Day 1 Flashcards
Which immune response is responsible for hyperacute, acute, and chronic transplant rejection? What is the time frame for each? (FA15 p217) (FA16 p211) (SU p384-385)
Hyperacute - (within minutes) pre-existing recipient antibodies to donor antigen (type II hypersensitivity reaction), activate complement
clx - widespread thrombosis of graft vessels –> ischemia and necrosis
tx - graft must be removed
Acute - (Weeks to months) Cellular: CD8+ T cells activated against donor MHCs (type IV hypersensitivity reaction)
Humoral: similar to hyperacute, except antibodies develop after transplant
clx - vasculitis of graft with dense interstitial lymphocytic infiltrate
tx - prevent/reverse with immunosuppressants
Chronic - (months to years) CD4+ T cells respond to recipient APCs presenting donor peptides, including allogeneic MHC
Both cellular and humoral components (type II and IV hypersensitivity reactions)
clx - Recipient T cells react and secrete cytokines –> proliferation of vascular smooth muscle, parenchymal atrophy, interstitial fibrosis
Bronchiolitis obliterans, Accelerated atherosclerosis, Chronc graft nephropathy, Vanishing bile duct syndrome
What is the treatment for digoxin toxicity? (FA15 p257) (FA16 p251) (SU p68) (GG p803)
Tx for Digoxin toxicity = Anti-dig Fab fragments
Normalize K and Mg
Brady –> atropine
Other arrhythmias –> ACLS
For which infections is vancomycin a good choice? How does vancomycin resistance develop? (FA15
p183) (FA16 p173) (SU p338)
Vancomycin = GRAM + bugs only serious, multi-drug resistant organisms MRSA S. epidermidis sensitive Enterococcus species Clostridium Difficile (oral dose for pseudomembranous colitis)
Resistance to Vanc? –> modification of amino acid sequence D-ala D-ala to D-ala D-lac
“Pay back 2 D-alas (dollars) for VANdalizing”
Do atypical antipsychotics primarily address the negative or positive symptoms of schizophrenia? How
does the mechanism of action of typical antipsychotics differ from the mechanism of action of the
atypical antipsychotics? (FA15 p509, 521) (FA16 p514, 525) (SU p53)
Positive symptoms = delusions, hallucinations, disorganized speech, Disorganized catatonic behavior
Negative symptoms = flat affect, avolition, anhedonia, asociality, alogia)
Typical = block dopamine D2 receptors (increase cAMP) Atypical = not completely understood, different mechanisms
A 67-year-old man with new-onset hepatic failure and normal renal function is currently taking a drug
metabolized and excreted by the kidneys. Would you need to change the loading dose or maintenance
dose of this medication because of this hepatic failure? If this patient were to develop hepatorenal
failure, would you need to change the loading dose or maintenance dose of the medicine? (FA15
p243) (FA16 p237) (SU p395)
In renal or liver disease:
Maintenance dose = decreased
Loading dose = same
What substances compose the matrix of the bone? (Phys p957)
Organic matrix (30%)
collagen, chondroitin sulfate, hyaluronic acid
Crystalline salts (70%)
calcium, phosphate, hydroxyapatite
While thiazide and loop diuretics are known for wasting potassium in the urine, there are other
diuretics that conserve it. Which diuretics are these? What are their mechanisms of action? What are
their important side effects? (FA15 p554) (FA16 p558) (SU p165)
Potassium-sparing diuretics: Spironolactone (aldosterone antagonists) Eplerenone (aldosterone antagonists) Triamterene (block Na channels) Amiloride (block Na channels) Distal tubules
Side Effects!
Hyperkalemia –> arrhythmia
SPIRONOLACTONE –> endocrine effects (gynecomastia, antiandrogen effect)
A 66-year-old woman is being treated in the ER for an acute MI. Nitroglycerin is given with the
expectation that it will vasodilate which vessels preferentially? Another patient in the ICU is on
hydralazine for acute treatment of his severe hypertension. How does hydralazine function? (FA15
p304-305) (FA16 p298-299) (SU p77)
Nitroglycerin = vasodilates vascular smooth muscles VEINS»>ARTERIES Decreases preload
Hydralazine = vasodilates arterioles»_space; veins Decreases afterload
What risk factors are associated with cholesterol gallstones? What risk factors are associated with
pigment gallstones? (FA15 p375) (FA16 p372) (SU p135)
Fat, Forty, Female, Fertile
Cholesterol stones = obesity, Crohn’s, advanced age, estrogen therapy, multiparity, rapid wt loss, Native American
Pigmented stones = Crohn’s, hemolysis, alcoholic cirrhosis, advanced age, biliary infection, TPN
A 35-year-old woman with multiple sclerosis presents to clinic with internuclear ophthalmoplegia.
What is internuclear ophthalmoplegia? (FA15 p486) (FA16 p490) (SU p35)
Medial Longitudinal Fasciculus (MLF): pair of tracts that allows for crosstalk between CN VI and CN III nuclei. Coordinates both eyes to move in same horizontal direction. Highly myelinated (must communicate quickly so eyes move at same time). Lesions may be unilateral or bilateral (latter classically seen in multiple sclerosis).
Lesion in MLF = INTERNUCLEAR OPHTHALMOPLEGIA (INO), a conjugate horizontal gaze palsy.
A female infant is brought to the clinic for evaluation of her genitalia. On exam, clitoromegaly and labial fusion is noted. Lab studies reveal elevated 17-hydroxyprogesterone levels. What is the most common form of adrenal hyperplasia? Which hormone levels are altered as a result of this enzyme deficiency? What are the clinical manifestations of this enzyme deficiency? (FA15 p318) (FA16 p312) (SU p168, 186)
MC form of Adrenal Hyperplasia = 21-hydroxylase deficiency
Decreased: aldosterone cortisol Increased: sex hormones
Increased renin / increased 17-hydroxyprogesterone
Clx - Hypotension Volume depletion Hyperkalemia (due to decreased aldosterone) Masculinization in females
Infancy = Salt Wasting Childhood = Precocious Puberty
What is the mechanism of action of the following antiemetics? (FA15 p251, 380) (FA16 p245, 376) (SU p139-141) (GG p1341-1344) Scopolamine Promethazine Prochlorperazine Metoclopramide Ondansetron
Muscarinic antagonist
CNS
motion sicknesss / decreases oral secretions
M1 antagonist
------------------------------- Histamine antagonist D2 dopamine antagonist --------------------------------- D2 dopamine antagonist ---------------------------------- D2 receptor antagonist / increases resting tone, contractility, LES tone, motility Does not influence colon transport time
5-HT3 antagonist, decrease vagal stimulation POWERFUL central-acting antiemetic
clx: post-op and chemo/cancer therapy pts
Side effects = headache, constipation, QT interval prolongation
A 25-year-old man complains of a scrotal mass and pain made worse by coughing or sneezing. A
scrotal exam reveals a palpable scrotal protrusion with the Valsalva maneuver. What type of hernia is
this patient experiencing? What type of hernia protrudes through Hesselbach’s triangle? What
structures form Hesselbach’s triangle? (FA15 p352) (FA16 p349) (SU p250-251)
Scrotal Mass = Indirect inguinal hernia
Hesselbach’s triangle = Direct inguinal hernia
Hesselbacj’s trinangle: Femoral Vessels / Inguinal ligament / Rectus abdominis muscle
How does a decrease in renal artery pressure cause an increase in blood pressure? (FA15 p534) (FA16
p540) (SU p147)
Decrease in renal artery pressure causes secretion of RENIN by JG cells. ANGIOTENSINOGEN is released from the liver and converted to ANGIOTENSIN I by RENIN. ANGIOTENSIN I is then converted to ANGIOTENSIN II by ACE from the lungs and kidney.
Angiotensin II acts on receptors type AT1 on vascular smooth muscle
Constricts efferent arterioles of glomerulus, this increases FF to preserve GFR in low volume state
Aldosterone secreted to increase Na channel and Na/K pump in principal cells / enhances K and H excretion by way of principal cell K channels and alpha-intercalated cell H ATPase / creates favorable Na gradient for Na and H2O reabsorption
ADH from posterior pituitary, increase aquaporin insertion in principal cells / H2O reabsorption
increase PCT Na/H activity / Na, HCO3, H2O reabsorption (can permit contraction alkalosis
Stimulates hypothalamus / stimulates THIRST
What are the three endogenous androgens in order from the most potent to the least potent? (FA15
p577) (FA16 p582) (SU p169)
Endogenous Androgens MOST POTENT DHT Testosterone Androstenedione
What is Osler-Weber-Rendu syndrome? (FA15 p83) (FA16 p71) (SU p90) (R p730) (H p409)
Hereditary Hemorrhagic Telangiectesia
inherited disorder of blood vessels / branching skin lesions (telegiectesia), recurrent epistaxis, skin discoloration, arteriovenous malformations (AVMs), GI bleeding, hematuria.
What is the fibrous band attached to the testis and scrotum that aids in normal testicular descent?
What is this structure called in females? (FA15 p569) (FA16 p573) (SU p198-200)
Gubernaculum (band of fibrous tissue) anchors testes within scrotum –> ovarian ligament +round ligament
What are the effects of NSAIDs’ inhibition of PGE2? (FA15 p445) (FA16 p447) (SU p243) What role do
prostaglandins and angiotensin II play on the renal arterioles? (FA15 p530, 532) (FA16 p535, 537) (SU
p148)
NSAIDs – reversibly inhibits cyclooxygenase (both COX-1 and COX-2) blocks prostaglandin synthesis
clx – antipyretic / analgesic / anti-inflamm / Indomethacin used to close PDA
Side effects – interstitial nephritis, gastric ulcer (prostaglandins protect gastric mucosa), renal ischemia (prostaglandins vasodilate afferent arteriole)
Prostaglandins preferentially dilate afferent arteriole (increase RPF, increases GFR, so no change in FF)
ATII - stimulates Na/H exchange –> increase Na, H2O, and HCO3 reabsorption (permitting contraction alkalosis)
What is the difference between a case-control study, a cohort study, and a clinical trial? (FA15 p48)
(FA16 p32) (SU p17-18) Which studies use odds ratios, and which use relative risks? (FA15 p48, 50)
(FA16 p32, 34) (SU p18)
Case-control study - look for prior exposure or risk factor “what happened” (OR)
Cohort study - Prospective (RR)
Clinical trial - experimental study involving humans.
T cells are found in the paracortex of the lymph node between the follicles and the medulla. Which
cytokines are secreted by the two different types of helper T cells (Th1 and Th2)? (FA15 p202) (FA16
p194) (SU p373-374)
Th1 - IL-2 / IFN-gamma
Th2 - IL-4 / IL-5 / IL-10 / IL-13
A 32-year-old man is being treated for alcohol dependence with disulfiram. One night, he begins drinking and later has severe nausea and vomiting. What is the mechanism of action of disulfiram? What other drugs have a disulfiram-like effect? (FA15 p95) (FA16 p83) (SU p305) (GG p643-644)
Mechanism of action of Disulfiram - inhibits acetaldehyde dehydrogenase (acetaldehyde accumulates, contributing to hangover symptoms)
Fomepizole - inhibits alcohol dehydrogenase, antidote for methanol and ethylene glycol poisoning
Metronidazole
Certain Cephalosporins
Griseofulvin
1st gen Sulfonylureas
What is PPAR-γ? How is it relevant to the treatment of diabetes mellitus? (FA15 p338-339) (FA16 p334-335) (SU p181)
PPAR-gamma - genes activated by PPAR regulate fatty acid storage and glucose metabolism. activation of PPAR increase insulin sensitivity and levels of adiponectin.
Peroxisome proliferator-activated receptor gamma
nuclear receptor and transcription factor found in adipose tissue
plays a role in adipocyte differentiation
TZD binds PPAR-gamma and improve insulin sensitivity
The thalamus is a relay station that conducts signals to and from the brain. Which thalamic nuclei are the relay stations for each of the following body sensations/activities? (FA15 p456) (FA16 p458) (SU p40) • Auditory sensation • Visual sensation • Motor to the body • Facial sensation • Body sensation
Medial geniculate nucleus ------------------------- Lateral geniculate nucleus ------------------------- Ventral lateral nucleus ------------------------- Ventral postero-medial nucleus ------------------------- Ventral postero-lateral nucleus
A 40-year-old man arrives at your clinic for his first physical in 20 years. He reeks of cigarette smoke,
and you notice his jacket bears the logo of his favorite tobacco company. He proudly informs you that
he got this great jacket by redeeming his cigarette cartons. At what stage of change in overcoming his
smoking habit is this man? (FA15 p517) (FA16 p521)
Precontemplation - not yet acknowledging that there is a problem
Contemplation Preparation Action Maintenance Relapse
A 23-year-old man comes to your clinic with a fever of 39°C, a headache, and myalgias. This is the
second fever he has had in the last two weeks. He recently finished treatment to eradicate the lice
infestation that he acquired during a recent trip to Mexico. What organism might be responsible for
this man’s recurrent fever? (FA15 p142) (FA16 p132)
(X) Rickettsia prowazekii (Epidemic typhus : recurrent fever from human louse)
Borrelia Recurrentis = relapsing fever due to variable surface antigens (louse/lice) Sudden fever Muscle or joint aches Nausea Rash
What physiologically is taking place in decompression sickness? (Phys p538)
Decompression sickness
gases (especially nitrogen) that had dissolved in the blood at high pressures form bubbles that can occlude blood vessels
Which drugs are known to cause aplastic anemia? What is the treatment for aplastic anemia? (FA15
p258, 393) (FA16 p252, 391) (SU p396, 263-264)
Carbamazepine, Methimazole, NSAIDs, Benzene, Chloramphenicol, Propylthiouracil / anti-Cancer drugs
immunosuppressive agents (antithymocyte globulin, cyclosporine), bone marrow allograft, RBC/platelet transfusion, bone marrow stimulation GM-CSF
Is a 34-year-old schizophrenic patient having active hallucinations, who is not oriented to time, place,
or person, able to legally agree to a plan of care? What factors must be in place in order for a patient
to have the capacity to make a decision? (FA15 p57) (FA16 p40) (SU p21)
No
Needs to make and communicate a clear choice
Needs to be informed and understand risks, benefits, and alternatives
Decision must be stable over time
Decision is consistent with patient’s values and goals
Decision is not based on hallucinations or delusions
A 34-year-old woman develops a painful right eye with decreased visual acuity. Exam demonstrates a
firm right eye. What type of glaucoma is the patient experiencing? What is the difference between the
mechanism of closed- and open-angle glaucoma? What is the fundoscopic finding associated with
glaucoma? What is the treatment for closed- and open-angle glaucoma? (FA15 p480, 494) (FA16 p484,
498) (SU p37)
Sudden vision loss, Rock hard eye ==> Acute Closed Angle Glaucoma (narrow angle glaucoma)
Open angle – microscopic blockage of trabecular meshwork (insidious, peripheral vision loss)
Closed angle – forward movement of lens against central iris / obstruction of normal aqueous flow through pupil
Fundoscopic finding – “cupping”
TX open - Latanoprost (topical prostaglandins) Topical beta blockers Topical alpha 2 agonists Topical acetazolamide Topical muscarinic agonists Surgery
closed - Timolol (topical beta blocker) Apraclonidine (topical alpha 2 agonist) Pilocarpine (topical muscarinic agonist) Acetazolamide PO or IV IV mannitol Laser Iridotomy
A 1-year-old boy is brought to the clinic for evaluation of his skin. The patient’s skin was normal at
birth but now is erythematous, scaly, and has many new freckles. Workup and an astute attending
reveal that this child has xeroderma pigmentosum. What cancers will this child be at higher risk of
developing? (FA15 p235) (SU p253)
XERODERMA PIGMENTOSUM -Skin cancer Melanoma Basal Cell Carcinoma Squamous Cell Carcinoma
What organism causes Hansen disease? What animal serves as the reservoir for this organism in the U.S.? Where in the body does this organism live? (FA15 p134) (FA16 p125) (SU p467-468)
Hansen Disease (Leprosy) - Caused by Mycobacterium Leprae
- ARMADILLOS - infects skin and superficial nerves "glove and stocking" which happens to be the coolest part of the bdy
What is BNP, and how is it useful in cases of heart failure? (FA15 p285) (FA16 p279) (H p2216)
BNP = B-type (brain) natriuretic peptide
released from ventricular myocytes in response to increased tension (stretch)
Similar physiologic action to ANP, longer half-life
BNP blood test used for diagnosing HF (very good negative predictive value
(useful as a diagnostic test)
Available in recombinant form (nesiritide) for treatment of HF
A 9-year-old child is brought into the clinic for evaluation of a right wrist drop and confusion. Physical exam reveals a bluish line on the gingivae. What peripheral smear finding is consistent with lead poisoning? What is the treatment for lead poisoning in this patient? (FA15 p388, 391) (FA16 p386, 389) (SU p259-260)
Basophilic Stippling ==> Lead poisoning –> bluish line on the gingivae
Lead inhibits ferrochelatase and ALA dehydratase –> decrease heme synthesis and increase RBC protoporphyrin
also inhibits rRNA degradation –> RBCs retain aggregates of rRNA (basophilic stippling)
L: lead lines on gingivae (Burton lines) and metaphyses of lone bones on x-ray
E: encephalopathy and erythrocyte basophilic stippling
A: abdominal colic and sideroblastic anemia
D: drops of wrist and foot –> 1st line: Dimercaprol & EDTA
Succimer used for chelation for kids “SUCks to be a kids who eats lead”
(EDTA +succimer / severe –> Dimercaprol +succimer)
A 62-year-old man complains of weak urine stream and hesitancy when trying to urinate. His physician
prescribes finasteride. How does this agent treat benign prostatic hyperplasia? (FA15 p597) (FA16
p603) (SU p217, 223) (GG p1205)
FINASTERIDE –> 5alpha-reductase inhibitor
decreases conversion of testosterone to DHT
A kidney transplant patient begins to experience renal failure seven years after receiving her kidney
transplant. What type of rejection is this, and how is it mediated? (FA15 p217) (FA16 p211) (SU p385)
Chronic (months to years)
Mediated by CD4+ T cells responding to recipient APCs presenting donor peptides
Both cellular and humoral components (type II and type IV hypersensitivity reactions)
(Obliterative vascular fibrosis)
What test is used to detect corneal abrasions?
Fluorescein dye test!!
What physiology accounts for the automaticity of the AV and SA nodes? (FA15 p281) (FA16 p275) (SU
p62-63) (Phys p111-112)
1) Gradually increasing Na channel conductance
2) Slow, spontaneous depolarization during diastole
3) When threshold reached, action potential generated
What is p value? What is an acceptable p value? (FA15 p54) (FA16 p38) (SU p19)
p value
probability that the study results occurred by chance alone
p<0.05 is considered statistically significant
A patient with an epilepsy diagnosis is pregnant with her first child. She is concerned that her child
may also have seizures. What are the most common causes of seizures in children? In adults? In the
elderly? (FA15 p489) (FA16 p494) (SU p44)
Order
Seizures Causes in Children Genetic Infection (febrile) Trauma Congenital Metabolism
Seizure causes in Adults Tumor Trauma Stroke Infection
Seizures causes in Elderly stroke tumor trauma metabolic infection
Which diuretics lower serum calcium levels? What is the mechanism by which these cause
hypocalcemia? (FA15 p553-554) (FA16 p557-558) (SU p164-165)
Loops Lose Ca++ –> decrease paracellular Ca++ reabsorption –> hypocalcemia
Inhibits cotransport system (Na+/K+/2CL)
Ca++ reabsorbed passively via electrochemical gradient
What is the difference between a promoter region and an enhancer region? (FA15 p68) (FA16 p54)
(SU p284)
Promoter region – site where RNA polymerase II and multiple other transcription factors bind to DNA upstream from gene locus
**TATA box / CAAT box
When RNA polymerase binds there, it PROMOTES gene expression and transcription
Enhancer region – stretch of DNA that alters gene expression by binding transcription factors
**does not have to be upstream
ENHANCES gene expression by binding transcription factors
What medications are considered first line in the treatment of ADHD? (GG p303)
1st for ADHD: Stimulants -Methylphenidate (Ritalin, Concerta) -Dextroamphetamine (Adderall) SSRI -Atomoxetine (Strattera) If insomnia --> clonidine
What are the signs of right-sided heart failure? What are the signs of left-sided heart failure? What is
most often the cause of right-sided heart failure? (FA15 p297) (FA16 p292) (SU p83-86)
Right-sided HF SXS Hepatomegaly Nutmeg liver JVD Peripheral Edema Left-sided HF SXS Orthopnea Paroxysmal Nocturnal Dyspnea Pulmonary Edema
What abnormal lab values would lead you to suspect alcoholic hepatitis? (FA15 p369) (FA16 p367) (SU
p136)
AST>ALT
Swollen and necrotic hepatocytes with neutrophilic infiltration
Mallory bodies
How many umbilical vessels are there? Which umbilical vessel has the highest oxygen content? (FA15
p563) (FA16 p567) (SU p63)
3: two arteries, one vein
umbilical vein has the highest oxygen content
What organisms are particularly known for causing infective endocarditis? (FA15 p128-130, 147)
(FA16 p119-121, 137) (SU p87) (H p1052) (R p559)
Infective Endocarditis Staphylococcus Aureus (30%) Viridans Strep (20-30%) Streptococcus mutans Enteroccocci (10%) Coagulase-negative staph (5-10%) Staphylococcus epidermidis
**Know it is endocarditis, but no cultures growing --> HACEK Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella
A 60-year-old male long-time patient of yours comes to your office complaining of sexual dysfunction.
What is the differential diagnosis? What drugs are known for causing sexual dysfunction? (FA15
p516) (FA16 p520) (SU p221)
Sexual Dysfunction Desire disorders (hypoactive sexual desire / sexual aversion) Sexual arousal disorders (erectile dysfunction) Orgasmic disorders (anorgasmia, premature ejaculation) Sexual pain disorders (dyspareunia, vaginismus)
DDx:
Drugs (antihypertensives like beta-blockers, neuroleptics, SSRIs, ethanol)
Diseases (depression, diabetes, STIs)
Psychological (performance anxiety)
A 44-year-old woman is seen in the ER for shortness of breath, malaise, and high fever. Chest x-ray
reveals a right-sided consolidation, and her labs reveal a WBC count of 12,000. Which organism is
overall the most common cause of lobar pneumonia? What organisms are the most common causes
of interstitial (walking) pneumonia? (FA15 p616) (FA16 p624) (SU p109)
MC for Lobar Pneumonia
Strep Pneumoniae Staph Aureus H. Influ
Klebsiella
MC for Interstitial (walking/atypical) Pneumonia
Mycoplasma
Chlamydia
Legionella
Viruses (RSV, CMV, influenza, adenovirus)
Which type of lymphoma has a presentation that is very similar to CLL and fewer constitutional
signs/symptoms? (FA15 p402) (FA16 p402) (SU p272)
Small lymphocytic lymphoma (one of the non-Hodgkin)
**
Lymphoma – cancer of the lymphocytes within the lymph nodes
~40 different types of lymphoma (Hodgkin’s vs all other non-Hodgkin’s)
SLL same disease as CLL but SLL is in lymph nodes and CLL is in the blood and marrow
A 30-year-old man is at an inpatient facility for opioid addiction. What symptoms might this patient
experience while discontinuing opioids? (FA15 p518) (FA16 p522) (SU p53)
Opioid withdrawal
Sweating (perspiration)
Dilated Pupils
Piloerection ("cold turkey")
Fever , Rhinorrhea ("flu-like symptoms")
* Yawning
Nausea / Stomach cramps / Diarrhea
Restless leg syndromeIn your own words, describe what type I () error is. (FA15 p54) (FA16 p38) (SU p19)
you observed or stated a difference that did not exist
**study shows a difference between two groups, when no difference exists
What trace element is essential to the function of carbonic anhydrase and lactate dehydrogenase? (Phys p856)
** Zinc (certain type of protein folding)
A 30-year-old man who is experiencing shortness of breath is diagnosed with obstructive lung disease on pulmonary function testing. The patient does not have a history of asthma and has never smoked. The patient is subsequently diagnosed with α1-antitrypsin deficiency. How does the emphysema caused by smoking differ from the emphysema caused by α1-antitrypsin deficiency? (FA15 p371, 610) (FA16 p369, 618) (SU p105)
Alpha1-antitrypsin deficiency : uninhibited elastase in alveoli –> decrease elastic tissue –> panacinar emphysema
**normally protects lung from ELASTASE –> neutrophils do their job but end up destroying connective tissue
Smoking emphysema –> upper lobes –> Centriacinar emphysema
In what clinical scenarios would you see a “nutmeg” liver? (FA15 p297, 370) (FA16 p292, 368) (SU p84, 135)
CHF (right-sided)
Budd-Chiari Syndrome (thrombosis or compression of hepatic veins with centrilobular congestion and necrosis –> congestive liver disease) + no JVD
**
increase central venous pressure
increase resistance to portal flow
You are performing a radical mastectomy and exercise extreme caution as you dissect laterally along the serratus anterior muscle. You do this in order to avoid severing which motor nerve, which would result in what sequela? (FA15 p419) (FA16 p420) (SU p239)
Long thoracic nerve
Winged scapula
A patient comes to the clinic complaining of severe low back pain that radiates down the back of her leg. What is the most likely explanation for her pain? (COA p474-475)
Sciatica
**
herniated intervertebral disc – nucleus pulposis protrudes thru vertebral canal, compresses the nerve root
What problem/abnormality is associated with the following buzzwords?
• Calf pseudohypertrophy (FA15 p624) (FA16 p630) (SU p249)
• Gower maneuver (FA15 p85) (FA16 p73) (SU p249)
• Subluxation of the lenses (FA15 p83) (FA16 p71) (SU p236)
• Café-au-lait spots (FA15 p83) (FA16 p71)
• Tuft of hair on lower back (FA15 p449) (FA16 p451) (SU p24)
Duchenne Muscular Dystrophy (x-linked recessive, gower sign, frameshift mutation of dystrophin gene) ------------------------------- ------------------------------- Marfan Syndrome FBN1 gene on chr15
** Homocystinuria ----------------------------- Neurofibromatosis type 1 McCune-Albright syndrome ----------------------------- Spina Bifida Occulta skin dimple
What type of cell differentiation and maturation takes place at the thymus? (FA15 p199) (FA16 p191) (SU p367, 372-373) The thymus also functions to positively restrict major histocompatibility complex (MHC) at the corticomedullary junction. On which cells would you expect to find MHC I? MHC II? (FA15 p200) (FA16 p192) (SU p371)
T cells = thymus
MHC I – CD8+ cytotoxic T cells (found on most all nucleated cells)
MHC II – CD4+ helper T cells (only on APCs)
A 59-year-old man with a 50-pack-year history of smoking sees you for management of his COPD. What is the clinical definition of chronic bronchitis? (FA15 p610) (FA16 p618) (SU p104)
CHRONIC BRONCHITIS
Productive cough >3 months per year for >2 consecutive years
EMPHYSEMA
Permanent enlargement of alveolar air spaces
A 50-year-old woman develops a new onset of low back pain without a specific injury. A lumbar x-ray reveals lytic lesions which raise suspicion for multiple myeloma. What is the characteristic finding on electrophoresis with multiple myeloma? What is the classic finding in the urine of a patient with multiple myeloma? (FA15 p401) (FA16 p401) (SU p276)
M spike on serum protein electrophoresis
Urine?
Bence-Jones proteins (Ig light chains, cannot detect via dipstick only urine electrophoresis)
What is the mechanism of action of local anesthetics? Which nerve fibers are blocked first with local anesthesia? (FA15 p499) (FA16 p503)
Local Anesethetics - block Na channels by binding to specific receptors on inner portion of channel
- prevents nerve firing
- first blocked: small myelinated fibers
What medications are used in the treatment of urge incontinence? (GG p232)
Urge incontinence - oxybutinin vs. bethanecol
** Anticholinergic drugs - oxybutynin - tolterodine - darifenacin - solifenacin - trospium
What are the three different eukaryotic RNA polymerases? What type of RNA does each make? (FA15 p68) (FA16 p54) (SU p284)
RNA polymerase I - makes rRNA
RNA polymerase II - makes mRNA
RNA polymerase III - makes tRNA
Which cell types do not require insulin for the uptake of glucose? (FA15 p314) (FA16 p308) (SU p174)
Normally, GLUT4 needed to transport glucose into tissue (muscle, fat, etc), triggered by insulin.
BRICK L
B: brain R: RBC I: intestine C: cornea K: kidneys L: liver
What are the layers of the epidermis beginning with the most superficial layer? What is Auspitz sign?
(FA15 p436, 439) (FA16 p437, 440) (SU p251-252)
Californians Like Girls in String Bikinis Stratum Corneum Stratum Lucidum Stratum Granulosum Stratum Spinosum Stratum Basale
Auspitz sign – bleeding from exposure of dermal papillae when scales are scraped off
What is Kallmann syndrome? (FA15 p579) (FA16 p586) (SU p201) (H p2878)
Failure to complete puberty (hypogonadotropic hypogonadism)
Usually sporadic but often X-linked if familial
Much more common in males
Defective migration of GnRH cells and formation of olfactory bulb
decreased synthesis of GnRH in the hypothalamus
ANOSMIA
Low FSH, low LH, low testosterone
A 67-year-old man with congestive heart failure lost his job and medical insurance, so he stops buying
and taking his digoxin, and develops dyspnea. What will this do to his cardiac output (CO)? What are
the mechanisms behind his development of dyspnea?
Digoxin – positive inotrope –> increases myocardial contractility
After stopping digitalis –> Cardiac Output will decrease due to loss of positive inotropic effect
Decreased CO –> decreased pumping of blood from LV –> backup of blood in pulmonary vasculature –>
pulmonary edema –> dyspnea
A 17-year-old girl is brought to the emergency room for abdominal pain and vomiting. She has a fever,
and further questioning and exam reveal that the pain is in the right lower quadrant and has rebound
tenderness. She says the pain began around the umbilicus. She is very nauseated and vomits again
during the exam. What must be ruled out prior to coming to the final diagnosis in this patient? (FA15
p363) (FA16 p360) (SU p118, 125)
beta-hCG to r/o preganancy or ectopic
A 31-year-old man is post-op day 1 after an exploratory laparotomy. The surgery was performed
emergently for intraperitoneal hemorrhage after a motorcycle crash. His creatinine today is elevated
to 2.0 mg/dL. His pain is currently uncontrolled. Explain why an NSAID could lead to a potential
complication in this patient. (FA15 p530, 533) (FA16 p535, 538) (SU p243-244)
NSAIDs – inhibits COX and blocks prostaglandins
Prostaglandins preferentially DILATES afferent arteriole (increase RPF, GFR, so no change in FF)
Afferent arteriole of glomeruruls does not dilate -> decreased plasma flow -> decreased GFR
Which phagocyte dysfunction disease increases patient susceptibility to Staphylococcus aureus and
Escherichia coli? What is the cause of this disease? (FA15 p215) (FA16 p209) (SU p308, 383)
Chronic granulomatous disease – defect in NADPH oxidase –> decrease reactive oxygen species
X-linked recessive
In absence of NADPH oxidase, phagocytes can use hydrogen peroxide from the environment to create oxygen free-radical
BUT, organisms w/ catalase –> no hydrogen peroxide in the environment
