Day 4 Flashcards
Clavulanic acid, sulbactam, and tazobactam aid penicillins in their activity against bacteria through
what mechanism? (FA15 p181) (FA16 p171) (SU p337)
Beta-lactamase inhibitors – protects antibiotics from destruction by beta-lactamase (penicillinase)
C & A: Clavulanic Acid
S: Sulbactam
T: Tazobactam
Which bacteria are most commonly responsible for sialadenitis? What condition most commonly
predisposes a patient to sialadenitis? (SU p119) (R p743)
Sialadenitis – infection of the salivary glands
**
Staphylococcus Aureus
Viridans Streptococci
Stone obstruction of the salivary gland duct (sialolithiasis)
Membranous glomerular diseases involve thickening of which structure? (FA15 p540) (FA16 p544) (SU
p152, 156)
Thickening of the glomerular basement membrane
An 88-year-old man arrives at the ER after he fell and struck his head. He has a history of atrial
fibrillation for which he takes warfarin. Noncontrast CT of the head reveals subarachnoid hemorrhage.
What is the antidote for warfarin anticoagulation or warfarin overdose? For heparin overdose? (FA15
p257, 406) (FA16 p251, 406) (SU p271)
Warfarin – Vitamin K (delayed) / FFP (immediate)
Heparin – Protamine sulfate
What important secretory products are secreted from each of the following cells of the GI tract? (FA15 p353-354) (FA16 p350-351) (SU p117, 119) Source Secretory products G cells I cells S cells D cells Parietal cells Chief cells
G cells : Gastrin --------------------------------- I cells : Cholecystokinin --------------------------------- S cells : Secretin --------------------------------- D cells : Somatostatin --------------------------------- Parietal cells : HCl & Intrinsic Factor --------------------------------- Chief cells : Pepsinogen --> Pepsin for protein digestion
You recommend that your patient, a 51-year-old woman, begin taking a calcium and vitamin D
supplement in order to prevent osteoporosis. What are the steps in the conversion of vitamin D to its
active form in the body? By what mechanism does vitamin D help prevent osteoporosis? (FA15 p319)
(FA16 p313) (SU p174)
D3 - from exposure to sun, ingestion of fish and plants
D2 - from ingestion of plants, fungi, yeast
Both are converted to 25-OH in liver and to 1,25-(OH)2 in the kidney, which is the active form
Vitamin D increases absorption of dietary Ca++ and PO4—, and thus enhances bone mineralization
A child arrives at the ER in hypotensive shock after taking his dad’s phenoxybenzamine. The intern on
call orders the nurse to get her a pressor STAT. The nurse informs the intern that there are two
pressors available in the ER, epinephrine and phenylephrine. Which one will be able to increase the
blood pressure of this pediatric patient? (FA15 p255) (FA16 p248) (SU p77)
Phenoxybenzamine - Irreversible alpha-blocker Epinephrine - alpha-agonist - beta-agonist - will stimulate beta2 receptors on vascular smooth muscle and cause peripheral vasodilation
Phenylephrine
- alpha-agonist - pure alpha-agonist and will not induce beta2-mediated vasodilation
Thus, we want phenylephrine
What can occur if a MAO inhibitor (MAOI) is added to an SSRI? What is the treatment for this
condition? (FA15 p523) (FA16 p527-528) (SU p55)
Serotonin Syndrome
- Tremor - Hyperreflexia - Muscle rigidity (clonus) - Hyperthermia - Diaphoresis - Flushed skin - Agitation - Seizures - Cardiovascular collapse
Tx: Cyproheptadine (5-HT2 receptor antagonist)
Stop serotonergic drugs
Benzos
Supportive care
What landmarks are used when placing an internal jugular central venous catheter? (COA p1011)
Sternocleidomastoid muscle (sternal head / Clavicular head) Clavicle
Place need at apex of triangle at 30 degree angle towards the nipple
Palpate carotid artery that should me medial to the vein
A patient presents with a 1 cm, painless, mobile mass in her right parotid gland. You inform the patient
that most tumors in the parotid gland are benign. What is the most common benign tumor of the
salivary gland? What is a Warthin’s tumor? Which cranial nerve goes through the parotid gland? (FA15
p357, 475) (FA16 p353, 479) (SU p41, 119)
Pleomorphic Adenoma (benign mixed tumor) - MC salivary gland tumor composed of chondromyxoid stroma and epithelium and recurs if incompletely excised or ruptured intraoperatively
Mucoepidermoid Carcinoma – MC malignant tumor, has mucinous and squamous components
Warthin tumor (papillary cystadenoma lymphomatosum) – benign cystic tumor with germinal centers
CN VII (Facial nerve) "To Zanzibar By Motor Car" T: Temporal Z: Zygomatic B: Bucal M: Marginal mandibular C: Cervical
What are the most common locations of lung cancer metastases? (FA15 p619) (FA16 p626) (SU p114)
Adrenals
Brain
Bone
Liver
What are some of the functions of bile produced by hepatocytes and stored in the gallbladder? (Phys p783) Which hormone is the most potent stimulator of gallbladder contractions? (Phys p785)
Functions of bile
Emulsifies large fat particles –> small fat particles
Absorption of fat end-products
Absorption of fat soluble vitamins
Excretion of bilirubin / copper / cholesterol
What is the characteristic fetal complication associated with lithium use in pregnancy? What other agents used to treat bipolar disorder can be teratogenic, and what are their corresponding fetal effects? (FA15 p560) (FA16 p564) (SU p58, 397)
Lithiuim use == Ebstein anomaly (apical displacement of tricuspid valve
Carbamazepine
- Neural tube defects - Craniofacial defects - IUGR - Developmental delay - Hypoplastic fingernails
Valproic acid
- Neural tube defects
Aripoprazole / Risperidone (atypical antipsychotics)
- Extrapyramidal symptoms
Which anatomic structures are found in the retroperitoneum? (FA15 p343) (FA16 p339)
SAD PUCKER S: Suprarenal A: Aorta and IVC D: Duodenum (2nd and 4th parts) P: Pancreas (except tail) U: Ureters C: Colon (descending and ascending) K: Kidneys E: Esophagus (thoracic portion) R: Rectum
What are the common causes of Erb-Duchenne palsy? Where is the brachial plexus insult with Erb-
Duchenne palsy? (FA15 p419) (FA16 p420) (SU p238)
Severe traction or tear of the upper portion of the brachial plexus (C5-C6) roots
Infants – lateral traction on neck during delivery (shoulder dystocia)
Adults – trauma
A central line is often placed in the subclavian vein to administer fluids and medications or to measure
central venous pressure. What landmarks are used when placing a subclavian central line? (COA
p1008)
Thumb of clavicle, forefinger on sternal/jugular notch
Needle goes rough at the tip of thumb
Metastasis to the brain, liver, and bone commonly comes from which locations? (FA15 p240) (FA16 p233) (SU p50) Brain Liver Bone
Brain: Lung Breast Prostate Melanoma GI
Liver:
COLON
Stomach
Pancreas
Bone:
Prostate / Breast
Lung / Thyroid / Kidney
Which glycogen storage disease fits each of the following features? (FA15 p110) (FA16 p99) (SU p302-
304)
Severe hypoglycemia with elevated blood
lactate
Hypoglycemia without elevated blood
lactate
Cardiomegaly
Myoglobinuria associated with exercise
Von Gierke diease ----------------------------------- Cori Disease ----------------------------------- Pompe disease (type II) ----------------------------------- McArdle disease (Type V) -----------------------------------
***** "Very Poor Carbohydrate Metabolism" V: Von Gierke disease (type I) P: Pompe disease (type II) C: Cori disease (type III) M: McArdle disease (type V)
What is the mechanism of organophosphate poisoning? What are the symptoms of cholinergic
excess? (FA15 p250) (FA16 p244) (SU p402)
Irreversibly inhibit AChE / toxic buildup of too much ACh "DUMBBELSS" D: diarrhea U: urination M: miosis B: bronchospasm B: bradycardia E: excitation of skeletal muscles & CNS L: lacrimation S: sweating (perspiration) S: salivation
TX: atropine (competitive inhibitor) + pralidoxime (regenerates AChE if given early)
What is the treatment for a pulmonary embolism? (FA15 p405, 609) (FA16 p405, 617) (SU p270) (R
p697)
IV Heparin
LMWH
Which cancers can cause the paraneoplastic syndrome Lambert-Eaton syndrome? (FA15 p238) (FA16 p229) (SU p115)
Lambert Eaton Syndrome - antibodies against presynaptic (P/Q-type) Ca++ channels at NMJ
Small Cell Lung Cancer
Hodgkin Lymphoma
Malignant thymoma
What is conductive hearing loss, and what are some causes? (H p248)
Sound is not conducted to the cochlear apparatus
Causes include:
- Wax buildup in ear canal
- Ear infection
- Ruptured TM
- Otosclerosis (abnormal growth of ossicles in the middle ear
vs. Sensorineural hearing loss
What is the most common tumor of the urinary tract? What is the usual presenting complaint of a patient with this tumor? What substance exposures increase the risk of developing this tumor? (FA15 p547) (FA16 p551) (SU p163)
Transitional Cell Carcinoma
Painless hematuria
No casts
"problem in your Pee SAC" P: phenacetin S: smoking A: aniline dyes C: cyclophophamide
What pulmonary artery pressures indicate pulmonary hypertension? (FA15 p614) (FA16 p622)
Pulmonary Artery Pressures >25 mmHg at rest
What conditions are associated with oligohydramnios, and what conditions are associated with polyhydramnios? (FA15 p583) (FA16 p589) (SU p144) What is Potter sequence? (FA15 p526) (FA16 p530) (SU p144)
Polyhydramnios fetal malformations -- inability to swallow amniotic fluid - esophageal atresia - duodenal atresia - anencephaly Association - Maternal diabetes - Fetal anemia - Multiple gestations
Oligohydramnios placental insufficiency bilateral renal agenesis posterior urethral vales (males) resultant inability to excrete urine can cause Potter Sequence
Potter Sequence -- "POTTER" P: pulmonary hypoplasia O: oligohydramnios T: twisted face T: twisted skin E: extremity defects R: renal failure
What are the mechanisms of action of each of the following toxins? (SU p27) (H p1197, 1200, 3580)
Strychnine
Tetanus toxin
Black widow spider toxin
Botulinum toxin
Glycine antagonist
(glycine is an important inhibitory substance in the spinal cord)
————————————-
Blocks gylcine and GABA
Exotoxin acts at Renshaw cells ------------------------------------- Causes excessive release of ACh ------------------------------------- Inhibits release of ACh at the NMJ
A 3-year-old girl presents with a fever of 102°F for the last three days. On the fourth day, the patient develops a red macular rash over the entire trunk, and her fever resolves abruptly. What viral infection is most likely in this case? (FA15 p158-159) (FA16 p149) (SU p345)
Roseola == HHV-6 & HHV-7
What is the difference between malingering and factitious disorder? (FA15 p514) (FA16 p518) (SU p58)
Malingering – secondary (external) gain, such as avoiding work, obtaining compensation
Factitious – primary (internal) gain, in order to assume “sick role” and to receive medical attention
Which phase of drug metabolism do geriatric patients lose first? Which phase of drug metabolism makes a slightly polar metabolite by oxidation, reduction, or hydrolysis? (FA15 p244) (FA16 p238) (SU p14)
Drug metabolism
Phase I – reduction, oxidation, hydrolysis with cytochrome p450 usually yields slightly polar, water soluble metabolites
Geriatric patients lose phase I first
Phase II -- conjugation (methylaion, glucuronidation, acetylation, sulfation) usually yields very polar, inactive metabolites (renally excreted) "geriatric patients have More GAS"
A patient complains of intense thirst and profuse urination. A diagnosis of diabetes insipidus is suspected after further testing. What would be the most likely urine specific gravity and serum osmolality findings in this patient? (FA15 p333) (FA16 p328) (SU p185) (Phys p354)
Regardless of central DI or Nephrogenic DI
Urine specific gravity <1.006
Serum osmolality >290 mOsm/kg
Hyperosmotic volume contraction
What are the essential amino acids? (FA15 p104) (FA16 p92) (SU p292)
"PVT TIM HALL" P: Phenylalanine V: Valine T: Threonine T: Tryptophan I: Isoleucine M: Methionine H: Histidine A: Arginine (only essential in children) L: Leucine L: Lysine
Only L-form optical isomers can be found in protein
Arginine and histidine are only essential during periods of growth
ACIDIC – aspartic acid & gluatmic acid
BASIC – arginine (most basic) / lysine / histidine (no charge at physiologic pH)
What medications are commonly used for the treatment of insomnia? (GG p477)
Melatonin Antihistamine - Diphenhydramine Trazodone TCAs - Amitriptyline Benzos - Temazepam - Lorazepam Zolpidem (Ambien) Zaleplon Eszopiclone (Lunesta) Ramelteon
Which mature structures arise from each of the following embryologic structures? (FA15 p268) (FA16 p262) (SU p61-62)
Bulbus cordis
Left horn of sinus venosus
Primitive atrium
Truncus arteriosus
Primitive ventricle
Right horn of sinus venosus
Right common and anterior cardinal veins
RV Outflow tracts of LV & RV ------------------------------------ Coronary sinus ------------------------------------ Trabeculated part of LA & RA ------------------------------------ Ascending aorta & pulmonary trunk ------------------------------------ Trabeculated part of LV & RV ------------------------------------ Sinus venarum of RA ------------------------------------ SVC
Describe the rash presentation (timing, description, location) associated with each of the following diseases. (FA15 p176) (FA16 p166) (SU p469, 472, 474-475)
Rubella
Herpes zoster
HHV-6
Parvovirus B19
Coxsackievirus type A
Streptococcus pyogenes
Timing -
Description -
Location - Begins on head, move inferiorly
————————————
Timing -
Description - grouped vesicles on an erythematous base, in a unilateral dermatomal distribution
Location -
Timing -
Description - high fever several days, then macular rash
Location -
Timing -
Description - “Slapped cheek rash, then over body in reticular lace-like pattern
Location -
Timing -
Description - vesicular rash on palms and soles, ulcers in oral mucosa
Location -
Timing -
Description - erythematous sandpaper-like rash, fever, sore throat
Location -
A 50-year-old man crashes on a motorcycle on the highway and sustains a right anterior hip dislocation and knee trauma. Now he cannot adduct his hip or plantarflex on that side. Which nerves are injured? (FA15 p421) (FA16 p422) (SU p241)
Tibial nerve – inverts & plantarflexes
Obturator nerve – hip adduction
How much does the H&H change in a person that has acclimatized to a hypoxic environment for weeks? (Phys p529)
Hgb increases to ~20
Hct increases to ~60
A 53-year-old man has just been diagnosed with peptic ulcer disease (PUD) visualized on endoscopy. Ranitidine and lansoprazole are the medications available on your hospital formulary for the treatment of PUD. Describe the different ways in which ranitidine and lansoprazole decrease parietal cell acid secretion. Why is ranitidine preferred over cimetidine? What other conditions can you treat with lansoprazole and ranitidine? (FA15 p378) (FA16 p374) (SU p139-140)
Ranitidine (H2 blocker) – reversible blockade of histamine H2-receptors –> decreases H+ secretion by parietal cells
Cimetidine:
- potent inhibitor of cytochrome p-450 (multiple drug interactions
- also anti-androgenic effects (prolactin release, gynecomastia, impotence, decrease libido in males
- cross BBB (causes confusion, dizziness, heachaches
- cross placenta
- Ranitidine & Cimetidine both decreases renal excretion of creatinine
Lansoprazole (PPI) – irreversibly inhibits H+/K+ ATPase in parietal cells
What are some extrapulmonary causes of restrictive lung disease? (FA15 p611) (FA16 p619) (SU p98)
Poor muscular effort
Polio
Myasthenia Gravis
Guillain-Barre syndrome
Poor structural apparatus
Scoliosis
Morbid obesity
Wallenberg syndrome is an injury of the lateral medulla that presents with a constellation of neurologic symptoms including difficulty with swallowing (dysphagia), hoarseness, and difficulty with palate elevation. Which part of the lateral medulla is responsible for swallowing and palate elevation? What other cranial nerves can be involved with this region? (FA15 p464, 476) (FA16 p467, 479) (SU p32)
Nucleus ambiguus
CN IX, X, XI
Which muscles compose the rotator cuff? (FA15 p417) (FA16 p417)
Supraspinatus (suprascapular n.)
Infraspinatus (suprascapular n.)
Teres minor (axillary n.)
Subscapularis (upper & lower subscapular n.)
How many half-lives does it take for a drug infused at a constant rate to reach 94% of steady state? What variables determine the half-life of a drug? (FA15 p243) (FA16 p237) (SU p395)
1st half-life: 50% remaining / 50% steady state
2nd half-life: 25% remaining / 75% steady state
3rd half-life: 12.5% remaining/ 87.5% steady state
4th half-life: 6.25% remaining / 94% steady state
Vd = volume of distribution
= amount of drug in the body / plasma drug concentration
CL = clearance
= rate of elimination of drug / plasma drug concentration
Describe the anatomical layers of the penis. (COA p419-420)
Outer dermis Dartos fascia Deep (Buck's) fascia Tunica albuginea Corpora cavernosa / Corpus spongiosum Urethra (within Corpus spongiosum)
What is the mechanism of action of penicillin? Is it a bacteriostatic or bactericidal antibiotic? (FA15 p180) (FA16 p170) (SU p337)
Blocks transpeptidase cross-linking of peptidoglycan in cell wall / activate autolytic enzymes
(Blocks synthesis of bacterial cell wall)
Bactericidal - Very Finely Proficient At Cell Murder
What is the adult remnant of each of the following fetal structures? (FA15 p271, 569) (FA16 p264, 573) (SU p61, 196)
Gubernaculum (female)
Processus vaginalis (male)
Foramen ovale
Notochord
Ovarian ligament + round ligament ------------------------------------ Tunica vaginalis ------------------------------------ Fossa ovalis ------------------------------------ nucleus pulposus
A 37-year-old patient with refractory peptic ulcer disease undergoes an esophagogastric duodenoscopy (EGD). Biopsies of the duodenum reveal hypertrophied submucosal glands. What are these glands? What are Peyer’s patches? How can these structures help you identify the location from which a histological specimen was taken? (FA15 p345, 360, 356) (FA16 p341, 357, 352)
Submucosal glands in duodenum – Brunner glands (secretes HCO3-) & crypts of Lieberkuhn
Peyer’s Patches – Unencapsulated lymphoid tissue in lamina propria & submucosa of ileum
MALT - mucosa associated lymphoid tissue
A person eating fugu sashimi in Japan is at risk for what toxicity? What is the mechanism of this toxicity? (FA15 p252) (FA16 p250)
Tetrodotoxin (puffer fish) – binds fast voltage-gated Na channels in cardiac/nerve tissue, preventing depolarization
Ciguatoxin (reef fish, barracuda, snapper, moray eel) – opens Na channels, causing depolarization
Histamine (spoiled dark-meat fish) – bacterial decarboxylase converts histidine to histamine / frequently misdiagnosed as fish allergy
You are performing a well-child examination on a 4-year-old girl. The patient was recently adopted after being removed from the biological mother for abandonment. What changes might you see in your evaluation? What are the effects seen in an infant when there is long-term deprivation of affection? (FA15 p506) (FA16 p510)
Infant deprivation effects – “4 W’s: Weak, Wordless, Wanting (socially), Wary”
- failure to thrive - poor language / socialization skills - lack of basic trust - reactive attachment disorder (infant withdrawn/unresponsive to comfort)
Which antifungal drugs cause gynecomastia and by what mechanism? Which diuretic drug causes gynecomastia and by what mechanism? (FA15 p191, 554) (FA16 p182, 558) (SU p216, 432, 454)
Azoles (Clotrimazole / Fluconazole / Itraconzaole / Ketoconazole (inhibits desmolase / cholesterol –> Pregnenolone) / Miconazole / Voriconazole)
MOA - inhibits fungal sterol (ergosterol) synthesis by inhibiting cytochrome p-450 enzymes that converts lanosterol to ergosterol
Testosterone synthesis inhibition (gynecomastia, especially ketoconazole)
Liver dysfunction – inhibits P450
"Some Drugs Cause Awesome Knockers" S: Spironolactone D: Digitalis C: Cimetidine A: Alcohol K: Ketoconazole
A 25-year-old woman presents to the clinic with severe pelvic pain that is always associated with menses. What diagnosis is characteristic of this type of pain and often results in infertility? What is the classic finding on the ovary that is associated with this diagnosis? (FA15 p588) (FA16 p594) (SU p206-207)
Endometriosis
Chocolate cyst of ovary (most common site, frequently bilateral)
What are the early cyanotic heart diseases? What are the late cyanotic heart diseases? (FA15 p288-289) (FA16 p282-283) (SU p64)
EARLY CYANOTIC HEART DISEASES (RIGHT-TO-LEFT)
Truncus Arteriosus
Transposition of Great Vessels
Tricuspid Atresia
Tetralogy of Fallot
Total Anomalous Pulmonary Venous Return (TAPVR)
LATE CYANOTIC HEART DISEASES (LEFT-TO-RIGHT) “Left-to-Right is LateR”
VSD
ASD
PDA
For what conditions is hyperbaric oxygen therapy particularly helpful? (SU p15-16) (Phys p540)
Severe CO poisoning Decompression sickness Arterial gas emboli Gas Gangrene (Clostridium perfingens) Osteomyelitis Acute MI
What is the pressure in the potential spaces of the body including the pleural cavity, the joint spaces, and the pericardial cavity? (Phys p300)
Pleural cavity: -7 to -8 cm H2O
Joint spaces: -3 to -5 cm H2O
Pericardial cavity: -5 to -6 mm Hg
If stroke volume determines cardiac output, and contractility determines stroke volume, what determines contractility? (FA15 p273) (FA16 p267) (Phys p231)
Contractility increased by:
- Catecholamines - Sympathetic stimulation - Increased intracellular Ca++ - Decreased extracellular Na+ - Digoxin
Contractility is decreased by:
- Beta1 blockade - HF - Acidosis - Hypoxia - CCB: Verapamil & Diltiazem - Decreased intracellular Ca++ - Increased extracellular Na+
A 48-year-old man presents to your office with a persistent cough that has become bloody. Chest x-ray reveals a coin lesion within the lung parenchyma. Further workup reveals that the patient has the most common type of lung cancer in nonsmokers. Which cancer is this? What other lung cancers are not associated with smoking? Which lung cancers are associated with smoking, and where are they located, centrally or peripherally? (FA15 p619) (FA16 p626) (SU p114)
Adenocarcinoma – KRAS / EGFR / ALK / ROS / MET / RET
Other non-smoking lung cancers:
Bronchial Carcinoid
Branchioloalveolar cell carcinoma
Metastases
Smoking lung cancers:
Squamous Cell Carcinoma (centrally)
Small Cell Carcinoma (centrally)
How does standard deviation differ from standard error of the mean? (FA15 p53) (FA16 p37) Which one is used in calculating confidence intervals? (FA15 p54) (FA16 p38)
Standard deviation – how much variability exists from the mean in a set of values
Standard error of the mean – an estimate of how much variability exists between the sample mean and the true population mean
Confidence Interval – use SEM to calculate CI
Diagram the pathway by which the cochlea communicates a signal to the primary auditory cortex. (Phys p639)
Cochlea –> Cochlear nuclei –> Contralateral superior olivary nucleus –> Lateral lemniscus –> Inferior colliculus –> Medial Geniculate body –> primary auditory cortex
Homocystinuria is one of the few diseases that can result in subluxation of the lens. What are the different causes of homocystinuria? How does the treatment differ for each? (FA15 p108) (FA16 p96) (SU p293)
Homocystinuria
- Cystathionine synthase deficiency
Tx: Decrease methionine, Increase cysteine, Increase B12, Increase folate in diet
- Decreased affinity of cystathionine synthase for pyridoxal phosphate
Tx: Highly Increase B6, Increase cysteine in diet
- Methionine synthase deficiency
Tx: Increase methionine in diet
A 34-year-old obese white woman develops urinary retention after undergoing a laparoscopic cholecystectomy. Which cholinergic agonist can be used to treat post-op ileus and urinary retention? What conditions can be made worse by using cholinomimetic agents? (FA15 p250) (FA16 p244) (SU p408)
Bethanechol (Direct cholinergic agonist)
Neostigmine (Indirect cholinergic agonist)
Conditions made worse by using cholinomimetic agents:
- Asthma - COPD - PUD
A 20-year-old Italian woman complains of weakness and fatigue. A CBC reveals a microcytic, hypochromic anemia with a normal iron panel. Which type of thalassemia does this patient most likely have? What is the structure of HbH? What disease results in HbH production? What is the structure of Hb Bart’s? What disease results in Hb Bart’s production? (FA15 p390-391) (FA16 p388-389) (SU p260-261)
Alpha thalassemia - Asian & African
Beta thalassemia - Mediterranean
Hgb A – 2 alpha, 2 beta
Hgb H – 4 bet-globin chains, alpha thalassemia (3 defective alleles)
Hgb Bart’s – 4 gamma-globin chains, alpha thalassemia (4 defective alleles) / incompatible with life
A 23-year-old man undergoes a splenectomy due to splenic rupture from blunt abdominal trauma. What would you expect to find on this patient’s peripheral RBC smear after the splenectomy? (FA15 p389) (FA16 p387) (SU p257) Asplenic patients are susceptible to which encapsulated organisms? (FA15 p199) (FA16 p191) (SU p367) What vaccines for these encapsulated organisms should be given to asplenic patients? (FA15 p122) (FA16 p112)
Howell-Jolly bodies – basophilic nuclear remnants found in RBCs / normally removed by splenic macrophages
Asplenic patients susceptible to which encapsulated organisms? Salmonella Strep Pneumo Klebsiella Hib Neisseria meningitidis
Vaccinations?
Strep pneumo
Hib
N. meningitidis
The parents of a 5-year-old girl are concerned because their daughter has night terrors, sleepwalking, and enuresis (bedwetting). In which stage of sleep do these occur? What medications shorten this stage of sleep and thus are useful in treating night terrors, sleepwalking, and enuresis? (FA15 p455) (FA16 p457) (SU p42-43)
Awake (Eyes open)
Alert, active mental concentration EEG Waveform - Beta (highest frequency, lowest amplitude)
Awake (Eyes closed)
EEG Waveform - Alpha
Non-REM sleep Stage N1 (5%) -- light sleep EEG Waveform - Theta
Stage N2 (45%) -- deeper sleep; bruxism occur EEG Waveform - Sleep spindles and K complexes Stage N3 (25%) -- Deepest non-REM sleep EEG Waveform - Delta (lowest frequency, highest amplitude) When sleep-walking, night terrors bedwetting occurs Tx: use Benzos
REM Sleep (25%)
Loss of motor tone, increase brain O2 use, EEG Waveform - Beta
increase and variable pulse and blood pressure
when dreaming, nightmares, penile/clitoral
tumescence occur, may serve memory processing
function
What medications are known for causing erectile dysfunction? (H p375)
ED causing drugs: Antidepressants Antipsychotics Spironolactone Ketoconazole Cimetidine Sympathetic blockers Clonidine Methyldopa Guanethidine Thiazide diuretics
A 48-year-old woman who has taken oral contraceptive pills for the past 15 years is concerned because she is not experiencing menopausal symptoms like the rest of her friends her age. What is the primary reason why menopausal women experience symptoms? Why might this patient not be experiencing menopausal symptoms? What symptoms/conditions are attributed to the changes that take place in menopause? (FA15 p576, 596) (FA16 p582, 601) (SU p208-209, 225)
Decreased estrogen production due to age-linked decline in number of ovarian follicles
Oral contraceptives provide exogenous source of estrogen
"HAVOCS" H: hot flashes A: Atrophy of V: vagina O: osteoporosis C: Coronary artery disease S: sleep disturbances
What is the rule of 2’s associated with a Meckel diverticulum? (FA15 p364) (FA16 p361) (SU p118)
Meckel Diverticulum The rule of 2's: 2 times as likely in males 2 inches long 2 feet from ileocecal valve 2% of population 2 years of life 2 types of epithelium (gastric & pancreatic)
A newly married couple is enjoying a honeymoon on a Caribbean beach in Mexico. A few days into the trip, the two begin complaining of abdominal cramps and watery diarrhea. They do not have fevers. Which type of Escherichia coli causes the very common “travelers’ diarrhea”? (FA15 p138) (FA16 p128) (SU p127)
ETEC - enterotoxins
A patient comes to your clinic because he has not been able to extend his wrist for the last three days. Upon further questioning, you discover that four days ago the patient passed out drunk for an entire night while his arm was draped over a chair. What is this patient’s condition? (FA15 p418) (FA16 p419) (SU p238) (COA p54, 743) Does the regeneration of neurons occur in both the CNS and the PNS? (SU p23-24, 239) (R p1228) What is the rate of growth of a new axon in the PNS? (R p1228)
Radial nerve neuropathy – “Saturday night palsy” – compression of axilla
Regeneration only happens in PNS
Rate of Growth: 1-2 mm per day
Women with polycystic ovarian syndrome can have decreased levels of sex hormone-binding globulin (SHBG) which contribute to the development of hirsutism. What can an elevated SHBG produce in men? What is the general mechanism of action of the steroid/thyroid hormones? (FA15 p321) (FA16 p316)
In men, increased SHBG decreases free testosterone –> gynecomastia
In women, decreased SHBG increases free testosterone –> hirsutism
OCPs / pregnancy –> increases SHBG (more womanly)
What is the equation for determining a drug’s volume of distribution? Which types of disease would alter the volume of distribution of a highly protein-bound drug such as ceftriaxone? (FA15 p243) (FA16 p237) (SU p12) (Phys p376-378)
Drug’s volume of distribution = amount of drug in the body / plasma drug concentration
Liver and Kidney disease can alter the Vd of a highly protein-bound drug
A 36-year-old malnourished woman comes to the ER with abdominal pain. She has a fever, abdominal tenderness (without rebound tenderness), and anorexia. Her WBC count is markedly elevated, and her RDW is high. The patient reports having had a bowel movement this morning and is not nauseated. A small bowel follow-through reveals skip lesions (discontinuous areas of focal narrowing) and a “string sign” (significant narrowing) in the terminal ileum. What disease does this patient likely have? What drugs can be used to treat it? (FA15 p362) (FA16 p359) (SU p128-129, 141)
Crohn Disease
Tx: 5-ASA / Glucocorticoids Corticosteroids / Azathioprine / Antibiotics / Infliximab / Adalimumab
A 30-year-old man begins to develop shortness of breath and cyanosis even at rest. Exam reveals clubbing and a systolic murmur. He mentions that he has had a murmur since childhood. Further workup reveals a large ventricular septal defect and pulmonary hypertension. The patient is diagnosed with Eisenmenger syndrome. Describe how this syndrome develops. (FA15 p289) (FA16 p283) (SU p64)
Uncorrected left-to-right shunt increased blood flow to pulmonary vasculature, eventually raising pulmonary vascular resistance and leads to PHTN. RV hypertrophies to compensate and shunt becomes right-to-left shunt. This leads to Eisenmenger syndrome:
Late cyanosis
Clubbing
Polycythemia
