Leydig cells make testosterone. Leydig cell tumors aren’t always physiological active, but those that are can cause masculinization. Granulosa cell tumors, on the other hand, sometimes produce estrogen (which can lead to precocious puberty in young girls but otherwise may be occult). Teratomas are oddballs that typically have fat, hair, teeth, etc. Thecomas will not be on your test. Ovarian carcinoid is highly unlikely to show up on your test, but if it did, it would likely present with a classic carcinoid syndrome.

Narcotic use for acutely painful conditions is both reasonable and important. Short-term use (immediately post-surgical) does not lead to long-term dependence (or so people have thought…). And yes, drugs addicts should also receive narcotics to control pain.

From Goljan:

Platelet problem = epistaxis, echymoses, petechia, bleeding from superficial scratches

Coagulation problem = late re-bleed, Menorrhagia, GI bleeds, hemarthroses

Why would it not be anemia of chronic disease with decreased serum transferrin concentration?

This question is very sneaky, but in essence this is whats happening.

The accidental removal of the PTH glands during thyroidectomy ⇒ ↓ PTH

PTH normally: --in bone: ↑ removal of Ca²⁺ and Phophate from bone --in kidneys: ↑ Ca²⁺ reabsorption and ↓ PO₄³⁻ reabsorption --↑ conversion of 25, Hydroxyvitamin D to 1,25 Hydroxyvitamin D (Calcitriol - active form) via ↑ activity of 1-a Hydroxylase deficiency

Therefore a ↓ PTH would lead to:

⇒ ↑ PO₄³⁻ ⇒ ↓ Ca²⁺ ⇒ ↓ 1,25 Hydroxyvitamin D

The question is sneaky (much like the rest of this exam) because someone who isnt focusing really hard or in a rush might pick the option C where phophate is ↑ and PTH is ↓ BUT ↓ 25 hydroxyvitamin D

This is wrong as only 1,25 hydroxyvitamin D would be decreased, the conversions before this are done by the skin (sunlight) and liver.

I really wish they would stop making the questions confusing PURELY for the sake of making them confusing. Isnt it enough that we have to know this ridiculous amount of information, without having them intentionally making it harder by pointing you to 1 answer choice but changing a minute detail to make you answer wrong. Or using a random ass nomenclature for a disease to avoid making it too simple (PSGN = "proliferative GN")

"Air droplets" sounds like respiratory (saliva or water) droplets. Inhalation of toxoplasma oocysts in cat feces isn't quite the same; not to say I know exactly what the oocysts are inhaled as (just microscopic dry cat poop particles?). Ingestion of undercooked meat to get the cysts is certainly a ROT for toxoplasma.

Toxoplasma as TORCH has triad of hydrocephalus, cerebral calcifications (intracerebral), and chorioretinitis. chorioretinitis can be in congenital CMV or toxoplasmosis. Periventricular calcifications are in CMV. Congenital CMV usually has hearing loss, seizures, petechial rash, “blueberry muffin” rash, chorioretinitis, and periventricular calcifications.

The answer is hyporeflexia because the afferent arc of the muscle stretch reflex has to go through the dorsal rami and dorsal root ganglia. Dumb question, I know, but it’s the only answer that made sense. If you hurt the DRG, you not only lose afferent somatic sensory fibers, you also lose the sensory bodies involved in the various reflexes.

You can also get hyporeflexia from damaging the efferent neurons that innervate the muscle (like a LMN), but as you know these are in the anterior horn and ventral rami.

Usual interstitial pneumonitis is the histological definition of Idiopathic pulmonary fibrosis. We know that this patient has pulmonary fibrosis because the question states that there is fibrous thickening of the alveolar septa. This question was just testing that we knew the other names for Pulmonary Fibrosis.

It was scabies, which is transmitted person-operon.

Nitrogen balance is a measurement of protein metabolism in the body. A negative nitrogen balance indicates muscle loss, as increased amounts of amino acids are being metabolized to produce energy. This increases the amount of nitrogen secreted from the body. Because the amount of nitrogen you are taking in is less than the amount of nitrogen you are secreting, you have a negative nitrogen balance.

This man is malnourished, edematous, cachetic, and has hypoalbuminemia. These clinical findings point to protein malnutrition (Kawashkior Disease), which causes edema due to decreased serum oncotic pressure. Low oncotic pressure in this case is due to protein loss, and hence a negative nitrogen balance.

I put constipation because I thought the medication being described might be CCB: can someone explain why nitrates over CCB?

The patient suffered from Immune Thrombocytopenia. autoantibodies against the glycoproteins GP2B/3A.

On labs, you’ll see: increase in megakaryocytes; on the question stem they’re described as “rare but large.” Megakaryocytes are not suppressed.

Histology showed coagulative necrosis (preserved architecture of myocardial fibers) with neutrophil infiltration which hinted that the MI was within 24 hours. Most likely cause of death within first 24 hours of MI is arrhythmia. Myocardial rupture would also be visible on gross appearance of the heart, which they described in the stem.

Deltoid is innervated by axillary nerve, which comes from roots C5/C6. Actions of the deltoid include abduction of the upper extremity.

Can't histamine also cause swelling or is it just not involved in the pathology of gout?

Usual interstitial pneumonitis is the histological definition of Idiopathic pulmonary fibrosis. We know that this patient has pulmonary fibrosis because the question states that there is fibrous thickening of the alveolar septa. This question was just testing that we knew the other names for Pulmonary Fibrosis.

LPS found in outer membrane of gram ⊝ bacteria (both cocci and rods). Composed of O antigen + core polysaccharide + lipid A (the toxic component).

Activates Macrophages and induces TNFalpha release -> Hypotension and fever.

Pg 133 Endotoxin.

Recurrent kidney stones should include hyperparathyroidism on your differential, couple that with gastrinoma and you’re looking at MEN 1. Lipomas are also associated with MEN 1.

infarcts would be a more peripheral wedge shape

abcess wouldnt be invasive to the surrounding area i think.

squamous cell is more centrally located

wasn't 100% sure but thats the best answer slthough stupid to give 0 symptoms and just a picture, nothing like an actual clinical scenario

Hydrocodone/Methadone can lead to dependence--you avoid in long term use. NSAIDs you also avoid due to partial ineffectiveness in neuropathic pain as well as ulcer risk. TCA's are known to treat neuropathic pain very well (i.e. diabetes, ART therapy)

does some mind explaining why this isn't a tear in the sciatic nerve?

In order for a drug to be cleared by the kidney, it must first be filtered in the glomeruli. Drugs with a high VD have more of the drug in the tissue that are not available to filtered by the kidney. Drugs with high protein binding won't be filtered either. So you want a drug with low Vd and low binding if you want it cleared via the kidneys and urine.

Acute interstitial renal inflammation. Pyuria (classically eosinophils) and azotemia occurring after administration of drugs that act as haptens, inducing hypersensitivity (eg, diuretics, NSAIDs, penicillin derivatives, proton pump inhibitors, rifampin, quinolones, sulfonamides).