08-12-2009, 01:42 AM
Q about the components of H. influenza vaccine à polysaccharide capsule
conjugated to diptheria toxin.
Q on glomerulonephritis , ask properties of causative bacteria à bacitracin
sensitive
Q on C. diphthriae -ask about coding of toxin à a beta prophage
Q case describe Ziehl-Nielsen stain (picture#8)“ ask diagnosis à TB
Q picture (picture#9) of synapse -where does botulinum toxin act? Ã inhibit Ach
release (look at the arrow)
Q Picture (picture#10) shows a lesion in the gasric mucosa and describe an
classic gastric ulcer what is the bug reponsibleà H. Pylori
Q on how would you differentiate b/t Klebsiella from Salmonella à Lactose
fermentation
Q on schistosoma “ will describe case history and picture (picture#11)
Q on a pedigree à all offspring of affected females show signs à A classic
MITOCHODRIAL inheritance (picture#2)
Q on why anticipation occurs? Ã More trinuleotide repeats.
Q always describes a child with malnutrition à which AA deficient? à look for
essential ones (remember PriVaTe TIM HALL in First Aid page 166)
Q must know about mech of action of Nitric Oxide à Nitric oxide stimulates
soluble guanylate cyclase (sGC) to convert GTP to the intracellular second
messenger cGMP.
Q always arises on how Insulin acts on GLUT4 Ã Translocates to membrane.
Qs on vitamin B12 à they always ask many questions here à the most popular
one is its relationship to intrinsic factor and pernicious anemiaà know everything
about B12.
Qs on vitamin DÃ question related to SARCOIDOSIS and Hypercalcemia.
What’s the relationship? à Macrophages convert Vit. D to its active formÃ
Hypercalcemia.
Q on DNA replication à What DNA Topoisomerase does? à Makes a nick in the
Helix to remove supercoils.
Q on the Lac Operon- what happens in the absence of lactose à the repressor
protein encoded by the I gene binds to the lac operator and prevents
transcription.
Q about Lesch Nyhan Syndrome- What Accumulatesà uric acid.
Q on Osteogenesis Imperfectaà Show BLUE sclera (picture#1) à what is the
problem? Ã Abnormal Collagen type 1.
Q on where RNA is made? Ã Nucleolus.
Q on how mutation in splicing affects protein synthesis.
Q about protein folding à is not random.
Q about the affect of no hydroxylation of proline à what happens? à The triple
Helix can’t be formed.
Q describes Ehlers Danlos what is abnormal? Ã Incorrect folding of Collagen Ã
what are the associated abnormalities? Ã Frequent joint dislocation.
Q Describes Scurvy à What Vitamin Def. à Vitamin C.
Q Describes the regulation of eukaryotic gene à what is location of the enhancer
related to the exon?
Q about what occurs many times in a protein life span? Ã Can be
phosphorylated many times.
Q describes a fat soluble vitamin à cranial nerve problem à which and why?Ã
Vitamin A causes bone deposition at the skill foramina which causes CN
compression…….also know that vitamin A is very toxic if taken orally.
Q on Hypoglycemia à Factitious… Insulin induced à look for serum C-peptide Ã
C-Peptide only made by endogenous Insulin.
Q on Melatonin à relationship to which AA à Tryptophan.
Q related to PKUÃ SHOULD be screened AT BIRTH.
Q About pseudohurler à defect in n-acetylglucosamine causes what? à failure to
add a marker to manose phosphate (lysosomal problem)
Q must know relationship between Insulin and glucagons in the fasting and fed
states- Know everything they always ask questions here.
Q on carnitine def. Ã what happens? Ã carnitine deficiency impairs the entry of
long-chain fatty acids into the mitochondrial matrixà production of ketone bodies
impaired
Q usually describes Popes disease à which molecule abnormal? à Glycogen.
(defect in lysosomal alpha-1,4-glucosidase)
Q always asked about Glucose 6-phosphatse à what happens in fasting? Ã
Increased.
Q asks about a child S. Aureus bacterial infection and describes a phagocyte
problemà NADPH oxidase def.
Q about which enzyme in bacteria help it survive in lysosomesà Catalase.
Q describes hypercholesterolemia à where is the defect? à LDL receptor
Q describes the initial lesion in atherosclerosis à fatty streaks.
Q drug of choice for increased VLDLÃ Niacin.
Q about a homeless man in a poisoning case that caused metabolic acidosisÃ
what is the poison? Ã ethylene glycol
.
Q about potassium levels in DKA Ã low intracellular and high extracellular.
Q Describes maple syrup disease- avoid which AA? Ã Branched chain Ile Leu
Valine
Q describes Cystathione synthase deficiency à which AA accumulates?
à methionine
Q describes a case of retinoblastoma and asks what is associated with it? Ã
Osteosarcoma
Q talks about a patient with pale stool and RUQ pain à primary biliary cirrhosis Ã
they will ask you what autoantibody associated. Ã Anti-Mitochondrial
Q describes a patient with a classic rheumatoid arthritisà Auto antibody? Ã
Anti-IgG
Q shows a gross picture (picture#3) and describes codman triangle lesion in the
metaphesis of a long bone and asks the diagnosisà Osteoscarcoma
Q Shows you a picture (picture#4) of a child à Hemangioma
Q describes pituitary adenoma in full (bitemporal loss of vision) Ã they ask you
what is the derivative of that structureà Rathke’s pouch.
Q describes a case of bronchogenic CA and you have to make the association
with Lambert Eaton syndrome. They will ask you- antibodies against what is the
problem? Ã Calcium Channels in the NMJ.
Q shows a gross picture (picture#5) of Renal cell CA- all you have to do is
diagnose.
Q shows a gross picture (picture#6) of polycystic renal tumor- ask diagnosis
Q about a man who have just eaten which part of his brain detected satietyÃ
hypothalamus (Ventromedial nucleus)
Q on what make up the Blood-Brain barrierà Remember the CIA (choroids,
intracerebral capillary endothilum and arachnoid)
Q on gene population- a=0.6 b=0.4 what is the % of heterozygotesà 2pq=48%
Q on a karyotype (picture#7) shows the chromosome 21 + various description of
the disease- what is the diagnosis? Ã Down syndrome
Q on Oocyte before ovulation and ask about the egg arrested at what stage? Ã
Prophase
Q describes a child with eczema; low platelets and immune def- ask diagnosis Ã
Wiscott Aldrich Syndrome.
Q to determine the effective renal plasma flow à remember Upah X V/Ppah also
remember that PAH is filtered and secreted.
Q describes a child genotype XX with external genitalia virilized “ what is the
problem? Ã Excess exposure to male androgens. (compare to Androgen
insensitivity)
Q describing a case of a defect in leukocyte adhesion- what is responsible? Ã
Integrins
Q describes a patient with gluten-sensitive enteropathy- ask what is the
appearance of the intestine à flattened villi.
Q asks about what part of the Antibody binds to cells? Ã FC portion
Q about what will happen in the absence of Ig class switching? Ã Only IgM is
produced.
Q about what will happen if you have a lysosomal abnormality à MHC II will be
affected (MHC I is made in the Endoplasmic Reticulum)
Q about the defect in DiGeorge syndrome- usually describe the case by
absence of thymic shaddow à pouch 3 and 4 fail to develop (make sure in the
case you don’t get distracted by B-Cell abnormalities)
Q describes type VI hypersensitivity rxn (contact derm and TB) - what cell
involved? Ã T cells
Q on Rh incompatibility- what causes it? Ã Rh (-) mom and Rh (+) dad
Q describes acute rejection (48 hrs)- mechanism? Ã T lymphocyte vs foreign
MHCs.
Q about ELISA - - They love to ask about the technique- know it very well.
Q on Flow cytometric analysis “ ask what immature T cell in the thymus
express? Ã Both CD 4 and CD8
Q on what does Staph Aureus colonize à nasopharynx
Q on why does mycoplsma not respond to penicillin à no peptidoglycan
Q of a child with pneumonia, rust colored sputum and optochin sensitive
organisms à strep. Pneumia.
Q describes word by word an isolated weakly acid fast bacteria with braching
rodsà nocardia
Q on the mech of action of amphotericin BÃ binds ergosterol
Q on PID described and ask complication of untreated Chlamydial infx Ã
ectopic pregnancy
Q describes endotoxin shock whats responsible à lipid A
Q describes clostridium difficile diarrhea- mechanism of action? Ã cytotoxic
toxin
Q on histoplasmosis- does not spread person to person, why? Ã intracellular
Q cryptococcus meningeal biopsy (picure#12) with organism ask diagnosis
Q AIDS patient with dyspnea- pick the most common causative organism of
pneumonia in AID Ã PCP
Q AIDS patient with diarrhea- what is the causative organism? Ã -
cryptosporidium
Q of a patient with brain lesions - taenia solium à cycticercosis
Q described a virus- positive strand and naked à PicoRNA virus
Q on which hepatitis causes continuous shedding of antigen à Hep B
Qs on HBV markers- they always ask about it - memorize it USMLE First Aid
page 204- VERY high Yield (make sure you don’t miss the marker at the window
period- notice Anti-HBc)
Q on acyclovir- they want you to know that for it to function it needs à thymidine
kinase (phosphorylates DNA polymerase)
Q on Viral transduction-how it occurs? Ã DNA transferred by virus from one cell
to another (know the difference between the generalized and specialized)
Q Electron micrograph of picture (picture#13) of villi, which organ? Ã small
intestine (they can ask you anything here try to look at different pictures and see
the different features of each part)
Q of a patient with foot drop- which nerve injury à common peroneal
Q asks- smooth RER increased in which tissue à steroid hormone producing
Q asks- An organelle has weird DNA, resembles bacteriaà mitochondria
Q describes Alzheimer’s patient where’s lesion à hippocampus (picture#14)
Q describes Parkinson’s where’s lesion? à substansia nigra (picture#15)
Qs Describe lesions in the Circle of willis and sometimes pointed out on
angiography -where’s the deficit? à Memorize your homunculi to ID the deficits-
also memorize the cerebral circulation and what areas in the brain each one
supplies. Without a question they will ask you questions here.
Q CT of the pelvis of a man with BPH describe à ID prostate (picture#16)
Q CT of the pelvis ID which muscle helps in valsalva à rectus abdominis
(picture#16)
Q about the sarcmere (always ask)- during muscle contraction, which band does
not change size à “A†Band
Q about congested spleen, thrombocytopeniaà ,splenomegaly, which vessel
thrombosed à splenic vein
Q about a child born respiratory distress, lung biopsy shows brown stuff,
diagnosis? Ã meconium aspiration
Q on which GI hormone causes pancreatic secretion rich in bicarbonateÃ
Secretin
Q ask which organ is not a foregut derivative but is supplied by an artery of the
foregutà spleen
Q on renal agenesis, cause ? Ã ureteric bud fails to induce the formation
Q to calculate glomerular filtration Fraction à know the formula very well
(FF=GFR/RPF)- this question is always there. Remember GFR reflects INULIN
(not Insulin) and RPF reflects PAH.
Q on the Effect of angiotensin II and where does it act? Ã Acts on the efferent
arteriole which causes is to constrict (this is very important because it balances
the FF. (AgII dec RPF and inc GFR which inc FF- makes sense..right!!)
“PLEASE compare all this to Prostaglandins. First AID page 359.
Q on how NSAIDS affect the kidney in general à INHIBITS prostaglandins. What
does that mean? Prostaglandins “Dilate†the afferent arteriole and if inhibited
GFR will dec- watch if for patients with renal failure.
Q that is you always see is- a kid with nephrotic syndromeà podocyte fusionÃ
minimal change disease.
Q about an adult with nephrotic syndrome- Basement membrane thickeningÃ
lesion? Ã membranous GN
Q about menopause and hormonal changes- Very important for the USMLE-
they started asking more about this topic lately.
Q about prolactinoma (galactorrhoea, amenorrhoea, what is next appropriate
investigationà cranial imaging looking for pituitary gland abnormalities.
Q describes neurofibromatosis where do the abnormal cells arise from à neural
crest
Q NE release from adrenal gland medulla is mediated by? Ã Ach
Q where is a diastolic murmur in a pt. With hypertension best heard? At the
Apex
Q describes a stab wound to root of neck- what should we worry about? Ã
Plueral injury (remember the lung extends above the level of the clavicle)
Q on a baby with pulmonary hypoplasia- what is the likely cause? Ã
diaphragmatic hernia
Q describe referred pain in a patient and ask innervation of parietal pleuraÃ
phrenic and intercoestal nerves
Q mentions meconium leak from umbilicus “ lesionà vitelline fistula
Q describes marfans syndrome and ask about complications à dissecting aortic
aneurysm.
Q about the base of bladder “ what is the structure closely associated with it? Ã
vas deferens
Q will mention cancer from descending colon spreads to which lymph nodesÃ
inferior mesenteric
Q Describe scarred kidney on IVP distorted calyceal system-ask diagnosis? Ã
Reflux nephropathy (picture#18 gives you a better understanding).
Q about a flattened hypothenar eminence no sensation over little finger- lesion?
à ulnar nerve
Q about horners syndrome- which tumor could have caused that? Ã pancoast
tumour (upper lobe tumor injuring the cervical sympathetic plexus)
Q shows a picture of a fractured orbital floor due to direct blow to the eye- which
sinus was opened? Ã identify on x-ray--- maxillary sinus (picture#19)
Q describe homer’s syndrome (ptosis, meiosis and anhidrosis) -where is
lesion? Ã cervical sympathetic plexus
Q patient has a tachycardia; carotid massage stops it, mechanism? Ã Pressure
on carotid sinus à CN IX send the signal to the brainstemà CN X (vagus) returns
the signal to slow down the heart. (this is my explanation in plain English
picture#20) Easy ha..
Q mentions that lateral and third ventricles enlarged, 4th is normal where is the
obstruction? Ã Aqueduct of sylvius
Q describes subacute combined degeneration of cord, which vitamin deficient?
à Vit. B12
Q description of UMN corticospinal tracts- ID lesion in cordà (picture#21)- try to
memorize the big ones from High Yield Neuroanatomy by Fix (very good source
for neuro for step 1)
Q of a patient that has unilateral hearing loss- vertigo diagnosis? à meniere’s
disease
Qsss about visual field defects STRIGHT from First Aid page 111- KNOW ALL
of them. Most famous question on this topic will be Bitemporal Hemianopsia-
whats causes it? Ã Optic chiasm compression by a pituitary adenoma.
Q describes internal capsule infarct, which artery? Ã lenticulostriate branches of
middle cerebral artery.
Q describes a case of Parkinson- ask which neurotransmitter responsible? Ã
Dopamine
Q on site of action of drugs tricyclic antidepressantsà inhibits reuptake of NE
Q ask simple case to calculate resistanceà Resistance= Pressure (change in
pressure)/ flow (Q) or just know it by P=QR (PQR alphabetically)
Q ALWAYS ask about V/Q mismatch- Just know that at the apex V/Q=3 which
is a wasted ventilation and at the base V/Q=0.6 which is wasted perfusion. In
plain English more flow of blood to the base but less air, more air to the apex
but less blood. Now the V/Q formula makes sense. (Always remember V
=Ventilation (Air) Q =flow (blood).
Q on autoregulation of the heart“what are the factors? à Nitric oxide most likely
a choice. Also remember “ O2 and adenosine (please look at other
autoregulation to other organs in FA (First Aid) page 356. If you want to skip
Auto regulation JUST know the Heart and Brain. For the Brain change in CO2
(PH) is the biggest factor-know it.
Q on cardiac volume-pressure loop (picture#22) always always always in the
exam- guess what!!!â€know it. They usually like to ask where the valves open
and close but I recommend you to know everything. FA p352
Q on why is FEV higher than expected in some restrictive lung diseases à radial
traction on airway
Q on what is the expected blood gases of a COPD patient? Ã Obstructive lung
volume is more than normal (inc TLC, inc FRC and inc RV) usually the show you
a graph and you have to pick the constrictive from the obstructive) FA
251----ALWAYS in the exam.
Q asks about a patient that has hyper-reactive airways- what substance used to
test for this à methacholine challenge
Q asks about a patient goes into shock then recovers; next day develops
abdominal pain and reduced bowel sounds- what is happening? Ã mesenteric
infarction
Q on a patient in shock, develops renal failure, prognosis? Ã Renal tubular
epithelium will regenerate completely if he recovers.
Q on the clearance of PAH at different plasma concentration à at high levels
clearance reduces -why? Ã carriers depleted
Q about Potassium concentration along tubule in a patient on a high salt dietÃ
excess K is secreted by distal tubules.
Q IP3 and DAG lead to what effects à activation of protein kinases
Q describes Addison’s (Hypotension and skin pigmentation), what’s the reason
for skin hyperpigmentaion?? Ã Increased ACTH due to the positive feed back of
dec. cortisol (ACTH acts like MSH in the case)
Q on Diabetes insipidus where they describe the patient then somewhere in the
case describes mood problems. What drug could have caused the diabetes? Ã
Lithium
Q describes a patient who has kidney problems and now he is progressing to
renal failure, his vit D levels are low, why? Ã conversion to Active form vitamin D
(1,25 (OH)2D3 is takes place in the kidney
Q Describes a woman who overcooks her food, what s vitamin def. will she
present with? Ã Folate (folic acid is heat labile)
Q about Vit C and ask it is a cofactor in the conversion of what? Ã Dopamine to
NE.
Q describes a patient with vit B12 and ask what test used to detect def.? Ã
Schilling test (In the exam the name might not be there but the procedure will be)
Q about LH - it increases testosterone secretion by stimulating which cells? Ã
Leydig
Q on what induces male external genitalia formation, causes BPH? Ã 5-alpha
reductase…Remember that its inhibitors used to treat BPH.
Q describes a classic case of endometriosis and describes the findings
Q asks hormones involved in breast maturation in pregnancy up to delivery-
know them
Q describes a patient has gastrectomy, later anemia and neurological problems
à B 12 deficiency
Q describes apoptosis, asked where else it occurs à embryological period
Q about type of necrosis seen in a 4 day old myocardial infarct à coagulative
Q on Zolinger Ellison syndrome and which type of MEN association à MEN type
1
Q case describes Carciniod syndrome- what is used to treat it? Ã Octreotide
Q asks about the most common location for Carcinoid syndrome à Appendix
Q on Barrets esophagus; type of change à metaplasia
Q sometimes does not give a lot of description of achalasia but shows an x-ray
usually easy to tell by the “birds peak appearance†(picture#23)
Q describes a case of GERD and shows gross slide (picture#24)Ã Barrets
Q on inflammation and you must know the mechanism of the edema in that case
Q on the mechanism of thromboxane and platelet aggregation- usually you have
to pick it out from the flow chart FA page 341. Know that thrombaxane à inc
platelet aggregation.
Q describes Reye’s syndrome and ask what is the mech of action of the drug
that causes it à Irreversibly inhibits cyclooxygenase(COX-I and COX-2) that is
Aspirin
Q on what is the advantage of COX-II inhibitors à It only plays a role in
inflammation ONLY and does not give any GI side effects (GI lining which is
protected by COX-I inhibited by Aspirin )
Q on which drug to add in a patient on NSAIDs and GI upset à add misoprostol
(Note that misoprostol should NOT be given to pregnant women because it is
abortifacient)
Q you must know the Mech of action of streptokinaseà conversion of
plasminogen to plasmin to aid in thrombolysis.
Q in a picture (Picture#25) must diagnoseà intussuuception
Q describes marfan’s syndrome and ask what is the function of fibillin Ã
stabilizes connective tissue integrity
Q on skin lesions know those 2Ã Nevus (picture#26) and melanoma
(picture#27)
Q about the commonest childhood cancer à ALL
Q on lymphatic spread of testicular cancer…you got to know that scrotal spread
is different. Know the difference. Also know where prostate cancer spreads. At
least you will get one question from here.
Q describes endocarditis and you have to pick the associationà Amyloidosis
Q on shipyard worker with lung problems, diagnosis? Ã mesothilioma
Q on the most preventable risk factor to heart disease à smoking
Q about the efficacy and potency curves for drugs…know the diagrams in FA
p299 p300. This is ALWAYS in the exam.
Q about the most common side effect of Calcium channel blockersà Flushing
Q about the substitute to ACEI in case of its coughing side effect à LOSARTAN
(AgII receptor antagonist)
Q about the drug (s) that cause SLE like symptoms à Procainamide
Q about the P450 inhibitorsà Cimetidine is almost always in the answer choices
Q about a drug that blocks gastric acid secretions even in the presence of Ach Ã
omeprazole
Q on accidental injection of NE into tissues what to give to prevent necrosis Ã
Alpha blocker
Q on patient who has mania and seizures whch drug to give to treat both Ã
valproate
Q case decribes hemorrhagic cystitis what drug causes it à cyclophasphamide
Q on what is used to treat the hemorrhagic cystitis of cyclophasphamide Ã
mesna•
Q about a a man has lost sensation over the posterior aspects of his hand,
unable to use forearm externsor muscles, what’s the lesion? à Humeral fracture
radial n
Q about a doctor who has teenage son who is a drug abuser....Doc. sees a pt.
that is teenager and also abuses drugs. Doc is upset and feels like slapping
him....what’s the defense mechà Projection
Q on a man who had past incidents of sudden fallà Narcolepsy
EM of a superior view of ‘villi†and asked where is it located? à . Small intestine
Q shows a picture (picture#28) of an arteriogram of the cerebral arteries and
Ant. Cerebral A. will be labeled and asked what functions will be lost if you
severe this artery? Pt. can climb the stairs
Q on a young male has fever, lymphadenopathy, hepatosplenoinegaly. Virus
responsible for this is also responsible for what other disease à EBVÃ
nasopharngeal CA.
Q of a man comes out of the bar... he is very aggressive, jerking movements,
took 4 people to hold him. What drug was he using? Ã PCP
Q on Pt who has a severe headache. Subarachnoid hemorrhage was noticed on
the CT. What are the other findings? - Ã Out pouching at the junction of the Ant.
Communicating Artery and Ant. Cerebral Art. Ã Berry Aneurysm
Q on who is the child @ risk for developing in a house where both parents
smoke? Ã Asthma
Q on a woman gave a birth to a child 2 days ago, she comes to the doc stating
that she is depressed, not socializing w/ her husband. What should you (the doc)
tell her? Ã It is normal and schedule a visit for the next week
Q on a pt who has a coronary artery occlusion. What changes will you notice in
the myocardium? Ã Low levels of ATP
Q on a woman comes to the doc, she tells the doc that she is motivated w/ her
job, but she doesn’t socialize w/ other people @ her work, she feels uneasy w/
them. What’s the Dx? à Avoidant Personality
Q on a woman had several episodes of Depression in the past, for which she
has used medication. She has discontinued her medication for the past six
months and didn’t have any episodes of depression. She is thinking of
becoming pregnant. What should you as a doc tell her?
Q on a pt. is in the hospital. The prognosis of his disease is vague. Although he
never designated any one as power of attorney or written consent but his wife
tells you that he had mentioned on several occasions not to resuscitate his life if
in case he is at the verge of dying. What should you as a doc do, if this pt. is
suddenly about to die? Ã Listen to the wife and do not resuscitate his life
Q on a pt who has renal failure, what other deficiency will you see? Inability to
form active Vit. D
What’s the role of ANP in increased Blood Pressure? à Causes the Na/water
loss from the kidney (mech: Increase blood pressure to the R.Atrium ANP
released by R. Atrium à Na+/H20 loss by the kidney)
Q on a child who has thyroid hormone def. What is the pt. at risk for developing?
à Mental Retardation
Q on a pt who has decrease T4, injection of T3 would result in what?
Decreased TSH and inc T3.
Q on Oxygen Dissociation (ODC) (picture#29) and will ask about the dotted line
indicating what? Ã Fetal Hb (basically the curve will show a shift to the left)
Q on an x ray pic (picture#30) of the kidney along w/ symps of kidney stones. Id
the type of kidney Stone à Calcium stones
Q on how do you diffentiate E.Coli from salmonella? Ã Lactose
Q on the Symps of Carcinoid Syncfrome given along w/ icreased Hydroxy-Indole
Acetic Acid (5-HIAA) in the urine, what is the dx?
Q on LMN lesion symps will be given (Flaccid Paralysis, Areflexia, muscle
atrophy) will ask you Asked the location of the lesion? ipsilateral Corticospinal
Track Le
Qs where they want you to know the difference b/t Grade and Stage- know them
Q on a woman wants to have her tubes ligated. She has been in a long
relationship with a man whom she is not married to) and lives w/ him. How
should a doctor reply? Ã Discuss the consequences w/ both
Q about what is it in the bacteria which inactivates the Hydrogen Peroxide in
PMN’s? à catalase
Q on Dx Nocardia clues “partially acid fast
Q on Dx Actinomyces lsrealis. clue “branching filamentsâ€Â
Q on the Transmission of H.Influenza? Aerosol
Q on the Symps of Atypical Pneumonia à non-productive cough, headache,
insidious onset etc.) What do you tx it w/ ? Ã Erythromycin
Q on why is Histoplasma not transmitted from person to person? Intracellular
Q shows picture (picture#31) of a glomerulus given w/ diabetic symps, asked to
identify the lesion? Kinimel-stein Wilson nodules (looks exactly like the one in
the FA)
Q of Symps of PID and cervical motion tenderness, purulent cervical discharge,
saphingitis ID the Bug? Ã C. trachomatis (MC than N. gonorrhea
Q shows a pic (picture#32) of Squamous Cell CA, Dx
W shows a pic (picture#33) of the nephron given and asked to identify the
location where Acetazolamide works? Ã Proximal Tubules
Q on a pt. is using 3 or 4 different drugs names listed) and present w/ some
symptoms. Which drug can be substituted to prevent the cough? Losartan
Q on pt. has Bipolar Affective Disorder and using Lithium. What is he most like
to develop? Ã Nephrogenic DI
Q will show a pic (picture#34) of supratentarial herniation occurs, what CN will
be affected mostly?
Q of a young male gets a stab wound in his neck right above the clavicle and
lateral to the manubrium sternum. What structures most likely damaged?
à Pleurae
Q on a Microscopic (picture#35) description of Paget’s Disease (Osteitis
Deformans(Pg 243 Kap notes)Haphazard arrangement of cement lines,
creating a mosaic pattern of lamellar bone and will ask about the cells involve in
the initial lesion? Ã Osteoclast
Q on PCR analysis basically will ask about whether the child has the disease.
You have to look at the bands and than interpret the results.
Q Asks about the Mitochondria....What Ion is involved in proton Gradient? Ã H+
Q will ask to identify the region which will indicate IgG isotype switching.
Q’s will ask about the Immunoglobulin structure- know it
Q on a child was stung by a bee....what mediators are involved in vasodilation
and increase permeabilityà ? Histamine
Q on what allows the bacteria to invade the respiratory tract? Ã Inhibition of lgA
protease
Q asks about two groups of females, one smoker and the other non-smoker, are
identified and followed for ten years to see the risk of developing breast CA.
What type of study is it? Ã Cohort (Prospective)
Q on a Karyotype of Trisomy and will ask what would you see? Ã Flat facies and
simian crease
Q will give a Description of Turner’s and will ask what another finding is
associated w/it? Ã Infertility
Q on a pt. who has a systolic murmur and you have to identify the location on the
chest. Ã apex
Q on an alcoholic pt. WI easily bruisibility. ecchymoses. etc. What’s the defect?
à Defective Hydroxyproline (require Vit. C)
Q on advantage of giving C-dopa w/ L-dopa? Increases the levels of dopamine
in the CNS (NOTE: peripheral decarboxylase inhibitor might not be option)
Q on Pt. has Hypokalemia. . .which diuretic should you use to restore the
potassium levels? Ã Amiloride
Q to ID an Antacid from the list? Ã Magnesium Hydroxide (FA 337)
Q asks what result will you see in a pt., who has PTH def., following
administration of PTH? Ã Increase Urinary PO4 & inc Urinary camp
Q asks how you would treat the Pt who is anemic and has a renal failure.
à Erythropoietin (EPO)
Q describes a child who has absence of both kidneys but the ureters are
present. What’s was the defect?
Q ASKS what vitamin could be supplemented to prevent neural tube defects. Ã
Folic Acid
Q describes of Lesh Nyhan was given and asked to identify the purines?
Guanine & Hypoxanthine
Q about PKU- a girl w/ blond hair, musty odor etc. What will you see?
à Phenylactate
Q shows a pic (picture#36) shows mouth lesions (Gray color) and will ask what
other diseases this virus is responsible for à Coxsakie virus à hand foot and
mouth disease
Q describes a pt. has Adenexal mass is going through a surgery, which ligament
would you ligate to prevent the bleeding? Ã Suspensory Ligament (has ovarian
vessels)
Q where immunoflorescence will be given....shows both granular and linear
pattern will ask to identify the disease? à IgA nephropathy (Berger’s disease)
Q Describes young male W/ lab values (hint: low ceruloplasinin) and his sister
also has choreathestosis Dx? à Hepatolenticular Degeneration “Wilson’s
Disease.â€Â
Q asks side effect of Aminoglycosides? Ã Nepbrotoxic
Q on action potential will be given in a Pic (picture#37) where the Ca channels
close. Will show the phases and you to have to ID.
Q shows a pic where drug X is stimulating muscular contractions while Drug Y is
inhibiting muscular contractions. ID? Ã Most of the time they have Atropine and
Succinylcholine as X and Y.
Q on the MOA of Ketoconazole? Ã Inhibit ergosterol synthesis
Q on the MOA of tetracyclines? Ã Prevents the attachment of amino-acyl tRNA to
the ribosome
Q on a Pt. who has Herpes, what’s the tx? à Acyclovir
Q on Parathion (organophosphate) poisoning along w/ it’s symptoms how ou
treat it? Ã Atropine
Q on a Pt w/ Wilson’s disease. Tx? à Penicillamine
Q describes a Pt who has a prolactin secreting tumor.Tx? Ã us Dopanine
Agonist
Q asks about aecond messenger of Nitroglycerin? Ã CGMP (FA 324)
Q describes a Mother who is pregnant, what anticoagulant should be used? Ã
Heparin
Q on the MOA of 5-FU? Ã Bioactivation of FdUMP which leads to decrease
dTMP
Q Tell you about hemorrhagic cystitis caused by cyclophosphamide and asked
the MOA? Ã Alkylating agent which covalently cross link DNA at guanine N-7.
Q asks why penicillin not effective against Mycoplasma. Has cholesterol in its
bacterial membrane……NOTE - “no cell wall†might not be an answer choice.
Q about the Defect in CGD? Ã NADPH oxidase
Q about the Defect-in Chediak Higashi? Ã Microtubule and lysosomal defect
Q asks where MHC Class II Ag loading occurs in. Ã Acidified Endosome
Q describes a woman who has RUQ pain, severe after eating a meal, Increase
Alk. Phos. What’s the Dx? à Gall stones(cholelithiasis)
Q asks about the function of the spliceosomes? Ã Remove Intervening
sequence....NOTE: introns might not be a choice.
Q describes an AIDs Pt. w/ “ring enhancing lesion†on the CT scan. Dx? Ã
Toxoplasmosis
Q on a pt. who has bacterial, viral, and fungal infection. Defect in this disease? Ã
Adenosine Deaminase Deficiency
Q will Ask to id the location of secondary TB
Q about Cholera Toxin mech: Ã ADP ribosylation of Os Protein
Q on the location of Colon Adenocarcinoma à splenic flexure/sigmoid colon
Q shows a Head CT (picture#38) w/ an arrow in the temporal lobe lesion
(around the Meyer’s Loop) and asked the visual field defect?- à Left upper
quadrantic anopsia (“pie in the skyâ€Â)
Q on a Pt. is in the car accident.. .has a whip-plash injury, dislocation of the
cervical vertebrae... What can be damaged à Vertebral A. most likely
Q to Calculate the power when Type I (Alpha) error=0.5, Type II (Beta)
error=0.20
Q on Symp. Of Ehler Danlos ask what is the defect? Defective lysyl hydroxylase
might be a choice beware of other choices
Q on what causes a negative feedback inhibition to FSH? Inhibin
Q might ask you tx a pt. w/ who has Ieukopenia, neutriopenia. Etc à Granulocyte
Colony Stimulating
Q shows a pic ask to id the preganglionic neurotransmitter? Ã Ach most likely be
labeled
Q on a pt. who has mild fasting hypoglycemia (might not be severe) and
enlarged heart.. .what’s the defect? à Debranching enzyme def. (Glycogen
Storage Disease)
Q on a pt is heterozygote for Familial Hypercholesteremia. What’s the defect?
apo B-100 receptors (are aka LDL receptor)
Q on a female tries to commit suicide by injecting herself w/ insulin. What would
you see in serum lab values? Ã C-peptide will be normal
Q on a Hematology slide (picture#39) of megaloblstic anemia (hypersegment
PMN’s might not be there ). . Ask for the mech or what is associated w/? Ã
Decrease conversion of N-methyl tetrahydrofolate to Tetrahydro folic acid
Q on Symp. of H. pylori infection was given and will ask the characteristic of the
bug? Ã Urease +
Q on Antigen Presenting Cells (APC’s) in the skin? à Langerhan cells
Q shows a Histology Slide of the Glands (breast) (picture#40), what type of
change?Ã Hypertrophy
Q on Which Zone of the lungs has the greatest pulmonary blood flow when pt is
supine exact pic like the one on FA 371 (bottom)Ã you have to ID the zone
Q on a woman is going through a menopause... which hormone will be
increase? Ã FSH.
Q on Which diuretic will you use to increase the urinary concentration of
NaHCO3? Ã Acetazolamide
Q on NE effect’s on renal arterioles? à Constriction of the afferent and
decrease GFR
Q on a pt. has a family hx of coronary artery disease, he works for chemical
company, he is single his cholesterol is normal. His other plasma values normal
as well. What’s his risk for CAD?à His risk is the same as in general population
since he has normal
Q on a clinical trial is being conducted to see the risk of developing cancer in
children who live in households near chemical factory. Will ask about whom
should the control group be? Ã children living w/ their parents near the factory
who do not develop the cancer
Q on an Old lady had just removed intraductal papiloma in the breast, what’s the
prognostic marker should you use? Ã Erb-B2
Q on a pt. presents w/ the severe chest pain. How should you (doc) initiate the
patient’s history so that can learn the most about the Pt’s problem... in other
words, what should you (doc) ask the pt. to learn most about the pt.’s problem? Ã
“Tell me more about your pain†Ans
Qs on accidents might be given, with bone fractures in the lower extremities
what’s the risk à fat emboslism.
Q about an old lady falls down the stairs and had a fracture and now has resp.
distress what would it cause or where would it lodge? Lungs (pulmonary
embolism)
Q ask about 5-fu mode of action à inhibit thymidylate synthase.
Q to trt Teenager with acne à tx is tetracycline
Q on which hormone has affect on renal vasculature à dopamine
Q where you must know the mech of action of Sertralineà inhibit the neuronal
reuptake of serotonin
Q on a child with an abdominal mass (picture#41) à wilm’s tumor
Q on an alcoholic man who recently had a coronary graft surgery 2 days after
surgery he develops seizuresà DT
Q on a Gross slide (picture#42) shown of a uterus case given about an teenage
girl whose uterus was the size of 16 wk gestation but she wasn’t pregnant what
could it be. Ã hydatidiform mole slide will give the answer)
Q on an athlete who fell on his knee- injury describes the tibia moving interiorly to
the femur what is the injury? Ã Anterior cruciate ligament injury
Q on women fallen on an outstretched hand what’s signs? à Media n.
compression or damage.
Q on a women off of a ladder down and bit her bead on the table..but she is ok,
2 or 3 days after she falls unconscious... Ã subdural hematoma.
Q on a construction worker digging up soil with a machine or something Ã
cryptococcal fungal infection.
Q on how you treat influnza A Ã neuranunidase..
Q on a patient taking an antiarhythmic has pulmonary fibrosis. Ã amiodarone.
Q with a picture (picture#43) of black female’s face will be shown. She has
granulomas and other things will be describedà sarcoidosis.
Q on a young guy dies suddenly, on autopsy heart is enlargedà hypertrophic
cardiomyopathy
Q descripes blunting villi à celiac sprue
Q on a guy who just turned positive for a TB testà Give INH with Vit. B6.
O on a guy comes in with a severe headache... Ã subaracbnoid hemmorhage.
Q on Allopurinol MOA....diagram will be given. Locate where it acts à xanthine
oxidase inhibitor
Q on colchicines MOA Ã inhibit microtublules
Q on what happens when u donate blood- what decreases? Blood volume
(Hemoglobin and hematocrit does not change)
Q about a kid who has asthma, what should be given during an acute
episodeà albuterol
Q on a women who was put on warfarin- what allergy medicine should be
avoidedà cimetidine
Q about ace inhibitors side effects.. . Ã renin is increased because of loss of
feedback inhibition
Q with a path slide (picture#44) show (microscpic) adipocytes, a case given a
guy who was chronic alcoholic- he came to hospital and dies within 2
days....What caused his sudden death? Ã heapatic Steatosis
Q on renal failure.. . Ã vit D production is affected
Q on a woman with nephrotic sx. Has membranous glomeuronephritis. “will ask
about what could be seen in IF: Ã granular pattern(linear for good pasture)
Q on a woman has a malar rash (picture#45) she has a glomeuronepbritis what
marker à ds DNA
Q describes a guy who has urethritis, visual problems and pain in leg à reiter’s
sx.
Q on a guy who has a transplant, 2 week after deterioration occurred
(rejection)..what cells are involvedà T cells (acute rejection)
what does bacteria use to defend against PMNÃ catalase
Q describes a woman who has an oral candidiasis... what drug should be used.
à nystatin
Q describes a patient on ahypertensive medication and now he is allergic to
sulfa- what to give? Ã Ethacrynic acid
Q on a guy goes camping has sx of lyme disease à Borrelia burgdorferi
Q on what factor of entrobacteriacea is important in virulence... Ã capsular
antigen
Q on a guy has bloody diarrhea . . . organism is nonmotile à shigella
Q southern blotting description- know the technique
Q on a guy who has a stroke and has aphasia and paresis what structure is
involved? Ã anterior capsule
Q on papillary light reflex....what is involvedà pretectal area
Q on diaphragmatic hernia (xray shown)(picture#46)- dignosis
Q on cardiac output calculation- know the formula they always ask one question
on CO
Q on C.periferengens mode of transmission. à wound infection à gas gangrene
Q on peroneal nerve injury... Ã loss of dorsiflexion
Q on 21-hydroxylase deficiency. Ã Know the whole pathway in FA page366
there are always one or 2 question on this pathway. Know which one will cause
hyper and hypotension.
Q describes a person is to have a surgery done and he was told about the
operation, side effects and other t
hings... signature of patient is required so how should this contract be worded?-
here you can have different ways to write the consent, you would easily pick it
upâ€its all common sense.
Q on a woman who has an argument with her boss, she comes home and yell at
her children à displacement
Q on odds ratio. .formula- always always there get it straight you won’t miss it if
you know the formula.
Q on a study is being done about the effects of contraceptive on reduction on
breast cancer.. .what is the prerequisite à inclusion of group patients who
shouldn’t have family history of breast cancer.
Q on a high school football player who smokes come to the doctor . . . what
should doc say to make him quitting smoking? à “smoking can and could affect
your sports activityâ€Â
Q about a mom brings in 12 year old son who has type 1 diabetes and he
doesn’t comply with the medications mother keeps complaining to the doc and
doesn’t let the kid talk- what should the doc say.... à “mam, can you please let
me hear his side of the storyâ€Â
Q on prevalence....a specialty clinic has a 12% prevalence of a disease but
when the docs go to a community clinic it decrease to 2% y?. . . Ã because
specialty clinic only sees particular disease
Q on a case scenario presents a guy has a problem but there are no physical
findings. Ã conversion disorder
Q on which Beta-blocker not to give an asthmatic à propranolol
Q asks which medium would you use for a pneumonia causing bacteria that has
no human to human trasmission that colonizes air conditioning units à (legionella
- charcoal-yeast extract).
Q on a Patient has a dignosis of amyloidosis which stain would you useà Congo
Red
Q on a Health care worker has a positive S. Aureus on a routine nasal culture,
which antibiotic do youuseà none, normal nasal flora
Q on a Patient infected with C. Dipthereia, what is the MOA Ã ADP ribosylation
of EF-2 “Always in the exam
Q on a Hiker has explosive diarrhea after drinking water from stream must ID
eosinophilic ova in stool sample à giardia
Q on a young boy with stridor and fuzzy X-Ray- thumb sign (picture#47) must ID
à H. influenza
Q on a Patient with duodenal ulcer must be treated aggressively to limit the
possibility à H pylori
Q on TB delineates the difference of the Ghon complex from the Ghon focus.
Questions Prophylaxis for accidental healthcare worker exposure to TB (Rif for a
month)
Q on which antibiotic would you not prescribe an eight year old. Ã Tetracycline
Q about a camper who developed a target like rash, if not treated will progress
to à purulent arthritis
Q on fungus, fungus ball in upper lobe of the lung, 45 degree hyphae in an
immunocompromised à aspergillosis
Q on baby girl with MR and inappropriate laughter à you have to have to ID
imprinting
Q describes Huntingtonsà you have to ID trinuclcotide base pair repeats.
Q on which amino acid is ketogenic à mot likely lysine
Q on a boy with violent behavior coarse facial features who bites off his own
fingers à ID the missing enzyme in a drawing of the Uric Acid pathway.
Q about a boy who uses Gowers sign to stand who has adipocytes in his calf
muscle biopsy à X-linked inheritence
Q on diagnosis of Fabrys diseaseà ID an accumulation of ceramide trihexose.
Qss on G-protein-linked second messengers, must know which ones release
calcium, inhibit and stimulate cAMP-Ã know the pathways for all the G
proteins---Always asked in the exam “ALWAYS.
Q activators of the P450 system and one question on inhibition of P450. FA 336
DRUG reaction table is a MUST KNOW.
Q on the activator of lipogenesis à citrate
Q on the rate limiting step of the TCA cycleà isocitrate
Q on the metabolism of methanol à ID formic acid via alcohol and acetaldehyde
dehydrogenase
Q to ID edema in Kwashiorkor (picture#48) versus Marasmus (picture#49) and
hypoalbuminemia. Ã Kwashiorkor is proteins deficient
Q on collagen synthesis and which process occurs immediately after the
procollegen leave the ER Ã ID peptidases cleave terminal sequences
Q to ID which blood cell lineage requires Vit EÃ Vit E
Q you have to ID the oncogene and tumor markers in clinical senarios. i.e
Patient skin lesions and is positive for S-100 Ã ID melanoma
Q on Amniocentesis shows low alpha-feto protein, what is baby at risk for Ã
Downs syndrome
Q on a Patient who has blood in stool, abdominal pain and a change in stool
caliber, which marker would you expect to be elevated à CEA
Q which foramen the maxillary (V3) branch of the trigeminal pass through. Ã
foramen ovale
Q on CATs-- subdural hematomas (picture#50) vs. Epidural hematoma
(picture#51). Ã Make sure you know that the subdural is crecent shaped and
epidural is bi- convex shaped- knowing this fact always helped me pick it up.
Qss always asked in the exam arediuretics “ know the MOA and Site of action
of Acetozolamide, MOA and site of action of Furosamide
Q on Which diuretic will you prescribe to a diabetic with a GFR of
Q on a schizophrenic patient who has diabetes develops facial and tongue
movements, what is the mechanism of action of the medication that you will
prescribe next? Ã ID clozapine MOA
A few questions on drug induced Cushing’s with lab values and stuff
like that.
Q on a fish bone was stuck in a kid’s “Periformis fossa,†the nerve Damaged will
delay what function? Ã gag reflex
Q on an infant dies suddenly due to pulmonary hypoplesia, what is the cause?
Diphragmatic hernia
Q on a child has to go thru Tracheaectomy, which structure does it passes thru?
à Skin and cricothyroid membrane most likely the answer will be.
Q on Loss of pain and temperature on one side of the face, what is the nerve
lesion? Ã CN V
Q on a child who was extremely HOT, which structure is damaged? Ã Anterior
hypothalamus
Q on what controls the Autononuic nervous system? Ã Hypothalamus
Q on an alcoholic who is losing memory, what structure is damaged?
à mammary bodies
Q on an alcoholic with confabulations, which vitamin? Ã Thiamine deficiency.
Q on a kid with clouding of the left cornea, which eye is he using the most after
replacing the cornea?
Q on child with craniopharyngima, what visual field is defect à heteronymous
hemianopsia
Q on a child with temporal lobe lesion, what visual field is defect? Ã Left Upper
qudrantic anopia (pie in the sky) “ Know the picture of Visual defects page 111-
here there are alwaysss questions.
Q on a patient with paralysis of the upper arm, which structure is lesioned?
à MCA
Q shows a c-section (picture#52) of the cord in a lady who losses pressure and
touch on her legs, which lesion? Ã Gracillis nucleus area (1. Nucleus gracilis )
Q on a Man with subararachnid bleeding, which area is most likely source? Ã
circle of Willis (berry aneurism)
Q on a man sleeping normal hours but is chronically tired all day, what is wrong?
à sleep apnea
Q on a man sleeps all the sudden collapses in sleep several times in the day,
what is wrong? Ã Narcolepsy
Q on a lady gets up very early and cann’t go to sleep, what is the problem?
à Time duration will meet Major depressive disorder criteria
Q mentions an Occlusion of the Superior Mesenteric Artery, what does it affect?
à Ascending colon most likely to be in the answer choices
Q on Huntington’s disease (anticipation), what is responsible for Anticipation? Ã
Trinucleotide repeat expansion
Q on what enzyme prevents RBC hemolysis from free radicals? Ã ADPH oxidase
Q where you have to know hypothyroidism- TH & TSH decreased give TRH
given no increase in TSH Ã pituitary problem
Q where you have to know DHEA & its action.
Q on R-A-A system for pressure & volume control- know this system very well-
Always asked
Q on high pressure barorceptors in carotid body & it’s function & firing strech
causes? In firing & what effect on symp/parasypm syst
Q on the Action of PTH on Ca++, how (one is increase formation of 1,25 do OH
D3 in proximal tubule) Ã by hydroxylase
Q shows a Slide (picture#53) showing various part of bone, asking where PTH
act by indirectly activating osteoclasts
Q on Male psuedohermaphrodism à (testicular ferminization)
Q on the action of inhibin in female repro
Q ask the Reason for plateu phase à ca influx (understand vent. AP generation &
status of various ion channels)
Q describing renal problem. “edema à Protein (albumin) loss
Q describes and inc of blood flow to an organ whyà to match increase
metabolism
Q on AP arise ca release from where à ER
Q says If a-v fistula opens, increase CO, what effect on loop à increase volume
more than normal
Q to find out blood flow from O2 consumption given, plum A-V (O2) diff given?
Remember equation. Ã Flow (Q)= O2 consumption/Pul A-V [O2] diff
Q involving alveolar gas equation: FIO2 & FICO2 will mostly likely be given
Q on High altitude changes- what happens to HCO3, pulm a, systemic a, when
person goes to high altitude. Ã Hyperventilation decrease CO2 and increase in
HC03.
Q shows a Graph excretion of glucose, staightline occurs when à when Tmax for
glucose reached
Q related to resp. alkalosis, what happens in the kidney? Ã increase urine
excretion of HCO3, renal compensation
Q on What is reabsorbed at terminal ileum à B12, bile salts
Q on what is needed for B12 reabsorption à IF from stomach and healthy
terminal ileum
Q on Co poisoning and how Hb saturation of O2 (SaO2) is affected
O2 dissociation curve and factors that shift curve to the left or right.
Q on Free radical injury, how does CCl4 damage liver,Ã lipid peroxidation.
Q on the Types of necrosis --Brain tissue necrosisà liqucfactive.
Acute pancreatitis à enzymatic fat necrosis
Q on Spherocytosis (picture#54) -what abnormality lead to ità spectrin.
Q with Clinical vignette describing S/S of CHF heart is enlaged what is the
reason à hypertrophy(not hyperplasia)
Q with a Slide describing endometrial hyperplasia (picture#55)
Q on complement and what is C5a responsible for à anaphylaxis
Q on C5b-9 deficiency and risk of infx with what bacteria? Ã Neisseria Sepsis
Q ask if you want to develop a new drug to stop leukocyte migration to site of
inflammation what is the target for drug à drug that acts on adhesion molecules
Q on the action of eosinophils on parasites à ADCC
Q ask about a potent endogenous platelet inhibitor à prosatcyclin
Q describes fever and whats responsible for it à the effect of IL-1 & TNF,
proinflammatory agent
Q on ankylosing spodylitis (picture#56) & relation with à HLA-B27
Q on goodpasture synd à antiglomerular basement Ab
Q on E.coli associated with what à hemolytic uremic syn
Q on Alcoholic, thiamine def, Ã wet beriberi (CHF), congestive (dilated
cardiomyopathy)
Q on INH Rx and it causesà pyridoxine (B6) def
Q on Anemia, neurologic abnormality, gave Folate which treated anemia but not
nuero abnormality à Should be treated with both Folate & B12
Q on mosaicism in autosomal cells
Q on PKU, no symptoms when in hospital, when home symptoms appear,
reason à home food contained Phenylalanine
Q Describes of galactosema, cataract, reason for It à osmotic damage by
formation galactilol
Q on antiCA -Bloomycin- it causes à interstitial pulmonary fibrosis
Q ask If tumor produced in rats, what is deleted à tumor superssor gene, p53 etc.
Q on Prosthetic heart halve abnormality, iv abuser -what Organismà s. aureus
Q-Notes Part 2:
Congenital adrental hyperplasia, various enzyme def Description of autosomal
dz Chances of child to get dz.
Congenital infection -vignette of rubella in 1st tri, what effects on mother and
child
College student, unconscious, what is the most likely substance of abuse
Barbiturates & alcohol, cross tolerance
Cyclophosphamide- hemorrhagic cyctitis
TGF & collagen desposition
Asbestosis (picture#57) & relation with tumor, smoker/nonsmoker, most
common tumor even in nonsmoker is bronchogenic ca.
Adult T cell leukemia, Japanese, relation with HTLV-1
HTLV-2, hairy cell leukemia
Tumor stage & its relation with prognosis
Genetic hyperlipidemia, all types with reason & abnormalitics in CH, TG , LDL
levels.
dissecting aneurysm-coz: hypertension
Opening of av fistula, high output CF, graph showing various output status
wegner’s granulomatosis, C-ANCA
CHF- pulmo edema, bilateral rales
ASD, reversal of shunt
PDA, both murmur and dia & sys
Closure of pda, indomothacin
ST depression, subendocardial depression
Acute fibrinous pericarditis, pericardial rub
Lobar pneumonia
Asbertosis
Sarcoidosi
s
Sq. cell Ca
Slide swith target cells (picture#58) what causes it?
avascular bone necrosis in sickle cell dz, African adult male
autoimmune hemolytic anemia, jaundice due to extra vascular hemolysis by
fixed macrophages
absolute neutrophillic leukocytosis
CLL, lady over 60 yrs
Slide showing owl’s eye (picture#59), hodgkin’s dz
Congential pyloric stenosis
Celiac dz desc, reason -wheat diet
Food poisoning: staph auerus-
within some hrs
clostridium diffâ€mech of action
Bacillus cereus- rice reheated
hirschsprung’s dz (picture#60) “ reason no ganglion cells from neural crest
Angiodysplasia- common cause for elderly GI bleeding
Crohn’s dz- (picture#61) all layer involvement, linear ulcers
Clonorchis sinensis infestation
Neonatal cholestasis- billary atresia
cystic fibrosis- pulm, inf, problem in which resp epi cells -goblet cells which
secret mucus
chr. Pancreatitis
Slide of APKD (picture#62)
GBM-Ab to it- G-P synd
Poststreplococcal GNâ€granular IF, no fibrin
Diabetic nephropathy- slide of glomeruloscelrosis, round hyaline deposition
prerenal azotemia- mostly shock status
Scar on both pole of kidney- Cause of it
Drug induced interstitial nephritis- methicillin
Seminoma- crpytorchid testis
Fetal lung maturity: how to detect- L:S Ratio
endometrial adenoCa
Tumors of ovary learn and understand the diff from each other
may be there slide on teratoma ovary
hydatidiform mole
slide (picture#63) of breat tissue a moveable mass in inner quadrant
breast tumor Esgn Rc positive, how to treat- tamoxifen
DI vignette, water deprivation test, detect if central or nephrogenic
Hyperprolactinemia assoc. with Dpamine
hashmoto’s thyroiditis
cushing’s synd- dexamethasone suppesion test: +ve in pirtuitary one
gastrinoma, ulcer, hyperacidity, islet tumor from pancreas G cells
ankylosing spondylitis
Slide of osteogenesis imperfecta: girl with blue sclera, type 1 collagen problem
Chondrosarcoma (try to diff all tumor by their age grp, location, bone part involv,
which commonly involved specific X ray appereance,if any
Duchenne’s muscular dystrophy, SXR, calf hypertrophy, gower’s signâ€defect in
dystrophin
maculopapular dz can be asked. So understand their distribution
on toxic shockâ€Female, MC, tampon
Slide of typical location of basal cell Ca (picture#64)
AIDS pt, vignette (??? May be a slide showing demyelination). Progressive
multifocal PML, leukoencephalopathy
amyo. Latc. Scle. (ALS)
wilson’s dz, -ceruloplasmin def kayser fleischer ring (picture#65)
Tumors of cns: in adult & child, most commong, with site
find out attributable risk from data and probability from data
Something on p-value, null hypothesis
On human sexuality, a physically female thinks she is wrongly born as female
she should be male
obese pt of DM on Rx, asked to eat only in kitchen, not anywhere in the house,
what kind of behavioural RX is this “ stimulus control
defense mech-
* pt female abused in childhood doesn’t abuse her children, but instead over
protect them, what kind of behavior is this
Pt with pain, aches, etc, some psychological problem, to differentiate among
somatization, conversion, hypochondriasis, factiotious, etc.
stages of adjustment of dying pt
factors that increase chances of depression in a female
narcissistic personality
absence seizure “ Rx ethosuccamide
erection problem in pt, how to Rx
function of diff parts of brain (Fist aid)
DNA formation from RNA, by a retrovirus, in which direction does it make DNA
Vignette of xeroderma pigmentosum, which enz def or what if formed-
Excession indonuclease /thymine dimmers.
Main RNA formation occurs when- histology slide point to nucleolus
If a pro, is reformed & structure is changed from a helix- to b-plated sheath, what
bonds are reformed “hydrogen bond
I-cell dz, que was what is the problemâ€mannose phosphorylation lysosmal enz
is deficient
Glucagon acts by increasing cAMP, which then acts on what? CREB- Lemcine
Zippen
As in pathology. determining risk of a child to get dz, when one or both parents
are having AD dz
If transgenic mice don’t have normal gene, which was present before, what this
study conferes?
how proto-oncoggene gets converted to oncogene, --translocation
Tumor & deletion /mutation of P53 supressor gene?
Which AA is used in biosynthetic pathways?
Km values of glucokinase & hexokinase, Km value of glucokinase is higher etc.
competitive inhibitors, effect on Km & Vmax
Pertusis toxin & action thru Gi protein, on increasing cAMP
If absorption prob occurs due to bile def, what of the following gets
depleted-look for fat soluble vits
Relation of HMP shunt, NADPH, & glutathione reductase
B12 def & methylmalonyl
Pt of diarrhea comes to ER. Only dextrose solution is given, what will be found
blood of pt in high conc
Allopurinol & action in gout by decreasing uric acid formation
A chart, show lower than normal conc of a drug from starting what was the
reason? “ first pass meta
Chart on agonist/ antagonist
Where glucagons acts- creb pr
Calculate half life, Vd & CL will be given
Difficulty in voiding, there is some residual urine after urination, how to
treatmuscarinie agonist & anticholinesterase, both can be given urinary
retension.
epinephrine reversal- KNOW IT VERY WELL
Asthmatic pt, & treatment for HT or something else, what will u give “ B1
selective blocker
CCB- site of action
antiHT, complain of dry cough- what drug? captorpil
Where thiazidde diuretic acts- Na-Cl transporter
Benzo antagonismâ€flumazenil
M/A of dantrolene, used for treatment of malignant hyperthermia after
amesthetic use--decrease release of Ca++ from SR
Pt after operation not recovering from relaxation, gave neostygmine, condition
didn’t improve, which was relaxant- succinylycholine
Antipsychotic causes EPS; how to treat it- antimuscarinic- Benztropine
S/S mania -what drug to treatâ€lithium
M/A of TCA drugs
gingival hypertrophyâ€phenytoin
What other drug act on beta- lactamases
Pencicilin elimination blocked where by probeneied- renal tubular secretion,
toxoplasma- treatment trimethoprimâ€sulfo
M/R to INHâ€by change in catalase
Rx of herpes zoster-acyclovir
Pulmonary fibrosis as an ADR-bleomycin
Pt on Rx hodkin’s dz, ADR, describing CHF, drug was doxorubicin
Breast Ca, Rc +ve,-- Rx with tamioxifen
Drug acting on IL-2 , INF, blocking their synthesis
M/A of B blockers in hyperthyroidism- inhibit peripheral conversion of T4 to T3,
cortisol use in some skin dz, what will u expect- skin thinning
Rx of diabetic ketoacidosis- crystalline insulin
Drug increasing effect of insulin on peripheral tissue- biguanide-meformin
drug interaction-pt on Rx of asthma, theophylline was given, drug is added,
increasing requirement of theophylline- look for P450 enzyme inducer
pt on warfarin action starts after one week, how it acts or why after 1 wkâ€slow
onset of action, decrease synthesis of factores II, VII, IX, X
conjugated to diptheria toxin.
Q on glomerulonephritis , ask properties of causative bacteria à bacitracin
sensitive
Q on C. diphthriae -ask about coding of toxin à a beta prophage
Q case describe Ziehl-Nielsen stain (picture#8)“ ask diagnosis à TB
Q picture (picture#9) of synapse -where does botulinum toxin act? Ã inhibit Ach
release (look at the arrow)
Q Picture (picture#10) shows a lesion in the gasric mucosa and describe an
classic gastric ulcer what is the bug reponsibleà H. Pylori
Q on how would you differentiate b/t Klebsiella from Salmonella à Lactose
fermentation
Q on schistosoma “ will describe case history and picture (picture#11)
Q on a pedigree à all offspring of affected females show signs à A classic
MITOCHODRIAL inheritance (picture#2)
Q on why anticipation occurs? Ã More trinuleotide repeats.
Q always describes a child with malnutrition à which AA deficient? à look for
essential ones (remember PriVaTe TIM HALL in First Aid page 166)
Q must know about mech of action of Nitric Oxide à Nitric oxide stimulates
soluble guanylate cyclase (sGC) to convert GTP to the intracellular second
messenger cGMP.
Q always arises on how Insulin acts on GLUT4 Ã Translocates to membrane.
Qs on vitamin B12 à they always ask many questions here à the most popular
one is its relationship to intrinsic factor and pernicious anemiaà know everything
about B12.
Qs on vitamin DÃ question related to SARCOIDOSIS and Hypercalcemia.
What’s the relationship? à Macrophages convert Vit. D to its active formÃ
Hypercalcemia.
Q on DNA replication à What DNA Topoisomerase does? à Makes a nick in the
Helix to remove supercoils.
Q on the Lac Operon- what happens in the absence of lactose à the repressor
protein encoded by the I gene binds to the lac operator and prevents
transcription.
Q about Lesch Nyhan Syndrome- What Accumulatesà uric acid.
Q on Osteogenesis Imperfectaà Show BLUE sclera (picture#1) à what is the
problem? Ã Abnormal Collagen type 1.
Q on where RNA is made? Ã Nucleolus.
Q on how mutation in splicing affects protein synthesis.
Q about protein folding à is not random.
Q about the affect of no hydroxylation of proline à what happens? à The triple
Helix can’t be formed.
Q describes Ehlers Danlos what is abnormal? Ã Incorrect folding of Collagen Ã
what are the associated abnormalities? Ã Frequent joint dislocation.
Q Describes Scurvy à What Vitamin Def. à Vitamin C.
Q Describes the regulation of eukaryotic gene à what is location of the enhancer
related to the exon?
Q about what occurs many times in a protein life span? Ã Can be
phosphorylated many times.
Q describes a fat soluble vitamin à cranial nerve problem à which and why?Ã
Vitamin A causes bone deposition at the skill foramina which causes CN
compression…….also know that vitamin A is very toxic if taken orally.
Q on Hypoglycemia à Factitious… Insulin induced à look for serum C-peptide Ã
C-Peptide only made by endogenous Insulin.
Q on Melatonin à relationship to which AA à Tryptophan.
Q related to PKUÃ SHOULD be screened AT BIRTH.
Q About pseudohurler à defect in n-acetylglucosamine causes what? à failure to
add a marker to manose phosphate (lysosomal problem)
Q must know relationship between Insulin and glucagons in the fasting and fed
states- Know everything they always ask questions here.
Q on carnitine def. Ã what happens? Ã carnitine deficiency impairs the entry of
long-chain fatty acids into the mitochondrial matrixà production of ketone bodies
impaired
Q usually describes Popes disease à which molecule abnormal? à Glycogen.
(defect in lysosomal alpha-1,4-glucosidase)
Q always asked about Glucose 6-phosphatse à what happens in fasting? Ã
Increased.
Q asks about a child S. Aureus bacterial infection and describes a phagocyte
problemà NADPH oxidase def.
Q about which enzyme in bacteria help it survive in lysosomesà Catalase.
Q describes hypercholesterolemia à where is the defect? à LDL receptor
Q describes the initial lesion in atherosclerosis à fatty streaks.
Q drug of choice for increased VLDLÃ Niacin.
Q about a homeless man in a poisoning case that caused metabolic acidosisÃ
what is the poison? Ã ethylene glycol
.
Q about potassium levels in DKA Ã low intracellular and high extracellular.
Q Describes maple syrup disease- avoid which AA? Ã Branched chain Ile Leu
Valine
Q describes Cystathione synthase deficiency à which AA accumulates?
à methionine
Q describes a case of retinoblastoma and asks what is associated with it? Ã
Osteosarcoma
Q talks about a patient with pale stool and RUQ pain à primary biliary cirrhosis Ã
they will ask you what autoantibody associated. Ã Anti-Mitochondrial
Q describes a patient with a classic rheumatoid arthritisà Auto antibody? Ã
Anti-IgG
Q shows a gross picture (picture#3) and describes codman triangle lesion in the
metaphesis of a long bone and asks the diagnosisà Osteoscarcoma
Q Shows you a picture (picture#4) of a child à Hemangioma
Q describes pituitary adenoma in full (bitemporal loss of vision) Ã they ask you
what is the derivative of that structureà Rathke’s pouch.
Q describes a case of bronchogenic CA and you have to make the association
with Lambert Eaton syndrome. They will ask you- antibodies against what is the
problem? Ã Calcium Channels in the NMJ.
Q shows a gross picture (picture#5) of Renal cell CA- all you have to do is
diagnose.
Q shows a gross picture (picture#6) of polycystic renal tumor- ask diagnosis
Q about a man who have just eaten which part of his brain detected satietyÃ
hypothalamus (Ventromedial nucleus)
Q on what make up the Blood-Brain barrierà Remember the CIA (choroids,
intracerebral capillary endothilum and arachnoid)
Q on gene population- a=0.6 b=0.4 what is the % of heterozygotesà 2pq=48%
Q on a karyotype (picture#7) shows the chromosome 21 + various description of
the disease- what is the diagnosis? Ã Down syndrome
Q on Oocyte before ovulation and ask about the egg arrested at what stage? Ã
Prophase
Q describes a child with eczema; low platelets and immune def- ask diagnosis Ã
Wiscott Aldrich Syndrome.
Q to determine the effective renal plasma flow à remember Upah X V/Ppah also
remember that PAH is filtered and secreted.
Q describes a child genotype XX with external genitalia virilized “ what is the
problem? Ã Excess exposure to male androgens. (compare to Androgen
insensitivity)
Q describing a case of a defect in leukocyte adhesion- what is responsible? Ã
Integrins
Q describes a patient with gluten-sensitive enteropathy- ask what is the
appearance of the intestine à flattened villi.
Q asks about what part of the Antibody binds to cells? Ã FC portion
Q about what will happen in the absence of Ig class switching? Ã Only IgM is
produced.
Q about what will happen if you have a lysosomal abnormality à MHC II will be
affected (MHC I is made in the Endoplasmic Reticulum)
Q about the defect in DiGeorge syndrome- usually describe the case by
absence of thymic shaddow à pouch 3 and 4 fail to develop (make sure in the
case you don’t get distracted by B-Cell abnormalities)
Q describes type VI hypersensitivity rxn (contact derm and TB) - what cell
involved? Ã T cells
Q on Rh incompatibility- what causes it? Ã Rh (-) mom and Rh (+) dad
Q describes acute rejection (48 hrs)- mechanism? Ã T lymphocyte vs foreign
MHCs.
Q about ELISA - - They love to ask about the technique- know it very well.
Q on Flow cytometric analysis “ ask what immature T cell in the thymus
express? Ã Both CD 4 and CD8
Q on what does Staph Aureus colonize à nasopharynx
Q on why does mycoplsma not respond to penicillin à no peptidoglycan
Q of a child with pneumonia, rust colored sputum and optochin sensitive
organisms à strep. Pneumia.
Q describes word by word an isolated weakly acid fast bacteria with braching
rodsà nocardia
Q on the mech of action of amphotericin BÃ binds ergosterol
Q on PID described and ask complication of untreated Chlamydial infx Ã
ectopic pregnancy
Q describes endotoxin shock whats responsible à lipid A
Q describes clostridium difficile diarrhea- mechanism of action? Ã cytotoxic
toxin
Q on histoplasmosis- does not spread person to person, why? Ã intracellular
Q cryptococcus meningeal biopsy (picure#12) with organism ask diagnosis
Q AIDS patient with dyspnea- pick the most common causative organism of
pneumonia in AID Ã PCP
Q AIDS patient with diarrhea- what is the causative organism? Ã -
cryptosporidium
Q of a patient with brain lesions - taenia solium à cycticercosis
Q described a virus- positive strand and naked à PicoRNA virus
Q on which hepatitis causes continuous shedding of antigen à Hep B
Qs on HBV markers- they always ask about it - memorize it USMLE First Aid
page 204- VERY high Yield (make sure you don’t miss the marker at the window
period- notice Anti-HBc)
Q on acyclovir- they want you to know that for it to function it needs à thymidine
kinase (phosphorylates DNA polymerase)
Q on Viral transduction-how it occurs? Ã DNA transferred by virus from one cell
to another (know the difference between the generalized and specialized)
Q Electron micrograph of picture (picture#13) of villi, which organ? Ã small
intestine (they can ask you anything here try to look at different pictures and see
the different features of each part)
Q of a patient with foot drop- which nerve injury à common peroneal
Q asks- smooth RER increased in which tissue à steroid hormone producing
Q asks- An organelle has weird DNA, resembles bacteriaà mitochondria
Q describes Alzheimer’s patient where’s lesion à hippocampus (picture#14)
Q describes Parkinson’s where’s lesion? à substansia nigra (picture#15)
Qs Describe lesions in the Circle of willis and sometimes pointed out on
angiography -where’s the deficit? à Memorize your homunculi to ID the deficits-
also memorize the cerebral circulation and what areas in the brain each one
supplies. Without a question they will ask you questions here.
Q CT of the pelvis of a man with BPH describe à ID prostate (picture#16)
Q CT of the pelvis ID which muscle helps in valsalva à rectus abdominis
(picture#16)
Q about the sarcmere (always ask)- during muscle contraction, which band does
not change size à “A†Band
Q about congested spleen, thrombocytopeniaà ,splenomegaly, which vessel
thrombosed à splenic vein
Q about a child born respiratory distress, lung biopsy shows brown stuff,
diagnosis? Ã meconium aspiration
Q on which GI hormone causes pancreatic secretion rich in bicarbonateÃ
Secretin
Q ask which organ is not a foregut derivative but is supplied by an artery of the
foregutà spleen
Q on renal agenesis, cause ? Ã ureteric bud fails to induce the formation
Q to calculate glomerular filtration Fraction à know the formula very well
(FF=GFR/RPF)- this question is always there. Remember GFR reflects INULIN
(not Insulin) and RPF reflects PAH.
Q on the Effect of angiotensin II and where does it act? Ã Acts on the efferent
arteriole which causes is to constrict (this is very important because it balances
the FF. (AgII dec RPF and inc GFR which inc FF- makes sense..right!!)
“PLEASE compare all this to Prostaglandins. First AID page 359.
Q on how NSAIDS affect the kidney in general à INHIBITS prostaglandins. What
does that mean? Prostaglandins “Dilate†the afferent arteriole and if inhibited
GFR will dec- watch if for patients with renal failure.
Q that is you always see is- a kid with nephrotic syndromeà podocyte fusionÃ
minimal change disease.
Q about an adult with nephrotic syndrome- Basement membrane thickeningÃ
lesion? Ã membranous GN
Q about menopause and hormonal changes- Very important for the USMLE-
they started asking more about this topic lately.
Q about prolactinoma (galactorrhoea, amenorrhoea, what is next appropriate
investigationà cranial imaging looking for pituitary gland abnormalities.
Q describes neurofibromatosis where do the abnormal cells arise from à neural
crest
Q NE release from adrenal gland medulla is mediated by? Ã Ach
Q where is a diastolic murmur in a pt. With hypertension best heard? At the
Apex
Q describes a stab wound to root of neck- what should we worry about? Ã
Plueral injury (remember the lung extends above the level of the clavicle)
Q on a baby with pulmonary hypoplasia- what is the likely cause? Ã
diaphragmatic hernia
Q describe referred pain in a patient and ask innervation of parietal pleuraÃ
phrenic and intercoestal nerves
Q mentions meconium leak from umbilicus “ lesionà vitelline fistula
Q describes marfans syndrome and ask about complications à dissecting aortic
aneurysm.
Q about the base of bladder “ what is the structure closely associated with it? Ã
vas deferens
Q will mention cancer from descending colon spreads to which lymph nodesÃ
inferior mesenteric
Q Describe scarred kidney on IVP distorted calyceal system-ask diagnosis? Ã
Reflux nephropathy (picture#18 gives you a better understanding).
Q about a flattened hypothenar eminence no sensation over little finger- lesion?
à ulnar nerve
Q about horners syndrome- which tumor could have caused that? Ã pancoast
tumour (upper lobe tumor injuring the cervical sympathetic plexus)
Q shows a picture of a fractured orbital floor due to direct blow to the eye- which
sinus was opened? Ã identify on x-ray--- maxillary sinus (picture#19)
Q describe homer’s syndrome (ptosis, meiosis and anhidrosis) -where is
lesion? Ã cervical sympathetic plexus
Q patient has a tachycardia; carotid massage stops it, mechanism? Ã Pressure
on carotid sinus à CN IX send the signal to the brainstemà CN X (vagus) returns
the signal to slow down the heart. (this is my explanation in plain English
picture#20) Easy ha..
Q mentions that lateral and third ventricles enlarged, 4th is normal where is the
obstruction? Ã Aqueduct of sylvius
Q describes subacute combined degeneration of cord, which vitamin deficient?
à Vit. B12
Q description of UMN corticospinal tracts- ID lesion in cordà (picture#21)- try to
memorize the big ones from High Yield Neuroanatomy by Fix (very good source
for neuro for step 1)
Q of a patient that has unilateral hearing loss- vertigo diagnosis? à meniere’s
disease
Qsss about visual field defects STRIGHT from First Aid page 111- KNOW ALL
of them. Most famous question on this topic will be Bitemporal Hemianopsia-
whats causes it? Ã Optic chiasm compression by a pituitary adenoma.
Q describes internal capsule infarct, which artery? Ã lenticulostriate branches of
middle cerebral artery.
Q describes a case of Parkinson- ask which neurotransmitter responsible? Ã
Dopamine
Q on site of action of drugs tricyclic antidepressantsà inhibits reuptake of NE
Q ask simple case to calculate resistanceà Resistance= Pressure (change in
pressure)/ flow (Q) or just know it by P=QR (PQR alphabetically)
Q ALWAYS ask about V/Q mismatch- Just know that at the apex V/Q=3 which
is a wasted ventilation and at the base V/Q=0.6 which is wasted perfusion. In
plain English more flow of blood to the base but less air, more air to the apex
but less blood. Now the V/Q formula makes sense. (Always remember V
=Ventilation (Air) Q =flow (blood).
Q on autoregulation of the heart“what are the factors? à Nitric oxide most likely
a choice. Also remember “ O2 and adenosine (please look at other
autoregulation to other organs in FA (First Aid) page 356. If you want to skip
Auto regulation JUST know the Heart and Brain. For the Brain change in CO2
(PH) is the biggest factor-know it.
Q on cardiac volume-pressure loop (picture#22) always always always in the
exam- guess what!!!â€know it. They usually like to ask where the valves open
and close but I recommend you to know everything. FA p352
Q on why is FEV higher than expected in some restrictive lung diseases à radial
traction on airway
Q on what is the expected blood gases of a COPD patient? Ã Obstructive lung
volume is more than normal (inc TLC, inc FRC and inc RV) usually the show you
a graph and you have to pick the constrictive from the obstructive) FA
251----ALWAYS in the exam.
Q asks about a patient that has hyper-reactive airways- what substance used to
test for this à methacholine challenge
Q asks about a patient goes into shock then recovers; next day develops
abdominal pain and reduced bowel sounds- what is happening? Ã mesenteric
infarction
Q on a patient in shock, develops renal failure, prognosis? Ã Renal tubular
epithelium will regenerate completely if he recovers.
Q on the clearance of PAH at different plasma concentration à at high levels
clearance reduces -why? Ã carriers depleted
Q about Potassium concentration along tubule in a patient on a high salt dietÃ
excess K is secreted by distal tubules.
Q IP3 and DAG lead to what effects à activation of protein kinases
Q describes Addison’s (Hypotension and skin pigmentation), what’s the reason
for skin hyperpigmentaion?? Ã Increased ACTH due to the positive feed back of
dec. cortisol (ACTH acts like MSH in the case)
Q on Diabetes insipidus where they describe the patient then somewhere in the
case describes mood problems. What drug could have caused the diabetes? Ã
Lithium
Q describes a patient who has kidney problems and now he is progressing to
renal failure, his vit D levels are low, why? Ã conversion to Active form vitamin D
(1,25 (OH)2D3 is takes place in the kidney
Q Describes a woman who overcooks her food, what s vitamin def. will she
present with? Ã Folate (folic acid is heat labile)
Q about Vit C and ask it is a cofactor in the conversion of what? Ã Dopamine to
NE.
Q describes a patient with vit B12 and ask what test used to detect def.? Ã
Schilling test (In the exam the name might not be there but the procedure will be)
Q about LH - it increases testosterone secretion by stimulating which cells? Ã
Leydig
Q on what induces male external genitalia formation, causes BPH? Ã 5-alpha
reductase…Remember that its inhibitors used to treat BPH.
Q describes a classic case of endometriosis and describes the findings
Q asks hormones involved in breast maturation in pregnancy up to delivery-
know them
Q describes a patient has gastrectomy, later anemia and neurological problems
à B 12 deficiency
Q describes apoptosis, asked where else it occurs à embryological period
Q about type of necrosis seen in a 4 day old myocardial infarct à coagulative
Q on Zolinger Ellison syndrome and which type of MEN association à MEN type
1
Q case describes Carciniod syndrome- what is used to treat it? Ã Octreotide
Q asks about the most common location for Carcinoid syndrome à Appendix
Q on Barrets esophagus; type of change à metaplasia
Q sometimes does not give a lot of description of achalasia but shows an x-ray
usually easy to tell by the “birds peak appearance†(picture#23)
Q describes a case of GERD and shows gross slide (picture#24)Ã Barrets
Q on inflammation and you must know the mechanism of the edema in that case
Q on the mechanism of thromboxane and platelet aggregation- usually you have
to pick it out from the flow chart FA page 341. Know that thrombaxane à inc
platelet aggregation.
Q describes Reye’s syndrome and ask what is the mech of action of the drug
that causes it à Irreversibly inhibits cyclooxygenase(COX-I and COX-2) that is
Aspirin
Q on what is the advantage of COX-II inhibitors à It only plays a role in
inflammation ONLY and does not give any GI side effects (GI lining which is
protected by COX-I inhibited by Aspirin )
Q on which drug to add in a patient on NSAIDs and GI upset à add misoprostol
(Note that misoprostol should NOT be given to pregnant women because it is
abortifacient)
Q you must know the Mech of action of streptokinaseà conversion of
plasminogen to plasmin to aid in thrombolysis.
Q in a picture (Picture#25) must diagnoseà intussuuception
Q describes marfan’s syndrome and ask what is the function of fibillin Ã
stabilizes connective tissue integrity
Q on skin lesions know those 2Ã Nevus (picture#26) and melanoma
(picture#27)
Q about the commonest childhood cancer à ALL
Q on lymphatic spread of testicular cancer…you got to know that scrotal spread
is different. Know the difference. Also know where prostate cancer spreads. At
least you will get one question from here.
Q describes endocarditis and you have to pick the associationà Amyloidosis
Q on shipyard worker with lung problems, diagnosis? Ã mesothilioma
Q on the most preventable risk factor to heart disease à smoking
Q about the efficacy and potency curves for drugs…know the diagrams in FA
p299 p300. This is ALWAYS in the exam.
Q about the most common side effect of Calcium channel blockersà Flushing
Q about the substitute to ACEI in case of its coughing side effect à LOSARTAN
(AgII receptor antagonist)
Q about the drug (s) that cause SLE like symptoms à Procainamide
Q about the P450 inhibitorsà Cimetidine is almost always in the answer choices
Q about a drug that blocks gastric acid secretions even in the presence of Ach Ã
omeprazole
Q on accidental injection of NE into tissues what to give to prevent necrosis Ã
Alpha blocker
Q on patient who has mania and seizures whch drug to give to treat both Ã
valproate
Q case decribes hemorrhagic cystitis what drug causes it à cyclophasphamide
Q on what is used to treat the hemorrhagic cystitis of cyclophasphamide Ã
mesna•
Q about a a man has lost sensation over the posterior aspects of his hand,
unable to use forearm externsor muscles, what’s the lesion? à Humeral fracture
radial n
Q about a doctor who has teenage son who is a drug abuser....Doc. sees a pt.
that is teenager and also abuses drugs. Doc is upset and feels like slapping
him....what’s the defense mechà Projection
Q on a man who had past incidents of sudden fallà Narcolepsy
EM of a superior view of ‘villi†and asked where is it located? à . Small intestine
Q shows a picture (picture#28) of an arteriogram of the cerebral arteries and
Ant. Cerebral A. will be labeled and asked what functions will be lost if you
severe this artery? Pt. can climb the stairs
Q on a young male has fever, lymphadenopathy, hepatosplenoinegaly. Virus
responsible for this is also responsible for what other disease à EBVÃ
nasopharngeal CA.
Q of a man comes out of the bar... he is very aggressive, jerking movements,
took 4 people to hold him. What drug was he using? Ã PCP
Q on Pt who has a severe headache. Subarachnoid hemorrhage was noticed on
the CT. What are the other findings? - Ã Out pouching at the junction of the Ant.
Communicating Artery and Ant. Cerebral Art. Ã Berry Aneurysm
Q on who is the child @ risk for developing in a house where both parents
smoke? Ã Asthma
Q on a woman gave a birth to a child 2 days ago, she comes to the doc stating
that she is depressed, not socializing w/ her husband. What should you (the doc)
tell her? Ã It is normal and schedule a visit for the next week
Q on a pt who has a coronary artery occlusion. What changes will you notice in
the myocardium? Ã Low levels of ATP
Q on a woman comes to the doc, she tells the doc that she is motivated w/ her
job, but she doesn’t socialize w/ other people @ her work, she feels uneasy w/
them. What’s the Dx? à Avoidant Personality
Q on a woman had several episodes of Depression in the past, for which she
has used medication. She has discontinued her medication for the past six
months and didn’t have any episodes of depression. She is thinking of
becoming pregnant. What should you as a doc tell her?
Q on a pt. is in the hospital. The prognosis of his disease is vague. Although he
never designated any one as power of attorney or written consent but his wife
tells you that he had mentioned on several occasions not to resuscitate his life if
in case he is at the verge of dying. What should you as a doc do, if this pt. is
suddenly about to die? Ã Listen to the wife and do not resuscitate his life
Q on a pt who has renal failure, what other deficiency will you see? Inability to
form active Vit. D
What’s the role of ANP in increased Blood Pressure? à Causes the Na/water
loss from the kidney (mech: Increase blood pressure to the R.Atrium ANP
released by R. Atrium à Na+/H20 loss by the kidney)
Q on a child who has thyroid hormone def. What is the pt. at risk for developing?
à Mental Retardation
Q on a pt who has decrease T4, injection of T3 would result in what?
Decreased TSH and inc T3.
Q on Oxygen Dissociation (ODC) (picture#29) and will ask about the dotted line
indicating what? Ã Fetal Hb (basically the curve will show a shift to the left)
Q on an x ray pic (picture#30) of the kidney along w/ symps of kidney stones. Id
the type of kidney Stone à Calcium stones
Q on how do you diffentiate E.Coli from salmonella? Ã Lactose
Q on the Symps of Carcinoid Syncfrome given along w/ icreased Hydroxy-Indole
Acetic Acid (5-HIAA) in the urine, what is the dx?
Q on LMN lesion symps will be given (Flaccid Paralysis, Areflexia, muscle
atrophy) will ask you Asked the location of the lesion? ipsilateral Corticospinal
Track Le
Qs where they want you to know the difference b/t Grade and Stage- know them
Q on a woman wants to have her tubes ligated. She has been in a long
relationship with a man whom she is not married to) and lives w/ him. How
should a doctor reply? Ã Discuss the consequences w/ both
Q about what is it in the bacteria which inactivates the Hydrogen Peroxide in
PMN’s? à catalase
Q on Dx Nocardia clues “partially acid fast
Q on Dx Actinomyces lsrealis. clue “branching filamentsâ€Â
Q on the Transmission of H.Influenza? Aerosol
Q on the Symps of Atypical Pneumonia à non-productive cough, headache,
insidious onset etc.) What do you tx it w/ ? Ã Erythromycin
Q on why is Histoplasma not transmitted from person to person? Intracellular
Q shows picture (picture#31) of a glomerulus given w/ diabetic symps, asked to
identify the lesion? Kinimel-stein Wilson nodules (looks exactly like the one in
the FA)
Q of Symps of PID and cervical motion tenderness, purulent cervical discharge,
saphingitis ID the Bug? Ã C. trachomatis (MC than N. gonorrhea
Q shows a pic (picture#32) of Squamous Cell CA, Dx
W shows a pic (picture#33) of the nephron given and asked to identify the
location where Acetazolamide works? Ã Proximal Tubules
Q on a pt. is using 3 or 4 different drugs names listed) and present w/ some
symptoms. Which drug can be substituted to prevent the cough? Losartan
Q on pt. has Bipolar Affective Disorder and using Lithium. What is he most like
to develop? Ã Nephrogenic DI
Q will show a pic (picture#34) of supratentarial herniation occurs, what CN will
be affected mostly?
Q of a young male gets a stab wound in his neck right above the clavicle and
lateral to the manubrium sternum. What structures most likely damaged?
à Pleurae
Q on a Microscopic (picture#35) description of Paget’s Disease (Osteitis
Deformans(Pg 243 Kap notes)Haphazard arrangement of cement lines,
creating a mosaic pattern of lamellar bone and will ask about the cells involve in
the initial lesion? Ã Osteoclast
Q on PCR analysis basically will ask about whether the child has the disease.
You have to look at the bands and than interpret the results.
Q Asks about the Mitochondria....What Ion is involved in proton Gradient? Ã H+
Q will ask to identify the region which will indicate IgG isotype switching.
Q’s will ask about the Immunoglobulin structure- know it
Q on a child was stung by a bee....what mediators are involved in vasodilation
and increase permeabilityà ? Histamine
Q on what allows the bacteria to invade the respiratory tract? Ã Inhibition of lgA
protease
Q asks about two groups of females, one smoker and the other non-smoker, are
identified and followed for ten years to see the risk of developing breast CA.
What type of study is it? Ã Cohort (Prospective)
Q on a Karyotype of Trisomy and will ask what would you see? Ã Flat facies and
simian crease
Q will give a Description of Turner’s and will ask what another finding is
associated w/it? Ã Infertility
Q on a pt. who has a systolic murmur and you have to identify the location on the
chest. Ã apex
Q on an alcoholic pt. WI easily bruisibility. ecchymoses. etc. What’s the defect?
à Defective Hydroxyproline (require Vit. C)
Q on advantage of giving C-dopa w/ L-dopa? Increases the levels of dopamine
in the CNS (NOTE: peripheral decarboxylase inhibitor might not be option)
Q on Pt. has Hypokalemia. . .which diuretic should you use to restore the
potassium levels? Ã Amiloride
Q to ID an Antacid from the list? Ã Magnesium Hydroxide (FA 337)
Q asks what result will you see in a pt., who has PTH def., following
administration of PTH? Ã Increase Urinary PO4 & inc Urinary camp
Q asks how you would treat the Pt who is anemic and has a renal failure.
à Erythropoietin (EPO)
Q describes a child who has absence of both kidneys but the ureters are
present. What’s was the defect?
Q ASKS what vitamin could be supplemented to prevent neural tube defects. Ã
Folic Acid
Q describes of Lesh Nyhan was given and asked to identify the purines?
Guanine & Hypoxanthine
Q about PKU- a girl w/ blond hair, musty odor etc. What will you see?
à Phenylactate
Q shows a pic (picture#36) shows mouth lesions (Gray color) and will ask what
other diseases this virus is responsible for à Coxsakie virus à hand foot and
mouth disease
Q describes a pt. has Adenexal mass is going through a surgery, which ligament
would you ligate to prevent the bleeding? Ã Suspensory Ligament (has ovarian
vessels)
Q where immunoflorescence will be given....shows both granular and linear
pattern will ask to identify the disease? à IgA nephropathy (Berger’s disease)
Q Describes young male W/ lab values (hint: low ceruloplasinin) and his sister
also has choreathestosis Dx? à Hepatolenticular Degeneration “Wilson’s
Disease.â€Â
Q asks side effect of Aminoglycosides? Ã Nepbrotoxic
Q on action potential will be given in a Pic (picture#37) where the Ca channels
close. Will show the phases and you to have to ID.
Q shows a pic where drug X is stimulating muscular contractions while Drug Y is
inhibiting muscular contractions. ID? Ã Most of the time they have Atropine and
Succinylcholine as X and Y.
Q on the MOA of Ketoconazole? Ã Inhibit ergosterol synthesis
Q on the MOA of tetracyclines? Ã Prevents the attachment of amino-acyl tRNA to
the ribosome
Q on a Pt. who has Herpes, what’s the tx? à Acyclovir
Q on Parathion (organophosphate) poisoning along w/ it’s symptoms how ou
treat it? Ã Atropine
Q on a Pt w/ Wilson’s disease. Tx? à Penicillamine
Q describes a Pt who has a prolactin secreting tumor.Tx? Ã us Dopanine
Agonist
Q asks about aecond messenger of Nitroglycerin? Ã CGMP (FA 324)
Q describes a Mother who is pregnant, what anticoagulant should be used? Ã
Heparin
Q on the MOA of 5-FU? Ã Bioactivation of FdUMP which leads to decrease
dTMP
Q Tell you about hemorrhagic cystitis caused by cyclophosphamide and asked
the MOA? Ã Alkylating agent which covalently cross link DNA at guanine N-7.
Q asks why penicillin not effective against Mycoplasma. Has cholesterol in its
bacterial membrane……NOTE - “no cell wall†might not be an answer choice.
Q about the Defect in CGD? Ã NADPH oxidase
Q about the Defect-in Chediak Higashi? Ã Microtubule and lysosomal defect
Q asks where MHC Class II Ag loading occurs in. Ã Acidified Endosome
Q describes a woman who has RUQ pain, severe after eating a meal, Increase
Alk. Phos. What’s the Dx? à Gall stones(cholelithiasis)
Q asks about the function of the spliceosomes? Ã Remove Intervening
sequence....NOTE: introns might not be a choice.
Q describes an AIDs Pt. w/ “ring enhancing lesion†on the CT scan. Dx? Ã
Toxoplasmosis
Q on a pt. who has bacterial, viral, and fungal infection. Defect in this disease? Ã
Adenosine Deaminase Deficiency
Q will Ask to id the location of secondary TB
Q about Cholera Toxin mech: Ã ADP ribosylation of Os Protein
Q on the location of Colon Adenocarcinoma à splenic flexure/sigmoid colon
Q shows a Head CT (picture#38) w/ an arrow in the temporal lobe lesion
(around the Meyer’s Loop) and asked the visual field defect?- à Left upper
quadrantic anopsia (“pie in the skyâ€Â)
Q on a Pt. is in the car accident.. .has a whip-plash injury, dislocation of the
cervical vertebrae... What can be damaged à Vertebral A. most likely
Q to Calculate the power when Type I (Alpha) error=0.5, Type II (Beta)
error=0.20
Q on Symp. Of Ehler Danlos ask what is the defect? Defective lysyl hydroxylase
might be a choice beware of other choices
Q on what causes a negative feedback inhibition to FSH? Inhibin
Q might ask you tx a pt. w/ who has Ieukopenia, neutriopenia. Etc à Granulocyte
Colony Stimulating
Q shows a pic ask to id the preganglionic neurotransmitter? Ã Ach most likely be
labeled
Q on a pt. who has mild fasting hypoglycemia (might not be severe) and
enlarged heart.. .what’s the defect? à Debranching enzyme def. (Glycogen
Storage Disease)
Q on a pt is heterozygote for Familial Hypercholesteremia. What’s the defect?
apo B-100 receptors (are aka LDL receptor)
Q on a female tries to commit suicide by injecting herself w/ insulin. What would
you see in serum lab values? Ã C-peptide will be normal
Q on a Hematology slide (picture#39) of megaloblstic anemia (hypersegment
PMN’s might not be there ). . Ask for the mech or what is associated w/? Ã
Decrease conversion of N-methyl tetrahydrofolate to Tetrahydro folic acid
Q on Symp. of H. pylori infection was given and will ask the characteristic of the
bug? Ã Urease +
Q on Antigen Presenting Cells (APC’s) in the skin? à Langerhan cells
Q shows a Histology Slide of the Glands (breast) (picture#40), what type of
change?Ã Hypertrophy
Q on Which Zone of the lungs has the greatest pulmonary blood flow when pt is
supine exact pic like the one on FA 371 (bottom)Ã you have to ID the zone
Q on a woman is going through a menopause... which hormone will be
increase? Ã FSH.
Q on Which diuretic will you use to increase the urinary concentration of
NaHCO3? Ã Acetazolamide
Q on NE effect’s on renal arterioles? à Constriction of the afferent and
decrease GFR
Q on a pt. has a family hx of coronary artery disease, he works for chemical
company, he is single his cholesterol is normal. His other plasma values normal
as well. What’s his risk for CAD?à His risk is the same as in general population
since he has normal
Q on a clinical trial is being conducted to see the risk of developing cancer in
children who live in households near chemical factory. Will ask about whom
should the control group be? Ã children living w/ their parents near the factory
who do not develop the cancer
Q on an Old lady had just removed intraductal papiloma in the breast, what’s the
prognostic marker should you use? Ã Erb-B2
Q on a pt. presents w/ the severe chest pain. How should you (doc) initiate the
patient’s history so that can learn the most about the Pt’s problem... in other
words, what should you (doc) ask the pt. to learn most about the pt.’s problem? Ã
“Tell me more about your pain†Ans
Qs on accidents might be given, with bone fractures in the lower extremities
what’s the risk à fat emboslism.
Q about an old lady falls down the stairs and had a fracture and now has resp.
distress what would it cause or where would it lodge? Lungs (pulmonary
embolism)
Q ask about 5-fu mode of action à inhibit thymidylate synthase.
Q to trt Teenager with acne à tx is tetracycline
Q on which hormone has affect on renal vasculature à dopamine
Q where you must know the mech of action of Sertralineà inhibit the neuronal
reuptake of serotonin
Q on a child with an abdominal mass (picture#41) à wilm’s tumor
Q on an alcoholic man who recently had a coronary graft surgery 2 days after
surgery he develops seizuresà DT
Q on a Gross slide (picture#42) shown of a uterus case given about an teenage
girl whose uterus was the size of 16 wk gestation but she wasn’t pregnant what
could it be. Ã hydatidiform mole slide will give the answer)
Q on an athlete who fell on his knee- injury describes the tibia moving interiorly to
the femur what is the injury? Ã Anterior cruciate ligament injury
Q on women fallen on an outstretched hand what’s signs? à Media n.
compression or damage.
Q on a women off of a ladder down and bit her bead on the table..but she is ok,
2 or 3 days after she falls unconscious... Ã subdural hematoma.
Q on a construction worker digging up soil with a machine or something Ã
cryptococcal fungal infection.
Q on how you treat influnza A Ã neuranunidase..
Q on a patient taking an antiarhythmic has pulmonary fibrosis. Ã amiodarone.
Q with a picture (picture#43) of black female’s face will be shown. She has
granulomas and other things will be describedà sarcoidosis.
Q on a young guy dies suddenly, on autopsy heart is enlargedà hypertrophic
cardiomyopathy
Q descripes blunting villi à celiac sprue
Q on a guy who just turned positive for a TB testà Give INH with Vit. B6.
O on a guy comes in with a severe headache... Ã subaracbnoid hemmorhage.
Q on Allopurinol MOA....diagram will be given. Locate where it acts à xanthine
oxidase inhibitor
Q on colchicines MOA Ã inhibit microtublules
Q on what happens when u donate blood- what decreases? Blood volume
(Hemoglobin and hematocrit does not change)
Q about a kid who has asthma, what should be given during an acute
episodeà albuterol
Q on a women who was put on warfarin- what allergy medicine should be
avoidedà cimetidine
Q about ace inhibitors side effects.. . Ã renin is increased because of loss of
feedback inhibition
Q with a path slide (picture#44) show (microscpic) adipocytes, a case given a
guy who was chronic alcoholic- he came to hospital and dies within 2
days....What caused his sudden death? Ã heapatic Steatosis
Q on renal failure.. . Ã vit D production is affected
Q on a woman with nephrotic sx. Has membranous glomeuronephritis. “will ask
about what could be seen in IF: Ã granular pattern(linear for good pasture)
Q on a woman has a malar rash (picture#45) she has a glomeuronepbritis what
marker à ds DNA
Q describes a guy who has urethritis, visual problems and pain in leg à reiter’s
sx.
Q on a guy who has a transplant, 2 week after deterioration occurred
(rejection)..what cells are involvedà T cells (acute rejection)
what does bacteria use to defend against PMNÃ catalase
Q describes a woman who has an oral candidiasis... what drug should be used.
à nystatin
Q describes a patient on ahypertensive medication and now he is allergic to
sulfa- what to give? Ã Ethacrynic acid
Q on a guy goes camping has sx of lyme disease à Borrelia burgdorferi
Q on what factor of entrobacteriacea is important in virulence... Ã capsular
antigen
Q on a guy has bloody diarrhea . . . organism is nonmotile à shigella
Q southern blotting description- know the technique
Q on a guy who has a stroke and has aphasia and paresis what structure is
involved? Ã anterior capsule
Q on papillary light reflex....what is involvedà pretectal area
Q on diaphragmatic hernia (xray shown)(picture#46)- dignosis
Q on cardiac output calculation- know the formula they always ask one question
on CO
Q on C.periferengens mode of transmission. à wound infection à gas gangrene
Q on peroneal nerve injury... Ã loss of dorsiflexion
Q on 21-hydroxylase deficiency. Ã Know the whole pathway in FA page366
there are always one or 2 question on this pathway. Know which one will cause
hyper and hypotension.
Q describes a person is to have a surgery done and he was told about the
operation, side effects and other t
hings... signature of patient is required so how should this contract be worded?-
here you can have different ways to write the consent, you would easily pick it
upâ€its all common sense.
Q on a woman who has an argument with her boss, she comes home and yell at
her children à displacement
Q on odds ratio. .formula- always always there get it straight you won’t miss it if
you know the formula.
Q on a study is being done about the effects of contraceptive on reduction on
breast cancer.. .what is the prerequisite à inclusion of group patients who
shouldn’t have family history of breast cancer.
Q on a high school football player who smokes come to the doctor . . . what
should doc say to make him quitting smoking? à “smoking can and could affect
your sports activityâ€Â
Q about a mom brings in 12 year old son who has type 1 diabetes and he
doesn’t comply with the medications mother keeps complaining to the doc and
doesn’t let the kid talk- what should the doc say.... à “mam, can you please let
me hear his side of the storyâ€Â
Q on prevalence....a specialty clinic has a 12% prevalence of a disease but
when the docs go to a community clinic it decrease to 2% y?. . . Ã because
specialty clinic only sees particular disease
Q on a case scenario presents a guy has a problem but there are no physical
findings. Ã conversion disorder
Q on which Beta-blocker not to give an asthmatic à propranolol
Q asks which medium would you use for a pneumonia causing bacteria that has
no human to human trasmission that colonizes air conditioning units à (legionella
- charcoal-yeast extract).
Q on a Patient has a dignosis of amyloidosis which stain would you useà Congo
Red
Q on a Health care worker has a positive S. Aureus on a routine nasal culture,
which antibiotic do youuseà none, normal nasal flora
Q on a Patient infected with C. Dipthereia, what is the MOA Ã ADP ribosylation
of EF-2 “Always in the exam
Q on a Hiker has explosive diarrhea after drinking water from stream must ID
eosinophilic ova in stool sample à giardia
Q on a young boy with stridor and fuzzy X-Ray- thumb sign (picture#47) must ID
à H. influenza
Q on a Patient with duodenal ulcer must be treated aggressively to limit the
possibility à H pylori
Q on TB delineates the difference of the Ghon complex from the Ghon focus.
Questions Prophylaxis for accidental healthcare worker exposure to TB (Rif for a
month)
Q on which antibiotic would you not prescribe an eight year old. Ã Tetracycline
Q about a camper who developed a target like rash, if not treated will progress
to à purulent arthritis
Q on fungus, fungus ball in upper lobe of the lung, 45 degree hyphae in an
immunocompromised à aspergillosis
Q on baby girl with MR and inappropriate laughter à you have to have to ID
imprinting
Q describes Huntingtonsà you have to ID trinuclcotide base pair repeats.
Q on which amino acid is ketogenic à mot likely lysine
Q on a boy with violent behavior coarse facial features who bites off his own
fingers à ID the missing enzyme in a drawing of the Uric Acid pathway.
Q about a boy who uses Gowers sign to stand who has adipocytes in his calf
muscle biopsy à X-linked inheritence
Q on diagnosis of Fabrys diseaseà ID an accumulation of ceramide trihexose.
Qss on G-protein-linked second messengers, must know which ones release
calcium, inhibit and stimulate cAMP-Ã know the pathways for all the G
proteins---Always asked in the exam “ALWAYS.
Q activators of the P450 system and one question on inhibition of P450. FA 336
DRUG reaction table is a MUST KNOW.
Q on the activator of lipogenesis à citrate
Q on the rate limiting step of the TCA cycleà isocitrate
Q on the metabolism of methanol à ID formic acid via alcohol and acetaldehyde
dehydrogenase
Q to ID edema in Kwashiorkor (picture#48) versus Marasmus (picture#49) and
hypoalbuminemia. Ã Kwashiorkor is proteins deficient
Q on collagen synthesis and which process occurs immediately after the
procollegen leave the ER Ã ID peptidases cleave terminal sequences
Q to ID which blood cell lineage requires Vit EÃ Vit E
Q you have to ID the oncogene and tumor markers in clinical senarios. i.e
Patient skin lesions and is positive for S-100 Ã ID melanoma
Q on Amniocentesis shows low alpha-feto protein, what is baby at risk for Ã
Downs syndrome
Q on a Patient who has blood in stool, abdominal pain and a change in stool
caliber, which marker would you expect to be elevated à CEA
Q which foramen the maxillary (V3) branch of the trigeminal pass through. Ã
foramen ovale
Q on CATs-- subdural hematomas (picture#50) vs. Epidural hematoma
(picture#51). Ã Make sure you know that the subdural is crecent shaped and
epidural is bi- convex shaped- knowing this fact always helped me pick it up.
Qss always asked in the exam arediuretics “ know the MOA and Site of action
of Acetozolamide, MOA and site of action of Furosamide
Q on Which diuretic will you prescribe to a diabetic with a GFR of
Q on a schizophrenic patient who has diabetes develops facial and tongue
movements, what is the mechanism of action of the medication that you will
prescribe next? Ã ID clozapine MOA
A few questions on drug induced Cushing’s with lab values and stuff
like that.
Q on a fish bone was stuck in a kid’s “Periformis fossa,†the nerve Damaged will
delay what function? Ã gag reflex
Q on an infant dies suddenly due to pulmonary hypoplesia, what is the cause?
Diphragmatic hernia
Q on a child has to go thru Tracheaectomy, which structure does it passes thru?
à Skin and cricothyroid membrane most likely the answer will be.
Q on Loss of pain and temperature on one side of the face, what is the nerve
lesion? Ã CN V
Q on a child who was extremely HOT, which structure is damaged? Ã Anterior
hypothalamus
Q on what controls the Autononuic nervous system? Ã Hypothalamus
Q on an alcoholic who is losing memory, what structure is damaged?
à mammary bodies
Q on an alcoholic with confabulations, which vitamin? Ã Thiamine deficiency.
Q on a kid with clouding of the left cornea, which eye is he using the most after
replacing the cornea?
Q on child with craniopharyngima, what visual field is defect à heteronymous
hemianopsia
Q on a child with temporal lobe lesion, what visual field is defect? Ã Left Upper
qudrantic anopia (pie in the sky) “ Know the picture of Visual defects page 111-
here there are alwaysss questions.
Q on a patient with paralysis of the upper arm, which structure is lesioned?
à MCA
Q shows a c-section (picture#52) of the cord in a lady who losses pressure and
touch on her legs, which lesion? Ã Gracillis nucleus area (1. Nucleus gracilis )
Q on a Man with subararachnid bleeding, which area is most likely source? Ã
circle of Willis (berry aneurism)
Q on a man sleeping normal hours but is chronically tired all day, what is wrong?
à sleep apnea
Q on a man sleeps all the sudden collapses in sleep several times in the day,
what is wrong? Ã Narcolepsy
Q on a lady gets up very early and cann’t go to sleep, what is the problem?
à Time duration will meet Major depressive disorder criteria
Q mentions an Occlusion of the Superior Mesenteric Artery, what does it affect?
à Ascending colon most likely to be in the answer choices
Q on Huntington’s disease (anticipation), what is responsible for Anticipation? Ã
Trinucleotide repeat expansion
Q on what enzyme prevents RBC hemolysis from free radicals? Ã ADPH oxidase
Q where you have to know hypothyroidism- TH & TSH decreased give TRH
given no increase in TSH Ã pituitary problem
Q where you have to know DHEA & its action.
Q on R-A-A system for pressure & volume control- know this system very well-
Always asked
Q on high pressure barorceptors in carotid body & it’s function & firing strech
causes? In firing & what effect on symp/parasypm syst
Q on the Action of PTH on Ca++, how (one is increase formation of 1,25 do OH
D3 in proximal tubule) Ã by hydroxylase
Q shows a Slide (picture#53) showing various part of bone, asking where PTH
act by indirectly activating osteoclasts
Q on Male psuedohermaphrodism à (testicular ferminization)
Q on the action of inhibin in female repro
Q ask the Reason for plateu phase à ca influx (understand vent. AP generation &
status of various ion channels)
Q describing renal problem. “edema à Protein (albumin) loss
Q describes and inc of blood flow to an organ whyà to match increase
metabolism
Q on AP arise ca release from where à ER
Q says If a-v fistula opens, increase CO, what effect on loop à increase volume
more than normal
Q to find out blood flow from O2 consumption given, plum A-V (O2) diff given?
Remember equation. Ã Flow (Q)= O2 consumption/Pul A-V [O2] diff
Q involving alveolar gas equation: FIO2 & FICO2 will mostly likely be given
Q on High altitude changes- what happens to HCO3, pulm a, systemic a, when
person goes to high altitude. Ã Hyperventilation decrease CO2 and increase in
HC03.
Q shows a Graph excretion of glucose, staightline occurs when à when Tmax for
glucose reached
Q related to resp. alkalosis, what happens in the kidney? Ã increase urine
excretion of HCO3, renal compensation
Q on What is reabsorbed at terminal ileum à B12, bile salts
Q on what is needed for B12 reabsorption à IF from stomach and healthy
terminal ileum
Q on Co poisoning and how Hb saturation of O2 (SaO2) is affected
O2 dissociation curve and factors that shift curve to the left or right.
Q on Free radical injury, how does CCl4 damage liver,Ã lipid peroxidation.
Q on the Types of necrosis --Brain tissue necrosisà liqucfactive.
Acute pancreatitis à enzymatic fat necrosis
Q on Spherocytosis (picture#54) -what abnormality lead to ità spectrin.
Q with Clinical vignette describing S/S of CHF heart is enlaged what is the
reason à hypertrophy(not hyperplasia)
Q with a Slide describing endometrial hyperplasia (picture#55)
Q on complement and what is C5a responsible for à anaphylaxis
Q on C5b-9 deficiency and risk of infx with what bacteria? Ã Neisseria Sepsis
Q ask if you want to develop a new drug to stop leukocyte migration to site of
inflammation what is the target for drug à drug that acts on adhesion molecules
Q on the action of eosinophils on parasites à ADCC
Q ask about a potent endogenous platelet inhibitor à prosatcyclin
Q describes fever and whats responsible for it à the effect of IL-1 & TNF,
proinflammatory agent
Q on ankylosing spodylitis (picture#56) & relation with à HLA-B27
Q on goodpasture synd à antiglomerular basement Ab
Q on E.coli associated with what à hemolytic uremic syn
Q on Alcoholic, thiamine def, Ã wet beriberi (CHF), congestive (dilated
cardiomyopathy)
Q on INH Rx and it causesà pyridoxine (B6) def
Q on Anemia, neurologic abnormality, gave Folate which treated anemia but not
nuero abnormality à Should be treated with both Folate & B12
Q on mosaicism in autosomal cells
Q on PKU, no symptoms when in hospital, when home symptoms appear,
reason à home food contained Phenylalanine
Q Describes of galactosema, cataract, reason for It à osmotic damage by
formation galactilol
Q on antiCA -Bloomycin- it causes à interstitial pulmonary fibrosis
Q ask If tumor produced in rats, what is deleted à tumor superssor gene, p53 etc.
Q on Prosthetic heart halve abnormality, iv abuser -what Organismà s. aureus
Q-Notes Part 2:
Congenital adrental hyperplasia, various enzyme def Description of autosomal
dz Chances of child to get dz.
Congenital infection -vignette of rubella in 1st tri, what effects on mother and
child
College student, unconscious, what is the most likely substance of abuse
Barbiturates & alcohol, cross tolerance
Cyclophosphamide- hemorrhagic cyctitis
TGF & collagen desposition
Asbestosis (picture#57) & relation with tumor, smoker/nonsmoker, most
common tumor even in nonsmoker is bronchogenic ca.
Adult T cell leukemia, Japanese, relation with HTLV-1
HTLV-2, hairy cell leukemia
Tumor stage & its relation with prognosis
Genetic hyperlipidemia, all types with reason & abnormalitics in CH, TG , LDL
levels.
dissecting aneurysm-coz: hypertension
Opening of av fistula, high output CF, graph showing various output status
wegner’s granulomatosis, C-ANCA
CHF- pulmo edema, bilateral rales
ASD, reversal of shunt
PDA, both murmur and dia & sys
Closure of pda, indomothacin
ST depression, subendocardial depression
Acute fibrinous pericarditis, pericardial rub
Lobar pneumonia
Asbertosis
Sarcoidosi
s
Sq. cell Ca
Slide swith target cells (picture#58) what causes it?
avascular bone necrosis in sickle cell dz, African adult male
autoimmune hemolytic anemia, jaundice due to extra vascular hemolysis by
fixed macrophages
absolute neutrophillic leukocytosis
CLL, lady over 60 yrs
Slide showing owl’s eye (picture#59), hodgkin’s dz
Congential pyloric stenosis
Celiac dz desc, reason -wheat diet
Food poisoning: staph auerus-
within some hrs
clostridium diffâ€mech of action
Bacillus cereus- rice reheated
hirschsprung’s dz (picture#60) “ reason no ganglion cells from neural crest
Angiodysplasia- common cause for elderly GI bleeding
Crohn’s dz- (picture#61) all layer involvement, linear ulcers
Clonorchis sinensis infestation
Neonatal cholestasis- billary atresia
cystic fibrosis- pulm, inf, problem in which resp epi cells -goblet cells which
secret mucus
chr. Pancreatitis
Slide of APKD (picture#62)
GBM-Ab to it- G-P synd
Poststreplococcal GNâ€granular IF, no fibrin
Diabetic nephropathy- slide of glomeruloscelrosis, round hyaline deposition
prerenal azotemia- mostly shock status
Scar on both pole of kidney- Cause of it
Drug induced interstitial nephritis- methicillin
Seminoma- crpytorchid testis
Fetal lung maturity: how to detect- L:S Ratio
endometrial adenoCa
Tumors of ovary learn and understand the diff from each other
may be there slide on teratoma ovary
hydatidiform mole
slide (picture#63) of breat tissue a moveable mass in inner quadrant
breast tumor Esgn Rc positive, how to treat- tamoxifen
DI vignette, water deprivation test, detect if central or nephrogenic
Hyperprolactinemia assoc. with Dpamine
hashmoto’s thyroiditis
cushing’s synd- dexamethasone suppesion test: +ve in pirtuitary one
gastrinoma, ulcer, hyperacidity, islet tumor from pancreas G cells
ankylosing spondylitis
Slide of osteogenesis imperfecta: girl with blue sclera, type 1 collagen problem
Chondrosarcoma (try to diff all tumor by their age grp, location, bone part involv,
which commonly involved specific X ray appereance,if any
Duchenne’s muscular dystrophy, SXR, calf hypertrophy, gower’s signâ€defect in
dystrophin
maculopapular dz can be asked. So understand their distribution
on toxic shockâ€Female, MC, tampon
Slide of typical location of basal cell Ca (picture#64)
AIDS pt, vignette (??? May be a slide showing demyelination). Progressive
multifocal PML, leukoencephalopathy
amyo. Latc. Scle. (ALS)
wilson’s dz, -ceruloplasmin def kayser fleischer ring (picture#65)
Tumors of cns: in adult & child, most commong, with site
find out attributable risk from data and probability from data
Something on p-value, null hypothesis
On human sexuality, a physically female thinks she is wrongly born as female
she should be male
obese pt of DM on Rx, asked to eat only in kitchen, not anywhere in the house,
what kind of behavioural RX is this “ stimulus control
defense mech-
* pt female abused in childhood doesn’t abuse her children, but instead over
protect them, what kind of behavior is this
Pt with pain, aches, etc, some psychological problem, to differentiate among
somatization, conversion, hypochondriasis, factiotious, etc.
stages of adjustment of dying pt
factors that increase chances of depression in a female
narcissistic personality
absence seizure “ Rx ethosuccamide
erection problem in pt, how to Rx
function of diff parts of brain (Fist aid)
DNA formation from RNA, by a retrovirus, in which direction does it make DNA
Vignette of xeroderma pigmentosum, which enz def or what if formed-
Excession indonuclease /thymine dimmers.
Main RNA formation occurs when- histology slide point to nucleolus
If a pro, is reformed & structure is changed from a helix- to b-plated sheath, what
bonds are reformed “hydrogen bond
I-cell dz, que was what is the problemâ€mannose phosphorylation lysosmal enz
is deficient
Glucagon acts by increasing cAMP, which then acts on what? CREB- Lemcine
Zippen
As in pathology. determining risk of a child to get dz, when one or both parents
are having AD dz
If transgenic mice don’t have normal gene, which was present before, what this
study conferes?
how proto-oncoggene gets converted to oncogene, --translocation
Tumor & deletion /mutation of P53 supressor gene?
Which AA is used in biosynthetic pathways?
Km values of glucokinase & hexokinase, Km value of glucokinase is higher etc.
competitive inhibitors, effect on Km & Vmax
Pertusis toxin & action thru Gi protein, on increasing cAMP
If absorption prob occurs due to bile def, what of the following gets
depleted-look for fat soluble vits
Relation of HMP shunt, NADPH, & glutathione reductase
B12 def & methylmalonyl
Pt of diarrhea comes to ER. Only dextrose solution is given, what will be found
blood of pt in high conc
Allopurinol & action in gout by decreasing uric acid formation
A chart, show lower than normal conc of a drug from starting what was the
reason? “ first pass meta
Chart on agonist/ antagonist
Where glucagons acts- creb pr
Calculate half life, Vd & CL will be given
Difficulty in voiding, there is some residual urine after urination, how to
treatmuscarinie agonist & anticholinesterase, both can be given urinary
retension.
epinephrine reversal- KNOW IT VERY WELL
Asthmatic pt, & treatment for HT or something else, what will u give “ B1
selective blocker
CCB- site of action
antiHT, complain of dry cough- what drug? captorpil
Where thiazidde diuretic acts- Na-Cl transporter
Benzo antagonismâ€flumazenil
M/A of dantrolene, used for treatment of malignant hyperthermia after
amesthetic use--decrease release of Ca++ from SR
Pt after operation not recovering from relaxation, gave neostygmine, condition
didn’t improve, which was relaxant- succinylycholine
Antipsychotic causes EPS; how to treat it- antimuscarinic- Benztropine
S/S mania -what drug to treatâ€lithium
M/A of TCA drugs
gingival hypertrophyâ€phenytoin
What other drug act on beta- lactamases
Pencicilin elimination blocked where by probeneied- renal tubular secretion,
toxoplasma- treatment trimethoprimâ€sulfo
M/R to INHâ€by change in catalase
Rx of herpes zoster-acyclovir
Pulmonary fibrosis as an ADR-bleomycin
Pt on Rx hodkin’s dz, ADR, describing CHF, drug was doxorubicin
Breast Ca, Rc +ve,-- Rx with tamioxifen
Drug acting on IL-2 , INF, blocking their synthesis
M/A of B blockers in hyperthyroidism- inhibit peripheral conversion of T4 to T3,
cortisol use in some skin dz, what will u expect- skin thinning
Rx of diabetic ketoacidosis- crystalline insulin
Drug increasing effect of insulin on peripheral tissue- biguanide-meformin
drug interaction-pt on Rx of asthma, theophylline was given, drug is added,
increasing requirement of theophylline- look for P450 enzyme inducer
pt on warfarin action starts after one week, how it acts or why after 1 wkâ€slow
onset of action, decrease synthesis of factores II, VII, IX, X