5/31 Mixed

Question 1

Milaria treatment

Answer 1

Chloroquine is the treatment of choice for uncomplicated malaria contracted in a cholorquine-sensitive geographic region
It eliminates susceptible erythrocytic forms of all Plasmodium species
Primaquine is added in the treatment of infections with P vivax and P ovale to eradicate the intrahepatic stages (hypnozoites) of these malarial species, which are responsible for relapses

Question 2

Cleft lip

Answer 2

Results when the maxillary prominence fails to fuse with the intermaxillary segment during the fifth-sixth week of embryonic development
Cleft palate occurs when the palatine shelves fail to fuse with one another or with the primary palate
Cleft lip and palate can occur together or in isolation

Question 3

Rx: Alcohol withdrawal

Answer 3

Benzodiazepines (diazepam, or chlordiazepoxide)

Question 4

Great saphenous vein

Answer 4

Located superficially in the leg and is the longest vein in the body
Courses superiorly from the medial foot, anterior to the medial malleolus and up the medial aspect of the leg and thigh
It drains into the femoral vein within the region of the femoral triangle, a few cm inferolateral to the pubic tubercle
Surgeons access in the medial leg or less commonly near its point of termination in the femoral triangle of the upper thigh

Question 5

Right ventricular myocardial infarction

Answer 5

Presents with hypotension, elevated JVP, and clear lungs
It most often occurs in the setting of acute inferior wall MI
Hemodynamic assessment reveals elevated right atrial and central venous pressures, reduced pulmonary capillary wedge pressure and reduced CO

Question 6

Functional hypothalamic amenorrhea

Answer 6

Results from loss of pulsatile gonadotropin-releasing hormone release from the hypothalamus and is caused by weight loss, strenuous exercise, systemic illness, or abnormal eating habits
Loss of cyclic gonadotropin release leads to a decrease in LH and FSH secretion from the pituitary, which in turn causes low circulating estrogen levels

Question 7

Suppression of the Hypothalamus-pituitary-adrenal axis by glucocorticoid therapy is the most common cause of adrenal insufficiency

Answer 7

In these patients, adrenal crisis can be precipitated by stressful situations (infections, surgery) if the glucocorticoid dose is not increased appropriately
Chronic glucocorticoid use is characterized by low CRH, ACTH and cortisol that cannot rise in response to stressful situations

Question 8

Paget’s disease of bone

Answer 8

Characterized by increased numbers of abnormal osteoclasts (very large, have up to 100 nuclei), excessive bone turnover and disorganized bone remodeling
Osteoclasts originate from hematopoietic progenitor cells
Macrophage colony-stimulating factor and receptor for activated nuclear factor kappa-B ligand (RANK-L) play an important role in osteoclast differentiation

Question 9

Erythroblastosis fetalis and hemolytic disease of the newbord

Answer 9

With maternal blood types A and B, these disease no no occur as the naturally occurring antibodies (anti-A and B) are of the IgM type and cannot cross the placenta
In contrast, in type O mothers, the antibodies are predominately IgG and can cross the placenta to cause fetal hemolysis

Question 10

Renal blood flow (RBF)

Answer 10

Refers to the volume of blood that flows through the kidney per unit time and can be calculated by dividing the renal plasma flow by (1-hematocrit)

Question 11

CREST syndrome Ab

Answer 11

Anti-centromere Ab (40% of patients)

Anti-DNA topoisomerase I (Scl-70) Ab (highly specific for systemic sclerosis)

Question 12

Necrotizing vasculitis of the upper and lower respiratory tract (causing nasal ulcerations, sinusitis, hemoptysis) and RPGN

Answer 12

Granulomatosis with polyangitis (Wegener’s)
Associated with C-ANCAs which may target NEUTROPHIL proteinase 3
C-ANCA= cytoplasmic staining anti-neutrophilic cystoplasmic antibodies

Question 13

Radial head subluxation (nursemaid’s elbow)

Answer 13

Results from sudden traction of the outstretched and pronated arm of a child
Affected children are usually in little distress unless attempts are made to move the elbow
The annular ligamnet is torn and displaced in this injury

Question 14

Neonatal meningitis due to E. coli

Answer 14

Possess the K1 capsular antigen
K1 capsule is a virulence factor that allows the bacteria to survive in the bloodstream and establish meningeal infection

Question 15

Tropheryma Whippelii

Answer 15

Gram-positive actinomycete
Whipple disease is a rare systemic illness that involves the small intestine, joints, and CNS
Classic histologic findings include small intestine mucosa containing enlarged, foamy macrophages packed with both rod-shaped bacilli and PAS-positive, diastase resistant granules

Question 16

Metabolism of dietary fructose

Answer 16

Phosphorylated in the liver to F1P which is rapidly metabolized because it bypassed PFK-1, the major rate limiting enzyme of glycolysis
Other sugars (glucose, galactose, mannose) enter glycolysis prior to PFK-1 and as a result are metabolized more slowly