5/7 Mixed

Question 1

Medical Therapy for Cholesterol Gallstones

Answer 1

Hydrophilic bile acid (eg urodeoxycholic acid)

Decrease biliary cholesterol secretion and increase biliary bile acid concentration, improving cholesterol solubility

Question 2

Concurrent use of NSAIDS with loop diuretics can result in decreased diuretic response

Answer 2

NSAIDS (ibuprofen, naproxen, indomethacin) inhibit prostaglandin synthesis

(Loop diuretics stimulate prostaglandin release, increasing renal blood flow leads to increased GFR)

Question 3

What is a requirement for referring a patient for hospice care?

Answer 3

Patient has a prognosis of

Question 4

Golgi tendon organs (GTOs)

Answer 4

Sensory receptors at the junction of the muscle and tendon, innervated by group Ib sensory axons.

Negative feedback system that regulates and maintains muscle tension. When the muscle exerts too much force, the GTOs inhibit contraction of the muscle, causing sudden muscle relaxation, preventing damage to the musculoskeletal system.

Question 5

Fragile X syndrome

Answer 5

Most common inherited cause of intellectual disability

Macroorchidism, dysmorphic facies, developmental delay, ADHD, autism

Mutation in FMRI gene on X chromosome
Full mutation = >200 CGG trinucleotide repeats, causing FMRI hypermethylation (inactivates FMR1)

Question 6

Neuroleptic Malignant Syndrome

Answer 6

Overdose of ridperidone
Diffuse muscle rigidity, high fever, autonomic instability (hypertension, tachycardia), altered sensorium, CK elevation

Rx: Dantrolene (direct acting skeletal muscle relaxant, antagonizes the ryanodine receptors, inhibiting calcium ion release from SR of skeletal muscle.
Bromocriptine (dopamine agonist) also helpful

Question 7

Anterior dislocations of humerus

Answer 7

Classically follow a blow to an externally rotated and abducted arm (throwing a football)

Flattening of the deltoid muscle with acromial prominence

Axillary nerve most commonly injured (innervated deltoid and teres minor, provides sensory innervation to skin overlying lateral shoulder)

Question 8

Inferior epigastric artery

Answer 8

1 of 2 branches of the external iliac artery

Takes off immediately proximal to the inguinal ligament

Provides blood supply to the lower anterior abdominal wall as it runs superiorly and medially up the abdomen

Question 9

Selective IgA deficiency

Answer 9

Recurrent sinopulmonary, GI infections, autoimmune disease, anaphylaxis during transfusions, low or absent serum IgA levels, normal IgM and IgG levels

Most common primary immunodeficiency

Question 10

Viral genome replication of HBV

Answer 10

Repaired double-stranded circular DNA serves as a template for transcription into an intermediate + single stranded RNA
RNA strand serves as a template for translation of viral proteins and reverse transcription into a single stranded DNA intermediated (converted back into partially double-stranded DNA)

Replicates via reverse transcription
DS DNA > +RNA template > DS DNA progeny

Question 11

Constrictive pericarditis

Answer 11

Calcification and thickening of the pericardium on CT

Slowly progressive dyspnea, peripheral edema ascites

Question 12

Carpal tunnel syndrome

Answer 12

Peripheral mononeuropathy
Compression of median nerve in carpal tunnel
Associated with conditions that reduce carpal tunnel space (pregnancy, hypothyroidism, DM, rheumatoid arthritis).
Patients with a long hx of hemodialysis can develop median nerve compression thru deposition of B2-microglobulin (dialysis associated amyloidosis)
Symptoms often bilateral, sensory impairment in first 3 digits , thenar atrophy, tinel sign, phalen sign, weakness on thumb abduction/opposition

Question 13

Antibodies seen in SLE

Answer 13

Antinuclear antibodies (ANA)
Anti-double stranded DNA (anti-dsDNA) Ab
Anti-snRNPs= "anti-Smith" Ab

Question 14

Cilostazol

Answer 14

Reduces platelet activation by inhibiting platelet phosphodiesterase (breaks down cAMP), direct vasodilator

decrease in claudication symptoms, increase in pain-free walking in patients with peripheral arterial disease (PAD)

Also put patients on graded exercise program!!

Question 15

B1 receptors

Answer 15

Found in cardiac tissue and renal juxtaglomerular cells, NOT in vascular smooth muscle

G protein coupled receptor associated with Gs, increases intracellular cAMP

Blockade of B1 will lead to decreased cAMP in cardiac and renal tissues, without affect cAMP levels in vascular smooth muscle

Atenolol is a selective B1 antagonist (at low doses)

Question 16

Allergic bronchopulmonary aspergillosis (ABPA)

Answer 16

Aspergillus fumigatus
Pts with asthma or CF may develop allergic hypersensitivity reaction to the fungus
High serum IgE levels, eosinophilia, IgE plus IgG serum antibodies to Aspergillus
Proximal bronchiectasis

Question 17

Integrins

Answer 17

Transmembrane protein receptors that interact with the extracellular matrix by binding to specific proteins, including collagen, fibronectin and laminin

Differential expression of integrin subtypes affects adhesion properties of individual cells and correlates with malignant behavior in a number of tumors, including melanoma

Question 18

Carcinoid heart disease

Answer 18

Endocardial thickening and fibrosis of tricuspid and pulmonary valves
Carcinoids are well-differentiated neuroendocrine tumors found in distal SI and proximal colon
Strong propensity for liver metastasis
Secrete histamine, serotonin, VIP
If liver met, hormones release directly into systemic circulation > carcinoid syndrome

Carcinoid heart dx is caused by excessive secretion of serotonin (stimulates fibroblast growth and fibrogenesis)
Deposits of fibrous tissue occur on endocardium
Right sided heart failure, tricuspid regurg, pulmonic valvulopathy

5-hydroxyindoleacetic acid (5-HIAA) = end product of serotonin metabolism, elevated in urine