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5 Flashcards

1
Q

What is the difference between a promoter region and an enhancer region? (FA15 p68) (FA16 p54)

A

promoter: Site where RNA polymerase II and multiple other transcription factors bind to DNA upstream from gene locus (AT-rich upstream sequence with TATA and CAAT boxes)
enhancer: Stretch of DNA that alters gene expression by binding transcription factors.

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2
Q

What medications are considered first line in the treatment of ADHD?

A

amphetamine/dextroamphetamine (indirect sympathomimetics)
clonidine (sympatholytic (α2-agonists), stimulants (e.g., *methylphenidate), CBT, atomoxetine, (selective NE reuptake inhibitor)

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3
Q

What are the signs of right-sided heart failure? What are the signs of left-sided heart failure? What is most often the cause of right-sided heart failure? (FA15 p297) (FA16 p292)

A

R: Hepatomegaly (nutmeg liver) JVD, Peripheral edema

Orthopnea, Paroxysmal nocturnal dyspnea, Pulmonary edema
most common cause of RHF is LHF

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4
Q

What abnormal lab values would lead you to suspect alcoholic hepatitis? (FA15 p369) (FA16 p367)

A

AST>ALT

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5
Q

How many umbilical vessels are there? Which umbilical vessel has the highest oxygen content? (FA15 p563) (FA16 p567)

A

2 umbilical arteries

1 umbilical vein (from placental, more oxygen)

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6
Q

What organisms are particularly known for causing infective endocarditis? (FA15 p128-130, 147) (FA16 p119-121, 137)

A 
Staph aureus (30%)
Strep viridans (mutans) (20-30%)
enterococci (10%)
CoNS (S. epidermidis) (5-10%)
also HACEK (harder to Cx)
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7
Q

A 60-year-old male long-time patient of yours comes to your office complaining of sexual dysfunction. What is the differential diagnosis? What drugs are known for causing sexual dysfunction? (FA15 p516) (FA16 p520)

A

Drugs (e.g., antiHTNs, B-blockers, neuroleptics, SSRIs, ethanol) 􏰃 Diseases (e.g., depression, diabetes, STIs, hyperprolactenemia, dec. testosterone)
Psychological (e.g., performance anxiety)

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8
Q

A 44-year-old woman is seen in the ER for shortness of breath, malaise, and high fever. Chest x-ray reveals a right-sided consolidation, and her labs reveal a WBC count of 12,000. Which organism is overall the most common cause of lobar pneumonia? What organisms are the most common causes of interstitial (walking) pneumonia? (FA15 p616) (FA16 p624)

A

S. pneumo (also Legionella, Kleb)
atypical: Viruses (influenza, CMV, RSV, adenoviruses),
Mycoplasma, Legionella, Chlamydia

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9
Q

Which type of lymphoma has a presentation that is very similar to CLL and fewer constitutional signs/symptoms? (FA15p402)(FA16p402)

A

SLL (small lymphocytic leukemia)

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10
Q

A 30-year-old man is at an inpatient facility for opioid addiction. What symptoms might this patient experience while discontinuing opioids? (FA15 p518) (FA16 p522)

A

Sweating, dilated pupils, piloerection (“cold turkey”), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (“flu-like” symptoms). Treatment: long-term support, methadone, buprenorphine.

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11
Q

Ceftriaxone is used for the treatment of sexually-transmitted N. gonorrhea infections. Which generation of cephalosporin is ceftriaxone? Which generation of cephalosporin is effective against Pseudomonas? Are cephalosporins bacteriostatic or bactericidal? (FA15 p182) (FA16 p172)

A

3rd generation
3rd gen. ceftazidime (and cefeperazone) and 4th gen cefepime are effective against pseudomonas
-bacteriocidal

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12
Q

A 35-year-old white woman presents with a dull ache in her jaw that is made worse by chewing. She states that this pain corresponds to her recent promotion and increase in responsibilities. What is the most likely diagnosis?

A

giant cell arteritis? too young
TMJ syndrome, 2nd most common cause of facial pain after ha
-exacerbated by stress
-have nocturnal bruxism, may have jaw clicking

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13
Q

A patient is undergoing treatment with recombinant interferon for his hepatitis C. In what ways do interferons interfere with viral protein synthesis? (FA15 p207-208) (FA16 p200-201)

A
  • produce RNA protein kinase (inhibits viral protein synthesis)
  • trigger pro-apoptotic pathways
  • influence activities of macrophages and dendritic cells
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14
Q

Your patient develops a cough with the new antihypertensive drug you prescribed her. What are some other side effects associated with this medication? (FA15 p555) (FA16 p559)

A

(ACE inhibitor)
SEs: Cough, Angioedema (contraindicated in C1 esterase inhibitor deficiency), Teratogen (fetal renal malformations), ^^􏰄Cr (dec. 􏰃GFR), Hyperkalemia, and Hypotension. Avoid in bilateral renal artery stenosis, because ACE inhibitors will further dec. GFR􏰃–>􏰅renal failure
“Captopril’s CATCHH”

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15
Q

In regard to seizures, what do the terms partial, generalized, simple and complex mean? (FA15 p489) (FA16 p494)

A
  • partial: affects single area of the brain (Most commonly originate in medial temporal lobe)
  • simple partial (consciousness intact): motor, sensory, autonomic, psychic
  • complex partial (impaired consciousness)
  • generalized: diffuse
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16
Q

How is thyroid hormone made and stored?

A

(see video 17) made in the follicles of thyroid release stimulated by TRH (hypothalamus)–>TSH (pituitary)–>follicular cells
stored as T4, activated in tissue to T3 (active form)

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17
Q

A 35-year-old man is seen in the office for his chronic, recurrent peptic ulcer disease. It has been refractory to conventional treatment with PPIs. Your attending mentions that this might be caused by a tumor. Which type of tumor may be responsible for this condition? If this patient also presented with kidney stones and signs of hypogonadism, what syndrome might you suspect? (FA15 p336-337) (FA16 p332-333)

A

ZES: gastrin-secreting tumor (gastrinoma)
-associated with MEN1: 3 P’s: Pituitary (PRL, GH, hypogonadism), Parathyroid (could be causing ^^Ca2+–>stone formation), and Pancreas tumors (ZES)

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18
Q

What is the role of clomiphene in the treatment of PCOS? What is the mechanism of action of clomiphene? (FA15 p596) (FA16 p601)

A

Antag. at estrogen receptors in hypothalamus; prevents normal feedback inhib. and 􏰄release of LH and FSH from pituitary, which stimulates ovulation. Used to treat infertility due to an ovulation (PCOS). May cause hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances.
PCOS: polycystic ovaries, androgen excess, anovulation/oligoovulation

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19
Q

A 49-year-old trauma patient comes into the ER unconscious and in need of surgery. What are the exceptions to informed consent? (FA15 p56) (FA16 p40)

A
  • pt lacks decision-making capacity or is legally incompetent
  • implied consent in an emergency
  • therapeutic privilege: withholding info when disclosure would severely harm the pt or undermine informed decision-making capacity
  • waiver—patient explicitly waives the right of informed consent
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20
Q

What are the side effects of amiodarone, and what testing should be performed periodically on patients taking it? (FA15 p309) (FA16 p303)

A

(Class III antiarrhythmic, K+ channel blocker)
SEs: pulmonary fibrosis, hepatotoxicity, hypothyroidism/ hyperthyroidism (amiodarone is 40% iodine by weight), acts as hapten (corneal deposits, blue/ gray skin deposits resulting in photodermatitis), neurologic effects, constipation, CV effects (bradycardia, heart block, HF).
check PFTs (PF), LFTs (heptox), and TFTs(thy. dysfunc)

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21
Q

INF clinical uses

A

IFN-α: chronic hepatitis B and C, Kaposi sarcoma, hairy cell leukemia, condyloma acuminatum, renal cell carcinoma, malignant melanoma.
IFN-β: multiple sclerosis.
IFN-γ: chronic granulomatous disease.

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22
Q

INF-γ:

A

Secreted by NK cells in response to IL-12 from macrophages; stimulates macros to kill phagosed pathos; Also activates NK cells to kill virus-infected cells. Increases MHC expression and Ag pres. by all cells.

23
Q

INF α,β:

A

part of innate host defense against both RNA and DNA viruses. INFs are glycoproteins syn. by virus-infected cells that act locally on uninfected cells, “priming them” for viral defense by helping to selectively degrade viral nucleic acid and protein.
Essentially results in apoptosis, thereby disrupting viral amplification.

24
Q

When is a fetus most susceptible to damage from teratogens? What drug used in the treatment of hypertension is a teratogen? What effect does this have on the fetus? (FA15 p560) (FA16 p564)

A

1st trimester: Most susceptible in 3rd–8th weeks (embryonic period—organogenesis) of pregnancy. Before week 3, “all-or-none” effects. After week 8, growth and function affected.

ACE inhibitors (also ARBs)
renal damage
25
Q

How is the body affected by a prolonged stay in space at zero gravity?

A
  • decrease in blood volume
  • decrease in RBC mass
  • dec. in musc. strength and work capacity
  • dec. in max cardiac output
  • loss of Ca2+ and phosphate from bones–>loss of bone mass
26
Q

What is the most common gynecologic neoplasm? What is the typical histological pattern? Is it benign or malignant? (FA15 p588) (FA16 p594)

A

leiomyoma (fibroid)
benign
Whorled pattern of smooth muscle bundles with well-demarcated borders

27
Q 
Describe how the following diuretics affect the nephron function. (FA15 p553-554) (FA16 p557-558)
Acetazolamide
Mannitol
Furosemide
Hydrochlorothiazide (thiazides)
Potassium sparing
ADH antagonists
A

Acetazolamide: CA inhibitor–>NaHCO3- diuresis
Mannitol: osmotic diuretic–>inc. urine flow
Furosemide: loop, inhibits Na+/K+/2Cl- cotransporter–>prevents urine concentration (asc. limb of loop of Henle)
Hydrochlorothiazide (thiazides): inhibit NaCl reabsorption in early DCT–>reduce diluting capacity of nephron
Potassium sparing: competitive aldosterone rec. antagonists and block Na+ channels in cortical collecting tubule
ADH antagonists: block ADH receptor action

28
Q

How are the following relative component levels in the blood of a polycythemia vera patient different from normal: plasma volume, RBC mass, O2 saturation, and endogenous erythropoietin? (FA15 p404) (FA16 p404)

A

^^plasma volume
^^RBC mass
O2 sat normal
decreased endogenous erythropoietin

Disorder of ^^ HCT, often associated with JAK2 mutation. May present as intense itching after hot shower (due to ^ 􏰄basophils). Rare but classic symptom is erythromelalgia (severe, burning pain and red-blue coloration) due to episodic blood clots in vessels of the extremities
2° polycythemia is via natural or artificial ^ 􏰄in EPO levels.

29
Q

What synthetic agent is used both as a pituitary hormone analog and as a treatment for von Willebrand disease? (SU p189) (GG p712)

A

Desmopressin

30
Q

What agent can be given as an inhaled drug to loosen mucus plugs, can be given orally to treat acetaminophen overdose, and can be given orally as prophylaxis against IV contrast-induced nephropathy in those with preexisting renal disease? (FA15 p257, 620) (FA16 p251, 627)

A

N-acetylcysteine (replenishes glutathione)

Mucolytic—can loosen mucous plugs in CF patients by disrupting disulfide bonds.

31
Q

Which type of diabetes mellitus fits each of the following descriptions? (FA15 p335) (FA16 p331) Associated with obesity
May cause ketoacidosis Strong genetic predisposition
Associated with HLA-DR3 and -DR4

A

DM 2
DM 1 (rarely DM 2)
DM 2 : genetic predisposition***
DM 1

32
Q

What viral illness is associated with Burkitt lymphoma? Is Burkitt lymphoma a neoplasm of mature T or B cells? (FA15 p400) (FA16 p400) Where are T cells found in the spleen? Where are B cells found in the spleen? (FA15 p199) (FA16 p191)

A

EBV
B cells

  • T cells are found in the periarteriolar lymphatic sheath (PALS) within the white pulp of the spleen.
  • B cells are found in FOLLICLES within the white pulp of the spleen.
33
Q 
In which lobes of the brain would you find each of the following brain functions? (FA15 p460) (FA16 p462)
Broca’s area (motor speech)
Wernicke’s area (speech understanding)
Primary auditory cortex
Principal visual cortex
Primary sensory cortex
Primary motor cortex
Premotor cortex
A

Broca’s area (motor speech): frontal lobe (inferior frontal gyrus)
Wernicke’s area (speech understanding): temporal lobe (posterior superior temporal gyrus)
Primary auditory cortex: temporal lobe
Principal visual cortex: occipital lobe
Primary sensory cortex: parietal lobe
Primary motor cortex: frontal lobe
Premotor cortex: frontal lobe

34
Q

An 18-year-old man is brought to your office for delayed onset of puberty. Physical exam confirms a small penis and testicles for his age, as well as lack of facial, pubic, and underarm hair. The patient also reveals that he has never been able to smell. What is the likely diagnosis? (FA15 p579) (FA16 p586)

A

Kallmann syndrome:
Failure to complete puberty; a form of hypogonadotropic hypogonadism. Defective migration of GnRH cells and formation of olfactory bulb; decreased 􏰃synthesis of GnRH in the hypothalamus; anosmia; decreased 􏰃GnRH, FSH, LH, testosterone. Infertility (low sperm count in males; amenorrhea in females).

35
Q

A 45-year-old woman who has been taking prednisone for control of rheumatoid arthritis symptoms has recently been diagnosed with Cushing syndrome. Other than exogenous steroids, what else can cause Cushing syndrome? How does the level of ACTH help differentiate the etiology? (FA15 p323) (FA16 p317)

A

adrenal tumor
Cushing disease

-Primary adrenal adenoma, hyperplasia, or carcinoma (functional adrenal adenoma, nodular adrenal hyperplasia)—result in decreased ACTH, atrophy of uninvolved adrenal gland. Can also present with pseudohyperaldosteronism (low ACTH)

-ACTH-secreting pituitary adenoma (Cushing disease); paraneoplastic ACTH secretion (ectopic) (e.g.,
small cell lung cancer, bronchial carcinoids)—result in ^􏰄ACTH, bilateral adrenal hyperplasia. Cushing disease is responsible for the majority of endogenous cases of Cushing syndrome. (high ACTH)

36
Q

A 66-year-old man is involved in a motorcycle accident and suffers a head injury that leaves him in a coma. Prior to this injury, the man met with his lawyer to write out specific instructions in case an event like this happened. What are these instructions called? (FA15 p57) (FA16 p41

A

written advanced directive (living well)

37
Q

What is the classic presentation of granuloma annulare?

A

asymptomatic

  • non-scaly, slightly erythematous annular plaque, irregular, well-defined edges, thick rope-like border
  • starts small and grows outward
  • usually localized to wrists, ankles or dorsal hands/feet (but can be disseminated, palms/soles usually not affected)
38
Q

What potentially fatal autoimmune skin disorder is caused by IgG antibodies against desmosomes? What is the difference between a desmosome and a hemidesmosome? (FA15 p437, 441) (FA16 p438, 443)

A

pemphigus vulgaris: IgG antibody against desmoglein (in desmosomes)
Desmosome (macula adherens)—structural support via keratin interactions. Autoantibodies–>􏰅pemphigus vulgaris.
Hemidesmosome—connects keratin in basal cells to underlying basement membrane. Autoantibodies–>􏰅􏰁bullous pemphigoid. (Hemidesmosomes are down “bullow”).

39
Q

Describe the flow of blood into and out of the thyroid gland

A

external carotid artery–>superior thyroid artery
thyrocervical trunk–>inferior thyroid artery

superior/middle/inferior thyroid veins

40
Q

A 30-year-old man is undergoing the Schilling test to investigate his B12 deficiency. What must be present in the enteric system in order for vitamin B12 to be absorbed? (FA15 p356) (FA16 p352)

A

intrinsic factor (produced by parietal cells in stomach)

B12-IF complex absorbed in terminal ileum

41
Q

The part of the brain responsible for attention and alertness has been implicated in schizophrenia, PTSD, Parkinson disease, narcolepsy, progressive supranuclear palsy, depression, and ADHD. Which part of the brain is this? (Hint: Lesion results in coma.) (FA15 p461) (FA16 p464

A

Reticular activating system (RAS)

-keeps you alert and attentive

42
Q

What is the definition of first-degree AV block? What are the symptoms of first-degree AV block?
(FA15 p284) (FA16 p278)

A

prolonged PR interval longer than 200 msec
asymptomatic
(5 little blocks, 1 big block)

43
Q

What are the main differences between delirium and dementia? Which is more commonly reversible?
(FA15 p508) (FA16 p512-513)

A

delirium is a “waxing and waning” levels of consciousness, typically acute and reversible
dementia is an insidious, progressive decline in cognitive function, typ. not reversible

44
Q

Clopidogrel (Plavix) and ticlopidine are commonly used after an MI or cardiac catheterization with stent placement. What is the mechanism of action of these drugs? (FA15 p407) (FA16 p407)

A

anti-platelet
-inhibit platelet aggregation by irreversibly blocking ADP receptors. Prevent expression of glycoproteins IIb/IIIa on platelet surface

45
Q

What are some of the signs and symptoms of pericarditis? (FA15 p299, 300) (FA16 p294, 295)

A

leaning forward to relieve pain
pain radiating to left trapezial ridge (shoulder)

  • sharp pain, (pleuritic) aggravated by inspiration, and relieved by sitting up and leaning forward. Presents with friction rub. ECG changes include widespread ST-segment elevation and/or PR depression.
  • JVD
  • Kussmaul sign (JVD with inspiration) with constrictive pericarditis
46
Q

What common over-the-counter medication is used to remove excess thick sputum by stimulating the vagus nerve to generate low viscosity secretions in the bronchial tree? (FA15 p620) (FA16 p627)

A

Guaifenesin

mucolytic: thins mucus so easier to cough up

47
Q

Preventive vaccines have been developed for which encapsulated bacteria? What test can be used to detect encapsulated bacteria? (FA15 p122) (FA16 p112)

A

Hib
Strep pneumo
N. meningitidis

test: add serum w. anti capsular Abs–>look for “Quellung reaction” (capsule swells in response to Abs)

48
Q

A 30-year-old Asian woman presents to the clinic with a variety of complaints. Upon completion of your exam, you suspect Takayasu arteritis. What symptoms does this patient likely have? (FA15 p302) (FA16 p296)

A

Lightheadedness, ha, vision problems, arm claudication, “pulseless disease” ^ESR
tx: corticosteroids

49
Q

What are the carpal bones of the wrist?

A

Scaphoid, Lunate, Triquetrum,

Pisiform, Hamate, Capitate, Trapezoid, Trapezium A . (So Long To Pinky, Here Comes The Thumb).

50
Q

A 6-year-old boy is receiving poor grades in school. His teachers and parents report that he has normal intelligence but is very distractible and full of excess energy. What medications might help this boy? (FA15 p506) (FA16 p511)

A

ADHD (onset before age 12)
tx: stimulants (e.g., methylphenidate, amphetamine) +/– cognitive behavioral therapy (CBT); atomoxetine may be an alternative to stimulants in selected patients.

51
Q

Why is diphenhydramine (Benadryl) a poor medication choice in the elderly and in those with BPH?
(FA15 p248, 620) (FA16 p242, 627)

A

anticholinergic side effects: delirium, confusion, urinary retention

disrupts normal sleep architecture

52
Q

On which cells would you find CD4 molecules? On which cells would you find CD8 molecules? What actions do the CD8+ cells accomplish? (FA15 p202-203) (FA16 p194-195)

A

T helper cells

cytotoxic T cells; kill intracellular pathogens (viral, fungal), cancer cells, transplant tissue via apoptosis

53
Q

What breast pathology fits each of the following descriptions? (FA15 p589-591) (FA16 p595-597)
• Most common breast tumor in women under 35
• Most common breast mass in postmenopausal women
• Most common breast mass in premenopausal women
• Most common form of breast cancer

A
  • Most common breast tumor in women under 35: fibroadenoma
  • Most common breast mass in postmenopausal women: invasive ductal carcinoma
  • Most common breast mass in premenopausal women: fibrocystic changes of the breast
  • Most common form of breast cancer: invasive ductal carcinoma

DIT (8 decks)

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