6 Flashcards
What are the positive symptoms of schizophrenia (adding a symptom)? What are the negative symptoms of schizophrenia (removing a normal finding/trait)? (FA15 p509) (FA16 p514)
Diagnosis requires 2 or more of the following (first 4 are “positive symptoms”):
Delusions
Hallucinations—often auditory
Disorganized speech (loose associations)
Disorganized or catatonic behavior
“Negative symptoms”—flat affect, social
withdrawal, lack of motivation, lack of speech or thought
What is HIPAA?
Health Insurance Portability and Accountability Act
Describe the anatomy of the femoral sheath. When placing a femoral line for central venous access, you palpate a femoral pulse. Where do you place the guide needle in relation to this pulse: medially or laterally? (FA15p350)(FA16p347)
femoral sheath contains femoral vein, artery and femoral canal (contains deep inguinal LNs) no femoral nerve (“venous near the penis”
general organization lateral to medial: NAVeL:
Femoral nerve, artery, vein, empty space, lymphatic
-guide needle in medially to pulse
Which area of the brain is damaged in Klüver-Bucy syndrome? What are the symptoms of Klüver-Bucy syndrome? (FA15 p461) (FA16 p464)
bilateral amygdala
disinhibited behavior: hyperphagia, hyperorality, hypersexuality, hyperdocility
-assoc. with HSV1
What long-term complication is associated with having to receive multiple blood transfusions? (FA15 p399)
Blood transfusion risks include infection transmission (low), transfusion reactions, iron overload (can lead to hemosiderosis or hemochromatosis), hypocalcemia (citrate is a Ca2+ chelator), and hyperkalemia (RBCs may lyse in old blood units).
What are Cheyne-Stokes respirations?
cyclic respiration
repeating cycles of apnea and hypercapnia with a compensatory phase of hyperventilation and hypocapnia
Which type of immunodeficiency disorder is caused by DiGeorge syndrome? (FA15 p214) (FA16 p208) Development of which branchial pouches is affected in DiGeorge syndrome? (FA15 p566) (FA16 p570)
Thymic aplasia; recurrent viral/fungal infections due to T-cell deficiency
3rd and 4th pharyngial pouches
What drugs and endogenous hormones regulate the secretion of gastric acid? (FA15 p353-354) (FA16 p350-351)
^ by gastrin, histamine, ACh
decreased by somatostatin, secretin, GIP (glucose-dep. insulinotropic peptide), prostaglandin
drugs that decrease: PPIs, H2 blockers, Octreotide
The E4 variant of Apo E is a known risk factor for Alzheimer’s disease. What is the primary function of each of the following major apoproteins? (FA15 p115) (FA16 p104) Apo A-I Apo B-48 Apo B-100 Apo C-II ApoE
Apo A-I: Activates LCAT
Apo B-48: Mediates chylomicron secretion from enterocytes
Apo B-100: Binds LDL receptor
Apo C-II: Lipoprotein lipase (LPL) cofactor
ApoE: Mediates remnant uptake (Alz. disease)
Name five or more drugs that inhibit acetylcholinesterase. What is the clinical application for each?
(FA15 p250) (FA16 p244)
Donepezil, galantamine, rivastigmine (Alzheimer’s disease)
Edrophonium (Tensilon test: dx myasthenia gravis)
Neostigmine: reversal of NM junction blockade (postop/neurogenic ileus and urinary retention, myasthenia gravis
Physostigmine (atropine OD)
Pyridostigmine (txmyasthenia gravis)
Echothiophate (tx open angle glaucoma)
Clavulanic acid, sulbactam, and tazobactam aid penicillins in their activity against bacteria through what mechanism? (FA15 p181) (FA16 p171)
inhibit β-lactamase/penicillinase
Which bacteria are most commonly responsible for sialadenitis? What condition most commonly predisposes a patient to sialadenitis? (SU p119)
(inflammation/infection of salivary gland)
S. aureus and Viridans strep
most commonly secondary to stone obstruction of salivary gland duct (sialolithiasis)
Membranous glomerular diseases involve thickening of which structure? (FA15 p540) (FA16 p544)
Thickening of glomerular basement membrane (GBM) i.e. membranous nephropathy
An 88-year-old man arrives at the ER after he fell and struck his head. He has a history of atrial fibrillation for which he takes warfarin. Noncontrast CT of the head reveals subarachnoid hemorrhage. What is the antidote for warfarin anticoagulation or warfarin overdose? For heparin overdose? (FA15 p257, 406) (FA16 p251, 406)
warfarin: vitamin K+ (delayed), FFP (immediate)
heparin: Protamine sulfate
What important secretory products are secreted from each of the following cells of the GI tract? (FA15 p353-354) (FA16 p350-351) G cells I cells S cells D cells K cells Parietal cells Chief cells
G cells: gastrin (antrum)
I cells: cholecystokinin (CCK) (duodenum, jejunum)
S cells: secretin (duodenum)
D cells: somatostatin (pancreatic islets and GI mucosa)
K cells: GIP
Parietal cells: intrinsic factor, HCl
Chief cells: pepsin
You recommend that your patient, a 51-year-old woman, begin taking a calcium and vitamin D supplement in order to prevent osteoporosis. What are the steps in the conversion of vitamin D to its active form in the body? By what mechanism does vitamin D help prevent osteoporosis? (FA15 p319) (FA16 p313)
D3 from sun exposure in skin. D2 ingested from plants. Both converted to 25-OH (calcidiol) in liver and to 1,25-(OH)2 (calcitriol, active form) in kidney.
^absorption of dietary Ca2+ and PO43−.
^bone resorption–>^Ca2+ and PO43–.
A child arrives at the ER in hypotensive shock after taking his dad’s phenoxybenzamine. The intern on call orders the nurse to get her a pressor STAT. The nurse informs the intern that there are two pressors available in the ER, epinephrine and phenylephrine. Which one will be able to increase the blood pressure of this pediatric patient? (FA15 p255) (FA16 p248)
phenoxybenzamine: irreversible a-blocker
epinephrine: a and B agonist
phenylephrine: purely a agonist (want this one! do not want to induce B2 induced vasodilation with epinephrine)
What can occur if a MAO inhibitor (MAOI) is added to an SSRI? What is the treatment for this condition? (FA15 p523) (FA16 p527-528)
serotonin syndrome with any drug that 5-HT (e.g., MAO inhibitors, SNRIs, TCAs)—tremor, hyperreflexia, hyperthermia, confusion, myoclonus, CV instability, flushing, diarrhea, seizures.
tx: stop drugs, give benzos (lorazepam), supportive care
cyproheptadine (5-HT2 receptor antagonist)
What landmarks are used when placing an internal jugular central venous catheter? (COA p1011
triangle between 2 heads of SCM muscle: clavicular head and sternal head
30 degree angle at apex (top) towards nipple, also palpate carotid to ensure not going in it
A patient presents with a 1 cm, painless, mobile mass in her right parotid gland. You inform the patient that most tumors in the parotid gland are benign. What is the most common benign tumor of the salivary gland? What is a Warthin’s tumor? Which cranial nerve goes through the parotid gland? (FA15 p357, 475) (FA16 p353, 479)
most common: Pleomorphic adenoma (benign mixed tumor)—
Composed of chondromyxoid stroma and epithelium and
recurs if incompletely excised or ruptured intraoperatively.
Warthin tumor (papillary cystadenoma lymphomatosum)—benign cystic tumor with germinal centers
CN VII (facial)
What are the most common locations of lung cancer metastases? (FA15 p619) (FA16 p626)
FROM lungs: Sites of metastases from lung cancer: adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatomegaly).
TO lungs: In the lung, metastases (usually multiple lesions)
are more common than 1° neoplasms. Most often from breast, colon, prostate, and bladder cancer.
What are some of the functions of bile produced by hepatocytes and stored in the gallbladder? Which hormone is the most potent stimulator of gallbladder contractions?
- emulsifies large fat particles–>small fat particles
- absorption of fat end-products
- absorption of fat-soluble vitamins
- excretion of bilirubin, copper, cholesterol
- CCK*
What is the characteristic fetal complication associated with lithium use in pregnancy? What other agents used to treat bipolar disorder can be teratogenic, and what are their corresponding fetal effects? (FA15 p560) (FA16 p564)
- lithium: Ebstein anomaly (atrialized right ventricle)
- valproic acid: Inhibition of maternal folate absorption–>neural tube defects (“Valproate inhibits folate absorption”)
- carbamezipine: Facial dysmorphism, developmental delay, neural tube defects, phalanx/fingernail hypoplasia
- aripiprazole/risperidone (atypicals): extrapyramidal symptoms
Which anatomic structures are found in the retroperitoneum? (FA15 p343) (FA16 p339)
"SAD PUCKER" (are so retro) Suprarenal (adrenal) glands Aorta and IVC Duodenum Pancreas (except tail) Ureters Colon (descending/ascending, not transverse) Kidneys Esophagus (thoracic portion) Rectum (partially)
What are the common causes of Erb-Duchenne palsy? Where is the brachial plexus insult with Erb- Duchenne palsy? (FA15 p419) (FA16 p420)
Infants—lateral traction on neck during delivery
Adults—trauma
-tear of UPPER (“Erb-er”) TRUNK: C5-C6 roots
-muscle deficits:
Deltoid, supraspinatus–>can’t abduct (arm hangs by side)
Infraspinatus–>can’t lateral rotate (arm medially rotated)
Biceps brachii–>can’t flex, supinate (arm extended and pronated)
A central line is often placed in the subclavian vein to administer fluids and medications or to measure central venous pressure. What landmarks are used when placing a subclavian central line?
thumb on middle 1/3 on clavicle, index finger on jugular notch, insert needle medially below thumb (inferior surface of clavicle) aiming about to tip of index finger
Metastasis to the brain, liver, and bone commonly comes from which locations? (FA15 p240) (FA16 p233)
brain:
liver:
bone:
brain: Lung > breast > prostate > melanoma > GI
(50% of brain tumors from metastases)
liver: Colon»_space; stomach > pancreas
(Liver and lung are the most common sites of metastasis after the regional LNs)
bone: Prostate, breast > lung, thyroid, kidney
(Bone metastasis » 1° bone tumors)
Which glycogen storage disease fits each of the following features? (FA15 p110) (FA16 p99)
Severe hypoglycemia with elevated blood lactate
Hypoglycemia without elevated blood lactate
Cardiomegaly
Myoglobinuria associated with exercise
Severe hypoglycemia with elevated blood lactate: Von Gierke disease
Hypoglycemia without elevated blood lactate: Cori disease
Cardiomegaly: Pompe disease (“Pompe trashes the Pump”; heart, liver, and muscle)
Myoglobinuria associated with exercise: McArdle disease
What is the mechanism of organophosphate poisoning? What are the symptoms of cholinergic excess? (FA15 p250) (FA16 p244)
Acetycholinesterase inhibitor, ^^ACh DUMBBELLS Diarrhea Urination Miosis Bronchospasm Bradycardia Excitation of skeletal muscle and CNS, Lacrimation Sweating and Salivation
What is the treatment for a pulmonary embolism? (FA15 p405, 609) (FA16 p405, 617)
IV Heparin or LMWH:
Immediate anticoagulation for PE, acute coronary syndrome, MI, DVT. Used during pregnancy (does not cross placenta). Follow PTT
antidote: protamine sulfate (positively charged molecule that binds negatively charged heparin).
Which cancers can cause the paraneoplastic syndrome Lambert-Eaton syndrome? (FA15 p238) (FA16 p229)
Small cell lung carcinoma
also Hodgkin lymphoma and malignant thymoma
LES: Antibodies against presynaptic Ca2+ channels at NMJ
What is conductive hearing loss, and what are some causes?
sound not conducted to cochlear apparatus
-causes: wax buildup, ear infection, ruptured TM, otosclerosis (abnormal growth of ossicles in middle ear)
What is the most common tumor of the urinary tract? What is the usual presenting complaint of a patient with this tumor? What substance exposures increase the risk of developing this tumor? (FA15 p547) (FA16 p551)
Transitional cell carcinoma: can occur in renal calyces, renal pelvis, ureters, and bladder
typical presenting complaint: painless hematuria
Associated with problems in your Pee SAC: Phenacetin, Smoking, Aniline dyes, and Cyclophosphamide
What pulmonary artery pressures indicate pulmonary hypertension? (FA15 p614)
greater/= to 25 mmHg at rest (normal: 10-14 mmHg (8-20 DIT)
What conditions are associated with oligohydramnios, and what conditions are associated with polyhydramnios? (FA15 p583) (FA16 p589) (SU p144)
oligohydramnios: placental insufficiency, bilateral renal agenesis, posterior urethral valves (in males) and resultant inability to excrete urine
(decreased urine production)
polyhydramnios: fetal malformations (e.g., esophageal/ duodenal atresia, anencephaly; both result in inability to swallow amniotic fluid), maternal diabetes, fetal anemia, multiple gestations.
What are the mechanisms of action of each of the following toxins? Strychnine Tetanus toxin Black widow spider toxin Botulinum toxin
Strychnine: glycine antagonist
Tetanus toxin: Blocks release of inhibitory NTs: GABA and glycine, from Renshaw cells in SC
Black widow spider toxin: cause excessive release of ACh (musc. cramping and pain)
Botulinum toxin: inhibits ACh release at NMJ
A 3-year-old girl presents with a fever of 102°F for the last three days. On the fourth day, the patient develops a red macular rash over the entire trunk, and her fever resolves abruptly. What viral infection is most likely in this case? (FA15 p158-159) (FA16 p149)
HHV 6/7: Roseola (exanthem subitum)
What is the difference between malingering and factitious disorder? (FA15 p514) (FA16 p518)
malingering pts have external/secondary desires (i.e. skip work, drug seeking)
the primary goal of pts w. factitious disorder is to receive medical care (internal/primary)
Which phase of drug metabolism do geriatric patients lose first? Which phase of drug metabolism makes a slightly polar metabolite by oxidation, reduction, or hydrolysis? (FA15 p244) (FA16 p238)
both Phase 1 (cyt P450)
IN CONTRAST, Phase 2:
Conjugation (Glucuronidation, Acetylation, Sulfation) usually yields very polar, inactive metabolites (renally excreted).
(lipid soluble)
Geriatric patients have GAS (phase II). Patients who are slow acetylators haveside
effects from certain drugs because ofrate of metabolism.
A patient complains of intense thirst and profuse urination. A diagnosis of diabetes insipidus is suspected after further testing. What would be the most likely urine specific gravity and serum osmolality findings in this patient? (FA15 p333) (FA16 p328)
Sp gravity: decreased, less than 1.006
low Ur Osm
Serum Osm greater than 290 mOsm/kg
“hyperosmotic volume contraction”
bonus: central DI: decreased ADH (can’t make ADH) vs nephrogenic DI: normal ADH (don’t respond to ADH)
What are the essential amino acids? (FA15 p104) (FA16 p92)
PVT TIM HA*LL Phenylalanine Valine Threonine Tryptophan Isoleucine Methionine Histidine Arginine (only in kiddos) Lysine Leucine
What medications are commonly used for the treatment of insomnia?
melatonin
antihistamine (diphenhydramine- poor quality sleep)
Trazodone (antidepressants)
TCAs: amitriptyline (arrhythmias)
benzos: temazepam, lorazepam (can be addictive)
zolpidem (ambien), Zaleplon, Eszopiclone (Lunesta), Ramelteon (serotonin receptors)
Which mature structures arise from each of the following embryologic structures? (FA15 p268) (FA16 p262) Bulbus cordis Left horn of sinus venosus Primitive atrium Truncus arteriosus Primitive ventricle Right horn of sinus venosus Right common and anterior cardinal veins
bulbus cordis: Smooth parts (outflow tract) of left and right ventricles
Left horn of sinus venosus: Coronary sinus
Primitive atrium: Trabeculated part of left and right atria
Truncus arteriosus: Ascending aorta and pulmonary trunk
Primitive ventricle: Trabeculated part of left and right ventricles
Right horn of sinus venosus: Smooth part of right atrium (sinus venarum)
Right common and anterior cardinal veins: SVC
describe the rash (timing, description, location): Rubella
Pink coalescing macules begin at head and move down–>fine desquamating truncal rash; postauricular lymphadenopathy
describe the rash (timing, description, location): Herpes Zoster (VZV, chicken pox)
Vesicular rash begins on trunk; spreads to face and extremities with lesions of different ages
describe the rash (timing, description, location): HHV-6 (roseola, exanthem subitum)
Asymptomatic rose-colored macules appear on body after several days of high fever; can present with febrile seizures; usually affects infants
describe the rash (timing, description, location): Parvovirus B19 (Erythema infectiosum- fifth disease)
“Slapped cheek” rash on face, later lace like over body (can cause hydrops fetalis in pregnant women)
describe the rash (timing, description, location): Coxsackievirus type A (hand-foot-mouth disease)
Oval-shaped vesicles on palms and soles; vesicles and ulcers in oral mucosa
describe the rash (timing, description, location): Streptococcus progenies (scarlet fever)
Erythematous, sandpaper-like rash with fever and sore throat
A 50-year-old man crashes on a motorcycle on the highway and sustains a right anterior hip dislocation and knee trauma. Now he cannot adduct his hip or plantarflex on that side. Which nerves are injured? (FA15 p421) (FA16 p422)
Obturator (L2–L4): dec. adduction
Tibial (L4–S3): Inability to curl toes and loss of sensation on sole of foot. In proximal lesions, foot everted at rest with loss of inversion and plantarflexion.
How much does the H/H change in a person that has acclimatized to a hypoxic environment for weeks?
(Hgb and Hct)
Hct rises to 60 (normal 40-50)
Hgb rises to 20 (normal 15)
A 53-year-old man has just been diagnosed with peptic ulcer disease (PUD) visualized on endoscopy. Ranitidine and lansoprazole are the medications available on your hospital formulary for the treatment of PUD. Describe the different ways in which ranitidine and lansoprazole decrease parietal cell acid secretion. Why is ranitidine preferred over cimetidine? What other conditions can you treat with lansoprazole and ranitidine? (FA15 p378) (FA16 p374)
ranitidine:
H2 blocker: Reversible block of histamine H2-receptors–> dec. H+ secretion by parietal cells (others: Cimetidine, famotidine, nizatidine) (Take H2 blockers before you “dine”. Think “table for 2” to remember H2.)
*Cimetidine is a potent inhibitor of cytochrome P-450, anti-androgen, can cross BBB/placenta
lansoprazole: PPI; Irreversibly inhibit H+/K+ ATPase in stomach parietal cells
(others: Omeprazole, esomeprazole, pantoprazole, dexlansoprazole)
also tx: gastritis, esophageal reflux, ZES (PPIs)
What are some extrapulmonary causes of restrictive lung disease? (FA15 p611) (FA16 p619)
NM diseases: polio, myathenia gravis
structure: scoliosis, morbid obesity, severe kyphosis
Wallenberg syndrome is an injury of the lateral medulla that presents with a constellation of neurologic symptoms including difficulty with swallowing (dysphagia), hoarseness, and difficulty with palate elevation. Which part of the lateral medulla is responsible for swallowing and palate elevation? What other cranial nerves can be involved with this region? (FA15 p464, 476) (FA16 p467, 479)
nucleus ambiguus–>efferent motor fibers of CN X (vagus)
CN IX: Glossopharyngeal
CN XI: spinal accessory
Which muscles compose the rotator cuff? (FA15 p417) (FA16 p417)
SITS
- subscapularis (upper and lower subscapular nerves) medially rotates and adducts arm.
- supraspinatus (suprascapular nerve) abducts arm initially (before the action of the deltoid); most common rotator cuff injury, assessed by “empty/full can” test. -infraspinatous (suprascapular nerve)—laterally rotates arm; pitching injury
- teres minor (axillary nerve)—adducts and laterally rotates arm
What is Potter sequence? (FA15 p526)
Pulmonary hypoplasia Oligohydramnios (trigger) Twisted face Twisted skin Extremity defects Renal failure (in utero)
