Cases/questions:

Female patient is on a whole bunch of drugs including Warfarin, diuretics, antihyperlipedimics,

etc. She has recently become pregnant and has consulted the doctor, which of the drugs should be
discontinued.

Answer: Warfarin (teratogenic for fetus).

Which of the abdominal aorta branches supply the foregut

Answer: Celiac trunk

Patient presents with inflammation and necrosis of small intestine, ascending colon and proximal
2/3 of transverse colon, which blood vessel is involved:

Answer: superior mesenteric A.

Which branchial arch makes up Mandible and Mylohyoid, etc.

Answer: first arch

Picture of endochondral bone formation (similar to picture in first aid) and asks which of the
following bones are formed by the shown process. Choices were clavicle, skull, femor, etc.

Answer: Femur (long bones)

Picture of a child being able to bring her shoulders together, which bone is she missing:

Answer: clavicle

Which cells in testes provide the Blood Testes barrier:

Answer: Sertoli cells

Knee injury and tear in MCL and ACL

Which organ in the body releases most ANG II into the body?

Answer: lungs (has ACE)

EM of muscle asking to point to Z line

Scraping the stratum corneum from the skin, what is the most important complication?

Answer: loss of fluid from body and dehydration (since stratum corneum contains Keratin and
protects against blood loss)

Gap junctions are able to transmit Electrical current between cells

Patient presents with fever and shivering. What is the purpose of shivering?

Answer: thermoregulation (it generates heat).

Sudden wild flailing of one arm, where is the lesion of the drawing:

Answer: subthalamus

Patient presents with deviation of uvula and shoulder droop, where is the lesion?

Answer: jugular foramen

Point to the muscle that depresses the eye from the adducted position

Answer: Superior Oblique muscle (same diagram as in page 108 first aid, 2001 edition).

Marcus Gunn Pupil

Lesion in which blood vessel causes left homonymous hemianopsia (angiography similar to circle
of willis pictures in High Yield Neuro)

Answer: right post. Cerebral

Brown Sequard lesion

Dorsal Column pathway and lesions of Gracilis fibers and Cuneatus fibers and how they affect
sensation on upper and lower limbs.

Radial nerve injury

Cervical rib and what it affects

Answer: inf. Trunk of brachial plexus

Cohort study

Heroin addiction and long term maintenance

Answer: methadone

Delirium (patient not oriented as compared to dementia in which patient is oriented)

Conversion disorder

Post traumatic stress disorder

Personality disorders: Avoidant and Schizotypal

Narcolepsy

Borderline patient using splitting as a defence mechanism (either everything is good or

everything is bad)

Lots of questions on shizophrenia (at least 4)

Thought disorder, Loose associations, etc.

Hardy Weinberg population genetics calculations

Glucose-6-phosphate dehydrogenase deficiency and reaction to sulfa drugs

Which a.a. become essential in a patient with PKU with phenylalanine restricted diet:

Answer: tyrosine

Picture of patient with blue sclera

Answer: abnormal collogen synthesis

Patient presents with muscle weakness and hypertrophy of calf muscles, which chromosome is
defective?

Answer: X chromosome (DMD)

Uncoupling agents and on which part of mitochondria they work?

Anwer: dissipate proton gradient across the inner mitochondrial membrane

Urea cycle

Arachidonic Acid products (very heavily tested, at least 5 questions)

LT B4 (neutrophil chemotactic agent)

LT C4, D4, E4 (slow reacting substances of anaphylaxis)

TX A2 (vasoconstrictor and stimulates platelet aggregation)

PG I2 (inhibits platelet aggregation and vasodilation)

Collogen Synthesis and structure

Vitamins (heavily tested):

B1 (alcoholics)
B2 (cofactor in oxidation and reduction-FADH2)

B6 (given along with isonizid to prevent peripheral neuropathy)

Vitamin C (hydroxylation of proline and lysine in collogen)

Vitamin D (which organ hydroxylates 25 hydroxy D3 at alpha1 position: kidney)

Vitamin K (coagulation factors)

Which test diffentiates staph aureus from other staph (believe it or not!)

Answer: Coagulase test

Alpha Hemolytic bacteria

H. pylori infection (at least 2 questions)

BMT regimen

Which of the pairs result in long term neurological complications?

Answer: Borrelia and Treponema

Mucor infection in diabetics

(same picture shown as on page 191 of first aid, 2001 edition)

After an earth quake in california, epidemic of lower respiratory infection which lasts for 2-3
weeks, which of the bugs responsible for it?

Answer: Coccidiodomycosis

Candida vaginalis in diabetics

Toxoplasma and brain abcess in HIV

Giardia and foul smelling stools

Most important sequale in infectious Mono:

Anwer: splenic rupture (I think).

Patient has C3 deficieny, which disease is he most likely to be susceptible to

Answer: only capsular organism listed was pnomococcus

2 questions on Huntington Disease:

trinuclear repeat pattern

point to Caudate Nuclei on MRI

alpha fetoprotein as a marker for malignancy

11,22 translocation in Ewing sarcoma of the bone

Hereditory Spherocytosis and treatment

Answer: splenectomy

IgG spike on plasma proteins (shown in a diagram) and asked how the patient presented

Answer: bone pain

Hirschprung’s disease and what causes it

Patient presents with cirrhosis after being diagnosed of liver disease many years ago. When he
presented at first ALT was elevated, what is the most likely cause of cirrhosis?

Answer: Hep C (if AST was higher, it would have been alcoholic cirrhosis).

Chronic pancreatitis and its association with alcoholism

Pancreatic adenocarcinoma and signs associated with it (eg. Weight loss, obstructive jaundice and
palpable gallbladder

Diagnosis of emphysema in a non-smoker 25 year old with dyspnea, hyperexpanded lung fields
and lowered breath sounds and it’s association with a1antitrypsin deficiency (panacinar
emphysema)

Restrictive lung disease and FEV/FVC ratio (>80%)

Paraneoplastic syndromes associated with small cell carcinoma of the lung and the signs
associated with it (eg. Hyponatremia associated with SIADH in small cell carcinoma)

Patient presents with tremor and rigidity, upon taking history you find out that patient has been
experiencing with a designer drug. What is the most likely region of the CNS that’s involved

Answer: Dopaminergic neurons of substantia nigra

Treatment of Parkinson’s

Patient presenting with upper and lower motor neuron problems

Answer: ALS

Epidural and Subdural hematomas and their diagnosis based on history.

Patient presenting with signs of Broca’s Aphasia, point to region of the brain that is most likely
involved.

Diagnosis of Horner’s Syndrome

Patient presents with signs and symptoms of arthritis, morning stiffness and Dup. Deformity of
the hands and fingers, what abnormal test result is expected.

Answer: Anti-IgG antibodies in the serum (diagnostic of RA)

At least 3 questions on gout and drugs used for it (eg. Patient presents with joint pain after
chemotherapy for Hodgkin’s lymphoma, etc.)

SLE and kidney’s wireloop lesions, False positive on syphilis test (VRDL) and drugs which
induce SLE and diagnostic features

Patient presents with Sacroiliac joint inflammation, which HLA tests are likely to be positive

Answer: choose whichever one had HLA B27

Hyperaldosteronism and it’s diagnosis based on renin, Na and K values in plasma

Distinguishing between primary and secondary adrenal insufficiency

Pheochromocytoma and drugs used for it (esp. nonselective irreversible alpha blocker)

All the features associated with MEN I and MEN II

Hypho and Hyperthyroidism and diagnosis based on symptoms and signs and plasma values of
T3, TSH for each

Diabetes types I and II (at least 5 questions)

• Ketoacidosis associated with type I

• Symptoms associated with diabetic coma
• Renal complications (arteriosclerosis and glomerular lesions on light microscope
• Lab values associated with diabetic ketoacidosis

Carcinoid tumor diagnosis based on symptoms and what abnormal test is positive in urine

Answer High HIAA in urine

Osteoprosis and it’s association with corticosteroids

BPH and drugs used for it

Hyadid mole and increased HCG associated with it early in pregnancy

Endometrial hyperplasia and incrased risk of endometrial carcinoma with abnormal uterine
bleeding

An obese female presents with high LH and hirsutism. Dx?

Answer: Polycystic Ovarian Syndrome

Cardiomyopathies esp. Hypertrophic cardiomyopathy: hypertrophy involves the interventricular

septum and 50% is caused by mutation in B globin gene of heavy chain (familial). Usually seen
in athletes.

Heart murmurs and their diagnosis based on features of the murmur

DVT and pulmonary embolism. Bone marrow embolism seen as a complication of bone fractures.
May lead to sudden death.

Wegener’s granulomatosis and it’s Dx based on symptoms (C-ANCA was not given). WG
involves the upper airways and you’ll see granulomas (this is the distinguishing feature from
Goodpasture’s syndrome

Minimal change disease effacement of BM

Acid Base physiology

Pharmacodynamics graphs distinguishing Agonist with competitive antagonist and irreversible

antagonist

Mechanism of Tetracycline

Nephrotoxicity associated with Aminoglycosides and also ototoxicity.

Isoniazid and B6 which can prevent neurotoxicity

HIV triple therapy (two nucleotide reverse transcriptase inhibitors with a protease inhibitor.

Mechanism of Dantrolene

Isoprotrenol effect and reflex tachycardia associated with it

Mechanisms of action of sympathetic receptors, Dopamine receptors (eg. cAMP, IP3, etc.)

Antipsychotics and Tardive dyskinesia

Lithium and it’s effect on thyroid (may cause hypothyroidism)

Sumatriptan and it’s mechanism of action

ACE inhibitors and it’s effect on blood pressure and it’s mechanism of action

Cardiac glycosides and it’s effect on intracellular and extracellular Na and K

Busulfan associated with pulmonary fibrosis

Cisplastin associated with Nephrotoxicity

Lead poisoning and it’s features (eg. lead lines) and treatment

H2 Blockers and their mode of action and their effects on gastrin and stomach acid

Arachidonic acid products and their effects on vascular tone and platelet action

Leuprolide and it’s indications (also mechanism of action).

Pacemaker action potential and it’s differences with ventricular action potential (eg. upstroke is
opening of Ca channels rather than Na channels).

Calculation of cardiac output with Fick principle

Cardiac cycle graphs

Mechanism of smooth muscle contraction and its differences with skeletal muscle (eg.
involvement of calmodulin)

Capillary fluid exchange and calculations involving hydrostastic and oncotic pressures, etc.

Glucose clearance and at plasma glucose of 200 glucosuria begins

PTH and Vit D effects on plasma Ca and phosphate.

Steroid hormone mechanisms (binds to receptor located in nucleus or in cytoplasm)

Distinguishing 11B hydroxylase and 21B hydroxylase

Prolactin regulation and Dopamine

Oxygen dissociation curve and which factors effect it (eg. pH)

Secretin and stimulation of release of antacid

Bile and how it’s recycled (absorption via ileum and how it causes malabsorption of fat in
patients with ileal resection).

> Here are the q's I recall:

>
> 1. know your mediators (IL-2, IL-456, IL 10,
> TNf,TGF, IFN)
> 2. know cd 16 and 56 are killer cells
> 3. where both clotting pathways meet
> 4. acute MI what the gross and histo look like at
> all stages,
> 5. brachial plexus- I had ulnar nerve b/c interossei
> weren't working
> 6. know 2nd messengers-oxtyocin, alpha 1
> 7. herpes pneumonitis, with giant cells
> 8. splenic infarct, from where?
> 9. cardiac tamponade
> 10. go over jamie's sheets- 10 icm type q's
> 11. know the arachadonic acid pathway and enzymes
> and inhibitors
> 12. t(9;22) cml
> 13. lat rectus on mri
> 14. wilsons- they showed the kleiser fleicher ring
> 15. cystic hygroma- turners syn
> 16. mitochondrial inheritance -2 q's
> 17. know everything about digoxin 4 q's
> 18. pku
> 19. b-cell def- no germinal centers in LN
> 20. know the cyto p450 inducers and inhibitors - 6
> q's
> 21. scleroderma- ab against?
> 22. I had no sle
> 23. bph and prostate cancer- drugrs, recepters, -
> 3q's
> 24. ebv in Aids cancer- lymphoma
> 25. know your endocrine physio- hormones up and down
> 26. know the resp. curves in first aid, where would
> fibrosis be?
> 27. know histo of the hepatocyte- fxn of organelle-
> I had mitochiondria
> 28. know histo of kidney- pct, dct, loh- where
> glucose is reabsordeb, where
> vit d is activated
> 29. restrictive cardiomyopathy
> 30. p. carinii -know what it looks like
> 31. marasmus
> 32. carcinogens in bladder cancer
> 33. schistosomes in bladder cancer
> 34. ASCVD-2 q's
> 35. prinzmetal angina- drugs, recepters, -2 q's
> 36. endocarditis-viral, bacterial
> 37. India ink-crypto
> 38. ida, anemia of chronic dz
> 39. vwb dz- whats up?
> 40. henoch-scholheim purpura on the leg-vasculitis
> 41. pathogenesis of TB
> 42. didn't have a lot of behavioral but what I did
> have was alzheimers, and
> a few "what do u tell the pt" q's
> 43. hand foot mouth dz- coxsackie
> 44. cherry red macula and European-hexoaminidase a2
> 45. gauchers
> 46. tuberous sclerosis- 2 q's (when did we learn
> this)- know it is assoc. w/
> embryonal rhabdomyosarcoma and calcifications in
> brain
> 47. cancer met. to colon
> 48. crohns dz
> 49. hirshprungs dz- failure of neural crest cells
> 50. know your gi physio- 5 q's
> 51. moa of omeprazole
> 52. moa of vancomycin
> 53. moa of neostigmine
> 54. causes of malig. Hyperthermia
> 55. pathogenesis of spider angioma
> 56. malig. Htn- pic
> 57. min. change dz- vignette was classic
> 58. pid-chlamydia
> 59. carnitine def-s/s
> 60. transformation- dnase
> 61. fracture to fibula- loss of deep peronial nerve-
> loss of dorsiflexion-
> 2q's
> 62. damage to base of penis-blodd flow is lost in
> which part of urethra
> (weird q)
> 63. hypertinic bladder-whereis lesion?
> 64. where does seminoma drain?
> 65. know your fractures- what muscles pull them
> where- 3 q's
> 66. fracture to lt. 9-11 ribs- spleen
> 67. cavernous sinus thrombosis- fxn's lost
> 68. av nicking , banking- learnit well ,2q's
> 69. myasthenia gravis- 2 q's
> 70. hashimotos= 2 q's
> 71. dermatomes
> 72. 6-8-10, 8-10-12, lung -pleura relationship
> 73. rt. Atrial hypertrophy on cxr
> 74. paradoxical emboli
> 75. brca met. via axillary nodes
> 76. soft tissue sarcoma
> 77. hemoglobin c
> 78. hla b27- reiters syn
> 79. proteus- uti stones
> 80. pathogenesis of gall stone-supersat. Of
> cholesterol
> 81. acute panreatitis vignette-inc. amylase
> 82. nodular glomerulosclerosis in D.M.
> 83. know your vaccines, and active and passive
> immunizations
> 84. cohort study, case series
> 85. I had 5 q's on epidem. (ppv, spec, sens)
> 86. p=id
> 87. endometriosis
> 88. 2 bitemp. Hemianopsia's
> 89. know your goiters- toxic, hot, cold, non toxic,
> multitoxic
> 90. brached hyphi- dermatophyte
> 91. hyper -PTHism
> 92. cushings syn
> 93. addisons dz
> 94. duchenne's musc. Dystrophy- pedigree
> 95. osteo sarcoma
> 96. comparing osteomyleitis and osteo chondritis-
> weird q
> 97. pseudo gout
> 98. neuro syph- arguile robinson pupil
> 99. vitamins- b12, pyridoxine, and vit c
> 100. desmopressin in diabetes insipidus
> 101. know your murmers. How thy look normally and on
> a wiggers
> 102. I had no ekg-s
> 103. salmonella
> 104. mhc 1- tap ptotein
> 105. cavernous hemangioma, is it bad?
> 106. lot of angio tension -renin stuff- 4 q's
> 107. ipratropium in copd
> 108. colchicimein acute gout
> 109. filtration fraction up and down..why?
> 110. know your acid-base stuff- weird q's with
> combined.alcoholic that
> vomits and had diarrhea (what the !@#$#$?) know the
> values
> 111. know your lesions in the CNS- whats ipsi whats
> contra
> 112. little biochem on the exam-know the rls's
>
>
>>>
>>>1. I had two questions r/t Baye's Theorum (Genetics)
>>>2. Remember how I said ANS &CNS Pharmacology are Key!!
>>>3. Gliaden and wheat causing Celiac Sprue
>>>4. They showed a picture of a Penis with a lot of Painful nodules. They
>>>did not have H. ducreyi, T. pallidum, Herpes, as the choices!!! By the
>>>way, this was the first question I saw after I got back from Lunch.
>>>5. Conditions favoring Metabolic Acidosis/Alkalosis
>>>6. Slide of Hairy Cell Leukemia.
>>>7. I had five Questions on Lyme Disease (Go Watsons!) A word of
Caution,
>>>Lyme Disease does happen in Oregon.
>>>8. What Causes Trendelenberg Sign and Waddling Gait
>>>9. Know all about Heparin and Warfarin
>>>10. I had a question on Croup and Slapped Cheek Disease (Fifth Disease)
>>>11. Lots of Vitamin Questions, so know the roles of Vitamin
A,C,K,B12,B6,
>>>Thiamine.
>>>12. For the behavioral questions, they would ask you what the next step
>>>is. Pick the least invasive and the answer that gives the most degree of
>>>freedom. What I mean is that if the competent patient refuses to comply

>>>with the doctor, that is his right.

>>>13. For those that have the plagarized MSA Notes (Red ICM Book), it
would
>>>be a good idea to go over them before the exam. I had a few respiratory
>>>questions that could not have been answered had I not red the chart in
>>>the book.
>>>14. Role of Gap Junctions
>>>15. Nephritic and Nephrotic Syndromes
>>>16. I only had one SLE Question
>>>17. McArdles Disease, Tay Sachs, Gaucher's Disease were questions.

ANATOMY
-mesonephric ducts=male spermatochord
-inguinal fascia and saddle injury (kids starts to pee, where will urine go
inside body cavity, NOT down thigh)
-diaphragmatic hernia
-GI blood supply (celiac trunk=forgeut)
-ureters and obstructions
-macula adherens
-ciliar dynein (Kartagener's syn)
-picture of lesion in Broca's area
-spianl cord lesions
-braichial plexus (of course, mine was axillary n.)

BEHAVIORAL
-lots of "how would you respond as the physician" questions, WITH lengthy
clinical descriptions. read the actual question first, it will allow you to skip a
lot of the data they give
-graph asking how you would maximize sensitivity
-odds ratio
-types of studies (cohort, case-control)
-speech development (what the hell?)
-developmental milestones
-narcolepsy
-sleep apena (central vs. obstructive) X2

BIOCHEM
-DNA mutations
-where in cell introns are removed
-tRNA attachemnt to ribosomes
-modes of inheritence (I actually had one ask me the chance of a MAN
passing an X-linked recessive gene to a son, read CAREFULLY)
-urea cycle
-carnitine
-glucokinase vs. hexokinase kinetics
-enzyme kinetics
-collagen structure and the role of lysyl oxidase

MICRO
-staph aures food poisoning
-fungal questions X3
-pork tape worm
-normal flora for nose
-infant pnuemonia
-hypersensitivity (for contact dermatitis)
-Rhogam is PASSIVE immunity

PATH
-congenital heart defects
-fragile X dz
-risk of translocation with maternal age
-Duchenne's MD is xlinked
-CF: psuedomaonas infections and autsomal recessive
-marfans and dissecting aortic anuerysms
-neural tube defects and alpha FP
-melanoma (depth of lesion is worst sign)
-epidural hematoma (they called it extradural)
-anemias
-bleeding disorders
-multiple myeloma
-obstructive lung dz
-ARDS
-arthritis
-SLE
-ankylosing spondylitis
-osteoporosis and compression fractures
-hydatidiform mole is 46 XX
-breast dz (what a blocked lymph duct would look like??)
-Coxsackie B (dilated cardiomyopathy)
-heart murmurs
-temporal ateritis (tx: prednisone)
-acid/base graphs
-Xray of pnuemothorax

PHARM
-maintanence dose
-first order elim.
-effect of antagonist in general
-tetracycline mechanism (MORE than knowing 30S)
-aminoglycosides=ototoxicity
-INH mechanism
-cocaine additction mech.
-PAM
-Dantrolene mech. (Ca2+ from SR) (yes, got it right Kelly)
-Beta blockers
-Alcohol and Benzodiazipenes
-Sumatriptan mech
-Diuretics X5-6
-Quinidein efx X3
-Bleomycin side efx (cancer bear will be your friend)
-warfarin mech
-misoprostol (w/NSAIDs)
-H2 blockers
-Arachidonic acid pathway X3
-diabetic drugs (increasing insulin receptor sens)
-prednisone

PHYS
(not that many calculations, few were there weren't too bad)
-cardic output
-cariac loop cycle (then inferring which one had largest CO)
-control of BP
-filtration fraction
-Glc. clearance
-kidney hormones
-PTH
-uses of estrogen
-menopause profile
-O2 diss. curve
-secretion and bicarb
-calculate calories (from CHO, prot. and fat)

"G-d Does not Play Dice with Nature, The only reason for time is so
everything doesn't happen at once."
"-Albert Einstein- (1879-1955)"
Every obstacle presents an opportunity to improve our condition