent formation on LM is Dx for RPGN. Crescents consist of glomerular parietal cells, lymphocytes, and macrophages along w/ abundant fibrin deposition. Crescents eventually become fibrotic, Renal, Urinary & Electrolytes Pathology (Path) 9
disrupting glomerular fxn and causing irreversible renal injury. (RE) RE Path
25 Poststreptococcal PSGN presents w/ oedema, HTN, and hematuria after a streptococcal infection. Most children recover completely, but adult pts have a relatively poor prognosis and higher risk of chronic HTN and renal Renal, Urinary & Electrolytes Pathology (Path) 8
glomerulonephritis insufficiency. (RE) RE Path
26 Renal vein thrombosis Nephrotic syndrome is a hypercoagulable state. Sudden-onset abdominal or flank pain, hematuria, and left-sided varicoceles suggest RVT, a well-known complication of nephrotic syndrome. Loss of Hematology & Oncology (HO) Pathology (Path) 1
anticoagulant factors, especially AT-III, is responsible for the thrombotic and TE complications of nephrotic syndrome. HO Path
27 Poststreptococcal Poststreptococcal glomerulonephritis is an immune complex-mediated disease that occurs 2-4 weeks after group A β-hemolytic Streptococcus infection. Immune complexes composed of IgG, IgM, and Renal, Urinary & Electrolytes Histology (Hist) 8
glomerulonephritis C3 are deposited along the glomerular basement membrane and are visible on electron microscopy as large, dome-shaped, subepithelial, electron-dense deposits. (RE) RE Hist
28 Glomerular disorders MCD is the most common childhood nephrotic syndrome. ↑ glomerular cap permeability causes massive protein (e.g. albumin) loss in the urine. Hypoalbuminaemia ↓ plasma oncotic pressure, which Renal, Urinary & Electrolytes Pathology (Path) 9
causes a fluid shift into the interstitial space, resulting in oedema. Low oncotic pressure also triggers ↑ LP production in the liver (i.e. hyperlipidaemia). (RE) RE Path
30 Turner syndrome Aortic coarctation in a child/young adult presents with lower-extremity claudication (eg, pain and cramping with exercise), blood pressure discrepancy between the upper and lower extremities, and Cardiovascular (CV) Genetics (Gene) 8
delayed or diminished femoral pulses. Turner syndrome (45,XO) is associated with coarctation of the aorta in up to 10% of cases. CV Gene
31 Aortic coarctation Pts w/ adult-type coarctation of the aorta commonly die of HTN-assoc complications, incl LV failure, ruptured dissecting AA, and SICH. These pts are at ↑ risk for ruptured intracranial aneurysms b/c of Cardiovascular (CV) Pathology (Path) 1
the ↑ incidence of congenital BAs of the COW as well as aortic arch HTN. CV Path
32 Patent ductus arteriosus Digital clubbing and cyanosis w/o BP or pulse discrepancy are pathognomonic for a large PDA complicated by Eisenmenger syndrome (reversal of shunt flow from L-R to R-L). Severe coarctation of the Cardiovascular (CV) Pathology (Path) 4
aorta can cause lower extremity cyanosis. R-L shunting in pts w/ large septal defects and TOF results in whole-body cyanosis. CV Path
33 Bicuspid aortic valve AS is the most common complication of bicuspid AVs. Pts w/ bicuspid AVs develop clinically significant AS on average around age 50. In comparison, senile calcific stenosis of normal AVs generally Cardiovascular (CV) Pathophysiology 1
becomes SSx age >65. (Patp) CV Patp
34 DiGeorge syndrome Chromosome 22q11.2 microdeletion results in DGS (cardiac anomalies, hypoplastic or absent thymus, and hypocalcemia) and VCFS (cleft palate, cardiac anomalies, dysmorphic facies). FISH is the "gold Miscellaneous (Multisystem) Genetics (Gene) 2
standard" for detecting a microdeletion. (MS) MS Gene
35 Transposition of the great vessels An echocardiogram showing an aorta lying anterior to the pulmonary artery is diagnostic of transposition of the great arteries (TGA). This life-threatening cyanotic condition results from failure of the Cardiovascular (CV) Embryology 1
fetal aorticopulmonary septum to spiral normally during septation of the truncus arteriosus. (Embr) CV Embr
36 Atherosclerosis Stable angina pectoris results from myocardial O2 demand-supply mismatch and MFx as chest pressure, tightness, or pain that is reliably produced by exertion and relieved by rest. It most commonly Cardiovascular (CV) Pathology (Path) 8
occurs due to a fixed atherosclerotic plaque obstructing >70% of the coronary artery lumen that limits blood flow during exertion. CV Path
37 Myocardial infarction STEMI involves transmural (full-thickness) infarction of the myocardial wall, and usually results from acute atherosclerotic plaque rupture w/ the devel of overlying thrombus that fully occludes the Cardiovascular (CV) Pathology (Path) 18
coronary artery lumen. It classically presents w/ sudden-onset substernal chest pain that's not relieved by rest or short-acting nitrates. ECG demonstrates STE in the affected leads w/ subseq devel of Q
waves. CV Path
38 Vasospastic angina Prinzmetal (variant) angina is Chx by episodic, transient atks of coronary vasospasm (at rest and at night), producing temporary transmural myocardial ischemia w/ ST-segment elevation. Possible triggers Cardiovascular (CV) Pharmacology 2
are cigarette smoking, cocaine/amphetamines, and dihydroergotamine/triptans. Tx includes tobacco/Rx cessation and vasodilator Thx (eg, nitrates, CCBs). (Phar) CV Phar
39 Atherosclerosis Gradually developing myocardial ischemia encourages the formation and maturation of collateral vessels and is most likely to occur in the setting of a slow-growing, stable atherosclerotic plaque. An Cardiovascular (CV) Pathology (Path) 8
unstable atherosclerotic plaque (eg, that w/ active inflammation, a lipid-rich core, a/o a thin fibrous cap) is more likely to rupture, resulting in the abrupt onset of ischemia/infarction that precludes the
development of viable collateral vessels. CV Path
40 Myocardial infarction After the onset of severe ischemia leading to MI, early signs of coag necrosis don't become apparent on LM until 4hrs after the onset of MI. Cardiovascular (CV) Pathology (Path) 18 CV Path
42 Myocardial infarction Loss of cardiomyocyte contractility occurs w/i 60 2nds after the onset of total ischemia. When ischemia lasts less than 30 min, restoration of blood flow leads to reversible contractile dysfxn (myocardial Cardiovascular (CV) Pathophysiology 18
stunning), w/ contractility gradually returning to normal over the next several hrs to days. However, after about 30 min of total ischemia, ischemic injury becomes irreversible. (Patp) CV Patp
43 Myocardial infarction Hibernating myocardium refers to the presence of LV systolic dysfxn due to ↓ coronary blood flow at rest that's partially or completely reversible by coronary revascularisation. Cardiovascular (CV) Pathology (Path) 18 CV Path
44 Hepatitis C Genetic variations created during HCV replication result in marked variety in the Agic structure of HCV envelope proteins. The production of host Abs lags behind that of new mutant HCV strains, Infectious Diseases (ID) Microbiology 4
preventing infected individuals from mounting an effective immune response. (Micr) ID Micr
45 Hepatitis D HDV is a replication-defective RNA virus that's capable of causing infection only in the setting of coinfection w/ HBV. HBV provides HBsAg for the HDV envelope. Infectious Diseases (ID) Microbiology 2
(Micr) ID Micr
46 Hepatitis B Infants born to HBeAg-positive mothers have a high risk of acquiring perinatal hepatitis B virus (HBV) infection. Infected neonates have high levels of HBV replication and are at high risk for chronic Infectious Diseases (ID) Microbiology 14
infection, but are usually asymptomatic or have only mildly elevated liver function tests. (Micr) ID Micr
47 Hepatitis D The HBsAg of HBV must coat the HDAg of HDV before it can infect hepatocytes and multiply. Gastrointestinal & Nutrition (GI) Microbiology 2
(Micr) GI Micr
48 Hepatitis E HEV is an unenveloped, ssRNA virus spread thru the faecal-oral route. The most concerning feature of hepE infection is the high mortality rate observed in infected preg women. Infectious Diseases (ID) Microbiology 1
(Micr) ID Micr
54 Hemangioma Cavernous hemangioma is the most common benign liver tumour. Microscopically, these tumours consist of cavernous, blood-filled vascular spaces of variable size lined by a single epithelial layer. The Gastrointestinal & Nutrition (GI) Pathology (Path) 6
Bx of a suspected hemangioma is not advisable, as the procedure has been known to cause fatal hemorrhage and is of low Dx yield. GI Path
56 Hepatocellular cancer AFP is a serum tumour marker that's often moderately ↑ in pts w/ chronic viral hepatitis. However, it can be strikingly ↑ in those w/ HCC, and a sudden rise can be a sign that a pt w/ chronic liver disease Gastrointestinal & Nutrition (GI) Pathology (Path) 5
is harbouring HCC. GI Path
57 Hepatocellular cancer High lvls of dietary aflatoxin exposure is a/w a G:C → T:A transversion in codon 249 of the p53 gene, a mut thought to greatly ↑ the risk of devel HCC. Gastrointestinal & Nutrition (GI) Pathology (Path) 5 GI Path
58 Hepatocellular carcinoma Both HBV and HCV infections ↑ the risk of HCC due to chronic hepatic inflammation and cell turnover. HBV is also carcinogenic due to the production of oncogenic proteins and the insertion of the Hematology & Oncology (HO) Pathology (Path) 1
HBV genome into the host chrom. HO Path
59 Metastatic liver disease Malignant hepatic lesions most often represent mets from another 1° site (e.g. breast, lung, colon); 1° liver neoplasms (e.g. HCC) are much less common. Gastrointestinal & Nutrition (GI) Pathology (Path) 1 GI Path
60 Hepatocellular cancer Universal vaccination of children against HBV would likely cause a steep decline in the worldwide incidence of hepatocellular carcinoma. Infectious Diseases (ID) Pathology (Path) 5 ID Path
61 Echinococcosis Echinococcus granulosus is the most common cause of hydatid cysts. Spilling of cyst contents can cause anaphylactic shock. Surgical manipulation should be performed with caution. Infectious Diseases (ID) Pathophysiology 1
(Patp) ID Patp
62 Liver abscess S. aureus can cause hepatic abscesses via heme seeding of the liver. Enteric bacteria (e.g. E. coli, Klebsiella, and enterococci) can cause hepatic abscesses by asc the biliary tract (i.e. asc cholangitis), Gastrointestinal & Nutrition (GI) Microbiology 1
portal vein pyemia, or direct invasion from an adjacent area (e.g. cholecystitis). (Micr) GI Micr
63 Wernicke-Korsakoff syndrome Oculomotor dysfxn, ataxia, and confusion form the triad of WE. Most of these SSx usually resolve after vitB1 administration. Korsakoff syndrome is a complication of WE, the hallmarks of which are Nervous (NS) Pathology (Path) 5
permanent memory loss and confabulation. NS Path
64 Vitamin B12 deficiency Vit B12 defx often Px w/ megaloblastic anemia (impaired DNA synthesis) and neuro deficits (impaired myelin synthesis). Chx neuro findings include SCD of the dorsal columns and lateral corticospinal Nervous (NS) Biochemistry 9
tract. ↑ in methylmalonic acid and homocysteine lvls occur due to ↓ metabolism of these molecules. (Bioc) NS Bioc
65 Vitamin B12 deficiency Myelopathy a/w vitB12 defic is called SCD. 'combo' refers to myelin degen of both the ascending (dorsal columns) and descending (corticospinal tract) pathways. Loss of position and vibration sensation, Nervous (NS) Pathology (Path) 9
sensory ataxia, and spastic paresis are common MFxs. NS Path
66 Guillain-Barre syndrome GBS is an acute, demyelinating polyneuropathy thought to be caused by molecular mimicry. Abs formed against infectious agents cross-react w/ myelin and Schwann cells, leading to immune-mediated Nervous (NS) Pathology (Path) 3
demyelination. LM shows segmental demyelination and an endoneurial inflammatory infiltrate composed of lymphocytes and macrophages. NS Path
67 Gallstone disease Fibrate Rx (e.g. fenofibrate, gemfibrozil) inhib cholesterol 7α-hydroxylase, which catalyzes the RLS in the synthesis of BAs. The ↓ BA production results in ↓ cholesterol solubility in bile and favors the Gastrointestinal & Nutrition (GI) Biochemistry 8
formation of cholesterol gallstones. (Bioc) GI Bioc
68 Gallstones and pregnancy Estrogen-induced cholesterol hypersecretion and progesterone-induced gallbladder hypomotility are responsible for the ↑ incidence of cholelithiasis in women who are pregnant or using oral Pregnancy, Childbirth & Pathophysiology 1
contraceptives. Puerperium (PR) (Patp) PR Patp
69 Gallstone disease Black pigment stones arise from conditions that ↑ the amount of unconjugated bilirubin in bile, which promotes Ca2+ bilirubinate precipitation. This may occur in the setting of chronic hemolysis (e.g. Hematology & Oncology (HO) Pathology (Path) 8
SCA, β-thalassaemia, HS) and ↑ enterohepatic cycling of bilirubin (e.g. ileal disease). HO Path
70 Gallstone disease Brown pigment gallstones are composed of Ca salts of unconjugated bilirubin and arise 2° to bacterial or helminthic infection of the biliary tract. β-glucuronidase released by injured hepatocytes and Gastrointestinal & Nutrition (GI) Biochemistry 8
bacteria hydrolyzes bilirubin glucuronides to unconjugated bilirubin. The liver fluke Clonorchis sinensis has a high prevalence in East Asian countries and is a common cause of pigment stones. (Bioc) GI Bioc
71 Gallstone disease The gallbladder fxns to actively absorb water from bile. Gallbladder hypomotility causes the bile to become concentrated, promoting precipitation and accumulation of particulate material. This forms a Gastrointestinal & Nutrition (GI) Pathology (Path) 8
viscous biliary sludge that can cause transient BDO (biliary colic) and promote cholesterol gallstone formation. GI Path
72 Endocarditis Janeway lesions are nontender, macular, and erythematous lesions typically located on the palms and soles of pts w/ acute IE and are the result of septic embolization from valvular vegetations. Cardiovascular (CV) Pathology (Path) 15 CV Path
73 SLE CV MFx of lupus include accelerated atherosclerosis, small-vessel necrotizing vasculitis, pericarditis, and Libman-Sacks endocarditis (small, sterile vegetations on both sides of the valve). Renal Cardiovascular (CV) Pathology (Path) 7
involvement classically MFx as DPGN, which is Chx by diffuse thickening of the glomerular capillary walls w/ "wire-loop" structures on LM. CV Path
74 Carcinoid tumors Carcinoid syndrome typically presents w/ episodic flushing, secretory diarrhoea, and wheezing. It can lead to pathognomonic plaque-like deposits of fibrous tissue on the right-sided endocardium, causing Cardiovascular (CV) Pathology (Path) 4
TR and right-sided HF. ↑ 24-hr urinary 5-HIAA can confirm the Dx. CV Path
75 Dilated cardiomyopathy DCM results from direct dmg to cardiomyocytes leading to myocardial contractile dysfxn (systolic dysfxn), volume overload, and ventricular dilation. Viral myocarditis is a common cause of DCM and Cardiovascular (CV) Pathophysiology 8
should be suspected in young pts who develop HF following a SSx viral prodrome. (Patp) CV Patp
76 Hypertrophic cardiomyopathy In pts w/ HCM, dynamic LVOT obstr is due to abn systolic anterior motion of the anterior leaflet of the MV toward a hypertrophied IV septum. Cardiovascular (CV) Pathology (Path) 9 CV Path
77 Gallstone disease The absence of normal enteral stim in pts receiving TPN leads to ↓ CCK release, biliary stasis, and ↑ risk of gallstones. Resection of the ileum can also ↑ the risk of gallstones due to disruption of normal Gastrointestinal & Nutrition (GI) Pathophysiology 8
enterohepatic circulation of the BAs. (Patp) GI Patp
78 Gallstone disease ↑ chol concs ↑ the likelihood of chol precipitation and gallstone formation. High lvls of bile salts and PC ↑ chol solubility and ↓ the risk of gallstones. Gastrointestinal & Nutrition (GI) Pathophysiology 8
(Patp) GI Patp
79 Cholecystitis Acute calculous cholecystitis is an acute inflammation of the gallbladder initiated by gallstone obstruction of the cystic duct. Subsequent steps in pathogenesis include mucosal disruption by lysolecithins, Gastrointestinal & Nutrition (GI) Pathology (Path) 5
bile salt irritation of the luminal epithelium, PG release w/ transmural inflammation, gallbladder hypomotility, ↑ intraluminal pressure causing ischemia, and bacterial invasion. GI Path
80 Cholecystitis Acute cholecystitis is most often caused by gallstones obstructing the cystic duct. The diagnosis can be made by identifying signs of gallbladder inflammation (eg, wall thickening, pericholecystic fluid) Gastrointestinal & Nutrition (GI) Pathophysiology 5
on ultrasonography. When ultrasound is inconclusive, nuclear medicine hepatobiliary scanning (ie, cholescintigraphy) can be used to assess cystic duct patency and make the diagnosis. (Patp) GI Patp
81 Cholecystitis Acute acalculous cholecystitis is an acute inflammation of the gallbladder in the absence of gallstones. It typically occurs in critically ill pts (eg, those w/ sepsis, severe burns, trauma, immunosuppression) Gastrointestinal & Nutrition (GI) Pathology (Path) 5
due to gallbladder stasis and ischemia. CFx may be subtle and include fever, RUQ pain, and leukocytosis. GI Path
82 Hypertrophic cardiomyopathy HCM is a common cause of SCD in young adults. Histologic features incl cardiomyocyte hypertrophy and myofiber disarray w/ ↑ interstitial fibrosis. The structural disarray creates a substrate for Cardiovascular (CV) Pathology (Path) 9
ventricular arrhythmia (e.g. v-tach, VF) that can lead to SCD. CV Path
83 Hypertrophic cardiomyopathy HCM is Chx by asymmetric (eg, septal) LVH that can result in SCD. AD mutations affecting the cardiac sarcomere genes (eg, cardiac β-myosin heavy chain gene and myosin-binding protein C gene) are Cardiovascular (CV) Pathology (Path) 9
responsible for the majority of cases. CV Path
84 Long QT syndrome Unprovoked syncope in a previously aSSx young person may result from a congenital LQTS. The 2 most important congenital syndromes w/ QT prolongation — RWS and JLNS — are thought to result Cardiovascular (CV) Pathology (Path) 4
from muts in a K+ channel protein that contributes to the delayed rectifier current (IK) of the cardiac AP. CV Path
85 Hypertrophic cardiomyopathy HCM is characterised by asymmetric ventricular septal hypertrophy and dynamic LVOT obstr. ↓ in LV blood volume, via manoeuvres or conditions that ↓ preload (e.g. abrupt standing, Valsalva strain Cardiovascular (CV) Pathophysiology 9
phase) or afterload, worsen LVOT obstr and ↑ the intensity of the HCM murmur. (Patp) CV Patp
86 Long QT syndrome Congenital LQTS is most often caused by genetic muts in a K+ channel protein that contributes to the outward-rectifying K+ current. A ↓ in the outward K+ current leads to prolongation of AP duration Cardiovascular (CV) Pathology (Path) 4
and QT interval. This prolongation predisposes to the devel of life-threatening ventricular arrhythmias (e.g. TdP) that can cause palpitations, syncope, seizures, or SCD. CV Path
87 Porcelain gallbladder Porcelain gallbladder is a potential MFx of chronic cholecystitis and is often found in a/w multi gallstones. It's due to dystrophic intramural deposition of Ca2+ salts in the setting of chronic inflammation. Gastrointestinal & Nutrition (GI) Pathology (Path) 1
Porcelain gallbladder is a/w an ↑ risk of adenocarcinoma of the gallbladder. GI Path
88 Bowel obstruction Gallstone ileus is a mech bowel obstr caused when a large gallstone erodes into the intestinal lumen. Pneumobilia (air in the biliary tract) is a common finding. Gastrointestinal & Nutrition (GI) Pathology (Path) 1 GI Path
89 Acute pericarditis In contrast to angina, the chest pain of pericarditis is sharp and pleuritic and may be exacerbated by swallowing or coughing. PIP occurs b/w 2 and 4 days following a transmural MI. PIP is an Cardiovascular (CV) Pathology (Path) 5
inflammatory rxn to cardiac muscle necrosis that occurs in the adjacent pericardium. CV Path
90 Wolff-Parkinson-White syndrome Wolff-Parkinson-White syndrome is characterized by symptomatic paroxysmal supraventricular tachycardia (eg, atrioventricular reentrant tachycardia) due to the presence of an accessory conduction Cardiovascular (CV) Pathophysiology 2
pathway. During normal sinus rhythm, the presence of this accessory pathway causes ventricular preexcitation, which can be identified on ECG by the triad of a shortened PR interval, early upslope of the (Patp)
QRS complex (delta Wave), and a widened QRS interval. CV Patp
91 Long QT syndrome Jervell and Lange-Nielsen syndrome is an AR disorder Chx by profound bilateral sensorineural hearing loss and congenital LQTS, which predisposes to ventricular arrhythmias and SCD. This condition Cardiovascular (CV) Pathology (Path) 4
occurs 2° to mutations in genes that encode voltage-gated K channels. CV Path
92 Dilated cardiomyopathy Dilation of the LV cavity commonly occurs in response to systolic dysfxn (eg, ischemic heart disease, DCM) or certain types of valvular disease (ie, AR, MR). Chronic volume overload causes Cardiovascular (CV) Pathology (Path) 8
progressive eccentric hypertrophy that eventually leads to ↓ ventricular contractility and DHF. CV Path
93 Restrictive cardiomyopathy Diastolic HF is caused by ↓ ventricular compliance and is characterised by normal LV EF, normal LV EDV, and ↑ LV filling pressures. HTN, obesity, and infiltrative disorders (e.g. transthyretin-related Cardiovascular (CV) Pathophysiology 1
amyloidosis, sarcoidosis) are important causes of DHF. (Patp) CV Patp
94 Amyloidosis RCM can be caused by infiltrative diseases (e.g. amyloidosis, sarcoidosis, hemochromatosis) and often results in diastolic HF due to ventricular hypertrophy w/ impaired ventricular filling. Cardiac Cardiovascular (CV) Pathology (Path) 1
amyloidosis is characterised histologically by areas of myocardium infiltrated by an amorphous and acellular pink material (amyloid). CV Path
95 Hypertrophic cardiomyopathy HCM is caused by genetic mutations affecting structural proteins of the cardiac sarcomere (eg, β-myosin heavy chain, myosin-binding protein C) and is one of the most common causes of SCD in young Cardiovascular (CV) Pathology (Path) 9
adults. Histologically, it is Chx by cardiomyocyte hypertrophy w/ haphazard cellular arrangement and interstitial fibrosis. CV Path
96 Cardiac tamponade CT typically presents w/ hypotension w/ PP, ↑ JVP, and muffled heart sounds (HS; Beck's triad). PP refers to an abn exaggerated ↓ in SBP >10mmHg on inspiration, and is a common finding in pts w/ Cardiovascular (CV) Pathophysiology 2
pericardial effusion w/ CT. (Patp) CV Patp
97 Acute pericarditis Acute-onset, sharp, and pleuritic chest pain that ↓ w/ leaning forward is char of acute pericarditis. Fibrinous/serofibrinous pericarditis is the most common form of pericarditis and a pericardial friction rub Cardiovascular (CV) Pathophysiology 5
is the most specific physical finding. Viral pericarditis is often preceded by a URI. (Patp) CV Patp
98 Constrictive pericarditis In constrictive pericarditis, normal pericardium is replaced by dense, rigid pericardial tissue that restricts ventricular filling, leading to low CO and progr right-sided HF. PEx findings in such pts incl ↑ Cardiovascular (CV) Pathology (Path) 2
JVP, pericardial knock, pulsus paradoxus, and a paradoxical ↑ in JVP w/ inspiration (Kussmaul sign). CV Path
99 Biliary excretory function A moderately ↑ ALP of unclear etiology should be f/u w/ GGT. Gastrointestinal & Nutrition (GI) Pathology (Path) 1 GI Path
100 Cirrhosis Hyperestrinism in liver cirrhosis likely arises due to ↑ in androstenedione production, androgen aromatisation, and sex hormone-binding globulin (SHBG) conc (preferentially binds testosterone). Gastrointestinal & Nutrition (GI) Pathology (Path) 7
Impaired oestrogen meta by the liver may also be a contributing factor. A ↓ free testosterone/oestrogen ratio leads to gynaecomastia, testicular atrophy, ↓ body hair, and spider angiomata. GI Path
101 Hereditary hyperbilirubinemia DJS is a benign disorder characterised by defective hepatic excretion of bilirubin glucuronides across the canalicular membrane, resulting in direct hyperbilirubinaemia and jaundice. Grossly, the liver Gastrointestinal & Nutrition (GI) Pathophysiology 1
appears black due to impaired excretion of EPI metabolites, which histo appear as dense pigments w/i lysosomes. (Patp) GI Patp
102 Hepatic encephalopathy HE is caused by ↑ lvls of NH3 and other neurotox in the circulation that lead to ↑ inhib neurotransmission and impaired excitatory NT release. HE is freq precipitated by a stressor (e.g. GI bleeding, Gastrointestinal & Nutrition (GI) Pathophysiology 2
infection) that ↑ blood NH3lvls. (Patp) GI Patp
103 Blastomycosis Dimorphic fungi grow as moulds at 25-30°C and as yeast at body temp (35-37°C). Med important dimorphic fungi incl Sporothrix, Coccidioides, Histoplasma, Blastomyces, and Paracoccidioides species. Pulmonary & Critical Care (PU) Microbiology 3
(Micr) PU Micr
104 Tinea Pityriasis versicolor (tinea versicolor) is a superficial skin infection caused by Malassezia species. It causes erythematous, hyper- or hypopigmented macules and patches. Malassezia forms spores and Dermatology (DE) Microbiology 4
hyphae, producing the characteristic "spaghetti and meatballs" appearance on KOH preparation light microscopy. (Micr) DE Micr
105 Aspergillosis Immsup pts are at risk for A. fumigatus infection. This fungus produces thin, septate hyphae w/ acute V-shaped branching. It causes invasive aspergillosis, aspergillomas, and allergic pulm aspergillosis. Infectious Diseases (ID) Microbiology 5
(Micr) ID Micr
106 Mucormycosis Mucormycosis is an opportunistic infection caused by Rhizopus, Mucor, and Absidia species. The classic clinical picture is paranasal sinus involvement in a diabetic or immsup pt. The fungi form broad Infectious Diseases (ID) Microbiology 3
non-septate hyphae that branch at right angles. (Micr) ID Micr
107 Mucormycosis Facial pain, headache, and black necrotic eschar in the nasal cavity in a pt w/ DKA are highly suggestive of mucormycosis. Histo Ex of the affected tissue is necessary to confirm the Dx. The fungi show Infectious Diseases (ID) Microbiology 3
broad non-septate hyphae w/ right-angle branching. Tx consists of Sx debridement and antifungal therapy. (Micr) ID Micr
108 Aspergillosis A. fumigatus causes a wide spectrum of disease. It can be an opportunistic infection in immsup and neutropaenic pts (invasive pulm aspergillosis). Aspergillosis can be colonising (aspergilloma) when it Pulmonary & Critical Care (PU) Microbiology 5
forms a fungus ball w/i a pre-existing lung cavity. It can also cause a lung HSR in allergic bronchopulm aspergillosis in individuals w/ asthma. (Micr) PU Micr
109 Febrile neutropenia Candida albicans is the most common cause of opportunistic mycosis. It can affect any organ and cause gen candidaemia. Yeasts and pseudohyphae on LM and a (+) germ tube test are Dx of Candida Infectious Diseases (ID) Microbiology 4
albicans infection. (Micr) ID Micr
110 Mucocutaneous candidiasis Abx suppress the normal vaginal flora and facilitate Candida overgrowth. Abx use is the most common cause of Candida vaginitis. Other potential causes include pregnancy, systemic corticosteroid use, Female Reproductive & Breast Microbiology 3
DM, and immunosuppression. (FR) (Micr) FR Micr
111 Mucocutaneous candidiasis Oral thrush is caused by Candida albicans infection and usually presents as white, plaque-like oropharyngeal lesions that're easily scraped off w/ a tongue depressor. Most cases arise in those who have Infectious Diseases (ID) Microbiology 3
disruptions to normal flora due to Abx or impairments in cell-mediated immunity from chemotherapy, inhaled corticosteroids, or HIV. Young, otherwise healthy pts w/ thrush should be tested for HIV, (Micr)
particularly if they have HIV RFs or other SSx of the virus. ID Micr
112 Febrile neutropenia Local defense against Candida is performed by T cells, whereas systemic infection is prevented by neutrophils. For this reason, localized candidiasis is common in patients who have HIV, but neutropenic Infectious Diseases (ID) Immunology 4
individuals are more likely to have the systemic form of the disease. (Immu) ID Immu
113 Meningitis C. neoformans is a yeast w/ a thick PSC that's found 1arily in soil contaminated by bird droppings. Inhalation of the pathogen into the lungs leads to (a usually aSSx) 1ary infection. In pts who're immsup Nervous (NS) Microbiology 17
(e.g. adv AIDS), the pathogen can spread thru the bloodstream to other organs, particularly the CNS. (Micr) NS Micr
114 Cryptococcal infections Meningoencephalitis is the most common presentation of C. neoformans infection. It occurs in immsup pts and can be Dx by India ink staining of the CSF. Cryptococcal pneumonia is Dx by mucicarmine Pulmonary & Critical Care (PU) Microbiology 3
staining of lung tissue and bronchoalveolar washings. (Micr) PU Micr
116 Meningitis Pts w/ suspected cryptococcal meningitis can be Dx using India ink staining of the CSF. Tx w/ amphotericin B and flucytosine is req at 1st, f/b long-term fluconazole maint therapy. Nervous (NS) Microbiology 17
(Micr) NS Micr
117 Cryptococcal infections C. neoformans is the only pathogenic fungus that has a PSC. The capsule appears red on mucicarmine stain and as a clear unstained zone w/ India ink. Pulmonary & Critical Care (PU) Microbiology 3
(Micr) PU Micr
118 Meningitis C. neoformans causes ME in pts w/ unTx AIDS. Dx can be made by detecting the PSC in CSF using the latex agglutination test. India ink staining of CSF is also used for Dx and can demo round or oval Nervous (NS) Microbiology 17
budding yeast. (Micr) NS Micr
119 Normal flora Expectorated sputum cultures are often contaminated by normal oral flora. The growth of C. albicans, a normal commensal of the GIT and skin, almost always indicates oral contamination rather than true Pulmonary & Critical Care (PU) Microbiology 1
pulm infection. (Micr) PU Micr
120 Blastomycosis B. dermatitidis is a dimorphic fungus seen in tissue as round or oval yeasts w/ thick walls and broad-based budding. It's endemic in the SE US (states east of the Mississippi River). The lungs are the 1° Pulmonary & Critical Care (PU) Microbiology 3
site of involvement, and the skin and bone are the major sites of dissemination. (Micr) PU Micr
121 Blastomycosis B. dermatitidis can cause pulm disease in the immcom host. Dissemination (most commonly to skin and bones) occurs in immsup individuals. Pulmonary & Critical Care (PU) Microbiology 3
(Micr) PU Micr
122 Esophageal cancer Major RFx for esophageal SCC include smoking, excessive Alc consumption, and intake of foods containing N-nitroso compounds. Gastrointestinal & Nutrition (GI) Pathology (Path) 4 GI Path
124 Vitamin B12 deficiency Pernicious anemia is an autoimmune disorder caused by the cell-mediated destruction of parietal cells in the superficial upper glandular layer of the gastric body and fundus. Parietal cells are responsible Gastrointestinal & Nutrition (GI) Histology (Hist) 9
for the secretion of hydrochloric acid and intrinsic factor, a glycoprotein involved in the absorption of B12. Deficiency leads to megaloblastic anemia and neurologic dysfunction. GI Hist
125 Stress gastric ulcer Stress-related mucosal disease is usually caused by local ischemia in the setting of severe physiologic stress (e.g. shock, extensive burns, sepsis, severe trauma). Ulcers arising in the setting of severe Gastrointestinal & Nutrition (GI) Pathology (Path) 1
trauma/burns are call Curling ulcers. Ulcers arising from intracranial injury are caused by direct vagal stim and are called Cushing ulcers. GI Path
126 Intestinal phase The cephalic and gastric phases stim gastric acid secr, while intestinal influences tend to ↓ gastric acid secr. Gastrointestinal & Nutrition (GI) Physiology 1
(Phys) GI Phys
127 Ovarian cancer A Krukenberg tumor is a gastric tumor that has metastasized to the ovary and can present with unintentional weight loss, epigastric pain, and adnexal masses. Histologically, the metastatic tumor cells Female Reproductive & Breast Pathology (Path) 9
have large amounts of mucin with apically displaced nuclei, resulting in a signet ring appearance. (FR) FR Path
128 Hypertrophic pyloric stenosis Congenital pyloric stenosis arises 2° to hypertrophy of the pyloric muscularis mucosae. Gastrointestinal & Nutrition (GI) Pathology (Path) 1 GI Path
129 Submucosal glands of Brunner Gastric acid is neutralised by HCO3- from the submucosal glands of the duodenum (Brunner glands) and from pancreatic duct secretions. Chronic overproduction of gastric acid can lead to hyperplasia of Gastrointestinal & Nutrition (GI) Anatomy (Anat) 1
the submucosal glands. GI Anat
130 Peptic ulcer disease Duodenal ulcers aren't a/w an ↑ risk of carcinoma in the same location. In contrast, ulcers located in the oesophagus, stomach (gastric), and colon may be malignant, and Bx is req. Gastrointestinal & Nutrition (GI) Pathology (Path) 10 GI Path
131 Whipple disease Caused by the gram (+) actinomycete Tropheryma whippelii, Whipple disease is a rare systemic illness that involves the small intestine, joints, and CNS. Classic histologic findings incl small intestine Gastrointestinal & Nutrition (GI) Pathology (Path) 2
mucosa containing enlarged, foamy macrophages packed w/ both rod-shaped bacilli and PAS (+), diastase-resistant granules. GI Path
132 Whipple disease The glycoprotein in the cell walls of the actinomycete Tropheryma whippelii colours magenta w/ PAS and is diastase-resistant, making this stain an excellent choice in evaluating tissue for Whipple Gastrointestinal & Nutrition (GI) Pathology (Path) 2
disease. GI Path
133 Lactose intolerance LI presents w/ flatulence, crampy abdo pain, and watery diarrhoea after dairy product consumption. It can be acq by inflammatory/infectious conditions that injure the mucosal brush border of the small Gastrointestinal & Nutrition (GI) Pathophysiology 3
intestine where lactase is expressed. Studies can show ↑ breath H+ content, ↓ stool pH, and ↑ stool osmolality. (Patp) GI Patp
134 Lactose intolerance The small bowel mucosa of pts w/ 1° lactase defic is normal on histo Ex. Gastrointestinal & Nutrition (GI) Pathophysiology 3
(Patp) GI Patp
136 Nitrates Nitrates (via conversion to NO) activate guanylate cyclase and ↑ intracellular lvls of cGMP. ↑ lvls of cGMP lead to myosin light-chain dephosphorylation, resulting in vascular smooth muscle relaxation. Cardiovascular (CV) Pharmacology 7
(Phar) CV Phar
137 Angina Pharmacologic nitrates (e.g. nitroglycerin, isosorbide mononitrate, isosorbide dinitrate) are meta to NO and S-nitrothiols in vascular smooth muscle cells, leading to an ↑ in cGMP that stims vasodilation. Cardiovascular (CV) Pharmacology 1
Large veins are predominantly affected, leading to ↑ venous capacitance and ↓ venous return (preload), which ↓ LV wall stress and myocardial O2 demand to relieve anginal SSx. (Phar) CV Phar
138 Nitrates Sublingual nitroglycerin is used for rapid SSx relief in pts w/ stable angina. The 1° anti-ischaemic effect of nitrates is mediated by venodilation w/ a ↓ in LV EDV and wall stress, resulting in ↓ myocardial Cardiovascular (CV) Pharmacology 7
O2 demand and relief of angina SSx. (Phar) CV Phar
139 Nitrates Isosorbide dinitrate has a low bioavailability due to extensive 1st-pass hepatic metabolism prior to release in systemic circulation. Sublingual NG is absorbed directly from oral mucosa into the venous Cardiovascular (CV) Pharmacology 7
circulation and has a higher bioavailability. (Phar) CV Phar
140 Nitrates The main AEx seen w/ nitrate Thx include h/a and cutaneous flushing along w/ lightheadedness and hypotension due to systemic vasodilation. Cardiovascular (CV) Pharmacology 7
(Phar) CV Phar
141 Hypertrophic cardiomyopathy The dynamic LVOT obstruction that occurs in HCM worsens w/ ↓ LV volume, which can be caused by ↓ in cardiac preload a/o afterload. Therefore, Rx that ↓ venous return or SVR (DHP CCBs, NG) Cardiovascular (CV) Pharmacology 9
should generally be avoided. (Phar) CV Phar
142 Nitrates Pts taking daily maintenance nitrates need to have a nitrate-free period every day to avoid tolerance to the Rx. Cardiovascular (CV) Pharmacology 7
(Phar) CV Phar
143 Nitrates Using nitrates together w/ PDEIs used for ED and pulm HTN causes a profound systemic hypotension b/c they both ↑ intracellular cGMP which causes vascular smooth muscle relaxation. Their use Cardiovascular (CV) Pharmacology 7
together is absolutely c/i. (Phar) CV Phar
144 Calcium channel blocker Contraction initiation in cardiac and SMCs is dependent on extracellular Ca influx through L-type Ca channels, which can be prevented by CCBs (eg, verapamil). Skeletal muscle is resistant to CCBs, as Cardiovascular (CV) Physiology 3
Ca release by the SR is triggered by a mechanical interaction b/w L-type and RyR Ca channels. (Phys) CV Phys
145 Calcium channel blocker CCBs inhib the L-type Ca2+ channel on vascular smooth muscle and cardiac cells. DHPs (e.g. nifedipine, amlodipine) primarily affect peripheral arteries and cause vasodilation. Non-DHPs (e.g. Cardiovascular (CV) Pharmacology 3
verapamil, diltiazem) affect the myocardium and can cause bradycardia and slowed AV conduction. (Phar) CV Phar
146 Subarachnoid hemorrhage Delayed cerebral ischemia due to cerebral vasospasm usually presents 3-12days after the initial SAH w/ an acute change in mental status a/o new focal neuro deficits. Nimodipine, a selective CCB, Nervous (NS) Pharmacology 4
improves outcomes in pts w/ cerebral vasospasm by inducing cerebral vasodilation and ↓ Ca2+-dependent excitotoxicity. (Phar) NS Phar
147 Digoxin Digoxin toxicity typically presents with cardiac arrhythmias and nonspecific gastrointestinal (nausea, vomiting), neurological (confusion, weakness), and visual symptoms. Elevated potassium is another Cardiovascular (CV) Pharmacology 4
sign of digoxin toxicity and is caused by inhibition of Na-K-ATPase pumps. (Phar) CV Phar
148 Digoxin Digoxin directly inhibs the Na-K-ATPase pump in myocardial cells, leading to a ↓ in Na+ efflux and an ↑ in intracellular Na+ lvls. This ↓ the forward activity of the NCX, causing ↑ intracellular Ca2+ Cardiovascular (CV) Pharmacology 4
concentration and improved myocyte contractility. (Phar) CV Phar
149 Chronic heart failure Milrinone is a PDE-3 inhib that ↓ the degradation of cAMP to provide 2 beneficial effects for treating systolic HF. Ca2+ influx into cardiomyocytes is ↑, which ↑ cardiac contractility. In addn, Ca2+- Cardiovascular (CV) Pharmacology 12
myosin light chain kinase interaction is ↓, which causes vasodilation and ↓ cardiac preload and afterload. (Phar) CV Phar
150 Primary hypertension α1-blockers such as doxazosin, prazosin, and terazosin are useful for the Tx of both BPH and HTN. Pts w/ CAD and HF along w/ HTN will benefit from cardioselective β-blockers. Hydrochlorothiazide is Cardiovascular (CV) Pharmacology 14
presently the 1st-line Rx for the Tx of essential HTN in the gen pop. (Phar) CV Phar
151 Diabetic nephropathy The risk of progression of DN in pts w/ proteinuria can be decr by approp glycemic and BP control. ACEIs and ARBs are the pref antiHTN agents due to their antiproteinuric effects, which're independent Renal, Urinary & Electrolytes Pharmacology 4
from their effects on syst BP. (RE) (Phar) RE Phar
152 Hyperaldosteronism Aldo excess will cause HTN, hypokalemia, meta alk, and depressed renin. Alt, hypoaldo-ism is the cause of RTA-IV. Aldo antags such as spironolactone or eplerenone can be used as med therapy for Renal, Urinary & Electrolytes Pharmacology 5
Conn syndrome. (RE) (Phar) RE Phar
153 Heart block Common AEx of non-DHP CCBs (eg, diltiazem, verapamil) include constipation, bradycardia, AV conduction block ((-) chronotropic effect), and worsening of HF in pts w/ ↓ LV fxn ((-) inotropic Cardiovascular (CV) Pharmacology 2
effect). (Phar) CV Phar
154 Calcium channel blocker Amlodipine is a DHP CCB commonly used as monoThx or in combination w/ other agents for Tx of HTN. Major AEx include h/a, flushing, dizziness, and peripheral edema. Cardiovascular (CV) Pharmacology 3
(Phar) CV Phar
155 Digoxin Digoxin is used for ventricular rate control in AF as it ↓ AV nodal conduction by ↑ parasympathetic vagal tone. Digoxin is also used in HF due to its (+) inotropic effect. These effects are accomplished Cardiovascular (CV) Pharmacology 4
via inhib of the Na-K-ATPase pump. (Phar) CV Phar
156 Digoxin Digoxin tox presents w/ nonspecific GI (e.g. anorexia, nausea, vomiting) and neuro (e.g. fatigue, confusion, weakness) SSx. Changes in colour vision are a more specific, but rarer, finding. Life- Cardiovascular (CV) Pharmacology 4
threatening ventricular arrhythmias are the most serious complication. (Phar) CV Phar
157 Natriuretic peptides ANP and BNP are released from the atria and ventricles, respectively, in response to myocardial wall stretch due to intravascular volume expansion. These endogenous hormones promote ↑ GFR, Cardiovascular (CV) Physiology 1
natriuresis. and diuresis. (Phys) CV Phys
159 Antiarrhythmic drugs For class I antiarrhythmics, Na+-channel-binding strength is IC > IA > IB. Use dependence describes the phenomenon in which higher HRs lead to ↑ Na+ channel blockade due to cumulative blocking Cardiovascular (CV) Pharmacology 12
effects over multiple cardiac cycles. Class IC antiarrhythmics demonstrate the most use dependence due to their slow dissociation from the receptor, and class IB drugs have the least use dependence as (Phar)
they rapidly dissociate. CV Phar
160 Dyslipidemia Niacin is used in the Tx of hyperlipidemia. It ↑ HDL lvls and ↓ LDL lvls and triglycerides. Niacin causes cutaneous flushing, which is mediated by prostaglandins and can be diminished by preTx w/ Cardiovascular (CV) Pharmacology 11
aspirin. (Phar) CV Phar
161 Drug induced myopathy Most statins are metabolized by cytochrome P450 3A4, w/ the exception of pravastatin. Concomitant administration of Rx that inhibit statin metabolism (eg, macrolides) is a/w ↑ incidence of statin- Cardiovascular (CV) Pharmacology 3
induced myopathy and rhabdomyolysis. ARF is a possible sequela of rhabdomyolysis. (Phar) CV Phar
163 Dyslipidemia BABRs inhib the enterohepatic circulation of BAs. This leads to diversion of hepatic chol to synthesis of new BAs, ↑ uptake of chol from the circulation, and ↓ blood LDL lvls. However, BABRs ↑ Endocrine, Diabetes & Pharmacology 11
hepatic production of TGs and can cause hypertriglyceridaemia. Metabolism (ES) (Phar) ES Phar
164 Dyslipidemia Gemfibrozil (and other fibrates) can ↓ chol sol and promote gallstone formation by ↓ BA synth. Caution should be used when prescribing fibrate therapy to pts w/ underlying gallbladder disease. Gastrointestinal & Nutrition (GI) Pharmacology 11
(Phar) GI Phar
165 Liver cholesterol production Simvastatin decreases hepatic cholesterol production, while cholestyramine increases hepatic cholesterol and bile acid synthesis. Combination therapy results in a synergistic reduction in plasma LDL Gastrointestinal & Nutrition (GI) Pharmacology 1
level. (Phar) GI Phar
166 Acute pancreatitis In pts w/ severe hypertriglyceridaemia, pancreatic lipases can cause toxic lvls of FFAs to be released w/i the pancreatic tissue, leading to acute pancreatitis. Fibrates (e.g. fenofibrate) are the most effective Endocrine, Diabetes & Pharmacology 9
agents for the Tx of hypertriglyceridaemia. Metabolism (ES) (Phar) ES Phar
167 Gout Gout occurs in the setting of hyperuricemia and causes an inflammatory arthritis characterized by negative birefringent, needle-shaped crystals visible on joint fluid microscopy. Most diuretics (eg, Endocrine, Diabetes & Pharmacology 11
hydrochlorothiazide, furosemide) can cause hyperuricemia and trigger gout flares by causing relative volume depletion, which decreases the fractional excretion of uric acid. Metabolism (ES) (Phar) ES Phar
168 Asthma Improper administration of inhaled glucocorticoids for the treatment of asthma can lead to adverse effects, including oropharyngeal candidiasis and dysphonia. Using a spacer during administration and Pulmonary & Critical Care (PU) Pharmacology 12
rinsing the mouth after each use can help prevent these adverse effects. (Phar) PU Phar
169 Asthma Asthma is Chx by chronic airway inflammation, which leads to airway remodeling, airway hyperresponsiveness, and bronchoconstriction. Corticosteroids ↓ airway inflammation and are used for both Pulmonary & Critical Care (PU) Pharmacology 12
chronic asthma Mx (inhaled administration) and acute exacerbations (systemic administration). (Phar) PU Phar
170 COPD Ipratropium, an anticholinergic agent and derivative of atropine, treats obstructive lung disease by blocking acetylcholine at muscarinic receptors, which prevents bronchoconstriction and reduces mucus Pulmonary & Critical Care (PU) Pharmacology 16
secretion from tracheobronchial submucosal glands. (Phar) PU Phar
171 Asthma Cromolyn and nedocromil are mast cell-stabilizing agents that inhibit mast cell degranulation independent of the triggering stimulus. They are less effective than inhaled glucocorticoids and are Pulmonary & Critical Care (PU) Pharmacology 12
considered second-line treatments for allergic rhinitis and bronchial asthma. (Phar) PU Phar
172 Theophylline Seizures are the major cause of morbidity and mortality from theophylline intoxication. Tachyarrhythmias are the other major concern. Poisoning & Environmental Pharmacology 2
Exposure (PO) (Phar) PO Phar
173 Antihistamines In addn to blocking H receptors, 1st-gen antihistamines (e.g. chlorpheniramine, diphenhydramine) have antimuscarinic, anti-α adrenergic, and anti-5-HT-ergic properties. Anticholinergic effects on the Nervous (NS) Pharmacology 3
ocular ciliary muscles impair accommodation and cause blurring of vision for close objects. (Phar) NS Phar
174 Antihistamines 1st-gen antihistamines can cause significant AEs due to blockade of cholinergic, α-adrenergic, and 5-HT-ergic pathways. They should be avoided in older pts w/ cognitive or fxnal impairments. Allergy & Immunology (AI) Pharmacology 3
(Phar) AI Phar
175 Motion sickness Antimusc agents and antihists w/ antimusc action are most effective for motion sickness prevention. Gastrointestinal & Nutrition (GI) Pharmacology 1
(Phar) GI Phar
176 Myocardial infarction Mitochondrial vacuolization is typically a sign of irreversible cell injury, signifying that the involved mitochondria are permanently unable to generate ATP. Cardiovascular (CV) Pathology (Path) 18 CV Path
177 Necrosis Irreversible ischemic injury to brain tissue causes tissue digestion by hydrolytic enzymes (liquefactive necrosis). The infarcted CNS tissue is eventually replaced w/ a cystic astroglial scar. In other organs, Nervous (NS) Pathology (Path) 3
lethal ischemic injury results in coag necrosis. NS Path
178 Necrosis Lethal tissue ischemia causes coag necrosis in most tissues (e.g. kidney, myocardium); cellular architecture is maintained but nuclei are absent. The exception is ischemic cell death in the CNS, which Renal, Urinary & Electrolytes Pathology (Path) 3
causes liquefactive necrosis. (RE) RE Path
179 Coronary blood flow In 90% of individuals, occlusion of the RCA can result in transmural ischemia of the inferior wall of the LV, producing ST elevation in leads II, III, and aVF as well as possible sinus node dysfxn. Cardiovascular (CV) Pathology (Path) 9
Occlusion of the proximal LAD would be expected to result in anteroseptal transmural ischemia, w/ ST elevations in leads V1-V4. Occlusion of the LCX would produce transmural ischemia of the lateral
wall of the LV, w/ ST elevations mainly in V5 and V6, and possibly also in I and aVL. CV Path
180 Aging Normal morphological changes in the aging heart incl a ↓ in LV chamber apex-to-base dimension, devel of a sigmoid-shaped ventricular septum, myocardial atrophy w/ ↑ collagen deposition, and Cardiovascular (CV) Pathology (Path) 8
accumulation of cytoplasmic lipofuscin pigment w/i cardiomyocytes. CV Path
181 Primary hypertension Concentric hypertrophy is characterised by uniform thickening of the ventricular wall and narrowing of the ventricular cavity due to ↑ afterload (e.g. chronic HTN, AS). Eccentric hypertrophy is Cardiovascular (CV) Pathology (Path) 14
characterised by ↓ ventricular wall thickness w/ an assoc ↑ in chamber size due to volume overload. CV Path
183 Coronary blood flow During ventricular systole, the coronary vessels supplying the LV are compressed by the surrounding muscle. As a result, the majority of LV blood flow occurs during diastole. The systolic ↓ in coronary Cardiovascular (CV) Physiology 9
blood flow is greatest in the subendocardial region, making this portion of the LV most prone to ischemia and infarction. (Phys) CV Phys
185 Chronic heart failure Alveolar hemosiderin-laden macrophages indicate alveolar hemorrhage. They most commonly result from chronic ↑ of pulm capillary hydrostatic pressure in the setting of left-sided HF. Cardiovascular (CV) Pathology (Path) 12 CV Path
186 Diastolic dysfunction HF w/ preserved EF is Chx by diastolic dysfunctlon, which frequently occurs in the setting of prolonged systemic HTN due to concentric LVH. Pts w/ longstanding HTN have ↑ SVR. Cardiovascular (CV) Pathophysiology 4
(Patp) CV Patp
187 Congenital cardiac defects Increased blood oxygen saturation between 2 right-sided vessels or chambers indicates the presence of a left-to-right shunt. If the abnormal oxygen increase occurs between the right atrium and the right Cardiovascular (CV) Pathophysiology 2
ventricle, a ventricular septal defect (VSD) is likely present. Small VSDs produce a holosystolic murmur that is loudest over the lower left sternal border. (Patp) CV Patp
188 Atrioventricular canal defect A complete AV canal defect is comprised of an ASD, a VSD, and a common AV valve. It's the most common congenital cardiac anomaly a/w Down syndrome. Cardiovascular (CV) Pathology (Path) 1 CV Path
189 Embolic stroke Paradoxical embolism occurs when a thrombus from the venous system crosses into the arterial circulation via an abnormal connection b/w the right and left cardiac chambers (eg, PFO, ASD, or VSD). Cardiovascular (CV) Pathophysiology 1
Atrial left-to-right shunts cause wide and fixed splitting of S2 and can facilitate paradoxical embolism due to periods of transient shunt reversal (eg, during straining or coughing). (Patp) CV Patp
190 Atherosclerosis Familial hypercholesterolemia, one of the most common autosomal dominant disorders, is the result of heterozygous or homozygous LDL receptor gene mutations, which cause hepatocyte under Gastrointestinal & Nutrition (GI) Pathology (Path) 8
expression of functional LDL receptors. This condition can lead to accelerated atherosclerosis and early-onset coronary artery disease. GI Path
191 Dyslipidemia Xanthelasmas, a type of xanthoma, are yellowish macules/papules found on the med. eyelids. They're dermal accumulations of macrophages containing cholesterol and TGs, and are generally a/w a 1° or Endocrine, Diabetes & Pathology (Path) 11
2° hyperlipidaemia or dyslipidaemia. An LDL receptor abn is the most common cause. Metabolism (ES) ES Path
192 Myocardial infarction VF is the most common mech of SCD due to AMI. It results from arrhythmogenic foci triggered by electrical instability in the ischemic myocardium. Cardiovascular (CV) Pathology (Path) 18 CV Path
193 Myocardial infarction LV free-wall rupture is an uncommon but devastating mech complication of transmural MI that occurs w/i 5 days or up to 2wks following the event. Rupture leads to cardiac tamponade that causes Cardiovascular (CV) Pathophysiology 18
hypotension and shock w/ rapid progr to cardiac arrest. Autopsy typically reveals a slit-like tear at the site of infarction in the LV wall. (Patp) CV Patp
194 Marfan syndrome CV lesions are the most life-threatening complications a/w MFS. Early-onset CMD of the aorta predisposes to AD, the most common COD in these pts. Cardiovascular (CV) Pathophysiology 2
(Patp) CV Patp
195 Myocardial infarction Rupture of the LV free wall is a catastrophic mechanical complication of anterior wall MI that usually occurs w/i the 1st 5-14 days after MI. Rupture leads to hemopericardium and CT, causing profound Cardiovascular (CV) Pathophysiology 18
hypotension and shock w/ rapid progression to PEA and death. (Patp) CV Patp
196 Pulmonary arterial hypertension PAH should be suspected in young and otherwise healthy pts w/ fatigue, progr dyspnoea, atypical chest pain, or unexplained syncope. Long-standing PAH leads to hypertrophy a/o dilation of the RV (cor Cardiovascular (CV) Pathophysiology 8
pulmonale). (Patp) CV Patp
197 Fat embolism FES most commonly results from the release of fat globules from bone marrow following a long-bone or pelvic fracture. The fat globules form inflammatory aggregates that cause microvessel obstr and Pulmonary & Critical Care (PU) Pathology (Path) 2
systemic inflammation leading to the triad of resp distress, neuro dysfxn, and petechial rash that characterises the condition. PU Path
198 Pulmonary arterial hypertension Left-sided HF can cause 2° PAH via ↑ left-sided diastolic filling pressures transmitting backward to the pulm veins, resulting in pulm venous congestion. Over time, pulm arterial remodelling (medial Cardiovascular (CV) Pathophysiology 8
hypertrophy and intimal thickening w/ fibrosis) can occur, but not to the extent that occurs in (1°) PAH. (Patp) CV Patp
200 Mitral regurgitation DHF is a common cause of 2° (fxnal) MV regurgitation. ↑ LV EDV causes dilation of the MV annulus and restricted movement of the chordae tendineae w/ subsequent regurgitation. Tx w/ diuretics and Cardiovascular (CV) Pathophysiology 6
vasodilators can improve HF-induced MR. (Patp) CV Patp
201 Atrial septal defect Wide, fixed splitting of the 2nd heart sound is a Chx auscultatory finding in pts w/ ASD. A hemodynamically significant ASD can produce chronic pulm HTN as a result of left-to-right intracardiac Cardiovascular (CV) Pathophysiology 2
shunting. Eisenmenger syndrome is the late-onset reversal of a left-to-right shunt due to pulm vascular sclerosis resulting from chronic pulm HTN. Closure of the ASD may be required to prevent (Patp)
irreversible pulm vascular sclerosis and a permanent Eisenmenger syndrome. CV Patp
202 Atrial septal defect The foramen ovale is patent in approximately 25% of normal adults. Although the foramen ovale usually remains fxnally closed, transient ↑ of RA pressure above LA pressure can produce a right-to-left Cardiovascular (CV) Embryology 2
shunt, leading to paradoxical embolism of venous clots into the arterial circulation. (Embr) CV Embr
203 Ventricular septal defect VSD typically presents in the neonatal period after pulm vascular resistance has declined. The clinical Px depends on the size of the defect, which ranges from an aSSx holosystolic murmur (small VSD) Cardiovascular (CV) Pathology (Path) 2
to HF (large VSD). CV Path
204 Tetralogy of Fallot In pts w/ TOF, the degree of RVOT obstr is the major determinant of the degree of R-L intracardiac shunting and resulting cyanosis. Cardiovascular (CV) Pathophysiology 3
(Patp) CV Patp
205 Tetralogy of Fallot In pts w/ TOF, squatting during a Tet spell ↑ SVR and ↓ right-to-left shunting, thereby ↑ pulm blood flow and improving O2ation status. Cardiovascular (CV) Physiology 3
(Phys) CV Phys
206 Diabetes insipidus Injury to the hypothal or post pit (e.g. head trauma, transsphenoidal neuroSx, suprasellar masses) can result in CDI. Dmg to the post pit gland typically causes transient DI, whereas dmg to the hypothal Endocrine, Diabetes & Anatomy (Anat) 4
nuclei often causes permanent DI. Metabolism (ES) ES Anat
207 Infertility Anovulation is a common cause of infertility. Menotropin (human menopausal gonadotropin) is a treatment option that acts like FSH and triggers the formation of a dominant ovarian follicle. Ovulation is Female Reproductive & Breast Physiology 3
then induced by administration of human chorionic gonadotropin, which mimics the LH surge. (FR) (Phys) FR Phys
208 Infertility Pulsatile administration of GnRH stimulates FSH and LH release and is useful for the Tx of infertility. Nonpulsatile (constant) infusion of GnRH, or a long-acting analog, suppresses FSH and LH release Female Reproductive & Breast Physiology 3
and subsequently suppresses gonadal fxn. (FR) (Phys) FR Phys
209 Prostate cancer Leuprolide is a GnRH agonist that causes a transient ↑ in pituitary LH secretion, which leads to a rise in testosterone lvls. However, continuous use of leuprolide suppresses LH release and leads to a ↓ in Endocrine, Diabetes & Pharmacology 5
testosterone production. Metabolism (ES) (Phar) ES Phar
210 Pituitary adenoma Pituitary tumours can present w/ h/a, bitemporal hemianopsia, and hypopituitarism; the most common hormonally active (fxnal) adenomas are PL-secreting adenomas (PRL-omas). PRL-omas can cause Endocrine, Diabetes & Pathophysiology 8
galactorrhoea and amenorrhoea in women. In men, they often present w/ hypogonadism. Metabolism (ES) (Patp) ES Patp
211 Diabetes insipidus Pts w/ DI are unable to concentrate their urine in response to dehydration. Following desmopressin admin during the water deprivation test, urine osmolality ↑ to normal lvls in CDI but doesn't change in Renal, Urinary & Electrolytes Pathology (Path) 4
complete NDI. (RE) RE Path
212 Primary polydipsia 1° (psychogenic) polydipsia is characterised by excessive intake of free water, leading to hyponatraemia and production of large volumes of dilute urine. Water restriction normalises serum Na+ lvls and ↑ Endocrine, Diabetes & Pathophysiology 1
urine osmolality. Metabolism (ES) (Patp) ES Patp
213 Pituitary adenoma Large PRL-secreting pituitary tumours can compress the optic chiasm, causing bitemporal hemianopsia. In addn, ↑ PRL lvls suppress release of GnRH, leading to ↓ LH secretion and subseq impaired Endocrine, Diabetes & Pathophysiology 8
testosterone production in men. Metabolism (ES) (Patp) ES Patp
214 Hyperprolactinemia The release of PRL is under inhib control by DA secretion from the hypothal. Disruption of DA-ergic pathways or blockade of DA D2 receptors can cause hyperprolactinaemia. Endocrine, Diabetes & Pathophysiology 1
Metabolism (ES) (Patp) ES Patp
215 Menopause Menopause occurs on average at age 51 and is Dx retrospectively after 12 mos of amenorrhea. An ↑ serum FSH level confirms the Dx. Female Reproductive & Breast Physiology 1
(FR) (Phys) FR Phys
216 Infertility LH stims the release of testo from the Leydig cells of the testes; FSH stims the release of inhibin B from the Sertoli cells in the seminiferous tubules. Testo and inhibin B induce (-) fb on LH and FSH Endocrine, Diabetes & Physiology 3
prod, respectively. Metabolism (ES) (Phys) ES Phys
217 Cryptorchidism Inhibin B is prod by the Sertoli cells and is the phys inhib of FSH secretion. LH conc is controlled 1°ly by testo fb. Endocrine, Diabetes & Physiology 2
Metabolism (ES) (Phys) ES Phys
218 Pituitary adenoma In pts w/ PRL-oma, high lvls of circulating PRL suppress GnRH secretion from the hypothal, leading to ↓ secretion of LH and subseq hypogonadism, anovulation, and amenorrhoea. The resulting Endocrine, Diabetes & Pathophysiology 8
oestrogen defic can cause osteoporosis w/ an ↑ risk for fragility fractures, and lead to vaginal dryness and atrophy. Metabolism (ES) (Patp) ES Patp
219 von Willebrand disease The vWF enhances clotting thru both augmentation of platelet binding and stabilisation of FVIII. Pts w/ vWD are defic in fxnal vWF and present w/ ↑ bruisability and prolonged mucosal bleeding. Hematology & Oncology (HO) Pharmacology 7
DDAVP can alleviate bleeding thru endothelial release of vWF. (Phar) HO Phar
220 Hypopituitarism High oestrogen lvls during preg cause enlargement of the pit gland w/o a proportional ↑ in blood supply. Peripartum hypotension can cause ischemic necrosis of the pit leading to panhypopituitarism Endocrine, Diabetes & Pathology (Path) 2
(Sheehan syndrome). Pts commonly develop failure of lactation due to defic of PRL. Metabolism (ES) ES Path
221 Craniopharyngiomas The ant. pit is formed from an out-pouching of the pharyngeal roof and is called Rathke's pouch. The post. pit gland arises from an extension of the hypothal neurons. Craniopharyngiomas are tumours Endocrine, Diabetes & Pathology (Path) 2
arising from Rathke's pouch remnants in the ant. pit. They char have 3 components: solid, cystic, and calcified. They present during childhood, usually, w/ mass effect and visual deficits. Metabolism (ES) ES Path
222 Antipsychotics The secretion of PRL is controlled by the inhib effect of hypothal DA. Risperidone and other antipsychs cause hyperprolactinaemia by blocking D2 receptors on lactotrophs. ↑ PRL leads to amenorrhoea Pregnancy, Childbirth & Pharmacology 9
(inhib of GnRH release), galactorrhoea, and breast soreness. Puerperium (PR) (Phar) PR Phar
223 Pituitary adenoma Hyperprolactinaemia suppresses secretion of GnRH, which leads to ↓ oestrogen in women. Low oestrogen lvls are a RF for accelerated bone loss. Endocrine, Diabetes & Pathophysiology 8
224 Growth hormone Gigantism is caused by excess GH during childhood and is characterised by accelerated linear growth, prognathism, and bone enlargement of the hands and feet. GH excess after closure of the epiphysial Endocrine, Diabetes & Pathophysiology 2
growth plates causes acromegaly. GH has direct effects on target tissues and indirect effects mediated by IGF-1 secretion from the liver. Metabolism (ES) (Patp) ES Patp
225 Pituitary apoplexy Acute pit hemorrhage (pit apoplexy) is char by severe h/a, BTH (compression of the optic chiasm), and ophthalmoplegia (compression of CNIII). It usually occurs in a pre-existing pit adenoma. Pit Endocrine, Diabetes & Pathology (Path) 1
apoplexy is a med emergency that req urgent Tx w/ GCs to prevent acute adrenal crisis and circulatory collapse. Metabolism (ES) ES Path
226 SIADH SIADH is characterised by low plasma Na+ and osmolality, inappropriately concentrated urine, and clinically normal volume status (euvolaemic hyponatraemia). An important cause of SIADH is a PNP Endocrine, Diabetes & Pathophysiology 3
effect 2° to SCLC. Metabolism (ES) (Patp) ES Patp
227 Aortic regurgitation AR causes a decrescendo diastolic murmur w/ maximal intensity occurring just after closure of the AV, when the pressure gradient b/w the aorta and LV is the highest. The pressure tracing for AR is Chx Cardiovascular (CV) Pathophysiology 8
by loss of the aortic dicrotic notch, steep diastolic decline in aortic pressure, and high-peaking systolic pressures. (Patp) CV Patp
228 Endocarditis Microemboli from the valvular vegetations of BE are the most common cause of subungual splinter hemorrhages. The presence of these lesions necessitates careful cardiac auscultation to detect a possible Cardiovascular (CV) Pathology (Path) 15
new-onset regurgitant murmur. CV Path
229 Endocarditis The most likely cause of fever and fatigue w/ new-onset cardiac murmur is IE. DPGN 2° to circulating IC deposition may complicate IE and can result in acute renal insufficiency. Renal, Urinary & Electrolytes Pathology (Path) 15
(RE) RE Path
230 Endocarditis MVP w/ MR is the most common predisposing condition for native valve IE in developed nations. Rheumatic heart disease remains a freq cause of IE in devel nations. Cardiovascular (CV) Pathology (Path) 15 CV Path
231 Endocarditis NBTE (marantic endocarditis) is a form of non-infectious endocarditis characterised by valvular deposition of sterile platelet-rich thrombi. It likely results from valvular dmg due to inflammatory Cardiovascular (CV) Pathology (Path) 15
cytokines in the setting of an underlying hypercoagulable state, and it's most commonly seen w/ advanced malignancy (esp. mucinous AC) or SLE. CV Path
232 Mitral stenosis Rheumatic MS is characterised by diffuse fibrous thickening and distortion of the MV leaflets along w/ commissural fusion at the leaflet edges. Pts often present w/ a diastolic murmur, dyspnoea, and Cardiovascular (CV) Pathology (Path) 7
fatigue and are at ↑ risk of AF and TE (e.g. stroke). CV Path
233 Mitral stenosis The best and most reliable auscultatory indicator of the degree of MS is the A2-OS interval. A shorter interval indicates more severe stenosis. Other auscultatory findings can incl a diastolic rumbling Cardiovascular (CV) Pathophysiology 7
murmur w/ presystolic accentuation due to LA contraction. (Patp) CV Patp
234 Mitral stenosis Isolated MS causes ↑ upstream pressures in the LA and pulm veins and arteries. LV EDP is normal or ↓ due to obstr of blood flow thru the stenotic valve. An ↑ LV EDP suggests addnal downstream Cardiovascular (CV) Pathophysiology 7
pathology (e.g. AV disease, LV failure). (Patp) CV Patp
235 Mitral stenosis Cardiac auscultation in pts w/ MS reveals a loud 1st heart sound, an early diastolic OS after the 2nd heart sound, and a low-pitched diastolic rumble best heard at the cardiac apex. The OS is caused by the Cardiovascular (CV) Pathophysiology 7
sudden opening of the MV leaflets when the LV pressure falls below the LA pressure at the beginning of diastole. (Patp) CV Patp
236 Mitral stenosis LA enlargement can sometimes cause left recurrent laryngeal nerve impingement. Neurapraxia resulting in left vocal cord paresis and hoarseness may result. Cardiovascular (CV) Pathology (Path) 7 CV Path
237 Aortic regurgitation In chronic AR, persistent LV volume overload triggers eccentric hypertrophy, which causes a compensatory ↑ in SV to maintain CO. This compensatory mech allows for a relatively long aSSx in most Cardiovascular (CV) Pathophysiology 8
pts; however, LV dysfxn eventually occurs, leading to HF. (Patp) CV Patp
238 Aortic regurgitation Chronic aortic regurgitation (AR) causes a reduction in diastolic blood pressure and a compensatory increase in left ventricular stroke volume. These changes create a high-amplitude, rapid rise-rapid fall Cardiovascular (CV) Pathophysiology 8
pulsation (ie, widened pulse pressure) and the other characteristic findings of AR (eg, head bobbing. "pistol-shot" femoral pulses). (Patp) CV Patp
239 Rheumatic fever The 1° cause of morbidity in ARF is HF from severe pancarditis. MS develops yrs or decades after the original illness. Joint involvement is usually transient. Rheumatology, Orthopedics & Pathology (Path) 5
Sports (RH) RH Path
240 Rheumatic fever Interstitial myocardial granulomas (Aschoff bodies) are found in carditis due to acute RF, which develops after an un-Tx GAS pharyngeal infection. Aschoff bodies contain plump macrophages w/ Cardiovascular (CV) Pathology (Path) 5
abundant cytoplasm and central, slender ribbons of chromatin (Anitschkow, or caterpillar cells). CV Path
241 Rheumatic fever Sydenham chorea presents w/ involuntary, rapid, irregular jerking movements involving the face, arms, and legs. It occurs mos after group A streptococcal infection and is one of the major clinical MFx Cardiovascular (CV) Pathology (Path) 5
of acute RF. Pts w/ this condition carry a high risk of chronic valvular disease. CV Path
242 Aortic stenosis Calcific degeneration of the trileaflet AV is the most common cause of AS in developed nations. AS is Chx by progressive AV leaflet thickening and calcification, leading to restricted leaflet excursion Cardiovascular (CV) Pathology (Path) 8
and mobility. AS murmur is usually a harsh ejection-type systolic murmur heard best at the base of the heart in the "aortic area" (2nd right ICS) w/ radiation to the carotid arteries. CV Path
243 Aortic stenosis The murmur of AS is a systolic ejection-type, crescendo-decrescendo murmur that starts after the 1st heart sound and typically ends before the A2 component of the 2nd heart sound. The intensity of the Cardiovascular (CV) Pathophysiology 8
murmur is proportional to the magnitude of the LV to aorta pressure gradient during systole. (Patp) CV Patp
244 Aortic stenosis In pts w/ chronic AS and concentric LVH, atrial contraction contributes significantly to LV filling. Loss of atrial contraction due to AF can ↓ LV preload and CO sufficiently to cause systemic Cardiovascular (CV) Pathophysiology 8
hypotension. ↓ forward filling of the LV can also result in backup of blood in the LA and pulm veins, leading to acute pulm edema. (Patp) CV Patp
246 Diastolic dysfunction A low-freq, late diastolic sound on cardiac auscultation that immediately precedes S1 is most often S4. An abn S4 can be heard in pts w/ ↓ ventricular compliance (e.g. HTN heart disease, AS, HCM) due Cardiovascular (CV) Pathophysiology 4
to a sudden rise in EDP w/ atrial contraction. (Patp) CV Patp
247 Generalized anxiety disorder Buspirone is an NBA used to Tx GAD. It has a slow onset of action, lacks muscle relaxant or anticon properties, and carries no risk of dependence. Pregnancy, Childbirth & Pharmacology 4
Puerperium (PR) (Phar) PR Phar
248 Generalized anxiety disorder SSRIs and SNRIs are 1st-line Rx for GAD. BZDs should be limited to short-term use while antidepressants take effect and avoided in pts w/ a Hx of substance abuse. Pregnancy, Childbirth & Behavioral 4
Puerperium (PR) Science (Beha) PR Beha
249 Seizures Older children w/ absence seizures may also develop gen onset tonic-clonic or myoclonic seizures. Although ethosuximide is effective against isolated absence seizures, it isn't effective for tonic-clonic Nervous (NS) Pharmacology 8
seizures. Valproic acid is a broad-spectrum antiepileptic that Tx both types of seizures. (Phar) NS Phar
250 Seizures Absence seizures are a type of gen epilepsy characterised by brief staring spells w/ momentary loss of awareness f/b an abrupt return to full consciousness. A classic 3-Hz spike-wave is seen on EEG; the Nervous (NS) Pharmacology 8
Tx is ethosuximide. (Phar) NS Phar
252 Holoprosencephaly A developmental field defect describes multiple malformations that occur 2° to an embryonic disturbance in an adjoining group of cells. HPE is a developmental field defect Chx by a spectrum of fetal Miscellaneous (Multisystem) Embryology 1
anomalies due to incomplete division of the forebrain (prosencephalon). (MS) (Embr) MS Embr
253 Colorectal cancer CEA lvls are ↑ in colon ca but are also ↑ in a number of other conditions (eg, pancreatic ca, COPD, cirrhosis). CEA cannot be used to Dx colon ca, but it is helpful for detecting residual disease and Gastrointestinal & Nutrition (GI) Pathology (Path) 15
recurrence. GI Path
255 Anal fissure Anal fissures are longitudinal tears in the mucosa. They're usually due to passage of hard stool in pts w/ chronic constipation. Most fissures occur at the posterior midline, likely due to ↓ blood flow in this Gastrointestinal & Nutrition (GI) Pathology (Path) 1
area. Fissures in other areas may be due to less common causes. GI Path
256 Turner syndrome Streak ovaries, amenorrhea, and infertility are the gynecologic complications of TS. In addition, pts w/ TS usually have short stature, webbed neck, shield chest, and low posterior hairline. Bicuspid AV is Female Reproductive & Breast Genetics (Gene) 8
the most common cardiac comorbidity. (FR) FR Gene
257 Colorectal cancer CAC is the most common GI malignancy. Right-sided lesions are more likely to bleed and cause IDA; left-sided lesions tend to present w/ obstructing SSx (e.g. altered bowel habits, constipation, abdo Gastrointestinal & Nutrition (GI) Pathology (Path) 15
distension, nausea, and vomiting). GI Path
258 Polycystic ovary disease PCOS is a/w oligomenorrhea, hirsutism, and polycystic ovaries. Disruption in intraovarian steroidogenesis causes anovulatory cycles and results in chronic estrogen stimulation w/ ↓ progesterone Female Reproductive & Breast Physiology 4
secretion, placing PCOS pts at risk for endometrial hyperplasia/carcinoma. (FR) (Phys) FR Phys
259 Parkinson disease Selegiline is an inhib of MAO-B and can prevent MPTP-induced dmg of DA-ergic neurons. Selegiline is used clinically to delay the progr of Parkinson disease. Many neurologists favour the use of Nervous (NS) Pharmacology 7
combos of selegiline, anticholinergics, and amantadine until they no longer provide control of SSx. Only then is L-DOPA/carbidopa introduced. (Phar) NS Phar
261 Antipsychotics DIP is an EPS caused by Rx that block D2 receptors (e.g. antipsychs). Mx strategies incl ↓ or discontinuing the offending Rx and Tx w/ an antichol Rx. Pregnancy, Childbirth & Pharmacology 9
262 Parkinson disease Adding carbidopa can ↓ most of the peri AEs of L-DOPA. However, behavioural changes from L-DOPA can actually worsen w/ addn of carbidopa b/c more DA becomes available to the brain. Nervous (NS) Pharmacology 7
(Phar) NS Phar
264 Parkinson disease Long-term Tx of PD w/ levodopa can be complicated by periodic and sometimes unpredictable fluctuations in motor fxn. This "on-off" phenomenon is thought to be a consequence of progressive Nervous (NS) Pharmacology 7
nigrostriatal neurodegeneration leading to a ↓ therapeutic window for levodopa. (Phar) NS Phar
265 Parkinson disease PD is typically Tx w/ L-DOPA (immediate precursor of DA), which crosses the BBB. L-DOPA is admin w/ DDCIs (e.g. carbidopa) and sometimes COMTIs (e.g. entacapone) to ↓ the peri meta of L- Nervous (NS) Pharmacology 7
DOPA, resulting in ↑ L-DOPA bioavailability to the brain. (Phar) NS Phar
266 Histoplasmosis H. capsulatum is endemic to the Ohio and Mississippi River valleys and is found 1arily in soil contaminated w/ bird or bat droppings. It exists in tissues as an ovoid/round yeast predominantly w/i the Pulmonary & Critical Care (PU) Microbiology 4
intracellular space of macrophages. Immcom pts are often aSSx but can infreq develop subacute pneumonia w/ hilar and mediastinal LAD. (Micr) PU Micr
267 Histoplasmosis H. capsulatum is a dimorphic fungus that exists as a small, ovoid yeast at tissue temps. It replicates w/i macrophages and spreads thru the lymphatic and RES. Immcom pts usually have an aSSx pulm Pulmonary & Critical Care (PU) Microbiology 4
infection, but those who are immsup (e.g. advanced AIDS) can develop disseminated disease to the liver, spleen, and bone marrow. (Micr) PU Micr
268 Coccidioidomycosis C. immitis infection can be aSSx or it can cause pulm disease ranging from a flulike illness to chronic pneumonia. It causes disseminated disease in immsup pts. Spherules containing endospores are found Pulmonary & Critical Care (PU) Microbiology 2
in tissue samples. (Micr) PU Micr
269 Coccidioidomycosis C. immitis is a dimorphic fungus endemic to the SW US. It exists in the environment as a mould (w/ hyphae) that forms spores. These spores are inhaled and turn into spherules in the lungs. Pulmonary & Critical Care (PU) Microbiology 2
(Micr) PU Micr
270 Sporotrichosis Sporothrix schenckii is a dimorphic fungus that causes a subcutaneous mycosis. It is often transmitted by a thorn prick. The disease manifests with nodules that spread along lymphatics. Dermatology (DE) Microbiology 1
(Micr) DE Micr
271 Antibiotic resistance The main groups of antifungal Rx are polyenes, azoles, echinocandins, and pyrimidines. Polyene antifungals (eg, amphotericin B, nystatin) act by binding ergosterol in the fungal cell membrane. Infectious Diseases (ID) Microbiology 8
(Micr) ID Micr
273 Aspergillosis Amphotericin B binds the ergosterol of fungal cell membranes to exert its antifungal effects. However, it also binds chol to some degree, causing tox to human tissues. The most important AEs of Infectious Diseases (ID) Pharmacology 5
amphotericin B are nephrotox, hypokalaemia, and hypomagnesaemia. (Phar) ID Phar
274 Mucormycosis Amphotericin B is a polyene antifungal drug notorious for its renal tox. Severe hypokalaemia and hypomagnesaemia are commonly seen during therapy and often req daily supplementation. Infectious Diseases (ID) Pharmacology 3
(Phar) ID Phar
275 Adverse drug reaction Hypokalaemia and hypomagnesaemia are common electrolyte disturbances in pts undergoing Tx w/ amphotericin B and reflect an ↑ in DCT membrane permeability. Infectious Diseases (ID) Pharmacology 2
(Phar) ID Phar
276 Azoles Azoles inhibit the synthesis of ergosterol by the fungal cytochrome P450 enzymes. They also suppress the human P450 system, resulting in many drug-drug interactions. Infectious Diseases (ID) Pharmacology 1
(Phar) ID Phar
277 Antibiotic resistance Echinocandins (e.g. caspofungin, micafungin) are antifungal Rx that inhib synthesis of the polysaccharide glucan, an essential component of the fungal cell wall. Infectious Diseases (ID) Microbiology 8
(Micr) ID Micr
278 Achalasia Chagas disease is caused by a chronic infection by Trypanosoma cruzi and causes secondary achalasia due to destruction of the submucosal (Meissner) and myenteric (Auerbach) plexus. Other Gastrointestinal & Nutrition (GI) Microbiology 3
manifestations can include nonischemic cardiomyopathy and megacolon. (Micr) GI Micr
279 Zenker diverticulum Diminished relaxation of cricopharyngeal muscles during swallowing results in ↑ intraluminal pressure in the oropharynx. This may eventually cause the mucosa to herniate thru a zone of muscle Gastrointestinal & Nutrition (GI) Pathophysiology 1
weakness in the post. hypopharynx, forming a Zenker (false) diverticulum, which presents in elderly pts w/ oropharyngeal dysphagia, halitosis, regurg, and recurrent aspiration. (Patp) GI Patp
280 Diffuse esophageal spasm DOS is characterised by periodic, simultaneous, and non-peristaltic contractions of the oesophagus due to impaired inhib innervation w/i the oesophageal myenteric plexus. Pts typically present w/ Gastrointestinal & Nutrition (GI) Pathology (Path) 1
liquid/solid dysphagia and chest pain due to inefficient propulsion of food into the stomach. GI Path
281 Mallory-Weiss syndrome Mallory-Weiss tears account for about 10% of cases of upper GI hemorrhage. They occur due to ↑ intraluminal gastric pressure due to retching, vomiting, or other abdominal straining. Gastrointestinal & Nutrition (GI) Pathology (Path) 2 GI Path
282 Barrett esophagus Barrett esophagus is a metaplastic condition in which the normal squamous epithelium of the distal esophagus is replaced by intestinal-type columnar epithelium. It occurs most often in longstanding acid Gastrointestinal & Nutrition (GI) Pathology (Path) 2
reflux and is associated with an increased risk of adenocarcinoma. GI Path
283 Esophagitis Infec esophagitis is common in pts w/ HIV. The most common cause is C. albicans, although CMV and HSV are also freq implicated. Dx is based on endoscopic and micro findings. Gastrointestinal & Nutrition (GI) Microbiology 3
(Micr) GI Micr
284 Systemic sclerosis Systemic sclerosis may result in oesophageal dysmotility and incompetence of the LOS due to atrophy and fibrous replacement of the oesophageal muscularis. This can cause GORD w/ an ↑ risk of Gastrointestinal & Nutrition (GI) Pathology (Path) 3
Barrett oesophagus and stricture formation. GI Path
285 Gastroesophageal reflux disease Metaplasia is the substitution of one differentiated cell type for another due to the presence of an adverse environmental stimulus. It is often seen in the bronchi of chronic cigarette smokers (substitution Miscellaneous (Multisystem) Pathology (Path) 7
of columnar for stratified squamous cells) and the distal esophagus of patients with chronic gastroesophageal reflux (substitution of stratified squamous with columnar cells). Metaplasia can lead to (MS)
dysplasia and malignant transformation. MS Path
286 Gastroesophageal reflux disease GERD is caused primarily by GEJ incompetence and can be a/w extraesophageal SSx (eg, nocturnal cough) in the absence of heartburn. Acidic gastric contents irritate the esophageal mucosa, leading to Gastrointestinal & Nutrition (GI) Pathology (Path) 7
Chx histologic findings that include basal zone hyperplasia, elongation of the lamina propria papillae, and scattered eosinophils. GI Path
287 Esophageal cancer The histopathologic features of esophageal SCC include solid nests of neoplastic squamous cells w/ abundant eosinophilic cytoplasm and distinct borders. Areas of keratinization and the presence of Gastrointestinal & Nutrition (GI) Pathology (Path) 4
intercellular bridges are also Chx. Pts typically Px w/ progressive solid and eventually liquid dysphagia and weight loss. GI Path
291 Peptic ulcer disease The gastroduodenal artery lies along the post. wall of the duodenal bulb and is likely to be eroded by post. duodenal ulcers. Ulceration into the gastroduodenal artery can be a source of life-threatening Gastrointestinal & Nutrition (GI) Anatomy (Anat) 10
hemorrhage. GI Anat
292 Peptic ulcer disease Most gastric ulcers arise along the lesser curvature of the stomach, usually at the transitional zone b/w the gastric corpus (body) and antrum. The left and right gastric arteries run along the lesser curvature Gastrointestinal & Nutrition (GI) Anatomy (Anat) 10
and are likely to be penetrated by ulcers, causing gastric bleeding. GI Anat
293 Peripheral vascular disease Phenotypically mixing refers to coinfection of a host cell by 2 viral strains, resulting in progeny virions that contain nucleocapsid proteins from 1 strain and the unchanged parental genome of the other Cardiovascular (CV) Pathophysiology 4
strain. B/c there's no change in underlying viral genomes (no genetic exchange), the next gen of virions revert to their original, unmixed phenotypes. (Patp) CV Patp
294 Autoimmune hemolytic anemia Fe overload (hemosiderosis) is a common and serious complication of chronic hemolytic anaemia and freq blood transfusions. hemosiderin accumulation is the cardinal histo finding. Chelation therapy is Hematology & Oncology (HO) Pathology (Path) 1
indicated to ↓ parenchymal Fe deposition. HO Path
295 Atrophy Pathologic atrophy can be caused by ↓ physical workload, loss of innervation, ↓ blood supply, inadequate nutrition, absent endo stimulation, aging, or mechanical pressure. Rheumatology, Orthopedics & Pathophysiology 1
Sports (RH) (Patp) RH Patp
296 Aging Dystrophic calcification occurs in dmgd or necrotic tissue in the setting of normal Ca lvls; metastatic calcification occurs in normal tissue in the setting of hypercalcemia. Cardiovascular (CV) Pathophysiology 8
(Patp) CV Patp
297 Apoptosis Cytochrome c is a mitochondrial enzyme that activates caspases and indirectly brings about cell death through intrinsic pathway apoptosis. General Principles (GP) Pathology (Path) 4 GP Path
298 Apoptosis The Fas receptor acts to initiate the extrinsic pathway of apoptosis. Mutations involving the Fas receptor or Fas ligand can prevent apoptosis of autoreactive lymphocytes, thereby increasing the risk of Rheumatology, Orthopedics & Immunology 4
autoimmune disorders such as systemic lupus erythematosus. Sports (RH) (Immu) RH Immu
299 Apoptosis Progesterone is the 1° hormone responsible for stimulating the endometrium so that it is suitable for implantation. Progesterone withdrawal causes endometrial cells to undergo apoptosis, resulting in Female Reproductive & Breast Physiology 4
menstrual bleeding. (FR) (Phys) FR Phys
300 Aging Lipofuscin is the product of lipid peroxidation, accumulating in aging cells (esp. in pts w/ malnutrition and cachexia). Cardiovascular (CV) Pathology (Path) 8 CV Path
301 Tuberculosis T-helper subtype 1 cells release interferon-gamma leading to the activation of macrophages, a process critical for control of Mycobacterium tuberculosis infection. Activated macrophages form mature Pulmonary & Critical Care (PU) Immunology 18
phagolysosomes that destroy phagocytosed mycobacteria and can differentiate into epithelioid and Langhans giant cells to wall off extracellular mycobacteria within caseating granulomas. Interferon-γ, (Immu)
IL-12, and TNF-α are critical cytokines for the formation and maintenance of granulomas. PU Immu
302 Lung abscess Abscess formation is largely driven by neutrophil recruitment and activation leading to the release of cytotoxic granules that kill bacteria but also cause liquefying necrosis of surround tissue. Pulmonary & Critical Care (PU) Pathophysiology 4
(Patp) PU Patp
303 Superior mesenteric artery SMA syndrome occurs when the transverse portion of the duodenum is entrapped b/w the SMA and aorta, causing SSx of partial intestinal obstr. This syndrome occurs when the aortomesenteric angle Gastrointestinal & Nutrition (GI) Anatomy (Anat) 1
syndrome critically ↓, 2° to diminished mesenteric fat, pronounced lordosis, or Sx correction of scoliosis. GI Anat
304 Zollinger-Ellison syndrome Pts w/ ZES develop PUD and parietal cell hyperplasia w/ gastric fold enlargement due to gastrin hypersecretion. Gastrointestinal & Nutrition (GI) Pathology (Path) 3 GI Path
305 Zollinger-Ellison syndrome ZES is caused by gastrinomas located in the small intestine/pancreas and Px w/ peptic ulcers (especially distal duodenal ulcers), heartburn, and diarrhea. Pts typically have ↑ gastrin lvls that rise in Gastrointestinal & Nutrition (GI) Pathology (Path) 3
response to exogenous secretin administration. In contrast, secretin inhibits release of gastrin from normal gastric G cells. GI Path
306 Mastocytosis Systemic mastocytosis is characterised by the abn proliferation of mast cells and ↑ hist release. Hist causes hypersecretion of GA by parietal cells in the stomach as well as a variety of other SSx (e.g. Gastrointestinal & Nutrition (GI) Pathophysiology 1
hypotension, flushing, pruritus). (Patp) GI Patp
307 Gastric cancer There are 2 morphological variants of GAC. The intestinal type forms a solid mass that projects into the stomach lumen and is composed of glandular-forming cuboidal or columnar cells. In contrast, Gastrointestinal & Nutrition (GI) Pathology (Path) 1
diffuse carcinoma (linitis plastica) infiltrates the stomach wall and displays signet-ring cells on LM. GI Path
308 Meniere disease Ménière disease is Chx by tinnitus, vertigo, and sensorineural hearing loss. Its pathogenesis is related to an ↑ volume and pressure of endolymph in the vestibular apparatus. Ear, Nose & Throat (EN) Pathophysiology 1
(Patp) EN Patp
309 Carcinoid tumors Carcinoid syndrome may accomp extraintestinal mets of GI carcinoid tumors. Octreotide is a synth SS analog used to control the SSx of carcinoid syndrome. Gastrointestinal & Nutrition (GI) Pharmacology 4
(Phar) GI Phar
310 SIDS The AEs of 2nd-hand smoke exposure incl an ↑ risk of low birth weight, asthma, middle ear disease, and SIDS. Up to 1/2 of all SIDS cases are due to tobacco exposure, likely from impaired arousal and Pulmonary & Critical Care (PU) Pathology (Path) 1
abn CV responses to stimuli. PU Path
311 Vitamin C deficiency Vitamin C is necessary for the hydroxylation of proline and lysine residues in pro-collagen. Vitamin C deficiency (scurvy) is most often seen in severely malnourished individuals and leads to capillary Miscellaneous (Multisystem) Biochemistry 3
bleeding, poor wound healing, and periodontal disease. In children, bony deformities and subperiosteal hemorrhages are also Chx. (MS) (Bioc) MS Bioc
312 Down syndrome DS is the most common chromosomal anomaly. It is a/w low lvls of maternal serum AFP and estriol and ↑ lvls of β-hCG and inhibin A. ↑ AFP lvls are seen in multiple gestation, open NT defects, and Pregnancy, Childbirth & Genetics (Gene) 6
abdominal wall defects. Puerperium (PR) PR Gene
313 Oncogenes and tumor suppressor p53 is a TSG that controls cell division and apoptosis. It's inactivated in many tumours. Hematology & Oncology (HO) Pathology (Path) 1
genes HO Path
314 Acute liver failure The P450 microsomal oxidase system plays an important role in detoxification. In CCl4 pois, however, it produces free radicals that start a vicious cycle of hepatic injury. Hematology & Oncology (HO) Pathology (Path) 2 HO Path
315 Patent ductus arteriosus PDA is common in preterm infants and presents w/ a continuous murmur, widened PPs, and SSx of CV strain. Indomethacin or ibuprofen therapy can inhib PGE2 synthesis and accelerate closure. Cardiovascular (CV) Pharmacology 4
(Phar) CV Phar
316 Osteonecrosis ON (AVN) occurs due to impaired blood supply to a segment of bone. The femoral head is the most common location. Common causes incl SCD, GC therapy, vasculitis, and alcoholism. Rheumatology, Orthopedics & Pathology (Path) 1
Sports (RH) RH Path
317 Biliary atresia Biliaryatresia, or obstr of extrahepatic bile ducts, presents w/ jaundice, dark urine, and acholic stools in the 1st 2mos of life due to conjugated hyperbilirubinaemia. Bx reveals intrahepatic bile duct Gastrointestinal & Nutrition (GI) Pathophysiology 1
proliferation, portal tract oedema, and fibrosis. (Patp) GI Patp
318 Malrotation Intestinal malrotation results when the midgut undergoes incomplete embryological counterclockwise rotation. It can Px as intestinal obstruction (due to compression by the adhesive bands) and midgut Gastrointestinal & Nutrition (GI) Embryology 1
volvulus (intestinal ischemia due to twisting around the blood vessels). (Embr) GI Embr
319 Intestinal atresia Intestinal atresia distal to the duodenum occurs due to vascular accidents in utero. "Apple-peel" atresia occurs when the superior mesenteric artery is obstructed. The result is a blind-ending proximal Gastrointestinal & Nutrition (GI) Embryology 1
jejunum; a length of absent bowel and mesentery: and, finally, a terminal ileum spiraled around an ileocolic vessel. (Embr) GI Embr
321 Embryology, Meckel A # of ectopic tissues are found in Meckel diverticulum - most commonly, gastric epithelium. Gastric mucosa is present in 80% of cases of SSx Meckel diverticulum. Gastric acid production leads to Gastrointestinal & Nutrition (GI) Embryology 1
ulceration and subsequent bleeding. (Embr) GI Embr
322 Meckel diverticulum The omphalomesenteric (vitelline) duct normally obliterates during the 7th wk of embryonic development. Both enterocysts and Meckel diverticula result from a failure of obliteration involving the Gastrointestinal & Nutrition (GI) Embryology 3
vitelline duct. (Embr) GI Embr
323 Malabsorption Malabsorption is a syndrome of impaired intestinal digestion and absorption. Fats are typically the most severely affected macronutrient in gen malabsorption, and testing the stool for fat (e.g. w/ Sudan Gastrointestinal & Nutrition (GI) Pathophysiology 4
III stain) is the most sensitive strategy for screening for malabsorptive disorders. (Patp) GI Patp
324 Celiac disease Celiac disease (gluten-sens enteropathy) classically Px b/w age 6-24 mos w/ abdo pain, diarrhea, vomiting, and weight loss. Duodenal Bx reveals crypt hyperplasia, villous atrophy, and intraepithelial Gastrointestinal & Nutrition (GI) Histology (Hist) 2
lymphocyte infiltration. Tx w/ a gluten-free diet resolves SSx and normalizes sero and histo. GI Hist
326 Celiac disease Celiac disease is caused by an immune-mediated rxn to gluten and can Px w/ bloating, diarrhea, and flatulence, as well as short stature and weight loss. Screening tests show an ↑ level of IgA against Gastrointestinal & Nutrition (GI) Pathology (Path) 2
tissue transglutaminase. Duodenal Bx is confirmatory, showing villus flattening and intraepithelial lymphocyte infiltration. GI Path
327 Abetalipoproteinemia Abetalipoproteinaemia is an inherited inability to synthesise apoB, an important component of chylomicrons and VLDL. Lipids absorbed by the small intestine can't be transported into the blood and Gastrointestinal & Nutrition (GI) Pathology (Path) 1
accumulate in the intestinal epithelium, resulting in enterocytes w/ clear or foamy cytoplasm. GI Path
328 Meckel diverticulum Meckel diverticulum is a remnant of the omphalomesenteric (vitelline) duct. It is connected to the ileum and is located 2 ft proximal to the ICV. It often contains acid-secreting ectopic gastric tissue, Gastrointestinal & Nutrition (GI) Embryology 3
which may cause ulceration of the adjacent mucosa and lower GI bleeding (melena/hematochezia). Meckel diverticulum is a true diverticulum and consists of all parts of the intestinal wall. (Embr) GI Embr
329 Meckel diverticulum Meckel diverticulum results from failed obliteration of the vitelline duct and usually Px w/ spontaneous but painless lower GI bleeding. (99m)Tc-pertechnetate localizes ectopic gastric mucosa, and its ↑ Gastrointestinal & Nutrition (GI) Embryology 3
uptake is Dx for Meckel diverticulum. (Embr) GI Embr
330 Hirschsprung disease Hirschsprung disease is a result of abnormal migration of neural crest cells during embryogenesis. These cells are the precursors of ganglion cells of intestinal wall plexi. Since neural crest cells migrate Gastrointestinal & Nutrition (GI) Embryology 2
caudally, the rectum is always affected in Hirschsprung disease. (Embr) GI Embr
331 Hirschsprung disease Submucosal (Meissner) and myenteric (Auerbach) autonomic plexi are absent in the affected segment of the bowel in HD. The submucosa of the narrowed area is the most superficial layer where the Gastrointestinal & Nutrition (GI) Pathology (Path) 2
absence of ganglion cells can be seen. GI Path
333 Endometriosis Endometriosis refers to the presence of endometrial glands and stroma outside the uterus. It may be asymptomatic or present with dysmenorrhea, dyspareunia, and/or infertility. Female Reproductive & Breast Pathology (Path) 1
(FR) FR Path
334 Ectopic pregnancy An ectopic pregnancy is Chx by implantation outside of the uterus. Uterine curettage would reveal decidual changes in the endometrium due to progesterone secretion but no embryonic or trophoblastic Pregnancy, Childbirth & Histology (Hist) 1
tissue (eg, no villi). Puerperium (PR) PR Hist
335 Gestational trophoblastic disease Choriocarcinoma is a malignant form of gestational trophoblastic disease composed of anaplastic cytotrophoblasts and syncytiotrophoblasts w/o villi. It often Px as dyspnea/hemoptysis due to pulm Pregnancy, Childbirth & Pathophysiology 3
metastasis from hematogenous spread. Puerperium (PR) (Patp) PR Patp
336 Bladder cancer Urothelial (transitional cell) carcinoma is the most common type of bladder ca. Tumor stage is the most important factor for determining prognosis and is based on the depth of invasion into the bladder Hematology & Oncology (HO) Pathology (Path) 4
wall and the degree of spread to other tissues. Tumor invasion into the muscular layer of the bladder wall carries an unfavorable prognosis. HO Path
337 Polyhydramnios Polyhydramnios (excessive accumulation of amniotic fluid) presents with increased abdominal circumference out of proportion to gestational age. The etiology is decreased fetal swallowing or increased Pregnancy, Childbirth & Embryology 1
fetal urination. Fetal anomalies associated with impaired swallowing include gastrointestinal obstruction (eg, duodenal, esophageal, or intestinal atresia) and anencephaly. Puerperium (PR) (Embr) PR Embr
339 Turner syndrome TS (45,X) MFx in the neonate w/ lymphedema and cystic hygromas. Short stature, 1° amenorrhea, and aortic anomalies are the other important CFx. Female Reproductive & Breast Genetics (Gene) 8
(FR) FR Gene
340 Systemic sclerosis CREST syndrome (limited scleroderma) MFx w/ calcinosis, Raynaud's phenomenon, oesophageal dysmotility, sclerodactyly, and telangiectasias. Anti-centromere Abs are found in about 40% of pts w/ Rheumatology, Orthopedics & Pathology (Path) 3
CREST syndrome. Anti-DNA topoisomerase I (Scl-70) Abs are highly specific for systemic sclerosis. Sports (RH) RH Path
341 Prostate cancer CFx that suggest a malignant cause of back pain incl occurrence at night, not relieved w/ rest or analgesics, advanced age, and systemic SSx. Common malignancies w/ a propensity for bony mets incl Hematology & Oncology (HO) Pathology (Path) 5
prostate, breast, kidney, thyroid, and lung. HO Path
342 Prenatal care The maternal serum quadruple screen is performed to Ax risk of congenital defects in fetuses. Accurate dating is important for determining whether levels of AFP and other analytes are abnormal for Pregnancy, Childbirth & Pathophysiology 1
gestational age. Pts w/ a Hx of irregular menses are at risk for inaccurate pregnancy dating. Puerperium (PR) (Patp) PR Patp
343 Klinefelter syndrome 47,XXY is the most common genotype causing KS. Pts Px w/ tall stature; small, firm testes; azoospermia; and gynecomastia. Mild intellectual disability is seen in some pts, and the severity generally ↑ w/ Male Reproductive (MR) Genetics (Gene) 3
each additional X chromosome. MR Gene
344 Fragile X syndrome FXS, an XL disorder, is the most common cause of inherited intellectual disability. The pathogenesis involves an unstable expansion of TNRs (CGG) in the FMR1 gene. Key physical findings include Nervous (NS) Genetics (Gene) 3
dysmorphic facial features (e.g. large jaw, protruding ears, long face) and macroorchidism. NS Gene
345 Li-Fraumeni syndrome LFS is caused by an AD mut in the TSG TP53. Leukaemia, sarcomas, and tumours of the breast, bran, and adrenal cortex are most common. Hematology & Oncology (HO) Pathology (Path) 1 HO Path
346 von Willebrand disease Following endothelial dmg, vWF binds GPIb receptors on platelets to mediate platelet adherence. The RCoA measures platelet agglutination via binding of GPIb receptors to vWF; it'll be abn in vWF Hematology & Oncology (HO) Biochemistry 7
defic but will correct w/ the addn of normal (vWF-containing) plasma. (Bioc) HO Bioc
347 Child abuse Abusive head trauma can be caused by vigorous shaking of an infant and results in SDH (due to tearing of bridging veins) and retinal hemorrhages. Additional red flags are injuries inconsistent w/ Hx or Nervous (NS) Pathology (Path) 2
developmental age. NS Path
348 Insomnia Benzos, antihists, and sedating antideps should be avoided in the Tx of insomnia in elderly pts due to their AEs. Ramelteon, a melatonin agonist, has a lower AE burden than other sedative-hypnotic Pregnancy, Childbirth & Pharmacology 3
agents and is effective in ↓ time to sleep onset in the elderly. Puerperium (PR) (Phar) PR Phar
349 Insomnia NonBZD Rx (eg, zolpidem, zaleplon, eszopiclone) stimulate specific subtypes of GABA-A receptors. As a result, nonBZDs are primarily hypnotics and do not produce the anxiolytic, muscle relaxant, or Pregnancy, Childbirth & Pharmacology 3
anticonvulsant effects a/w BZDs. Puerperium (PR) (Phar) PR Phar
350 Alcohol withdrawal AWS should be considered in hospitalised pts who develop tremulousness, agitation, and ↑ HR and BP w/i 48hrs following admission. Benzos act as a substitute for the effects of alcohol on GABA Pregnancy, Childbirth & Pharmacology 2
receptors, preventing AWS from occurring. Puerperium (PR) (Phar) PR Phar
351 Antiepileptics Phenytoin meta depends on the fxn of hepatic P450 oxidases and is dose-dependent. Drugs that induce hepatic microsomal enzymes (phenobarbital, carbamazepine, and rifampin) enhance phenytoin meta Nervous (NS) Pharmacology 3
and ↓ its serum conc. You should know all of the commonly-prescribed Rx that're meta by the P450 system, and you should know which drugs induce or inhib the fxn of these enzymes. (Phar) NS Phar
352 Benzodiazepines 1st-gen H1 receptor antagonists, incl diphenhydramine and chlorpheniramine, can cause significant sedation, esp. when used w/ other Rx that caused CNS depression (such as benzos). Nervous (NS) Pharmacology 6
(Phar) NS Phar
353 Seizures SE is a single seizure lasting >5min or the occurrence of multi discrete seizures w/ incomplete recovery of consciousness b/w episodes. The initial Tx incls IV lorazepam and phenytoin given Nervous (NS) Pharmacology 8
concurrently. Phenytoin is a long-acting anticonvulsant that inhibs neuronal high-freq firing by ↓ the ability of Na+ channels to recover from inactivation. (Phar) NS Phar
354 Trigeminal neuralgia CNV neuralgia presents w/ brief episodes of sudden and severe 'electric shock-like' or 'stabbing' pain in the distribution of CNV (particularly V2 and V3). Carbamazepine is the DOC. Nervous (NS) Pharmacology 2
(Phar) NS Phar
355 Seizures Broad-spectrum anticonvulsants (e.g. levetiracetam, valproic acid) Tx both focal and gen onset seizures, whereas narrow-spectrum anticonvulsants (e.g. carbamazepine, phenytoin) are 1arily used only for Nervous (NS) Pharmacology 8
focal onset seizures. B/c the seizures in JME are usually gen onset (i.e. affect both cerebral hemispheres at onset), Tx is w/ a broad-spectrum agent such as valproic acid. (Phar) NS Phar
356 Antiepileptics Lamotrigine can be used to Tx partial and gen seizures and works by blocking v-gated Na+ channels. SJS and TEN are rare, life-threatening AEs characterised by flu-like SSx f/b widespread Nervous (NS) Pharmacology 3
mucocutaneous epidermal necrosis. (Phar) NS Phar
357 Mitochondrial diseases, inheritance Red ragged muscle fibers are seen in mitochondrial diseases. Muscle fibers have this appearance b/c abnormal mitochondria accumulate under the sarcolemma. Mitochondrial diseases show maternal Nervous (NS) Genetics (Gene) 1
inheritance. NS Gene
358 Cystic fibrosis The most common gastrointestinal disorder in patients with cystic fibrosis is pancreatic insufficiency. Mutations in the cystic fibrosis transmembrane conductance regulator gene lead to thick, viscous Gastrointestinal & Nutrition (GI) Pathology (Path) 11
secretions in the lumens of the pancreas, resulting in obstruction, inflammation, and subsequent fibrosis. Clinical manifestations include steatorrhea, failure to thrive, and deficiency of fat-soluble
vitamins. GI Path
360 Renal artery occlusion Central RAO Px w/ sudden, painless, and permanent monocular blindness. Funduscopic Ex reveals a pale retina and a "cherry-red" macula. Ophthalmology (OP) Pathophysiology 1
(Patp) OP Patp
361 snRNP function Small nuclear RNA (SARNA) is synthesized by RNA polymerase II in the nucleus and complexes with specific proteins to form small nuclear ribonucleoproteins (snRNPs). SnRNPs are an essential Rheumatology, Orthopedics & Biochemistry 1
component of spliceosomes, which remove introns from pre-mRNA to form mature mRNA. Patients with systemic lupus erythematosus can have autoantibodies directed against snRNPs (eg, anti-Smith Sports (RH) (Bioc)
antibody). RH Bioc
362 Gilbert syndrome Gilbert syndrome is the likely Dx in pts w/ no apparent liver disease who have mild unconjugated hyperbilirubinaemia that appears provoked by 1 of the classic triggers. Gastrointestinal & Nutrition (GI) Pathology (Path) 1 GI Path
363 Kernicterus CNS is an AR disorder of bilirubin meta caused by a genetic lack of the UGT enzyme needed to catalyse bile glucuronidation. Unconjugated hyperbilirubinaemia develops in these infants, causing Gastrointestinal & Nutrition (GI) Pathophysiology 1
kernicterus and often death. (Patp) GI Patp
364 Cholestasis Cholestatic liver disease can cause malabsorption and nutritional defic of fat-soluble vits. Gastrointestinal & Nutrition (GI) Pathology (Path) 1 GI Path
365 Hepatitis B Acute hepB infection can cause a serum sickness-like syndrome w/ joint pain, LAD, and a pruritic urticarial rash. Other features may incl RUQ pain, hepatomegaly, and ↑ hepatic TA lvls. Gastrointestinal & Nutrition (GI) Pathophysiology 14
(Patp) GI Patp
366 Hepatitis A Acute hepA is a self-limited infection that typically presents acutely w/ prodromal SSx (e.g. fever, malaise, anorexia, nausea/vomiting, RUQ pain) followed by SSx of cholestasis (e.g. jaundice, pruritus, Gastrointestinal & Nutrition (GI) Pathology (Path) 4
dark-coloured urine, clay-coloured stool). GI Path
367 Hepatitis B HepB infection causes the hepatocellular cytoplasm to fill w/ HBsAg. These inclusions are highly specific for hepB infection and have a finely granular, pale eosinophilic, ground-glass appearance. Gastrointestinal & Nutrition (GI) Pathology (Path) 14 GI Path
368 Cirrhosis Cirrhosis is Chx by diffuse hepatic fibrosis w/ replacement of the normal lobular architecture by fibrous-lined parenchymal nodules. Chronic viral hepatitis (eg, hepatitis B and C), Alc, hemochromatosis. Gastrointestinal & Nutrition (GI) Pathology (Path) 7
and NAFLD are the most common causes of cirrhosis in the United States. GI Path
369 Acute liver failure Inhaled anesthetics, such as halothane, can be associated with a highly lethal fulminant hepatitis that cannot be distinguished histologically from acute viral hepatitis. Patients have significantly elevated Gastrointestinal & Nutrition (GI) Pathophysiology 2
aminotransferase levels due to massive hepatocellular injury and a prolonged prothrombin time due to failure of hepatic synthetic function. (Patp) GI Patp
370 Alcoholic liver disease The pathogenesis of Alc-induced hepatic steatosis appears related primarily to a ↓ in FFA oxidation 2° to excess NADH production by the 2 major Alc metabolism enzymes, Alc dehydrogenase and Gastrointestinal & Nutrition (GI) Pathology (Path) 1
aldehyde dehydrogenase. GI Path
372 Hepatitis A Transmission of the HAV occurs thru the fecal-oral route and is common in areas w/ overcrowding and poor sanitation. Outbreaks freq result from contam water or food, and raw or steamed shellfish is a Gastrointestinal & Nutrition (GI) Microbiology 4
common culprit in the US. (Micr) GI Micr
373 Hepatitis A HAV infection is most commonly silent or subclinical ('anicteric') in young children but can also present as an acute, self-limited illness characterised by jaundice, malaise, fatigue, anorexia, nausea, Infectious Diseases (ID) Microbiology 4
vomiting, RUQ pain, or an aversion to smoking. (Micr) ID Micr
374 Hepatitis B The HBV replicated via the following seq: dsDNA → (+)RNA template → partially dsDNA progeny. Although it's a DNA virus, HBV uses reverse transcriptase to generate new viral DNA from a (+)- Infectious Diseases (ID) Microbiology 14
sense RNA template. (Micr) ID Micr
375 Hepatitis B HBV doesn't have a cytotox effect itself; however, the presence of viral HBsAg and HBcAg on the cell surface stim the host's CD8+Tc lymphocytes to destroy infected hepatocytes. Gastrointestinal & Nutrition (GI) Pathophysiology 14
(Patp) GI Patp
376 Hepatitis B Replication of the hepatitis B genome occurs w/i a newly synthesized capsid through the action of reverse transcriptase on an RNA template. The mature capsid contains partially ds circular DNA and Infectious Diseases (ID) Microbiology 14
reverse transcriptase. (Micr) ID Micr
377 Hepatitis B Individuals who are successfully immunized against HBV develop protective anti-HBs Ab. Individuals who recover from hepatitis B infection, however, have anti-HBs as well as anti-HBc Abs. The Infectious Diseases (ID) Microbiology 14
presence of circulating HBsAg indicates active infection. (Micr) ID Micr
378 Hepatitis B Vertical transmission of hepB from preg females to the unborn child can occur in women w/ active hepB infection. The presence of HBeAg (a marker of viral replication and ↑ infectivity) in the mother Infectious Diseases (ID) Microbiology 14
greatly ↑ the risk of vertical transmission of the virus. B/c of this concern, the newborns of all mothers w/ active hepB are passively immunised at birth w/ HBIG, f/b active immunisation w/ recombinant (Micr)
HBV vax. ID Micr
379 Hepatitis B If HBeAg persists for several months and host anti-HBeAg remain at low or undetectable levels, suspect chronic hepatitis B infection with high infectivity. Infectious Diseases (ID) Microbiology 14
(Micr) ID Micr
380 Hepatitis B The presence of anti-HBc and anti-HBs antibodies in the serum without detectable viral antigens indicates recovery from acute hepatitis B infection. In contrast, patients vaccinated against hepatitis B will Infectious Diseases (ID) Immunology 14
have anti-HBs antibodies without detectable levels of anti-HBc. Chronic hepatitis B is indicated by persistent levels of HBsAg and HBV DNA in the serum. (Immu) ID Immu
382 Glomerular disorders MG is a common cause of nephrotic syndrome in adults and can occur in a/w solid malignancy, viral hepatitis, and SLE. IC deposition in the subepithelial portion of the glomerular cap wall causes diffuse Renal, Urinary & Electrolytes Pathology (Path) 9
thickening of the GBM (w/o ↑ cellularity); these deposits have a 'spike and dome' appearance when stained w/ silver stains. (RE) RE Path
383 Glomerular disorders MCD is the most common cause of nephrotic syndrome in children. Systemic T-cell dysfxn leads to the production of glomerular permeability factor, which causes podocyte foot process fusion and ↓ the Renal, Urinary & Electrolytes Pathology (Path) 9
anionic properties of the GBM. The loss of (-) charge leads to selective albuminuria. (RE) RE Path
384 Glomerular disorders MCD is the most common cause of nephrotic syndrome in children. Classic MFxs incl proteinuria, hypoalbuminaemia, and oedema that're usually reversible w/ corticosteroids. The principal lesion is a Renal, Urinary & Electrolytes Pathology (Path) 9
diffuse foot process effacement that can be seen on EM. LM and IF are normal. (RE) RE Path
385 Glomerular disorders MCD is cause by immune dysregulation and overproduction of glomerular permeability factor, which dmgs podocytes and ↓ the anionic properties of the GBM. This results in selective loss of albumin in Renal, Urinary & Electrolytes Pathology (Path) 9
the urine, in contrast to the nonselective proteinuria in other forms of nephrotic syndrome. (RE) RE Path
386 Hepatitis B The main modes of transmission of HBV incl sexual (among both heterosex partners and MSM) and percutaneous (e.g. IVDU, needlestick accidents, blood transfusions). The risk of sexual transmission Gastrointestinal & Nutrition (GI) Microbiology 14
of HCV is low. (Micr) GI Micr
388 Hepatitis C The HCV is genetically unstable b/c it lacks proofreading 3’ → 5’ exonuclease activity in its RNA pol. Its env GP seqs also contain an HVR prone to freq genetic mut. Gastrointestinal & Nutrition (GI) Microbiology 4
(Micr) GI Micr
390 Hepatitis B The most common outcome in HBV-infected adults (>95%) is acute hepatitis w/ mild or subclinical SSx that eventually completely resolve. Infectious Diseases (ID) Microbiology 14
(Micr) ID Micr
391 Hemochromatosis Physiologic Fe loss through menstruation and pregnancy slows the progression of hemochromatosis in women. Gastrointestinal & Nutrition (GI) Pathophysiology 4
(Patp) GI Patp
393 Hemochromatosis HH is most commonly caused by a missense mut in the HFE gene, resulting in excessive intestinal Fe absorption and organ dmg (e.g. cirrhosis, DM, cardiomyopathy, arthropathy) due to Fe accumulation Gastrointestinal & Nutrition (GI) Pathology (Path) 4
w/i parenchymal tissues. GI Path
394 Hemochromatosis Hereditary hemochromatosis is an autosomal recessive disease characterized by abnormally high intestinal iron absorption. Common manifestations include liver disease, skin hyperpigmentation, diabetes Gastrointestinal & Nutrition (GI) Pathology (Path) 4
mellitus, arthropathy, and cardiac enlargement with conduction abnormalities or heart failure. GI Path
395 Hemochromatosis HFE protein mutations are the most common cause of 1° hemochromatosis. Inactivation of the HFE protein results in ↓ hepcidin synthesis by hepatocytes and ↑ DMT1 expression by enterocytes, leading Hematology & Oncology (HO) Pathology (Path) 4
to Fe overload. Pts w/ hemochromatosis are at an ↑ risk for liver cirrhosis and HCC. HO Path
396 Copper excretion Absorbed Cu is used to form ceruloplasmin, which accounts for 90-95% of circulating Cu. Senescent ceruloplasmin and the unabsorbed Cu are secreted into bile and excreted in stool, which is the 1° Gastrointestinal & Nutrition (GI) Pathophysiology 1
route for Cu elimination. (Patp) GI Patp
397 Wilson disease WD is an AR condition Chx by excessive Cu deposition into tissues (eg, liver, basal ganglia, cornea). It typically Px in young adults w/ liver disease, neuropsych SSx (eg, gait disturbance, dysarthria, Nervous (NS) Pathology (Path) 5
depression, personality changes), and Kayser-Fleischer rings on slit lamp Ex. NS Path
398 Wilson disease The Kayser-Fleischer ring is an ophthalmologic finding most strongly associated with Wilson's disease. It is seen most frequently in patients with neuropsychiatric complications. Basal ganglia atrophy is Ophthalmology (OP) Pathology (Path) 5
typically present in these patients. OP Path
399 Alpha1 antitrypsin deficiency AAT is a serum protein that, thru the inhib of neutrophil elastase, ↓ tissue dmg caused by inflammation. Histo, AATD can demonstrate reddish-pink globules on PAS stain; these globules represent un- Pulmonary & Critical Care (PU) Pathophysiology 8
secreted, polymerised AAT in the periportal hepatocytes. (Patp) PU Patp
400 Alpha1 antitrypsin deficiency AAT is a serine protease inhib that regulates the activity of elastase in the lung. Inherited defic of AAT leads to alveolar destruction and panacinar emphysema; in addn, accumulation of improperly folded Gastrointestinal & Nutrition (GI) Pathology (Path) 8
AAT proteins in hepatocytes can leads to liver dysfxn and cirrhosis in some pts. GI Path
401 Primary biliary cholangitis PBC is a chronic liver disease characterised by autoimmune destruction of the intrahepatic bile ducts and cholestasis (↑ ALP). The condition is most common in middle-aged women, w/ severe pruritus Gastrointestinal & Nutrition (GI) Pathology (Path) 4
(esp. at night) often 1 of the 1st reported SSx. GI Path
402 Primary biliary cholangitis PBC is a chronic AI liver disease Chx by lymphocytic infiltrates and destruction of small and mid-sized intrahepatic bile ducts. Similar findings are seen in hepatic GVHD, highlighting the immunologic Gastrointestinal & Nutrition (GI) Pathophysiology 4
etiology of the disorder. (Patp) GI Patp
403 Primary biliary cholangitis PBC is a chronic autoimmune liver disease characterised by destruction of intrahepatic, interlobular bile ducts by granulomatous inflammation. The disease typically presents insidiously w/ pruritus and Gastrointestinal & Nutrition (GI) Pathology (Path) 4
fatigue in middle-aged women. Pts may eventually develop SSx of cholestasis (e.g. jaundice, pale stool, dark urine) and hypercholaemia (e.g. xanthelasma). GI Path
404 Inflammatory bowel disease CD typically Px w/ prolonged diarrhea and abdominal pain. Constitutional SSx (eg, low-grade fever, fatigue), malabsorption, and weight loss are also common. Transmural inflammation of the bowel wall Gastrointestinal & Nutrition (GI) Pathology (Path) 9
may result in the formation of fistulas (eg, enteroenteric, enterocutaneous), abscesses, and fibrotic strictures. GI Path
405 Inflammatory bowel disease NCGs are a hallmark of CD and can help distinguish it from UC, which does not form granulomas. Histopathology in CD also demonstrates transmural inflammation, distortion of the normal architecture, Gastrointestinal & Nutrition (GI) Pathology (Path) 9
and Paneth cell metaplasia. GI Path
406 Inflammatory bowel disease Granulomas are characterised by a large # of epithelioid macrophages that may fuse together to form multinucleated cells (Langhans giant cells) surrounded by a band of lymphocytes. Granuloma Gastrointestinal & Nutrition (GI) Pathology (Path) 9
formation involves chronic Th1 and macrophage activation in response to a difficult-to-eradicate Ag. GI Path
407 Inflammatory bowel disease CD is an IBD characterised by patchy inflammation that can occur throughout the entire GIT. Gross path demonstrates skip lesions, cobble-stoning of the mucosa, bowel wall thickening, and creeping fat. Gastrointestinal & Nutrition (GI) Pathology (Path) 9 GI Path
408 Inflammatory bowel disease CD is a/w oxalate kidney stones. Impaired BA absorption in the terminal ileum leads to loss of BAs in faeces w/ subseq fat malabsorption. Intestinal lipids then bind Ca2+ions, and the resulting soap Gastrointestinal & Nutrition (GI) Pathophysiology 9
complex is excreted. Free oxalate (normally bound by Ca2+ to form an unabsorbable complex) is absorbed and forms urinary calculi (enteric oxaluria). (Patp) GI Patp
409 Inflammatory bowel disease CD is characterised by patchy, transmural inflammation of the GIT. It can affect any part of the tract from the mouth to the anus. Complications incl strictures (due to bowel wall oedema, fibrosis, and Gastrointestinal & Nutrition (GI) Pathology (Path) 9
thickening of the muscularis mucosae), fistulas (due to penetration of ulcers thru the intestinal wall), and abscesses. GI Path
410 Toxic megacolon Toxic megacolon is a well-recognised complication of UC. Pts typically present w/ abdo pain/distension, bloody diarrhoea, fever, and SSx of shock. Plain abdo XR is the preferred Dx imaging study. Gastrointestinal & Nutrition (GI) Pathology (Path) 1
Barium contrast studies and colonoscopy are c/i due to the risk of perforation. GI Path
411 Colorectal cancer IBD, especially ulcerative pancolitis, is a/w a significant risk for CRC. Compared w/ sporadic CRC, colitis-associated CRC is more likely to occur at a younger age, is typically more aggressive w/ a Gastrointestinal & Nutrition (GI) Pathology (Path) 15
higher histopathologic grade, often evolves from flat (nonpolypoid) lesions, and is frequently multifocal. Pts should be monitored regularly via colonoscopy w/ random Bx. GI Path
412 Gallstone disease Pts w/ CD affecting the terminal ileum (most common site of involvement) are prone to devel gallstones. ↓ BA reabsorption by the inflamed terminal ileum promotes chol supersaturation of the bile, Gastrointestinal & Nutrition (GI) Pathophysiology 8
resulting in gallstone formation. (Patp) GI Patp
413 Colonic ischemia The splenic flexure and RSJ lie b/w regions of perfusion of major arteries. These 'watershed' areas are susceptible to ischemic dmg during hypotensive states, esp. in ps w/ underlying arterial insufficiency. Gastrointestinal & Nutrition (GI) Pathology (Path) 1 GI Path
414 Mesenteric ischemia CMI is Chx by atherosclerosis of the mesenteric arteries, resulting in diminished blood flow to the intestine after meals. This causes postprandial epigastric pain (intestinal angina) w/ associated food Gastrointestinal & Nutrition (GI) Pathology (Path) 1
aversion/weight loss. Its pathogenesis is similar to angina pectoris. GI Path
415 Diverticular disease Colonic diverticula often involve the sigmoid colon and develop due to exaggerated contractions of colonic smooth muscle segments. This results in ↑ intraluminal pressure, causing outpouching of the Gastrointestinal & Nutrition (GI) Pathology (Path) 3
mucosa and submucosa through the muscularis (false diverticula). Individuals (typically age >60) may be aSSx or have hematochezia or diverticulitis. GI Path
416 Intussusception Intussusception most often occurs in children younger than 2 y/o and in the region of the ICV. It MFx w/ intermittent, severe, colicky abdo pain, 'currant jelly' stools, and sometimes a palpable mass in the Gastrointestinal & Nutrition (GI) Pathology (Path) 1
RLQ. GI Path
417 Groin hernias FHs can present w/ groin discomfort and a tender bulge on the upper thigh inf. to theinguinal ligament, lat. to thepubic tubercle and lacunar ligament. The structure that lies immediately lat. to the hernia Gastrointestinal & Nutrition (GI) Anatomy (Anat) 3
w/i the femoral sheath is the femoral vein. Incarceration and strangulation are common complications of FHs. GI Anat
418 Groin hernias The inf. epigastric vessels are useful as a landmark during lap hernia repair to classify the type of IH. IIHs protrude thru the DIR into the inguinal canal lat. to theinf. epigastric vessels. In contrast, DIHs Gastrointestinal & Nutrition (GI) Anatomy (Anat) 3
protrude thru Hesselbach's triangle med. to theinf. epigastric vessels. GI Anat
419 Hydrocele Communicating hydroceles and IIHs are caused by an incomplete obliteration of the processus vaginalis. The resultant connection b/w the scrotum and abdominal cavity can allow for fluid leakage Male Reproductive (MR) Embryology 2
(hydrocele) or the passage of abdominal contents (IIH). (Embr) MR Embr
420 Colorectal cancer The adenoma to carcinoma seq is a series of gene muts that leads to the devel of CAC. TP53 TSG mut is part of the final step in the seq and leads to malignant transformation of pre-existing large Gastrointestinal & Nutrition (GI) Pathology (Path) 15
adenomatous polyps. GI Path
421 Colorectal cancer The size of adenomatous polyps determines their malignant potential. Adenomas <1 cm are unlikely to undergo malignant transformation, whereas those >4 cm are very likely to progress to AC. KRAS Gastrointestinal & Nutrition (GI) Pathology (Path) 15
proto-oncogene mutation facilitates the growth of adenomas by causing uncontrolled cell proliferation. GI Path
423 Colorectal cancer Prognosis of CRAC is directly related to the stage of the tumour (not to the grade!). Hematology & Oncology (HO) Pathology (Path) 15 HO Path
424 Carcinoid tumors Carcinoid tumours are composed of islands or sheets of uniform cells w/ eosinophilic cytoplasm and oval-to-round stippled nuclei. These tumours are often derived from neuroendocrine cells in the GI Gastrointestinal & Nutrition (GI) Pathology (Path) 4
tract. Appendiceal carcinoids typically have a benign course but may cause appendicitis or, rarely, carcinoid syndrome (e.g. w/ liver mets). GI Path
425 Carcinoid tumors Carcinoid tumors confined to the intestine don't cause carcinoid syndrome as their secretory products are meta by the liver before entering the syst circulation. In contrast, intestinal carcinoids that met to Hematology & Oncology (HO) Pathophysiology 4
the liver and extraintestinal (e.g. bronchial) carcinoids release vasoactive substances that avoid 1st-pass meta, resulting in carcinoid syndrome (e.g. flushing, diarrhea, bronchospasm). (Patp) HO Patp
426 Appendicitis obstr of the lumen of the appendix is the 1st event in pathogenesis of acute appendicitis. Fecaliths, hyperplastic lymphoid follicles, foreign bodies, or tumours may cause the obstr. RLQ abdo pain, nausea, Gastrointestinal & Nutrition (GI) Pathology (Path) 5
vomiting, diarrhoea, and fever are the typical MFxs of acute appendicitis. GI Path
427 Colonic polyps Adenomatous and serrated polyps (i.e. sessile serrated polyp, traditional serrated adenoma) are neoplastic polyps that have malignancy potential. ↑ polyp size is the most important RF for ca; villous Gastrointestinal & Nutrition (GI) Pathology (Path) 2
histology and high-grade dysplasia are addnal RFs. GI Path
428 Colorectal cancer Mutation of the APC TSG is the 1st step in the classic adenoma-to-carcinoma sequence; it is found in most cases of sporadic colon ca and in all pts w/ FAP. The microsatellite instability pathway is Chx Gastrointestinal & Nutrition (GI) Pathology (Path) 15
by mutations in DNA mismatch repair genes and is implicated in the development of HNPCC (Lynch syndrome). GI Path
429 Lynch syndrome HNPCC, or Lynch syndrome, leads to occurrence of colonic ACs at a young age (age <50) along w/ a predisposition for extraintestinal malignancies. Mutations of DNA mismatch repair genes are Gastrointestinal & Nutrition (GI) Pathology (Path) 1
responsible for HNPCC. GI Path
430 Colonic polyps Adenomatous polyps are either tubular, villous, or tubulovillous, depending on their histologic appearance. Villous adenomas tend to be larger, sessile, and more severely dysplastic than tubular Gastrointestinal & Nutrition (GI) Pathology (Path) 2
adenomas. Villous adenomas can cause a secretory diarrhea from ↑ mucin production; pts may develop hypoproteinemia and hypokalemia. GI Path
431 Colorectal cancer Adenomatous polyps contain dysplastic mucosa and are premalignant. Regular screening w/ timely excision of polyps is effective for prevention of CAC. Studies have linked ↑ activity of COX-2 to some Gastrointestinal & Nutrition (GI) Pathology (Path) 15
forms of CAC and suggest that regular aspirin use ↓ adenomatous polyp formation. GI Path
432 Colorectal cancer Right-sided colon ca usually grow as exophytic masses and present w/ occult bleeding and SSx of IDA. Left-sided colon ca tend to infiltrate the intestinal wall and encircle the lumen, causing constipation Gastrointestinal & Nutrition (GI) Pathology (Path) 15
and SSx of intestinal obstr. Rectosigmoid involvement often causes hematochezia. GI Path
433 Acute pancreatitis Multi inhib mechs exist to prevent premature activation of trypsinogen before it reaches the duodenal lumen, incl cleavage inactivation of trypsin by trypsin itself and production of trypsin inhibs (e.g. Gastrointestinal & Nutrition (GI) Pathophysiology 9
SPINK1). Gene muts that render trypsin insensitive to cleavage inactivation cause hereditary pancreatitis. (Patp) GI Patp
434 Acute pancreatitis After gallstones, Alc abuse is the 2nd most common cause of acute pancreatitis. Macrocytosis and an AST:ALT ratio >2 are indirect indicators of chronic Alc consumption. Alc-related macrocytosis can Gastrointestinal & Nutrition (GI) Pathology (Path) 9
occur independently of folate deficiency. GI Path
435 Acute pancreatitis Pancreatic pseudocyst is a common complication of acute pancreatitis. It is a collection of fluid rich in enzymes and inflammatory debris. Its walls consist of granulation tissue and fibrosis. Unlike true Gastrointestinal & Nutrition (GI) Pathology (Path) 9
cysts, pseudocysts are not lined by epithelium. GI Path
436 Pancreatic cancer Smoking is the most important environmental RF for pancreatic ca. Other RFs incl advanced age, chronic pancreatitis, and genetic predisposition (e.g. Peutz-Jegher's syndrome). Gastrointestinal & Nutrition (GI) Pathology (Path) 1 GI Path
437 Acute pancreatitis The dorsal pancreatic bud forms the majority of pancreatic tissue (body, tail, and most of the head). The ventral pancreatic bud is a precursor of the uncinate process, inf/post portion of the head, and Gastrointestinal & Nutrition (GI) Embryology 9
major pancreatic duct (of Wirsung). Failure of the dorsal and ventral pancreatic buds to fuse leads to pancreas divisum. In this condition, the pancreatic ductal systems remain separate, w/ the accessory (Embr)
duct draining the majority of the pancreas. GI Embr
438 Acute pancreatitis Annular pancreas, or pancreatic tissue encircling the desc duodenum, is caused by failure of the ventral pancreatic bud to properly migrate and fuse w/ the dorsal bud during the 7th and 8th wk of fetal Gastrointestinal & Nutrition (GI) Embryology 9
development. Annular pancreas is usually aSSx but may Px w/ duodenal obstruction or pancreatitis. (Embr) GI Embr
439 Acute pancreatitis In AIP the pancreas is grossly oedematous. Focal areas of fat necrosis, Ca2+ deposition, and interstitial oedema are seen on LM. In ANP (hemorrhagic), chalky-white areas of fat necrosis interspersed w/ Gastrointestinal & Nutrition (GI) Pathology (Path) 9
hemorrhage are seen on macroscopic Ex. GI Path
440 Acute pancreatitis Eighty percent of acute pancreatitis cases are caused by gallstones and chronic Alcism. Less common causes account for the other 20%. Inherited or acquired hypertriglyceridemia can cause acute Gastrointestinal & Nutrition (GI) Pathology (Path) 9
pancreatitis if the serum lvl of TGs exceeds 1000 mg/dL. GI Path
441 Acute pancreatitis Pancreatic zymogens are normally converted into their active form by trypsin in the duodenal lumen. Premature cleavage of trypsinogen to trypsin w/i the pancreas leads to uncontrolled activation of these Gastrointestinal & Nutrition (GI) Pathophysiology 9
zymogens, causing pancreatic autodigestion and acute pancreatitis. (Patp) GI Patp
442 Atherosclerosis Atherosclerosis is initiated by repetitive endothelial cell injury, which leads to a chronic inflammatory state in the underlying intima of large elastic arteries as well as in large- and medium-sized muscular Cardiovascular (CV) Pathology (Path) 8
arteries. CV Path
443 Coronary artery disease VSMCs are the only cells w/i the atherosclerotic plaque capable of synthesizing structurally important collagen isoforms and other matrix components. Progressive enlargement of the plaque results in Cardiovascular (CV) Pathology (Path) 4
remodeling of the ECM and VSMC death, promoting development of vulnerable plaques w/ an ↑ propensity for rupture. CV Path
444 Atherosclerosis Fatty streaks are the earliest lesions of atherosclerosis and can be seen as early as the 2nd decade of life. They appear as a collection of lipid-laden macrophages (foam cells) in the intima that can Cardiovascular (CV) Pathology (Path) 8
eventually progress to atherosclerotic plaques. CV Path
446 Atherosclerosis During the development of atherosclerotic plaque (atheroma), activated macrophages, platelets, and endothelial cells release GFs (eg, PDGF) that stimulate recruitment of SMCs from the arterial wall Cardiovascular (CV) Pathology (Path) 8
media and their subsequent proliferation in the intima. CV Path
447 Atherosclerosis The likelihood of plaque rupture is related to plaque stability rather than plaque size or the degree of luminal narrowing. Plaque stability largely depends on the mech strength of the fibrous cap. Cardiovascular (CV) Pathology (Path) 8
Inflammatory macrophages in the intima may ↓ plaque stability by secreting metalloproteinases, which degrade ECM proteins (e.g. collagen). CV Path
448 Peripheral vascular disease Intermittent claudication describes muscle pain that's reproducibly caused by exercise and relieved by rest; it occurs due to atherosclerotic stenoses (lipid-filled intimal plaques) in the large arteries that Cardiovascular (CV) Pathology (Path) 4
prevent sufficient blood flow to exercising muscle. The lower extremities are most commonly affected; however, proximal lesions (i.e. aortoiliac occlusion) can cause gluteal claudication a/o impotence. CV Path
449 Primary hypertension HTE is severely ↑ BP (typically >180/120 mm Hg) w/ evidence of end-organ dmg. In the kidneys, this can MFx as malignant nephrosclerosis, Chx by fibrinoid necrosis and hyperplastic arteriolosclerosis Cardiovascular (CV) Pathology (Path) 14
("onion-skin" appearance). A MAHA can occur due to erythrocyte fragmentation and platelet consumption at the narrowed arteriolar lumen. CV Path
450 Giant cell arteritis GCA is char by granulomatous inflammation of the media and predominantly involves medium to smaller branches of the carotid artery, esp. the temporal artery. The resulting SSx respond promptly to Rheumatology, Orthopedics & Pathology (Path) 5
GC therapy. Sports (RH) RH Path
451 Peripheral vascular disease Thromboangiitis obliterans (Buerger disease) is a segmental, inflammatory vasculitis that affects the small- and medium-sized arteries and veins of the distal extremities w/ inflammatory, intraluminal Cardiovascular (CV) Pathology (Path) 4
thrombi and sparing of the vessel wall. It is usually seen in young, heavy smokers, and can Px w/ digital ischemia and ulceration, extremity claudication, Raynaud phenomenon, and superficial
thrombophlebitis. CV Path
452 Takayasu arteritis Takayasu arteritis is a chronic, large-artery vasculitis that 1arily involves the aorta and its branches. It presents w/ constitutional (e.g. fever, weight loss) and arterio-occlusive (e.g. claudication, BP Cardiovascular (CV) Pathology (Path) 1
discrepancies, pulse deficits) findings in pts age <40. Histopathology shows granulomatous inflammation of the vascular media. CV Path
453 Renal artery stenosis RAS is most often due to atherosclerosis. It can cause severe, refractory HTN due to activation of the RAAS. Over time, renal atrophy may occur due to chronic O2 and nutrient deprivation. Histologic Ex Cardiovascular (CV) Pathology (Path) 9
may show crowded glomeruli, tubulointerstitial atrophy and fibrosis, and focal inflammatory infiltrates. CV Path
454 Hyperaldosteronism Hypersecreting AC tumours can have fxnality resembling the outer (aldosterone/Conn syndrome), middle (cortisol/Cushing syndrome), or inner (androgens/hirsutism and virilisation) layers of the AC. Endocrine, Diabetes & Pathophysiology 5
455 Hypertensive nephropathy Homogeneous deposition of eosinophilic hyaline material in the intima and media of small arteries and arterioles characterises hyaline arteriolosclerosis. This is typically produced by un-Tx or poorly Renal, Urinary & Electrolytes Pathology (Path) 1
controlled HTN a/o DM. (RE) RE Path
456 Primary hypertension Isolated systolic HTN (ISH; SBP >140mmHg w/ DBP <90mmHg) is due to age-related stiffness and ↓ in compliance of the aorta and major peri arteries. Cardiovascular (CV) Physiology 14
(Phys) CV Phys
457 Polyarteritis nodosa PAN is a multisystem vasculitis char by episodic ischemic SSx in various organs w/ sparing of the lungs. Bx shows segmental, transmural inflammation w/ fibrinoid necrosis. PAN is commonly a/w Rheumatology, Orthopedics & Pathology (Path) 2
hepB. Sports (RH) RH Path
458 Henoch-Schonlein purpura Small vessel leucocytoclastic angiitis a/w IgA and C3 deposition is typical of HSP. HSP is most common in children 3 to 11 y/o and is most often related to a recent infection. Most children present w/ Allergy & Immunology (AI) Pathology (Path) 3
palpable skin lesions, +/- abdo pain and arthralgias. Although usually self-limiting, pts afflicted w/ HSP should be observed carefully b/c glomerulonephritis and even ESRD are possible complications. AI Path
459 Granulomatosis with polyangiitis The histopath features of oesophageal SCC incl solid nests of neoplastic squamous cells w/ abundant eosinophilic cytoplasm and distinct borders. Areas of keratinisation and the presence of intercellular Allergy & Immunology (AI) Pathology (Path) 2
bridges are also char. Pts typically present w/ progr solid and eventually liquid dysphagia and weight loss. AI Path
460 Polyarteritis nodosa PAN is segmental, transmural, necrotizing inflammation of medium- to small-sized arteries. Renal artery involvement is often prominent. Vessels of the kidneys, heart, liver, and gastrointestinal tract are Cardiovascular (CV) Pathology (Path) 2
most commonly involved in resulting ischemia, infarction, or hemorrhage. Cutaneous manifestations occur in up to one-third of patients, and include palpable purpura. The lung is very rarely involved. CV Path
461 Giant cell arteritis GCA is char by granulomatous inflammation of the media, w/ fragmentation of the internal elastic lamina of medium and small branches of the carotid artery. Irreversible blindness is a severe Rheumatology, Orthopedics & Pathology (Path) 5
complication of GCA, and pts w/ suspected GCA req immediate GC therapy. Sports (RH) RH Path
462 Aortic aneurysm Myxomatous changes w/ pooling of proteoglycans in the media layer of large arteries are found in CMD, which predisposes to the devel of ADs and AAs. Medial degen is freq seen in younger individuals Cardiovascular (CV) Pathology (Path) 6
w/ Marfan syndrome. CV Path
463 Aortic aneurysm AAA is a/w RFs (e.g. age >60, smoking, HTN, male sex, FHx) that lead to chronic transmural inflammation and ECM degradation w/i the wall of the aorta. This leads to weakening and progr expansion Cardiovascular (CV) Pathology (Path) 6
of the aortic wall, resulting in aneurysm formation, typically below the renal arteries. CV Path
464 Aortic dissection AD classically presents w/ severe retrosternal pain that radiates to the back. This condition develops when overwhelming hemodynamic stress leads to tearing of the aortic intima w/ blood subseq Cardiovascular (CV) Pathology (Path) 6
dissecting thru the aortic media. The resulting intramural hematoma can extend both proximally and distally and can compress major arterial branches and impair blood flow. CV Path
465 Inherited thrombophilia Inherited causes of hypercoagulability should be considered in pts younger than age 50 who present w/ thrombosis and no obvi explanation for an acq prothrombotic state. The FV Leiden mut, which Hematology & Oncology (HO) Pathology (Path) 2
causes FVa resistance to inactivation by activated protein C, may account for approx. 20% of cases of atypical venous thrombosis. HO Path
466 Hemangioma Cutaneous, strawberry-type capillary hemangiomas are common, benign, congenital tumors, which are composed of unencapsulated aggregates of closely packed, thin-walled capillaries. Initially, Cardiovascular (CV) Pathology (Path) 6
strawberry hemangiomas grow in proportion to the growth of the child, before eventually regressing. In 75-95% of cases, the vascular tumor will regress completely by age 7. CV Path
467 Glomus tumor A benign glomus tumour (glomangioma) can produce a very tender, small (a few mm in diameter), red-blue lesion under the nail bed. This type of tumour originates from the modded SMCs that control Dermatology (DE) Pathology (Path) 1
the thermoregulatory fxns of dermal glomus bodies. DE Path
468 von Hippel-Lindau disease A cerebellar hemangioblastoma in a/w congenital cysts of the kidneys, liver, a/o pancreas is highly suggestive of vHL disease, a rare AD condition. Nervous (NS) Pathology (Path) 1 NS Path
469 Hereditary hemorrhagic Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasia) is an AD condition marked by the presence of telangiectasias in the skin as well as the mucous membranes of the lips, Cardiovascular (CV) Pathology (Path) 1
telangiectasia oronasopharynx, resp tract, GIT, and urinary tract. Rupture of these telangiectasias may cause epistaxis, GI bleeding, or hematuria. CV Path
471 Hepatocellular cancer Hepatic angiosarcoma is a/w exposure to carcinogens such as arsenic, thorotrast, and polyvinyl chloride. Tumour cells express CD31, an endothelial cell marker. Gastrointestinal & Nutrition (GI) Pathology (Path) 5 GI Path
472 Syphilis Tertiary syphilis can result in thoracic aortic aneurysm. If the aneurysm compresses adjacent structures and dilates the aortic valve ring, a murmur and mediastinal widening might be present. The Infectious Diseases (ID) Pathology (Path) 9
pathogenesis begins with vasa vasorum endarteritis and obliteration, resulting in inflammation, ischemia, and weakening of the aortic adventitia. Fluorescent treponemal antibody absorption testing is
specific for syphilis. ID Path
473 Aortic dissection HTN is the single most important RF for the devel of intimal tears leading to AD. HTN, smoking, DM, and hypercholaemia are all major RFs for atherosclerosis, which predisposes more to AA formation Cardiovascular (CV) Pathology (Path) 6
than AD. CV Path
474 Chronic venous insufficiency Varicose veins are dilated, tortuous veins most commonly found in the superficial veins of the leg. They're caused by chronically ↑ intraluminal pressure a/o loss of tensile strength in the vessel wall, Cardiovascular (CV) Pathology (Path) 3
leading to incompetence to the venous valves. Common complications incl oedema, stasis dermatitis, skin ulcerations, poor wound healing, and infections. CV Path
475 Thrombophlebitis A PNPS of hypercoagulability may be seen in some pts w/ ca, especially ACs of the pancreas, colon, or lung. Superficial venous thromboses may therefore appear in one site and then resolve, only to Cardiovascular (CV) Pathology (Path) 1
recur in another site. This is known as Trousseau syndrome (migratory superficial thrombophlebitis), an indication of visceral ca. CV Path
476 Pulmonary embolism V/Q scans use radiotracers to compare the ventilation and blood perfusion of each area of the lung. V/Q mismatch w/ perfusion defects are often indicative of a PE, which are most commonly caused by Pulmonary & Critical Care (PU) Pathology (Path) 13
DVT in the lower extremities that embolises to the pulm vasculature. PU Path
478 Respiratory mucosa Type II pneumocytes have 2 important functions: regeneration of the alveolar lining following injury and surfactant production. Pulmonary & Critical Care (PU) Histology (Hist) 4 PU Hist
479 Neonatal respiratory distress The lamellar bodies of type II pneumocytes store and release pulm surfactant into the fluid layer lining the inner surfaces of alveoli. The major fxn of surfactant is to ↓ surface tension in this fluid layer, Pulmonary & Critical Care (PU) Pathology (Path) 5
syndrome and so a surfactant defic can cause alveolar atelectasis, as seen in NRDS. PU Path
480 Respiratory mucosa Bronchi have a ciliated pseudostratified columnar epithelium with mucin-secreting goblet cells and submucosal mucoserous glands. The airway epithelium gradually changes to ciliated simple cuboidal by Pulmonary & Critical Care (PU) Histology (Hist) 4
the level of the terminal bronchioles. Bronchioles lack glands and cartilage, and the number of goblet cells decreases distally, ending before the terminal bronchioles. Ciliated epithelium persists up to the
respiratory bronchioles. PU Hist
481 Respiratory physiology The airway resistance at each lvl of the LRT is inv related to the TCSA of all the airways at that lvl. Airway resistance is high in the trachea and reaches a peak in the medium-sized bronchi, where TCSA Pulmonary & Critical Care (PU) Physiology 8
is at a mini. Airway resistance then progr decr as TCSA incr thru the smaller bronchioles, term bronchioles, and alv. (Phys) PU Phys
482 Neonatal respiratory distress Phospholipids, including dipalmitoyl phosphatidylcholine, are a major component of pulmonary surfactant. The amniotic fluid lecithin (phosphatidylcholine) to sphingomyelin ratio (L/S ratio) is measured Pulmonary & Critical Care (PU) Embryology 5
syndrome in order to assess fetal lung maturity. The fetal lungs are considered mature when they are producing adequate surfactant to yield an L/S ratio greater than 2. (Embr) PU Embr
483 Human papillomavirus HPV is a small DNA virus w/ a tropism for stratified squamous epithelium, which protectively lines anatomical areas that undergo frequent friction and abrasion, including the true vocal cords, cervix, Infectious Diseases (ID) Histology (Hist) 4
and anus. Infants can acquire resp papillomatosis via passage through an HPV-infected birth canal. ID Hist
484 Alpha1 antitrypsin deficiency Alveolar fluid contains neutral proteases (e.g. elastases) that're derived from alveolar macrophages and infiltrating neutrophils. These proteases can cause destruction of terminal lung parenchyma (e.g. Pulmonary & Critical Care (PU) Pathology (Path) 8
emphysema) when secreted in excess or if left unchecked by defic antiprotease activity. PU Path
485 ARDS Pancreatitis is a major RF for ARDS as it results in the release of large amounts of inflammatory cytokines and pancreatic enzymes, which leads to activation of neutrophils in the alveolar tissues. During Pulmonary & Critical Care (PU) Pathology (Path) 3
the initial phase, interstitial and intra-alveolar oedema, inflammation, and fibrin deposition cause the alveoli to become lined w/ waxy hyaline membranes. PU Path
486 ARDS ARDS is characterised by hypoxia and bilateral pulm infiltrates and is a/w pneumonia, sepsis, trauma, and pancreatitis. The assoc pulm oedema is noncardiogenic in nature, so the PCWP will be w/i the Pulmonary & Critical Care (PU) Pathology (Path) 3
normal range (6-12mmHg). PU Path
487 COPD The flow-volume loop for COPD is Chx by ↑ RV and TLC, as well as a "scooped-out" expiratory pattern due to ↓ expiratory flow rates. Both airway narrowing due to chronic bronchitis and ↓ elasticity Pulmonary & Critical Care (PU) Pathophysiology 16
due to emphysematous destruction of interalveolar walls are responsible for the hyperinflation and airflow limitation. (Patp) PU Patp
488 COPD The path of centriacinar emphysema a/w chronic, heavy smoking predominantly involves the release of proteases, esp. elastase, from infiltrating neutrophils and alveolar macrophages. Pulmonary & Critical Care (PU) Pathophysiology 16
(Patp) PU Patp
489 Alpha1 antitrypsin deficiency The major serum inhibitor of extracellular elastase is AAT; pts w/ AATD typically develop early-onset panacinar emphysema due to unchecked elastase activity. Exposure to tobacco smoke dramatically Pulmonary & Critical Care (PU) Pathophysiology 8
accelerates the development of emphysema in pts w/ AATD and should be avoided. (Patp) PU Patp
490 Pneumothorax PSP occurs in pts w/o pre-existing pulm disease when a large change in the alveolar or intrapleural pressure results in a break in the visceral (e.g. ruptured superficial bleb) pleura and air trapping b/w the Pulmonary & Critical Care (PU) Pathology (Path) 2
pleural spaces. PU Path
491 Alpha1 antitrypsin deficiency AAT is the major serum inhib of neutrophil elastase. AATD typically causes early-onset panacinar emphysema, predominantly affecting the lower lung lobes. Pulmonary & Critical Care (PU) Pathology (Path) 8 PU Path
492 Ischemic stroke Neurons that sustain irreversible ischemic injury begin to develop char histopath changes 12-24hrs after the inciting event. These changes incl shrinkage of the cell body, pyknosis of the nucleus, loss of Nervous (NS) Pathology (Path) 19
Nissl bodies, and cytoplasmic eosinophilia (red neurons). NS Path
493 Ischemic stroke CNS injury is a/w astrocyte hypertrophy and proliferation (gliosis). This process leads to the formation of a glial scar, which compensates for the volume loss that occurs after neuronal death. Nervous (NS) Pathology (Path) 19 NS Path
494 Neuronal physiology The changes in the body of a neuron after the axon has been severed are called axonal rxn. This process reflects an ↑ protein synthesis that facilitates axon repair. Enlarged, rounded cells w/ perily located Nervous (NS) Pathology (Path) 3
nuclei and dispersed finely granular Nissl substance are seen. NS Path
495 Brain herniation Transtentorial (ie, uncal) herniation is a complication of an ipsilateral mass lesion, such as a hemorrhage or brain tumor. The 1st sign of uncal herniation is a fixed and dilated pupil on the side of the Nervous (NS) Pathology (Path) 2
lesion. Ipsilateral paralysis of oculomotor muscles, contralateral or ipsilateral hemiparesis, and contralateral homonymous hemianopsia w/ macular sparing may also occur. NS Path
496 Neural tube defects Failure of neural tube closure at 4 wks gestation results in NTDs. 1st trimester use of valproate is a significant RF for NTDs, but periconceptional vit B9 supplementation ↓ this risk. Nervous (NS) Embryology 4
(Embr) NS Embr
497 Subarachnoid hemorrhage SAH Px w/ a generalized, excruciating h/a. It is classically described by pts as "the worst h/a of my life." SAH usually occurs due to rupture of saccular (berry) aneurysms or AVMs. Berry aneurysms of Nervous (NS) Pathology (Path) 4
the COW are a/w AD PKD. NS Path
498 Hemorrhagic stroke Deep intraparenchymal hemorrhage is most commonly caused by HTN vasculopathy of the small penetrating branches of the cerebral arteries (Charcot-Bouchard aneurysm rupture). This is in contrast to Nervous (NS) Pathology (Path) 3
rupture of saccular aneurysms, which tyrupture of saccular aneurysms, which typically cause SAH. NS Path
499 Hemorrhage stroke Cerebral amyloid angiopathy is the most common cause of spontaneous lobar hemorrhage, particularly in the elderly. The most common sites of hemorrhage include the occipital and parietal lobes. Nervous (NS) Pathology (Path) 1 NS Path
500 Subarachnoid hemorrhage The most common complication of aneurysmal SAH is vasospasm, which typically occurs 3-12days after the initial insult and can cause delayed cerebral ischemia (e.g. sudden change in mental status, Nervous (NS) Pathology (Path) 4
new focal neuro deficits). The CT scan usually remains unchanged, unlike w/ rebleeding. NS Path
501 Ischemic stroke Several mos to yrs after ischemic brain infarction, the necrotic area appears as a cystic cavity surrounded by a wall composed of dense fibers formed by astrocytic processes (glial scar). Nervous (NS) Pathology (Path) 19 NS Path
502 Neural tube defects NTDs most often occur when the neural folds fail to fuse in the region of the ant or post neuropores. Persistent communication b/w the spinal canal and the amniotic cavity allows leakage of AFP and Nervous (NS) Embryology 4
AChE into the amnionic fluid, leading to ↑ lvls of AFP and AChE that can be detected on amniocentesis. (Embr) NS Embr
503 Syringomyelia Syringomyelia is characterised by the formation of a cavity (syrinx) in the cervical region of the spinal cord. The syrinx dmgs the ventral white commissure, leading to bilateral loss of pain and temp Nervous (NS) Pathology (Path) 2
sensation that's limited to the affected lvls (typically the arms and hands); distal sensation is preserved. Destruction of the motor neurons in the ventral horns (due to extension of the syrinx) results in
flaccid paralysis and atrophy of the intrinsic muscles of the hand. NS Path
504 Chiari malformation Chiari malformations are congenital disorders that result from underdevelopment of the posterior fossa, causing parts of the cerebellum and medulla to herniate through the foramen magnum. Chiari-I is Nervous (NS) Pathology (Path) 1
relatively benign and Px during adulthood w/ occipital h/a and cerebellar dysfxn. Chiari-II is a more severe form that affects neonates and is often a/w lumbar myelomeningocele and hydrocephalus. NS Path
505 Epidural hematoma EDH is an accumulation of blood b/w the bone and dura mater. It typically occurs due to a tear of the MMA a/w fracture of the pterion region of the skull (often involving the temporal bone). Pts char Nervous (NS) Pathology (Path) 2
have transient LOC f/b a lucid interval before ↑ ICP leads to neuro deterioration. NS Path
506 Subdural hematoma SDH occurs due to the rupture of cortical bridging veins. In young pts, it results from a fall or MVA and MFx w/ gradual onset of h/a and confusion. In elderly pts it may occur after a minor trauma and Cardiovascular (CV) Pathology (Path) 1
present w/ a variety of neuro SSx. You should know how to recognise this on CT scan. CV Path
507 Neural tube defects Valproate ↓ levels of folic acid and ↑ the risk of NTDs (eg, meningocele, myelomeningocele). Pregnancy, Childbirth & Pharmacology 4
508 DRESS syndrome DRESS syndrome typically occurs 2-8wks after exposure to high-risk drugs such as anticonvulsants (e.g. phenytoin, carbamazepine), allopurinol, sulphonamides (e.g. sulfasalazine), and Abx (e.g. Nervous (NS) Pharmacology 1
minocycline, vancomycin). Pts typically develop fever, gen LAD, facial oedema, diffuse skin rash, eosinophilia, and internal organ dysfxn. (Phar) NS Phar
509 Seizures Ethosuximide, the 1st-line Tx for absence seizures, prevents neuronal burst firing by blocking thalamic T-type Ca2+ channels. Phenytoin, carbamazepine, and valproic acid inhib neuronal high-freq firing Nervous (NS) Pharmacology 8
by ↓ the ability of Na+ channels to recover from inactivation. (Phar) NS Phar
510 Antipsychotics Akathisia is an EPS of antipsychRx characterised by inner restlessness and an inability to sit or stand in 1 position. Tx involves a ↓ in the antipsychdose, if possible, or the addn of a β blocker or benzo. Pregnancy, Childbirth & Pharmacology 9
511 Antipsychotics Tardive dyskinesia consists of abnormal involuntary movements of the mouth, tongue, face, extremities, or trunk associated with prolonged exposure to antipsychotics. Characteristic movements include Pregnancy, Childbirth & Behavioral 9
lip smacking, facial grimacing, tongue protrusions, and choreoathetoid movements of the head, limbs, and trunk. Puerperium (PR) Science (Beha) PR Beha
512 Neuroleptic malignant syndrome NMS is an AE to antipsych Rx characterised by severe 'lead-pipe' rigidity, hyperthermia, sympathetic hyperactivity, and mental status changes. NMS is characterised by severe rigidity rather than the NM Pregnancy, Childbirth & Pharmacology 2
irritability (e.g. hyperreflexia, myoclonus) seen in SS. Puerperium (PR) (Phar) PR Phar
513 Antipsychotics Antipsychotic Rx work by blocking DA-2 receptors in the mesolimbic DA pathway. DA-2 receptor blockade in the tuberoinfundibular pathway can result in galactorrhea and amenorrhea. Pregnancy, Childbirth & Anatomy (Anat) 9
Puerperium (PR) PR Anat
515 Antipsychotics FGAs can be classified according to high or low potency and have char AE profiles. Low-potency antipsychs are more likely to cause sedation, antichol AEs, and orthostatic hypotension. High-potency Pregnancy, Childbirth & Pharmacology 9
antipsychs are more likely to cause EPS (e.g. dystonia, akathisia, parkinsonism). Puerperium (PR) (Phar) PR Phar
516 Antipsychotics Pts Tx w/ clozapine are req to have regular monitoring of the absolute neutrophil count due to the risk of life-threatening agranulocytosis. Pregnancy, Childbirth & Pharmacology 9
518 Bipolar disorder Antidepressant monotherapy can induce mania in susceptible pts, esp. those w/ unrecognised BD. Pregnancy, Childbirth & Behavioral 7
519 Lithium Chronic lithium tox (e.g. confusion, ataxia, NM excitability) can be precipitated by volume depletion and drug interactions w/ TZDs, ACEIs, and NSAIDs. Pregnancy, Childbirth & Pharmacology 2
520 Hypothyroidism Hypothyroidism and NDI are the most common AEs of long-term lithium therapy. Serum TSH and renal fxn (BUN and creatinine) should be monitored routinely. Pregnancy, Childbirth & Pharmacology 13
521 COPD COPD is a combo of emphysema and chronic bronchitis and commonly presents w/ progr dyspnoea and recurrent URIs. Bronchial obstr and alveolar destruction cause air trapping that MFx on PFT as ↓ Pulmonary & Critical Care (PU) Pathophysiology 16
FEV1, FVC, and FEV1/FVC ratio. RV and TLC are ↑. (Patp) PU Patp
522 COPD COPD involves components of chronic bronchitis and emphysema. Bronchial airway obstr from chronic bronchitis and ↓ alveolar elasticity from emphysema result in air-trapping and lung hyperinflation. Pulmonary & Critical Care (PU) Pathophysiology 16
The FRC is ↑, as are RV and TLC. (Patp) PU Patp
523 Asthma Eosinophils have bilobed nuclei and numerous eosinophilic granules in the cytoplasm and are important in allergic disease and defence against parasitic infection. The eosinophilic granules predominantly Pulmonary & Critical Care (PU) Pathophysiology 12
contain MBP, which, once release, acts as a potent anti-helminthic toxin. MBP also dmgs epithelial and endothelial cells and is a major cause of chronic lung dmg in asthma. (Patp) PU Patp
524 COPD Thickened bronchial walls, lymphocytic infiltration, mucous gland enlargement, and patchy squamous metaplasia of the bronchial mucosa are features of chronic bronchitis. Tobacco smoking is the Pulmonary & Critical Care (PU) Histology (Hist) 16
leading cause of chronic bronchitis. PU Hist
525 COPD Hyperplasia of the submucosal bronchial glands is the major contributor to bronchial wall thickening in chronic bronchitis. The Reid index is the ratio of the thickness of the submucosal bronchial glands Pulmonary & Critical Care (PU) Pathology (Path) 16
to the thickness of the bronchial wall b/w the epithelial BM and the bronchial cartilage. Higher values correlate w/ ↑ duration and severity of chronic bronchitis. PU Path
526 Asthma An excess of Th2 cell activity relative to Th1 cell activity may underlie the pathogenesis of asthma. In the asthma sensitization phase, inhaled antigens stimulate Th2 cells to secrete IL-4 and IL-13, which Pulmonary & Critical Care (PU) Immunology 12
together promote B-lymphocyte class switching for IgE synthesis, leading to mast cell priming. Th2 cells also secrete IL-5, which activates eosinophils. (Immu) PU Immu
527 Asthma Paroxysmal breathlessness and wheezing in a young pt that're unrelated to ingestion of aspirin, pulm infection, inhalation of irritants, a/o exercise should raise a strong suspicion for atopic (extrinsic) Pulmonary & Critical Care (PU) Pathophysiology 12
asthma. Classic sputum findings incl eosinophils and Charcot-Leyden crystals. Eosinophils are recruited and activated by IL-5 secreted by Th2 type T cells. (Patp) PU Patp
528 Respiratory alkalosis An acute V/Q mismatch (e.g. due to PE or pneumonia) causes hypoxaemia and triggers hyperventilation. B/c the removal of CO2 is directly dependent on ventilation but the absorption of O2 is capped by Pulmonary & Critical Care (PU) Pathophysiology 1
the high baseline sat of Hb, the hyperventilation response typically leads to resp alkalosis (low PaCO2) w/ persistent hypoxaemia. (Patp) PU Patp
529 Pulmonary embolism The risk of VTE (i.e. PE or DVT) in hospitalised pts can be greatly ↓ w/ the admin of prophylactic anticoags, usually w/ LMWH. Pulmonary & Critical Care (PU) Pathology (Path) 13 PU Path
530 Pulmonary arterial hypertension Hereditary PAH develops in 2 steps. An abn BMPR2 gene predisposes affected individuals to excessive endothelial and SMC proliferation. An insult (e.g. infection, drugs) is thought to then activate the Pulmonary & Critical Care (PU) Pathophysiology 8
disease process, resulting in vascular remodelling, ↑ pulm vascular resistance, and progr PAH. (Patp) PU Patp
531 Community acquired pneumonia Lobar pneumonia is marked by the cytokine-mediated accumulation of neutrophils and proteinaceous material in the alveoli. Over several days, the proteinaceous material becomes fibrinous, neutrophils Pulmonary & Critical Care (PU) Pathology (Path) 21
are replaced by macrophages, and macrophages digest the fibrinous exudate, thereby restoring normal lung histology. PU Path
532 Lung abscess Lung abscess usually occurs in individuals w/ episodes of impaired consciousness (e.g. alcohol/drug abuse, dementia) or ↓ ability to swallow (e.g. oesophageal strictures). They're gen caused by aspiration Infectious Diseases (ID) Microbiology 4
of anaerobic and aerobic bacteria from the oral cavity into the LRT. (Micr) ID Micr
533 Lung abscess Lung abscess is most often due to aspiration of anaerobic oral bacteria such as Peptostreptococcus, Prevotella, Bacteroides, and Fusobacterium species. RFs for lung abscess incl conditions that ↑ Pulmonary & Critical Care (PU) Pathology (Path) 4
aspiration risk, such as alcoholism, drug abuse, seizure disorders, previous stroke, and dementia. PU Path
534 Lung transplantation Chronic lung transplant rejection is due primarily to progressive scarring of the small airways, leading to bronchiolitis obliterans. Manifestations occur months or years after transplantation and include Pulmonary & Critical Care (PU) Immunology 2
obstructive lung disease (eg, reduced FEV1) with dyspnea and dry cough. (Immu) PU Immu
535 Lung transplantation Chronic rejection is a major problem in lung transplant recipients; it affects small airways, causing bronchiolitis obliterans. It's characterised by lymphocytic inflammation, fibrosis, and, ultimately, Pulmonary & Critical Care (PU) Pathology (Path) 2
destruction of the bronchioles. PU Path
536 Respiratory mucosa The pneumoconioses are diseases resulting from the inhalation of fine dust particles that reach the resp bronchioles and alv. Particles that lodge in this region are normally cleared by alv macrophages. Pulmonary & Critical Care (PU) Physiology 4
High particulate burden can cause the excessive release of cytokines from macrophages, resulting in progr PF. (Phys) PU Phys
537 Wiskott-Aldrich syndrome The WAS consists of the triad of eczema, thrombocytopenia, and combined B-lymphocyte and T-lymphocyte defic. Onset of disease is early in life w/ thrombocytopenia present at birth and eczema and Hematology & Oncology (HO) Immunology 1
repeated infections, particularly by encapsulated organisms, following at 6-12 mos of age. (Immu) HO Immu
538 Primary immunodeficiency Leukocyte adhesion deficiency is due to absence of CD18 antigens necessary for the formation of integrins. Clinical features are caused by failure of leukocyte chemotaxis and include recurrent skin and Rheumatology, Orthopedics & Immunology 7
disorder mucosal infections without purulence, delayed separation of the umbilical cord, and persistent leukocytosis. Sports (RH) (Immu) RH Immu
539 Immunoglobulins The carboxy terminal of the Fc portion of the heavy immunoglobulin chains represents the site that binds to the Fc receptors on neutrophils and macrophages. Antibody bound to antigen is able to signal Allergy & Immunology (AI) Immunology 2
for the phagocytosis of that antigen by a conformational change of the Fc region allowing binding to the Fc receptor on phagocytes. This leads to subsequent phagocytosis of the organism / antibody (Immu)
complex and subsequent destruction of the organism. AI Immu
540 Immunoglobulins The CCC begins w/ binding of the C1 complement component to either 2 molecules of IgG or to 2 molecules of IgM. B/c IgM circulates in pentameric form, it's a much better activator of the complement Allergy & Immunology (AI) Immunology 2
system. The C1 molecule binds to the Fc region of the heavy Ig chain in the region near the hinge point. (Immu) AI Immu
541 Hyper-IgM syndrome Hyper-IgM syndrome results from defective Ig class switching due to a defect in CD40L-CD40 interaction. Absence of the CD40L is the most common cause and is inherited in an XLR pattern. CFx incl. Allergy & Immunology (AI) Immunology 1
recurrent sinopulm, GI, and opport infections. (Immu) AI Immu
542 Major histocompatibility class MHC class II is expressed on the surface of antigen presenting cells (APC) and presents extracellular antigens to T cells after extracellular protein is degraded within acidified lysosomes. Failure to acidify General Principles (GP) Immunology 1
lysosomes would lead to deficient expression of MHC class II-antigen complexes with subsequent impaired interaction between APCs and T cells. (Immu) GP Immu
543 DiGeorge syndrome DGS results from maldevel of the 3rd (inf PT and thymus) and 4th (sup PT) pharyngeal/branchial pouches. Subseq PT and thymic hypoplasia results in hypcalcemia and T cell defic. Endocrine, Diabetes & Embryology 2
Metabolism (ES) (Embr) ES Embr
544 Hypersensitivity reactions Type IV (delayed) hypersensitivity reactions (eg, Candida extract skin test, contact dermatitis) are characterized by erythema and induration that develops 24-48 hours after repeat exposure to an antigen. Pulmonary & Critical Care (PU) Immunology 4
T lymphocytes mediate the inflammation in these reactions through cytokine release, CD8+ cytotoxicity, and macrophage recruitment. (Immu) PU Immu
545 Rhesus alloimmunization HDN most commonly occurs from maternal sensitization to Rh Ags during a prior preg w/ an Rh(D)+ fetus. In subseq Rh(D)+ pregs, maternal anti-Rh(D) IgG Abs cross the placenta and cause a severe Hematology & Oncology (HO) Immunology 2
AIHA in the fetus and life-thr hydrops fetalis. (Immu) HO Immu
546 Transplant rejection Organ rejection can be hyperacute, acute, or chronic. Acute rejection most often occurs within weeks or up to 6 months after transplant and is predominantly cell-mediated, involving sensitization of host Renal, Urinary & Electrolytes Immunology 4
T lymphocytes against donor MHC antigens. There is typically graft dysfunction with histology showing a dense, mononuclear (ie, lymphocytic) infiltrate. (RE) (Immu) RE Immu
547 Hyperaldosteronism PH is caused by excessive aldosterone secretion, typically as a result of bilateral nodular hyperplasia of the ZG or an aldosterone-producing adrenal adenoma. Clinical findings incl HTN, low PRA, Endocrine, Diabetes & Pathophysiology 5
hypokalaemia, and meta alkalosis. Metabolism (ES) (Patp) ES Patp
548 Corticosteroids GCs are predominantly catabolic, causing muscle weakness, skin thinning, impaired wound healing, osteoporosis, and immsup. However, they also cause ↑ hepatic synthesis of GNG and glycogenic Endocrine, Diabetes & Pharmacology 3
proteins to ↑ Glc availability. This, along w/ peri antagonism of insulin, contributes to the devel of hyperglycaemia. Metabolism (ES) (Phar) ES Phar
549 Corticosteroids The acute effects of corticosteroids on the WBC incl an ↑ neutrophil count and ↓ lymphocyte, monocyte, basophil, and eosinophil counts. The ↑ in the neutrophil count results from 'demargination' of Endocrine, Diabetes & Pharmacology 3
neutrophils previously attached to the vessel wall. Metabolism (ES) (Phar) ES Phar
550 Neonatal respiratory distress Both maternal and fetal cortisol help to accelerate fetal lung maturation by stimulating surfactant production. Betamethasone or dexamethasone is administered to pregnant women at risk of premature Pulmonary & Critical Care (PU) Embryology 5
syndrome delivery to prevent neonatal respiratory distress syndrome. (Embr) PU Embr
551 Dose response curves Cortisol exerts a permissive effect on many hormones to help improve the response to a variety of stressors. For example, cortisol increases vascular and bronchial smooth muscle reactivity to Cardiovascular (CV) Pharmacology 4
catecholamines and increases glucose release by the liver in response to glucagon. (Phar) CV Phar
552 Lung nodule Hamartomas are the most common benign lung tumours. They present as aSSx perily located 'coin lesion' in pts 50-60 y/o. These tumours are composed of disorganised cartilage, fibrous, and adipose Pulmonary & Critical Care (PU) Pathology (Path) 1
tissue. PU Path
553 Asbestos Pts w/ a long Hx of asbestos exposure are at risk for devel asbestosis, pleural disease, and malignancies such as bronchogenic carcinoma and mesothelioma. Bronchogenic carcinoma is the most common Pulmonary & Critical Care (PU) Pathology (Path) 5
malignancy in this pop, although mesothelioma is more specific for asbestos exposure. PU Path
554 Lung cancer Adenocarcinoma is the most common 1° lung ca in the gen pop, women, and non-smokers. EGFR muts and ALK gene rearrangements are seen more commonly in non-smokers and thought to contribute Pulmonary & Critical Care (PU) Pathology (Path) 9
to disease formation in this subgroup. Adenocarcinoma is typically located perily and may be a/w clubbing or hypertrophic osteoarthropathy (HOA). PU Path
555 Lung cancer SCLC is strongly a/w smoking and is usually centrally located. Histopath shows small, round or oval cells w/ scant cytoplasm and large, hyperchromatic (blue) nuclei; abundant mitoses are also usually Pulmonary & Critical Care (PU) Pathology (Path) 9
seen. IHC stains are freq (+) for neuroendocrine markers (e.g. chromogranin, synaptophysin, NCAM (CD56)). PU Path
556 Hypersensitivity reactions Wheal-and-flare lesions usually result from allergic (type 1 hypersensitivity) reactions. On initial exposure, an allergen (eg, insect venom) promotes antibody class switching to IgE. Subsequent exposure Allergy & Immunology (AI) Immunology 4
promotes cross-linking of IgE on basophils and mast cells, resulting in degranulation and release of multiple vasoactive mediators, including histamine. (Immu) AI Immu
557 Primary immunodeficiency Chronic granulomatous disease is an X-linked disorder resulting from deficiency of NADPH oxidase, the enzyme responsible for formation of reactive oxygen species in phagosomes. Neutrophils affected Allergy & Immunology (AI) Immunology 7
disorder by this disorder are unable to kill catalase-producing organisms, resulting in recurrent bacterial and fungal infections that frequently involve the lungs, skin, and lymph nodes. (Immu) AI Immu
558 Cell mediated immunity The process of (-) selection in T cell maturation is essential for eliminating T cells that bind to self MHC or self Ags w/ overly high affinity. This process occurs in the TM. If these cells were permitted to Allergy & Immunology (AI) Immunology 5
survive, they would likely induce immune and inflam rxns against self Ags leading to AI disease. (Immu) AI Immu
559 Cell mediated immunity Immature T-lymphocytes express both the CD4 and CD8 cell surface Ags in addn to a complete TCR or a pro-TCR. These lymphocytes exist in the TC where they undergo (+) selection and in the TM Hematology & Oncology (HO) Immunology 5
where they undergo (-) selection. (Immu) HO Immu
560 Gonococcal infection IgA protease is produced by N. meningitidis, N. gonorrhoeae, S. pneumoniae, and H. influenzae. This enzyme cleaves secretory IgA at its hinge region, rendering it ineffective. Secretory IgA exists on Infectious Diseases (ID) Microbiology 3
mucosal surfaces and in secretions and acts to bind and inhib the action of pili as well as other cell surface Ags that normally mediate mucosal adherence and subseq penetration. (Micr) ID Micr
561 Severe combined The 2nd most common cause of SCID is AR defic of ADA, an enzyme necessary for the elimination of excess adenosine w/i cells. Tox lvls of adenosine accum w/i lymphocytes in this condition, leading Allergy & Immunology (AI) Immunology 3
immunodeficiency disease to lymphocyte cell death and resultant cellular and humoral ID. Tx is presently being researched using retroviral vectors to "infect" pt stem cells w/ the gene coding for ADA. (Immu) AI Immu
564 Lung cancer Adenocarcinoma, the most common pulm malignancy, is characterised histopathologically by invasive glandular cells w/ abundant cytoplasm and eccentrically placed nuclei; mucin production is Pulmonary & Critical Care (PU) Pathology (Path) 9
common. Imaging typically demonstrates a discrete mass or pneumonia-like consolidation at the periphery of the lung. PU Path
565 Superior vena cava syndrome Intrathoracic spread of bronchogenic carcinoma may lead to compression of the SVC, causing impaired venous return from the upper part of the body. SSx incl dyspnoea, facial swelling, and dilated Pulmonary & Critical Care (PU) Pathology (Path) 1
collateral veins in the upper trunk. PU Path
566 Lung cancer Pancoast tumours are NSCLCs (e.g. SCC, AC) that arise near the superior sulcus. Pts may develop ipsilateral shoulder pain, upper limb paraesthesias, and areflexic arm weakness due to involvement of Nervous (NS) Anatomy (Anat) 9
the brachial plexus. Horner's syndrome (e.g. ipsilateral partial ptosis, miosis, anhidrosis) can also occur due to involvement of the cervical sympathetic ganglia. NS Anat
567 Poststreptococcal Poststreptococcal glomerulonephritis is the most common cause of nephritic syndrome (eg, hematuria, edema, hypertension) in children, typically occurring 2-4 weeks after a streptococcal infection (eg, Renal, Urinary & Electrolytes Immunology 8
glomerulonephritis impetigo, cellulitis, pharyngitis). It is caused by a type III (immune-complex-mediated) hypersensitivity reaction resulting from nephritogenic strains of group A β-hemolytic Streptococcus. (RE) (Immu) RE Immu
568 Heart transplantation Acute cardiac transplant rejection occurs wks following transplantation and is primarily a cell-mediated process. On histopathologic analysis of an endomyocardial Bx, a dense mononuclear lymphocytic Cardiovascular (CV) Immunology 1
infiltrate w/ cardiac myocyte dmg will be visualized. Tx w/ immunosuppressive Rx is aimed primarily at preventing this form of rejection. (Immu) CV Immu
569 Transplant rejection Hyperacute rejection is caused by preformed Abs in the recipient that recognize and attack donor Ags (ie, type II HS). These are often anti-ABO blood group or anti-HLA Abs. Vascular injury and Allergy & Immunology (AI) Immunology 4
capillary thrombotic occlusion lead to rapid ischemic necrosis of the renal graft, often evidenced by gross cyanosis and mottling immediately following graft perfusion. (Immu) AI Immu
571 Primary immunodeficiency CGD is most commonly due to an XL mut affecting NADPH oxidase. Defic of this enzyme leads to an inability of neutrophils to form the ox burst necessary to kill organisms in their phagolysosomes. Allergy & Immunology (AI) Immunology 7
disorder CGD can be Dx by absence of the normal blue and fluorescent green pigment produced by the NBT test and DHR FC test, respectively. (Immu) AI Immu
572 Monoamine oxidase inhibitors MAO is a mitochondrial enzyme that breaks down MA NTs (e.g. DA, NE, 5-HT). Tyramine-induced HTC can occur in pts taking MAOIs who consume foods containing high amounts of tyramine (e.g. Pregnancy, Childbirth & Pharmacology 1
aged cheeses, cured meats, draft beer). Puerperium (PR) (Phar) PR Phar
573 Depression MAOIs are particularly useful in pts w/ Tx-resistant MDD w/ atypical features. ↑ appetite and sleep, leaden paralysis, rejection sensitivity, and mood reactivity are hallmarks of the atypical subtype. Pregnancy, Childbirth & Behavioral 8
574 Tricyclic antidepressants TCA OD can cause fatal cardiac arrhythmias and refractory hypotension due to inhib of fast Na+ channels in cardiac myocytes. Pregnancy, Childbirth & Pharmacology 1
575 Urinary retention TCAs have strong antichol properties. Potential AEs incl confusion, constipation, and urinary retention. These Rx should be used w/ caution in elderly pts. Pregnancy, Childbirth & Pharmacology 4
576 Selective serotonin reuptake SSRIs have improved tolerability and a better AE profile compared w/ TCAs and MAOIs but are a/w sexual dysfxn. Physicians should routinely inquire about sexual dysfxn b/c it's a relatively common Pregnancy, Childbirth & Behavioral 3
inhibitors AE of SSRIs that may lead to non-adherence. Puerperium (PR) Science (Beha) PR Beha
577 Contraception The absolute c/i to the use of OCPs are: prior Hx of TE event or stroke, Hx of an oestrogen-dependent tumour, women over age 35yrs who smoke heavily, hypertriglyceridaemia, decompensated or active Cardiovascular (CV) Pharmacology 3
liver disease (would impair steroid meta), preg. (Phar) CV Phar
578 Ovarian cancer The pathogenesis of epithelial ovarian ca is linked to the frequency of trauma and repair at the ovarian surface. OCPs, multiparity, and breastfeeding are protective by ↓ the frequency of ovulation. RFx Female Reproductive & Breast Pathophysiology 9
include BRCA mutation, nulliparity, and infertility. (FR) (Patp) FR Patp
579 Kallmann syndrome In KS, there's an absence of GnRH secretory neurons in the hypothal due to defective migration from the olfactory placode. These pts have central hypogonadism and anosmia, and often present w/ Endocrine, Diabetes & Pathology (Path) 1
delayed puberty. Metabolism (ES) ES Path
580 Cryptorchidism In undescended testes, the seminiferous tubules atrophy if uncorrected due to higher body temperatures, resulting in decreased fertility and increased risk for malignancy. Orchiopexy (surgical placement Male Reproductive (MR) Pathology (Path) 2
of the testes in the scrotal sac) can minimize damage and decrease risk for testicular cancer. MR Path
581 Breast cancer Selective ER modulators (eg, tamoxifen, raloxifene) are competitive inhibitors of estrogen binding to ERs. They can have agonist or antagonist effects depending on the specific tissue. Tamoxifen has an Female Reproductive & Breast Pharmacology 7
estrogenic effect on the uterus and can cause endometrial hyperplasia and ca. (FR) (Phar) FR Phar
582 Klinefelter syndrome KFS (47,XXY) causes infertility characterised by 1° hypogonadism (↑ FSH and LH, low testosterone) and azoospermia. Other findings incl long lower extremities; small, firm testes; and gynecomastia. Endocrine, Diabetes & Pathophysiology 3
583 Abortion Progesterone is necessary for implantation and maintenance of pregnancy. Mifepristone is a progesterone antagonist that is used w/ misoprostol (a PGE1 agonist) to terminate a 1st-trimester pregnancy. Female Reproductive & Breast Pharmacology 3
(FR) (Phar) FR Phar
584 Aromatase inhibitors Oestrogen is the main hormone responsible for the growth and devel of ER(+) breast tumours. Aromatase inhibs (e.g. anastrozole, letrozole, exemestane) ↓ the synthesis of oestrogen from androgens, Endocrine, Diabetes & Pharmacology 1
suppressing oestrogen lvls and slowing progr of ER(+) tumours. Metabolism (ES) (Phar) ES Phar
585 Neuroendocrine tumors Glucagonoma presents w/ hyperglycaemia (often as newly Dx DM) and necrolytic migratory erythema (blistering erythematous plaques w/ central clearing) affecting the groin, face, and extremities. The Endocrine, Diabetes & Pathology (Path) 1
Dx is made by detecting ↑ glucagon lvls. Metabolism (ES) ES Path
586 Zollinger-Ellison syndrome ZES is caused by gastrin-secreting tumors (gastrinomas) involving the small intestine or pancreas. Pts typically have peptic ulcers (often beyond the duodenal bulb), abdominal pain/acid reflux, and Gastrointestinal & Nutrition (GI) Pathology (Path) 3
diarrhea. The condition is frequently a/w MEN-1. GI Path
587 Ataxia telangiectasia Cerebellar ataxia, telangiectasias, and ↑ risk of sinopulm infections constitute a Chx triad of AT. This illness exhibits AR inheritance, and the defect is in a gene that codes for the ATM gene which plays a Nervous (NS) Pathophysiology 2
role in DNA break repair. The immune defx primarily MFx as an IgA defx and predisposes to infections of the upper and lower airways. (Patp) NS Patp
588 Histiocytosis Langerhans cells are dendritic cells found in the skin that act as professional antigen presenting cells. These cells are derived from the myeloid cell line and they possess characteristic racquet shaped Dermatology (DE) Histology (Hist) 1
intracytoplasmic granules known as Birbeck granules. DE Hist
590 Down syndrome Pts w/ trisomy 21 (DS) have 3 copies of the amyloid precursor protein gene located on chrom 21. This ↑ amyloid-β accumulation in the brain, placing these pts at high risk for developing early-onset AD. Nervous (NS) Genetics (Gene) 6 NS Gene
591 Alzheimer disease Early-onset familial AD is a/w 3 gene muts: APP (chrom 21), presenilin 1, and presenilin 2. Late-onset familial AD is a/w apoE4 genotype. Nervous (NS) Genetics (Gene) 7 NS Gene
592 Alzheimer disease Amyloid is an abnormally folded (insoluble) extracellular protein that has apple-green birefringence when stained w/ Congo red and viewed under polarized light. AD is a/w β-amyloid deposits in the Nervous (NS) Pathology (Path) 7
brain parenchyma (neuritic plaques) and walls of cerebral vessels (amyloid angiopathy). NS Path
593 Alzheimer disease AD is characterised by ↓ lvls of ACh in the nucleus basalis of Meynert and the hippocampus, caused by ↓ activity of choline acetyltransferase. Nervous (NS) Pathology (Path) 7 NS Path
594 Frontotemporal dementia FTD is a/w pronounced atrophy of the prefrontal cortex w/ later degen of the anterior temporal cortex. It MFx initially w/ changes in personality, social behaviour, and language that progress over time to Nervous (NS) Pathology (Path) 2
a more global dementia w/ obvi neurocognitive deficits. NS Path
595 Cerebellar degeneration PNP syndromes can occur due to the production of hormone-like substances from tumour cells. They can also result from immune rxns against tumour cells that cross-react w/ normal cells, causing Nervous (NS) Pathology (Path) 1
dysfxn a/o dmg to healthy organs and tissues. Neuro PNP syndromes (e.g. PNP cerebellar degen) are an autoimmune phenomenon. NS Path
596 Mitochondrial disorders Mitochondrial diseases are Chx by exclusively-maternal inheritance. The variable severity of these diseases is explained by the random distribution of normal and mutated mitochondria b/w daughter cells Nervous (NS) Genetics (Gene) 4
during mitosis; as a result, some cells may have completely healthy mitochondria, while other cells contain mitochondria affected by genetic mutation (heteroplasmy). MELAS is a mitochondrial
syndrome. NS Gene
597 Wernicke-Korsakoff syndrome WE is a complication of thiamine deficiency Chx by encephalopathy, ataxia, and oculomotor dysfxn. It occurs most commonly in pts w/ chronic Alc abuse and may be precipitated by infusion of Glc- Nervous (NS) Pathology (Path) 5
containing fluids. Neuroimaging reveals focal hemorrhage or atrophy of the mammillary bodies. NS Path
598 Wernicke-Korsakoff syndrome Chronic vit B1 defx impairs Glc utilization in the CNS. This occurs due to ↓ activity of the enzymes that use B1 as a cofactor (e.g. PDH, α-KG dehydrogenase, transketolase). B1 defx can be Dx if Nervous (NS) Biochemistry 5
baseline erythrocyte transketolase activity is low but ↑ after addition of B1-PPi. (Bioc) NS Bioc
599 Diabetes mellitus TZDs (e.g. pioglitazone) can cause fluid retention, leading to peri oedema and weight gain. The excess fluid can potentially exacerbate underlying CHF. Endocrine, Diabetes & Pharmacology 31
Metabolism (ES) (Phar) ES Phar
600 Diabetes mellitus DKA is initially Tx w/ an IV infusion of regular insulin, which allows for rapid adjustments in dose based on BSLs. When given subcutaneously, regular insulin starts working w/i 30min, peaks in 2-4hrs, Endocrine, Diabetes & Pharmacology 31
and lasts 5-8hrs. Metabolism (ES) (Phar) ES Phar
601 Gastrointestinal hormones Reduced gallbladder contractility, due to decreased cholecystokinin secretion, is responsible for biliary stones in patients with somatostatinoma. Endocrine, Diabetes & Pathophysiology 2
602 Pheochromocytoma Cortisol ↑ the conversion of NE to EPI in the AM by ↑ the expression of PNMT. Endocrine, Diabetes & Biochemistry 4
Metabolism (ES) (Bioc) ES Bioc
604 Diabetes mellitus SGLT2 inhibs (e.g. canagliflozin, dapagliflozin) ↓ renal reabsorption of Glc, leading to urinary Glc loss and ↓ BSLs. In pts w/ CKD, these Rx are less effective. Therefore, serum creatinine should be Endocrine, Diabetes & Pharmacology 31
measured prior to therapy. Metabolism (ES) (Phar) ES Phar
606 Diabetes mellitus SUs inhib the ATP-sensitive K+ channel on the pancreatic β cell membrane, inducing depol and L-type Ca2+ channel opening. The ↑ Ca2+ influx stims β cell insulin release independent of BGCs. SUs Endocrine, Diabetes & Pharmacology 31
can induce hypoglycaemia b/c they stim insulin secretion even when BSLs are normal. Metabolism (ES) (Phar) ES Phar
607 Diabetes mellitus Metformin inhibs hepatic GNG and ↑ peri Glc utilisation. Lactic acidosis is a rare complication of metformin therapy, but its risk is ↑ in pts w/ underlying renal insufficiency. Endocrine, Diabetes & Pharmacology 31
608 Adrenal insufficiency Admin of metyrapone will cause a ↓ in cortisol synthesis via inhib of 11-β-hydroxylase. In pts w/ an intact HPA axis, this will cause a reactive ↑ in ACTH, 11-deoxycortisol, and urinary 17- Endocrine, Diabetes & Pathophysiology 5
hydroxycorticosteroid lvls. Metabolism (ES) (Patp) ES Patp
609 Hypopituitarism Suppression of the HPA axis by GC therapy is the most common cause of AI. In these pts, adrenal crisis can be precipitated by stressful situations (e.g. infections, Sx) if the GC dose isn't ↑ appropriately. Endocrine, Diabetes & Pathophysiology 2
610 Congenital adrenal hyperplasia 17α-hydroxylase defic impairs the synthesis of androgens, oestrogens, and cortisol but doesn't inhib MC production. Boys appear phenotypically female at birth, but girls develop normal genitalia. Pts Endocrine, Diabetes & Pathophysiology 6
typically present w/ hypogonadism, HTN, and hypokalaemia. Metabolism (ES) (Patp) ES Patp
611 Congenital adrenal hyperplasia 11β-hydroxylase defic typically results in excessive adrenal androgen and MC (11-deoxycorticosterone) production. Genetically female infants are born w/ ambiguous genitalia, and affected individuals Endocrine, Diabetes & Pathophysiology 6
develop HTN and hypokalaemia early in life. Metabolism (ES) (Patp) ES Patp
612 Cushing syndrome In Cushing syndrome due to an ACTH-secreting pituitary adenoma (Cushing disease), ACTH is high and cortisol production can be suppressed by high-dose, but not low-dose, dexamethasone. In pts w/ Endocrine, Diabetes & Pathophysiology 5
ectopic ACTH production (e.g. from malignant tumours), cortisol and ACTH production aren't suppressed by low- or high-dose dexamethasone. Metabolism (ES) (Patp) ES Patp
613 Brain tumors GBM is the most common 1° cerebral neoplasm of adults that's typically located w/i the cerebral hemispheres and may cross the midline ('butterfly glioma'). These tumours are highly malignant and Nervous (NS) Pathology (Path) 10
grossly contain areas of necrosis and hemorrhage. NS Path
614 Glioblastoma (Multiforme) GBM is the most common 1° brain tumour in adults. Areas of necrosis and hemorrhage are seen on gross Ex. LM showing pseudopalisading tumour cells around areas of necrosis is Dx. Nervous (NS) Pathology (Path) 1 NS Path
615 Brain tumors Pilocytic astrocytomas are the most common brain tumors in children. They frequently arise in the cerebellum and can be differentiated from medulloblastomas by the presence of both cystic and solid Hematology & Oncology (HO) Pathology (Path) 10
components on imaging. HO Path
622 Hyperthyroidism Graves ophthalmopathy is caused by stimulation of orbital fibroblasts by thyrotropin receptor antibodies and cytokines released by activated T-cells. Excess deposition of extracellular glycosaminoglycans Endocrine, Diabetes & Pharmacology 8
and inflammatory infiltration lead to expansion of extraocular Muscles and retro orbital tissues. Glucocorticoids improve Graves ophthalmopathy by decreasing the severity of inflammation and reducing Metabolism (ES) (Phar)
the excess extraocular volume. ES Phar
623 Hyperthyroidism Pretibial myxoedema and Graves ophthalmopathy are specific features of GD. They're caused by an autoimmune response directed against the TSH receptor that results in the accumulation of GAGs w/i Endocrine, Diabetes & Pathophysiology 8
the affected tissues. Metabolism (ES) (Patp) ES Patp
624 Testicular cancer Human chorionic gonadotropin (hCG) has a structure similar to TSH. Patients with testicular germ cell tumors or gestational trophoblastic disease may develop very high serum hCG concentrations, Male Reproductive (MR) Pathology (Path) 4
which can stimulate TSH receptors and cause paraneoplastic hyperthyroidism. MR Path
625 Amiodarone Amiodarone is 40% iodine by weight. It can cause hypothyroidism due to ↓ production of thyroid hormone. Amiodarone can also cause hyperthyroidism due to ↑ thyroid hormone synthesis or destructive Cardiovascular (CV) Pharmacology 1
thyroiditis w/ release of preformed thyroid hormone. (Phar) CV Phar
626 Hyperthyroidism Thioamides (e.g. methimazole, PTU) ↓ the formation of THs via inhib of TPO, the enzyme responsible for both iodine organification and coupling of iodotyrosines. PTU also ↓ the peri conversion of T4 Endocrine, Diabetes & Pharmacology 8
to T3. Metabolism (ES) (Phar) ES Phar
628 Osteoporosis Regular exercise leads to increased peak bone mass, a reduced rate of bone loss, and a decreased risk of osteoporosis. Rheumatology, Orthopedics & Physiology 10
Sports (RH) (Phys) RH Phys
629 Osteoporosis Initially in OP, bone loss predominantly affects trabecular bone, leading to trabecular thinning and perforation w/ loss of interconnecting bridges. Over time, cortical bone, which composes most of the Rheumatology, Orthopedics & Pathology (Path) 10
appendicular skeleton, also becomes involved. Sports (RH) RH Path
630 Vitamin D deficiency Rickets is char by an excess of un-mineralised osteoid matrix and epiphyseal cartilage due to vitD defic. CFx incl frontal bossing, craniotabes, CCJ deformity ('rachitic rosary'), and bowed legs. Rheumatology, Orthopedics & Pathology (Path) 4
Sports (RH) RH Path
631 Hyperparathyroidism ↑ bone resorption in PHPT leads to osteoporosis 1arily involving the cortical bone of the appendicular skeleton. The cortical thinning appears radiologically as subperiosteal erosions. More advanced Endocrine, Diabetes & Pathophysiology 2
disease can present as osteitis fibrosa cystica (i.e. granular decalcification of the skull, osteolytic cysts, and brown tumours). Metabolism (ES) (Patp) ES Patp
632 Huntington disease HD is an AD neurodegen disorder that MFx w/ chorea (e.g. involuntary, jerky, fidgety movements) and behavioural abns (e.g. aggressiveness, depression). Char neuroimaging findings incl atrophy of the Nervous (NS) Pathology (Path) 5
caudate nuclei which results in enlargement of the frontal horns of the lateral ventricles. NS Path
633 Huntington disease An increased number of trinucleotide repeats on the HTT gene is associated with Huntington disease. The larger the number of repeats, the earlier the onset of the disease. Trinucleotide expansion occurs General Principles (GP) Genetics (Gene) 5
more frequently during paternal transmission, causing a genetic phenomenon called anticipation. GP Gene
634 Dystonia Dystonia is a syndrome of prolonged, repetitive muscle contractions. This condition may be the result of impaired fxn of the basal ganglia. Cervical dystonia (spasmodic torticollis), blepharospasm, and Nervous (NS) Pathology (Path) 1
writer's cramp are the most common types of focal dystonia. NS Path
635 Hemiballismus The STN plays an important role in the modulation of BG output. Damage to this structure (eg, due to lacunar stroke) may result in contralateral hemiballism, Chx by wild, involuntary, large-amplitude, Nervous (NS) Anatomy (Anat) 1
flinging movements of the proximal limbs (eg, arm a/o leg) on one side of the body. NS Anat
636 Friedreich ataxia FA is an AR condition that presents during childhood/adolescence w/ progr gait ataxia (due to degen of the spinocerebellar tracts) and impaired joint and vibration sense (due to degen of the posterior Nervous (NS) Pathology (Path) 2
columns and DRG). Other features incl HCM (most common cause of death), skeletal abns (e.g. kyphoscoliosis, pes cavus), and DM. NS Path
637 Hyperthyroidism Agranulocytosis is a serious complication of antithyroid drugs (e.g. methimazole, PTU) that results from drug-induced granulocyte destruction and conseq neutropaenia. Initial MFxs often incl fever, sore Endocrine, Diabetes & Pharmacology 8
throat, and oral ulcerations. If drug-induced agranulocytosis is suspected, the drug should be discontinued immediately and a CBC w/ diffial should be obtained to help confirm the Dx. Metabolism (ES) (Phar) ES Phar
638 Bone remodeling Bone-specific alkaline phosphatase levels correlate with osteoblast activity. Other markers of osteoblast activity include N-terminal propeptide of type 1 procollagen, which is released during post Rheumatology, Orthopedics & Physiology 1
translation cleavage of type 1 procollagen. Sports (RH) (Phys) RH Phys
639 Paget disease of bone Osteoclasts originate from hematopoietic progenitor cells. Macrophage colony-stimulating factor and receptor for activated nuclear factor kappa-B ligand (RANK-L) play an important role in osteoclast Rheumatology, Orthopedics & Physiology 4
differentiation. Paget's disease of bone is characterized by increased numbers of abnormal osteoclasts, excessive bone turnover and disorganized bone remodeling. Sports (RH) (Phys) RH Phys
640 Osteoporosis The receptor activator of nuclear factor kappa B (RANKY/RANK ligand (RANK-L) interaction is essential for the formation and differentiation of osteoclasts. Osteoprotegerin blocks binding of RANK- Rheumatology, Orthopedics & Pathophysiology 10
L to RANK and reduces formation of mature osteoclasts. Low estrogen states cause osteoporosis by decreasing osteoprotegerin production, increasing RANK-L production, and increasing RANK Sports (RH) (Patp)
expression in osteoclast precursors. RH Patp
641 Hypercalcemia PTH causes ↑ bone resorption, ↑ serum Ca lvls, and ↑ renal PO4 excretion. Chron high lvls of PTH ↑ the risk of OP. However, intermittent admin of recomb PTH analogs (e.g. teriparatide) induces a Endocrine, Diabetes & Physiology 5
greater ↑ in osteoblast activity in proportion to osteoclast activity and a net ↑ in bone formation. Metabolism (ES) (Phys) ES Phys
643 Antibiotic resistance The mech of vancomycin resistance in organisms such as VRE is a substitution of D-lactate in the place of D-alanine during the process of PGCW synthesis. This prevents the binding of vancomycin to Infectious Diseases (ID) Pharmacology 8
its usual D-ala-D-ala binding site in the cell wall. (Phar) ID Phar
644 Foodborne illness Staphylococcal food pois is mediated by the ingestion of a preformed, heat-stable enterotox that induces rap-on (<6 hrs) nausea and vomiting. Most cases arise due to improper food handling and storage. Gastrointestinal & Nutrition (GI) Microbiology 2
Common culprit foods incl eggs, dairy prods, and mayonnaise-based salads. (Micr) GI Micr
645 Endocarditis Initial empiric Tx of coagulase (-) staphylococcal infection should include vancomycin due to widespread methicillin resistance, esp. in nosocomial infections. If susceptibility results indicate a Cardiovascular (CV) Pharmacology 15
methicillin-susceptible isolate, vancomycin can be switched to nafcillin or oxacillin. (Phar) CV Phar
646 Osteomyelitis Hematogenous osteomyelitis is predominantly a disease of children that most frequently affects the long bones. Staphylococcus aureus is implicated in most cases secondary to a bacteremic event. Rheumatology, Orthopedics & Microbiology 4
Streptococcus pyogenes (group A streptococcus) is the second most common cause of hematogenous osteomyelitis. Sports (RH) (Micr) RH Micr
647 Lung cancer The phrenic nerve arises from the C3-C5 segments of the spinal cord and innervates the ipsilateral hemidiaphragm. Intrathoracic spread of lung ca may affect the phrenic nerve, causing hiccups and Nervous (NS) Pathology (Path) 9
diaphragmatic paralysis w/ dyspnoea. Brachial plexus involvement can cause pain in the distribution of the C8, T1, and T2 nerve roots. Involvement of the recurrent laryngeal nerve may cause hoarseness. NS Path
648 Lung cancer Tumors located in the lung apex (superior sulcus) are called Pancoast tumors. Invasion of surrounding structures can lead to ipsilateral Horner syndrome, rib destruction, atrophy of hand muscles, and pain Pulmonary & Critical Care (PU) Pathology (Path) 9
in the distribution of C8, T1, and T2 nerve roots. PU Path
649 Asbestos Malignant mesothelioma is a rare neoplasm typically arising from the pleura. It's strongly a/w asbestos exposure and presents w/ progr dyspnoea, cough, and chest pain. Unilateral pleural thickening or Pulmonary & Critical Care (PU) Pathology (Path) 5
plaque formation is seen on imaging; pleural effusions are also common and may be hemorrhagic. Histopathology reveals tumour cells w/ numerous long, slender microvilli and abundant tonofilaments. PU Path
650 Lung cancer SCLC is the most aggressive type of lung ca and is commonly a/w PNP syndromes (e.g. SIADH, Cushing syndrome). It's thought to have a neuroendocrine origin; tumour cells express neuroendocrine Pulmonary & Critical Care (PU) Pathology (Path) 9
markers (e.g. neural cell adhesion molecule (NCAM; CD56), chromogranin, synaptophysin) and contain neurosecretory granules in the cytoplasm. PU Path
651 Syphilis The clinical Px of 3° syphilis includes CV involvement and gummas. Gummas are necrotizing granulomas occurring on the skin, mucosa, subcutaneous tissue, and bones and w/i other organs. Infectious Diseases (ID) Microbiology 9
Neurosyphilis can occur at any stage of infection. (Micr) ID Micr
652 Congenital anomalies of kidney The urachus is a remnant of the allantois that connects the bladder with the yolk sac during fetal development. Failure of the urachus to obliterate at birth results in a patent urachus, which can facilitate Renal, Urinary & Electrolytes Embryology 3
and urinary tract discharge of urine from the umbilicus. (RE) (Embr) RE Embr
653 Interstitial lung disease PF presents w/ gradual-onset progr dyspnoea, non-productive cough, fatigue, eventual weight loss, and bilateral reticulonodular opacities on CXR. PFTs reveal a restrictive pattern. Pts w/ RA can develop Pulmonary & Critical Care (PU) Pathology (Path) 8
interstitial lung diseases, both from the pulm MFxs of the disease itself and from certain therapies (e.g. methotrexate, cyclophosphamide, sulfasalazine). PU Path
654 Penetrating thoracic trauma The LV forms the apex of the heart and can reach as far as the 5th ICS at the left MCL. All other chambers of the heart lie medial to the left MCL. The lungs overlap much of the anterior surface of the Cardiovascular (CV) Anatomy (Anat) 2
heart. CV Anat
656 Polycystic ovary disease Male-pattern hair growth in a woman is called hirsutism; the most common cause is PCOS. Combo OCPs can Tx hirsutism by suppressing pituitary LH secretion and subseq ↓ ovarian androgen Endocrine, Diabetes & Pathophysiology 4
production. Metabolism (ES) (Patp) ES Patp
657 Prostate cancer Flutamide is a nonsteroid anti-androgen that acts as a competitive inhibitor of testosterone receptors. It is used in combination w/ long-acting GnRH agonists for the Tx of prostate ca. Male Reproductive (MR) Pharmacology 5
(Phar) MR Phar
658 Benign prostatic hyperplasia Finasteride is a 5-α-reductase inhib that suppresses peri conversion of testosterone to DHT. It's used for Tx of BPH and androgenetic alopecia. Endocrine, Diabetes & Pharmacology 6
659 Anesthesia The onset of action of a gas anaesthetic depends on its solubility in the blood (blood/gas partition coefficient). Drugs w/ high blood/gas partition coefficients are more soluble in the blood, demonstrate Nervous (NS) Pharmacology 9
slower equilibrium w/ the brain, and have longer onset times. (Phar) NS Phar
660 Anesthesia The arteriovenous concentration gradient reflects the overall tissue solubility of an anesthetic. Anesthetics with high tissue solubility are characterized by large arteriovenous concentration gradients and Nervous (NS) Pharmacology 9
slower onsets of action. (Phar) NS Phar
661 Allergic rhinitis HS-I rxns are an allergic response triggered by the binding of previously recognized Ag to IgE Abs on mast cells. In the early phase of the response, histamine, already stored in preformed granules in Pulmonary & Critical Care (PU) Pathophysiology 2
mast cells, is the 1st chemical mediator released. Once released, histamine stimulates smooth muscle contraction (bronchoconstriction), ↑ vascular permeability (edema), and ↑ mucus secretion. (Patp) PU Patp
663 Asthma Bronchial challenge testing is a highly sensitive but nonspecific measure that can help excl a Dx of asthma. A provocative stim (typically aerosolised methacholine) is admin at ↑ concs to induce Pulmonary & Critical Care (PU) Pathophysiology 12
bronchoconstriction. Pts w/ asthma are hyperresponsive to this stim and experience a decline in FEV1 at lower doses than non-asthmatics. (Patp) PU Patp
664 Bronchiectasis Primary ciliary dyskinesia results from an autosomal recessive mutation in the proteins responsible for normal flagellar and ciliary structure and function (eg, dynein, assembly proteins). Clinical Male Reproductive (MR) Pathology (Path) 2
manifestations include situs inversus, chronic sinusitis, bronchiectasis, and infertility. MR Path
665 Aspergillosis ABPA due to A. fumigatus may complicate asthma. ABPA can result in transient recurrent pulm infiltrates and eventual prox. bronchiectasis. Pulmonary & Critical Care (PU) Microbiology 5
(Micr) PU Micr
666 Interstitial lung disease IPFis characterised by patchy interstitial inflammation intermixed w/ areas of dense fibrosis and normal lung, focal fibroblastic proliferation, and a honeycomb pattern most prominent in the periphery. Pulmonary & Critical Care (PU) Pathology (Path) 8
Repetitive injury and disordered healing are implicated as potential causes; lung injury results in focal loss of type 1 pneumocytes and hyperplasia of type 2 pneumocytes. PU Path
667 Churg-Strauss syndrome Eosinophilic GPA (CSS) is a small to medium vessel vasculitis char by late-onset asthma, rhinosinusitis, and eosinophilia. Mononeuritis multiplex due to involvement of the epineural vessels of peri Rheumatology, Orthopedics & Pathology (Path) 1
nerves is common. Sports (RH) RH Path
668 Silicosis Silicosis is characterised by dyspnoea and productive cough occurring yrs after inhalational exposure to crystalline silica. Histo, it's characterised by birefringent silicate particles w/i dense, whorled Pulmonary & Critical Care (PU) Pathology (Path) 2
collagenous nodules surrounded by dust-laden macrophages. Radiography typically demonstrates numerous small, rounded nodules predominant in the upper lobes; calcification of the rim of hilar LNs
(eggshell calcification) may also be seen. PU Path
669 Asbestos Asbestos-related pleural disease is characterised by pleural plaques (focal pleural thickening, typically w/ calcifications). Common occup exposures incl shipbuilding, insulation manufacturing and Pulmonary & Critical Care (PU) Pathology (Path) 5
application, and drywall application. Most affected pts remain aSSx for 20-30yrs following initial exposure. PU Path
670 Silicosis In silicosis, internalised silica particles impair macrophage fxn by disrupting phagocytosis and promoting apoptosis. This ↑ the risk of mycobacteria infection (particularly M. tuberculosis). Pulmonary & Critical Care (PU) Pathophysiology 2
(Patp) PU Patp
671 Vitamin E deficiency VitE is a lipid-soluble vit that has antioxidative properties. Neuro SSx of vitE defic closely mimic FA and incl ataxia (due to degen of spinocerebellar tracts), loss of position and vibration sense (due to Nervous (NS) Pathology (Path) 2
degen of the dorsal columns), and loss of DTR (due to peri nerve degen). NS Path
672 Friedreich ataxia FA is Chx by cerebellar ataxia (spinocerebellar tract degeneration) and loss of position/vibration sensation (dorsal column/DRG degeneration), kyphoscoliosis, and HCM. Foot abnormalities and DM are Nervous (NS) Pathology (Path) 2
also common. NS Path
673 Ataxia telangiectasia AT is an AR disorder resulting from a defect in DNA-repair genes. The DNA of these pts is hypersensitive to ionizing radiation. MFx include cerebellar ataxia, oculocutaneous telangiectasias, repeated Nervous (NS) Pathology (Path) 2
sinopulm infections, and an ↑ incidence of malignancy. NS Path
674 Amyotrophic lateral sclerosis UMN dmg leads to spastic paralysis, hyperreflexia, and an upgoing plantar reflex (Babinski sign) due to loss of descending inhib over LMNs in the anterior horn. Conversely, LMN lesions cause flaccid Nervous (NS) Pathology (Path) 2
paralysis, hypotonia, hyporeflexia, muscle atrophy, and fasciculations. NS Path
675 Amyotrophic lateral sclerosis ALS causes both UMN and LMN lesions. Loss of neurons of the anterior horns of the spinal cord (LMN lesion) causes muscle weakness and atrophy. Demyelination of the lateral corticospinal tract Nervous (NS) Pathology (Path) 2
(UMN lesion) leads to spasticity and hyperreflexia. NS Path
676 Toxic shock syndrome Superantigens (eg, toxic shock syndrome toxin) interact with major histocompatibility complex molecules on antigen-presenting cells and the variable region of the T lymphocyte receptor to cause Infectious Diseases (ID) Immunology 2
nonspecific, widespread activation of T cells. This results in the release of interleukin (IL)-2 from the T cells and IL-1 and tumor necrosis factor from macrophages. This immune cascade is responsible for (Immu)
the manifestations of toxic shock syndrome. ID Immu
677 Skin and soft tissue infections Protein A is a virulence factor found in the PGCW of S. aureus that binds to the Fc portion of IgG, leading to impaired complement activation, opsonisation, and phagocytosis. Infectious Diseases (ID) Microbiology 8
(Micr) ID Micr
678 Urinary tract infection S. saprophyticus is responsible for almost half of all UTIs in sexually active young women. S. saprophyticus belongs to coag (-) staphylococci (CoNS) and is unique among these b/c it's resistant to Infectious Diseases (ID) Microbiology 12
novobiocin. (Micr) ID Micr
679 Endocarditis Staphylococcus epidermidis, a Gram (+) coccus that grows in clusters, is a skin commensal that is a common cause of infection in pts w/ prosthetic devices such as artificial joints or heart valves. Unlike S Cardiovascular (CV) Microbiology 15
aureus, S epidermidis is coagulase (-). Unlike S saprophyticus (another coagulase (-) staphylococci species), S epidermidis is susceptible to novobiocin. (Micr) CV Micr
680 Staphylococcal scalded skin The staphylococcal scalded skin syndrome occurs in infants and children due to the production of the exotoxin exfoliatin by Staphylococcus species. It causes widespread epidermal sloughing. especially Dermatology (DE) Microbiology 1
syndrome with gentle pressure (Nikolsky's sign). (Micr) DE Micr
681 Loop diuretics LoopDs act by inhib the Na+K+2Cl- cotransporter in the thick asc limb of the LOH, incr Na+, Cl-, and water excretion. They're the most potent diuretics and are used as 1st-line therapy for rapid relief of Renal, Urinary & Electrolytes Pharmacology 3
SSx in pts w/ acute DHF. (RE) (Phar) RE Phar
682 Acetazolamide CA is found in high conc in the PCT and is responsible for catalyzing rxns necessary for NaHCO3 reabs. Acetazolamide is a diuretic that works by inhib CA, which effectively blocks NaHCO3 and water Renal, Urinary & Electrolytes Pharmacology 1
reabs in the PCTs resulting in urinary HCO3- wasting. CAIs are also used to relieve IOP in open-angle and angle-closure glaucoma. (RE) (Phar) RE Phar
683 Thiazides TZDs work by blocking Na+Cl- symporters in the DCTs, causing enhanced Na+, Cl-, and water excretion. Since only a small amount of filtered Na+ reaches the DCTs, TZD aren't as efficacious as Renal, Urinary & Electrolytes Pharmacology 3
loopDs. Unlike loopDs, TZDs can cause hypercalcemia. (RE) (Phar) RE Phar
684 Loop diuretics Furosemide is a loop diuretic that works by inhib Na+-K+-2Cl- symporters in the LOH effectively causing ↑ Na+, Cl-, and fluid excretion. Addnally, loop diuretics also stim PG release. By stim renal PG Renal, Urinary & Electrolytes Physiology 3
release, loop diuretics also ↑ RBF leading to ↑ GFR and enhanced drug delivery. Thus concurrent use of NSAIDs w/ loop diuretics can result in a ↓ diuretic response. (RE) (Phys) RE Phys
685 Loop diuretics Ototox 2ary to loopDs usually occurs w/ higher dosages, pre-existing CKD, rapid IV admin, or when used in combo w/ other ototox agents (aminoglycosides, salicylates, and cisplatin). Hearing Renal, Urinary & Electrolytes Pharmacology 3
impairment is usually rev but may be permanent in some cases. (RE) (Phar) RE Phar
686 Aldosterone antagonists MRBs (e.g. spironolactone, eplerenone) improve survival in pts w/ CHF and ↓ LV EF. They shouldn't be used in pts w/ hyperkalaemia or renal failure. Cardiovascular (CV) Pharmacology 3
(Phar) CV Phar
687 Gynecomastia Spironolactone is an aldo antag commony used to Tx HF. It has significant antiandrogenic effects and can cause gynecomastia, decr libido, and impotence. Eplerenone is a more selective aldo antag w/ Renal, Urinary & Electrolytes Pharmacology 3
fever AEs. (RE) (Phar) RE Phar
688 Mannitol Mannitol is an osmoD that works by incr plasma or tubular fluid osmolality. Incr plasma and fluid osmolality causes extraction of water from the interstitial space into the vasc space or tubular lumen, w/ Renal, Urinary & Electrolytes Pharmacology 1
subseq diuresis. In the brain, water redistribution from the tissues into the plasma helps decr edema and ICP in the setting of cerebral edema. 1 of the more severe tox of aggressive osmoDs is pulm edema. (RE) (Phar) RE Phar
689 Primary hypertension Fenoldopam is a selective peripheral dopamine-1 receptor agonist. It is given IV to ↓ BP in HTE, especially in pts w/ renal insufficiency. Fenoldopam causes arteriolar dilation, ↑ renal perfusion, and Cardiovascular (CV) Pharmacology 14
promotes diuresis and natriuresis. (Phar) CV Phar
690 Renin angiotensin aldosterone ACEIs block the effect of ACE, decr AT-II and aldo lvls. By decr AT-II lvls, ACEIs directly interrupt (-) fb loops, thereby incr renin and AT-I lvls. ACE is also responsible for the breakdown of Renal, Urinary & Electrolytes Pharmacology 1
system bradykinin; ACEIs therefore incr bradykinin lvls. (RE) (Phar) RE Phar
691 Angiotensin receptor blockers ARBs work by blocking ATII-1 receptors, inhib the effects of ATII. This results in arterial vasodilation and ↓ aldosterone secretion. The resulting fall in BP ↑ renin, ATI, and ATII lvls. ARBs don't affect Cardiovascular (CV) Pharmacology 1
the activity of ACE, and therefore they don't affect bradykinin degradation and don't cause cough. (Phar) CV Phar
692 Beta blockers Beta-adrenergic blocking drugs inhib renin release by blocking beta1 receptor-mediated regulation of the RAAS. This decr PRA, w/ a resulting decr in AT-I, AT-II, and aldo lvls. Renal, Urinary & Electrolytes Pharmacology 3
(RE) (Phar) RE Phar
693 ACE inhibitors ACEIs can cause significant 1st-dose hypotension in pts w/ volume depletion (eg, from diuretic use) or HF. To ↓ the risk of 1st-dose hypotension, ACEI Thx should be initiated at low dosages. Cardiovascular (CV) Pharmacology 7
(Phar) CV Phar
694 ACE inhibitors Pts w/ bilateral RAS have decr renal perfusion (due to atherosclerotic blockage) and are dependent upon AT-II-induced eff vasocon to maint GFR. ACEIs block AT-II-mediated vasocon, which can decr Renal, Urinary & Electrolytes Pharmacology 7
syst BP and decr renal perfusion. In addn, ACEIs cause dilation of the eff art, leading to a decr in GFR and RFF. (RE) (Phar) RE Phar
695 Renal artery stenosis In RAS, incr production of AT-II causes incr syst BP (to incr renal perfusion) and pref constriction of the glom eff art (to incr GFR). Pts w/ bilateral RAS are dependent on this response to maint renal fxn; Renal, Urinary & Electrolytes Pharmacology 9
initiation of ACEIs or ARBs can precip ARF. However, UA is typically u/r (i.e. no hematuria, proteinuria, or casts). (RE) (Phar) RE Phar
696 ACE inhibitors ACEIs decr AT-II lvls and cause eff art dilation, thereby decr the GFP and GFR. This can precip ARF in pts w/ decr intrarenal perfusion pressure at baseline (e.g. RAS, CHF, hypovolemia). Renal, Urinary & Electrolytes Pharmacology 7
(RE) (Phar) RE Phar
697 Hyperkalemia ACEIs block the conversion of AT-I to AT-Il, thereby ↓ vasoconstriction and aldosterone secretion. ↓ aldosterone leads to K retention, which can cause hyperkalemia, especially in pts w/ renal Cardiovascular (CV) Pharmacology 1
insufficiency and in those taking other Rx that ↑ K lvls (eg, ARBs, MRBs). (Phar) CV Phar
698 Precocious puberty Sex hormones promote both growth and epiphyseal plate closure; hence, precocious puberty may result in a shorter stature, despite an initial growth spurt. Gigantism is caused by excessive pituitary Endocrine, Diabetes & Pathophysiology 1
production of GH; these pts achieve enormous heights b/c, unlike excessive sex steroids, excessive IGF-1 doesn't lead to premature closure of the epiphysis. Metabolism (ES) (Patp) ES Patp
700 Achondroplasia Unlike the process of intramembranous ossification that forms flat bones, endochondral ossification proceeds along a cartilage template and is responsible for the formation of long bones. Achondroplasia Rheumatology, Orthopedics & Pathophysiology 2
is characterized by an exaggerated inhibition of chondrocyte proliferation in the growth plates of long bones and manifests with proximal limb shortening, midface hypoplasia, and macrocephaly. Sports (RH) (Patp) RH Patp
701 Achondroplasia Achondroplasia is an AD disorder that results in a GOF mut in the FGFR3 gene. Most individuals affected by AD disorders are heterozyg and have a 50% chance of transmitting the mut to their offspring. General Principles (GP) Genetics (Gene) 2 GP Gene
702 Osteogenesis imperfecta OI results from defective synthesis of type I collagen by osteoblasts. CFx incl a Hx of MTFs, blue sclerae, and small, malformed teeth. In most pts, OI is transmitted by AD inheritance. Rheumatology, Orthopedics & Pathology (Path) 1
Sports (RH) RH Path
703 Parkinson disease DA agonists have a chem structure similar to the NT DA and directly stim DA receptors. The 2 classes of DA agonists are ergot compounds (e.g. bromocriptine) and non-ergot compounds (e.g. Nervous (NS) Pharmacology 7
pramipexole, ropinirole). (Phar) NS Phar
704 Antidepressants Bupropion is a 1st-lineantidep that isn't a/w sexual AEs or weight gain. However, it's a/w an ↑ seizure risk at high doses and is c/i in pts w/ seizure disorders, AN, and BN. Pregnancy, Childbirth & Pharmacology 4
706 Antidepressants Sexual dysfxn is seen in up to 50% of pts Tx w/ SSRIs. Bupropion, an NDRI, is a 1st-line Tx for MDD and doesn't cause sexual dysfxn. Pregnancy, Childbirth & Pharmacology 4
707 Priapism Trazodone is a highly sedating antidepressant commonly used to Tx insomnia. Priapism is a rare but serious AE. Pregnancy, Childbirth & Behavioral 1
708 Antidepressants TCA overdose can Px w/ mental status changes, seizures, prolonged QRS duration, ventricular arrhythmias, and anticholinergic findings. NaHCO3 is used to Tx associated cardiac toxicity and works by ↑ Poisoning & Environmental Pharmacology 4
serum pH and extracellular Na (alleviating fast Na channel blockade). Exposure (PO) (Phar) PO Phar
709 Warfarin reversal Both vitK and FFP are used for reversing warfarin-induced anticoag. FFP rapidly reverses warfarin's effects whereas vitK req time for clotting factor re-synthesis. Hematology & Oncology (HO) Pharmacology 1
(Phar) HO Phar
710 Vitamin K deficiency VitK is necessary for the carboxylation and fxnality of coag Fs II, VII, IX, and X. Newborns who don't receive prophylactic supplementation are at risk for bleeding complications. Pts w/ CF are also at Hematology & Oncology (HO) Pathology (Path) 2
risk for vitK defic due to poor absorption of fat-soluble vits. HO Path
711 Dyslipidemia Tx w/ statins causes hepatocytes to ↑ their LDL receptor density, leading to ↑ uptake of circulating LDL. Cardiovascular (CV) Pharmacology 11
(Phar) CV Phar
712 Drug induced myopathy Statins inhib the intracellular RLS of chol biosynthesis via competitive inhib of HMG-CoA reductase. This leads to enhanced hepatic LDL receptor recycling and ↑ LDL clearance from the circulation. Endocrine, Diabetes & Pharmacology 3
Statin-induced myopathy (e.g. myalgia, ↑ CK) is the most common complication of statin use. Metabolism (ES) (Phar) ES Phar
713 Antiplatelet therapy GI mucosal injury and bleeding are the most common side effects of aspirin. These are due primarily to COX-1 inhib, which results in impaired PG-dependent GI mucosal defence and ↓ platelet Cardiovascular (CV) Pharmacology 1
aggregation. (Phar) CV Phar
714 NSAIDs ASA is an NSAID that irreversibly inhibs COX-1 and -2 enzymes via acetylation. In contrast, other NSAIDs (e.g. diclofenac, ibuprofen, indomethacin) reversibly inhib COX-1 and -2. Hematology & Oncology (HO) Pharmacology 4
(Phar) HO Phar
716 COX 2 inhibitor Selective cyclooxygenase 2 (COX 2) inhibitors relieve pain with lower risk of bleeding and gastric ulceration than nonselective nonsteroidal anti-inflammatory drugs. Rheumatology, Orthopedics & Pharmacology 1
Sports (RH) (Phar) RH Phar
718 Rheumatoid arthritis Methotrexate is the preferred disease-modifying treatment for patients with moderate to severe rheumatoid arthritis. Significant adverse effects include stomatitis, bone marrow suppression, and liver Rheumatology, Orthopedics & Pharmacology 9
function abnormalities. Sports (RH) (Phar) RH Phar
719 Rheumatoid arthritis The foundation of management for rheumatoid arthritis is disease-modifying antirheumatic drugs, which alleviate pain and inflammation and reduce long-term joint destruction. However, the response to Rheumatology, Orthopedics & Pharmacology 9
treatment may take several weeks. Nonsteroidal anti-inflammatory drugs and glucocorticoids can provide rapid symptom relief in the interim. Sports (RH) (Phar) RH Phar
720 Biologic agents Tumor necrosis factor-alpha (TNF-α) inhibitors impair cell-mediated immunity. All patients beginning treatment with TNF-α inhibitors should be evaluated for latent tuberculosis. Rheumatology, Orthopedics & Pharmacology 2
721 Osteomyelitis heme OM is most common in children and usually affects the metaphysis of long bones due to the slower blood flow and cap fenestrae in this region. W/o proper Tx, the infection can progress to chronic Rheumatology, Orthopedics & Pathology (Path) 4
suppurative OM. Sports (RH) RH Path
722 Poststreptococcal GN is a/w prior streptococcal pharyngeal or skin infection; acute RF is a/w prior streptococcal pharyngitis but not skin infection. Streptococci are catalase (-), staphylococci are catalase (+). Streptococcus Infectious Diseases (ID) Microbiology 8
glomerulonephritis pyogenes (GAS) is β-hemolytic, bacitracin-susceptible, and pyrrolidonyl arylamidase (+). Streptococcus pneumoniae is bile-soluble and optochin-susceptible. (Micr) ID Micr
723 Pharyngitis The major virulence factor of S. pyogenes is M protein, an α-helical coiled-coil protein that shares structural homology w/ tropomyosin and myosin. It extends from the cell wall and prevents Infectious Diseases (ID) Microbiology 2
phagocytosis, inhibs complement binding, and mediates bacterial adherence. Abs against M protein form shortly after acute infection and may cross-react w/ epitopes on myosin, leading to rheumatic (Micr)
carditis. ID Micr
724 Rheumatic fever Acute rheumatic fever is an autoimmune reaction following an untreated group A streptococcal pharyngitis. Anti-group A Streptococcus antibodies (eg, anti-M protein, anti-N-acetyl-β-D glucosamine) Infectious Diseases (ID) Pathophysiology 5
cross-react and attack cardiac and central nervous system antigens. (Patp) ID Patp
725 Skin and soft tissue infections ARF and PSGN are post-infectious complications of GAS (S pyogenes) infections. PSGN can follow either streptococcal skin infection (impetigo) or streptococcal pharyngitis, whereas ARF is classically Infectious Diseases (ID) Microbiology 8
associated only w/ streptococcal pharyngitis. (Micr) ID Micr
726 Rheumatic fever Acute RF is a complication of untreated group A streptococcal pharyngitis. RHD is the most common cause of acquired valvular heart disease and CV death in developing countries. The incidence of Cardiovascular (CV) Pathophysiology 5
acute RF and RHD has been ↓ in industrialized nations w/ prompt Tx of streptococcal pharyngitis w/ penicillin. (Patp) CV Patp
727 Skin and soft tissue infections S. aureus is the most common cause of skin and soft-tissue abscess (e.g. furuncle). Tx of the abscess w/ incision and drainage and Abx can eliminate the local infection but doesn't eliminate colonisation of Infectious Diseases (ID) Microbiology 8
the anterior nares and skin. Therefore, recurrent infections are common. (Micr) ID Micr
728 Catheter related bloodstream Nosocomial bloodstream infections are usually a/w intravascular catheters, which allow skin commensals such as S. aureus and CoNS to enter the bloodstream. Infectious Diseases (ID) Microbiology 3
infection (Micr) ID Micr
729 Endocarditis Staphylococcus aureus causes acute BE w/ rapid onset of SSx, including shaking chills (rigors), high fever, dyspnea on exertion, and malaise. In IVDUs, it can cause right-sided endocarditis w/ septic Cardiovascular (CV) Microbiology 15
embolization into the lungs. (Micr) CV Micr
730 Community acquired pneumonia The 1° VF of S. pneumoniae is a PSC that inhibs opsonisation and phagocytosis. The PSC of the most virulent strains is targeted by the PCV, which confers immunity against those subtypes. Pulmonary & Critical Care (PU) Microbiology 21
(Micr) PU Micr
731 Community acquired pneumonia S. pneumoniae are gram (+), α-hemolytic, optochin-sen, bile-soluble diplococci. Viridans group streptococci are also α-hemolytic, but they're optochin-res and bile insoluble. S. pyogenes (GAS) appear as Pulmonary & Critical Care (PU) Microbiology 21
gram (+) cocci in chains w/ bacitracin susceptibility. (Micr) PU Micr
732 Asplenia The spleen acts as both a blood filter capable of removing circulating pathogens and as a major site of opsonising Ab synthesis. Asplenic pts are prone to infections caused by encapsulated organisms such Allergy & Immunology (AI) Microbiology 2
as S. pneumoniae, H. influenzae, and N. meningitidis. (Micr) AI Micr
733 Endocarditis Enterococcus is a component of the normal colonic and urogenital flora and is capable of growing in hypertonic saline and bile. It is γ-hemolytic, catalase (-), and pyrrolidonyl arylamidase (+). GU Cardiovascular (CV) Microbiology 15
instrumentation or catheterization has been a/w enterococcal endocarditis. (Micr) CV Micr
734 Community acquired pneumonia S. pneumoniae vax ↓ the risk of invasive disease and is recommended for young pts and the elderly. The PCPSV is an unconjugated vax that induces a T-cell-independent humoral immune response. In Pulmonary & Critical Care (PU) Microbiology 21
contrast, the PCCV contains polysaccharide material attached to a protein Ag, which creates a robust T-cell-mediated humoral immune response. (Micr) PU Micr
735 Meningitis Bacterial meningitis causes an incr in CSF neutrophil count and protein conc as well as decr in CSF Glc. S. pneumoniae is a leading cause of CAP, OM, and meningitis in adults. S. pneumoniae appears Nervous (NS) Microbiology 17
on Gram stain as lancet-shaped, Gram (+) cocci in pairs. (Micr) NS Micr
736 Bacterial gene transfer S. pneumoniae is able to undergo transformation, which allows the bacterium to take up exogenous DNA fragments and express the encoded proteins. Thru this method, strains of S. pneumoniae that don't Infectious Diseases (ID) Microbiology 1
form a capsule can acq the genes that code for the capsule and therefore gain virulence. (Micr) ID Micr
737 Meningitis N. meningitidis is transmitted 1arily by aerosolized droplets and subseq colonizes the nasopharyngeal epithelium. Penetration of the epithelium can lead to bloodstream infection. Spread to the meninges Nervous (NS) Microbiology 17
occurs via transcellular penetration of the cerebral cap endothelium or entry at the choroid plexus. (Micr) NS Micr
738 Meningitis N. meningitidis can cause sepsis and circulatory collapse in previously healthy young individuals. LOS, a VF in the pathogens outer membrane, is the major underlying cause of disease severity. Nervous (NS) Microbiology 17
(Micr) NS Micr
739 Complement deficiency Deficiency of the complement factors that form the membrane attack complex (i.e., C5b-C9) results in recurrent infections by Neisseria species. Infectious Diseases (ID) Immunology 1
(Immu) ID Immu
740 Myasthenia gravis Myasthenia gravis results from an autoimmune type II (antibody-mediated) hypersensitivity reaction against skeletal myocyte surface acetylcholine receptors. Goodpasture syndrome similarly involves Rheumatology, Orthopedics & Pathophysiology 10
autoantibodies against basement membrane collagen in the renal glomeruli and lung alveoli. Sports (RH) (Patp) RH Patp
741 Serum sickness Serum sickness is a type III hypersensitivity reaction to nonhuman proteins characterized by vasculitis resulting from tissue deposition of circulating immune complexes. Clinical findings include fever, Rheumatology, Orthopedics & Immunology 1
pruritic skin rash, arthralgias, and low serum C3 and C4 complement levels. Sports (RH) (Immu) RH Immu
742 Antiphospholipid syndrome GN, a photosensitive skin rash, and arthralgias in a young woman are suggestive of SLE. Up to 30% of pts w/ SLE have antiphospholipid Abs, which can cause paradoxical aPTT prolongation and a false Hematology & Oncology (HO) Pathology (Path) 1
(+) RPR/VDRL. Pts w/ antiphospholipid Abs are at risk for venous and arterial TE and unexplained, recurrent preg loss. HO Path
743 Reactive arthritis The classic triad of ReA is nongonococcal urethritis, conjunctivitis, and arthritis. It's an HLA-B27-assoc. arthropathy that occurs w/i several wks following a GU or enteric infection. It belongs to the Allergy & Immunology (AI) Immunology 2
group of SNSAs (incl. AS) and can cause SI in about 20% of cases. (Immu) AI Immu
744 Transplant rejection Chronic renal allograft rejection manifests months to years after a transplant and presents with worsening hypertension and a gradual decline in renal function. It involves a chronic, antibody mediated Renal, Urinary & Electrolytes Immunology 4
response against donor antigens and leads to obliterative vascular wall thickening, tubular atrophy, and interstitial fibrosis. The process is usually irreversible and eventually leads to graft failure. (RE) (Immu) RE Immu
745 Cell mediated immunity NK cells recognize and kill cells w/ decr. MHC-I Ag cell surface expression, such as virus-infected cells and tumor cells. They're large lymphocytes that contain perforins and granzymes in cytoplasmic Allergy & Immunology (AI) Immunology 5
granules. NK cells kill target cells by inducing apoptosis. (Immu) AI Immu
746 Immunology principles CD8+ cells recognize foreign antigens presented with MHC class I proteins. Each MHC class | molecule consists of a heavy chain and a β2-microglobulin. General Principles (GP) Immunology 2
(Immu) GP Immu
747 Blood transfusion Acute hemolytic transfusion reaction is a antibody-mediated (type II) hypersensitivity reaction caused by pre-existing anti-ABO antibodies that bind antigens on transfused donor erythrocytes. Subsequent Renal, Urinary & Electrolytes Immunology 2
complement activation results in erythrocyte lysis, vasodilation, and symptoms of shock. Common findings include fever, hypotension, chest and back pain, and hemoglobinuria. (RE) (Immu) RE Immu
748 Polymyositis and dermatomyositis Polymyositis causes symmetric proximal muscle weakness. Muscle biopsy reveals inflammation, necrosis, and regeneration of muscle fibers. Over-expression of major histocompatibility complex class I Rheumatology, Orthopedics & Pathophysiology 5
proteins on the sarcolemma leads to infiltration with CD8+ T lymphocytes and myocyte damage. Sports (RH) (Patp) RH Patp
749 Myasthenia gravis MG is caused by circulating Abs directed against AChR of the NMJ. Auto-Ab binding leads to receptor degradation, producing fluctuating weakness that worsens over the course of the day and most Nervous (NS) Pathology (Path) 10
commonly affects the extraocular muscles (e.g. ptosis, diplopia). Most pts also have thymic abns (e.g. thymoma). NS Path
750 Cell mediated immunity Eosinophils play a role in host defense during multicellular parasitic infection. When stimulated by antibodies bound to a parasitic organism, they destroy the parasite via antibody-dependent cell mediated Allergy & Immunology (AI) Immunology 5
cytotoxicity with enzymes from their cytoplasmic granules. Another function of eosinophils is regulation of type I hypersensitivity reactions. (Immu) AI Immu
751 Prostacyclins Prostacyclin (prostaglandin I2) is synthesized from prostaglandin H2 by prostacyclin synthase in vascular endothelial cells. Once secreted, it inhibits platelet aggregation and causes vasodilation to oppose Cardiovascular (CV) Pathophysiology 1
the fxns of thromboxane A2 and help maintain vascular homeostasis. (Patp) CV Patp
752 Ankylosing spondylitis The seronegative spondyloarthropathies include ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and arthritis associated with inflammatory bowel disease. Individuals expressing HLA B27 are Rheumatology, Orthopedics & Immunology 2
at increased risk for the seronegative spondyloarthropathies. Sports (RH) (Immu) RH Immu
753 Ankylosing spondylitis Ankylosing spondylitis is characterized by stiffness and fusion of axial joints (ankylosis) and inflammation at the site of insertion of tendons into bone (enthesitis). Involvement of the thoracic spine and Rheumatology, Orthopedics & Pathophysiology 2
costovertebral and costosternal junctions can limit chest wall expansion, leading to hypoventilation. Sports (RH) (Patp) RH Patp
754 Rheumatoid arthritis Rheumatoid arthritis results from an immune response directed against autoantigens in the joints. Infiltrating CD4+ T cells secrete cytokines that promote inflammatory synovitis. They also stimulate B Rheumatology, Orthopedics & Immunology 9
cells to produce rheumatoid factor (IgM antibody specific for Fc component of IgG) and anti citrullinated protein antibodies that contribute to chronic inflammation and joint destruction. Sports (RH) (Immu) RH Immu
755 Nutrition, protein Metabolism of 1 g of protein or carbohydrate produces 4 Calories of energy; metabolism of 1 g of fat produces 9 Calories. Gastrointestinal & Nutrition (GI) Biochemistry 1
(Bioc) GI Bioc
756 Myasthenia gravis Myasthenia gravis is associated with abnormalities of the thymus (e.g. thymoma, thymic hyperplasia). The thymus and inferior parathyroid glands arise from the 3rd pharyngeal pouch. Rheumatology, Orthopedics & Embryology 10
Sports (RH) (Embr) RH Embr
757 Rough ER protein synthesis The rough endoplasmic reticulum (RER) is covered with ribosomes and is involved in the transfer of proteins to the cell membrane and extracellular space. The RER is well developed in protein secreting General Principles (GP) Physiology 1
cells. The smooth ER lacks surface ribosomes and functions in lipid synthesis, carbohydrate metabolism, and detoxification of harmful substances. (Phys) GP Phys
758 Henoch-Schonlein purpura Henoch-Schönlein purpura is an IgA-mediated type III hypersensitivity reaction in children that generally follows infection. Deposition of circulating IgA-containing immune complexes in small vessels Renal, Urinary & Electrolytes Immunology 3
results in systemic vasculitis. Common manifestations include palpable lower-extremity purpura, abdominal pain, arthralgias, and hematuria. (RE) (Immu) RE Immu
759 Latex allergy IL-4 is produced by the Th2 subset of Th cells. It facilitates proliferation of B cells and Th2 lymphocytes and stims Ab isotype switching to IgE which mediates HS-1 (allergic) rxns. Allergy & Immunology (AI) Immunology 1
(Immu) AI Immu
760 Tetanus Clostridium tetani produces the neurotoxin tetanospasmin, which blocks inhibitory neurotransmission in the spinal cord and leads to tonic muscular contraction. Tetanus is prevented by immunization with Infectious Diseases (ID) Immunology 5
an inactivated toxoid that triggers the production of antitoxin antibodies (active immunity). (Immu) ID Immu
761 SLE ANAs are found in almost all pts w/ SLE but are also found in many other AI disorders and have low specificity. Anti-dsDNA Abs and anti-Smith Abs have lower sensitivity but higher specificity. Allergy & Immunology (AI) Pathophysiology 7
(Patp) AI Patp
762 Cell mediated immunity IL-12 stimulates the differentiation of naive Th0 cells into Th1 cells. Pts w/ IL-12 receptor deficiency are susceptible to severe mycobacterial infections due to the inability to mount a strong cell-mediated Allergy & Immunology (AI) Immunology 5
granulomatous immune response; therefore, they require Tx w/ IFN-γ. (Immu) AI Immu
763 Ectopic thyroid The thyroid gland is formed from evagination of the pharyngeal epithelium and desc to the lower neck. Due to failure of migration, the thyroid can reside anywhere along the thyroglossal duct's usual Endocrine, Diabetes & Embryology 1
path, incl the tongue (lingual thyroid). Metabolism (ES) (Embr) ES Embr
764 Hypothyroidism The thyroid releases TH (T3 and T4) in response to TSH from the pituitary, which is regulated by TRH from the hypothal. TH suppresses the secretion of TSH and TRH via (-) feedback, and small Endocrine, Diabetes & Pathophysiology 13
changes in TH lvls cause large changes in TSH. Serum TSH is the most sensitive test for 1° hypothyroidism. Metabolism (ES) (Patp) ES Patp
765 Hypothyroidism Hypothyroid myopathy presents w/ myalgias, prox. muscle weakness, ↑ CK lvls, and delayed relaxation of DTRs. The Dx can be confirmed w/ an ↑ TSH lvl. Other common causes of myopathy w/ ↑ CK Endocrine, Diabetes & Pathophysiology 13
lvls incl inflammatory myopathies, muscular dystrophies, and HMG-CoA reductase inhibs. Metabolism (ES) (Patp) ES Patp
767 Radiation injury KI competitively inhibs thyroid uptake of radioactive I- isotopes and is often admin following nuclear accidents to protect the thyroid and prevent devel of radiation-induced thyroid carcinoma. Endocrine, Diabetes & Pharmacology 1
768 Subacute thyroiditis SGT (de Quervain) is char by painful thyroid enlargement and usually follows a viral illness. Bx shows a mixed inflammatory infiltrate w/ macrophages and multinucleated giant cells. Endocrine, Diabetes & Pathology (Path) 1
Metabolism (ES) ES Path
769 Hypothyroidism Chronic lymphocytic (Hashimoto) thyroiditis is the most common cause of hypothyroidism. Histopath char shows an intense lymphocytic infiltrate, often w/ germinal centres. Residual follicles may be Endocrine, Diabetes & Pathology (Path) 13
surrounded by Hürthle cells (large oxyphilic cells filled w/ granular cytoplasm). Metabolism (ES) ES Path
770 Hypothyroidism TPO catalyzes the ox of I- to iodine, the iodination of TG tyrosine residues, and the iodotyrosine coupling rxn that forms T3 and T4. Abs against TPO are present in >90% of pts w/ CLT (Hashimoto). Endocrine, Diabetes & Physiology 13
771 Pheochromocytoma Neural crests are embryological structures composed of parallel strips of cells arising from the ectoderm at the margin of the neural tube. Structures derived from neural crest cells include Schwann cells, Endocrine, Diabetes & Embryology 4
odontoblasts, melanocytes, enterochromaffin cells, spinal membranes, adrenal medulla/ganglia, laryngeal cartilage, and tracheal cartilage. Metabolism (ES) (Embr) ES Embr
772 Hypothyroidism An ↑ in oestrogen activity, as seen in preg or postmenopausal ORT, ↑ the lvl of TBG. This leads to an ↑ in total TH lvls, but feedback control maintains normal lvls of free (biologically active) TH. Endocrine, Diabetes & Pharmacology 13
773 Serotonin syndrome Co-admin of SSRIs and MAOIs can produce excessive synaptic 5-HT lvls 2° to ↓ reuptake and ↓ degradation of 5-HT, potentially causing SS. To avoid this risk, a 2-wk washout period after discontinuing Pregnancy, Childbirth & Pharmacology 2
a MAOI and before initiating SSRI therapy is req to allow sufficient time for MAO regen. Puerperium (PR) (Phar) PR Phar
774 Opioids Buprenorphine is a partial opioid receptor agonist that binds w/ high affinity but has low intrinsic activity. In pts on long-term opioid therapy, buprenorphine can displace other opioids and precipitate Pregnancy, Childbirth & Pharmacology 13
withdrawal. Puerperium (PR) (Phar) PR Phar
775 Opioids β-endorphin is 1 endogenous opioid peptide that is derived from POMC. POMC is a polypeptide precursor that goes thru enzymatic cleavage and modification to produce not only β-endorphins, but also Nervous (NS) Physiology 13
ACTH and MSH. The fact that β-endorphin and ACTH are derived from the same precursor suggests that there may be a close physiological relationship b/w the stress axis and the opioid system. (Phys) NS Phys
776 Opioids Opiate analgesics ↓ pain by binding to μ receptors and inhib synaptic activity in the CNS. Activation of presynaptic μ receptors on the 1° afferent neuron leads to closure of v-gated Ca2+ channels and ↓ Nervous (NS) Pharmacology 13
excitatory NT release. Binding to μ receptors on the postsynaptic membrane causes opening of K+ channels and membrane hyperpol. (Phar) NS Phar
778 Drug induced myopathy The 1° side effects of statins include myopathy and hepatitis. Fibrates such as gemfibrozil can impair hepatic clearance of statins, ↑ the risk of severe myopathy. Cardiovascular (CV) Pharmacology 3
(Phar) CV Phar
780 Drug induced liver injury Common AEs of HMG-CoA reductase inhibs (statins) include muscle and liver tox. Hepatic transaminases should be checked prior to initiating therapy and repeated if SSx of hepatic injury occur. Cardiovascular (CV) Pharmacology 2
(Phar) CV Phar
781 Dyslipidemia Although low HDL concentration is a/w ↑ CV risk, the use of Rx to ↑ HDL lvls does not improve CV outcomes. HMG-CoA reductase inhibitors (statins) ↓ total cholesterol and LDL lvls. Statins are the Cardiovascular (CV) Pharmacology 11
most effective lipid-↓ing Rx for 1° and 2° prevention of CV events, regardless of baseline lipid lvls. (Phar) CV Phar
782 Dyslipidemia Familial chylomicronaemia syndrome (HLP-I) freq presents in childhood w/ recurrent episodes of acute pancreatitis. Pts w/ this disorder aren't usually at ↑ risk for premature CAD. Eruptive skin Endocrine, Diabetes & Pathology (Path) 11
xanthomas may be present in hypertriglyceridaemia, but tendon xanthomas and xanthelasmas are 1arily seen w/ hypercholesterolaemia. Metabolism (ES) ES Path
784 Patient confidentiality Under the HIPAA, physicians may disclose pt information to friends and family members in emergency situations or when the pt is otherwise incapacitated, depending on what is in the best interest of the Social Sciences (SS) Behavioral 5
pt. Otherwise, pt information may be disclosed only when the pt gives explicit permission or does not object when given a reasonable opportunity. Science (Beha) SS Beha
787 Iron deficiency anemia Hepcidin is a polypeptide synthesized by the liver that acts as the central regulator of iron homeostasis. High iron levels and inflammatory conditions increase the synthesis of hepcidin; hypoxia and Hematology & Oncology (HO) Physiology 7
increased erythropoiesis act to lower hepcidin levels. Low hepcidin levels increase intestinal iron absorption and stimulate iron release by macrophages. (Phys) HO Phys
788 Homocysteine ↑ lvls of plasma homocysteine are an independent RFx for thrombotic events. Homocysteine can be metabolized to methionine via remethylation or to cystathionine via transsulfuration. Cardiovascular (CV) Biochemistry 2
Hyperhomocysteinemia is most commonly due to genetic mutations in critical enzymes or deficiencies of vitamin B12, vitamin B6, and folate. (Bioc) CV Bioc
789 Hematopoietic drugs Vits B12 and B9 defic cause similar heme pictures. However, neuro dysfxn is only seen in pts w/ vitB12 defic. If megaloblastic anaemia due to vitB12 defic is mistakenly Tx w/ vitB9 alone, the neuro Hematology & Oncology (HO) Pathology (Path) 1
dysfxn can worsen. HO Path
790 Colorectal cancer Regulation of the Ras-MAPK signal transduction pathway requires a balance b/w active (GTP-bound) and inactive (GDP-bound) Ras proteins. RAS gene muts, which result in constitutively activated Ras Gastrointestinal & Nutrition (GI) Biochemistry 15
proteins, are implicated in the development of malignant tumors. (Bioc) GI Bioc
791 Gestational trophoblastic disease - A complete mole is composed of multiple cystic edematous hydropic villi as a result of trophoblast proliferation. Serial measurements of B-hCG should be performed following evacuation of a Pregnancy, Childbirth & Pathophysiology 1
complete mole hydatidiform mole. Persistently elevated or rising levels may signify the development of an invasive mole or choriocarcinoma. Puerperium (PR) (Patp) PR Patp
792 Gestational trophoblastic disease A partial mole will have a triploid karyotype (eg, 69,XXX or XXY) and contain fetal tissue w/ some edematous villi w/ focal trophoblastic proliferation, and normal-appearing villi. Pts Px w/ vaginal Pregnancy, Childbirth & Pathophysiology 3
bleeding, and prior miscarriage is a RFx. Puerperium (PR) (Patp) PR Patp
793 Congenital adrenal hyperplasia The most common form of CAH is 21-hydroxylase defic. Genetically female infants typically have ambiguous genitalia (virilisation) at birth, whereas males have phenotypically normal genitalia, w/ salt- Endocrine, Diabetes & Pathophysiology 6
wasting or precocious puberty appearing later. ↑ 17-hydroxyprogesterone is Dx. Metabolism (ES) (Patp) ES Patp
794 Alzheimer disease The hippocampus is the area of the brain demonstrating the greatest degree of atrophy in AD. Hippocampal atrophy on MRI is highly suggestive of the Dx. Nervous (NS) Pathology (Path) 7 NS Path
795 Sarcoidosis Sarcoidosis often presents in young AA women w/ the insidious onset of resp SSx (e.g. cough, dyspnoea, chest pain) accompanied by fatigue, fever, and weight loss. The char histopath feature is NCGs, Pulmonary & Critical Care (PU) Pathology (Path) 7
which consist of aggregates of epithelioid macrophages and multinucleated giant cells. PU Path
796 Sarcoidosis Sarcoidosis is a CD4+ T-cell mediated disease, in which large # of CD4+ lymphocytes release IFN-γ and TNF-α to drive macrophage activation and granuloma formation. BAL fluid in pulm sarcoidosis Pulmonary & Critical Care (PU) Pathology (Path) 7
demonstrates a lymphocytic predominance w/ a high CD4+/CD8+ ratio. PU Path
797 Sarcoidosis Sarcoidosis is characterized by noncaseating granulomas due to dysregulated cell-mediated immunity. Activated antigen-presenting cells produce IL-12, which stimulates the differentiation of Th1-type Pulmonary & Critical Care (PU) Immunology 7
CD4+ cells. Th1 cells produce IL-2 and interferon-y, which stimulate Th1 cell proliferation and macrophage activation, respectively. (Immu) PU Immu
798 Sarcoidosis Sarcoidosis is a systemic inflammatory disorder characterised by NCGs in a variety of tissues. Most pts develop liver involvement, which typically MFx as aSSx hepatomegaly w/ mild LFT abns. Liver Pulmonary & Critical Care (PU) Pathology (Path) 7
Bx freq demonstrates scattered NCGs. PU Path
799 Neonatal respiratory distress Use of concentrated O2 therapy for NRDS may be complicated by retinopathy of prematurity. This abn retinal neovascularisation is a major cause of blindness in developed nations. Pulmonary & Critical Care (PU) Pathology (Path) 5
syndrome PU Path
800 Neonatal respiratory distress Dipalmitoyl phosphatidylcholine (lecithin, L) and phosphatidylglycerol are major constituents of surfactant. Fetal lung lecithin production increases sharply after 30 weeks gestation, and Pulmonary & Critical Care (PU) Embryology 5
syndrome phosphatidylglycerol production increases at 36 weeks gestation. The amniotic fluid sphingomyelin (S) level should remain approximately constant during the third trimester. An L/S ratio > 2.0 indicates (Embr)
adequate surfactant production to avoid neonatal hyaline membrane disease. PU Embr
802 Cystic fibrosis Cystic fibrosis (CF) is most commonly due to a 3-base pair deletion in the CF transmembrane conductance regulator (CFTR) gene at amino acid position 508 (ΔF508). This mutation impairs post Pulmonary & Critical Care (PU) Genetics (Gene) 11
translational processing of CFTR, resulting in shunting of CFTR toward the proteasome, with complete absence of the protein on the cell surface. Elevated sweat chloride concentrations are found in most
patients with CF. PU Gene
803 Cystic fibrosis Meconium ileus is a distal SBO due to abnly dehydrated meconium in a pt w/ CF. Persistent, Tx-resistant infectious pneumonias, bronchiectasis, and cor pulmonale account for most deaths due to CF. Pulmonary & Critical Care (PU) Pathology (Path) 11 PU Path
804 Cystic fibrosis In CF, impairment of the CFTR protein ↓ Cl- secretion and ↑ Na+ absorption by the resp epithelia, resulting in dehydrated mucus. When saline is applied to the nasal mucosa, the ↑ Na+ absorption in pts Pulmonary & Critical Care (PU) Pathophysiology 11
w/ CF causes a more (-) nasal transepithelial potential diff, which can be used to Dx CF. (Patp) PU Patp
805 Cystic fibrosis ΔF508 is the most common mutation in the CFTR protein in pts w/ CF. This mutation leads to protein misfolding and failure of glycosylation, f/b proteasome-mediated degradation and significantly ↓ Pulmonary & Critical Care (PU) Genetics (Gene) 11
number of transmembrane CFTR proteins. PU Gene
806 Cystic fibrosis Recurrent sinopulm infections and exocrine gland atrophy in a young Caucasian are suggestive of CF. CF can lead to pancreatic insufficiency, fat malabsorption, and a defic of vits A, D, E, and K. VitA Pulmonary & Critical Care (PU) Pathology (Path) 11
maintains orderly diff of specialised epithelia, incl the mucus-secreting columnar epithelia of the ocular conjunctiva, resp and urinary tracts, and pancreatic and other exocrine ducts. Avitaminosis A can
cause squamous metaplasia of such epithelia to a keratinising epithelium. PU Path
807 Cystic fibrosis CFTR gene mutations are the most common cause of congenital bilateral absence of the vas deferens (CBAVD). Patients with CBAVD have azoospermia and infertility but normal levels of FSH, LH, and Male Reproductive (MR) Genetics (Gene) 11
testosterone. Elevated sweat chloride levels are diagnostic of cystic fibrosis. MR Gene
808 Cystic fibrosis In a young Caucasian pt, the combo of recurrent resp infecs w/ P. aeruginosa, diarrhea, and FTT suggests a Dx of CF. CF causes steatorrhea and FTT due to malabs 2° to PI, which can be corrected by Gastrointestinal & Nutrition (GI) Pharmacology 11
pancr enzyme supp. (Phar) GI Phar
809 Renal infarction Renal infarction presents w/ flank pain, hematuria, ↑ LDH, and a wedge-shaped kidney lesion on CT scan. The most common cause of renal infarction is systemic TE, often due to thrombus formation Cardiovascular (CV) Pathology (Path) 2
during AF. The brain and kidneys are more likely than other organs to suffer embolic infarctions b/c they are perfused at a higher rate. CV Path
810 Atheroembolism Invasive vascular procedures can be complicated by atheroembolic disease, which may involve the kidneys, GIT, CNS, and the skin. LM show a partially or completely obstructed arterial lumen w/ Renal, Urinary & Electrolytes Pathology (Path) 2
needle-shaped chol clefts w/i the atheromatous embolus. (RE) RE Path
811 Benign prostatic hyperplasia Benign prostatic hyperplasia leads to progressive bladder outlet obstruction. Over time, increased urinary pressures can cause hydronephrosis and renal parenchymal atrophy with scarring. This can Renal, Urinary & Electrolytes Pathology (Path) 6
progress to chronic kidney disease. (RE) RE Path
813 Renal calculi Hypercalciuria is the most common RFx for Ca (Ca oxalate and Ca PO4) kidney stones in adults; contributing factors may include ↑ GI absorption, ↑ mobilization of Ca from bone, or ↓ renal tubular Ca Renal, Urinary & Electrolytes Pathophysiology 7
reabsorption. However, most pts remain normocalcemic due to regulation of plasma Ca levels by vitamin D and PTH. (RE) (Patp) RE Patp
814 Cystinuria Cystinuria results from defective dibasic AA transport in intestinal and PCT epithelial cells. It most often presents w/ recurrent stone formation at a young age due to ↓ reabsorption of cysteine from the Renal, Urinary & Electrolytes Pathology (Path) 2
urine. UA shows pathognomonic hexagonal cystine crystals, and the Na+ cyanide-nitroprusside test can be used to detect excess cystine in the urine. (RE) RE Path
815 Cystinuria Cystinuria is an autosomal recessive disorder caused by defective transportation of cystine, ornithine, arginine, and lysine across the intestinal and renal tubular epithelium. Recurrent nephrolithiasis is the Renal, Urinary & Electrolytes Pathophysiology 2
only clinical manifestation. Urinalysis shows pathognomonic hexagonal cystine crystals. (RE) (Patp) RE Patp
816 Renal calculi Urine supersaturation is the main mech underlying all types of renal stones. Low fluid intake ↑ the conc of stone-forming agents, thereby promoting stone formation. All pts w/ nephrolithiasis should be Renal, Urinary & Electrolytes Pathology (Path) 7
advised to maintain adequate fluid intake. (RE) RE Path
817 Renal calculi Renal calculi occur due to an imbalance of factors that facilitate or inhib stone formation. ↑ urinary concs of Ca2+, oxalate, and uric acid promote salt crystallisation, whereas ↑ urinary citrate conc and Renal, Urinary & Electrolytes Pathology (Path) 7
high fluid intake prevent calculi formation. (RE) RE Path
818 Renal cell carcinoma CCC is the most common subtype of RCC and is composed of large, rounded, or polygonal cells w/ clear cytoplasm. These tumours are often detected incidentally at an advanced stage; the lung is the Renal, Urinary & Electrolytes Pathology (Path) 8
most common site for mets, f/b osteolytic bone and liver. (RE) RE Path
819 Antiretroviral therapy PIs are HIV ARV Rx that inhib cleavage of the polypeptide precursor into mature viral proteins. Their AEs as a class incl. hyperglycaemia, lipodystrophy, and drug-drug interactions due to inhib of Infectious Diseases (ID) Pharmacology 7
CYP450. (Phar) ID Phar
820 Bronchiectasis Digital clubbing is often a/w prolonged hypoxia. It can be found in pts w/ large-cell lung ca, TB, CF, and suppurative lung diseases such as empyema, bronchiectasis, and chronic lung abscesses. Pulmonary & Critical Care (PU) Pathology (Path) 2 PU Path
821 Brown adipose tissue BAT is found in newborns and in hibernating mammals. BACs contain several intracytoplasmic fat droplets and many more mitochondria than WACs. They fxn to prod heat by uncoupling ox phos w/ the Endocrine, Diabetes & Physiology 1
protein thermogenin. Metabolism (ES) (Phys) ES Phys
823 Myocardial infarction Fibrinolytic Thx for acute STEMI is a reasonable reperfusion technique for pts w/ no c/i to thrombolysis. Fibrinolytic agents such as alteplase bind to fibrin in the thrombus (clot) and activate plasmin, Cardiovascular (CV) Pharmacology 18
which leads to thrombolysis. The most common AEx of thrombolysis is hemorrhage (eg, GI, intracerebral). (Phar) CV Phar
824 Muscle structure & physiology Transverse tubules (T-tubules) are invaginations of the sarcolemma that transmit depolarization signals to the sarcoplasmic reticulum to trigger the release of calcium and induce muscle contraction. The Rheumatology, Orthopedics & Physiology 8
uniform distribution of T-tubules in striated muscle fibers ensures that each myofibril contracts at the same time, which is necessary for efficient contraction. Sports (RH) (Phys) RH Phys
825 Systemic sclerosis PAH is a common complication of systemic sclerosis, likely resulting from proliferation of T cells w/ release of cytokines (e.g. TGF-β) and conseq progr thickening and occlusion of the small and Pulmonary & Critical Care (PU) Pathology (Path) 3
medium-sized pulm arteries/arterioles. Pts typically have progr dyspnoea and a loud pulm component of S2 and may develop SSx of right-sided HF (e.g. hepatomegaly, peri oedema). PU Path
826 Cherry angioma Cherry hemangiomas are small, red, cutaneous papules common in aging adults. They don't regress spontaneously and typically ↑ in # w/ age. LM of these lesions shows proliferation of caps and post-cap Dermatology (DE) Pathology (Path) 1
venules in the papillary dermis. DE Path
827 Hemangioma Superficial infantile hemangiomas (i.e. strawberry/cap hemangiomas) are benign vascular tumours of childhood. They appear during the 1st wks of life, initially grow rapidly, and typically regress by the Dermatology (DE) Pathology (Path) 6
time the child is 5-9yrs old. These tumours are composed of blood-filled caps separated by CT. DE Path
828 Achalasia Achalasia is caused by ↓ # of inhib ganglion cells in the oesophageal wall. Oesophageal manometry in achalasia shows ↓ amplitude of peristalsis in the mid oesophagus, w/ ↑ tone and incomplete Gastrointestinal & Nutrition (GI) Pathophysiology 3
relaxation at the LOS. (Patp) GI Patp
829 Traumatic hemolytic anemia Schistocytes (helmet cells) are fragmented erythrocytes. They occur 2° to mech trauma from MAHAs or prosthetic cardiac valves. Intravascular hemolytic anaemias are characterised by ↓ serum Hematology & Oncology (HO) Pathology (Path) 2
haptoglobin lvls as well as ↑ LDH and bilirubin. HO Path
831 Urinary tract infection Suppression of endogenous flora, colonization of the distal urethra by pathogenic gram-negative rods, and attachment of these pathogens to the bladder mucosa are the stages of pathogenesis in lower Renal, Urinary & Electrolytes Pathophysiology 12
urinary tract infections. Anatomic or functional vesicoureteral reflux is almost always necessary for the development of acute pyelonephritis. (RE) (Patp) RE Patp
832 Renal artery stenosis Marked unilateral kidney atrophy is suggestive of renal artery stenosis. It occurs in elderly individuals due to atherosclerotic narrowing of the renal artery and is often seen in association with other Renal, Urinary & Electrolytes Pathology (Path) 9
atherosclerotic risk factors or diseases (eg, chronic mesenteric ischemia, coronary artery disease, peripheral vascular disease). Hypertension and abdominal and flank bruits are often present. (RE) RE Path
833 Vesicoureteral reflux VUR is caused by retrograde urine flow from the bladder into the ureter. The hydrostatic pressure of refluxing urine along w/ infections due to ascending bacteria causes inflammation. The compound Renal, Urinary & Electrolytes Pathology (Path) 1
papillae in the upper and lower poles of the kidney are most susceptible to reflux-induced dmg, which appears as dilated calyces w/ overlying renal cortical scarring. (RE) RE Path
834 Renal papillary necrosis RPN classically presents w/ gross hematuria, acute flank pain, and passage of tissue fragments in urine. It's most commonly seen in pts w/ SCD or trait, DM, analgesic nephropathy, or severe OPN. Renal, Urinary & Electrolytes Pathology (Path) 1
(RE) RE Path
835 Acute interstitial nephritis Fever, maculopapular rash, and ARF occurring 1-3wks after beginning a new Rx (e.g. Abx, PPIs) is highly suggestive of AIN. peri eosinophilia, sterile pyuria, eosinophiluria, and WBC casts may also be Renal, Urinary & Electrolytes Pathology (Path) 2
seen. Histo reveals leucocyte infiltration and oedema of the renal interstitium. (RE) RE Path
836 Tinea Terbinafine is used for treatment of dermatophytosis. It inhibits synthesis of fungal membrane ergosterol by suppressing the enzyme squalene epoxidase. Dermatology (DE) Pharmacology 4
(Phar) DE Phar
837 Urinary tract obstruction Inadequate canalization of the ureteropelvic junction, the connection site between the kidney and the ureter, is the most common cause of unilateral fetal hydronephrosis. Renal, Urinary & Electrolytes Embryology 4
(RE) (Embr) RE Embr
838 Retroperitoneal hematoma Retroperitoneal hematoma is a common complication of abdo and pelvic trauma. The pancreas is a retroperitoneal organ, and pancreatic injury is freq a source of retroperitoneal bleeding. Gastrointestinal & Nutrition (GI) Anatomy (Anat) 1 GI Anat
839 Urethral injury Injury to the posterior urethra is associated with pelvic fractures, and the anterior urethra is most commonly damaged in straddle injuries. Inability to void with a full bladder sensation, a high-riding boggy Male Reproductive (MR) Anatomy (Anat) 1
prostate, and blood at the urethral meatus are suggestive of urethral injury, particularly in the presence of a pelvic fracture. If urethral injury is suspected, placement of a Foley catheter is contraindicated. MR Anat
840 Huntington disease Hypo-acetylated histones bind tightly to DNA and prevent transcription of genes in their associated regions. Alteration of gene expression in HD occurs in part due to deacetylation of histones. This Nervous (NS) Genetics (Gene) 5
prevents the transcription of certain genes that code for neurotrophic factors, contributing to neuronal cell death. NS Gene
841 Arsenic poisoning Acute arsenic poisoning impairs cellular resp and Px w/ abdominal pain, vomiting, diarrhea, hypotension, and a garlic odor on the breath. Insecticides and contaminated water are common sources of Poisoning & Environmental Pharmacology 1
arsenic. Dimercaprol is the chelating agent of choice. Exposure (PO) (Phar) PO Phar
843 Chronic heart failure ↓ CO in HF triggers neuroendo compensatory mechanisms to maintain organ perfusion; however, the compensatory mechanisms are maladaptive over the long term. ↑ sympathetic output and activation of Cardiovascular (CV) Pathophysiology 12
the RAAS stimulate vasoconstriction and volume retention, compounding the hemodynamic stress on an already failing heart and creating a vicious cycle of decompensation. (Patp) CV Patp
844 Thoracentesis Thoracentesis should be performed below the 6th rib in the midclavicular line, the 8th rib along the midaxillary line, or the 10th rib along the paravertebral line in order to minimize the risk of lung injury. Pulmonary & Critical Care (PU) Anatomy (Anat) 2
Insertion of a needle lower than 9th rib increases the risk of penetrating abdominal structures. The needle should also be inserted along the upper border of the rib to prevent injury to the intercostal
vessels. PU Anat
846 Diabetes mellitus In hyperglycemic states, aldose reductase converts Glc to sorbitol at a rate faster than sorbitol can be metabolized. Sorbitol accumulates in certain cells such as lens cells, causing an influx of water and Endocrine, Diabetes & Biochemistry 31
resulting in osmotic cellular injury. Depletion of NADPH by aldose reductase also ↑ oxidative stress, which accelerates development of cataracts and diabetic microvascular complications (e.g. Metabolism (ES) (Bioc)
neuropathy, retinopathy). ES Bioc
847 Diabetes mellitus GLUT-4 is an insulin-sensitive Glc transporter expressed in skeletal muscle cells and adipocytes that translocates to the plasma membrane in response to ↑ insulin lvls. Endocrine, Diabetes & Biochemistry 31
848 Diabetes mellitus Pancreatic islet amyloid deposition is char of DM-2. A strong linkage w/ HLA-II gene makeup, pancreatic islet infiltration w/ leucocytes (insulitis), and Abs against islet Ags are freq seen in DM-1. Endocrine, Diabetes & Pathology (Path) 31
849 Hypoglycemia Glucagon ↑ serum Glc by ↑ hepatic glycogenolysis and GNG. Glucagon also stims insulin secretion from the pancreas. Unlike EPI, glucagon has an insignificant effect on Glc homeostasis in the skeletal Endocrine, Diabetes & Pathophysiology 6
muscle, adipose tissue, and RC. Metabolism (ES) (Patp) ES Patp
850 Diabetes mellitus Long-acting insulin analogues (e.g. degludec, detemir, glargine) have an extended duration of action w/o a noticeable peak in activity and are typically given once daily to mimic basal insulin secretion. Endocrine, Diabetes & Pharmacology 31
Rapid-acting insulins (e.g. aspart, lispro, glulisine) are quickly absorbed from the injection site and are given at mealtimes to replicate postprandial insulin secretion. Metabolism (ES) (Phar) ES Phar
851 Anesthesia The MAC is a measure of potency of an inhaled anaesthetic. It's the conc of the anaesthetic in the alveoli that renders 50% of pts unresponsive to painful stimuli (ED50). Potency is inversely proportional Nervous (NS) Pharmacology 9
to the MAC: the lower the MAC, the more potent the anaesthetic. (Phar) NS Phar
852 Anesthesia Following intravenous administration, a highly lipophilic drug will be rapidly distributed to organs with high blood flow (eg, brain, liver, kidneys, lungs). The drug is then redistributed to tissues with General Principles (GP) Pharmacology 9
relatively lower blood flow (eg, skeletal muscle, fat, bone). This accounts for the short duration of action of many commonly used anesthetics, such as propofol. (Phar) GP Phar
853 Drug induced liver injury Halogenated inhaled anaesthetics (e.g. halothane, enflurane, isoflurane, sevoflurane, desflurane) are meta by the hepatic CYP450 system by which they're converted to reactive intermediates that can cause Nervous (NS) Pharmacology 2
hepatocellular dmg (halothane hepatitis). Pts often present w/ acute hepatitis days after Rx exposure, and liver Bx may show centrilobular hepatic necrosis. (Phar) NS Phar
854 Anesthesia Almost all volatile anaesthetics ↑ cerebral blood flow. It's an undesirable effect as it results in ↑ ICP. Other important effects of inhalation anaesthetics are myocardial depression, hypotension, resp Nervous (NS) Pharmacology 9
depression, and ↓ renal fxn. (Phar) NS Phar
855 Malignant hyperthermia Malignant hyperthermia occurs after admin of inhalation anaesthetics a/o SCh to genetically susceptible individuals. It's Tx w/ dantrolene that blocks RyR and prevents release of Ca2+ into the cytoplasm Nervous (NS) Pharmacology 1
of skeletal muscle fibres. (Phar) NS Phar
856 Anesthesia Propofol and other highly lipophilic drugs readily diffuse across membranes, quickly accumulating in tissues receiving high blood flow; this accounts for their rapid onset of action. These compounds are Nervous (NS) Pharmacology 9
subseq redistributed to organs receiving less blood flow, which explains their short duration of action. (Phar) NS Phar
858 Gout Colchicine is used for treatment of acute gouty arthritis in patients who cannot take nonsteroidal anti inflammatory drugs. It inhibits leukocyte migration and phagocytosis by blocking tubulin Rheumatology, Orthopedics & Pharmacology 11
polymerization. Significant side effects of colchicine include nausea and diarrhea. Sports (RH) (Phar) RH Phar
859 Gout Colchicine inhibits tubulin polymerization into microtubules and can be used for acute treatment and prophylaxis of gout. Important side effects of colchicine include nausea, abdominal pain, and diarrhea. Rheumatology, Orthopedics & Pharmacology 11
860 Gout Nonsteroidal anti-inflammatory drugs are the first-line treatment for acute gouty arthritis. They inhibit cyclooxygenase and therefore decrease prostaglandin synthesis and exert a broad anti-inflammatory Rheumatology, Orthopedics & Pharmacology 11
effect that includes inhibition of neutrophils. Sports (RH) (Phar) RH Phar
861 Gout Chronic uric acid-lowering therapy is recommended for patients with gout who have frequent gouty attacks, uric acid kidney stones, tophi, or chronic joint destruction from gout. Xanthine oxidase Rheumatology, Orthopedics & Pharmacology 11
inhibitors are the preferred treatment. Sports (RH) (Phar) RH Phar
862 Aging Presbyopia and skin wrinkles are age-related changes. Presbyopia occurs due to denaturation of structural proteins within the lens, leading to loss of lens elasticity which can result in improved vision in Miscellaneous (Multisystem) Pathology (Path) 8
patients with mild myopia. Decreased synthesis and increased breakdown of collagen and elastin contribute to the development of skin wrinkles. (MS) MS Path
863 Retinoblastoma Familial retinoblastoma occurs as a result of mutations of each of the two Rb genes ("two hits"). These patients have an increased risk of secondary tumors, especially osteosarcomas, later in life. Ophthalmology (OP) Pathology (Path) 1 OP Path
865 Constipation PEG is an osmotic laxative. Diarrhea a/w lactase defic is also osmotic and occurs due to accum of nonabs lactose in the intestinal lumen. MgOH (and other Mg-containing compounds, such as Mg citrate) Gastrointestinal & Nutrition (GI) Pharmacology 3
is another osmotic laxative that’s often used, although its efficacy is Q-able and there’s not enough evidence to support its widespread use. (Phar) GI Phar
866 Febrile seizure Febrile seizures are the most common neuro disorder affecting children and are benign sequelae of fever. Children who experience a febrile seizure are at risk for recurrence but have a low risk of Nervous (NS) Pharmacology 1
developing epilepsy. Supportive care (eg, antipyretics) can improve pt comfort during fever but does not prevent future seizures. (Phar) NS Phar
867 Fibromyalgia Fibromyalgia occurs most commonly in women age 20-55 and presents with diffuse musculoskeletal pain, fatigue, and neuropsychiatric disturbances. It is characterized by abnormal central processing of Rheumatology, Orthopedics & Pathophysiology 1
painful stimuli. Although initially painful, aerobic exercise helps to improve pain and functioning in these patients. Sports (RH) (Patp) RH Patp
868 Fetal hemoglobin HbF is the predominant Hb type in the 2nd and 3rd trims of preg and during the 1st few mos after birth. HbF consists of 2 alpha and 2 gamma protein subunits (a2g2) and has a high affinity for O2, which Hematology & Oncology (HO) Biochemistry 1
facilitates O2 transport across the placenta to the fetus. HbA (a2b2) is the major Hb in adults. (Bioc) HO Bioc
869 Cervical cancer Consistent use of barrier contraceptives is extremely important for preventing STIs, including HPV. Pts infected w/ carcinogenic strains of HPV (ie, 16, 18, and 31) are at risk of SCC of the cervix. Female Reproductive & Breast Pathophysiology 3
(FR) (Patp) FR Patp
870 Alcohol withdrawal Tremulousness is typically 1 of the earliest SSx of alcohol withdrawal. Other common SSx incl GI distress, agitation, anxiety, and autonomic disturbance. DT is the most severe MFx of alcohol Pregnancy, Childbirth & Behavioral 2
withdrawal and typically begins 48-96hrs after the last drink. Puerperium (PR) Science (Beha) PR Beha
871 Necrosis Liquefactive necrosis is characterised by complete digestion and removal of necrotic tissue w/ formation of a cystic cavity. Irreversible ischemic CNS injury is typically f/b liquefactive necrosis due to the Nervous (NS) Pathology (Path) 3
release of lysosomal enzymes from inflammatory cells and dmgd neurons. NS Path
872 Multiple myeloma Amyloid light-chain amyloidosis is a/w MM and other monoclonal plasma cell dyscrasias due to the deposition of insoluble Ig light-chain fibrils in major organs (e.g. kidneys, heart, neuro system). A Hematology & Oncology (HO) Pathology (Path) 9
bone marrow sample w/ >10% plasma cells is strongly suggestive of MM. HO Path
873 Alcohol use disorder Folic acid deficiency anemia commonly occurs in Alcism. It is a megaloblastic anemia that can develop w/i wks. PBS shows macrocytosis, ovalocytosis, and neutrophils w/ hypersegmented nuclei. Hematology & Oncology (HO) Pathology (Path) 3 HO Path
874 Keloid Keloids result from excessive collagen formation during the remodeling phase of wound healing. They present as raised, painful, and pruritic nodules that grow beyond the wound borders. Dermatology (DE) Pathophysiology 2
(Patp) DE Patp
875 SLE SLE is an autoimmune disorder that occurs most commonly in women. heme abns are common; auto-Abs against blood cell Ags (i.e. HS-II) can cause pancytopaenia (i.e. anaemia, thrombocytopaenia, Hematology & Oncology (HO) Pathology (Path) 7
leucopoenia). In contrast, lupus nephritis is caused by IC deposition (i.e. HS-III) in the glomeruli. HO Path
876 Atopic dermatitis AD (eczema) is a common, chronic inflammatory disorder caused by impairment of the skin's barrier fxn. Eczema presents w/ pruritus and erythematous papules and plaques and is a/w other atopic Dermatology (DE) Pathology (Path) 2
diseases, such as allergic rhinitis and asthma. DE Path
877 Sarcoidosis Sarcoidosis commonly presents w/ hilar adenopathy, pulm infiltrates, and skin (e.g. erythema nodosum) and ocular findings. Biopsy shows NCGs composed of epithelioid cells (activated macrophages) Pulmonary & Critical Care (PU) Pathology (Path) 7
and giant multinucleated cells. Oral glucocorticoids are the Tx of choice for significant disease. PU Path
878 Chronic venous insufficiency Chronically ↑ venous pressure in the ↓ extremities can lead to incompetent venous valves and venous dilation (varicose veins). Venous congestion and tissue ischemia can result in venous stasis Cardiovascular (CV) Pathology (Path) 3
dermatitis. CV Path
879 Contraception All hormone-containing contraceptives prevent pregnancy through the actions of progestins. The main mechanism of contraceptives with systemically active progestins (eg, combined hormonal oral Female Reproductive & Breast Pharmacology 3
contraceptives) is inhibiting ovulation by decreasing FSH and LH synthesis in the anterior pituitary. (FR) (Phar) FR Phar
880 Brain tumors Synaptophysin is a protein found in presynaptic vesicles of neurons, neuroendocrine, neuroectodermal cells. CNS tumours of neuronal origin freq stain (+) for synaptophysin on IHC. Neoplasms of glial Nervous (NS) Pathology (Path) 10
origin (astrocytomas, ependymomas, and oligodendrogliomas) stain for GFAP. NS Path
881 Reye syndrome Reye syndrome occurs in children w/ febrile illness Tx w/ salicylates (aspirin). It consists of hepatic failure and encephalopathy. The char histo finding is microvesicular steatosis of hepatocytes w/o Gastrointestinal & Nutrition (GI) Pathology (Path) 1
inflammation and cerebral oedema. GI Path
882 Down syndrome DS is most commonly caused by maternal meiotic nondisjxn, a process by which the fetus receives 3 full copies of chromosome 21. Dysmorphic features (eg, flat facial profile, protruding tongue, small Cardiovascular (CV) Genetics (Gene) 6
ears, upslanting palpebral fissures) and cardiac defects (eg, endocardial cushion defects) are Chx. CV Gene
883 Xeroderma pigmentosum Xeroderma pigmentosum develops due to a defect in nucleotide excision repair. This disease is characterized by increased sensitivity to ultraviolet radiation and a high incidence of cutaneous malignancy. Dermatology (DE) Genetics (Gene) 2 DE Gene
884 Diabetic nephropathy NGS is characterised by GBM thickening, ↑ mesangial matrix deposition, and formation of Kimmelstiel-Wilson (KW) nodules. It's most common caused by diabetic nephropathy and indicates irreversible Renal, Urinary & Electrolytes Pathology (Path) 4
glomerular dmg w/ a rapid decline in kidney fxn. (RE) RE Path
885 Acute kidney injury ATN is caused by renal ischemia and is characterised by oliguria, ↑ serum creatinine, and muddy brown casts. Ischemic injury predominantly affects the renal medulla, which has a relatively low blood Renal, Urinary & Electrolytes Pathology (Path) 5
supply. The terminal (straight) portion of the proximal tubules and the thick ascending limb of the LOH are the most commonly involved portions of the nephron due to their high meta rate and location (RE)
w/i the medulla. RE Path
886 Acute kidney injury ATN is characterised by tubular injury due to renal ischemia or direct cytotoxicity. The course of the disease can be broken into 3 stages: initiation (initial insult), maintenance (oliguric renal failure), and Renal, Urinary & Electrolytes Pathology (Path) 5
recovery. During the recovery period, GFR improves prior to restoration of renal tubular resorptive capacity, so transient polyuria and electrolyte wasting (e.g. hypokalaemia) can occur. (RE) RE Path
887 Acute kidney injury Ethylene glycol ingestion causes ATN w/ vacuolar degen and ballooning of the PCT cells. Typical clinical findings incl AMS, ARF, high AGMA, ↑ osmolar gap, and Ca2+-oxalate crystals in the urine. Renal, Urinary & Electrolytes Pathology (Path) 5
(RE) RE Path
888 Urinary tract infection Pyuria and bacteriuria are found in both upper and lower UTIs. However, WBC casts only form in the renal tubules and are pathognomonic for acute pyelonephritis (APN) when accompanied by SSx of Renal, Urinary & Electrolytes Pathology (Path) 12
acute UTI. (RE) RE Path
889 Hereditary spherocytosis HS results from red cell cytoskeleton abns, most commonly spectrin and ankyrin. hemolytic anaemia, jaundice, and splenomegaly are classic MFxs. Spherocytes are seen on peri blood smear. Hematology & Oncology (HO) Pathology (Path) 3 HO Path
890 Hereditary spherocytosis In spherocytosis, MCHC is incr due to mild dehydration of the RBC. Markers of hemolysis are often evident and incl incr LDH, reticulocytosis, and decr haptoglobin. Hematology & Oncology (HO) Pathophysiology 3
(Patp) HO Patp
891 Hereditary spherocytosis HS results from red cell cytoskeleton abns, most commonly in the proteins spectrin and ankyrin. ↑ osmotic fragility on acidified glycerol lysis testing confirms the Dx. hemolytic anaemia, jaundice, and Hematology & Oncology (HO) Pathology (Path) 3
splenomegaly are classic MFxs. Complications incl pigmented gallstones and aplastic crises from PVB19 infection. HO Path
892 Sickle cell HU ↑ HbF synthesis by an unknown mech. HU is reserved for pts w/ freq pain crises. Gardos channel blockers hinder the efflux of K+ and water from the cell, preventing dehydration of erythrocytes and Hematology & Oncology (HO) Pharmacology 13
↓ the polymerisation of HbS. (Phar) HO Phar
893 G6PD deficiency hemolytic anaemia is a possible AE of dapsone and is most significant in pts defic for G6PD. G6PD defic anaemia is characterised by episodes of hemolytic anaemia precipitated by oxidative stress Hematology & Oncology (HO) Pathology (Path) 5
(drugs, infections). peri smear typically shows bite cells and Heinz bodies (req special prep). HO Path
894 G6PD anemia inheritance pattern G6PD defic has an XLR inheritance. HS follows an AD inheritance pattern. Hematology & Oncology (HO) Pathology (Path) 1 HO Path
895 Sickle cell Pts /w SCT are typically aSSx and have relative protection from malaria caused by P. falciparum. These pts usually have normal Hb, reticulocyte, and RBC index values. Life expectancy is the same as Hematology & Oncology (HO) Pathology (Path) 13
that of the gen pop. HO Path
896 Sickle cell Patients with sickle cell disease become functionally asplenic within the first few years of life due to repeated microinfarction of splenic vascular beds. This dramatically increases the risk for fulminant Hematology & Oncology (HO) Microbiology 13
infections with encapsulated bacterial organisms, particularly Streptococcus pneumoniae. Patients with sickle cell disease are also at increased risk for other bacterial infections, most notably salmonella (Micr)
osteomyelitis. HO Micr
897 Paroxysmal nocturnal The triad of HA, hypercoag, and pancytopenia suggests PNH. PNH results from an acq mut in the PIGA gene that causes absence of the GPI anchor and assoc defic of CD55 and CD59 complement inhib Hematology & Oncology (HO) Pathophysiology 2
hemoglobinuria proteins. (Patp) HO Patp
898 Antiarrhythmic drugs Adenosine causes hyperpolarization of the nodal PM to briefly block conduction through the AV node, and it is effective in the initial Tx of PSVT. Common AEx include flushing, chest burning (due to Cardiovascular (CV) Pharmacology 12
bronchospasm), hypotension, and high-grade AV block. (Phar) CV Phar
899 Antiarrhythmic drugs Amiodarone (and other class III and class IA antiarrhythmic agents) causes lengthening of the cardiac AP, which MFx as QT interval prolongation on ECG. QT prolongation caused by amiodarone, in Cardiovascular (CV) Pharmacology 12
contrast to other Rx, is a/w a very low risk of TdP. (Phar) CV Phar
900 Antiarrhythmic drugs Lidocaine is a class IB antiarrhythmic Rx that tends to bind to inactivated Na channels and rapidly dissociates. As a result, it is effective in suppressing ventricular tachyarrhythmias induced by rapidly Cardiovascular (CV) Pharmacology 12
depolarizing and ischemic myocardium. (Phar) CV Phar
901 Antiarrhythmic drugs Class III antiarrhythmic drugs (e.g. amiodarone, sotalol, dofetilide) predominantly block K+ channels and inhib the outward K+ currents during phase 3 of the cardiac AP, thereby prolonging repol and Cardiovascular (CV) Pharmacology 12
total AP duration. (Phar) CV Phar
902 Huntington disease HD is an AD neurodegen disease that leads to the accumulation of abn, toxic huntingtin protein in neural cells. Inhib GABAergic neurons in the caudate nuclei are most susceptible, and their loss is Nervous (NS) Pathology (Path) 5
responsible for the ChFx of HD (e.g. chorea, behavioural abns). NS Path
903 Pulmonary arterial hypertension Pulmonary arterial hypertension (PAH) typically affects young women and can be familial. It is characterized by luminal narrowing of the pulmonary arteries and arterioles, with medial hypertrophy, Pulmonary & Critical Care (PU) Pharmacology 8
intimal fibrosis, and the eventual development of plexiform lesions. Bosentan is a competitive antagonist of endothelin receptors used for the treatment of PAH. (Phar) PU Phar
904 Renal cell carcinoma Sporadic and hereditary (a/w vHL disease) RCCs are a/w mutations involving the VHL gene on chromosome 3p. The VHL gene is a tumor suppressor that inhibits hypoxia-inducible factors; mutations Renal, Urinary & Electrolytes Genetics (Gene) 8
lead to constitutive activation of these proteins, resulting in the activation of multiple angiogenic and tumorigenic growth factors (eg, VEG-F, PDG-F). (RE) RE Gene
905 Renal cell carcinoma CCC is the most common type of RCC and originates from the epithelial cells of the proximal renal tubules. Gross pathology typically demonstrates a sphere-like mass composed of golden-yellow cells Renal, Urinary & Electrolytes Pathology (Path) 8
(due to high lipid content) w/ areas of necrotic cells and focal hemorrhage. (RE) RE Path
906 Syphilis Tabes dorsalis, a later form of neurosyphilis, causes progr degen of the dorsal columns and dorsal roots of the spinal cord. MFxs incl loss of proprioception and vibratory sensation, severe lancinating Nervous (NS) Pathology (Path) 9
pains, and sensory ataxia (e.g. wide-based gait, (+) Romberg sign). Many pts also have Argyll Robertson pupils. NS Path
907 HSV infection HSV-1 encephalitis is a potentially fatal complication from 1ary infection or reactivation of latent disease. NS invasion leads to necrosis of the temp lobe, which can result in aphasia and personality Nervous (NS) Microbiology 9
changes in addn to classic features of encephalitis (e.g. h/a, fever, AMS, seizure). (Micr) NS Micr
908 HSV infection Viral infections of the CNS are usually characterised by ↑ protein, normal Glc, and an ↑ WBC count w/ a lymphocytic predominance. Pts w/ herpes encephalitis also usually have ↑ erythrocytes in the Nervous (NS) Pathology (Path) 9
CSF due to hemorrhagic inflammation of the temporal lobes. NS Path
910 Measles SSPE is a rare complication of measles infection that occurs several yrs after apparent recovery from initial infection. Oligoclonal bands of measles virus Abs are found in the CSF of these pts. Nervous (NS) Pathology (Path) 3 NS Path
911 Prion disease CJD is a prion disease characterised by rapidly progr dementia, myoclonus, and death w/i a yr of SSx onset. Histopath shows widespread neuronal loss w/ small, uniform vacuoles in the grey matter of the Nervous (NS) Pathology (Path) 3
brain (e.g. spongiform encephalopathy). NS Path
912 Prion disease Prion diseases are rapidly progr neurodegen disorders caused by the accumulation an abnly folded protein w/i the brain. Prion proteins are normally found in an α helix form; a conformation change into a Nervous (NS) Pathology (Path) 3
β-sheet form confers resistance to proteases and can trigger similar conformational changes in other normally folded proteins. Char micro findings incl spongiform degen of the grey matter w/
vacuolisation of neurons, gliosis, and cyst formation. NS Path
913 Giant cell arteritis Polymyalgia rheumatica occurs in more than 1/2 of pts w/ temporal arteritis. It's characterised by neck, torso, shoulder, and pelvic girdle pain and morning stiffness. Fatigue, fever, and weight loss may Nervous (NS) Pathology (Path) 5
also occur. Monocular vision loss is a common complication of temporal arteritis. NS Path
914 Giant cell arteritis ESR and CRP have very high sensitivity for GCA. Pts w/ suspected GCA who have an ↑ ESR or CRP lvl should be referred for temporal artery Bx to confirm the Dx. Rheumatology, Orthopedics & Pathology (Path) 5
Sports (RH) RH Path
915 Central pontine myelinolysis Rapid correction of chronic hyponatraemia may led to osmotic demyelination syndrome (i.e. central pontine myelinolysis). It typically MFx 2-6days after the osmotic insult w/ spastic quadriplegia, Nervous (NS) Pathology (Path) 2
pseudobulbar palsy, and locked-in syndrome. NS Path
916 Multiple sclerosis MS is Chx by episodic, progressive neuro deficits involving multiple anatomic regions w/i the CNS. Demyelinating plaques are commonly seen as hyperintense lesions on T2-weighted MRI of the brain Nervous (NS) Pathology (Path) 6
and spinal cord. Common MFx include optic neuritis, INO, sensory deficits, and fatigue, which may worsen w/ heat exposure. NS Path
917 Multiple sclerosis MS is an AI disorder of the CNS Chx by recurrent episodes of demyelination, leading to ↓ saltatory conduction. INO and optic neuritis are common MFx. Nervous (NS) Pathology (Path) 6 NS Path
918 Multiple sclerosis MS is an autoimmune demyelinating disease that results from oligodendrocyte depletion. W/i the lesions, inflammatory infiltrates of lymphocytes and macrophages are seen surrounding oligodendrocytes Nervous (NS) Pathology (Path) 6
and myelin sheaths. Oligoclonal bands are highly sensitive but nonspecific in pts w/ MS. NS Path
919 Multiple sclerosis MS is an immune-mediated disorder of the CNS characterised by focal demyelination (plaques). Histo, plaques contain foci of perivenular inflammatory infiltrates made up 1arily of autoreactive T Nervous (NS) Pathology (Path) 6
lymphocytes and macrophages. Patchy demyelination occurs f/b astrocyte hyperplasia (glial scarring). NS Path
920 Diabetes mellitus TZDs lower blood Glc by ↓ insulin resistance. TZDs activate PPAR-γ, a nuclear receptor that alters the transcription of genes involved in Glc and lipid meta. Endocrine, Diabetes & Pharmacology 31
921 Diabetes mellitus DM-1 typically presents sub-acutely w/ polyuria and polydipsia accompanied by fatigue and weight loss. The Dx can be confirmed w/ an FBG or HbA1c measurement. Endocrine, Diabetes & Pathophysiology 31
922 Gestational diabetes Maternal hyperglycaemia causes ↑ transplacental Glc delivery to the infant, foetal hyperglycaemia, and, ultimately, β cell hyperplasia. The resulting hyperinsulinaemia caused by islet cell hyperplasia is Endocrine, Diabetes & Pathophysiology 2
a/w foetal macrosomia and hypoglycaemia after delivery. Metabolism (ES) (Patp) ES Patp
924 Adrenal insufficiency Pts w/ DM-1 are at ↑ risk for other autoimmune endocrinopathies, incl PAI (Addison disease). Electrolyte abns in PAI incl hyponatraemia, hyperkalaemia, hyperchloraemia, and NAGMA. Endocrine, Diabetes & Pathophysiology 5
925 Amenorrhea FHA results from loss of pulsatile GnRH release from the hypothal and is caused by weight loss, strenuous exercise, systemic illness, or abn eating habits. Loss of cyclic Gn release leads to a ↓ in LH and Endocrine, Diabetes & Pathophysiology 2
FSH secretion from the pituitary, which in turn causes low circulating oestrogen lvls. Metabolism (ES) (Patp) ES Patp
926 Pheochromocytoma PCC is a tumour arising from the chromaffin cells of the AM characterised by excess production of catecholamines. CFx incl episodic HTN, diaphoresis, and palpitations. Micro Ex of the tumour cells Endocrine, Diabetes & Pathophysiology 4
shows electron-dense, membrane-bound secretory granules, and IHC is (+) for synaptophysin, chromogranin, and neuron-specific enolase. Metabolism (ES) (Patp) ES Patp
927 Cushing syndrome CS caused by a pit adenoma or ectopic (PNP) ACTH secretion is a/w ↑ ACTH lvls. High-dose dexamethasone suppresses ACTH and cortisol secretion when CS is caused by a pit adenoma (CD) but not Endocrine, Diabetes & Pathology (Path) 5
when it's caused by ectopic ACTH secretion (e.g. SCLC). Metabolism (ES) ES Path
928 Cushing syndrome Long-term use of supraphysiologic doses of GCs cause suppression of the HPA axis, which in turn leads to bilateral AC atrophy involving the ZF and ZR. Sudden cessation of the exogenous Endocrine, Diabetes & Pathophysiology 5
corticosteroids can precipitate adrenal crisis. Metabolism (ES) (Patp) ES Patp
929 Hyperaldosteronism 1° MC excess (hyperaldosteronism) causes ↑ renal Na+ reabsorption, leading to HTN, hypokalaemia, and meta alkalosis. PHA is freq caused by adrenal adenoma or bilateral hyperplasia. Endocrine, Diabetes & Pathophysiology 5
930 Congenital adrenal hyperplasia Pts w/ classic, salt-wasting 21-hydroxylase defic have defic cortisol and aldosterone synthesis combo w/ adrenal androgen overproduction. Male infants have normal genitalia and present 1-2wks after Endocrine, Diabetes & Pathophysiology 6
birth w/ vomiting, hypotension, hyponatraemia, and hyperkalaemia. Females present at birth w/ ambiguous genitalia. Metabolism (ES) (Patp) ES Patp
931 Adrenal insufficiency Meningococcal septicaemia can cause bilateral hemorrhagic infarction of the adrenal glands, leading to acute adrenal crisis (WFS). Endocrine, Diabetes & Pathology (Path) 5
932 Adrenal insufficiency Pts w/ AI aren't able to ↑ GC production in response to acute stress (e.g. illness, Sx). Adrenal crisis is characterised by severe hypotension, abdo pain, vomiting, weakness, and fever. In addn to aggressive Endocrine, Diabetes & Pathophysiology 5
fluid resuscitation, Tx req immediate GC supplementation. Metabolism (ES) (Patp) ES Patp
934 Diabetes mellitus In the polyol pathway, aldose reductase converts Glc into sorbitol, which is slowly meta into fructose by SDH. Chronic hyperglycaemia overwhelms this pathway, causing intracellular sorbitol Endocrine, Diabetes & Biochemistry 31
accumulation and ↑ osmotic/oxidative stress. This accelerates cataract devel in pts w/ DM, and contributes to the path of diabetic retinopathy, neuropathy, and nephropathy. Metabolism (ES) (Bioc) ES Bioc
935 Actinic keratoses AK develops on chronically sun-exposed areas of the skin in predisposed individuals. The lesions consist of erythematous papules w/ a central scale and a rough 'sandpaper-like' texture. AKs are Dermatology (DE) Pathology (Path) 2
considered premalignant lesions and have the potential to progress to SCC. DE Path
936 Acanthosis nigricans AN presents w/ thickening and hyperpigmentation of skin in the flexural areas. The lesions have a classic 'velvety' texture. AN is commonly a/w insulin-resistant states (e.g. DM, acromegaly, obesity) and Dermatology (DE) Pathology (Path) 1
GI malignancies. DE Path
937 Benzodiazepines Benzos act by binding to the benzo binding site, which allosterically mods the binding of GABA, resulting in an ↑ freq of Cl- ion channel opening. The influx of Cl- ions into the neurons causes neuronal Pregnancy, Childbirth & Pharmacology 6
hyperpol and inhib of the AP. Puerperium (PR) (Phar) PR Phar
939 Aortic stenosis The murmur of valvular AS is typically an ejection or midsystolic murmur of crescendo-decrescendo configuration w/ max intensity over the right 2nd ICS and radiation to neck and carotid arteries. The Cardiovascular (CV) Pathology (Path) 8
most common cause of AS in elderly pts (age >70) is degen calcification of the AV leaflets. CV Path
940 Polymyositis and dermatomyositis DM is char by prox. muscle weakness (similar to PM) and dermal MFxs (e.g. heliotrope rash, Gottron papules). Lab testing shows ↑ muscle enzymes (e.g. CK) and auto-Abs (e.g. antinuclear, anti-Jo-1). Rheumatology, Orthopedics & Pathology (Path) 5
Initial Tx incl systemic GCs and eval for potential underlying malignancy. Sports (RH) RH Path
941 Hemophiliacs Bleeding after a tooth extraction and Hx of hemarthrosis are suggestive of hemophilia. ↓ lvls of FVIII or IX lead to failure to convert prothrombin into thrombin and defic thrombus formation. The Hematology & Oncology (HO) Pathology (Path) 2
addition of thrombin to the blood of a pt w/ hemophilia results in clotting. HO Path
942 von Willebrand disease Pts w/ SSx vWD can be Tx w/ DDAVP, a syntheticADH analogue that has no vasoconstrictive effects. DDAVP transiently ↑ vWF and FVIII release from endothelial cell storage thru indirect mechs; it Hematology & Oncology (HO) Pharmacology 7
can be used prophylactically prior to procedures or to Tx minor bleeding. (Phar) HO Phar
943 Mitral regurgitation In pts w/ MR, LV afterload is determined by the balance of resistance b/w forward flow (aortic pressure) and regurgitant flow (LA pressure). A ↓ in SVR ↑ the ratio of forward to regurgltant blood flow Cardiovascular (CV) Pathophysiology 6
and improves CO. (Patp) CV Patp
944 Mitral regurgitation Pts w/ severe MR develop left-sided volume overload w/ an S3 gallop due to the large volume of regurgitant flow re-entering the ventricle during mid-diastole. The absence of an S3 gallop excludes Cardiovascular (CV) Pathophysiology 6
severe chronic MR. (Patp) CV Patp
945 Mitral regurgitation LV systole corresponds to the time of passive filling of the LA (atrial diastole). MR leads to markedly ↑ LA pressure during this period, creating the char early and large V wave on LA pressure tracing. Cardiovascular (CV) Pathophysiology 6
(Patp) CV Patp
947 Mitral valve prolapse MVP is most often caused by defects in connective tissue proteins that predispose to myxomatous degen of the mitral leaflets and chordae tendineae. Cardiac auscultation typically reveals a MC f/b a MR Cardiovascular (CV) Pathology (Path) 1
murmur; the click and murmur occur later in systole or disappear completely w/ manoeuvres (e.g. squatting) that ↑ LV EDV. CV Path
948 Chronic cough Cough is a very well recognized AEx of ACEI Thx. Cough 2° to ACEI Thx is Chx as dry, nonproductive, and persistent. The mechanism behind ACEI induced cough is accumulation of bradykinin, Cardiovascular (CV) Pharmacology 1
substance P, or prostaglandins. b/c ARBs do not affect ACE activity, they theoretically should not cause cough. (Phar) CV Phar
949 ACE inhibitors Angioedema is a rare and serious AE of ACEI therapy. ACEI ↑ bradykinin lvls, which ↑ vascular permeability and lead to angioedema. SSx include tongue, lips, or eyelid swelling and, less frequently, Cardiovascular (CV) Pharmacology 7
laryngeal oedema and difficulty breathing. ACEI should be discontinued in affected pts. (Phar) CV Phar
951 Coronary blood flow The high systolic intraventricular pressure and wall stress of the LV prevent myocardial perfusion during systole; therefore, the majority of LV myocardial perfusion occurs during diastole. Shorter Cardiovascular (CV) Physiology 9
duration of diastole is the major limiting factor for coronary blood supply to the LV myocardium during periods of tachycardia (e.g. exercise). (Phys) CV Phys
952 Coronary blood flow ↑ in resting blood flow to ischemic myocardium are primarily mediated by locally-acting substances (eg, adenosine, NO) that trigger coronary arteriolar vasodilation. Rx arteriolar vasodilators (eg, Cardiovascular (CV) Pathophysiology 9
adenosine, dipyridamole) mimic the vasodilation that occurs w/ exercise and may cause redistribution of blood flow from ischemic to nonischemic areas of myocardium, so-called coronary steal. (Patp) CV Patp
953 HIV The chemokine receptor CCR5 is a coreceptor that enables the HIV virus to enter cells. Blockade of CCR5 by chemokine receptor antagonists prevents viral entry into host cells. Infectious Diseases (ID) Microbiology 11
(Micr) ID Micr
954 Sexual differentiation 5α-reductase converts testo to DHT, which mediates devel of the ext genitalia in the male fetus. Male neonates w/ 5α-reductase defic are born w/ feminized ext genitalia that typically masculinize at Endocrine, Diabetes & Physiology 2
puberty. A small phallus and hypospadias are common. Metabolism (ES) (Phys) ES Phys
955 Aromatase deficiency Aromatase converts androgens into estrogens in the ovaries, testes, placenta, and other peripheral tissues. Placental aromatase deficiency causes accumulation of androgens during pregnancy, resulting in Pregnancy, Childbirth & Pathophysiology 1
ambiguous external genitalia in female infants and maternal virilization. Puerperium (PR) (Patp) PR Patp
956 Metabolic alkalosis Metabolic alkalosis is characterized by a high arterial blood pH, HCO3, and pCO2. Vomiting/nasogastric suctioning and thiazide/loop diuretic use cause volume and Cl depletion, resulting in metabolic Renal, Urinary & Electrolytes Pathophysiology 1
alkalosis that is saline-responsive. In contrast, hyperaldosteronism leads to metabolic alkalosis that is saline-unresponsive. Determining the patient's volume status and measuring the urinary chloride (RE) (Patp)
concentration can help to identify the cause of metabolic alkalosis. RE Patp
957 Community acquired pneumonia Mycoplasma pneumoniae binds an oligosaccharide on the respiratory epithelium that is also present on erythrocytes, leading to the generation of cross-reacting IgM antibodies (cold agglutinins). Patients Hematology & Oncology (HO) Microbiology 21
with M pneumoniae infections often develop mild, transient hemolytic anemia that resolves as IgM antibody titers decline (6-8 weeks after infection begins). (Micr) HO Micr
958 Community acquired pneumonia Infection w/ M. pneumoniae can result in the formation of cold agglutinins, which are IgM Abs (1arily) that bind RBCs and cause clumping/agglutinations at low body temps. Other illnesses resulting in Pulmonary & Critical Care (PU) Microbiology 21
cold agglutinin formation incl IM and certain heme malignancies. (Micr) PU Micr
959 Cephalosporins Penicillins, cephalosporins, and vancomycin are able to disrupt the PGCW of gram (+) and gram (-) organisms. The PGCW of these organisms gives them the ability to survive osmotic stress; this ability Infectious Diseases (ID) Pharmacology 2
is lost after Tx w/ these Abx agents. (Phar) ID Phar
960 Community acquired pneumonia L. pneumophila has a propensity to affect older adults w/ chronic lung disease who smoke. It causes Legionnaires' disease which is characterised by high fever, diarrhoea, h/a, and confusion. L. Pulmonary & Critical Care (PU) Microbiology 21
pneumophila is a gram (-) rod that's typically not detected on Gram stain but can be Dx by PCR of an LRT sample or detection of Legionella Ag in the urine. (Micr) PU Micr
961 Community acquired pneumonia L. pneumophila commonly contaminates natural bodies of water, municipal water supplies, and water-based cooling systems. The organism is inhaled in aerosolised water and establishes infection via the Pulmonary & Critical Care (PU) Microbiology 21
pulm route. Dx is gen made by urine Ag testing, Ag stain, or culture on buffered charcoal yeast extract agar supplemented w/ L-cysteine and Fe. (Micr) PU Micr
962 Epiglottitis PRP is a capsule and major VF for Hib. Hib is the most common cause of epiglottitis, which presents w/ fever, stridor, and dyspnoea. Pulmonary & Critical Care (PU) Microbiology 2
(Micr) PU Micr
963 Haemophilus influenzae Haemophilus influenzae is a "blood-loving" organism that requires X (hematin) and V (NAD+) factors for growth. This can be accomplished by growing H influenzae in the presence of Staphylococcus Infectious Diseases (ID) Microbiology 2
aureus and demonstrating the "satellite phenomenon," whereby H influenzae grow only near the β-hemolytic S aureus colonies that produce the needed X and V factors. (Micr) ID Micr
964 Septic arthritis H. influenzae is a gram (-) coccobacillus that req both X factor (hematin) and V factor (NAD+) to grow. Hib has an antiphagocytic PSC, which allows it to spread hematogenously and cause invasive Pulmonary & Critical Care (PU) Microbiology 4
disease such as septic arthritis and meningitis. (Micr) PU Micr
965 Immunizations The Hib vax consists of a CPS conjugated to a carrier protein (TT protein or OMP of N. meningitidis). Protein conjugation causes a T cell-mediated immune response leading to long-term immunity thru Allergy & Immunology (AI) Immunology 4
production of memory B-lymphocytes. (Immu) AI Immu
966 Tetanus Tetanospasmin is a neuro-exotoxin released by C. tetani. The toxin blocks the release of glycine and GABA from the spinal inhib interneurons that regulate the LMNs. These disinhib motor neurons cause Nervous (NS) Pathophysiology 5
↑ activation of muscles, leading to spasms and hyperreflexia. (Patp) NS Patp
967 Epiglottitis Rapidly progressing fever, severe sore throat, drooling and progressive airway obstruction potentially accompanied by stridor are the presenting symptoms of acute epiglottitis. This illness is most Pulmonary & Critical Care (PU) Immunology 2
commonly caused by H. influenzae type b, but the Hib vaccine has dropped the incidence of this disease considerably. H. influenzae type b can still cause disease in unimmunized or improperly (Immu)
immunized patients as well as fully immunized patients in some cases. PU Immu
968 Tetanus Neonatal tetanus can be prevented by hygienic delivery and umbilical cord care and universal immunisation of women who're preg or may become preg. Immunised mothers provide passive immunity via Infectious Diseases (ID) Microbiology 5
transplacental IgG, protecting infants until they receive active immunisation (vax) around age 2mos. (Micr) ID Micr
969 Tetanus Tet is a CDx that should be suspected in pts who have Chx SSx (e.g. lockjaw, muscle pain/spasms, difficulty swallowing), particularly if they are unlikely to be adequately vax or have an antecedent Nervous (NS) Pathophysiology 5
cutaneous injury. (Patp) NS Patp
970 Professional conduct Physicians are ethically obligated to question orders that raise concern about potential harm to pts. Issues should initially be discussed directly w/ the physician who made the order and not involve Pregnancy, Childbirth & Behavioral 3
ancillary staff. Puerperium (PR) Science (Beha) PR Beha
972 Anthrax Bacillus anthracis is a large, sporulating, gram-positive rod that is encased in an antiphagocytic polypeptide capsule composed of D-glutamic acid. Inhalation of B anthracis spores can cause pulmonary Infectious Diseases (ID) Microbiology 1
anthrax, which is usually characterized by nonspecific symptoms followed by hemorrhagic mediastinitis, shock, and death. (Micr) ID Micr
973 Febrile neutropenia Ecthyma gangrenosum is a cutaneous necrotic disease with a strong association with Pseudomonas aeruginosa bacteremia. It occurs from perivascular invasion and release of tissue-destructive exotoxins, Dermatology (DE) Microbiology 4
causing vascular destruction and insufficient blood flow to patches of skin that become edematous and subsequently necrose. Pseudomonas infections are common in patients who are neutropenic, are (Micr)
hospitalized, have burns, or have indwelling catheters. DE Micr
974 Skin and soft tissue infections Hot tub folliculitis is a superficial and self-limited Pseudomonas aeruginosa infection of the hair follicles that tends to occur in minor outbreaks following exposure to a pool or spa in which the chemicals Dermatology (DE) Microbiology 8
have not been maintained at appropriate concentrations. Pseudomonas are gram negative, oxidase-positive, nonlactose-fermenting, motile rods that produce green pigment. (Micr) DE Micr
975 Pulmonary embolism Pulm infarcts are typically hemorrhagic (red) and wedge-shaped in the periphery of the lung. IVDUs are at ↑ risk of TV endocarditis, which can cause multi septic pulm infarcts due to embolisation of TV Pulmonary & Critical Care (PU) Pathology (Path) 13
vegetation fragments. PU Path
976 Cholera V. cholerae and ETEC cause a purely toxin-mediated watery diarrhoea. The toxins secreted by these organisms modify electrolyte handling by enterocytes but don't cause cell death; therefore, no Infectious Diseases (ID) Microbiology 2
erythrocytes or leucocytes are typically noted on stool micro. (Micr) ID Micr
977 Cholera V. cholerae must survive the acidic environment of the stomach to reach the small intestine and cause disease. B/c the organism is easily destroyed by acid, a high burden of organisms must be ingested to Infectious Diseases (ID) Microbiology 2
cause infection. However, conditions that ↓ gastric acidity (e.g. antacid use) ↓ the minimum infectious dose of V. cholerae by multi orders of magnitude. (Micr) ID Micr
978 Hypercalcemia Serum calcium >13 mg/dL is suggestive of an underlying malignancy. Secretion of parathyroid hormone-related protein (PTHrP), which closely resembles parathyroid hormone at the bioactive amino- Renal, Urinary & Electrolytes Pathophysiology 5
terminal region, is a frequent cause of malignancy-related hypercalcemia and is commonly seen with squamous cell carcinomas (eg, lung, neck). (RE) (Patp) RE Patp
979 Chronic kidney disease CKD usually causes hyperphosphataemia (binds serum Ca2+) and low 1,25-dihydroxyvit D (↓ intestinal Ca2+ absorption and Ca2+ release from bone). The resulting hypocalcaemia stims release of PTH, Renal, Urinary & Electrolytes Pathology (Path) 8
causing 2° hyperparathyroidism. (RE) RE Path
980 Hypercalcemia TZDs cause hypercalcaemia by ↑ the DCT reabsorption of Ca2+. The ↑ circulating Ca2+ lvls result in suppression of PTH, which distinguishes this effect from HPT. Endocrine, Diabetes & Pathology (Path) 5
981 Vitamin D deficiency Malabsorption caused by coeliac disease can lead to vitD defic. Pts have ↓ serum P, ↑ serum PTH (2° HPT), and low (or normal) serum Ca2+. Endocrine, Diabetes & Pathophysiology 4
982 Osteoporosis Patients with osteoporosis have low bone mass, resulting in increased susceptibility to fragility fractures (ie, those occurring with minimal or no trauma). In primary osteoporosis (not caused by a medical Rheumatology, Orthopedics & Pathophysiology 10
disorder), serum calcium, phosphorus, and parathyroid hormone levels are typically normal. Sports (RH) (Patp) RH Patp
983 Hypothyroidism 1° hypoTH-ism is char by ↓ T4 lvls and ↑ TSH. T3 is 1°ly prod by conversion from T4 in peri tissues; serum lvls widely fluctuate due to its short ½ life, and can often be w/I the normal range in pts w/ Endocrine, Diabetes & Physiology 13
hypoTH-ism. Metabolism (ES) (Phys) ES Phys
984 Sarcoidosis Hypercalcaemia in sarcoidosis is caused by PTH-independent formation of 1,25-dihydroxyvit D by activated macrophages. This leads to ↑ intestinal absorption of Ca2+. Pulmonary & Critical Care (PU) Pathology (Path) 7 PU Path
985 Diabetic ketoacidosis Most pts w/ DKA have normal to ↑ serum K+ lvls despite a total body K+ deficit. Replacement of K+ is a crucial step in the Mx of pts w/ DKA. Endocrine, Diabetes & Pathophysiology 6
986 Multiple endocrine neoplasia MEN-1 consists of HPT (e.g. hypercalcaemia, constipation, kidney stones), pit tumours, and PETs (e.g. gastrinoma). The genetic defect involves muts of the MEN1gene. Endocrine, Diabetes & Pathology (Path) 5
987 Paget disease of bone Bone pain and elevated alkaline phosphatase level in an elderly patient can occur with osteoblast metastases and Paget disease of bone (PDB). Biopsy showing a mosaic pattern of lamellar bone is Rheumatology, Orthopedics & Pathophysiology 4
diagnostic for PDB. The initial phase in PDB is characterized by an increase in osteoclastic activity. Sports (RH) (Patp) RH Patp
988 Multiple endocrine neoplasia MEN-2B is characterised by MTC, PCCs, mucosal neuromas, and Marfanoid habitus. HPT isn't a feature of this syndrome. Endocrine, Diabetes & Pathophysiology 5
989 Gluconeogenesis In a fasting state, glucagon and EPI bind to transmembrane receptors and prevent hypoglycaemia by ↑ hepatic glycogenolysis and GNG. Prolonged fasting ↑ the secretion of cortisol, a steroid hormone Endocrine, Diabetes & Biochemistry 4
that binds to an intracellular receptor and acts to ↑ transcription of enzymes involved in GNG, lipolysis, and proteolysis. Metabolism (ES) (Bioc) ES Bioc
990 Vitamin D deficiency Sunlight exposure catalyzes conversion of 7-dehydrochol to vit D3 in the skin. Subseq 25-hydroxylation in the liver and 1-hydroxylation in the kidneys prod 1,25-OH2 vit D, the active form. Inadequate Endocrine, Diabetes & Physiology 4
exposure to sunlight can lead to vit D defic. Metabolism (ES) (Phys) ES Phys
991 Vitamin D deficiency In CKD, conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D is impaired. In addition, failure of glomerular and tubular fxn results in PO4 retention and hypocalcemia. This leads to a Endocrine, Diabetes & Physiology 4
compensatory rise in PTH (2° HPT) that can Px w/ weakness, muscle and joint pain, defective bone mineralization, and ↑ fracture risk. Metabolism (ES) (Phys) ES Phys
992 Hypercalcemia Ca-sensing receptors are GPCRs that regulate the secretion of PTH in response to changes in circulating Ca levels. FHH is a benign AD disorder caused by defective Ca-sensing receptors in the Endocrine, Diabetes & Physiology 5
parathyroid gland and kidneys. Metabolism (ES) (Phys) ES Phys
993 Thiazides Thiazide diuretics increase calcium absorption in the distal convoluted tubules within the nephron. Thiazides are associated with increased bone mineral density and are recommended for treatment of Rheumatology, Orthopedics & Pharmacology 3
hypertension in patients at risk for osteoporosis. Loop diuretics increase urinary calcium loss. Sports (RH) (Phar) RH Phar
994 Second messengers PKA is responsible for the intracellular effects of the G protein-mediated adenylate cyclase 2nd messenger system. Hormone receptors that use this system incl the TSH, glucagon, and PTH receptors. Endocrine, Diabetes & Biochemistry 2
995 Second messengers After a ligand binds to a G protein-coupled receptor that activates phospholipase C, membrane phospholipids are broken down into diacylglycerol (DAG) and inositol triphosphate (IP3). Protein kinase C General Principles (GP) Biochemistry 2
is subsequently activated by DAG and calcium; the latter is released from the endoplasmic reticulum under the influence of IP3. (Bioc) GP Bioc
996 Lactic acidosis In the presence of oxygen, Pyruvate produced during glycolysis is converted by Pyruvate dehydrogenase to acetyl coenzyme A, which is subsequently metabolized by oxidative phosphorylation. General Principles (GP) Biochemistry 1
However, if inadequate oxygen is present in the tissues, pyruvate is converted to lactate by lactate dehydrogenase, leading to lactic acidosis. (Bioc) GP Bioc
997 Gluconeogenesis After 12-18hrs of fasting, GNG becomes the principal source of blood Glc. GNG uses many glycolytic enzymes, but hexokinase, PFK, and PK need to be bypassed as they're unidirectional. The initial Endocrine, Diabetes & Biochemistry 4
steps of GNG involve the conversion of pyruvate to OA and OA to PEP by PC and PEPCK, respectively. Metabolism (ES) (Bioc) ES Bioc
998 PDH and ketogenic amino acids PDH complex defic is an inherited inborn error of meta causing lactic acidosis and neuro defects. Pts are unable to convert pyruvate to acetyl-CoA, resulting in a shunting of pyruvate to lactic acid. In Endocrine, Diabetes & Biochemistry 1
these pts, meta of exclusively ketogenic AAs (e.g. lysine, leucine) can provide energy in the form of acetyl-CoA w/o ↑ lactate production. Metabolism (ES) (Bioc) ES Bioc
999 Group B streptococcal infection Universal prenatal screening for group B strep colonization by vaginal-rectal culture at 35-37 weeks gestation is recommended to identify colonized women who require INTRAPARTUM antibiotics, Pulmonary & Critical Care (PU) Microbiology 2
most frequently with penicillin or ampicillin, to prevent neonatal GBS sepsis, pneumonia and meningitis. (Micr) PU Micr
1000 Aminoglycoside Aminoglycoside (e.g. gentamicin) resistance is most commonly due to Abx-modding enzymes. These enzymes add chem groups to the Abx, which diminishes its ability to bind to the 16S rRNA w/i the Infectious Diseases (ID) Pharmacology 3
30S ribosomal subunit. (Phar) ID Phar
1001 Endocarditis Streptococcus gallolyticus (formerly S bovis) endocarditis and bacteremia are a/w GI lesions (colon ca) in ~25% of cases. When S gallolyticus is cultured in the blood, workup for colonic malignancy w/ Cardiovascular (CV) Microbiology 15
colonoscopy is essential. (Micr) CV Micr
1002 Endocarditis Viridans streptococci produce dextrans that aid them in colonizing host surfaces, such as dental enamel and heart valves. These organisms cause subacute BE, classically in pts w/ pre-existing cardiac Cardiovascular (CV) Microbiology 15
valvular defects after dental manipulation. (Micr) CV Micr
1003 Endocarditis Viridans streptococci are normal inhabitants of the oral cavity and are a cause of transient bacteremia after dental procedures in healthy and diseased individuals. In pts w/ pre-existing valvular lesions, Cardiovascular (CV) Microbiology 15
viridans streptococci can adhere to fibrin-platelet aggregates and establish infection that leads to endocarditis. (Micr) CV Micr
1004 Meningitis Rifampin is the most frequently used agent for chemoprophylaxis of meningococcal disease. Persons with exposure to the respiratory secretions of a patient with meningococcal disease require Infectious Diseases (ID) Microbiology 17
chemoprophylaxis. Vaccination is an important public health strategy but is not useful for post exposure prophylaxis. (Micr) ID Micr
1005 Meningitis Pili are the 1ary VF that allow N. meningitidis to initially attach to and colonize the nasopharyngeal epithelial surface. Pili undergo significant Ag variation, which makes them a difficult vax target. Nervous (NS) Microbiology 17
(Micr) NS Micr
1007 Septic arthritis Septic arthritis in a young, sexually active adult should raise suspicion for disseminated N. gonorrhoeae infection. Pts may also have the triad of polyarthritis, a vesiculopustular skin rash, and Infectious Diseases (ID) Microbiology 4
tenosynovitis. N. gonorrhoeae is a gram (-) diplococci that's usually ID'd by micro, culture, or NAAT. (Micr) ID Micr
1008 Cervicitis Neisseria gonorrhoeae and Chlamydia trachomatis cause mucopurulent cervicitis, which can progress to PID if unTx. PID can cause scarring of the fallopian tubes, leading to ectopic pregnancy and Female Reproductive & Breast Microbiology 1
infertility. (FR) (Micr) FR Micr
1009 Hypoglycemia Ox meta of Glc in pancreatic β cells generates ATP. ATP-induced closure of the ATP-sens K channels leads to membrane depol and subseq insulin release. Endocrine, Diabetes & Physiology 6
1010 Diabetes mellitus Insulin release by pancreatic β cells is stim by ↑ Glc meta and ATP production. Glucokinase fxns as a Glc sensor in pancreatic β cells by controlling the rate of Glc entry into the glycolytic pathway. muts Endocrine, Diabetes & Biochemistry 31
in the glucokinase gene lead to a state in which higher Glc lvls are req to stim insulin secretion and are a cause of MODY. Metabolism (ES) (Bioc) ES Bioc
1011 Diabetes mellitus Pts w/ non-coronary atherosclerotic disease, DM, or CKD are at the same risk of CV events (e.g. MI, stroke) as pts w/ known CAD. CAD is the most common COD in pts w/ DM. Endocrine, Diabetes & Pathology (Path) 31
1012 Diabetes mellitus AI insulitis w/ progr β cell loss is the most common cause of DM-1. IRaccompanied by relative insulin defic is the main cause of DM-2. Endocrine, Diabetes & Pathology (Path) 31
1013 Diabetes mellitus Smoking cess is by far the most effective preventive intervention in almost all pts, and this is esp true in those w/ DM. Endocrine, Diabetes & Biostatistics 31
Metabolism (ES) (Bios) ES Bios
1014 Dilated cardiomyopathy Anthracycline CTx agents (e.g. doxorubicin, daunorubicin) cause cardiotox mainly thru the formation of anthracycline-topoisomerase II DNA cleavage complexes that affect healthy cardiomyocytes. The Cardiovascular (CV) Pharmacology 8
cardiotox is dependent on the cumulative dose of anthracycline received, and it manifests as DCM. (Phar) CV Phar
1015 Human papillomavirus Human papillomavirus (HPV) infection causes cutaneous and genital warts as well as benign and malignant intraepithelial neoplasia. Koilocytosis is a hallmark sign of HPV infection. Koilocytes are Female Reproductive & Breast Pathology (Path) 4
pyknotic, superficial or immature squamous cells with a dense, irregularly staining cytoplasm and perinuclear halo-like clearing. (FR) FR Path
1016 Prerenal azotemia Hypovolaemia results in a ↓ renal plasma flow (RPF) and GFR. This leads to compensatory efferent arteriolar vasoconstriction, which raises the filtration fraction and maintains GFR at near-normal lvls. Renal, Urinary & Electrolytes Pathology (Path) 6
As RPF continues to decline, ↑ glomerular oncotic pressure will eventually overwhelm the compensatory ↑ in hydrostatic pressure, leading to a precipitous drop in GFR and ARF. (RE) RE Path
1017 GFR Selective vasoconstriction of the efferent arteriole (up to certain extent) ↑ hydrostatic pressure in the glom caps, and therefore ↑ the GFR. As efferent arteriolar constriction continues to ↑, the GFR begins Renal, Urinary & Electrolytes Physiology 6
to ↓ due to a flow-mediated rise in oncotic pressure in the glom caps. The FF always ↑ w/ ↑ efferent arteriole constriction. (RE) (Phys) RE Phys
1019 LDH and glycolysis Under anaerobic conditions, NADH transfers electrons to pyruvate to form lactate and regenerate NAD*. NAD+ is required to convert glyceraldehyde-3-phosphate to 1-3-bisphosphoglycerate in Endocrine, Diabetes & Biochemistry 1
glycolysis. Metabolism (ES) (Bioc) ES Bioc
1020 Pyruvate kinase deficiency PKD causes HA due to failure of glycolysis and resultant failure to generate sufficient ATP to maintain erythrocyte structure. In this case, splenic hyperplasia results from incr. work of the splenic Hematology & Oncology (HO) Biochemistry 1
parenchyma, which must remove these deformed erythrocytes from the circulation. (Bioc) HO Bioc
1021 Wernicke-Korsakoff syndrome Pyruvate dehydrogenase and a-ketoglutarate dehydrogenase require thiamine as a cofactor. Administration of glucose to thiamine-deficient patients (eg, alcoholics) can result in Wernicke encephalopathy Pregnancy, Childbirth & Biochemistry 5
(eg, acute confusion, ophthalmoplegia, and ataxia) due to increased thiamine demand. Puerperium (PR) (Bioc) PR Bioc
1022 Citric acid cycle GTP is synthesised by succinyl-CoA synthetase during the conversion of succinyl-CoA to succinate in the TCA cycle. During GNG, PEPCK uses GTP to synthesise PEP from OA. Endocrine, Diabetes & Biochemistry 1
1023 Glycogen storage disease Acid maltase (a-glucosidase) deficiency presents in early infancy with cardiomegaly, macroglossia, and profound muscular hypotonia. Abnormal glycogen accumulation within lysosomal vesicles is seen Endocrine, Diabetes & Biochemistry 3
on muscle biopsy. Metabolism (ES) (Bioc) ES Bioc
1024 Meningococci The Thayer-Martin medium is used to isolate pathogenic Neisseria species such as N. meningitidis and N. gonorrhoeae. It's a chocolate sheep blood agar that contains vancomycin to inhib the growth of Infectious Diseases (ID) Microbiology 1
gram (+) organisms; colistin and trimethoprim to inhib gram (-) bacteria (other than pathogenic Neisseria); and nystatin to inhib yeasts. (Micr) ID Micr
1025 Gonococcal infection Gonococci use their pili to mediate adherence to the mucosal epithelium. Through Ag variation, each gonococcus can modify the pilus protein expressed, thereby avoiding host defenses (to some degree) Infectious Diseases (ID) Microbiology 3
and making vax directed against the pilus protein difficult. (Micr) ID Micr
1026 Urethritis N. gonorrhoeae has high antigenic variability of its surface molecules (e.g. porins, Opa proteins), which prevents the formation of protective immunity and leads to susceptibility to repeat infection. Infectious Diseases (ID) Microbiology 4
(Micr) ID Micr
1027 Pelvic inflammatory disease PID is most frequently caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Severe or inadequately Tx PID can result in fallopian tube scarring, which in turn can lead to infertility. Tx must Female Reproductive & Breast Pathophysiology 2
always include coverage of both organisms w/ a 3rd-generation cephalosporin (eg, ceftriaxone) as well as azithromycin or doxycycline. (FR) (Patp) FR Patp
1028 Calcium and glycogen Synchronization of glycogen degradation with skeletal muscle contraction occurs due to release of sarcoplasmic calcium following neuromuscular stimulation. Increased intracellular calcium causes General Principles (GP) Biochemistry 1
phosphorylase activation of phosphorylase kinase, stimulating glycogen phosphorylase to increase glycogenolysis. (Bioc) GP Bioc
1029 2,3-bisphosphoglycerate 2,3-BPG decr Hb's affinity for O2. Therefore, in the presence of decr blood O2 conc., higher 2,3-BPG lvls w/i erythrocytes enable incr O2 delivery in the peri tissues. 2,3-BPG is produced from 1,3-BPG Hematology & Oncology (HO) Biochemistry 1
metabolism by the enzyme BPG mutase. This rxn bypasses an ATP-generating step of glycolysis, causing no net gain in ATP. (Bioc) HO Bioc
1030 Glycogen storage disease Debranching enzyme defic (Cori disease) leads to accumulation of glycogen w/ abnly short outer chains (limit dextrins) due to the inability to degrade α-1,6-glycosidic branch points. Pts present w/ Endocrine, Diabetes & Biochemistry 3
hypoglycaemia, ketoacidosis, hepatomegaly, and muscle weakness and hypotonia. Metabolism (ES) (Bioc) ES Bioc
1031 Fructose 2,6 bisphosphate F-2,6-BP activates PFK-1 (↑ glycolysis) and inhibs F-1,6-BPase (↓ GNG). F-2,6-BP conc is regulated by a bifxnal enzyme complex: PFK-2 ↑ F-2,6-BP lvls in response to insulin, and F-2,6-BPase ↓ F- Endocrine, Diabetes & Biochemistry 1
2,6-BP lvls in response to glucagon. Metabolism (ES) (Bioc) ES Bioc
1032 Glycogen storage disease Glycogen serves as a source of Glc during fasting and as an energy store that can be mobilised quickly during strenuous muscle contraction. Myophosphorylase defic (McArdle disease or GSD-V) causes Endocrine, Diabetes & Biochemistry 3
failure of muscle glycogenolysis, resulting in ↓ exercise tolerance, muscle pain and cramping, and myoglobinuria w/ physical activity). Metabolism (ES) (Bioc) ES Bioc
1034 Gluconeogenesis Acetyl-CoA stims GNG by ↑ the activity of PC when acetyl-CoA is abundant. This regulatory step allows pyruvate to be shunted toward acetyl-CoA production when acetyl-CoA lvls are low, preventing Endocrine, Diabetes & Biochemistry 4
the cell from becoming depleted of energy. Metabolism (ES) (Bioc) ES Bioc
1035 G6PD deficiency The PPP consists of an ox (irrev.) branch and a nonox (rev.) branch, and each can fxn independently based on cellular reqs. Transketolase, an enzyme of the nonox branch, is responsible in part for the Hematology & Oncology (HO) Biochemistry 5
interconversion of R5P (nucleotide precursor) and F6P (glycolytic intermediate). (Bioc) HO Bioc
1036 G6PD deficiency G6PD is the RLE of the PPP. G6PD defic is a common XLR disorder resulting in episodes of HA during times of incr. ox stress (e.g. use of antimalarials/sulfonamide, infections). Hematology & Oncology (HO) Biochemistry 5
(Bioc) HO Bioc
1037 G6PD deficiency G6PD defic causes HA and jaundice 2ary to incr. ox stress due to the lack of NADPH. Glutathione reductase defic has a similar clin conseq as its absence results in an inability to utilize NADPH to red Hematology & Oncology (HO) Biochemistry 5
glutathione. (Bioc) HO Bioc
1038 Toxoplasmosis Congenital toxoplasmosis is a transplacental infection (acq in utero). Its classic triad includes hydrocephalus, intracranial calcifications, and chorioretinitis. Expecting mothers should avoid cat feces to Nervous (NS) Microbiology 5
help prevent exposure to Toxoplasma. (Micr) NS Micr
1039 Cancer anorexia cachexia TNF-a is thought to mediate PNP cachexia in humans by suppressing appetite and ↑ BMR. Hematology & Oncology (HO) Pathology (Path) 2
syndrome HO Path
1040 Acute pericarditis Pericarditis is the most common CV MFx a/w SLE. It presents w/ sharp pleuritic chest pain that is relieved by sitting up and leaning forward. Cardiovascular (CV) Pathology (Path) 5 CV Path
1041 Barrett esophagus Squamous metaplasia is a reversible, adaptive response to chronic irritation, such as smoking. The normal columnar epithelium is replaced by squamous epithelium, which is more resistance to irritation Pulmonary & Critical Care (PU) Pathology (Path) 2
but has ↓ mucociliary clearance. Metaplasia also occurs w/ Barrett oesophagus, in which oesophageal squamous epithelium is replaced by columnar epithelium in response to chronic acid exposure. PU Path
1042 Herpes zoster HZ (shingles) develops due to reactivation of VZV in the DRG (sensory neurons). It presents w/ a painful vesicular rash in a dermatomal distribution. Intranuclear inclusions in keratinocytes and Dermatology (DE) Pathology (Path) 4
multinucleated giant cells are seen on LM. DE Path
1043 Diabetes insipidus The asc. limb of the LOH is impermeable to water regardless of serum ADH lvls. Reabsorption of electrolytes by the Na+/K+/2Cl-cotransporter occurs in the thick asc. limb and contributes to formation Renal, Urinary & Electrolytes Physiology 4
of the corticomedullary conc gradient. (RE) (Phys) RE Phys
1045 Measles VitA can be beneficial in the Tx of measles infection by ↓ comorbidities (e.g. ocular complications, diarrhoea, pneumonia), recovery time, and length of hospital stay. Infectious Diseases (ID) Microbiology 3
(Micr) ID Micr
1046 Anorexia nervosa AN is an eating disorder characterised by low body weight, intense fear of becoming fat, and distorted body image. Med complications due to starvation in AN incl bradycardia, hypotension, osteoporosis, Pregnancy, Childbirth & Behavioral 3
and amenorrhoea. Puerperium (PR) Science (Beha) PR Beha
1047 Dilated cardiomyopathy Thiamine deficiency causes beriberi and Wernicke-Korsakoff syndrome. Dry beriberi is characterized by symmetrical peripheral neuropathy; wet beriberi includes the addition of high-output congestive Cardiovascular (CV) Biochemistry 8
heart failure. (Bioc) CV Bioc
1048 Vitamin A toxicity Vit A overuse can result in intracranial HTN, skin changes, and HSM. Nervous (NS) Biochemistry 1
(Bioc) NS Bioc
1049 NSAIDs Analgesic nephropathy is a form of CKD caused by prolonged, heavy intake of NSAIDs a/o acetaminophen. Path chars incl CIN and RPN. Renal, Urinary & Electrolytes Pathology (Path) 4
(RE) RE Path
1050 Acute urate nephropathy Tumor lysis syndrome occurs when tumors with a high cell turnover are treated with chemotherapy. The lysis of tumor cells causes intracellular ions, such as potassium and phosphorous, and uric acid Renal, Urinary & Electrolytes Pathophysiology 1
(metabolite of tumor nucleic acid) to be released into serum. Uric acid is soluble at physiologic pH, but it can precipitate in the normally acidic environment of distal tubules and collecting ducts. The (RE) (Patp)
prevention of tumor lysis syndrome includes urine alkalinization and hydration, as high urine flow and high pH along the nephron prevents crystallization and precipitation of uric acid. RE Patp
1052 Polycystic kidney disease ADPKD MFx in pts 40-50 y/o w/ enlarged kidneys, HTN, and ARF. In newborns, the kidneys are of normal size, and the cysts are too small to be detected on abdo US. As the cysts enlarge, they Renal, Urinary & Electrolytes Pathology (Path) 3
compress the renal parenchyma and cause SSx. (RE) RE Path
1053 Acute kidney injury Most pts w/ ATN experience tubular re-epithelialisation and regain renal fxn. However, when ATN is a/w multiorgan failure, renal fxn may be permanently impaired; in such pts, foci of interstitial Renal, Urinary & Electrolytes Pathology (Path) 5
scarring can be seen on LM. (RE) RE Path
1054 Multiple myeloma MM should be suspected in elderly pts w/ any combo of hypercalcaemia, normocytic anaemia, bone pain, ↑ γ gap, or renal failure. Renal failure is commonly caused by light chain cast nephropathy; large, Renal, Urinary & Electrolytes Pathology (Path) 9
waxy, eosinophilic casts composed of BJ proteins are seen in the tubular lumen. (RE) RE Path
1055 Klinefelter syndrome Patients with Klinefelter syndrome (47, XXY) have primary hypogonadism characterized by low testosterone and elevated gonadotropin (FSH, LH) levels. In addition, elevated estradiol results in the Male Reproductive (MR) Pathology (Path) 3
common finding of gynecomastia. MR Path
1056 Breast cancer Invasive breast carcinoma typically presents as an irregularly shaped, adherent breast mass, most commonly in the upper outer quadrant. Malignant infiltration of suspensory ligaments of the breast can Female Reproductive & Breast Anatomy (Anat) 7
cause skin retractions. (FR) FR Anat
1057 Ductal carcinoma in situ Ductal carcinoma in situ is characterized by ducts distended by pleomorphic cells with prominent central necrosis that do not penetrate the basement membrane. It is the precursor to invasive ductal Female Reproductive & Breast Pathology (Path) 1
carcinoma, the most common type of breast cancer. (FR) FR Path
1058 Guillain-Barre syndrome GBS is an acute demyelinating polyneuropathy. It's thought to be due to molecular mimicry and is commonly preceded by a viral URI or gastroenteritis. Segmental demyelination of the peri nerves and an Nervous (NS) Pathology (Path) 3
endoneurial inflammatory infiltrate are seen on LM. NS Path
1059 Peripheral neuropathy Diabetic peri neuropathy is characterised by numbness and paraesthesia in a stocking-and-glove distribution. It results from nonenzymatic glycosylation of proteins, leading to hyalinisation of endoneurial Nervous (NS) Pathology (Path) 3
arteries and ischemic nerve dmg. In addn, accumulation of toxic substances w/i neurons results in deranged meta and ↑ oxidative stress. NS Path
1060 Cranial nerve palsy Diabetic mononeuropathy often involves CNIII. It's caused by predominantly central ischemia, which affects the somatic nerve fibres but spares peri parasympathetic fibres. SSx incl ptosis, a 'down and Nervous (NS) Pathology (Path) 9
out' gaze, and normal light and accommodation reflexes. NS Path
1061 Vitamin C deficiency Ascorbic acid (vitamin C) is a cofactor in the hydroxylation of proline and lysine residues and is important in the synthesis of collagen. Deficiency (scurvy) is characterized by microvascular bleeding, Dermatology (DE) Biochemistry 3
gingivitis, and impaired wound healing. (Bioc) DE Bioc
1062 Vitamin K deficiency Vitamin K deficiency results in impaired clotting factor carboxylation. Newborns are at risk for vitamin K deficiency due to poor transplacental transfer of vitamin K and low content in breast milk. All Hematology & Oncology (HO) Physiology 2
newborns should receive vitamin K prophylaxis to prevent bleeding complications. (Phys) HO Phys
1063 Biotin deficiency Biotin acts as a CO2 carrier on the surface of carboxylase enzymes and is an essential cofactor for numerous rxns, including the conversion of pyruvate to OA and FA metabolism. Excess ingestion of Endocrine, Diabetes & Biochemistry 1
avidin, found in egg whites, has been a/w biotin deficiency. This condition Px w/ mental status changes, myalgias, anorexia, macular dermatitis, and lactic acidosis. Metabolism (ES) (Bioc) ES Bioc
1064 Niacin deficiency Niacin (vitamin B2) can be synthesized endogenously from tryptophan and is an essential component of nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate Dermatology (DE) Biochemistry 3
(NADP). A deficiency of this vitamin results in pellagra, which is characterized by dermatitis, diarrhea, and dementia. (Bioc) DE Bioc
1065 Vitamin D toxicity Excessive vit D intake can lead to hypercalcemia and cause AMS, muscle weakness, constipation, and polyuria/polydipsia. Activated macrophages in sarcoidosis and other gran diseases express 1α- Endocrine, Diabetes & Physiology 1
hydroxylase, leading to excess prod of 1,25-OH2 vit D and hypercalcemia. Metabolism (ES) (Phys) ES Phys
1066 Hyperphosphatemia Glucose-6-phosphate dehydrogenase is the rate-limiting enzyme in the pentose phosphate pathway, the major source of cellular NADPH. This molecule is necessary for reducing glutathione (protects red Endocrine, Diabetes & Biochemistry 1
blood cells from oxidative damage) and for the biosynthesis of cholesterol, fatty acids, and steroids. Metabolism (ES) (Bioc) ES Bioc
1067 Fructose metabolism Unlike HFI (aldolase B deficiency) and classic galactosemia (GALT deficiency), essential fructosuria (fructokinase deficiency) is a benign disorder. Although affected pts are aSSx, their urine will test (+) Endocrine, Diabetes & Biochemistry 4
for a reducing sugar due to the presence of unmetabolized fructose. Metabolism (ES) (Bioc) ES Bioc
1068 Fructose metabolism Dietary fructose is phosphorylated in the liver to F1P and is rapidly metabolized b/c it bypasses PFK-1, the major RLE of glycolysis. Other sugars (e.g. Glc, Gal, mannose) enter glycolysis prior to PFK-1 Gastrointestinal & Nutrition (GI) Biochemistry 4
and as a result are metabolized more slowly. (Bioc) GI Bioc
1069 Hereditary fructose intolerance Aldolase B defic causes HFI. This disease MFx after intro of fructose into the diet w/ vomiting and hypoglycaemia about 20-30min after fructose ingestion. These infants can present w/ FTT, jaundice, Endocrine, Diabetes & Biochemistry 1
and hepatomegaly. Metabolism (ES) (Bioc) ES Bioc
1070 Fructose metabolism Essential fructosuria is a benign disorder of fructose metabolism caused by fructokinase deficiency. In pts w/ essential fructosuria, some of the dietary fructose load is converted by hexokinase to F6P, Endocrine, Diabetes & Biochemistry 4
which can then enter glycolysis; this pathway is not significant in normal individuals. Metabolism (ES) (Bioc) ES Bioc
1071 Galactosemia Class galactosemia results from deficiency of GALT. CFx include vomiting, lethargy, jaundice, and E. coli sepsis. Cessation of breastfeeding and switching to soy milk-based formula is recommended. Gastrointestinal & Nutrition (GI) Biochemistry 2
(Bioc) GI Bioc
1072 Lactose intolerance Secondary lactase deficiency can occur after inflammatory (eg, celiac disease) or infectious (eg. giardiasis) processes damage the microvilli of the small intestines. Clinical presentation includes Gastrointestinal & Nutrition (GI) Biochemistry 3
abdominal distension and cramping, flatulence, and diarrhea. (Bioc) GI Bioc
1073 Fructose metabolism Aldolase B defic, or HFI, leads to accumulation of the tox metabolite F1P. Pts have hypoglycaemia and vomiting when fructose or sucrose is consumed. Tx involves strict removal of both carbs from the Endocrine, Diabetes & Biochemistry 4
diet. Metabolism (ES) (Bioc) ES Bioc
1074 Galactosemia Lenticular accumulation of galactitol in the lenses of pts w/ galactosemia can cause osmotic dmg and development of cataracts. Cataracts may be the only MFx of galactokinase deficiency. Gastrointestinal & Nutrition (GI) Biochemistry 2
(Bioc) GI Bioc
1075 Iron deficiency anemia PVS is characterised by dysphagia (oesophageal web formation) and IDA. Findings a/w ID incl koilonychia (spoon-shaped nails) and a shiny red tongue. Most SSx resolve following Fe supplementation. Hematology & Oncology (HO) Pathology (Path) 7 HO Path
1077 Anticoagulants Heparin is commonly used for the prevention of DVT in non-ambulatory pts or those undergoing elective Sx, esp. hip and knee Sx. Heparin ↑ the effect of the naturally occurring anticoag ATIII. Hematology & Oncology (HO) Pharmacology 8
(Phar) HO Phar
1078 Anticoagulants HIT is Tx w/ DTIs such as argatroban. Both HMWH and LMWH should be avoided in these pts. Hematology & Oncology (HO) Pharmacology 8
(Phar) HO Phar
1079 Glanzmann thrombasthenia Abciximab is a blocker of GP IIb/IIIa receptor, which normally promotes platelet binding to FI. GP IIb/IIIa is either defic or defective in pts w/ Glanzmann thrombasthenia. Hematology & Oncology (HO) Pharmacology 1
(Phar) HO Phar
1080 Peripheral vascular disease SSx Mx PVD includes a graded exercise program and cilostazol. Cilostazol is a PDEI that inhibs platelet aggregation and acts as a direct arterial vasodilator. Pts w/ PVD should also receive an antiplatelet Cardiovascular (CV) Pharmacology 4
agent (aspirin or clopidogrel) for 2° prevention of CAD and stroke. (Phar) CV Phar
1082 Myocardial infarction In the fibrinolytic pathway, tPA converts plasminogen to plasmin, which then breaks down fibrin clot. The administration of a tPA analogue (eg, alteplase, tenecteplase, streptokinase) triggers fibrinolysis Cardiovascular (CV) Pharmacology 18
and can restore myocardial perfusion in pts w/ STEMI who cannot undergo timely PCI. (Phar) CV Phar
1083 Breast cancer Hereditary breast ca is most commonly a/w muts in BRCA1 and BRCA2. These TSGs are involved in DNA repair, and their mut ↑ the risk of devel breast and ovarian ca. Hematology & Oncology (HO) Pathology (Path) 7 HO Path
1084 Matrix metalloproteinase Metalloproteinases are Zn-containing enzymes that degrade the ECM. They participate in normal tissue remodeling and in tumor invasion through the BM and CT. Hematology & Oncology (HO) Pathology (Path) 1 HO Path
1086 Non-Hodgkin lymphoma Analgesic nephropathy is a form of CKD caused by prolonged, heavy intake of NSAIDs a/o acetaminophen. Path char incl CIN and RPN. Hematology & Oncology (HO) Pathology (Path) 6 HO Path
1087 Anticoagulants Protamine sulphate binds to heparin, causing chem inactivation. VitK and FFP can be used to reverse warfarin effects. Hematology & Oncology (HO) Pharmacology 8
(Phar) HO Phar
1088 Anticoagulants Warfarin inhibits proteins C and S (natural anticoagulants present in blood), which can lead to skin necrosis, particularly in pts w/ protein C or S deficiency. This complication is usually seen in the 1st Hematology & Oncology (HO) Pathology (Path) 8
few days of warfarin Thx. HO Path
1090 Anticoagulants Rifampin, phenobarbital, and phenytoin are potent enhancers of the CYP450 pathway; concurrent use of warfarin w/ these Rx results in ↓ efficacy of warfarin. In contrast, cimetidine, amiodarone, and Hematology & Oncology (HO) Pharmacology 8
TMP-SMX inhib warfarin meta, ↑ the risk of bleeding. (Phar) HO Phar
1091 Penicillin β-lactamase inhibs (e.g. clavulanic acid, sulbactam, tazobactam) prevent β-lactamase from inactivating penicillin class drugs, which extends the spectrum of their activity. Infectious Diseases (ID) Pharmacology 2
(Phar) ID Phar
1092 Diphtheria Toxigenic strains of C. diphtheria produce diphtheria toxin, which irreversibly inhibs host protein synthesis due to ADP-ribosylation of EF-2. Local effects incl pseudomembranous pharyngitis; systemic Infectious Diseases (ID) Microbiology 6
effects incl potentially life-threatening myocarditis and neuritis. Immunisation w/ diphtheria toxoid generates protective circulating IgG against the exotoxin B subunit. (Micr) ID Micr
1093 Diphtheria Diphtheria exotoxin inhibs host cell protein synthesis by catalysing the ADP-ribosylation of host cell EF-2. Infectious Diseases (ID) Microbiology 6
(Micr) ID Micr
1094 Diphtheria Diphtheria toxin is an AB exotoxin that ribosylates and inactivates EF-2. This action inhibits protein synthesis and ultimately leads to cell death. Infectious Diseases (ID) Microbiology 6
(Micr) ID Micr
1096 Urinary tract infection Urinary tract infections are most common in women and are typically caused by enteric pathogens. Escherichia coli is the leading pathogen. Renal, Urinary & Electrolytes Microbiology 12
(RE) (Micr) RE Micr
1097 Acute diarrhea Enterohemorrhagic Escherichia coli (EHEC) is primarily contracted after eating undercooked ground beef. EHEC produces Shiga toxin, which causes hemorrhagic colitis and can lead to hemolytic uremic Hematology & Oncology (HO) Microbiology 13
syndrome (HUS). HUS is characterized by acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia; children age <10 are at greatest risk. (Micr) HO Micr
1098 Acute diarrhea Shiga-like tox (Vero cytotox), prod by EHEC, are nearly identical to the Shiga tox prod by S. dysenteriae. They inhib the 60S ribosomal subunit in human cells, thereby blocking protein synth by Gastrointestinal & Nutrition (GI) Microbiology 13
preventing binding of tRNA. (Micr) GI Micr
1099 Acute diarrhea Traveller's diarrhoea is most freq due to ETEC. This pathogen produces plasmid-encoded, heat-labile (LT, choleragen-like) and heat-stable (ST) enterotoxins. LT activates adenylate cyclase, leading to ↑ Infectious Diseases (ID) Microbiology 13
intracellular cAMP; ST activates guanylate cyclase leading to ↑ intracellular cGMP. Both cause water and electrolyte loss and watery diarrhoea. (Micr) ID Micr
1100 Acute diarrhea EHEC O157:H7 infec is a common cause of bloody diarrhea and can lead to HUS. It’s a/w consumption of undercooked ground beef and elabs a Shiga-like tox capable of inhib protein synth in colonic Gastrointestinal & Nutrition (GI) Microbiology 13
mucosal cells and renal endothelial cells. This particular strain of E. coli is unable to ferment sorbitol and doesn’t prod a glucuronidase. (Micr) GI Micr
1101 Pertussis B. anthracis oedema factor is an adenylate cyclase that ↑ intracellular cAMP, leading to neutrophil and macrophage dysfxn and tissue oedema. This MOA is similar to that of adenylate cyclase toxin, Infectious Diseases (ID) Microbiology 3
produced by B. pertussis. (Micr) ID Micr
1102 Otitis media Nontypeable strains of Haemophilus influenzae are part of the normal upper respiratory tract flora and are a common cause of acute otitis media, sinusitis, and bronchitis. Because nontypeable strains do Ear, Nose & Throat (EN) Microbiology 1
not form a polysaccharide capsule, immunity is not conferred by vaccination with the H influenzae type b vaccine. (Micr) EN Micr
1103 Meningitis The Hib vax induces anticapsular Abs that facilitate complement-mediated phagocytosis of the bacterium. The vax series has drastically ↓ the incidence of invasive disease caused by Hib, such as Infectious Diseases (ID) Microbiology 17
meningitis, bacteremia, pneumonia, and epiglottitis. (Micr) ID Micr
1104 Folate antimetabolites TMP, MTX, and pyrimethamine inhib DHFR. TMP restricts bacterial growth thru this process, and works particularly well in conjunction w/ sulphonamide, which inhibs an earlier step in the bacterial Infectious Diseases (ID) Pharmacology 1
vitB9 pathway. (Phar) ID Phar
1105 Bullous pemphigoid BP is characterised by auto-Abs against hemidesmosomes along the BM of the DEJ. This causes the entire epidermis to separate from the dermis, forming tense, subepidermal blisters. Dermatology (DE) Pathology (Path) 1 DE Path
1107 Child abuse Physicians should contact CPS immediately if there is suspicion of child abuse. Social Sciences (SS) Behavioral 2
Science (Beha) SS Beha
1108 Dyslipidemia Xanthomas are suggestive of hyperlipidaemia, esp. when present in conjunction w/ a FHx of early cardiac death. Dermatology (DE) Pathology (Path) 11 DE Path
1109 Fibroadenoma breast Fibroadenomas are the most common benign tumor of the breast. They are characterized histologically by a cellular or myxoid stroma that encircles and sometimes compresses epithelium lined glandular Female Reproductive & Breast Pathology (Path) 1
and cystic spaces. (FR) FR Path
1110 Vitiligo Vitiligo is a common condition characterised by the loss of epidermal melanocytes. It occurs more commonly in pts w/ autoimmune disorders (e.g. autoimmune thyroiditis, DM-1) and results in well- Dermatology (DE) Pathology (Path) 1
defined, variably sized patches of hypopigmentation. DE Path
1111 Dermatitis herpetiformis DH is characterised by erythematous pruritic papules, vesicles, and bullae that appear bilaterally and symmetrically on the extensor surfaces. DH is strongly a/w coeliac disease. Dermatology (DE) Pathology (Path) 1 DE Path
1112 Seborrheic keratosis SK is a common epidermal tumour that presents as a tan or brown, round lesion w/ a well-demarcated border and 'stuck-on' appearance. Micro Ex shows small cells resembling basal cells, w/ Dermatology (DE) Pathology (Path) 2
pigmentation, hyperkeratosis, and keratin-containing cysts. Rapid onset of numerous lesions is often a/w internal malignancy (Leser-Trelat sign). DE Path
1113 Melanoma Melanoma often has an early horizontal growth phase w/ low mets potential f/b a nodular, vertical growth phase w/ a significantly ↑ risk of mets. Depth of invasion (Breslow thickness) is the most Dermatology (DE) Pathology (Path) 6
important prognostic indicator in malignant melanoma. DE Path
1114 Urticaria Urticaria is a transient HS disorder characterised by pruritic erythematous plaques that arise suddenly and resolve over hrs. They're most often caused by IgE-mediated degranulation of mast cells, leading Dermatology (DE) Pathology (Path) 2
to ↑ permeability of the microvasculature w/ oedema of the superficial dermis. DE Path
1115 Contact dermatitis Acute ACD is caused by an HS-IV (delayed) rxn to an Ag on the skin surface. Gross findings incl erythematous, papulovesicular, weeping lesions. Histo is characterised by spongiosis, an accumulation of Dermatology (DE) Pathology (Path) 2
oedema fluid in the intercellular spaces of the epidermis. W/ chronic exposure, lesions become less oedematous, w/ thickening of the stratum spinosum and stratum corneum. DE Path
1116 Psoriasis Common complications of psoriasis incl psoriatic arthritis, nail changes, and uveitis. Dermatology (DE) Pathology (Path) 5 DE Path
1117 Psoriasis Psoriasis is characterised by hyperkeratosis and confluent parakeratosis of the stratum corneum, and epidermal hyperplasia (acanthosis) w/ elongated rete ridges. Neutrophilic foci in the stratum corneum Dermatology (DE) Pathology (Path) 5
and epidermis may coalesce to form microabscesses (Munro microabscesses). DE Path
1118 Phosphodiesterase inhibitors ANP, BNP, and NO activate guanylyl cyclase and ↑ conversion of GTP to cGMP. PDEIs (e.g. sildenafil) ↓ the degradation of cGMP. ↑ intracellular cGMP lvls lead to relaxation of vascular smooth Cardiovascular (CV) Pharmacology 1
muscle and vasodilation. (Phar) CV Phar
1119 Principles of cell biology Cellular compartmentalisation allows multi bch processes to occur simultaneously at max efficiency. β-oxidation of FAs, the TCA cycle, and the carboxylation of pyruvate (GNG) all occur w/i the Endocrine, Diabetes & Biochemistry 1
mitochondria. The enzymes responsible for glycolysis, FA synthesis, and the PPP reside in the cytosol. Metabolism (ES) (Bioc) ES Bioc
1120 Peroxisomal disorders The buildup of very long chain and branched-chain (e.g. phytanic) FAs due to impaired oxidation is the hallmark of peroxisomal disorders (e.g. Zellweger syndrome, adrenoleukodystrophy). Nervous (NS) Biochemistry 1
Accumulation of these FAs in the brain results in permanent neuro dysfxn. (Bioc) NS Bioc
1121 Diabetes mellitus Insulin is an anabolic hormone that acts via RTK signalling to ↑ the synthesis of glycogen, proteins, FAs, and NAs. Tyrosine kinase/PI3K stim promotes glycogen synthesis by activating protein Endocrine, Diabetes & Biochemistry 31
phosphatase, an enzyme that dephosphorylates (activates) glycogen synthase. Metabolism (ES) (Bioc) ES Bioc
1122 Signal transduction The phosphoinositol 2nd messenger system begins w/ ligand-receptor binding and Gq-protein activation leading to activation of PLC. PLC then hydrolyzes PIP2 and forms DAG and IP3. Finally, IP3 Miscellaneous (Multisystem) Biochemistry 1
activates PKC via an ↑ in intracellular Ca2+. (MS) (Bioc) MS Bioc
1123 Physician patient communication Physicians are frequently asked to evaluate whether a pt is entitled to disability benefits. When interacting w/ demanding pts, it is best to explain that the physician has a responsibility to perform a Social Sciences (SS) Behavioral 11
thorough Ax prior to making this determination. Science (Beha) SS Beha
1124 Decision making capacity When pts are unable to make their wishes known and there is no written documentation of them, the responsibility for medical decision-making falls to their designated health care proxy. If a pt has not Social Sciences (SS) Behavioral 5
designated a surrogate decision maker, medical decisions default to the NOK. In the case of a married person, the NOK is usually the spouse. Science (Beha) SS Beha
1125 Ethical principles in healthcare Consent of a married or unmarried significant other is not required for a pt to undergo any type of procedure, including sterilization. Physicians should counsel the pt regarding the risks and benefits of, Social Sciences (SS) Behavioral 3
and alternatives to, any procedure or Tx. Science (Beha) SS Beha
1126 Physician patient communication In situations in which a parent's presence may interfere w/ obtaining honest answers from an adolescent pt, physicians should politely ask the parent to wait outside and interview the pt privately. This is Social Sciences (SS) Behavioral 11
also important when discussing drugs, alcohol, tobacco, and sexual activity w/ teenagers. Science (Beha) SS Beha
1128 End of life care When pts are unable to make end-of-life decisions for themselves and no written ADs exist, responsibility for those decisions falls to the NOK. However, all surrogate medical decisions, including NOK Social Sciences (SS) Behavioral 2
decisions, must be based on the best estimation of what the pt would have wanted. Science (Beha) SS Beha
1129 Patient confidentiality Pt confidentiality is strongly protected because pts must feel free to disclose details of all aspects of their lives so that physicians can provide optimal care. Exceptions to pt confidentiality include Social Sciences (SS) Behavioral 5
suspected child, disabled person, or elder abuse; knife or gunshot wounds; Dx of a reportable communicable disease; and pts at risk of physically harming themselves or others. Science (Beha) SS Beha
1130 Selective IgA deficiency Selective IgA deficiency is the most common primary immune deficiency and can present with recurrent sinopulmonary and gastrointestinal infections as well as autoimmune disease. Patients with severe Pulmonary & Critical Care (PU) Immunology 1
IgA deficiency can have anaphylaxis during transfusion of blood products that contain small amounts of IgA. (Immu) PU Immu
1131 Hypersensitivity reactions Type 1 hypersensitivity reactions are mediated by the interaction of allergen with preexisting IgE bound to basophils and mast cells. This facilitates cross-linking of the surface IgE molecules that signals Pulmonary & Critical Care (PU) Immunology 4
the cell to degranulate releasing chemical mediators (eg, histamine, heparin). These agents are responsible for the immediate signs and symptoms of allergy, from a local wheal and flare to life threatening (Immu)
anaphylaxis. PU Immu
1132 Chediak-Higashi syndrome CHS is an AR disorder of neutrophil phagosome lysosome fusion that results in neuro abns, partial albinism, and an ID caused by defective neutrophil fxn. Allergy & Immunology (AI) Immunology 1
(Immu) AI Immu
1133 Contact dermatitis Poison ivy dermatitis is a form of allergic contact dermatitis, which is a type IV hypersensitivity reaction mediated primarily by T lymphocytes. It manifests as intensely pruritic erythematous papules, Dermatology (DE) Immunology 2
vesicles, or bullae that often form linear patterns. (Immu) DE Immu
1134 X-linked agammaglobulinemia XLA (Bruton) is caused by a defect in B cell maturation, resulting in the absence of mature B cells w/ severe defic of all Ig types. T cell # and fxn remain intact. Due to the absence of B cells, 1ary Hematology & Oncology (HO) Immunology 2
lymphoid follicles and germinal centers won't form w/i LNs. (Immu) HO Immu
1135 Acute diarrhea Shigella is a non-motile, non-lactose fermenting organism that doesn't produce H2S when grown on triple sugar Fe agar. Mucosal invasion of the M cells that overlie Peyer's patches is an essential Infectious Diseases (ID) Microbiology 13
pathogenic mech for Shigella infection. Shigella then escapes the phagosome and spreads laterally to other epithelial cells via actin polymerisation. (Micr) ID Micr
1136 Acute diarrhea Depending on the age and condition of the host and the species of Shigella, as few as 10-500 cells can cause infec. Gastrointestinal & Nutrition (GI) Microbiology 13
(Micr) GI Micr
1137 Typhoid Typhoid strains of Salmonella contain a capsular Ag (Vi) that inhibs neutrophil phagocytosis, neutrophil recruitment, and macrophage-mediated destruction. Therefore, typhoid strains are able to undergo Infectious Diseases (ID) Microbiology 2
extensive replication w/i the intracellular space of macrophages w/ subseq spread thru the lymphatic and RES, leading to a widespread systemic disease (typhoid fever). (Micr) ID Micr
1138 Typhoid Typhoid fever is caused by S. typhi or paratyphi and presents w/ escalating fever, f/b abdo pain, formation of rose spots on the chest/abdo, and hemorrhagic enteritis w/ possible bowel perforation. Infectious Diseases (ID) Microbiology 2
Humans are the only reservoir; transmission is faecal-oral and 1arily occurs due to ingestion of food or water contaminated w/ faeces. (Micr) ID Micr
1139 Urinary tract infection E coli is one of the dominant components of the normal flora in the intestinal tract of humans and animals. It causes approximately 80% of all UTIs. P fimbriae are the most important VF that UPEC Infectious Diseases (ID) Microbiology 12
express. W/o P fimbriae, E coli would not be able to bind to uroepithelial cells and infect the bladder, ureters, and kidneys. Instead, the bacteria would simply be washed away during urination. (Micr) ID Micr
1140 Neonatal sepsis E. coli is a freq cause of neonatal meningitis, 2nd only to GBS. E. coli strains that cause neonatal meningitis possess the K1 capsular Ag. The K1 capsule is a VF that allows the bacteria to survive in the Nervous (NS) Microbiology 1
bloodstream and establish meningeal infection. (Micr) NS Micr
1141 Septic shock Gram (-) sepsis is caused by the release of LPSs from bacterial cells during cell division or bacteriolysis. Lipid A is the toxic component of LPSs and induces the widespread release of IL-1 and TNF-α Infectious Diseases (ID) Microbiology 6
from activated macrophages. These cytokines cause the SSx of septic shock (eg, fever, hypotension, organ dysfunction). (Micr) ID Micr
1142 Urinary tract infection Escherichia coli is the most common cause of UTI in both healthy adults and elderly pts. E coli is a part of the normal GI flora, and special adhesive proteins (fimbriae) allow some strains to colonize and Infectious Diseases (ID) Microbiology 12
ascend the urinary tract. This can result in UTI, pyelonephritis, or bacteremia and sepsis following access to the bloodstream. UTIs are the most common cause of E coli bacteremia. (Micr) ID Micr
1143 Acute diarrhea Shigellosis is an infectious disease that can be caused by a variety of Shigella species; S. sonnei is the most common cause of shigellosis in industrialised nations. Shigella invades the GI mucosa by Gastrointestinal & Nutrition (GI) Pathology (Path) 13
gaining access to microfold cells in ileal Peyer patches thru endocytosis. Shigella subseq lyses the endosome and spreads laterally into other epithelial cells, causing cell death and ulceration w/
hemorrhage and diarrhoea. GI Path
1144 Treatment adherence Physicians should use a nonjudgmental, pt-centered approach in discussing Tx nonadherence. Acknowledging the difficulty of taking Rx regularly can strengthen the therapeutic alliance, potentially Endocrine, Diabetes & Behavioral 5
improving pt receptiveness to educational efforts. Metabolism (ES) Science (Beha) ES Beha
1145 Physician patient communication Delivering bad news effectively requires determining the pt's perception of the situation, providing appropriate details in an empathic manner, and allowing the pt time to react emotionally and express Social Sciences (SS) Behavioral 11
concerns. Empathic, supportive communication should be directed at understanding the pt's wishes and beliefs while maintaining cultural and religious sensitivity. Science (Beha) SS Beha
1146 Urinary tract infection Pseudomonas aeruginosa is an oxidase (+), non-lactose-fermenting, Gram (-) organism. It is a common cause of UTIs in pts w/ indwelling bladder catheters. Renal, Urinary & Electrolytes Microbiology 12
(RE) (Micr) RE Micr
1147 Sarcoidosis Sarcoidosis is an inflammatory disorder characterised histologically by NCGs consisting of aggregates of epithelioid macrophages and multinucleated giant cells. Common MFxs incl hilar adenopathy, Pulmonary & Critical Care (PU) Pathology (Path) 7
pulm infiltrates, skin rash, ophthalmic findings, and constitutional SSx. PU Path
1148 Primary hypertension Common AEs of ACEIs incl decr GFR, hyperkalemia, and cough. Angioedema is a rare, but life-thr, AE. Renal, Urinary & Electrolytes Pharmacology 14
(RE) (Phar) RE Phar
1149 Peroneal neuropathy The common peroneal nerve is susceptible to injury at the lateral neck of the fibula caused by compression or fracture. Pts often have weakness on foot dorsiflexion ('foot drop') and eversion, as well as Nervous (NS) Anatomy (Anat) 3
toe extension. Sensory loss typically occurs over the lateral leg and dorsolateral foot. NS Anat
1150 Meningiomas Meningiomas are common adult intracranial tumours that typically arise in regions of dural reflection (e.g. falx cerebri, tentorium cerebelli). Parasagittal lesions compressing the medial portion of the 1° Nervous (NS) Anatomy (Anat) 2
somatosensory cortex in the parietal lobe can result in contralateral lower limb sensory loss along w/ contralateral hemineglect if there's also dmg to the parietal assoc cortex (non-dom hemisphere). NS Anat
1151 Meningiomas Meningiomas are slow-growing, well-circumscribed, benign intracranial tumors typically found at the cerebral convexities in adults. Chx histopathologic features include a whorled pattern of cellular Nervous (NS) Pathology (Path) 2
growth that forms nests, which may calcify into round, eosinophilic laminar structures called psammoma bodies. NS Path
1152 Craniopharyngiomas Craniopharyngiomas are suprasellar tumours found in children and composed of calcified cysts containing chol crystals. They arise from remnants of Rathke's pouch, an embryonic precursor of the Nervous (NS) Pathology (Path) 2
anterior pituitary. NS Path
1153 Brain tumors A cystic tumor in the cerebellum of a child is most likely a pilocytic astrocytoma. Biopsy will show a well-differentiated neoplasm comprised of spindle cells with hair-like glial processes that are Nervous (NS) Pathology (Path) 10
associated with microcysts. These cells are mixed with Rosenthal fibers and granular eosinophilic bodies. NS Path
1154 Lymphogranuloma venereum C. trachomatis serotypes L1 thru L3 cause LGV, an STD characterised initially by painless ulcers w/ later progr to painful inguinal LAD ('buboes') and ulceration. Chlamydial inclusion bodies are seen in Infectious Diseases (ID) Microbiology 1
host cell cytoplasm. (Micr) ID Micr
1155 Calcineurin inhibitors Calcineurin is an essential protein in the activation of IL-2, which promotes the growth and diff of T cells. Immsups such as cyclosporine and tacrolimus work by inhib calcineurin activation. Allergy & Immunology (AI) Immunology 1
(Immu) AI Immu
1156 Lead poisoning Pb pois in adults typically occurs thru occup exposure. SSx incl colicky abdo pain, constipation, Pb lines on the gum, peri neuropathy, and anemia. LFx shows microcytic anemia w/ normal Fe studies, and Hematology & Oncology (HO) Pathophysiology 4
PBS may reveal basophilic stippling. (Patp) HO Patp
1158 Ovarian cancer Granulosa cell tumors are sex-cord stromal tumors of the ovary that secrete estrogen and can cause endometrial hyperplasia. Call-Exner bodies (cells arranged in a microfollicular or rosette pattern) are Female Reproductive & Breast Pathology (Path) 9
seen on microscopy. On gross pathology, the tumor appears yellow due to the lipid content in theca cells. (FR) FR Path
1159 Osteocyte connections Osteocytes have long intracanalicular processes that extend through the ossified bone matrix. These cytoplasmic processes send signals to and exchange nutrients and waste products with the osteocytes Rheumatology, Orthopedics & Histology (Hist) 1
within neighboring lamellae via gap junctions. Osteocytes can sense mechanical stresses and send signals to modulate the activity of surface osteoblasts, thereby helping to regulate bony remodeling. Sports (RH) RH Hist
1160 Keratin as a marker Keratin is a marker of epithelial cell origin. Hematology & Oncology (HO) Pathology (Path) 1 HO Path
1161 Urinalysis ADH acts on the medullary segment of the CD to ↑ urea and water reabsorption, allowing for the production of max concentrated urine. Renal, Urinary & Electrolytes Physiology 2
(RE) (Phys) RE Phys
1163 Cushing syndrome ACTH is the major trophic hormone of the ZF and ZR, whereas the ZG is 1arily regulated by ATII. Excess production of ACTH causes ↑ cortisol synthesis w/i the ZF (Cushing's MFxs) and ↑ androgen Endocrine, Diabetes & Pathophysiology 5
production w/i the ZR (irregular menstruation, hirsutism is women). Metabolism (ES) (Patp) ES Patp
1164 Sympathomimetic agents Blanching of a vein into which NE is being infused together w/ induration and pallor of the tissues surrounding the IV site are signs of NE extravasation and resulting vasoconstriction. Tissue necrosis is Cardiovascular (CV) Pharmacology 5
best prevented by local injection of an α1 blocking drug, such as phentolamine. (Phar) CV Phar
1165 Phencyclidine PCP is 1arily an NMDA receptor antagonist, w/ lesser effects on the reuptake inhib of biogenic amines and other receptors. It can have dissociative and anaesthetic effects but may also cause psychosis Pregnancy, Childbirth & Behavioral 2
and severe agitation, leading to violent trauma. Ataxia, horizontal and vertical nystagmus, and memory loss can also be present. Puerperium (PR) Science (Beha) PR Beha
1166 ACE inhibitors ACEIs and ARBs ↓ the risk of CKD in pts w/ HTN and DM. ACEIs ↑ lvls of bradykinin and can cause nonproductive cough, an effect not see w/ ARBs. Cardiovascular (CV) Pharmacology 7
(Phar) CV Phar
1167 Wilson disease WD (hepatolenticular degen) is an AR condition of excess Cu leading to toxic accumulation in the liver, basal ganglia, and cornea. Chelation Thx w/ D-penicillamine is indicated to remove excess loosely Nervous (NS) Pathophysiology 5
bound serum Cu. (Patp) NS Patp
1168 Gout Colchicine is a 2nd-line agent for treating acute gouty arthritis. It inhibits tubulin polymerization and microtubule formation in leukocytes, ↓ neutrophil chemotaxis and emigration to sites inflamed by Rheumatology, Orthopedics & Pharmacology 11
tissue deposition of monosodium urate crystals. GI mucosal fxn is also impaired by microtubule disruption, leading to diarrhea and, less commonly, nausea, vomiting, and abdominal pain. Sports (RH) (Phar) RH Phar
1169 Positive predictive value (+) and (-) predictive values depend on disease prevalence in the tested pop. The sens and spec of a Dx test aren’t affected by disease prevalence. Gastrointestinal & Nutrition (GI) Biostatistics 1
(Bios) GI Bios
1170 Bias Lead-time bias occurs when a new test Dx a condition earlier than conventional studies, causing an apparent ↑ in survival time despite no improvement in overall mortality. Long-term mortality rates, not Biostatistics & EpInfectious Biostatistics 4
survival times, should be considered for measuring the effect of early screening and Tx. Diseases (ID)emiology (BS) (Bios) BS Bios
1171 Risk, rate, prevalence, and Incident cases represent new cases Dx in a given period of time. Prevalent cases are the total number of cases (both old and new) at a particular point in time. Any Tx that prolongs survival but does not Biostatistics & EpInfectious Biostatistics 3
incidence cure the disease will ↑ prevalence due to an ↑ in the number of afflicted (but still living) individuals over time. Diseases (ID)emiology (BS) (Bios) BS Bios
1172 Normal distribution In a normal (bell-shaped) distribution curve, 68% of observations lie w/i 1 SD of the mean, 95% of observations lie w/i 2 SDs of the mean, and 99.7% of observations lie w/i 3 SDs of the mean. Biostatistics & EpInfectious Biostatistics 3
Diseases (ID)emiology (BS) (Bios) BS Bios
1173 Confounding, effect modification, Confounding occurs when the exposure-disease relationship is muddled by the effect of an extraneous factor a/w both exposure and disease. Confounding bias can result in the false association of an Biostatistics & EpInfectious Biostatistics 3
bias, errors exposure w/ a disease. Diseases (ID)emiology (BS) (Bios) BS Bios
1174 Number needed to treat The NNT is the number of pts that need to be Tx w/ a Rx to avoid an additional (-) outcome. NNT is calculated by dividing 1 by the ARR (the difference b/w the control and experimental group event Biostatistics & EpInfectious Biostatistics 2
rates). Lower NNT values represent more beneficial Tx. Diseases (ID)emiology (BS) (Bios) BS Bios
1175 Risk ARR = event rate in the control group - event rate in the Tx group. Biostatistics & EpInfectious Biostatistics 6
1176 Risk RRR = (absolute risk [control] - absolute risk [Tx]) / absolute risk [control]. Biostatistics & EpInfectious Biostatistics 6
1177 Sensitivity, specificity, positive Sensitivity = true positives / (true positives + false negatives). Screening tests should have high sensitivity. Biostatistics & EpInfectious Biostatistics 4
predictive value PPV, negative Diseases (ID)emiology (BS) (Bios)
predictive value NPV BS Bios
1178 Sensitivity, specificity, positive The specificity of a test is its ability to correctly identify individuals w/o the disease. Specificity should be high in confirmatory tests to ↓ FPs. Biostatistics & EpInfectious Biostatistics 4
1179 Decision making capacity Capacity to refuse Tx requires the ability to express a choice, understand the relevant medical information, appreciate the consequences of Tx options, and offer a rationale for the decision. Pts w/ Social Sciences (SS) Behavioral 5
decision-making capacity have the right to refuse any medical Tx. Science (Beha) SS Beha
1181 Professional conduct Physicians are ethically obligated to inform pts of medical errors, regardless of whether harm has occurred. Disclosure should be timely and accompanied by an explanation of what happened and an Social Sciences (SS) Behavioral 3
apology. Science (Beha) SS Beha
1182 Ethical principles in healthcare Pts have the right to make decisions about their healthcare. However, based on the principle of non-maleficence, the prescription of Rx likely to do more harm than good should be avoided, even if Pregnancy, Childbirth & Behavioral 3
requested by pts. Puerperium (PR) Science (Beha) PR Beha
1183 Central tendency (mean, median, An outlier is defined as an extreme and unusual observed value in a dataset. It can affect measures of central tendency (mean, median, mode) as well as measures of dispersion (SD, variance). Modes tend Biostatistics & EpInfectious Biostatistics 2
mode, outliers) to be resistant to outliers. Diseases (ID)emiology (BS) (Bios) BS Bios
1184 Statistical tests A 2x2 table is normally used to record the presence or absence of exposure and disease in research. Rows and columns represent the different levels for each categorical (ie, exposure and disease) variable. Biostatistics & EpInfectious Biostatistics 2
The chi-square test for independence is used to evaluate the association b/w 2 categorical variables. Diseases (ID)emiology (BS) (Bios) BS Bios
1185 Risk Risk is the probability of developing a disease over a certain period of time. To calculate this probability, divide the number of affected subjects by the total number of subjects in the corresponding Biostatistics & EpInfectious Biostatistics 6
exposure group. Diseases (ID)emiology (BS) (Bios) BS Bios
1186 Risk The attributable risk percent (ARP) in the exposed represents the excess risk in the exposed population that can be attributed to the risk factor. It can be easily derived from the relative risk (RR) using the Biostatistics & EpInfectious Biostatistics 6
formula: ARP exposed = 100 [(RR - 1)/RR). Diseases (ID)emiology (BS) (Bios) BS Bios
1187 Risk, rate, prevalence, and Prevalence equals the incidence rate multiplied by the average disease duration. Changing disease prevalence in a steady-state population w/ a constant incidence rate means that there is an additional Biostatistics & EpInfectious Biostatistics 3
incidence factor affecting the duration of the condition. A factor that prolongs disease duration (eg, improved quality of care) will ↑ disease prevalence, as affected pts survive longer. Diseases (ID)emiology (BS) (Bios) BS Bios
1188 Confounding, effect modification, In prospective studies, disproportionate loss to f/u b/w the exposed and unexposed groups creates the potential for attrition bias, which is a form of selection bias. As a result, investigators generally try to Biostatistics & EpInfectious Biostatistics 3
bias, errors achieve high pt f/u rates in prospective studies. Diseases (ID)emiology (BS) (Bios) BS Bios
1189 Matching Matching is used in case-control studies in order to control confounding. Matching variables should always be the potential confounders of the study (eg, age, race). Cases and controls are then selected Biostatistics & EpInfectious Biostatistics 1
based on the matching variables so that both groups have a similar distribution in accordance w/ the variables. Diseases (ID)emiology (BS) (Bios) BS Bios
1190 Predictive values NPV is the probability of not having a disease when the test result is (-). The NPV will vary w/ the pretest probability of a disease. A pt w/ a high probability of having a disease will have a low NPV w/ a General Principles (GP) Biostatistics 3
(-) test, but a pt w/ a low probability of having a disease will have a high NPV w/ a (-) test. (Bios) GP Bios
1191 Quantitative diagnostic tests The cutoff value of a quantitative Dx test determines whether a given result is interpreted as (+) or (-). Lowering the cutoff point typically causes more pts w/ the disease to test (+), ↓ the number of FNs Biostatistics & EpInfectious Biostatistics 1
and ↑ test sensitivity. Consequently, more pts w/o the disease will also test (+), resulting in an ↑ number of FPs and ↓ specificity. Diseases (ID)emiology (BS) (Bios) BS Bios
1192 Sensitivity, specificity, positive The PPV of a test answers the question: If the test result is (+), what is the probability that a pt has the disease? PPV = TPs / (TPs + FPs). Biostatistics & EpInfectious Biostatistics 4
1193 Bipolar disorder Lithium and the anticons valproate, carbamazepine, and lamotrigine are mood-stabilising agents used in BD. Valproate is commonly used in the Tx of gen as well as myoclonic seizures. Pregnancy, Childbirth & Pharmacology 7
1194 Venous thromboembolism Heparins are ideal anticoagulants for most patients with thromboembolic disease in pregnancy as they do not cross the placenta and therefore the risk of fetal bleeding or teratogenicity is low. Low Pulmonary & Critical Care (PU) Pharmacology 2
molecular weight heparin (eg, enoxaparin) is the preferred therapy, with patients transitioned to unfractionated heparin at term. (Phar) PU Phar
1195 Mucocutaneous candidiasis Nystatin is a polyene antifungal and the Rx of choice for oropharyngeal candidiasis in pts w/o advanced immunodeficiency. It acts by binding to ergosterol in the fungal cell membrane, causing the Ear, Nose & Throat (EN) Pharmacology 3
formation of pores and leakage of fungal cell contents. Nystatin is not absorbed from the GIT and is administered as an oral "swish and swallow" agent. (Phar) EN Phar
1196 Myocardial infarction β blockers are used in AMI to ↓ morbidity and mortality by ↓ CO and myocardial O2 demand. Non-cardioselective β blockers (e.g. propranolol, nadolol) can trigger bronchospasm in pts w/ underlying Cardiovascular (CV) Pharmacology 18
asthma and COPD. Cardioselective β blockers (e.g. metoprolol) predominantly affect β1 receptors and are preferred in such pts. (Phar) CV Phar
1197 Antiepileptics Gingival hyperplasia is a common side effect of phenytoin and is sometimes reversible when phenytoin is withdrawn. Phenytoin causes increased expression of platelet-derived growth factor (PDGF). Nervous (NS) Pharmacology 3
When gingival macrophages are exposed to increased amounts of PDGF, they stimulate proliferation of gingival cells and alveolar bone. Phenytoin toxicity mainly affects the cerebellum and vestibular (Phar)
system, causing ataxia and nystagmus. NS Phar
1198 Diabetic foot Piperacillin-tazobactam is a combo of extended-spectrum penicillin w/ β-lactamase inhib. It's effective against most gram (-) enteric rods (incl P. aeruginosa) and against B. fragilis. Infectious Diseases (ID) Pharmacology 2
(Phar) ID Phar
1199 Trigeminal neuralgia The first-line treatment for trigeminal neuralgia is carbamazepine, a neuroleptic medication that inhibits neuronal high-frequency firing by reducing the ability of sodium channels to recover from Nervous (NS) Pharmacology 2
inactivation. Carbamazepine can cause bone marrow suppression; therefore, complete blood cell counts should be monitored periodically. (Phar) NS Phar
1200 Anticoagulants Warfarin is an oral anticoagulant that inhibits the carboxylation of vitamin K-dependent coagulation factors II, VII, IX, and X. It is used in AF, DVT, and pulm TE. PT/INR should be monitored regularly Cardiovascular (CV) Pharmacology 8
during Tx w/ warfarin. aPTT is used for monitoring UFH. (Phar) CV Phar
1201 Normal distribution In a normal (bell-shaped) distribution: 68% of all values are w/i 1 SD from the mean; 95% of all values are w/i 2 SDs from the mean; 99.7% of all values are w/i 3 SDs from the mean. Biostatistics & EpInfectious Biostatistics 3
1202 Study designs Selection of control subjects in case-control studies is intended to provide an accurate estimation of exposure frequency among the non-diseased general population. Cases and controls should be selected Biostatistics & EpInfectious Biostatistics 6
based on disease status, not exposure status. Diseases (ID)emiology (BS) (Bios) BS Bios
1203 Prospective cohort study Prospective cohort studies are organized by selecting a group of individuals (i.e., cohort), determining their exposure status, and then following them over time for development of the disease of interest. Hematology & Oncology (HO) Biostatistics 1
(Bios) HO Bios
1204 Power and sample size The power of a study indicates the probability of seeing a difference when there is one. The formula is Power = 1- β, where β is the type II error rate. Biostatistics & EpInfectious Biostatistics 3
1205 Odds ratio The odds ratio (OR) is a measure of the strength of an association between an exposure and an outcome. Specifically, it represents the odds that an outcome occurred in the presence of a particular Biostatistics & EpInfectious Biostatistics 2
exposure compared with the odds that the outcome occurred in the absence of that exposure. In a standard contingency table, OR = ad/bc. Diseases (ID)emiology (BS) (Bios) BS Bios
1206 Prevalence and incidence According to 2019 estimates, the most common cancers (excluding basal and squamous cell skin cancer) in women by order of incidence are breast, lung, and colorectal cancer. In terms of mortality, lung Hematology & Oncology (HO) Biostatistics 3
cancer claims the most lives, followed by breast and colorectal cancer. (Bios) HO Bios
1207 Risk The RR represents the risk of an outcome in the exposed divided by the risk of that outcome in the unexposed. Applying the correct formula for RR calculations depends on the proper formatting of a 2x2 Biostatistics & EpInfectious Biostatistics 6
(contingency) table. Diseases (ID)emiology (BS) (Bios) BS Bios
1208 Morbidity and mortality rates Case-fatality rate is calculated by dividing the number of fatal cases of a disease or condition by the total number of people w/ that disease or condition. Biostatistics & EpInfectious Biostatistics 1
1209 Urinary tract infection The average (or mean) of a dataset of values is the sum of the values divided by the total number of values. Biostatistics & EpInfectious Biostatistics 12
1210 Correlation coefficient The correlation coefficient (r) ranges from -1 to +1 and describes the strength and polarity of a linear association. Biostatistics & EpInfectious Biostatistics 1
1211 Urinary retention Postop urinary retention, w/ incomplete bladder emptying, is a common complication thought to involve decr micturition reflex activity, decr contractility of the bladder detrusor, a/o incr vesical sphincter Renal, Urinary & Electrolytes Pharmacology 4
tone. This condition may be Tx w/ a musc ag (bethanechol) or an alpha1 blocking drug. (RE) (Phar) RE Phar
1212 Neuromuscular blocker Succinylcholine is a fast-acting, depolarizing neuromuscular blocking agent used for rapid-sequence intubation that causes equal reduction of all 4 twitches during train-of-four stimulation (phase I Pulmonary & Critical Care (PU) Pharmacology 1
blockade). Prolonged administration of succinylcholine or use in patients with abnormal plasma cholinesterase activity causes transition to a phase ll (nondepolarizing) block, seen as a progressive (Phar)
reduction in each of the 4 twitches. PU Phar
1213 Hyperthyroidism Hyperthyroidism causes upregulation of β-adrenergic receptor expression, leading to ↑ catecholamine effect. β blockers are used to blunt the adrenergic MFxs of hyperthyroidism. In addn, lipid-soluble β Endocrine, Diabetes & Pharmacology 8
blockers ↓ conversion of T4 to T3 by inhib 5'-monodeiodinase in peri tissues. Metabolism (ES) (Phar) ES Phar
1214 Atopic dermatitis Local cutaneous adverse effects of chronic topical corticosteroid administration include atrophy/thinning of the dermis that is associated with loss of dermal collagen, drying, cracking, and/or tightening of Dermatology (DE) Pharmacology 2
the skin, telangiectasias, and ecchymoses. (Phar) DE Phar
1215 Tuberculosis The acid-fast stain IDs organisms that have mycolic acid present in their cell walls, incl Mycobacterium and some Nocardia species. Acid-fast staining is carried out by applying an aniline dye (e.g. Pulmonary & Critical Care (PU) Microbiology 18
carbolfuchsin) to a smear and then decolourising w/ acid alcohol to reveal whether the organisms present are 'acid fast'. (Micr) PU Micr
1216 Tuberculosis M. tuberculosis grows in long, serpentine cords due to the presence of cord factor, a surface glycolipid, on the cell wall. Cord factor is a 1° VF of M. tuberculosis; it prevents macrophages from being Pulmonary & Critical Care (PU) Microbiology 18
bactericidal due to the inhib of phagolysosome acidification and also leads to the formation of CGs. (Micr) PU Micr
1217 Tuberculosis 1° Tb infection is marked by initial unchecked M. tuberculosis replication w/i the alveolar space and alveolar macrophages. after a few wks, CD4 lymphocytes are stim to release IFN-γ, which activates Pulmonary & Critical Care (PU) Microbiology 18
macrophages and leads to control of the infection. (Micr) PU Micr
1218 Tuberculosis Mycobacteria tuberculosis primarily replicates w/i the phagosome, leading to display of mycobacterial Ags on MHC-II molecules. This results in the activation of CD4 cells and subsequent control of the Pulmonary & Critical Care (PU) Immunology 18
infection w/ macrophages. (Immu) PU Immu
1219 Tuberculosis 1° TB causes the formation of Ghon foci in the lower lungs. 2° (reactivation) TB occurs in pts w/ prior TB infection that never cleared completely. Reactivation TB occurs most often in Pulmonary & Critical Care (PU) Pathology (Path) 18
immunosuppressed pts and is characterised by apical cavitary lesions and hemoptysis. PU Path
1220 Tuberculosis Mycobacterium tuberculosis triggers CD4 T lymphocytes to release interferon-gamma, which leads to macrophage activation (improves intracellular killing ability) and differentiation into epithelioid Pulmonary & Critical Care (PU) Immunology 18
histiocytes. These cells, along with horseshoe-shaped, multinucleated Langhans giant cells (fused, activated macrophages) are a key component of granuloma formation. (Immu) PU Immu
1221 Tuberculosis The Ghon complex describes the 2 initial sites (lower lobe of lung, ipsilateral hilar LN) of 1° TB infection. Over time, these sites become calcified and fibrosed and can be visualised on gross pathology Pulmonary & Critical Care (PU) Pathology (Path) 18
and radiographic imaging (Ranke complex). PU Path
1222 Tuberculosis The control of Mycobacterium tuberculosis infection is primarily mediated by activated macrophages, which surround extracellular mycobacteria and wall them off within granulomas. The release of Pulmonary & Critical Care (PU) Pathology (Path) 18
digestive enzymes by these cells helps control the infection but also leads to damage of the surrounding tissue and the formation of cavitary lung lesions. PU Path
1223 Tuberculosis Mycobacterial resistance to INH can be accomplished thru non-expression of the catalase-peroxidase enzyme or thru genetic mod of the INH binding site on the mycolic acid synthesis enzymes. Infectious Diseases (ID) Microbiology 18
(Micr) ID Micr
1225 Tuberculosis Active TB is never Tx w/ Rx monotherapy due to the fast emergence of mycobacterial Abx resistance from rapid, selective gene muts. INH monotherapy may be used for pts who have a (+) PPD and a (-) Infectious Diseases (ID) Microbiology 18
CXR (i.e. no evidence of clinical disease). (Micr) ID Micr
1226 Tuberculosis The rifamycins block the action of the bacterial DNA-dependent RNA polymerase, thereby inhib transcription. Resistance is acq by mod of the rifampin binding site on the bacterial DNA-dependent RNA Infectious Diseases (ID) Pharmacology 18
polymerase. Common AEs incl hepatotox, blood dyscrasias, and harmless red-orange discolouration of body fluids. (Phar) ID Phar
1228 Tuberculosis Ethambutol can cause optic neuropathy that results in colour blindness, central scotoma, and ↓ visual acuity. This AE may be reversed w/ discontinuation of the drug. Infectious Diseases (ID) Pharmacology 18
(Phar) ID Phar
1229 Sensitivity and specificity When undergoing Dx testing, pts w/ the disease can test (+) (true (+), TP) or (-) (false (-), FN). The sensitivity of a test determines the proportion of pts that are correctly classified: Cardiovascular (CV) Biostatistics 4
TP = (Sensitivity) x (Number of pts w/ the disease) (Bios)
FN = (1 - Sensitivity) x (Number of pts w/ the disease) CV Bios
1230 Sensitivity and specificity Specificity is the number of TNs divided by the total number of subjects confirmed as not having the disease. TNs = (Specificity) * (Number of pts confirmed w/o the disease). FPs = (1 - Specificity) * Biostatistics & EpInfectious Biostatistics 4
(Number of pts confirmed w/o the disease). Diseases (ID)emiology (BS) (Bios) BS Bios
1231 Number needed to treat The NNH represents the number of people who must be Tx before 1 additional adverse event occurs. In order to calculate NNH, the absolute risk ↑ b/w the Tx and control groups must be known: NNH = Biostatistics & EpInfectious Biostatistics 2
1 / Absolute risk ↑. Diseases (ID)emiology (BS) (Bios) BS Bios
1232 Sensitivity, specificity, positive PPV represents the probability of truly having a disease given a (+) test result. It ↑ w/ ↑ disease prevalence and ↓ w/ ↓ disease prevalence. Biostatistics & EpInfectious Biostatistics 4
1233 Predictive values Negative predictive value (NPV) represents the probability of not having a disease given a negative test result. NPV is inversely proportional to the prevalence of a disease. When a patient has Biostatistics & EpInfectious Biostatistics 3
characteristics similar to the overall population (eg, age, sex, risk factor status), the disease prevalence is a valid estimate of the pretest probability of disease. Diseases (ID)emiology (BS) (Bios) BS Bios
1234 Defense mechanisms In displacement, emotions are transferred from the person causing the (-) emotions to a more neutral, less threatening person or object. Pregnancy, Childbirth & Behavioral 8
1235 Advance directives The admission process should include discussion of ADs and code status to ensure that medical personnel adhere to the pt's specific wishes in the event that the pt becomes incapacitated. Social Sciences (SS) Behavioral 3
1237 Requests to withhold information Patients have the right to have information withheld from them regarding their medical condition. Physicians must respect their wish not to know, but should also explore the patient concerns to better Social Sciences (SS) Behavioral 1
understand their preferences and maximize their involvement in subsequent medical decision making. Science (Beha) SS Beha
1239 Professional disagreements among When treating patients who have been referred for specialty care or a second opinion, it is imperative to not undermine the patient's relationship with the primary physician. A physician should avoid Social Sciences (SS) Behavioral 1
providers making negative comments about the quality of care rendered by that practitioner unless practices are imminently dangerous or far outside acceptable standards of care. Science (Beha) SS Beha
1240 Carbon monoxide poisoning CO binds heme Fe in Hb w/ an affinity much greater than O2, generating HbCO. Remaining binding sites on HbCO have an incr. affinity for O2 that causes the O2 dissociation curve to shift to the left, Hematology & Oncology (HO) Biochemistry 2
impeding O2 delivery to tissues. (Bioc) HO Bioc
1241 Sickle cell HbS aggregates in the deoxy state. HbS polymers form fibrous strands that decr. RBC membrane flex and promote sickling. Sickling occurs under conditions a/w anoxia incl. low pH and high lvls of 2,3- Hematology & Oncology (HO) Biochemistry 13
BPG. These inflex erythrocytes predispose to microvascular occlusion and microinfarcts. (Bioc) HO Bioc
1242 Sickle cell Hemoglobin S (HbS) contains valine in place of glutamic acid at the sixth amino acid position of the beta globin chain. This promotes hydrophobic interaction among Hb molecules and results in HbS Hematology & Oncology (HO) Biochemistry 13
polymerization and erythrocyte sickling. (Bioc) HO Bioc
1243 Beta-thalassemia HbF contains gamma-globin instead of beta-globin. Pts w/ homozygotic beta-thalassemia (beta-thalassemia major) are aSSx at birth due to the presence of gamma-globins and HbF. Switching to HbA Hematology & Oncology (HO) Biochemistry 1
production and the cessation of gamma-globin synth precips the SSx of beta-thalassemia. (Bioc) HO Bioc
1244 Ehlers-Danlos syndrome Ehlers-Danlos syndrome (EDS) is a heritable connective tissue disease associated with abnormal collagen formation. EDS usually manifests clinically as overflexible (hypermobile) joints, overelastic Dermatology (DE) Biochemistry 1
(hyperelastic) skin, and fragile tissue susceptible to bruising, wounding, and hemarthrosis. (Bioc) DE Bioc
1245 Collagen synthesis Ehlers-Danlos syndrome is a group of rare hereditary disorders characterized by defective collagen synthesis. It can be caused by procollagen peptidase deficiency, which results in impaired cleavage of Dermatology (DE) Biochemistry 1
terminal propeptides in the extracellular space. Patients often have joint laxity, hyperextensible skin, and tissue fragility due to the formation of soluble collagen that does not properly crosslink. (Bioc) DE Bioc
1247 Vitamin C deficiency The hydroxylation of proline and lysine residues in collagen helps it attain its maximum tensile strength. This process occurs in the rough endoplasmic reticulum and requires vitamin C as a cofactor. Dermatology (DE) Biochemistry 3
Impaired collagen synthesis resulting from vitamin C deficiency (scurvy) can lead to fragile vessels, predisposing to gingival bleeding, ecchymosis, and petechia. (Bioc) DE Bioc
1248 Collagen structure Glycine is the most abundant amino acid in collagen. The triple helical conformation of collagen molecules occurs due to the repetitive amino acid sequence within each alpha chain, in which glycine General Principles (GP) Biochemistry 1
(Gly) occupies every third amino acid position (Gly-X-Y). (Bioc) GP Bioc
1249 Alpha1 antitrypsin deficiency The rubber-like properties of elastin are due to high content of nonpolar (hydrophobic) amino acids and extensive cross-linking between elastin monomers facilitated by lysyl oxidase. Patients with α-1 Pulmonary & Critical Care (PU) Biochemistry 8
antitrypsin deficiency can develop early-onset, lower lobe-predominant emphysema due to excessive alveolar elastin degradation. (Bioc) PU Bioc
1250 Marfan syndrome Marfan syndrome is due to a defect in fibrillin-1, an extracellular glycoprotein that acts as a scaffold for elastin. It is abundant in the zonular fibers of the lens, periosteum, and aortic media. Aortic root Rheumatology, Orthopedics & Biochemistry 2
dilation with dissection and rupture is a common cause of death. Sports (RH) (Bioc) RH Bioc
1251 Malabsorption The duodenal brush border enzyme EntP activates trypsin from its inactive precursor, trypsinogen. Trypsin degrades complex polypeps to dipeps, tripeps, and AAs while activating other pancr enzymes. Gastrointestinal & Nutrition (GI) Physiology 4
EntP defic impairs both protein and fat abs, leading to diarrhea, FTT, and hypoproteinemia. (Phys) GI Phys
1252 Primary hypertension Direct arteriolar vasodilators ↓ BP but trigger reflex sympathetic activation and stimulate the RAA axis. This results in tachycardia and edema. To counteract such compensatory effects, these agents are Cardiovascular (CV) Pharmacology 14
often given in combination w/ sympatholytics and diuretics. (Phar) CV Phar
1253 SLE DILE is Chx by abrupt onset of lupus SSx (eg, fever, arthralgias, pleuritis) w/ (+) anti-histone Abs. It has been linked to Rx metabolized by N-acetylation in the liver (eg, procainamide, hydralazine, INH). Rheumatology, Orthopedics & Pharmacology 7
Genetically predisposed individuals who are slow acetylators are at greater risk for developing DILE. Sports (RH) (Phar) RH Phar
1254 Cyanide poisoning Cyanide toxicity can occur in pts Tx w/ nitroprusside. Cyanide toxicity Px w/ altered mental status, seizures, CV collapse, lactic acidosis, and bright red venous blood. Antidotal Tx of cyanide toxicity can Poisoning & Environmental Pharmacology 2
be achieved by 3 different strategies: direct binding of cyanide ions (hydroxocobalamin), induction of methemoglobinemia (Na nitrite), and use of detoxifying sulfur donors (Na thiosulfate). Exposure (PO) (Phar) PO Phar
1255 Opioids Neonatal abstinence syndrome presents with neurologic, gastrointestinal, and autonomic symptoms. Tremors, irritability, diarrhea, and poor feeding are classic findings. Opiate replacement therapy is the Pregnancy, Childbirth & Pharmacology 13
treatment of choice; the dose is titrated to the patient's symptoms, and the patient is then slowly weaned. Puerperium (PR) (Phar) PR Phar
1256 Opioids Naloxone is a pure opioid receptor antagonist used to Tx opioid intox or OD. Although it binds to μ, κ, and δ opioid receptors, it has the greatest affinity for μ receptors (which mediate opioid-induced Pregnancy, Childbirth & Pharmacology 13
bradycardia and resp depression), making it an ideal agent for Tx opioid intox. Puerperium (PR) (Phar) PR Phar
1257 Opioids Chronic opioid use leads to the devel of tolerance to analgesic effects and most AEs, w/ the exception of constipation and miosis. To prevent bowel complications, it's recommended that pts be Tx Hematology & Oncology (HO) Pharmacology 13
prophylactically w/ adequate fluid intake and daily laxatives. (Phar) HO Phar
1258 Opioids Opioid analgesics can cause contraction of smooth muscles in the sphincter of Oddi, leading to ↑ pressures in the CBD and the gallbladder. Gastrointestinal & Nutrition (GI) Pharmacology 13
(Phar) GI Phar
1259 Brain tumors Medulloblastoma is the 2nd most common brain neoplasm of childhood. It is located in the cerebellum, often at the vermis, and consists of sheets of small, blue cells. Like other "PNET" tumors, Nervous (NS) Pathology (Path) 10
medulloblastomas are poorly differentiated and have a bad prognosis. NS Path
1260 CNS lymphoma 1° CNS lymphomas occur in immunosuppressed pts, such as those suffering from AIDS. These tumors arise from B cells and are universally a/w EBV. They are high-grade tumors w/ a poor prognosis. Nervous (NS) Pathology (Path) 2 NS Path
1261 Brain tumors Germinomas are the most common pineal gland tumor and Px w/ obstructive hydrocephalus and dorsal midbrain (Parinaud) syndrome. Germinomas in the suprasellar region cause endocrinopathies due to Nervous (NS) Anatomy (Anat) 10
pituitary/hypothalamic dysfxn. NS Anat
1262 Pituitary adenoma PRL-omas are the most common pit adenoma and can cause galactorrhoea, menstrual irregularities, and infertility in premenopausal women. Large pit adenomas can cause h/a from mass effect and BTH Endocrine, Diabetes & Pathology (Path) 8
from compression of the optic chiasm. Metabolism (ES) ES Path
1263 Neuroblastoma Opsoclonus-myoclonus is a PNP syndrome a/w neuroblastoma, the most common extracranial solid neoplasm in children. The tumour typically arises from the neural crest cells of the adrenal medulla and Nervous (NS) Pathology (Path) 1
presents w/ an abdo mass and ↑ catecholamine breakdown products. NS Path
1264 Carpal tunnel syndrome CTS is a peri neuropathy characterised by pain/paraesthesias in a median nerve distribution (palmar surface of the 1st 3 digits and radial half of the 4th digit), weakness on thumb abduction/opposition, Nervous (NS) Pathology (Path) 3
thenar atrophy, and a (+) Tinel a/o Phalen test. It's caused by median nerve compression at the transverse carpal ligament. NS Path
1265 Duchenne dystrophy DMD is an XLR myopathy that MFx w/ prox. muscle weakness and enlargement of the calf muscles in boys age 2-5. It most often results from frameshift deletions affecting the dystrophin gene. Rheumatology, Orthopedics & Pathology (Path) 2
Dystrophin provides a stabilising interaction b/w the sarcolemma and the intracellular contraction apparatus, and disruption of the protein results in membrane dmg and myonecrosis. Sports (RH) RH Path
1266 Duchenne dystrophy DMD MFx w/ prox. muscle weakness and atrophy. True hypertrophy of the dist. muscle is noted early in the disease as dist. muscles compensate for weak prox. ones. Muscle fibres of the dist. extremities Rheumatology, Orthopedics & Pathology (Path) 2
are later replaced by fat and CT (pseudohypertrophy). Sports (RH) RH Path
1267 Lambert-Eaton myasthenic LEMS is characterised by Abs against presynaptic v-gated Ca2+ channels. Pts develop progr proximal muscle weakness w/ ↓/absent reflexes that predominantly involves the lower extremities. The Nervous (NS) Pathology (Path) 2
syndrome syndrome is often a/w malignancy, particularly SCLC. NS Path
1268 Myotonic dystrophy MMD is an AD disorder. It is caused by an ↑ number of TNRs on MPK gene. Sustained muscle contraction (myotonia), along w/ weakness and atrophy, is common. Cataracts are seen in almost all pts. Nervous (NS) Pathology (Path) 1
Frontal balding and gonadal atrophy are other common features. NS Path
1270 Prevalence and incidence The cumulative incidence of a disease is the number of new cases of a disease over a specific period divided by the total population at risk at the beginning of the study (ie, the proportion of at-risk Biostatistics & EpInfectious Biostatistics 3
individuals who contract the disease over the specified period). Diseases (ID)emiology (BS) (Bios) BS Bios
1271 Predictive values Various parameters are used to evaluate the accuracy and usefulness of Dx tests. PPVs and NPVs are influenced by disease prevalence in the target population; sensitivity, specificity, and likelihood ratios Biostatistics & EpInfectious Biostatistics 3
are not prevalence-dependent. Diseases (ID)emiology (BS) (Bios) BS Bios
1272 Power and sample size Power (1 - β) is the probability of rejecting a null hypothesis when it is truly false. It is typically set at 80% and depends on sample size and difference b/w outcomes. Biostatistics & EpInfectious Biostatistics 3
1273 Bias Recall bias results from study participants' inaccurate recall of past exposure and occurs most often in retrospective studies such as case-control studies. People who have experienced an adverse event are Biostatistics & EpInfectious Biostatistics 4
more likely to recall RFx than those who have not experienced an adverse event. Diseases (ID)emiology (BS) (Bios) BS Bios
1274 P-value and confidence interval A result is considered statistically significant if the 95% CI does not cross the null value, which corresponds to a p-value <0.05. Biostatistics & EpInfectious Biostatistics 2
1275 Bias Observer bias occurs when the investigator's evaluation is affected by preconceived expectations or prior knowledge, typically leading to overestimation of the disease association or Tx effects. This type Biostatistics & EpInfectious Biostatistics 4
of bias can be ↓ by conducting a blinded study in which observers are unaware of study details and pt Chx that could unduly influence them. Diseases (ID)emiology (BS) (Bios) BS Bios
1276 Study designs In a cross-sectional study, exposure and outcome are measured simultaneously at a particular point in time ("snapshot study"). In other study designs, a certain time period separates the exposure from the Biostatistics & EpInfectious Biostatistics 6
outcome. Diseases (ID)emiology (BS) (Bios) BS Bios
1277 Odds ratio A case-control study is used to compare the exposure status of people w/ the disease (ie, cases) to the exposure status of people w/o the disease (ie, controls). The main measure of association is the OR. Biostatistics & EpInfectious Biostatistics 2
1278 Validity and reliability A precise/reliable test is reproducible in that it gives similar results on repeat measurements. Reliability is maximal when random error is minimal. Biostatistics & EpInfectious Biostatistics 1
1279 Confounding, effect modification, Effect modification is present when the effect of the main exposure on the outcome is modified by the presence of another variable. Effect modification is not a bias. Biostatistics & EpInfectious Biostatistics 3
bias, errors Diseases (ID)emiology (BS) (Bios) BS Bios
1280 Risk The concept of accumulation effect can be applied to disease pathogenesis and exposure to risk modifiers. Cumulative exposure to a RFx or risk reducer must sometimes occur for prolonged periods Biostatistics & EpInfectious Biostatistics 6
before a clinically significant effect is detected. Diseases (ID)emiology (BS) (Bios) BS Bios
1281 Central tendency (mean, median, The median is the value that is located in the precise center of an ordered dataset. It separates the right half of the data from the left half. Biostatistics & EpInfectious Biostatistics 2
mode, outliers) Diseases (ID)emiology (BS) (Bios) BS Bios
1282 Normal distribution In general, in a (+)ly skewed distribution, the mean is the most shifted in the (+) direction (to the right), followed by the median and then the mode. In such a situation, the median often reflects a central Biostatistics & EpInfectious Biostatistics 3
tendency better than the mean does. Diseases (ID)emiology (BS) (Bios) BS Bios
1283 Comparing 2 means The two-sample t test is a statistical method commonly employed to compare the means of 2 groups of subjects. Cardiovascular (CV) Biostatistics 1
(Bios) CV Bios
1284 Probability theory If events are independent, the probability that all events will turn out the same is the product of the separate probabilities for each event. The probability of at least 1 event turning out differently is given Biostatistics & EpInfectious Biostatistics 2
as 1 - P(all events being the same). Diseases (ID)emiology (BS) (Bios) BS Bios
1285 Sensitivity and specificity The degree of overlap b/w the healthy and the diseased population curves limits the maximum combined sensitivity and specificity of a quantitative Dx test. The degree to which sensitivity or specificity Biostatistics & EpInfectious Biostatistics 4
is affected depends on the chosen cutoff value. Diseases (ID)emiology (BS) (Bios) BS Bios
1286 Lung cancer B/w 1950 and 2000, rising rates of tobacco use resulted in an ↑ in female lung ca incidence and mortality. Lung ca is currently the most common cause of ca death in both women and men in the US. Hematology & Oncology (HO) Pathology (Path) 9 HO Path
1287 Opioids Methadone is a potent, long-acting opioid agonist used in the maintenance Tx of opioid use disorder. Its prolonged effects suppress withdrawal SSx and cravings. Pregnancy, Childbirth & Behavioral 13
1288 Phencyclidine PCP is a hallucinogen that causes dissociative SSx, agitation, hallucinations, and violent behaviour. Ataxia, nystagmus, and memory loss are other distinguishing SSx of PCP abuse. Pregnancy, Childbirth & Behavioral 2
1289 Cannabis Marijuana contains tetrahydrocannabinol, which stims cannabinoid receptors to produce a mild euphoria w/ inappropriate laughter, ↑ appetite, slowed rxn time/motor speed, and cognitive impairment. Pregnancy, Childbirth & Behavioral 1
Tachycardia and conjunctival injection are the 2 most immediate physical SSx of marijuana use. Puerperium (PR) Science (Beha) PR Beha
1290 Irritable bowel syndrome Diphenoxylate is an opioid antidiarrheal drug that binds μ opiate receptors in the gut to slow motility. Overuse can lead to euphoria and physical dependence. To discourage abuse, diphenoxylate is combo Gastrointestinal & Nutrition (GI) Pharmacology 1
w/ atropine, which induces AEs if taken in high doses. (Phar) GI Phar
1291 Cirrhosis Vit K-dependent CFs (II, VII, IX, and X) are synth in the liver. FVII has the shortest 1/2-life of the CFs. Failure of the PT to correct w/ vit K supp indicates FVII defic, which is often due to underlying Hematology & Oncology (HO) Pathophysiology 7
liver disease. (Patp) HO Patp
1292 Atrial fibrillation Pts started on warfarin develop a transient hypercoag state due to the short 1/2-life of protein C. This hypercoag is further exaggerated by pre-existing protein C defic and can result in thrombotic Hematology & Oncology (HO) Pathophysiology 5
occlusion of the microvasc w/ skin necrosis. (Patp) HO Patp
1293 Uremic platelet dysfunction abn bleeding in pts w/ uraemia is due to a qualitative platelet disorder that causes prolonged BT w/ normal platelet count, PT, and aPTT. Hematology & Oncology (HO) Pathology (Path) 1 HO Path
1294 Hemolytic uremic syndrome Schistocytes suggest MAHA (eg, HUS, TTP), DIC or mechanical damage (eg, prosthetic valve). In childhood, HUS is often preceded by bloody diarrhea. Coagulation studies (PT and PTT) are normal in Hematology & Oncology (HO) Pathology (Path) 3
HUS-TTP but abnormal in DIC. HO Path
1295 DIC DIC is a common complication of gram (-) bacterial sepsis due to activation of the coag cascade by bacterial endotoxins, which leads to the formation of microthrombi. peri smear shows fragmented Hematology & Oncology (HO) Pathology (Path) 5
erythrocytes (schistocytes) and thrombocytopaenia. Lab tests show ↓ fibrinogen lvls and prolonged PT and PTT. HO Path
1296 DIC The most common trigger for DIC in preg is release of tissue factor (thromboplastin) from an injured placenta (e.g. placental abruption) into the maternal circulation. DIC presents w/ bleeding from Hematology & Oncology (HO) Pathology (Path) 5
incision sites, IV line sites, and mucosal surfaces due to rapid consumption of clotting factors and platelets. HO Path
1297 Traumatic hemolytic anemia RBC fragments, burr cells, and helmet cells are a/w either MAHA or mech red cell destruction. In pts w/ prosthetic valves, RBCs are exposed to excessive shear and turbulence in the circulation, causing Hematology & Oncology (HO) Pathology (Path) 2
dmg from mech trauma. HO Path
1298 DIC DIC commonly occurs in the setting of sepsis and is characterised by widespread activation of the coag cascade w/ formation of microthrombi. Lab results reveal prolonged PT/PTT, thrombocytopaenia, Hematology & Oncology (HO) Pathology (Path) 5
and low fibrinogen (i.e. a consumptive coagulopathy), and pts usually have SSx of bleeding (e.g. oozing from venepuncture sites). HO Path
1299 P-value and confidence interval The SD reflects the spread of individual values in a normal distribution (ie, it measures the variability of the observations w/i a single sample). The standard error of the mean reflects the variability of Biostatistics & EpInfectious Biostatistics 2
means (ie, variance b/w the means of different samples) and helps estimate the true mean of the underlying population. Diseases (ID)emiology (BS) (Bios) BS Bios
1300 Sensitivity and specificity The sensitivity of a test refers to its ability to correctly identify those w/ the disease. A highly sensitive test should always be considered over a highly specific test when screening for life threatening Biostatistics & EpInfectious Biostatistics 4
diseases, where identification of every person w/ the disease is important. Diseases (ID)emiology (BS) (Bios) BS Bios
1301 Bias The main purpose of blinding is to prevent pt or researcher expectancy from interfering w/ an outcome. Cardiovascular (CV) Biostatistics 4
(Bios) CV Bios
1302 Hawthorne effect The Hawthorne effect (observer effect) is the tendency of study subjects to change their behavior as a result of their awareness that they are being studied. Biostatistics & EpInfectious Biostatistics 1
1303 Power and sample size A study's power ↑ as its sample size ↑. Therefore, the larger the sample, the greater the ability of a study to detect a difference when one truly exists. Biostatistics & EpInfectious Biostatistics 3
1304 Vestibular schwannoma Schwannomas Px histologically w/ a biphasic pattern of cellularity (Antoni A and B areas) and S-100 (+) (indicating neural crest origin). Schwannomas can arise from the peripheral nerves, nerve roots, Nervous (NS) Pathology (Path) 3
and CNs (except CN II). Acoustic neuromas are the most common type of intracranial schwannoma and are located at the CPA at CN VIII. NS Path
1305 Neurofibromatosis Bilateral acoustic neuromas are a/w NF-2, an AD condition caused by mut of the NF-2 gene on chrom 22. Nervous (NS) Pathology (Path) 3 NS Path
1306 Vestibular schwannoma Vestibular schwannomas arise from CNVIII and are usually located at the CPA. These tumours can cause a range of SSx by dmging CNVIII (unsteadiness and ipsilateral sensorineural hearing loss w/ Nervous (NS) Anatomy (Anat) 3
tinnitus), CNV (ipsilateral facial paraesthesia and ↓ corneal reflex), and CNVII (ipsilateral facial paresis). Bilateral acoustic neuromas are a/w NF-2. NS Anat
1307 Neurofibromatosis NF-I is a single-gene AD disorder. It occurs due to mut of the NF1 gene located on chrom 17. Café-au-lait spots, multiple neurofibromas, and Lisch nodules are the most common SSx. Nervous (NS) Genetics (Gene) 3 NS Gene
1308 Tuberculosis Isoniazid is structurally similar to vitB6. As a result, this Abx ↑ the urinary excretion of vitB6 — often causing a frank defic of vitB6 — and competes for vitB6-binding sites, leading to the defective Nervous (NS) Pharmacology 18
synthesis of NTs like GABA. Isoniazid-induce neuropathy can usually be prevented w/ vitB6 supplementation. (Phar) NS Phar
1309 Tuberculosis Isoniazid is an antimycobacterial agent that specifically inhibits the synthesis of mycolic acids, which are essential components of the unique mycobacterial peptidoglycan cell wall. Without mycolic Infectious Diseases (ID) Pharmacology 18
acids, the mycobacteria lose their acid-fastness and become unable to synthesize new cell walls or multiply. (Phar) ID Phar
1310 Antibiotic resistance The aminoglycoside streptomycin inhibs protein synthesis by inactivating the 30S (small) ribosomal subunit. ↓ activity of bacterial catalase-peroxidase is a mech of mycobacterial resistance to INH. Infectious Diseases (ID) Microbiology 8
Structural alteration of enzymes involved in RNA synthesis (DNA-dependent RNA polymerase) is the mech thru which organisms become resistant to rifampin. (Micr) ID Micr
1312 Mycobacterium avium MAC infections are common in pts w/ advanced AIDS. The bacterium often spreads thru the bloodstream and RES and causes nonspecific SSx (e.g. fever, fatigue, weight loss, diarrhoea), LAD, and Infectious Diseases (ID) Pharmacology 1
intracellulare complex HSM. Dx is often made on blood culture or bone marrow aspirate (intracellular acid-fast bacteria that aren't M. tuberculosis). (Phar) ID Phar
1313 Leprosy The severity of leprosy, a systemic illness caused by Mycobacterium leprae, depends on the strength of the cell-mediated immune (CMI) response, with tuberculoid leprosy representing the milder form Dermatology (DE) Microbiology 2
intact Th1 CMI response) and lepromatous leprosy, the more severe form (weak CMI response). (Micr) DE Micr
1314 Leprosy The lepromin skin test will be (+) w/ Tb leprosy as they exhibit a strong CD4+ Th1 cell-mediated immune response to M. leprae. Pts w/ lepromatous leprosy will test (-) due to their weak Th1 cell- Dermatology (DE) Pathology (Path) 2
mediated immune response. DE Path
1315 Syphilis Pts w/ early syphilis (e.g. chancre) often have false (-) initial serologic testing. Direct visualisation of the organism (T. pallidum) by dark-field micro or fluorescent Ab testing is the gold standard for Dx Infectious Diseases (ID) Microbiology 9
but isn't widely available. (Micr) ID Micr
1316 Syphilis Syphilis is caused by the spirochete T. pallidum. Confirmation of the Dx req 2 forms of serologic testing to prevent false (+) results. Non-treponemal tests (e.g. RPR, VDRL) evaluate for anticardiolipin Infectious Diseases (ID) Microbiology 9
Abs (nonspecific); treponemal tests evaluate for Abs targeted against T. pallidum. (Micr) ID Micr
1317 Menstrual cycle Of all hormones influencing the menstrual cycle (LH, FSH, estrogen, progesterone), progesterone ↑ the most in concentration after ovulation. During the latter half of the menstrual cycle, the CL secretes Female Reproductive & Breast Physiology 2
high levels of progesterone, which thickens the endometrium and prepares it to receive and nourish a blastocyst. (FR) (Phys) FR Phys
1318 Multiple sclerosis The speed of conduction down an axon depends on 2 constants: the length constant and the time constant (i.e. velocity = length / time). Myelination ↑ the length constant and ↓ the time constant, both of Nervous (NS) Physiology 6
which improve axonal conduction speed. Demyelination thus impairs stim transmission. (Phys) NS Phys
1319 Cholecystitis CCK is the hormone responsible for gallbladder contraction. It’s made in the duodenum and jejunum in response to FAs and AAs. Gastrointestinal & Nutrition (GI) Physiology 5
(Phys) GI Phys
1320 Myasthenia gravis Exacerbation of MG in a pt Tx w/ long-acting AChEIs (e.g. pyridostigmine) occurs due to myasthenic or cholinergic crisis. The edrophonium (Tensilon) test helps to diffiate these 2 conditions. Clinical Nervous (NS) Pharmacology 10
improvement after edrophonium admin indicates that the pt is under-Tx (myasthenic crisis). (Phar) NS Phar
1321 Anticholinergics Anticholinergic agents (e.g. atropine, scopolamine) competitively inhib ACh at the mAChR. The effects can be memorised w/ the mnemonic, 'blind as a bat, mad as a hatter, red as a beat, hot as a hare, Nervous (NS) Pharmacology 3
dry as a bone, full as a flask, and fast as a fiddle,' and can be reversed by AChEIs (physostigmine). (Phar) NS Phar
1322 Glaucoma Atropine is indicated for the Tx of bradycardia as it ↓ vagal influence on the SA and AV nodes. A common AE is ↑ IOP. It may precipitate acute CAG in susceptible individuals. Nervous (NS) Pharmacology 3
(Phar) NS Phar
1323 Organophosphate poisoning OPs inhibit AChE in both muscarinic and nicotinic cholinergic synapses, leading to ↓ ACh degradation and over-stim of the corresponding receptors. Atropine reverses muscarinic effects but doesn't Nervous (NS) Pharmacology 2
prevent the devel of nicotinic effects such as muscle paralysis. Pralidoxime is a AChE-reactivating agent that allows for degradation of excess ACh and Tx both the muscarinic and nicotinic effects of (Phar)
OPs. NS Phar
1324 Diabetes mellitus α2 adrenergic receptors inhib insulin secretion, and β2 adrenergic receptors stim insulin secretion. The α2 mediated inhib effect is gen predominant, causing sympathetic stim to lead to overall inhib of Endocrine, Diabetes & Pharmacology 31
insulin secretion. Metabolism (ES) (Phar) ES Phar
1325 Hypoglycemia Uptake of Glc by skel muscle is mediated by GLUT4, which is translocated to the cell membrane in response to insulin and muscle contraction. Hypoglycemia can be precip by exercise in pts w/ insulin- Endocrine, Diabetes & Physiology 6
Tx DM due to the persistent effects of exog insulin. Metabolism (ES) (Phys) ES Phys
1326 Diabetes mellitus Phosphorylation of serine and threonine residues of IR and IRS by serine kinase leads to insulin resistance. This type of phosphorylation can be induced by TNF-α, catecholamines, GCs, and glucagon. Endocrine, Diabetes & Pathophysiology 31
1327 Metabolic syndrome Visceral obesity as measured by waist circumference or waist-to-hip ratio is an important predictor of insulin resistance. Endocrine, Diabetes & Pathophysiology 2
1328 Metabolic syndrome DM-2 is due to insulin resistance and relative insulin defic. Chronically ↑ FFA lvls contribute to insulin resistance by impairing insulin-dependent Glc uptake and ↑ hepatic GNG. Endocrine, Diabetes & Pathophysiology 2
1332 Homocysteine Homocystinuria is most commonly caused by a defect in cystathionine synthase, resulting in an inability to form cysteine from homocysteine. Cysteine becomes essential in affected pts, and homocysteine Gastrointestinal & Nutrition (GI) Biochemistry 2
buildup leads to ↑ methionine. Homocysteine is prothrombotic, resulting in premature TE events (e.g. atherosclerosis, ACS) in these pts. (Bioc) GI Bioc
1334 Niacin deficiency Hartnup disease is caused by impaired transport of neutral AAs in the small intestine and PCT of the kidney. SSx incl pellagra-like skin eruptions and cerebellar ataxia, which occur as a result of vitB3 Endocrine, Diabetes & Biochemistry 3
defic. The Dx can be confirmed thru detection of excessive amounts of neutral AAs in the urine. Metabolism (ES) (Bioc) ES Bioc
1335 Maple syrup urine disease MSUD classically presents w/ irritability, dystonia, poor feeding, and a 'maple syrup' scent to the pt's urine w/i the 1st few days of life. Dietary restriction of BCAAs (e.g. leucine, isoleucine, valine) is the Endocrine, Diabetes & Biochemistry 2
hallmark of Tx. Metabolism (ES) (Bioc) ES Bioc
1336 Maple syrup urine disease BCKD req several coenzymes: Thiamine. Lipoate, Coenzyme A, FAD, NAD (mnemonic: Tender Loving Care Fore Nancy). Some pts w/ MSUD improve w/ high-dose vitB1 Tx, but most req lifelong Endocrine, Diabetes & Biochemistry 2
restriction of leucine, isoleucine, valine. Metabolism (ES) (Bioc) ES Bioc
1337 Porphyria cutanea tarda Enzyme defics of the early steps in porphyrin synth cause neuropsych MFx w/o photosens, whereas late step derangements lead to photosens. Photosens MFx as vesicle and blister formation on sun- Hematology & Oncology (HO) Biochemistry 1
exposed areas as well as edema, pruritus, pain, and erythema. (Bioc) HO Bioc
1338 ALA synthase AIP atks are due to the accum of ALA and PBG, resulting from inher PBG deaminase defic combo w/ ALA synthase induction (typically due to certain Rx, Alc use, or a low-calorie diet). Mx w/ Glc or Hematology & Oncology (HO) Biochemistry 1
hemin inhibs ALA synthase activity. (Bioc) HO Bioc
1339 Acute intermittent porphyria AIP is an AD condition caused by PBG deaminase defic. Most pts remain aSSx, but a minority Px w/ acute atks char by abdo pain and vomiting, peri neuropathy, neuropsych SSx, and reddish-brown Hematology & Oncology (HO) Pathophysiology 1
urine. Tx consists of IV Glc or heme preps, which downreg ALA synthase activity. (Patp) HO Patp
1340 Organic acidemias Propionyl-CoA is derived from the metabolism of valine, isoleucine, methionine, threonine, and odd-chain FAs. Congenital defx of propionyl-CoA carboxylase, the enzyme responsible for the conversion Nervous (NS) Biochemistry 1
of propionyl-CoA to methylmalonyl-CoA, leads to the development of propionic acidemia. The condition Px w/ lethargy, poor feeding, vomiting, and hypotonia 1-2 wks after birth. (Bioc) NS Bioc
1341 Metabolic acidosis Methylmalonic acidemia is an organic acidemia due to complete or partial defx of methylmalonyl-CoA mutase. Complete defx classically Px w/ lethargy, vomiting, and tachypnea in a newborn. LTx Nervous (NS) Biochemistry 4
shows hyperammonemia, ketotic hypoglycemia, and metabolic acidosis. The Dx is confirmed by ↑ urine methylmalonic acid and propionic acid. (Bioc) NS Bioc
1342 Orthostatic hypotension Orthostatic hypotension is a frequent cause of light-headedness and syncope and is defined as a ↓ in SBP (>20mmHg) or DBP (>10mmHg) on standing from the supine position. Rx (α1-adrenergic Cardiovascular (CV) Pharmacology 1
antagonists, diuretics), volume depletion, and autonomic dysfxn are common causes of orthostatic hypotension. (Phar) CV Phar
1343 Alpha agonists α-adrenergic agonists ↑ SBP and DBP by stimulating α1-adrenoreceptors in the vascular walls, causing vasoconstriction. The ↑ systemic BP then causes a reflexive ↑ in vagal tone, resulting in ↓ HR and Cardiovascular (CV) Pharmacology 1
slowed AV node conduction. (Phar) CV Phar
1344 Cardiogenic shock Dobutamine is a β adrenergic agonist w/ predominant activity on β1 receptors. It causes an ↑ in HR and cardiac contractility, leading to an ↑ in myocardial O2 consumption. Cardiovascular (CV) Pharmacology 1
(Phar) CV Phar
1345 Nonallergic rhinitis Topical preparations of α-adrenergic agonists cause vasoconstriction of the nasal mucosa vessels and are used as decongestants. Overuse of these Rx causes (-) feedback, resulting in ↓ NE synthesis and Ear, Nose & Throat (EN) Pharmacology 1
release from nerve endings, which ↓ their effect (ie, tachyphylaxis). (Phar) EN Phar
1346 Body dysmorphic disorder BDD involves fixation on a perceived defect in appearance and repetitive behaviours in response to the fixation. It can present w/ absent insight/delusional beliefs and result in significant psychosocial Pregnancy, Childbirth & Behavioral 1
dysfxn. Puerperium (PR) Science (Beha) PR Beha
1347 Dysthymia The DSM-5 Dx of dysthymia is characterised by chronic depressed mood and at least 2 other depressive SSx lasting for at least 2yrs. Pregnancy, Childbirth & Behavioral 1
1348 Bipolar disorder The anticonvulsant valproate has mood-stabilising properties and is an effective maintenance Tx for BD. Other maintenance options for BD incl lithium, lamotrigine, and quetiapine. Pregnancy, Childbirth & Behavioral 7
1350 Defense mechanisms Splitting is a defence mech that involves organising experiences of the self or others into extremes to keep (+) and (-) aspects separated. It's commonly seen in pts w/ BPD. Pregnancy, Childbirth & Behavioral 8
1351 Defense mechanisms Suppression is a mature defence mech involving a conscious choice not to dwell on a particular thought or feeling. Pregnancy, Childbirth & Behavioral 8
1352 Benzodiazepines When benzos are used in the Tx of anxiety, drug selection should consider the Rx's duration of action. Short- to intermediate-acting benzos (e.g. lorazepam) are pref in situations in which prolonged AEs Pregnancy, Childbirth & Behavioral 6
of sedation and cognitive impairment must be minimalised. Puerperium (PR) Science (Beha) PR Beha
1353 Opioids Opioid withdrawal is marked by mydriasis, abdo pain, diarrhoea, piloerection, lacrimation, and yawning. It's gen non-life-threatening, unlike withdrawal from alcohol and benzos. Pregnancy, Childbirth & Behavioral 13
1354 GFR The net filtration pressure is calculated by the following equation: NFP = (Pc- Pi) - (πc- πi). Renal, Urinary & Electrolytes Physiology 6
(RE) (Phys) RE Phys
1355 Cellular transports Transport of Glc into the cells of most tissues occurs by means of fac diffusion. Glc moves from areas of high conc to areas of low conc w/ the help of transmembrane GLUT. These carrier proteins are Endocrine, Diabetes & Physiology 2
stereoselective and have pref for D-Glc. Metabolism (ES) (Phys) ES Phys
1356 Macular degeneration A scotoma is a visual field defect that occurs due to a pathologic process that involves parts of the retina or the optic nerve resulting in a discrete area of altered vision surrounded by zones of normal Ophthalmology (OP) Pathophysiology 2
vision. Lesions of the macula cause central scotomas. (Patp) OP Patp
1357 Respiratory acidosis Resp acid Px w/ a low pH and a high PaCO2. HCO3- initially remains w/i the normal range, but becomes incr over hrs to dys as renal comp develops. Pulmonary & Critical Care (PU) Physiology 1
(Phys) PU Phys
1358 Active transport Parietal cells release H ions into the gastric lumen by means of the H/K ATPase, which reqs hydrolysis of ATP and is therefore an active transport mech. Omeprazole and other PPIs suppress the activity Gastrointestinal & Nutrition (GI) Physiology 1
of the gastric parietal cell H/K ATPase leading to an ↑ in the pH of the gastric lumen. (Phys) GI Phys
1359 Autonomic nervous system The SNS typically regulates visceral fxn via 2-neuron signal transmission involving cholinergic preganglionic neurons and adrenergic postganglionic neurons. Eccrine sweat glands and the AMs are Nervous (NS) Pharmacology 3
exceptions to this rule as they're both innervated by cholinergic neurons. The PSNS uses both preganglionic and postganglionic cholinergic neurons. (Phar) NS Phar
1360 Autonomic nervous system The ANS utilises 3 types of signal pathways: cAMP, IP3, and ion channels. nAChRs are ligand-gated ion channels that open after binding ACh. This results in an immediate influx of Na+ and Ca2+ into Nervous (NS) Pharmacology 3
the cell and an outflux of K+ from the cell. (Phar) NS Phar
1361 Mushroom poisoning Activation of mAChRs by ACh or cholinergic agonists results in peripheral vasodilation due to synthesis of NO in endothelial cells, which leads to vascular smooth muscle relaxation (e.g. hypotension). Nervous (NS) Physiology 2
mAChR activation in other sites causes smooth muscle contraction. (Phys) NS Phys
1362 Urinary retention Cholinomimetics are indicated in non-obstr urinary retention, paralytic ileus, and glaucoma. Their AEs incl nausea, vomiting, abdo cramps, diarrhoea, dyspnoea, and ↑ secretions (sweating, lacrimation, Nervous (NS) Pharmacology 4
and salivation). (Phar) NS Phar
1363 Glaucoma OAG is Chx by progressive loss of peripheral vision from ↑ IOP. Timolol and other nonselective β blockers work by diminishing the secretion of aqueous humor by the ciliary epithelium. Acetazolamide, Ophthalmology (OP) Pharmacology 3
a CAI, also ↓ aqueous humor secretion by the ciliary epithelium. PGF2α (eg, latanoprost, travoprost) and cholinomimetics (eg, pilocarpine, carbachol) ↓ IOP by ↑ the outflow of aqueous humor. (Phar) OP Phar
1364 Sympathomimetic agents EPI ↑ SBP (α1 + β1) and HR (β1), and either ↑ or ↓ DBP depending on the dose (either α1 or β2 predominates). PreTx w/ propranolol eliminates the β effects of EPI (vasodilation and tachycardia), Cardiovascular (CV) Pharmacology 5
leaving only the α effect (vasoconstriction). (Phar) CV Phar
1365 Sympathomimetic agents Low-dose dopamine infusion stimulates Di receptors in the renal and mesenteric vasculature, resulting in vasodilation and increased blood flow to these sites. Increasing doses of dopamine stimulate B, General Principles (GP) Pharmacology 5
and a receptors, resulting in increased cardiac output and elevated systemic vascular resistance. At the higher end of the dose range, the increase in afterload can result in decreased cardiac output. (Phar) GP Phar
1366 Anaphylaxis Anaphylactic shock is characterised by vasodilation, ↑ vascular permeability, and bronchoconstriction. EPI counteracts these physiological mechs and is the DOC for the Tx of anaphylaxis. Allergy & Immunology (AI) Pharmacology 3
(Phar) AI Phar
1367 Sympathomimetic agents NE stim cardiac β1 adrenoceptors, which ↑ cAMP concentration w/i cardiac myocytes and leads to ↑ contractility, conduction, and HR. Peripheral vasoconstriction occurs via stim of α1 adrenoreceptors in Cardiovascular (CV) Pharmacology 5
vascular smooth muscle cells and activation of an IP3 signalling pathway. (Phar) CV Phar
1368 Autonomic nervous system Inhib of uterine contractions (tocolysis) is a result of β2 adrenergic receptor stim. α1 receptor stim causes contraction of the ocular pupillary dilator muscle, resulting in mydriasis (pupillary dilation). Nervous (NS) Pharmacology 3
(Phar) NS Phar
1369 TCA cycle Alanine is the major AA responsible for transferring N to the liver for disposal. During the catabolism of proteins, amino groups are transferred to α-KG to form glutamate. Glutamate is then processed in Nervous (NS) Biochemistry 2
the liver to form urea, the 1° disposal form of N in humans. Free NH3 is also excreted into the urine by the kidney for regulation of acid-base status. (Bioc) NS Bioc
1370 Urea cycle Pts w/ urea cycle disorders typically have discrete episodes of vomiting, tachypnoea, and confusion/coma 2° to hyperammonaemia (a meta emergency). OTC defic is the most common disorder of the urea Endocrine, Diabetes & Biochemistry 3
cycle and is characterised by hyperammonaemia and ↑ urinary orotic acid. Metabolism (ES) (Bioc) ES Bioc
1372 Urea cycle Ornithine transport into mitochondria is necessary for proper fxn of the urea cycle, which is the major disposal pathway for waste N generated by catabolism of AAs. Urea cycle defects typically cause Nervous (NS) Biochemistry 3
neuro dmg due to the accumulation of NH3. Protein restriction improves this condition by ↓ the amount of AA turnover. (Bioc) NS Bioc
1373 Upper respiratory tract infections For a purified RNA molecule to induce viral protein synthesis in a host cell, it must be able to act directly as mRNA using the host's intracellular machinery for translation. Therefore, in general, purified Ear, Nose & Throat (EN) Microbiology 2
(+) sense ssRNA can be infectious; (-) sense ssRNA or dsRNA is not. (Micr) EN Micr
1374 Parvovirus Infection w/ PVB19 (a nonenveloped ss DNA virus) can cause arthralgia +/- rash in adults. An infected fetus may develop hydrops fetalis (severe anemia, HF, pleural effusions, pericardial effusions, and Infectious Diseases (ID) Microbiology 3
ascites). (Micr) ID Micr
1375 Epstein Barr virus The initial attachment of the virion envelope or capsid surface proteins to the complementary host cell surface receptors is essential to viral tropism for specific tissues and invasion of cells. Many viruses Hematology & Oncology (HO) Microbiology 1
bind to normal host cell plasma membrane receptors to enter host cells. Known host cell receptor and virion/virion protein binding specificities include: CD4 with HIV gp120, CD21 with Epstein-Barr (Micr)
virus gp350, and erythrocyte P antigen with parvovirus B19. HO Micr
1377 Influenza Alc-based disinfectants kill enveloped viruses (eg, influenza) by dissolving their outer lipid envelope. Nonenveloped viruses are less susceptible to some Alc-based disinfectants b/c they have no lipid Infectious Diseases (ID) Microbiology 5
envelope to target. (Micr) ID Micr
1378 Cellular transports Carrier-mediated transport includes facilitated diffusion and active transport. Movement of substrate across the cell membrane by these mechanisms depends on the presence of carrier proteins that can General Principles (GP) Physiology 2
become saturated at high substrate concentrations. (Phys) GP Phys
1379 Body fluid distribution Volume contraction and expansion can be divided into isosmotic, hyposmotic, and hyperosmotic states. Hyperosmotic volume contraction is caused by a loss of free water (w/ retention of electrolytes). It Endocrine, Diabetes & Biochemistry 1
can occur in pts w/ DI or as a result of ↓ fluid intake/excessive sweating. Metabolism (ES) (Bioc) ES Bioc
1380 Resting membrane potential and The AP results from changes in the membrane permeability to K and Na ions. Depol results from massive influx of Na thru v-gated Na channels. Repol occurs due to closure of v-gated Na channels and Nervous (NS) Physiology 5
action potential opening of v-gated K channels. K ion permeance is highest during the repol phase of the AP. (Phys) NS Phys
1381 Resting membrane potential and When a specific ion channel opens, the respective ions will flow across the membrane in a direction that brings the resting membrane potential closer to that ion's equilibrium potential. Rheumatology, Orthopedics & Physiology 5
action potential Sports (RH) (Phys) RH Phys
1382 Resting membrane potential and The resting membrane potential is the difference in the electrical charges across the cell membrane under steady-state conditions. The ions that are most permeable to the cell membrane make the largest Rheumatology, Orthopedics & Physiology 5
action potential contribution to the resting membrane potential. In general, a high potassium efflux and some sodium influx are responsible for the value of the resting potential, which is typically about -70 mV. Sports (RH) (Phys) RH Phys
1383 Protein structure Integral membrane proteins contain transmembrane domains composed of α helices w/ hydrophobic AA residues (e.g. alanine, valine, leucine, isoleucine, phenylalanine, tryptophan, methionine, proline, Endocrine, Diabetes & Biochemistry 1
glycine). These transmembrane domains help anchor the protein to the phospholipid bilayer of the cell membrane. Metabolism (ES) (Bioc) ES Bioc
1384 Hemoglobin properties Pso refers to the partial pressure of oxygen at which hemoglobin is 50% saturated. Hemoglobins with high oxygen affinity have a decreased P50 that is represented by a leftward shift of the oxygen Hematology & Oncology (HO) Biochemistry 4
dissociation curve. The reduced ability to release oxygen within the peripheral tissues leads to renal hypoxia, increased erythropoietin synthesis, and compensatory erythrocytosis. (Bioc) HO Bioc
1385 Hemoglobin properties A left shift of the Hb O2 dissociation curve indicates ↑ Hb O2 affinity and can be caused by ↑ pH, ↓ 2,3-BPG, and ↓ temperature. Leftward shifts of the curve inhibit the release of O2 w/i peripheral Hematology & Oncology (HO) Biochemistry 4
tissues. (Bioc) HO Bioc
1386 Respiratory physiology The binding of O2 to hemoglobin increases the affinity for binding of subsequent O2 molecules (cooperative binding). In the lungs, the binding of O2 to hemoglobin drives the release of H+ and CO2 Pulmonary & Critical Care (PU) Biochemistry 8
from hemoglobin (Haldane effect). In the peripheral tissues, high concentrations of CO2 and H+ facilitate O2 unloading from hemoglobin (Bohr effect). (Bioc) PU Bioc
1387 Hemoglobin properties 2,3-BPG normally forms ionic bonds w/ the beta subunits of deoxy HbA, facilitating O2 release in the peri tissues. Muts that result in loss of the 2,3-BPG binding pocket's (+) charge cause HbA to Hematology & Oncology (HO) Biochemistry 4
resemble HbF, which binds O2 w/ a higher affinity due to its inability to interact w/ 2,3-BPG. (Bioc) HO Bioc
1388 Diphtheria The 1° Tx for diphtheria is diphtheria antitoxin (passive immunization), which inactivates circulating toxin. Abx should also be administered to ↓ continued production of toxin. Allergy & Immunology (AI) Microbiology 6
(Micr) AI Micr
1389 Diphtheria Lysogenic bacteriophages are responsible for converting non-pathogenic Corynebacterium into toxigenic Corynebacterium. Toxigenic strains elaborate the diphtheria exotoxin, which causes Infectious Diseases (ID) Microbiology 6
pseudomembranous pharyngitis and potentially life-threatening systemic effects (e.g. myocarditis, neuritis). (Micr) ID Micr
1390 Diphtheria Diphtheria toxin and pseudomonal exotoxin A act by ribosylating and inactivating EF-2, inhibiting host cell protein synthesis and causing cell death. Infectious Diseases (ID) Microbiology 6
(Micr) ID Micr
1391 Listeria L. monocytogenes is a facultative, intracellular, gram (+) rod that produces a very narrow zone of β hemolysis on blood agar, shows tumbling motility at room temp, and can grow at refrigerated temps. Infectious Diseases (ID) Microbiology 1
Intracellular pathogens such as Listeria are largely eliminated by the cell-mediated immune response (e.g. T-cells, macrophages, cytokines). Pts w/ impaired cell-mediated immunity are at risk for invasive (Micr)
Listeria infections. ID Micr
1392 Meningitis Listeriosis is most commonly transmitted thru food ingestions and can cause meningitis in immsup adults. Listeria is a Gram (+) rod w/ tumbling motility. It grows well in cold temps and can therefore Nervous (NS) Microbiology 17
contaminate refrigerated food. (Micr) NS Micr
1393 Meningitis Ampicillin is the treatment of choice for Listeria, which is not sensitive to cephalosporins. Listeria most commonly causes disease in those with deficient cell-mediated immunity, such as young infants or Infectious Diseases (ID) Microbiology 17
immunocompromised patients. (Micr) ID Micr
1394 Clostridial myonecrosis Clostridium perfringens causes late-onset food poisoning and clostridial myonecrosis (gas gangrene). The food poisoning is toxin-mediated, late-onset, and causes transient watery diarrhea. Infectious Diseases (ID) Microbiology 3
(Micr) ID Micr
1395 Clostridial myonecrosis Lecithinase, also known as alpha toxin, is the main toxin produced by Clostridium perfringens. Its function is to degrade lecithin, a component of cellular phospholipid membranes, leading to membrane Rheumatology, Orthopedics & Microbiology 3
destruction, cell death, and widespread necrosis and hemolysis. Sports (RH) (Micr) RH Micr
1396 Clostridium difficile infection Abx disrupt the normal intestinal flora and which can allow for overgrowth of Clostridium difficile, an anaerobic, Gram (+), spore-forming bacillus. C difficile produces 2 toxins that penetrate colonic Gastrointestinal & Nutrition (GI) Pathology (Path) 7
epithelial cells leading to watery diarrhea, abdominal cramping, and colitis. The presence of a pseudomembrane (exudate on colonic mucosa consisting of fibrin and inflammatory cells) is highly
suggestive of C difficile infection. GI Path
1397 Clostridium difficile infection C. difficile toxs A and B exert their effects by disrupting the actin CSK structure and intracellular signaling. Although the toxs have overlapping effects, tox A causes relatively more intestinal inflam and Gastrointestinal & Nutrition (GI) Microbiology 7
fluid secretion, and tox B is more cytotox. (Micr) GI Micr
1398 Clostridium difficile infection In the absence of normal intestinal microbial flora (as may be the case after a course of antibiotics), Clostridium difficile can overgrow and produce enterotoxin (toxin A) and cytotoxin (toxin B). Clinical Gastrointestinal & Nutrition (GI) Microbiology 7
disease resulting from C difficile overgrowth can range from transient diarrhea to severe pseudomembranous colitis. (Micr) GI Micr
1399 Botulism Botulinum neurotoxin produced by Clostridium botulinum prevents the release of acetylcholine from presynaptic nerve terminals. The toxin impairs peripheral muscarinic and nicotinic neurotransmission, Nervous (NS) Microbiology 4
causing both autonomic symptoms (eg, fixed pupillary dilation, dry mouth) and skeletal muscle weakness (eg, diplopia, dysphagia, respiratory depression). Its effects at the neuromuscular junction can be (Micr)
seen on electromyography as a decrease in muscle response following stimulation of a motor nerve. NS Micr
1400 Botulism Infant bot is freq due to honey consumption. More than 12% of honey samples contain low # of C. botulinum spores. Whereas infant bot results from consuming C. botulinum spores, adult bot results Gastrointestinal & Nutrition (GI) Microbiology 4
from consuming preformed tox, typically in canned food. SSx of infant bot incl constipation, mild weakness, lethargy, and poor feeding. (Micr) GI Micr
1401 Botulism C. botulinum is a spore-forming, Gram (+), anaerobic bacillus that synth bot tox, which prevents the presynaptic release of ACh from the nerve terminal at the NMJ. Bot tox can be used to Tx focal Nervous (NS) Microbiology 4
dystonia and other disorders of abn muscle contraction. (Micr) NS Micr
1402 Tetanus Tet is caused by infection w/ toxigenic strains of the anaerobic bacterium C. tetani. Transmission typically occurs when spores are inoculated into the skin via a puncture wound. The bacteria germinate, Nervous (NS) Microbiology 5
replicate locally, and elaborate tetanospasmin (TT). The tox spreads in a retrograde fashion thru the LMNs to the spinal cord, where it blocks inhib interneurons and causes spasmodic muscle contraction (Micr)
(e.g. trismus, risus sardonicus). NS Micr
1403 Acute promyelocytic leukemia The cytogenetic defect t(15;17) is a/w APML. A translocation involving the RARα gene from chromosome 17 and the PML gene on chromosome 15 leads to the formation of PML/RARα, a fusion gene Hematology & Oncology (HO) Pathology (Path) 3
whose product inhibits differentiation of myeloblasts and triggers the development of APML. HO Path
1404 Acute myeloid leukemia APML is the M3 variant of acute myelogenous leukemia. It affects adult pts and may Px w/ DIC. The cytogenetic abnormality t(15;17) leads to formation of the PML/RARα fusion gene, which is unable Hematology & Oncology (HO) Pathology (Path) 3
to signal for proper cellular differentiation, unlike the normal RAR. HO Path
1405 Acute promyelocytic leukemia The presence of rod-shaped intracytoplasmic inclusions known as Auer rods is char of many forms of AML. The M3 variant of AML, APML, is a/w the cytogenetic abn t(15;17). Hematology & Oncology (HO) Pathology (Path) 3 HO Path
1406 Acute myeloid leukemia Auer rods are deformed azurophilic granules found in the cytoplasm of myeloblasts that stain (+)ly for MPO. Auer rods are found in abundance in AML M3 (APML). Hematology & Oncology (HO) Pathology (Path) 3 HO Path
1407 Hypothyroidism Congenital hypoTH-ism is usually aSSx at birth. After maternal T4 wanes, infants develop constipation, lethargy, hypotonia, macroglossia, an umbi hernia, and a large ant fontanelle. Endocrine, Diabetes & Genetics (Gene) 13
Metabolism (ES) ES Gene
1409 HSV infection 1° HSV-1 infection in children causes gingivostomatitis (vesicular lesions on the lips and hard palate). HSV-1 and other herpesviruses are enveloped dsDNA viruses. Infectious Diseases (ID) Microbiology 9
(Micr) ID Micr
1411 Influenza The tissue tropism of viruses is 1arily mediated by viral surface glycoproteins that bind to specific host cell receptors. muts to viral surface glycoproteins can alter tissue tropism and cause noninfective Infectious Diseases (ID) Microbiology 5
viruses to become infectious. (Micr) ID Micr
1412 Mutations Deletion or addn of a # of bases that's not divisible by 3 in the coding region of a gene will cause a frameshift mut. Frameshift muts alter the reading frame of the genetic code, resulting in the formation of General Principles (GP) Genetics (Gene) 3
nonfxnal proteins. GP Gene
1413 Hemoglobin properties The individual subunits of the Hb molecule are structurally analogous to Mb. If separated, the monomeric subunits will demo a hyperbolic O2 dissociation curve similar to that of Mb. Hematology & Oncology (HO) Biochemistry 4
(Bioc) HO Bioc
1414 Respiratory physiology The majority of CO2 produced in the tissues is transported to the lungs as HCO3-. W/i RBCs, the enzyme CA forms HCO3- from CO2 and water. The excess HCO3- is then transferred out of RBCs into Pulmonary & Critical Care (PU) Physiology 8
the plasma via exchange w/ Cl-. This exchange is known as 'Cl- shift' and is the principal cause of high RBC Cl- content in venous blood. (Phys) PU Phys
1415 Cyanide poisoning Nitrites are ox agents that're effective in Tx CN- pois due to their ability to induce HbM-emia. HbM contains Fe3+ rather than Fe2+. CN- binds to Fe3+ more avidly than to mitochondrial cytochrome Hematology & Oncology (HO) Biochemistry 2
enzymes, diminishing CN-'s toxic effect. (Bioc) HO Bioc
1416 Methemoglobinemia HbM-emia causes dusky discoloration of the skin (similar to cyanosis), and b/c HbM is unable to carry O2, a state of fxnal anemia is induced. However, the blood PO2 will be unchanged as it's a measure Hematology & Oncology (HO) Biochemistry 1
of O2 dissolved in plasma and is unrelated to Hb fxn. (Bioc) HO Bioc
1417 RNA structure & function The nucleolus is a dense intranuclear body visible by light and electron microscopy that functions as the primary site of ribosome synthesis and assembly. All ribosomal RNA except 5S rRNA is General Principles (GP) Histology (Hist) 2
transcribed in the nucleolus. GP Hist
1418 DNA replication DNA synth can occur only in the 5' --> 3' direction. Okazaki fragments are short stretches of newly synth DNA that're separated by RNA primers. They're formed by the discontinuous synth of DNA on General Principles (GP) Genetics (Gene) 3
the lagging strand during replication. GP Gene
1419 DNA replication DNA replication occurs in the 5'+3' direction on both strands. In contrast to the continuous synthesis of the leading strand, lagging strand synthesis occurs discontinuously and is composed of short General Principles (GP) Biochemistry 3
stretches of RNA primer plus newly synthesized DNA segments (Okazaki fragments). As a result, lagging strand synthesis requires the repetitive action of DNA primase and DNA ligase. (Bioc) GP Bioc
1420 Genetic code Translation of the mRNA template proceeds in the 5' to 3' direction. B/c complementary sequences align in antiparallel fashion, during translation tRNA anticodons will be oriented in the opposite 3' to 5' Miscellaneous (Multisystem) Genetics (Gene) 1
direction. Stop codons (UAA, UAG, and UGA) halt protein synthesis by binding a RF; they do not add AAs to the polypeptide chain. (MS) MS Gene
1421 Fragile X syndrome FXS is caused by an ↑ # of CGG TNRs on the FMR1 gene on the long arm of the X chrom. This leads to hypermethylation and inactivation of FMR1. Nervous (NS) Genetics (Gene) 3 NS Gene
1422 Acute diarrhea Campylobacter infection is a common cause of GE and is typically acquired from contaminated food (eg, undercooked poultry) or domesticated animals (eg, household dogs). MFx usually include fever, Gastrointestinal & Nutrition (GI) Microbiology 13
cramping abdominal pain, and watery diarrhea that may be bloody. Stool studies typically show blood and leukocytes. Campylobacter infection is a/w GBS. (Micr) GI Micr
1423 Cirrhosis ↑ AST and ALT are indicators of hepatocellular dmg, and ↑ ALP and GGT indicate biliary injury. Serum albumin lvls, bilirubin lvls, and PT are reflective of liver fxn and are of greatest prognostic Gastrointestinal & Nutrition (GI) Pathology (Path) 7
significance in pts w/ cirrhosis. GI Path
1424 tRNA wobble The genetic code is considered "degenerate" because more than 1 codon can code for a particular amino acid. Some of this degeneracy is explained by the wobble hypothesis, which states that the first 2 General Principles (GP) Biochemistry 1
nucleotide positions on the mRNA codon require traditional (Watson-Crick) base pairing, whereas the third "wobble" nucleotide position may undergo less stringent (nontraditional) base pairing. (Bioc) GP Bioc
1425 Hypokalemia Thiazide diuretics decrease intravascular fluid volume, which stimulates aldosterone secretion and leads to increased excretion of potassium and hydrogen ions in the urine. This results in hypokalemia Renal, Urinary & Electrolytes Pharmacology 2
and metabolic alkalosis. (RE) (Phar) RE Phar
1426 G6PD deficiency G6PD defic is an XL disorder of the hexose monophosphate (PPP) pathway. In affected individuals, the amount of NADPH produced in RBCs is low, which impairs glutathione-mediated inactivation of Hematology & Oncology (HO) Pathology (Path) 5
free radicals. hemolytic episodes are induced by infections, Rx, and other oxidants. HO Path
1427 Mullerian inhibitory factor The embryonic testis secretes testosterone and MIF. MIF is responsible for regression of the paramesonephric (Mullerian) ducts that normally give rise to the internal genitalia in the female fetus. Male Reproductive (MR) Embryology 1
Testosterone mediates development of male internal genitalia and DHT mediates development of the external genitalia. (Embr) MR Embr
1428 RNA structure & function The 3' CCA tail of tRNA serves as the amino acid binding site. Aminoacyl tRNA synthetase is the enzyme responsible for "loading" the appropriate amino acid to the 3' terminal hydroxyl group of the General Principles (GP) Biochemistry 2
CCA tail. (Bioc) GP Bioc
1429 Defense mechanisms Projection is an immature defence mech involving the misattribution of 1's unacceptable feelings or thoughts to another person who doesn't actually have them. Pregnancy, Childbirth & Behavioral 8
1430 Depression Postpartum mood disturbances incl postpartum blues, postpartum depression, and, rarely, postpartum psychosis. The most common disturbance, postpartum blues, is a benign self-limited condition that Pregnancy, Childbirth & Behavioral 8
begins several days postpartum and resolves w/i 14days w/o intervention. Puerperium (PR) Science (Beha) PR Beha
1431 Personality disorders APD is a maladaptive pattern of behaviour characterised by social inhib, feelings of inadequacy, and fear of embarrassment and rejection. Pregnancy, Childbirth & Behavioral 6
1432 Interviewing technique Open-ended questions are the most effective way to begin a medical interview. Once the patient provides an initial history, the physician can use closed-ended and follow-up questions to clarify certain General Principles (GP) Behavioral 1
points and fill gaps in the history. Science (Beha) GP Beha
1433 Conversion disorder Conversion disorder is Chx by neuro SSx and Ex findings that are incompatible w/ a known neuro disease. Pts do not consciously produce the SSx like in factitious disorder or malingering, and the Pregnancy, Childbirth & Behavioral 1
condition may cause significant distress/impairment. Puerperium (PR) Science (Beha) PR Beha
1434 Exonuclease In prokaryotes, DNA polymerase I has 5' to 3' exonuclease activity in addition to 5' to 3' polymerase and 3 to 5' exonuclease activities. This 5' to 3' exonuclease activity functions to remove the RNA General Principles (GP) Biochemistry 2
primer created by RNA primase and repair damaged DNA sequences. (Bioc) GP Bioc
1435 Exonuclease All 3 prokaryotic DNA polymerases can remove mismatched nucleotides via their 3 to 5 exonuclease ("proofreading") activity. Only DNA polymerase i has 5' to 3' exonuclease activity. which is used to General Principles (GP) Biochemistry 2
remove the RNA primer synthesized by RNA primase. (Bioc) GP Bioc
1436 DNA replication Bloom syndrome is a rare autosomal recessive condition caused by mutations in the BLM gene encoding helicase, an enzyme that unwinds the double helix during DNA replication. Patients typically General Principles (GP) Biochemistry 3
present with growth retardation, facial anomalies, photosensitive skin rash, and immunodeficiency due to chromosomal instability and breakage. (Bioc) GP Bioc
1437 Eukaryotic DNA replication Multiple origins of replication make eukaryotic DNA replication quick and effective despite the large size and complexity of the genome compared to that of prokaryotic organisms. General Principles (GP) Biochemistry 1
(Bioc) GP Bioc
1438 Aging Crit shortening in telomere length can signal for programmed cell death. Telomerase is a reverse transcriptase (RNA-dependent DNA polymerase) that lengthens telomeres by adding TTAGGG repeats to General Principles (GP) Genetics (Gene) 8
the 3' end of chroms. SCs have long telomeres due to high telomerase activity, allowing them to proliferate indefinitely in a controlled manner. GP Gene
1439 Cardiac tamponade The combo of JVD, hypotension, and muffled heart sounds is highly suggestive of cardiac tamponade. Tachycardia and pulsus paradoxus are also freq seen w/ tamponade. Lung Ex is normal, which can Cardiovascular (CV) Pathology (Path) 2
help distinguish cardiac tamponade from tension PTX. CV Path
1440 Diabetes mellitus Neonates born to mothers with poorly controlled diabetes during pregnancy are exposed to high maternal glucose levels in utero, resulting in excessive fetal insulin production and islet hyperplasia. Fetal Pregnancy, Childbirth & Pathology (Path) 31
hyperinsulinemia persists for several days following birth and predisposes the infant to transient hypoglycemia. Puerperium (PR) PR Path
1441 Primary immunodeficiency Chronic granulomatous disease (CGD) results from a genetic defect in NADPH oxidase. Normally, NADPH oxidase participates in the killing of microbes within neutrophil and macrophage Pulmonary & Critical Care (PU) Immunology 7
disorder phagolysosomes. Patients with CGD develop recurrent bacterial and fungal infections that are predominantly caused by 5 catalase-positive organisms: Staphylococcus aureus, Burkholderia cepacia, (Immu)
Serratia marcescens, Nocardia, and Aspergillus. PU Immu
1442 Alzheimer disease A chronically progressive pre-senile dementia with cortical atrophy but no other radiological or laboratory abnormalities permits a clinical diagnosis of Alzheimer's disease (AD), which is a diagnosis of Nervous (NS) Pharmacology 7
exclusion. Current AD-specific therapies include cholinesterase inhibitors (Donepezil), antioxidants (vitamin E), and NMDA receptor antagonists (e.g. memantine). (Phar) NS Phar
1443 Benzodiazepines Benzos bind GABAA receptors, resulting in an ↑ freq of Cl- channel opening in the presence of GABA. Indications for prescribing incl short-term Tx of anxiety disorders and AWS. Pregnancy, Childbirth & Pharmacology 6
1444 Beta blocker poisoning Pts who have OD'd on β blockers should be Tx w/ glucagon, which ↑ HR and contractility independent of adrenergic receptors. Glucagon activates GPCRs on cardiac myocytes, causing activation of Cardiovascular (CV) Pharmacology 1
adenylate cyclase and ↑ intracellular cAMP. The result is Ca2+ release from intracellular stores and ↑ SA node firing. (Phar) CV Phar
1446 Lung abscess Patients with alcoholism are at increased risk for lung abscess due to the aspiration of oral flora during periods of unconsciousness. Lung abscesses tend to be polymicrobial; they are usually composed of Pulmonary & Critical Care (PU) Pharmacology 4
anaerobic oral flora (Bacteroides, Prevotella, Fusobacterium, and Peptostreptococcus) and aerobic bacteria. Clindamycin provides coverage against both anaerobic and aerobic organisms and has been (Phar)
traditionally used in the treatment of lung abscess. PU Phar
1447 Metronidazole Metronidazole is used to Tx trichomonal vaginitis and bacterial vaginosis. It can cause disulfiram like effects (eg, abdominal cramps, nausea, headache) when combined w/ Alc due to acetaldehyde Female Reproductive & Breast Pharmacology 1
accumulation. (FR) (Phar) FR Phar
1448 Warfarin Most available rodenticides contain brodifacoum, a long-acting 4-hydroxycoumarin derivative. A pt who has ingested a quantity of rodenticide sufficient to cause coagulopathy and abnormal bleeding Poisoning & Environmental Pharmacology 2
(similar to warfarin toxicity) requires immediate Tx w/ FFP in addition to vitamin K. Exposure (PO) (Phar) PO Phar
1449 Sexual differentiation The SRY gene on the Y chromosome codes for the TDF, which differentiates the primitive gonads into testes. Sertoli cells produce AMH, which causes regression of the Mullerian ducts and suppresses Male Reproductive (MR) Embryology 2
female internal reproductive organ development. Leydig cells produce testosterone, differentiating Wolffian ducts into internal male reproductive organs. DHT is required for differentiation of the external (Embr)
male genitalia. MR Embr
1450 Gout Gout results from the deposition of monosodium urate crystals in the joints and soft tissues. Under polarized light, urate crystals appear needle-shaped and negatively birefringent. Conditions that increase Rheumatology, Orthopedics & Pathophysiology 11
uric acid production or decrease uric acid clearance can increase the risk of gout. Sports (RH) (Patp) RH Patp
1451 Pseudogout Synovial fluid analysis showing rhomboid-shaped Ca-PPi crystals is Dx of pseudogout. These crystals are (+) birefringent under pol light. The knee joint is involved in >50% of cases. Rheumatology, Orthopedics & Pathology (Path) 1
Sports (RH) RH Path
1452 Facial nerve The stapedius muscle is innervated by the stapedius nerve (a branch of CNVII). Paralysis of the stapedius muscle results in hyperacusis (e.g. ↑ sensitivity to sound). Nervous (NS) Anatomy (Anat) 3 NS Anat
1453 Trigeminal nerve General sensation from the anterior 2/3 of the tongue is carried by the mandibular division of the trigeminal nerve. Gustatory innervation of the anterior 2/3 of the tongue is provided by the chorda Nervous (NS) Anatomy (Anat) 3
tympani branch of the facial nerve. NS Anat
1454 Lead poisoning Young children who reside in homes built before 1978 are at significant risk for Pb toxicity. Pb directly inhibits ferrochelatase and δ-ALA dehydratase, resulting in anemia, ALA accumulation, and ↑ Zn Poisoning & Environmental Biochemistry 4
protoporphyrin levels. Neurotoxicity is also a significant long-term complication. Exposure (PO) (Bioc) PO Bioc
1455 Heme metabolism Maturing erythrocytes lose their ability to synthesize heme when they lose their mitochondria, which are necessary for the 1st and final 3 steps of heme synthesis. Hematology & Oncology (HO) Biochemistry 2
(Bioc) HO Bioc
1456 Heme metabolism Heme oxygenase concerts heme to biliverdin, a pigment that causes the greenish color to develop in bruises several days after an injury. Hematology & Oncology (HO) Biochemistry 2
(Bioc) HO Bioc
1458 Narcolepsy Narcolepsy is a chronic sleep disorder characterised by excessive daytime sleepiness, cataplexy, and REM sleep-related phenomena (i.e. hypnagogic/hypnopompic hallucinations, sleep paralysis). Pregnancy, Childbirth & Behavioral 3
1459 Defense mechanisms Rxn formation is a defence mech that involves replacing unacceptable feelings and impulses w/ their extreme opposites. Pregnancy, Childbirth & Behavioral 8
1460 Obstructive sleep apnea OSA is due to relaxation of oropharyngeal muscle tone w/ occlusion of the upper airway. SSx incl daytime sleepiness, h/a, and depression. Complications incl HTN and PAH, RHF, and an ↑ risk for Pulmonary & Critical Care (PU) Pathophysiology 4
cardiac events. (Patp) PU Patp
1461 Viral genetics Recombination refers to gene exchange that occurs through the crossing over of 2 ds DNA molecules. Reassortment describes the mixing of genome segments in segmented viruses that infect the same Infectious Diseases (ID) Microbiology 4
host cell. (Micr) ID Micr
1462 Viral genetics Phenotypically mixing refers to coinfection of a host cell by 2 viral strains, resulting in progeny virions that contain nucleocapsid proteins from 1 strain and the unchanged parental genome of the other Infectious Diseases (ID) Microbiology 4
strain. B/c there's no change in underlying viral genomes (no genetic exchange), the next gen of virions revert to their original, unmixed phenotypes. (Micr) ID Micr
1463 HIV ART during preg ↓ the risk of perinatal transmission of HIV to 1-2% and is recommended for all preg women w/ HIV. Infectious Diseases (ID) Microbiology 11
(Micr) ID Micr
1464 Rubella The CRS is predominantly Chx by neonatal defects of the head (microcephaly, mental retardation), eyes (cataracts), ears (deafness), and heart/CV system (PDA, peripheral pulmonic stenosis). To ↓ the Pregnancy, Childbirth & Microbiology 3
incidence of this syndrome, the CDC currently recommends the vax of children and non-pregnant females of childbearing age w/ live, attenuated rubella virus vax. Puerperium (PR) (Micr) PR Micr
1465 Rabies In the US, bats are the main source of rabies (only transmitted by mammals). Agitation and spasms progressing to coma w/i wks of exposure is strongly suggestive of rabies encephalitis. Prophylactic vax Infectious Diseases (ID) Microbiology 2
is recommended for individuals at high risk for exposure to rabid animals or their tissues. The approved rabies vax consist of various rhabdovirus strains grown in tissue cell culture and then inactivated. (Micr) ID Micr
1466 Immunizations Inactivated (killed or component) viral vaccines primarily generate a humoral immune response against extracellular viral antigens, preventing viral entry into the cell. In contrast, live attenuated viral Infectious Diseases (ID) Immunology 4
vaccines can generate a strong cell-mediated immune response that can kill virally-infected cells, in addition to providing humoral immunity. (Immu) ID Immu
1467 Immunizations The live attenuated oral (Sabin) poliovirus vaccine produces a stronger mucosal secretory IgA immune response than does the inactivated poliovirus (Salk) vaccine. This increase in mucosal IgA offers Gastrointestinal & Nutrition (GI) Immunology 4
immune protection at the site of viral entry by inhibiting attachment to intestinal epithelial cells. (Immu) GI Immu
1468 Influenza IFN-alpha and -beta are produced by most human cells in response to viral infections. The production of alpha and beta IFNs helps suppress viral replication by halting protein synth and promoting Allergy & Immunology (AI) Immunology 5
apoptosis of infected cells, limiting the ability of viruses to spread thru the tissues. (Immu) AI Immu
1469 Viral genetics Viruses with segmented genomes (eg, orthomyxoviruses, rotaviruses) are capable of genetic shifts through reassortment. Reassortment (genetic shift) involves exchange of entire genomic segments, a far Infectious Diseases (ID) Genetics (Gene) 4
more dramatic process than the point mutations responsible for genetic drift. ID Gene
1470 Hemoglobin C disease HbC is caused by a missense mut that results in a glutamate residue being substituted by lysine in the beta globin chain. This results in an overall decr. in (-) charge for the Hb molecule. The spd of Hb Hematology & Oncology (HO) Biochemistry 1
movement during GE is HbA > HbS > HbC. (Bioc) HO Bioc
1471 Escherichia coli During bacterial DNA replication, DNA polymerase I functions to remove RNA primers (via 5' to 3' exonuclease activity) and replace them with DNA (via 5' to 3' polymerase activity). DNA polymerase I Infectious Diseases (ID) Biochemistry 1
is the only bacterial DNA polymerase that possesses 5' to 3' exonuclease activity. (Bioc) ID Bioc
1472 DNA structure & function Nucleosomes are composed of DNA wrapped around a core of 8 histone proteins (2 molecules each of H2A, H2B, H3, and H4). H1 histone is located outside of this histone core and helps package General Principles (GP) Genetics (Gene) 2
nucleosomes into more compact structures by binding and linking the DNA b/w adjacent nucleosomes. GP Gene
1473 Mitochondrial disorders Mitochondrial DNA (mtDNA) is the most common non-nuclear DNA found in eukaryotic cells. It resembles prokaryotic DNA and is maternally derived. Mutations involving mtDNA or nuclear DNA General Principles (GP) Histology (Hist) 4
that codes for mitochondrial proteins can cause a variety of mitochondrial disorders, including Leigh syndrome and MELAS. GP Hist
1474 Radiation therapy Exposure to ionizing radiation, including therapeutic and palliative radiation therapy, induces DNA damage through DNA double-strand fractures and the formation of oxygen free radicals. Hematology & Oncology (HO) Genetics (Gene) 1 HO Gene
1475 Base excision repair BER is used to correct single-base DNA defects induced spontaneously or by exogenous chemicals. In this process, glycosylases remove the defective base, and the corresponding empty sugar-P site is Gastrointestinal & Nutrition (GI) Biochemistry 1
cleaved and removed by the action of endonuclease and lyase. DNA pol then replaces the missing nucleotide, and ligase seals the final remaining nick. (Bioc) GI Bioc
1476 Xeroderma pigmentosum Xeroderma pigmentosum is an autosomal recessive disorder characterized by defective nucleotide excision repair often caused by a deficiency in UV-specific endonuclease. Affected children usually have Dermatology (DE) Genetics (Gene) 2
severe photosensitivity, hyperpigmentation in sun-exposed areas, and a greatly increased risk for skin cancer. DE Gene
1477 Sunburn Pyrimidine dimers are formed in DNA as a result of ultraviolet light exposure. They are recognized by a specific endonuclease complex that initiates the process of repair by nicking the damaged strand Dermatology (DE) Pathophysiology 1
on both sides of the pyrimidine dimer. The damaged segment is then excised, and replacement DNA is synthesized by DNA polymerase. (Patp) DE Patp
1479 Lac operon The lac operon is regulated by 2 distinct mechs: (-) by binding of the repressor protein to the operator locus and (+) by cAMP-CAP binding upstream from the promoter region. Constitutive expression of Gastrointestinal & Nutrition (GI) Biochemistry 2
the structure genes of the lac operon occurs w/ muts that impair the binding of the repressor protein (Lac I) to its regulatory sequences in the operator region. (Bioc) GI Bioc
1480 Urea cycle Arginase is a urea cycle enzyme that produces urea and ornithine from arginine. Arginase deficiency results in progressive spastic diplegia, growth delay, and abnormal movements. Treatment includes an Nervous (NS) Biochemistry 3
arginine-free, low-protein diet. (Bioc) NS Bioc
1482 Transamination Transamination reactions typically occur between an amino acid and an a-keto acid. The amino group from the amino acid is transferred to the a-keto acid, and the a-keto acid in turn becomes an amino General Principles (GP) Biochemistry 1
acid. Pyridoxal phosphate (active vitamin B ) serves as a cofactor in amino acid transamination and decarboxylation reactions. (Bioc) GP Bioc
1483 Phenylketonuria Deficiency of the enzyme phenylalanine hydroxylase or its cofactor BH4 causes accumulation of phenylalanine in body fluids and the CNS. Homozygous infants are normal at birth but gradually develop Nervous (NS) Biochemistry 5
severe intellectual disability and seizures if left unTx. Hypopigmentation of the skin, hair, eyes, and catecholaminergic brain nuclei is also frequently seen. (Bioc) NS Bioc
1484 Phenylketonuria PKU results from an inability to convert phenylalanine to tyrosine by the phenylalanine hydroxylase system, making tyrosine an essential AA in these pts. Classic CFx of unTx PKU include intellectual Endocrine, Diabetes & Biochemistry 5
disability, seizures, light pigmentation, and a “musty” odor. Metabolism (ES) (Bioc) ES Bioc
1485 Lac operon Bacterial mRNA can be polycistronic, meaning that 1 mRNA codes for several proteins. An example of polycistronic mRNA is the bacterial lac operon, which codes for the proteins necessary for lactose Gastrointestinal & Nutrition (GI) Biochemistry 2
metabolism by E. coli; the transcription and translation of these bacterial proteins is regulated by a single promoter, operator, and set of regulatory elements. (Bioc) GI Bioc
1486 DNA structure & function X-inact occurs in genetically normal females and results in conversion of the inact X chrom into compact heterochrom (Barr body). Heterochrom is condensed chromatin composed of heavily meth DNA General Principles (GP) Genetics (Gene) 2
in tight a/w deacet histones. It has a low lvl of transcriptional activity. In contrast, euchrom is loosely arranged and exhibits a high lvl of transcriptional activity. GP Gene
1487 Mutations DMD Px w/ progr prox muscle weakness in young boys due to incr muscle fiber degen. It's caused by frameshift muts (most common) or nonsense muts in the dystrophin gene that lead to the formation General Principles (GP) Genetics (Gene) 3
of a truncated, defective protein. Nonsense muts intro premature stop codons (e.g. UAA, UAG, UGA) in the coding seq of mRNA. GP Gene
1488 Aminoglycoside Aminoglycosides inhibit genetic code reading and protein synthesis by binding to the prokaryotic 30S ribosomal subunit. Infectious Diseases (ID) Pharmacology 3
(Phar) ID Phar
1490 Congenital cardiac defects Li is commonly used to Tx bipolar disorder. Its use during pregnancy is a/w Ebstein's anomaly, which is Chx by apical displacement of the TV leaflets, ↓ RV volume, and atrialization of the RV. Pregnancy, Childbirth & Pharmacology 2
1491 Bursitis A bursa is a fluid-filled synovial sac that serves to alleviate pressure from bony prominences and ↓ friction b/w muscles and tendons. Acute trauma or chronic repetitive pressure can cause injury, leading Rheumatology, Orthopedics & Anatomy (Anat) 1
to localized pain and tenderness. Prepatellar bursitis causes anterior knee pain and is usually due to repetitive or prolonged kneeling. Sports (RH) RH Anat
1492 Hypoglycemia Nonselective β blockers exacerbate hypoglycaemia and mask hypoglycaemic SSx mediated by NE/EPI. Endocrine, Diabetes & Pharmacology 6
1493 Traumatic brain injury Carbon dioxide is a potent vasodilator of cerebral vasculature. Tachypnea causes hypocapnia and cerebral vasoconstriction, thereby decreasing cerebral blood volume and intracranial pressure. Nervous (NS) Physiology 5
(Phys) NS Phys
1494 Respiratory physiology Panic atks are typically accomp by hypervent, leading to hypocapnia. CBF is directly related to PaCO2; therefore, hypocapnia can lead to decr CBF and SSx of cerebral hypoperfusion (e.g. blurred vision, Pulmonary & Critical Care (PU) Physiology 8
dizziness, lightheadedness). (Phys) PU Phys
1495 Parvovirus Erythema infectiosum (5th disease) is caused by PVB19 and Px w/ a nonspecific prodrome (eg, malaise, fever, congestion) f/b a classic "slapped-cheek" facial rash and a lacy, reticular body rash. Infectious Diseases (ID) Microbiology 3
Parvovirus is highly tropic for erythroid precursor cells and replicates predominantly in the bone marrow. (Micr) ID Micr
1496 Sickle cell In patients with sickle cell anemia and other chronic hemolytic disorders, the most common viral cause of an aplastic crisis is infection of erythroid progenitor cells with parvovirus B19, a nonenveloped Hematology & Oncology (HO) Microbiology 13
single-stranded DNA virus. (Micr) HO Micr
1497 Upper respiratory tract infections Adenovirus is a self-limiting, yr-round infection that causes the acute onset of fever, cough, congestion, pharyngitis, and conjunctivitis. This pharyngoconjunctival disease can occur in outbreaks among Infectious Diseases (ID) Microbiology 2
those living in close quarters (eg, camp dormitories, military barracks). (Micr) ID Micr
1498 Acute diarrhea Norovirus is the most common cause of viral GE. Outbreaks (eg, schools, cruise ships, nursing homes) are common, and SSx include vomiting and watery diarrhea. Infectious Diseases (ID) Microbiology 13
(Micr) ID Micr
1499 HSV infection Herpetic gingivostomatitis is a severe vesicular or ulcerative disease following 1° infection w/ HSV-1. Involvement of the gingiva, tongue, palate, and pharynx along w/ systemic SSx (e.g. fever, malaise) Infectious Diseases (ID) Microbiology 9
is common. In contrast, reactivation of a latent herpes infection in the CNV ganglia gen results in mild perioral vesicles. (Micr) ID Micr
1500 Phenylketonuria BH4 is a cofactor used by hydroxylase enzymes in the synthesis of tyrosine, DA, and 5-HT. PKU can result from BH4 defx due to dihydropteridine reductase defx. Intellectual disability is the hallmark of Nervous (NS) Biochemistry 5
this condition and results in NT (e.g. 5-HT) defx and hyperphenylalaninemia. Tx involves a low phenylalanine diet and BH4 supplementation. (Bioc) NS Bioc
1501 Phenylketonuria BH2 reductase defic (DHBRD) results in impaired BH4 lvls. BH4 is an important cofactor for both phenylalanine hydroxylase and tyrosine hydroxylase. Although phenylalanine lvls can be corrected w/ Endocrine, Diabetes & Biochemistry 5
dietary restriction, downstream defic of DA, NE, EPI, and 5-HT lead to progr neuro deterioration. Metabolism (ES) (Bioc) ES Bioc
1502 Alkaptonuria Alkaptonuria is an AR disorder in which the lack of homogentisic acid dioxygenase blocks the metabolism of tyrosine, leading to an accumulation of homogentisic acid. CFx include a black urine color Miscellaneous (Multisystem) Biochemistry 2
when exposed to air, a blue-black pigmentation on the face, and ochronotic arthropathy. (MS) (Bioc) MS Bioc
1503 Alkaptonuria Alkaptonuria is an autosomal-recessive disorder caused by a deficiency of homogentisic acid dioxygenase, an enzyme involved in tyrosine metabolism. Excess homogentisic acid causes diffuse blue-black Rheumatology, Orthopedics & Biochemistry 2
deposits in connective tissues. Adults have sclerae and ear cartilage hyperpigmentation along with osteoarthropathy of the spine and large joints. Sports (RH) (Bioc) RH Bioc
1504 Homocystinuria Homocystinuria is most commonly caused by cystathionine synthase deficiency. Affected individuals have marfanoid habitus, ectopia lentis, and developmental delay. Significant morbidity and mortality Miscellaneous (Multisystem) Biochemistry 1
are due primarily to TE. Many pts w/ homocystinuria respond dramatically to pyridoxine (vitamin B6) supplementation. (MS) (Bioc) MS Bioc
1505 SLE Procainamide and hydralazine have the highest risk of causing DILE, which is Chx by the development of lupus-like SSx in addition to (+) ANA and anti-histone Abs. Unlike w/ SLE, anti-dsDNA Abs Cardiovascular (CV) Pharmacology 7
are rarely seen. (Phar) CV Phar
1506 Antiarrhythmic drugs Sotalol has both β adrenergic-blocking and class III antiarrhythmic (K+ channel-blocking) properties and is occasionally used in Tx of AF. Major AEs of sotalol include bradycardia, proarrhythmia, and Cardiovascular (CV) Pharmacology 12
most commonly TdP due to QT interval prolongation. (Phar) CV Phar
1507 Antiarrhythmic drugs Class III antiarrhythmic Rx (amiodarone, sotalol, dofetilide) predominantly block K channels and inhibit the outward K currents during phase 3 of the cardiac AP, thereby prolonging repolarization and Cardiovascular (CV) Pharmacology 12
total AP duration. (Phar) CV Phar
1508 Antiarrhythmic drugs Class IC antiarrhythmic agents (flecainide) block the fast Na+ channels responsible for ventricular depol (phase 0), prolonging QRS duration w/ little effect on the QT interval. Class IA and class III Cardiovascular (CV) Pharmacology 12
agents cause the most QT prolongation. (Phar) CV Phar
1509 Antiarrhythmic drugs The class IA antiarrhythmics (quinidine, procainamide, and disopyramide) are Na+ channel-blocking agents that depress phase 0 depol. They also prolong repol due to moderate K+ channel-blocking Cardiovascular (CV) Pharmacology 12
activity, ↑ AP duration in cardiac myocytes. (Phar) CV Phar
1510 Cardiac physiology An ↑ in effective SV or EF is depicted on the LV pressure-volume relationship by widening of the loop w/ a shift in the isovolumic relaxation line to the left (indicating less residual blood volume in the Cardiovascular (CV) Physiology 6
ventricle at end-systole). (Phys) CV Phys
1511 Cardiac physiology Pressure-volume loops represent the relationship b/w pressure and volume in the LV during systole and diastole. An ↑ in the circulating volume ↑ preload (LV EDV) and causes a rightward widening of Cardiovascular (CV) Physiology 6
the pressure-volume loop. (Phys) CV Phys
1512 Hypovolemic shock Intravenous fluids increase the intravascular and left ventricular end-diastolic volumes. The increase in preload stretches the myocardium and increases the end-diastolic sarcomere length, leading to an Cardiovascular (CV) Physiology 1
increase in stroke volume and cardiac output by the Frank-Starling mechanism. (Phys) CV Phys
1513 Cardiac physiology The cardiac AP conduction speed is slowest in the AV node and fastest in the Purkinje system. Conduction speed of the atrial muscle is faster than that of the ventricular muscle. Cardiovascular (CV) Physiology 6
(Phys) CV Phys
1514 Cystic fibrosis CF is an AR disease caused by muts in the CFTR gene. The CFTR protein is a transmembrane ATP-gated Cl- channel. Defects in CFTR result in thick, plugging mucous and incr Na+ and Cl- lvls in Pulmonary & Critical Care (PU) Physiology 11
sweat. (Phys) PU Phys
1515 Carotid baroreceptors Carotid sinus massage leads to an ↑ in PSNS tone causing temporary inhib of SA node activity, slowing of conduction thru the AV node, and prolongation of the AV node refractory period. It's a useful Cardiovascular (CV) Physiology 1
vagal manoeuvre for termination of PSVT. (Phys) CV Phys
1516 Coronary blood flow Coronary autoregulation allows coronary blood flow to be 1arily driven by myocardial O2 demand over a wide range of perfusion pressures (60-140mmHg). It's mostly accomplished by alterations in Cardiovascular (CV) Physiology 9
vascular resistance via release of adenosine and NO in response to myocardial hypoxia. (Phys) CV Phys
1517 Mitral stenosis The classic cardiac auscultation findings in MV stenosis include an OS f/b a diastolic rumbling murmur that is heard best over the apex of the heart. On the ventricular pressure-volume loop, MV opening Cardiovascular (CV) Physiology 7
occurs at the point b/w isovolumetric relaxation and diastolic filling. (Phys) CV Phys
1518 AV fistula and P/V curves AV shunts can be congenital or acquired; acquired forms can result from medical interventions or penetrating injuries. AV shunts ↑ preload and ↓ afterload by routing blood directly from the arterial Cardiovascular (CV) Physiology 1
system to the venous system, bypassing the arterioles. High-volume AV shunts can eventually result in high-output cardiac failure. (Phys) CV Phys
1521 COPD COPD causes air trapping and hyperinflation; conseq, these pts breathe at higher baseline LVs (higher FRC). The absolute volume of air in the lungs that's not respired (RV) incr substantially, as does the Pulmonary & Critical Care (PU) Physiology 16
fraction of air in the lungs that's not involved in resp (RV/TLC ratio). (Phys) PU Phys
1522 Pulmonary gas exchange Gas exchange b/w the alv and pulm cap blood depends on both Q and D. The exchange of O2 and CO2 in a normal individual at rest is Q-limited, so alv and cap partial pressures are equal. Situations in Pulmonary & Critical Care (PU) Physiology 1
which O2 exchange becomes D-limited (e.g. emphysema, PF) cause a large gradient b/w alv and cap PO2; PCO2 is less affected due to the greater DC of CO2. (Phys) PU Phys
1523 Asthma Asthma is characterized by reversible airway obstruction, and lung function tests may be normal between exacerbations. Bronchoprovocation can be used to aid diagnosis in patients with normal Pulmonary & Critical Care (PU) Pharmacology 12
spirometry; methacholine is administered and followed by serial spirometry. Patients with asthma demonstrate hyperresponsivity to the stimulus, leading to FEV1 reductions at lower doses than in those (Phar)
without asthma. PU Phar
1524 Hypovolemia Regardless of the pt's hydration status, the majority of water reabsorption in the nephron occurs in the PCT passively w/ the reabsorption of solutes. Renal, Urinary & Electrolytes Physiology 1
(RE) (Phys) RE Phys
1525 Cholecystitis Gallstone ileus results from passage of a large gallstone thru a cholecystenteric fistula into the small bowel, where it ultimately causes obstr at the ileum. Pts typically present w/ SSx of SBO, and an AXR Gastrointestinal & Nutrition (GI) Anatomy (Anat) 5
may reveal gas w/i thegallbladderandbiliary tree. GI Anat
1526 Obesity hypoventilation syndrome OHS is char by chronic fatigue, dyspnea, difficulty conc, and evidence of hypovent (PaCO2 >45 mmHg while awake). It's 1 of the important causes of hypoxemia w/ a normal A-a O2 gradient. Pulmonary & Critical Care (PU) Physiology 1
(Phys) PU Phys
1527 Iron deficiency anemia The 3 variables that affect the total oxygen content of blood are hemoglobin concentration, oxygen saturation of hemoglobin (SaO2), and the partial pressure of oxygen dissolved in blood (PaO2). Anemia Pulmonary & Critical Care (PU) Physiology 7
is characterized by decreased hemoglobin concentration in the setting of normal SaO2 and PaO2. (Phys) PU Phys
1528 Pulmonary blood flow The circulatory system is a continuous circuit, and therefore the volume output of the left ventricle must closely match the output of the right ventricle. This balance is necessary to maintain continuous Cardiovascular (CV) Physiology 2
blood flow through the body and exists both at rest and during exercise. (Phys) CV Phys
1529 Cardiac physiology The Fick principle can be applied to calculate CO using the rate of O2 consumption and the AV O2 content difference: Cardiovascular (CV) Physiology 6
CO = rate of O2 consumption / AV O2 content difference (Phys) CV Phys
1530 LV volume and pressure Ventricular pressure and volume curves allow 1 to ID the phases of the cardiac cycle and to determine the exact time of opening and closure of the cardiac valves. The AV opens when LVP exceeds the Cardiovascular (CV) Physiology 1
central aortic pressure at the end of isovolumetric contraction. (Phys) CV Phys
1531 Cardiac physiology In cardiac pacemaker cells, phase 0 depol is mediated by an inward flux of Ca2+. This differs from phase 0 of cardiomyocytes and Purkinje cells, which results from an inward Na+ current. Cardiovascular (CV) Physiology 6
(Phys) CV Phys
1532 Chronic heart failure The ↓ CO in HF leads to ↓ renal perfusion and conseq stim of the RAAS in a maladaptive effort to maintain effective BV. Inactive AT-I is converted into active AT-II by endothelial-bound ACE in the Cardiovascular (CV) Pathophysiology 12
lungs. (Patp) CV Patp
1533 Aldosterone antagonists Aldo is a component of the RAAS that acts on the principal and intercalated cells of the renal CDs to cause resorption of Na+ and water and loss of K+ and H+ ions. Aldo receptor antags (e.g. Renal, Urinary & Electrolytes Pharmacology 3
spironolactone, eplerenone) inhib these effects. (RE) (Phar) RE Phar
1534 Neurofibromatosis NF-I (vRD) is an AD disorder caused by muts in the NF1 TSG. Pts Chx develop numerous cutaneous neurofibromas comprised mostly of Schwann cells, which are embryologically derived from the Nervous (NS) Embryology 3
neural crest. (Embr) NS Embr
1535 Community acquired pneumonia Irritation of the parietal pleura will cause sharp pain, which is worse on inspiration. Pain arising from the mediastinal or diaphragmatic pleura will be carried by the phrenic nerve and referred to the C3 C5 Pulmonary & Critical Care (PU) Anatomy (Anat) 21
distribution. PU Anat
1536 Parkinson disease The BBB is formed by tight jxns b/w nonfenestrated capillary endothelial cells that prevent the paracellular passage of fluid and solutes. This barrier only permits the passage of substances from the blood Nervous (NS) Histology (Hist) 7
to the brain via transcellular movement across the endothelial plasma membrane, which is limited by diffusion or carrier-mediated transport. NS Hist
1537 Portal hypertension The portal vein can be ID'd on cross-sectional scans lying med. to (or just w/i) the right lobe of the liver and ant. to the IVC. The pressure in the portal system is ↑ in liver cirrhosis. Gastrointestinal & Nutrition (GI) Anatomy (Anat) 1 GI Anat
1538 Pulmonary embolism The IVC courses through the abdomen and inferior thorax in a location anterior to the right half of the vertebral bodies. The renal veins join the IVC at the lvl of L1/L2, and the common iliac veins merge Cardiovascular (CV) Anatomy (Anat) 13
to become the IVC at the lvl of L5. IVC filters are placed in pts w/ DVT who have c/i to anticoagulation Thx. CV Anat
1540 Diabetic ketoacidosis Normal BGLs are maint by the opp effects of insulin and glucagon. Glucagon stims hepatic glycogenolysis and GNG, whereas insulin ↑ peri Glc uptake and inhibs lipolysis and KA formation. Insulin also Endocrine, Diabetes & Physiology 6
suppresses glucagon release. Metabolism (ES) (Phys) ES Phys
1541 Respiratory physiology Both perfusion and ventilation are highest in the base of the lung and lowest in the apex; however, the variability in perfusion is greater than that in ventilation. This causes the ventilation/perfusion ratio Pulmonary & Critical Care (PU) Physiology 8
to follow the opposite gradient: it is lowest in the base and highest in the apex. (Phys) PU Phys
1542 Respiratory physiology The pO2 in the LA and LV is lower than that in the pulm caps due to mixing of oxy blood from the pulm veins w/ deoxy blood from the bronchial circulation and thebesian veins. Pulmonary & Critical Care (PU) Physiology 8
(Phys) PU Phys
1543 Interstitial lung disease ILD is a/w decr LVs and incr lung elastic recoil caused by fibrotic interstitial tissue. The incr elastic recoil results in incr radial traction (outward pulling) on the airways, leading to incr exp flow rates Pulmonary & Critical Care (PU) Physiology 8
when corrected for the low LV. (Phys) PU Phys
1544 Aspirin poisoning Aspirin intoxication should be suspected in a pt w/ the triad of fever, tinnitus, and tachypnea. Adults w/ aspirin toxicity initially develop a 1° resp alkalosis f/b a mixed resp alkalosis and AGMA. When Poisoning & Environmental Pathophysiology 1
the PaCO2 and HCO3 are outside the normal range, a normal pH suggests a mixed acidosis/alkalosis disorder, as compensatory responses do not correct the pH completely. Exposure (PO) (Patp) PO Patp
1545 Carbon monoxide poisoning Carbon monoxide (CO) binds to hemoglobin with much higher affinity than oxygen, thereby preventing oxygen binding to hemoglobin. It also reduces oxygen unloading from hemoglobin in the tissues. Hematology & Oncology (HO) Physiology 2
CO poisoning increases carboxyhemoglobin concentrations but does not affect the partial pressure of oxygen and does not precipitate methemoglobinemia. (Phys) HO Phys
1546 Gastrointestinal hormones Secretin is prod by S cells in the duodenal mucosa in response to stim by intraluminal activity. Secretin stims the release of HCO3-rich secrs from the exocrine pancr, which is the major source of acid- Gastrointestinal & Nutrition (GI) Physiology 2
neutr HCO3 entering the duodenum. (Phys) GI Phys
1547 Chronic pancreatitis Diarrhoea, weight loss, and epigastric calcifications in a pt w/ chronic alcoholism suggest chronic pancreatitis w/ resulting pancreatic exocrine insufficiency and malabsorption. Gastrointestinal & Nutrition (GI) Pathology (Path) 3 GI Path
1548 Respiratory mucosa Most inhaled particles that lodge in the bronchial tree are removed via prox transport by ciliated epithelial cells (mucociliary clearance). Mucus-secreting cells are present to the lvl of the larger Pulmonary & Critical Care (PU) Physiology 4
bronchioles, after which club cells become the prominent secretory cell type. (Phys) PU Phys
1549 HSV infection 1° infection w/ HSV-2 typically Px w/ fever and a painful vesicular genital rash. HSV-2 primarily infects the sacral DRG and can be reactivated to cause recurrent genital lesions. Female Reproductive & Breast Microbiology 9
(FR) (Micr) FR Micr
1550 HSV infection A new-onset genital vesicular rash w/ a (+) Tzanck smear in a previously aSSx pt is suggestive of 1° genital HSV infection due to HSV-2. Recurrences of genital herpes can be ↓ thru daily Tx w/ oral Infectious Diseases (ID) Microbiology 9
valacyclovir, acyclovir, or famciclovir. Condom use can help prevent a 1° genital HSV infection but doesn't prevent reactivation of latent infection. (Micr) ID Micr
1551 Acyclovir Antiviral drugs currently recommended for the Tx of 1° genital herpes incl the nucleoside analogues (e.g. acyclovir). These are incorporated into newly replicating viral DNA and ultimately terminate Infectious Diseases (ID) Pharmacology 4
viral DNA chain synthesis. (Phar) ID Phar
1552 Herpes zoster 1ary VZV infection (chickenpox) occurs most commonly in childhood. Subseq, the virus migrates to the sensory ganglia, where it lies dormant for decaded. Over time, waning cell-mediated immunity Nervous (NS) Microbiology 4
allows reactivation of the virus, which spreads down a single nerve to cause a painful, erythematous, vesicular rash in a derm distribution. (Micr) NS Micr
1553 Herpes zoster A unilateral vesicular rash localized on a single dermatome in an older patient is most likely herpes zoster. Postherpetic neuralgia is the most common neurologic complication of varicella zoster virus Dermatology (DE) Microbiology 4
infection. (Micr) DE Micr
1554 Urinalysis Most of the K+ filtered by the glomeruli is resorbed in the proximal tubule and loop of Henle. The late distal and cortical collecting tubules are the primary sites for regulation of K* concentration in the Renal, Urinary & Electrolytes Physiology 2
urine. K depletion stimulates a-intercalated cells to reabsorb extra potassium; principal cells secrete K under conditions of normal or increased K load. (RE) (Phys) RE Phys
1555 Filtration fraction The GFR can be estimated by the insulin or creatinine clearance, while the RPF is calculated using the PAH clearance. The FF (FF = GFR / RPF) is the fraction of the RPF that's filtered across the glom Renal, Urinary & Electrolytes Physiology 2
caps into BS. It's usually equal to 20% in healthy individuals. (RE) (Phys) RE Phys
1556 Renal blood flow The RBF refers to the volume of blood that flows thru the kidney per unit time and can be calculated by dividing the RPF by (1 - Hct). Renal, Urinary & Electrolytes Physiology 1
(RE) (Phys) RE Phys
1557 Heart sounds The 3rd heart sound (S3) is a low-frequency sound occurring during early diastole after S2. LV gallops (S3 a/o S4) are best heard w/ the bell of the stethoscope over the cardiac apex while the pt is in the Cardiovascular (CV) Physiology 1
left lateral decubitus position at end expiration. (Phys) CV Phys
1558 Muscle structure & physiology During skeletal muscle contraction, calcium is released from the sarcoplasmic reticulum and binds troponin C, thereby allowing the binding of actin to myosin. Rheumatology, Orthopedics & Physiology 8
1559 Glucose clearance Glc is normally filtered at the glom and completely reabsorbed by the PCT. Inhib of Na+-coupled, carrier-mediated transport of Glc by the PCT would cause the Glc clearance to approach the value of the Renal, Urinary & Electrolytes Physiology 1
GFR, which is typically estimated by calculating the clearance of inulin. (RE) (Phys) RE Phys
1560 Estrogen synthesis LH stimulates the theca interna cells of the ovarian follicle to produce androgens. Aromatase w/i the follicle's granulosa cells subsequently converts these androgens to estradiol under FSH stimulation. Female Reproductive & Breast Physiology 1
The theca externa cells serve as a CT support structure for the follicle. (FR) (Phys) FR Phys
1561 SIADH ADH and Oxt are synthesised w/i neurons found in the PVN and SON and are released into the circulation from axon terminals in the posterior pituitary. NPs are involved in the post-translational Endocrine, Diabetes & Pathophysiology 3
processing and stabilisation of Oxt and ADH w/i neurosecretory vesicles during transport to the posterior pituitary. Metabolism (ES) (Patp) ES Patp
1562 Diabetes insipidus NPs are carrier proteins for Oxy and ADH. Oxy and ADH are carried by unique NPs from their site of prod in the cell bodies of the PVN and SON to their site of release in the axon terminals of the post Endocrine, Diabetes & Physiology 4
pit. Point muts in NP-II underlie most cases of HHDI, a disorder resulting from insuff ADH release into the syst circulation. Metabolism (ES) (Phys) ES Phys
1563 Respiratory physiology Min vent is equal to the product of TV and RR and incl dead space vent. Alv vent is equal to the product of RR and the diff b/w TV and dead space volume. Pulmonary & Critical Care (PU) Physiology 8
(Phys) PU Phys
1564 Anticholinergics Physostigmine is a AChEI w/ a 3° NH4+ structure that can reverse both the CNS and PNS SSx of anticholinergic tox. Neostigmine, edrophonium, and pyridostigmine have a 4° NH4+ structure that limits Nervous (NS) Pharmacology 3
CNS penetration. (Phar) NS Phar
1565 Chronic heart failure Neurohormones (e.g. NE, ATII, and aldosterone) play a large role in the deleterious cardiac remodelling that occurs in HF w/ ↓ EF. ACEIs, ARBs, MRBs, and β blockers ↓ mortality in these pts by ↓ Cardiovascular (CV) Pharmacology 12
neurohormonal-mediated cardiac remodelling. (Phar) CV Phar
1568 Teratogens Isotretinoin is used to Tx severe acne w/ significant scarring. Pregnancy is an absolute c/i due to the risk of teratogenicity. Sexually active women should be advised to use 2 forms of contraception and Pregnancy, Childbirth & Pharmacology 2
take monthly pregnancy tests. Puerperium (PR) (Phar) PR Phar
1569 Chronic myeloid leukemia CML and LR can have presentations similar to leucocytosis; however, LAP lvl is normal or ↑ in an LR but ↓ in CML. The definitive Dx of CML req demonstration of the Philadelphia chrom t(9;22) or Hematology & Oncology (HO) Pathology (Path) 2
BCR-ABL fusion gene or mRNA. HO Path
1570 Acute myeloid leukemia The finding of Auer rods (linear purple-red inclusions w/i immature myeloid precursors) is helpful in making the Dx of AML. Auer rods are not found in ALL. In CML, there are more mature cells and Hematology & Oncology (HO) Pathology (Path) 3
fewer blasts. HO Path
1571 Acute lymphoblastic leukemia Precursor B-ALL and precursor T-ALL can only be distinguished by immunophenotyping. The lymphoblasts in precursor B-ALL are TdT+, CD10+, and CD19+, whereas the lymphoblasts in precursor Hematology & Oncology (HO) Pathology (Path) 3
T-ALL express T-cell markers (e.g. CD2, CD3, CD4, CD5, CD7, and CD8), TdT, and CD1a. HO Path
1572 Nasopharyngeal carcinoma NPC is endemic in southern China due genetic and dietary factors that promote nasopharyngeal epithelial pre-malignant lesions. In almost all cases, malignant transformation occurs due to infection of Hematology & Oncology (HO) Pathology (Path) 1
pre-malignant cells w/ EBV and the subseq expression of oncogenic viral proteins. HO Path
1573 Toxoplasmosis The finding of multi ring-enhancing lesions in an HIV pt is most likely due to toxoplasmosis. Nervous (NS) Microbiology 5
(Micr) NS Micr
1574 Giardia Giardia lamblia is the most common enteric parasite in the United States and Canada and is a common cause of diarrhea in campers/hikers. Iodine-stained stool smear classically shows pear-shaped, Infectious Diseases (ID) Microbiology 2
flagellated trophozoites or ellipsoidal cysts w/ smooth, well-defined walls and 2+ nuclei. Metronidazole is the Tx of choice. (Micr) ID Micr
1575 Rubella Maternal rubella infection produces a low-grade fever, a maculopapular rash w/ cephalocaudal progression, and posterior auricular and suboccipital LAD. Most adult women pts develop polyarthritis and Pregnancy, Childbirth & Microbiology 3
polyarthralgia as sequelae. CRS is a/w sensorineural deafness, cataracts, and cardiac malformations (PDA). Puerperium (PR) (Micr) PR Micr
1576 Cytomegalovirus In a transplant pt, pneumonia w/ intranuclear and cytoplasmic inclusion bodies histo points to opportunistic infection w/ CMV, an enveloped virus that contains a dsDNA genome. Pulmonary & Critical Care (PU) Microbiology 9
(Micr) PU Micr
1577 Glomerular disorders Frothy or foamy urine may be caused by proteinuria. Heavy proteinuria, as in nephrotic syndrome, can cause regional or generalized interstitial edema because the decrease in serum albumin and total Renal, Urinary & Electrolytes Pathophysiology 9
protein concentrations lowers the plasma oncotic pressure and increases net plasma filtration in capillary beds. (RE) (Patp) RE Patp
1578 Cor pulmonale Peripheral edema results from the accumulation of fluid in the interstitial spaces. Factors that promote edema include elevated capillary hydrostatic pressure, decreased plasma oncotic pressure, sodium Cardiovascular (CV) Pathophysiology 1
and water retention, and impaired lymphatic drainage. In chronic heart failure, increased lymphatic drainage initially offsets factors favoring edema, whereas acute changes (eg, venous thrombosis, heart (Patp)
failure decompensation) are more likely to produce edema. CV Patp
1579 ARDS ARDS is caused by injury of the pulm epithelium a/o endothelium, and occurs most often due to sepsis or pneumonia. Cytokines recruit neutrophils to the lung tissue, which cause cap dmg and leakage of Pulmonary & Critical Care (PU) Pathology (Path) 3
protein-rich fluid into the alveoli. Later, cellular proliferation and collagen deposition occurs, and in some pts, this leads to irreversible PF. PU Path
1580 Folic acid The underlying biochemical feature of megaloblastosis is a defect in DNA synthesis. In chronic Alcics, megaloblastic macrocytic anemia can result from a nutritional deficiency of vitamin B12 or of Hematology & Oncology (HO) Pathology (Path) 1
folate, which impairs synthesis of purine and pyrimidine bases. HO Path
1581 Vitamin A deficiency VitA defic causes night blindness and hyperkeratosis. defic of this fat-soluble vit can develop in pts w/ biliary disorders, exocrine PI, or intestinal malabsorption. Gastrointestinal & Nutrition (GI) Pathophysiology 1
(Patp) GI Patp
1582 Acute respiratory failure There're 5 major causes of hypoxemia (low PaO2): alv hypovent, low PiO2, V/Q mismatch, diffusion impairment, and R-L shunting. The A-a gradient is normal w/ alv hypovent and low PiO2, which Pulmonary & Critical Care (PU) Physiology 1
helps distinguish these causes from other causes of hypoxemia. (Phys) PU Phys
1583 COPD PaCO2 is the major stim of resp in healthy individuals; even a slight incr in PaCO2 stims cChRs and triggers incr vent. In pts w/ COPD, the response to PaCO2 is blunted and hypoxemia can contribute to Pulmonary & Critical Care (PU) Physiology 16
resp drive. pChRs are 1arily responsible for sensing PaO2 and can be suppressed w/ O2 admin. (Phys) PU Phys
1584 Pulmonary embolism PE is common in hosp and and postop pts, and classically Px w/ sud-on SOB and pleuritic chest pain. It causes hypoxemia due to V/Q mismatch; PaCO2 is usually normal or decr. Pulmonary & Critical Care (PU) Physiology 13
(Phys) PU Phys
1585 Acute heart failure LHF is common following MI affecting the LV. The resulting accumulation of oedema in the pulm interstitium makes the lungs heavy and stiff, restricting inspiratory expansion and ↓ lung compliance. Pulmonary & Critical Care (PU) Pathophysiology 7
(Patp) PU Patp
1586 Polycythemia Erythrocytosis is defined as a Hct lvl >52% in men and >48% in women. Measurement of RBC mass is necessary to distinguish absolute from relative erythrocytosis. A normal RBC mass indicates Pulmonary & Critical Care (PU) Physiology 5
plasma volume contraction as the cause of polycythemia. (Phys) PU Phys
1587 Pulmonary arterial hypertension The pulm vasc bed is unique in that tissue hypoxia results in a vasocon response. Such hypoxic vasocon occurs in the small muscular pulm arteries to divert blood flow away from undervent lung regions Pulmonary & Critical Care (PU) Physiology 8
and toward well-vent lung areas to mini V/Q mismatch, leading to more efficient overall gas exchange. (Phys) PU Phys
1588 Para-aminohippuric acid PAH is 1arily secreted into the nephron by the PCT, but some is also freely filtered by the glom. PAH isn't reabsorbed by any portion of the nephron. Therefore, tubular fluid conc of PAH is lowest in BS. Renal, Urinary & Electrolytes Physiology 1
(RE) (Phys) RE Phys
1589 Physical exercise The cardioresp response to exercise includes ↑ HR, CO, and RR in order to balance the ↑ total tissue O2 consumption and CO2 production. These coordinated adaptations result in relatively constant ABG Cardiovascular (CV) Physiology 2
values whereas venous O2 is ↓ and venous CO2 is ↑. (Phys) CV Phys
1590 Respiratory physiology During physical ex, there's incr skeletal muscle CO2 production that incr the CO2 content of venous blood. Art O2 and CO2 content remains constant via incr in alv vent and gas exchange efficiency. Pulmonary & Critical Care (PU) Physiology 8
Venous O2 content remains constant or is decr due to incr O2 extraction by the tissues that matches or exceeds the rate of O2 delivery (i.e. O2 consumption during ex is limited by CO). (Phys) PU Phys
1591 Mitral stenosis Under normal circumstances, PCWP closely reflects LA and LV EDP. MS leads to an ↑ in the LA pressure that is reflected as ↑ PCWP during pulm artery catheterization. LV filling may be normal, Cardiovascular (CV) Physiology 7
resulting in an ↑ pressure gradient b/w the LA and LV during diastole. (Phys) CV Phys
1592 Cytomegalovirus Cytomegalovirus (CMV) is typically associated with subclinical infection in the immunocompetent, with the occasional individual developing a mononucleosis-like syndrome that is heterophile antibody General Principles (GP) Microbiology 9
(Monospot) negative. In the immunocompromised, primary or reactivated CMV infection can result in severe retinitis, pneumonia, esophagitis, colitis, or hepatitis. (Micr) GP Micr
1593 Cytomegalovirus The Monospot test is positive in most cases of Epstein-Barr virus-associated mononucleosis. In immunocompetent patients with a heterophile antibody-negative mononucleosis-like syndrome, the most Infectious Diseases (ID) Microbiology 9
likely diagnosis is cytomegalovirus infection. (Micr) ID Micr
1594 Infectious mononucleosis EBV commonly infects B cells, stim them to proliferate continuously ('transformation' or 'immortalisation'). EBV is an oncogenic virus that promotes polyclonal B cell proliferation and heterophile Ab Infectious Diseases (ID) Microbiology 5
production. The heterophile Ab test is sensitive and highly specific for EBV infection. (Micr) ID Micr
1595 Infectious mononucleosis Typical clinical and laboratory features of Epstein-Barr virus (EBV) mononucleosis include fever, pharyngitis, lymphadenopathy, splenomegaly, and atypical lymphocytosis. EBV is generally transmitted Infectious Diseases (ID) Microbiology 5
from an asymptomatic virus shedder to a susceptible individual through saliva transfer (eg, kissing). (Micr) ID Micr
1596 Giardia G. lamblia causes injury to the duodenal and jejunal mucosa by adhering to the intestinal brush border and releasing molecules that induce a mucosal inflammatory response. Secretory IgA, which impairs Infectious Diseases (ID) Microbiology 2
adherence, is the major component of adaptive immunity against G. lamblia infection. Conditions causing IgA defic predispose pts to chronic giardiasis. (Micr) ID Micr
1597 Inflammatory bowel disease Of the cytokines released in the setting of tissue injury, IL-10 plays important anti-inflammatory and immunomodulatory roles, especially in the pathogenesis of inflammatory bowel disease. IL-10 Gastrointestinal & Nutrition (GI) Immunology 9
attenuates the immune response through the inhibition of Th1 cytokines, reduction of major histocompatibility complex class Il expression, and suppression of activated macrophages and dendritic cells. (Immu) GI Immu
1598 Tuberculosis The CGs of TB are almost always surrounded by large epithelioid macrophages w/ pale pink granular cytoplasm. CD14 is a surface marker spec. to the monocyte-macrophage cell lineage. Hematology & Oncology (HO) Immunology 18
(Immu) HO Immu
1599 Down syndrome Trisomy 21 is detectable by cytogenetic karyotype analysis and is the most common genetic cause of congenital intellectual disability. Patients with Down Syndrome are at increased risk of developing Hematology & Oncology (HO) Genetics (Gene) 6
acute lymphoblastic leukemia and acute megakaryoblastic leukemia. HO Gene
1600 Reactive arthritis Reactive arthritis is a spondyloarthropathy associated with HLA-B27 that can occur following infection with Chlamydia, Campylobacter, Salmonella, Shigella, or Yersinia. It presents with sterile arthritis Rheumatology, Orthopedics & Pathophysiology 2
due to deposition of immune complexes. Sports (RH) (Patp) RH Patp
1601 Guillain-Barre syndrome GBS represents a group of imm-med polyneuropathies that're thought to be caused by molecular mimicry, leading to demyelination of the peri nerves. Up to 1/3 of GBS cases are preceded by a C. jejuni Nervous (NS) Microbiology 3
infection, which is a common cause of acute diarrheal illness. (Micr) NS Micr
1603 Peptic ulcer disease H. pylori antral gastritis is a/w the formation of duodenal ulcers due to ↑ gastric acid production. This ↑ in acidity is caused by unchecked gastrin production due to the destruction of somatostatin- Gastrointestinal & Nutrition (GI) Pathology (Path) 10
secreting cells in the gastric antrum. GI Path
1604 Peptic ulcer disease H. pylori produces the enzyme urease, which splits urea into CO2 and NH3+ and neutralises the local acidic gastric pH. Active infection can be confirmed thru rapid urease testing, in which gastric Gastrointestinal & Nutrition (GI) Pathology (Path) 10
mucosa is evaluated in the presence of urea and a pH indicator. Evidence of alkalinisation (due to NH3+ formation) is confirmatory. GI Path
1605 Gastrectomy IF is a gp that's normally secreted by parietal cells in the stomach and is necessary for the absorption of vitB12 in the ileum. Pts who have undergone a total gastrectomy req lifelong vitB12 Gastrointestinal & Nutrition (GI) Pathophysiology 1
supplementation due to inability to produce IF. (Patp) GI Patp
1607 Nephron osmolarity ADH acts 1arily on the CDs, ↑ their permeability to water. In the absence of ADH, the tubular fluid is most concentrated at the junction b/w the desc. and asc. limbs of the LOH and most dilute in the Renal, Urinary & Electrolytes Physiology 2
CDs. (RE) (Phys) RE Phys
1608 Nephron osmolarity Dehydration stim ADH secretion. ADH acts on the CDs, ↑ their permeability to water. Thus, in the presence of ADH, the CDs contain the most concentrated fluid in the nephron, while the DCT contains Renal, Urinary & Electrolytes Physiology 2
the most dilute fluid. (RE) (Phys) RE Phys
1609 Carotid sinus hypersensitivity The carotid sinus is a dilation of the ICA located just above the bifurcation of the CCA. The carotid sinus reflex has an afferent limb that arises from the baroreceptors in the carotid sinus and travels to the Cardiovascular (CV) Physiology 1
vagal nucleus and medullary centers via the glossopharyngeal nerve (CN IX); the efferent limb carries parasympathetic impulses via the vagus nerve (CN X). (Phys) CV Phys
1610 Aneuploidy Common findings in DS include cognitive impairment, facial dysmorphism, and cardiac defects; 95% of cases are caused by the presence of an extra chromosome 21 (trisomy) resulting from General Principles (GP) Genetics (Gene) 1
nondisjunction. Unbalanced Robertsonian translocations or mosaicism are less common causes. GP Gene
1611 Immotile cilia syndrome Kartagener syndrome is a form of primary ciliary dyskinesia characterized by the triad of situs inversus, chronic sinusitis, and bronchiectasis. It occurs due to mutations that impair the structure or function Pulmonary & Critical Care (PU) Immunology 1
of cilia. Cystic fibrosis also causes chronic respiratory infections, but it is not associated with situs inversus. (Immu) PU Immu
1612 Angioedema Angioedema can be hereditary (AD) or acq (a/w ACEI Tx). In HAE, low C1 esterase inhib activity leads to ↑ in bradykinin activity. ACEI shouldn't be used in these pts. Allergy & Immunology (AI) Pharmacology 2
(Phar) AI Phar
1613 Graft versus host disease Graft-versus-host disease can occur following transplantation of organs rich in lymphocytes (eg. liver). T lymphocytes found in the donor organ become sensitized against the MHC antigens of the Dermatology (DE) Immunology 1
recipient and subsequently attack the host's tissues. The skin, liver, and gastrointestinal tract are most frequently affected. (Immu) DE Immu
1614 Humoral immunity The 1ary imm response to a new Ag initially results in plasma cells that only produce IgM. Isotype switching later occurs in the germinal centers of LNs and req interaction of the CD40 receptor on B Allergy & Immunology (AI) Immunology 1
cells w/ the CD40L (CD154) expressed by activated T cells. IgG is the main serum Ig of the 2ary response. (Immu) AI Immu
1615 Hypothyroidism TSH from the ant pit stims the thyroid to prod T4 and a small amount of T3. T4 is converted in peri tissues to T3 (active form) and rT3 (inactive form). TSH secretion is under (-) fb by TH on the hypothal Endocrine, Diabetes & Physiology 13
and pit. Metabolism (ES) (Phys) ES Phys
1616 Flow/resistance The total resistance for a group of vessels arranged in parallel is equal to one divided by the sum of the inverse values for resistance of each of the contributing vessels as follows: 1/TPR = 1/R1+1/R2 + General Principles (GP) Physiology 1
1/R3 + ... 1/Rn. Total body circulation can be best described as a parallel circuit, whereas circulation in an individual organ is often best described by a series arrangement. (Phys) GP Phys
1617 GFR The concs of PAH, creatinine, inulin, and urea ↑ as fluid runs along the PCT, while the concs of HCO3-, Glc, and AAs ↓. Renal, Urinary & Electrolytes Physiology 6
(RE) (Phys) RE Phys
1618 GFR ↑ in the cap hydrostatic pressure or the BS oncotic pressure will ↑ GFR, while ↑ in cap oncotic pressure or BS hydrostatic pressure will ↓ GFR. The FF can be calculated by dividing the GFR by the RPF. Renal, Urinary & Electrolytes Physiology 6
↑ in GFR or ↓ in RPF will ↑ the FF. (RE) (Phys) RE Phys
1619 PAH clearance PAH is freely filtered from the blood in the glom caps to the tubular fluid in BS. It's also secreted from the blood into the tubular fluid by the cells of the PCT by a carrier protein-mediatedprocess. The Renal, Urinary & Electrolytes Physiology 1
secretion of PAH can be saturated at high blood concs. (RE) (Phys) RE Phys
1621 Renal artery stenosis Blood flow is directly proportional to the vessel radius raised to the fourth power. Resistance to blood flow is inversely proportional to the vessel radius raised to the fourth power. Cardiovascular (CV) Physiology 9
(Phys) CV Phys
1622 Physical exercise Exercising muscles can receive up to 85% of the total CO during periods of strenuous activity. Although sympathetic discharge during exercise causes ↑ CO and splanchnic vasoconstriction, there's only a Cardiovascular (CV) Physiology 2
modest ↑ in mean BP as vasodilation w/i active skeletal muscles significantly ↓ the total SVR. (Phys) CV Phys
1623 Left atrial enlargement CV dysphagia can result from external compression of the esophagus by a dilated and posteriorly displaced LA in pts w/ RHD and MS/MR. Cardiovascular (CV) Anatomy (Anat) 1 CV Anat
1624 Cardiac output and venous return MI causes a sharp ↓ in CO due to loss of fxn of a zone of myocardium. On a cardiac fxn curve, MI would ↓ both the slope and the maximal height of the line. Cardiovascular (CV) Physiology 2
(Phys) CV Phys
1625 Cardiac output and venous return A chronic AV shunt would ↑ CO b/c of ↑ sympathetic stimulation to the heart, ↓ TPR, and ↑ venous return. It would also cause the venous return curve to shift to the right b/c the circulating blood volume Cardiovascular (CV) Physiology 2
is ↑ through renal retention of fluids and b/c venous pooling is ↓ by the ↑ sympathetic tone. (Phys) CV Phys
1626 Hodgkin lymphoma The presence of RS cells on LN Bx is Dx of classic Hodgkin lymphoma. RS cells have abundant cytoplasm, bilobed or double nuclei, and inclusion-like eosinophilic nucleoli. Hematology & Oncology (HO) Pathology (Path) 2 HO Path
1627 Non-Hodgkin lymphoma Follicular lymphoma is characterised by aggregates of packed follicles that obscure the normal LN architecture. 90% of pts w/ follicular lymphoma have the t(14;18) translocation, which causes Hematology & Oncology (HO) Pathology (Path) 6
overexpression of the anti-apoptotic BCL-2 protein. HO Path
1628 Non-Hodgkin lymphoma Rituximab is a mAb directed against the CD20 Ag. Its intro has improved the prognosis of some lymphomas. Hematology & Oncology (HO) Pharmacology 6
(Phar) HO Phar
1629 Burkitt lymphoma Histo, Burkitt lymphoma has a 'starry sky' appearance due to the presence of macrophages and apoptotic bodies in a sea of medium-sized lymphocytes. The rates of mitosis and apoptosis in the cancerous Hematology & Oncology (HO) Pathology (Path) 3
tissue are high. Almost all cases of Burkitt lymphoma are a/w translocations of the c-Myc gene on chrom 8, usually onto the Ig heavy chain region of chrom 14 [t(8;14)]. HO Path
1630 Burkitt lymphoma The EBV genome is ID'd in approx. 50% of systemic B-cell lymphomas and almost all 1° CNS lymphomas occurring in the setting of HIV infection. A high mitotic index is typical of Burkitt lymphoma. Hematology & Oncology (HO) Pathology (Path) 3 HO Path
1631 Lymphadenopathy Most of the cutaneous lymph from the umbilicus down, including the anus below the dentate line, drains to the superficial inguinal lymph nodes. Exceptions are the glans penis and posterior calf, which Hematology & Oncology (HO) Anatomy (Anat) 1
drain to the deep inguinal nodes. HO Anat
1632 Ovarian cancer The suspensory ligament of the ovary contains the ovarian artery, vein, lymphatics, and nerves. The ovarian artery is the major blood supply to the ovary and must be ligated during an oophorectomy to Female Reproductive & Breast Anatomy (Anat) 9
prevent heavy bleeding. (FR) FR Anat
1633 Hearing loss Prolonged exposure to loud noises causes hearing loss due to damage to the stereociliated hair cells of the organ of Corti. Ear, Nose & Throat (EN) Anatomy (Anat) 2 EN Anat
1634 Ulnar nerve neuropathy The ulnar nerve can be injured at the med. epicondyle of the humerus ('funny bone') or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist. Pts often have sensory loss over the Rheumatology, Orthopedics & Anatomy (Anat) 2
med. 1.5 digits and hypothenar eminence, and weakness on wrist flexion/adduction, finger abduction/adduction, and flexion of the 4th/5th digits. The hypothenar eminence may flatten due to muscle Sports (RH)
atrophy. RH Anat
1635 Hydrocephalus CSF flows from the third ventricle to the fourth ventricle via the cerebral aqueduct of Sylvius. Obstruction at this level can cause dilated lateral and third ventricles with a normal-sized fourth ventricle. Nervous (NS) Anatomy (Anat) 4
Obstruction at the foramen of Monro would cause enlargement of only the affected lateral ventricle, while obstruction at the foramen of Magendie and Luschka causes enlargement of all 4 ventricles. NS Anat
1636 Brachial plexus The musculocutaneous nerve innervates the major forearm flexors (e.g. biceps brachii, brachialis) and coracobrachialis (flexes and adducts the arm) and provides sensory innervation to the lateral forearm. Nervous (NS) Anatomy (Anat) 6
It's derived from the upper trunk of the brachial plexus (C5-C7) and can be injured by trauma or strenuous upper extremity exercise. NS Anat
1638 Tibial nerve injury The tibial nerve may be injured at the lvl of the popliteal fossa due to deep penetrating trauma or knee Sx. Pts typically have weakness on foot plantarflexion, foot inversion, and toe flexion, w/ sensory Rheumatology, Orthopedics & Anatomy (Anat) 1
loss over the sole. Sports (RH) RH Anat
1639 Falls Superior gluteal nerve injury results in weakness and paralysis of the gluteus medius, gluteus minimus, and tensor fasciae latae muscles. This causes the pelvis to tilt downward toward the contralateral Nervous (NS) Anatomy (Anat) 1
side ((+) Trendelenburg SSx). Pts will also lean toward the ipsilateral side when walking to help stabilise the pelvis (gluteus medius gait). NS Anat
1640 Peripheral neuropathy Injections given in the superomedial part of the buttock risk injury to the sup. gluteal nerve. Injections into the superomedial, inferomedial, and inferolateral regions of the buttock risk injury to the sciatic Rheumatology, Orthopedics & Anatomy (Anat) 3
nerve. The superolateral quadrant of the buttock is a relatively safe site for intragluteal injections, although the anterolateral gluteal region is preferred. Sports (RH) RH Anat
1641 Herpes zoster Acyclovir, the acyclovir prodrug valacyclovir, famciclovir, and ganciclovir are all nucleoside analogues that require both herpes viral and cellular kinases for conversion to their active nucleoside Dermatology (DE) Pharmacology 4
triphosphate form. Cidofovir is a nucleoside monophosphate (ie, a nucleotide) that requires only cellular kinases for activation. (Phar) DE Phar
1642 Acyclovir IV acyclovir can cause crystalline nephropathy if adequate hydration isn't also provided. Infectious Diseases (ID) Pharmacology 4
(Phar) ID Phar
1643 Foscarnet Foscarnet is an analogue of PPi that can chelate Ca2+ and promote nephrotox renal Mg wasting. These tox can result in hypocalcaemia and hypomagnesaemia, which can cause seizures. Infectious Diseases (ID) Pharmacology 1
(Phar) ID Phar
1644 Cytomegalovirus Of all the antiviral agents that bind and inhib DNA polymerase in herpesvirus and reverse transcriptase in HIV, the PPi analogue foscarnet is 1 of few that don't req intracellular activation by viral or Infectious Diseases (ID) Pharmacology 9
cellular kinases. (Phar) ID Phar
1645 Acyclovir Monophosphorylation of acyclovir by a viral thymidine kinase is the 1st (and RLS) step in conversion of acyclovir to its active triphosphate form. Acyclovir and related drugs (e.g. famciclovir, Infectious Diseases (ID) Pharmacology 4
valaciclovir) are more effective against HSV and VZV than CMV and EBV. (Phar) ID Phar
1646 Cytomegalovirus CMV retinitis is the most common cause of ocular disease in pts w/ unTx AIDS who have CD4 counts <50/mm3. Dx is made by funduscopy, which typically reveals yellow-white, fluffy retinal lesions Ophthalmology (OP) Pharmacology 9
near the retinal vessels w/ associated hemorrhage. Tx w/ ganciclovir is required to prevent blindness. (Phar) OP Phar
1647 Cytomegalovirus 1st-line therapy for CMV colitis and retinitis is ganciclovir. This Rx inhibs viral synthesis by blocking CMV DNA polymerase. However, ganciclovir also blocks host DNA polymerase to a lesser degree, Infectious Diseases (ID) Pharmacology 9
which can lead to heme AEs such as neutropaenia, anaemia, and thrombocytopaenia. (Phar) ID Phar
1648 Influenza Oseltamivir is a neuraminidase inhib useful in the Tx and prevention of both influenza A and B virus infections. This Rx impairs the release of newly formed virions from infected host cells and impairs Infectious Diseases (ID) Pharmacology 5
viral penetration of mucous secretions that overlie the resp epithelium. (Phar) ID Phar
1649 Influenza Major adaptive immune mechs that prevent reinfection w/ the influenza virus incl anti-hemagglutinin Abs. Pulmonary & Critical Care (PU) Microbiology 5
(Micr) PU Micr
1650 Interstitial lung disease Decr in the slope of the curve depicting LV vs distending pressure indicates decr lung compliance (the hallmark of PF). Pulmonary & Critical Care (PU) Physiology 8
(Phys) PU Phys
1651 GFR Acuteureteral constriction or obstr ↓ the GFR and FF. Renal, Urinary & Electrolytes Physiology 6
(RE) (Phys) RE Phys
1652 Diastolic dysfunction Na nitroprusside is a short-acting agent that causes balanced vasodilation of the veins and arteries to ↓ both LV preload and afterload. The balanced vasodilation allows for maintenance of SV and CO at a Cardiovascular (CV) Physiology 4
↓ LV pressure (↓ cardiac work). (Phys) CV Phys
1653 Cardiac pressure range Right-sided pressures in the heart are lower than left-sided pressures due to lower resistance in the pulm vasculature. RV diastolic pressure is similar to RA/CVP (1-6 mm Hg), whereas pulm artery Cardiovascular (CV) Physiology 1
diastolic pressure is slightly higher (6-12 mm Hg) due to resistance to flow in the pulm circulation. (Phys) CV Phys
1654 Blood transfusion Citrate anticoagulants in high-volume blood transfusion can chelate plasma calcium, leading to hypocalcemia which causes peripheral neuromuscular excitability (eg, paresthesia, muscle spasms). This is Hematology & Oncology (HO) Physiology 2
most common with very rapid transfusion rates, but it can also be seen at lower rates in patients with hepatic insufficiency because citrate is metabolized by the liver. (Phys) HO Phys
1655 Diabetes mellitus Proinsulin is cleaved into mature insulin and C-peptide, which are co-secreted from pancreatic β cells in equimolar amounts. Circulating lvls of C-peptide can be used as a marker of endogenous insulin Endocrine, Diabetes & Pharmacology 31
secretion. SUs and meglitinides ↓ blood Glc by stim pancreatic insulin secretion; hypoglycaemia due to these agents is a/w ↑ C-peptide lvls. Metabolism (ES) (Phar) ES Phar
1656 Hypoparathyroidism Hypocalcaemia can cause muscle cramps, perioral paraesthesias, hypotension, and neuromuscular hyperexcitability. Injury to the PT glands during thyroid Sx is a common cause of hypoparathyroidism Endocrine, Diabetes & Pathophysiology 1
and acute hypocalcaemia. Metabolism (ES) (Patp) ES Patp
1657 Myasthenia gravis Progressively weakening diaphragmatic contractions during max voluntary ventilation w/ intact phrenic nerve stim indicate NMJ pathology (e.g. MG) a/o abnormally rapid diaphragmatic muscle fatigue Nervous (NS) Pathophysiology 10
(e.g. restrictive lung or chest wall disease). (Patp) NS Patp
1658 Thyroid cancer PTC is the most common type of thyroid ca. ChFx on histopath incl large cells w/ nuclei containing finely disperse chromatin, giving an empty or ground-glass appearance (Orphan Annie eye), and Endocrine, Diabetes & Pathology (Path) 6
intranuclear inclusions or grooves. Metabolism (ES) ES Path
1659 Thyroid cancer MTC is a NET that arises from parafollicular calcitonin-secreting C cells. It's char by nests or sheets of polygonal or spindle-shaped cells w/ extracellular amyloid deposits derived from calcitonin. Endocrine, Diabetes & Pathology (Path) 6
1660 Thyroid cancer MTC is a NET that arises from calcitonin-secreting C (parafollicular) cells. It's often seen in the context of MEN-2 (A and B), although the majority of cases are sporadic. Both sporadic and familial Endocrine, Diabetes & Pathology (Path) 6
MTCs are a/w muts in the RETproto-oncogene. Metabolism (ES) ES Path
1661 Aortic regurgitation AR causes an ↑ in total SV w/ abrupt distension and rapid falloff of peripheral arterial pulses, resulting in a wide PP. This leads to bounding peripheral pulses and head bobbing w/ each heartbeat. Cardiovascular (CV) Physiology 8
(Phys) CV Phys
1662 Mallory-Weiss syndrome A MW tear is a tear in the gastric mucosa near the GOJ. It typically results from repetitive forceful vomiting, which can also cause meta alkalosis. Gastrointestinal & Nutrition (GI) Pathophysiology 2
(Patp) GI Patp
1663 Chronic kidney disease Pts w/ CKD may develop renal osteodystrophy from 2° hyperparathyroidism (caused by hyperphosphataemia and hypocalcaemia). Renal, Urinary & Electrolytes Pathology (Path) 8
(RE) RE Path
1664 Muscle structure & physiology The H band is the region of the sarcomere that contains only thick (myosin) filaments. The H band is the part of the Aband (which is on either side of the M line) where thick filaments have no Rheumatology, Orthopedics & Physiology 8
overlapping thin (actin) filaments. Sports (RH) (Phys) RH Phys
1665 Muscle structure & physiology During the skeletal muscle contraction cycle, ATP binding to myosin causes release of the myosin head from its binding site on the actin filament. Rheumatology, Orthopedics & Physiology 8
1666 Community acquired pneumonia Influenza infection alters the resp epithelium and can ↑ the risk of 2° bacterial pneumonia. The leading pathogens are S. pneumoniae, S. aureus, and H. influenzae. The elderly are affected most Pulmonary & Critical Care (PU) Microbiology 21
commonly, but S. aureus can cause 2° pneumonia in young, previously healthy pts. (Micr) PU Micr
1667 Laryngotracheobronchitis Brassy, barking cough; dyspnoea, and recent Hx of URI in a child are suggestive of viral laryngotracheitis (croup). The most common cause of croup is parainfluenza virus. Pulmonary & Critical Care (PU) Microbiology 1
(Micr) PU Micr
1668 Bronchiolitis Viral bronchiolitis is most commonly caused by RSV and presents w/ low-grade fever, cough, tachypnoea, and ↑ work of breathing. Ex shows diffuse wheezes and crackles. Infectious Diseases (ID) Microbiology 1
(Micr) ID Micr
1669 Rubella In a susceptible child, a febrile maculopapular rash that begins on the face and spreads to the trunk and extremities is suggestive of rubeola (measles) or rubella (German measles). The additional finding Dermatology (DE) Microbiology 3
of postauricular lymphadenopathy indicates that rubella is the most likely etiology. (Micr) DE Micr
1670 Measles Measles Px w/ fever, cough, rhinorrhea, and conjunctivitis f/b a maculopapular rash that starts on the face and spreads downwards. Koplik spots are pathognomonic for measles and Chx by tiny white or Infectious Diseases (ID) Microbiology 3
blue-gray lesions on the buccal mucosa. (Micr) ID Micr
1672 HIV In the HIV replication cycle, polyprotein precursors are encoded by the structural genes gag, pol, and env. Only the env gene polyprotein product (gp160) is glycosylated. This polyprotein is subseq Infectious Diseases (ID) Microbiology 11
cleaved in the GA to form the envelope glycoproteins gp120 and gp41. (Micr) ID Micr
1673 Lipodystrophy HAART for HIV is commonly a/w body fat redistribution. Subcutaneous lipoatrophy involving the face and extremities is a/w NRTIs (esp. stavudine and zidovudine) and PIs. Central fat accumulation in Endocrine, Diabetes & Pharmacology 1
the trunk and viscera can occur w/ any HAART regimen. Metabolism (ES) (Phar) ES Phar
1674 Antiretroviral therapy NNRTIs are ARV drugs that don't req activation via intracellular phosphorylation. The more common NNRTIs incl nevirapine and efavirenz. Infectious Diseases (ID) Pharmacology 7
(Phar) ID Phar
1675 Antiretroviral therapy Fusion inhibs (e.g. enfuvirtide) bind the HIV transmembrane glycoprotein gp41 and prevent it from approx. the viral and host cellular membranes, which prevents HIV penetration into new host cells. Infectious Diseases (ID) Pharmacology 7
(Phar) ID Phar
1676 Lyme disease The characteristic cutaneous lesion in Borrelia burgdorferi infection (Lyme disease) is erythema migrans, which begins as an erythematous macule at the site of an Ixodes tick bite. The erythema spreads Infectious Diseases (ID) Pathology (Path) 3
outward, often leaving a zone of central clearing ("bull's-eye" rash). ID Path
1677 Community acquired pneumonia All organisms in the Mycoplasma genus, incl U. urealyticum, lack peptidoglycan cell walls and are therefore resistant to agents that target the cell wall such as penicillins, cephalosporins, carbapenems, Pulmonary & Critical Care (PU) Microbiology 21
and vancomycin. Mycoplasma infections can be Tx w/ anti-ribosomal agents (e.g. tetracyclines, macrolides). (Micr) PU Micr
1678 Actinomycosis Actinomyces species are gram (+), branching, filamentous bacteria that may cause cervicofacial infections when introduced to the submucosa during mech trauma (e.g. tooth extraction). MFxs incl a Infectious Diseases (ID) Microbiology 2
slowly enlarging, nonpainful, chronic mandibular mass that evolves into multi abscesses and sinus tracts draining yellow-orange sulphur granules. (Micr) ID Micr
1679 Community acquired pneumonia M. pneumoniae is the causative agent of 'walking pneumonia', an infection typically characterised by a nagging nonproductive cough, low-grade fever, and malaise. Often, the CXR suggests a severe Pulmonary & Critical Care (PU) Microbiology 21
pneumonia even though the pt appears relatively well. Mycoplasma species req chol supplementation to grow on artificial media. (Micr) PU Micr
1680 Ureter injury The proximal ureter receives its blood supply from the renal artery whereas the distal ureter is supplied by the superior vesical artery. Circulation to the middle portions of the ureter is variable and Renal, Urinary & Electrolytes Anatomy (Anat) 3
anastomotic. (RE) RE Anat
1682 Hand injury The lunate bone is the more med. (ulnar) of the 2 prox. carpal bones that articulate w/ the radius. A FOOSH can cause dislocation of the lunate bone w/ resulting compression of the median nerve (e.g. Rheumatology, Orthopedics & Anatomy (Anat) 1
wrist pain, numbness in the 1st 3.5 digits). Sports (RH) RH Anat
1683 Rhogam (anti-D IgG) Anti-Rh Ig consists of IgG anti-D Abs that opsonize Rh+ fetal erythrocytes, promoting clearance by maternal RES macrophages and preventing maternal Rh sensitization. It's routinely admin to Rh(-) Hematology & Oncology (HO) Immunology 1
women at 28 wks gestation and immediately postpartum. (Immu) HO Immu
1685 Radial neuropathy Radial nerve injury can occur w/ repetitive pressure/trauma at the axilla (eg, improperly fitted crutches). Findings include weakness of the forearm, hand, and fingers extensors (eg, wrist drop, absent Nervous (NS) Anatomy (Anat) 3
triceps reflex) and sensory loss over the posterior arm and forearm, dorsolateral hand, and dorsal thumb. More distal lesions spare the triceps brachii. NS Anat
1686 Thyroid cancer The recurrent laryngeal nerve travels in close proximity to the inferior thyroid artery and can be injured during thyroid surgery, resulting in vocal cord paralysis (eg, hoarseness). Ear, Nose & Throat (EN) Anatomy (Anat) 6 EN Anat
1687 Ischemic stroke Upper motor neuron lesions (ie, internal capsule stroke) cause contralateral weakness with clasp knife spastic rigidity, hyperreflexia, and a positive Babinski sign. These lesions damage the pyramidal Nervous (NS) Anatomy (Anat) 19
motor system (eg, corticospinal tracts), which runs from the precentral gyrus (primary motor cortex) through the internal capsule to the brainstem and spinal cord. NS Anat
1688 Oogenesis 1° oocytes are completely developed in female embryos by the 5th month of gestation, at which point they are arrested in prophase of meiosis I. Normal menstrual cycle hormones stimulate the 1° oocyte Pregnancy, Childbirth & Genetics (Gene) 1
to resume differentiation. Prior to fertilization, 2° oocytes are arrested in metaphase of meiosis II. Puerperium (PR) PR Gene
1689 Wilson disease WD can cause cystic degen of the putamen as well as dmg to other BG structures. The putamen is located medial to the insula and lateral to the GP on coronal sections. Nervous (NS) Anatomy (Anat) 5 NS Anat
1690 Huntington disease The head of the caudate lies in the inferolateral wall of the frontal horn of the lateral ventricle. It is separated from the GP and putamen by the IC. Atrophy of the caudate nuclei w/ enlargement of the Nervous (NS) Anatomy (Anat) 5
lateral ventricles is Chx of HD and can be observed on neuroimaging. NS Anat
1691 Pharyngeal arches The development of derivatives of the 1st (e.g. CN V, mandible, maxilla, zygoma, incus, malleus) and 2nd (e.g. CN VII, stapes, styloid process, lesser horn of hyoid) pharyngeal arches can be disrupted in Nervous (NS) Embryology 1
genetic disorders (e.g. TCS), resulting in hypoplasia of the mandibular and zygomatic bones. (Embr) NS Embr
1692 Radiculopathy Sciatica is a nonspecific term for low back pain that radiates down the leg due to compression of the lumbosacral nerve roots (eg, from vertebral disc herniation). The S1 nerve root is commonly involved, Nervous (NS) Anatomy (Anat) 3
resulting in pain/sensory loss down the posterior thigh and calf to the lateral aspect of the foot. Pts may also have weakness on thigh extension, knee flexion, and foot plantarflexion w/ an absent ankle jerk
reflex. NS Anat
1693 Cauda equina syndrome Saddle anesthesia and loss of the anocutaneous reflex are SSx of CES, which is a/w damage to the S2 through S4 nerve roots. Nervous (NS) Anatomy (Anat) 1 NS Anat
1694 Radial neuropathy Injury to the radial nerve during its passage thru the supinator canal may occur due to repetitive pronation/supination of the forearm, direct trauma, or subluxation of the radius. Pts typically have Nervous (NS) Anatomy (Anat) 3
weakness during finger and thumb extension ('finger drop') w/o wrist drop or sensory deficits. NS Anat
1695 Pneumothorax The lung apices extend above the level of the clavicle and first rib through the superior thoracic aperture. Penetrating injury in this area may lead to pneumothorax, tension pneumothorax, or hemothorax. Pulmonary & Critical Care (PU) Anatomy (Anat) 2 PU Anat
1696 Ischemic stroke The ACAs supply the medial portions of the 2 hemispheres (frontal and parietal lobes). Occlusion can cause contralateral motor and sensory deficits of the lower extremities, behavioral changes, and Nervous (NS) Anatomy (Anat) 19
urinary incontinence. NS Anat
1697 Knee trauma The ACL can be damaged by sudden changes in direction or awkward landings (eg, excessive internal rotation or valgus stress) during sports activity. ACL tears are typically a/w rapid-onset Rheumatology, Orthopedics & Anatomy (Anat) 4
hemarthrosis. PEx shows anterior laxity of the tibia relative to the femur (eg, Lachman test, anterior drawer test). Sports (RH) RH Anat
1698 Orbital fracture Blunt trauma to the globe can cause orbital blowout fractures. These fractures most commonly involve the medial or inferior orbital walls due to the thin bone bordering the ethmoid and maxillary sinuses. Ear, Nose & Throat (EN) Anatomy (Anat) 2 EN Anat
1699 Penetrating thoracic trauma The RV composes most of the heart's anterior surface. A deep, penetrating injury at the left sternal border in the 4th ICS would puncture the RV. Cardiovascular (CV) Anatomy (Anat) 2 CV Anat
1700 Rib fracture The left kidney lies immediately deep to the tip of the 12th rib. Renal, Urinary & Electrolytes Anatomy (Anat) 1
(RE) RE Anat
1701 Esophageal varices PVT causes portal HTN, splenomegaly, and varicosities at portocaval anastomoses. It does not cause histologic changes to the hepatic parenchyma. Ascites is uncommon as the obstruction is Gastrointestinal & Nutrition (GI) Pathology (Path) 2
presinusoidal; ascites typically only develops in conditions that cause sinusoidal HTN. GI Path
1702 Clavicle fracture The clavicle is commonly fractured in children after a fall on an outstretched arm. In a distal clavicle fracture, the deltoid muscle and the weight of the arm cause inferolateral displacement of the distal Rheumatology, Orthopedics & Anatomy (Anat) 1
fragment, whereas the sternocleidomastoid and trapezius muscles cause superomedial displacement of the proximal fragment. Sports (RH) RH Anat
1703 Cranial nerve palsy The oculomotor nerve (CN III), ophthalmic nerve (CN V1) branches, trochlear nerve (CN IV), abducens nerve (CN VI), and superior ophthalmic vein enter the orbit via the superior orbital fissure. Nervous (NS) Anatomy (Anat) 9 NS Anat
1704 Humerus fracture The deep brachial (profunda brachii) artery and radial nerve run together along the post. aspect of thehumerus. Midshaft fractures of the humerus risk injury to these structures. Rheumatology, Orthopedics & Anatomy (Anat) 1
Sports (RH) RH Anat
1705 Tetralogy of Fallot TOF results from anterior and cephalad deviation of the infundibular septum during embryologic development, resulting in a malaligned VSD w/ an overriding aorta. As a result. the pt has RV outflow Cardiovascular (CV) Embryology 3
obstruction (resulting in a systolic murmur) and squats to ↑ the peripheral SVR (afterload) and ↓ right-to-left shunting across the VSD. (Embr) CV Embr
1706 Gastroesophageal reflux disease The oesophagus is located b/w the trachea and the vertebral bodies in the sup. thorax. It's typically collapsed w/ no visible lumen on CT images of the chest. Gastrointestinal & Nutrition (GI) Anatomy (Anat) 7 GI Anat
1707 Dose response curves Efficacy is a measure of the maximum pharmacodynamic effect achievable with a drug. Potency refers to the dose of drug that is required to produce a given effect. Drugs that bind their receptors with a General Principles (GP) Pharmacology 4
higher affinity or are better able to gain access to their target tissues will have greater potency (lower ED50). (Phar) GP Phar
1708 Dose response curves The changes in the log dose-response curve expected for the effect of a reversible competitive antagonist added to a full agonist are: 1) a parallel shift to the right in the log-dose response curve, General Principles (GP) Pharmacology 4
illustrating an increase in the ED50, and 2) no change in the maximum effect (Emax). Competitive=change ED50=shift right; noncompetitive=change Emax=shift down. (Phar) GP Phar
1709 Route of administration & F refers to the fraction of admin drug that reaches the syst circulation in a chem unchanged form. F for a drug admin by a non-IV route is always less than 1. It can be determined by examining a graph of Gastrointestinal & Nutrition (GI) Pharmacology 2
bioavailability plasma conc vs time then applying the formula: F = (AUC oral x dose IV) / (AUC IV x dose oral). (Phar) GI Phar
1710 Drug structure and properties Characteristics of a drug such as high molecular weight, high plasma protein binding, high charge, and hydrophilicity tend to trap the drug in the plasma compartment resulting in a low Vd (3-5 L). General Principles (GP) Pharmacology 3
(Phar) GP Phar
1711 Drug metabolism and clearance Cytochrome P450 enzymes found in the liver are responsible for the majority of drug metabolism. Polymorphisms occurring in the genes coding for these enzymes result in various phenotypes that differ General Principles (GP) Pharmacology 2
in their rates of metabolism; individual differences in phenotype alter treatment efficacy and drug toxicity. (Phar) GP Phar
1712 Pharmacogenomics Isoniazid is metabolized by acetylation. The speed with which a patient is able to acetylate drugs depends on whether they are genetically "fast" or "slow" acetylators. The presence of fast and slow General Principles (GP) Pharmacology 1
acetylators within the same population results in a bimodal distribution of the speed of isoniazid metabolism. Slow acetylators are at increased risk of adverse side effects. (Phar) GP Phar
1713 Route of administration & Bioavailability is the fraction of an administered drug that reaches the systemic circulation unchanged. Drugs administered orally enter the portal circulation and are subject to first-pass metabolism. General Principles (GP) Pharmacology 2
bioavailability Rectal administration is capable of partially bypassing first-pass metabolism as a proportion of rectal blood flow enters the systemic circulation directly. Drugs that undergo extensive first-pass (Phar)
metabolism have increased bioavailability when administered rectally. GP Phar
1714 Serum drug levels and half-life The half-life (t[½]) is a measure of how quickly a drug with first-order kinetics is eliminated from the body. A drug is almost completely eliminated after 5 half-life intervals. The half-life can be General Principles (GP) Pharmacology 3
calculated from the drug's volume of distribution (Vd) and clearance rate (CL) using the equation: t[½] = (0.7 x Vd) / CL. (Phar) GP Phar
1715 Drug structure and properties While the kidney is the primary site of elimination of most drugs, the liver is the main site of biotransformation of these agents in preparation for elimination. Drugs that are more lipophilic (high Va good General Principles (GP) Pharmacology 3
penetration into CNS) are preferentially processed by the liver into more polar compounds for easier elimination in the bile and urine. Liver disease (e.g., cirrhosis) or the concomitant use of other drugs (Phar)
may limit or enhance the clearance of drugs metabolized in the liver. GP Phar
1716 Drug metabolism and clearance In first-order kinetics, a constant fraction (or proportion) of drug is metabolized per unit of time, so the amount metabolized changes based on the serum concentration. In zero-order kinetics, a constant General Principles (GP) Pharmacology 2
amount of drug is metabolized per unit of time, independent of serum levels. (Phar) GP Phar
1717 Retinoblastoma (Rb) protein The Rb TSG encodes the Rb protein, which regulates the cell cycle. Active (hypophosphorylated) Rb protein prevents damaged cells from proceeding past the G1 to S checkpoint, while the inactive Hematology & Oncology (HO) Pathology (Path) 1
(hyperphosphorylated) Rb protein allows the damaged cell to enter mitosis. Abnormal phosphorylation of Rb protein results in its inactivation. HO Path
1718 Rb protein Proliferation signals activate CDK4, resulting in hyperphosphorylation of the Rb protein. B/c hyperphosphorylated Rb is inactive, cells are allowed to transition unchecked from the G1 phase to the S Hematology & Oncology (HO) Pathology (Path) 1
phase in the cell cycle. HO Path
1720 Turner syndrome GH binds to cell surface receptors, leading to intracellular activation of the JAK-STAT pathway. Cytokines (e.g. IFN) and hematopoietic GFs (e.g. EPO, G-CSF) also use this pathway. Endocrine, Diabetes & Biochemistry 8
1722 HIV HIV pol gene mutations are responsible for acquired resistance to RTIs, PIs, and integrase strand transfer inhibitors. Mutations of the env gene enable escape from host-neutralizing Abs. Infectious Diseases (ID) Microbiology 11
(Micr) ID Micr
1723 Anal cancer HPV types 16 and 18 are strongly a/w anal and cervical SCC. HIV infection ↑ the prevalence of HPV infection and the risk of anal carcinoma; this risk is further augmented in MSM. Infectious Diseases (ID) Microbiology 1
(Micr) ID Micr
1724 HIV Pts w/ HIV have much higher rates of lymphoma than the general population. Many cases are due to underlying EBV infection. Hematology & Oncology (HO) Pathology (Path) 11 HO Path
1725 Hair loss Androgenetic alopecia is the most common cause of hair loss in both males and females. The pattern and severity of the baldness depend on both hormonal (circulating androgens) and genetic factors and Dermatology (DE) Genetics (Gene) 2
vary between males and females. The condition is polygenic with variable expressivity. DE Gene
1726 Hair loss Androgenetic alopecia causes hair loss primarily at the anterior scalp and vertex. It shows polygenic inheritance, with dihydrotestosterone (DHT) being the primary pathogenic factor. 5-a-reductase Dermatology (DE) Pharmacology 2
inhibitors decrease the conversion of testosterone to DHT and are effective for treating the condition. (Phar) DE Phar
1727 X-linked inheritance In XLR inheritance, 1) affected males will always produce unaffected sons and carrier daughters, and 2) carrier females have a 50% chance of producing affected sons and carrier daughters. G6PD defic General Principles (GP) Genetics (Gene) 2
follows this inheritance pattern and causes acute HA in response to ox drugs. GP Gene
1728 Autosomal recessive inheritance AR disorders affect 25% of offspring of aSSx heterozygous carrier parents. Classical galactosemia is the most common and severe galactosemic disorder and Px w/i days of birth w/ jaundice, vomiting, Miscellaneous (Multisystem) Genetics (Gene) 5
and hepatomegaly. (MS) MS Gene
1729 Behavioural responses Classical conditioning involves a neutral stim being repeatedly paired w/ a non-neutral stim that elicits a reflexive, unconditioned response. Over time, the formerly neutral stim is able to evoke a Pregnancy, Childbirth & Behavioral 1
conditioned response by itself in absence of the non-neutral stim. Puerperium (PR) Science (Beha) PR Beha
1730 Rectus muscle and Valsalva The Valsalva maneuver ↑ vagal tone and can be used to abolish PSVT. The rectus abdominis is the most important muscle in achieving the ↑ IAP and ITP of the Valsalva maneuver. Rheumatology, Orthopedics & Anatomy (Anat) 1
Sports (RH) RH Anat
1732 Rotator cuff The supraspinatus muscle assists in abduction of the arm and stabilisation of the GHJ. The supraspinatus tendon is vulnerable to injury due to impingement b/w the acromion and the head of the humerus. Rheumatology, Orthopedics & Anatomy (Anat) 3
Supraspinatus tendinopathy is the most common cause of RCS. Sports (RH) RH Anat
1733 Rotator cuff The most commonly injured structure in RCS is the tendon of the supraspinatus muscle. B/c the supraspinatus is an abductor of the humerus, injury to its tendon causes pain on abduction of the arm. Rheumatology, Orthopedics & Anatomy (Anat) 3
Sports (RH) RH Anat
1734 Muscle structure & physiology A single sarcomere is defined as the distance between two Z lines. Thin (actin) filaments in the band are bound to structural proteins at the Z line, whereas thick (myosin) filaments in the Aband are bound Rheumatology, Orthopedics & Histology (Hist) 8
to structural proteins at the M line. Sports (RH) RH Hist
1735 Visual pathway CNII carries the afferent limb of the pupillary light reflex pathway, which activates the efferent limb bilaterally and causes both direct and consensual pupillary constriction. Unilateral CNII lesions (e.g. Nervous (NS) Anatomy (Anat) 5
demyelination due to optic neuritis) can result in impaired pupillary constriction bilaterally when light enters the eye ipsilateral to the lesion. When light enters the contralateral eye, pupillary constriction
occurs normally in both eyes. NS Anat
1736 Congenital anomalies of kidney The metanephros (metanephric blastema) gives rise to the glomeruli, Bowman's space, proximal tubules, the loop of Henle, and distal convoluted tubules. The ureteric bud becomes the collecting system Renal, Urinary & Electrolytes Embryology 3
and urinary tract of the kidney, including the collecting tubules and ducts, major and minor calyces, renal pelvis, and the ureters. (RE) (Embr) RE Embr
1737 Benign prostatic hyperplasia The prostate is located between the pubic symphysis and the anal canal and is visible on inferior sections of the pelvis on CT scan. Benign prostatic hyperplasia is a common, age-related condition that Male Reproductive (MR) Anatomy (Anat) 6
causes urinary symptoms (eg, hesitancy, straining, incomplete voiding). It can be medically treated with a-adrenergic blockers and 5-a reductase inhibitors. MR Anat
1738 Chronic pancreatitis Chronic pancreatitis often presents w/ epigastric pain and pancreatic exocrine insufficiency resulting in fat malabsorption/steatorrhoea. On abdo CT scan, the pancreas can be ID'd by its head in close a/w Gastrointestinal & Nutrition (GI) Anatomy (Anat) 3
the 2nd part of the duodenum; its body overlying the aorta, left kidney, and renal vessels; and its tail lying w/i the splenorenal ligament. GI Anat
1739 Anesthesia A pudendal nerve block is performed by injecting an anesthetic intravaginally, medial to the ischial spine, through the sacrospinous ligament. This provides anesthesia to most of the perineum. Female Reproductive & Breast Anatomy (Anat) 9
(FR) FR Anat
1740 Cleft lip and cleft palate Cleft lip results when the maxillary prominence fails to fuse with the intermaxillary segment during the fifth-sixth week of embryonic development. Cleft palate occurs when the palatine shelves fail to Ear, Nose & Throat (EN) Embryology 1
fuse with one another or with the primary palate. Cleft lip and palate can occur together or in isolation. (Embr) EN Embr
1741 Nausea and vomiting The vomiting reflex is initiated by the chemoreceptor trigger zone (ie, area postrema) and nucleus tractus solitarius within the dorsal medulla at the caudal end of the fourth ventricle. The area postrema Nervous (NS) Anatomy (Anat) 2
does not have a well-developed blood brain barrier, allowing it to be activated directly by emetogenic substances (eg, drugs, toxins) or indirectly by ascending afferents from the bowel wall (eg,
chemotherapy-induced release of serotonin). NS Anat
1743 Ulnar nerve neuropathy Ulnar nerve injury most commonly occurs at the elbow (eg, compression due to resting arm on a hard surface while using a computer) and usually Px w/ discomfort and sensory loss/paresthesia in the 5th Nervous (NS) Anatomy (Anat) 2
digit, medial half of the 4th digit, and the hypothenar eminence. In severe cases, pts can also have weakness on wrist flexion and adduction (ie, ulnar deviation) along w/ finger weakness/clumsiness. NS Anat
1744 Gastrointestinal hemorrhage The hindgut encompasses the dist. 1/3 of the transverse colon, the desc. colon, the sigmoid colon, and the rectum. These structures receive their main arterial blood supply from the IMA. Gastrointestinal & Nutrition (GI) Anatomy (Anat) 1 GI Anat
1745 Aspiration pneumonia Due to gravity, supine patients typically aspirate into the posterior segments of the upper lobes and superior segments of the lower lobes. Patients who are upright tend to aspirate into the basilar segments Pulmonary & Critical Care (PU) Anatomy (Anat) 2
of the lower lobes. Aspirated material is more likely to travel down the right main bronchus. PU Anat
1747 Thyroid cancer The ext branch of the sup laryngeal nerve is at risk of injury during thyroidectomy due to its prox to the sup thyroid art and vein. This nerve innervs the cricothyroid muscle. Endocrine, Diabetes & Anatomy (Anat) 6
Metabolism (ES) ES Anat
1748 Peroneal neuropathy Trauma/sustained pressure to the neck of the fibula can injure the common peroneal nerve, causing weakness on foot dorsiflexion and eversion and impaired sensation over the lateral shin and dorsal foot, Nervous (NS) Anatomy (Anat) 3
and b/w the 1st and 2nd toes. NS Anat
1749 Carpal tunnel syndrome CTS occurs due to compression a/o inflammation of the median nerve in the carpel tunnel and typically results in sensory loss over the palm and anterior aspect of the 1st 3.5 digits w/ thenar atrophy and Nervous (NS) Anatomy (Anat) 3
impairment of thumb flexion/opposition. In the forearm, the median nerve courses b/w the humeral and ulnar heads of the pronator teres muscle and b/w the FDS and FDP muscles. NS Anat
1750 Embryologic derivatives The 1st AA gives rise to a portion of the maxillary artery, and the 2nd AA gives rise to the stapedial artery, which typically regresses in humans. The 5th AA completely regresses, leaving no structures or Cardiovascular (CV) Embryology 2
vestiges in the adult. The 3rd AA forms the CCAs and proximal ICAs. The 4th AA gives rise to part of the true AA and a portion of the SCAs. The 6th AA gives rise to the pulm arteries and the ductus (Embr)
arteriosus. CV Embr
1751 Patent ductus arteriosus The ductus arteriosus is derived from the sixth embryonic aortic arch. A patent ductus arteriosus (PDA) causes left-to-right shunting of blood that can be heard as a continuous murmur over the left Cardiovascular (CV) Anatomy (Anat) 4
infraclavicular region. Indomethacin (a PGE2 synthesis inhibitor) can be used to close a PDA in premature infants, but surgical ligation is often necessary in older patients. CV Anat
1752 Potter sequence Potter sequence results from a renal anomaly that causes decreased fetal urine output leading to oligohydramnios. The lack of amniotic fluid causes compression of the fetus (characteristic facies and limb Renal, Urinary & Electrolytes Embryology 1
abnormalities) and pulmonary hypoplasia, which is the most common cause of death in affected infants. (RE) (Embr) RE Embr
1753 Cervical cancer Dysplasia is characterized by disruption of organized epithelial cell differentiation with marked cellular pleomorphism. Although high-grade dysplasia (involving most or the entire epithelial layer) often Miscellaneous (Multisystem) Pathology (Path) 3
progresses to invasive cancer, low-grade dysplasia (involving a small portion of epithelium) typically spontaneously regresses. Invasive cancer occurs when the abnormal cells penetrate the basement (MS)
membrane. MS Path
1754 Non-Hodgkin lymphoma Benign LN enlargement in response to Ag stim is a/w a polyclonal proliferation of lymphocytes. A monoclonal lymphocytic proliferation is strong evidence of malignancy. Hematology & Oncology (HO) Pathology (Path) 6 HO Path
1755 Burkitt lymphoma Burkitt lymphoma is Chx by aggressive rapid growth and a "starry sky" microscopic appearance. Translocation of the c-Myc oncogene on the long arm of chromosome 8 w/ the Ig heavy chain region on Hematology & Oncology (HO) Pathology (Path) 3
chromosome 14 produces a nuclear phosphoprotein (c-Myc) that fxns as a transcription activator. HO Path
1756 Apoptosis Apoptosis can occur through either the intrinsic (mitochondria-mediated) pathway or the extrinsic (receptor-initiated) pathway. Both pathways converge in the activation of caspases. Caspases are General Principles (GP) Immunology 4
proteolytic enzymes that cleave cellular proteins. (Immu) GP Immu
1757 Infectious mononucleosis EBV causes IM in teens and young adults. It's also a/w a # of malignant conditions, incl Burkitt lymphoma and NPC. Hematology & Oncology (HO) Pathology (Path) 5 HO Path
1758 Non-Hodgkin lymphoma Overexpression of bcl-2 leads to ↑ secretion of Bcl-2 protein, which inhibits apoptosis and promotes survival of tumor cells. This overexpression occurs in follicular lymphoma 2° to translocation of the Hematology & Oncology (HO) Pathology (Path) 6
bcl-2 oncogene from chromosome 18 to the Ig heavy chain locus on chromosome 14 [t(14:18)]. HO Path
1759 Anaplasia Undifferentiated (anaplastic) tumors bear no resemblance to the tissue of origin. They are composed of pleomorphic cells w/ large, hyperchromatic nuclei that grow in a disorganized fashion. Anaplastic Hematology & Oncology (HO) Pathology (Path) 1
tumors may also contain numerous, abnormal mitoses and giant tumor cells. HO Path
1760 Colorectal cancer Most tumors possess multiple cytogenetic abnormalities. Activation of POCs results in stimulation of cellular proliferation. Inactivation of anti-oncogenes eliminates oversight of the cell cycle. Hematology & Oncology (HO) Pathology (Path) 15 HO Path
1761 Kaposi sarcoma Kaposi sarcoma typically presents as blue-violet or brownish skin plaques on the extremities and mucous membranes of HIV (+) pts. This tumour arises from primitive mesenchymal cells and is strongly Hematology & Oncology (HO) Pathology (Path) 2
a/w HHV-8. HO Path
1762 Breast cancer ER or PR (+) in breast ca indicates expected sensitivity to tamoxifen and aromatase inhibitor Tx. HER2 overexpression in breast ca suggests a more aggressive tumor that typically responds to Thx w/ the Hematology & Oncology (HO) Pathology (Path) 7
anti-HER2 mAb trastuzumab. HO Path
1763 X-linked agammaglobulinemia X-linked agammaglobulinemia is characterized by low or absent circulating CD19+ and CD20+ B cells and pan-hypogammaglobulinemia. Affected patients have increased susceptibility to pyogenic Pulmonary & Critical Care (PU) Immunology 2
bacteria, enteroviruses, and Giardia lamblia due to the absence of opsonizing and neutralizing antibodies. (Immu) PU Immu
1765 Accuracy and precision A precise tool is one that consistently provides very similar or the same value when measuring a fixed quantity. An accurate tool is one that provides a measurement identical or similar to the actual value Biostatistics & EpInfectious Biostatistics 1
(as reflected in a gold standard measurement). Diseases (ID)emiology (BS) (Bios) BS Bios
1766 Peptic ulcer disease PPIs (e.g. omeprazole, lansoprazole) block the final common pathway of gastric acid secr from parietal cells, which is stim by ACh, hist, and gastrin. Gastrointestinal & Nutrition (GI) Pharmacology 10
(Phar) GI Phar
1767 Community acquired pneumonia The most common cause of CAP in both HIV-infected and HIV-uninfected individuals is S. pneumoniae. Risk of invasive pneumococcal disease is significantly ↑ in pts w/ HIV regardless of CD4 count. Pulmonary & Critical Care (PU) Microbiology 21
(Micr) PU Micr
1768 Diabetes mellitus Cleavage of proinsulin in pancreatic β-cell secretory granules yields insulin and C-peptide, which are stored in the granules until they’re secreted in equimolar amounts. Endocrine, Diabetes & Physiology 31
1771 Osteoarthritis OA of the hands is char by osteophyte formation leading to hard bony enlargement of the dist. IPJs (Heberden nodes) and prox. IPJs (Bouchard nodes). Brief morning stiffness may be present. Rheumatology, Orthopedics & Pathology (Path) 2
Sports (RH) RH Path
1772 Normal pregnancy β-hCG is produced by the syncytiotrophoblast after implantation, which generally occurs 6-7 days after fertilization at the earliest. β-hCG typically is detectable in the maternal serum approximately 8 Pregnancy, Childbirth & Embryology 2
days after fertilization, whereas it is detectable in the urine 14 days after fertilization. Therefore, a serum pregnancy test will be (+) before a urine pregnancy test. Puerperium (PR) (Embr) PR Embr
1773 Corticosteroids Osteoporosis is a common cause of fragility fractures, which occur in the absence of significant trauma. Chronic, systemic use of glucocorticoids such as prednisone promotes osteoporosis and increases Rheumatology, Orthopedics & Pharmacology 3
the risk of fractures. Sports (RH) (Phar) RH Phar
1774 Tuberculosis INH can be directly hepatotox, causing acute, mild hepatic dysfxn in 10-20% of pts and frank hepatitis (fever, anorexia, and nausea, sometimes progressing to hepatic failure) in a small % of pts. Infectious Diseases (ID) Pharmacology 18
(Phar) ID Phar
1775 Teratogens Although tetracyclines are the 1st-line Tx for Lyme disease, they are c/i in pregnancy due to the potential for fetal tooth discoloration. Amoxicillin should be given instead for Tx of Lyme disease in Pregnancy, Childbirth & Pharmacology 2
pregnant women. Puerperium (PR) (Phar) PR Phar
1777 Warfarin St John's wort induces CYP450 hepatic microsomal enzymes. As a result, a wide variety of drugs that're meta by these enzymes, such as warfarin, will have lower plasma concs and ↓ efficacy. Nervous (NS) Pharmacology 2
(Phar) NS Phar
1778 Peptic ulcer disease Most duodenal PUs are caused by H. pylori infec. The most effective method to prevent disease recurrence is to eradicate the infec w/ Abx (e.g. tetracycline, metronidazole), typically in combo w/ PPIs (e. Gastrointestinal & Nutrition (GI) Pharmacology 10
g. omeprazole) and, often, bismuth subsalicylate (quad therapy). (Phar) GI Phar
1779 Infection control Spore-forming bacteria can survive boiling temps. Bacillus and Clostridium species are common pathogenic spore-forming bacteria. Infectious Diseases (ID) Microbiology 3
(Micr) ID Micr
1780 Aging Digoxin is a cardiac glycoside that's predominantly cleared by the kidneys. Elderly pts typically exhibit age-related renal insufficiency, even in the presence of normal creatinine lvls. The dose of digoxin Cardiovascular (CV) Pharmacology 8
must be ↓ in these pts to prevent tox. (Phar) CV Phar
1781 Developmental milestones By age 3, a child is expected to play imaginatively in parallel w/ others, speak in simple sentences, copy a circle, use utensils, and ride a tricycle. Pregnancy, Childbirth & Behavioral 1
1782 Pericardial effusion PP refers to an exaggerated drop (>10 mm Hg) in SBP during inspiration. It is most commonly seen in pts w/ CT but can also occur in severe asthma, COPD, hypovolemic shock, and constrictive Cardiovascular (CV) Physiology 1
pericarditis. (Phys) CV Phys
1783 Inflammatory bowel disease CD typically presents w/ the insidious onset of abdo pain, diarrhoea, and constitutional SSx (e.g. weight loss, fever). Pts are prone to devel fistulas/abscesses as the lesions affect the entire thickness of the Gastrointestinal & Nutrition (GI) Pathology (Path) 9
bowel wall. Perianal disease (e.g. skin tags, fissures) is also common. GI Path
1784 Anticoagulants Enoxaparin is a low-molecular-weight heparin (LMWH) that functions like heparin in that it binds and activates antithrombin III (AT III). Activated AT III binds to factor Xa and stops factor Xa from Hematology & Oncology (HO) Pharmacology 8
converting prothrombin to thrombin. Due to its fewer number of molecules, LMWH acts primarily on factor Xa, not thrombin. (Phar) HO Phar
1785 Aplastic anemia AA causes pancytopaenia as the bone marrow is replaced by fat cells and marrow stroma. The absence of splenomegaly on PEx is char. A bone marrow Bx can be extremely useful in making the Dx. Hematology & Oncology (HO) Pathology (Path) 3 HO Path
1786 Pure red cell aplasia PRCA is a rare form of marrow failure Chx by severe hypoplasia of marrow erythroid elements in the setting of normal GPO and TPO. PRCA is a/w thymoma, lymphocytic leukemias, and PVB19 Hematology & Oncology (HO) Pathology (Path) 1
infection. HO Path
1787 Aplastic anemia AA is most commonly due to a toxic effect or AI response causing apoptosis of pluripotent stem cells (pancytopenia). Bone marrow Bx reveals hypocellularity w/ an abundance of fat cells. Hematology & Oncology (HO) Pathology (Path) 3 HO Path
1788 X-linked inheritance Given phenotypically normal parents, the probability that a female sibling of a male affected by an X linked recessive disease will give birth to an affected child is 1/8. Hematology & Oncology (HO) Genetics (Gene) 2 HO Gene
1789 Phenylketonuria Intellectual disability, gait or posture abn, eczema, and a musty body odor in a toddler are SSx of PKU. Most infants w/ PKU are born to 2 heterozyg carrier parents. The prob that heterozyg carrier Endocrine, Diabetes & Genetics (Gene) 5
parents will transmit an AR disease such as PKU to a child is 1/4. Metabolism (ES) ES Gene
1790 Autosomal recessive inheritance The prob that an AR disease will be transmitted to a child can be calculated based on the maternal and paternal pedigrees. An unaffected individual (w/ unaffected parents) who has a sibling affected by an General Principles (GP) Genetics (Gene) 5
AR condition has a 2/3 chance of being a carrier for that condition. GP Gene
1791 Autosomal recessive inheritance The probability that a child of parents from 2 populations with different mutant allele carrier frequencies will inherit an autosomal recessive disease is 25% multiplied by the carrier frequencies. Pulmonary & Critical Care (PU) Genetics (Gene) 5 PU Gene
1792 Vitamin B12 deficiency defic of vitB12 is a/w both megaloblastic anaemia and neuro dysfxn, while vitB9 defic is a/w megaloblastic anaemia alone. Mod improvement in the Hb lvl often occurs when a defic in vitB12 is Tx w/ Hematology & Oncology (HO) Pathology (Path) 9
vitB9, or vice versa. Tx of vitB12 defic w/ vitB9 alone can actually worsen neuro dysfxn. HO Path
1793 Iron deficiency anemia Hypochromic, microcytic anemia is most commonly due to Fe deficiency. Blood loss, especially occult loss from the GI tract, must be r/o in a pt w/ IDA. Hematology & Oncology (HO) Pathology (Path) 7 HO Path
1794 Iron deficiency anemia Anemia in a woman of childbearing age is most commonly caused by iron deficiency secondary to menstrual blood loss. Iron deficiency is associated with decreased serum ferritin, increased total iron- Hematology & Oncology (HO) Pathology (Path) 7
binding capacity (transferrin), and microcytic, hypochromic red blood cells. HO Path
1795 Osteoporosis Selective estrogen receptor modulators exhibit estrogen antagonist and agonist properties in a tissue-specific manner. Raloxifene has estrogen agonist activity on bone, which decreases bone resorption Rheumatology, Orthopedics & Pharmacology 10
and improves bone density. Raloxifene has an estrogen antagonist effect on breast tissue and can decrease the risk of breast cancer; it also acts as an estrogen antagonist in the uterus, and does not increase Sports (RH) (Phar)
the risk of endometrial cancer. RH Phar
1796 Iron deficiency anemia ↑ bone marrow EPO results in an accelerated release of immature RBCs (reticulocytes) into the bloodstream. Reticulocytes contain bluish cytoplasm and reticular precipitates of residual ribosomal RNA. Hematology & Oncology (HO) Pathology (Path) 7 HO Path
1797 Carcinogens Most chem carcinogens enter the body in an inactive state (i.e. as pro-carcinogens). These pro-carcinogens are converted into active metabolites by the CYP450 oxidase system. Individual susceptibility to Hematology & Oncology (HO) Pathology (Path) 1
chem carcinogens depends on the activity of these P450 enzymes, which is genetically determined. HO Path
1798 ALL and T cells ALL is the most common malignancy of childhood. B-cell ALL is responsible for approximately 70-80% of all cases of ALL, whereas T-cell ALL accounts for 15-17% of all cases of ALL. T-cell ALL Hematology & Oncology (HO) Pathology (Path) 1
often Px as a mediastinal mass that can cause resp symptoms, dysphagia, or SVC syndrome. HO Path
1799 Septic shock Tumor necrosis factor-α is released from activated macrophages and is one of the most important mediators of the systemic inflammatory response in sepsis. Other cytokines responsible for inducing the Infectious Diseases (ID) Pathophysiology 6
systemic inflammatory response include IL-1 and IL-6. (Patp) ID Patp
1800 Inflammation Leukotriene B, stimulates neutrophil migration to sites of inflammation. Other important chemotactic agents include 5-HETE (leukotriene precursor), complement component C5a, and IL-8. Pulmonary & Critical Care (PU) Immunology 3
(Immu) PU Immu
1801 Inflammatory bowel disease Chronic inflammation is associated with increased circulating pro-inflammatory cytokines (eg, IL-1, IL-6, tumor necrosis factor-alpha), which stimulates the liver to release acute-phase reactants (eg, C General Principles (GP) Pathology (Path) 9
reactive protein, fibrinogen). The presence of acute-phase reactants increases the erythrocyte sedimentation rate, a nonspecific marker for inflammation. GP Path
1802 Bladder cancer The obturator nerve is the only major nerve that exits the pelvis through the obturator foramen. Nerve injury typically results from compression (eg, due to pelvic trauma, Sx, or tumor) and Px w/ Nervous (NS) Anatomy (Anat) 4
weakness on thigh adduction and sensory loss over the distal medial thigh. NS Anat
1803 Peroneal neuropathy The common peroneal nerve is vulnerable to injury where it courses around the neck of the fibula. Fibular neck fractures can injure this nerve, causing weakness of dorsiflexion (deep peroneal nerve) and Rheumatology, Orthopedics & Anatomy (Anat) 3
eversion (superficial peroneal nerve) of the foot as well as loss of sensation over the dorsum of the foot. Sports (RH) RH Anat
1804 Ureter injury The ureters pass posterior to the ovarian (gonadal) vessels within the retroperitoneum and cross anterior to the common/external iliac arteries to reach the true pelvis. Within the true pelvis, the ureters lie Renal, Urinary & Electrolytes Anatomy (Anat) 3
anterior to the internal iliac artery and posterior to the uterine artery. (RE) RE Anat
1805 Varicocele Pressure in the left renal vein may become ↑ due to compression where the vein crosses the aorta beneath the SMA. This "nutcracker effect" can cause hematuria and flank pain. Pressure can also be ↑ in Cardiovascular (CV) Anatomy (Anat) 1
the left gonadal vein, leading to formation of a varicocele. CV Anat
1806 Vitamin E deficiency VitE defic can occur in individuals w/ fat malabsorption. defic of this fat-soluble vit is a/w ↑ susceptibility of the neuronal and erythrocyte membranes to oxidative stress. Clinical MFxs incl ataxia, Gastrointestinal & Nutrition (GI) Pathology (Path) 2
impaired proprioception and vibratory sensation, and hemolytic anaemia. GI Path
1807 TCA cycle Vit B2 is a precursor of the coenzymes FMN and FAD. FAD participates in the TCA cycle and ETC by acting as an electron acceptor for succinate dehydrogenase (complex II), which converts succinate Gastrointestinal & Nutrition (GI) Biochemistry 2
into fumarate. (Bioc) GI Bioc
1808 Fragile X syndrome FXS is an XL disorder that Px w/ a long, narrow face, a prominent chin and forehead, and large testes. Pts often have developmental delay and neuropsych findings that overlap w/ anxiety disorders, Nervous (NS) Genetics (Gene) 3
autism, and ADHD. NS Gene
1809 Amenorrhea Pts w/ Müllerian aplasia (ie, Mayer-Rokitansky-Küster-Hauser syndrome) have no upper vagina (eg, short vagina) and variable uterine development. These pts are 46,XX females w/ normal ovaries and Female Reproductive & Breast Embryology 2
2° sexual Chx. (FR) (Embr) FR Embr
1810 Turner syndrome Pts w/ TS may have karyotype 45,X (complete monosomy), 45,X/46,XX (mosaicism), or 46,XX (w/ partial deletion of one X chromosome). Complete monosomy X usually results from meiotic Female Reproductive & Breast Genetics (Gene) 8
nondisjunction during gametogenesis. (FR) FR Gene
1812 Brachial plexus Dissection of the axillary LNs can injure the LTN. This results in weakness of the serratus ant. w/ winging of the scapula and impaired abduction of the shoulder past the horizontal. Rheumatology, Orthopedics & Anatomy (Anat) 6
Sports (RH) RH Anat
1813 Epidural hematoma The MMA is a branch of the maxillary artery, which enters the skull at the foramen spinosum and courses intracranially deep to the pterion (where the frontal, parietal, temporal, and sphenoid bones Nervous (NS) Anatomy (Anat) 2
meet). Skull fractures at this site may cause laceration of this vessel, leading to an EDH. NS Anat
1814 Otitis externa The vagus nerve provides cutaneous sensation to the posterior external auditory canal via its small auricular branch. Sensation to the rest of the canal is from the mandibular division of the trigeminal Ear, Nose & Throat (EN) Anatomy (Anat) 2
nerve. EN Anat
1815 Cranial nerve palsy Lesions of the glossopharyngeal nerve result in loss of the gag reflex (afferent limb); loss of sensation in the upper pharynx, posterior tongue, tonsils, and middle ear cavity; and loss of taste sensation on Nervous (NS) Anatomy (Anat) 9
the posterior 3rd of the tongue. NS Anat
1816 Urinary tract infection hemorrhagic cystitis during therapy w/ cyclophosphamide or ifosfamide is caused by the urinary excretion of the tox metabolite acrolein. It can be prevented by aggressive hydration, bladder irrigation, Hematology & Oncology (HO) Pharmacology 12
and admin of mesna, a sulfhydryl compound that binds acrolein in the urine. (Phar) HO Phar
1817 Nausea and vomiting Ondansetron inhibits serotonin (5-HT3) receptors and is used primarily to treat nausea and vomiting following chemotherapy, 5-HT3 receptors are located peripherally in the presynaptic nerve terminals Gastrointestinal & Nutrition (GI) Pharmacology 2
of the vagus nerve in the gastrointestinal tract. These receptors are also present centrally in the chemoreceptor trigger zone and the solitary nucleus and tract. (Phar) GI Phar
1818 Methotrexate Folinic acid (leucovorin) can reverse the tox of MTX in non-ca cells in the GI mucosa and bone marrow if admin at the appropriate time. Leucovorin serves as a reduced form of vitB9 that doesn’t req the Hematology & Oncology (HO) Pharmacology 2
action of DHFR. (Phar) HO Phar
1819 Chemotherapy The human MDR1 gene codes for P-gp, a transmembrane ATP-dependent efflux pump protein that has a broad specificity for hydrophobic compounds. This protein can both ↓ the influx of drugs into the Hematology & Oncology (HO) Pharmacology 3
cytosol and can ↑ efflux from the cytosol, thereby preventing the action of CTx agents. (Phar) HO Phar
1822 Trisomy 13 Patau syndrome (trisomy 13) usually occurs secondary to meiotic nondisjunction in mothers of advanced maternal age. Key physical findings reflect defective prechordal mesoderm fusion resulting in Miscellaneous (Multisystem) Genetics (Gene) 1
midline defects (eg, holoprosencephaly, microphthalmia, cleft lip/palate, omphalocele) as well as polydactyly and cutis aplasia. (MS) MS Gene
1823 Trisomy 18 Trisomy 18, or ES, is most commonly the result of meiotic nondisjxn due to advanced maternal age. Key findings include fetal growth retardation, hypertonia (clenched hands w/ overlapping fingers), Miscellaneous (Multisystem) Genetics (Gene) 1
rocker bottom feet, and cardiac/GI/renal defects. (MS) MS Gene
1824 Down syndrome DS (trisomy 21) is a/w ↓ maternal serum AFP and ↑ nuchal translucency. Duodenal atresia is the most common GI complication in these pts. Miscellaneous (Multisystem) Genetics (Gene) 6
(MS) MS Gene
1825 Down syndrome Unbalanced Robertsonian translocations account for a minority of DS cases. Karyotyping shows 46 chromosomes w/ a translocation b/w 2 acrocentric nonhomologous chromosomes [eg, 46, XX, t(14; Pregnancy, Childbirth & Genetics (Gene) 6
21)]. Puerperium (PR) PR Gene
1827 Hydrocele A communicating hydrocele results when serous fluid accumulates within the tunica vaginalis in the setting of a patent processus vaginalis. It presents as a painless swelling that transilluminates on Male Reproductive (MR) Anatomy (Anat) 2
examination. MR Anat
1828 Coronary artery disease Clopidogrel irreversibly blocks the P2Y12 component of ADP receptors on the platelet surface and prevents platelet aggregation. Clopidogrel is as effective as aspirin in the prevention of CV events in pts Cardiovascular (CV) Pharmacology 4
w/ coronary heart disease. (Phar) CV Phar
1829 Brachial plexus The lower trunk of the brachial plexus carries nerve fibers from the C8 and T1 spinal levels that are responsible for innervating all of the intrinsic muscles of the hand (via the median and ulnar nerves). Nervous (NS) Anatomy (Anat) 6
Sudden upward stretching on the arm at the shoulder can damage the lower trunk, resulting in finger clumsiness w/ total claw hand deformity. NS Anat
1830 Gestational trophoblastic disease A complete mole usually results when an empty ovum is fertilized by a haploid sperm. Subsequent duplication of the paternal genetic complement (23X) results in the Chx 46, XX genotype. Female Reproductive & Breast Genetics (Gene) 3
(FR) FR Gene
1831 Mullerian anomalies In females, the paramesonephric ducts fuse to form the fallopian tubes, uterus, cervix, and upper vagina. Disruptions of this process can lead to a variety of Müllerian tract anomalies, and renal anomalies Female Reproductive & Breast Embryology 1
are a common comorbidity. Incomplete lateral fusion of the paramesonephric ducts results in a bicornuate uterus Chx by an indentation in the center of the fundus. (FR) (Embr) FR Embr
1832 Duodenum and superior mesenteric The 3rd part of the duodenum courses horizontally across the abdo aorta and IVC at the lvl of the 3rd lumbar vertebra. The SMVs lie ant. to the duodenum at this location. Gastrointestinal & Nutrition (GI) Anatomy (Anat) 1
artery GI Anat
1833 Fetal circulation The most highly oxygenated blood in the fetus is carried by the umbilical vein, which empties directly into the inferior vena cava via the ductus venosus. Pulmonary & Critical Care (PU) Embryology 1
(Embr) PU Embr
1834 Generalized anxiety disorder Serotonin-releasing neurons in the CNS are located in the raphe nuclei. These neurons disseminate widely to synapse on numerous structures in the CNS. Antidepressants such as SSRIs, SNRIs, and Nervous (NS) Anatomy (Anat) 4
TCAs inhib serotonin reuptake at these synapses. NS Anat
1835 Septic arthritis A high synovial fluid leucocyte count (>100k/mm3) and absent crystals on micro Ex strongly suggest bacterial joint infection. SA req Abx Tx to prevent joint destruction, OM, and sepsis. Rheumatology, Orthopedics & Pathology (Path) 4
Sports (RH) RH Path
1836 Beta 2 agonists Isoproterenol is a β1 and β2 adrenergic receptor agonist that causes ↑ myocardial contractility and ↓ SVR. Cardiovascular (CV) Pharmacology 1
(Phar) CV Phar
1837 Ovarian cancer Epithelial ovarian cancer is the most common ovarian malignancy. Histologic findings include anaplasia of epithelial cells with invasion into the stroma, along with multiple papillary formations with Female Reproductive & Breast Pathology (Path) 9
cellular atypia. Epithelial ovarian tumors produce CA-125, which can be used as a serum marker for this condition. (FR) FR Path
1838 Vitamin B12 deficiency Vit B12 is obtained thru the diet solely from animal sources, which places strict vegans at risk for dietary defic. This defic takes yrs to develop due to the large hepatic B12 reserve, and Px w/ Hematology & Oncology (HO) Biochemistry 9
megaloblastic anemia and potentially irrev. neuro deficits (e.g. paresthesias, weakness, ataxic gait). (Bioc) HO Bioc
1839 Anorexia nervosa Distorted bodyimage, inadequatediet, dryskin, and lanugo hair in a female suggest AN. Anorexic females commonly have impaired GnRH release from the hypothal, leading to low lvls of LH, FSH, and Endocrine, Diabetes & Pathology (Path) 3
oestrogen (fxnal hypothal amenorrhoea). Metabolism (ES) ES Path
1841 ACE inhibitors In the kidney, angiotensin II preferentially constricts the efferent arteriole, thereby maintaining the glomerular filtration rate (GFR) within normal range. ACE-inhibitors promote efferent arteriolar Renal, Urinary & Electrolytes Pathophysiology 7
dilation, causing GFR reduction. (RE) (Patp) RE Patp
1842 Sickle cell The major chronic path changes in the spleens of pts w/ SCA result from repetitive splenic infarctions caused by splenic microvessel occlusion. Fibrosis, brownish discolouration, and eventual Hematology & Oncology (HO) Pathology (Path) 13
autosplenectomy ultimately result. HO Path
1843 Bulimia nervosa BN is characterised by episodes of binge eating and compensatory weight-↓ behaviours. SSx of self-induced vomiting incl hypokalaemia, meta alkalosis, parotid gland enlargement, dorsal hand calluses, Pregnancy, Childbirth & Behavioral 4
and dental erosion. Puerperium (PR) Science (Beha) PR Beha
1844 Multiple endocrine neoplasia MEN-2B is char by MTC, PCC, marfanoid habitus, and oral and intestinal mucosal neuromas. Endocrine, Diabetes & Pathology (Path) 5
1845 Multiple endocrine neoplasia MEN-1 syndrome is characterised by tumours of the pituitary, PT gland, and pancreas (the '3 Ps'). Endocrine, Diabetes & Pathophysiology 5
1846 Aphasia A lesion in Wernicke's area can cause receptive aphasia, which is characterised by well-articulated, nonsensical speech paired w/ a lack of language comprehension (Wernicke-Word salad). Wernicke's Nervous (NS) Anatomy (Anat) 2
area is located in the auditory assoc cortex w/i the posterior portion of the superior temporal gyrus in the dom temporal lobe. The MCA supplies Broca's area (superior division) and Wernicke's area
(inferior division). NS Anat
1847 Folic acid deficiency Vit B9 inhibs the synth of NAs, particularly the formation of dTMP. This leads to defective DNA synth that char causes incr. apoptosis of HPO cells and megaloblastic anemia. Thymidine Hematology & Oncology (HO) Biochemistry 1
supplementation bypasses the enzyme and can decr. erythroid cell apoptosis. (Bioc) HO Bioc
1848 Vitamin B12 deficiency Atrophic gastritis can result in profound hypochlorhydria, inadequate IF production, vitB12 defic, and ↑ MMA lvls. The reticulocyte count ↑ dramatically once vitB12 replacement therapy is initiated in Hematology & Oncology (HO) Pathology (Path) 9
an individual w/ pernicious anaemia. Hb and erythrocyte count lvls rise more gradually and take up to 8wks to normalise. HO Path
1849 Hemolytic uremic syndrome HUS is a common cause of ARF in children. It's characterised by the triad of MAHA, thrombocytopaenia, and AKI. Most cases develop following a diarrhoeal illness caused by Shiga toxin-producing Renal, Urinary & Electrolytes Pathology (Path) 3
organisms (e.g. E. coli O157:H7, S. dysenteriae). (RE) RE Path
1850 Henoch-Schonlein purpura HSP gen affects young children and is classically preceded by an URI. This IgA-mediated HS (leucocytoclastic) vasculitis commonly causes abdo pain, joint pain, lower extremity palpable purpura and Renal, Urinary & Electrolytes Pathology (Path) 3
hematuria. (RE) RE Path
1851 Hemolytic uremic syndrome HUS MFx w/ AKI, MAHA, and thrombocytopenia. Char lab abns incl decr Hb and platelet count and incr BT, LDH, bilirubin, BUN, and creat. Hematology & Oncology (HO) Pathophysiology 3
(Patp) HO Patp
1852 Kawasaki disease Kawasaki disease is a vasculitis of medium-sized arteries that presents w/ persistent fever for >5days, bilateral conjunctivitis, cervical LAD, and mucocutaneous involvement. Coronary artery aneurysms Cardiovascular (CV) Pathology (Path) 1
are a serious complication of Kawasaki disease. CV Path
1853 Meningitis Abs against the PSC of N. meningitidis provide immunity against this pathogen. Quadrivalent MCVs contain capsular PSs from major serotypes (A, C, Y, and W) of N. meningitidis. Serotype B vax use Nervous (NS) Microbiology 17
recomb proteins. (Micr) NS Micr
1854 Hydrocephalus Hydrocephalus in infants presents with macrocephaly and poor feeding. Imaging studies showing enlarged ventricles are characteristic. Untreated hydrocephalus leads to spasticity due to stretching of the Nervous (NS) Pathophysiology 4
periventricular pyramidal tracts, developmental delays, and seizures. (Patp) NS Patp
1855 Sickle cell Dactylitis (painful swelling of the hands and feet) is a common presentation of sickle cell disease (SCD) in young children. It is one of many vasoocclusive manifestations of SCD. Sickling episodes result Hematology & Oncology (HO) Pathophysiology 13
in hemolysis, which leads to increased indirect bilirubin and lactate dehydrogenase and decreased levels of haptoglobin. (Patp) HO Patp
1857 Methotrexate MTX is a vitB9 antagonist used to Tx ectopic preg. It competitively inhibs the enzyme DHFR, which catalyses the synthesis of THF. DHFR inhib causes the intermediate DHF to accumulate Hematology & Oncology (HO) Pharmacology 2
intracellularly. (Phar) HO Phar
1858 Muscle structure & physiology Postural skeletal muscles such as the soleus and paraspinal muscles contain predominantly Type I slow twitch, red muscle fibers that derive ATP primarily from oxidative (aerobic) metabolism. Rheumatology, Orthopedics & Physiology 8
1859 Extramedullary hematopoiesis The presence of erythroid precursors in organs such as the liver and spleen is indicative of EMH, a condition characterised by EPO-stim, hyperplastic marrow cell invasion of EM organs. EMH is most Hematology & Oncology (HO) Pathology (Path) 1
freq caused by severe chronic hemolytic anaemias, such as β-thalassaemia. HO Path
1860 Aging Photoaging is a product of excess exposure to ultraviolet A wavelengths and is characterized by epidermal atrophy with flattening of rete ridges. In addition, there is decreased collagen fibril production Dermatology (DE) Pathophysiology 8
and increased degradation of collagen and elastin in the dermis. (Patp) DE Patp
1861 Aplastic anemia The triad of low Hb, thrombocytopaenia, and absent HPO cells in the bone marrow is consistent w/ AA. A compensatory ↑ in circulating EPO lvls would be expected in individuals w/ AA and normal Hematology & Oncology (HO) Pathology (Path) 3
renal fxn. HO Path
1862 Renal cell carcinoma The most common renal malignancy is CCC, which arises from renal PCT cells. Rounded or polygonal cells w/ abundant clear cytoplasm are seen on LM. 'Clear cells' are gen those w/ a high glycogen or Renal, Urinary & Electrolytes Pathology (Path) 8
lipid content that dissolves during routine tissue prep. (RE) RE Path
1863 Hepatitis A Acute hepatitis due to most hepatotropic viruses causes hepatocyte ballooning degen and apoptosis w/ mononuclear cell infiltrations. Gastrointestinal & Nutrition (GI) Pathology (Path) 4 GI Path
1864 Hodgkin lymphoma RS cells are large binucleated cells w/ an 'owl's eyes' appearance that appear on a background of lymphocytic infiltrates. RS cells must be present histopath in order to make the Dx of HL. Hematology & Oncology (HO) Pathology (Path) 2 HO Path
1865 Lead poisoning Coarse erythrocyte basophilic stippling and microcytic hypochromic anemia are common PBS findings in Pb poisoning. High-risk groups include young children ingesting paint chips and industrial Hematology & Oncology (HO) Pathology (Path) 4
workers inhaling particulate Pb. HO Path
1866 Gluconeogenesis Ethanol inhibs GNG and can cause hypoglycaemia once hepatic glycogen stores are depleted. Endocrine, Diabetes & Pathophysiology 4
1867 Primary biliary cholangitis A yellowish eyelid papule or plaque containing lipid-laden macrophages is most likely xanthelasma. Xanthelasma may occur in a/w 1° or 2° hyperlipidaemia. Cholestatic conditions such as PBC are a Dermatology (DE) Pathology (Path) 4
potential cause of hypercholesterolaemia leading to xanthelasma. DE Path
1868 Anticholinergics Anticholtox is characterised by fever; confusion; cutaneous flushing; dry oral mucosa; and dilated, poorly reactive pupils. TCAs, particularly amitriptyline, have strong anticholinergic effects. Pregnancy, Childbirth & Pharmacology 3
1869 Allergic rhinitis First-generation antihistamines are nonspecific and interact with multiple receptors, including the muscarinic receptor. This leads to anticholinergic effects (eg, fever, flushing, mydriasis, urinary retention, General Principles (GP) Pharmacology 2
tachycardia, altered mental status). (Phar) GP Phar
1870 Hypospadia and epispadia In males, incomplete fusion of the urethral (urogenital) folds results in hypospadias, an abnormal opening of the urethra proximal to the glans penis along the ventral shaft of the penis. Male Reproductive (MR) Embryology 1
(Embr) MR Embr
1871 Coronary blood flow The inferior wall of the LV forms most of the inferior (diaphragmatic) surface of the heart and is supplied by the PDA. In 85%-90% of individuals, the PDA derives from the RCA (right dominant Cardiovascular (CV) Anatomy (Anat) 9
coronary circulation). CV Anat
1872 Fibronectin Adhesion of cells to the ECM involves integrin-mediated binding to fibronectin, collagen, and laminin. diffial expression of integrin subtypes affects adhesion properties of individual cells, and has been Hematology & Oncology (HO) Pathology (Path) 1
found to correlate w/ malignant behaviour in a # of tumours. HO Path
1873 Hemangioma The key GFs that promote angiogenesis in neoplastic and granulation tissue are VEGF and FGF. Pro-inflammatory cytokines (e.g. IL-1, IFN-γ) can indirectly promote angiogenesis thru ↑ VEGF Hematology & Oncology (HO) Pathology (Path) 6
expression. The laminin in BMs may pose a physical barrier to the sprouting of new blood vessels. HO Path
1874 Wound healing During wound healing, excessive MMP activity and myofibroblast accumulation in the wound margins can result in contracture. Contractures produce deformities of the wound and surrounding tissues, Rheumatology, Orthopedics & Pathology (Path) 1
most often on the palms, soles, ant. thorax, or at serious burn sites. Sports (RH) RH Path
1875 Ischemic hepatitis Organ susceptibility to infarction after occlusion of a feeding artery is ranked from greatest to least as follows: CNS, myocardium, kidney, spleen, and liver. The presence of a dual a/o collateral blood Gastrointestinal & Nutrition (GI) Anatomy (Anat) 1
supply (as seen in the liver, which is supplied by the hepatic artery and portal vein) enables an organ to tolerate arterial occlusion better than those w/ end-arterial circulations. GI Anat
1876 Fat embolism FES should be strongly suspected in a pt w/ severe long-bone a/o pelvic fractures who develops acute-onset neuro abns, hypoxaemia, and a petechial rash. Occlusion of the pulm microvessels by fat Pulmonary & Critical Care (PU) Pathology (Path) 2
globules is an early histo finding of this syndrome. PU Path
1877 Breast cancer Peau d'orange is an erythematous, itchy breast rash w/ skin texture changes that resemble an orange peel. It's the key derm Px of inflam breast ca and is caused by ca cells spreading to the dermal Hematology & Oncology (HO) Pathophysiology 7
lymphatic spaces and obstr lymphatic drainage. (Patp) HO Patp
1878 Ecchymosis Ecchymoses freq indicate a deep hemorrhage (hematoma) due to bony fracture, ligamentous rupture, or muscular injury. They don't blanch under pressure as the RBCs aren't contained w/i the vasculature. Dermatology (DE) Pathology (Path) 1
Ecchymoses often pass thru an evolution of colour change (blue or red to brown, green, and yellow), which can be used to estimate the age of the injury. DE Path
1879 Inherited thrombophilia 1-9% of Caucasians worldwide are heterozyg carriers of FV Leiden, which is modded to resist activated protein C. The resulting hypercoagulable state predisposes to DVT, which are the source of most Hematology & Oncology (HO) Pathology (Path) 2
PE. HO Path
1880 Pulmonary embolism Saddle PE straddles the bifurcation of the main pulm artery. VTE (i.e. PE or DVT) arises due to the Virchow triad of endothelial injury, venous stasis, and a hypercoagulable state. Malignancy causes a Hematology & Oncology (HO) Pathology (Path) 13
hypercoagulable state and is a strong RF for VTE. HO Path
1881 Acute heart failure Acute pulm oedema is a common conseq of AMI affecting the LV. ↑ hydrostatic pressure in the pulm venous system leads to engorged alveolar caps w/ transudation of fluid into the alveoli, appearing as Pulmonary & Critical Care (PU) Pathology (Path) 7
acellular pink material on histo. hemosiderin-laden macrophages are indicative of chronic lung congestion and aren't present acutely. PU Path
1882 Myocardial infarction Ion pump failure due to ATP defic during cardiac ischemia causes intracellular accumulation of Na+ and Ca2+. The ↑ intracellular solute conc draws free water into the cell, causing the cellular and Cardiovascular (CV) Pathology (Path) 18
mitochondrial swelling that's observed histologically. CV Path
1883 Community acquired pneumonia On posteroanterior chest x-ray, the right middle lobe is seen adjacent to the right border of the heart, which is primarily formed by the right atrium. Consolidation in the right middle lobe can obscure the Cardiovascular (CV) Anatomy (Anat) 21
X-ray silhouette of the right heart border. CV Anat
1884 CT abdomen The IVC is formed by the union of the right and left common iliac veins at the lvl of L4-L5. The renal arteries and veins lie at the lvl of L1. The IVC returns venous blood to the heart from the ↓ Cardiovascular (CV) Anatomy (Anat) 1
extremities, portal system, and abdominal and pelvic viscera. CV Anat
1885 Psoas abscess The psoas muscle originates from the ant. surface of the transverse processes and lat. surface of the vertebral bodies and fxns 1arily as a hip flexor. Psoas abscess may form due to direct spread of infection Rheumatology, Orthopedics & Anatomy (Anat) 2
from an adjacent structure (e.g. vertebral bodies, appendix, hip joint) or from heme seeding from a distant site. Sports (RH) RH Anat
1886 Beta oxidation Carnitine deficiency impairs FA transport from the cytoplasm into mitochondria, preventing β-oxidation of FAs into acetyl-CoA. This leads to cardiac and skeletal myocyte injury (lack of ATP from Endocrine, Diabetes & Biochemistry 3
TCA) and impaired ketone body production by the liver during fasting periods. Metabolism (ES) (Bioc) ES Bioc
1887 Ketone utilization When glycogen stores are depleted during fasting, ketone bodies are produced in the liver and can be used as an energy source in the mitochondria of peri tissues. The brain preferentially uses Glc, but Endocrine, Diabetes & Biochemistry 1
will utilise ketones for most of its energy needs during prolonged starvation. Erythrocytes lack mitochondria and are unable to use ketones. Metabolism (ES) (Bioc) ES Bioc
1888 Beta oxidation Impaired β-oxidation of FAs causes hypoglycaemia after prolonged fasting and insufficient lvls of ketone bodies. MCAD catalyses the 1st step in the β-oxidation pathway and is the most commonly defic Endocrine, Diabetes & Biochemistry 3
enzyme. Metabolism (ES) (Bioc) ES Bioc
1889 Triglyceride metabolism Glycerol produced by the degradation of TGs in adipose tissue can be used by glycerol kinase in the liver and kidney to synthesize Glc during GNG. Endocrine, Diabetes & Biochemistry 2
1890 Acute lymphoblastic leukemia 6-MP is mainly degraded in the liver by XO. Allopurinol, an XO inhib, can ↑ the conc of 6-MP significantly. Both 6-MP and 6-TG are prodrugs that req activation by HGPRT. Hematology & Oncology (HO) Pharmacology 3
(Phar) HO Phar
1892 Chemotherapy MTX and 5-FU both effectively inhib thymidylate formation, but the CTx effect of MTX is overcome by N5-formyl-THF (folinic acid, leucovorin) supplementation. Hematology & Oncology (HO) Pharmacology 3
(Phar) HO Phar
1893 Vincristine The vinca alkaloids are cell cycle-specific agents that prevent proper separation of chrom into daughter cells during the M phase of the cell cycle. The main dose-limiting AE of vincristine is neurotox, Hematology & Oncology (HO) Pharmacology 1
which commonly MFx as peri neuropathy. (Phar) HO Phar
1894 Chemotherapy Neurotox is the dose-limiting AE of vincristine therapy. This tox results from failure of microtubule polymerisation in neuronal axons. Other notable AEs classically a/w CTx agents incl PF and flagellate Hematology & Oncology (HO) Pharmacology 3
skin discolouration w/ bleomycin use; CHF w/ doxorubicin; and hemorrhagic cystitis w/ cyclophosphamide. (Phar) HO Phar
1895 Urethritis Urethritis in a young man is most likely to be due to Neisseria gonorrhoeae or Chlamydia trachomatis, both of which cause dysuria and mucopurulent urethral discharge. The standard Tx for suspected Infectious Diseases (ID) Microbiology 4
gonococcal urethritis presumes infection by both organisms. Therefore, ceftriaxone is given for N gonorrhoeae, and doxycycline or azithromycin is given for C trachomatis. (Micr) ID Micr
1896 Parvovirus PVB19 causes erythema infectiosum (5th disease) in children and arthritis in adults. PV arthritis can mimic RA but is usually self-resolving. Rheumatology, Orthopedics & Pathology (Path) 3
Sports (RH) RH Path
1897 Lyme disease Early Lyme disease causes flu-like symptoms and erythema chronicum migrans. The second stage of Lyme disease may involve atrioventricular block and facial palsy. Late Lyme disease can cause Rheumatology, Orthopedics & Pharmacology 3
chronic asymmetric large joint arthritis and encephalopathy. Lyme disease is easily treated with doxycycline or penicillin-type antibiotics (eg, ceftriaxone). Sports (RH) (Phar) RH Phar
1898 Bartonella Bartonella henselae causes cat-scratch disease, bacillary angiomatosis, and culture-negative endocarditis. Cat-scratch disease is characterized by low fever, lymphadenopathy, and a self-limited course. Dermatology (DE) Microbiology 2
(Micr) DE Micr
1899 Dysfunctional uterine bleeding, Anovulation is common in the 1st several yrs after menarche and the last few yrs before menopause. It MFx w/ marked menstrual cycle variability. Female Reproductive & Breast Physiology 1
anovulation (FR) (Phys) FR Phys
1900 Lambert-Eaton myasthenic LEMS is a NM disorder char by auto-Abs against presynaptic v-gated Ca2+channels. It causes progr prox. muscle weakness and ↓ DTRs that improve w/ exercise (post-exercise facilitation); CN Rheumatology, Orthopedics & Pathology (Path) 2
syndrome involvement and autonomic SSx may also occur. LEMS is strongly a/w SCLC. Sports (RH) RH Path
1901 Androgenic steroids Androgenic steroidabuse may lead to erythrocytosis, testicularatrophy, acne, and virilisation in women (e.g. clitoromegaly, hirsutism). Endocrine, Diabetes & Pathology (Path) 2
1902 Inhibin Sertoli cells produce inhibin in response to FSH from the anterior pituitary. Inhibin suppresses FSH production in the pituitary. Sertoli cells also facilitate spermatogenesis w/i the seminiferous tubules. Male Reproductive (MR) Physiology 1
Impaired Sertoli cell fxn would lead to ↓ production of inhibin, ↑ FSH lvls, and impaired fertility. (Phys) MR Phys
1903 Factor VII deficiency A normal BT indicates adequate platelet hemostatic fxn. A normal aPTT indicates an intact intrinsic coag system. Prolonged PT in the setting of normal aPTT indicates a defect in the extrinsic coag Hematology & Oncology (HO) Pathophysiology 1
system at a step that's not shared w/ the intrinsic system. (Patp) HO Patp
1904 Syringomyelia The combo of fixed segmental loss of upper extremity pain and temp sensations, upper extremity LMN SSx, a/o lower extremity UMN SSx in the setting of scoliosis suggests syringomyelia. Nervous (NS) Pathology (Path) 2 NS Path
1905 SCA mutation Exertional dyspnea, pneumonia resulting in life-thr ACS, and recurrent abdo and bone pain are CFx of SCA. SCA results from a point mut that causes valine to substitute for glutamic acid in the 6th Hematology & Oncology (HO) Biochemistry 1
position of the beta-globin chain of Hb. (Bioc) HO Bioc
1906 West Nile virus infection West Nile virus is a single-strand flavivirus transmitted by mosquitoes, most commonly in the summer. Most infections are asymptomatic or may present with a flu-like illness (West Nile fever), often Nervous (NS) Microbiology 2
with a maculopapular or morbilliform rash. Neuroinvasive disease manifests as meningitis, encephalitis, or asymmetric flaccid paralysis; patients may have parkinsonian features. (Micr) NS Micr
1907 Malabsorption PSs must be degraded to MSs by pancreatic and brush border amylases before they can be absorbed. MSs can be absorbed directly. D-xylose is a MS whose absorption isn't affected by exocrine PI, and Gastrointestinal & Nutrition (GI) Pathophysiology 4
can be used to diffiate b/w pancreatic vs. mucosal causes of malabsorption. (Patp) GI Patp
1908 Malaria RBCs filled w/ multiple, small rings suggest Plasmodium infection (malaria). Erythrocytic forms of this parasite may be Tx w/ antimalarials such as chloroquine (in non-resistant areas), atovaquone- Infectious Diseases (ID) Microbiology 5
proguanil, and artemisinins. Primaquine is req to kill P. vivax and P. ovale liver hypnozoites. (Micr) ID Micr
1910 Community acquired pneumonia The green discolouration of pus or sputum seen during common bacterial infections is due to the presence of MPO, a blue-green hem-based enzyme that’s released from neutrophil azurophilic granules Pulmonary & Critical Care (PU) Pathophysiology 21
and forms HOCl (bleach). (Patp) PU Patp
1911 Non-Hodgkin lymphoma Follicular lymphoma is an NHL of follicular B-lymphocytes. Pts w/ follicular lymphoma char have a translocation b/w chroms 14 and 18 which causes bcl-2 overexpression. Bcl-2 is considered a Hematology & Oncology (HO) Pathology (Path) 6
protooncogene b/c it has anti-apoptotic effects. HO Path
1912 Urethritis Neisseria can be isolated by culture on selective media such as the Thayer-Martin VCN (vancomycin/colistin/nystatin) medium, which inhibs growth of contaminants such as gram (+) organisms, gram (-) Infectious Diseases (ID) Microbiology 4
organisms other than Neisseria, and fungi. (Micr) ID Micr
1913 Diabetic nephropathy Moderately ↑ albuminuria (urine albumin 30-300mg/day) is the earliest MFx of diabetic nephropathy (DN). Screening for DN is best achieved using an albumin-specific urine assay (regular dipstick UA Renal, Urinary & Electrolytes Pathology (Path) 4
has low sensitivity). (RE) RE Path
1914 Preeclampsia Preeclampsia is defined as hypertension onset after 20 weeks gestation plus proteinuria or signs of end-organ damage. End-organ damage is due to endothelial damage secondary to the release of Pregnancy, Childbirth & Pathology (Path) 1
inflammatory factors from abnormal placentation. Puerperium (PR) PR Path
1915 Polycystic kidney disease In its most severe phenotype, autosomal recessive polycystic kidney disease can be detected on prenatal sonogram along with oligohydramnios. Potter sequence (flattened facies, limb deformities, Renal, Urinary & Electrolytes Embryology 3
pulmonary hypoplasia) is caused by oligohydramnios and is associated with high mortality. (RE) (Embr) RE Embr
1916 Urinary tract obstruction The ureters run in close proximity to the pelvic LNs and the uterine artery in the female pelvis, which predisposes them to injury during pelvic surgery. Renal, Urinary & Electrolytes Pathology (Path) 4
(RE) RE Path
1917 Pituitary adenoma Prolactinomas are the most common hormonally active pituitary adenomas. The excess prolactin produced by these tumors can cause galactorrhea and amenorrhea in premenopausal women. With a large Female Reproductive & Breast Pathology (Path) 8
mass, visual changes and headaches may occur due to compression of the optic chiasm. (FR) FR Path
1918 Peptic ulcer disease Acute Helicobacter pylori infection initially causes nonatrophic antral gastritis and an ↑ risk for duodenal ulcers. Chronic infection results in patchy, multifocal, atrophic gastritis w/ loss of parietal cells Gastrointestinal & Nutrition (GI) Pathology (Path) 10
and G cells in the gastric body; this is a/w ↓ acid secretion and an ↑ risk of gastric ulcers, GAC, and MALT lymphoma. GI Path
1919 Alpha1 antitrypsin deficiency Emphysema most commonly results from chronic smoking but can also occur in genetically predisposed individuals w/ AATD. Pts w/ emphysema have a ↓ FEV1/FVC ratio, ↑ TLC, and ↓ DLCO. Pulmonary & Critical Care (PU) Pathophysiology 8
(Patp) PU Patp
1920 Ischemic stroke UMN SSx include abnormal plantar flexion (Babinski sign), spastic paralysis, ↑ muscle tone, clasp-knife rigidity, hyperreflexia, pronator drift, and pyramidal weakness (weakness more pronounced in Nervous (NS) Pathophysiology 19
lower extremity flexors and upper extremity extensors). LMN SSx include flaccid paralysis, weakness w/ hypotonia and muscle atrophy, fasciculations, and suppressed or absent reflexes. (Patp) NS Patp
1921 Cushing syndrome PNP hypercortisolism, most commonly caused by SCLC, is due to ectopic ACTH secretion. CFx incl HTN, hyperglycaemia, oedema, and hyperpigmentation. Unlike non-PNP CS, central obesity is Endocrine, Diabetes & Pathology (Path) 5
uncommon. Metabolism (ES) ES Path
1922 Neuronal physiology Kinesin is a microtubule-associated motor protein that fxns in the anterograde transport of materials and organelles w/i cells. Reactivation of latent HSV requires anterograde transport of viral particles Nervous (NS) Histology (Hist) 3
from neuronal cell bodies in the sensory ganglia to the skin and oral mucosa. NS Hist
1923 von Willebrand disease vWD is the most common inherited bleeding disorder. It has an AD pattern of inheritance and variable penetrance. Absence of vWF leads to impaired platelet fxn (prolonged BT) and coagulation pathway Hematology & Oncology (HO) Pathology (Path) 7
abnormalities due to ↓ factor VIII activity (prolonged PTT). HO Path
1924 Shoulder dislocation Flattening of the deltoid muscle w/ acromialprominence after a shoulder injury suggests an ant. humerus dislocation. This injury most commonly results from a blow to an ext. rotated and abducted arm. Rheumatology, Orthopedics & Anatomy (Anat) 1
There's often assoc axillary nerve injury, resulting in deltoid paralysis and loss of sensation over the lat. shoulder. Sports (RH) RH Anat
1925 Asthma Intermittent resp SSx in a pts w/ a normal CXR, sputum eosinophils, and ↓ FEV1 suggest asthma. Common asthma triggers incl exercise, cold air, resp infection, and exposure to inhaled allergens (e.g. Pulmonary & Critical Care (PU) Pathology (Path) 12
dust mites, cockroaches, pet dander, mould, pollen). PU Path
1926 Breastfeeding The breast milk content of vits D and K is typically insuff for the nutr needs of the newborn. Vit K is given parenterally to all newborns at birth to prevent HDN. Exclusively breastfed infants req vit D Gastrointestinal & Nutrition (GI) Physiology 1
supp due to lack of sunlight exposure and to prevent rickets. (Phys) GI Phys
1927 Hepatitis C IVDU is a major RF for HBV and HCV viral infection. Acute viral hepatitis is marked by panlobular inflammation and hepatocyte necrosis and ballooning. Tc cell-mediated signals also cause hepatocyte Gastrointestinal & Nutrition (GI) Pathology (Path) 4
apoptosis w/ the formation of intensely eosinophilic Councilman bodies. GI Path
1928 Ovarian cancer Sertoli-Leydig cell tumors of the ovary arise from the sex cord stroma and secrete testosterone. Typical features include a large ovarian mass and signs of virilization. Tubular structures lined by round Female Reproductive & Breast Pathology (Path) 9
Sertoli cells and surrounded by a fibrous stroma are seen on pathology. (FR) FR Path
1929 Bacterial vaginosis Bacterial vaginosis is a/w a grayish-white vaginal d/c w/ a "fishy" odor. The etiology involves an overgrowth of Gardnerella vaginalis, an anaerobic Gram-variable rod. Clue cells (squamous epithelial Female Reproductive & Breast Microbiology 3
cells covered w/ bacterial organisms) are seen on wet mount microscopy or cytology. (FR) (Micr) FR Micr
1930 Brachial plexus The radial nerve provides sensory innervation to the skin of the posterior arm, forearm, and dorsal lateral hand and provides motor innervation to all of the extensor muscles of the upper limb below the Nervous (NS) Anatomy (Anat) 6
shoulder. Damage to the proximal radial nerve (eg, at the axilla or midshaft humerus) may result in wrist drop. NS Anat
1931 Muscle structure and physiology Ca efflux from cardiac cells prior to relaxation is primarily mediated via an Na/Ca exchange pump and SR Ca-ATPase pump. Cardiovascular (CV) Physiology 1
(Phys) CV Phys
1932 Pelvic inflammatory disease Ruptured ectopic pregnancy can cause abdominal pain, vaginal bleeding, and hemodynamic instability. PID is most commonly caused by Neisseria gonorrhoeae or Chlamydia trachomatis and Female Reproductive & Breast Microbiology 2
significantly ↑ the risk of ectopic pregnancy. (FR) (Micr) FR Micr
1933 Cranial nerve palsy CNIV innervates the SO muscle, which causes the eye to intort (internally rotate) and depress while adducted. CNIV palsy is typically traumatic or idiopathic and presents w/ vertical diplopia that worsens Nervous (NS) Anatomy (Anat) 9
when the affected eye looks down and toward the nose (e.g. walking downstairs, up-close reading). Pts may compensate by tucking the chin and tilting the head away from the affected eye. NS Anat
1934 Neuromuscular junction ACh release from presynaptic terminal vesicles at the NMJ depends upon the influx of extracellular Ca into the presynaptic terminal. Ca influx into the nerve terminal occurs following neuronal depol and Nervous (NS) Pathophysiology 1
opening of v-gated Ca channels. (Patp) NS Patp
1935 Mitochondrial disorders The presence of lactic acidosis and ragged skeletal muscle fibers histologically suggests a mitochondrial myopathy. Variable clinical expressions in affected family members can occur due to Rheumatology, Orthopedics & Genetics (Gene) 4
heteroplasmy, which is the coexistence of distinct versions of mitochondrial genomes in an individual cell. Sports (RH) RH Gene
1936 Neuronal physiology Kinesin is a microtubule-associated, ATP-powered motor protein that facilitates the anterograde transport of neurotransmitter-containing secretory vesicles down axons to synaptic terminals. Nervous (NS) Histology (Hist) 3 NS Hist
1937 Lymphoedema Axillary LN dissection is an RF for the devel of chronic lymphoedema involving the ipsilateral arm. Chronic lymphoedema predisposes to the devel of angiosarcoma (Stewart-Treves syndrome). Dermatology (DE) Pathology (Path) 1 DE Path
1938 VIPoma VIPomas are pancr islet cell tumors that hypersecr VIP, which ↑ intestinal Cl loss into the stool and causes excess losses of the accomp water, Na, and K. VIP also inhibs gastric acid secr. SS inhibs the Gastrointestinal & Nutrition (GI) Physiology 1
secr of VIP and is used to Tx the SSx of VIPoma. (Phys) GI Phys
1939 Cystic fibrosis Pts w/ CF produce eccrine sweat w/ higher-than-normal concs of Na+ and Cl-. Exposure to high temp or exercise can lead to hyponatraemia and hypochloraemia due to excessive NaCl loss thru sweat; Pulmonary & Critical Care (PU) Pathophysiology 11
therefore, salt supplementation is recommended. (Patp) PU Patp
1940 Thalassemia Beta-thalassemia is caused by muts that result in defective transcription, processing, and translation of beta-globin mRNA. This leads to defic of the beta-globin chains req for normal Hb synth. Hematology & Oncology (HO) Pathophysiology 3
(Patp) HO Patp
1941 Polycythemia Renal cortical cells sense hypoxia and respond by synthesizing and releasing EPO. EPO stimulates the production of erythrocytes in the bone marrow. Hematology & Oncology (HO) Pathology (Path) 5 HO Path
1942 Polycythemia In response to tissue hypoxia, specialised interstitial cells in the RM and RC release EPO to stim the bone marrow to ↑ RBC production and improve the O2-carrying capacity of the blood. This response, Pulmonary & Critical Care (PU) Pathophysiology 5
known as 2° polycythemia, is an expected finding in diseases or conditions that cause significant chronic hypoxaemia (e.g. COPD). (Patp) PU Patp
1943 Brachiocephalic vein obstruction The BCV drains the ipsilateral jugular and SCVs. The bilateral BCVs combine to form the SVC. BCV obstruction causes SSx similar to those seen in SVC syndrome, but only on one side of the body. Cardiovascular (CV) Anatomy (Anat) 1 CV Anat
1944 Chronic heart failure Rx that have been shown to improve long-term survival in pts w/ HF due to LV systolic dysfxn include β blockers, ACEIs, ARBs, and aldosterone antagonists. Cardiovascular (CV) Pharmacology 12
(Phar) CV Phar
1945 Hyperthyroidism Hyperthyroidism causes a hyperadrenergic state Chx by HTN, palpitations/tachycardia, sweating, heat intolerance, tremor, and hyperreflexia. β blockers can relieve these SSx. Exophthalmos in Graves Endocrine, Diabetes & Pharmacology 8
disease is due to an immune-mediated ↑ in orbital soft tissue mass and does not improve w/ β blockers. Metabolism (ES) (Phar) ES Phar
1946 Essential tremor Essential tremor is the most common movement disorder. Pts experience a slowly progr, symmetric postural a/o kinetic tremor that most commonly affects the upper extremities. Essential tremor is often Nervous (NS) Pharmacology 1
inherited in an AD fashion (referred to as familial tremor). 1st-line Tx is the nonspecific β-adrenergic antagonist propranolol. (Phar) NS Phar
1947 Dose response curves Phenoxybenzamine is an irreversible α1 and α2 adrenergic antagonist that effectively ↓ the arterial vasoconstriction induced by NE. B/c phenoxybenzamine is an irreversible antagonist, even very high Cardiovascular (CV) Pharmacology 4
concentrations of NE, such as those seen in pheochromocytoma, can't overcome its effects. (Phar) CV Phar
1948 Primary hypertension β blockers inhibit release of renin from renal juxtaglomerular cells through antagonism of β1 receptors on these cells. Inhibition of renin release prevents activation of the RAA pathway, which results in ↓ Cardiovascular (CV) Pharmacology 14
vasoconstriction and ↓ renal Na and water retention. (Phar) CV Phar
1949 Urethritis Gonorrhoea can cause urethritis (dysuria and purulent urethral d/c). The NAAT is the Dx tool of choice. Gram stain showing gram (-), intracellular diplococci is also Dx. Dual therapy w/ ceftriaxone and Infectious Diseases (ID) Microbiology 4
azithromycin is the 1st-line Tx due to concerns about resistance and chlamydia coinfection. (Micr) ID Micr
1952 Syphilis Penicillins, structurally similar to D-alanine-D-alanine, inhibit transpeptidase by binding covalently to its active site. The result is failed synthesis of the bacterial peptidoglycan cell wall. Infectious Diseases (ID) Microbiology 9
(Micr) ID Micr
1953 Hemophiliacs Hemophilia is an XLR coagulopathy that Px w/ IM hemorrhage, hemarthrosis, and delayed bleeding after procedures. LFx show PTT prolongation; other tests of hemostatic fxn are generally normal. Hematology & Oncology (HO) Pathology (Path) 2 HO Path
1954 ITP Autoimmune platelet destruction is a common cause of thrombocytopaenia and should be suspected in pts w/ ecchymoses, petechiae, mucosal bleeding, and no other obvi causes of thrombocytopaenia (e. Hematology & Oncology (HO) Pathology (Path) 1
g. Rx, bone marrow failure). HO Path
1955 Aphasia Broca (motor, nonfluent) aphasia results from damage to the inferior frontal gyrus of the dominant hemisphere. Patients are often frustrated as they understand language but cannot properly formulate the Nervous (NS) Anatomy (Anat) 2
motor commands to write or form words (eg, slow, fragmented speech). Aphasia may be associated with right upper limb and face weakness due to extension of the lesion into the primary motor cortex. NS Anat
1956 Femoral fracture The med. FCX artery and its branches provide the majority of the blood supply to the femoral head and neck. Injury to these vessels due to a displaced femoral neck fracture can cause ON of the femoral Rheumatology, Orthopedics & Anatomy (Anat) 1
head. Sports (RH) RH Anat
1957 Adenomyosis Adenomyosis is the presence of endometrial glandular tissue w/i the myometrium. Menorrhagia and dysmenorrhea are common Px SSx. Pts have a uniformly enlarged uterus w/ normal-appearing Female Reproductive & Breast Histology (Hist) 1
endometrial tissue on Bx. (FR) FR Hist
1958 Bacterial vaginosis Bacterial vaginosis is a vaginal infection diagnosed by the presence of clue cells and a positive amine "whiff" test with potassium hydroxide (KOH). The pathogenesis involves a loss of lactobacilli in the Infectious Diseases (ID) Pathology (Path) 3
normal vaginal flora and overgrowth of Gardnerella vaginalis. It is treated with clindamycin or metronidazole. ID Path
1959 Penicillin Clavulanic acid, sulbactam, and tazobactam are β-lactamase inhibs. Concurrent admin of clavulanate w/ amoxicillin expands amoxicillin's spectrum of activity to incl strains of β-lactamase synthesising Infectious Diseases (ID) Pharmacology 2
bacteria that're resistant to amoxicillin alone. (Phar) ID Phar
1960 Melanoma The most common metastatic tumors to the brain are lung cancer, renal cancer, and melanoma. Melanoma is a malignancy of melanocytes, which are embryologically derived from neural crest cells. Dermatology (DE) Embryology 6
(Embr) DE Embr
1962 Cluster headache CHs cause severe, episodic, unilateral periorbital and temporal pain a/w ipsilateral autonomic SSx (e.g. lacrimation, nasal congestion, miosis, conjunctival injection). The h/a typically last 15-180min and Nervous (NS) Pathology (Path) 1
tend to occur in clusters (often at the same time each day). Males are affected more commonly than females. NS Path
1963 Acute promyelocytic leukemia APML can present w/ persistent infection and coagulopathy causing hemorrhagic SSx. Bone marrow Bx classically reveals promyelocytes w/ intracytoplasmic Auer rods. APML is a/w a t(15;17) chrom Hematology & Oncology (HO) Pathology (Path) 3
translocation that causes fusion of the RARA gene and PML gene. HO Path
1964 Multiple myeloma The finding of a high peak in the γ-globulin region on SPEP usually represents an M protein consisting of an overproduced monoclonal Ig. MM causes an M protein peak on SPEP as well as anaemia Hematology & Oncology (HO) Pathology (Path) 9
(weakness), lytic bone lesions (back pain, path fractures), and renal insufficiency (related to amyloid deposition and hypercalcaemia). HO Path
1965 Malaria Chloroquine is the TOC for uncomplicated malaria contracted in a chloroquine-sen geographic region. It eliminates susceptible erythrocytic forms of all Plasmodium species. Primaquine is added in the Infectious Diseases (ID) Pharmacology 5
Tx of infections w/ P. vivax and P. ovale to eradicate the intrahepatic stages (hypnozoites) of these malarial species, which are responsible for relapses. (Phar) ID Phar
1966 Meningitis Fever; meningeal SSx (e.g. h/a, neck stiffness); and CSF that shows lymphocytic pleocytosis, a modestly incr protein lvl, and normal Glc are suggestive of aseptic meningitis. Enteroviruses are the most Nervous (NS) Microbiology 17
common cause of aseptic meningitis. (Micr) NS Micr
1967 CABG The great saphenous vein is a superficial vein of the leg that originates on the medial side of the foot, courses anterior to the medial malleolus, and then travels up the medial aspect of the leg and thigh. It Cardiovascular (CV) Anatomy (Anat) 1
drains into the femoral vein w/i the region of the femoral triangle, a few cm inferolateral to the pubic tubercle. CV Anat
1968 Knee trauma The PCL prevents posterior displacement of the tibia relative to the femur. It originates from the anterolateral surface of the medial femoral condyle and inserts into the posterior intercondylar area of the Rheumatology, Orthopedics & Anatomy (Anat) 4
tibia. Its integrity can be tested in the clinical setting by using the posterior drawer test. Sports (RH) RH Anat
1969 Knee trauma The PCL prevents post. displacement of the tibia relative to the femur when the knee is flexed. It attaches to the post. part of the intercondylar area of the tibia and the ant. part of the lat. surface of the Rheumatology, Orthopedics & Anatomy (Anat) 4
med. epicondyle of the femur. Sports (RH) RH Anat
1970 Pleiotropy Pleiotropy describes instances where multiple phenotypic manifestations result from a single genetic mutation. Most syndromic genetic illnesses exhibit pleiotropy. General Principles (GP) Genetics (Gene) 1 GP Gene
1971 Pancreatic secretion Duodenal S-cells secr secretin in response to ↑ H concs. Secretin ↑ pancr HCO3 secr. The Cl content of pancr secrs ↓ in proportion to HCO3 conc ↑. Gastrointestinal & Nutrition (GI) Physiology 1
(Phys) GI Phys
1973 Antiarrhythmic drugs Class IV antiarrhythmics (eg, verapamil, diltiazem) are commonly used to prevent recurrent nodal arrhythmias (eg, PSVT). They work by blocking Ca channels in slow-response cardiac tissues, slowing Cardiovascular (CV) Physiology 12
phase 4 (spontaneous depolarization) and phase 0 (upstroke). This ↓ impulse conduction velocity in the SA and AV nodes. (Phys) CV Phys
1974 Cardiac AP The cardiac myocyte AP consists of rapid depolarization (phase 0), initial rapid repolarization (phase 1), plateau (phase 2), late rapid repolarization (phase 3), and resting potential (phase 4). The AP is a/w Cardiovascular (CV) Physiology 1
↑ membrane permeability to Na and Ca and ↓ permeability to K. (Phys) CV Phys
1975 Cardiac physiology The phase 4 slow depolarization in cardiac PM cells occurs due to the closure of repolarizing K channels, the slow influx of Na through funny channels, and the opening of T-type Ca channels. ACh and Cardiovascular (CV) Physiology 6
adenosine ↓ the rate of spontaneous depolarization in cardiac PM cells by prolonging phase 4. (Phys) CV Phys
1976 Pacemaker potential Cardiac pacemaker impulse generation normally occurs in the SA node, which has the fastest firing rate of all conductive cells. The cells in other areas of the conduction system (eg, AV node, bundle of Cardiovascular (CV) Physiology 1
His, and Purkinje fibers) may serve as pacemakers if normal impulse conduction is impaired. (Phys) CV Phys
1977 Atrial fibrillation AF occurs due to irregular, chaotic electrical activity w/i the atria and Px w/ absent P waves, irregularly irregular R-R intervals, and narrow QRS complexes. The AV node refractory period regulates the Cardiovascular (CV) Physiology 5
number of atrial impulses that reach the ventricle and determines the ventricular contraction rate in conditions where the atria undergo rapid depolarization. (Phys) CV Phys
1978 Chronic heart failure Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are secreted by atrial and ventricular cardiomyocytes in response to myocardial stretching induced by hypervolemia. These natriuretic Cardiovascular (CV) Physiology 12
peptides inhibit the renin-angiotensin-aldosterone system and stimulate peripheral vasodilation and increased urinary excretion of sodium and water. Neprilysin inhibitors (eg. sacubitril) prevent the (Phys)
degradation of ANP and BNP, enhancing their beneficial effects in heart failure. CV Phys
1979 Metabolic acidosis Normally, meta acidosis is partially compensated for by resp alkalosis. When the steady-state PaCO2 persists above the range given by the Winter formula (PaCO2 = [1.5 * HCO3-] + 8 +/- 2), the pt has a Endocrine, Diabetes & Pathophysiology 4
superimposed resp acidosis (resp failure). Metabolism (ES) (Patp) ES Patp
1980 High altitude illness At high altitude, the low PiO2 leads to hypoxemia that triggers hypervent w/ incr exhalation of CO2 and resulting resp alk. The kidneys comp by incr HCO3- excretion to help normalize pH. Hypoxemia Pulmonary & Critical Care (PU) Physiology 3
persists, but phys adjustments take place to improve O2 use. (Phys) PU Phys
1981 Pulmonary embolism The combo of ac-on dyspnea, calf swelling, and Hx of prolonged immobility is strongly suggestive of PE. PE typically Px w/ hypoxemia due to V/Q mismatch and resp alk (hypocapnia) due to hypervent. Pulmonary & Critical Care (PU) Physiology 13
(Phys) PU Phys
1982 Filtration fraction The FF is the fraction of plasma flowing through the glomeruli that is filtered across the glomerular capillaries into Bowman's space (FF = GFR/RPF). RPF can be determined from RBF by multiplying Renal, Urinary & Electrolytes Physiology 2
the RBF by (1 – Hct). (RE) (Phys) RE Phys
1983 Tricuspid regurgitation A holosystolic murmur that ↑ in intensity on inspiration most likely represents TR. The other holosystolic murmurs (which are 2° to MR or a VSD) do not typically ↑ in intensity during inspiration. Cardiovascular (CV) Physiology 3
(Phys) CV Phys
1984 Hypoglycemia Severe hypoglycaemia w/ LOC is typically Tx w/ IM glucagon in the non-med setting and w/ IV dextrose in the med setting. Endocrine, Diabetes & Pharmacology 6
1985 Obstructive sleep apnea OSA presents in obese individuals w/ excessive daytime sleepiness and SSx of nocturnal upper airway obstr (e.g. snoring, gasping). The condition is a/w systemic HTN. Prolonged, un-Tx OSA can also Pulmonary & Critical Care (PU) Pathophysiology 4
cause PAH and RHF. (Patp) PU Patp
1986 Menstrual cycle The secretory phase of the menstrual cycle occurs b/w ovulation and menses, from days 15-28 of the normal menstrual cycle. Progesterone released by the CL causes the uterine glands to coil and secrete Female Reproductive & Breast Physiology 2
glycogen-rich mucus in preparation for embryo implantation. The endometrial stroma becomes edematous and completely traversed by tortuous spiral arteries that extend from the deeper layers to the (FR) (Phys)
uterine lumen. FR Phys
1987 Normal pregnancy In pregnancy, progesterone is secreted by the corpus luteum and later by the placenta. Although PRL secretion ↑ as pregnancy progresses, high progesterone lvls inhibit lactation by preventing binding of Pregnancy, Childbirth & Physiology 2
PRL to receptors on alveolar cells in the breast. Puerperium (PR) (Phys) PR Phys
1988 Diffusion Diffusion speed across a semipermeable membrane ↑ w/ higher molecular concgradients, larger membrane SAs, and ↑ solubility of the diffusing substance. Diffusion speed ↓ w/ ↑ membrane thickness, Renal, Urinary & Electrolytes Physiology 1
smaller pore size, higher molecular weights, and lower temps. (RE) (Phys) RE Phys
1989 Fabry disease In Fabry disease, α-galactosidase A deficiency causes accumulation of the sphingolipid Gb3. The earliest MFx of Fabry disease are neuropathic pain and angiokeratomas. Glomerular (e.g. proteinuria, Endocrine, Diabetes & Biochemistry 1
renal failure), cardiac (e.g. LVH), and cerebrovascular (e.g. TIA, stroke) complications develop in adulthood. Metabolism (ES) (Bioc) ES Bioc
1990 Niemann-Pick NPD is an AR disorder that's common in the Ashkenazi Jewish pop. This disorder is characterised by sphingomyelinase defic and sphingomyelin accumulation, which cause hepatosplenomegaly and Endocrine, Diabetes & Biochemistry 2
neuro regression in infancy. Metabolism (ES) (Bioc) ES Bioc
1991 Niemann-Pick In NPD, sphingomyelinase defic causes accumulation of the lipid sphingomyelin. CFx incl hepatosplenomegaly, neuro regression, and a cherry-red macular spot in infancy. Endocrine, Diabetes & Biochemistry 2
1992 Cervical cancer Human papillomavirus (HPV) infection, especially with strain 16 or 18, is the strongest risk factor for development of cervical dysplasia and invasive cervical carcinoma. HIV coinfection allows HPV Female Reproductive & Breast Pathology (Path) 3
infection to persist and enhances expression of HPV oncogenes, increasing the risk for cervical dysplasia/cancer. (FR) FR Path
1993 Actinic keratoses AKs are small (usually <1cm), erythematous epidermal lesions w/ adherent scale that're the result of chronic sun exposure. Histo findings incl keratinocyte atypia, hyperkeratosis, and parakeratosis. A Dermatology (DE) Pathology (Path) 2
small % of AKs progress to invasive SCC; therefore, freq monitoring is necessary. DE Path
1995 Severe combined SCID is char by combo T and B cell dysfxn. It's a life-thr condition that Px in infancy w/ severe bacterial and viral infections; mucocutaneous candidiasis; persistent diarrhea; and FTT. LFx incl. absent T Allergy & Immunology (AI) Immunology 3
immunodeficiency disease cells and hypoGg-emia. The thymic shadow isn't usually present due to severe T cell deficiency. (Immu) AI Immu
1996 Diabetes mellitus HbA1c is produced by NEG of the Hb molecule. A HbA1c assay provides an estimate of chronic glycaemic control over the life span of circulating erythrocytes (~3mos). However, rapid erythrocyte Endocrine, Diabetes & Pathology (Path) 31
turnover (e.g. hemolytic anaemia) can give a misleadingly low HbA1c in relation to glycaemic status. Metabolism (ES) ES Path
1997 Botulism Bot tox blocks the presynaptic exocytosis of ACh vesicles, causing impaired musc and nico NT; it char Px as a symmetric, desc paralysis that 1st MFx w/ CN abns, often following consumption of home- Nervous (NS) Microbiology 4
canned foods. (Micr) NS Micr
1998 Organophosphate poisoning OPs are AChEIs that are widely used as pesticides in agriculture. They inhib the breakdown of ACh, leading to a state of cholinergic excess. SSx of OP poisoning include salivation, lacrimation, Nervous (NS) Biochemistry 2
diaphoresis, bradycardia, and bronchospasm. (Bioc) NS Bioc
2000 Beta blockers β blockers are used in the Tx of essential tremor. Propranolol, a nonselective β blocker, is the most commonly used therapy and prevents the interaction of EPI and NE w/ β1 and β2 receptors to relieve Nervous (NS) Pharmacology 3
tremor SSx. However, inhib of pulm β2 receptors in pts w/ underlying reactive airway disease can cause bronchoconstriction, leading to cough, wheeze, and dyspnoea. (Phar) NS Phar
2001 Cocaine Cocaine is a stim that inhibs the presynaptic reuptake of NE, DA, and 5-HT. Intox pts develop agitation, tachycardia, HTN, and light-responsive mydriasis due to ↑ sympathetic activity. Cocaine is also a Pregnancy, Childbirth & Pharmacology 3
potent vasoconstrictor that can cause myocardial ischemia and atrophy of the nasal mucosa and septum. Puerperium (PR) (Phar) PR Phar
2002 Primary hypertension TZDs ↑ serum Ca, uric acid, Glc, cholesterol, and triglyceride lvls. They ↓ serum Na, K, and Mg lvls. Cardiovascular (CV) Pharmacology 14
(Phar) CV Phar
2003 Thiazides TZDs effectively incr renal Ca2+ reabs. In pts w/ recurrent Ca2+ nephrolith, TZDs can help prevent stone formation by decr urine Ca2+ excretion. Renal, Urinary & Electrolytes Pharmacology 3
(RE) (Phar) RE Phar
2005 Aldosterone antagonists All diuretics except for the K-sparing class cause K loss by ↑ Na delivery to the late distal tubule and cortical collecting duct, where aldosterone-induced Na reabsorption occurs at the expense of K. K- Cardiovascular (CV) Pharmacology 3
sparing diuretics (eg, spironolactone, amiloride) act on the late distal tubule and cortical collecting duct to antagonize the effects of aldosterone. (Phar) CV Phar
2006 Antiarrhythmic drugs β blockers ↓ AV nodal conduction, leading to an ↑ AV nodal refractory period. This correlates to PR interval prolongation on an ECG. Cardiovascular (CV) Pharmacology 12
(Phar) CV Phar
2007 Resting membrane potential and Changes in membrane potential occur in response to changes in neuronal membrane permeability to various cellular ions. The more permeable the membrane becomes for a cellular ion, the more that ion’ Nervous (NS) Physiology 5
action potential s equilibrium potential contributes to the total membrane potential. (Phys) NS Phys
2008 Diabetic ketoacidosis The kidneys compensate for meta acidosis by completely reabsorbing filtered HCO3- and excreting excess H+ in the urine. Most of the excreted H+ is buffered by H2PO4- and NH4+, which allows for Renal, Urinary & Electrolytes Physiology 6
large amounts of acid to be excreted w/o precipitously dropping the pH. (RE) (Phys) RE Phys
2009 Coronary blood flow Myocardial oxygen extraction exceeds that of any other tissue or organ; therefore, the cardiac venous blood in the coronary sinus is the most deoxygenated blood in the body. Due to the high degree of Cardiovascular (CV) Physiology 9
oxygen extraction, increases in myocardial oxygen demand can only be met by an increase in coronary blood flow. (Phys) CV Phys
2010 GFR At normal plasma concs of Glc, the renal tubules reabsorb the entire filtered load of Glc as this is below the max tubular reabsorption ability (TmG). At higher plasma concs, Glc is excreted when the Renal, Urinary & Electrolytes Physiology 6
filtered amount exceeds the TmG. (RE) (Phys) RE Phys
2011 Excretion rate Inulin clearance can be used to estimate the GFR and to calculate the TFR of a freely filtered substance when the plasma conc of the substance is known. If the substance is subseq reabsorbed from the Renal, Urinary & Electrolytes Physiology 1
nephron lumen, then the net RER of the substance will be equal to its TFR minus the total TRR. (RE) (Phys) RE Phys
2012 ADH and urea clearance ADH and DDAVP cause a V2receptor-mediated ↑ in water and urea permeability at the inner medullary CD. The resulting rise in urea reabsorption (↓ urea clearance) enhances the medullary osmotic Renal, Urinary & Electrolytes Physiology 1
gradient, allowing the production of max concentrated urine. (RE) (Phys) RE Phys
2013 Hyperaldosteronism ↑ serum aldolvls can MFx w/ HTN, hypokalaemia, and muscle weakness. ↑ lvls of both renin and aldoare indicative of 2° hyperaldosteronism, which can be caused by renovascular disease and renin- Renal, Urinary & Electrolytes Physiology 5
secreting tumours. (RE) (Phys) RE Phys
2014 Diabetic ketoacidosis Diabetic ketoacidosis (DKA) is characterized by polydipsia, polyuria, and a fruity odor to the breath and/or urine. DKA is associated with elevated anion gap metabolic acidosis that is usually Renal, Urinary & Electrolytes Physiology 6
accompanied by compensatory respiratory alkalosis. This combination yields a low pH, low serum bicarbonate, and low PaCO2. (RE) (Phys) RE Phys
2015 Transcription Homeobox genes encode DNA-binding TFs that play an important role in the segmental organization of the embryo along the cranio-caudal axis. General Principles (GP) Genetics (Gene) 7 GP Gene
2016 Steroid hormones The initial step in the synthesis of steroid hormones is the conversion of cholesterol to pregnenolone in the mitochondria. The remainder of steroidogenesis occurs in the smooth endoplasmic reticulum. Endocrine, Diabetes & Biochemistry 1
Steroid-producing cells contain a well-developed smooth endoplasmic reticulum. Metabolism (ES) (Bioc) ES Bioc
2017 Transcription Primase is a DNA-dependent RNA polymerase that incorporates short RNA primers into replicating DNA. Renal, Urinary & Electrolytes Biochemistry 7
(RE) (Bioc) RE Bioc
2018 Etoposide Etoposide is a CTx agent that inhibs the sealing activity of topoisomerase II. Tx w/ etoposide causes chrom breaks to accumulate in dividing cells, ultimately causing cell death. Hematology & Oncology (HO) Pharmacology 1
(Phar) HO Phar
2019 Antiretroviral therapy ZDT is an NRTI used to prevent maternal to foetal transmission of HIV during labour (when the mother isn't virally suppressed). It's a thymidine analogue that doesn't have the normal 3'-OH group found Infectious Diseases (ID) Pharmacology 7
on thymidine. B/c new nucleotides are added to growing DNA chains only at the 3'-OH group, the addn of ZDT into DNA results in chain termination. (Phar) ID Phar
2020 Brain tumors The hypothalamus is a key region responsible for homeostasis. The VMN mediates satiety; lesions of this area of the hypothalamus can result in hyperphagia and obesity. Nervous (NS) Anatomy (Anat) 10 NS Anat
2021 Testicular cancer Lymph from the testes drains through lymph channels directly back to the para-aortic lymph nodes. In contrast, lymph from the scrotum drains to the superficial inguinal lymph nodes. Male Reproductive (MR) Anatomy (Anat) 4 MR Anat
2022 Spleen rupture The spleen is of mesodermal origin (the dorsal mesentery). Although it is supplied by the splenic artery (a branch of the major foregut vessel, the celiac trunk), It is not a foregut derivative. Gastrointestinal & Nutrition (GI) Embryology 2
(Embr) GI Embr
2023 Central venous catheter The common cardinal veins of the developing embryo drain directly into the sinus venosus. These cardinal veins ultimately give rise to the SVC and other constituents of the systemic venous circulation. Cardiovascular (CV) Anatomy (Anat) 2 CV Anat
2024 Trigeminal nerve CNV3 exits the skull thru the foramen ovale and innervates the muscles of mastication, incl the masseter, the medial and lateral pterygoids, and the temporalis muscles. Nervous (NS) Anatomy (Anat) 3 NS Anat
2025 Enhancer sequence Enhancers and silencers may be located upstream, downstream, or within a transcribed gene; these gene sequences function to increase and decrease the rate of transcription, respectively. In contrast, General Principles (GP) Genetics (Gene) 1
promoter regions are typically located 25 or 75 bases upstream from their associated genes and function to initiate transcription. GP Gene
2027 Mutations A frameshift mutation occurs with the deletion/addition of a number of bases not divisible by 3 in the coding region of a gene. Frameshift mutations alter the reading frame of the genetic code, General Principles (GP) Genetics (Gene) 3
dramatically changing the protein structure and often resulting in the formation of a premature stop codon. GP Gene
2028 Mismatch repair Lynch syndrome is an AD disease caused by abnormal nucleotide mismatch repair. The mismatch repair system involves several genes, including MSH2 and MLH1, which code for components of the Gastrointestinal & Nutrition (GI) Biochemistry 1
human MutS and MutL homologs. Mutations in these 2 genes account for around 90% of cases of Lynch syndrome. (Bioc) GI Bioc
2029 Releasing factors RFs recog stop codons (e.g. UAA, UAG, and UGA) and terminate protein synthesis. They facilitate release of the polypeptide chain from the ribosome and dissolution of the ribosome-mRNA complex. General Principles (GP) Genetics (Gene) 1 GP Gene
2030 TATA box mutations The TATA box is a promoter region that binds TFs and RNA polymerase II during the initiation of transcription. It is located approximately 25 bases upstream from the beginning of the coding region. General Principles (GP) Genetics (Gene) 1 GP Gene
2031 Transcription DNA-binding proteins incl TFs (Myc, CREB), steroid receptors (cort, aldo, progest), TH receptor, fat-sol vit receptors (vit D, retinoic acid), and DNA transcription and replication proteins. General Principles (GP) Genetics (Gene) 7 GP Gene
2032 Mischarged tRNA The seq of AAs in a growing polypeptide chain is dictated by the interaction of the mRNA codon w/ the tRNA anticodon. tRNA that's mischarged w/ the incorrect AA (and not corrected by AA-tRNA Hematology & Oncology (HO) Biochemistry 1
synthetase proofreading) will incorporate the wrong AA into the growing polypeptide chain. (Bioc) HO Bioc
2033 Poly A tail The poly-A tail isn't transcribed from DNA; instead, it's added as a PTM downstream of the consensus seq (AAUAAA) located near the 3' end of the mRNA molecule. This tail protects mRNA from General Principles (GP) Genetics (Gene) 1
degradation w/i the cytoplasm after it exits the nucleus. GP Gene
2034 Southern blotting Southern blotting is a technique used to identify DNA mutations. It involves restriction endonuclease digestion of sample DNA, gel electrophoresis, and gene identification w/ a labeled DNA probe. Cardiovascular (CV) Biochemistry 1
(Bioc) CV Bioc
2035 mRNA processing and regulation When mRNA is first transcribed from DNA, it is in an unprocessed form called pre-mRNA or heterogeneous nuclear mRNA (hnRNA). Several processing steps are required before finalized mRNA General Principles (GP) Biochemistry 1
molecules can leave the nucleus, including 5'-capping, poly A tail addition, and intron splicing. Cytoplasmic P bodies play an important role in mRNA translation regulation and mRNA degradation. (Bioc) GP Bioc
2036 Spinal muscular dystrophy snRNPs are important components of the spliceosome, a molecule which removes introns from pre-mRNA during processing w/i the nucleus. SMA is a disorder caused by muts in the SMN1 gene, Nervous (NS) Biochemistry 1
resulting in impaired assembly of snRNPs in LMNS. Infants often have flaccid paralysis due to degen of ant horn cells in the spinal cord. (Bioc) NS Bioc
2037 tRNA structure Transfer RNA (tRNA) is a small, noncoding form of RNA that contains chemically modified bases (eg, dihydrouridine, ribothymidine, pseudouridine). tRNA has a CCA sequence at its 3'-end that is used General Principles (GP) Biochemistry 1
as a recognition sequence by proteins. The 3' terminal hydroxyl group of the CCA tail serves as the amino acid binding site. (Bioc) GP Bioc
2038 Splice site mutation Splicing is performed by spliceosomes, which remove introns containing GU at the 5' splice site and AG at the 3' splice site. Splice site mutations may result in inappropriate removal of exons and Dermatology (DE) Biochemistry 1
retention of introns, leading to the formation of dysfunctional proteins. (Bioc) DE Bioc
2039 Protein synthesis The nucleolus is the site of ribosomal subunit maturation and assembly. RNA polymerase I functions exclusively within the nucleolus to transcribe the 45S pre-rRNA gene, which codes for most of the Hematology & Oncology (HO) Genetics (Gene) 2
ribosomal RNA components (18S, 5.8S, and 28S rRNAs). HO Gene
2040 Sickle cell Sickle cell anemia is an autosomal recessive hemoglobinopathy. In order for a child to have sickle cell disease, both parents must be carriers. Hemoglobin electrophoresis can be used to determine the Hematology & Oncology (HO) Genetics (Gene) 13
carrier status of a prospective parent who has no history of sickle cell anemia. HO Gene
2041 Prion disease Western blotting is used to identify proteins, Northern blotting identifies specific RNA sequences, and Southern blotting identifies specific DNA sequences in an unknown sample. Hematology & Oncology (HO) Genetics (Gene) 3 HO Gene
2042 Transcription Northern blots detect target mRNA in a sample and can be used to Ax the degree of gene transcription. General Principles (GP) Genetics (Gene) 7 GP Gene
2043 Polymerase chain reaction PCR is used to amp small fragments of DNA (e.g. genes, exons, NCRs) by repeated replication. It req primers that're complementary to the regions of DNA flanking the segment of interest. Thermostable Hematology & Oncology (HO) Biochemistry 2
DNA polymerase, dNTPs, and a source DNA template strand are also necessary. (Bioc) HO Bioc
2044 Southwestern blot Southwestern blotting is used to detect DNA-binding proteins such as transcription factors, nucleases, and histones. General Principles (GP) Biochemistry 1
(Bioc) GP Bioc
2045 Schizophrenia The Dx of schizophrenia req >2 of the following 5 SSx: delusions, hallucinations, disorganised speech, grossly disorganised behaviour, and (-) SSx. The total impairment duration must be >6mos. Pregnancy, Childbirth & Behavioral 4
2046 Psychosis DD is characterised by >1 delusions for >1mos in the absence of other psychotic SSx. Behaviour isn't obvi bizarre, and fxning isn't significantly impaired apart from the direct impact of the delusions. Pregnancy, Childbirth & Behavioral 6
2047 Schizoaffective disorder For Dx of schizoaffective disorder, psychosis must occur in the absence of major mood episodes, but mood episodes must be present for a majority of this lifelong illness. In BD and MDD w/ psychotic Pregnancy, Childbirth & Behavioral 1
features, psychotic SSx occur exclusively during mood episodes. Puerperium (PR) Science (Beha) PR Beha
2048 Generalized anxiety disorder GAD involves excessive uncontrollable worry about multi issues w/ a SSx duration of >6mos. assoc SSx incl restlessness, muscle tension, fatigue, sleep disturbance, irritability, and difficulty Pregnancy, Childbirth & Behavioral 4
concentrating. Puerperium (PR) Science (Beha) PR Beha
2049 Obsessive compulsive disorder OCD is characterised by persistent, intrusive thoughts leading to repetitive, ritualistic behaviours. SSRIs are considered 1st-line Tx for OCD and exert their effects by inhib 5-HT reuptake. Pregnancy, Childbirth & Behavioral 2
2050 Bulimia nervosa BN is characterised by recurrent episodes of binge eating f/b compensatory behaviours to prevent weight gain (e.g. fasting, exercising, vomiting, using laxatives). In contrast to pts w/ AN, BN pts are Pregnancy, Childbirth & Behavioral 4
normal weight to overweight. Puerperium (PR) Science (Beha) PR Beha
2051 Defense mechanisms Passive aggression is the expression of angry feelings in a non-confrontational manner. Pregnancy, Childbirth & Behavioral 8
2053 Defense mechanisms Transference is the unconscious shifting of emotions a/w a significant person from 1's past to a person in the present. Pregnancy, Childbirth & Behavioral 8
2054 Physician patient communication Physicians should respond to disclosure of past sexual abuse w/ empathy and concern. Clearly acknowledging the trauma and communicating willingness to discuss it when the pt is ready will help Social Sciences (SS) Behavioral 11
strengthen the physician-pt relationship. Science (Beha) SS Beha
2055 Atrial fibrillation Palpitations refer to a subjective sensation/awareness of the heartbeat due to rapid arrhythmias or forceful ventricular contractions. AF is the most common cause of an irregularly irregular rhythm and is Cardiovascular (CV) Physiology 5
detected on ECG by an absence of organized P waves and varying R-R intervals. (Phys) CV Phys
2056 Female genital tract histology The uterine mucosa is covered by endometrium, and abnormal implantation of endometrial glands/stroma is referred to as endometriosis. The ovary is covered by a simple cuboidal epithelium involved in Female Reproductive & Breast Pathology (Path) 1
surface repair of defects from ovulation. Endometriosis commonly affects the ovary and results in infertility. (FR) FR Path
2057 Emancipated minor Minors can consent for medical Tx in certain circumstances, including legal emancipation (eg, parent, married), emergency care, and specific conditions (eg, STI, pregnancy, substance abuse). Social Sciences (SS) Behavioral 1
2058 Decision making capacity Pts who are temporarily incapacitated should not be allowed to make important health care decisions. Acutely intoxicated pts should be reAx when sober. Social Sciences (SS) Behavioral 5
2059 Physician patient communication Pts have the right to refuse to receive medical information. Physicians must understand and respect the beliefs of cultures that value beneficence and nonmaleficence over autonomy. In these cultures, Social Sciences (SS) Behavioral 11
family members may be expected to make medical decisions to avoid perceived harm, disrespect, or mental distress caused by direct disclosure to the pt. Science (Beha) SS Beha
2061 Myasthenia gravis MG is an AI disease that causes a ↓ in the # of fxnal AChRs w/i the NMJ. This ↓ the # of postsynaptic cation channels that can open in response to ACh, which ↓ the amplitude of motor end plate potential Nervous (NS) Pathophysiology 10
and prevents muscle fiber depol. (Patp) NS Patp
2062 Myasthenia gravis The Tx of MG involves the use of an AChEI, immsups, and possible thymectomy. AChEIs may cause AEs related to muscarinic overstim, which can be ameliorated by the use of an antimusc agent such Nervous (NS) Pathophysiology 10
as glycopyrrolate, hyoscyamine, or propantheline. (Patp) NS Patp
2063 Psychosis Schizophreniform disorder is characterised by psychotic SSx (delusions, hallucinations, disorganised speech and behaviour, (-) SSx) lasting >1mos and <6mos. Pregnancy, Childbirth & Behavioral 6
2064 Dyslipidemia Familial dysbetalipoproteinemia (type III hyperlipoproteinemia) is an autosomal recessive disorder characterized by elevated cholesterol and triglyceride levels. It is caused by defects in ApoE3 and Endocrine, Diabetes & Biochemistry 11
ApoE4, leading to decreased clearance of chylomicrons and VLDL remnants. Patients can develop eruptive and palmar xanthomas and premature atherosclerosis. Metabolism (ES) (Bioc) ES Bioc
2065 Pemphigus vulgaris PV is an autoimmune bullous disease characterised by auto-Abs directed against desmosomal proteins (e.g. desmoglein). It presents w/ painful flaccid bullae and erosions affecting the skin and mucosal Dermatology (DE) Pathology (Path) 1
membranes. The bullae spread laterally w/ pressure and new blisters may form w/ gentle rubbing. DE Path
2066 Protein synthesis Orotic aciduria is a rare AR disorder of de novo pyrimidine synthesis that occurs due to a defect in UMP synthase. Children typically present w/ physical and mental retardation, megaloblastic anaemia, Endocrine, Diabetes & Biochemistry 2
and large amounts of urinary orotic acid. Uridine supplementation can improve SSx as uridine is converted to UMP via nucleoside kinases. Metabolism (ES) (Bioc) ES Bioc
2067 Lesch-Nyhan syndrome LNS is an XLR disorder caused by a defect in HGPRT. This results in failure of the purine salvage pathway, leading to ↑ degradation of hypoxanthine and guanine to uric acid. De novo purine synthesis Nervous (NS) Biochemistry 1
must ↑ to replace the lost bases, necessitating an ↑ in PRPP amidotransferase activity. (Bioc) NS Bioc
2068 Anaphylaxis Anaphylaxis is the result of widespread mast cell and basophil degranulation and the release of preformed inflammatory mediators, including histamine and tryptase. Tryptase is relatively specific to mast Allergy & Immunology (AI) Immunology 3
cells and can be used as a marker for mast cell activation. (Immu) AI Immu
2069 Anaphylaxis The high-affinity IgE receptor (FCERI) is found on the surface of mast cells and basophils and normally binds the Fc portion of circulating IgE antibodies. Cross-linking of multiple membrane bound IgE Allergy & Immunology (AI) Immunology 3
antibodies by a multivalent antigen results in aggregation of the FcERI receptors, causing degranulation and the release of preformed mediators (eg, histamine, tryptase) that initiate an allergic response. (Immu) AI Immu
2070 Jugular venous pulse On JVP tracings, the 1st peak is the a wave, which is generated by atrial contraction. This is notably absent in pts w/ AF. Cardiovascular (CV) Pathophysiology 1
(Patp) CV Patp
2071 Constrictive pericarditis Calcification and thickening of the pericardium are common features of constrictive pericarditis on CT. CFx include slowly progressive dyspnea, peripheral edema, and ascites. Cardiovascular (CV) Pathophysiology 2
(Patp) CV Patp
2072 Diabetic ketoacidosis meta acidosis is characterised by a ↓ in serum pH and serum HCO3-. PaCO2 will also ↓ as a result of resp compensation for 1° meta acidosis. Renal, Urinary & Electrolytes Pathology (Path) 6
(RE) RE Path
2073 Diabetic ketoacidosis The Tx of choice for DKA is IV normal saline and insulin. These therapies ↑ serum HCO3- and Na+ and ↓ serum Glc, osmolality, and K+. Renal, Urinary & Electrolytes Pathology (Path) 6
(RE) RE Path
2074 Endocarditis Chronic valvular inflammation and scarring a/w RHD predispose to an ↑ risk of IE, which is Chx by valvular vegetations w/ destruction of the underlying cardiac tissue. Cardiovascular (CV) Pathology (Path) 15 CV Path
2075 Endocarditis Vegetations are caused by bacterial colonization and growth on a sterile fibrin-platelet nidus that forms on the damaged/disrupted endothelial surface of the valvular apparatus. Cardiovascular (CV) Pathology (Path) 15 CV Path
2076 Ischemic stroke The ventral posterior lateral nucleus (receives input from the spinothalamic tract and dorsal columns) and ventral posterior medial nucleus (receives input from the trigeminal pathway) of the thalamus Nervous (NS) Anatomy (Anat) 19
send somatosensory projections to the cortex via thalamocortical fibers. Damage to these nuclei results in complete contralateral sensory loss. NS Anat
2077 Ischemic stroke Lacunar infarctions are the result of small vessel occlusion (eg, due to lipohyalinosis and microatheroma formation) in the penetrating vessels supplying the deep brain structures. Uncontrolled Nervous (NS) Anatomy (Anat) 19
hypertension and diabetes mellitus are major risk factors for this condition. NS Anat
2078 Primary immunodeficiency SCID is caused by a genetic defect in T cell development, leading to loss of both cellular and humoral immunity. Pts Px in infancy w/ recurrent bacterial, viral, fungal, and opport infections as well as FTT Allergy & Immunology (AI) Immunology 7
disorder and chronic diarrhea. (Immu) AI Immu
2079 Hypersensitivity reactions The candidal Ag skin test Ax the activity of T cell-mediated imm thru the recruitment of macrophages and CD4+ and CD8+ T lymphocytes in a HS-IV rxn. Anergy, or failure to respond to candida Ag Allergy & Immunology (AI) Immunology 4
testing, is typical in pts w/ SCID. (Immu) AI Immu
2080 Congenital adrenal hyperplasia Males w/ classic, non-salt-wasting 21-hydroxylasedefic present at age 2-4yrs w/ early virilisation, ↑ linear growth, and ↑ lvls of 17-hydroxyprogesterone and androgens. Females w/ classic 21-hydroxylase Endocrine, Diabetes & Pathology (Path) 6
defic (+/- salt-wasting) present w/ ambiguous genitalia at birth. Metabolism (ES) ES Path
2081 Congenital adrenal hyperplasia Tx of CAH involves low doses of exogenous CSs to suppress excessive ACTH secretion and ↓ stim of the AC. Endocrine, Diabetes & Pathology (Path) 6
2082 Toxoplasmosis In patients with HIV, the presence of multiple ring-enhancing lesions with mass effect is most often indicative of toxoplasmosis, followed by primary central nervous system lymphoma. Nervous (NS) Microbiology 5
(Micr) NS Micr
2083 CNS lymphoma Primary central nervous system lymphoma is typically composed of B-lymphocytes. Nervous (NS) Microbiology 2
(Micr) NS Micr
2084 Sickle cell SCD is characterised by repeated splenic infarctions that ultimately result in splenic atrophy and fibrosis, a process that's typically complete by late childhood/adolescence. After autosplenectomy, pts are Hematology & Oncology (HO) Pathology (Path) 13
predisposed to infections w/ encapsulated bacterial organisms. HO Path
2085 Sickle cell An MCV >110μm3 is highly suggestive of megaloblastic anaemia, such as that caused by vitB9 or vitB12 defic. Pts w/ chronic hemolytic anaemia have ↑ vitb9 req due to ↑ erythrocyte turnover and are Hematology & Oncology (HO) Pathology (Path) 13
predisposed to devel macrocytosis. HO Path
2086 Thalassemia The Kozak consensus sequence occurs on eukaryotic mRNA and is defined by the following sequence: (gcc)gccRccAUGG, in which R is either adenine or guanine. This sequence helps initiate translation Hematology & Oncology (HO) Genetics (Gene) 3
at the methionine start codon (AUG). HO Gene
2087 Thalassemia B thalassemia results in hypochromic, microcytic anemia due to decreased ß globin chain synthesis. Unpaired a chains precipitate within red cells and cause membrane damage, leading to ineffective Hematology & Oncology (HO) Genetics (Gene) 3
erythropoiesis and extravascular hemolysis. HO Gene
2088 Selective serotonin reuptake SS is characterised by AMS, autonomic hyperactivity, and NM excitation (e.g. hyperreflexia, clonus). Causes incl high doses a/o combos of 5-HT-ergic drugs (e.g. SSRI and MAOI). Tryptophan is a Pregnancy, Childbirth & Pharmacology 3
inhibitors precursor for 5-HT. Puerperium (PR) (Phar) PR Phar
2089 Selective serotonin reuptake Cyproheptadine is an antihist w/ anti-5HT-ergic properties that can be used as an antidote in severe cases of SS that don't respond to supportive measures. Pregnancy, Childbirth & Pharmacology 3
inhibitors Puerperium (PR) (Phar) PR Phar
2090 Gout Gout occurs with increased frequency in patients with activating mutations involving phosphoribosyl pyrophosphate synthetase due to increased production and degradation of purines. Rheumatology, Orthopedics & Biochemistry 11
Sports (RH) (Bioc) RH Bioc
2091 Gout Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line therapy for treating acute gouty arthritis. They inhibit cyclooxygenase and exert a broad anti-inflammatory effect that includes inhibition of Rheumatology, Orthopedics & Biochemistry 11
neutrophils. When NSAIDs are contraindicated (eg, peptic ulcer disease, renal impairment), colchicine is useful in the acute management of gout as it inhibits neutrophil chemotaxis and phagocytosis by Sports (RH) (Bioc)
preventing microtubule formation. RH Bioc
2092 Breast cancer Cytokeratin is a commonly used IHC marker of epithelial cell carcinomas. Hematology & Oncology (HO) Pathology (Path) 7 HO Path
2093 Breast cancer The HER2 oncogene encodes for a transmembrane glycoprotein w/ intrinsic tyrosine kinase activity and is a member of the family of EGFRs. Overexpression of this protein is a/w a worse prognosis and ↑ Hematology & Oncology (HO) Pathology (Path) 7
risk of disease recurrence. HO Path
2094 Polycystic ovary disease Polycystic ovary syndrome is characterized by elevated LH levels, excess androgen production, and insulin resistance. Clinical features include obesity, menstrual irregularities, hirsutism, enlarged Female Reproductive & Breast Pathophysiology 4
ovaries, and an increased risk of diabetes mellitus and endometrial hyperplasia. (FR) (Patp) FR Patp
2095 Polycystic ovary disease Patients with polycystic ovary syndrome who desire fertility can be treated with clomiphene. Clomiphene is an estrogen receptor modulator that decreases negative feedback inhibition on the Female Reproductive & Breast Pathophysiology 4
hypothalamus by circulating estrogen, thereby increasing gonadotropin production. (FR) (Patp) FR Patp
2096 Mitral regurgitation MR results in a blowing, holosystolic murmur heard best over the cardiac apex w/ radiation to the axilla. RHD is a very common cause of MR in underdeveloped countries. Cardiovascular (CV) Pathophysiology 6
(Patp) CV Patp
2097 von Willebrand disease Pts w/ vWD often Px w/ a lifelong Hx of mucosal bleeding, incl gingival bleeding, epistaxis, a/o menorrhagia. These pts have normal platelet lvls but typically have a prolonged BT due to impaired Hematology & Oncology (HO) Pathophysiology 7
platelet fxning. (Patp) HO Patp
2098 von Willebrand disease vWF fxns as a promoter of platelet adhesion at sites of vasc injury by binding platelet GPs to SEC on injured blood vessel walls. It also acts as a protective carrier protein for circulating FVIII. Hematology & Oncology (HO) Pathophysiology 7
(Patp) HO Patp
2099 Pulsus paradoxus PP is defined by a ↓ in SBP of >10 mm Hg w/ inspiration. It is most commonly seen in pts w/ CT but can also occur in severe asthma, COPD, and constrictive pericarditis. Cardiovascular (CV) Pathophysiology 2
(Patp) CV Patp
2100 Pulsus paradoxus Asthma and COPD exacerbation are the most frequent causes of PP in the absence of significant pericardial disease. β-adrenergic agonists control acute asthma and COPD exacerbations by causing Cardiovascular (CV) Pathophysiology 2
bronchial smooth muscle relaxation via ↑ intracellular cAMP. (Patp) CV Patp
2101 Metabolic acidosis Lactic acidosis in septic shock results from tissue hypoxia, which impairs oxidative phosphorylation and causes shunting of pyruvate to lactate following glycolysis. Hepatic hypoperfusion also Pulmonary & Critical Care (PU) Pathology (Path) 4
contributes to the build-up of lactic acid as the liver is the 1° site of lactate clearance. PU Path
2102 Aspiration pneumonia Elderly pts w/ dementia or hemiparesis may have dysphagia, which is a RF for aspiration pneumonia. Dependent lung consolidation is commonly seen in aspiration pneumonia. Pulmonary & Critical Care (PU) Pathology (Path) 2 PU Path
2105 Aortic regurgitation AR causes a high-pitched, blowing, diastolic murmur w/ a decrescendo intensity pattern. The murmur of AR due to aortic root dilation is best heard at the right upper sternal border, whereas the murmur Cardiovascular (CV) Pathophysiology 8
of AR due to valvular pathology is best heard at the left 3rd ICS. (Patp) CV Patp
2106 Aortic stenosis A bicuspid AV is a common cause of AS in the United States. The classic auscultatory finding in pts w/ AS is a harsh, crescendo-decrescendo systolic ejection murmur heard best in the right 2nd ICS w/ Cardiovascular (CV) Pathophysiology 8
radiation to the carotids. (Patp) CV Patp
2107 S4 The 4th heart sound (S4) is a low frequency sound heard at the end of diastole just before S1. It is due to ↓ LV compliance and is often a/w RCM and LVH. Cardiovascular (CV) Pathophysiology 1
(Patp) CV Patp
2108 Chronic heart failure S3 is a low-freq sound occurring immediately after S2 that's commonly a/w ↑ ventricular ESV. S3 freq occurs in the setting of MR and systolic HF (e.g. DCM). Cardiovascular (CV) Pathophysiology 12
(Patp) CV Patp
2109 Patent ductus arteriosus PDA is characterised by a continuous murmur heard best in the left infraclavicular region w/ max intensity at S2. A small PDA is often aSSx and is usually detected incidentally during routine cardiac Cardiovascular (CV) Pathophysiology 4
auscultation. It occurs most commonly in pts born prematurely and those w/ cyanotic congenital heart disease. (Patp) CV Patp
2110 Cephalosporins Penicillins and cephalosporins fxn by irreversible binding to PBPs such as transpeptidases. Infectious Diseases (ID) Microbiology 2
(Micr) ID Micr
2111 Antibiotic resistance A change in the structure of PBPs that prevents cephalosporin binding is 1 mech of bacterial resistance to cephalosporins. Infectious Diseases (ID) Microbiology 8
(Micr) ID Micr
2112 Serum drug levels and half-life During continuous infusion of a drug metabolized by first-order kinetics, the steady state concentration is reached in 4 to 5 half-lives. General Principles (GP) Pharmacology 3
(Phar) GP Phar
2113 Lithium Li-induced DI is the result of Li's antag effect on the action of ADH on principal cells w/i the CD system. Renal, Urinary & Electrolytes Pharmacology 2
(RE) (Phar) RE Phar
2116 Atelectasis An obstr lesion in a mainstem bronchus can prevent ventilation of an entire lung, leading to obstr atelectasis and complete lung collapse. ChFx on CXR incl unilateral pulm opacification and deviation of Pulmonary & Critical Care (PU) Pathology (Path) 1
the mediastinum toward the opacified lung. PU Path
2117 Ventricular septal defect A VSD is a/w a low-pitched, holosystolic murmur at the mid to ↓ left sternal border. It accentuates during maneuvers that ↑ afterload (eg, handgrip maneuver). A small VSD is usually aSSx and produces Cardiovascular (CV) Pathophysiology 2
a louder murmur due to higher interventricular pressure gradient. (Patp) CV Patp
2122 Delirium Delirium is a reversible, acute-onset confusional state characterised by a fluctuating lvl of consciousness w/ deficits in attn, memory, and executive fxn. In contrast, dementia has a gradual onset, is Pregnancy, Childbirth & Behavioral 4
irreversible, and doesn't involve fluctuations in consciousness. Puerperium (PR) Science (Beha) PR Beha
2123 Post-traumatic stress disorder PTSD is characterised by intrusive thoughts, nightmares, flashbacks, avoidance of trauma reminders, hypervigilance, and sleep disturbance lasting >1mos. Pregnancy, Childbirth & Behavioral 3
2124 Coronary blood flow The coronary sinus communicates freely w/ the RA and will become dilated 2° to any factor that causes ↑ RA pressure. The most common cause is pulm HTN, leading to ↑ right heart pressures. Cardiovascular (CV) Pathophysiology 9
(Patp) CV Patp
2125 Trigeminal nerve Infarcts involving the anterior portion of the medial pons can produce dysarthria and contralateral hemiparesis/lower facial palsy due to disruption of the ipsilateral corticospinal and corticobulbar tracts. Nervous (NS) Anatomy (Anat) 3
The trigeminal nerve arises at the level of the middle cerebellar peduncle at the lateral aspect of the mid-pons. NS Anat
2126 Cranial nerve palsy CNIII is most susceptible to injury from ipsilateral PComA aneurysms. Aneurysmal compression of CNIII produces mydriasis (due to superficial parasympathetic fibre dmg) w/ diplopia, ptosis, and down Nervous (NS) Anatomy (Anat) 9
and out deviation of the ipsilateral eye (due to somatic efferent fibre injury). NS Anat
2127 Ischemic stroke The PCA branches off the basilar artery and supplies CNs III and IV and other structures in the midbrain. It also supplies the thalamus, medial temporal lobe, splenium of the corpus callosum, and Nervous (NS) Anatomy (Anat) 19
occipital lobe. The most common finding w/ PCA stroke is contralateral homonymous hemianopia, often w/ macular sparing. NS Anat
2128 Asthma IgE-binding monoclonal antibodies (eg, omalizumab) are effective in treating asthma that remains uncontrolled despite optimal therapy with bronchodilators and inhaled corticosteroids. IgE-binding Pulmonary & Critical Care (PU) Pharmacology 12
monoclonal antibodies reduce airway inflammation by blocking the binding of IgE to the IgE receptors on mast cells and preventing the release of proinflammatory substances, including histamine and (Phar)
leukotrienes. PU Phar
2129 Wernicke-Korsakoff syndrome WE is a complication of vitB1 defic and is characterised by CNIII dysfxn, encephalopathy, and ataxia. Chronic defic results in Korsakoff syndrome (e.g. anterograde and retrograde amnesia, Nervous (NS) Anatomy (Anat) 5
confabulation, apathy). VitB1 is involved in Glc meta, and areas of the brain w/ high meta demands are particularly susceptible; the mammillary bodies are most commonly affected. NS Anat
2130 Blunt aortic injury Traumatic aortic rupture is most often caused by the rapid deceleration that occurs in MVCs. The most common site of injury is the aortic isthmus, which is tethered by the ligamentum arteriosum and is Cardiovascular (CV) Anatomy (Anat) 1
relatively fixed and immobile compared to the adjacent descending aorta. CV Anat
2131 Membranous nephropathy 1° (idiopathic) MN is a/w IgG4 Abs to the PLA2 receptor, which might play a role in devel of the disease. Ab titres are useful for Dx and correlate w/ disease activity. Renal, Urinary & Electrolytes Pathology (Path) 2
(RE) RE Path
2132 Anticoagulants Both UFH and LMWH can bind to ATIII to ↑ its activity against FXa. Only UFH is able to bind to both ATIII and FIIa to allow ATIII to inactivate FIIa. Hematology & Oncology (HO) Pharmacology 8
(Phar) HO Phar
2133 Direct factor Xa inhibitors Direct FXa inhibs (e.g. apixaban, rivaroxaban) incr the PT and aPTT but don't affect the TT. UFH and DTIs (e.g. dabigatran) prolong the TT. Hematology & Oncology (HO) Pathophysiology 1
(Patp) HO Patp
6510 Clostridium difficile infection Clostridium difficile infection is associated with white, patchy pseudomembranes on the bowel mucosa. These pseudomembranes consist of a neutrophil-predominant inflammatory infiltrate, fibrin, Gastrointestinal & Nutrition (GI) Microbiology 7
bacteria, and necrotic epithelium. Patients may develop a nonobstructive colonic dilation known as toxic megacolon, which can lead to colonic perforation. (Micr) GI Micr
6530 Multiple myeloma MM is a/w ↑ circulating paraproteins (monoclonal Igs), which causes erythrocytes to stack like coins (rouleaux formation). Pts classically have normocytic anemia, hypercalcemia, bone pain, and renal Hematology & Oncology (HO) Pathology (Path) 9
insufficiency. HO Path
6547 HSV infection Pts infected w/ HSV develop a lifelong latent infection of the sensory ganglion. Periodic viral replication can lead to SSx that flare and resolve over time. Infectious Diseases (ID) Microbiology 9
(Micr) ID Micr
6554 Myasthenia gravis MG is an AI disorder caused by an autoAb-mediated atk on the ACh receptors of the postsynaptic NMJ, leading to a ↓ number of ACh receptors. It is Chx by fatigable weakness of the skeletal muscles; Nervous (NS) Pathology (Path) 10
resp failure can occur due to diaphragmatic weakness. NS Path
6643 Community acquired pneumonia The virulence of S. pneumoniae is predominantly due to its PSC, which impedes phagocytosis and complement binding. Infectious Diseases (ID) Microbiology 21
(Micr) ID Micr
6705 Gastroparesis Erythromycin stims upper GI motility by acting as an ag on motilin receptors in the muscularis externa. Therefore, it can be used to Tx gastroparesis (i.e. delayed gastric emptying), a condition that freq Gastrointestinal & Nutrition (GI) Pharmacology 2
occurs in pts w/ long standing DM. (Phar) GI Phar
6731 Acute diarrhea Campylobacter jejuni is an oxidase-positive, curved, gram-negative rod that is a leading cause of gastroenteritis. The pathogen is a zoonotic organism most commonly contracted by consuming Gastrointestinal & Nutrition (GI) Microbiology 13
contaminated, undercooked poultry. Cases are marked by fever, abdominal pain, and diarrhea that may be bloody. (Micr) GI Micr
6739 Renal calculi Staghorn calculi are large renal stones that take on the shape of the renal calyces. They're composed 1arily of struvite (MgNH4PO4) and are a/w recurrent upper UTIs by urease-producing organisms (e.g. Renal, Urinary & Electrolytes Pathology (Path) 7
Proteus, Klebsiella). Hydrolysis of urea yields NH3, which alkalinises the urine and facilitates precipitation of struvite crystals. (RE) RE Path
6781 Community acquired pneumonia Mycoplasma pneumoniae is a leading cause of atypical pneumonia. B/c this pathogen lacks a cell wall, it does not show up on Gram stain and cannot be treated w/ β-lactam Abx. PSIs (eg, macrolides, Infectious Diseases (ID) Microbiology 21
tetracycline) are the Tx of choice. (Micr) ID Micr
6792 High altitude illness At high altitude, the low PiO2 leads to hypoxemia w/ consequent hyperventilation and respiratory alkalosis. The hypoxemia and alkalemia can cause SSx of altitude sickness (eg, h/a, fatigue, Renal, Urinary & Electrolytes Physiology 3
lightheadedness). The kidneys respond by creating a compensatory metabolic acidosis and by ↑ EPO secretion. (RE) (Phys) RE Phys
6803 Diabetes mellitus Incretin fxns by stim insulin release following oral consumption of Glc. Incretin-stim insulin release is independent of the ↑ in insulin secretion brought on by ↑ in the BGL. Endocrine, Diabetes & Physiology 31
6811 Septic shock Phenylephrine is a selective α1 adrenergic receptor agonist that ↑ PVR and SBP and ↓ PP and HR. Cardiovascular (CV) Pharmacology 6
(Phar) CV Phar
7214 Cirrhosis Portal HTN, as seen in ALD, produces splenomegaly by causing congestion of blood w/i the spleen, which produces expansion of the red pulp. Gastrointestinal & Nutrition (GI) Pathology (Path) 7 GI Path
7215 Esophageal varices Acute Mx of variceal hemorrhage req rapid lowering of portal pressure. Somatostatin and octreotide (a long-acting somatostatin analogue) inhib the release of hormones that induce splanchnic Gastrointestinal & Nutrition (GI) Pathology (Path) 2
vasodilation, indirectly causing splanchnic vasoconstriction and ↓ portal blood flow. GI Path
7226 Renal cell carcinoma RCC tends to invade the renal vein; IVC obstr can occur by intraluminal extension of the tumour. obstr of the IVC produces symmetric bilateral extremity oedema, often a/w prominent devel of venous Renal, Urinary & Electrolytes Pathology (Path) 8
collaterals in the abdo wall. (RE) RE Path
7227 Renal cell carcinoma RCC causes a variety of PNP syndromes incl erythrocytosis (due to excessive EPO production) and hypercalcaemia (due to PTHrP). Renal, Urinary & Electrolytes Pathology (Path) 8
(RE) RE Path
7228 Cytomegalovirus CMV is a common cause of colitis in pts w/ advanced AIDS. It is the 2nd most common CMV reactivation disease in this population (CMV retinitis is the most common). Pts w/ CMV colitis often have Gastrointestinal & Nutrition (GI) Pathology (Path) 9
abdominal pain, fever, diarrhea, and weight loss. Colonoscopy usually shows erythema, erosions, and ulcerations; colonic Bx typically reveals large cells w/ prominent basophilic intranuclear inclusions. GI Path
7229 Antiretroviral therapy The HIV genome contains 3 major structural genes that are translated as polyproteins and subsequently cleaved by host protease (env gene products) or viral protease (gag-pol gene products) into the Gastrointestinal & Nutrition (GI) Pathology (Path) 7
individual proteins that compose the HIV virus. PIs block viral protease from cleaving gag-pol polyproteins, which results in the formation of immature virions that are noninfectious. GI Path
7487 Physician patient communication In nonemergent settings, trained language interpreters should be used to ensure optimal medical care; this applies to deaf pts using ASL. Social Sciences (SS) Behavioral 11
7489 Turner syndrome Common MFx of TS include 1° amenorrhea, short stature, a high arched palate, and widely spaced nipples. 1° amenorrhea occurs in these pts due to in utero degeneration of the ovarian follicles (gonadal Female Reproductive & Breast Genetics (Gene) 8
dysgenesis). (FR) FR Gene
7490 Alzheimer disease Alzheimer dementia typically Px insidiously w/ memory loss (especially of recent events), executive dysfxn, and visuospatial impairment. Classic histopathologic findings include amyloid plaques Nervous (NS) Pathology (Path) 7
(central amyloid β core surrounded by dystrophic neurites) and NFTs (aggregates of hyperphosphorylated τ protein). NS Path
7492 Tension headache THs are the most common form of h/a. They are Chx by an achy or pressure-like pain that is often bilateral and a/w pericranial muscle tenderness. THs are not a/w other neuro SSx and do not typically Nervous (NS) Pathology (Path) 1
limit a pt's ability to perform daily fxns. NS Path
7556 Osteoarthritis OA is char by progr fissuring and erosion of articular cartilage. RFs incl advancing age, obesity, joint trauma, and repetitive stress. Pts may have mild effusion and crepitus on PEx, but SSx of synovitis (e. Rheumatology, Orthopedics & Pathology (Path) 2
g. redness, warmth) are less prominent than in the classic inflammatory arthritic disorders. Sports (RH) RH Path
7558 COPD Smoking is the strongest RF for COPD and is responsible for accelerated decline in FEV1 in pts w/ COPD. Smoking cessation will slow the accelerated decline in FEV1, but FEV1 won't return to the lvl Pulmonary & Critical Care (PU) Pathophysiology 16
it would've been had the pt never smoked. (Patp) PU Patp
7568 Renal artery stenosis In unilateral RAS, the narrowed renal artery causes hypoperfusion of the affected kidney w/ subseq ischemic dmg (e.g. tubular atrophy, interstitial ischemia, glomerular crowding). In contrast, the Cardiovascular (CV) Pathology (Path) 9
contralateral kidney is exposed to high BP and typically shows changes of HTN nephrosclerosis (e.g. arteriolar wall thickening due to hyaline or hyperplastic arteriolosclerosis). CV Path
7569 Renal artery stenosis Renal artery stenosis causing significant renal hypoperfusion will result in a decreased glomerular filtration rate and activation of the renin-angiotensin-aldosterone system. This leads to increased renin Renal, Urinary & Electrolytes Pathophysiology 9
release by modified smooth muscle (juxtaglomerular) cells in the walls of afferent glomerular arterioles. Chronic renal hypoperfusion can cause hyperplasia of the juxtaglomerular apparatus. (RE) (Patp) RE Patp
7570 Primary hypertension Chronic HTN can result in HTN nephrosclerosis (HN), which is characterised by compensatory medial hypertrophy and fibrointimal proliferation; endothelial dmg from ↑ systemic pressure also leads to Renal, Urinary & Electrolytes Pathology (Path) 14
hyaline arteriolosclerosis. The narrowed arteriolar lumens cause a progr ↓ in renal blood flow, resulting in glomerular ischemia and fibrosis (glomerulosclerosis). (RE) RE Path
7571 Primary hypertension Hyperplastic arteriosclerosis ("onion-skinning") and fibrinoid necrosis of the renal arterioles are typical morphologic findings in hypertensive (malignant) nephrosclerosis. End-organ damage can be Renal, Urinary & Electrolytes Pathology (Path) 14
prevented by treatment of high blood pressure with antihypertensives. (RE) RE Path
7573 Appendicitis Intra-abdo infecs are polymicro, w/ B. fragilis and E.coli being the most prominent organisms isolated. Gastrointestinal & Nutrition (GI) Microbiology 5
(Micr) GI Micr
7581 Syphilis The Jarisch-Herxheimer reaction is an acute inflammatory reaction that occurs within hours of treatment for spirochetal (eg, syphilis) infections. The rapid lysis of spirochetes releases inflammatory Allergy & Immunology (AI) Microbiology 9
bacterial lipoproteins into the circulation and causes acute fevers, rigors, and myalgias. (Micr) AI Micr
7584 GI surgery Fe abs occurs predom in the duodenum and prox jejunum. Bypass of this segment of small bowel by gastrojejunostomy results in IDA that can be corrected w/ Rx Fe supp. Malabs of vits B12, B9, fat-sol Gastrointestinal & Nutrition (GI) Pharmacology 1
vits (esp vit D), and Ca may also be obs following gastric bypass procedures. (Phar) GI Phar
7585 Androgenic steroids Androgens stimulate follicular epidermal hyperproliferation and excessive sebum production, thereby promoting acne development. Anabolic steroid misuse is a known cause of acne, especially in Dermatology (DE) Pharmacology 2
competitive athletes. (Phar) DE Phar
7592 Muscle structure & physiology The contractile mechanism in skeletal muscle depends on proteins (myosin II, actin, tropomyosin, and troponin) as well as calcium ions. Rheumatology, Orthopedics & Physiology 8
7601 COPD In COPD, air-trapping leads to an incr in RV and TLC, as well as an incr in the RV/TLC ratio. Airway obstr causes a decr in FVC, FEV1, and the FEV1/FVC ratio. Pulmonary & Critical Care (PU) Physiology 16
(Phys) PU Phys
7614 Pleural effusion Fluid in the pleural space acts to insulate sound vibrations that originate in the airways; therefore, pleural effusion causes ↓ tactile fremitus and ↓ intensity of breath sounds. The high density of pleural Pulmonary & Critical Care (PU) Pathophysiology 4
fluid compared to normal lung tissue also causes dullness to percussion. (Patp) PU Patp
7616 Acute heart failure Acute cardiogenic pulm oedema results from ↑ pulm venous pressure. The alveolar capillaries become engorged w/ blood and there's a transudation of fluid plasma across the alveolar-capillary membrane, Cardiovascular (CV) Pathology (Path) 7
appearing as pink, acellular material w/i the alveoli. CV Path
7621 Iliopsoas muscle Muscles used when sitting up from the supine position incl the ext. abdo obliques, the rectus abdominis, and the hip flexors. The iliopsoas muscle is the most important of the hip flexors and incls the Rheumatology, Orthopedics & Anatomy (Anat) 1
psoas major, psoas minor, and iliacus. The rectus femoris, sartorius, tensor fascia lata, and the med. compartment of the thigh also contribute to hip flexion. Sports (RH) RH Anat
7623 Bladder cancer Urothelial (transitional cell) bladder ca typically affects the elderly and presents w/ gross hematuria. A Hx of smoking or occup exposure to rubber, plastics, aromatic amine-containing dyes, textiles, or Renal, Urinary & Electrolytes Pathology (Path) 4
leather ↑ the risk. (RE) RE Path
7624 Prerenal azotemia Blood volume loss can cause prerenal or intrinsic ARF. Prerenal ARF is a/w normal nephron fxn (e.g. low urine Na+ lvl, low fractionated Na+ excretion, high urine osmolarity, and a high BUN/creatinine Renal, Urinary & Electrolytes Pathology (Path) 6
ratio), whereas intrinsic ARF features diminished renal resorptive capacity (e.g. lower urine osmolarity, higher urinary Na+, normal serum BUN/creatinine ratio). (RE) RE Path
7640 Torsades de pointes TdP refers to polymorphic ventricular tachycardia that occurs in the setting of a congenital or acquired prolonged QT interval. TdP is most commonly precipitated by Rx that prolong the QT interval such Cardiovascular (CV) Pharmacology 1
as certain antiarrhythmics (sotalol, quinidine), antipsychotics (haloperidol), and Abx (macrolides, fluoroquinolones). (Phar) CV Phar
7642 Cryptosporidiosis Cryptosporidium is a common cause of self-lim diarrhea in immcom hosts, but may cause life-thr diarrhea in immsup pts (e.g. adv AIDS). Dx is usually made when oocysts are visualized w/ modded Gastrointestinal & Nutrition (GI) Microbiology 1
acid-fast stain in stool or Bx (oocysts lining the brush-border). (Micr) GI Micr
7643 Infectious mononucleosis The 1° immune response to EBV is mediated by CD8+ T lymphocytes, which are activated thru the presentation of viral Ags on infected CD21+ B lymphocytes. These reactive (atypical) CD8+ T Hematology & Oncology (HO) Pathology (Path) 5
lymphocytes can be observed in the peri blood smears of pts w/ IM. HO Path
7646 Implantable cardioverter LV leads in biventricular PMs course through the coronary sinus, which resides in the AV groove on the posterior aspect of the heart. Cardiovascular (CV) Anatomy (Anat) 1
defibrillator CV Anat
7648 Interstitial lung disease Histologic findings of IPF are most prominent in the lung periphery and incl a heterogeneous mix of chronic inflammation and patchy interstitial fibrosis, focal fibroblast proliferation, and formation of Pulmonary & Critical Care (PU) Pathology (Path) 8
fibrotic cystic spaces in a honeycomb pattern. PU Path
7649 Seborrheic keratosis SKs are pigmented macules or plaques w/ a greasy surface and well-demarcated borders. Rapid onset of numerous lesions is an indicator of internal malignancy (Leser-Trelat sign), esp. GAC. Dermatology (DE) Pathology (Path) 2 DE Path
7650 Pertussis B. pertussis, a small, gram (-) coccobacillus, can cause outbreaks of whooping cough in un-vax individuals. Infected infants and children gen develop mucoid rhinorrhoea f/b severe, paroxysmal cough Infectious Diseases (ID) Microbiology 3
that may be a/w an inspiratory whoop and vomiting. The bacterium is largely non-invasive and secretes several exotoxins that severely dmg ciliated resp epithelium. (Micr) ID Micr
7651 Growth hormone Acromegaly is caused by excessive production of GH, usually due to a pit somatotroph adenoma. MSK MFxs incl bony hypertrophy (e.g. frontal bossing; enlarged jaw, hands, and feet) and OA. LVH is Endocrine, Diabetes & Pathology (Path) 2
often common in acromegaly and may progress to HF. Metabolism (ES) ES Path
7660 Pulmonary embolism PE causes dead space vent, which leads to hypoxemia due to the conseq V/Q mismatch. Pulmonary & Critical Care (PU) Physiology 13
(Phys) PU Phys
7661 Pulmonary embolism Pts being weaned from mech vent typically breathe at low TVs, w/ a comp incr in RR to maintain min vent. B/c at low TVs a higher proportion of each breath is composed of dead space, this type of Pulmonary & Critical Care (PU) Physiology 13
breathing leads to an incr in wasted vent (inefficient breathing). (Phys) PU Phys
7666 Myocardial infarction RV infarction (right-sided HF) can lead to shock via impaired forward blood flow to the left heart, which ↓ left-sided preload (↓ PCWP) and ↓ CO. The ↓ RV output also ↑ RA and CVP. Cardiovascular (CV) Pathology (Path) 18 CV Path
7667 Myocardial infarction Severe systemic hypotension (eg, shock) is most likely to cause ischemia 1st in areas of high metabolic demand (eg, hippocampus) or watershed zones, which are areas that are supplied by the distal Cardiovascular (CV) Pathology (Path) 18
branches of two different major arteries. Commonly affected areas in the colon include the splenic flexure and RSJ. CV Path
7707 Melanoma BRAF is a PK involved in activation of signalling pathways for melanocyte proliferation; the BRAF V600E mut is seen in 40-60% of pts w/ melanoma. Dermatology (DE) Pathology (Path) 6 DE Path
7710 Peptic ulcer disease Helicobacter pylori is a common cause of peptic ulcers. Duodenal ulcers are a/w heavy colonization in the gastric antrum, whereas colonization in the gastric corpus is a/w gastric ulcers. Gastrointestinal & Nutrition (GI) Pathology (Path) 10 GI Path
7721 Macular degeneration Wet age-related macular degeneration is characterized by retinal neovascularization due to increased vascular endothelial growth factor (VEGF) levels. Patients typically have acute vision loss and Ophthalmology (OP) Pharmacology 2
metamorphopsia with funduscopy showing a grayish-green subretinal membrane and/or subretinal hemorrhage. Treatment includes smoking cessation and VEGF inhibitor therapy (eg, ranibizumab, (Phar)
bevacizumab). OP Phar
7733 Patient confidentiality It is unethical to discuss any information regarding a pt's Dx and Tx w/ another individual, including a physician who is not involved in the pt's care. Likewise, the physician should neither confirm nor Social Sciences (SS) Behavioral 5
deny whether the person of interest is, in fact, a pt. Science (Beha) SS Beha
7752 Traumatic brain injury Pts w/ OFC injury often experience personality changes, disinhib, and irritability 2° to impairment of the behavioural and emotional mod systems. Pregnancy, Childbirth & Behavioral 5
7767 Professional conduct It is ethically problematic for physicians to accept expensive gifts as they may influence or appear to influence physician behavior. These gifts should be declined after expressing appreciation for the Social Sciences (SS) Behavioral 3
gesture. Science (Beha) SS Beha
7791 DNA methylation Genomic imprinting refers to the phenomenon in which an offspring's genes are expressed in a parent-specific manner. Genomic imprinting is caused by DNA meth, an epigenetic process in which genes General Principles (GP) Genetics (Gene) 1
can be silenced by attaching methyl groups to cytosine residues in the DNA molecules. GP Gene
7792 NSAIDs Cyclooxygenase-2 (COX-2) is an inducible enzyme upregulated during inflammation by interleukin-1 and TNF-α. Selective COX-2 inhibitors (eg, celecoxib) decrease inflammation by inhibiting COX-2 Rheumatology, Orthopedics & Pharmacology 4
production of pro-inflammatory arachidonic acid metabolites. Because they do not affect COX-1, they have minimal gastroduodenal toxicity. Sports (RH) (Phar) RH Phar
8249 Urinary incontinence Urge incontinence, or OBS, is caused by uninhib bladder contractions (detrusor instability). It results in a sense of urgency accompanied by an involuntary loss of urine. If beha therapy alone is Renal, Urinary & Electrolytes Pharmacology 7
unsuccessful, Rx therapy w/ an antimusc drug (targeting M3 receptors) can help improve SSx. (RE) (Phar) RE Phar
8257 Community acquired pneumonia L. pneumophila is a facultative intracellular gram (-) bacillus that can cause a systemic infection. SSx freq incl high fever, cough, confusion, and diarrhoea. The most common lab abn seen w/ Legionella Pulmonary & Critical Care (PU) Microbiology 21
pneumonia is hyponatraemia, and sputum Gram stain often shows many neutrophils but few or no organisms. (Micr) PU Micr
8259 Narcolepsy Tx for narcolepsy incls psychostims (e.g. modafinil) for daytime sleepiness. Pregnancy, Childbirth & Pharmacology 3
8260 Interstitial lung disease The work of breathing is minimised in pts w/ ↑ elastic resistance (e.g. PF) when their RR is high and TV is low (fast, shallow breaths). In contrast, pts w/ diseases that ↑ airflow resistance (e.g. asthma, Pulmonary & Critical Care (PU) Pathophysiology 8
COPD) breathe at a lower RR and higher TV (slow, deep breaths) to minimise the work of breathing. (Patp) PU Patp
8261 Rhesus alloimmunization W/ maternal blood types A or B, HDFN very rarely occurs b/c materal Abs (anti-A or anti-B) are of the IgM type and can't cross the placenta. In contrast, mothers w/ blood type O also produce IgG Abs Hematology & Oncology (HO) Immunology 2
(anti-A and anti-B), which can cross the placenta and cause fetal hemolysis. (Immu) HO Immu
8262 Obstructive sleep apnea OSA, the most common sleep-related breathing disorder, is characterized by recurrent obstruction of the upper airways. Relaxation of the oropharyngeal a/o soft palate musculature during sleep results in Pulmonary & Critical Care (PU) Pathophysiology 4
a fxnal collapse of the airway, producing periods of ↓ (hypopnea) or absent (apnea) airflow despite continued breathing efforts. (Patp) PU Patp
8266 Muscle structure & physiology The muscle spindle system is a feedback system that monitors and maintains muscle length, while the Golgi tendon system is a feedback system that monitors and maintains muscle force. GTOs are Rheumatology, Orthopedics & Physiology 8
exquisitely sensitive to increases in muscle tension but are relatively insensitive to passive stretch. Sports (RH) (Phys) RH Phys
8276 Alternative splicing Alt splicing is a process where the exons of a gene are reconnected in multi ways during PTP. This creates diff mRNA seqs and subseq, diff protein isoforms. It's a normal phenomenon in eukaryotes that Hematology & Oncology (HO) Biochemistry 1
greatly incr. the biodiversity of proteins encoded by the genome. (Bioc) HO Bioc
8281 Chronic myeloid leukemia Some pts w/ NSCLC harbour a chrom rearrangement that creates a fusion gene b/w EML4 and ALK. This results in a constitutive active tyrosine kinase that causes malignancy. Hematology & Oncology (HO) Pathology (Path) 2 HO Path
8282 Catheter related bloodstream The most important steps for prevention of CVC infections are as follows: Cardiovascular (CV) Microbiology 3
infection Proper hand hygiene (Micr)
Full barrier precautions during insertion
Chlorhexidine skin disinfection
Avoidance of the femoral insertion site
Removal of the catheter when it is no longer needed CV Micr
8283 Linkage disequilibrium Two allele loci are said to be in linkage disequilibrium when a pair of alleles are inherited together in the same gamete (haplotype) more often or less often than would be expected given random pairing. Miscellaneous (Multisystem) Genetics (Gene) 1
This most often occurs when the genes are in close physical proximity on the same chromosome. (MS) MS Gene
8288 Daptomycin Daptomycin is a lipopeptide Abx w/ activity limited to gram (+) organisms, incl MRSA. It causes depol of bacterial cellular membrane and inhib of DNA, RNA, and protein synthesis. Daptomycin is a/w Infectious Diseases (ID) Pharmacology 1
↑ CPK lvls and an ↑ incidence of myopathy. (Phar) ID Phar
8289 Beta blockers β1 adrenergic receptors are found in cardiac tissue and on renal JGA cells, but not in vascular smooth muscle. Selective blockade of the β1 receptor (e.g. w/ atenolol) leads to ↓ cAMP lvls in cardiac and Cardiovascular (CV) Pharmacology 3
renal tissue w/o significantly affecting cAMP lvls in vascular smooth muscle. (Phar) CV Phar
8290 Kaposi sarcoma Kaposi's sarcoma usually involves the skin and GI tract and is common in HIV patients not on antiretroviral therapy. Endoscopy reveals characteristic lesions, which range from reddish/violet flat Infectious Diseases (ID) Pathology (Path) 2
maculopapular lesions to raised hemorrhagic nodules or polypoid masses. Biopsy can show spindle cells, neovascularization, and extravasated red blood cells. ID Path
8291 Pharmacokinetics Clearance (CL) determines the dose rate required to maintain a steady-state plasma concentration (Cpss): #6nov Cardiovascular (CV) Pharmacology 1
Maintenance dose = Cpss x CL / [Bioavailability fraction] (Phar)
The bioavailability fraction = 1 if administered IV. CV Phar
8292 Turner syndrome TS is a/w congenital anomalies of the aorta, and the most common defect is a bicuspid AV. A nonstenotic bicuspid AV can MFx as an early systolic, high-frequency click over the right 2nd interspace. Cardiovascular (CV) Genetics (Gene) 8
Bicuspid AVs are at risk for stenosis, insufficiency, and infection. CV Gene
8293 Supine hypotension Pregnant women > 20 wks gestation can experience compression of the IVC by the gravid uterus while in the supine position. This ↓ venous return and CO, which can result in hypotension and syncope. Cardiovascular (CV) Physiology 1
(Phys) CV Phys
8294 Tricuspid regurgitation IE in IVDUs commonly affects the TV, often leading to septic pulm emboli. Pts can have an early- or holo-systolic murmur of TR, which is best auscultated in the 4th or 5th ICS at the left lower sternal Cardiovascular (CV) Anatomy (Anat) 3
border. CV Anat
8295 Mental status examination Quick clinical tests to Ax attn and conc incl counting down from 100 by intervals of 3 or 7, reciting the mos of the yr in reverse order, and spelling 'world' backwards. Pregnancy, Childbirth & Behavioral 1
8296 Atrial myxoma Myxomas are the most common 1° cardiac neoplasm and usually arise w/i the LA. The tumours typically cause position-dependent obstr of the MV, leading to a mid-diastolic murmur and SSx of ↓ CO (e. Cardiovascular (CV) Pathology (Path) 3
g. dyspnoea, syncope). Constitutional SSx (e.g. fever, weight loss) may also be present. Histologically, the tumours demonstrate scattered cells w/i a mucopolysaccharide stroma and abn blood vessels w/
hemorrhaging. CV Path
8323 Torticollis Acute EPS (e.g. dystonia, akathisia, parkinsonism) are due to D2 blockade in the nigrostriatal pathway. High-potency FGAs (e.g. haloperidol, fluphenazine) strongly block D2 receptors and are most Nervous (NS) Behavioral 2
likely to cause EPS. Science (Beha) NS Beha
8324 Rabies Rabies virus has a bullet-shaped envelope w/ knob-like GP that bind to nAChRs. Once transmission occurs (usually due to a bite wound from an infected animal), the virus replicates locally in muscle Nervous (NS) Microbiology 2
tissue for several dys or wks before spreading in a retrograde fashion thru the peri nerve axons to the CNS. (Micr) NS Micr
8325 Torticollis Congenital torticollis is typically noted by 2 to 4 weeks of age, after which the child prefers to hold the head tilted to one side. It is most commonly the result of malposition of the head in utero or birth Pregnancy, Childbirth & Pathology (Path) 2
trauma. Most cases resolve with conservative therapy and stretching exercises. Puerperium (PR) PR Path
8326 Scrotum Due to its intra-abdominal origin, lymphatic drainage of the testis is to the para-aortic lymph nodes. In contrast, lymph drainage from the scrotum goes into the superficial inguinal lymph nodes. Male Reproductive (MR) Anatomy (Anat) 1 MR Anat
8327 Serotonin syndrome SS is characterised by a triad of autonomic instability, AMS, and NM irritability. It may develop when a MAOI antidep or a non-antidep w/ MAOI activity (e.g. linezolid) is combo w/ a 5-HT-ergic Rx Pregnancy, Childbirth & Pharmacology 2
such as a SSRI, SNRI, or TCA. Puerperium (PR) (Phar) PR Phar
8328 Cell cycle Nondisjxn is the failure of chrom pairs to separate properly during cell division. This could be due to a failure of homologous chroms to separate in meiosis I or a failure of sister chromatids to separate General Principles (GP) Genetics (Gene) 2
during meiosis II or mitosis. GP Gene
8329 Bell's palsy In addn to unilateral CNVII paralysis, pts w/ Bell's palsy may experience ↓ tearing, hyperacusis, a/o loss of taste sensation over the anterior 2/3 of the tongue. Nervous (NS) Anatomy (Anat) 1 NS Anat
8330 Gestational diabetes hPL ↑ maternal IR during the 2nd and 3rd trimesters, leading to a rise in serum Glc that helps provide adequate nutrition to the growing fetus. Gestational diabetes occurs when the compensatory rise in Pregnancy, Childbirth & Physiology 2
maternal insulin secretion is inadequate to prevent serum Glc lvls from reaching excessively high lvls. Puerperium (PR) (Phys) PR Phys
8332 Echocardiography The LA forms the majority of the posterior surface of the heart and resides adjacent to the esophagus. Enlargement of the LA can compress the esophagus and cause dysphagia. Cardiovascular (CV) Anatomy (Anat) 2 CV Anat
8333 Echocardiography The descending thoracic aorta lies posterior to the esophagus and the LA. This position permits clear visualization of the descending aorta by TEE, allowing for the detection of abnormalities such as Cardiovascular (CV) Anatomy (Anat) 2
dissection or aneurysm. CV Anat
8334 Skin and soft tissue infections Granulomatous inflammation is a form of chronic inflammation characterised by aggregates of activated macrophages that assume an epithelioid appearance. Persistent granulomatous inflammation w/ Dermatology (DE) Pathology (Path) 8
subseq fibrosis can cause organ dysfxn, which is seen in a # of granulomatous diseases. DE Path
8342 Otitis externa Pseudomonas aeruginosa is a non lactose-fermenting, oxidase (+), motile, Gram (-) rod. It is the most common cause of MOE, a serious infection of the ear seen in elderly diabetic pts. MOE Px w/ Ear, Nose & Throat (EN) Microbiology 2
exquisite ear pain and drainage, and granulation tissue is often seen w/i the ear canal. (Micr) EN Micr
8351 Erectile dysfunction Psychogenic causes of erectile dysfunction include performance anxiety, depression, sexual trauma, relationship problems, and stress. Important clues include sudden-onset and normal nocturnal Male Reproductive (MR) Pathology (Path) 3
erections. MR Path
8352 Seafood poisoning Pufferfish poisoning is caused by tetrodotoxin, a neurotoxin produced by microorganisms a/w the fish. Tetrodotoxin binds to v-gated Na channels in nerve and cardiac tissue, preventing Na influx and Nervous (NS) Pathophysiology 1
depol. (Patp) NS Patp
8371 Antiretroviral therapy Integration of HIV dsDNA into the host cell's chrom is necessary to induce viral gene expression and prevent degradation of the viral genome. Raltegravir is an integrase inhib that disrupts HIV genome Infectious Diseases (ID) Pharmacology 7
integration, preventing synthesis of viral mRNA. (Phar) ID Phar
8384 Primary immunodeficiency Inherited defects involving the interferon-y signaling pathway result in disseminated mycobacterial disease in infancy or early childhood. Patients require lifelong treatment with antimycobacterial agents. Allergy & Immunology (AI) Immunology 7
disorder (Immu) AI Immu
8385 Ubiquitin proteasome pathway Ubiquitin is a protein that undergoes ATP-dependent attachment to other proteins, labeling them for degradation. These modified proteins enter the proteasome and are degraded into small peptides. Nervous (NS) Biochemistry 2
Impairment of the ubiquitin-proteasome system can contribute to the development of neurodegen disorders, including PD and AD. (Bioc) NS Bioc
8390 Imperforate hymen Imperforate hymen is caused by incomplete degeneration of the central portion of the fibrous tissue band connecting the walls of the vagina. Adolescent patients typically present with primary Female Reproductive & Breast Anatomy (Anat) 1
amenorrhea, normal secondary sexual characteristics, and cyclic abdominal or pelvic pain due to accumulation of menstrual blood in the vagina and uterus (eg, hematocolpos). (FR) FR Anat
8406 Multiple gestation Dizygotic twins occur due to fertilization of 2 oocytes by 2 different sperm, can be different genders, and almost always have 2 chorions and 2 amnions (eg, dichorionic/diamniotic). In contrast, Pregnancy, Childbirth & Embryology 1
monozygotic twins arise from the fertilization of a single oocyte, are the same gender, and can be dichorionic/diamniotic (days 0-4), monochorionic/diamniotic (days 4-8), monochorionic/monoamniotic Puerperium (PR) (Embr)
(days 8-12), or monochorionic/monoamniotic conjoined twins (> 13 days). PR Embr
8422 Study designs In a crossover study, subjects are randomly allocated to a sequence of 2 or more Tx given consecutively. A washout (no Tx) period is often added b/w Tx intervals to limit the confounding effects of prior Biostatistics & EpInfectious Biostatistics 6
Tx. Diseases (ID)emiology (BS) (Bios) BS Bios
8424 Pheochromocytoma Chromaffin cells are modified neuroendo cells derived from the neural crest. Chromaffin cells in the AM are stimulated by ACh released by sympathetic preganglionic neurons and secrete CAs directly Endocrine, Diabetes & Histology (Hist) 4
into the bloodstream to amplify SNS activity. Metabolism (ES) ES Hist
8425 Obesity Leptin is a protein hormone produced by adipocytes in proportion to the quantity of fat stored. Leptin acts on the arcuate nucleus of the hypothalamus to inhib production of NPY (↓ appetite) and stim Gastrointestinal & Nutrition (GI) Biochemistry 2
production of α-MSH (↑ satiety). Muts in the leptin gene or receptor result in hyperphagia and profound obesity. (Bioc) GI Bioc
8456 Health insurance Capitation is an arrangement in which a payor pays a fixed, predetermined fee to provide all the services required by a patient. Payors may negotiate a capitated contract with an insurance company that General Principles (GP) Behavioral 3
then pays the providers, or a large medical group may negotiate directly with the payor. Science (Beha) GP Beha
8457 Elder abuse & neglect Clinicians have a legal and ethical obligation to report elder abuse, neglect, and exploitation. If there is reason to suspect possible mistreatment, the patient should be interviewed alone to avoid Social Sciences (SS) Behavioral 1
intimidation by potential perpetrators. Science (Beha) SS Beha
8458 Electrical injury Although lightning injuries are rare, they are a/w a 25% fatality rate. Two-3rds of lightning-related deaths occur w/i the 1st hr after injury, w/ fatal arrhythmias and resp failure as the most common causes. Cardiovascular (CV) Pathology (Path) 1
Pts w/ minor cutaneous involvement may still have major internal injury after lightning strikes and high-voltage electrical contact. CV Path
8468 Contraception After vasectomy, viable sperm remain in the portion of the vas deferens distal to the ligation. Pts can still have viable sperm in the ejaculate for 3 mos and at least 20 ejaculations. Male Reproductive (MR) Physiology 3
(Phys) MR Phys
8476 Migraine Migraine h/a are unilateral, have a pulsating or throbbing quality, and are a/w photophobia, phonophobia, and nausea. Triptans are 5-HT1B/5-HT1D agonists used as abortive therapy during an acute Nervous (NS) Pharmacology 3
migraine. β blockers, antidepressants (e.g. amitriptyline and venlafaxine), and anticonvulsants (e.g. valproate and topiramate) are commonly used for migraine prophylaxis. (Phar) NS Phar
8480 Inflammation Inflam is char by the passage of circulating inflam leukocytes into the inflamed tissue. The steps involved incl. margination, rolling, activation, tight adhesion and crawling, and transmigration. Hematology & Oncology (HO) Immunology 3
(Immu) HO Immu
8481 Anesthesia SCh can cause significant K+ release and life-threatening arrhythmias in pts at high risk for hyperkalaemia, incl those w/ burns, myopathies, crush injuries, and denervating injuries or disease. Nervous (NS) Pharmacology 9
(Phar) NS Phar
8482 Mushroom poisoning Amatoxins are found in a variety of poisonous mushrooms (eg, Amanita phalloides, known as death cap) and are potent inhibitors of RNA polymerase II (halting mRNA synthesis). Poisoning & Environmental Biochemistry 2
Exposure (PO) (Bioc) PO Bioc
8519 Statistical tests A t-test is used to compare the difference b/w the means of 2 groups. ANOVA compares the difference b/w the means of 2 or more groups. Results from a t-test and ANOVA test will be equivalent when Biostatistics & EpInfectious Biostatistics 2
comparing the difference b/w the means of 2 groups. Diseases (ID)emiology (BS) (Bios) BS Bios
8522 Cranial nerve palsy Lesions of the JF can result in JF (Vernet) syndrome, which is characterised by the dysfxn of CNs IX, X, and XI. SSx incl dysphagia, hoarseness, loss of gag reflex on the ipsilateral side, and deviation of Nervous (NS) Anatomy (Anat) 9
the uvula toward the normal side. NS Anat
8523 Drug structure and properties The suffix of a biological agent indicates whether a medication is a monoclonal antibody (mab), a receptor molecule (cept), or a kinase inhibitor (nib). Monoclonal antibodies also include in their names General Principles (GP) Pharmacology 3
the type of target (eg, bacterial or immune system) and their origin (eg, human or mouse). (Phar) GP Phar
8524 Tay-Sachs Tay-Sachs disease is an autosomal recessive disorder caused by B-hexosaminidase A deficiency, which results in GM2 ganglioside accumulation. Key clinical features include progressive Nervous (NS) Biochemistry 1
neurodegeneration and a cherry-red macular spot. In contrast to patients with Niemann-Pick disease, those with Tay Sachs disease have no hepatosplenomegaly. (Bioc) NS Bioc
8530 Cytokines IL-2 is produced by Th cells and stims the growth of CD4+ and CD8+ T cells and B cells. IL-2 also activates NK cells and monocytes. The incr. activity of T cells and NK cells is thought to be Allergy & Immunology (AI) Immunology 1
responsible for IL-2's anti-ca effect on met melanoma and RCC. (Immu) AI Immu
8531 Hypoglycemia Hypoglycaemia is char by tremor, diaphoresis, and confusion in a/w a low BGL and resolution of SSx when the BGL is corrected. Hypoglycaemia w/ ↑ insulin and low C-peptide lvls suggests exogenous Endocrine, Diabetes & Pathology (Path) 6
insulin injection, whereas ↑ C-peptide suggests an insulin secretagogue or insulin-secreting tumour. Metabolism (ES) ES Path
8532 Primary immunodeficiency DGS causes an extreme defic in the # of mature T lymphocytes, leading to poor development of the LN paracortex. In contrast, aGg-emia causes an absence of B cells, preventing 1ary lymphoid follicles Hematology & Oncology (HO) Immunology 7
disorder and germinal centers from forming in the LN cortex. (Immu) HO Immu
8533 Staphylococci Staphylococcus epidermidis is a common cause of foreign body infections due to its ability to produce adherent biofilms. Infectious Diseases (ID) Microbiology 1
(Micr) ID Micr
8538 Intestinal helminth parasites E. vermicularis infection (enterobiasis) occurs most freq in school-age children and presents w/ perianal pruritus. Dx is made by the Scotch tape test. Albendazole is the 1st-line Tx, w/ pyrantel pamoate as Infectious Diseases (ID) Pharmacology 3
an alt agent preferred in preg pts. (Phar) ID Phar
8539 Inflammation Interleukin-8 is a chemokine produced by macrophages that induces chemotaxis and phagocytosis in neutrophils. Other significant chemotactic agents include leukotriene B4, 5-HETE (the leukotriene Allergy & Immunology (AI) Immunology 3
precursor), and complement component C5a. (Immu) AI Immu
8540 Myelofibrosis The chronic MPDs (PV, ET, and PMF) often have a mutation in JAK2, a cytoplasmic tyrosine kinase. This results in constitutive tyrosine kinase activity, and consequently, in the cytokine-independent Hematology & Oncology (HO) Pathology (Path) 3
activation of STAT proteins (JAK-STAT signaling pathway). HO Path
8541 Schistosomiasis Humans acquire schistosomiasis via contact w/ freshwater sources that contain snails infected w/ Schistosoma larvae. S japonicum and S mansoni cause intestinal and hepatic schistosomiasis, and S Renal, Urinary & Electrolytes Microbiology 2
haematobium causes urinary schistosomiasis. (RE) (Micr) RE Micr
8542 Tumor lysis syndrome TLS can develop during CTx for ca w/ rapid cell turnover (e.g. poorly diffiated lymphomas and leukaemias), substantial tumour burden, or high sensitivity to CTx. It's characterised by Hematology & Oncology (HO) Pharmacology 1
hyperphosphataemia, hypocalcaemia, hyperkalaemia, and hyperuricaemia. Prevention often involves hydration and the use of hypouricaemic agents such as allopurinol or rasburicase. (Phar) HO Phar
8546 Chronic heart failure The ↓ CO in HF triggers compensatory activation of the SNS and RAAS, resulting in vasoconstriction (↑ afterload), fluid retention (↑ preload), and deleterious cardiac remodelling. These mechs Cardiovascular (CV) Physiology 12
perpetuate a downward spiral of cardiac deterioration, leading to SSx DHF. (Phys) CV Phys
8547 Cirrhosis In cirrhosis, portal HTN arises from ↑ resistance to portal flow at the hepatic sinusoids. This causes ↑ pressure in the portosystemic collateral veins w/i the lower end of the oesophagus, ant. abdo, and Gastrointestinal & Nutrition (GI) Anatomy (Anat) 7
lower rectum. Dilation of these collateral vessels is responsible for the oesophageal varices, caput medusae, and anorectal varices commonly seen in pts w/ cirrhosis. GI Anat
8557 Cranial nerve palsy The pupillary light reflex is assessed by shining light in an eye and observing the response in that eye (direct) and the opposite eye (consensual). The optic nerve (CN II) is responsible for the afferent limb Ophthalmology (OP) Anatomy (Anat) 9
of the pupillary reflex, and the oculomotor nerve (CN III) is responsible for the efferent limb. OP Anat
8559 Polycythemia PV is a clonal MPD characterised by an ↑ RBC mass, ↑ plasma volume, and low EPO lvls. PV can be diffiated from 2° polycythemia by the presence of leucocytosis, thrombocytosis, a/o splenomegaly. Hematology & Oncology (HO) Pathology (Path) 5
The majority of pts w/ PV have a JAK2 mut rendering HSCs more sensitive to GFs. HO Path
8563 Arginine in NO production Nitric oxide is synthesized from arginine by nitric oxide synthase. As a precursor of nitric oxide, arginine supplementation may play an adjunct role in the treatment of conditions that improve with Cardiovascular (CV) Physiology 1
vasodilation, such as stable angina. (Phys) CV Phys
8564 Intraventricular hemorrhage Neonatal IVH usually originates from the fragile germinal matrix in infants born before 32wks gestation a/o w/ birth weight <1.5kg (3lbs 5oz). It's a common complication of prematurity that can lead to Nervous (NS) Anatomy (Anat) 1
long-term neurodevel impairment. NS Anat
8565 Scarlet fever Scarlet fever is characterised by fever, pharyngitis, sandpaper-like rash, circumoral pallor, and a strawberry tongue. It's caused by strains of GAS that produce pyrogenic exotoxins. Scarlet fever can Infectious Diseases (ID) Microbiology 1
predispose to acute RF and GN. (Micr) ID Micr
8569 Psoriasis First-line treatment options for localized psoriasis include high-potency topical corticosteroids and vitamin D analogs. Vitamin D analogs inhibit T-cell and keratinocyte proliferation and stimulate Dermatology (DE) Pharmacology 5
keratinocyte differentiation. Corticosteroids also have anti-inflammatory and antiproliferative properties; their mechanism of action is complementary to the vitamin D analogs. (Phar) DE Phar
8573 Circadian rhythm The suprachiasmatic nucleus regulates circadian rhythms by processing light info from the retina and modulating body temp and the production of hormones (e.g. cortisol, melatonin). Dyssynchrony b/w Nervous (NS) Physiology 1
the local environment (e.g. daylight hrs, sleep schedules) and internal circadian rhythms can cause insomnia and daytime sleepiness (i.e. jet lag). Melatonin supplementation is recommended for the Tx of (Phys)
insomnia associated w/ jet lag. NS Phys
8574 Splenic artery The splenic artery originates from the coeliac artery and gives off several branches to the stomach and pancreas (pancreatic,short gastric, andleft gastroepiploic arteries) before finally reaching the spleen. Gastrointestinal & Nutrition (GI) Anatomy (Anat) 1
Due to poor anastomoses, the gastric tissue supplied by the short gastric arteries is vulnerable to ischemic injury following splenic artery blockage. GI Anat
8578 Hepatic encephalopathy Hyperammonemia in advanced liver failure occurs as a direct result of the cirrhotic liver's inability to metabolize nitrogenous waste products. Ammonia crosses the blood-brain barrier and causes excess Gastrointestinal & Nutrition (GI) Biochemistry 2
glutamine to accumulate within astrocytes. This decreases the amount of glutamine available for conversion to glutamate in the neurons, resulting in disruption of excitatory neurotransmission. (Bioc) GI Bioc
8579 Radial head subluxation Radial head subluxation (i.e. nursemaid's elbow) is the displacement of the annular ligament into the RHJ, classically resulting from sudden axial traction (e.g. pulling) on the arm of a child age <5. Rheumatology, Orthopedics & Anatomy (Anat) 1
Although most patients don't have any obvious swelling or deformity, they avoid moving the arm due to pain and hold it w/ the elbow flexed and forearm pronated. Sports (RH) RH Anat
8587 Lesser omentum The lesser omentum is a double layer of peritoneum that extends from the liver to the lesser curvature of the stomach and the beginning of the duodenum. It's divided into the hepatogastric and Gastrointestinal & Nutrition (GI) Anatomy (Anat) 1
hepatoduodenal ligaments. GI Anat
8589 Hearing loss In conductive hearing loss, bone conduction will be greater than air conduction (abnormal Rinne test), and the Weber test will lateralize to the affected ear. In sensorineural hearing loss, air conduction Ear, Nose & Throat (EN) Physiology 2
will be greater than bone conduction (normal Rinne test), and the Weber test will lateralize to the unaffected ear. (Phys) EN Phys
8591 Polycythemia PV is an MPD characterised by uncontrolled erythrocyte production. Virtually all pts w/ PV have a mut in JAK2, a non-receptor (cytoplasmic) tyrosine kinase a/w the EPO receptor. Hematology & Oncology (HO) Pathology (Path) 5 HO Path
8592 Visual pathway Lesions of the occipital cortex (e.g. PCA occlusion) can produce contralateral homonymous hemianopia w/ macular sparing. Nervous (NS) Anatomy (Anat) 5 NS Anat
8593 Infection control Alcohols fxn by disorganising the lipid structure in membranes, causing them to be leaky, and by denaturing cellular proteins. They're bactericidal, tuberculocidal, fungicidal, and virucidal, but don't Infectious Diseases (ID) Pharmacology 3
destroy bacterial spores. (Phar) ID Phar
8594 Visual pathway Injury to Meyer's loop in the temporal lobe results in contralateral superior quadrantanopia. Nervous (NS) Anatomy (Anat) 5 NS Anat
8610 Acute heart failure The CXR in ADHF typically shows prominent pulm vessels; patchy, bilateral airspace opacification; and blunting of the costophrenic angles due to pleural effusions. Cardiovascular (CV) Pathology (Path) 7 CV Path
8631 Airway emergency Cricothyrotomy is indicated when an emergency airway is required and orotracheal or nasotracheal intubation is either unsuccessful or contraindicated. The cricothyrotomy incision passes through the Ear, Nose & Throat (EN) Anatomy (Anat) 1
superficial cervical fascia, pretracheal fascia, and the cricothyroid membrane. EN Anat
8636 Visual pathway An aneurysm of the ICA can laterally impinge on the optic chiasm. This can cause ipsilateral nasal hemianopia by dmging uncrossed CNII fibres from the temporal portion of the retina. Nervous (NS) Anatomy (Anat) 5 NS Anat
8669 Groin hernias DIHs occur most commonly in older men due to weakness of the transversalis fascia. They protrude med. to theinf. epigastric vessels into the Hesselbach's triangle and pass only thru the SIR w/ no direct Gastrointestinal & Nutrition (GI) Anatomy (Anat) 3
route to the scrotum. GI Anat
8670 Scaphoid fracture A FOOSH may cause fracture of the scaphoid bone. Ex shows tenderness in the anatomical snuffbox. The scaphoid bone is vulnerable to AVN due to its tenuous blood supply. Rheumatology, Orthopedics & Anatomy (Anat) 1
Sports (RH) RH Anat
8671 Femoral neuropathy FNMN can occur due to trauma, compression from a retroperitoneal hematoma or abscess, or injury during Sx or childbirth. Findings incl quadriceps weakness, ↓ patellar reflex, and sensory loss over the Rheumatology, Orthopedics & Anatomy (Anat) 1
ant. and med. thigh and med. leg. Sports (RH) RH Anat
8701 Cranial nerve palsy Lesions involving CNIII cause ptosis, a downward and laterally deviated eye, impaired pupillary constriction and accommodation, and diagonal diplopia. The most dreaded cause of CNIII palsy is an Nervous (NS) Anatomy (Anat) 9
enlarging intracranial aneurysm. NS Anat
8702 Pituitary adenoma All adult cells and tissues can be traced back to the 3 1° germ layers: ectoderm, mesoderm, and endoderm. The ectoderm gives rise to the surface ectoderm, neural tube, and neural crest. Nervous (NS) Embryology 8
(Embr) NS Embr
8703 Foreign body aspiration The internal laryngeal nerve mediates the afferent limb of the cough reflex above the vocal cords. Foreign bodies (eg, fish bones) can become lodged in the piriform recess and may cause damage to the Ear, Nose & Throat (EN) Anatomy (Anat) 1
nerve, impairing the cough reflex. EN Anat
8710 Psoas abscess Psoas abscess presents w/ fever, back or flank pain, an inguinal mass, and difficulty walking. Inflammation of the psoas muscle leads to pain w/ extension at the hip (i.e. psoas sign). Psoas abscess can Rheumatology, Orthopedics & Anatomy (Anat) 2
develop due to heme or lymphatic seeding from a distant site, particularly in pts w/ DM, IVDU, and immsup (e.g. HIV infection). Sports (RH) RH Anat
8711 Collagen types Type I collagen is the most prevalent collagen in the human body and is the 1° collagen in mature scars. Cardiovascular (CV) Histology (Hist) 1 CV Hist
8754 Smoking cessation Varenicline is a partial agonist of nicotinic acetylcholine receptors. It can assist patients with cessation of tobacco use by reducing withdrawal cravings and attenuating the rewarding effects of nicotine. Pulmonary & Critical Care (PU) Pharmacology 1
(Phar) PU Phar
8802 Rheumatoid arthritis Rheumatoid arthritis is characterized by symmetric polyarthritis (involving the metacarpophalangeal and proximal interphalangeal joints) with prolonged morning stiffness and associated fatigue. Rheumatology, Orthopedics & Pathophysiology 9
Antibodies to citrullinated peptides/proteins have a high specificity for the condition. Sports (RH) (Patp) RH Patp
8857 Necrotizing soft tissue infections Necrotizing fasciitis is a severe infection of the subcutaneous tissue and deep fascia that is a surgical emergency. The infection is often polymicrobial, but monomicrobial cases due to Streptococcus Rheumatology, Orthopedics & Microbiology 1
pyogenes (group A strep) can also occur. S pyogenes is a pyrrolidonyl arylamidase (PYR)-positive, beta-hemolytic, Gram-positive cocci that grows in chains. Sports (RH) (Micr) RH Micr
8858 Skin and soft tissue infections Pseudomonas aeruginosa is a major pathogen in burn patients. Only a few specific penicillins (eg. ticarcillin, piperacillin) and cephalosporins (eg, ceftazidime, cefepime) have activity against it. Certain Dermatology (DE) Microbiology 8
aminoglycosides, fluoroquinolones (eg, ciprofloxacin, levofloxacin), and carbapenems (eg, imipenem, meropenem) are also effective. (Micr) DE Micr
8859 Vertigo Vertigo is a sensation of excessive motion compared to physical reality. It is most commonly due to dysfxn w/i the vestibular system. Nervous (NS) Pathology (Path) 1 NS Path
8869 Antiarrhythmic drugs Class 10 antiarrhythmics such as flecainide are potent sodium channel blockers that have increased effect at faster heart rates (use-dependence). This makes them more effective at treating Cardiovascular (CV) Pharmacology 12
tachyarrhythmias, but can also cause prolonged QRS duration (a proarrhythmic effect) at higher heart rates. (Phar) CV Phar
8873 Strongyloides S. stercoralis infec begins following skin penetration by filariform (infec) larva and can be Dx by finding rhabditiform (noninfec) larvae in the stool. Rhabditiform larvae can mature into filariform larva in Gastrointestinal & Nutrition (GI) Microbiology 1
the human HIT, precip an autoinfec cycle that occurs entirely w/i the affected indiv. This can result in a hyperinfec syndrome char by massive dissem of the organism, leading to MOD and septic shock. (Micr) GI Micr
8878 Narcolepsy Hypocretin-1 (orexin-A) and hypocretin-2 (orexin-B) are neuropeptides produced in the lateral hypothal that promote wakefulness and inhib REM sleep-related phenomena. Most pts who have narcolepsy Pregnancy, Childbirth & Behavioral 3
w/ cataplexy have undetectable lvls of hypocretin-1 in their CSF. Puerperium (PR) Science (Beha) PR Beha
8881 Chronic kidney disease When the GFR is normal, relatively large ↓ in GFR result in only small ↑ in serum creatinine. Conversely, when the GFR is significantly ↓, small decrements in GFR produce relatively large changes in Renal, Urinary & Electrolytes Physiology 8
serum creatinine. A good rule of thumb is that every time GFR halves, serum creatinine doubles. (RE) (Phys) RE Phys
8884 Diuretics and electrolyte imbalance TZD and loopDs cause significant volume depletion, activating the RAAS, which can lead to hypokalemia and meta alk. TZDs are more likely to cause hyponatremia and hypercalcemia; loop diuretics Renal, Urinary & Electrolytes Pharmacology 1
cause hypocalcemia. (RE) (Phar) RE Phar
8893 Iron deficiency anemia Pica is the compulsive consumption of a non-nutritive a/o non-staple food. It's common in preg and is often a/w IDA and other forms of nutritional defic. Pregnancy, Childbirth & Behavioral 7
8904 Accessory nipple Accessory nipples are the most common congenital breast anomaly resulting from failed regression of the mammary ridge in utero. They are usually asymptomatic but can become tender along with Dermatology (DE) Pathophysiology 1
breast tissue during times of hormonal fluctuation. (Patp) DE Patp
8930 Benign prostatic hyperplasia 5-α reductase inhibitors (eg, finasteride, dutasteride) block the conversion of testosterone to DHT in the prostate. These Rx ↓ prostate volume in pts w/ BPH and relieve the fixed component of bladder Male Reproductive (MR) Pharmacology 6
outlet obstruction. (Phar) MR Phar
8943 Opioids When abuse of prescription opioids is suspected, physicians should 1st engage pts in a non-judgemental, collaborative discussion to understand the reasons for the misuse. Pregnancy, Childbirth & Behavioral 13
8954 Opioids In the US, the majority of overdose deaths are caused by opioids, incl prescription analgesics and heroin. Pregnancy, Childbirth & Behavioral 13
9814 Suicide Access to firearms greatly ↑ the risk of completed suicide. Eval of a pt's access to guns is a key part of suicide risk Ax. Other interventions to ↓ suicide risk incl ↓ stress, ↑ psychosocial support, Tx psych Pregnancy, Childbirth & Behavioral 1
illness and substance use, and Mx pain. Puerperium (PR) Science (Beha) PR Beha
9920 Necrotizing enterocolitis NEC is 1 of the most common GI emergencies affecting newborns. It's characterised by bacterial invasion and ischemic necrosis of the bowel wall, and is a/w prematurity and initiation of enteral feeding. Gastrointestinal & Nutrition (GI) Pathology (Path) 1
Abdo XR showing pneumatosis intestinalis (i.e. air in the bowel wall confirms the Dx. GI Path
9989 Community acquired pneumonia Klebsiella is an encapsulated, lactose-fermenting, gram (-) bacillus that appears mucoid in culture. It causes pneumonia in individuals w/ impaired host defences, esp. pts w/ alcoholism. Klebsiella Pulmonary & Critical Care (PU) Microbiology 21
pneumonia is characterised by tissue necrosis and early abscess formation w/ production of thick, mucoid, blood-tinged sputum (currant jelly sputum). (Micr) PU Micr
10086 Beneficence The EMTALA was enacted by Congress to prevent hospitals from inappropriately transferring, discharging, or refusing to Tx indigent pts. All pts who Px to the ED must receive an appropriate screening Social Sciences (SS) Behavioral 1
medical Ex and stabilization of their condition, regardless of ability to pay. Science (Beha) SS Beha
10168 Scabies Scabies is a highly contagious disease that presents with an intensely pruritic rash (usually worse at night) in the flexor surfaces of the wrist, lateral surfaces of the fingers, and the finger webs. Patients Dermatology (DE) Microbiology 2
usually have excoriations with small, crusted, red papules scattered around the affected areas. Diagnosis is confirmed by skin scrapings from excoriated lesions that show mites, ova, and feces under light (Micr)
microscopy. DE Micr
10289 Physician patient communication Physicians should ask pts their preferred form of address. When in doubt, pts should be addressed formally unless they indicate otherwise when asked. Social Sciences (SS) Behavioral 11
10290 End of life care Pts w/ advanced metastatic ca or other terminal illnesses and a life expectancy of <6 months should be evaluated for hospice care. Social Sciences (SS) Behavioral 2
10362 Restless leg syndrome RLS is characterised by an uncomfortable sensation in the legs accompanied by an urge to move them. It's worse at rest and when falling asleep. DA agonists are the preferred Rx for Tx. Nervous (NS) Pharmacology 1
(Phar) NS Phar
10398 Treatment adherence IDing and Mx non-adherence is critical to improving outcomes for many chronic conditions, incl HTN. Creating an alliance by validating the pt's perspective and using an open-ended, non-judgemental Pregnancy, Childbirth & Behavioral 5
question is the most effective way to initiate a discussion. Puerperium (PR) Science (Beha) PR Beha
10399 Impaired colleague Physicians are ethically and legally obligated to report impaired colleagues in a timely manner. Reporting protects pt safety and can assist the impaired physician in receiving appropriate evaluation and Social Sciences (SS) Behavioral 1
Tx. Science (Beha) SS Beha
10401 Clostridium difficile infection C. difficile infec can be Tx w/ oral vancomycin or fidaxomicin. Fidaxomicin is a macrocyclic Abx that inhibs RNA pol. It’s bactericidal against C. difficile. Gastrointestinal & Nutrition (GI) Pharmacology 7
(Phar) GI Phar
10443 Attack rate The attack rate is the ratio of the number of people who contract an illness divided by the number of people who are at risk of contracting that illness. Biostatistics & EpInfectious Biostatistics 1
10449 Physician patient communication When confronting an angry patient, the physician should use a non-defensive, empathic approach that acknowledges the patient's anger and attempts to build a collaborative physician-patient relationship. Pregnancy, Childbirth & Behavioral 11
10452 Physician patient communication Physicians may become frustrated w/ a pt who's hopeless about Tx, often compelling them to refer the pt to a specialist. Empathising w/ the pt's frustration over past Tx failures can help build the Pregnancy, Childbirth & Behavioral 11
physician-pt relationship. Puerperium (PR) Science (Beha) PR Beha
10458 Physician patient communication Empiric Abx therapy for pts w/ uncomplicated URIs is c/i. Pts requesting Abx prescriptions should be educated in a non-judgemental manner about the lack of efficacy and AEs of Abx therapy. Pregnancy, Childbirth & Behavioral 11
10463 Abortion Physicians are not required to provide medical services that are against their personal beliefs. In such cases, the physician should provide referral to providers who will perform the requested procedure. Social Sciences (SS) Behavioral 3
10464 Ethical principles in healthcare Romantic and sexual relationships w/ current pts as well as former psych pts are always unethical. Relationships w/ former non-psych pts may be acceptable provided the physician-pt relationship is Social Sciences (SS) Behavioral 3
terminated well beforehand. Science (Beha) SS Beha
10465 Grief Transient behavioural disturbances are common in children after the death of a loved 1. Hallucinations of recently deceased relatives are part of a normal grief rxn and may not be indicative of major Pregnancy, Childbirth & Behavioral 3
psychiatric illness. Puerperium (PR) Science (Beha) PR Beha
10467 Myocardial infarction Leads I and aVL correspond to the lateral limb leads on ECG. Therefore, ST elevation or Q waves in these leads are indicative of infarction involving the lateral aspect of the left ventricle, which is Cardiovascular (CV) Anatomy (Anat) 18
supplied by the left circumflex artery. CV Anat
10468 Terminal illness Pts faced w/ terminal illness may experience stages of grief, including denial, anger, bargaining, depression, and acceptance. Denial that does not impair relationships or interfere w/ pt care should not be Social Sciences (SS) Behavioral 1
confronted. Science (Beha) SS Beha
10488 Informed consent Physicians must ensure the appropriate use of medical interpreters to promote adequate pt understanding and participation in the decision-making process. This is particularly important during the Social Sciences (SS) Behavioral 3
informed consent process. Science (Beha) SS Beha
10507 Medical errors Physicians should disclose Rx errors and provide an apology in a timely fashion regardless of whether harm has occurred. Social Sciences (SS) Behavioral 8
10508 Medical errors Root cause analysis is a quality improvement measure that identifies what, how, and why a preventable adverse outcome occurred. The first step involves collecting data mainly through interviewing Social Sciences (SS) Behavioral 8
multiple individuals involved in the steps leading to the outcome. Science (Beha) SS Beha
10509 Patient confidentiality Physicians must be cautious about discussing protected pt health information in public places, including public settings w/i the hospital, even w/ other medical personnel. Conversations regarding pts Social Sciences (SS) Behavioral 5
should be deferred to a later time when a more private setting can be arranged. Science (Beha) SS Beha
10510 Patient confidentiality The HIPAA protects health information by requiring verbal or written authorization for release of information. Family members who contact the physician for information about their relative should not Social Sciences (SS) Behavioral 5
be given any information about the pt w/o the pt's consent. Science (Beha) SS Beha
10532 Advance directives Advance directives take precedence over the wishes of family members. Physicians should respect patient autonomy and adhere to patients' wishes as outlined in advance directives. Social Sciences (SS) Behavioral 3
10533 Decision making capacity Parents' authority to make medical decisions for their children can be challenged in cases in which a child is at significant risk for harm. Physicians are justified in obtaining a court injunction to proceed Social Sciences (SS) Behavioral 5
w/ life-saving medical Tx of the child. Science (Beha) SS Beha
10534 Advance directives A health care proxy is a person legally designated to make medical decisions in the event the patient loses decision-making capacity. The proxy overrules all other possible surrogate decision makers, Social Sciences (SS) Behavioral 3
including family members. Science (Beha) SS Beha
10542 Decision making capacity In the absence of an AD and designated health care proxy, a family member of an incapacitated pt should be contacted to act as a surrogate decision maker, followed by a person who cares about and Social Sciences (SS) Behavioral 5
knows the pt's wishes. In an emergency, the physician can Tx an incapacitated pt w/o obtaining consent. Science (Beha) SS Beha
10545 Informed consent Informed consent should be obtained by a provider who has sufficient knowledge to give an accurate description of the intervention, the risks and benefits of Tx, and available alternative Tx and to answer Social Sciences (SS) Behavioral 3
all of the pt's questions. Science (Beha) SS Beha
10570 Study designs The unit of analysis in ecological studies is populations rather than individuals. Biostatistics & EpInfectious Biostatistics 6
10579 Risk, rate, prevalence, and Incidence corresponds to the number of new cases of a disease in a certain population at risk over a given time period. Prevalence is the total number of cases in the population over a given period. Biostatistics & EpInfectious Biostatistics 3
incidence Diseases (ID)emiology (BS) (Bios) BS Bios
10581 Somatic symptom disorder SSD is best Mx w/ regularly scheduled medical visits that aren't contingent on having active SSx. Unnecessary Dx testing and specialist referrals should be avoided. Pregnancy, Childbirth & Behavioral 1
10583 Penetrating abdominal trauma Occlusion of the portal triad can be used to distinguish the source of RUQ bleeding. If the bleeding subsides following occlusion, the source is likely to be the hepatic artery or portal vein. If hepatic Gastrointestinal & Nutrition (GI) Anatomy (Anat) 1
bleeding persists after occlusion, the IVC or hepatic veins are likely to be injured. GI Anat
10659 Intimate partner violence Pts experiencing intimate partner violence should be approached in a supportive, nonjudgmental, open-ended manner. A thorough safety Ax and development of an emergency safety plan are essential. Social Sciences (SS) Behavioral 1
10672 Meta analysis A meta-analysis groups results of several trials to ↑ statistical power and provide an overall pooled effect estimate. Biostatistics & EpInfectious Biostatistics 1
10930 Osteoporosis Long-term acid suppression with proton pump inhibitors may be associated with an increased risk of osteoporotic fractures, possibly due to decreased calcium absorption. Other medications associated Rheumatology, Orthopedics & Pharmacology 10
with an increased risk of osteoporosis include glucocorticoids, aromatase inhibitors, and anticonvulsants that induce cytochrome P450. Sports (RH) (Phar) RH Phar
10962 Urinary incontinence Stress incontinence is due to loss of pelvic floor support and incompetence of the urethral sphincter. Increased abdominal pressure (eg, coughing, sneezing, or vigorous effort) greater than the urethral Renal, Urinary & Electrolytes Anatomy (Anat) 7
sphincter pressure can cause brief involuntary urine loss, which is virtually diagnostic of stress incontinence. (RE) RE Anat
10993 Actinomycosis Pulm actinomycosis develops most commonly following aspiration and can be confused w/ lung abscess, malignancy, or Tb. Micro findings incl filamentous, branching, gram (+) bacteria and sulphur Pulmonary & Critical Care (PU) Microbiology 2
granules. (Micr) PU Micr
10999 Antiemetics 5-HT3 receptor antags are useful for the Tx of visc nausea due to GI insults, such as GE, ChTx, and gen anes. Antihists and antichols are recom for vestibular nausea. DA antags are useful for nausea a/w Gastrointestinal & Nutrition (GI) Pharmacology 1
migraine. (Phar) GI Phar
11038 Urinary incontinence Patients with multiple sclerosis most commonly develop urge incontinence due to loss of central nervous system inhibition of detrusor contraction in the bladder. As the disease progresses, the bladder can Renal, Urinary & Electrolytes Pathophysiology 7
become atonic and dilated, leading to overflow incontinence. (RE) (Patp) RE Patp
11040 Urinary incontinence Diabetic autonomic neuropathy is common in type 1 diabetics and can cause overflow incontinence due to inability to sense a full bladder and incomplete emptying. PVR testing w/ US or catheterization Renal, Urinary & Electrolytes Pathophysiology 7
can confirm inadequate bladder emptying. (RE) (Patp) RE Patp
11064 Kidney transplantation Acute renal allograft rejection can be an antibody-or cell-mediated process. Acute cellular rejection is associated with diffuse lymphocytic infiltration of the renal vasculature (endotheliitis), tubules, and Renal, Urinary & Electrolytes Pathophysiology 1
interstitium. (RE) (Patp) RE Patp
11105 Primary hypertension Health promotion, according to the WHO, is "the process of enabling people to ↑ control over their health and its determinants, and thereby improve their health." Biostatistics & EpInfectious Biostatistics 14
11377 Dengue fever The Aedes aegypti mosquitoes can transmit the viruses that cause DF and chikungunya. Classic DF Px as an acute febrile illness w/ h/a, retro-orbital pain, and joint and muscle pain. Chikungunya is a Infectious Diseases (ID) Microbiology 2
febrile illness w/ flu-like SSx, prominent polyarthralgias, and diffuse macular rash. (Micr) ID Micr
11395 Dengue fever Dengue viruses are ssRNA viruses w/ 4 diff serotypes. 1° (1st) infection can be aSSx or cause a self-limited disease in most adults. 2° infection is due to infection w/ a diff viral serotype and usually Infectious Diseases (ID) Microbiology 2
causes more severe illness. (Micr) ID Micr
11456 Leukocytosis LR is a benign leucocytosis (>50k/mm3) that occurs in response to an underlying condition such as severe infection/hemorrhage, malignancy (e.g. leukaemia), or acute hemolysis. LAP lvls are normal or Hematology & Oncology (HO) Pathology (Path) 1
↑. peri smear can show ↑ bands, early mature neutrophil precursors (e.g. myelocytes), and granules (e.g. Dohle bodies) in the neutrophils. HO Path
11458 Spasticity Baclofen, an agonist at the GABA-B receptor, is effective as monoThx for the Tx of spasticity 2° to both brain and spinal cord disease, including MS. Tizanidine, an α-2 adrenergic agonist, is also Nervous (NS) Pharmacology 1
effective and commonly used. (Phar) NS Phar
11459 Clostridium difficile infection Clostridium difficile requires additional contact precautions, including handwashing w/ soap and water, a gown for any pt contact, and nonsterile gloves that should be changed after contact w/ Infectious Diseases (ID) Microbiology 7
contaminated secretions. Alc-based hand sanitizers do not kill the bacterial spores. (Micr) ID Micr
11462 Parkinson disease Nigrostriatal degen in Parkinson disease ↓ activity of the thalamus and its projections to the cortex, resulting in bradykinesia and rigidity. Pts w/ medically intractable SSx of Parkinson disease may benefit Nervous (NS) Pathology (Path) 7
from high-freq deep brain stimulation of the globus pallidus internus (GPi) or subthalamic nucleus (STN) as it promotes thalamo-cortical disinhib w/ improved mobility. NS Path
11464 Urinary incontinence Patients with multiple sclerosis often develop a spastic bladder a few weeks after developing an acute lesion of the spinal cord. These patients present clinically with increased urinary frequency and urge Renal, Urinary & Electrolytes Pathophysiology 7
incontinence. Urodynamic studies show the presence of bladder hypertonia. (RE) (Patp) RE Patp
11502 Melanocytic nevus Compound naevi are benign proliferations of melanocytes that involve both the dermis and epidermis. The lesions appear as slightly raised papules w/ uniform pigmentation and symmetrical sharp Dermatology (DE) Pathology (Path) 1
borders. DE Path
11514 Infection control HH is the single most important measure to ↓ the risk of transmission of hospital-acquired infections. Infectious Diseases (ID) Microbiology 3
(Micr) ID Micr
11515 Medical errors Risk of wrong-site surgery can be reduced by requiring "dual identifiers" (usually a nurse and physician) to independently confirm that they have the correct patient, site, and procedure. Checks must be General Principles (GP) Behavioral 8
truly independent to ensure patient safety. Science (Beha) GP Beha
11516 Urinary tract infection Urinary tract infections (UTIs) are common in hospitalized patients with indwelling urinary catheters. The risk for UTI can be reduced by avoiding unnecessary catheterization, using sterile technique Renal, Urinary & Electrolytes Pathophysiology 12
when inserting the catheter, and removing the catheter as soon as possible. (RE) (Patp) RE Patp
11518 Physician patient communication Physicians should remain alert to pts w/ a low level of literacy as this can often impair communication and result in low-quality medical care and poor adherence. Alternate learning methods (eg, visual Social Sciences (SS) Behavioral 11
resources) should be used to address this challenge. Science (Beha) SS Beha
11524 Babesiosis Babesiosis should be considered in pts w/ febrile illness who reside in geographic areas where they're exposed to Ixodes ticks. Dx can be established w/ the ID of intraerythrocytic organisms on peri blood Infectious Diseases (ID) Microbiology 2
smear. (Micr) ID Micr
11525 Tuberculosis IGRAs test for LTBI by measuring the amount of IFN-γ released by T lymphocytes when exposed to Ags unique to M. tuberculosis. Allergy & Immunology (AI) Microbiology 18
(Micr) AI Micr
11531 Medical errors Physicians must be able to identify pts w/ limited English proficiency and ensure that professional interpreters are made available in high-risk clinical situations. Miscellaneous (Multisystem) Behavioral 8
(MS) Science (Beha) MS Beha
11532 Medical errors Sleep deprivation in physicians often causes cognitive impairment, resulting in medical errors. Although mandated resident work-hr limitations are in place, it is the responsibility of all physicians to self- Miscellaneous (Multisystem) Behavioral 8
regulate their workloads to promote pt safety. (MS) Science (Beha) MS Beha
11533 Polypharmacy Falls are a common problem in elderly nursing home patients. Optimal management includes a careful medication review with the goal of limiting the use of agents associated with increased fall risk. Miscellaneous (Multisystem) Behavioral 1
11534 Treatment adherence Effective d/c planning requires collaboration of multiple disciplines (physician, nurse, social worker). A social worker can be instrumental in Ax whether the pt has adequate family or caregiver support at Miscellaneous (Multisystem) Behavioral 5
home. (MS) Science (Beha) MS Beha
11535 Medical errors Avoiding the use of unsafe abbreviations and trailing zeros in Rx orders can help ↓ the incidence of Rx errors. Miscellaneous (Multisystem) Behavioral 8
11536 Treatment adherence Pts' misunderstanding of Rx use can result in Rx errors, including potential overdose, toxicity, and withdrawal. Physicians must Ax the pt's understanding and provide targeted education to address Miscellaneous (Multisystem) Behavioral 5
misconceptions. (MS) Science (Beha) MS Beha
11537 Antihistamines Review of Rx to determine if any are unnecessary or causing AEx is essential in providing high-quality pt care. The cumulative anticholinergic burden of multiple Rx is especially problematic in the Miscellaneous (Multisystem) Behavioral 3
elderly. (MS) Science (Beha) MS Beha
11540 Babesiosis Babesiosis and Lyme disease are transmitted by the Ixodes tick and occur in similar geographic regions. Coinfection is common. Infectious Diseases (ID) Microbiology 2
(Micr) ID Micr
11547 Animal and human bite injuries P. multocida is a cause of soft-tissue infection that develops w/i 24hrs following a dog or cat bite. Mx incls wound care and Abx targeted against this organism. Infectious Diseases (ID) Microbiology 1
(Micr) ID Micr
11548 Cytomegalovirus CMV oesophagitis can occur in transplant pts and usually presents w/ odynophagia or dysphagia that can be accompanied by fever or burning chest pain. Endoscopy typically shows linear and shallow Gastrointestinal & Nutrition (GI) Pathology (Path) 9
ulcerations in the lower oesophagus, and histo usually shows enlarged cells w/ intranuclear inclusions. GI Path
11549 Patient safety Health care providers working on a team should employ closed-loop communication, in which team members repeat back the information received to ensure that the correct information has been Social Sciences (SS) Behavioral 1
conveyed. This highly effective form of communication ↓ the risk of medical errors in the health care setting. Science (Beha) SS Beha
11550 Treatment adherence A d/c checklist detailing Rx changes and f/u appointments can significantly facilitate a pt's transition from the hospital and improve adherence to outPt Tx. Individuals who experience a smooth transition Miscellaneous (Multisystem) Behavioral 5
from the inPt to the outPt setting are at ↓ risk for early rehospitalization. (MS) Science (Beha) MS Beha
11551 Cytomegalovirus The most common eye-related complication of congenital CMV infection is chorioretinitis. Ophthalmology (OP) Microbiology 9
(Micr) OP Micr
11564 Osteoporosis Bisphosphonates have a chemical structure similar to that of pyrophosphate and attach to hydroxyapatite binding sites on bony surfaces to inhibit bone resorption by osteoclasts. Rheumatology, Orthopedics & Pharmacology 10
11565 Diabetes mellitus SUs (e.g. glyburide, glimepiride) ↑ insulin secretion by pancreatic β cells independent of BGC. These Rx have a high incidence of hypoglycaemia, esp. in the elderly. Endocrine, Diabetes & Pharmacology 31
11567 Drug interaction The Beers criteria identify drugs that should be used with caution in geriatric patients. Common drugs to avoid include anticholinergics (eg, first-generation antihistamines), alpha blockers, tricyclic General Principles (GP) Pharmacology 2
antidepressants, benzodiazepines (and other sedating medications), antipsychotics, most antiarrhythmics, and skeletal muscle relaxants. (Phar) GP Phar
11568 HIV HIV-assoc dementia should be suspected in pts w/ AIDS who have progr cognitive decline. The char histopath finding is microglial nodules (groups of activated microglia/macrophages around small Nervous (NS) Pathology (Path) 11
areas of necrosis) and multinucleated giant cells. NS Path
11574 Traumatic brain injury Damage to the brainstem at/below the level of the red nucleus (eg, midbrain tegmentum, pons) typically results in decerebrate (extensor) posturing. In contrast, damage to neural structures above the red Nervous (NS) Pathology (Path) 5
nucleus (eg, cerebral hemispheres, IC) typically results in decorticate (flexor) posturing. NS Path
11576 Ischemic stroke WD refers to the process of axonal degeneration and breakdown of the myelin sheath that occurs distal to a site of injury. Axonal regeneration does not occur in the CNS due to the persistence of myelin Nervous (NS) Pathology (Path) 19
debris, secretion of neuronal inhibitory factors, and development of dense glial scarring. NS Path
11577 Alcohol use disorder The opioid antagonist naltrexone is a 1st-line Rx for mod-to-severe alcohol use disorder, and works by preventing the reinforcing effects of alcohol use. Pregnancy, Childbirth & Pharmacology 3
11584 Multiple myeloma In MM, neoplastic plasma cells synthesise large amount of monoclonal Ig or Ig fragments. These cells are particularly susceptible to proteasome inhib due to the large amount of proteins that they Hematology & Oncology (HO) Pharmacology 9
manufacture. The resulting accumulation of tox intracellular and pro-apoptotic proteins ↑ cellular apoptosis. (Phar) HO Phar
11585 Trastuzumab Human epidermal growth factor receptor 2 (HER2) is a tyrosine kinase receptor that is overexpressed in 20% of breast cancer patients. In such patients, HER2 blockade with the monoclonal antibody Hematology & Oncology (HO) Pharmacology 1
trastuzumab downregulates cellular proliferation and promotes apoptosis. (Phar) HO Phar
11586 Child and adolescent mental health Adolescence often involves some degree of moodiness, intense self-consciousness, and transient emotional outbursts. Ax of severity, persistence, and degree of social and academic impairment can help Pregnancy, Childbirth & Behavioral 1
diffiate normal adolescent behaviour from behavioural changes during further evaluation. Puerperium (PR) Science (Beha) PR Beha
11587 Bipolar disorder Patients who experience major depressive and hypomanic episodes are diagnosed with bipolar II disorder. In contrast to manic episodes, hypomanic episodes are less severe, do not involve psychosis, and Pregnancy, Childbirth & Behavioral 7
cause a lesser degree of functional impairment. Puerperium (PR) Science (Beha) PR Beha
11590 Antiretroviral therapy Abacavir HSR occurs in 2-8% of pts and is strongly a/w the HLA-B*57:01 allele. Infectious Diseases (ID) Pharmacology 7
(Phar) ID Phar
11591 Gastroesophageal reflux disease New-onset odynophagia in the setting of chronic GORD should raise suspicion for erosive oesophagitis w/ oesophageal ulcers. Dx is made by upper endoscopy. Gastrointestinal & Nutrition (GI) Pathophysiology 7
(Patp) GI Patp
11592 Oppositional defiant disorder ODD is a behavioural disorder of childhood characterised by argumentative and defiant behaviour toward authority figures. It doesn't involve the more severe violations of the basic rights of others seen in Pregnancy, Childbirth & Behavioral 1
CD. Puerperium (PR) Science (Beha) PR Beha
11593 Personality disorders BPD is characterised by a persistent pattern of unstable relationships, mood lability, and impulsivity. Individuals w/ this disorder may exhibit suicidal ideation or behaviour in the context of an Pregnancy, Childbirth & Behavioral 6
interpersonal crisis in which they feel rejected or abandoned. Puerperium (PR) Science (Beha) PR Beha
11594 Personality disorders Individuals w/ PPD exhibit a lifelong pattern of pervasive suspicion and distrust. Unlike pts w/ psychotic disorders, they don't have fixed delusions and other psychotic SSx. Pregnancy, Childbirth & Behavioral 6
11595 Translation Short non-coding RNA sequences (eg, microRNA and small interfering RNA) induce posttranscriptional gene silencing by base-pairing with complementary sequences within target mRNA molecules. General Principles (GP) Biochemistry 1
(Bioc) GP Bioc
11596 Acute parotitis Acute bacterial parotitis occurs more commonly in elderly postoperative patients who are intubated or dehydrated. Staphylococcus aureus is the most common bacterial etiology. Diagnosis can be Infectious Diseases (ID) Microbiology 1
confirmed by imaging and an elevated serum amylase level (with a normal serum lipase level and no evidence of pancreatitis). (Micr) ID Micr
11602 Health insurance Medicare is a federal socialized medical insurance program that covers individuals age 65 and older who have a work Hx and younger individuals w/ disabilities. Miscellaneous (Multisystem) Behavioral 3
11603 Specific phobia Exposure-based cognitive-behavioral therapy, in which patients are systematically confronted with their feared objects or situations, is the most effective long-term treatment for specific phobia. Pregnancy, Childbirth & Behavioral 1
11604 HSV infection The finding of multiple painful genital ulcers and constitutional SSx in a sexually active pt is highly suggestive of 1° genital HSV infection. Dx can be established by PCR testing, direct fluorescence Ab Infectious Diseases (ID) Microbiology 9
testing, viral culture, or Tzanck smear. (Micr) ID Micr
11605 Substance-induced psychotic Stimulant intoxication can present with paranoid ideation and must be differentiated from primary psychiatric disorders. Physical signs of stimulant intoxication include mydriasis, tachycardia, Pregnancy, Childbirth & Behavioral 1
disorder hypertension, and diaphoresis. Puerperium (PR) Science (Beha) PR Beha
11606 Personality disorders STPD is characterised by a long-standing pattern of eccentric behaviour, odd beliefs, perceptual distortions, and social anxiety despite familiarity. Pregnancy, Childbirth & Behavioral 6
11607 Bipolar disorder Pts experiencing a major depressive episode should be carefully screened for past manic episodes to r/o BD. Antidepressant monotherapy should be avoided in pts w/ BD due to the risk of precipitating Pregnancy, Childbirth & Behavioral 7
mania. Puerperium (PR) Science (Beha) PR Beha
11608 Thrombotic thrombocytopenic 1° TMA syndromes share common clinical and path features and result in platelet activation and diffuse microthrombosis in arterioles and caps. TMA syndromes present w/ hemolytic anaemia w/ Renal, Urinary & Electrolytes Pathology (Path) 3
purpura schistocytes, thrombocytopaenia, and organ injury (e.g. brain, kidneys, heart). (RE) RE Path
11609 Vestibular schwannoma Acoustic neuromas are Schwann cell-derived tumours that typically arise from the vestibular portion of CNVIII and are commonly located at the CPA (b/w the cerebellum and lateral pons). Pts usually Nervous (NS) Anatomy (Anat) 3
present w/ unilateral sensorineural hearing loss and tinnitus. NS Anat
11617 Depression Major depressive disorder (MDD) with psychotic features is a severe subtype of unipolar major depression characterized by symptoms meeting the criteria for MDD and the presence of delusions and/or Pregnancy, Childbirth & Behavioral 8
hallucinations. Puerperium (PR) Science (Beha) PR Beha
11618 Depression Suicide risk Ax incls consideration of both RFs and protective factors. A Hx of a previous suicide attempt is the strongest single RF for further attempts and completed suicide. Pregnancy, Childbirth & Behavioral 8
11619 Adjustment disorders Eval of depressive SSx occurring in response to psychosocial stressors must take into account the severity, duration, and degree of fxnal impairment. Mild or brief sadness w/o significant interference in Pregnancy, Childbirth & Behavioral 2
psychosocial fxning is consistent w/ normal sadness. Puerperium (PR) Science (Beha) PR Beha
11622 Depression Pts w/ sufficient depressive SSx are Dx w/ MDD even if there's a clear psychosocial stressor that precipitated the depression. Pregnancy, Childbirth & Behavioral 8
11624 Thrombotic thrombocytopenic TTP is 1 of several 1ary TMAs resulting in MAHA and thrombocytopenia, which are essential to the Dx. Plasma exchange therapy has prompted more rapid Dx and is life-saving. Hematology & Oncology (HO) Pathophysiology 3
purpura (Patp) HO Patp
11625 Thrombotic thrombocytopenic TTP results from impaired fxn of the vWF-cleaving protease ADAMTS13, resulting in uncleaved vWF multimers that are significantly more prothrombotic and cause diffuse microvascular thrombosis, Hematology & Oncology (HO) Pathology (Path) 3
purpura MAHA, and thrombocytopenia. HO Path
11626 Antibiotic resistance ESBLs can be produced by gram (-) bacteria, rendering cephalosporins and other β-lactam Abx inactive. These genes can be transmitted b/w organisms thru plasmid conjugation. Infectious Diseases (ID) Pharmacology 8
(Phar) ID Phar
11627 Hemangioma Cavernous hemangiomas are vascular malformations that occur most commonly w/i the brain parenchyma; they carry an ↑ risk of intracerebral hemorrhage and seizure. Nervous (NS) Pathology (Path) 6 NS Path
11628 Cholesteatoma Cholesteatomas are collections of squamous cell debris that form a mass behind the TM. Cholesteatomas can be congenital or may occur as an acquired 1° lesion or following infection, trauma, or Sx of Ear, Nose & Throat (EN) Pathophysiology 1
the middle ear. They can cause hearing loss due to erosion into auditory ossicles. (Patp) EN Patp
11629 Complementary and alternative Physicians should routinely ask their pts about the use of herbal preps and nutritional supplements and advise them on the quality, safety, and efficacy of these products. Pregnancy, Childbirth & Behavioral 1
medicine Puerperium (PR) Science (Beha) PR Beha
11630 Pertussis Pertussis should be considered in any adult who hasn't had updated vax boosters. The clinical presentation is a paroxysmal cough lasting >2wks that's a/w post-tussive emesis or inspiratory whoop after a Pulmonary & Critical Care (PU) Microbiology 3
severe coughing episode. (Micr) PU Micr
11631 Multiple sclerosis The pathogenesis of MS involves an AI response (T cell and Ab mediated) targeting oligodendrocytes and myelin in the CNS, leading to slowed nerve conduction w/ neuro deficits. Nervous (NS) Pathology (Path) 6 NS Path
11632 Hemorrhagic stroke Acute lesions to the cerebellar vermis typically cause truncal and gait ataxia due to impaired modulation of the medial-descending motor systems. Involvement of the lower vermis and the flocculonodular Nervous (NS) Pathology (Path) 3
lobe also causes vertigo/nystagmus due to dysregulation of the vestibular nuclear complex. NS Path
11633 Catheter related bloodstream The presence of central vascular catheter and receipt of parenteral nutrition are RFs for candidaemia. Candida display a morphology of branching pseudohyphae w/ blastoconidia. Infectious Diseases (ID) Microbiology 3
infection (Micr) ID Micr
11634 Dyslipidemia Ezetimibe ↓ intestinal absorption of chol. As a result, the amount of dietary chol reaching the liver ↓. To compensate, the liver ↑ LDL receptor expression, which draws chol out of the circulation. Endocrine, Diabetes & Pharmacology 11
11635 Compartment syndrome Acute compartment syndrome (ACS) is caused by increased pressure within fascial compartments of the limbs, leading to impaired perfusion. ACS can cause severe pain, myonecrosis, and nerve injury. Miscellaneous (Multisystem) Anatomy (Anat) 2
The anterior compartment of the leg, which contains the deep peroneal (fibular) nerve, is the most common site of ACS. (MS) MS Anat
11636 Atherosclerosis Atherosclerosis is a PPx process involving endothelial cell dysfxn, and it develops most rapidly in areas w/ bends and branch points that encourage turbulent blood flow. The lower abdo aorta and Cardiovascular (CV) Pathology (Path) 8
coronary arteries are the vascular beds most susceptible to atherosclerosis; they tend to develop atherosclerosis earliest in life and have the highest overall atherosclerotic burden. CV Path
11637 Aspergillosis Pts w/ profound and prolonged neutropenia are at especially high risk for viral and fungal infections. The most common fungal causes are Aspergillus and Candida species. Invasive pulm aspergillosis Px Infectious Diseases (ID) Microbiology 5
w/ some combination of fever, chest pain, cough, dyspnea, and hemoptysis. (Micr) ID Micr
11638 Nocardiosis Nocardia is a filamentous, branching, gram (+) bacteria that's partially acid-fast. It most commonly causes pneumonia and brain abscesses in immsup pts. Pulmonary & Critical Care (PU) Microbiology 1
(Micr) PU Micr
11640 Costochondritis Costosternal syndrome (costochondritis) usually occurs after repetitive activity and is characterised by pain that is reproducible w/ palpation and worsened w/ movement or changes in position. Cardiovascular (CV) Pathology (Path) 1 CV Path
11646 Polymyositis and dermatomyositis Polymyositis and dermatomyositis are characterized by symmetric proximal muscle weakness and are associated with antinuclear and anti-tRNA synthetase (anti-Jo-1) autoantibodies. Biopsy in Rheumatology, Orthopedics & Pathophysiology 5
polymyositis shows patchy endomysial inflammatory infiltrate (ie, direct invasion of individual muscle fibers), whereas dermatomyositis causes perifascicular inflammation (ie, localized around blood Sports (RH) (Patp)
vessels and the septa between muscle fascicles). RH Patp
11650 Meningitis Listeria is a relatively common foodborne illness a/w outbreaks after the consumption of contaminated food, particularly processed meats and dairy products. Healthy pts may develop gastroenteritis; pts Infectious Diseases (ID) Microbiology 17
w/ impaired cell-mediated immunity are at risk for invasive infection (e.g. sepsis, meningoencephalitis) and listeriosis in preg is a/w adverse foetal outcomes (e.g. foetal death, premature birth). (Micr) ID Micr
11652 Ovarian cancer Teratomas are the most common subtype of germ cell tumor. Ovarian teratomas occur most frequently in females age 10-30. They are divided into mature (cell lines of >1 germ layer, commonly Female Reproductive & Breast Pathology (Path) 9
including hair, teeth, and skin) and immature types. (FR) FR Path
11653 Hip fracture MAS is char by the triad of fibrous dysplasia of the bone, endocrine abns, and café-au-lait spots. The condition results from an activating mut in the G protein/cAMP/adenylate cyclase signalling pathway. Rheumatology, Orthopedics & Pathology (Path) 2
Sports (RH) RH Path
11657 Gynecomastia Gynecomastia is the devel of glandular breast tissue in males and is commonly seen in men receiving androgen deprivation therapy for prostate ca. Tamoxifen inhibs the effect of oestrogen on breast Endocrine, Diabetes & Pharmacology 3
tissue and can ↓ the risk of gynecomastia in these pts. Metabolism (ES) (Phar) ES Phar
11658 Testicular torsion Testicular torsion is due to twisting of the testis around the spermatic cord (containing the gonadal artery), which can eventually lead to ischemia. The gonadal arteries arise from the abdominal aorta. The Male Reproductive (MR) Anatomy (Anat) 1
right gonadal vein drains directly into the inferior vena cava while the left gonadal vein drains into the left renal vein. MR Anat
11659 Knee trauma Patella fractures are most commonly due to a direct impact to the anterior aspect of the knee. Signs include an acutely swollen knee, focal patella tenderness, inability to extend the knee against gravity, Rheumatology, Orthopedics & Anatomy (Anat) 4
and a palpable gap in the extensor mechanism. Sports (RH) RH Anat
11660 Hypocalcemia Postop hypocalcemia is common after thyroid Sx, due to inadvertent removal or dmg to the PT glands. The acute drop in PTH lvl results in ↓ Ca and PO4 resorption from bone and ↓ Ca reabs by the Endocrine, Diabetes & Physiology 1
kidneys. Metabolism (ES) (Phys) ES Phys
11661 Cirrhosis Tx for HE incl lactulose (↑ conversion of NH3 to NH4) and rifaximin (↓ intraluminal NH3 prod). Gastrointestinal & Nutrition (GI) Pharmacology 7
(Phar) GI Phar
11662 Erythema multiforme EM is a cell-mediated inflammatory disorder of the skin characterised by erythematous papules that evolve into target lesions. It's most commonly a/w HSV. Dermatology (DE) Pathology (Path) 2 DE Path
11663 Temporomandibular disorders Temporomandibular disorder is a/w dysfxn of the TMJ and hypersensitivity of the mandibular nerve (CN V3). This can result in pathologic contraction of the pterygoid muscles (eg, jaw pain/dysfxn) and Nervous (NS) Anatomy (Anat) 1
the tensor tympani in the middle ear (eg, ear pain, muffled hearing). NS Anat
11664 Hyperthyroidism Postop hypoparathyroidism w/ resultant hypocalcaemia is a common complication of thyroidectomy due to inadvertent injury or removal of the PT glands. Postop supplementation w/ oral Ca2+ and vitD Endocrine, Diabetes & Pharmacology 8
can be used to Tx and prevent postop hypocalcaemia. Metabolism (ES) (Phar) ES Phar
11665 Seizures IV benzos (e.g. lorazepam) are the initial DOC for SE. They work by enhancing the effect of GABA at the GABA-A receptor, leading to ↑ Cl- influx and suppression of AP firing. Nervous (NS) Pharmacology 8
(Phar) NS Phar
11667 Angioedema C1INH defic causes ↑ cleavage of C2 and C4 and results in inappropriate activation of the complement cascade. C1INH also blocks kallikrein-induced conversion of kininogen to bradykinin, a potent Allergy & Immunology (AI) Pathology (Path) 2
vasodilator a/w angioedema. AI Path
11668 Health insurance A HMO is an insurance plan w/ low monthly premiums, low copayments and deductibles, and low total cost for the pt. HMOs ↓ utilization by confining pts to a limited panel of providers, requiring Social Sciences (SS) Behavioral 3
referral from a PCP prior to specialist consultations, and denying payment for services that do not meet established guidelines. Science (Beha) SS Beha
11670 Neurocysticercosis Neurocysticercosis is a relatively common cause of seizures in pts from Central and South America and should be considered in pts w/ suggestive SSx and imaging (e.g. cystic brain lesion) and char Infectious Diseases (ID) Microbiology 1
epidemiological RFs. (Micr) ID Micr
11674 Ubiquitin proteasome pathway An essential step in the activation of the cellular immune response to a virus is the breakdown of intracellular viral proteins by the ubiquitin proteasome pathway. This pathway is initiated by ubiquitin General Principles (GP) Immunology 2
ligases, which recognize specific protein substrates and attach a ubiquitin tag. The target proteins are then degraded by a proteasome into peptide fragments, which are coupled with major (Immu)
histocompatibility complex class proteins and presented on the cell surface for surveillance by cytotoxic CD8+ lymphocytes. GP Immu
11675 Hypertensive retinopathy Severe hypertension in retinal precapillary arterioles causes endothelial disruption, leakage of plasma into the arteriolar wall, and fibrinous necrosis. The necrotic vessels can then bleed into the nerve fiber Ophthalmology (OP) Pathology (Path) 1
layer, which can be seen on examination as dot- or flame-shaped hemorrhages. OP Path
11676 Neuroleptic malignant syndrome NMS is a life-threatening rxn to antipsychotic Rx characterised by diffuse muscle rigidity, hyperthermia, autonomic instability, and altered sensorium. The antipsychotic should be stopped and supportive Nervous (NS) Pharmacology 2
care provided; dantrolene, a RyR blocker that inhibs Ca2+ release from the SR, is an effective antidote. (Phar) NS Phar
11677 Pharyngitis Opsonization occurs when host proteins such as Igs or complement bind to foreign cells such as bacteria and coat the surface, enhancing phagocytosis. The most important opsonins (coating proteins) are Allergy & Immunology (AI) Immunology 2
IgG and complement C3b. (Immu) AI Immu
11678 Serum drug levels and half-life The half-life (t[½]) of a drug is the time required to lower its concentration by 50%. The volume of distribution (Vd) refers to how well the drug distributes into tissues compared to plasma; the higher the General Principles (GP) Pharmacology 3
Vd, the greater the drug distribution into the tissues. The drug concentration (mg/L) is equal to drug dose (mg) divided by Vd (L). (Phar) GP Phar
11679 Brachial plexus The latissimus dorsi is a large thoracolumbar muscle that originates from the iliac crest and lumbar fascia to the spinous processes of T7-12 and lower ribs, and inserts at the bicipital groove of Rheumatology, Orthopedics & Anatomy (Anat) 6
thehumerus. It's innervated by the TDN. 1° fxns incl extension, adduction, and med. rotation of the humerus. Sports (RH) RH Anat
11680 Capsaicin Topical capsaicin causes defxnalisation of afferent pain fibres and depletion of substance P. Initial application results in a burning and stinging sensation, but chronic exposure leads to ↓ pain transmission. Nervous (NS) Pharmacology 1
(Phar) NS Phar
11681 Axillary nerve injury Injury to the axillary nerve most commonly occurs in the setting of shoulder trauma (e.g. anterior dislocation, humeral fracture) and presents w/ sensory loss over the lateral shoulder and weakness on Nervous (NS) Anatomy (Anat) 1
shoulder abduction (due to denervation of the deltoid muscle). NS Anat
11682 Synapse V-gated Na channels are important for the generation and propagation of APs. When the AP reaches the axon terminal, v-gated Ca channels open and allow the influx of Ca, which is essential for the Nervous (NS) Physiology 1
fusion and release of NT vesicles into the synaptic cleft. (Phys) NS Phys
11683 Carpal tunnel syndrome The CT is formed by the carpal bones and the transverse carpal ligament (flexor retinaculum). CTS results from compression of the median nerve as it passes thru the CT w/ 9 flexor tendons. Longitudinal Rheumatology, Orthopedics & Anatomy (Anat) 3
incision of the transverse carpal ligament can ↓ pressure w/i the CT, improving pts' SSx. Sports (RH) RH Anat
11684 Lateral epicondylitis Lat. epicondylitis (i.e. tennis elbow) is characterised by overuse of wrist extensor muscles (e.g. extensor carpi radialis, extensor digitorum), leading to angiofibroblastic tendinosis at their attachment on Rheumatology, Orthopedics & Anatomy (Anat) 1
the lat. epicondyle. Sports (RH) RH Anat
11685 Visual pathway Damage to the left temporal hemiretina will disrupt the transmission of visual information along the ipsilateral optic nerve, lateral optic chiasm, optic tract, lateral geniculate body, optic radiations, and 1° Nervous (NS) Anatomy (Anat) 5
visual cortex. NS Anat
11708 Urinary retention The bladder is extraperitoneal. In placement of a suprapubic cystostomy, the trocar and cannula will pierce the layers of the abdominal wall but will not enter the peritoneum. Renal, Urinary & Electrolytes Anatomy (Anat) 4
(RE) RE Anat
11709 Antibiotic resistance Aminoglycosides work by interfering w/ the 30S ribosomal subunit and causing the cell to misread mRNA, thereby halting protein synthesis. An important mech of resistance is the methylation of the Infectious Diseases (ID) Microbiology 8
aminoglycoside-binding portion of the ribosome, which inhibs the ability of aminoglycoside to interfere w/ protein translation. (Micr) ID Micr
11727 Sciatic neuropathy The piriformis passes through the greater sciatic foramen and is involved w/ external hip rotation. Muscle injury or hypertrophy can compress the sciatic nerve in the foramen, causing piriformis Rheumatology, Orthopedics & Anatomy (Anat) 2
syndrome. Sports (RH) RH Anat
11728 Ovarian cancer Vomiting is a reflex regulated mainly by 5 receptors, incl M1 muscarinic, D2 DA-ergic, H1 histaminic, 5-HT3 5-HT-ergic, and NK1 receptors. 5-HT3 and NK1 receptor antagonists are particularly useful Hematology & Oncology (HO) Pharmacology 9
for CTx-induced vomiting. (Phar) HO Phar
11729 Acyclovir The most effective Tx for HSV encephalitis is IV acyclovir; whose MOA is complete inhib of the viral DNA polymerase (synthesises viral DNA). Infectious Diseases (ID) Microbiology 4
(Micr) ID Micr
11730 Sinoatrial node The SA node consists of specialized PM cells located at the jxn of the RA and SVC. It is the site of earliest electrical activation in pts w/ sinus rhythm. Cardiovascular (CV) Anatomy (Anat) 1 CV Anat
11731 Venous thromboembolism Rivaroxaban is an oral anticoag that directly inhibs FXa. It's used in VTE and AF. Hematology & Oncology (HO) Pharmacology 2
(Phar) HO Phar
11732 Attention deficit hyperactivity ADHD is Chx by a pattern of inattention a/o hyperactivity/impulsivity that interferes w/ fxning in >2 settings. Pregnancy, Childbirth & Behavioral 5
disorder Puerperium (PR) Science (Beha) PR Beha
11737 Autism spectrum disorders ASD is characterised by impaired social communication/interactions and restricted, repetitive interests or behaviours. It can occur +/- language and intellectual impairment. Pregnancy, Childbirth & Behavioral 2
11738 Keloid TGF-β is critical for fibroblast migration, proliferation, and CT synthesis. ↑ TGF-β activity is responsible for the hypertrophic/keloid scarring and fibrosis of the lung, liver, and kidney that occur w/ Dermatology (DE) Pathology (Path) 2
chronic inflammation. DE Path
11739 Gallstone disease Medical therapy to dissolve cholesterol gallstones is an option in patients refusing cholecystectomy or with high surgical risk. Hydrophilic bile acids (eg, ursodeoxycholic acid) improve cholesterol Gastrointestinal & Nutrition (GI) Pharmacology 8
solubility by reducing the amount of cholesterol secreted into the bile and increasing biliary bile acid concentration. (Phar) GI Phar
11740 Adverse drug reaction Most adverse drug reactions are predictable and due to the known pharmacologic properties of the drug. Unpredictable reactions are less common and are due to genetic differences, immune interactions, General Principles (GP) Pharmacology 2
or other mechanisms. (Phar) GP Phar
11741 Thoracentesis A chest tube for drainage of pleural effusion is placed through the skin and subcutaneous fat into the 4th or 5th intercostal space in the anterior axillary or midaxillary line. The tube traverses through the Pulmonary & Critical Care (PU) Anatomy (Anat) 2
serratus anterior muscle, intercostal muscles, and parietal pleura. PU Anat
11742 Orbital fracture Fractures to the orbital floor commonly result from direct frontal trauma to the orbit. The infraorbital nerve runs along the orbital floor in a groove in the maxilla before exiting the skull just inferior to the Nervous (NS) Anatomy (Anat) 2
orbit. Dmg can result in paraesthesia of the upper cheek, upper lip, and upper gingiva. In addn, the IR muscle can also become entrapped, limiting vertical gaze. NS Anat
11743 Schizophrenia The antipsychotic clozapine is the DOC for Tx-resistance schizophrenia. Tx req monitoring of the absolute neutrophil count due to the risks of neutropaenia and agranulocytosis. Pregnancy, Childbirth & Behavioral 4
11744 Brachial plexus An interscalene nerve block is used to provide anaesthesia for the shoulder and upper arm by anaesthetising the upper brachial plexus (C5-C7) as it passes b/w the anterior and middle scalene muscles. Nervous (NS) Anatomy (Anat) 6
Anaesthetic also transverses along the interscalene sheath, freq resulting in transient ipsilateral diaphragmatic paralysis due to involvement of the phrenic nerve roots (C3-C5). NS Anat
11745 Chronic heart failure Neprilysin is responsible for the breakdown of the natriuretic peptides and AT-II; therefore, inhibition of neprilysin ↑ the activity of these peptides. For Tx of HF, neprilysin inhibition is combined w/ AT- Cardiovascular (CV) Physiology 12
II receptor blockade to optimize the (+) effects of the natriuretic peptides (eg, vasodilation, diuresis) while blocking the (-) effects of AT-II (eg, vasoconstriction, fluid retention). (Phys) CV Phys
11746 Cocaine Cocaine withdrawal is characterised by the devel of acute depression accompanied by fatigue, hypersomnia, hyperphagia, and vivid dreams. Pregnancy, Childbirth & Behavioral 3
11747 Prostate cancer The skeletal system is a common site of metastasis due to hematogenous seeding. Cancers of the pelvis, including the prostate, spread to the lumbosacral spine via the vertebral venous plexus, which in Male Reproductive (MR) Anatomy (Anat) 5
turn communicates with a number of venous networks, including the prostatic venous plexus. MR Anat
11749 Gout Xanthine oxidase (XO) catalyzes 1 of 2 major azathioprine-inactivating pathways. Allopurinol competitively inhibits XO, which results in increased conversion of azathioprine to its active metabolite. Rheumatology, Orthopedics & Pharmacology 11
11750 Hairy cell leukemia HCL is an indolent B-cell neoplasm predominantly found in middle-aged men and characterised by bone marrow failure and infiltrations into the RES, causing massive splenomegaly. Other typical Hematology & Oncology (HO) Pathology (Path) 1
features incl a 'dry tap' (unsuccessful bone marrow aspiration) and the presence of lymphocytes w/ cytoplasmic projections. HO Path
11751 Panic disorder PD involves recurrent, unexpected panic atks characterised by an abrupt surge of fear accompanied by physical and cognitive SSx. Individuals experience persistent worry about future atks and typically Pregnancy, Childbirth & Behavioral 4
restrict their activities as a result. Puerperium (PR) Science (Beha) PR Beha
11752 Theophylline Theophylline is an adenosine receptor antagonist and indirect adrenergic agent with a narrow therapeutic index. It is predominantly metabolized by the hepatic cytochrome oxidases. Inhibition of these Pulmonary & Critical Care (PU) Pharmacology 2
enzymes by concurrent illness (eg, infection with fever) or ingestion of certain drugs or substances (eg, ciprofloxacin) can raise serum theophylline concentrations and cause toxicity (eg, seizures, cardiac (Phar)
arrhythmias). PU Phar
11753 Spleen rupture Any abdo process (e.g. ruptured spleen, peritonitis, hemoperitoneum) irritating the phrenic nerve sensory fibres around the diaphragm can cause referred pain to the C3-C5 shoulder region (Kehr sign). Gastrointestinal & Nutrition (GI) Anatomy (Anat) 2 GI Anat
11754 Prostate cancer Imaging of bone mets assists in ca Dx. Bone mets are characterised as osteolytic or osteoblastic. Bony pain in an older man w/ osteoblastic lesions on imaging is highly suspicious for prostate ca. Hematology & Oncology (HO) Pathology (Path) 5 HO Path
11755 Resting membrane potential and A Rx that binds to and activates GABA-A receptors (or enhances their activity) will ↑ the conductance of Cl ions, leading to ↑ passive transport of Cl into the cell interior. This causes the membrane Nervous (NS) Physiology 5
action potential potential to become hyperpolarized (more (-) than the RMP) by approaching or reaching the equilibrium potential for Cl. (Phys) NS Phys
11756 Panic disorder PD is characterised by recurrent, unexpected panic atks and should be considered in young, healthy adults who come to the ED w/ unexplained chest pain. Pregnancy, Childbirth & Behavioral 4
11757 Medical errors Communication failures b/w physicians during pt handoffs are a major cause of medical errors and can be ↓ by use of a standardized handoff process including systematic sign-out notes. Social Sciences (SS) Behavioral 8
11758 Bipolar disorder BD-I is Dx in pts w/ >1 episodes of mania. Manic episodes are characterised by ↑/irritable mood, impulsivity, hyperactivity, ↓ need for sleep, pressure speech, and grandiosity and may occur w/ psych Pregnancy, Childbirth & Behavioral 7
features. Puerperium (PR) Science (Beha) PR Beha
11759 Social anxiety disorder SAD involves excessive fear of scrutiny or embarrassment in social or performance situations, resulting in significant distress and fxnal impairment. Pregnancy, Childbirth & Behavioral 2
11760 Hepatocellular cancer The celiac trunk is the first main branch of the abdominal aorta; it provides oxygenated blood to the spleen, stomach, liver, abdominal esophagus, and parts of the duodenum and pancreas. The proper Gastrointestinal & Nutrition (GI) Anatomy (Anat) 5
hepatic artery branches off the common hepatic artery from the celiac trunk and provides arterial blood supply to the liver. GI Anat
11761 Drug interaction Calcineurin inhib nephrotox w/ resultant impairment of renal fxn is the most significant AE of cyclosporine. CYP3A is responsible for cyclosporine meta in the small intestine and liver. Grapefruit juice Renal, Urinary & Electrolytes Pharmacology 2
inhibs this enzyme and incr the nephrotox of cyclosporine by incr circulating drug lvls (pharmacokinetic interaction). (RE) (Phar) RE Phar
11762 Superficial inguinal ring The superficial and deep inguinal rings are physiologic openings in the external abdominal oblique aponeurosis and the transversalis fascia, respectively. Surgical repair of an undescended testicle lodged Male Reproductive (MR) Anatomy (Anat) 1
in the inguinal canal involves reducing the testis through the superficial inguinal ring and fixing it in the scrotum (orchiopexy). MR Anat
11763 Central venous catheter The femoral triangle (lateral to medial) consists of the femoral nerve, femoral artery, femoral vein, and deep inguinal nodes/lymphatic vessels. Cannulation of the femoral vein should occur approximately Cardiovascular (CV) Anatomy (Anat) 2
1 cm below the inguinal ligament and just medial to the femoral artery pulsation. CV Anat
11764 Cardiac catheterization The optimal site for obtaining vascular access in the lower extremity during cardiac catheterization is the common femoral artery below the inguinal ligament. Cannulation above the inguinal ligament can Cardiovascular (CV) Anatomy (Anat) 2
significantly ↑ the risk of retroperitoneal hemorrhage. CV Anat
11765 Bacterial vaginosis Bacterial vaginosis is caused by a disruption of the vaginal bacteria flora and is Chx by a "fishy-smelling," thin, grayish vaginal d/c and clue cells on wet mount microscopy. Metronidazole and Female Reproductive & Breast Microbiology 3
clindamycin are the preferred Tx options. (FR) (Micr) FR Micr
11766 Urinary tract infection Escherichia coli are lactose-fermenting, indole-positive gram-negative rods that are an important cause of urinary tract infection in women. Infectious Diseases (ID) Microbiology 12
(Micr) ID Micr
11769 Appendicitis The iliohypogastric nerve provides sensation to the suprapubic and gluteal regions and motor fxn to the anterolateral abdominal wall muscles. Abdominal Sx (eg, appendectomy) can damage the nerve and Nervous (NS) Anatomy (Anat) 5
cause ↓ sensation a/o burning pain at the suprapubic region. NS Anat
11770 Giant cell arteritis Cell-mediated immunity is the primary mechanism underlying giant cell arteritis. The production of cytokines, in particular interleukin-6, is an important driver of this process and closely correlates with Rheumatology, Orthopedics & Pathophysiology 5
the severity of symptoms. Sports (RH) (Patp) RH Patp
11771 Hemorrhoids External hemorrhoids, which originate below the dentate line, are covered by modded squamous epithelium and have cutaneous (somatic) nervous innervation from the inf. rectal nerve, a branch of the Gastrointestinal & Nutrition (GI) Anatomy (Anat) 2
pudendal nerve. GI Anat
11772 Cranial nerve palsy The spinal accessory nerve is vulnerable to injury in the posterior triangle of the neck. Injury results in weakness of the trapezius muscle, which Px w/ drooping of the shoulder, impaired abduction of the Nervous (NS) Anatomy (Anat) 9
arm above horizontal (due to weakness in rotating the glenoid upward), and winging of the scapula. NS Anat
11773 Grief Normal grief presents w/ SSx similar to those of a major depressive episode. However, in normal grief, pervasive anhedonia, worthlessness, and suicidality aren't present. Pregnancy, Childbirth & Behavioral 3
11774 Pulmonary embolism The lungs are supplied by dual circulation from both the pulmonary and bronchial arteries. This collateral circulation can help protect against lung infarction due to pulmonary artery occlusion (ie, Pulmonary & Critical Care (PU) Pathophysiology 13
pulmonary embolism), as the bronchial circulation can continue to provide blood to the lung parenchyma. (Patp) PU Patp
11775 Appendicitis Appendicitis causes dull visceral pain at the umbilicus due to afferent pain fibres entering at the T10 lvl in the spinal cord. progr inflammation in the appendix irritates the parietal peritoneum and abdo Gastrointestinal & Nutrition (GI) Anatomy (Anat) 5
wall to cause more severe somatic pain shifting from the umbilicus to McBurney's point (2/3 of the distance from the umbilicus to the ASIS). GI Anat
11776 Rotator cuff The RC muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) all insert onto the humeral head, allowing them to stabilise the shoulder joint and move the arm at the shoulder. An Rheumatology, Orthopedics & Anatomy (Anat) 3
infraspinatus injury would result in shoulder pain and weak, painful ext. rotation of the arm against resistance. Sports (RH) RH Anat
11777 Anesthesia A femoral nerve block at the inguinal crease will anesthetize the skin and muscles of the anterior thigh (eg, quadriceps), femur, and knee. Nervous (NS) Anatomy (Anat) 9 NS Anat
11778 Thoracic outlet syndrome Thoracic outlet syndrome (TOS) is most often caused by compression of the brachial plexus as it passes through the scalene triangle, the space bordered by the anterior and middle scalene muscles and the Rheumatology, Orthopedics & Anatomy (Anat) 1
first rib. Symptoms typically include upper extremity numbness, tingling, and weakness that worsen with repetitive overhead arm movements. The presence of an anomalous cervical rib is a risk factor for Sports (RH)
TOS. RH Anat
11779 Radiculopathy The C5-C6 spinal nerves mediate the biceps and brachioradialis reflexes. Nervous (NS) Anatomy (Anat) 3 NS Anat
11780 Pulmonary blood flow PAOP is measured at the distal tip of the pulm artery catheter after an inflated balloon occludes blood flow through a pulm artery branch. It closely corresponds to LA and LV EDP. Cardiovascular (CV) Anatomy (Anat) 2 CV Anat
11781 Ureter injury The ureter can be injured during hysterectomy due to its close proximity to the uterine structures. The distal ureter may be severed during ligation of the uterine vessels because the ureter passes inferior Female Reproductive & Breast Anatomy (Anat) 3
and lateral to the uterine artery at the level of the internal cervical os prior to entering the bladder (eg, "water under the bridge"). (FR) FR Anat
11782 Appendicitis The teniae coli are 3 separate smooth muscle ribbons that travel longitudinally on the outside of the colon and converge at the root of the vermiform appendix. If the appendix cannot be identified by Gastrointestinal & Nutrition (GI) Anatomy (Anat) 5
palpation during an appendectomy, it can be located by following the teniae coli to their origin at the cecal base. GI Anat
11783 Epistaxis Epistaxis is commonly caused by irritation of the highly vascular mucosa at the anterior nasal septum. The anterior nasal septum contains the Kiesselbach plexus. The anterior ethmoidal, sphenopalatine, Ear, Nose & Throat (EN) Anatomy (Anat) 1
and superior labial arteries anastomose in this region. EN Anat
11784 Attention deficit hyperactivity Stim Rx are a 1st-line Tx for ADHD. They work by ↑ the availability of NE and DA in the prefrontal cortex. Pregnancy, Childbirth & Behavioral 5
11785 Adolescent adherence Adolescents have low Tx adherence rates due to issues w/ autonomy, rebellion against authority, ↑ self-consciousness, and a lack of understanding of potential risks. Peer behaviour has a strong influence Pregnancy, Childbirth & Behavioral 1
on adherence due to adolescents' desire to fit in w/ their social groups. Puerperium (PR) Science (Beha) PR Beha
11786 Transplant rejection Sirolimus binds to the immunophilin FKBP in the cytoplasm, forming a complex that binds and inhibits mTOR (mammalian target of rapamycin). Inhibition of mTOR signaling blocks IL-2 signal Renal, Urinary & Electrolytes Immunology 4
transduction and prevents cell cycle progression and lymphocyte proliferation. (RE) (Immu) RE Immu
11787 Alcohol use disorder Behavioural change often happens in 5 distinct stages: precontemplation (denial of the problem), contemplation (acceptance of the problem and thinking about change), prep (planning to make a change in Pregnancy, Childbirth & Behavioral 3
the near future), action (putting active changes into place), and maintenance (maintaining change over the long term). Puerperium (PR) Science (Beha) PR Beha
11789 Separation anxiety disorder SAD consists of excessive and distressing anxiety (>4wks in children, >6mos in adults) due to separation from attachment figures. Children w/ this disorder often experience physical SSx and nightmares. Pregnancy, Childbirth & Behavioral 1
11792 Factitious disorder Factitious disorder involves the conscious and deceptive feigning or self-production of physical or psychological SSx to obtain attn and medical care from health care personnel. Pregnancy, Childbirth & Behavioral 1
11793 Rheumatoid arthritis Long-standing RA can affect the cervical spine, causing vertebral misalignment (subluxation) that can affect the atlantoaxial joint. Extension of the neck during endotracheal intubation can worsen the Nervous (NS) Pathophysiology 9
subluxation, leading to acute compression of the spinal cord a/o vertebral arteries. (Patp) NS Patp
11795 Chronic pancreatitis The short gastric veins drain blood from the gastric fundus into the splenic vein. Pancreatic inflammation (e.g. pancreatitis, pancreatic ca) can cause a blood clot w/i the splenic vein, which can ↑ pressure Gastrointestinal & Nutrition (GI) Anatomy (Anat) 3
in the short gastric veins and lead to gastric varices only in the fundus. GI Anat
11796 Rett syndrome Rett syndrome is characterised by loss of speech and motor skill, deceleration of head growth, and stereotypically purposeless hand movements after a period of normal devel. It affects mainly girls and is Pregnancy, Childbirth & Behavioral 1
a/w muts in the MECP2 gene. Puerperium (PR) Science (Beha) PR Beha
11797 Wolff-Parkinson-White syndrome WPW pattern is characterised by a shortened PR interval, widening of the QRS complex, and slurred initial upstroke of the QRS complex (δ wave). It's caused by an accessory pathway that bypasses the Cardiovascular (CV) Pathophysiology 2
AV node, causing preexcitation of the ventricles. Pts w/ WPW pattern can develop SSx arrhythmia (e.g. AV re-entrant tachycardia) due to re-entry of electrical impulses thru the accessory conduction (Patp)
pathway. CV Patp
11798 SLE SLE is char by loss of immune self-tolerance w/ production of auto-Abs against nuclear Ags. Binding of auto-Abs to self Ags leads to deposition of ICs in tissues and consumption of complement. Rheumatology, Orthopedics & Pathology (Path) 7
Sports (RH) RH Path
11799 Ankle trauma Lat. ankle sprain is due to inversion of a plantar-flexed foot and most commonly involves the ant. talofibular ligament. Stronger forces can cause joint instability by injuring addnal ligaments. Rheumatology, Orthopedics & Anatomy (Anat) 1
Sports (RH) RH Anat
11800 Erectile dysfunction The prostatic plexus lies within the fascia of the prostate and innervates the corpus cavernosa of the penis, which facilitates penile erection. As a result, prostatectomy or injury to the prostatic plexus can Male Reproductive (MR) Anatomy (Anat) 3
cause erectile dysfunction. MR Anat
11801 Medial collateral ligament injury The medial collateral ligament resists force that pushes the knee medially. Increased laxity of the knee with the valgus stress test indicates injury to the medial collateral ligament. Rheumatology, Orthopedics & Anatomy (Anat) 1
Sports (RH) RH Anat
11802 Vulvovaginitis Trichomonas vaginitis is caused by a motile protozoan which can be seen on wet mount microscopy of vaginal d/c. It Px w/ yellow-green vaginal d/c and vaginal burning and is sexually transmitted. Female Reproductive & Breast Microbiology 1
(FR) (Micr) FR Micr
11803 Umbilical hernia Umbilical hernias are caused by a defect in the linea alba and Px as protrusions at the umbilicus that are soft, reducible, and benign. They can occur in isolation or in a/w other conditions, such as DS. Gastrointestinal & Nutrition (GI) Embryology 1
(Embr) GI Embr
11804 Brain herniation Expanding space occupying lesions w/i the temporal lobe can cause ↑ ICP w/ transtentorial herniation of the uncus. Uncal herniation often compresses the ipsilateral CNIII as it exits the midbrain, Nervous (NS) Anatomy (Anat) 2
resulting in CNIII palsy w/ a fixed pupil (e.g. due to preganglionic parasympathetic fibre dmg). NS Anat
11805 Polymyositis and dermatomyositis Dermatomyositis is characterized by proximal muscle weakness resembling polymyositis, with additional inflammatory features involving the skin (heliotrope rash, Gottron papules). Both Rheumatology, Orthopedics & Pathophysiology 5
dermatomyositis and polymyositis may occur alone or as a paraneoplastic syndrome associated with an underlying adenocarcinoma (eg, ovary, lung, pancreas). Sports (RH) (Patp) RH Patp
11806 Renal cell carcinoma Classic SSx of RCC incl hematuria, an abdo mass, flank pain, and weight loss. Hypercalcaemia and erythrocytosis are common PNP syndromes a/w RCC. Renal, Urinary & Electrolytes Pathology (Path) 8
(RE) RE Path
11807 Bulimia nervosa Tx options for bulimia nervosa incl nutritional rehab, CBT, and Rx w/ SSRIs. Fluoxetine is the DOC. Pregnancy, Childbirth & Behavioral 4
11809 Attention deficit hyperactivity ↓ appetite and insomnia are the most common AEs of psychostimulant Rx used to Tx ADHD. They're usually mild and can be Mx w/o stopping the Rx. Pregnancy, Childbirth & Behavioral 5
11810 Language disorder At age 2, children should have a vocab of 50-200 words and be using 2-word phrases. Parents' concerns about delayed milestones should be validated; they should be reassured that children often catch up Pregnancy, Childbirth & Behavioral 1
but may need help. Further eval and regular monitoring are req. Puerperium (PR) Science (Beha) PR Beha
11812 Urinary tract infection Enterococcus is an important cause of urinary tract infections. These organisms are gram-positive cocci in pairs and chains and, when grown on blood agar, they do not cause hemolysis (gamma Renal, Urinary & Electrolytes Microbiology 12
hemolytic). (RE) (Micr) RE Micr
11814 Learning disorders Learning disorders are characterised by difficulties w/ key academic skills (reading, writing, or math), resulting in performance well below expectations for age. Providers should consider a possible Pregnancy, Childbirth & Behavioral 1
learning disorder in any school-aged child w/ behavioural, academic, or social difficulties at school. Puerperium (PR) Science (Beha) PR Beha
11816 Sideroblastic anemia INH inhibs vit B6 PK, leading to vit B6 defic. Vit B6's active form is the cofactor for delta-ALA synthase, the enzyme that catalyzes the RLS of heme synth. Inhib of this step can result in sideroblastic Hematology & Oncology (HO) Biochemistry 1
anemia. (Bioc) HO Bioc
11817 Lymphatic drainage Lymphatic drainage of the rectum prox. to the anal dentate line occurs via the inf. mesenteric and int. iliac LNs. Areas distal to the dentate line drain 1arily into the inguinal nodes. Gastrointestinal & Nutrition (GI) Anatomy (Anat) 2 GI Anat
11818 Septic arthritis Synovitis is char by pain, erythema, swelling, and ↓ ROM in a joint. Acute synovitis may represent serious path (e.g. SA), esp. if accompanied by fever or leucocytosis; it should be eval urgently w/ Rheumatology, Orthopedics & Pathology (Path) 4
synovial fluid analysis. Sports (RH) RH Path
11819 Osgood-Schlatter disease The quadriceps muscle group is connected to the patella, which is attached to the tibial tubercle by the patellar ligament. Repetitive quadriceps contraction (e.g. jumping) in adolescents can result in OSD, Rheumatology, Orthopedics & Anatomy (Anat) 1
which is characterised by focal ant. knee pain and swelling due to chronic avulsion of the tibial tubercle. Sports (RH) RH Anat
11820 Urinary incontinence Stress urinary incontinence is defined as involuntary urine loss with increased intraabdominal pressure. Pelvic floor strengthening (eg, Kegel exercises) targets the levator ani to improve support around Female Reproductive & Breast Anatomy (Anat) 7
the urethra and bladder. (FR) FR Anat
11821 Rheumatoid arthritis RA causes progr joint destruction involving the hands, wrists, elbows, and knees. Cervical spine involvement can lead to spinal instability and cord compression. Rheumatology, Orthopedics & Pathology (Path) 9
Sports (RH) RH Path
11822 Roseola infantum HHV-6 infection (roseola) classically presents w/ fever for 3-5days f/b a truncal rash. It's also the most common cause of febrile seizures. Infectious Diseases (ID) Microbiology 1
(Micr) ID Micr
11823 Perineal lacerations The perineal body is a fibromuscular tissue between the urogenital and anal triangle. A midline episiotomy is a vertical incision from the posterior vaginal opening to the perineal body. It transects the Female Reproductive & Breast Anatomy (Anat) 1
vaginal submucosal tissue but not the external anal sphincter or the rectal mucosa. (FR) FR Anat
11824 Depersonalization disorder D/DD is a dissociative disorder involving recurrent episodes of feeling detached from 1's body or surroundings a/o feelings of unreality. Pregnancy, Childbirth & Behavioral 1
11825 Obsessive compulsive disorder OCD is characterised by persistent, unwanted thoughts (obsessions) and repetitive, time-consuming rituals (compulsions) that the individual feels driven to perform to alleviate anxiety. Pregnancy, Childbirth & Behavioral 2
11828 Conduct disorder Conduct disorder involves a persistent pattern of violating major societal norms or the rights of others. Behaviors include aggression toward people and animals, deceitfulness or theft, destruction of Pregnancy, Childbirth & Behavioral 1
property, and serious violation of rules. Puerperium (PR) Science (Beha) PR Beha
11829 Substance use disorders Physicians have a responsibility to ID SSx of potential drug-seeking behaviour and prescription drug misuse. This involves being alert to red flags (e.g. lost or stolen Rx, pain inconsistent w/ PEx) and Pregnancy, Childbirth & Behavioral 1
attempting to clarify Rx Hx by using prescription drug-monitoring programs or other info sources. Puerperium (PR) Science (Beha) PR Beha
11830 Lymphatic drainage In the lower extremities, the superficial lymphatic system is divided into medial and lateral tracks. The medial track runs up to the superficial inguinal lymph nodes, bypassing the popliteal nodes. General Principles (GP) Anatomy (Anat) 2
Consequently, lesions on the medial foot cause inguinal lymphadenopathy, whereas lateral lesions are more likely to cause lymphadenopathy in both the popliteal and inguinal areas. GP Anat
11831 Coronary artery disease The inferior epigastric artery is 1 of 2 branches of the external iliac artery and takes off immediately proximal to the inguinal ligament. It provides blood supply to the lower anterior abdominal wall as it Cardiovascular (CV) Anatomy (Anat) 4
runs superiorly and medially up the abdomen. CV Anat
11832 Retinal artery occlusion RAO is a cause of acute, painless, monocular vision loss. It is usually caused by TE complications of atherosclerosis traveling from the ICA and through the ophthalmic artery. Cardiovascular (CV) Anatomy (Anat) 1 CV Anat
11833 Myocardial infarction The dominant RCA perfuses both the inferior wall of the LV and the majority of the RV. Proximal occlusion can cause RV MI, which Px w/ hypotension (↓ CO) and distended jugular veins (↑ CVPs). Cardiovascular (CV) Pathophysiology 18
The lungs will be clear on auscultation and XR (lack of pulm edema) unless concomitant left-sided HF is also present. (Patp) CV Patp
11835 Autosomal recessive inheritance The Hardy-Weinberg equation can be used to estimate carrier frequency, disease frequency, and frequency of different genotypes if at least 1 of these values is known. Biostatistics & EpInfectious Genetics (Gene) 5
Diseases (ID)emiology (BS) BS Gene
11836 Nitrates Nitrates are primarily venodilators and increase peripheral venous capacitance, thereby reducing cardiac preload and left ventricular end-diastolic volume and pressure. Nitrates also have a modest effect Cardiovascular (CV) Pharmacology 7
on arteriolar dilation and cause a decrease in systemic vascular resistance and cardiac afterload. (Phar) CV Phar
11837 Coronary blood flow Coronary dominance is determined by the coronary artery supplying the PDA. The PDA originates from the RCA in approximately 70%-80% of pts (right dominant), both the RCA and LCX in 10%-20% Cardiovascular (CV) Anatomy (Anat) 9
(codominant), and the LCX in 5%-10% (left dominant). The dominant coronary artery supplies blood to the AV node via the AV nodal artery. CV Anat
11838 Panic disorder Rx of PD incls SSRIs and benzos. SSRIs are often preferred to benzos due to the lack of phys dependence and abuse potential. Pregnancy, Childbirth & Behavioral 4
11839 Aortic aneurysm The SMA and IMA are the 2 main vessels supplying the small and large intestines. They're connected by a pair of anastomoses: the marginal artery of Drummond, which is the principal anastomosis, and Gastrointestinal & Nutrition (GI) Anatomy (Anat) 6
the inconsistently present arc of Riolan (mesenteric meandering artery). GI Anat
11840 Hemorrhoids hemorrhoids results from abn distension of a portion of the anal AV plexus. The vascular components of internal hemorrhoids drain into the sup. rectal vein, which subseq drains into the IMV. Band Gastrointestinal & Nutrition (GI) Anatomy (Anat) 2
ligation of hemorrhoids cuts off their blood supply, causing them to degen. GI Anat
11841 Glaucoma Glaucoma is a form of optic neuropathy characterized by increased intraocular pressure associated with increased production or decreased outflow of aqueous humor. Topical prostaglandins (eg, Ophthalmology (OP) Pharmacology 3
latanoprost) increase outflow of aqueous via the uveoscleral pathway and are the preferred treatment for open-angle glaucoma. (Phar) OP Phar
11842 Atrial fibrillation AF is a/w ↑ risk of systemic TE. The LA appendage is the most common site of thrombus formation. Cardiovascular (CV) Anatomy (Anat) 5 CV Anat
11843 Dandy-Walker syndrome DWM is a developmental anomaly Chx by hypoplasia/absence of the cerebellar vermis and cystic dilation of the 4th ventricle w/ posterior fossa enlargement. Pts often Px during infancy w/ Nervous (NS) Pathology (Path) 1
developmental delay and progressive skull enlargement. Other features may include cerebellar dysfxn and NCH. NS Path
11844 Dyslipidemia Fibrates lower TG lvls by activating PPAR-α, which leads to ↓ hepatic VLDL production and ↑ LPL activity. Fish oil supplements containing high concentrations of ω-3 FAs ↓ TGs by ↓ production of Cardiovascular (CV) Pharmacology 11
VLDL and apoB. (Phar) CV Phar
11845 Obstructive sleep apnea Neuromuscular weakness of the oropharynx is involved in the pathophysiology of obstructive sleep apnea. Electrical stimulation of the hypoglossal nerve increases the diameter of the oropharyngeal Pulmonary & Critical Care (PU) Anatomy (Anat) 4
airway and decreases the frequency of apneic events. PU Anat
11846 Post-traumatic stress disorder First-line treatment for post-traumatic stress disorder includes trauma-focused cognitive-behavioral therapy and antidepressant medication. Selective serotonin reuptake inhibitors have the best evidence Pregnancy, Childbirth & Behavioral 3
for efficacy. Puerperium (PR) Science (Beha) PR Beha
11847 Medical errors A preventable adverse event is defined as injury to a patient due to failure to follow evidence-based best practice guidelines. General Principles (GP) Behavioral 8
Science (Beha) GP Beha
11848 Antipsychotics As a class, 2nd-gen antipsychotics are a/w meta AEs (e.g. weight gain, dyslipidaemia, hyperglycaemia, ↑ risk of DM). W/i the class, olanzapine and clozapine carry the greatest risk. Pregnancy, Childbirth & Behavioral 9
11849 Primary hypertension PRA is a measure of the amount of ATI generated per unit of time. It provides a useful Ax of the RAA axis. Factors that ↑ PRA incl low Na+ intake and anti-HTN Rx such as diuretics (e.g. Cardiovascular (CV) Pathophysiology 14
hydrochlorothiazide), ACEIs, and ARBs (e.g. valsartan). (Patp) CV Patp
11850 Anterior abdominal wall Horizontal transection of the rectus abdominis muscle must be performed w/ great caution as the inf. epigastric arteries enter this muscle at the lvl of the arcuate line. The inf. epigastric arteries below the Gastrointestinal & Nutrition (GI) Anatomy (Anat) 1
arcuate line are susceptible to injury (e.g. hematoma) due to lack of a supporting post. rectus sheath. GI Anat
11851 Mitral regurgitation Regurg flow into the LA in acute MR leads to ↑ LA pressure and ↑ LV EDV (preload). The low-resistance pathway also ↓ LV afterload w/ a resulting ↑ in EF but overall ↓ in forward SV. ↑ LA pressure Cardiovascular (CV) Pathophysiology 6
and ↓ CO result in pulm oedema and severe hypotension, respectively. (Patp) CV Patp
11852 Urticaria A # of Rx, incl opioids, radiocontrast agents, and some Abx (e.g. vancomycin), can trigger IgE-independent mast cell degran. Common SSx incl diffuse itching and pain, bronchospasm, and localized Dermatology (DE) Pathology (Path) 2
swelling (urticaria). DE Path
11854 Depression Most available antidepressants target the neurotransmission of 5-HT or NE, or both. Inhib of 5-HT reuptake by blocking the 5-HT transporter is the 1° MOA of SSRIs. Pregnancy, Childbirth & Behavioral 8
11855 Radial neuropathy Supracondylar humeral fractures commonly occur after hyperextension of the elbow as a result of a FOOSH. The radial nerve runs along the anterolateral aspect of the elbow and is the structure most Rheumatology, Orthopedics & Anatomy (Anat) 3
likely to be injured w/ anterolateral displacement of the prox. fracture fragment. The brachial artery runs w/ the median nerve on the anteromedial aspect of the elbow and will usually be spared in these Sports (RH)
pts (e.g. intact radial pulse). RH Anat
11858 Human papillomavirus Human papillomavirus infection of basal cervical cells can progress to premalignant and cancerous lesions. Cervical intraepithelial neoplasia refers to atypical squamous cells and is classified as low grade Female Reproductive & Breast Pathology (Path) 4
squamous intraepithelial lesions (if extending <1/3 of the epithelium) or high-grade squamous intraepithelial lesions (if extending beyond). Basement membrane breach signifies invasive disease. (FR) FR Path
11859 Q fever Q fever is a zoonotic infection that occurs in farm workers exposed to waste from cattle and sheep. Its causative agent is Coxiella burnetii. A patient with exposure to waste from farm animals who Infectious Diseases (ID) Microbiology 1
develops a nonspecific illness (myalgias, fatigue, fever (>10 days), retroorbital headache) with a normal leukocyte count, thrombocytopenia, and increased liver enzymes should be evaluated for acute Q (Micr)
fever infection. ID Micr
11860 Small intestinal bacterial Gastric bypass Sx can cause SIBO due to excessive bacterial proliferation in the blind-ended gastroduodenal segment. SIBO results in defic of most vits (B12, A, D, and E) and Fe, but ↑ production of Gastrointestinal & Nutrition (GI) Pathophysiology 1
overgrowth vitB9 and vitK. (Patp) GI Patp
11862 Meningitis The classic triad of fever, stiff neck, and AMS should raise suspicion for acute bacterial meningitis. Eval req prompt blood cultures, empiric Abx, and LP w/ CSF analysis. Nervous (NS) Microbiology 17
(Micr) NS Micr
11864 Gaucher disease Gaucher disease is an AR lysosomal storage disorder that's characterised by β-glucocerebrosidase defic and presents w/ pancytopaenia and HSM. Glucocerebroside accumulation leads to distended Hematology & Oncology (HO) Pathology (Path) 1
macrophages w/ a 'wrinkled tissue paper' appearance, aka Gaucher cells. HO Path
11866 Anxiety The DDx of anxiety incls medical conditions and substance-induced aetiologies (e.g. intox, withdrawal). 1° anxiety disorders aren't Dx when anxiety is caused by the phys effects of a medical condition Pregnancy, Childbirth & Behavioral 1
(e.g. hyperthyroidism) or drug. Puerperium (PR) Science (Beha) PR Beha
11868 Osteomyelitis Vertebral osteomyelitis should be suspected in patients with new or worsening back pain, fever, and recent endocarditis or bacteremia (especially Staphylococcus aureus). It should also be suspected if Rheumatology, Orthopedics & Microbiology 4
there are new neurologic findings and fever with or without back pain. MRI of the spine is preferred for diagnosis. Sports (RH) (Micr) RH Micr
11869 Paroxysmal nocturnal PNH is due to a gene defect that leads to uncontrolled complement-mediated hemolysis. The classic triad incls hemolytic anaemia (hemoglobinuria), pancytopaenia, and thrombosis at atypical sites. Hematology & Oncology (HO) Pathology (Path) 2
hemoglobinuria Chronic hemolysis can cause Fe deposition in the kidney (hemosiderosis). HO Path
11870 Erectile dysfunction Premature ejaculation is characterised by recurrent episodes of early ejaculation accompanied by a sense of lack of control. Eval of any sexual disorder req taking careful med and substance use Hx and Pregnancy, Childbirth & Behavioral 3
Ax psychosocial stressors and comorbid psych conditions. Puerperium (PR) Science (Beha) PR Beha
11872 Immunizations PCVs are strongly immunogenic in infancy due to both B and T cell recruitment. They provide higher, longer-lasting Ab titers relative to PPSVs. The PPSV is poorly immunogenic in infants due to their Allergy & Immunology (AI) Immunology 4
relatively immature humoral Ab response. (Immu) AI Immu
11874 Tourette syndrome Tourette syndrome is a common childhood neuropsych disorder characterised by both vocal and multi motor tics. These tics char wax and wane, can be suppressed temporarily, and are preceded by a Pregnancy, Childbirth & Behavioral 1
premonitory urge. Puerperium (PR) Science (Beha) PR Beha
11875 Normal child development Although children understand the concept of gender by age 4, it's normal for them to explore activities culturally a/w the opposite gender. In contrast, gender dysphoria is Dx when there's marked distress Pregnancy, Childbirth & Behavioral 2
a/w a prolonged and intense feeling that 1 is a diff gender from 1's birth sex. Puerperium (PR) Science (Beha) PR Beha
11885 Uterine fibroids Subserosal leiomyomas (fibroids) often cause irregular uterine enlargement, resulting in pelvic pressure. Fibroids arising from the posterior subserosal surface of the uterus can cause constipation due to Female Reproductive & Breast Anatomy (Anat) 1
pressure on the colon. (FR) FR Anat
11888 Labor management Gap junctions facilitate communication and coordination b/w cells and play an important role in labor contractions. Connexins are proteins that assemble into gap junctions and their density ↑ in the uterus Female Reproductive & Breast Histology (Hist) 1
before delivery in response to rising estrogen levels. (FR) FR Hist
11890 Intraductal papilloma Intraductal papilloma is a proliferation of papillary cells in a cyst wall or duct that may contain focal atypia. It is the most common cause of bloody nipple discharge and typically presents without breast Female Reproductive & Breast Histology (Hist) 1
masses or skin changes. (FR) FR Hist
11891 Placenta accreta Postpartum hemorrhage is an obstetric emergency and can result from abnormal placentation. Prior uterine surgery can impair decidualization, resulting in myometrial invasion by villous tissue and a Pregnancy, Childbirth & Pathology (Path) 1
placenta that is abnormally adherent to the myometrium (placenta accreta). Puerperium (PR) PR Path
11899 Delirium Delirium may MFx as acute changes in cognition and behaviour. When non-Rx interventions are ineffective, low-dose antipsychotics (e.g. haloperidol) are the Rx of choice to Tx the behavioural (e.g. Pregnancy, Childbirth & Behavioral 4
severe agitation) and psychotic MFxs of delirium. Puerperium (PR) Science (Beha) PR Beha
11900 Obesity Obesity, particularly morbid, central obesity, can cause a pattern of extrinsic restrictive PFTs. The most common indicator of obesity-related disease is a ↓ in ERV and FRC, but FEV1, FVC, and TLC are Pulmonary & Critical Care (PU) Pathophysiology 2
also typically ↓. (Patp) PU Patp
11901 Ovarian torsion Ovarian torsion typically involves twisting of the infundibulopelvic ligament, often due to the weight of a large adnexal mass. The resulting occlusion of the blood and nerve supply to the ovary results in Female Reproductive & Breast Anatomy (Anat) 1
severe, acute pelvic pain and ovarian ischemia. (FR) FR Anat
11904 Multifactorial inheritance Many freq encountered diseases (e.g. HTN, spinal bifida) display multifactorial inheritance, which involves the complex interaction of numerous genetic and environmental factors to determine General Principles (GP) Genetics (Gene) 1
phenotypically expression. Although the exact inheritance risk can't be determined, the closer a relative is to the affected person, the more likely the relative is to develop the trait. GP Gene
11908 Postpartum hemorrhage Postpartum hemorrhage is an obstetrical emergency. Bilateral ligation of the internal iliac artery can decrease uterine blood flow and control postpartum hemorrhage that is unresponsive to medical Female Reproductive & Breast Anatomy (Anat) 1
management (eg, uterine massage, uterotonic medications). (FR) FR Anat
11912 Ovarian cancer Telomerase is an RNA-dependent DNA polymerase that synthesizes telomeric DNA sequences that can replace the lost chromosomal ends of the telomeres. Cancer cells typically contain increased Hematology & Oncology (HO) Genetics (Gene) 9
telomerase activity to allow for continued proliferation. HO Gene
11913 Transcription Alt splicing is a process by which a single gene can code for various unique proteins by selectively incl or excl diff DNA coding regions (exons) into mature mRNA. General Principles (GP) Genetics (Gene) 7 GP Gene
11914 Mitochondrial disorders Mitochondrial dysfxn freq Px w/ myopathy, NS dysfxn, lactic acidosis, and ragged red fibers on muscle Bx. Mitochondrial myopathies due to mtDNA muts are inherited solely in a maternal fashion (i.e. General Principles (GP) Genetics (Gene) 4
maternal inheritence). Therefore, transmission occurs only thru affected females and never thru males. GP Gene
11916 Compartment syndrome As an antioxidant, superoxide dismutase neutralizes reactive oxygen species, preventing cell injury. In a pathologic state such as post-ischemic reperfusion, oxidative stress is high and reactive oxygen General Principles (GP) Biochemistry 2
species production exceeds the neutralizing capability of antioxidants, leading to increased cell damage and death. (Bioc) GP Bioc
11917 Triglyceride metabolism HSL is found in adipose tissue, where it fxns to drive the breakdown of stored TGs into FFAs and glycerol. During times of starvation, this enzyme provides substrates for hepatic GNG and ketone body Endocrine, Diabetes & Biochemistry 2
formation. Metabolism (ES) (Bioc) ES Bioc
11918 Beta oxidation Cytosolic acetyl-CoA carboxylase converts acetyl-CoA to malonyl-CoA during the rate-limiting step of de novo fatty acid synthesis. Malonyl-CoA also inhibits the action of mitochondrial carnitine Endocrine, Diabetes & Biochemistry 3
acyltransferase, thereby inhibiting beta-oxidation of newly formed fatty acids. Metabolism (ES) (Bioc) ES Bioc
11919 Amniotic fluid embolism AFE is a rare and catastrophic pregnancy complication that results from amniotic fluid entering the maternal circulation. Common signs of AFE include hypoxia, hypotensive shock, and DIC. Fetal Pregnancy, Childbirth & Pathophysiology 1
squamous cells are seen in the pulm vasculature during histologic evaluation. Puerperium (PR) (Patp) PR Patp
11920 Ovarian vein thrombosis Venous stasis and hypercoagulability from pregnancy in addition to endothelial damage from delivery can cause ovarian vein thrombosis in the puerperium. Symptoms include fever and localized Female Reproductive & Breast Anatomy (Anat) 1
abdominal or flank pain. Most thrombosis is right-sided and can extend to the inferior vena cava; however, left ovarian vein thrombosis can extend to the left renal vein. (FR) FR Anat
11925 Sympathomimetic agents Dobutamine is a β-adrenergic agonist w/ predominant activity on β1 receptors and weak activity on β2 and α receptors. Stimulation of β2 receptors leads to an ↑ production of cAMP and ↑ cytosolic Ca Cardiovascular (CV) Pharmacology 5
concentration. This facilitates the interaction b/w actin and myosin, resulting in ↑ myocardial contractility. (Phar) CV Phar
11926 Urinary incontinence A common SSx during pregnancy is stress urinary incontinence, which occurs due to ↑ IAP from the gravid uterus that exceeds the pressure point that maintains closure of the urethral valve. Pregnancy Female Reproductive & Breast Pathophysiology 7
hormones ↓ urethral tone and relax the pelvic floor muscles (levator ani, coccygeus), which maintain closure of the urethral valve. (FR) (Patp) FR Patp
11927 Chancroid Chancroid, due to Haemophilus ducreyi, Px as deep, painful (you "do cry" w/ H ducreyi) ulcers w/ ragged borders that are a/w a gray exudate and inguinal LAD. Dx is established by Gram stain and Infectious Diseases (ID) Microbiology 1
culture of the organism from a scraping of the ulcer base. (Micr) ID Micr
11929 Human papillomavirus Human papillomavirus (HPV) oncogenicity relies on the inhibitory effects of viral proteins E6 and E7 on cell cycle regulatory proteins p53 and Rb. This allows cells infected with HPV to undergo Female Reproductive & Breast Pathology (Path) 4
unchecked cellular proliferation and evasion of apoptosis, promoting genomic instability and malignant transformation. (FR) FR Path
11930 Lysosomal storage disorder Protein targeting is the process by which proteins with different intra- and extracellular fates reach their destination. Proteins destined for the lysosome require phosphorylation of specific mannose General Principles (GP) Biochemistry 1
residues to ensure proper transit through the Golgi apparatus. (Bioc) GP Bioc
11939 Metabolic acidosis Acidosis stimulates renal ammoniagenesis, a process by which renal tubular epithelial cells metabolize glutamine to glutamate, generating ammonium that is excreted in the urine and bicarbonate that is Renal, Urinary & Electrolytes Biochemistry 4
absorbed into the blood. This process is responsible for the vast majority of renal acid excretion in chronic acidotic states. (RE) (Bioc) RE Bioc
11945 Erythropoietin ESAs can substantially improve anemia SSx, avoiding the need for blood transfusions in CKD and dialysis pts. However, ESAs are a/w incr risk for HTN and TE events. Renal, Urinary & Electrolytes Pharmacology 1
(RE) (Phar) RE Phar
11949 Lead poisoning Lead poisoning can cause neurologic, gastrointestinal, renal, and hematologic complications. Although symptoms can be vague, lead poisoning should be suspected if these symptoms arise while residing Poisoning & Environmental Pathology (Path) 4
in a home built before 1978. Diagnosis is made by measuring the patient's blood lead level. Exposure (PO) PO Path
11950 Transcription Zn-finger motifs are composed of chains of AAs bound together around a Zn atom via linkages w/ cysteine and histidine residues. They recognise specific DNA seqs and are used by many TFs to bind Endocrine, Diabetes & Biochemistry 7
DNA and alter activity of target genes. Intracellular receptors that bind steroids, TH, and fat-soluble vits act directly as TFs and contain Zn-finger binding domains. Metabolism (ES) (Bioc) ES Bioc
11952 Fecal incontinence Stretch injury of the pudendal nerve may occur due to stress placed on the pelvic floor during labour. Pudendal nerve injury leads to weakness of the perineal musculature causing faecal and urinary Nervous (NS) Anatomy (Anat) 1
incontinence, perineal pain, and sexual dysfxn. NS Anat
11955 Nuclear factor kappa B Nuclear factor-kappa B (NF-kB) is a transcription factor with a critical role in the immune response to infection. NF-kB is normally present in the cytoplasm in a latent, inactive state bound to its inhibitor Miscellaneous (Multisystem) Pathology (Path) 1
protein, IKB. Extracellular substances such as lipopolysaccharide can initiate a signal cascade that results in the destruction of IKB and translocation of free NF-kB to the nucleus. (MS) MS Path
11956 AV node The AV node is located on the endocardial surface of the RA, near the insertion of the septal leaflet of the TV and the orifice of the coronary sinus. Cardiovascular (CV) Anatomy (Anat) 1 CV Anat
11960 Autosomal recessive inheritance SCA is an AR disease that results in recurrent episodes of anemia, jaundice, and painful swelling of the hands and feet. Offspring of carrier parents have a 25% chance of being affected and a 50% chance General Principles (GP) Genetics (Gene) 5
of being heterozyg carriers, resulting in a 75% change of inheriting at least 1 mut allele. GP Gene
11961 Abortion Septic abortion typically Px w/ fever, abdominal pain, uterine tenderness, a/o foul-smelling d/c after pregnancy termination. Common offending pathogens include Staphylococcus aureus and Escherichia Female Reproductive & Breast Microbiology 3
coli due to seeding of the uterine cavity during instrumentation. (FR) (Micr) FR Micr
11962 Tracheoesophageal fistula TEF/EA results from failure of the primitive foregut to appropriately divide into separate trachea and esophageal structures. Infants Px shortly after birth w/ excessive secretions and choking/cyanosis Gastrointestinal & Nutrition (GI) Embryology 1
during feeds. (Embr) GI Embr
11977 Chronic kidney disease CKD causes disordered mineralisation and bone meta that usually presents w/ hyperphosphataemia, 2° hyperparathyroidism, and ↓ calcitriol lvls. Pts can be aSSx or develop weakness, bone pain, and Renal, Urinary & Electrolytes Pathology (Path) 8
fractures. (RE) RE Path
11995 Brain tumors The cerebellar hemispheres are responsible for motor planning and coordination of the ipsilateral extremities via their connections w/ the lateral descending motor systems. Consequently, cerebellar Nervous (NS) Anatomy (Anat) 10
hemisphere lesions typically result in ipsilateral dysdiadochokinesia, limb dysmetria, a/o intention tremor. NS Anat
12007 Hemorrhagic stroke Spontaneous deep intracerebral hemorrhage is typically caused by hypertensive vasculopathy involving the small, penetrating branches of the major cerebral arteries. The most frequently affected Nervous (NS) Anatomy (Anat) 3
locations include the BG (putamen), cerebellar nuclei, thalamus, and pons. The putamen is supplied by the lenticulostriate arteries, which are deep, small vessel branches off the MCAs. NS Anat
12008 Seizures The 1° somatosensory cortex (postcentral gyrus) is responsible for processing all somatic sensory input from the contralateral side of the body. A focal onset seizure originating in this region of the Nervous (NS) Anatomy (Anat) 8
cerebral cortex often results in contralateral sensory disturbance (e.g. numbness, paraesthesia). NS Anat
12011 Alzheimer disease Inappropriate processing of amyloid precursor protein down the β- and γ-secretase pathway results in the production of β-amyloid. Insufficient clearance of β-amyloid can result in formation of Nervous (NS) Pathology (Path) 7
extracellular amyloid plaques, which are neurotoxic and thought to play a key role in the pathogenesis of AD. NS Path
12019 Sickle cell Sickle cell disease is the result of a missense mutation that causes valine to replace glutamic acid at position 6 in the hemoglobin beta-globin chain. RNA contains the pyrimidine base uracil, whereas Hematology & Oncology (HO) Genetics (Gene) 13
DNA contains the base thymidine. HO Gene
12023 Ischemic stroke Gerstmann syndrome results from damage to the angular gyrus of the dominant parietal lobe and is Chx by agraphia (inability to write), acalculia (inability to carry out mathematical calculations), finger Nervous (NS) Anatomy (Anat) 19
agnosia (inability to identify individual fingers on the hand), and left-right disorientation. NS Anat
12024 High altitude illness People traveling to elevations >2500 m (8000 ft) can develop high-altitude illness, characterized by hypobaric hypoxia with the potential to develop life-threatening cerebral and/or pulmonary edema. Key General Principles (GP) Physiology 3
adaptive responses to hypoxemia include hyperventilation to increase blood oxygenation and increased synthesis of 2,3-bisphosphoglycerate in erythrocytes (facilitating oxygen offloading into peripheral (Phys)
tissues). GP Phys
12025 Facial nerve The facial nerve (CN VII) exits the stylomastoid foramen and courses through the substance of the parotid gland, where it divides into its 5 terminal branches that innervate the muscles of facial Nervous (NS) Anatomy (Anat) 3
expression. Malignant tumors of the parotid gland often compress and disrupt the facial nerve and its branches, causing ipsilateral facial droop. NS Anat
12029 Cavernous sinus thrombosis Infection of the medial face, sinuses (ethmoidal or sphenoidal), or teeth may spread through the valveless facial venous system into the cavernous sinus, resulting in cavernous sinus thrombosis. Pts Nervous (NS) Anatomy (Anat) 1
typically Px w/ h/a, fever, proptosis, and ipsilateral deficits in CNs III, IV, VI, and V (ophthalmic and maxillary branches). NS Anat
12030 Spinal cord injury Brown-Séquard syndrome results from hemisection of the spinal cord. It is Chx by ipsilateral spastic paralysis (due to corticospinal tract injury), ipsilateral loss of tactile/vibratory/position sensation Nervous (NS) Anatomy (Anat) 1
(dorsal columns), and contralateral loss of pain and temperature sensation (spinothalamic tract) below the level of injury. NS Anat
12031 Vitamin B12 deficiency Neuro damage a/w vitamin B12 deficiency classically includes SCD of the dorsal columns (loss of position and vibration sensation, (+) Romberg sign) and lateral corticospinal tracts (spastic paresis). Nervous (NS) Anatomy (Anat) 9 NS Anat
12035 Syphilis The Romberg test is a test of proprioception in which pts are observed for unsteadiness as they stand w/ their feet close together, arms to the sides, and eyes closed. Failure to maintain this posture Nervous (NS) Anatomy (Anat) 9
indicates sensory ataxia, which may be caused by defects in the posterior column or peri nerves (e.g. tabes dorsalis, vitB12 defic). NS Anat
12046 Subclavian steal syndrome Subclavian steal syndrome occurs due to severe stenosis of the proximal SCA, which leads to reversal in blood flow from the contralateral vertebral artery to the ipsilateral vertebral artery. Pts may have Cardiovascular (CV) Anatomy (Anat) 1
SSx related to arm ischemia in the affected extremity (eg, exercise-induced fatigue, pain, paresthesias) or vertebrobasilar insufficiency (eg, dizziness, vertigo). CV Anat
12047 Malabsorption Crohn disease with ileal resection or extensive ileal involvement can cause bile acid malabsorption, which may lead to impaired absorption of fat-soluble vitamins (A, D, E, K). Vitamin K deficiency can Gastrointestinal & Nutrition (GI) Pathophysiology 4
result in impaired coagulation with easy bruising, large hematoma formation in deep tissues and joints (eg, hemarthrosis) after minor trauma, and prolonged bleeding after surgery. (Patp) GI Patp
12048 Immunotherapy The binding of PD-1 to 1 of its ligands (PD-L1) downregs the immune response by inhib Tc cells. Many types of ca evade immunodetection by incr. expression of PD-L1 on their surface. mAbs against Hematology & Oncology (HO) Immunology 2
PD-1 upreg the T cell response and promote tumor cell apoptosis. (Immu) HO Immu
12049 Colorectal cancer Activating mutations of the KRAS gene lead to constitutive activation of the EGFR pathway, promoting ↑ cell proliferation and growth. Tumors harboring these mutations are resistant to Tx w/ anti- Hematology & Oncology (HO) Pathology (Path) 15
EGFR drugs (eg, cetuximab, panitumumab). HO Path
12062 Short bowel syndrome SBS typically occurs in pts w/ massive small bowel resection a/o Crohn disease due to loss of intestinal absorptive surface area and a ↓ in intestinal transit time. Pts usually present w/ postprandial Gastrointestinal & Nutrition (GI) Pathology (Path) 1
voluminous diarrhoea and weight loss due to malabsorption. Loss of fxnal distal ileum may result in vitB12 defic. GI Path
12066 Enzyme kinetics Competitive inhibitors compete with substrate for active binding sites on enzymes. Additional substrate is required to achieve the same rate of reaction, increasing the measured value of the Michaelis General Principles (GP) Biochemistry 1
constant (Km). Competitive inhibitors do not affect enzyme function; therefore, maximal velocity (Vmax) is unchanged in their presence. (Bioc) GP Bioc
12068 Vitamin B12 deficiency Pernicious anaemia is an AI disease characterised by CD4+cell-mediated destruction of parietal cells. As parietal cells are destroyed, their ability to secrete HCl ↓, resulting in an ↑ intraluminal pH that Gastrointestinal & Nutrition (GI) Pathophysiology 9
leads to upregulation of gastrin secretion. Pts also develop vitB12 defic as a result of ↓ IF secretion. (Patp) GI Patp
12073 Spinal stenosis Spinal stenosis occurs most commonly in the lumbar region and presents w/ posture-dependent lower extremity pain, numbness/paraesthesia, and weakness. The most common cause is degen arthritis of Rheumatology, Orthopedics & Anatomy (Anat) 1
the spine, which results in narrowing of the spinal canal due to intervertebral disc herniation, ligamentum flavum hypertrophy, and osteophyte formation affecting the facet joints. Sports (RH) RH Anat
12081 Renal calculi Formation of uric acid kidney stones is promoted by low urine pH, which favours formation of insoluble uric acid over soluble urate ion. GI HCO3- loss due to chronic diarrhoea leads to chronic meta Renal, Urinary & Electrolytes Pathology (Path) 7
acidosis and production of acidic urine, promoting formation of uric acid stones. (RE) RE Path
12082 COPD Neutrophils, macrophages, and CD8+ T lymphocytes are the 1° mediators of disease in COPD. They secrete enzymes and proteases that cause and perpetuate both the alveolar destruction of emphysema Pulmonary & Critical Care (PU) Pathophysiology 16
and the mucus hypersecretion found in chronic bronchitis. (Patp) PU Patp
12083 Internuclear ophthalmoplegia INO is a disorder of impaired horizontal gaze caused by a lesion in the MLF. The affected eye (ipsilateral to the lesion) is unable to adduct while the contralateral eye is able to abduct (often w/ assoc Nervous (NS) Anatomy (Anat) 1
nystagmus). Convergence and the pupillary light reflex are preserved b/c these pathways bypass the MLF. NS Anat
12084 Spinal anatomy The optimal location for needle insertion during a LP is the L3/L4 or L4/L5 space as this is well below the spinal cord termination site (L1 in adults). The L4 vertebral body lies on a line drawn b/w the Nervous (NS) Anatomy (Anat) 1
highest points of the iliac crests. NS Anat
12100 Aging Aging is a/w steady decr in chest wall compliance but incr in lung compliance due to a loss of elastic recoil. This results in a marked incr in RV, a decr in FVC, and relatively unchanged TLC. Pulmonary & Critical Care (PU) Physiology 8
(Phys) PU Phys
12101 Hypercalcemia Multiple myeloma is associated with increased bone resorption due to the production of tumor related cytokines. This results in elevated serum calcium levels, which reduce parathyroid hormone (PTH) Renal, Urinary & Electrolytes Pathophysiology 5
production. Low PTH decreases renal calcium reabsorption (hypercalciuria), and, in combination with renal insufficiency, reduces 1,25-dihydroxyvitamin D synthesis. (RE) (Patp) RE Patp
12119 Anoxic brain injury The upper midbrain contains neural structures (e.g. CNII, pretectal nuclei, EWN, CNIII) that mediate the direct and consensual pupillary light reflex. Nervous (NS) Anatomy (Anat) 1 NS Anat
12141 COPD Supplemental O2 admin in pts w/ COPD can lead to ↑ CO2 retention (O2-induced hypercapnia), resulting in confusion and depressed consciousness. The major cause is reversal of hypoxic pulm Pulmonary & Critical Care (PU) Pathophysiology 16
vasoconstriction, which ↑ physiologic dead space as blood is shunted away from well-ventilated alveoli. (Patp) PU Patp
12144 Myocardial infarction Papillary muscle rupture is a life-threatening complication that typically occurs 3-5 days after MI and presents w/ acute MR and pulm edema. The posteromedial papillary muscle is supplied solely by the Cardiovascular (CV) Anatomy (Anat) 18
PDA, making it susceptible to ischemic rupture. CV Anat
12151 Aortic dissection The intimal tear in Stanford type A AD (involving the ascending aorta) usually originates in the sinotubular jxn whereas the intimal flap in Stanford type B AD usually starts near the origin of the left Cardiovascular (CV) Anatomy (Anat) 6
SCA. Dissections can propagate distally to the thoracoabdominal aorta. CV Anat
12155 Ischemic stroke PICA occlusion causes lateral medullary (Wallenberg) syndrome, Chx by vertigo/nystagmus, ipsilateral cerebellar signs, loss of pain/temperature sensation in the ipsilateral face and contralateral body, Nervous (NS) Anatomy (Anat) 19
bulbar weakness, and ipsilateral Horner syndrome. This condition can occur in the setting of cervical spine trauma w/ dissection of the vertebral artery. NS Anat
12175 Seizures Seizures can be classified as focal (partial) if they originate from a localized region of one cerebral hemisphere or generalized if they involve both hemispheres at onset. The MFx of focal seizure depend Nervous (NS) Pathology (Path) 8
on the brain region in which seizure activity is occurring. Focal seizure can be subclassified as simple if consciousness is preserved or complex if there is LOC. NS Path
12184 Pulmonary embolism V/Q scanning can be useful for Dx PE. A large perfusion defect w/o ventilation defect is the characteristic (+) test result. Pulmonary & Critical Care (PU) Pathophysiology 13
(Patp) PU Patp
12187 Endocarditis During the normal cardiac cycle, central aortic pressure is higher than RV pressure during systole and diastole. Consequently, an intracardiac fistula b/w the aortic root and RV will most likely Cardiovascular (CV) Physiology 15
demonstrate a left-to-right cardiac shunt as blood continuously flows from the aortic root (high pressure) to the RV (low pressure). (Phys) CV Phys
12198 Embryologic derivatives The spleen is a large, wedge-shaped lymphatic organ that is situated in the post sup portion of the left abdo cavity. It is derived from mesoderm in the dorsal mesentery during embryonic development. Gastrointestinal & Nutrition (GI) Embryology 2
(Embr) GI Embr
12225 Mosaicism Mosaicism is defined as the presence of multiple, genetically different cell lines w/i the body. It can result from several processes, including chromosomal nondisjunction or a mutation during the 1st Female Reproductive & Breast Genetics (Gene) 1
stages of embryonic development. Somatic mosaicism results in a mixture of normal and mutated somatic cells, often leading to a milder form of the disease. (FR) FR Gene
12226 Acute intracerebral hemorrhage The locus coeruleus is a paired brainstem nucleus located in the posterior rostral pons near the lateral floor of the 4th ventricle and fxns as the principal site for NE synthesis in the brain. It projects to Nervous (NS) Anatomy (Anat) 1
virtually all parts of the CNS and helps control mood, arousal (reticular activating system), sleep-wake states, cognition, and autonomic fxn. NS Anat
12227 Traumatic brain injury Smell occurs when odorants bind to nasal chemoreceptors that relay signals via the olfactory nerve through the cribriform plate to the olfactory bulb, which then projects to the primary olfactory cortex in Nervous (NS) Anatomy (Anat) 5
the medial temporal lobe. Head trauma can tear olfactory nerve rootlets as they cross the cribriform plate, causing anosmia. Anosmia is often associated with ageusia (loss of taste). NS Anat
12252 Facial nerve Hyperacusis (↑ sensitivity to sound) is an indication of dmg to the facial nerve (CN VII) close to its origin from the brainstem. Nervous (NS) Pathology (Path) 3 NS Path
12255 Leukocytoclastic vasculitis CSVV is a/w Rx (e.g. penicillins, cephalosporins) use and typically presents w/ palpable purpura in the lower extremities. Char histopath findings incl marked perivascular inflammation of the small blood Rheumatology, Orthopedics & Pathology (Path) 1
vessels w/ fibrinoid necrosis and a predominance of neutrophils and fragmented neutrophilic nuclei (LCV). Sports (RH) RH Path
12257 Idiopathic intracranial Idiopathic intracranial HTN (pseudotumor cerebri) Px in young obese women w/ daily h/a (which worsens during Valsalva), bilaterally symmetric papilledema, and transient visual disturbances. ↑ ICP Ophthalmology (OP) Pathophysiology 1
hypertension compresses the optic nerves, resulting in impaired axoplasmic flow and optic disc edema. (Patp) OP Patp
12262 ACE inhibitors Fetopathy due to ACEIs or ARBs results from blockade of AT-II, which is necessary for normal renal development. Use of these antiHTN Rx during pregnancy can result in fetal anuria, oligohydramnios, Pregnancy, Childbirth & Pharmacology 7
pulm hypoplasia, limb contractures, and calvarium defects. Puerperium (PR) (Phar) PR Phar
12263 Transcription The TATA and CAAT boxes are promoters of transcription in eukaryotic cells and are located approximately 25 and 75 bases upstream from the transcription start site, respectively. They promote General Principles (GP) Genetics (Gene) 7
initiation of transcription by serving as binding sites for transcription factors and RNA polymerase II. GP Gene
12276 Niacin deficiency Niacin is a precursor for nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP), two important cofactors for many dehydrogenase and reductase enzymes. Dermatology (DE) Biochemistry 3
Niacin deficiency results in pellagra (ie, diarrhea, dementia, and dermatitis). (Bioc) DE Bioc
12278 Polymerase chain reaction Reverse transcription polymerase chain reaction (RT-PCR) is used to detect and quantify levels of mRNA in a sample. It uses reverse transcription to create a complementary DNA template that is then General Principles (GP) Biochemistry 2
amplified using the standard PCR procedure. RT-PCR can be used to diagnose chronic myelogenous leukemia by identifying an mRNA transcript containing both BCR and ABL exons in affected cells. (Bioc) GP Bioc
12283 Hemangioma Cavernous hemangiomas are vascular malformations composed of abnly dilated capillaries separated by thin connective tissue septa. The lack of structural support gives them a tendency to bleed, and Nervous (NS) Pathology (Path) 6
those that occur in the brain can present w/ neurologic deficits and seizures. NS Path
12293 SIADH Small cell lung cancer is a neuroendocrine malignancy associated with several paraneoplastic syndromes. It is the most common cause of syndrome of inappropriate antidiuretic hormone (SIADH) due to Pulmonary & Critical Care (PU) Pathology (Path) 3
ectopic secretion of antidiuretic hormone. SIADH is characterized by hyponatremia, decreased serum osmolality, and urine osmolality >100 mOsm/kg H2O. PU Path
12298 Turner syndrome IVF using a donated ovum is the most promising means of achieving pregnancy in a woman w/ TS. Pregnancy can occasionally occur spontaneously in some pts w/ TS, but the risk of spontaneous Female Reproductive & Breast Genetics (Gene) 8
abortion, DS and TS are all ↑ in such cases. (FR) FR Gene
12299 Immunology principles A radioimmunoassay uses specific antibodies and a fixed quantity of radiolabeled antigen to determine the amount of antigen present in an unknown sample. This is done by measuring the amount of General Principles (GP) Immunology 2
radiolabeled antigen displaced from the antibodies in the system. (Immu) GP Immu
12504 Opioids Opioid intox presents w/ miosis, depressed mental status, ↓ RR, ↓ bowel sounds, and hypotension. Of these, ↓ RR is the best predictor of intox and is also a freq cause of mortality. Nervous (NS) Pharmacology 13
(Phar) NS Phar
12512 Hypothyroidism Prolactin production is regulated primarily by inhibitory effects of hypothalamic dopaminergic pathways. However, prolactin secretion is stimulated by thyrotropin-releasing hormone (TRH). In patients Female Reproductive & Breast Anatomy (Anat) 13
with primary hypothyroidism, the increased production of TRH by the hypothalamus can lead to hyperprolactinemia. (FR) FR Anat
12708 Viral genetics Influenza epidemics and pandemics are typically caused by reassortment of the RNA segments coding for HA or NA proteins (major antigenic shifts). This process can occur b/w human and animal Infectious Diseases (ID) Microbiology 4
strains of influenza A virus in avian or swine hosts. (Micr) ID Micr
12854 Probability theory The multiplication law of probability states that the probability of 2 or more independent events occurring together can be calculated by multiplying the individual probabilities of each event. The Biostatistics & EpInfectious Biostatistics 2
multiplication law of probability can be extended to complementary events (1 - probability of event) in the same manner. Diseases (ID)emiology (BS) (Bios) BS Bios
13402 COPD Most COPD exacerbations are triggered by viral or bacterial URIs, w/ rhinovirus, influenza virus, H. influenzae, M. catarrhalis, and S. pneumoniae being among the most common causes. Pulmonary & Critical Care (PU) Microbiology 16
(Micr) PU Micr
13600 Dilated cardiomyopathy AD mutations in the TTN gene, which encodes for the sarcomere protein titin, are the most common cause of familial DCM. Cardiovascular (CV) Genetics (Gene) 8 CV Gene
13907 Benzodiazepines Benzo withdrawal is characterised by anxiety, tremor, insomnia, and sympathetic hyperactivity (e.g. diaphoresis, palpitations). Severe benzo withdrawal may also be accompanied by psychosis, seizures, Pregnancy, Childbirth & Pharmacology 6
or death. Puerperium (PR) (Phar) PR Phar
13911 Scabies Scabies is a human mite infection associated with a pruritic papular rash with excoriations and burrows. Patients with impaired cell-mediated immunity (eg, HIV) often develop a very high mite burden. Dermatology (DE) Microbiology 2
Treatment with topical permethrin and/or ivermectin is generally curative. (Micr) DE Micr
13979 Septic shock Septic shock causes widespread arteriolar vasodilation, which leads to a decrease in systemic vascular resistance and a compensatory increase in cardiac output. Central venous pressure and pulmonary Cardiovascular (CV) Pathophysiology 6
capillary wedge pressure are also decreased due to pooling of blood in the dilated veins Increased flow rates through the peripheral capillaries lead to incomplete oxygen extraction by the tissues and high (Patp)
mixed venous oxygen saturation. CV Patp
14111 Informed consent The process of informed consent involves understanding a pt's knowledge about Tx, responding to specific concerns, and discussing the risks and benefits of Tx and the risks of refusing Tx. Social Sciences (SS) Behavioral 3
14136 Diabetes mellitus GLP-1 is secreted by intestinal L cells in response to food intake and regulates Glc lvls by slowing gastric emptying, suppressing glucagon secretion, and ↑ Glc-dependent insulin release. GLP-1 agonists Endocrine, Diabetes & Pharmacology 31
are parenteral anti-DM agents that can improve glycaemic control w/ low risk of hypoglycaemia. They're also a/w significant weight loss unlike many other anti-DM agents. Metabolism (ES) (Phar) ES Phar
14677 Rheumatoid arthritis The pathogenesis of rheumatoid arthritis involves early activation of CD4+ T cells (especially Th1 and Th17 subsets) with release of cytokines such as tumor necrosis factor-alpha and IL-1 that cause Rheumatology, Orthopedics & Pathophysiology 9
destruction of cartilage and bone. Monoclonal antibodies that inhibit tumor necrosis factor-alpha or IL-1 receptors can slow progression of the disease. Sports (RH) (Patp) RH Patp
14743 Atrial fibrillation AF is recognized by an irregularly irregular rhythm w/ variable R-R intervals and absence of P waves on ECG. The development of AF most commonly involves ectopic electrical foci in the pulm veins Cardiovascular (CV) Physiology 5
that trigger fibrillatory conduction in abnormal (remodeled) atrial tissue. (Phys) CV Phys
14745 Atrial flutter Atrial flutter demonstrates rapid and regular atrial activity in a saw-toothed pattern (flutter or F waves) on ECG. Typical atrial flutter is caused by a large re-entrant circuit that traverses the cavotricuspid Cardiovascular (CV) Physiology 1
isthmus of the RA, which is the target site for radiofrequency ablation. (Phys) CV Phys
14772 Cancer anorexia cachexia The ubiquitin-proteasome pathway mediates targeted protein degradation, which allows for rapid disposal of unneeded intracellular proteins. In ca-related cachexia, high lvls of pro-inflammatory Hematology & Oncology (HO) Pathology (Path) 2
syndrome cytokines lead to ↑ ubiquitination of sarcomeric muscle proteins, which in turn leads to extensive skeletal muscle loss. HO Path
14780 Bradycardia Conduction impairment is common w/ acute inferior wall MI. Sinus bradycardia often occurs due to nodal ischaemia and an ↑ in vagal tone triggered by infarction of myocardial tissue; the ↑ vagal tone Cardiovascular (CV) Pharmacology 1
can be counteracted by the antichol effects of atropine. (Phar) CV Phar
14789 Myocarditis Acute myocarditis is most commonly caused by a viral infection (e.g. coxsackievirus, adenovirus, influenza). It often resolves w/o noticeable SSx, but pts can develop serious complications, incl Cardiovascular (CV) Pathology (Path) 1
decompensated HF due to DCM or SCD due to ventricular arrhythmia. Histopathology typically demonstrates myofibrillary necrosis w/ inflammatory mononuclear infiltrate. CV Path
14797 Benign prostatic hyperplasia BPH is a/w stromal and glandular growth in the periurethral and transitional zone of the prostate. The hyperplastic cells are supported by the formation of new blood vessels, which are friable and prone to Renal, Urinary & Electrolytes Pathology (Path) 6
bleeding. Therefore, BPH is often a/w microscopic or gross hematuria. (RE) RE Path
14798 Benign prostatic hyperplasia BPH can ↑ resistance to urine flow in the urethra and lead to incomplete bladder emptying during micturition. The residual urine can act as a growth medium for pathogenic bacteria and ↑ the risk for UTI. Renal, Urinary & Electrolytes Pathology (Path) 6
(RE) RE Path
14816 Myelofibrosis PMF is an MPD a/w the clonal expansion of megakaryocytes. Bone marrow fibrosis accounts for most of the major MFxs, incl HSM, cytopaenias, and blood smear evidence of dacrocytes. Bone marrow Hematology & Oncology (HO) Pathology (Path) 3
aspiration is usually dry, but bone marrow Bx will show marked fibrosis w/ occasional clusters of atypical megakaryocytes. HO Path
14818 Gynecomastia 5-α reductase inhibs (e.g. finasteride, dutasteride) are used in the Tx of BPH. These Rx block the conversion of testosterone to DHT; the excess testosterone is then available for conversion to oestrogens Endocrine, Diabetes & Pathophysiology 3
(e.g. oestradiol) by aromatase, which can lead to gynecomastia. Metabolism (ES) (Patp) ES Patp
14837 Perforated viscus Pneumoperitoneum is air or gas in the peritoneal cavity; it can be seen as free air under the diaphragm in an upright CXR. The most common cause is a perforated duodenal ulcer, but perforation can occur Gastrointestinal & Nutrition (GI) Anatomy (Anat) 1
anywhere along the GIT (or female repro). subseq peritonitis can lead to diffuse abdo pain w/ rebound and guarding, sometimes w/ referred shoulder pain due to diaphragmatic irritation. GI Anat
14840 Pneumocystis pneumonia Pneumocystis pneumonia is common in patients with advanced HIV and usually presents with slowly worsening cough and dyspnea, hypoxia, and bilateral interstitial infiltrates. Diagnosis requires Pulmonary & Critical Care (PU) Microbiology 2
visualizing the organism in respiratory secretions using special stains (eg, silver stain). First-line treatment is trimethoprim-sulfamethoxazole. (Micr) PU Micr
14844 Dilated cardiomyopathy Trastuzumab is a mAb that blocks HER2 to disrupt malignant cell signalling and encourage apoptosis. B/c HER2 helps preserve cardiomyocyte fxn, trastuzumab can cause cardiotox that manifests as a ↓ Cardiovascular (CV) Pharmacology 8
in myocardial contractility w/o cardiomyocyte destruction or myocardial fibrosis. (Phar) CV Phar
14847 Pulmonary arterial hypertension Pulm HTN can occur due to a 1° change in the pulm arteries (i.e. PAH) or it can be 2° to a separate disease process such as LHF (r/o by normal PCWP). Endothelin receptor antagonists (e.g. bonsetan, Pulmonary & Critical Care (PU) Pathophysiology 8
ambrisentan) ↓ pulm arterial pressure and improve dyspnoea in pts w/ PAH. (Patp) PU Patp
14848 Interstitial lung disease Bleomycin is an antineoplastic agent that binds to Fe and O2 molecules to create free radicals that cause DNA strand breaks. The most clinically important AE of bleomycin is lung tox, usually MFxing as Hematology & Oncology (HO) Pharmacology 8
PF. Pts develop dyspnoea and NPC, and PFT shows a restrictive pattern w/ ↓ DLCO. (Phar) HO Phar
14850 Myasthenia gravis MG is caused by auto-Abs against postsynaptic nAChRs, leading to fewer fxnal AChRs and fatigable muscle weakness. Non-depolarising neuromuscular blocking agents (e.g. vecuronium) are Nervous (NS) Pharmacology 10
competitive antagonists of AChRs; due to the depletion of receptors, pts w/ MG are extremely sensitive to these agents and very small doses can induce paralysis and impair airway protection. (Phar) NS Phar
14853 Prevalence and incidence Unlike period prevalence, point prevalence considers only the number of disease cases that are active at a specific point in time. Biostatistics & EpInfectious Biostatistics 3
14855 Syphilis Histopathologic examination of syphilitic lesions classically demonstrates a proliferative endarteritis with a surrounding plasma cell infiltrate. Most of the manifestations of syphilis are due to localized Infectious Diseases (ID) Pathology (Path) 9
tissue ischemia resulting from endarteritis. ID Path
14861 Study designs A RCT is an experiment in which participants are randomly allocated to >2 groups to Ax the effect of specific interventions (eg, Tx). Biostatistics & EpInfectious Biostatistics 6
14862 Study designs A case-control study is an observational study design; it begins w/ selecting individuals who have the outcome ("cases") and individuals who do not have the outcome ("controls") and then retrospectively Biostatistics & EpInfectious Biostatistics 6
comparing their Hx of exposure to RFx. Diseases (ID)emiology (BS) (Bios) BS Bios
14870 Pneumocystis pneumonia Pneumocystis pneumonia is an atypical fungal infection seen primarily in those with impaired cell mediated immunity (eg, advanced AIDS). Manifestations often include slowly worsening pulmonary Infectious Diseases (ID) Pathophysiology 2
symptoms, hypoxia, and bilateral interstitial infiltrates on chest x-ray. The cystic organism can be Visualized using silver stain of respiratory secretions. (Patp) ID Patp
14872 Gastroesophageal reflux disease Mx of GERD incl dietary and LSMs (e.g. weight loss, tobacco avoidance) and Rx such as H2 receptor antags (e.g. ranitidine) or PPIs (e.g. pantoprazole, omeprazole). PPIs irrev inhib the H/K ATPase on Gastrointestinal & Nutrition (GI) Pharmacology 7
parietal cells, thereby ↓ gastric acid secr. (Phar) GI Phar
14873 Gastroesophageal reflux disease Pregnant women often develop GERD due to ↑ lvls of estrogen and progesterone, which relax the smooth muscle of the LES. Later in pregnancy, GERD can also develop when the gravid uterus presses Gastrointestinal & Nutrition (GI) Pathology (Path) 7
on the stomach and leads to an altered LES angle or ↑ gastric pressure. GI Path
14877 Gastroesophageal reflux disease Mg salts and Al-OH are basic mineral salts used to neutr gastric acid and relieve GERD SSx. AEs incl diarrhea and constipation, respectively. Therefore, these Rx are often combo to offset the AEs of the Gastrointestinal & Nutrition (GI) Pharmacology 7
indiv Rx. (Phar) GI Phar
14878 Esophageal cancer Oesophageal SCC presents mostly in the proximal 2/3 of the oesophagus and freq mets to the mediastinal LNs. Histo char shows sheets of pleomorphic squamous cells w/ keratin pearls and intercellular Gastrointestinal & Nutrition (GI) Pathology (Path) 4
bridges. GI Path
14879 Esophageal cancer OAC usually occurs in the distal oesophagus due to underlying Barrett oesophagus. Long-standing GORD is the most important RF. Obesity, smoking, use of Rx that lower oesophageal sphincter Gastrointestinal & Nutrition (GI) Pathology (Path) 4
pressure, and consumption of foods containing nitroso compounds also ↑ the risk. GI Path
14880 Hiatal hernia HHs occur when contents of the abdo cavity herniate thru the diaphragm at the oesophageal hiatus into the thoracic cavity. Sliding HHs occur due to laxity of the phreno-oesophageal membrane, leading Gastrointestinal & Nutrition (GI) Anatomy (Anat) 1
to herniation of the GOJ and prox. stomach, whereas para-oesophageal hernias occur due to defects in the membrane, resulting in the gastric fundus herniation. GI Anat
14890 Achalasia Achalasia is caused by loss of inhib gang cells in the dist esoph wall and is char by the absence of esoph peristalsis and incomplete relaxation of a hypertonic LES. Bot tox prevents ACh release into the Gastrointestinal & Nutrition (GI) Pharmacology 3
NM synapse, resulting in inhib of ACh-ergic neurons and LES relaxation. (Phar) GI Phar
14891 Esophagitis HSV esophagitis is most common in those w/ impaired cell-mediated immunity. Endoscopy typically reveals small vesicles and "punched-out" ulcers. Findings on Bx usually include multinucleated giant Gastrointestinal & Nutrition (GI) Pathology (Path) 3
cells and eosinophilic intranuclear inclusions (Cowdry type A inclusion bodies). Acyclovir is the Tx of choice. GI Path
14892 Esophagitis EOO is a Th2 cell-mediated disorder leading to eosinophilic infiltration of the oesophageal mucosa. It occurs most commonly in males w/ a Hx of atopic conditions and typically presents w/ solid food Gastrointestinal & Nutrition (GI) Pathology (Path) 3
dysphagia, reflux, and occasionally food impaction. GI Path
14898 Brain abscess A single brain abscess is usually caused by direct spread of a contiguous infection. Temporal lobe abscess is usually a result of OM that has spread to the mastoid air cells, while frontal lobe abscess is Nervous (NS) Anatomy (Anat) 1
usually due to ethmoid or frontal sinusitis. Multiple brain abscesses typically indicate hematogenous dissemination of a distant infection (eg, endocarditis, empyema). NS Anat
14899 Meningitis Pneumococcal meningitis is associated with massive cerebrospinal fluid inflammatory cytokine release in response to bacterial cell wall components. Treatment with dexamethasone prior to antibiotic Nervous (NS) Pathophysiology 17
therapy has been shown to reduce inflammation and decrease the risk of adverse outcomes (eg, seizures, focal neurologic deficits) and death. Other forms of bacterial meningitis do not seem to benefit (Patp)
from glucocorticoid treatment. NS Patp
14900 Diverticular disease Colonic diverticulosis refers to multi sac-like outpouchings w/i the sigmoid colon. Complications incl diverticular bleeding and diverticulitis. RFs for diverticulosis incl a diet high in red meat and fat and Gastrointestinal & Nutrition (GI) Pathology (Path) 3
low in fibre, as well as obesity, physical inactivity, and smoking. GI Path
14903 Chikungunya fever Chikungunya is an α-virus spread by mosquitos to humans in tropical and subtropical areas. Initial MFx incl self-limited fever, severe polyarthralgia, and rash. Relapsed or chronic arthralgias, polyarthritis Infectious Diseases (ID) Microbiology 1
(e.g. wrist, fingers, ankles), or tenosynovitis occur in >50% of infected individuals. (Micr) ID Micr
14905 Toxoplasmosis T. gondii is an intracellular parasite that's typically transmitted to humans after accidental ingestion of contaminated cat feces (e.g. cat handling, litter box). Most initial cases are aSSx. However, the Nervous (NS) Microbiology 5
organism establishes a latent infection that can reactivate in the setting of severe immsup, particularly adv AIDS. Pts usually develop encephalitis w/ multi ring-enhancing lesions. (Micr) NS Micr
14907 Diverticular disease Diverticulitis is characterised by inflammation of colonic diverticula. Pts have abdo pain, nausea, vomiting, and changes in bowel habits. Low-grade fever and leucocytosis are common, and PEx may Gastrointestinal & Nutrition (GI) Pathology (Path) 3
demonstrate a tender mass in the LLQ. GI Path
14916 Cystic fibrosis In pts w/ CF, pathogenic bacteria colonise the resp tract early in the disease course. The leading pathogen in adults is P. aeruginosa, which forms a thick biofilm to prevent its full elimination from the Infectious Diseases (ID) Microbiology 11
body. (Micr) ID Micr
14919 Osteoporosis Rx-induced oesophagitis is a common AE of BPs. BPs are also a/w ↑ risk of osteonecrosis of the jaw and atypical femoral fractures. Endocrine, Diabetes & Pharmacology 10
14921 Community acquired pneumonia Acute phase reactants (APRs) are proteins whose serum concentrations change by 225% during periods of inflammation. Procalcitonin is a unique APR that can rise or fall depending on the etiology of Infectious Diseases (ID) Pathology (Path) 21
the infection; elevated levels correlate with a bacterial source, whereas low levels indicate a viral source. ID Path
14922 Community acquired pneumonia Alveolar consolidation occurs when the alveoli become filled w/ fluid (e.g. inflammatory exudate in bacterial pneumonia). The ↑ compactness of the alveolar fluid (compared to air) causes sound to travel Pulmonary & Critical Care (PU) Pathophysiology 21
faster and more efficiently, resulting in bronchophony, ↑ tactile fremitus (vibration), and ↑ intensity of breath sounds over the affected area. Dullness to percussion is also present. (Patp) PU Patp
14925 Haemophilus influenzae Most COPD exacerbations are caused by infection w/ an upper resp pathogen. The leading bacterial cause is H. influenzae and the leading viral cause is rhinovirus. Pulmonary & Critical Care (PU) Microbiology 2
(Micr) PU Micr
14930 Osteoporosis The NFκB (RANK)/RANK-L interaction is essential for the formation and diff of osteoclasts. OPG blocks binding of RANK-L to RANK and ↓ formation of mature osteoclasts, leading to ↓ bone Endocrine, Diabetes & Pathophysiology 10
resorption. Denosumab is a mAb used in the Tx of postmenopausal osteoporosis that works in a manner similar to OPG. Metabolism (ES) (Patp) ES Patp
14952 Osteoporosis Long-term use of GnRH agonists (e.g. leuprolide) suppresses pituitary LH release and leads to the ↓ production of testosterone. The lower lvls of circulation testosterone produce a clinical effect similar to Endocrine, Diabetes & Pharmacology 10
that of Sx orchiectomy and can lead to accelerated bone loss and ↑ risk for osteoporosis. Metabolism (ES) (Phar) ES Phar
14956 Immunotherapy Ca cells avoid immune recognition by overexpression PD-L1, which binds to the PD-1 receptor on Tc cells and inhibs their response (T-cell exhaustion). mAbs that block PD-L1 and PD-1 are effective Hematology & Oncology (HO) Pharmacology 2
against ca that express high lvls of neo-Ags on their surface b/c these tumours are particularly susceptible to immune recognition by Tc cells. (Phar) HO Phar
14959 Pulmonary arterial hypertension Pulmonary arterial hypertension results from endothelial dysfunction that leads to an increase in vasoconstrictive, proproliferative mediators (eg, endothelin, thromboxane A2) and a decrease in Cardiovascular (CV) Pathophysiology 8
vasodilative, antiproliferative mediators (eg, nitric oxide, prostacyclin). The relative imbalance in these mediators leads to vasoconstriction and intimal-wall thickening with a consequent increase in (Patp)
pulmonary vascular resistance. CV Patp
14964 Aortic stenosis AS most commonly results from age-related CAVD. The early pathogenesis of CAVD closely mimics that of arterial atherosclerosis. In the later stages, fibroblasts diffiate into osteoblast-like cells and Cardiovascular (CV) Pathology (Path) 8
deposit bone matrix, leading to progr valvular calcification and stenosis. CV Path
14966 Aortic stenosis Angina often occurs in AS even in the absence of obstr CAD. It results from ↑ myocardial O2 demand due to an ↑ in LV mass (i.e. concentric hypertrophy) and ventricular wall stress. Cardiovascular (CV) Pathophysiology 8
(Patp) CV Patp
14967 Gout Patients undergoing solid organ transplantation are at increased risk of gout due to medications that impair renal clearance of uric acid. Cyclosporine is particularly associated with gout in the post Renal, Urinary & Electrolytes Pharmacology 11
transplantation period due to decreased uric acid excretion. (RE) (Phar) RE Phar
14976 Aortic regurgitation AR causes a rapid fall in aortic pressure during diastole w/ an ↑ in LV EDV and a compensatory ↑ in SV. These hemodynamic changes create Chx pressure changes, including ↓ aortic diastolic pressure, ↑ Cardiovascular (CV) Physiology 8
aortic systolic pressure, and ↑ LV diastolic and systolic pressures. (Phys) CV Phys
14978 Myocardial infarction MI that causes ischemia of the papillary muscle or nearby LV wall can result in acute MR w/ development of a new systolic murmur. Timely restoration of blood flow can improve papillary muscle Cardiovascular (CV) Pathology (Path) 18
dysfxn and lead to resolution of the regurgitation. CV Path
14980 Lymphedema Chronic lymphedema is most commonly caused by an acquired disruption of lymphatic drainage (eg, due to malignancy or lymphadenectomy), and typically presents with swelling and thickened skin in Cardiovascular (CV) Pathology (Path) 1
one or more extremities. Treatment is usually conservative and involves compression bandages and physiotherapy; diuretics are ineffective and contraindicated. CV Path
14983 Asplenia Target cells form when erythrocytes have decr cell volume (e.g. thalassemia, Fe defic) or excessive membrane (e.g. OLD, postsplenectomy). Pts who undergo splenectomy usually develop target cells b/c Hematology & Oncology (HO) Pathophysiology 2
the spleen is the 1ary organ that prunes excessive RBC membrane. (Patp) HO Patp
14984 Chronic venous insufficiency SD is characterised by chronic erythema, fibrosis, and reddish-brown discolouration due to deposition of hemosiderin (from breakdown of extravasated RBCs). SSx are typically bilateral, and usually Dermatology (DE) Pathology (Path) 3
worse at or above the ankles. Complications incl poor wound healing, weeping, and ulceration. DE Path
14985 Hypothyroidism Thyrotoxicosis, whether due to endogenous hyperthyroidism or over-replacement with thyroid hormone in patients with hypothyroidism, causes a hyperadrenergic state that can lead to atrial fibrillation, Endocrine, Diabetes & Pathophysiology 13
high-output heart failure, and worsening of angina pectoris. Metabolism (ES) (Patp) ES Patp
14988 Hypothyroidism HypoTH-ism causes ↓ expression of LDL receptors in the liver, leading to ↓ clearance of LDL and ↑ blood LDL lvls. It also causes hyperTG-emia due to ↓ expression of LPL. The AEs of hypoTH-ism on Endocrine, Diabetes & Physiology 13
lipid lvls can ↑ the risk of coronary atherosclerosis. Metabolism (ES) (Phys) ES Phys
14989 Stress cardiomyopathy Stress-induced (takotsubo) cardiomyopathy is characterised by hypokinesis of the mid and apical segments and hyperkinesis of the basal segments of the LV, resulting in systolic dysfxn. The condition is Cardiovascular (CV) Pathology (Path) 1
likely caused by a surge of catecholamines in the setting of physical or emotional stress. It usually affects postmenopausal women and resolves on its own w/i several wks. CV Path
14992 Dilated cardiomyopathy Peripartum cardiomyopathy is a relatively uncommon cause of DCM that may be related to impaired fxn of angiogenic GFs. DCM involves compensatory eccentric hypertrophy, which ↑ ventricular Cardiovascular (CV) Pathology (Path) 8
compliance and also allows for temporary maintenance of CO. Over time, ovewhelming wall stress leads to LV failure w/ ↓ EF and SSx HF. CV Path
14993 Dilated cardiomyopathy DCM results from 1° myocardial dysfxn leading to eccentric remodelling of the LV. Pts can develop LV mural thrombus and are at risk for SCD due to ventricular arrhythmia. Familial DCM is typically Cardiovascular (CV) Pathology (Path) 8
inherited in an AD pattern, and most commonly results from truncating muts of the TTN gene that codes for the sarcomere protein titin. CV Path
14995 Hypothyroidism Central hypothyroidism is characterised by low serum TSH and T4 lvls and is due to HP dysfxn. Sheehan syndrome is ischemic necrosis of the pituitary gland and is typically caused by systemic Endocrine, Diabetes & Pathophysiology 13
hypotension during delivery. In addn to central hypothyroidism, pts may also develop defic of other pituitary hormones (e.g. ACTH, PRL, Gn). Metabolism (ES) (Patp) ES Patp
14997 Atrial myxoma Myxomas are the most common 1° cardiac neoplasm and approx. 80% originate in the LA. Pts may present w/ SSx MV obstr that may worsen w/ certain body positions, constitutional findings (e.g. fever, Cardiovascular (CV) Pathology (Path) 3
weight loss), or systemic embolisation (e.g. stroke, mesenteric ischemia, acute limb ischemia). CV Path
14998 Atrial myxoma Myxomas are the most common 1° cardiac neoplasm, and approx. 80% originate in the LA. Pts may have systemic embolisation (e.g. stroke) or SSx MV obstr that may be worse w/ certain body positions. Cardiovascular (CV) Pathology (Path) 3
Histopathologic Ex reveals amorphous ECM w/ scattered stellate or globular myxoma cells w/i abundant mucopolysaccharide ground substance. CV Path
14999 Acute pericarditis Fibrinous pericarditis is the most common type of pericarditis and is Chx by pericardial inflammation w/ a serous, fibrin-containing exudate in the pericardial space. Pleuritic chest pain and a triphasic Cardiovascular (CV) Pathology (Path) 5
friction rub are frequently seen. Common causes include viral infection, MI, uremia, and rheumatologic disease (eg, SLE, RA). CV Path
15000 Acute pericarditis Viral infection is thought to be the most common cause of acute pericarditis. It causes a fibrinous or serofibrinous pericarditis that is often Chx by pleuritic chest pain, a friction rub on cardiac Cardiovascular (CV) Pathology (Path) 5
auscultation, diffuse ST elevation on ECG, and mild to moderate-sized pericardial effusion. CV Path
15001 Vasospastic angina Vasospastic angina involves hyperreactivity of coronary artery smooth muscle. Pts are usually young (age <50) and w/o significant RFx for CAD; they experience recurrent episodes of chest discomfort Cardiovascular (CV) Pathophysiology 2
that typically occur during rest or sleep and resolve w/i 15 min. (Patp) CV Patp
15011 Colorectal cancer Tumour stage (degree of invasion/spread) is the most important prognostic determinant for CRC. Tumours confined to the BM and lamina propria are early stage and have the best prognosis. Outcomes Gastrointestinal & Nutrition (GI) Pathology (Path) 15
gen deteriorate as the stage advances: spread of tumour into the muscularis propria → regional LNs → distant sites. GI Path
15012 Colorectal cancer Most hepatic neoplasms are due to mets from a distant site. CRC is the most common cause of hepatic mets due to direct blood flow from the colon (and superior rectum) to the liver via the portal venous Gastrointestinal & Nutrition (GI) Pathology (Path) 15
circulation. GI Path
15016 Hyperthyroidism Exogenous hyperthyroidism is characterised by ↑ free T4, suppressed TSH, and low/undetectable TG. It can occur w/ surreptitious levothyroxine abuse, use of animal-sourced thyroid supplements, and Endocrine, Diabetes & Pathophysiology 8
erroneous dosing of thyroid replacement therapy. Over time, the lack of TSH stim causes the thyroid follicles to become atrophic. Metabolism (ES) (Patp) ES Patp
15018 Peptic ulcer disease Peptic ulcers are most commonly caused by Helicobacter pylori infection or NSAID use. NSAIDs inhibit COX-1, leading to ↑ gastric acid formation, ↓ mucosal bicarbonate production, and ↓ mucosal Gastrointestinal & Nutrition (GI) Pathology (Path) 10
blood flow, which promote mucosal injury and ulcer formation. GI Path
15020 Colorectal cancer FAP is an AD disorder caused by germline mutation to the TSG adenomatous polyposis coli. Pts w/ FAP develop hundred or thousands of colonic polyps; lifetime risk of colon ca is close to 100%. Gastrointestinal & Nutrition (GI) Pathology (Path) 15 GI Path
15021 Familial adenomatous polyposis FAP is an AD hereditary disorder that results in the formation of innumerable colonic polyps and a nearly 100% risk of CRC. It arises due to germline mut to the TSG APC. Gastrointestinal & Nutrition (GI) Pathology (Path) 1 GI Path
15024 Nonalcoholic fatty liver disease Stellate (Ito) cells are the primary cells involved in hepatic fibrosis. In response to hepatic injury, the stellate cells are activated and transform into myofibroblasts capable of proliferating, promoting Gastrointestinal & Nutrition (GI) Histology (Hist) 1
chemotaxis, and producing large quantities of collagen. Collagen stains blue with Masson trichrome stain. GI Hist
15027 Clostridial myonecrosis Clostridium septicum is a spore-forming, exotoxin-producing, Gram (+) organism that is the most common cause of spontaneous gas gangrene (eg, rapid-onset pain, hemorrhagic bullae, tissue crepitus). Infectious Diseases (ID) Microbiology 3
Underlying colonic malignancy is the greatest RFx for infection. (Micr) ID Micr
15028 Thyroglossal duct cyst Thyroglossal duct cysts form from epithelial remnants of the thyroglossal duct along the path of thyroid descent. They present as midline masses that rise with swallowing or tongue protrusion. Ear, Nose & Throat (EN) Embryology 1
(Embr) EN Embr
15034 Zika virus Zika virus is an ssRNA that infects foetal neural progenitor cells, causing severe congenital malformations (e.g. microcephaly, arthrogryposis), cerebral cortical thinning, and possible foetal demise. Infectious Diseases (ID) Microbiology 1
(Micr) ID Micr
15049 Clostridium difficile infection C. difficile commonly Px w/ diarrhea and abdo pain; hosp and Abx use ↑ the risk of contracting the disease. A NAAT is considered the most sens method for Dx of C. difficile infec in pts w/ CFx. Gastrointestinal & Nutrition (GI) Microbiology 7
(Micr) GI Micr
15057 Histoplasmosis TNF-α inhibs are a/w impairments to the cell-mediated immune response and ↑ the risk of infection w/ intracellular bacteria and granulomatous fungi (e.g. Histoplasma capsulatum). Histoplasma Infectious Diseases (ID) Microbiology 4
replicates w/i the intracellular space of macrophages and can spread from the lungs to the LNs and the RES (liver, spleen, bone marrow). (Micr) ID Micr
15061 Histoplasmosis Histoplasma capsulatum replicates w/i macrophages and often spreads from the lungs thru the pulm lymphatics to the RES (e.g. spleen, liver). Most healthy individuals quickly contain the infection w/i Pulmonary & Critical Care (PU) Pathology (Path) 4
granulomas and don't become ill; a minority develop self-limited pneumonia. Over time, the granulomas at the initial sites of infection calcify and may be seen incidentally on radiographic imaging. PU Path
15066 HIV Pts w/ advanced HIV and low CD4 counts are at risk for opportunistic infections and req antimicrobial prophylaxis. P. jiroveci pneumonia prophylaxis w/ TMP-SMX is indicated when CD4 count is Infectious Diseases (ID) Microbiology 11
<200/mm3. (Micr) ID Micr
15067 Bartonella Bacillary angiomatosis is 1arily seen in pts w/ advanced AIDS. It's caused by the gram (-) bacterium B. henselae, which is typically transmitted by a cat scratch. Pts usually develop highly vascular, Infectious Diseases (ID) Microbiology 2
violaceous, cutaneous lesions over wks or mos. Histo of the lesions reveals large endothelial cells forming small vascular channels w/ a surrounding inflammatory infiltrate. (Micr) ID Micr
15068 Progressive multifocal Pts w/ advanced AIDS can have reactivation of JC virus, which causes PML. This condition usually presents w/ slowly progr confusion, ataxia, and motor deficits. Brain MRI reveals multifocal areas of Infectious Diseases (ID) Microbiology 1
leukoencephalopathy white matter demyelination w/ no mass effect or enhancement. (Micr) ID Micr
15069 HIV Initial HIV infection is often a/w mononucleosis-like SSx (eg, fever, LAD, sore throat) 2-4 wks after transmission. Important Dx clues are oropharyngeal ulcers and a diffuse maculopapular rash. As the Infectious Diseases (ID) Microbiology 11
humoral Ab response is not fully activated early in infection, LFx typically show HIV in the serum ((+) viral load and p24 Ag) but (-) HIV serology. (Micr) ID Micr
15070 Pulmonary embolism Massive PE can lead to SCD due to a sudden loss of CO. Less commonly, SCD may result from cardiac arrhythmia triggered by RV strain and ischemia. Pulmonary & Critical Care (PU) Pathology (Path) 13 PU Path
15075 Rocky mountain spotted fever RMSF is a tick-borne illness due to Rickettsia rickettsii, a weakly gram (-), obligate intracellular organism that has an affinity for vascular endothelial cells. Pts usually have non-specific SSx (e.g. fever, Infectious Diseases (ID) Microbiology 1
malaise, myalgia) f/b a macular-petechial rash that begins on the ankles and wrists and spreads to the centre of the body as well as to the palms and soles. Urgent Tx w/ doxycycline, an inhib of bacterial (Micr)
protein synthesis, is req. ID Micr
15076 Lice infestation Phthirus pubis is the human pubic louse. It is transmitted sexually via skin-to-skin contact and causes intense pruritus. Louse and nits can often be visualized on Ex, which is Dx. Tx w/ topical permethrin Infectious Diseases (ID) Microbiology 2
is generally curative. (Micr) ID Micr
15077 Meningitis N. fowleri is a free-living, motile protozoan that lives in warm water. Exposure can result in 1° amoebic encephalitis (PAM), which is characterised by acute fever, h/a, confusion, and neck stiffness. The Infectious Diseases (ID) Microbiology 17
Dx is confirmed when motile trophozoites are seen in CSF wet mount. Nearly all pts die. (Micr) ID Micr
15105 Multiple endocrine neoplasia MEN-2 is caused by germline activating muts in the RET proto-oncogene and freq results in both MTC and PCC. In pts w/ un-Dx PCC, induction of anaesthesia (e.g. prep for thyroidectomy) can Endocrine, Diabetes & Pathophysiology 5
precipitate a catecholamine surge, leading to HTN crisis, flash pulm oedema, and AF. Metabolism (ES) (Patp) ES Patp
15107 HIV R5 strains (macrophage-tropic) of HIV attach to the host CD4 receptor and CCR5 chemokine coreceptor; CCR5 inhibs such as maraviroc can be used in the Tx of R5 virus. X4 strains (T lymphotropic) of Infectious Diseases (ID) Pharmacology 11
HIV bind to the CD4 receptor and CXCR4 chemokine receptor; X4 virus can't be Tx w/ CCR5 inhibs. (Phar) ID Phar
15113 HIV Tenofovir is a NRTI that's a common component of HIV therapy. This drug is gen well tolerated but may occasionally cause dmg to the PCT of the kidney, leading to AKI a/o PCT impairment (e.g. Infectious Diseases (ID) Microbiology 11
phosphoruria, glucosuria, water retention). Bx typically reveals a normal glomerulus and renal interstitium but dmg to the PCT. (Micr) ID Micr
15120 Heparin induced thrombocytopenia HIT and thrombosis results from the production of IgG Abs against complexes of heparin and platelet factor 4. The Fc component of these Abs binds to platelets, resulting in widespread platelet activation Hematology & Oncology (HO) Pathology (Path) 1
and a prothrombotic state. HO Path
15125 HIV Most cases of AIDS worldwide are caused by HIV-1. However, AIDS can also be caused by infection w/ HIV-2, which is endemic to West Africa. HIV-2 infection is a/w lower viral loads, less risk of Infectious Diseases (ID) Microbiology 11
transmission, and a slower progr to AIDS. The Dx is often suspected when HIV tests are incongruent ((+) screening serology but indeterminate Western blot and (-) plasma HIV-1 RNA). Confirmation (Micr)
can be made using HIV-1/HIV-2 immunodiff assay (IDA). ID Micr
15126 Interstitial lung disease Histologic findings of idiopathic pulmonary fibrosis include patchy lymphoplasmacytic infiltrates, focal fibroblastic proliferation with dense fibrosis, honeycombing, and hyperplasia of type 2 Pulmonary & Critical Care (PU) Pharmacology 8
pneumocytes. Therapies are directed at slowing the progression of fibrosis by inhibiting transforming growth factor β and other fibrogenic growth factors (eg, PDGF, fibroblastic growth factor, and (Phar)
VEGF). PU Phar
15133 Multiple myeloma MM should be suspected in elderly pts who have any combo of osteolytic lesions, hypercalcemia, anemia, or AKI. Renal disease is most commonly caused by LC cast nephropathy, in which free LCs Hematology & Oncology (HO) Pathophysiology 9
form obstr casts in the renal tubules. Monoclonal paraproteins aren't detected by urine dipstick (which detects only albumin), but both spot and 24 hr protein concs will be incr. (Patp) HO Patp
15134 Multiple myeloma MM is a plasma cell malignancy a/w purely radiolucent (osteolytic) bone lesions due to the stim of osteoclasts and the inhib of osteoblasts. Myeloma cells stim osteoclast devel by secreting RANKL and Hematology & Oncology (HO) Pathophysiology 9
destroying OPG, which incr RANK activity and results in osteoclast diff. (Patp) HO Patp
15144 Hepatitis C Chronic HCV infec is Tx w/ DAA Rx such as ledipasvir and sofosbuvir. These Rx target spec HCV enzymes (e.g. protease, NS5A, RNA pol), which inhibs viral replication and assembly. Tx w/ DAAs Gastrointestinal & Nutrition (GI) Microbiology 4
results in cure in >97% of pts. (Micr) GI Micr
15155 Asthma occup asthma is characterised by airway inflammation, bronchial hyperreactivity, and a variable airflow obstr triggered by workplace exposure. Exposure can be immu (atopic), due to exposure to a Pulmonary & Critical Care (PU) Pathophysiology 12
workplace aeroallergen causing a Th2-mediated IgE formation, or non-immu, due to exposure to workplace irritants that lead to denudation of the bronchial mucosa. (Patp) PU Patp
15156 Asthma Bronchodilators induce bronchial smooth muscle relaxation to relieve airway spasm and bronchoconstriction in pts w/ asthma. Bronchodilation is most commonly accomplished w/ β2 receptor agonists (e. Pulmonary & Critical Care (PU) Pathophysiology 12
g. albuterol), which fxn by ↑ cAMP lvls in bronchial smooth muscle. (Patp) PU Patp
15158 Phrenic nerve injury The right phrenic nerve courses along the pericardium overlying the right side of the heart and is at risk for injury during procedures in or near the RA (eg, radiofrequency ablation). Right phrenic nerve Nervous (NS) Anatomy (Anat) 1
injury is typically recognized by elevation of the right hemidiaphragm. NS Anat
15169 Hepatitis B HBV has a partially dsDNA genome and contains a viral DNA polymerase w/ reverse transcriptase activity. Reverse transcriptase serves a crucial step in viral replication; it converts transcribed (+) sense Infectious Diseases (ID) Microbiology 14
ssRNA into the partially dsDNA genome of viral progeny. (Micr) ID Micr
15172 Acute interstitial nephritis AIN is a common cause of renal dysfxn; up to 75% of cases are due to Rx incl NSAIDs, Abx, diuretics, and PPIs. Presenting features incl fever, rash, and eosinophilia. UA often demonstrates pyuria and Renal, Urinary & Electrolytes Pathology (Path) 2
WBC casts w/ ↑ urine eosinophils. (RE) RE Path
15176 Renal cell carcinoma RCC may present w/ a combo of hematuria, abdo mass, or flank pain; however, this triad occurs together in <10% of cases. Pathology demonstrates rounded, polygonal cells w/ a clear cytoplasm and Renal, Urinary & Electrolytes Pathology (Path) 8
eccentric nuclei. RFs incl smoking, toxin exposure, and certain hereditary disorders (e.g. VHL syndrome). (RE) RE Path
15177 Hepatitis B Immunization against hepatitis B virus uses recombinant HBsAg to generate anti-HBs antibodies. These antibodies prevent infection by binding to the envelope of circulating virus and inhibiting viral Infectious Diseases (ID) Immunology 14
entry. (Immu) ID Immu
15180 Coronary artery disease Stable angina results from fixed coronary artery stenosis that limits blood flow to downstream myocardium, preventing the myocardial O2 supply from ↑ during exertion. Dobutamine mimics the effects Cardiovascular (CV) Pathophysiology 4
of exercise and ↑ myocardial O2 demand; it can be used during stress testing to provoke areas of ischemic myocardium, which can be recognized on imaging by a localized and transient ↓ in contractility (Patp)
(ie, wall motion defect). CV Patp
15186 Bladder cancer Major RFs for urothelial ca of the bladder incl age >60, cigarette smoking, and occup exposure to rubber, plastics, or aromatic amine-containing dyes. Cyclophosphamide therapy also ↑ the risk. Renal, Urinary & Electrolytes Pathology (Path) 4
(RE) RE Path
15193 Urinary tract obstruction Urinary tract obstruction causes reflux of urine into the renal tubules and increased tubular hydrostatic pressure. The intraglomerular capillary hydrostatic pressure is unchanged, resulting in a decreased Renal, Urinary & Electrolytes Pathophysiology 4
hydrostatic pressure gradient across the glomerular capillary wall and a reduction in glomerular filtration. Oncotic pressure is maintained by large plasma proteins which are not filtered across the (RE) (Patp)
glomerular capillary basement membrane; it is unaffected by a urinary tract obstruction. RE Patp
15195 Aortic regurgitation Eccentric ventricular hypertrophy results in a dilated cavity w/ relatively thin ventricular walls due to the addition of myocardial contractile fibers in series in response to chronic volume overload. Chronic Cardiovascular (CV) Pathology (Path) 8
AR can result from aortic root dilation and is a common cause of eccentric hypertrophy. CV Path
15196 Aortic stenosis Concentric LVH involves thickening of the ventricular walls and ↓ in the ventricular cavity size. It occurs via the addition of myocardial contractile fibers in parallel in response to chronic pressure Cardiovascular (CV) Pathology (Path) 8
overload. AS and prolonged systemic HTN are common causes of concentric LVH. CV Path
15197 Cardiac catheterization To access the left side of the heart, CVCs must cross the interatrial septum at the site of the foramen ovale. Entry into the LA allows for direct measurement of LA pressure and for access to Cardiovascular (CV) Anatomy (Anat) 2
arrhythmogenic foci on the LA myocardium or pulm veins. CV Anat
15198 Pulmonary stenosis PV stenosis causes a crescendo-decrescendo systolic murmur (best heard at the left upper sternal border) and delays closure of the PV, resulting in widened splitting of S2. Inspiration ↑ blood flow to the Cardiovascular (CV) Pathology (Path) 1
right side of the heart, causing ↑ intensity of the murmur and even later closure of the PV. CV Path
15199 Pulmonary arterial hypertension Pulm HTN can be recognized on PEx by a loud pulmonic component of S2 and an accentuated, palpable impulse at the left stemal border (left parasternal lift due to RV heave). Cardiovascular (CV) Pathophysiology 8
(Patp) CV Patp
15200 Urinary tract obstruction AUR is characterised by anuria and bladder distension, and can result in hydronephrosis and AKI. A palpable, distended bladder is present on Ex, and abdo and flank pain may be present. The most Renal, Urinary & Electrolytes Pathology (Path) 4
common cause of urinary retention is bladder outlet obstr (urethral compression) due to BPH. (RE) RE Path
15205 Acute diarrhea Nontyphoidal Salmonella is a leading cause of foodborne gastroenteritis. Most cases are marked by 3-4days of self-limited fever, nausea, vomiting, and watery diarrhoea. A minority of individuals Infectious Diseases (ID) Microbiology 13
develop subseq invasive disease w/ spread to the long bones (osteomyelitis), vasculature (mycotic aneurysm), or heart (endocarditis). Risk of invasion is greatest in those w/ SCD or impaired immunity or (Micr)
at the extremes of age. ID Micr
15206 Alpha1 antitrypsin deficiency Pts w/ advanced emphysema typically have chronic CO2 retention leading to chronic resp acid w/ meta comp (high PaCO2, comp high HCO3-, slightly acidic pH), often accompanied by hypoxaemia Pulmonary & Critical Care (PU) Pathophysiology 8
(PaO2 <75mmHg on room air). (Patp) PU Patp
15207 Prerenal azotemia Hypovolemia (eg, excessive diuresis) can cause AKI due to ↓ RBF (prerenal azotemia). Urine Na and fractional excretion of Na levels are low, and the BUN/creatinine ratio is ↑. In severe cases, ATN can Renal, Urinary & Electrolytes Pathophysiology 6
occur and cause an intrinsic renal injury pattern (ie, high urine Na, normal BUN/creatinine ratio) w/ muddy brown casts on UA. (RE) (Patp) RE Patp
15208 Prerenal azotemia Compensatory mechanisms for hypovolemia include activation of the renin-angiotensin-aldosterone system and increased antidiuretic hormone release. This results in increased renal sodium, chloride, Renal, Urinary & Electrolytes Pathophysiology 6
water, and urea reabsorption with increased potassium excretion. (RE) (Patp) RE Patp
15209 Prerenal azotemia Hypovolemia triggers a variety of compensatory mechanisms to improve tissue perfusion. These include activation of the renin-angiotensin-aldosterone system (resulting in increased aldosterone and Renal, Urinary & Electrolytes Pathophysiology 6
endothelin release), increased vasopressin release, and increased sympathetic tone. (RE) (Patp) RE Patp
15210 Foodborne illness Staphylococcal foodborne illness is due to the consumption of a preformed enterotoxin in contaminated food. Most cases can be prevented by washing hands thoroughly prior to food prep (prevents Infectious Diseases (ID) Microbiology 2
contamination) and ensuring proper refrigerated storage (prevents bacterial proliferation/enterotoxin production). (Micr) ID Micr
15212 COPD Emphysema consists of alveolar destruction and enlargement that results from a combo of inflammation and leucocyte infiltration, ↑ protease activity, and oxidative stress, usually in response to exposure Pulmonary & Critical Care (PU) Pathology (Path) 16
to cig smoke. In severe disease, large air spaces known as subpleural blebs can form in the lung apices. PU Path
15215 Acute diarrhea Rotavirus is a common cause of self-limited childhood diarrhoea in un-vax individuals. It infects villous enterocytes in the duodenum and prox. jejunum and results in villous blunting, proliferation of Infectious Diseases (ID) Microbiology 13
secretory crypt cells, and a loss of brush border enzymes; this results in water diarrhoea w/o faecal leucocytes. (Micr) ID Micr
15217 Rhabdomyolysis Rhabdomyolysis usually presents w/ myalgia, proximal muscle weakness, and dark urine (Mburia) in the setting of trauma, sepsis, or overexertion. AKI occurs due to heme pigment-mediated tubular Renal, Urinary & Electrolytes Pathology (Path) 2
injury, leading to ATN. Urine microscopy typically reveals granular, muddy brown casts. (RE) RE Path
15218 Rhabdomyolysis Rhabdomyolysis is characterised by the release of intracellular muscle contents (e.g. Mb, electrolytes) due to myocyte injury; it's common w/ crush injuries, seizures, or drug use (e.g. statins). heme Renal, Urinary & Electrolytes Pathology (Path) 2
pigment (released from Mb after degradation in the kidney) is toxic to tubular cells and can cause ATN. (+) blood on urine dipstick in the absence of RBCs on microscopic UA suggests Mburia. (RE) RE Path
15221 Prerenal azotemia Cardiorenal syndrome is due to hemodynamic alterations related to a low cardiac output state and maladaptive neurohormonal changes. Low cardiac output results in renal hypoperfusion, leading to Renal, Urinary & Electrolytes Pathophysiology 6
activation of the renin-angiotensin-aldosterone system, antidiuretic hormone release, and increased sympathetic nervous system activity. The resultant increase in sodium and water reabsorption and (RE) (Patp)
systemic vasoconstriction have detrimental effects on left ventricular systolic function, further worsening cardiac output and renal perfusion. RE Patp
15225 Acute kidney injury Surgeries complicated by significant blood loss or those req the use of cardiopulm bypass or clamping of the aorta can cause sustained renal hypoperfusion and result in ATN. ATN presents w/ oliguria, ↑ Renal, Urinary & Electrolytes Pathology (Path) 5
serum creatinine, and BUN/creatinine ratio <20:1. UA is characterised by muddy brown granular casts composed of sloughed renal tubular epithelial cells. (RE) RE Path
15227 Aminoglycoside Aminoglycosides are filtered across the glomerulus and concentrate in the renal tubules, leading to PCT injury and ATN. This is visualised histo as focal tubular epithelial necrosis, often w/ extensive Renal, Urinary & Electrolytes Pathology (Path) 3
granular casts that obstruct the tubular lumen and lead to rupture of the BM. (RE) RE Path
15228 Head and neck cancers Most OPCs (e.g. tonsil, base of tongue) are caused by HPV infection. HPV-16 is particularly likely to cause malignant transformation. Hematology & Oncology (HO) Pathology (Path) 1 HO Path
15229 NSAIDs Pts w/ intravascular volume depletion (e.g. CHF, diarrhoea, excessive diuresis) and CKD depend on renal PG production to dilate the afferent glomerular arteriole and maintain the GFR. NSAIDs inhib Renal, Urinary & Electrolytes Pathology (Path) 4
PG synthesis, which cause prerenal azotaemia in at-risk pts. (RE) RE Path
15230 Amoebiasis Entamoeba histolytica is an amoeba that causes colitis characterised by ulcers w/ undermining edges (i.e. flask-shaped) that may contain cysts and trophozoites. Trophozoites can occasionally (~1%) Infectious Diseases (ID) Microbiology 1
invade the colonic wall and disseminate thru the blood to the liver, brain, or lungs. Amoebic hepatic abscess is the most common extraintestinal MFx. (Micr) ID Micr
15233 COPD Chronic obstructive pulmonary disease causes air trapping and hyperinflation; consequently, these patients breathe at higher baseline lung volumes (higher functional residual capacity). The volume of air Pulmonary & Critical Care (PU) Pathophysiology 16
in the lungs that is not respired (residual volume) increases substantially, as does the fraction of air in the lungs that is not involved in respiration (residual volume/total lung capacity ratio). (Patp) PU Patp
15235 Toxic alcohols Ethylene glycol and methanol are toxic alcohols that cause AGMA and an ↑ osmolar gap. Toxicity occurs after metabolization by alcohol dehydrogenase; fomepizole is a competitive inhibitor of alcohol Poisoning & Environmental Pharmacology 1
dehydrogenase and is used for the Tx of acute poisoning. Exposure (PO) (Phar) PO Phar
15239 Diabetic nephropathy In diabetic nephropathy, early adaptive changes in the kidney cause a transient increase in glomerular filtration (hyperfiltration). As diabetic nephropathy progresses, glomerular filtration falls, with a Renal, Urinary & Electrolytes Pathophysiology 4
concurrent increase in urine albumin loss. (RE) (Patp) RE Patp
15240 Septic shock The initial Mx of septic shock req RFR to replace intravasc volume and restore adequate EOP. This is best accomplished w/ IV boluses of isotonic crystalloid in the form of 0.9% (normal) saline or Pulmonary & Critical Care (PU) Physiology 6
lactated Ringer solution b/c these solutions remain in the ECS. (Phys) PU Phys
15241 Septic shock Septic shock can Px w/ either hyper- or hypothermia. The initial disturbance is peripheral vasodilation leading to ↓ SVR, ↓ CVP and ↓ PCWP. A compensatory ↑ in sympathetic drive causes an ↑ in CO; Cardiovascular (CV) Pathophysiology 6
the resulting high flow rates lead to incomplete O2 extraction in the tissues, resulting in high mixed venous O2 saturation. (Patp) CV Patp
15242 Defense mechanisms Countertransference consists of a provider's response (e.g. attitudes, thoughts, feelings, behaviours) toward a pt based on past personal relationships. Countertransference can be (+) or (-), conscious or Pregnancy, Childbirth & Behavioral 8
unconscious; if unrecognised, it may have detrimental effects on pt care. Puerperium (PR) Science (Beha) PR Beha
15243 Intestinal helminth parasites Hookworms are transmitted when human skin comes into contact w/ soil contaminated w/ human faeces. The larvae penetrate the skin, travel to the lungs, are coughed up, and then subseq swallowed. Infectious Diseases (ID) Microbiology 3
Adult hookworms live in the small intestine and feed on human blood. Therefore, chronic IDA (microcytic anaemia) is the greatest complication. (Micr) ID Micr
15244 Acute diarrhea Children w/ watery diarrhea should be Tx w/ oral rehydr solns containing hypotonic, equimolar concs of Na and Glc to help prevent dehydr and electrolyte abns. Gastrointestinal & Nutrition (GI) Pharmacology 13
(Phar) GI Phar
15246 Renal artery stenosis RAS (e.g. severe HTN, abdo bruits) causes decr renal art perfusion, which activates the RAAS. Incr secretion of renin leads to incr production of AT-I and AT-II, which causes incr TPR and incr syst BP. Renal, Urinary & Electrolytes Pharmacology 9
Incr aldo secretion causes incr renal Na+ reabs and K+ and H+ excretion, resulting in relative hypokalemia and meta alk. (RE) (Phar) RE Phar
15247 Renal artery stenosis Fibromuscular dysplasia (FMD) is characterised by abn tissue growth w/i arterial walls, resulting in stenotic and tortuous arteries that can cause tissue ischemia and are prone to aneurysm formation. Path Renal, Urinary & Electrolytes Pathology (Path) 9
typically demonstrates alternating fibromuscular webs and aneurysmal dilation w/ absent internal elastic lamina (string-of-beads appearance). Renovascular HTN occurs due to RAS and activation of the (RE)
RAAS. RE Path
15248 Myelofibrosis PMF is a chronic MPD a/w bone marrow fibrosis. EMH leads to marked expansion of the splenic red pulp w/ HPO progenitor cells and results in massive splenomegaly. Pts also usually have Hematology & Oncology (HO) Pathophysiology 3
hepatomegaly, cytopenias, and PBS abns (e.g. dacrocytes, nucleated RBCs, immature granulocytes). (Patp) HO Patp
15250 Atheroembolism Atheroembolic disease typically occurs after an invasive vascular procedure due to mech dislodgement of atherosclerotic plaque, resulting in the showering of chol-rich microemboli into the circulation. Renal, Urinary & Electrolytes Pathology (Path) 2
Needle-shaped chol clefts in affected vessels are Dx. Commonly involved organs incl the kidneys (e.g. AKI), skin (e.g. blue toe syndrome, livedo reticularis), GIT (e.g. bleeding, infarction), and CNS (e.g. (RE)
stroke, amaurosis fugax). RE Path
15252 Psychosis In addn to (+) psychotic SSx (e.g. delusions, hallucinations, disorganisation), pts w/ schizophrenia freq exhibit (-) SSx such as flat affect (i.e. lack of facial expression). (-) SSx typically persist b/w acute Pregnancy, Childbirth & Behavioral 6
psychotic episodes and are more resistant to Tx. Puerperium (PR) Science (Beha) PR Beha
15253 Psychosis Brief psychotic disorder is characterised by >1 psychotic SSx lasting >1day and <1mos w/ full return to previous lvls of fxning. Onset is typically sudden and a/w a stressor. Pregnancy, Childbirth & Behavioral 6
15254 Psychosis Antipsych Rx are 1st-line Rx for schizophrenia. Their 1° MOA is D2 receptor antagonism. Pregnancy, Childbirth & Pharmacology 6
15255 Vibrio vulnificus V. vulnificus is a curved, gram (-), free-living bacterium that grows in marine environments. Transmission 1arily occurs due to the consumption of raw seafood (e.g. oysters) or wound contamination. Infectious Diseases (ID) Microbiology 1
MFxs are often mild, but individuals w/ liver disease or Fe overload are at very high risk of severe, fulminant infection (e.g. sepsis, necrotising fasciitis). (Micr) ID Micr
15259 Renal calculi Struvite stones are typically seen in pts w/ recurrent upper UTI by urease-producing organisms (e.g. Proteus, Klebsiella). Hydrolysis of urea yields NH3, which alkalinises the urine and facilitates Renal, Urinary & Electrolytes Pathology (Path) 7
precipitation of MgNH4PO4. UA shows hematuria and ↑ urine pH. (RE) RE Path
15269 Athlete's heart Athlete's heart refers to physiologic cardiac adaptations that improve cardiac fxn in response to high-lvl endurance training. There's predominant eccentric hypertrophy w/ a smaller component of Cardiovascular (CV) Pathophysiology 1
concentric hypertrophy, leading to an overall ↑ in LV mass, enlarged LV cavity size, ↑ LV wall thickness, and ↓ resting HR. (Patp) CV Patp
15270 Hyperparathyroidism Most kidney stones are made of Ca2+ salts and are idiopathic, but conditions that ↑ renal Ca2+ excretion can ↑ the risk of stones. Hyperparathyroidism is a common cause of recurrent kidney stones and is Renal, Urinary & Electrolytes Pathology (Path) 2
typically a/w mild hypercalcaemia and hypophosphataemia. (RE) RE Path
15271 Renal calculi Urine sediment in acute ureterolithiasis typically shows free RBCs (hematuria) and crystals consistent w/ the type of stone. US can reveal ureteral and calyceal dilation (hydronephrosis), but small stones Renal, Urinary & Electrolytes Pathology (Path) 7
themselves may not be visible. (RE) RE Path
15273 Renal artery stenosis Unilateral RAS causes hypoperfusion and activation of the RAAS. ATII causes arteriolar vasoconstriction and ↑ aldo and ADH synthesis. The resultant HTN helps ↓ the decline in GFR in the affected Renal, Urinary & Electrolytes Physiology 9
kidney, but causes a pressure natriuresis w/ ↑ Na+excretion in the unaffected kidney. (RE) (Phys) RE Phys
15276 Opioids Acute opioid OD is characterised by altered lvl of consciousness, pinpoint pupils, and central resp depression. Pts are expected to have acute resp acidosis (low pH, high PaCO2) due to hypoventilation. Pulmonary & Critical Care (PU) Pathophysiology 13
Serum HCO3- is typically near normal as there isn't time for meta compensation in the acute setting. (Patp) PU Patp
15278 Acute lymphoblastic leukemia ALL is marked by a high conc of circulating lymphoblasts. Flow cytometry can be used to distinguish b/w B-cell (CD19-expressing) and T-cell (CD3-expressing) lineages. T-cell ALL usually arises in Hematology & Oncology (HO) Pathology (Path) 3
teens or individuals in their 20s and often presents w/ a large mediastinal mass. HO Path
15283 Attention deficit hyperactivity ADHD often persists into adulthood. Adults w/ ADHD are less overtly hyperactive but experience chronic problems w/ distractibility, disorganisation, and impulsivity that cause significant social and Pregnancy, Childbirth & Behavioral 5
disorder occup impairment. Puerperium (PR) Science (Beha) PR Beha
15284 Normal child development Short attn span and varying degrees of hyperactivity and impulsivity are commonly seen in children under age 4. ADHD shouldn't be Dx until age 4-5. Pregnancy, Childbirth & Behavioral 2
15285 Attention deficit hyperactivity Dx of ADHD req evidence of inattentive a/o hyperactive/impulsive SSx for >6mos in >2 settings (e.g. home, school, after-school program). Teacher evals can assist in Dx. Pregnancy, Childbirth & Behavioral 5
15286 Autism spectrum disorders Pts w/ milder forms of ASD freq have normal language and cognitive devel. ChFx incl deficits in social communication and reciprocal social interactions, restricted interests, and behavioural rigidity that Pregnancy, Childbirth & Behavioral 2
become more apparent as social and academic demands ↑. Puerperium (PR) Science (Beha) PR Beha
15288 Renal infarction Renal infarctions are most commonly caused by cardioembolic disease; AF is the greatest RF. CFx incl flank pain, nausea, vomiting, low-grade fever, and HTN (due to renin release from hypoxic tissue). Renal, Urinary & Electrolytes Pathology (Path) 2
Gross path demonstrates sharply demarcated, yellow-white, wedge-shaped areas w/ surrounding hyperaemia. (RE) RE Path
15289 Chronic kidney disease In chronic kidney disease, reduced excretion of phosphate can cause hyperphosphatemia. This induces hypocalcemia directly by binding free calcium and depositing in tissues, and indirectly by triggering Renal, Urinary & Electrolytes Pathophysiology 8
fibroblast growth factor 23 secretion (decreases calcitriol production and intestinal calcium absorption). The resulting hypocalcemia can manifest as neuromuscular excitability (eg, carpal spasm). (RE) (Patp) RE Patp
15291 Chronic kidney disease CKD can cause hyperphosphataemia due to impaired renal excretion of P. ↑ blood PO43- triggers the release of FGF-23, which lowers calcitriol production and intestinal Ca2+absorption. The resulting Renal, Urinary & Electrolytes Physiology 8
hypocalcaemia, along w/ hyperphosphataemia, leads to 2° HPT. (RE) (Phys) RE Phys
15293 Severe combined ADA inhib/absence is highly lymphocytotox. Rx that block ADA are used to Tx lymphocyte-derived ca. Inherited gene muts in ADA lead to the AR disease of SCID. Allergy & Immunology (AI) Immunology 3
immunodeficiency disease (Immu) AI Immu
15299 Cell cycle CDKs 4/6 regulate the movement of cells from G1 → S phase. Ca often have muts that enhance the activity or downstream effects of CDK 4/6, which contribute to unregulated cellular growth. Inhibs to Hematology & Oncology (HO) Pharmacology 2
CDK 4/6 can be used to Tx certain forms of ca. However, they can inhib cellular replication in other rapidly dividing cells such as the heme cells in the bone marrow (e.g. neutropaenia, anaemia, or (Phar)
thrombocytopaenia). HO Phar
15301 Laboratory techniques FISH can Id specific chrom translocations, duplications, or deletions using a complementary ssDNA segment that's tagged w/ a radiotracer. FISH is rapid, highly sens and spec, and can be used on tissues Hematology & Oncology (HO) Biochemistry 1
w/ low mitotic rates. However, the targeted chrom abn must be somewhat large in order to be Id. (Bioc) HO Bioc
15303 Pituitary adenoma Galactorrhoea is abn secretion of breast milk not a/w preg or breastfeeding. It's most commonly due to excess PRL, as seen in PRL-secreting pituitary adenomas. PRL is under (-) regulation by hypothal Endocrine, Diabetes & Pharmacology 8
DA-ergic neurons, and DA agonists can be sued to Tx hyperprolactinaemia. Metabolism (ES) (Phar) ES Phar
15307 Anemia of chronic disease Erythropoietin (EPO) is produced by peritubular fibroblast cells in the renal cortex in response to decreased renal oxygen delivery. EPO acts on erythrocyte precursors in the bone marrow to increase red Hematology & Oncology (HO) Physiology 2
blood cell production. Patients with chronic kidney disease often have damage to renal EPO-producing cells, which results in normocytic anemia. (Phys) HO Phys
15308 Diabetes mellitus Insulin has both renal and hepatic clearance. In pts w/ adv CKD and DM, ↓ renal clearance of insulin can lead to SSx hypoglycemia if exog insulin doses aren't adjusted based on the change in renal fxn. Endocrine, Diabetes & Physiology 31
15310 Hypertrophic cardiomyopathy Pts w/ HCM may be aSSx and often have a FHx of HCM or SCD. Findings consistent w/ HCM incl an overall ↑ in LV mass, ↓ LV cavity size w/ impaired diastolic fxn, LVH predominantly affecting the Cardiovascular (CV) Pathophysiology 9
septum, and normal or ↑ LV EF. (Patp) CV Patp
15312 Chronic kidney disease CKD can cause hyperPO4-emia due to decr renal excretion of P. Dietary P restriction is recommended, but oral PO4 binders are often needed. Sevelamer is a nonabsorbable anion-exchange resin that Renal, Urinary & Electrolytes Pharmacology 8
binds intestinal PO4 to decr absorption. (RE) (Phar) RE Phar
15323 Chronic kidney disease Chronic kidney disease is commonly associated with normocytic anemia due to reduced production of erythropoietin by the kidneys. Erythropoietin signal transduction is primarily mediated by the Janus Hematology & Oncology (HO) Physiology 8
kinase 2/signal transducers and activators of transcription (JAK2/STAT) pathway, which promotes erythrocyte precursor survival. (Phys) HO Phys
15324 Anemia of chronic disease EPO is produced 1arily by peritubular fibroblast cells in the RC in response to ↓ renal O2 delivery (e.g. ↓ blood Hb content). EPO acts on erythrocyte precursor cells in the bone marrow to stim RBC Renal, Urinary & Electrolytes Physiology 2
production. Pts w/ CKD have inflammatory dmg to renal EPO-producing cells and often develop normocytic anaemia due to insufficient EPO. (RE) (Phys) RE Phys
15325 Malaria P. vivax is the most common cause of malaria in non-African countries. It's transmitted by the female Anopheles mosquito and is a/w a latent liver phase that must be Tx (w/ primaquine) independently of Infectious Diseases (ID) Microbiology 5
the erythrocytic phase to fully eliminate the organism. (Micr) ID Micr
15327 Schizophrenia (+) SSx of schizophrenia (e.g. delusions, hallucinations) are a/w ↑ activity of DA in the mesolimbic pathway. Antipsychotics work by antagonising DA receptors in this pathway. Pregnancy, Childbirth & Behavioral 4
15328 Psychosis Huntington Disease is an autosomal dominant, progressive neurodegenerative disorder characterized by chorea, psychiatric symptoms, and dementia. Psychiatric symptoms may occur early in the disease Pregnancy, Childbirth & Behavioral 6
course and include irritability, anxiety, apathy, depression, and psychosis. Puerperium (PR) Science (Beha) PR Beha
15335 Asbestos Asbestosis is a pneumoconiosis that occurs w/ inhalation of asbestos fibres, most commonly in pts w/ occup exposure (e.g. insulation installation, shipbuilding, pipe work). Histopath demonstrates diffuse Pulmonary & Critical Care (PU) Pathophysiology 5
interstitial fibrosis and ferruginous asbestos bodies (translucent fibres coated w/ a golden Fe-containing material). Pleural disease (e.g. plaques, benign effusions) is common. (Patp) PU Patp
15339 Skin and soft tissue infections The most common cause of nonpurulent cellulitis is beta-hemolytic streptococci, particularly group A streptococcus. The most common cause of purulent cellulitis is Staphylococcus aureus. Dermatology (DE) Microbiology 8
(Micr) DE Micr
15346 Membranous nephropathy MN is a common cause of nephrotic syndrome in adults. EM of the glomerular capillary demonstrates irregular, subepithelial, electron-dense immune deposits on the GBM w/ moderate effacement of the Renal, Urinary & Electrolytes Pathology (Path) 2
podocyte foot processes; IF microscopy demonstrates a diffuse granular pattern of IgG along the capillary loops. (RE) RE Path
15347 Antibiotic resistance MRSA is resistant to most β-lactam Rx (e.g. oxacillin, methicillin, cephalosporins) due to the acquisition of a mobile genetic element that contains the mecA gene. This gene encodes for a specialised PBP Infectious Diseases (ID) Pharmacology 8
that has low affinity for β-lactam Abx. Tx of MRSA therefore req a non-β-lactam Rx such as TMP-SMX, clindamycin, doxycycline, or vancomycin. (Phar) ID Phar
15348 Adjustment disorders Adjustment disorder involves emotional or behavioural SSx occurring w/i 3mos of an ID-able stressor. The Dx is indicated when the pt has significant distress and impairment but doesn't meet full criteria Pregnancy, Childbirth & Behavioral 2
for another mental disorder. Puerperium (PR) Science (Beha) PR Beha
15349 Post-traumatic stress disorder Acute stress disorder is characterised by intrusive experiences (flashbacks, nightmares), arousal (poor conc, restless sleep), dissociative SSx, and avoidance of traumatic reminders, as well as mood Pregnancy, Childbirth & Behavioral 3
disturbances in response to a life-threatening trauma. SSx last b/w 3days and 1mos. Puerperium (PR) Science (Beha) PR Beha
15353 IgA nephropathy IgA nephropathy is characterised as recurrent hematuria that occurs spontaneously or w/i 5-7days of an URI or pharyngeal infection (synpharyngitic hematuria). Unlike other causes of IC-mediated Renal, Urinary & Electrolytes Pathology (Path) 1
nephritic syndromes (e.g. PSGN), IgA nephropathy is a/w normal serum complement lvls. (RE) RE Path
15354 Aortic aneurysm AAA is focal dilation of the abdominal aorta above normal (or >3 cm in diameter). It is generally aSSx until aneurysm rupture, which is frequently fatal. RFx include age >65, smoking, and male sex. Cardiovascular (CV) Pathophysiology 6
(Patp) CV Patp
15355 Glomerular disorders MCD is the most common cause of nephrotic syndrome in children. It's often idiopathic but may be triggered by drugs, immunisations, or malignancy. LM shows normal glomeruli, w/ no Ig or Renal, Urinary & Electrolytes Pathology (Path) 9
complement deposits on IF staining. However, EM shows diffuse podocyte foot process effacement and fusion. (RE) RE Path
15357 Personality disorders ASPD involves a pattern of violating the rights of others, engaging in unlawful behaviours (e.g. physical aggression, illegal occups), and lacking remorse for transgressions. Individuals must be age >18 Pregnancy, Childbirth & Behavioral 6
for Dx and have a Hx of CD prior to age 15. Puerperium (PR) Science (Beha) PR Beha
15358 Personality disorders SPD consists of a persistent pattern of social detachment, preference for solitary activities, and constricted range of affect in social interactions. Pregnancy, Childbirth & Behavioral 6
15361 Skin and soft tissue infections BI is a superficial infection by S. aureus that's most common in young children. It's characterised by a blistering skin rash w/ tan- to honey-coloured crusts. The blistering in BI is caused by exfoliative Dermatology (DE) Pathology (Path) 8
toxin A, which targets desmoglein 1 in epidermal cellular junctions and causes a loss of cell adhesion. DE Path
15370 Asbestos Mesothelioma is a neoplasm arising from mesothelial cells and is strongly associated with asbestos exposure. In early mesothelioma, multiple nodules form on the parietal pleura and gradually encase the Pulmonary & Critical Care (PU) Pathophysiology 5
lung parenchyma. Immunohistochemistry is important for diagnosis; nearly all mesotheliomas stain positive for cytokeratins and many also stain positive for calretinin. (Patp) PU Patp
15373 Acne vulgaris RFs for acne incl ↑ androgen lvls; obstr of pilosebaceous glands by oil-based hair products; and mech irritation of skin follicles. Sports participation freq triggers acne due to the use of tight-fitting Dermatology (DE) Pathology (Path) 3
clothing and protective gear. DE Path
15374 Acne vulgaris Acne vulgaris is an inflammatory disorder of pilosebaceous follicles. Contributing factors incl hyperkeratinisation and obstr of follicles; sebaceous gland enlargement w/ ↑ secretion of sebum; colonisation Dermatology (DE) Pathology (Path) 3
and proliferation in the gland by P. (C.) acnes; and follicular and perifollicular inflammation. DE Path
15379 Acne vulgaris Acne typically arises in adolescents and young adults due to adrenarche-associated enlargement in sebaceous glands with subsequent increases in sebum production. Follicles clogged with sebum provide Dermatology (DE) Pathophysiology 3
the anaerobic, lipid-rich environment necessary for the proliferation of Propionibacterium acnes, the skin commensal responsible for acne lesions. (Patp) DE Patp
15384 Depression Somatic SSx of depression (weight loss, low energy, sleep disturbance) are less reliable indicators of MDD in pts w/ advanced medical illness. Focusing on non-somatic SSx, such as loss of interest, Pregnancy, Childbirth & Behavioral 8
anhedonia, worthlessness, excessive guilt, and suicidality, can assist in Dx comorbid depression in these pts. Puerperium (PR) Science (Beha) PR Beha
15391 Diastolic dysfunction Prolonged systemic HTN leads to concentric LVH via the addition of myocardial contractile fibers in parallel. The thickening of the LV walls ↓ LV compliance, leading to impaired diastolic filling and Cardiovascular (CV) Physiology 4
HF w/ preserved EF. In response to ↓ CO, the kidneys activate the RAAS, stimulating Na retention and vasoconstriction that worsens volume overload and can lead to DHF. (Phys) CV Phys
15397 Antipsychotics SGAs block 5-HT2A receptors and have lower binding affinity at DA D2 receptor sites, which is a/w a lower risk of EPS. Pregnancy, Childbirth & Pharmacology 9
15400 Plague Bubonic plaque is a zoonotic infection that causes febrile illness w/ regional inflammatory LAD (buboes). The underlying pathogen is Y. pestis, a gram (-) coccobacillus that exhibits bipolar staining Infectious Diseases (ID) Microbiology 1
(resembling a close safety pin). The major environmental reservoir is rodents, and transmission usually occurs via rodent flea bite. (Micr) ID Micr
15407 Leptospirosis Leptospirosis is a zoonotic infection caused by the motile spirochete Leptospira. Transmission primarily occurs when humans come into contact w/ water contaminated w/ animal urine during outdoor Infectious Diseases (ID) Microbiology 1
recreational or occupational activities. Pts classically have a mild, self-limited, flu-like illness but may develop more serious complications such as renal or hepatic failure. (Micr) ID Micr
15408 Psoriasis Psoriasis is characterised on histo by hyperkeratosis and confluent parakeratosis of the stratum corneum (producing the char silvery scales seen on gross Ex), diffuse epidermal hyperplasia w/ elongated Dermatology (DE) Pathology (Path) 5
and clubbed rete ridges (corresponding to the typical erythematous plaques), and dilated caps in the dermal papillae. DE Path
15410 Delirium Delirium is freq a/w psychotic SSx. It's diffiated from 1° psychotic disorders by fluctuating lvls of consciousness, impaired attn, and disorientation. Delirium can occur post-op a/o in a/w underlying med Pregnancy, Childbirth & Behavioral 4
illnesses or the intro of certain Rx. Puerperium (PR) Science (Beha) PR Beha
15416 Schizophrenia 2nd-gen antipsychotics are a/w a lower risk of EPS AEs compared w/ 1st-gen antipsychotics but may cause metabolic AEs. Pregnancy, Childbirth & Behavioral 4
15419 Hand, foot, mouth disease HFMD (oral ulceration and extremity rash) and herpangina (oral ulcerations w/o rash) are the most common MFxs of enteroviral infection. Rare but serious complications of infection incl myocarditis and Infectious Diseases (ID) Microbiology 2
CNS disease (e.g. aseptic meningitis). (Micr) ID Micr
15420 Pleural effusion Transudative effusions are typically caused by alterations in hydrostatic or oncotic pressure (e.g. HF, cirrhosis, nephrotic syndrome), whereas exudative effusions typically result from inflammation and Pulmonary & Critical Care (PU) Pathophysiology 4
conseq ↑ vascular membrane permeability (e.g. infection, malignancy, rheumatologic disease). Exudative effusions are characterised by a high ratio of pleural fluid to serum total protein (>0.5) or LDH (Patp)
(>0.6), or high absolute lvls of LDH. PU Patp
15429 Pleural effusion A pleural effusion is a collection of fluid b/w the visceral pleura that lines the lungs and the parietal pleura that lines the thoracic cavity. The fluid acts to insulate vibrations and sounds that originate in the Pulmonary & Critical Care (PU) Pathology (Path) 4
airways of the lung; therefore, tactile fremitus and breath sounds are ↓ over a pleural effusion. Dullness to percussion is also present. PU Path
15430 Pleural effusion Transudative pleural effusions result from ↑ intracapillary pressure (e.g. HF) and exudative effusions develop from inflammatory disruption of the vascular membrane. Transudative pleural effusions have Pulmonary & Critical Care (PU) Pathophysiology 4
low fluid/serum ratios of total protein and LDH and low absolute lvls of LDH compared to exudative effusions. (Patp) PU Patp
15431 Cutaneous larva migrans Hookworm infections are transmitted via direct contact between human skin and contaminated soil/sand (eg, walking barefoot). Dermal penetration is often characterized by an intensely pruritic papule Dermatology (DE) Microbiology 1
that may form serpiginous tracks due to the subcutaneous migration of hookworm larvae. (Micr) DE Micr
15436 Chagas disease Chagas disease is a protozoal illness that's endemic to Latin America. Pts in rural areas are at greatest risk when their houses harbor the vector (Triatome bug) in adobe walls or thatched roofs. Acute Infectious Diseases (ID) Microbiology 1
infections are often aSSx, but pts can develop Chagas cardiomyopathy (e.g. HF, ventricular arrhythmias, ventricular aneurysms) several decades later. (Micr) ID Micr
15438 Schistosomiasis Schistosomiasis is a parasitic blood fluke infection that is associated with bathing in freshwater contaminated with cercariae from infected snails. Patients often are asymptomatic for months or years but Infectious Diseases (ID) Pathology (Path) 2
may eventually develop eosinophilic granulomatous inflammation in the liver, spleen, gastrointestinal tract, or genitourinary system. One common manifestation of genitourinary schistosomiasis is
painless terminal hematuria; eggs can often be identified in the urine or on biopsy. ID Path
15441 Ichthyoses Ichthyosis vulgaris is characterized by dermal xerosis (dryness) and scaling that primarily affect the trunk and extensor surfaces of the extremities. It is caused by mutations of the filaggrin gene, resulting Dermatology (DE) Pathology (Path) 1
in epidermal hyperplasia, defective desquamation, and loss of the normal barrier function. DE Path
15447 Depression Depression-related cognitive impairment refers to cognitive impairment that occurs in the context of MDD, which may be mistaken for mild cognitive impairment or dementia. Pregnancy, Childbirth & Behavioral 8
15448 Leishmaniasis Leishmania species are obligate intracellular protozoa that mature in macrophages and can be identified on biopsy by the presence of rod-shaped kinetoplasts. They are transmitted to humans by infected Dermatology (DE) Microbiology 1
sand flies and cause the clinical syndrome of cutaneous leishmaniasis, characterized by a chronic, pinkish papule that evolves into a nodule or plaque. (Micr) DE Micr
15453 Malaria Mefloquine chemoprophylaxis for malaria must be continued for 4wks after return from an endemic region to ensure the elimination of hepatic schizonts (which develop in the liver over 8-30days). Infectious Diseases (ID) Microbiology 5
(Micr) ID Micr
15457 Malaria Malaria is Dx when intraerythrocytic diamond ring-shaped parasites are seen on peri blood smear. This disease should be suspected in travellers to endemic regions who develop a febrile illness. Infectious Diseases (ID) Microbiology 5
(Micr) ID Micr
15460 Lung cancer Melanoma is a highly aggressive malignancy that often mets early in the disease course. Pts may be aSSx for yrs prior to onset of met MFxs. Dx is gen made when a histopath sample shows cellular atypia Hematology & Oncology (HO) Pathology (Path) 9
w/ cells containing brown pigment (melanin granules); immunostaining for melanin/melanoma markers (e.g. S-100, HMB-45) is gen (+). HO Path
15466 Multiple myeloma MM is a/w the clonal proliferation of plasma cells in the bone marrow. This prevents normal B cell lymphogenesis and incr. the risk of bacterial infection due to decr. production of normal Igs. Hematology & Oncology (HO) Immunology 9
(Immu) HO Immu
15467 Multiple myeloma MM is a plasma cell malignancy that replicates in the bone marrow and causes osteolytic bone lesions, bone destruction, hypercalcaemia, and path fractures. Histopath will show replacement of the Hematology & Oncology (HO) Pathology (Path) 9
normal bone marrow w/ plasma cells and blasts. HO Path
15481 Social anxiety disorder SAD is characterised by anxiety and fear of scrutiny in social situations and can result in marked social-occup impairment. Preferred pharmacotherapy is Rx that inhibs 5-HT reuptake (e.g. SSRIs or Pregnancy, Childbirth & Behavioral 2
SNRIs). Puerperium (PR) Science (Beha) PR Beha
15482 Impulse control disorders IED is characterised by recurrent episodes of explosive verbal or physical aggression. The aggressive behaviours are impulsive and grossly out of proportion to the provocation. Pregnancy, Childbirth & Behavioral 1
15489 Hemophilias hemophilia A is an XL disorder a/w a defic of FVIII. Emicizumab — a bispecific, mAb — mimics the activity of FVIII by binding to both FIXa and FX, bringing them into close proximity to allow for Hematology & Oncology (HO) Pharmacology 1
FX activation. (Phar) HO Phar
15490 Infectious mononucleosis Reactive (atypical) lymphocytes are activated, pathogen-specific cytotoxic T cells or natural killer cells that form in response to certain intracellular infections. In contrast to normal lymphocytes, reactive Infectious Diseases (ID) Immunology 5
lymphocytes are large, scalloped, and have abundant cytoplasm. Reactive lymphocytosis is a diagnostic feature of infectious mononucleosis. (Immu) ID Immu
15491 Arbovirus Arboviruses, small RNA viruses transmitted by biting arthropods, are the most common cause of encephalitis outbreaks in the US. B/c no vax are currently available, prevention 1arily involves Infectious Diseases (ID) Microbiology 1
eliminating the vector arthropods (e.g. infected mosquitoes). (Micr) ID Micr
15493 Grief Preschool children haven't developed an understanding of the finality of death, which typically occurs around age 7. They may have magical thoughts that death is temporary or reversible and believe that Pregnancy, Childbirth & Behavioral 3
other people's grief is their fault. Puerperium (PR) Science (Beha) PR Beha
15500 Bulimia nervosa Hypokalaemia in an otherwise healthy young adult w/ a normal BMI and preoccup w/ body size is concerning for self-induced vomiting a/w BN. Common PEx findings in BN incl tachycardia, Pregnancy, Childbirth & Behavioral 4
hypotension, painless parotid gland swelling, calluses or scarring on the dorsum of the hand, and erosion of dental enamel. Puerperium (PR) Science (Beha) PR Beha
15501 Anorexia nervosa AN is characterised by a distorted body image and fear of weight gain despite significantly low body weight. Pts may restrict their food intake a/o binge and purge. The key in distinguishing AN from BN Pregnancy, Childbirth & Behavioral 3
is abnly low body weight. Puerperium (PR) Science (Beha) PR Beha
15509 Toxic shock syndrome Toxic shock syndrome is typically associated with the prolonged use of tampons or wound packing, which allows Staphylococcus aureus to replicate locally and release pyrogenic toxic superantigens (eg, Infectious Diseases (ID) Immunology 2
toxic shock syndrome toxin-1) into the blood. Superantigens bind to the MHC-II complex of antigen-presenting cells without processing and nonspecifically activate T cells. This leads to a dramatic (Immu)
release of inflammatory cytokines, which causes the manifestations of the disease (eg, hypotension; high fever; organ failure; diffuse, erythematous rash). ID Immu
15515 Hypertrophic cardiomyopathy Many pts w/ HCM have poor cardiac reserve (e.g. exercise intolerance) due to LVOT obstruction. This outflow obstruction is worsened by ↓ LV blood volume. β blockers ↓ HR and LV contractility to ↑ Cardiovascular (CV) Pharmacology 9
LV blood volume, ↓ LVOT obstruction, and improve SSx. (Phar) CV Phar
15516 Hypertrophic cardiomyopathy HCM typically involves interventricular septal hypertrophy that obstructs LV outflow and creates a systolic murmur that ↓ in intensity w/ maneuvers that ↑ LV blood volume (eg, hand grip, passive leg Cardiovascular (CV) Physiology 9
elevation). HCM is Chx by ↑ LV muscle mass w/ a small LV cavity, preserved EF, and impaired LV relaxation leading to diastolic dysfxn. (Phys) CV Phys
15518 Gonococcal infection N. gonorrhoeae is spread sexually by GU secretions and can be prevented by the consistent use of condoms. GUIs are often aSSx, which ↑ the risk of spread thru the bloodstream, leading to disseminated Infectious Diseases (ID) Microbiology 3
gonococcal infection. Pts w/ disseminated disease typically present w/ the triad of polyarthralgia, tenosynovitis, and dermatitis or purulent arthritis. (Micr) ID Micr
15523 Parasomnias REM sleep is characterized by dreaming and voluntary muscle paralysis, and occurs more often during the final third of the night. Nightmares occur during REM sleep and can be differentiated from sleep Pregnancy, Childbirth & Pathophysiology 2
terrors, a non-REM parasomnia characterized by incomplete arousals and lack of recall of dream content. Puerperium (PR) (Patp) PR Patp
15526 Acute heart failure SV is the absolute volume of blood ejected from the LV w/ each contraction and is calculated by subtracting LV ESV from LV EDV. EF is the relative volume of blood ejected from the LV w/ each Cardiovascular (CV) Physiology 7
contraction; it is calculated by dividing SV by LV EDV. CO, the volume of blood ejected into the aorta per unit time, is estimated by multiplying SV by HR. (Phys) CV Phys
15528 Sick sinus syndrome aSSx LV systolic dysfxn is a common stage in the progr of HF. Neurohormonal mechs, incl the SNS and RAAS, help maintain the aSSx period by ↑ volume retention and peri resistance to maintain organ Cardiovascular (CV) Pathophysiology 2
perfusion. Although these mechs are beneficial in the short term, they're ultimately deleterious, ↑ hemodynamic stress and cardiac remodelling that eventually lead to DHF. (Patp) CV Patp
15534 Chronic heart failure LHF leads to chronically ↑ pulm venous and capillary pressures, w/ resulting pulm oedema and extravasation of RBCs into the alveolar parenchyma. The Fe from RBCs is taken up by alveolar Cardiovascular (CV) Physiology 12
macrophages and stored as hemosiderin, appearing as brown pigment on histopathology. (Phys) CV Phys
15535 Acute heart failure Congestive hepatopathy is a common complication of RHF. Patchy hemorrhage and necrosis predominantly affect the centrilobular regions (zone 3) where hepatic congestion is most prominent. The Gastrointestinal & Nutrition (GI) Pathology (Path) 7
centrilobular necrosis, combo w/ relatively normal-appearing periportal regions (zone 1), creates an overall heterogenous appearance sometimes referred to as 'nutmeg liver'. GI Path
15542 Primary hypertension Concentric LVH involves uniform thickening of the LV walls w/ ↓ in LV cavity size and most commonly results from prolonged systemic HTN. It can progress to HTN heart disease w/ impaired diastolic Cardiovascular (CV) Pathology (Path) 14
filling and HF w/ preserved EF. Histopathology demonstrates transverse thickening of cardiomyocytes w/ prominent hyperchromatic nuclei and interstitial fibrosis. CV Path
15543 Ehrlichiosis and anaplasmosis Ehrlichia chaffeensis is harbored in white-tailed deer and transmitted to humans by tick bite. It replicates in vacuoles w/i monocytes and forms mulberry-shaped, intraleukocytic inclusions (morulae). MFx Infectious Diseases (ID) Microbiology 1
usually include nonspecific SSx (eg, fever, chills, myalgia), maculopapular rash, and significant laboratory abnormalities, particularly lymphopenia. (Micr) ID Micr
15545 Chronic lymphocytic leukemia CLL is a chronic LPD marked by the progressive accumulation of mature B cells. Most pts are aSSx for yrs but eventually develop anemia, thrombocytopenia, a/o neutropenia. The Dx is generally made Hematology & Oncology (HO) Pathology (Path) 1
when CBC reveals dramatic leukocytosis, and FC subsequently shows a clonal population of leukocytes w/ typical B-cell markers such as CD19, CD20, and CD23. HO Path
15549 Intestinal helminth parasites Ascaris lumbricoides is transmitted via contaminated food or water. Eggs hatch into larvae in the small intestine, penetrate the intestinal wall, and migrate across the lung into the alveoli. Larvae are Infectious Diseases (ID) Microbiology 3
subsequently coughed up and swallowed into the GIT, where they mature to adult worms. Most pts are aSSx, but some develop early pulm MFx (Loeffler syndrome) or later GI SSx. (Micr) ID Micr
15550 Hand, foot, mouth disease HFMD is a common childhood illness characterised by painful, vesicular mouth lesions; ulcers on the extremities; and low-grade fever. It's caused by the ingestion and subseq dissemination of an Dermatology (DE) Pathology (Path) 2
enterovirus (e.g. Coxsackievirus). DE Path
15553 Radiculopathy Motor and sensory deficits across multi peri upper extremity nerves (e.g. radial and median) indicate a lesion in the brachial plexus prox. to the formation of the terminal branches. In the absence of Hx of Rheumatology, Orthopedics & Anatomy (Anat) 3
trauma or malignancy, the most likely cause is nerve root compression due to cervical spondylosis (cervical radiculopathy). Sports (RH) RH Anat
15554 Pulmonary embolism Transcatheter aortic valve implantation (TAVI) allows for minimally invasive management of severe aortic stenosis in elderly patients who are unable to tolerate open surgical valve replacement. Cardiovascular (CV) Pathology (Path) 13
Paravalvular aortic regurgitation is a common complication of TAVI, resulting from improper sealing of the prosthetic valve to the native aortic valve annulus. CV Path
15555 Heart block 3rd-degree (complete) AV block involves dysfxn of the AV node, resulting in total lack of communication b/w the atria and ventricles. On ECG, there's dissociation of P waves and QRS complexes, w/ P Cardiovascular (CV) Pathology (Path) 2
waves marching out at the intrinsic rate of the SA node and QRS complexes at the intrinsic rate of the His bundle or ventricles (escape rhythm). CV Path
15557 Odontogenic infections Sjogren syndrome is characterised by autoimmune inflammation of exocrine glands (e.g. salivary, lacrimal, vaginal). Pts typically have severe dry mouth (xerostomia) due to ↓ saliva production, which Infectious Diseases (ID) Microbiology 1
can lead to an ↑ rate of dental caries and other oral infections (e.g. thrush) b/c of the loss of protective factors in saliva. Bx of the salivary glands shows a lymphocytic infiltrate, often w/ germinal centres. (Micr) ID Micr
15559 Lyme disease Early disseminated Lyme disease can have cardiac involvement (Lyme carditis) that most commonly MFx w/ varying degrees of AV conduction block. Pts may be aSSx, but those w/ complete AV Cardiovascular (CV) Pathology (Path) 3
conduction block are likely to have dyspnea, lightheadedness, or syncope. CV Path
15560 Epididymitis Epididymitis presents with acute testicular pain, tenderness, and pyuria. It is caused by retrograde passage of organisms from the urethra into the ejaculatory duct and vas deferens. The microbiology is Male Reproductive (MR) Pathology (Path) 1
largely influenced by patient age: epididymitis in young men is usually due to sexually acquired infections (eg, Chlamydia trachomatis, Neisseria gonorrhoeae), whereas in older men (age >35) it is
usually due to gram-negative colonic flora. MR Path
15562 Sickle cell PVB19 infection can cause transient aplastic crisis, particularly in those w/ underlying Hb disorders such as SCA. Pts develop SSx anaemia (e.g. exertional dyspnoea, fatigue, low Hct) due to inhib of Hematology & Oncology (HO) Pathology (Path) 13
erythropoiesis by the virus. Bone marrow Ex will show giant pronormoblasts w/ glassy, intranuclear viral inclusions. HO Path
15565 HSV infection HSV is a common, STI marked by the formation of painful genital ulcers. Tzanck smear can reveal the char cytopathic effects of the virus, incl multinucleated giant cells, ground-glass opacities, Infectious Diseases (ID) Microbiology 9
acantholytic cells, keratinocyte ballooning, and nuclear moulding. (Micr) ID Micr
15566 Febrile neutropenia Chemotherapy-assoc neutropaenic fever is most often caused by endogenous commensal bacteria that have translocated across dmgd mucosal sites. Infectious Diseases (ID) Microbiology 4
(Micr) ID Micr
15574 Sick sinus syndrome SSS results from degeneration (usually age-related) of the SA node, leading to impaired conduction and ↓ CO w/ SSx of dyspnea, fatigue, lightheadedness, presyncope, and syncope. ECG typically Cardiovascular (CV) Pathophysiology 2
demonstrates bradycardia w/ sinus pauses (delayed P waves), sinus arrest (dropped P waves), and jxnal escape beats. (Patp) CV Patp
15578 Group B streptococcal infection Streptococcus agalactiae (GBS), one of the most common causes of early neonatal sepsis, is typically identified by the presence of a narrow zone of β-hemolysis when plated on blood agar. It is also Infectious Diseases (ID) Microbiology 2
identified by the production of CAMP factor, which enhances β-hemolysis by particular strains of Staphylococcus aureus. (Micr) ID Micr
15579 Tinea Tinea corporis presents with round or ovoid lesions with a raised, scaly border and central clearing. Trichophyton rubrum is the most common cause and infects keratinized matter in the stratum corneum Dermatology (DE) Microbiology 4
of the superficial epidermis but does not invade the dermis and subcutaneous tissues. (Micr) DE Micr
15580 Cryptococcal infections Cryptococcus neoformans is a round/oval yeast w/ a thick PSC. It is a common cause of meningoencephalitis (eg, h/a, vomiting, confusion, seizure) in pts w/ unTx AIDS. The yeast can frequently be Nervous (NS) Microbiology 3
visualized in the CSF by India ink or silver stain. (Micr) NS Micr
15587 West Nile virus infection WNV is harbored in birds and transmitted to humans by mosquitos. Most pts are aSSx, but the virus can cause an influenza-like illness or neuroinvasive disease w/ meningitis, encephalitis, and flaccid Nervous (NS) Microbiology 2
paralysis. (Micr) NS Micr
15588 Toxoplasmosis Pregnant women should avoid raw or undercooked meat in order to prevent infection w/ Toxoplasma gondii, an intracellular parasite that can spread across the placenta to the fetus. Congenital Infectious Diseases (ID) Microbiology 5
toxoplasmosis is typically Chx by retinal lesions, hydrocephalus, jaundice, and HSM. (Micr) ID Micr
15596 Sjogren syndrome SS is an AI disorder char by inflammation of exocrineglands. Bx of the labial salivaryglands shows periductal lymphocytic infiltrates (focal lymphocytic sialadenitis), often w/ germinal centres; the Rheumatology, Orthopedics & Pathology (Path) 2
glandular tissue is typically atrophic and fibrotic. Sports (RH) RH Path
15597 Sjogren syndrome SS is an AI disorder char by lymphocytic inflammation in exocrine glands (e.g. lacrimal, salivary glands). It presents w/ dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia). Chronic B-cell Rheumatology, Orthopedics & Pathology (Path) 2
proliferation in pts w/ SS ↑ the risk of devel NHL. Sports (RH) RH Path
15600 Central pontine myelinolysis Osmotic demyelination syndrome results from overly rapid correction of chronic hyponatremia. Clinical features include quadriplegia, pseudobulbar palsy, and reduced level of consciousness. MRI Nervous (NS) Pathophysiology 2
demonstrates focal demyelination of the pons. (Patp) NS Patp
15602 Wilson disease WD is a/w Cu accumulation in the liver, brain, and cornea. It commonly presents in childhood or adolescence w/ abn LFTs a/o neuropsych SSx. Psych SSx may predate other MFxs and incl personality Pregnancy, Childbirth & Behavioral 5
changes, depression, mania, a/o psychosis. Puerperium (PR) Science (Beha) PR Beha
15603 Polymyositis and dermatomyositis Dermatomyositis is characterised by proximal muscle weakness resembling polymyositis, w/ addnal inflammatory features affecting the skin (e.g. heliotrope rash, Gottron papules). In both conditions, Gastrointestinal & Nutrition (GI) Pathology (Path) 5
involvement of striated muscle in the oropharynx and heart can lead to dysphagia, pulm aspiration, and myocarditis. GI Path
15606 Benzodiazepines Flumazenil is a benzo receptor antagonist. It can reverse the sedative effects of benzos related to overdose and procedural sedation. Pregnancy, Childbirth & Pharmacology 6
15607 Antidepressants Antidepressants (e.g. SSRIs) take 4-6wks to achieve max clinical effect. Pregnancy, Childbirth & Behavioral 4
15609 Fetal alcohol syndrome Typical features of fetal alcohol syndrome include facial dysmorphism (short palpebral fissures, thin upper lip, smooth philtrum), growth retardation, neurological abnormalities, and behavioral Pregnancy, Childbirth & Pathophysiology 1
difficulties. Puerperium (PR) (Patp) PR Patp
15611 Myasthenia gravis MG is characterised by auto-Abs against post-synaptic nAChRs at the NMJ, which result in receptor degradation. Pts typically have extraocular, bulbar, and facial weakness that worsens w/ activity. In Pulmonary & Critical Care (PU) Pathophysiology 10
severe cases, the resp muscles may be affected, leading to hypoventilation and resp failure. (Patp) PU Patp
15612 Peripheral neuropathy Ulnar neuropathy is Chx by numbness of the 4th and 5th digits, pain, and weakness. It is most commonly caused by compressive injury, leading to tissue ischemia and demyelination (Schwann cell Nervous (NS) Pathophysiology 3
injury). A nerve conduction study can help differentiate demyelinating vs axonal neuropathies; demyelination causes slowed or blocked nerve conduction velocity whereas axonal injury leads to a ↓ in (Patp)
signal strength. NS Patp
15613 Inhalants Inhalant intox is characterised by immediate onset of euphoria, lethargy, ataxia, a/o LOC f/b rapid recovery w/i 45mins. Perioral and perinasal dermatitis (i.e. 'glue sniffer's rash') may be seen in chronic Pregnancy, Childbirth & Behavioral 1
users. Puerperium (PR) Science (Beha) PR Beha
15615 Cocaine Cocaine intox can produce psychotic SSx (e.g. paranoid delusions), euphoria, and agitation. Physical SSx indicating sympathetic stim (e.g. tachycardia, diaphoresis, mydriasis) can assist in diffiating Pregnancy, Childbirth & Behavioral 3
cocaine intox from 1° psychiatric disorders. Puerperium (PR) Science (Beha) PR Beha
15619 SLE SLE is an autoimmune disease characterised by the formation of ANA (e.g. anti-DNA Abs). Lupus nephritis occurs 1arily due to the formation of ICs containing DNA and anti-DNA in the circulation. Renal, Urinary & Electrolytes Pathology (Path) 7
These are deposited in the glomerulus where they result in complement activation, recruitment of inflammatory cells, and renal injury (HS-III). (RE) RE Path
15627 Rheumatoid arthritis Joint destruction in RA is char by synovial hyperplasia, an inflammatory infiltrate, and synovial angiogenesis. The joint space often becomes replaced by pannus, an invasive mass composed of fibroblast- Rheumatology, Orthopedics & Pathology (Path) 9
like synovial cells, granulation tissue, and inflammatory cells that can erode into the articular cartilage and underlying bone. Sports (RH) RH Path
15629 Rheumatoid arthritis RA is char by synovial hyperplasia w/ inflammatory infiltrates. The accelerated meta rate of the inflamed synovium causes local hypoxia, which leads to synovial angiogenesis. As the disease progresses, Rheumatology, Orthopedics & Pathology (Path) 9
the joint space is replaced by a rheumatoid pannus (an invasive mass of fibroblast-like synovial cells, granulation tissue, and inflammatory cells) which can destroy the articular cartilage and underlying Sports (RH)
subchondral bone. RH Path
15635 Bone tumor ES is the 2nd most common malignant bone tumor of childhood (after OS). It most commonly involves the lower extremity and pelvis and often metastasizes to the lungs. Histopathology is Chx by Hematology & Oncology (HO) Pathology (Path) 3
uniform, small, round, cells; fibrous septae; and patches of necrosis and hemorrhage. HO Path
15636 Bone tumor OS is the most common 1° bone tumour in children and young adults and typically arises near the metaphyses of long bones. Pts usually have slowly worsening pain and soft-tissue swelling. XR typically Rheumatology, Orthopedics & Pathology (Path) 3
reveals a lytic bone lesion, and Bx classically shows pleomorphic, spindle-shaped tumour cells that generate osteoid and thin trabeculae of neoplastic bone. Sports (RH) RH Path
15637 Neural tube defects MTX and other vit B9 antagonists adversely affect rapidly dividing cells (e.g. epithelial cells, stem cells, neural tube cells) by limiting the production of precursors essential to DNA synthesis and repair. Nervous (NS) Embryology 4
If used in the 1st trimester of pregnancy, these drugs can cause major congenital abnormalities (e.g. CV abnormalities, NTDs). (Embr) NS Embr
15638 Brain tumors Ependymomas originate from the ependymal cells that line the ventricular system and the central canal of the spinal cord. Ventricular ependymomas can block the flow of CSF thru the interventricular Nervous (NS) Pathology (Path) 10
foramina, causing SSx of ↑ ICP (e.g. h/a, papilloedema) due to obstr (noncommunicating) hydrocephalus. NS Path
15644 Insomnia Age-related sleep changes may be reported as insomnia and must be diffiated from 1° sleep disorders and other disorders. Normal changes incl ↓ total sleep time, ↑ night-time awakenings, sleepiness Pregnancy, Childbirth & Behavioral 3
earlier in the evening w/ earlier morning awakening, and ↑ daytime napping. Puerperium (PR) Science (Beha) PR Beha
15645 Bone tumor OS is the most common 1° bone malignancy in children and young adults. It occurs most frequently at the metaphyses of long bones and Px w/ local pain and swelling. Most cases are a/w sporadic or Hematology & Oncology (HO) Pathology (Path) 3
inherited mutations in RB1 (HRb) and TP53 (LFS). HO Path
15646 Cerebral aneurysm An expanding aneurysm in the cavernous portion of the ICA is most likely to initially cause h/a and diplopia (ipsilateral lateral rectus weakness) due to compressing or stretching of the abducens nerve Nervous (NS) Anatomy (Anat) 1
(CN VI) as it runs next to the ICA in the cavernous sinus. Other commonly affected nerves include the oculomotor nerve (CN III), trochlear nerve (CN IV), and the V1 and V2 branches of the trigeminal
nerve (CN V). NS Anat
15648 Frontotemporal dementia The frontal lobes are involved in personality, language, motor fxns, and executive fxns (e.g. abstraction). Frontal lobe fxn may be Dx by testing abstraction ability (e.g. asking about the similarities b/w 2 Nervous (NS) Pathophysiology 2
related objects) on the MSE. (Patp) NS Patp
15650 Acute heart failure Pts w/ DHF have ↑ LV EDP and ↓ CO that's most often 1arily due to LV dysfxn. RA pressure (i.e. CVP) is also ↑ in advanced HF due to volume overload; RHF (most often occurring 2° to LHF) can also Cardiovascular (CV) Pathophysiology 7
contribute to ↑ RA pressure. (Patp) CV Patp
15651 Chronic heart failure The ventricular myocardium secretes BNP in response to the ventricular stretch and strain that typically occurs w/ volume overload. BNP, along w/ ANP secreted by the atrial myocardium, stimulates Cardiovascular (CV) Pathophysiology 12
vasodilation and salt and water excretion to help relieve volume overload. (Patp) CV Patp
15652 Gastroparesis Diabetic gastroparesis results from the destruction of enteric neurons due to chronic hyperglycaemia, leading to impaired relaxation and disordered and ineffective peristalsis. This causes delayed gastric Gastrointestinal & Nutrition (GI) Pathophysiology 2
emptying, which presents as postprandialfullness, regurgof undigested food, nausea, and vomiting. (Patp) GI Patp
15659 Brain tumors GBM is an aggressive 1° brain neoplasm that generally Px w/ slowly worsening h/a, seizure, a/o focal neuro issues. Most cases are a/w oncogenic mutations that increase EGFR expression on the tumor Nervous (NS) Pathology (Path) 10
cells, leading to ↑ transduction of growth signals that promote cellular survival and proliferation. NS Path
15660 Hip fracture The greater trochanter of the femur serves as the site of insertion for the gluteus medius muscle, which is responsible for hip abduction and stabilisation of the pelvis during ambulation. Fractures of the Rheumatology, Orthopedics & Anatomy (Anat) 2
greater trochanter (e.g. fragility fracture from a fall) can disrupt the integrity of the gluteus medius tendon and result in lat. hip pain w/ gait instability and weakness of hip abduction. Sports (RH) RH Anat
15665 Lipoma Lipomas are common, benign tumours that arise from the subcutaneous fat and present as soft, mobile masses that're stable or enlarge slowly over time. The Dx is usually made clinically, but histopath Rheumatology, Orthopedics & Pathology (Path) 1
shows well-diffiated, matureadipocytes w/ a fibrous capsule. Sports (RH) RH Path
15666 Osteomyelitis M. tuberculosisspondylitis (Pott's disease) is usually the result of heme seeding of vertebrae from 1° pulm infection. MFxs typically arise mos or yrs later (due to reactivation) and incl chronic, progr back Rheumatology, Orthopedics & Pathology (Path) 4
pain, fever, and radiographic evidence of vertebral bone destruction and fluid collection. Sports (RH) RH Path
15667 Diabetic neuropathy DM is the most common cause of peri polyneuropathy in adults. Common findings incl numbness and paraesthesias in a stocking-glove distribution and ↓ proprioception due to degen of large-fibre Nervous (NS) Pathology (Path) 1
sensory axons. NS Path
15668 Diabetic retinopathy Chronic hyperglycemia in patients with diabetes can lead to increased permeability and arteriolar obstruction in retinal vessels. The resulting ischemia stimulates production of vascular endothelial growth Ophthalmology (OP) Pathology (Path) 1
factor and other angiogenic factors, leading to neovascularization (proliferative diabetic retinopathy). Complications include retinal hemorrhage, retinal detachment, and vision loss. OP Path
15675 Diabetic foot Neuropathic foot ulcers can occur in diabetic pts when loss of pain sensation and proprioception delays recognition of injury due to trauma, friction, or sustained pressure (on plantar surface of foot Dermatology (DE) Pathology (Path) 2
bones). The risk is greatest in pts w/ longstanding DM who have poor glycaemic control. DE Path
15677 Paget disease of bone PDB is Chx by disordered bone formation. Involvement of long bones can lead to bone pain, bowing, fracture, or arthritis of adjacent joints. Serum ALP is ↑ due to ↑ production of new bone, but Ca and P Rheumatology, Orthopedics & Pathology (Path) 4
levels remain normal. Sports (RH) RH Path
15678 Traumatic brain injury DAI is a type of TBI that results from disruption of the white matter tracts. Microscopically, DAI is visible as widespread axonal swelling, most pronounced at the gray-white matter jxn, w/ accumulation Nervous (NS) Pathology (Path) 5
of transport proteins (eg, amyloid precursor, α synuclein) at the site of injury. NS Path
15683 Migraine Migraines are an episodic neurological disorder that results in severe, unilateral, throbbing headaches often associated with photophobia, phonophobia, and nausea/vomiting. Migraines typically last 4-72 Nervous (NS) Pathology (Path) 3
hours, and up to 25% of patients also develop an aura (focal, reversible neurologic symptoms that precede or accompany the headache). NS Path
15684 Migraine Migraine is an episodic disorder characterised by severe, often unilateral h/a, commonly a/w nausea and sensitivity to light and sound. Tx is divided into abortive therapy (e.g. mild analgesics, triptans, Nervous (NS) Pharmacology 3
antiemetics, ergotamines) for acute SSx and preventive therapy (e.g. β blockers, TCAs, anticonvulsants [topiramate, valproate]) to ↓ the freq of h/a. (Phar) NS Phar
15693 Long QT syndrome Congenital LQTS is commonly caused by a mutation that slows the delayed rectifier K current that repolarizes the cardiomyocyte AP. Certain Rx (eg, macrolide Abx, antipsychotics, antiemetics) also Cardiovascular (CV) Pathophysiology 4
slow the K repolarization current and prolong the QT interval. Excessive QT prolongation can trigger serious cardiac arrhythmia (ie, TdP), resulting in syncope or SCD. (Patp) CV Patp
15695 Erythema multiforme EM is a target-shaped, inflammatory skin lesion that typically arises in the setting of infection, particularly w/ HSV or M. pneumoniae. It's caused by the deposition of infectious Ags in keratinocytes, Dermatology (DE) Pathology (Path) 2
leading to a strong cell-mediated (e.g. Tc-cell) immune response. DE Path
15696 Paget disease of bone PDB is char by excessive and disordered bone formation. It commonly affects the skull, long bones, and vertebral column. The ↑ formation of new bone is a/w an ↑ serum ALP lvl. Radiographs shows Rheumatology, Orthopedics & Pathology (Path) 4
lytic or mixed lytic-sclerotic lesions, thickening of cortical and trabecular bone, and bony deformities. Sports (RH) RH Path
15701 Panic disorder PD consists of recurrent and unexpected panic atks characterised by an abrupt surge of anxiety and distressing cardiopulm/neuro SSx. Agoraphobia, a common comorbid disorder, results in anxiety about Pregnancy, Childbirth & Behavioral 4
and avoidance of situations where pts may feel trapped and helpless in the event of a panic atk (e.g. crowds, enclosed spaces, public transportation. Puerperium (PR) Science (Beha) PR Beha
15702 Delirium Delirium is characterised by the acute onset of fluctuating disturbance in attn and gen cognition (e.g. altered lvl of consciousness, disorientation, hallucinations). Common Rx that may precipitate delirium Nervous (NS) Pathology (Path) 4
in high-risk pops (e.g. elderly pts) incl sedative-hypnotics, benzos, opioids, and anticholinergic Rx. NS Path
15705 Sciatic neuropathy Sciatic neuropathy is a common complication of hip fracture a/o arthroplasty b/c of the proximity of the sciatic nerve to the hip joint. Injury to the sciatic nerve in the pelvis causes neuro deficits across the Nervous (NS) Anatomy (Anat) 2
sciatic nerve (knee flexion), common peroneal nerve (dorsiflexion, numbness of the calf and dorsal foot), and tibial nerve (plantar flexion, ankle reflex). NS Anat
15706 Chemotherapy induced nausea and CTx-induced nausea and vomiting is mediated by peri and central mechs. It can be Tx w/ 5-HT receptor antagonists (e.g. ondansetron) to prevent 5-HT stim of afferent vagal fibres in the bowel wall (peri Hematology & Oncology (HO) Pharmacology 1
vomiting cause) and NK-1 receptor antagonists (e.g. aprepitant) to prevent the effects of substance P in the brainstem (central cause). (Phar) HO Phar
15727 Median nerve injury The median nerve is most commonly injured w/i the carpal tunnel, leading to pain and numbness in the first 3 digits and lateral half of the 4th, as well as weakness of thumb flexion and opposition. More Nervous (NS) Anatomy (Anat) 1
proximal injury (in the forearm) additionally causes ↓ sensation over the thenar eminence and weakness of flexion in the wrist and 2nd and 3rd digits. NS Anat
15729 Tricuspid regurgitation Severe TR can lead to right-sided HF, evidenced by JVD, hepatomegaly, lower extremity edema, and the absence of pulm edema. Permanent PM placement can cause TR b/c the RV lead passes through Cardiovascular (CV) Pathophysiology 3
the TV orifice and can disrupt valve closure. (Patp) CV Patp
15730 Bipolar disorder Manic episodes are characterized by euphoric/irritable mood, impulsivity, hyperactivity, decreased need for sleep. pressured speech, racing thoughts, and grandiosity. They may occur with or without Pregnancy, Childbirth & Behavioral 7
psychotic features. Puerperium (PR) Science (Beha) PR Beha
15732 Illness anxiety disorder IAD is characterised by excessive concern about having a serious, un-Dx disease, despite few or no SSx and (-) medical workup. Pregnancy, Childbirth & Behavioral 1
15762 Parasomnias Sleepwalking, a common non-REM parasomnia of childhood, occurs during slow-wave sleep (stage N3), which is characterized by delta Waves on EEG. Sleepwalking typically occurs during the first Pregnancy, Childbirth & Pathophysiology 2
half of the night, when slow-wave sleep is most prominent. Puerperium (PR) (Patp) PR Patp
15765 Ischemic stroke The ACA supplies the medial aspects of the frontal and parietal lobes, which contain the UMNs responsible for contralateral lower extremity motor control. TE occlusion of the ACA Chx results in Nervous (NS) Anatomy (Anat) 19
contralateral lower extremity weakness w/ hyperreflexia. NS Anat
15766 Transient ischemic attack TIAs are transient episodes of focal neuro impairment that occur due to local brain ischemia; tissue infarction doesn't occur, and brain imaging is normal. Pts w/ TIA are at ↑ risk of future stroke; 2° Nervous (NS) Pharmacology 1
prevention incls antiplatelet agents (e.g. aspirin, clopidogrel), statins, and LSMs (e.g. tobacco cessation, exercise) to ↓ future risk. (Phar) NS Phar
15770 Diabetes mellitus SGLT2 inhibs (e.g. canagliflozin, dapagliflozin) ↓ renal reabsorption of Glc and Na+, leading to lower BSLs. The ↓ reabsorption of Na+ and Glc also induces osmotic diuresis, which causes a ↓ in BP. Endocrine, Diabetes & Pharmacology 31
Excess urinary Glc also leads to an ↑ risk for GUTIs. Metabolism (ES) (Phar) ES Phar
15804 Testicular cancer A painless, solid scrotal mass should be considered testicular cancer until proven otherwise. Examination generally reveals a solid, firm, or fixed nodule in the tunica albuginea that is ovoid in shape and Male Reproductive (MR) Pathology (Path) 4
painless to palpation. Testicular tumors do not transilluminate. MR Path
15821 BCL 2 CLL is a/w overexpression of BCL-2, an anti-apoptotic protein, on the mitochondrial membrane. Tx w/ a BCL inhib causes ca cell death by promoting cyt c release from the mitochondria, which subseq Hematology & Oncology (HO) Pharmacology 1
activates caspases. (Phar) HO Phar
15828 Testicular cancer Most cases of testicular cancer are either seminomatous or nonseminomatous germ cell tumors. Nonseminomatous germ cell tumors are composed of partially differentiated germ cells, which often retain Male Reproductive (MR) Pathology (Path) 4
the ability to secrete human chorionic growth hormone and alpha-fetoprotein (serum tumor markers). Serum lactate dehydrogenase, a marker of tissue injury and cell turnover, is also frequently increased. MR Path
15839 Aortic aneurysm TAAs are usually aSSx until they grow large enough to compress surrounding structures or cause rupture. The most common SSx presentation is chest or back pain, but compression of nearby structures Cardiovascular (CV) Pathology (Path) 6
can cause dysphagia, hoarseness, cough, or dyspnoea. CV Path
15840 Aortic aneurysm Ruptured AAA is a Sx emergency that usually Px w/ the acute onset of severe abdominal and back pain in pts w/ appropriate RFx (eg, advanced age, smoking, atherosclerosis). Accompanying syncope, Cardiovascular (CV) Pathology (Path) 6
hypotension, and shock may occur quickly (intraperitoneal rupture) or may be delayed (retroperitoneal rupture). CV Path
15876 Diabetes mellitus Phys insulin secretion can be approx. by a combo of long-acting and rapid-acting insulin analogues. Long-acting preps (e.g. glargine) are released from the injection site slowly throughout the day and Endocrine, Diabetes & Pharmacology 31
replicate basal insulin secretion. Boluses of a rapid-acting insulin (e.g. lispro) w/ quick absorption are given w/ meals to control postprandial Glc ↑. Metabolism (ES) (Phar) ES Phar
15881 Diabetes mellitus SUs inhib the ATP-sensitive K+ channel on the pancreatic β cell membrane, inducing depol and L-type Ca2+ channel opening. The ↑ Ca2+ influx stims β cell insulin release independent of BGCs. SUs Endocrine, Diabetes & Pharmacology 31
stim insulin secretion, even when BSLs are normal, which can lead to hypoglycaemia. Metabolism (ES) (Phar) ES Phar
15885 Aortic dissection The most common SSx of acute AD is sudden onset of severe, sharp or tearing chest and back pain. Complications include stroke, AR, and myocardial ischemia. In addition, a dissection can extend into Cardiovascular (CV) Pathology (Path) 6
the pericardium, resulting in tamponade w/ ↓ CO and shock. CV Path
15886 Aortic dissection Marfan syndrome involves a deleterious mut in fibrillin that mainly affects the structural integrity of the CV and MSK systems. Aortic root disease predisposes to AD, which can present w/ sudden-onset Cardiovascular (CV) Pathology (Path) 6
chest or back pain, acute AR, and HF. Common histologic findings in aortic disease incl fragmentation and loss of the elastic lamellae w/ fibrosis and CMD. CV Path
15891 Aortic dissection CMD (necrosis) is the classic histologic finding in AD, as it weakens the aortic wall and allows a small intimal tear to readily propagate. Collagen, elastin, and smooth muscle are replaced by a basophilic Cardiovascular (CV) Pathology (Path) 6
mucoid ECM w/ elastic tissue fragmentation and cystic collections of mucopolysaccharide. CV Path
15941 Biologic agents Monoclonal antibodies (mAbs) are not eliminated by hepatic or renal clearance. Therefore, no dose adjustment is necessary with impaired hepatic/renal function or use of cytochrome P450 inducers or General Principles (GP) Pharmacology 2
inhibitors. (Phar) GP Phar
16070 Focal nodular hyperplasia FNH is a benign liver tumor marked by a central stellate scar containing an abnormally large artery. It usually arises in young women and most cases are aSSx and found incidentally. Gastrointestinal & Nutrition (GI) Pathology (Path) 1 GI Path
16287 Vitamin B12 deficiency Vit B12 is an essential cofactor in the recycling of 5MTHF to THF, which is req for AA, purine, and thymidine synth. Defic 1arily affect HPO cell maturation and is marked by incr nuclear-cytoplasmic Hematology & Oncology (HO) Pathophysiology 9
ratio, leading to macrocytic RBCs and hyperseg neutrophils; incr apoptosis often also leads to anemia and mild thrombocytopenia/leukopenia. (Patp) HO Patp
16324 Diabetes mellitus GLP-1 regulates Glc by slowing gastric emptying, suppressing glucagon secretion, and ↑ Glc-dependent insulin release. DPP-4 inhibs (e.g. sitagliptin, saxagliptin) ↓ the breakdown of GLP-1 and improve Endocrine, Diabetes & Pharmacology 31
glycaemic control in pts w/ DM-2. B/c the effect on insulin is Glc-dependent, these Rx have a low risk of hypoglycaemia. Metabolism (ES) (Phar) ES Phar
16395 Lichen planus LP presents w/ pruritic, purple/pink, polygonal papules and plaques that can affect the flexural surfaces of the wrists and ankles, along w/ the nails, oral mucous membranes, and genitalia. Histo findings Dermatology (DE) Pathology (Path) 1
incl hyperkeratosis, lymphocytic infiltrates at the DEJ, thickened stratum granulosum w/ sawtooth rete ridges, and eosinophilic colloid bodies in the papillary dermis. DE Path
16441 DIC Acute DIC is a consumptive coagulopathy linked to severe trauma. Widespread formation of microvascular thrombi leads to consumption of platelets, coagulation factors, and fibrinogen. Subsequent Hematology & Oncology (HO) Pathology (Path) 5
activation of anticoagulant proteins leads to low protein C/S; fibrinolysis ↑ D-dimer. Most pts have bleeding complications (eg, oozing from venipuncture/catheter sites) and EOD to the lungs or kidneys. HO Path
16442 DIC DIC is marked by widespread activation of the coag cascade, leading to excessive FIIa production and formation of microthrombi. Subseq conversion of plasminogen to plasmin results in incr fibrinolysis Hematology & Oncology (HO) Pathophysiology 5
to clear the thrombi. LFx show a consumption of CFs (prolonged PT/PTT) and platelets (thrombocytopenia) and SSx of excessive fibrinolysis (e.g. incr D-dimer). (Patp) HO Patp
16596 Aortic regurgitation A large, acute pulmonary embolism causes a rapid increase in right ventricular (RV) pressure that leads to RV cavity enlargement and RV dysfunction. Thickening of the RV wall is not seen in acute Cardiovascular (CV) Pathophysiology 8
pulmonary embolism, as there is no time for compensatory hypertrophy to occur in response to the increased pressure load. (Patp) CV Patp
16705 von Willebrand disease vWD is the most common inherited bleeding disorder and is usually transmitted in an AD fashion. SSx pts typically Px w/ easy bruising and mucosal bleeding. LFx will show normal platelets, normal PT, Hematology & Oncology (HO) Pathophysiology 7
and either normal or prolonged PTT due to low levels of factor VIII. (Patp) HO Patp
16855 Tinea Tinea pedis is a superficial infection of the epidermis caused by dermatophytes (e.g. T. rubrum). It most often presents as a pruritic, erythematous rash b/w the toes that freq extends along the sole. KOH Infectious Diseases (ID) Pharmacology 4
micro of skin scrapings shows branching hyphae. Tx options incl a variety of topical antifungals (e.g. clotrimazole), but not nystatin. (Phar) ID Phar
16862 Melanoma Melanoma lesions often have multiple color variations. The different colors represent different activities within the tumor. Whitish/gray areas occur when cytotoxic T cells recognize tumor antigens and Dermatology (DE) Immunology 6
destroy malignant cells, leading to melanocyte regression. Red areas arise due to vessel ectasia and local inflammation, whereas brown or black areas are generally due to advancing malignant (Immu)
melanocytes. DE Immu
16865 Melanoma Melanoma is often Dx when immunostaining of Bx samples reveals multi melanocyte markers (e.g. S-100, HMB-45, MART-1). Dermatology (DE) Pathology (Path) 6 DE Path
16895 Melanoma PD-1 is a checkpoint inhibitor that downregulates the Tc cell response. Neoplastic cells often exploit this receptor via the overexpression of PD-L1. PD-1 receptor inhibitors (eg, Pembrolizumab) restore Dermatology (DE) Immunology 6
the T cell response, allowing Tc cells to invade the tumor and induce apoptosis of neoplastic cells. (Immu) DE Immu
16978 Hypokalemia Hypokalaemia can result from the intracellular shift of K+, which can occur due toβ-adrenergic hyperactivity (e.g. β2agonists, endogenous EPI release), ↑ insulin lvls, ↑ extracellular pH, or ↑ cell Renal, Urinary & Electrolytes Physiology 2
production (e.g. acute leukaemia). (RE) (Phys) RE Phys
17004 Constipation Dyssynergic defecation occurs when the puborectalis muscle or the int.or ext. anal sphincter fails to relax during defecation, leading to chronic constipation. Dyssynergic defecation is usually considered a Gastrointestinal & Nutrition (GI) Anatomy (Anat) 3
fxnal disorder and occurs more commonly in the elderly but may also occur w/ certain neuro disorders (e.g. PD, MS) or trauma. GI Anat
17005 Constipation The pelvic splanchnic nerves (S2-S4) provide parasympathetic innervation to the bowel and bladder, and their impairment in CES can cause constipation and difficulty urinating. Other SSx of CES incl Gastrointestinal & Nutrition (GI) Anatomy (Anat) 3
radicular LBP and leg weakness (sciatic nerve) as well as saddle anaesthesia (pudendal, ilioinguinal nerves). GI Anat
17062 Psoriasis Psoriasis is a common inflammatory skin disorder characterised by hyperkeratosis (overgrowth of the stratum corneum) and epidermal hyperplasia. Plaque psoriasis is the most common form and presents Dermatology (DE) Pathology (Path) 5
w/ chronic, well-demarcated, erythematous plaques w/ a thick, silver scale. DE Path
17230 Lice infestation Pediculus humanus capitis (ie, head lice) infestation is common in school children and adults who come into close contact w/ infested individuals. Transmission is usually by direct contact. The eggs (nits) Dermatology (DE) Microbiology 2
are attached to the hair shaft and can be identified on inspection. Head lice do not carry infection, but the bite can induce a pruritic allergic rxn. 1st-line Tx includes topical pediculicides (eg, permethrin, (Micr)
ivermectin). DE Micr
17236 Thyroid cancer Foll neoplasms typically present as slowly enlarging, painless thyroid nodules. diff b/w a foll adenoma and FTC isn't possible using only FNA results. Histo evidence of invasion of the tumour capsule a/o Endocrine, Diabetes & Pathology (Path) 6
surrounding blood vessels is needed to Dx FTC. Metabolism (ES) ES Path
17246 Adrenal insufficiency Primary adrenal insufficiency (PAI) is characterized by weight loss, abdominal pain, fatigue, and hyperpigmentation. Physiologic stress in patients with PAI can trigger acute adrenal crisis (eg, fever, Endocrine, Diabetes & Pathology (Path) 5
shock, mental status changes). Autoimmune adrenalitis is the most common cause of PAI and leads to bilateral adrenal atrophy. Metabolism (ES) ES Path
Full Breakdown Topic Count
Anat Beha Bioc Bios Embr Gene Hist Immu Micr Path Patp Phar Phys Diabetes mellitus 31
AI 30 4 3 1 3 41 Community acquired pneumonia 21
BS 61 1 62 Ischemic stroke 19
CV 31 3 3 4 4 1 1 7 100 72 84 52 362 Myocardial infarction 18
DE 7 1 3 1 4 17 42 5 6 86 Tuberculosis 18
EN 7 2 3 2 2 1 17 Meningitis 17
ES 2 1 46 1 3 2 1 31 52 40 22 201 COPD 16
FR 12 2 7 3 8 14 6 4 9 65 Colorectal cancer 15
GI 33 16 1 13 3 2 22 109 32 22 8 261 Endocarditis 15
GP 1 4 20 1 27 2 5 1 2 18 4 85 Hepatitis B 14
HO 1 30 2 10 11 5 120 23 34 6 242 Primary hypertension 14
ID 1 1 1 9 159 8 4 38 221 Acute diarrhea 13
MR 9 4 2 8 2 2 27 Hypothyroidism 13
MS 1 9 4 1 7 5 27 Opioids 13
NS 83 1 16 6 9 3 28 99 16 53 9 323 Pulmonary embolism 13
OP 1 1 4 3 4 13 Sickle cell 13
PO 2 1 1 6 10 Antiarrhythmic drugs 12
PR 1 131 1 3 3 1 2 4 10 40 2 198 Asthma 12
PS 0 Chronic heart failure 12
PU 6 2 4 3 3 14 39 56 43 13 29 212 Urinary tract infection 12
RE 6 2 5 1 3 6 4 81 22 26 31 187 Cystic fibrosis 11
RH 37 5 1 1 2 5 4 36 16 18 12 137 Dyslipidemia 11
SS 45 45 Gout 11
231 191 155 69 49 81 24 87 304 723 308 413 187 2822 HIV 11
Physician patient communication 11
Brain tumors 10
Myasthenia gravis 10
Osteoporosis 10
Peptic ulcer disease 10
Acute pancreatitis 9
Anesthesia 9
Antipsychotics 9
Coronary blood flow 9
Cranial nerve palsy 9
Cytomegalovirus 9
Glomerular disorders 9
HSV infection 9
Hypertrophic cardiomyopathy 9
Inflammatory bowel disease 9
Lung cancer 9
Multiple myeloma 9
Ovarian cancer 9
Renal artery stenosis 9
Rheumatoid arthritis 9
Syphilis 9
Vitamin B12 deficiency 9
Aging 8
Alpha1 antitrypsin deficiency 8
Antibiotic resistance 8
Anticoagulants 8
Aortic regurgitation 8
Aortic stenosis 8
Atherosclerosis 8
Chronic kidney disease 8
Defense mechanisms 8
Depression 8
Dilated cardiomyopathy 8
Gallstone disease 8
Hyperthyroidism 8
Interstitial lung disease 8
Medical errors 8
Muscle structure & physiology 8
Pituitary adenoma 8
Poststreptococcal glomerulonephritis 8
Pulmonary arterial hypertension 8
Renal cell carcinoma 8
Respiratory physiology 8
Seizures 8
Skin and soft tissue infections 8
Turner syndrome 8
ACE inhibitors 7
Acute heart failure 7
Alzheimer disease 7
Antiretroviral therapy 7
Bipolar disorder 7
Breast cancer 7
Cirrhosis 7
Clostridium difficile infection 7
Gastroesophageal reflux disease 7
Iron deficiency anemia 7
Mitral stenosis 7
Nitrates 7
Parkinson disease 7
Primary immunodeficiency disorder 7
Renal calculi 7
Sarcoidosis 7
SLE 7
Transcription 7
Urinary incontinence 7
von Willebrand disease 7
Aortic aneurysm 6
Aortic dissection 6
Benign prostatic hyperplasia 6
Benzodiazepines 6
Brachial plexus 6
Cardiac physiology 6
Congenital adrenal hyperplasia 6
Diabetic ketoacidosis 6
Diphtheria 6
Down syndrome 6
GFR 6
Hemangioma 6
Hypoglycemia 6
Melanoma 6
Mitral regurgitation 6
Multiple sclerosis 6
Non-Hodgkin lymphoma 6
Personality disorders 6
Prerenal azotemia 6
Psychosis 6
Risk 6
Septic shock 6
Study designs 6
Thyroid cancer 6
Acute kidney injury 5
Acute pericarditis 5
Adrenal insufficiency 5
Appendicitis 5
Asbestos 5
Aspergillosis 5
Atrial fibrillation 5
Attention deficit hyperactivity disorder 5
Autosomal recessive inheritance 5
Cell mediated immunity 5
Cholecystitis 5
Cushing syndrome 5
Decision making capacity 5
DIC 5
G6PD deficiency 5
Giant cell arteritis 5
Hepatocellular cancer 5
Huntington disease 5
Hyperaldosteronism 5
Hypercalcemia 5
Infectious mononucleosis 5
Influenza 5
Malaria 5
Multiple endocrine neoplasia 5
Neonatal respiratory distress syndrome 5
Patient confidentiality 5
Phenylketonuria 5
Polycythemia 5
Polymyositis and dermatomyositis 5
Prostate cancer 5
Psoriasis 5
Resting membrane potential and action potential 5
Rheumatic fever 5
Sympathomimetic agents 5
Tetanus 5
Toxoplasmosis 5
Traumatic brain injury 5
Treatment adherence 5
Visual pathway 5
Wernicke-Korsakoff syndrome 5
Wilson disease 5
Acyclovir 4
Antidepressants 4
Apoptosis 4
Bias 4
Bladder cancer 4
Botulism 4
Bulimia nervosa 4
Carcinoid tumors 4
Coronary artery disease 4
Delirium 4
Diabetes insipidus 4
Diabetic nephropathy 4
Diastolic dysfunction 4
Digoxin 4
Dose response curves 4
Esophageal cancer 4
Febrile neutropenia 4
Fructose metabolism 4
Generalized anxiety disorder 4
Gluconeogenesis 4
Hemochromatosis 4
Hemoglobin properties 4
Hepatitis A 4
Hepatitis C 4
Herpes zoster 4
Histoplasmosis 4
Human papillomavirus 4
Hydrocephalus 4
Hypersensitivity reactions 4
Immunizations 4
Knee trauma 4
Lead poisoning 4
Long QT syndrome 4
Lung abscess 4
Malabsorption 4
Metabolic acidosis 4
Mitochondrial disorders 4
Neural tube defects 4
NSAIDs 4
Obstructive sleep apnea 4
Osteomyelitis 4
Paget disease of bone 4
Panic disorder 4
Patent ductus arteriosus 4
Peripheral vascular disease 4
Pheochromocytoma 4
Pleural effusion 4
Polycystic ovary disease 4
Primary biliary cholangitis 4
Respiratory mucosa 4
Schizophrenia 4
Sensitivity and specificity 4
Sensitivity, specificity, positive predictive value PPV, negative predictive value NPV 4
Septic arthritis 4
Subarachnoid hemorrhage 4
Testicular cancer 4
Tinea 4
Transplant rejection 4
Urethritis 4
Urinary retention 4
Urinary tract obstruction 4
Viral genetics 4
Vitamin D deficiency 4
Abortion 3
Achalasia 3
Acne vulgaris 3
Acute lymphoblastic leukemia 3
Acute myeloid leukemia 3
Acute promyelocytic leukemia 3
Advance directives 3
Alcohol use disorder 3
Aldosterone antagonists 3
Aminoglycoside 3
Anaphylaxis 3
Anorexia nervosa 3
Anticholinergics 3
Antiepileptics 3
Antihistamines 3
Aplastic anemia 3
ARDS 3
Atrial myxoma 3
Autonomic nervous system 3
Bacterial vaginosis 3
Beta blockers 3
Beta oxidation 3
Blastomycosis 3
Bone tumor 3
Burkitt lymphoma 3
Calcium channel blocker 3
Carpal tunnel syndrome 3
Catheter related bloodstream infection 3
Cervical cancer 3
Chemotherapy 3
Chronic pancreatitis 3
Chronic venous insufficiency 3
Clostridial myonecrosis 3
Cocaine 3
Confounding, effect modification, bias, errors 3
Congenital anomalies of kidney and urinary tract 3
Constipation 3
Contraception 3
Corticosteroids 3
Cryptococcal infections 3
Diverticular disease 3
DNA replication 3
Drug induced myopathy 3
Drug structure and properties 3
Erectile dysfunction 3
Esophagitis 3
Ethical principles in healthcare 3
Facial nerve 3
Fragile X syndrome 3
Gestational trophoblastic disease 3
Glaucoma 3
Glycogen storage disease 3
Gonococcal infection 3
Grief 3
Groin hernias 3
Guillain-Barre syndrome 3
Gynecomastia 3
Health insurance 3
Hemolytic uremic syndrome 3
Hemorrhagic stroke 3
Henoch-Schonlein purpura 3
Hereditary spherocytosis 3
High altitude illness 3
Infection control 3
Infertility 3
Inflammation 3
Informed consent 3
Insomnia 3
Intestinal helminth parasites 3
Klinefelter syndrome 3
Lactose intolerance 3
Loop diuretics 3
Lyme disease 3
Measles 3
Meckel diverticulum 3
Migraine 3
Mucocutaneous candidiasis 3
Mucormycosis 3
Mutations 3
Myelofibrosis 3
Narcolepsy 3
Necrosis 3
Neurofibromatosis 3
Neuronal physiology 3
Niacin deficiency 3
Normal distribution 3
Parvovirus 3
Peripheral neuropathy 3
Peroneal neuropathy 3
Pertussis 3
Polycystic kidney disease 3
Post-traumatic stress disorder 3
Power and sample size 3
Predictive values 3
Prevalence and incidence 3
Prion disease 3
Professional conduct 3
Radial neuropathy 3
Radiculopathy 3
Risk, rate, prevalence, and incidence 3
Rotator cuff 3
Rubella 3
Selective serotonin reuptake inhibitors 3
Serum drug levels and half-life 3
Severe combined immunodeficiency disease 3
SIADH 3
Systemic sclerosis 3
Tetralogy of Fallot 3
Thalassemia 3
Thiazides 3
Thrombotic thrombocytopenic purpura 3
Tricuspid regurgitation 3
Trigeminal nerve 3
Urea cycle 3
Ureter injury 3
Vestibular schwannoma 3
Vitamin C deficiency 3
Zollinger-Ellison syndrome 3
Achondroplasia 2
Actinic keratoses 2
Actinomycosis 2
Acute interstitial nephritis 2
Acute liver failure 2
Adjustment disorders 2
Adverse drug reaction 2
Alcohol withdrawal 2
Alkaptonuria 2
Allergic rhinitis 2
Amenorrhea 2
Amyotrophic lateral sclerosis 2
Androgenic steroids 2
Anemia of chronic disease 2
Angioedema 2
Ankylosing spondylitis 2
Anti GBM disease 2
Aphasia 2
Aspiration pneumonia 2
Asplenia 2
Ataxia telangiectasia 2
Atheroembolism 2
Atopic dermatitis 2
Atrial septal defect 2
Autism spectrum disorders 2
Babesiosis 2
Barrett esophagus 2
Bartonella 2
Biologic agents 2
Blood transfusion 2
Brain herniation 2
Bronchiectasis 2
Cancer anorexia cachexia syndrome 2
Carbon monoxide poisoning 2
Cardiac catheterization 2
Cardiac output and venous return 2
Cardiac tamponade 2
Celiac disease 2
Cell cycle 2
Cellular transports 2
Central pontine myelinolysis 2
Central tendency (mean, median, mode, outliers) 2
Central venous catheter 2
Cephalosporins 2
Child abuse 2
Cholera 2
Chronic myeloid leukemia 2
CNS lymphoma 2
Coccidioidomycosis 2
Colonic polyps 2
Compartment syndrome 2
Congenital cardiac defects 2
Constrictive pericarditis 2
Contact dermatitis 2
Craniopharyngiomas 2
Cryptorchidism 2
Cyanide poisoning 2
Cystinuria 2
Dengue fever 2
Diabetic foot 2
DiGeorge syndrome 2
DNA structure & function 2
Drug induced liver injury 2
Drug interaction 2
Drug metabolism and clearance 2
Duchenne dystrophy 2
Echocardiography 2
Embryologic derivatives 2
End of life care 2
Epidural hematoma 2
Epiglottitis 2
Erythema multiforme 2
Esophageal varices 2
Exonuclease 2
Fat embolism 2
Filtration fraction 2
Foodborne illness 2
Friedreich ataxia 2
Frontotemporal dementia 2
Galactosemia 2
Gastrointestinal hormones 2
Gastroparesis 2
Gestational diabetes 2
Giardia 2
Granulomatosis with polyangiitis 2
Group B streptococcal infection 2
Growth hormone 2
Haemophilus influenzae 2
Hair loss 2
Hand, foot, mouth disease 2
Hearing loss 2
Heart block 2
Heme metabolism 2
Hemophiliacs 2
Hemorrhoids 2
Hepatic encephalopathy 2
Hepatitis D 2
Hip fracture 2
Hirschsprung disease 2
Hodgkin lymphoma 2
Homocysteine 2
Hydrocele 2
Hyperparathyroidism 2
Hypokalemia 2
Hypopituitarism 2
Immunoglobulins 2
Immunology principles 2
Immunotherapy 2
Inherited thrombophilia 2
Kaposi sarcoma 2
Keloid 2
Lac operon 2
Lambert-Eaton myasthenic syndrome 2
Leprosy 2
Lice infestation 2
Lithium 2
Lung transplantation 2
Lymphatic drainage 2
Macular degeneration 2
Mallory-Weiss syndrome 2
Maple syrup urine disease 2
Marfan syndrome 2
Membranous nephropathy 2
Meningiomas 2
Menstrual cycle 2
Metabolic syndrome 2
Methotrexate 2
Mushroom poisoning 2
Nausea and vomiting 2
Nephron osmolarity 2
Neuroleptic malignant syndrome 2
Niemann-Pick 2
Normal child development 2
Normal pregnancy 2
Normal pressure hydrocephalus 2
Number needed to treat 2
Obesity 2
Obsessive compulsive disorder 2
Odds ratio 2
Orbital fracture 2
Organophosphate poisoning 2
Osteoarthritis 2
Otitis externa 2
P-value and confidence interval 2
Parasomnias 2
Paroxysmal nocturnal hemoglobinuria 2
Pelvic inflammatory disease 2
Penetrating thoracic trauma 2
Penicillin 2
Pharyngitis 2
Phencyclidine 2
Physical exercise 2
Pneumocystis pneumonia 2
Pneumothorax 2
Polyarteritis nodosa 2
Polymerase chain reaction 2
Probability theory 2
Protein synthesis 2
Psoas abscess 2
Pulmonary blood flow 2
Pulsus paradoxus 2
Rabies 2
Reactive arthritis 2
Renal infarction 2
Rhabdomyolysis 2
Rhesus alloimmunization 2
RNA structure & function 2
Route of administration & bioavailability 2
Scabies 2
Schistosomiasis 2
Sciatic neuropathy 2
Seborrheic keratosis 2
Second messengers 2
Serotonin syndrome 2
Sexual differentiation 2
Sick sinus syndrome 2
Silicosis 2
Sjogren syndrome 2
Social anxiety disorder 2
Spleen rupture 2
Statistical tests 2
Syringomyelia 2
TCA cycle 2
Teratogens 2
Theophylline 2
Thoracentesis 2
Torticollis 2
Toxic shock syndrome 2
Traumatic hemolytic anemia 2
Trigeminal neuralgia 2
Triglyceride metabolism 2
Typhoid 2
Ubiquitin proteasome pathway 2
Ulnar nerve neuropathy 2
Upper respiratory tract infections 2
Urinalysis 2
Urticaria 2
Vasospastic angina 2
Venous thromboembolism 2
Ventricular septal defect 2
Vitamin E deficiency 2
Vitamin K deficiency 2
Warfarin 2
West Nile virus infection 2
Whipple disease 2
Wolff-Parkinson-White syndrome 2
X-linked agammaglobulinemia 2
X-linked inheritance 2
Xeroderma pigmentosum 2
2,3-bisphosphoglycerate metabolism 1
Abetalipoproteinemia 1
Acanthosis nigricans 1
Accessory nipple 1
Accuracy and precision 1
Acetazolamide 1
Active transport 1
Acute intermittent porphyria 1
Acute intracerebral hemorrhage 1
Acute parotitis 1
Acute respiratory failure 1
Acute urate nephropathy 1
Adenomyosis 1
ADH and urea clearance 1
Adolescent adherence 1
Airway emergency 1
ALA synthase 1
Alcoholic liver disease 1
ALL and T cells 1
Alpha agonists 1
Alternative splicing 1
Amiodarone 1
Amniotic fluid embolism 1
Amoebiasis 1
Amyloidosis 1
Anal cancer 1
Anal fissure 1
Anaplasia 1
Aneuploidy 1
Angina 1
Angiotensin receptor blockers 1
Animal and human bite injuries 1
Ankle trauma 1
Anoxic brain injury 1
Anterior abdominal wall 1
Anthrax 1
Antiemetics 1
Antiphospholipid syndrome 1
Antiplatelet therapy 1
Anxiety 1
Aortic coarctation 1
Arbovirus 1
Arginine in NO production 1
Aromatase deficiency 1
Aromatase inhibitors 1
Arsenic poisoning 1
Aspirin poisoning 1
Atelectasis 1
Athlete's heart 1
Atrial flutter 1
Atrioventricular canal defect 1
Atrophy 1
Attack rate 1
Autoimmune hemolytic anemia 1
AV fistula and P/V curves 1
AV node 1
Axillary nerve injury 1
Azoles 1
Bacterial gene transfer 1
Base excision repair 1
BCL 2 1
Behavioural responses 1
Bell's palsy 1
Beneficence 1
Beta 2 agonists 1
Beta blocker poisoning 1
Beta-thalassemia 1
Bicuspid aortic valve 1
Biliary atresia 1
Biliary excretory function 1
Biotin deficiency 1
Blunt aortic injury 1
Body dysmorphic disorder 1
Body fluid distribution 1
Bone remodeling 1
Bowel obstruction 1
Brachiocephalic vein obstruction 1
Bradycardia 1
Brain abscess 1
Breastfeeding 1
Bronchiolitis 1
Brown adipose tissue 1
Bullous pemphigoid 1
Bursitis 1
CABG 1
Calcineurin inhibitors 1
Calcium and glycogen phosphorylase 1
Cannabis 1
Capsaicin 1
Carcinogens 1
Cardiac AP 1
Cardiac pressure range 1
Cardiogenic shock 1
Carotid baroreceptors 1
Carotid sinus hypersensitivity 1
Cauda equina syndrome 1
Cavernous sinus thrombosis 1
Cerebellar degeneration 1
Cerebral aneurysm 1
Cervicitis 1
Chagas disease 1
Chancroid 1
Chediak-Higashi syndrome 1
Chemotherapy induced nausea and vomiting 1
Cherry angioma 1
Chiari malformation 1
Chikungunya fever 1
Child and adolescent mental health 1
Cholestasis 1
Cholesteatoma 1
Chronic cough 1
Chronic lymphocytic leukemia 1
Churg-Strauss syndrome 1
Circadian rhythm 1
Citric acid cycle 1
Clavicle fracture 1
Cleft lip and cleft palate 1
Cluster headache 1
Collagen structure 1
Collagen synthesis 1
Collagen types 1
Colonic ischemia 1
Comparing 2 means 1
Complement deficiency 1
Complementary and alternative medicine 1
Conduct disorder 1
Conversion disorder 1
Copper excretion 1
Cor pulmonale 1
Correlation coefficient 1
Costochondritis 1
COX 2 inhibitor 1
Cryptosporidiosis 1
CT abdomen 1
Cutaneous larva migrans 1
Cytokines 1
Dandy-Walker syndrome 1
Daptomycin 1
Depersonalization disorder 1
Dermatitis herpetiformis 1
Developmental milestones 1
Diabetic neuropathy 1
Diabetic retinopathy 1
Diffuse esophageal spasm 1
Diffusion 1
Direct factor Xa inhibitors 1
Diuretics and electrolyte imbalance 1
DNA methylation 1
DRESS syndrome 1
Ductal carcinoma in situ 1
Duodenum and superior mesenteric artery 1
Dysfunctional uterine bleeding, anovulation 1
Dysthymia 1
Dystonia 1
Ecchymosis 1
Echinococcosis 1
Ectopic pregnancy 1
Ectopic thyroid 1
Ehlers-Danlos syndrome 1
Ehrlichiosis and anaplasmosis 1
Elder abuse & neglect 1
Electrical injury 1
Emancipated minor 1
Embolic stroke 1
Embryology, Meckel 1
Endometriosis 1
Enhancer sequence 1
Enzyme kinetics 1
Epididymitis 1
Epistaxis 1
Epstein Barr virus 1
Erythropoietin 1
Escherichia coli 1
Essential tremor 1
Estrogen synthesis 1
Etoposide 1
Eukaryotic DNA replication 1
Excretion rate 1
Extramedullary hematopoiesis 1
Fabry disease 1
Factitious disorder 1
Factor VII deficiency 1
Falls 1
Familial adenomatous polyposis 1
Febrile seizure 1
Fecal incontinence 1
Female genital tract histology 1
Femoral fracture 1
Femoral neuropathy 1
Fetal alcohol syndrome 1
Fetal circulation 1
Fetal hemoglobin 1
Fibroadenoma breast 1
Fibromyalgia 1
Fibronectin 1
Flow/resistance 1
Focal nodular hyperplasia 1
Folate antimetabolites 1
Folic acid 1
Folic acid deficiency 1
Foreign body aspiration 1
Foscarnet 1
Fructose 2,6 bisphosphate 1
G6PD anemia inheritance pattern 1
Gallstones and pregnancy 1
Gastrectomy 1
Gastric cancer 1
Gastrointestinal hemorrhage 1
Gaucher disease 1
Genetic code 1
Gestational trophoblastic disease - complete mole 1
GI surgery 1
Gilbert syndrome 1
Glanzmann thrombasthenia 1
Glioblastoma (Multiforme) 1
Glomus tumor 1
Glucose clearance 1
Graft versus host disease 1
Hairy cell leukemia 1
Hand injury 1
Hawthorne effect 1
Head and neck cancers 1
Heart sounds 1
Heart transplantation 1
Hematopoietic drugs 1
Hemiballismus 1
Hemoglobin C disease 1
Hemophilias 1
Hemorrhage stroke 1
Heparin induced thrombocytopenia 1
Hepatitis E 1
Hepatocellular carcinoma 1
Hereditary fructose intolerance 1
Hereditary hemorrhagic telangiectasia 1
Hereditary hyperbilirubinemia 1
Hiatal hernia 1
Histiocytosis 1
Holoprosencephaly 1
Homocystinuria 1
Humerus fracture 1
Humoral immunity 1
Hyper-IgM syndrome 1
Hyperkalemia 1
Hyperphosphatemia 1
Hyperprolactinemia 1
Hypertensive nephropathy 1
Hypertensive retinopathy 1
Hypertrophic pyloric stenosis 1
Hypocalcemia 1
Hypoparathyroidism 1
Hypospadia and epispadia 1
Hypovolemia 1
Hypovolemic shock 1
Ichthyoses 1
Idiopathic intracranial hypertension 1
IgA nephropathy 1
Iliopsoas muscle 1
Illness anxiety disorder 1
Immotile cilia syndrome 1
Impaired colleague 1
Imperforate hymen 1
Implantable cardioverter defibrillator 1
Impulse control disorders 1
Inhalants 1
Inhibin 1
Internuclear ophthalmoplegia 1
Interviewing technique 1
Intestinal atresia 1
Intestinal phase 1
Intimate partner violence 1
Intraductal papilloma 1
Intraventricular hemorrhage 1
Intussusception 1
Irritable bowel syndrome 1
Ischemic hepatitis 1
ITP 1
Jugular venous pulse 1
Kallmann syndrome 1
Kawasaki disease 1
Keratin as a marker 1
Kernicterus 1
Ketone utilization 1
Kidney transplantation 1
Labor management 1
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Lactic acidosis 1
Language disorder 1
Laryngotracheobronchitis 1
Lateral epicondylitis 1
Latex allergy 1
LDH and glycolysis 1
Learning disorders 1
Left atrial enlargement 1
Leishmaniasis 1
Leptospirosis 1
Lesch-Nyhan syndrome 1
Lesser omentum 1
Leukocytoclastic vasculitis 1
Leukocytosis 1
Li-Fraumeni syndrome 1
Lichen planus 1
Linkage disequilibrium 1
Lipodystrophy 1
Lipoma 1
Listeria 1
Liver abscess 1
Liver cholesterol production 1
Lung nodule 1
LV volume and pressure 1
Lymphadenopathy 1
Lymphedema 1
Lymphoedema 1
Lymphogranuloma venereum 1
Lynch syndrome 1
Lysosomal storage disorder 1
Major histocompatibility class 1
Malignant hyperthermia 1
Malrotation 1
Mannitol 1
Mastocytosis 1
Matching 1
Matrix metalloproteinase 1
Medial collateral ligament injury 1
Median nerve injury 1
Melanocytic nevus 1
Meniere disease 1
Meningococci 1
Menopause 1
Mental status examination 1
Mesenteric ischemia 1
Meta analysis 1
Metabolic alkalosis 1
Metastatic liver disease 1
Methemoglobinemia 1
Metronidazole 1
Mischarged tRNA 1
Mismatch repair 1
Mitochondrial diseases, inheritance 1
Mitral valve prolapse 1
Monoamine oxidase inhibitors 1
Morbidity and mortality rates 1
Mosaicism 1
Motion sickness 1
mRNA processing and regulation 1
Mullerian anomalies 1
Mullerian inhibitory factor 1
Multifactorial inheritance 1
Multiple gestation 1
Muscle structure and physiology 1
Mycobacterium avium intracellulare complex 1
Myocarditis 1
Myotonic dystrophy 1
Nasopharyngeal carcinoma 1
Natriuretic peptides 1
Necrotizing enterocolitis 1
Necrotizing soft tissue infections 1
Neonatal sepsis 1
Neuroblastoma 1
Neurocysticercosis 1
Neuroendocrine tumors 1
Neuromuscular blocker 1
Neuromuscular junction 1
Nocardiosis 1
Nonalcoholic fatty liver disease 1
Nonallergic rhinitis 1
Normal flora 1
Nuclear factor kappa B 1
Nutrition, protein 1
Obesity hypoventilation syndrome 1
Odontogenic infections 1
Oncogenes and tumor suppressor genes 1
Oogenesis 1
Oppositional defiant disorder 1
Organic acidemias 1
Orthostatic hypotension 1
Osgood-Schlatter disease 1
Osteocyte connections 1
Osteogenesis imperfecta 1
Osteonecrosis 1
Otitis media 1
Ovarian torsion 1
Ovarian vein thrombosis 1
Pacemaker potential 1
PAH clearance 1
Pancreatic cancer 1
Pancreatic secretion 1
Para-aminohippuric acid 1
Patient safety 1
PDH and ketogenic amino acids 1
Pemphigus vulgaris 1
Penetrating abdominal trauma 1
Perforated viscus 1
Pericardial effusion 1
Perineal lacerations 1
Peroxisomal disorders 1
Pharmacogenomics 1
Pharmacokinetics 1
Pharyngeal arches 1
Phosphodiesterase inhibitors 1
Phrenic nerve injury 1
Pituitary apoplexy 1
Placenta accreta 1
Plague 1
Pleiotropy 1
Poly A tail 1
Polyhydramnios 1
Polypharmacy 1
Porcelain gallbladder 1
Porphyria cutanea tarda 1
Portal hypertension 1
Positive predictive value 1
Postpartum hemorrhage 1
Potter sequence 1
Precocious puberty 1
Preeclampsia 1
Prenatal care 1
Priapism 1
Primary polydipsia 1
Principles of cell biology 1
Professional disagreements among providers 1
Progressive multifocal leukoencephalopathy 1
Prospective cohort study 1
Prostacyclins 1
Protein structure 1
Pseudogout 1
Pulmonary gas exchange 1
Pulmonary stenosis 1
Pure red cell aplasia 1
Pyruvate kinase deficiency 1
Q fever 1
Quantitative diagnostic tests 1
Radial head subluxation 1
Radiation injury 1
Radiation therapy 1
Rb protein 1
Rectus muscle and Valsalva 1
Releasing factors 1
Renal artery occlusion 1
Renal blood flow 1
Renal papillary necrosis 1
Renal vein thrombosis 1
Renin angiotensin aldosterone system 1
Requests to withhold information 1
Respiratory acidosis 1
Respiratory alkalosis 1
Restless leg syndrome 1
Restrictive cardiomyopathy 1
Retinal artery occlusion 1
Retinoblastoma 1
Retinoblastoma (Rb) protein 1
Retroperitoneal hematoma 1
Rett syndrome 1
Reye syndrome 1
Rhogam (anti-D IgG) 1
Rib fracture 1
Rocky mountain spotted fever 1
Roseola infantum 1
Rough ER protein synthesis 1
S4 1
SCA mutation 1
Scaphoid fracture 1
Scarlet fever 1
Schizoaffective disorder 1
Scrotum 1
Seafood poisoning 1
Selective IgA deficiency 1
Separation anxiety disorder 1
Serum sickness 1
Short bowel syndrome 1
Shoulder dislocation 1
Sideroblastic anemia 1
SIDS 1
Signal transduction 1
Sinoatrial node 1
Small intestinal bacterial overgrowth 1
Smoking cessation 1
snRNP function 1
Somatic symptom disorder 1
Southern blotting 1
Southwestern blot 1
Spasticity 1
Specific phobia 1
Spinal anatomy 1
Spinal cord injury 1
Spinal muscular dystrophy 1
Spinal stenosis 1
Splenic artery 1
Splice site mutation 1
Sporotrichosis 1
Staphylococcal scalded skin syndrome 1
Staphylococci 1
Steroid hormones 1
Stress cardiomyopathy 1
Stress gastric ulcer 1
Strongyloides 1
Subacute thyroiditis 1
Subclavian steal syndrome 1
Subdural hematoma 1
Submucosal glands of Brunner 1
Substance use disorders 1
Substance-induced psychotic disorder 1
Suicide 1
Sunburn 1
Superficial inguinal ring 1
Superior mesenteric artery syndrome 1
Superior vena cava syndrome 1
Supine hypotension 1
Synapse 1
Takayasu arteritis 1
TATA box mutations 1
Tay-Sachs 1
Temporomandibular disorders 1
Tension headache 1
Terminal illness 1
Testicular torsion 1
Thoracic outlet syndrome 1
Thrombophlebitis 1
Thyroglossal duct cyst 1
Tibial nerve injury 1
Torsades de pointes 1
Tourette syndrome 1
Toxic alcohols 1
Toxic megacolon 1
Tracheoesophageal fistula 1
Transamination 1
Transient ischemic attack 1
Translation 1
Transposition of the great vessels 1
Trastuzumab 1
Tricyclic antidepressants 1
Trisomy 13 1
Trisomy 18 1
tRNA structure 1
tRNA wobble 1
Tuberous sclerosis 1
Tumor lysis syndrome 1
Umbilical hernia 1
Uremic platelet dysfunction 1
Urethral injury 1
Uterine fibroids 1
Validity and reliability 1
Varicocele 1
Vertigo 1
Vesicoureteral reflux 1
Vibrio vulnificus 1
Vincristine 1
VIPoma 1
Vitamin A deficiency 1
Vitamin A toxicity 1
Vitamin D toxicity 1
Vitiligo 1
von Hippel-Lindau disease 1
Vulvovaginitis 1
Warfarin reversal 1
Wiskott-Aldrich syndrome 1
Wound healing 1
Zenker diverticulum 1
Zika virus 1
Zika virus 1

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