Board prep TrueLearn questions Flashcards
Random ass questions that I took for board prep
In the very early stages of atherosclerosis, where would you find macrophages?
Macrophages will be found w/in “foam cells” in fatty streaks in the intimal layer of vessel walls during the very early stages of atherosclerosis.
What type of lung cancer will you find peripherally located in the lung?
Adenocarcinoma
What type of lung cancer will you find centrally located within the lung?
Squamous cell carcinoma (Also heavily linked to smoking)
What is the primary treatment for overdose of an OTC medication which causes vertigo, nausea, vomiting, hyperpnea and tinnitus?
Sodium Bicarbonate is the initial treatment of a patient w/ Salicylate (Aspirin) toxicity.
Initially: Resp. alkalosis
Later: High anion gap metabolic acidosis
Describe the pathogenesis of pulmonary HTN in obstructive sleep apnea
The patient is unable to protect the upper airway from collapsing soft tissue results in gasping for air. The resulting hypoxia will trigger pulmonary vasoconstriction, resulting in pulmonary hypertension.
What is the causatory pathogen of a young child who presents w/ stridor, low-grade fever, barking cough and “steeple-sign” on radiograph?
“Croup,” or laryngotracheobronchitis is most commonly caused by a parainfluenza virus.
What is that A-a gradient, and what is considered normal?
The difference between the partial pressure of oxygen in the alveoli and the partial pressure of oxygen in the arteries. Normal is between 4 and 15.
A mid-diastolic rumble heard at the cardiac apex is indicative of what?
Mitral stenosis
What potentially fatal complication can come from taking an SSRI and a -triptan medication concomittantly?
Serotonin syndrome d/t the agonistic properties of -triptan meds and the increased serotonin in the neuronal cleft from the SSRI
Treat with Cyproheptadine, a serotonin receptor antagonist
What is the definition of chronic bronchitis, and what pulm function test changes would we expect to see?
Chronic Bronchitis, a form of COPD is: 3+ months of productive cough during each of 2 consecutive years.
PFTs: Decreased FEV1, Decreased FEV1/FVC, Increased TLC
What is a common pathologic organism found that causes respiratory symptoms, fever and fatigue which is found in the SE United states?
Histoplasma Capsulatum
A patient presents w/ a history of A-Fib, new onset visual blurriness and yellow halos. What is the mechanism of action of that at-fault drug?
Digoxin is a Na+/K+ ATPase inhibitor. You will find the following EKG for a patient suffering w/ Digoxin toxicity. commonly called the “Digitalis effect.”
What organ is at risk of rupture from Mononucleosis infection, and what embryologic layer is it derived from?
The spleen is derived from the mesoderm, along w/ the heart, blood, lymph vessels, kidneys, ovaries, testes and the cortex of the adrenal glands.
What heart valve is most at risk and from what organism in a patient with a history of IV drug use?
The tricuspid valve is most at risk for infection from Staph Aureus
Remember: Staph aureus is a gram+ cocci arranged in clusters. Coagulase + and beta-hemolytic
4-year old child presents w/ classic symptoms of Laryngotracheobronchitis including respiratory distress, stridor and a fever. What is the morphology of the causative agent?
Parainfluenza type 1 is a negative-sense ssRNA virus
Epiglottitis presemts with what?
Patients w/ Epiglottitis present w/ fever, sore throat, dysphagia, drooling and respiratory distress
Medical emergency! Danger of very rapid airway collapse
What organism is most likely at fault for a chronic alcohol abuser who presents w/ SOB, cough w/ thick bloody sputum and diabetes?
Klebsiella Pneumoniae, a gram-negative (RED) lactose fermenting bacillus
What is the antidote for beta-blocker overdose?
Glucagon. Patient will present w/ bradycardia, hypotension, mild hypoglycemia and fatigue. If blood pressure/HR fall enough, syncope may occur.
What is a normal V/Q ratio?
TRICK QUESTION! It varies throughout the lung – at the apex of the lung, ventilation > perfusion, so V/Q ~ 3.0. At the base of the lung, perfusion > ventilation, therefore V/Q ~ 0.8
What cardiac marker will you expect to be elevated in the setting of a Pulmonary Embolism?
D-Dimer
Also expect an INCREASED V/Q Ratio. Perfusion is decreased, therefore Ventilation/Perfusion will increase.
During acute re-feeding syndrome, what electrolytes are most at risk of fatal deficiency?
Magnesium, Phosphate, Potassium
Where do the potassium sparing diuretics exert their action?
There are 2 types -
1 - Aldosterone receptor antagonists such as Spironolactone and Epleronone which work on the distal convoluted tubule
2 - Epithelial Na+ channel (ENaC) blockers such as triamterene and amiloride which work in the distal convoluted tubule and the collecting duct
What biomarker will be elevated, and in what demographic would you most expect to see Sarcoidosis?
ACE is non-specific, but can be elevated in up to 50% of pts.
Expect to see Sarcoidosis in black females
Clinically, what are the differences between typical and atypical pneumonia?
Atypical pneumonia is less severe, see below chart.
Which cytokine is responsible for increased ESR in the setting of inflammation, infection or malignancy?
IL-6
What medication can be used for both BPH and HTN and what is it’s MOA?
Terazosin, or other alpha-1 adrenergic inhibitors work well in this setting
Does increased INR mean faster or slower clotting time?
Increased INR (& PT) = SLOWER clotting time
A patient w/ acute pulmonary edema presents to the ER. What would lung biopsy show histologically?
Pink, acellular material within the alveoli
Briefly explain “Cardiac Index”
Cardiac index is the LV output in one minute to body size. Unit of measure = Liter/min/m^2
A patient presents w/ a grey/white pseudomembrane on the hard palate, fever and lymphadenopathy. What is the morphology of the causative agent?
Corynebacterium Diphtheriae is a gram-positive rod that can cause diphtheria (a pseudomembrane is pathognomonic with diphtheria)
A 25 yo patient presents w/ classic aortic dissection symptoms. He is 6’5” w/ pectus excavatum, is extremely thin w/ long extremeties. What is the inherited defect?
Patients w/ Marfan syndrome have a defect in the FBN1 gene, which encodes for the connective protein Fibrillin-1. It presents in Autosomal Dominant patterns
What will be the results of a peripheral blood smear for a symptomatic anemia patient on Phenytoin?
Phenytoin decreases activity of Intestinal Conjugase, which is necessary to convert folate into an absorbable form. Folate deficiency causes megaloblastic anemia, so on a peripheral smear you would expect to see hypersegmented neutrophils.
The parents of a patient w/ Cystic Fibrosis worry about the chances of having another child with the ailment. What is the possibility of this happening?
For Autosomal recessive diseases like CF, the chances of having an affected child is 25%
Remember – CF is d/t a mutation on the CFTR gene on chromosome 7. It causes sticky secretions and general failure to thrive.
This is just a refresh of viscerosomatic reflexes
What disease is pathognomonic with “sawtooth” rete ridges of the epidermis into the dermis?
Lichen planus is a chronic inflammatory disease which most commonly presents w/ purple papules with well-demarcated, irregular borders on the wrists, LE and genitoanal region. The lesions may exhibit Wickham’s striae, or a pattern of white lines.
