Day 3 Flashcards
What enzyme catalyzes the rate-limiting step in cholesterol synthesis? What class of drugs inhibits this enzyme? (FA15 p96) (FA16 p84) (SU p123)
HMG-CoA reductase
Statins
Simvastatin
Atorvastatin
KNOW RATE-DETERMINING ENZYMES OF METABOLIC PROCESSES
What arteries supply the adrenal glands? From what arteries do these arteries arise? (COA p296)
BILAT
superior suprarenal / middle suprarenal / inferior suprarenal a.
inferior phrenic a / Aorta / renal a.
Many factors are involved in the proper morphogenesis of organs in utero. In the case of oligohydramnios, lack of fluid flowing in and out of the fetal lungs leads to pulmonary hypoplasia. This is an example of which type of error in organ morphogenesis? (FA15 p559) (FA16 p563) (SU p144)
Agenesis - absent organ due to absent primordial tissue
Aplasia - absent organ despite presence of primordial tissue
Hypoplasia - incomplete organ development; primordial tissue present
Disruption - secondary breakdown of previously normal tissue or structure (amniotic band syndrome)
Deformation - Extrinsic disruption; occurs after embryonic development
Malformation - intrinsic disruption; occurs during embryonic period (3-8 weeks)
Sequence - abnormalities result from a single primary embryonic event (oligohydramnios –> Potter sequence)
Given the following scenarios describe the corresponding complement deficiency? (FA15 p206)
(FA16 p199) (SU p371)
Clinical scenario
Complement deficiency
Frequent Neisseria infections
Frequent pyogenic respiratory tract infections
Paroxysmal nocturnal hemoglobinuria
Increased frequency of type III hypersensitivity reaction
C5-C9 deficiencies
C3 deficiencies
Strep pneumo / H influ
DAF (GPI-anchored enzyme) deficiency
- CD55 / CD59
C3 deficiency
Which neoplasm is most commonly responsible for the following paraneoplastic effects? (FA15 p238) (FA16 p229) (SU p115, 163)
Syndrome or Effect
Neoplasm
ACTH Cushing’s syndrome
PTH-related peptide hypercalcemia
Erythropoietin polycythemia
ADH SIADH
Small cell lung cancer
Squamous cell carcinoma of: - lung - head - neck Renal cancer Bladder cancer Breast cancer Ovarian cancer
Renal cell cancer Hepatocellular carcinoma Hemangioblastoma Pheochromocytoma Leiomyoma
Small cell lung cancer
Intracranial neoplasms
What nerve is damaged when a patient presents with the following symptom (upper extremity)? (FA15 p418-420) (FA16 p419-421) (SU p238-239) (Answers given for self study) Symptom Claw hand Ape hand Wrist drop Scapular winging Unable to wipe bottom/anus Loss of forearm pronation Cannot abduct or adduct fingers Loss of arm abduction Weak lateral rotation of arm Loss of arm and forearm flexion Loss of forearm extension Trouble initiating arm abduction Unable to abduct arm beyond 10 degrees Unable to raise arm above horizontal
Nerve
Ulnar
Median
Radial
Long thoracic
Thoracodorsal
Median
Ulnar
Axillary
Suprascapular and/or axillary
Musculocutaneous
Radial
Suprascapular
Axillary
Long thoracic
What renal pathology is characteristic of RBC casts and proteinuria? (FA15 p539-541) (FA16 p544-547) (SU p104, 154) (R p910, Table 20-5)
Glomerulonephritis
Acute malignant HTN w/ EOD of kidneys
In which pulmonary disease would you see an increased Reid index? (FA15 p610) (FA16 p618)
(SU p104)
Chronic Bronchitis (RI >50%)
Reid Index – thickness of mucosal gland layer to thickness of wall between epithelial and cartilage
A 56-year-old man develops right lower extremity edema after returning from Europe from a business trip. An exam of the right lower extremity demonstrates a red, warm, lower leg with a positive Homan’s sign. What is the patient’s diagnosis? What is a positive Homan’s sign? What is Virchow’s triad? What is the most common inherited hypercoagulability syndrome? (FA15 p608) (FA16 p616) (SU p103)
Pulmonary Embolism / *** DVT
Virchow’s Triad – hypercoagulability / Epithelial injury / stasis of blood flow
MC inherited hypercoagulability syndrome – Factor V Leiden mutation
clotting factor V cannot be degraded by protein C, resulting in inability for protein C to control the clotting cascade
Which adrenergic antagonists can be used to treat hypertension as well as urinary retention in patients with benign prostatic hyperplasia (BPH)? What is the difference between the prostate exam findings in BPH versus adenocarcinoma of the prostate? (FA15 p594) (FA16 p599) (SU p76)
Alpha1-antagonists (Terazosin / Prazosin / Doxazosin)
A type 2 diabetic with a HgbA1c of 10% presents to your clinic with many complaints. You are concerned about the effect of the patient’s long-term hyperglycemia. What diabetic complications can be attributed to sorbitol-induced osmotic damage? Which enzyme converts glucose to sorbitol? (FA15 p104) (FA16 p92)
Cataracts / Retinopathy / Peripheral neuropathy
Glucose – Aldose Reductase –> Soritol – Sorbitol dehydrogenase (lacking in schwann cells) –> Fructose
Which efferent fibers carry input from the brain that influences the outer hair cells (OHCs) of the cochlea in much the same way that gamma motor neurons influence muscle spindles? What is the result of this input? (SU p34) (Phys p639) (H p248) What is the result of damaging the OHCs (as with antibiotics such as gentamicin and streptomycin)? (H p250)
Olivocochlear bundles
Contraction of the outer hair cells –> stiffening of basilar membrane in cochlea –> sensitizes inner hair cells to a particular frequency
Damaging OHC w/ gentamicin or streptomycin
Wide deflection of basilar membrane –> hearing loss
What is type II (β) error? (FA15 p54) (FA16 p38) (SU p19)
saying that there is no difference when there is a difference
A child in India is brought to the doctor with symptoms of muscle weakness, malaise, headache, fever,
and hyporeflexia. For the past few weeks, he had been swimming in a waterway known to contain
sewage. You think this boy has contracted a pathogen via the fecal-oral route. Which area of the body
is this pathogen attacking to give the neurologic symptoms seen? (FA15 p471) (FA16 p474) (SU p45)
Poliomyelitis
Werdnig-Hoffmann disease
Amyotrophic Lateral Sclerosis
Complete occlusion of anterior spinal artery
Tabes dorsalis
Syringomyelia
Vitamin B12 deficiency
Polio virus –> fecal-oral
destruction of cells in anterior horn of the spinal cord –> ultimately causes lower motor neuron destruction
What are the risk factors for osteosarcoma? (FA15 p428) (FA16 p429) (SU p231)
Paget disease of bone
bone infarcts
radiation
familial retinoblastoma (mutation in Rb gene)
Li Fraumeni syndrome (germline p53 mutation)
Male Sex
Age 10-20
What disorders can cause cotton-wool spots on the retina? (H p231)
Diabetes
HTN
AIDS Lupus Temporal arteritis Wegener granulomatosis Polyarteritis nodosum
Which cardiac valve is most commonly involved in infective endocarditis and acute rheumatic fever?
(FA15 p298-299) (FA16 p293-294) (SU p87)
Mitral Valve most commonly involved
Tricuspid Valve involved with IV drug abusers (“dont TRI drugs”)
Name the syndromes below that are common causes of anovulation. (FA15 p323, 585) (FA16 p317,
591) (SU p207-208)
Elevated cortisol, central obesity
Amenorrhea + hirsutism + obesity
Cushing Syndrome
PCOS
Which neurotransmitters in the brain are affected in each of the following disorders? Are the levels increased or decreased? (FA15 p507) (FA16 p511) Schizophrenia Parkinson disease Alzheimer disease Huntington disease Anxiety Depression
increased dopamine ------------------------------ decreased dopamine increased ACh Increased 5-HT ------------------------------- decreased ACh Increased glutamate ------------------------------- decreased GABA decreased ACh increased dopamine ------------------------------ increased NE decreased GABA decreased 5-HT ------------------------------ decreased NE decreased 5-HT decreased dopamine
5-HT decreased in both anxiety and depression –> why we use SSRIs to treat both disorders
What is the underlying cause of DiGeorge syndrome? What are the manifestations of DiGeorge
syndrome? (FA15 p88, 214, 566) (FA16 p76, 208, 570) (SU p167, 382)
Microdeletion at chromosome 22q11
** Underlying cause –> 3rd and 4th branchial pouches fail to develop –> no thymus or parathyroid glands
C: cleft palate
A: abnormal facies
T: thymic asplasia (absent thymic shadow on CXR) –> failure to develop 3rd and 4th pharyngeal pouches –> T cell deficiencies
C: cardiac defects –> tetralogy of Fallot, truncus arteriosus
H: hypocalcemia 2/2 parathyroid aplasia –> tetany
22: 22q11 deletion –> FISH
T cell deficiencies:
recurrent viral & fungal infections
Ceftriaxone is used for the treatment of sexually-transmitted N. gonorrhea infections. Which generation of cephalosporin is ceftriaxone? Which generation of cephalosporin is effective against Pseudomonas? Are cephalosporins bacteriostatic or bactericidal? (FA15 p182) (FA16 p172) (SU p337-338)
Ceftriaxone = Third Generation cephalosporin
Pseudomonas
Ceftazidime / Cefoperazone (3rd generation)
Cefepime (4th generation)
Bactericidal "Very Finely Proficient At Cell Murder" V: vancomycin F: fluoroquinolones P: penicillin A: aminoglycosides C: cephalosporins M: metronidazole
Bacteriostatic: ECSTaTiC E: erythromycin C: clindamycin S: sulfamethoxazole T: trimethoprim T: tetracycline C: chloramphenicol
A 35-year-old white woman presents with a dull ache in her jaw that is made worse by chewing. She states that this pain corresponds to her recent promotion and increase in responsibilities. What is the most likely diagnosis? (H p269)
Maybe Giant Cell Arteritis (Temporal Arteritis) but… 35yo is too young
TMJ syndrome = young woman / 2nd MC cause of facial pain Exacerbated by stressful life events Nocturnal bruxism (grinding teeth at night)
A patient is undergoing treatment with recombinant interferon for his hepatitis C. In what ways do
interferons interfere with viral protein synthesis? (FA15 p207-208) (FA16 p200-201) (SU p431)
Interferons are glycoproteins synthesized by virus-infected cells that act locally on uninfected cells, priming them for viral defense by helping to selectively degrade viral nucleic acid and protein
- RNA protein kinase (inhibits viral protein synthesis by degrading viral mRNA)
- Trigger pro-apoptotic pathways
- Influence activities of macrophages / dendritic cells
Your patient develops a cough with the new antihypertensive drug you prescribed her. What are some
other side effects associated with this medication? (FA15 p555) (FA16 p559) (SU p76-77, 84)
ACE inhibitors C: cough A: angioedema P: hyperKalemia (Potassium) T: taste changes O: hypOtension P: pregnancy changes R: rash I: increased renin L: low angiotensin II
In regard to seizures, what do the terms partial, generalized, simple and complex mean? (FA15 p489)
(FA16 p494) (SU p44)
Seizures
Partial – affect single area
Generalized – diffuse area
Simple – consciousness intact
Complex – impaired consciousness
How is thyroid hormone made and stored? (SU p190) (Phys p907) (H p2913)
epithelial cells of thyroid bring in iodide from blood using Na/I cotransporter
- Iodide oxidized by peroxidase –> bind to thyroglobulin (organification)
- MIT / DIT links together to make T3 and T4
- T3 is the active
- T4 is most that gets released
A 35-year-old man is seen in the office for his chronic, recurrent peptic ulcer disease. It has been
refractory to conventional treatment with PPIs. Your attending mentions that this might be caused by
a tumor. Which type of tumor may be responsible for this condition? If this patient also presented with
kidney stones and signs of hypogonadism, what syndrome might you suspect? (FA15 p336-337) (FA16
p332-333) (R p769, 1136)
Zollinger-Ellison syndrome (gastrinoma)
duodenum and pancreas
MEN I (???)
** Kidney stones (calcium --> hyperparathyroidism) & hypogonadism (pituitary disease, prolactinoma)
What is the role of clomiphene in the treatment of PCOS? What is the mechanism of action of
clomiphene? (FA15 p596) (FA16 p601) (SU p224)
Clomiphene – used to treat infertility in PCOS
Antagonist at estrogen receptors in hypothalamus Prevents normal feedback inhibition and increase release of LH and FSH from pituitary, which stimulates ovulation
A 49-year-old trauma patient comes into the ER unconscious and in need of surgery. What are the
exceptions to informed consent? (FA15 p56) (FA16 p40) (SU p21-22)
Exceptions to informed consent:
Pt lacks decision-making capacity or is legally incompetent
Implied consent in emergency
Therapeutic privilege - withholding information when disclosure would severely harm the pt or undermine informed decision-making
Waiver – pt explicitly waives the right of informed consent
What are the side effects of amiodarone, and what testing should be performed periodically on
patients taking it? (FA15 p309) (FA16 p303) (SU p72-73)
Amiodarone (class III anti-arrhythmic)
Side effects
- Pulmonary fibrosis - hepatotoxicity - hypothyroidism/hyperthyroidism (amiodarone is 40% iodine by wt) - acts as hapten (corneal deposits, blue/gray skin deposits resulting in photodermatitis) - neurologic effects - constipation - cardiovascular effects (bradycardia, heart block, HF)
CHECK: PFTs, LFTs, TFTs
When is a fetus most susceptible to damage from teratogens? What drug used in the treatment of hypertension is a teratogen? What effect does this have on the fetus? (FA15 p560) (FA16 p564) (SU p76, 201)
Fetus most susceptible to damage from teratogens: 3rd to 8th week (embryonic period - organogenesis)
ACE inhibitors and ARBs
Fetal Kidney damage
How is the body affected by a prolonged stay in space at zero gravity? (Phys p533)
- Decrease in blood volume
- Decrease in RBC mass
- Decrease in muscle strength and work capacity
- Decrease in maximum cardiac output
- Loss of calcium and phosphate from the bones –> loss of bone mass
What is the most common gynecologic neoplasm? What is the typical histological pattern? Is it benign or malignant? (FA15 p588) (FA16 p594) (SU p215)
Leiomyoma (fibroids) – MC tumor in females
whorled pattern on histology
Endometrial Carcinoma – MC gynecologic malignancy / typically preceded by endometrial hyperplasia
Describe how the following diuretics affect the nephron function. (FA15 p553-554) (FA16 p557-558) (SU p165-166) Diuretic Nephron Effect Acetazolamide Mannitol Furosemide Hydrochlorothiazide (thiazides) Potassium sparing ADH antagonists (Vaptans / Demeclocycline)
Carbonic anhydrase inhibitor
Causes self-limited NaHCO3 diuresis and decrease total body HCO3 stores
Sodium bicarb diuresis
Osmotic diuretic / Increases tubular fluid osmolarity –> increase urine flow / decrease intracranial & intraocular pressure
———————————–
Loop diuretic. Inhibit cotransport system (Na/K/2Cl) of thick ascending limb of loop of Henle
Abolish hypertonicity of medulla, preventing concentration of urine
Stimulate PGE release (vasodilatory effect on afferent arteriole) – inhibited by NSAIDs
"Loops Lose Ca++" "OH DANG" ----------------------------------- Inhibit NaCl reabsorption in early DCT --> decrease diluting capacity of nephron Decrease Ca++ excretion ----------------------------------- Competitive aldosterone receptor antagonists in cortical collecting tubule ----------------------------------- Blocks the action of ADH receptors
How are the following relative component levels in the blood of a polycythemia vera patient different from normal: plasma volume, RBC mass, O2 saturation, and endogenous erythropoietin? (FA15 p404) (FA16 p404) (SU p275)
Polycythemia vera patient:
Plasma volume – increased
RBC mass – highly increased
O2 sat – same
Endogenous Erythropoietin – decreased
What synthetic agent is used both as a pituitary hormone analog and as a treatment for von Willebrand disease? (SU p189) (GG p712) (H p972)
DDAVP (Desmopressin)
What agent can be given as an inhaled drug to loosen mucus plugs, can be given orally to treat acetaminophen overdose, and can be given orally as prophylaxis against IV contrast-induced nephropathy in those with preexisting renal disease? (FA15 p257, 620) (FA16 p251, 627) (SU p113-114)
N-acetylcysteine
liquefies mucus in COPD patients by disrupting disulfide bonds / also used as an antidote for acetaminophen overdose
Which type of diabetes mellitus fits each of the following descriptions? (FA15 p335) (FA16 p331) (SU p179) (R p1107) Associated with obesity May cause ketoacidosis Strong genetic predisposition Associated with HLA-DR3 & -DR4
T2DM -------------------------------------- T1DM & rarely in T2DM -------------------------------------- T2DM -------------------------------------- T1DM
What viral illness is associated with Burkitt lymphoma? Is Burkitt lymphoma a neoplasm of mature T or B cells? (FA15 p400) (FA16 p400) (SU p272) Where are T cells found in the spleen? Where are B cells found in the spleen? (FA15 p199) (FA16 p191) (SU p367-368) (R p623)
Burkitt Lymphoma – associated with EBV
Neoplasm of mature B cells
SPLEEN:
T cells are found in the periarteriolar lymphatic sheath (PALS) within the white pulp
B cells are found in follicles within the white pulp
In which lobes of the brain would you find each of the following brain functions? (FA15 p460) (FA16 p462) (SU p31) Function Lobe Broca’s area (motor speech) Wernicke’s area (speech understanding) Primary auditory cortex Principal visual cortex Primary sensory cortex Primary motor cortex Premotor cortex
Frontal Lobe -------------------------------------- Temporal lobe -------------------------------------- Temporal Lobe -------------------------------------- Occipital lobe -------------------------------------- Parietal lobe --------------------------------------- Frontal lobe --------------------------------------- Frontal lobe
What potentially fatal autoimmune skin disorder is caused by IgG antibodies against desmosomes? What is the difference between a desmosome and a hemidesmosome? (FA15 p437, 441) (FA16 p438, 443) (SU p251-253)
Pemphigus vulgaris
Desmosome – connects cells to cells from side to side
Hemidesmosome – connects cells to the basement membrane
What is the classic presentation of granuloma annulare? (H p2988)
- AXS
- Non-scaly, slightly erythematous annular plaque
- Irregular, well-defined edges
- Thick, rope-like border
- Starts small and grows outward
- Usually localized to the wrists, ankles, or dorsal hands/feet
A 66-year-old man is involved in a motorcycle accident and suffers a head injury that leaves him in a coma. Prior to this injury, the man met with his lawyer to write out specific instructions in case an event like this happened. What are these instructions called? (FA15 p57) (FA16 p41) (SU p21-22)
Advance directives:
Oral advance directives
Living will (written advance directives) Medical power of attorney
An 18-year-old man is brought to your office for delayed onset of puberty. Physical exam confirms a small penis and testicles for his age, as well as lack of facial, pubic, and underarm hair. The patient also reveals that he has never been able to smell. What is the likely diagnosis? (FA15 p579) (FA16 p586) (SU p201)
Kallmann Syndrome
failure to complete puberty – a form of hypogonadotropic hypogonadism
defective migration of GnRH cells and formation of olfactory bulbs
decrease synthesis of GnRH in the hypothalamus
anosmia
decrease GnRH, FSH, LH, testosterone
Infertility (low sperm count in males / amenorrhea in females)
A 45-year-old woman who has been taking prednisone for control of rheumatoid arthritis symptoms has recently been diagnosed with Cushing syndrome. Other than exogenous steroids, what else can cause Cushing syndrome? How does the level of ACTH help differentiate the etiology? (FA15 p323) (FA16 p317) (SU p185)
Cushing’s
Exogenous corticosteroids (MC) Primary adrenal adenoma / hyperplasia / carcinoma ACTH-secreting pituitary adenoma (Cushing Disease) Paraneoplastic ACTH secretion (small cell lung cancer / bronchial carcinoids)
Describe the flow of blood into and out of the thyroid gland. (COA p1018-1020)
Superior thyroid artery (External carotid a.)
Inferior thyroid artery (Thyrocervical trunk)
Superior / Middle / Inferior thyroid vein
A 30-year-old man is undergoing the Schilling test to investigate his B12 deficiency. What must be present in the enteric system in order for vitamin B12 to be absorbed? (FA15 p356) (FA16 p352) (SU p119)
Intrinsic factor (produced by parietal cells of stomach)
B12 + intrinsic factor absorbed in terminal ileum
The part of the brain responsible for attention and alertness has been implicated in schizophrenia, PTSD, Parkinson disease, narcolepsy, progressive supranuclear palsy, depression, and ADHD. Which part of the brain is this? (Hint: Lesion results in coma.) (FA15 p461) (FA16 p464) (SU p45)
Reticular Activating System of the Midbrain
What is the definition of first-degree AV block? What are the symptoms of first-degree AV block? (FA15 p284) (FA16 p278) (SU p70)
1st Degree AV Heart Block – prolonged PR interval (>200msec / five little boxes), asx, no tx
What are the main differences between delirium and dementia? Which is more commonly reversible? (FA15 p508) (FA16 p512-513) (SU p47-48)
Delirium
- Waxing/waning level of consciousness - Acute onset - Usually secondary to acute illness - Usually reversible
Dementia
- Slow decline in cognitive function - Usually irreversible
Clopidogrel (Plavix) and ticlopidine are commonly used after an MI or cardiac catheterization with stent placement. What is the mechanism of action of these drugs? (FA15 p407) (FA16 p407) (SU p270)
Clopidogrel / Ticagrelor
Inhibit platelet aggregation by irreversibly blocking ADP receptors on platelets
What are some of the signs and symptoms of pericarditis? (FA15 p299, 300) (FA16 p294, 295) (SU p91) (R p573-575)
Pericarditis
Chest pain worsens when leaning back / sharp pain aggravated with inspiration / relieved by sitting up and leaning forward
Diffuse ST segment elevation and/or PR depression
Friction rub
**
JVD
Kussmaul sign (JVD with inspiration)
What common over-the-counter medication is used to remove excess thick sputum by stimulating the vagus nerve to generate low viscosity secretions in the bronchial tree? (FA15 p620) (FA16 p627) (SU p113)
Guaifenesin - makes mucus thinner
Preventive vaccines have been developed for which encapsulated bacteria? What test can be used to detect encapsulated bacteria? (FA15 p122) (FA16 p112) (SU p318)
Pneumococcal (PCV / PPSV) Streptococcus pneumoniae H influ type B (conjugate) Meningococcal vaccine (conjugate) Neisseria Meningitidis
Add serum that contains anticapsular antibodies
Look for Quellung reaction
-Capsule appears to swell in response to antibodies
A 30-year-old Asian woman presents to the clinic with a variety of complaints. Upon completion of your exam, you suspect Takayasu arteritis. What symptoms does this patient likely have? (FA15 p302) (FA16 p296) (SU p90)
TAKAYASU ARTERITIS – granulomatous thickening and narrowing of aortic arch and proximal great vessels (increased ESR)
Weak UE pulses "Pulseless disease" fever / night sweats arthritis / myalgias / arm claudication skin nodules ocular disturbance
Tx: corticosteroids
What are the carpal bones of the wrist? (COA p679-680)
S: scaphoid L: lunate T: triquetrum P: pisiform T: trapezium T: trapezoid C: capitate H: hamate
A 6-year-old boy is receiving poor grades in school. His teachers and parents report that he has normal intelligence but is very distractible and full of excess energy. What medications might help this boy? (FA15 p506) (FA16 p511) (SU p58)
ADHD - symptoms present before age 12 Stimulants Amphetamines Methylphenidate Atomoxetine CBT
Why is diphenhydramine (Benadryl) a poor medication choice in the elderly and in those with BPH? (FA15 p248, 620) (FA16 p242, 627) (SU p112)
Anticholinergic side effects Delirium Confusion Urinary retention Sedating, but... Disrupts normal sleep architecture
On which cells would you find CD4 molecules? On which cells would you find CD8 molecules? What actions do the CD8+ cells accomplish? (FA15 p202-203) (FA16 p194-195) (SU p371-372)
Helper T cells have CD4
Cytotoxic T cells have CD8 – binds to MHC I on virus-infected cells
Kill virus-infected, neoplastic, and donor graft cells by inducing apoptosis
Release cytotoxic granules containing preformed proteins (perforin, granzyme B)
What breast pathology fits each of the following descriptions? (FA15 p589-591) (FA16 p595-597) (SU p216)
• Most common breast tumor in women under 25
• Most common breast mass in postmenopausal women
• Most common breast mass in premenopausal women
• Most common form of breast cancer
Fibroadenoma ---------------------------------- Invasive ductal carcinoma ---------------------------------- Fibrocystic change ---------------------------------- Invasive ductal carcinoma
What are the positive symptoms of schizophrenia (adding a symptom)? What are the negative symptoms of schizophrenia (removing a normal finding/trait)? (FA15 p509) (FA16 p514) (SU p53)
Positive Delusions Hallucinations - often auditory Disorganized speech Disorganized or catatonic behavior Negative Flat affect Avolition Anhedonia Asociality Alogia
What is HIPAA?
Health Insurance Portability and Accountability Act
Describe the anatomy of the femoral sheath. When placing a femoral line for central venous access, you palpate a femoral pulse. Where do you place the guide needle in relation to this pulse: medially or laterally? (FA15 p350) (FA16 p347)
NAVL from lateral to medial
N: nerve ** femoral nerve is outside of femoral sheath **
A: artery
V: vein
L: lymphatics ** lymphatics close to groin to handle infections **
Which area of the brain is damaged in Klüver-Bucy syndrome? What are the symptoms of Klüver-Bucy syndrome? (FA15 p461) (FA16 p464) (SU p31)
Amygdala is damaged bilaterally
Disinhibited behavior – hyperphagia / hypersexuality / hyperorality
associated with HSV-1 encephalitis
What long-term complication is associated with having to receive multiple blood transfusions? (FA15 p399) (FA16 p399)
Infection transmission Transfusion reactions Iron Overload --> secondary hemochromatosis Hypocalcemia Hyperkalemia
What are Cheyne-Stokes respirations? (SU p101) (H p1904) (Phys p512)
“Periodic Respirations / Cyclic Respirations”
Repeating cycles of:
- Apnea - Hypercapnia
Compensatory phase of:
- Hyperventilation - Hypocapnia
Due to diminished sensitivity of the medullary respiratory center, caused by:
- drug overdose - cerebral atherosclerosis - cerebral lesions - prolonged circulation time from HF
Which type of immunodeficiency disorder is caused by DiGeorge syndrome? (FA15 p214) (FA16 p208) (SU p382) Development of which branchial pouches is affected in DiGeorge syndrome? (FA15 p566) (FA16 p570) (SU p167)
T Cell deficiency – recurrent viral and fungal infections
3rd and 4th pharyngeal pouches fail to develop –> no thymus or parathyroid glands
3rd – inferior parathyroids and thymus
4th – superior parathyroids
What drugs and endogenous hormones regulate the secretion of gastric acid? (FA15 p353-354) (FA16 p350-351) (SU p119)
GASTRIC ACID SECRETION (parietal cells secret both HCl and intrinsic factor) Increases Gastrin Histamine Acetylcholine
Decreases Prostaglandins Somatostatin Secretin Glucose-dependent insulinotropic peptide (GIP)
Proton pump inhibitors (PPIs) H2 blockers Octreotide
The E4 variant of Apo E is a known risk factor for Alzheimer’s disease. What is the primary function of each of the following major apoproteins? (FA15 p115) (FA16 p104) (SU p309) • Apo A-I • Apo B-48 • Apo B-100 • Apo C-II • Apo E
Activates LCAT (enzyme that catalyzes the esterification of cholesterol) ------------------------------------- mediates chylomicron secretion from enterocytes ------------------------------------- binds LDL receptor ------------------------------------- Lipoprotein lipase cofactor Removes FFA from lipid particles ------------------------------------- Mediates remnant uptake
REVIEW LIPID TRANSPORT
Name five or more drugs that inhibit acetylcholinesterase. What is the clinical application for each? (FA15 p250) (FA16 p244) (SU p249, 420-421, 441, 449)
Neostigmine
- Reverse neuromuscular blockade - Ileus - Bladder atony
Physostigmine
- Atropine overdose
Edrophonium (Tensilon)
- Diagnose myasthenia gravis (use only for diagnosis, bc short half-life of 5-10 mins)
Pyridostigmine
- Treat myasthenia gravis
Echothiophate
- Treat open-angle glaucoma
Donepezil / Rivastigmine / Galantamine
- Treat Alzheimer disease
