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Note: The “good stuff” is way below. I had to add some filler because some a-holes alleged I was infringing some copyright. So I made this document more “original” by adding some filler up front! Hey Yall, I hope all is well! I know a lot of you are probably feeling like you don't know anything, trust me, 4th made all of us feel that way the entire semester, it was just a feeling we had to get used to, just keep "doing you" and doing what has worked up 'til this point and its going to be fine. I wanted to write yall to give yall some info on the comp, now that the comp exam is over and scores are out. A lot of yall have also been asking about why Brittany and I chose michigan over miami over so I figured I would write about that in this email too. If neither one of these topics interests you, then stop reading and get back to studying :) First, THE COMP (insert dramatic music). What exactly is the comp? Its an NBME (national board of medical examiner's??) exam that is 200 questions long and you get 4 hours and 15 minutes to take it, it is a paper exam (so you don't need to worry about taking it on a computer). Its a standardized test that medical schools throughout the country can give to their students to see how they match up with all other med students and to see how prepared their students are for Step 1. Your comp score can be converted into a "projected USMLE Step 1" score, so it is a very cool tool for you to assess where you are. You normally take the comp on the 1st day of 5th semester, you will need to bring your Ross ID and some number 2 pencils (still can't use mechanical). When do I start studying for the Comp? We didn't start "studying" for the comp until after 4th semester was over. Your top priority right now needs to be passing 4th semester so that you are able to take the comp. Use your time this semester to really solidify all the topics they are teaching you in 4th, and that in turn will set you up for success on your final and for the comp (and the step). Finals are tough this semester, so study hard for them and take the time and make the effort to review all that info from 3rd and 4th, the reason being that the majority of the Comp, (and from what I hear, the step) is based off that info. If you are using the DIT videos as I explained below, I would suggest counting back 17 days from when your Comp date is going to be (this will give you 15 days for the videos and then 2 days to review whatever material you still aren't solid on). Any time you have in between the last day of 4th and the 1st day you need to start the DIT videos use to spend some stress free time with your family and friends, you will need that to help you push through studying for the Comp. How do you study for the comp? Britt and I both passed, so this advice is therefore based on what we did, but just because we did it this way doesn't mean there aren't other ways to study for and pass the comp. We used the DIT (doctors in training)

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videos and accompanying packets. We signed up for the DIT program for the step, but the 2011 videos haven't been made yet, so we got boot-leg copies of the 2009 videos from our friends at Ross (I've heard the 2010 videos and packets are floating around hard drives at Ross now, so try to get those). Whichever version of DIT you get (2009, or 2010) make sure you also get the First Aid book for that year (if you have the 2009 videos, get the 2009 First Aid). The way this program works is that there are 15 days worth of videos (usually you have about 4 hours of video per day), and the videos basically walk you through First Aid and they guy who makes them tells you everything you need to know for the Step (and the COMP). He has you fill in his packets as he goes along and also has you make notes in First Aid (which is why you need to make sure you have both). There are also multiple quizzes that are in the packets that help solidify the high yield material. I would NOT suggest using study products from Ross to study for the COMP or the Step, because there is a lot of very low yield material that you will waste your time studying. These tests are very HIGH YIELD tests, which is why the DIT videos are so good, because he walks you through ALL the high yield material in those 15 days. In addition to doing the DIT videos, make sure you purchase either Kaplan Q bank or USMLE world (Kaplan is the one most people recommend to do first) After the videos were done for the day we would do anywhere from 50 to 100 questions from Kaplan Q bank and then we would review all the answers (whether they were right or wrong, that is key!) After that was done for the day....we would CHILL. We would go work out, or go out for dinner, or watch a movie, or watch football to take our minds off everything and take a break. Trust me, you are going to be spent after 4th is over and the last thing you are going to want to do is study for the Comp, so you need to make sure you schedule some "you" time in there as well. What kind of questions are on the Comp? Ross minis are close to the comp, but not really. Kaplan q bank questions are almost exactly what comp questions look like, and that is why I recommend you do Q bank, because there were literally questions on the comp that I had done on Kaplan Q bank. The stem is always 4-5 sentences long, so you need to make sure you can get through that stem in a timely manner to allow yourself enough time to take the test. There are people every semester that run out of time and end up literally having to bubble in C for the last 30 questions. That is why doing timed questions through Kaplan Q bank or USMLE world is so important, so you get used to those long stems and learn how to read them. Also, get used to using the Normal Values table and get familiar with where everything is. They do not provide normal values within the stem of the question, so you have to go to the back of the test to find the normal values. That is all I have for the Comp, if you still have questions, just let me know and I will be more than happy to answer them. Finally, why did Britt and I choose Michigan? We lived in Miami for close to 2 years while Britt got her Masters, so we were very familiar with traffic (horrible) and cost of living (super expensive) in miami, so right there we were swayed towards

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Michigan. We had also heard that Michigan was more organized than Miami and that since there were only 60 people, learning was more personal. After being here for a few weeks and talking with some of our classmates in Miami, we are definitely glad we came here. In Michigan, we have lecture on Mondays and Fridays, and then you spend 1 day a week (tues, wed, or thurs) in the nursing home with your patient. So for the most part, we have 4 days off every week (we never have anything on weekends). From what we hear about Miami, their schedule is a little more all over the place, with clinics and lectures at all times of the day, and even some classes on weekends during the first couple of weeks. However, the woman who was the director in Michigan, went to Miami this semester to make it more organized, so I wouldn't be surprised if it is totally different for yall next semester. That being said, even with the traffic and cost of living, Britt and I loved Miami when we lived there, and overall those who do 5th in Miami have done great and have ended up having a good experience. One other thing that they never told us, if you don't pass the comp the first time, which none of yall should even be thinking about right now, then you have to go to either Miami or Dominica to re take it, so those who are in Miami would have an easier time of re-taking them comp. As far as the Dominica 5th semester goes, I haven't heard much, except that you get a TON of hands on experience there (delivering babies, etc.). Hey Yall! I hope 4th ended up well for everyone! For all of those people who came back to the States, welcome back! Just wanted to send out an email before 5th starts to try an give you one final heads up about the comp and about 5th semester. If you are in Michigan and have specific questions about the program there I will be more than happy to answer them if you just shoot me an email. In general though, 5th semester is going to be a good time for you to use to get ready for Step 1. Studying for and taking the Comp is a GREAT foundation in preparing for the Step, so use 5th semester to build on that foundation. Don't go crazy or overboard in studying, just keep things fresh (best done by reading through all of First Aid throughout the semester) and take some time to focus on the subjects or concepts you had trouble with on the island. However, keep in mind that you want to make sure you have plenty of gas in the tank by the time you get to 6 weeks before your Step 1 because that is when the 10-12 hour study days need to start back up, so also use this time to go party on South Beach ( or if you are in Saginaw....at the D.I. Lounge, hahahahaha....no seriously, go to Harvey's) and relax a little bit, NOT A WHOLE LOT, just a little bit, you still want to do well in 5th semester. Let me get back on track....5th semester. You will see that there is nothing hard in 5th, it is mostly all review with clinical information added on top, so as long as you stay up with the information and your assignments you will have a very enjoyable 5th semester. With things like the 200 point checklist, OSCE's, etc. don't start worrying about those until they explain to you what those are all about, you will just waste your time trying to figure them out on your own. With 200 point checklist you will be

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required to pair up with one of your classmates and perform a head to toe physical exam on them, and then switch roles and they will perform a head to toe exam on you, each person gets 45 minutes to do the exam, its nothing difficult, its much easier than ICM especially if you watch the video that they give you and find a partner early so you can start practicing it a little bit each week. Make sure you talk to the professors at your sight and find out what kind of questions you can expect on your mid-term and final. And, in 5th semester, an 80 is no longer an A, to get an A you must make a 90 or above, so keep that in mind. The sites like the one in Saginaw where you can do most of your core rotations at one place usually require you to at least make a B in 5th semester, and I know the site in Saginaw requires that you make at least a 200 on Step 1, at none of the sites does your COMP score matter. For info on the Comp make sure you refer back to the email I sent out to yall last semester, if you can't find it let me know and I will forward it to you. In a nut shell though, the DIT videos and workbook, coupled with First Aid, and a question bank (Kaplan is great for the Comp, USMLE world is great for Step 1) will put you in great shape for the comp. And don't forget that you can buy practice COMP exams that are the exact same format of the one you will take, on the NBME website (buy the Basic Science ones, they cost about $50 each, but taking at least one is well worth it) Some of yall have been asking me how scores on Kaplan Q bank, USMLE world, and other question banks correlate to your score on the Comp or on Step 1, so here are a couple of websites that brittany found that we use to help us figure out where we stand. www.clinicalreview.com/solutions/resources/usmle-score-calculator.html http://usmle-score-correlation.blogspot.com Status: Black Hawk Down Date: 2012; AUA island Comp Compliments of Dr. Jagbir S. Nagra, Sidney Phillips, Julio Lima, Dr. John Goldman

1. Tay sachs question: frequency of disease is 1/3900, what is the heterozygote frequency? The answer is 1/30.

2. Gave 2 graphs and asked which range is the greatest prevalence? Since one of the graphs showed that more people died every 10 bp increase I went with 90-100. b/c deaths would decrease prevalence (amt decreased in population)

3. Asked where to do laminectomy? Where the lamina is in this diagram. “cut the horns off”

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4. Pt. with costovertebral angle tenderness and fever? Glomerulonephritis (RENAL) 5. Asked to find prevalence? I put CANNOT FIND OUT WITH THIS INFO. Not sure about it

but I know prevalence is supposed to be the total cases in TOTAL population. And this was an experiment with a few people.

6. PICK THE ONE THAT IS PRECISE BUT INACCURATE? I put 500 people went in for a general checkup at the health fair

7. Gave a bunch of numbers (weights). Told that the median, mean, and standard deviation were all calculated. But one of the weights was wrong and it was reweighed, which will not change? Choices are Median, mean, standard deviation.

8. 15 yr old girl comes in to doctor for routine checkup. Mother had squamous cell carcinoma of skin, grandmother had malignant melanoma. Based on her age what advice would you give her to ensure compliance? Protection from the sun will also assist in slowing down the aging process. (suggestion from her peers)

9. 13yr old boy with Diabetes Mellitus type I has been injecting himself with insulin since the age of 8. Recently he has stopped, what do you do? Talk to him about coping with dealing with a chronic illness.

10. Med student participates in sleep study. He has increase heart rate and erections. Which stage of sleep? REM

11. Person hasn't eaten for 10 hours (something like that) which organ assists the liver in gluconeogenesis? KIDNEYS**

12. Pt. has 7th cervical rib. Why? HOX gene is activated when it should only be activated caudally from C7. (activated above C7)

13. Man has no relationship with family or friends, and has no hobbies. When asked why he shrugs his shoulders and seems to be indifferent to that fact. He also has FLAT affect à Schizoid 1. Be careful, if it also said he believes in magic and lives in a fantasy world then he is

schizotypal 14. Pt. has parotidectomy. Which nerve can be injured? Facial nerve 15. Pt. has pedal edema and hepatomegaly, systolic murmur, and is IV drug user? Tricuspid

Insufficiency/Regurgitation 16. Calculate compliance given tidal volume and change in pressure. Couldnt figure it out because

they didnt give expiratory volume so I have no IDEA I put 25. 17. Something about the MOA of VIT A on gene transcription. Retinoic acid (Vit. A) regulates

HOX genes as well as receptor genes. Effect gene expression/ Tc/nuclear receptor, retinoic acid receptor pg. 263)

18. MOA of Vitamin B2 (riboflavin)? Either increase adenylate cyclase or increase cAMP (look up the NEMONIC IN FAà “qiss qiq until siq of sqs”

19. Pt. had a pneumothorax and said he had SHARP stabbing pain. Goes on to ask what nerve delivers the pain? PHRENIC (Somatic is phrenic nerve) (Dull pain would be Vagus nerve)

20. When someone eats something salty what prevents salt from entering buccal cells? Zonula occludens.

21. A boy that plays soccer, he has to be careful not to injure what part of his bone since he’s still

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growing? Epiphysal plate that is part of the metaphysis. (Epiphysis) 22. I’m not sure if this was a question I might be mixing it with COMP recall. But question said pt.

had increased risk of bacterial infection since birth. Can’t produce what? SUPEROXIDE (NADPH oxide…dx CGD)

23. Stenosed thoracic duct. What will not drain properly? Lymph collects in pleural cavity (chylothorax) and will see enlarged Virchow’s node (Left supraclavicular area). Left Breast, Left Upper Limb, and all the body below the diaphragm drain from the thoracic duct.

24. HIV pt. with TB. What cell type is compromised? CD4 was not a choice. I put macrophage 25. Pt. from Mississippi, TB like symptoms and hilar lymphandopathy. Histoplasmosis 26. Gave hepatitis markers. Mode of transmission? Food 27. Pt. with EBV has nose bleeds and enlarged lymph. What type of cancer? Nasopharyngeal

carcinoma. 28. Picture of scabies. What to ask pt? DOES ANYONE IN YOUR FAMILY HAVE THE SAME

problem? 29. Described PKU disease (mental retardation, seizures, mousy odor) ..BE CAREFUL THEY did

not ask what is the buildup so the answer is not phenylalanine. They asked what to supplement the diet with so its TYROSINE

30. Child with cystic fibrosis and has easy bruisability and ecchymosis. What vitamin is deficient? Vitamin K

31. Described histological findings of apoptosis and said due to damage of what? I put MITOCHONDRIA, b/c if damaged releases cytochrome C

32. Described lysosomal enzymes in serum and cytoplasm. Coarse facies, hypotonia. What is it? I CELL DISEASE = lack of Mannose 6-P tag

33. Heart is affected and you are trying to put a bronchoscope into lingula of lung, which segment would you pass? Left Upper (Superior) Lobe Bronchus (UPPER BRONCHUS)

34. Physiology of aging what happens to compliance, paO2 , and (paO2/ pAO2)? Compliance decreases, paO2 decreases, the ration stays the same (RV increase; PaO2 increase; all increase)

35. Why is there a drop on pCO2 from arteries to veins in chimpanzees? ??? HCO3 within the erythrocyte

36. Describes right heart failure in patient and then says what is underlying condition? So pick chronic lung disease à DIFFUSE Pulmonary FIBROSIS

37. Weight lifting pt. sudden pain. Hyperresonance on side with pain and trachea deviates to opposite side. TENSION PNEUMOTHORAX

38. Left side: TVF decreased, dull percussion, decreased breathsounds. Right side everything normal except for crackles at lung base. PLEURAL EFFUSION

39. Described neonatal respiratory distress in baby 36 week gestation (premature) and asked why it got better eventually. Decreased surface tension. (Surfactant lowers surface tension)

40. Stem involved shipbuilder, showed feruginous body due to asbestos, picked up by what in lungs? Alveolar macrophage

41. Pt. treated for Renal cell carcinoma in the past now has coughing bilaterally, showed chest xray. Pick the one with diffuse coin lesions bilaterally.

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42. Described Pt. with seasonal allergies (bug bites and couldn’t sleep) what to give? Diphenhydramine (H1 agonist)

43. Pt. given oral contraceptives containing estrogen what serum levels will increase? I put Free T-3. Other choices were TSH, thyroglobulin, albumin saturation. Cortisol also rises.

44. Teenager tried to commit suicide with pills don’t know what it is. She had red urine what is it? Cyclophosphamide

45. Pt. has atrophied hypothenar, cannot abduct the thumb and numbness and pain in first 3 digits. What nerve damaged? MEDIAN NERVE

46. PICTURE: electron microscope of cardiac muscle where are antibodies to alpha actinin 1? On the Z line (the thin dark line running down a clear area) Look for End of sarcomere

47. Woman described as being anorexic; what is she at high risk for? Osteoporosis/Ovarian

Cancer 48. Question about Paget’s disease (osteitis deformans) dont remember just know it à ALP

increased, normal calcium and phosphate levels. Bone is hypervascular 49. PICTURE of needle shaped crystals. Negative birefringence. Knee pain? GOUT-

hyperuricemia 50. Pt. has involuntary movement. MRI pointing to something (caudate). What is it due to?

(CAG trinucleotide repeat)

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Huntington’s Disease 51. Woman has confusion, no drugs or alcohol where is lesion? Choices are amygdala, parietal

(my choice), mamillary, hypothalamus, or hippocampus 52. Vignette of pt. with both sensory and motor loss of legs. Point out lesion. It was either

pointing to pons or interior sagittal section of cerebral cortex. 53. Can’t see on right hemifield where is lesion. I picked pointing to primary visual cortex in

occipital lobe 54. Cough reflex what nerve? Its internal laryngeal nerve a branch of superior laryngeal 55. Pt. in car accident has hemorrhagic pleural effusion and subdural hematoma. Why do we

want to hyperventilate? To increase intracranial vasoconstriction (increase vasoconstriction; decrease BF to the brain)

56. An electrode was put in dorsal part of thoracic vertebra to ease pain. Why? Inhibit Spinothalamics (Pain and Temperature)

57. Pt. with cough and history of weight loss eventually gets ptosis, miosis, and anhydrosis (describing Horner’s Syndrome). Why? Lung tumor (pancoast tumor)

58. Pt. gets hit in face with softball. Has periorbital edema. Sinus CT with fracture in maxillary sinus. Which nerve is damaged? Infraorbital nerve

59. After surgery pt. has vomiting, nausea, and fullness after meals. Alleviated by eating small

low carb diet. What was surgery? Cholecystectomy (remove gallbladder) 60. Baby with mitral regurgitation and macroglossia. What should we do? Thyroid function

test (cretinism) 61. Person with bilateral acoustic neuroma (deafness, vertigo, difficulty standing due to tumor

compressing CN 8). Neurofibramatosis (type 2 if both are there) 62. Unilateral headache associated with rhinnorhea and lacrimation? Cluster headache 63. How to treat cluster headache? 100% O2 64. Woman with ammenhorea and galactorrhea no visual disturbances what to treat with?

Bromocriptine (DOPAMINE AGONIST)- because its prolactinoma

Parkinson's disease Degenerative disorder ol CNS associated with Lewy bodies (composed ol a-syiniclein — iiitiaeellular inclusion) and depigmentation oflhe substantia nigra pars eompacla (loss of dopaminergic neurons). Rare cases haw been linked to exposure lo MPTP. a conlaininanl in illicil slreel drugs.

TRAP = Tremor (at resl—e.g., pill-rolling tremor), cogwheel Rigidity-, Akinesia, and Poslnral iuslabilily (yon are TRAPpecl in \(iur body).

Hemiballismus Sudden, wild flailing of 1 arm +/- leg. Characlerislic of contralateral subtlKilamie nucleus

lesion (e.g.. lacunar slroke in a patient with a history of liyperlension). Loss of inhibition of thalamns llnoiigh globus pallidus.

I lalf ballistic (as in throwing a baseball).

Huntington's disease Anlosoiiuil-dominant triiiiiclentide repeal disorder. Chromosome 4. Neuronal death via NMDA-R binding and glntamate loxicilv. Chorea, depression, progressive dementia. Symptoms manifest in affecled individuals helween llie ages nl 2(1 and ''(I,

Kspansioi i of GAG repeals (anticipation). Caudate loses ACh and GABA,

(Reproduced, with permission, from Fauci AS et a I. Harrison's Principles of Internal Medicine, 17th ed. New York: McGraw-Hill, 2008, Fig, 367-1.)

Atrophy of caudate nucleus (loss of CABA): enlarged lateral ventricles, atrophy of putamen, and defined sulci

Chorea Sudden, jerky, purposeless movements. Charaeteristie of basal ganglia lesion (e.g.,

I Inntington's disease).

Chorea = dancing (Greek), Think choral dancing or choreography.

Athetosis Slow, wrilhing inoveinents, especially of fingers, diaraeleri.slie ol basal ganglia lesion (e.g.,

lluuliiiHlon's disease).

Athetos= nol fixed (Creek) Think siiakelike.

Myoclonus Sudden, brief muscle contraction. jerks, hiccups.

Dystonia Sustained, involnntan- muscle contractions. Writer's cramp.

397

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65. What drug has side effect that will alleviate renal stones à thiazide diuretic (hydrochlorothiazide), it is calcium sparing also (low Ca2++)

66. Person with pinpoint pupils à Heroin (opiods) (tx: naloxone) 67. Pt. on local anesthetic and on succinyl choline. Eventually gets malignant hyperthermia Rx?

Dantrolene 68. Described alzheimers pt. Rx? Donepezil 69. Described child that is making trouble at school? Oppositional defiant disorder. Would be

antisocial if it was an adult (-) reuptake of NE 70. Child described as having ADD (defiant towards teacher, cuts people off, cannot hold

attention or sit still) Rx. MOA? Increase dopamine and NE concentration by preventing reuptake (Methylphenidate)

71. Women that stays up thinking about family and financial problems? Generalized anxiety disorder

72. Pt. snorted cocaine. MOA? Inhibit NE uptake 73. Pt. has diabetes mellitus type I. What will be increased? Potassium 74. Silver stained kidney section. I think the ANS was mesangial one 75. Pt. from Egypt with bladder squamous cancer. Why? Schistosomiasis 76. Duchenne Muscular Dystrophy (DMD) pedigree, Mom is affected, odds of her unborn male

kid getting the disease (It is x-linked recessive)? 1/8 77. Describes infertile pt. that also has cough. Kartageners syndrome. What is wrong?

Microtubule defect is best answer, otherwise choose dynein arms defective 78. Rx that inhibits leydig cells, thus no LH, what will be the side effect? Decreased facial hair

(decreased testosterone) 79. Mouse embryo tried to introduce 2 sperm together and 2 ovum. Didn’t work. Why?

Imprinting 80. Increased temperature during menstruation, what hormone caused this? Progesterone 81. What hormone indicates ovulation? LH 82. Described guy with gynocomastia and tall extremities. What leads to these symptoms?

Decreased testosterone (XXY Klinfelters) 83. What are D-dimers from? FIBRIN 84. Serum levels indicate anemia with 10% reticulocyte why? I put hemolysis. Other choice

was hemoglobinopathy, also hypersplenism 85. Described woman with chronic problem, scarring of the uterus, inflammation which bug?

Chlamydia 86. Pt. on HIV drug (AZT) that no longer works, why? RNA dependent DNA polymerase

(Reverse Transcriptase) mutation 87. Interferon Gamma (IFN-y) is released by what? CD4 and CD8 T lymphocytes once antigen

specific immunity develops. Otherwise, by NK and NK-T cells in the innate immune response

88. Vaccination meant to target which master APC? Dendritic Cell (according to wiki) and not circulating macrophages. Dendritic Cell is strongest Antigen presenting cell

89. Which part of kidney is more susceptible to ischemia/damage and proteinuria? Proximal convoluted tubule

90. Described red lesion on ear. What is it? basal cell carcinoma 91. PICTURE: Farmer had red colored lesion behind his ear due to sun exposure. Actinic

keratosis, also called solar keratosis. Do not confuse with seborrheic keratosis 92. Patient came in and said that her sister’s son suffers from spina bifida so what are the

chances that her child will get it? There is no correlation because neural tube defects have to do with folic acid intake and are not hereditary

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93. Anancephaly? Increased alpha feto protein 94. Smoker and Chinese peanut farmer gets liver cancer, why? Aflatoxin 95. Via which vein did breast cancer spread to spine? Intercostal vein (Internal Thoracic Artery

better choice if artery is an option) 96. The inverse enzyme kinetics graph. Know how to read. Its real easy 97. Drug pKa is 4.4 (weak acid) what is it in stomach and blood respectively. Non ionized and

ionized 98. GRAPH: It was either a partial agonist (starts to the left of the control and ends at the

right) or a noncompetitive antagonist (different slope and slightly to the right of control). A competitive antagonist has the same slope and is far to the right of control. Remember: Increased potency means closer to Y axis.

99. MOA of lithium induced nephrogenic diabetes insipidus? Loss of adenylate cyclase activity in collecting tubules of kidneys, resulting in no response to ADH (-) of camp receptor collecting duct

100. Ulcerative epiglottis with pt. on PTU why? Agranulocytosis (decreased wbc’s) 101. They gave MAP and CO. Calculate TPR (resistance). MAP= CO X TPR. CO=HRxSV 102. Described pt. with systolic murmur crescendo-decrescendo. Rx? Replace valve (Aortic

Regurge) 103. Machine like murmur (PDA). Where is connection? Aorta and pulmonary artery PDA 104. Right heart failure, why edema? Increased central venous pressure. (when the right

ventricle fails, blood backs up to the venae cavae and venous system, causing pedal edema) 105. Pt. with murmur, athletic. Enlarged ventricular septum, why? Hypertrophic obstructive

cardiomyopathy (HOC – think Jonathon) 106. PICTURE: Cardiac tumor shown on microscope slide, syncope a symptom? Atrial

myxoma at Left Atrium 107. Diabetic ketoacidosis what happens to pH, HCO3, and pCO2? Decrease HCO3,

decrease pH (increase H), decrease pCO2 (respiratory compensation via hyperventilation) 108. MOA of Glitazones (Treat Type II Diabetes)? Activate PPAR-y (free fatty acid binds to

this receptor), receptor migrates to DNA and activates transcription of gene products that increase sensitivity of fat metabolism (Decrease TAG, Increase HDL & LDL), and decrease insulin resistance.

109. Something about removing uterus and which artery to ligate? Branch of internal iliac (Hadi: internal pudendal off the uterine)

110. Kid has volvulus of midgut. Which artery is involved? SMA (Superior Mesenteric Artery)

111. External hemorrhoids due to what? Inferior rectal veins 112. Question about hormone that can reduce appetite? Leptin (from the hypothalamus) 113. Kid got softball to the face and is in pain and has edema? Bradykinin (pain and

vasodilation). 114. Saliva question drug for Sjogren’s. Tx: Cevimeline or Pilocarpine to increase salivary

flow. Pilocarpine is a parasympathetic, muscarinic receptor agonist (ductal reabsorption; low Na++ flow rate)

115. Macrocytic anemia, MCV above 100, Tx? Folate 116. Segmented neutrophils, neurological problems, large immature rbc’s (symptoms

describe megaloblastic anemia), Tx? Vitamin B12 117. Cholicky pain and (obstructive, post-hepatic) jaundice. Why? Increased conjugated

bilirubin 118. Question talked about apical and basal surfaces in the gut. Something about what makes

the specific enzymes possible. MICROVILLI (brush border)

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119. Person had white plaques on his glottis and tonsils (CANDIDA). What drug to use? Use Nystatin topically. Nystatin binds to ergosterol and punches hole in fungal cell membrane causing leakage of K+.

120. Described a person camping with rickettsia, what is the drug’s (Doxycycline a tetracycline) mode of action? Inhibits 30S. Inhibits protein synthesis by inhibiting the binding of aminoacyl-tRNA to the mRNA-ribosome complex.

121. Patient has history of meningoccal infections why? Late compliment deficiency. 122. Resident doesn’t have enough knowledge about a surgery. What to do for consent? Ask

the attending to get the consent. 123. Lady is in emergency and no family. What to do? Implied consent. 124. Baby can stand with assistance. How old? 9 months 125. Retardation, self mutilation, aggression (Lesch Nyhan)? HGPRT deficiency 126. Match tRNA with codon? I think the answer was GUA 127. What is attached to the 3’ end of the tRNA? CCA tail 128. Patient with Androgen insensitivity. The labia majora is equivalent to what in males?

SCROTUM 129. Pt. with fever and staph aureus. What caused it? SUPERANTIGEN (TSST-1) toxin

that allows nonspecific binding of MHC II with T Cell Receptors 130. Ecoli infection I don’t remember if it was UTI or diarrhea but I’m sure the answer was

ecoli. What is MOA? Increase adenylate cyclase (increase cAMP) 131. Staph: Gram +, Catalase + and Coagulase +, facultative anaerobic 132. Strep group A (streptococcus pyogenes) à Beta hemolysis, Gram +, and catalase -;

shows clear colonies. 133. Old pt. what vaccine do you give? 23 valent Streptoccus pneumonia vaccine

(pneumovax) 134. PICTURE: Stem about guy getting disease in Africa à Malaria 135. Pt. had periorbital edema and other symptoms. Preventative measures? COOK TO 104.

Trichinella Spiralis is a nematode in undercooked meat 136. Bone marrow without cells and instead bony trabeculae. Dry tap done and peripheral

smear shows nucleated, weird shaped RBC and promyelocytes. Splenomegaly. Why? MYELODYSPLASTIC change (Myelofibrosis)

137. Which contraceptive has the most chance of preventing fertility in the future? NO IDEA. Choices were Oral contraceptive, implanted device, progesterone, IUD

138. Women having problem with fertility. Why? Anovulation 139. MOA of Flutamide? Nonsteroidal competitive inhibitor of testosterone. It is a drug

used to treat prostate cancer by binding to androgen receptors in the prostate gland and preventing testosterone and DHT from binding.

140. Pain that radiates from back to buttocks in old man. Xray sacroiliac joints 141. Person with osteomyelitis (they described it) what drug to give? Staph Aureus is a

frequent cause so give NAFCILLIN 142. Pseudomonas pt. on drug and got nephrotoxicity, what to give? GENTAMICIN 143. MOA of flouroquinolone? INHIBIT DNA GYRASE (topoisomerase II), inhibiting DNA

replication 144. Imunocompromised kid. His father has influenza. What to give prophylactically?

ZANAMIVIR. (or Oseltamivir, don’t remember if it was a choice) = neuraminidase inhibitor

145. Pt. with BPH and HTN. Develops orthostatic hypotension on drug. What drug? Prazosin 146. Pt. has iron overload (hemochromatosis). Drug to treat? Deferoxamine

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147. Pt. on an anticoagulant develops thrombocytopenia. What is the MOA of the drug causing it? It would be heparin (so activates Antithrombin III, inhibiting thrombin)

148. Benzo or sleeping med overdose. Used a drug to treat. MOA? (Flumazenil). COMPETITIVE INHIBITOR OF GABA (not competitive antagonist of BENZO) be careful

149. Pt. has BP of 190/130, hyperplastic onion skinning, what is he at risk for? HYPERPLASTIC ARTERIOLOSCLEROSIS

150. Described pt. with blurry vision, headache, jaw claudication, increased ESR. (giant cell temporal arteritis) what is Rx? PREDNISONE

151. Pt. has hypertension. MOA of drug to Rx? Increase cGMP (not sure about this, look for alpha 1 blocker, it’s a better choice)

152. Pt. has 200 LDL level want to drop it to 130 he tried eating healthy and it didn’t work. What drug? Simvastatin.

153. Where does ADH come from? Neurohypophysis (posterior pituitary gland) 154. Experiment on bone growth: without a hormone the bone didn’t grow, which hormone?

Thyroxin, BUT if it’s not an answer choice choose insulin like growth factor 155. Pt. with HTN, increased Aldosterone and Renin. Why? RENAL ARTERY STENOSIS 156. Pt. on dialysis, why does he have bone pain? Amyloidosis is the best choice, if it’s not

there choose Hyperparathyroid (secondary) 157. Pt. with diabetes is having visual problems. Best Rx? REDUCE GLYCEMIC INDEX 158. Gland that is responsible for smell à Apocrine Gland 159. Osteoclasts communicate with osteoblasts by what mechanism? Paracrine signaling 160. Guy swallows a fishbone gets stuck at the trachea, what sensory nerve most affected?

Internal laryngeal nerve, which is a branch of the Vagus Nerve (X). Remember that the efferent part of the cough reflex (diaphragm) is innervated by the phrenic nerve.

161. Person has decreased breathing, rib cage doesn’t expand, what nerve is affected? Phrenic 162. Route of lymph node metastasis in breast cancer? Pectoral to central axillary to apical

axillary nodes. Axillary lymph nodes 163. Most common route for metastatic breast cancer to spinal cord? Posterior intercostal

veins best choice, otherwise Internal Thoracic Artery 164. Pt. had the symptoms of a migraine headache (diplopia, headache that lasts 30 minutes).

What drug do you give to treat? Sumatriptan, a serotonin agonist that vasoconstricts 165. PICTURE: Normal colon and feathery colon, what causes? Villous Adenoma =

degeneration of villi. 166. Girl from china, had pus from neck. Positive for keratin and EBV à Burkitt’s

lymphoma 167. Myasthenia Gravis patient has what also? Thymoma accompanied with dysphagia,

cough, chest pain 168. Warthin’s Tumor = aka papillary cystadenoma, Benign tumor of the salivary glands due

to smoking 169. Bronze skin, diabetes, defective erythropoiesis, defect in transferrin, increased ferritin,

decreased TIBC, what is wrong (Hemochromatosis described)? Increased intestinal iron absorption.

170. What to give for gastric ulcer (caused by H. Pylori)? Omeprazole (proton pump inhibitor) along with clarithromycin and amoxicillin (or metronidazole in penicillin hypersensitive patients)

171. Complication of PID? Ectopic Pregnancy 172. Blood donor/recipient à O – is universal donor and AB+ is universal recipient 173. Coagulation disorder à Factor 10 deficiency 174. Drugs that cause pulmonary fibrosis à Bleomycin, Amiodarone, Busulfan

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175. Achondroplasia (dwarfism) à AD inheritance, ½ chance of passing the disease 176. Pt. has morning stiffness that improved with use à Rheumatoid Arthritis 177. PICTURE of mole/skin cancer with a ruler next to it showing the sunovabitch is 1 cm

large, what is it? Malignant melanoma 178. Why does Huntington’s get progressively worse with each generation? Anticipation 179. PICTURE: Hemi-Section of spinal cord, which part affected? Nucleus gracilis 180. Guy got erection, what sleep stage is he in? REM Delta 181. Which tumor can boys with cryptorchidism get? Seminoma 182. What can increase your risk for breast cancer? Estrogen. Know what diseases and

tumors can increase estrogen (endometrial hyperplasia, granulosa cell tumor) 183. Know the Oxygen-Hb dissociation curve. Review 1st aid or biochem class notes 184. Hereditary Non Polyposis Colon Cancer, cause? Defect in DNA mismatch repair 185. Stem described proteins going from RER to Golgi, but there was something wrong with

the RER. What was wrong? N-linked oligosaccharide 186. Stem described myoclonic epilepsy with ragged red fibers (MERRF) which is a type of

heteroplasmy disease à answer was the DNA came from the mother because it was mitochondrial

187. Pyruvate kinase deficiency causes what? Hemolytic anemia due to decreased ATP so there’s an inability to maintain activity of the Na+/K+ ATPase pump

188. Deficiency in G6PD leads to NADPH oxidase deficiency, which leads to? Chronic Granulomatous disease

189. Sorbitol question- people that have sorbitol accumulation have increased glucose and no sorbitol dehydrogenase, which leads to diabetes, nerve problems, and cataracts

190. Homeobox gene product binds to what? Promoter region 191. Pt. has increased ICP, irritability, vomiting, convulsions, ataxia (describing Dandy-

Walker syndrome), what does he have? Obstructive hydrocephalus at 4th ventricle 192. Described hydronephrosis (pain, hyponatremia, elevated urine pH), where is the

blockage? Ureteropelvic Junction 193. What increases your risk for transitional cell carcinoma (cancer of kidneys and urinary

system)? Smoking is the best choice, but if the question asks specifically TCC of the upper urinary tract choose Phenacetin. Analine dyes are also a possibility, but the stem must mention worker in petroleum industry.

194. KNOW the hepatitis serologic markers à There are 2 questions on these 195. Pt. is on propylthiouracil (PTU) to treat hyperthyroidism in Graves’ disease, what is he

at increased risk for? Aplastic anemia (thrombocytopenia) aka agranulocytosis 196. Described Wiskott-Aldrich Syndrome (Thrombocytopenia, Immune deficiency, Eczema)

à Know that it’s X-Linked Recessive and it’s a deletion of B and T Cells 197. Decreased ACTH, but increased Cortisol, why? Adrenal hyperplasia 198. GRAPH that showed an agonist plus irreversible antagonist à Decreased Vmax and

Efficacy 199. What is the receptor for the antihypertensive drugs methyldopa and clonidine? Alpha 2 200. Why is a lady infertile? Salpingitis 201. MOA for Treatment of Lyme Disease à Inhibitor Cell wall synthesis 30S

(Doxycyclin) 202. Tx for Smoking Cessation à Bupropion 203. E.Coli virulence factors: fimbriae, K capsule, LPS endotoxin

1. Ecoli O157 à Shiga like toxin 204. +PPD Skin Testà Delayed Type Hypersensity 205. Patient with Type 2 Diabetes. What vaccine is recommended? Influenza

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206. Tx for Heroin Overdose: Naloxone 207. Contact Dermatitis Rash, why? à Change in Laundry Detergent 208. Glipizide (anti-diabetic drug) MOA: Sulfonylurea: Close K+ channel in B-cell

membraneà Insulin Release 209. Bradykinin à Made by metalloprotease chopping up HMWK 210. Low ceruloplasmin, keyser-fleischer ring around eye à Wilson’s disease 211. Kid on bike fell. Fluid buildup in abdomen and scrotum, but peritoneum was free of

fluid why? Posterior Bladder rupture 212. Squamous Cell Carcinoma à Caused by Cigarette Smoke 213. Nitroglycerin MOA for smooth muscle relaxation: ↑in cGMP 214. Kid with Type 1 Diabetes: Blood Acidity Increases due to Diabetic ketoacidosis 215. Itching, severe burning pain in hands and feet, peptic ulcer disease à Polycythemia

Vera (bone marrow makes too many rbc’s) 216. Something to do with Inflammation, what cell is involved? Neutrophils 217. Picture of Kidney à Membranous glomerulonephritis or Minimal Change Disease? 218. Shows a picture of restriction fragments and 2 plasmids à Cuts at same location in both

plasmids 219. What type of delayed hypersensitivity reaction is TB? Type 4 (T cells activate

macrophages) 220. PICTURE: Brain side profile shown, visual field defect à Pick occipital lobe (furthest

to back) 221. MOA of Finasteride in treating pancreatic cancer? block the conversion of testosterone

to dihydrotestosterone 222. PICTURE of skin with blue collagen à Actinic keratosis 223. Increased 2,3-BPG…what enzyme would increase it at G3 phostphatase? 224. Increased H2 leads to à Decreased Ca2+ 225. Wound healing, 1st substance? Endothelin (protein that constricts blood vessels and

raises bp) 226. Local injury -> What inhibits matrix metalloproteinase and a bunch of other stuff? TIMP

(not sure if that was an answer choice). Robbins says TGF-Beta or steroids 227. Increased TVF, Dullness on percussion à Lobar Pneumonia 228. Homeless looking lady thinks she is prominent doctor and council member, NOT

alcoholic though, where is the lesion in her brain? Hippocampus 229. Cholestyramine MOA? à removes bile acids from the body by forming insoluble

complexes with bile acids in the intestine, which are then excreted in the feces. When bile acids are excreted, plasma cholesterol is converted to bile acid to normalize bile acid levels. This conversion of cholesterol into bile acids lowers plasma cholesterol concentrations.

230. What artery do you ligate to stop bleeding in a pregnant woman? Internal Pudendal Artery

231. Decreased sensation in face and forehead and decreased taste anterior 2/3 of tongue, what nerve lesion? Chorda Tympani

232. Knockout mouse has a shorter bone than wild-type mouse, why? Calcineurin 233. Guy travelled to Mexico, got sick, how he could have prevented? Wash hands. 234. Bronze skin, diabetes, defective erythropoiesis, defect in transferrin, increased ferritin,

decreased TIBC, what is wrong (Hemochromatosis described)? Increased intestinal iron absorption.

235. Nicotine, how to get the guy to quit à Have the patient himself discuss pro’s and con’s of quitting, medication

236. Hyperactive kid, what do you give him to treat? GABA agonist

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237. 2 drugs both have same bicarbonate level à Different sodium 238. Why is there greater affinity non-NMDA vs. NMDA? Non-NMDA has greater affinity

to calcium 239. GRAPH: you give a guy opoid, give him drug x, the graph of x was lower à

competitive agonist or partial agonist (slope was not parallel)? 240. What is the difference between basement membrane and apical in transport? Microvilli 241. Gymnast women wasn’t having her period and if this continues what is she at risk for?

Ovarian carcinoma 242. Person had ecoli recurrent uti and what caused this? Mannose fimbrae 1 243. Beta agonist à increase cAMP 244. 40 subjects and then decreased to 10 subjects and what would happen to the width of

standard deviation= NO Change 245. How many molecules of ATP are released when hydrogen is hydrolyzed.? 9 Hydrogen

molecules are required to produce 1 ATP, but the answers were in terms of ATP. 1, 6, or 38 ATP’s?

246. Pt has diarrhea. What is tx? Magnesium Hydroxide 247. Subarachonoid Hematoma- VasospasmàTx: Nimodipine 248. Vancomycin Resistant-Replacement of D-Ala D-Ala with D-Ala D-Lac

249. Absence Seizure: Kid staring into spaceà Tx: Ethosuximide