Deck 5

Question 1

What is the extrapyramidal side effects of antipsychotics?

Answer 1

Q.id 510: akathisia, tardive dyskinesia

Question 2

What happens in cleft lip? Cleft palate?

Answer 2

Cleft lip: failure of fusion of maxillary prominence with intermaxillary segment during 5-6th week. Cleft palate: failure of fusion of palatine shelves/ primary palate

Question 3

What is the principle site for NE synthesis in brain?

Answer 3

Locus ceruleus: paired pigmented nucleus in post rostral pons & lateral floor of 4th ventricle; involved in mood, arousal, sleep-wake states, cognition, autonomic function; pathogenesis in anxiety disorders

Question 4

What effect do glucocorticoids have on liver? Peripherally?

Answer 4

stimulate gluconeogenesis; peripherally oppose insulin actions and promote catabolism; net effect = hyperglycemia

Question 5

How can crohns cause gallstones?

Answer 5

Bile salts aren’t reabsorbed/ recycled in terminal ileum => hyperconcentrated cholesterol

Question 6

What macrolide does not have P-450 effect?

Answer 6

Azithromycin

Question 7

What is the clinical triad of congenital rubella?

Answer 7

Congenital cataracts (white pupils), sensory-neural deafness, and PDA

Question 8

What does heparin do?

Answer 8

LMWH: binds antithrombin III that binds Xa - stops it from converting prothrombin to thrombin; Unfractioned binds both Xa and thrombin

Question 9

What does IL-2 do?

Answer 9

T cells! Stimulates growth of CD4 and CD8 T cells and B cells; activates NK and monocytes. Anti tumor because of T cell + NK

Question 10

What compound is decreased in narcolepsy?

Answer 10

Hypocretin-1 (orexin-A) and Hypocretin-2 (orexin-B). Produced in lateral hypothalamus - promote wakefulness and inhibit REM

Question 11

What general anesthetic can cause acute hepatitis?

Answer 11

Halothanes (“anes”): metabolized by P-450 and can are converted to toxic metabolites damaging or causing immune damage to liver; 2 days - 3 weeks post-exposure

Question 12

What are the actions of ANP?

Answer 12

Peripheral vasodilation, natriuresis, diuresis = kidneys (dilates afferent arteriole, limits sodium reabsorption, inhibits renin), adrenal (restricts aldosterone), blood vessels (vasodilation, capillary leak)

Question 13

What inhibits ANP?

Answer 13

Neprilysin = metalloprotease that also inhibits bradykinin, glucagon, enkephalins

Question 14

What does CO poisoning change/ not change?

Answer 14

Decreases fraction of hemoglobin available for O2 binding-> decr O2 carrying capacity & O2 content of blood; does not change PaO2 (amount of O2 dissolved in plasma)

Question 15

Where and what are symptoms of conus medullaris syndrome?

Answer 15

L2: Flaccid paralysis of bladder & rectum, impotence, saddle (S3-5) anesthesia, maybe weakness of leg; From herniated disk, tumors, spinal fractures

Question 16

Where and what are symptoms of cauda equina syndrome?

Answer 16

Anywhere in cauda equina: S2-4 = lower back pain radiating to leg, saddle anesthesia, loss of anocutaneous reflex w/ plantar flexion weakness, bowel and bladder dysfunction (S3-5), loss of ankle jerk reflex with plantar flexion weakness

Question 17

How can you reduce the risk of ovarian cancer?

Answer 17

oral contraceptives, multiparity, breastfeeding. HPV vaccine does NOT reduce risk (only cervical, vaginal, vulvar)

Question 18

Where’s Guyons canal? What nerve? What injury?

Answer 18

Hook of hamate. Ulnar nerve. Fall on outstretched arm

Question 19

What are symptoms of acute & chronic vitamin A toxicity?

Answer 19

Acute = nausea, vomiting, vertigo, blurred vision; Chronic = alopecia, dry skin, hyperlipidemia, hepatotoxicity, hepatoSM, visual difficulties, papilloedema (pseudotumor cerebri)

Question 20

What is an aschoff body?

Answer 20

Mycoardial granuloma (interstitial fibrosis with lymphs/ macros + multinucleated giant cells) found in acute rheumatic fever- myocarditis; Will be replaced by fibrous scar leading to chronic mitral stenosis

Question 21

Production of PTH-related protein occurs with what cancer?

Answer 21

Most commonly with squamous cell carcinoma of lung, head, and neck causing incr osteoclast activity and incr Ca

Question 22

Why increased calcium in granuloma disorders (sarcoid, tuberc)?

Answer 22

Macrophages in granuloma express 1-alpha-hydroxylase, which increases 1,25-dihydroxyvitamin D synthesis -> incr GI absorption of Ca

Question 23

A mutation in what causes polycythemia vera? What else can this cause?

Answer 23

JAK2 (cytoplasmic non-receptor tyrosine kinase) = causes constitutive activation of kinase domain….. Also implicated in essential thrombocytopenia, primary myelofibrosis, etc

Question 24

Where are long fatty chains (and some branched chain fatty acids) broken down?

Answer 24

Peroxisomes- special beta oxidation or alpha oxidation; Peroxisomal disease = hypotonia, seizures, hepatomegaly, retardation,

Question 25

What medications are given in to prevent ischemic stroke in patients with TIA?

Answer 25

blood pressure control, statins, low-dose aspirin

Question 26

Characteristics of VSD in newborn? When are they detected?

Answer 26

Loud, blowing holocystolic murmur at mid to lower left sternal border; not detectable at birth but 4-10 days post; LARGE = heart failure, failure to thrive, diaphoresis with eating, Eisenmenger syndrome

Question 27

What cells are affected in HIV-associated dementia?

Answer 27

Inflammatory activation of microglial cells: HIV infected monocytes cross BBB to become mx + microglial form microglial nodules;

Question 28

What are features/ structures affected in HIV-associated dementia?

Answer 28

Features of subcortical dementia (attention/ working/ memory problems, executive function, processing) and affect subcortical/ deep gray matter structures

Question 29

What is immediate Tx of diphtheria?

Answer 29

Administration of 1. Diphtheria antitoxin (passive immunity: inactivates circulating exotoxin but can’t for toxin that has already gained access to cardiac & neural cells) 2. Penicillin or erythromycin (prevents release of new exotoxin) 3. DPT vaccine (active immunization prevents further)

Question 30

Difference between 1st gen / 2nd gen antihistamines?

Answer 30

1st gen (diphenhydramine, chlorpheniramine, promethazine, hydroxyzine, “ine”, “ate”, etc) cross BBB and cause sedation- DON’T USE IN ELDERLY; 2nd Gen = less sedation

Question 31

What medications cause fat redistribution (lipoatrophy, central deposition)?

Answer 31

HAART = Lipoatrophy is loss of fat from face, extremities, butt w/ nucleoside reverse transcriptase inhibitor/ protease; Central fat dep = HIV Tx regimen

Question 32

Why squat in tetra of fallot?

Answer 32

Increase SVR and route blood into lungs

Question 33

What ratio indicates lung maturity?

Answer 33

Lecithin (phophatidylcholine): sphingomyelin; First is in surfactant - second is in membrane. Equal until 30 weeks and 2:1 by 35 weeks

Question 34

LAD: inheritence? Deficiency in what? Characteristics?

Answer 34

Auto recessive; absence of CD18 antigen necessary for integrins; recurrent skin/mucosa infections (staph, gram - rods), late separation of umbilical cord, leukocytosis, impaired wound healing, lack of purulence or pus

Question 35

Classic symptoms of primary hyperPTH?

Answer 35

Bones, stones, moans = bone pain, renal stones, GI groans (peptic ulcer), psych overtones. However, usually asymptomatic

Question 36

What are most important substances for autoregulation in coronary blood flow?

Answer 36

NO & adenosine (product of ATP acts as vasodilatory element)

Question 37

Defect in marfans?

Answer 37

Fibrillin-1: large extracellular glycoprotein that surrounds elastin to form microfibrils in large blood vessels, periosteum, suspensory ligaments of the lens

Question 38

What is unique about telomerase?

Answer 38

Made up of telomerase reverse transcriptase (TERT) (RNA dependent DNA polymerase) and RNA component (TERC) that is RNA template; adds TTAGGG sequences to telomeres; long telomerases in stem cells

Question 39

What hormone increases bicarb secretion?

Answer 39

Secretin from S cells in duodenum - causes to secrete bicarb rich, Cl- poor fluid

Question 40

Spliceosomes cut at what intron sequences?

Answer 40

GU at 5’ and AG at 3’