assesment

Question 1

ARDS

Answer 1

Defined:
acute onset of lung dysfunction. pulmonary edema, normal LA pressure and PaO2/FiO2 of < 200.
-damage to endothelial cells lining the pulmonary capillaries resulting in leakage of fluid into the alveoli, sometimes referred to as the exudative stage.
-The process evolves to include a proliferative stage and sometimes a final fibrotic stage

Question 2

Osteosarcoma

Answer 2

• assoc with Pagets disease
• arrising in the femur, tibia, humerous and other bones
• destruction of the normal trabecular bone pattern, mixed radiodense and radiolucent areas, periosteal new bone formation, lifting of the cortex and codmans triangle.
• adjacent soft tissue usually demonstrates ossification in a sunburst pattern.

Question 3

Globus hystericus (glubus sensation or lump in throart)

Answer 3

• emotions trigger
• fear, tension, anger, mental anguish
• assoc. GERD, upper esophageal sphincter abnormalities, achalasia, psychiatric disorders and stress
• the neck examination and barium swallow will show nothing

Question 4

endometriosis

Answer 4

• characterized by the presence of endometiral glands and stroma outside the uterus
• significant pelvic pain, dysmenorhhrea, infertility and deep dyspaeunia are frequent

Question 5

oseltamivir (tamiflu)

Answer 5

• sialic acid analogue that inhibits the neuraminidases of the influezna A and influenza B viruses. Which attacht to cells and respiratory tract mucins though hemagglutinin binding of glycoconjugate receptors.
• prevents release

Question 6

DNA laddering

Answer 6

• lab phenomenon used to identify apoptotic cells and distinguid them from necrotic cells.
• during karyorrhexis, endonucleases degrade DNA into fragments that are mutioles of 180 base pairs, these fragments are equally spaced on gel electrophoresis giving the appearance of a ladder

Question 7

slower benzodiasepine metabolism in the elderly increases the likelihood of adverse effects

Answer 7

confusion, anterograde amnesia, and psychomotor retardation are commonly reported in this patient population

Question 8

Anticholinergic syndrome

hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter

Answer 8

-fever, dry skin, mucous membranes, flushing, mydriasis, cycloplegia and altered mental status.

thus confusion, blurred vision, dry mucous membranes and intense thirst are associated with anticholinergic toxicity

Question 9

germline mosaicism

Answer 9

• the presence of two or more genetically different gamete cell lines
• should be considered when a genetic mutation is identified in the offspring but not the parents

Question 10

Name an interleukin which is produced exclusively by antigen-stimulated T-lymphocytes

Answer 10

IL-2

-stimulates growth and differentiation of T, B and NK cells and macrophages.

Question 11

Cadherins

Answer 11

• calcium dependant transmembrane proteins that participate in desmosome formation via homolougous interaction with cadherins on adjoining cells
• bind within the cytoplasm to intermediate filaments (keratin) or microfilaments (actin) via intermediate proteins (catenin, plakoglobin and demoplakin) and bind extracellularly to cadherin molecules on adjacent cells, forming adherin junctions and desmosomes.

Question 12

Molluscum contagiosum

-caused by Poxvirus (MC virus_

Answer 12

• contagious in children from skin to skin contacts and formites
• in adults –> sexually transmitted
• HIV or other immunocompromised individuals they experience a longer course

-multiple firm, flesh colored, dome shaped papules on the skin and mucous membranes. The papules are often pruitic and have umbilicated centers containing white, curdlike material

Question 13

Endometritis is an infection of the uterus, most cases follow dlivery

Answer 13

• signs: fever, leukocytosis, uterine tenderness and foul smelling discharge
• it is most commonly cause by mixed flora with Bacteriodes the most commonly isolate organism

Question 14

reflection interview technique

Answer 14

• this assures the patient that the physician has been listening to his concerns and allos the patient to clarify any points that have been misunderstood
• repeats what the paitents has just siad

Question 15

long term intranasal cocaine abusers

Answer 15

• chronic nasal discharge
• atrophic nasal mucosa
• thinning of the nasal septum are likely to be long term intranasal cocaine abusers
• nasal septum perforation
• oropharyngeal ulcers and osteolytic sinusitis

Question 16

heminephrectomy

Answer 16

• causes an acute reduction of the total GFR to 50%

- The long term results –> compensatory hyperfiltration and hypertrophy of the nephrons in the remaining kidney. ~ 80%

Question 17

site of sidenfinil

Answer 17

-the cavernous venous sinuses of the corpora cavernosa

Question 18

false positive ratio

Answer 18

= 1- specificity

Question 19

HSV encephalitis

Answer 19

• most common viral encephalitis
• both immunocompetent and immunosupressed patients can be affected
• the temporal lobe is the main region of the brain affected, so in addition to fever, headahce and malaise, patients may experience seizures, personality changes and psychosis

Question 20

Acute intermittent porphyria

Answer 20

• caused by a deficiency of HMB synthase
• characterized by intermittent episodes of abdominal pain with neurological manifestations after exposure to an offending medication
• urine will classically darken upon standing and contain porphobilinogen and aminolevulinic acid
• skin photosensitivity is characteristically absent

Question 21

Exudates vs transudates

CHF is transudate

Answer 21

Exudates will demonstrate pleural fluid protein/serum protein < 0.5
-pleural fluid LDH/serum LDH > 0.6 or a pleural fluid LDH more than 2/3 the upper limit of normal serum LDH.

Transudates will lack these features, CHF cause a pleural fluid that is transudative

excudative pleural effusions result from infection, malignancy