Block 6

Question 1

Describe the clinical presentation of a patient with adenomyosis

Answer 1

UNIFORMLY enlarged uterus, dysmenorrhea[menstrual cramps], heavy menstrual bleeding

Question 2

Differentiate adenomyosis from endometrial hyperplasia clinically.

Answer 2

Adenomyosis will be painful and irregular muenstrual cycles, while endometrial hyperplasia will be non-painful, usually presenting as postmenopausal vaginal bleeding.

Question 3

Why is salmonella typhi so much more virulent that salmonella enteridis?

Answer 3

Salmonella typhi has the Vi virulence capsule that decreases neutrophil recruitment and phagocytosis, also preventing the macrophages from have the oxidative burst kill the bacteria. Thus typhi can actually survive and replicate inside the macrophages, and then disseminate into the lymphatics and RES.

Question 4

Which enzyme increases in lesch-nyan disease?

Answer 4

PRPP amidotransferase

Question 5

what opthalmological findings would you see in a noncompliant HIV patient with CMV retinitis.

Answer 5

Fluffy, yellow-white retinal lesions associated with hemorrhage.

Question 6

What class of antibodies are found in the serum of type A or type B patients?

Answer 6

IgM

Question 7

What class of antibodies are found in the serum of type O patients? What is the complication of this in pregnant women?

Answer 7

IgG usually. If type O mom and different type baby, then hemolysis can actually occur

Question 8

What are the neoplasms associated with Von hippel lindau disease?

Answer 8

RCC, hemangioblastoma, pheochromocytoma

Question 9

What is the function of procollagen peptidases in collagen synthesis?

Answer 9

They cleave the terminal propeptides [N and C terminals] in procollagen, allowing the collagen to become insoluble extracellularly

Question 10

What is the repetitive amino acid sequence of collagen molecules?

Answer 10

Gly-X-Y

Question 11

What is the WDHA syndrome?

Answer 11

It can be the result of a VIPoma causing watery diarrhea, hypokalemia and achlorhydria.

Question 12

What are the side effects of SSRIs?

Answer 12

mania, sexual dysfunctions, SIADH, serotonin syndrome, GI distress, drowsiness

Question 13

Describe the usage of trastuzumab?

Answer 13

Use as monoclonal antibody in HER2 + breast cancer and gastric cancer

Question 14

Where do the glans penis and the skin of the posterior calf drain their lymph nodes?

Answer 14

Deep inguinal nodes

Question 15

What are the structures that drain lymph into the superficial inguinal lymph nodes?

Answer 15

area surrounding anal canal, most skin below umbilicus and external genitalia

Question 16

Name all the bacteria that can lead to a post-infection reactive arthritis

Answer 16

campylobacter, shigella, salmonella, yersinia, C. Difficile and chlamydia trachomatis, bartonella

Question 17

What are the differences between nitroprusside and nitrates.

Answer 17

Nitroprusside- used in hypertensive emergencies, increases vasdilation of large veins and large arteries by producing NO and increased cGMP
Nitrates- used in angina, acute coronary syndrome, pulmonary edema. causes smooth muscle relaxation and venodilation in large veins selectively. Metabolized to nitric oxide and s-nitrosothiol

Question 18

What is one of the most modifiable risk factors for falls.

Answer 18

Medication

Question 19

What are the side effects of the first generation histamine blockers?

Answer 19

Sedation [because of the histamine blockade], antimuscarinic [blurry vision, loss of accommodations] and anti alpha adrenergic effects

Question 20

What is the distinctive histology in babesiosis?

Answer 20

Maltese cross ring shaped intraerythrocytic inclusions

Question 21

How does conversion of non-toxigenic diphtheria strain to a toxigenic diphtheria strain occur?

Answer 21

This occurs through the lysogenic bacteriophage called corynephage beta that inserts the tox gene resulting in the expression of the diphtheria AB toxin

Question 22

What process does Strep pneumoniae use to gain capsule?

Answer 22

Transformation

Question 23

What is a heparin-specific antidote?

Answer 23

protamine

Question 24

What is the effective treatment for a rat poison ingestion following 48 hours? Why?

Answer 24

Fresh frozen plasma because we need to replenish vitamin K dependent clotting factors that were depleted due to warfarin toxicity

Question 25

What structures are derived from the ventral pancreatic portion? What about the dorsal portion?

Answer 25

Ventral- main pancreatic duct proximal portion, uncinate process and portion of pancreatic head
Dorsal- tail, body, head, small accessory pancreatic duct

Question 26

what is the difference between a mallory-weiss tear and a boarhaave tear?

Answer 26

Mallory-weiss tear is a mucosal tear in the esophagus while boarhaave tear is a transmural tear in the esophagus

Question 27

What causes the esophageal dysmotility in CREST syndrome?

Answer 27

atrophy and fibrous replacement of muscularis in lower esophagus—> fibrous strictures, dilation, atonia, GERD and possible barrett’s

Question 28

Where does the thoracic duct drain lymph from?

Answer 28

Entire left side of body and everything below umbilicus

Question 29

What is the difference between incidence rate and cumulative incidence?

Answer 29

Incidence rate is the rate of new cases among all the people AT RISK per unit time.
Cumulative incidence does not take time into the denominator