Amboss

Question 1

What usually occurs prior to muscle weakness in Lambert-Eaton Myasthenic Syndrome?

Answer 1

Symptoms of autonomic dysfunction (e.g., dry mouth, constipation) are prominent and usually precede the muscle weakness, while muscle reflexes are typically absent or reduced.

Paraneoplastic autoantibodies against presynaptic voltage-gated calcium channels cause Lambert-Eaton myasthenic syndrome

Question 2

At what age does indomethacin stop inducing closure of a Patent Ductus Arteriosus?

Answer 2

At full term.
NSAIDs only induce PDA closure in pre-term infants,
ie, in infants born prior to 37 weeks gestation.

Question 3

What is a major possible side effect of Natalizumab?

Answer 3

PML infection.
Natalizumab is a biologic treatment for MS

Natalizumab decreases migration of lymphocytes to the CNS and thus increases the risk of progressive multifocal leukoencephalopathy.

Question 4

How does the A-a gradient change during a PE

Alveolar Arterial

Answer 4

It increases

Question 5

What is Hamann’s sign

Answer 5

Crepitus that is heard when auscultating the chest, that correlates to heart beats.
Associated with pneumomediastinum

Question 6

What does pronator drift indicate when the arm drops down and pronates?

What about when it drifts up and pronates?

Answer 6

Down: Upper motor neuron lesion.
Up: Cerebellar lesion.

Question 7

what is the target of the antibodies in pemphigus vulgaris

Answer 7

desmogleins. the cadherin proteins joining cell to cell epitelials, which form desmosomes.

Question 8

What drugs are used for pharmacologic cardiac stress tests

Answer 8

Dipyridamole Dobutamine

Question 9

What is the Whipple triad

Answer 9

fasting hypoglycemic episodes. labs showing hypoglycemia, symptom relief from consuming or receiving glucose

Question 10

What are the histologic traits seen in lichen planus

Answer 10

Hyperkeratosis - increased stratum corneum
and especially
Hypergranulosis - increased stratum granulosum

and very specifically,
Lymphocytic infiltration of the dermoepidermal junction.

oral lesions - Wickhkam Stria.

Question 11

Histology change in psoriasis

Answer 11

DECREASED thickness of stratum granulosum.

plus
Acanthosis: Increased st. Corneum
and most specifically
Parakeratosis - Nuclear retention in the st. Croneum.

Question 12

Difference in muscle activity between NMS and Serotonin syndrome

Answer 12

NMS = Rigidity and Tremors

Serotonin Syn = Myoclonus and Hyper-reflexia.

Question 13

Inducers and Inhibitors of CYP

Answer 13

CYP Inducers: start of with chronic alcohol, this is a clear inducer.

Chronic Alcoholics Steal Phen Phen and never refuse Greasy Carbs.

CYP inhibitors:
SICKFACES.COM

Question 14

What pathogen can cause erysipelas and/or lymphangitis following an insect bite?

Answer 14

Strep Pyogenes. Group A Strep.

It infects the insect wound following the bite, not necessarily carried or transmitted by the bite itself.

Question 15

How is eRPF calculated?

Answer 15

= Urine[PAH] x Urine flow rate/Plasma[PAH]

Question 16

How is RBF calculated?

Answer 16

= RPF/(1-HCT)

Question 17

What condition OTHER than hereditary spherocytosis do we find spherocytes?

Answer 17

Autoimmune hemolytic anemia.

AIHA.

Question 18

What vitamin deficiency can carcinoid tumors lead to?

Answer 18

Carcinoid syndrome depletes Tryptophan, which is needed for Niacin.
So Carcinoid syndrome can deplete Niacin and lead to Pellagra.

Question 19

What is used to determine if a patient with pneumonia needs hospitalization?

Answer 19

the CURB-65

Confusion
Urea
Respiratory rate
Blood pressure
Age over 65

• Confusion
• Urea (blood) > 7 mmol/L (20 mg/dL)
• Respiratory rate ≥ 30/min
• Blood pressure (systolic) ≤ 90 mm Hg or diastolic BP ≤ 60 mm Hg
• ≥ 65 years (of age)
  If the CURB-65 score is ≥ 2, hospitalization is indicated

Question 20

What other systemic disease is commonly associated with Giant Cell Arteritis/Temporal Arteritis?

Answer 20

Polymyalgia Rheumatica.

Question 21

What are macula communicans another word for?

Answer 21

Gap junctions.

Question 22

Is the 12;21 translocation favorable or unfavorable in pediatric B-ALL

Answer 22

It is favorable
Kids FLIP back to health!
12 is 21 flipped

Question 23

What genetic deficiency is a contraindication to ACE inhibitors

Answer 23

C1 inhibitor deficiency

Question 24

What condition causes Lupus Pernio

Answer 24

Sarcoidosis

Question 25

What other major organ pathology is present early on in Autosomal Recessive Polycystic Kidney disease?

Answer 25

The Liver,

Periportal Liver fibrosis.

Question 26

What autimmune condition is toxic megacolon associated with?

Answer 26

Ulcerative Colitis.

Question 27

What is the Thompson test?

Answer 27

Patient lays supine with legs flat. 
Squeeze the calf muscle.
Foot should plantar flex. 
Absence of flexion = positive test
Indicates a Achilles tendon rupture.

Question 28

What is the Uhthoff phenomenon?

Answer 28

The worsening of neurological symptoms in MS patients with increasing body temperatures.
ie after a hot bath.

Question 29

What are the “lateral anlagen”

Answer 29

the ultimobranchial bodies
Form the parafollicular C cells of the thyroid

The ‘medial anlangen’ form the thyroid follicular cells.
Both are of endodermal origin.

Question 30

How does lupus anticoagulant affect coagulation labs?

Answer 30

It increases the aPTT

Question 31

What other disorder has a single palmar crease besides downs?

Answer 31

Cri du chat syndrome

Question 32

which macrolide drug is NOT an inhibitor of CYP enzymes?

Answer 32

Azithromycin

Question 33

What drugs are contraindicated in acute gout?

Answer 33

Allopurinol
and
ASPIRIN. It is contraindicated always in gout, bc it inhibts Uric acid excretion at low doses.
Other NSAIDs are indicated like indomethacin or acetominophen.

Question 34

What drug is is indicated to treat WPW syndrome patients with atrial fibrillation?
What are contraindicted drugs?

Answer 34

Procainamide is the drug of choice.

Drugs that inhibit SA and AV nodal activity are contraindicated bc they increase the alternate pathway conduction.
ie NO CCBs, NO Beta Blockers, NO Adenosine.

Question 35

Which beta blocker with the name A-M is NOT cardioselective?

Answer 35

Labetalol

Question 36

What other conditions does nephrotic syndrome presidopse patients to having?

Answer 36

Patients with nephrotic syndrome are at high risk of developing infections (due to urinary loss of IgG), hypocalcemia (due to vitamin D deficiency), and venous thrombus formation (due to urinary loss of antithrombin III and loss of fluid into the extravascular space).