April 14

Question 1

What 2 disorders results from a 22q11.2 micro deletion?

Answer 1

DiGeorge syndrome
velocardiofacaial syndrome

FISH–gold standard for dx of micro deletion

Question 2

IFN a and B are produced by human cells in response to viral infection, what is there role?

Answer 2

Help suppress viral replication by halting protein synthesis and promoting apoptosis of infected cells

Question 3

Normal or elevated ACTH levels that can be suppressed during high-dose dexamethasone test?

Answer 3

Pituitary adenoma

Ectopic ACTH production –if NOT suppressed

Question 4

What has activity against pseudomonas?

Answer 4

Piperacillin/ticarcillin
Ceftazaidime/cefepime
Ciprofloxacin/levofloxacin
Imipenem/meropenem

Question 5

What vessel has to most deoxygenated blood?

Answer 5

Coronary sinus–heart takes more O2 than any other tissue in the body

Question 6

What is typically seen in CSF when viral infection occurs?

Answer 6

Normal glucose
Elevated protein
Lymphocytic pleocytosis

Question 7

What are the 3 Dopamine agonist drugs that directly stimulate dopamine receptors?

Answer 7

Ergot–Bromocriptine

Non-ergot (preferred)–Parmipexole and Ropinirole

Question 8

G6PD deficiency has what type of inheritance pattern?

Answer 8

X-linked recessive

Question 9

What are the characteristics of drugs with low Vd (3-5L)?

Answer 9

Large/Charged molecules, plasma protein bound

Question 10

Wilsons disease presents with what brain abnormality?

Answer 10

Basal ganglia atrophy–due to deposition of copper

Question 11

How does galactokinase deficiency present?

Answer 11

Autosomal recessive disease that develops when infant begins feeding–lactose present in breast milk and routine formula

Galactose appears in blood and urine and infantile cataracts occur due elevated galactitol which is formed from excess circulating galactose by aldose reductase

Question 12

Effect of substance A is required for the full effects of substance B?

Answer 12

Permissive

Question 13

Pt with PCOS wants to become pregnant, what should she take and what is the MOA?

Answer 13

Clomiphene citrate–Selective estrogen receptor modulator preventing negative feedback inhibition by circulating estrogen
–Increases LH and FSH–> ovulation

Question 14

What are the 3 drugs used for pregnancy termination and MOA of each?

Answer 14

Misoprostol–PGE1 agonist–causes cervical shortening and uterine contraction
Mifepristone–Progesterone and glucocorticoid antagonist–prevents further development of the 1st trimester pregnancy
Methotrexate–Folic acid antagonist –inhibits trophoblast division

Question 15

What can be given to prevent hemorrhagic cystitis seen with cyclophosphamide?

Answer 15

Mesna–thiol group of meson binds toxic metabolites

Or N-acetylcysteine

Question 16

With what condition can pt develop R-sided varicocele?

Answer 16

Nephrotic syndrome–due to right renal vein thrombosis from loss of antithrombin III in urine

Question 17

Administration of glucose to thiamine deficient pt can lead to what?

Answer 17

Wernicke encephalopathy –acute confusion, opthalmoplegia, and ataxia due to increased thiamine demand within TCA cycle

Damage to the mamillary bodies –hemorrhagic characteristic

Always infuse thiamine with glucose when thiamine deficiency is suspected

Question 18

What is power (1-B)?

Answer 18

Represents a study’s ability to detect a difference when one exists

Question 19

What type of cells are involved in sarcoidosis?

Answer 19

CD4+ T cells

Question 20

The concentration of what 3 substances decreases as fluid travels through the proximal convoluted tubule?

Answer 20

HCO3-
Glucose
Amino acids

PAH, CR, Inulin and Urea increase

Question 21

Glycerol can be converted to glucose during gluconeogenesis by using what enzyme?

Answer 21

Glycerol kinase
–Pts with DKA have breakdown of TGs in adipocytes –> glycerol

Hormone sensitive lipase–found in adipose tissue where it functions to break down stored TGs into FFA and glycerol
–during starvation-provides substrates for gluconeogenesis and ketone body formation

Question 22

PCL attaches to what condyle?

Answer 22

Medial femoral condyle

ACL–attaches to the lateral

Question 23

Low solubility in blood for inhaled anesthetic=

Answer 23

rapid onset and fast equilibrium with brain

Small amount need to saturate the blood

Question 24

Where do anal fissures most often occur and why?

Answer 24

Below the Pectinate line. Pain while Pooping; blood on toilet Paper. Located Posteriorly because this area is Poorly Perfused

Associated with low-fiber diets and constipation

Question 25

Pt presents with itchy breast rash with thick skin resembling an orange peel. Dx?

Answer 25

Inflammatory breast cancer

–Cancerous cells obstruct lymphatic drainage due to spread to dermal lymphatic spaces

Question 26

Low C1 esterase inhibitor activity leads to increases in ______ activity and therefore ______ are CI with this disorder.

Answer 26

Bradykinin
ACE inhibitors

Hereditary angioedema has decreased C1 esterase inhibitor activity

Question 27

What is the classic triad of fat embolus?

Answer 27

Hypoxemia
Neurologic abnormalities
Petechial rash

Associated with long bone fractures

Question 28

What are symptoms of atypical depression and what drug class is used?

Answer 28

Mood reactivity–improved modd in response to positive events
Reversed vegetative symptoms
Leaden paralysis–heavy feeling in arms and legs

MAO inhibitors can be used especially if pt has depression resistant to other tx–like SSRIs, which are first line.
(Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline)

Question 29

Middle meningeal artery is a branch off what artery?

Answer 29

Maxillary artery–which enters the skull where the frontal, parietal, temporal, and sphenoid bones meet

Skull fractures at this site can cause damage to this vessel leading to epidural hematoma

Question 30

Renal angiomyolipoma is a benign tumor composed of blood vessels, smooth muscle and fat and is associated with what disease?

Answer 30

Tuberous sclerosis
HAMARTOMAS
-Hamartomas in CNS and skin
-Angiofibromas
-Mitral regurgitation
-Ash-leaf spots
-cardiac Rhabdomyoma
-Tuberous sclerosis
-autosomal dOminant 
-Mental retardation
-renal Angiomyolipoma 
-Seizures
-Shagreen patches

Question 31

What is Chi-square test used for?

Answer 31

Used to test the association between 2 categorical variables

Question 32

What is the difference btw the polysaccharide capsule vaccine and the conjugated vaccine used for strep pneumoniae?

Answer 32

Conjugate vaccines are more immunogenic in infancy due to both T and B cell recruitment
They provide higher, longer lasting antibody titers relative to the polysaccharide

Question 33

What vitamin deficiency is characterized by symmetrical peripheral neuropathy and can also include high-output CHF?

Answer 33

Thiamine deficiency

Dry beriberi–peripheral neuropathy
Wet beriberi–peripheral neuropathy + CHF

Can also see Wernicke-Korsakoff syndrome

Question 34

How does Rett syndrome present?

Answer 34

Almost exclusively in girls–ages 1-4
—develop normally and the have loss of development, loss of verbal abilities, intellectual disability, ataxia, stereotyped hand-wringing –deceleration of head growth

Question 35

What can occur 4-10 days after a subarachnoid hemorrhage causing an ischemic infarct?

Answer 35

Vasospasm

–use nimodipine to prevent

Question 36

What is the cause of cataracts and peripheral neuropathy seen with DM pts?

Answer 36

Increased glucose–> conversion to sorbitol–accumulates within some cells and attracts H2O into these tissues leading to osmotic cellular injury

Question 37

What compound is most likely to be low in a pts CSF if they have Narcolepsy?

Answer 37

Hypocretin-1 –orexin

–Decreased production in the lateral hypothalamus