-erythromycin interferes with translocation, INHIBITS PROTEIN SYNTHESIS.

-A

5-y/o girl is brought to the physician because of listlessness,

fatigue, and dull pain in the right upper quadrant of the abdomen. Her
height and weight are below the 25th percentile. Laboratory findings
indicate that the content of her B-globin chain is 15% to 20% of
normal. Sequencing of the B-globin gene shows a point mutation in a
sequence 3' to the coding region in which AATAAA is converted to
AACAAA. Consequently, the amount of mRNA for B-globin is
decreased to 10% of normal. Which of the following functions in
mRNA synthesis and processing is most likely encoded by the
sequence AATAAA?
A.
Capping with GTP
B.
Cleavage and
polyadenylation
C.
Silencing of the promoter
D.
Splicing of the initial mRNA
transcript in the nucleus
E.
Transport of the mRNA out of
the nucleus

-propranolol blocks renin, AT1,

AT2, n aldosterone levels but
doesnt affect Bradykinin since
it doesnt work through ACE
. T-cell thymocytes in thymic cortex.
-The cells are T-cell in origin because they have t-cell receptors so can't be Bcells so cross out B & C & D.
-Cytotoxic T-cells are CD8+, these cells are not, cross out A.
-Answer is E because immature T-cells in thymic cortex are CD4- and CD8-.

They have not undergone positive/negative selection yet to become either

CD4+ or CD8+.
-Also, MHC I is expressed in all nucleated cells.
lymphatic drainage of vulva - internal iliac,external
iliac and superficial femoral nodes.
external iliac nodes - drain vulva, cervix and lower
portion of the uterus;
internal iliac nodes - receive drainage from all
internal pelvic organs as well as vulva, clitoris and
urethra;
common iliac nodes - receives lymph drainage
from cervix and upper portion of vagina;
inferior gluteal nodes - receives lymph drainage
from cervix, the lower portion of the vagina and
Bartholin's glands;
superior gluteal nodes - receives drainage from
cervix and vagina;
- sacral nodes - drain cervix and vagina;
subaortic nodes - drain cervix and vagina;
aortic nodes - drain cervix, uterus, oviducts and
ovaries;
rectal nodes - drain cervix and vagina;
parauterine nodes - drain vagina, cervix and
uterus;
superficial femoral nodes - drain external genitalia
of the vulvar region, gluteal region, leg and foot;
deep femoral nodes - drains the leg.
Some facts about Clitoris
A woman's clitoris extends from the visible portion
to a point below the pubic bone.

Artery ;Dorsal artery of clitoris

Nerve ;Dorsal nerve of clitoris
Precursor ;Genital tubercle
The clitoris has the most dense nerve supply of
any part of the skin, with many mucocutaneous
end-organs and closely set nerve networks. The
Vater-Pacini corpuscle is at the base of the clitoris
and the organized mucocutaneous ending is
present on the entire inner surface of the labia,
with greater concentration toward the clitoris. No
sign of specific nerve endings has been found in
deep vaginal mucosa and no intraepithial endings
are present.
Nerve supply to perineum
The nerve supply to the perineum originates from
three main sources:
1. The Genito-femoral Nerve (L1,L2).
2. The pudendal nerve arises from the anterior
rami of the second to fourth sacral roots. These
form a trunk before leaving the pelvis via the
greater sciatic foramen. It passes immediately
behind the ischial spine and swings forward to
enter the perineum via the lesser sciatic foramen.
The nerve passes through the ischiorectal fossa
where it gives off its terminal branches. The
inferior rectal nerve innervates the external anal
sphincter and the perianal skin. The perineal nerve
innervates the sphincter urethrae and other
muscles of the anterior compartment via a deep
branch, and the skin of the perineum poterior to
the clitoris via its superficial branch. The dorsal
nerve of the clitoris supplies the skin surrounding
this structure.
3. The perineal branch of the posterior femoral
nerve.

a frameshift mutation is a genetic mutation in

which a number of nucleotides not divisible by 3 is
inserted or removed from the DNA sequence. As a

result, the reading frame is disrupted and the

product of translation is changed. Familial
hypercholesterolemia has been associated with
frameshift mutation.
-the viral component or killed vaccines tend to
induce only humoral immunity, whereas the live
attenuated vaccines induce both humoral and cellmediated immunity.
-HIV attachment to the target cells is mediated by
the binding of viral proteins p120 to the CD4
membrane protein of T helper cels.
-Antiretroviral agents that selectively bind to the
HIV envelope transmembrane glycoprotein Gp41
prevent the conformational changes necessary for
the viral membrane to fuse with the target cellular
membrane. Fusion Inhibitors
-fatty acid oxidation occurs in mitochondria
whereas, fatty acid synthesis takes place in the
cytosol.
-Thioridazine is an anti-psychotic medication that
may cause retinal deposits that resemble retinitis
pigmentosa
-Chlorpromazine is an anti-psychotic associated
with corneal deposits.
-Olanzapine is associated with weight gain
-Clozapine is associated with agranuocytosis and
seizures.
-Factor 7 prolong PT
Factor 8 prolong PTT
-a component of Hep B virus envelope, HBsAg is a
noninfective glycopretein that forms spheres and
tubules 22nm in diameter.
-HBcAg and HBeAg are two nucleocapsid
components of HBV that has have been found to
correlate with viral replication.

-In diabetes Ketoacidosis, theres gonna be

increased extracellular K+ concentrations, and
decreased intracellular K+ stores.
-case-fatality rate is calculated by dividing the
number of fatal cases by the total number of
people with the disease.
-calcineurin is an essential protein in the activation
of IL-2 which promotes the growth and
differentiation of T cells. Immunosuppressants
such as cyclosporine and tacrolimus work by
inhibiting calcinerin activation.
-Dobutamine is a relativelt selective B1 adrenergic
agonist that increases heart rate, contractility,
connection velocity, and myocardial oxygen
conduction!
-Abciximab is a blocker of GP2b/3a receptor. this
receptor is either deficient or defective in pts with
Glanzmann thrombasthenia.
-rabies virus contains a ss negative RNA genome
with viral encoded RNA dependent RNA
polymerase. TX is a killed vaccine.
-ceftriaxone adequately covers all of the organisms
except for Listeria. You have to administer
Ampicillin to treat Listeria.
-end product of sorbitol metabolism is fructose,
not glucose.
-Primary ciliary dyskinesia, A.R. disorder,
kartagener > impaired sperm motiloty due to
abnormal tail function implies a defect in the
structure or function of axoneme of the sperm
flagellum.
-Trazodone>highly sedative anti-depressant causes
Priapism.
-Fluoxetine and other SSRIs cause decreeased
libido, anorgasmia and increased lately to
ejaculation. they can be used to treat premature
ejaculation.

-Phenelzine is a monoamine oxidase inhibitor

(MAO-I) used in the treatment of depression.
Monoamine oxidase is a mitochondrial enzyme that
dominates primary and secondary aromatic
amines. No priapism associated with MAO-Is
-beta blockers including esmolol, slow AV
conduction. delayed condition through the AV node
causes PR interval prolongation.
-meckel diverticulum occurs due to failure of
obliteration of the omphalomesenteric duct.
-in optic neuritis, optic nerve is damaged. light
shown in the affected eye will cause neither pupil
to constrict bcoz that nerve cant sense the light.
howler, the contralateral eye, once light shown
there, will cause both pupils to constrict because
the motor pathways are intact.
-infertility due to PCOS, you treat them with
Clomiphene, a selective estrogen receptor
modulator that prevents negative feedback
inhibition on the hypothalamus by circulating
estrogen, which is increased gonadotropin
production (FSH and LH) and ovulation.
-Treated with Acyclovir, it means it was a viral
infection caused by herpes simplex. elevated
protein, normal glucose, and lymphocytic
predominance are characteristic of viral meningitis.
-brachiocephalic vein syndrome vs SVC
:brachiocephalic vein drains the ipsilateral jugular
veins so the symptoms of face swelling, right arm
swelling, and engorgement of subcutaneous tens
on the right sid of the neck will be on one side. as
compared to with SVC syndrome, these same
presentation will be bilateral.
-hyper M syndrome, B cells produce high amount
of IGM, but fail to switch to the synthesis of other
types of immunoglobulins.
-defcts in T-cells IL-2 receptors can cause severe
combined immunodeficiency disease (SCID). In pts
with SCID, both B and T cell mediated immunity is
depressed.

-Vit K is an essential cofactor for the hepatic

microsomal carboxylase that converts glumly
residues into gamma-carboxylglutamates.
-pathophysiology of EML4-ALK NSCLC is most
similar to the pathphys of CML.
-ABL proto-oncogene is transported from
chromosome 9 to chromosome 22 where its placed
adjacent to the BCR gene.
-Bcr-Abl in CML, codes for the fusion protein with
constitutive tyrosine kinase activity.
-doxorubicin, leads to swelling of the sarcoplasmic
reticulum is the morphologic sign of an early
stage of doxorubicin associated cardiomyopathy.
-the most effective method of preventing
doxorubicin cardiomyopathy is dexrazoxane.
-non-selective b blocker such as propranolol
exacerbate hypoglycemia and mask its adrenergic
symptoms. for this reason, they should not be
used in patients with diabetes mellitus. selective
B1 antagonists should be used instead if a bblocker is necessary.
-the nucleolus, the dark intranuclear body visible
by both light microscopy and EM,is the site of
ribosomal RNA synthesis.
-gram positive, catalase positive, coagulase
negative.staph epidermis. TX is Vancomycin with
or without rifampin!
-killed or viral component vaccines predominately
generate a hymnal immune response instead of a
strong cell-mediated immune response. (they
block viral entry into cells).
-interferons a and B are produced in response to
viral infections and act on neighboring cells
(paracrine signaling) stimulating them to
synthesize antiviral proteins that degrease
intracellular mRNA and impair protein synthesis.
-PKU, AR, 1/4th chance of it getting passed onto
future generations.

-goodpasture>anti-GBM-Abs>target alpha3-chain
of collagen type 4.Linear IgG and c3 deposition.
-ANA test for SLE is quiet sensitive, but not
specific. sDNA and Smith antibodies are more
specific for SLE.
-granulomatous with polyangitis is associated with
anti-neutrophil cytoplasmic antibodies (C-Anca).
pauci immune
-Amphotericin B is used to treat mucormycosis and
has renal toxicity as its SE. so, serum postassium
and magnesium are routinely monitored.
-AV node refractory period determines the number
of atrial impulses that reach the ventricle.
-overexpression of bcl-2 leads to increased
secretion of Bcl-2 protein, which inhibits apoptosis
and promotes survival of tumor cells. associated
with cell death cascade
-Vincristine, an vinca alkaloid, precent
polymerization of microtubule formation, causing
cell cycle-specific cytotoxicity during the M phase
of the cell cycle as the replicated chromosome are
unable to align and subsequenty unable to
segregate into the daughter cells.
-immature t-lymphocytes express both CD4 and
CD8 cell surface in addition to a complete TCR or a
pro-TCR.
-these lymphocytes exist in the thyme cortex
where they undergo positive section.
-thymic medulla-where they undergo negative
selection.
-subacute headache, fever, and neck stiffness in
the rpresence of a lymphocytic CSF pleocytosis,
modestly elevated CSF protein, and otherwise
normal CSF parameters points to a diagnosis of
ascetic meningitis. Enteroviruses, including
coxsackievirus and echovirus, are the most
common cause of aseptic meningitis.
-Like aseptic meningitis, pts with bacterial
meningitis causes fever, nuchal rigidity, and

headache. however, pts with bacterial meningitis,

tend to also show a sign of significant meningeal
irritation, and are more likely to experience
alterations in mental status and seizures. CSF of
bacterial meningitis often shows a neutrophilic
pleocytosis, low glucose, significantly elevated
protein, and positive gram stain and culture.
-homozygote carriers of factor V leiden have fifty
to one hundred times the risk of developing a
thrombosis.
-osteoclasts originate from hematopoietic
progenitor cells. Rank-L and M-CSF play an
important role in osteoclast differentiation. Pagets
disease of the bone is csaused by excessive
osteoclastive respiration.
-primary VZV typically occurs in children and is a
highly contagious condition described as
chickenpox. produces fever, malaise, laryngitis,
and a generalized vesicular and pruritic rash.
secondary, combination of variables IgG antibodies
and dermatome-centered, vesicular , painful rash
is strongly suggestive of herpes zoster (shingles).
herpes zoster results from the reactivation of
latent varicella-zoster virus infection within the
formal root ganglia and most frequently occurs in
the elderly or immunocompromised.
the recurrent laryngeal nerve travels in close
approximation to the inferior thyroid artery and
can be injured in surgical procedures of the
anterior neck (thyroidectomy), resulting in
laryngeal muscle paralysis, hoarseness and
dyspnea.
-the cephalic and gastric phases stimulate gastric
acid secretion, while intestinal influences tend to
reduce gastric acid secretion.
-a pt with ruptured ectopic prennancy would
rpesent with abdominal pain, vaginal bleeding,
hemorrhagic shock, and a history of amenorrhea.
endometrial biopsy would reveal decidual
(gestational) changes in the endometrium but no
chorionic villi.

-myotonic dystrophy is an autosomal-dominant

disorder. causes by an increased number of
trinucleotide repeats on myotonia-protein kinase
gene. sustained muscle contraction (myotonia),
along with weakness and atrophy is common.
cataracts are seen in almost all pts. frontal balding
and gonadal atrophy are other common features.
-T-cell ALL often presents as a mediastinal mass
that can cause respiratory symptoms, dysphagia,
or superior vena cava syndrome.
-B-cell ALL which accounts for almost 70-80% of
all cases of ALL, presents with fever, malaise,
bleeding, bone pain, and hepatosplenomegaly.
Generally, B-cell ALL isnt associated with
symptoms of mediastinal compression.
-in ARDS, theres deceased in lung compliance, an
increase in the work of breathing, and worsened
V/Q mismatching. the pulmonary capillary wedge
pressure is typically normal.
-any treatment that prolongs the survival but does
not cure the disease will increase prevaemce due
to an increase in th number of afflicted (but still
alive) individuals over time.
-pons involvement, trigeminal nerve assoication!
-erythrocytes precursors found in the liver and the
spleen, indicating extra medullary hematopoiesis,
a condition characteriszed by erythropoietinstimulated, hyper plastic marrow cell invasion of
extra medullary organs.
-sickle cell trait pts, got 60% HbA and 40% HbS,
will be protective against plasmodium falciform,
however, they will sickle when sodium
metabisulfite is added.
-Leuprolife is a GnRH agonist that causes first a
transient increase, then a decrease in both
testosterone and DHT levels. Finasteride causes a
discordant decrease in DHT level.
-Transmural inflammation with fibrinoid necrosis is

most characteristic of PAN. (polyarteritis nods).

fever, malaise, weight loss, abdominal pain, and
melon are frequent symptoms of PAN. PAN is
associated with hep B infection in 10-30% of
cases.
-darkening of skin due to UV is due to increased in
the production of melanin but stable number of
melanocytes.
-severity of mitral stenosis: S2 to opening snap
time interval
-best indicator of severity of MR is: presence of
audible S3.
-mid-systolic click: MVP.
Cricopharyngeal muscle dysfunction is a condition
caused by diminished relaxation of pharyngeal
muscles during swallowing. he subsequently
increased intraluminal pressure in the oropharynx
causes the mucosa to herniate through the wall at
a point of muscle weakness, forming a Zener
diverticulum. Clinically, patients elderly presents
with oropharyngeal dysphagia, coughing, choking ,
and recurrent aspiration.
-zenker occurs occurs in the top esophagus (false
diverticulum)
-meckels occurs in the mid esophagus and results
from mediastinal lymphadenitis (tuberculosis,
fungal infections).
-free wall rupture occurs 3-7 days after the onset
of total ischemia, when coagulative necrosis,
neutrophil infiltration, and enzymatic lysis of
connective tissue gave suffienently weekend the
infarcted myocardium .
-lowering the cut-off point increases the sensitivity
of a test. the true positive will also increase but
the false positive hwill have a relatively larger
increase. this results in a decrease in the PPV and
the FN.
-in liver cirrhosis, the pressure is elevated in the
portal vein.
-Myelodysplasia is a premalignant condition that

manifests with pancytopenia, impaired blood cell

differentiaiton, and clonal expansion of the
mutated hematopoietic cells in the bone marrow.
elevated MCV can be present but
hyperhsegmented neutrophils are not seen.
-increased AFP>Hepatocellular caridnoma
(HBV)>integration of viral DNA into the genome of
host hepatocytes triggers neoplastic changes.
-Alveoli normally has partial pressure (PAO2) of
104
-oxygen in the arterial blood (PaO2) is normally
100 mmhm
-after resolution of symptoms of VZV, it travels via
sensory fibers to the dorsal root of the spinal cord
where it remains dormant for years. weakening of
cellular immunity leads to reactivation of the virus
that manifests as herpes zoster (shingles). ON LM,
u see intranuclear inclusions in keratinocytes and
multinucleate giant cells.
-increasing heme prep will lead to repression of
hepatic ALA synthase activity.
-cisplastinnephrotoxicity . Amifostine is a thiolbased cytoprotective free-radical scavenging agent
used to decrease the cumulative nephrotoxicity
associated with platinum-containing agents,
thereby disallowing reaction with the renal tubules.
Another preventative measure is establishing a
chloride diuresis (via intravenous normal saline)
because cisplatin stays in a nonreactive state when
in a higher chloride concentration.
-adding clavulinic acid to the amoxicillin treatment
will decrease amoxicillin cleavage by bacterial
cells.
-probenecid is a compound that decreases the
renal clearance of penicillins by inhibiting the
tubular organic acid secretion system. this agent
has been utilized to prolong the action of penicillin
in some settings.
-Aldosterone excess (conns syndrome) will cause
hypertrnsion, hypokalemia, metabolic alkalosis and

depressed renin. Alternatively, hyperaldosteronism

is the cause of type 4 renal tubular acidosis.
Aldosterone antagonists such as spironolactone or
eperenone can be used as medical therapy for
Conns syndrome.
-fibrates + statins = muscle pain!
-fibric acid derivates and bile acid binding resins =
cholesterol stones
-fenofibrate does not significantly alter statin
pharmacokinetic, it causes myopathy itself.
-length constant/space constant is decreased in
demyelination diseases like Multiple Sclerosis.
-glomus tumors occurring under the nailed, this
type of tumor originates from the modifid smooth
muscle cells that control thermoregulatory
functions of dermal gloms bodies.
-intermittent claudication (muscle pain with
exercise that remits with rest). its a result of
atherosclerosis of larger named arteries Lipidfilled intimal plaque
-isotype occurs in the centers of lymph npdes and
require interaction of the CD40 receptor on Bcells
with CD40 ligand z(CD154)
-HCV is a RNA-dependent RNA-polymerase, which
lacks 35 exonuclease activity.
-DNA primase, is a form of RNA polymerase. in
bacteria, it binds with DNA helices and synthesizes
a short RNA primer to which nucleotides can be
added by DNA polymerase
-3 of the mRNA transcript is responsible for
addition of the Poly-A-tail. the ponytail is not
transcribed from DNA, but rather added as a
posttransciptional modification downstream of a
consensus swuqnce (usually AAUAAA). [this part
is not transcribed from the DNA template].
-the short gastric artery and the left gastroepiploic
artery arise from the splenic artery immediately
after it passes the greater curvature of the

stomach.
-gastrodudodenal>posterior part of the duodenum,
it arises from the common hepatic artery.
-the right gastric artery supplies lood to the distal
elsser curvature of the stomach . it arises from the
proper hepatic artery.
-ALS: UMN (hyperreflexia and spasticity)
LMN(atrophy and fasciculations).
-transport of glucose into the cells of most tissues
occurs by means of facilitated diffusion.
-O2 and CO2 through simple diffusion
-receptor mediated endocytosis alows for cellular
uptake through the formation of membranebound, typically clarthin-coated, vesicles.
-dialated cardiomyopathy > high systolic pessure
gradient between the left ventricle and the aorta.
-major source of blood supply to the upper ureter
are the renal arteries.
-the superior vesicle artery is a branch of the
internal iliac artery that supplies blood to the
superior portion of the urinary bladder. it also
provides branches to th distal ureter.
-Cilostazol is a phosphodiesterase inhibitor used in
pts with intermittent claudication. in addition to
inhibition of platelet aggregation, cilostazol is a
also a direct arterial vasodilator. citostazol has
been shown to be superior to aspirin in the
treatment of peripheral arterial disease.
-hypocalcemia and hypomagnesemia are
associated with Foscarnet, not ganciclovir.
-CCK is the hormone responsibel for gallbladder
contraction. it is made in the duodenum and
jejunum in response to fatty acids and amino
acids.
-lipofuscin in an insoluble yellow-brown pigment

composed of lipids and phospholipids that is

associated with aging wear and tear
-hemosiderin accumulaton is prominent in pts with
hemolytic anemia or who receive repeated blood
transfusions. iron chelation therapy is indicated.
-Alkaptonuria>brown spots on sclerae, urine turns
black, dark connective tissue>Homogentisic acid
oxidase def
-the macrophages that form the giant cells in m.
tuberculosis (acid-fast bacilli) are activated by
CD4+ Th1 lymphocytes.
-HCTZ>causes hypercalcemia by increasing the
distal tubular reabsorption of filtered calcium. the
increased serum calcium levels usually suppress
PTH.
-low frequency sound is best detected at the apex
of the cochlea near the helicotrema.
-high frequency sound isbest detected at the base
of he cochlea near the oval and round windows.
-Restrictive lung disease >Radial traction on
airways walls.
-Carbamazepine can cause aplastic anemia and so
requires monitoring of CBC
-Citalopram is a selective serotonin reuptake
inhbitor. side effects with this class are generally
mild, though sexual dysfunction is common,
especially in women.
-Clozapine (an atypical antipsychotic) can cause
agranulocytosis and seizures.
-Lamotrigine is associated with risk of rash,
including Stvens-Johnson syndrome, which can be
life threatening.
-Ridperidone is an atypical antipsychotic. common
SEs include symptoms of hyperprlactinemia such
as galactorrhea and amenorrhea.
-Significant adverse effects of tradozone include
painful erection (Priapism), orthostatic
hypotension, and sedation.
-bone specific ALP reflects osteoblastic activity.
TRAP. urinary hydroxyproline, and urinary

deoxypyridinoline reflect osteolastic activity.

(Urinary deoxypyridinoline is the m reliable of the
three)
-dystonia is a syndrome of prolonged, repetitive
muscle contractions. this condition may be the
result of impaired function of basal ganglia.
cervical dystonia (spasmodic torticollis),
blepharospasm, and writers cramp are the m c
types of focal dystonia.
-Parvovirus infection B19, is a highly tropic for
erythroid precursor cells and replicates
predominately in the bone marrow.
-major basic protein released by eosinophils
normally functions to kill helminiths. it is also
thought to contribute to the bronchial epithelial
damage sustained by patients with atopic
(extrinsic allergic) asthma
-coopers pectineal ligament will be posterior to a
femoral hernia.