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06-16-2004, 02:06 PM
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tommykQ1200-1331
hyc 1201 You have a 45 year old woman with a history of ulcer with diarrhea and duodenal ulcer disease, and you suspect Zollinger Ellison syndrome. You give secretin IV to test for gastrinoma. Pick which one would support gastrinoma's existence? (inhibition of gastric secretion) OR (increased blood levels of gastrin) TRICKY
A) Increased blood levels of gastrin. Those gastrinomas are gastrin secreting tumors in the pancreas. Know that although secretin blocks antral release of gastrin, it stimulates gastrin release from tumors. Know also that SECRETIN inhibits gastric emptying, inhibits gastric secretion, and stimulates pancreatic bicarb secretion. 1202 Let's say I show you a table with the ratio of urinary concentration to plasma concentration of inulin U/P is decreasing! Pick which of the following is true if the GFR is constant? HARD question (Pick either Inulin clearance has decreased OR Urine flow rate has increased) A) Urine flow rate is increasing. Recall that Inulin is freely filtered by neither reabsorbed or secreted. Thus, since ALL the inulin filtered will show in the urine, the amount of water in the urine WILL give the inulin concentration, so inulin U/P will DECREASE if urine flow rate increases! This is a hard but essential concept. 1203 Given this list below, which is used to INDUCE abortion?? (Pick from: PGG2, PGE2, PGH2, PGI2) A) PGE2, know that PGI2 is a prostacyclin, a potent INHIBITOR of platelet aggregation. 1204 A 70 year old man cannot urinate today, but could in previous days. PE has BP of 180/100. Labs show creatinine of 5 and BUN of 120. U/A has specific gravity of 1. What med will you give? (pick either Doxazosin OR Benazepril) A) Doxazosin... BPH is very common and tested. Like Prazosin, Doxazosin is an alpha 1 blocker and will also help his high BP! 1205 You see a pt with a headache and nuchal rigidity. Labs show a lumbar puncture with bloody CSF and elevated pressure, high protein, and low glucose. Does she have (subdural hemorrhage OR berry aneurysm OR hypertensive vascular lesions OR amyloid angiopathy)? A) berry aneurysm. 1206 You have an HIV positive 35 year old female pt. with possible B-cell lymphoma. What is most likely in the pt? (pick Very high IgG OR very high IgM or Reed Sternberg cells OR +EBV titer OR HTLV-1 infection) A) Likely positive for EBV infection. KNOW that high IgG is a type of macroglobulinemia, usually NOT seen in B-cell lymphomas. And KNOW that high IgM is seen in Waldenstrom macroglobulinemia. KNOW Bence Jones protein is LIGHT chains in urine. 1207 You have a 30 year old drug addict with gonorrhea and fear and SOB. Pulse-ox shows hypoxia. Chest x-*** shows bilateral interstitial infiltrates. What finding is diagnostic? (Pick acid fast bugs in sputum OR positive methenamine silver stain) A) positive methenamine silver stain. With his risk factors, he is susceptible to Pneumocystis carinii!, most common. 1208 Listen, 2nd messengers are basically one type of SIGNALING MECHANISMS for neurotransmitter/drug effects. There are five types, but two distinct ones are famous...1) TRANSMEMBRANE DIFFUSION to a cytosolic receptor. and 2) G-protein coupled receptors (the so called 2nd messengers). Listen, with respect to G-proteins, one of the most common are the sympathomimetic drugs, which activate or inhibit adenylyl cyclase by a multistep process. When you activate the receptor, you activate the G protein and either INHIBITS or STIMULATES the cyclase. REMEMBER, there are basically TWO THREE G-PROTEINS, a Q, an S, and an I. Thus, Gq, Gs, and Gi. (3 G-PROTEIN classes are in existence for the USMLE) YOU HAVE TO KNOW THE FOLLOWING!!!!!!!!!: Gq----Gq, stimulatory, works through Phospholipase C and either boosts IP3/Ca2+ AND DAG/Protein Kinase C. How do you remember??? Well recall that Gi stands for inhibitory (thus the "i") and the others, q and s are thus stimulatory...like our Gq. And then think that Phospholipase "C" is linked with the "C" in Calcium and the "C" for protein kinase C. (Thus, link in your mind a bunch of "C"s together with Gq. {I THINK OF A GQ MAN AS "C"OOL and is Stimulating to a woman} This is a famous cool men's magazine. Therefore, the ideas of "C"s being cool and stimulatory related to the "G"q magazine forever solidifies the connection. AGAIN, connect forever, Gq is the magazine and it is C for Cool Stimulating magazine (Phospholipase C and Protein kinase C). Gs----As we said, the Gs is "stimulatory" (Think the initials Gs stands for "G"reat "s"ex which is stimulatory...so equate the G"s" with "s" in stimulatory. Now, think and equate the Gs with cAMP and Protein kinase A. HOW? First off, cAMP is always linked to a Protein kinase. A weirdo linko is to think of a GSA, "G"reat "S"ex "A"lways. So forever, you will link Gs with A, thus Gs with Protein kinase A in a STIMULATORY way. Gi----HERE, it is easy because the "i' is inhibitory, and thus pushes down the cAMP and Protein kinase A. To LINK, Now, think of GiA, or "G"reat "i"nhibitory "A"nus (Since most of us have "no access" to our inhibitory anal openings.) So always link Gi with a inhibitory to Protein kinase A (A for anus). Remember, i stands for inhibitory for "A"nus. hyc 1209 (guest) Tired of all this? It is so hard to keep straight, I think I need to vomit right about now. NOW we have to touch on what the activation of each receptor actually DOES in your body. Start with alpha 1. OK, this is elementary, most know this is a VASOCONSTRICTOR. Alpha 2 then? Unknown to many, this BLOCKS insulin release and is used as an antihypertensive. B1 then? HERE, repeat to yourself over and over....this B1 boosts up everything! Think "Be number 1"...Be 1...B number 1! Be the best and rev up everything, esp in the heart. B2 then? Remember, the 2 links that you have 2 lungs. So, B2 DILATES the lungs, and ALSO release pancreatic insulin! How do you recall this? Think "Be 2 in su (yours) lin" Think a salacious thought that you wish to be "inside" sexually your friend's sister Lin. Thus, B2--insulin. M1 then? Stimulation here targets the CNS and stimulates it. Recall that it is Gq, as most 1s are (like alpha 1, Beta 1,etc.) And since Gq is a "Cool" magazine, again take the first letter of Cool, "C" and link that it works with phospholipase C. M2 then? Recall that most "2s" are inhibitory. So this DECREASES and inhibits heart rate. M3 then? Stimulation here via Gq boosts up exocrine gland secretions. (NOW, if you remembered what we just talked about, that Gq is COOL and is STIMULATING from pictures of handsome man (not that I would be influenced), then you will know that SECONARILY, it works via the "C"s, Phospholipase C, Ca 2+, and Protein kinase C. See, the guys in Gq magazine are "C"ute. The C keeps coming back with Gq, the Men's Magazine. D1 then? Again, this is stimulatory but this time with Gs, so you now have the A motif. You have to link the Gs with "A"--Gs is linked with ATP, c"A"MP, Protein kinase "A" Just start again with Gs with yet another link to "A", like GsA, like "G"oing "S"lowly up the "Anus" GsA, as you do a hemocult test. Again, equate Gs wtih A, GsA, GsA. D1 is assoicated wtih Gs and NOT Gq because D stands for a "dope" which is not as cool as a person with a Gq looks on their face. Is this helping? (Step 1)Beta 1 and 2 both are Gs and inc adenylyl cyclase --> inc cAMP (tommyk)My previous mnemonic was the company AMD is SECOND (2) to the company Intel Corp in power. Thus, AMD Inc. is "inhibitory" to Intel's dominance. Then link the company's initials A.M.D. to the word inhibitory and the number 2. Finally link the fact tha A2, M2, D2 (and you are correct that B2 is NOT inhibitory), are all inhibitory. Again, Alpha 2, Muscarinic 2, Dopamine 2, A2, M2, D2 are all inhibitory. 1210 You have a 60 year old man, PAINLESS swelling on his neck. PE is splenomegaly. Biopsy of the neck reveals a neoplasm with small cleaved cells that recapitulate the normal follicle of lymph node. Is this (L-myc, OR p53, OR bcl-2 OR ras)? A) Bcl-2...This is a case of non Hodgkin lymphoma, follicular type. Bcl-2 stops apoptosis. In most of B-cell lymphomas (esp. follicular), the gene is OVER expressed which causes other mutations like the lymphoma. 1211 If you are asked which of the following demonstrates AGING at the CELLULAR level, which is it? (pick hemosiderin, lipfuscin, or melanin spots). A) Lipofuscin. This brown stuff accumulates with aging and is made from the PEROXIDATION of lipids inside the cell. 1212 A woman, 50 years old, is jaundiced. LABS=high CONJUGATED hyperbilirubinemia. Urine bilirubin leves are WAY UP. Urine urobilinogen are WAY below normal. What is the MOA of her jaundice? (is it Blockage of the common bile duct OR deficiency of glucuronyl transferase OR hemolytic anemia OR hepatocellular damage) A) Blockage of the common bile duct. Recall, it is CONJUGATED ALREADY. 1213 You see a 40 year old man with a vomiting of green stuff 45 minutes after eating. He is scheduled for a barium to evaluate the upper portion of the GI. There is no pain, but he is NOT jaundiced. What is the mech of action? (is he have annular pancreas OR esophageal atresia, or gallstones, or Meckel's) A) The answer is annular pancreas, where a ring of pancreatic tissue that forms around the duodenum causing partial or complete obstruction of the duodenum. A complete duodenal obstruction may be detected. An annular pancreas may put pressure on the duodenum, a make the pt vomit bile. KNOW that esophageal atresia is found usu. in neonates. Gallstones cause indigestion, pain and jaundice. A Meckel's is the persistence of a portion of the embryonic vitelline duct or yolk stalk and is usu. asymptomatic. 1214 A football player gets hit from the lateral side. The THREE structure to be affected are: A) Think of mnemonic, "Mam, that hurt!" M,A,M,... M..edial collateral ligaments A..nterior cruciate M..edial meniscus 1215 I am showing you a volume-pressure diagram of the left ventricle during one cardiac cycle. Where is the exactly part where systole starts. A) on that rhomboid looking figure, it is the right most, lower right point. LOOK IT UP PLEASE! (1216)In an experiment you did, radiolabeled ATP is injected into a muscle and stimulated for 10 seconds. Next, if you saw an audiogram from muscle biopsy, you will see radiolabeled ATP bound to what? (actin OR myosin OR tropomyosin OR troponin C) A) the answer is MYOSIN. During the contraction, ATP binds to MYOSIN, causing the dissocation of myosin from action. KNOW then the actin forms cross bridges with myosin but there is no ATP binding. KNOW that Tropomyosin runs alongside actin. It blocks myosin binding sites. KNOW that Troponin C is the calcium-binding SUBUNIT of the troponin complex and makes it shift to expose myosin binding sites. hyc 1218 (Good question on physio/endo) You are a doctor who wanted to conduct a neurotransmitter experiment to assess extracellular neurotransmitter levels in the brain following electrical stimulation of the raphe nucleus. What will rise? (ACh, Dopamine, GABA, Norepinephrine, Serotonin). Can you point to all the structures? A) Serotonin. it is the main neurotransmitter in the raphe nuclei. KNOW that ACh is found mainly in the basal nucleus of Meynert. KNOW that dopamine is found mainly in the substantia nigra. Although I did not mention it, GABA is inihib. and found everywhere in the brain. Also, know that NOREPINEPHRINE is found in the locus ceruleus. 1219 You will likely face this concept if not on USMLE, then in clinic. The question is...What is the general ERPF or effective renal plasma flow for the average person? Do you know the simple equation? YOU HAVE TO KNOW THIS. A) Around 635 mL/min. The equation is UpahV/Ppah. 1220 Ah, good one. You have a father coming in wtih his son wondering if he is the TRUE biological father. What can you verify? A) This is done a LOT, it is called RFLP...Here a blood sample is drawn and digested with restriction enzymes and you observe the distance of the fragments on the gel. Please look it up on a microbiology book!!!! We also use this test sadly for rape victims, etc. 1221 Hey, the molecular biology of pituitary hormones and pancreas are which? (pick catecholamines, OR amino acid derivatives, OR peptides) A) PEPTIDES, Recall that pancreatic glucagon and insulin are peptides!!! 1222 You have a pt with megaloblastic anemia with folate def. Erythropoiesis is lesioned due to a defect in what reaction? (pick Acyl transfer OR Carboxylation OR Decarboxylation OR Hydroxylation OR Methylation) A) This is a toughie! Listen, ans is methylation. Recall the MOA is from TH4 in its reduced form. TH4 accepts methyl, methylene, carbons to transfer them! So the answer is methylation. KNOW that Acyl transfers occurs in Pantothenic acid/Acetyl CoA....KNOW that Carboxylations occurs in Biotin/Vitamin K....KNOW that Oxidative decarboxylations occur in thiamine rxns....KNOW that Hydroxylations occurs in Ascorbic Acid reactions.!!!!!!!!!!!! 1223 You see a 60 year old alcoholic in the ER. You know you need to give thiamine. But your med students asks, "Why not Biotin, Niacin, Pyridoxine, Riboflavin?" How do you answer? A) Biotin is a activated carboxyl carrier used to treat baldness, bowel inflammation, myalgias. Niacin treats PELLAGRA (Diarrhea, Dermatitis, dementia). Pyridoxine treats neuropathy and dermatitis. Riboflavin treats skin lesions.!!! 1224 You are looking at a skin biopsy of malignant melanoma and see large visible nucleoli. Thus, the cells are making WHICH OF THE FOLLOWING? (Cell surface markers, Golgi apparatus, IgGs, DNA, Ribosomes) A) Ribosomes! 1225 Tell us which enzyme is stimulated by glucagon? (acetyl CoA carboxylase, Glycogen phosphorylase, Glycogen synthase, OR pyruvate kinase) A) Think about it, glucagon WILL be needed when glucose is needed...so, THINK we either need to break apart glucagon or create glucose (gluconeogenesis). THEREFORE, think we need glycogen phosphorylase to catalyze the first step in glycogenolysis! KNOW that acetyl Coa carboxylase is fatty acid synthesis, which is stimulated by INSULIN!!!! KNOW that you dont want to MAKE glycogen KNOW that pyruvate kinase catalyzes the LAST REACTION in glycolysis. Glucagon acts to INACTIVATE it, to STOP glucose consumption. 1226 You need to know HOW glycogen degradation and glycogen synthesis is different. Tell me, the glucose used in glycogen synthesis are bound to WHAT KNOWN nucleotide??? A) UDP!!! When you cook up glycogen after eating too many fatty steaks, one high energy phosphate bond of uridine triphosphate is used by UDP glucose pyrophosphorylase to make UDP-glucose. THEN, this binds to glycogen primers to make glycogen. KNOW that if you chose GDP or GTP, you are thinking about the TCA cycle! 1227 A neonate comes in with vomit, diarrhea, stomach pain, hypoglycemia when the mom tries to feed. She has lactic acidosis, hyperuricemia, hyperphosphatemia. YOU are told this is fructose intolerance. The baby should also avoid WHICH other sugar? A) SUCROSE. KNOW that You can be missin g either fructokinase OR aldolase B. If you do not have aldolase B, you are in BIG trouble because you lose intracellular phosphate to make ATP. YOU HAVE to stop eating sucrose because it IS FRUCTOSE and GLUCOSE! 1228 Lets say I give you a pic of a histo slide. Then I ask you to point to the thing that anchors an EPITHELIAL cell to the BASEMENT MEMBRANE? (is it adherent OR connexon OR hemidesmosome OR tight junction????? A) Hemidesmosomes! They are like spot welds between cells and hook onto an extracellular matrix like the basement membrane. KNOW that adherences/zonula adherens are "attachments" and tight junctions are "seals". 1229 One of the previous posters said TCA cycles was high yield for his test. Let me ask then...succinate thiokinase cleaves to make a high energy compound. What can the resulting compound be used for INSIDE the cell? A) YOU must know that GTP is synthesized here...so you need to know that GTP and NOT ATP is used to make proteins in ribosomes and they power tRNA binding!!!!! 1230 Regarding amino acids, which one is involved in the BUFFERING capacity of hemoglobin? (pick arginine, aspartic acid, glutamic acid, histidine, OR lysine) A) A buffer is good if it is close to pKa, pH wise. Thus, HISTIDINE is closest to physiologic pH and thus the right answer!!!! 1231 IF the USMLE or your attending asks, KNOW that 1 g of protein or carbohydrate makes 4 kcal of energy and 1 g of fat makes about 9 kcal of energy. You need to know this to calculate if someone goes on a crash diet or something. Let's say an MD/PhD takes a culture plate of bugs which need almost no food, and then takes the buggies out and puts them on a plate full of bacterial goodies to eat. When the bacteria grow, each TYPE is isolated. The ones that cannot grow at all are called "THE MUTANTS", and their genes are sequenced. In one case, the MD/PhD finds that a two nucleotide segment of DNA is deleted. This is what kind of MUTATION? A) FRAMESHIFT. See, a long long vignette to ask a simple question... 1232 What DECREASES the fluidity of the plasma membrane? (Pick either LOWERING the melting temp OR Increasing cholesterol OR increasing unsaturated fatty acids) A) Increasing cholesterol!!! The more the cholesterol, the more tightly the phospholipids are packed up, resulting in a membrane with high rigidity and low fluidity. KNOW that if you decrease the membrane's long chain fatty acids, you increase fluidity because the molecules pack tigher than UNsaturated fatty acids. 1233 Ahhh..great one. I present to you an imaginary picture of a glucocorticoid receptor. What is the role of it? (TATA box, Enhancer, Cis element, Transcription factor) A) Surprise, it is a TRANSCRIPTION factor. It stimulates teh binding of RNA polymerase to promoter sites on DNA. KNOW a cis element regulates the expression of nearby genes. KNOW that an enhancer is a DNA sequence that itself stimulates promotors. KONW that a promotor is where the RNA polymerase binds. 1234 Say someone is allergic to niacin. Which of the following can be a substitute? (Asparagine, Alanine, Proline, Tryptophan) A) It is ... Tryptophan! A derivative can be used in NAD synthesis. Lots of tryptophan can replace a lack of niacin. 1235 You have a fetus (deceased) with a small head, eyes, cleft lip, palate, six fingers. Is he Trisomy 13 or Trisomy 18???? A) Trisomy 13! Remember to think of polydactyly (thirteen fingers) and CLEFT stuff like palate and lip. Trisomy 18 has the rocker bottom feet (18 year olds like to "rock n' roll") and have prominent occiput and low set ears. Both are mentally retarded. 1236 A patient has a PMH for multiple infections involving the lungs, liver, bones, granulomas, gingivits, APHTHOUS ulcers. What enzyme is deficient?? (Good Question) A) NADPH oxidase! Recall that this is results in Chronic granulomatous disease of childhood, thus, here, the neutrophils and phagocytic cells cannot make superoxides! Some people think the answer is MYELOPEROXIDASE but are wrong b/c this defect is usu. seen in diabetics with fungal infections. 1237 A cell that makes glycoproteins with 8-9 mannose residues per sugar chain possesses a glycosylation enzyme defect in an organelle? Which one is it? A) GOLGI APPARATUS! This step occurs in rough ER. The trimming of mannoses to 5 residues occurs in the Golgi PRIOR to complex sugar addition. 1238 You see a 18 year old with bilateral weakness with difficulty relaxing mostly the hands and feet. A muscle biopsy shows prominent ring fibers, central nuclei, nuclei chains. This disease is a mutation on which chromosome? What dx? A) This is MYOTONIC DYSTROPHY, mutation on chromosome 19, Autosomal dominant. It also causes cataracts, testicular atrophy, heart trouble, dementia, baldness, and weakness. This is COMMON and systemic. 1239 You are asked to use DNA polymerase in the PCR test. This enzyme is resistant to which? (Pick Acid OR Base OR Heat OR high Na+) A) HEAT! Recall PCR uses heat to separate the DNA strands to be used as templates. Thus, the DNA polymerase used MUST be resistant to the heat! 1240 Amongst your friends, the FREQUENCY of color blindness in males is 1 in 100. Assuming Hardy Weinberg equilibrium, the frequency of color blind females is what? (Hint: it is NOT zero) A) Recall this is an X linked recessive for males. So the freq of it in males is EQUAL to the fequency of the allele in the population. So q = .01 and p = .99. Then IF a female had BOTH copies of each gene, the rare case would show a frequency of q2 or .0001. © 2003, 2004 ValueMD, Inc. 1241 You see a man exercising. Aerobic glycolysis is used for the energy source. What exact COMPOUND will enter the TCA cycle? A) Acetyl CoA...I wanted to know if you were paying attention. 1242 Let me guess, which of the amino acids is POST translationally HYDROXYLATED in the cytoplasm of fibroblasts? (Pick cysteine, glycine, proline, serine) A) PROLINE!! The hydroxylation of proline in fibroblasts generates the modified amino acid hydroxyproline. This is used for stabilizing the three dimensional triple helix of collagen. KNOW that cysteine are part of the double disulfide bonds in the triple helix. KNOW that while GLYCINE is every third amino acid in collagen, it is NOT hydroxylated. KNOW that when SERINE is phosphorylated, it plays a role in signal transduction. 1243 1244 You have a pt running away from his angry wife in a short burst. You estimate that he will use .5 L O2 aerobically. BUT, the metabolism of 15 L of O2 needed to escape is mostly from anaerobic sources. SO, the majority of ATP generated is derived from what? (Creatine phosphate? OR Gluconeogenesis? Glycolysis?) A) GLYCOLYSIS!!! KNOW that he will use up his ATP stores in only ONE second. Creatine is used up next for say 3 to 4 seconds. Then, to escape his angry wife, he will use glycolysis. KNOW that if his wife chases him all around the town for hours on end, gluconeogenesis and even lipolysis will KICK in. 1245 Which lipoprotein disorders is noted by an increase in chylomicrons and xanthomas INSTEAD of atherosclerosis? (is it Abetalipoproteinemia OR Familial hypercholesterolemia OR Familial Lipoprotein lipase def) A) familial lipoprotein lipase deficiency. 1246 Your pt is a 28 year old with ORAL ULCERS. PMH is that she is a VEGETARIAN ONLY. LABS are severe for riboflavin def. Which ENZYME in the TCA cycle is most afffected by the riboflavin def.? A) Succinate dehydrogenase!!!! Riboflavin is used to MAKE FAD and succinate dehydrogenase uses FAD as a cofactor. 1247 Say I show you a figure of a DEOXY-nucleotide, does it block (cDNA synthesis? mRNA synthesis? poliovirus? ) A) cDNA synthesis. Because these babies lack the OH group, they can be seen as substrates by DNA polymerase, including reverse transcriptase (This IS ACTUALLY a RNA dependent DNA polymerase). RECALL that the RNA polymerases do not recognize deoxynucleotides as a substrate. 1248 True or False: Both sickle cell anemia AND Tay Sachs are autosomal recessive. A) True! 1249 Your pt is a mommy AND her daughter. The girl suffers from a disorder where a sugar substitute called aspartame could really harm her. What dx does the daughter likely have? (Hyperuricemia? PKU? Hyper-valinemia?) A) She has PKU. Phenylalanine to TYROSINE is lost. 1250 You are shown a picture of a cell. Given a list of AA, what is likely found on the outside SURFACE of the cell? (Alanine OR Arginine OR Leucine OR Tryptophan) A) This is a typical TWO stepper. KNOW hydrophilic amino acids are likely to appear on the protein molecule surface exterior, and hydrophobic AA are interior. SO, what AAs are hydrophilic? Arginine is one, as it is a basic AA positively charged. The other AAs I gave are NEUTRAL! 1251 Given a picture of a retinoblastoma (can you spot one)? Tell me what chromosome is lesioned? A) Usually this is a chromosome 13 lesion. They look like small masses of hyperchromatic cells with rosettes that form a circle. 1252 You have a 25 year old man in your clinic with pneumonia. Since age 5 months, he has had recurrent sinopulmonary infections from encapulated bacteria. He has abnormal immune function of? (T-cells, B-cells, NK cells, Macrophages, Platlets) A) B-cells, likely Common Variable Hypogammaglobulinemia, low serum levels of IgG at around 6 months of age when mommy's levels disappear from his blood. 1253 You have a female pt, 18, who tells her boyfriend that sex hurts. She also has to urinate a LOT. PE is high fever and no vaginal discharge or cervicitis. UA has 15 WBCs with Gram neg rods. What do you give her in meds? (More than one answer could be right) A) You should try Ampicillin for her SIMPLE UTI. Some may think of Ceftriaxone, but reserve the "big gun" drugs for later. You can rule out Metronidazole since there is no discharge and there ARE gram negs in the pee. ValueMD.com 1254 You see a 30 year old female with allergic rhinitis who got hit in the face and stomach with a blunt object. Her spleen is lesioned. She is transfused with 4 units of ABO and Rh type blood. As the transfusion goes, she becomes hypotensive with airway edema. WHAT preexisting condition did she have? Pick either C1 esterase inhibitor def OR IgA def. A) Likely she has IgA def. This is common with BLOOD TRANSFUSIONS and the combo with sinopulmonary infections! If you thought C1 esterase, you should have seen recurrent attacks of colic, WITHOUT pruritis or COLIC or allergic type reactions. 1255 Great question...A young woman at 35 weeks pregnancy comes in with urinary frequency and BURNING. PE has NO fever, chills, vomiting, nausea. LABS are positive for WBCs, PROTEIN, hematuria, gram neg buggies. What is the VIRULENCE FACTOR of the bug (is it HEAT STABLE toxin, HEAT LABILE toxin, P pili, Type 1 pili? A) This is E-coli most commonly and is P pili as the virulence factor in most cases. 1256 What cell surface marker is used to lyse IgG coated cells by NK (natural killer cells)? (CD3 or CD 19 or CD 16) A) NK cells = CD 16 is an Fc receptor for NK cells. RECALL that CD3 is NONvariable part of the T cell receptor.. NK cells are CD3 negative. RECALL that CD19 is a B-cell marker! RECALL that CD 56 (if you thought about that) IS a NK cell marker, but is not involved with antibody dependent toxicity. 1257 You get a question/patient with a kidney stone made of STRUVITE (Magnesium Ammonium Phosphate). What bug is responsible (Proteus OR Ureaplasma urealyticum)? A) Proteus. This buggie raises the pH. RECALL that Ureaplasma DOES made urease like Proteus, but causes urethritis. 1258 A young college dude comes in with fever, cough, blood in sputum. LABS show high BUN/creatinine. Microscopy shows LINEAR pattern of fluorescene along basement membranes. What HYPERSENSITIVITY TYPE IS THIS? (I, II, III, or IV) A) II !!! Goodpasture's!! OK, when given stuff like autoimmune rxns, drug allergies, blood transfusions, hemolytic dx, think TYPE II. TYPE I, with the asthma, eczema, hives, are more obvious. TYPE III recall have IgG or IgM and activate complement. C3b, I repeat, C3b is made, and so is C3a and C5a. KNOW that TYPE III happens a week to two weeks AFTER exposure and classic TYPE III is serum sickness, and Arthus response and SLE and glomerulonephritis. TYPE IV is UNIQUE in that it is NOT mediated by antibody and tuberculin sensitivity and poison ivy/contact dermatitis are CLASSIC egs. 1259 Nasty dx. and bug...a man comes in with sickle cell dx. He has bad venous access, so a catheter is put in a subclavian vein. He later has arm pain and swelling and fever and chills. Bugs are cultured with gram positive cocci, catalase positive and gamma hemolytic. What is the BUGGIE? (Enterococcus OR Staph. epidermidis) A) Don't be tricked by the gamma hemolytic and think of Enterococcus! Staph epidermidis is the right answer. 1260 Man, alcoholic, dental caries, pulmonary abscess, "treated with antibiotics". Days later he gets terrible diarrhea and GI pain. What antibiotic is more likely (Chloramphenicol OR Clindamycin)? A) Clindamycin is likely here and he has C difficile. 1261 A middle aged man...chronic renal failure...gets new kidney...takes cyclosporine...7 MONTHS later his creatinine RISES. Your biopsy of his kidney shows what??? (Neutrophils?) A) NOT neutrophils, which are part of HYPERACUTE rejection, but rather you will see INTIMAL FIBROSIS and TUBULAR ATROPHY from chronic rejection! KNOW the subtle differences. If he had rejection within say 4 months, you will see INTIMAL THICKENING, not fibrosis. ACUTE rejection often involves T-cells, interstitial edema, hemorrhage. 1262 KNOW that periplasmic space is found only in gram neg buggies. 1263 You have a boy, smoky urine, previous sore throat. PE has HTN (hypertension), edema. U/A has RBC casts. Is the buggies (Catalase +, Coagulase +, OR bacitracin sensitive)? A) Bacitracin sensitive! The buggies are S. pyogenes. This is BETA hemolytic and BACITRACIN SENSITIVE 1264 What can you remember about the functions and production of IL-4? A) It is produced by TH2 cells and mast cells. It induces cells to express MHC class II antigens and B-cell proliferation, induction of atopic allergies, AND it helps class switching to IgG and IgE but not IgA. IL 5 does the class switching to IgA. 1265 We just said that IL-5 stimulates B-cell class switching to IgA. KNOW it is secreted by T helper cells and promotes B cell proliferation, production and eosinophils. What then does IL-6 do? A) IL-6 recall stimulates acute phase reactants and Ig production. 1265 You see a child in your office with yellow stained teeth. Mother took antibiotics during the pregnancy...the one that caused this works how? A) Think of Tetracycline. It works by binding to the 30S subunit and stopping aminoacyl tRNA attachment! (A common family member is Doxycycline) 1266 Someone takes a drug that is nephrotoxic and ototoxic. It requires O2 for uptake, and prevents bacterial initiation complex formation. What drug is it? A) Aminoglycoside. 1267 A young man gets a new kidney, etc. from a donor wtih blood type B. He has blood type A. Immediately he gets a horrible reaction w/ hemorrhage, fever, etc. Is this due to (hyperacute rejection fr. lymphocyte and macrophages OR hyperacute rejection fr. preformed ABO antibodies) A) ABO antibodies...The preformed anti-B ABO antibody is causing this HYPERACUTE rxn., where complement reacts and kills the tissue. KNOW that preformed antibodies can also be found fr. previous grafts, blood transfusions, or pregnancy. 1268 A man gets an abd. abscess and responds to NAFCILLIN but not cephalosporin. The bug hydrolyzes what bond if given a molecular diagram of cephalosporin? A) Look for the arrow on the AMIDE bond. S. aureus is the likely bug here. 1269 Year to year, the influenza A vaccine is not effective because??? A) Antigenic shift from reassortment. 1270 present you with a case of sickle cell disease. The bug is motile, but does it ferment lactose? A) Yes, Salmonella does. 1271 You are a clinician next to the Ohio River Valley. You see a young woman with headache, nonproductive cough, getting sick after cleaning a chicken coup. Is this Cryptococcus? A) No, this is Histoplasma. 1272 Is the bladder supplied by the internal OR external iliacs? A) INternal iliacs 1273 What artery supplied the left lesser curvature of the stomach? What artery supplies the right half of the greater curvature of the stomach? A) Left HALF of Lesser curvature= left gastric. (Right HALF of Lesser curvature = right gastric. Greature curvature=right gastroepiploic. 1274 The short gastric off the splenic artery/LEFT gastroepiploic, supplies what part of the stomach? A) FUNDUS of the stomach. 1275 You have to know everywhere that the internal pudenal artery gives rise to. Waht are they? A) It COMES from the anterior internal iliacs, and divides to the INFERIOR RECTAL, PERINEAL A., URETHRAL A., DEEP A. and DORSAL arter of penis/clitoris. 1276 You see a radiograph with an arrow pointing to a structure medial and deep to the uncus. What is it? A) It is the AMYGDALA. If you thought Caudate nucleus, it lies LATERAL to the lateral ventricles. The putamen lies LATERAL to the caudate. 1277 A little boy, w/ blood in feces. +4 cm ileal outpouching 50 cm from ileocecal vlave. What kind of ecoptic tissue is here? What dx? (Hint: it is a persistence of the vitelline duct) A) This is MECKEL'S Diverticulum. Very common. Causes ulceration, inflammation, bleeding because of ectopic gastric tissue. 1278 A woman, stabbed in the superolateral aspect of the thoracic wall at the third rib. No bleeding, no SOB. But, the medial border of the scapula on the injured side pulls away from the body wall when the arm is raised. Also, the arm cannot be abducted above the horizontal. What muscle is LESIONED? Innervation too please? A) Serratus anterior! It holds the scapula against the body. You are seeing a "winging". It is innervated by the LONG THORACIC NERVE. 1279 For the previous concept case, why isn't the answer the supraspinatus? Give innervation. A) It does NOT hold the scapula against the body wall, and a knife at the 3rd rib will not affect it. It is innervated by teh suprascapular n. 1280 You are in lab looking at cells arrested at various stages of oogenesis. You see a follicle in the ovarian stroma that develops an antrum. This follicle is what? A Graafian follicle? A) No, it is a primordial follicle. RECALL: Primordial follicle > Primary follicle > Secondary follicle > Graafian follicle 1281 A man with cirrhosis, portal obstruction in the liver. Portal blood could still reach the caval system through WHAT veins? More than one answer is possible, just give one... A) Consider the azygous and hemiazygous veins. Because they anastomose with the left gastric vein, portal blood can go thru the superior vena cava via the azygous veins. Recall there are a couple of OTHERS like the superior rectal vein and the middle/inferior rectal veins. ALSO there is the paraumbilical veins with the epigastric veins (recall caput medusae?); ALSO recall the splenic and colic veins with the renal veins and those of the poster BODY wall. 1282 (Per reader request, on with second messengers..hyc 1208 )Now that we got that straightened (And you WILL be asked such stuff), we need to link that with the specific receptors. As I said before, for: Alpha 1 receptor, you MUST link it with G protein class "q" because that connection will connect alpha 1 with Phospholipase C and Protein kinase C and Ca2+. To do so, you need to think that the word "alpha" and the number "1" is first in every ordinal list. Then think of how a Gorgeous Queen "q" comes first in the priority list. Again, repeat, Alpha 1 is tops, and a Beautiful Queen is tops. Then you will recall that the Gq (GQ magazine) with good looking guys and gals) is stimulatory, and a boost of Calcium is always stimulatory, as is the Protien kinase "C". So again, going backwards, if you "C" (see) that Gq (magazine) features 1 Alpha males, you hopefully will link this. See?? For Alpha 2 receptors, just recall that it is the opposite of alpha 1 in that in is inhibitory in action Gi. This fact is easily remembered if you say it over and over that Alpha 1 and Alpha 2 are OPPOSITES of each other. Plus, know that ALL the subtype 2s like alpha 2, M2, D2 (except B2 for the lungs), are Gi proteins. Then, connect Gi with the letter A to form the word GiA, who was a famous model (like those in Gq magazines). The letter A connects you to Protein kinase A. (except for B2), the Gi proteins which lower protein kinase A are inhibitory. Beta 1 receptors...what are they? They are Gs or stimulatory. You may recall this from all that cardio stuff and the stimulation, but then think B1S, or Barf 1 sandwich for B1 and S. Again, B1 AND B2 are stimulatory via a Gs protein. Again, "B"e stimulatory. NOW, listen, the Gs protein is associated with c"A"mp and "A"TP and Protein kinase "A". Connect "Gs" and "A" with GSA. GSA, GSA, GSA, what can it stand for? Good Sex Alnight. G-S-A. Again, protein Gs stimulates protein kinase A via cAMP and ATP. Beta 2 receptors..think here that you have ONE heart Beta one, and TWO lungs..for Beta 2. Both BETAS are stimulatory. Think Be-"T"otally "Awesome". Say over and over, Betas are STIMULATORY> {Now for the Ms} M1 is Gq and thus stimulatory (recall the magazine) via IP3 and Calcium. AND Protein Kinase C. M2 is Gi and thus inhibitory via cAMP and Protein kinase A M3 is Gq and is thus stimulatory via IP3 and Calcium and Protein Kinase C For the D1, think it is stimulatory because ALL 1's are stimulatory! Alpha 1, Beta 1, M1, D1, H1, are all stimulatory.. They are first, and thus stimulating. The 2's, Alpha 2, M2, D2, V2 are INHIBITORY! So, D1 is Gs D2 is Gi H1 is Gq H2 is Gq (an exception) V1 is Gq V2 is Gs (an exception) H2 and V2 are exceptions...again, say it again, H2 and V2 are exceptions. they are stimulatory and not inhibitory like the other 2s.. Say it again, H2V2, H2V2, H2V2, H2V2,...sick of it yet? Well I am not, you have to know they are exceptions. (This was helpful thanks!! But one lil correction, B2 is also stimulatory, it is an exception to the 2s being inhibitory - since it is in Gs class!) (All 2s', only alpa2 and D2 are inhibitory!) (Plus M2.) (But, I am just trying to generalize. You cannot know everything, and these second messengers are heavily tested guaranteed. So you need some weird NON perfect way to lump them...UNLESS you have a WORLD CLASS memory. I know I don't. .. sorry.) 1283 1282 (Remember, secondaries, secondaries) A man comes to you with gait problems, slow, slurred speech, cannot move items back and forth quickly, intention tremor, hypotonia, nystagmus.The lesion is a brain part that comes from which EMBRYONIC structure????? A) Metencephalon. The man has a CEREBELLAR lesion. KNOW that the ANTERIOR end of the neural tube makes three parts (prosencephalon/forebrain, mesencephalon/midbrain, rhombencephalon/hindbrain). KNOW the cerebellum AND pons comes from the metencephalon. hyc 1217 A 50 yo woman with CHF goes to the ER. PE shows resting O2 of 200 ml/min, a peripheral arterial O2 of .20 ml O2/ml of blood, and a mixed venous O2 of .17 ml O2/ml serum. What is the cardiac output? YOU HAVE TO DO SIMPLE CALCULATION ON USMLE and in CLINICS! A) Simply, CO = O2 consumption/(O2 arterial-O2 venous). So, we have 200 ml/min/(.20 ml O2/mL blood - .17 mL O2/ml blood =4000 mL/min =4.0 L/min © 2003, 2004 ValueMD, Inc. 1283 Regarding the previous concept, just KNOW that AFTER say a month, the PROSENCEPHALON develops further into the telencephalon and the diencephalon. The TELENCEPHALON breaks up into the CEREBRAL HEMIPHERES (cerebral cortex, basal ganglia white matter). The diencephalon becomes everything "thalamus"...thalamus, hypothlamus, subtalamus, incl. posterior pituitary and neural retina. KNOW the mesencephalon/midbrain STAYS the mesencephalon. 1284 Hey, the ciliary body is deformed...this is due to malformation of what? Hard question...sorry. A) NeuroECTODERM...of the optic cup, from the evaginations of the diencephalon. 1285 You likely recall that the PULMONARY valve is heard over the LEFT 2nd intercostal space. So, give me a children's common cause of such pulmonary stenosis? (more than one answer is possible) A) TETRALOGY OF FALLOT. 1286 You attempt a study to increase the norepinephrine concentraiton in the cortex of an animal. He does this by electrically stimulating a nucleus in the brain. What nucleus is important for noradrenegic innervation to the cerebral cortex. ? A) Locus coeruleus. 1287 KNOW that the Nucleus of Meynert are CHOLINERGIC neurons. It innervates the neocortex, hippocampus, amygdala. This degenerates in Alzheimers. Can you point to it on a CT scan of the head? 1288 KNOW the caudate nucleus (part of the basal ganglia) has GABA projection to the globus pallidus and substantia nigra. The GABA neurons lesion in HUNTINGTON'S. Therefore, the nucleus, which is lateral side of lateral ventricles will atrophy so the ventricles will look bigger. Also, the caudate has CHOLINERGIC neurons which provide the ACh to the striatum. 1289 Recall, raphe nucleus = SEROTONIN. Can you point to it on a CT scan? 1290 Now, what about the SUBSTANTIA NIGRA pars compacta? What is the main substance here? Can you point to it? A) Here we find DOPAMINE. This degenerates in Parkinson's disease or if you take MPTP. It is above the pons, posterior to the Nucleus Meynert. RECALL the Raphe nucleus and Locus Ceruleus are POSTERIOR on the brainstem. Be ready to point to them. 1291 KNOW that if you are asked by anyone in the future about the Ventral Tegmental Area, know that it has dopamine for the limbic and cortex. These area is also known as the mesolimbic neurons, which if overactive, leads to schizophrenia. 1292 You notice your attending tapping the side of the face of a patient who just had thyroid surgery. The attending is concerned about a lesion to WHAT vessels? Very hard question... A) The attending is checking for tetany, which happens if the parathyroids are damaged and the superior and interior thyroid arteries are accidentally lesioned during the surgery. If PTH is lessened, the pt. will contract HARD his masseter muscle from hypocalcemia. 1293 A man comes to you, abd. pain, nausea, vomiting, afebrile. LABS show a loop of small intestine passed into the epiploic foramen into the omental bursa. If you try to FREE the intestine by cutting the epiploic foramen, what structures are you likely to damage? A) You may cut parts of the portal triad: the hepatic artery, common bile duct, portal vein. 1294 A young man, stabbed in the left chest, comes in with decreased function of the LEFT arm. PE shows a WINGED scapula. What nerve was cut? A) The long thoracic nerve was severed, and the serratus anterior m is not healthy. 1295 A young man is stabbed in his right fifth intercostal space at the midaxillary line. What is lesioned? A) LIVER. Any wound usu. BELOW the fourth intercostal space likely hits the liver (recall midaxillary is NOT in midline) . If you thought R. atrium, KNOW it goes from the third costal cartilage to teh 6th costal cartilage just to the right of the sternum. 1296 The eustachian tubes and epithelial line of the tympanic membrane comes from which pharyngeal POUCH or ARCH? A) Comes from the first pharyngeal pouch 1297 If I point to the AXILLARY nerve, what cord does it comes from? What muscles assoc.with the rotator cuff is affected? A) So important, it is from the posterior cord (C5, C6). Often comes from a break in the surgical neck of the humerus. The teres minor and deltoids can be lesioned so you lose arm abduction and sensation. 1298 Now I point to the lower subscapular nerve. What muscle does it innervate? a) The teres MAJOR, tis a branch of posterior cord C5, C6. 1299 What structure is most MEDIAL in a kidney if shown a histology slide? Is it the Renal pyramid? A) No, it is the Renal pelvis, which is the dilated upper part of the ureter. 1300 A young man, falls while skating, lacerates a 4 cm gash on the lateral knee. You can see the head of the fibula sticking out. You see a foot drop while the pt. walks. What nerve is lesioned? A) Common peroneal. If you thought Tibial, know the tibial nerve supplies the POSTERIOR compartment of the leg inc. the gastrocneumius and soleus and flexor digitorum LONGUS. 1301 You are doing an echo (cardiac). The anterior wall of the left ventricle is found ischemic. Is it the (left anterior descending OR left circumflex) that is lesioned? A) Left anterior descending. 1302 What artery supplies the AV node AND the posterior wall of the LEFT ventricle? A) Tricky. It is the Right coronary artery, which ALSO supplies the R ventricle 1303 Which famous nerve gives rise to the cremasteric reflex? A) Genitofemoral nerve. 1304 YOU HAVE to know a few of the most famous nerves in anatomy. So, what nerve supplies the LATERAL side of the thigh? A) Lateral cutaneous nerve. 1305 Again, famous nerves...What nerve supplies the anterior LOWER abdominal wall? A) Iliohypogastric Nerve 1306 You will have to know how to calc. an ODDS RATIO for the USMLE. So, what is the formula and what's it for? A) Odds ratio = (TruePositives/TrueNegatives)/(FalsePositives/FalseNegatives). 1307 OH, I forgot to say, ODDS RATIO is used for CASE CONTROL studies to assess and approx. of the relative risk of disease if the PREVALENCE is low. 1308 You are going crazy studying for the USMLE because it is a torture to keep at it. You are given CHLORPROMAZINE. What are the side effects? A) This has antimuscarinic effects, (DRY MOUTH, CONSTIPATION). And ORTHOSTATIC HYPOTENSION, SEDATION. 1309 Your friend is depressed studying for USMLE. You given her Imipramine. SEs? Just name a couple. You cannot know everything, ya know... A) This classic Tricyclic has anticholinergic, antihistamine effects, hypomania. And orthostatic hypotension. 1310 A classic MAO inhibitor is Phenelzine. What are a few of the classic side effects if given a case on the USMLE? A) MAO inh. don't mix well with TYRAMINE, you get HTN. You can also face hypotension when getting up too fast. 1311 Tricky. There is a group of USMLE students, number is a quarter of a million. 10,000 have a disease called "I can't standing studying for USMLE." 1,000 new cases are diagnosed each year. 400 die from that PARTICULAR disease. Unfortunately, 2500 DIE from ALL causes every year. Give the PREVALENCE of the dx? A) 0.04...Recall PREVALENCE is the # of cases of a dx at a single moment in time divided by the TOTAL population within a given span of time. so, 10K/250K. 1312 REFER to case/concept 1311. What if the USMLE question asked you to calculate disease specific mortality rate? WHAT is it? A. It is the number of deaths per year from the dx in question DIVIDED by the population. So, 400/250,000. 1313 Refer again to Case/Concept 1311, what is the RATE OF INCREASE of the disease? A) Here, it is the number of NEW cases a year minus the number of deaths (or cures) per year....ALL divided by the total population. So, here, (1000-400)/250,000. 1314 True or False, a psychotic has tardive dyskinesia, can you substitute fluphenazine with CLOZAPINE to control for the side effects? A) YES, but watch out for agranulocytosis... 1315 USMLE literature said you need to know Kubler Ross stages of dying. What are they? A) Recall the word Dabsa, say it over and over. DABSA: D enial A nger B argaining S adness A cceptance It is SO depressing, but you will see this in patients over and over. Life is very very difficult. Keep a soft and loving heart in God. 1316 A man comes to your office unhappy with his past relations with women but HAPPY with his relations with men. He admits tremendous guilt. Is this (ego-dystonic or ego-syntonic)? A) Ego-dystonic...due to his guilt. 1317 Which of the following will alter the pos. pred. value of a test? (PPV) (Pick Incidence, Odds ratio, Prevalence, Relative Risk...one of the previous is correct) A) Prevalence (which is defined as the total number of disease cases in a specific period of time). This directly affects the PPV value (True Positives/Total Positives). RECALL that INCIDENCE is the number of NEW cases of a disease in a specific time period. There is a formula, but RR or Relative risk can define the incidence of a disease in a TREATMENT group divided by the incidence of a disease in a PLACEBO group. 1318 A kid comes in with BACTERIAL meningitis. What is released by the PREDOMINANT WBC present? Is it peroxidase???? A) No, it is LYSOZYME released by neutrophils. Peroxidase is released by eosinophils. Note that if it were a viral meningitis, there would be more LYMPHOCYTES. 1319 KNOW that if you are faced with a diabetic type I, GIP, (gastric inhibitory peptide) is released in response to HYPERGLYCEMIA. 1320 If I point to a cell on the pancreas and you figure out that it is an alpha cell, do you know it promotes glycogenolysis? Can you point to one if given a histo slide of the pancreas? Recall that the alpha cells are on the outside periphery, beta cells fill the inside. 1321 True or False: The GFR can be calculated by determining the clearance of PAH? A) False! PAH determines ERPF or Effective Renal Plasma Flow. Recall ERPF = UV/P for PAH. PAH is totally secreted in the proximal tubule and into the urine. You may have gotten confused if you said true because GFR is found by INULIN, which is filtered, not reabsorbed, and only slightly secreted into the urine. KNOW that in clinic, you approximate GFR though with CREATININE. valuemd.com 1322 You will see liver disease and thus ascites on your test and in clinic. What exactly causes this process? Descreased plasma volume?? A) NO! This is due to INCREASED hydrostatic pressure in the splanchnic beds secondary to portal hypertension! KNOW also that hypoalbuminemia and reduced oncotic pressure also play a part. 1323 Q) You have a woman who types 12 hours a day for years coming in with numbness on her hands. What deficit in sensation/action will she face? A) YOU HAVE TO KNOW carpal tunnel syn. The damage to the median nerve makes the THUMB weak via the abductor pollicis brevis, flexor pollicis brevis, opponens pollicis. Distal to the carpal tunnel, you will lose control of the first and second lumbricals which flexes the digits two and three at the metacarpophalangeal joints and extension of the interphalangeal joints of the same digits. KNOW that the ADDUCTION of the thumb is the only short thumb muscle NOT innervated by the median nerve. KNOW that you will NOT lose sense in the lateral half of the dorsum of the hand because the area is supplied by the RADIAL n. Gosh, this is CONFUSING, but HIGH HIGH YIELD. Look at the innervations of the hand on a diagram in Netter's! 1324 You have to know how to do this easy calculation/concept....there is an adult male weighing 75 kg. What is the volume of the Total Body Water, Intracellular Volume, Extracellular volume? A) First, KNOW 60% of the weight is Total Body Water (so 45 Liters). Now, KNOW that of this 45 Liters, 2/3 is INTRACELLULAR and 1/3 is EXTRACELLULAR (people often get these mixed up). So Intracellular is 30 Liters, Extracellular is 15 Liters! 1325 Listen, your attending asks you how you will know if a spot of a patient's drop of bodily fluid is PLASMA or SERUM. A high level of what substance will identify the specimen as PLASMA? (pick Albumin OR Fibrinogen) A) Fibrinogen. You have to UNDERSTAND that serum and plasma are DIFFERENT. Serum is DERIVED FROM plasma by extraction of fibrinogen and coag factors 2, 5, 8. KNOW that Albumin is present in BOTH serum and plasma. 1326 YOU HAVE TO KNOW THIS because your attending will ask, after he places a Swan Ganz catheter in an ARDS pt. with a pulmonary artery wedge pressure of 6 mmHg. The SAME pressure will be found in WHAT HEART CHAMBER? A) Left Atrium 1327 A student is late to his USMLE test and is HYPERVENTILATING! And thus doubles his alveolar ventilation. Suppose his initial alveolar PACO2 is 50 mmHg and his CO2 production is constant. What is his NEW alveolar PCO2 on HYPERVENTILATION???? A) 25 mmHg. It is HALVED. 1328 During the USMLE and in clinic meetings, you will have to read hundreds of FLOW VOLUME CURVES. Given a "typical one" what point on the curve represents RESIDUAL VOLUME? What about the "Effort Independent" part? A) Residual volume is the LOWEST volume, usually all the way to the right of the graph. The effort independent part is the even downward sloping area. 1329 Students get Secretin and Somatostatin mixed up. What is the difference? Origins please? A) KNOW secretin is secreted by the S cells of the duodenum and in response to an meal. It stimulates BICARB. fluid from the pancreas and bile ducts. This neutralization allows pancreatic enzyme activation. KNOW that somatostatin is secreted by the D cells of the pancreatic islets. It is inhibitory to most things secreted.... 1330 Q) ACTH promotes CORTISOL production by stimulating WHAT reaction? A) Cholesterol to Pregnenolone (via enzyme desmolase). This is the FIRST step. The next step is Pregnenolone to PROGESTERONE. From there, it is converted to 17 hydroxyprogesterone, then 11 deoxycortisol (via 21 B Hydroxylase), then finally to cortisol. 1331 An OLDER pt. of yours has ONE SIDED hearing loss. What is lesioned? (pick Organ of Corti OR Medial Lemniscus or Inferior colliculus) A) Organ of Corti. KNOW any lesion of a structure PROXIMAL to the superior olivary nucleus will give an ipsilateral deafness. Lesions DISTAL like the inferior colliculus to the medial geniculate nucleus to the primary auditory cortex/Hesch's gyrus will give BILATERAL deafness.     
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02-03-2005, 09:34 AM
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Amazing work from a great Man.
Hi tommy,
I think you are simply great.All adjectives fail to explain what i feel about u.You can be a superior teacher.You are not insecure and jealous to hide anything which itself shows how good a human being u r.U r truly superior. Keep it up. Jagdish
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