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)
