Doctors In Training Questions Flashcards
How does flutamide differ from finasteride in relation to MOA and clinical use
Flutamide-prostate cancer, competitive testosterone receptor inhibitor
Finasteride-BHP, or bald man, inhibits 5a reductase (convert T to DHT)
What is the difference between mean, median and mode? ALL SAME IN NORMAL SHAPED CURVE
Mean-average
Median-middle
Mode-most
What is a positive skewed curve and what is a negative skewed curve to mean median mode
+Left shift tail to right
Mean greater than median, median greater than mode
- shift right with tail to the left , mode is greater than median, median greater than mean
A 22 year old man who recently immigrated from a developing country is seen at the county health clinic with. A complaint of chronic, but recently worsening, productive cough and sinusitis symptoms/ he also mentions to you that he and his wife have not been able to have kids despite trying for 2 years. While you not this last complains, you order a chest x ray out of concern this man may have TB given his immigration status. The chest x ray appears backwards on the display, but you realize this means beast is actually not he opposite side of his chest. What is the primary defect in this syndrome and what are the charactistic signs and symptoms
Kartagener syndrome (primary ciliary dyskinesia—non motil cilia)
Bronchiectasis (bronchioles wont stay open, recurrent sinusitis, infertility, situs invertus)
What foods, typically high in mercury should be avoided during pregnancy?
Fish -fish that eat other fish so FDA say preg no eat
Shark, swordfish, king mackerel, tilefish
Mercury-brain damage to baby
IFN-y stimulates macrophages and inhibits TH2 . What cell type releases IFN-y
TH1 release IFN y
Amyloidosis and sarcoidosis are associated with which cardiomyopathy? What are some othe diseases or conditions associated with this cardiomyopathy?
Restrictive or obliterative cardiomyopathy —-bulk up tissue restrict function of the tissue
-postradioation fibrosis, endocardial fibroelastosis, lofflers syndrome, hemochromatosis
A 40 year old man is beginning to have symptoms of a resting tremor, postural instability, and mask like fancies. Name the antiviral drug that can be used against this disease and what is the MOA
Parkinson
Amantadine (same for flu)
-increase release of dopamine
What does the eustachian time connect? What is its purpose? What drug is commonly prescribed for Eustachian tube dysfunction?
Connect middle ear to nasal pharynx make pressure in middle ear same as astomspheric
Nasal steroids
Where do each of the following paranasal sinuses drain into the nasal cavity?
Ethmoidal air cells
Frontal sinus
Maxillary sinus
Sphenoidal sinus
Ethmoid air cells-ethmoid bone-anterior middle and posterior
Anterior ethmoidal air sinus-into nasal cavity by middle meatus into the semilunar hiatus
Middle ethmoidal air cells-drain into ethmoidal bulla
Posterior ethmoidal air cells drain into superior meatus
Frontal sinus drains into the semilunar hiatus via the frontonasal duct
Maxillary sinus drains into the semilunar hiatus
Sphenoidal sinus drain into the sphenoethmoidal recess (posterior superior to the nasal concha)
MOA for varenicline
Partial agonist at nicotine acetylcholine receptors
Smoking cessation
Black box for neuropsychiatric events depression suicide stuff
When is a fetus most susceptible to damage from teratogens? What antihypertensive drug class is teratogenic? What effect does this have on the fetus?
3-8 weeks embryonic period this is when organs formed
ACE-pril
ARB-sartan
Fetal kidney damage, act on RAAS
What physiological changes occur due to a prolonged stay in space at zero gravity
Decrease blood volume, rbc mass, muscle strength and work capacity, max CO, loss of calcium and phosphate from bones->loss of bone mass
Which bone is commonly fractured when falling on an outstretched hand, resulting in pain in the anatomical snuff box
Scaphoid-most commonly injured carpal bone
What is the cause of carcinoid syndrome? What are the classic symptoms
Secretion serotonin from carcinoid tumors (most GI or lung in bronchi)
B-FDR Bronchospasm Flushing Diarrhea Right sided valvular disease
What is antidote for digoxin toxicity
Digoxin immune Fab-expensive
Usually we normalize K and Mg, lidocaine for arrhythmias and cardiac pacing
What are some of the circumstances in which information is HIPPA exempt, meaning that your health information can be shared with another party
Child abuse, birth or death information, state mandated reportable illness, public health disease surveillance, state sponsored disease intervention activities , schools(vaccination)
A 55 yo alcoholic is admitted to the hospital for upper GI bleed. A reputures esophageal varix is found. What is the preferred medical treatment for this condition
Cirrhosis and portal venous HTN cause varices in esophagus and stomac
Octerotide-long acting somatostatin analog clamp down vascular bed
Endoscopic ligation
A 3 day old preterm infant delivered at 34 weeks gestational age develops neonatal RDS . What pneumocytes? What is the MOA that leads to poor o2-co2 exchange at the gas exchange barrier in preterm infants with rds? What structures make up the gas exchange barrier? How would you incrase surfactant production in preterm neonates?
Type II
No surfactantso cant get reduction in surface tension
Collapse and hyaline membrane impede gas exchange
(Hyaline membrane disease)
Type 1 pneumocytes-pulmonary epithelial cells
Basement membranes of the pulmonary capillaries
Endothelial cells of the pulmonary capillaries
Give mom glucocorticoids before delivery to mature type II
What is the most common gynecological neoplasm? Wat is the typical histological pattern? Benign or malignant?
Leiomyoma-fibroid
—menorrhagia and anemia
See smooth msucle bundles in different directions
Benign do not progress
Acetazolamide
Sodium bicarb diuresis
Mannitol
Osmotic prevent resorption
Increases urine flow
Furosemide
Inhibit NaKCL cotransporter ont hick to interstitial of medulla less hypertonic so in thin limb cant concentrate urine
Prevent concentration of urine
Hydrochlorothiazide
Inhibit na cl absorption
Reduces the diluting capcity of the nephron
Spironolactone
Competitive aldosterone receptor antagonist
Incrase an water excretion without increasing k secretion
ADH antagonist
Tolvaptan
Block ADH in collecting tube
Less water reabsorbed
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 contrastinduced nephropathy in those with preexisting renal disease
N-acetylcysteine
Associated with obesity, ketoacidosis, genetic, DR3/4
Type II
Type I
Type II
Type I
Platelet disorder: bleeding time, PT and PTT, clincial features
Hemostasis 1 platelet 2 fibrin clot
Bleeding time-prolonged
PTnormal
PTT normal
Small hemorrhage-epistaxis, petechiae, purpura
Coagulation factor defect: bleeding time, PT and PTT , and clincial features
Normal
Prolonged
Major hemorrhage-hemarthrosis, intracranial, hemorrhages
MRI
No ionizing radiaiton
Soft tissue-brain, spinal cord, joints ligaments, cartilage (brain parenchymal, acl tear
Use with caution-pacemakers metal problem
Bone grey
CT
Ionizing radiation-not on pregnant
Bone detail, recognition of blood (stroke for hemorrhage
Can have metal
Bone white
Weakness, pallor, craving ice chips and tachycardia and chronic hemorrhoids What is cause of anemia and how treat
Pica-want ice chips
-iron defiency anemia , rectal bleed cause
Treat with iron replacement and possible colonoscopy
62 year old with weak urine stream and hesitance when trying to urinate. He is given finasteride. How does this treat BPH
5 a reductase inhibitor
Can’t get testosterone to DHT
Dht make prostate tissue grow
Test for corneal abrasions
Fluorescein dye on surface of eye
Thalmic nuclei for auditory sensation
Medial geniculate nucleus
Thalamus nuclei for visual sensation
Lateral geniculate nucleus
Thalamus nuclei for motor to body
Ventral lateral nucleus
Thalamus nuclei for facial sensation
Ventral posteromedial nuclei
Thalami nucle for body sensation
Ventral posterolateral nuclei
Describe decompression sickness
Divers come to quick gases (N) that had dissolved in blood at high pressure form gas bubbbles that can occlude blood vessels
First line treatment for erectile dysfunction
Sildenafil, vardenafil, tadalafil
Phosphodiesterase inhibitors
-hypogonadism cause start testosterone replacement
An elderly patient dell and struck his head on a coffee table. His family brought him to the er. He is currently conscious and at his neurological baseline. Non contrast ct of the head reveals a crescent shaped radioopacity that follows the contour of the skull crossing suture lines. What type of intracranial hemorrhage might this be and which vessels would be involved
Crescent shape cross sutures is subdural hematoma
Bringing veins
Where is the most of CSF generated. What is function of CSF
Choriod plexus of lateral ventraicals
Suspend brain, prevent gravity from distorting it
Bathe neurons and glial cells in homeostatic medium, for regulation of pH and electrolytes
Route for chemical messengers to be distributed in the nervous system
What is the most common renal malignancy in adults? What is the associated gene deletion?
Renal cell carcinoma
Hematuria, flank pain, palpable flank mass
Gene deletion chromosome 3 and VHL
A 28 year old man is being treated with the combination of bleomycin, etoposide and cisplastin for metastatic non seminoma testicular cancer. The patient develops shortness of breath during the course of treatment. Pulmonary function testing indicates that he has a restrictive lung disease. Which of the chemotherapy agents is responsible fo their restrictive lung disease? Which agent in the above regimen works by inducing free radicals to interfere with DNA structure?
Bleomycin (busulfan and methotrexate cause interstitial pulmonary disease and fibrosis)
Bleomycin works by inducing free radicals to interfere with DNA structure
What might you observe in a patient who presents to the ER with PCP intoxication
Psychomotor agitation
Impulsiveness
Psychosis
Belligerence
Homicidality
Aggressive violent
Fever
Tachycardia
Vertical and horizontal nystagmus**
At what positive g force dose visual blackout occur. Why
4-6 G
G force pool blood in abdomen and legs
The dorsal root ganglion is considered gray matter within the spinal cord. From what embryological derivative are the dorsal root ganglia derived
Neural crest (ectoderm)
What is the definition of tidal volume, residual volume and vital capacity?
Tidal volume0amount in and out each normal quiet breat,
Residual volume-after blow out as much as can
Vital capacity max amount of air into lungs
And blow out
A 40 year old woman treated with lisinopril for state I HTN becomes pregnant. Why are ace inhibitors contraindicated in pregnancy? What centrally acting a2 agonist is often used to treat HTN in pregnancy
1st trimester
-cardiac and cns malformations
2 3 trimester
Renal problems
Use methyldopa in pregnancy
How does the mechanism of action of benzodiazepine differ from barbiturates? What toxicities of barbiturates can be fatal
Benzodiazepines
-increase frequency of GABAa receptor Cl channel opening
Barbiturates
Increase the duration of GABA receptor Cl channel opening
Toxicity barbiturates
CNS depression effects
Respiratory depression
Cardiovascular depression (bradycardia)
Worse with alcohol dont give with alcohol
Hydatidiform mole is the most common precursor of whaat malignancy? What tumor marker is monitored after the dilation and curettage of a hydatidiformmole
Choriocarcinoma
B HCG-if stay elevated worry not get all of it and little piece could progress to choriocarcinoma
You are reading a research article about the prostate specific antigen test, and it mentions that the PSA blood test is associated with a high false positive frequency. In your own words, explain what false positive means
Positiveeven though disease not present
What is the primary function of LH in the body
Acts on thecal luteum cells to make estrogen and progesterone
Stimulate ovulation and help form CL
Men-leydig to make testosterone
Inhibited by increase progesterone and testosterone.
Which complement defiency is most likely in “frequent neisseria infections”
C5, C6, C7, C8, C9
Which complement defiency is most likely in “frequent pyogenic respiratory tract infections” HI or strep pneumonia
C3
Which complement defiency is most common in “paroxysmal nocturnal hemoglobinuria”
CD55 , CD59 DAF
Which complement defiency is most likely in “increased frequency of type III hypersensitivity reaction”
C3
What viral illness is associated with Burkett lymphoma? Is Burkett lymphoma a neoplasm of mature T or B cells
EBV
B cell lymphoma
T-periarterial lymphatic sheath and white pulp
B white pulp
Where are T cells found in the spleen? Where are B cells found in the spleen
Ok
In which lobe of brain is “brocas” speech
Motor control speech
Frontal (inferior frontal gyrus)
Which lobe is wernickes “speech comprehension”
What lobe is primary auditory cortex(temporal)
Posterior part of superior temporal gyrus
What lobe is principal visual cortex
Occipital lobe
What lobe is primary sensory cortex
Most anterior part of parietal lobe
What lobe is primary motor cortec
Just anterior to central sulcus most posterior part of frontal lobe
What lobe is premotor cortex
Frontal lobe just anterior to primary motor cortex
Which neoplasm most common for ACTH paraneoplastic->cushing
Small cell carcinoma, carcinoid
Which neoplasm most common for PTH related peptide->hypercalcemia
Squamous cell carcinoma lung
Also other squamous cell and renal cell carcinoma and breast cancer
Which neoplasm most common for epo->polycythemia
Pheochromocytoma, renal cell carcinoma, hepatocellular carcinoma, hemangioblastomas
Possibly really high hematocrit
Which neoplasm most common for ADH->SIADH
Small cell lung cancer
Also any intracranial thing
In which pulmonary disease would you see na increased Reid index
50% in COPD and chronic bronchitis
A 56 year old man develops right lower extremity edema after returning from a business trip in Europe. Physical exam demonstrates a red, warm lower led with a positive humans sign. What is the most likely diagnosis? What is a positive humans sign? What is Virchow triad? What is the most common inherited hypercoagulability
DVT, pain with dorsiflexion in calf muscle(negative does not rule out DVT)
-coagulabiltiy, stasis, endothelial damage
————-factor V Leiden mutation-cant be degraded by protein c predisposition for hypercoagulability
A 45 year old woman is brought to the ED for chest pain, a racing heartbeat, and dizziness. Examination reveals a HR of 120 b/m , blood pressure 116/74 and 20 RR. The patients is diaphoretic and anxious. An initial ECG reveals ventricular tachycardia with shifting sinusoidal waveforms. What is this classic ECG finding? What are the possible causes of this patients condition
Torsades de points (twisting of the points)
Anything prolongs QT
Hypokalemia or hypomagnesemia
Check electrolytes give IV mg and maybe K
Congenital long QT syndromes -cardiac K channel defects or cardiac Na channel defects
A female infant is brought to the clinic for evaluation of her genitalia. On exam, clitoramegaly 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 defiency? What are the clincial manifestations
21 a hydroxylase
Decreased aldosterone and cortisol increased sex hormone
Hypotension
Volume depletion
Hyperkalemia
Masculanizinging effect in female from increased androgens
MOA scopolamine
Anticholinergic drug, an antagonist of M1 muscarinic receptors
Motion sickness sea sickness transdermal patch behind ear
MOA promethazine
Antagonist of histamine receptors and D2 dopamine receptors
MOA prochlorperazine
Also phenothiazine, blocks d2
MOA metoclopramide
D2 antagonist
Often prokinetic to spread up gi tract when diabetic gastroparesis
MOA ondansetron
Serotonin receptos antagonist 5-ht3 receptos
Nausea and morning sickness if severe
Whihc efferent fibers carry input from the brain that influence the outer hair cells of the cochlea in much the same way that gamma motor neurons influence muscle spindles. What is the result
Olivocochlear bundles from superior olive to cochlea
Get contraction OHC and stiffening basilar membrane in cochlea to sensitize inner hair cells to frequency
What is the result of damaging outer hair cells (gentamicin and streptomycin)
Wide deflection of basilar membrane so get hearing loss
Risk factors for osteosarcoma
Bone infarcts Radiation Paget disease Familial retinoblastoma (Rb) Male 10-20
What conditions are associated with oligohydramnios and what conditions are associated with polyhydramnios? What is potter sequence
Olig-less amniotic fluid-placental insuffiency, bilateral renal agenesis, posterior urethral valves in males
Poly-more-esophageal or duodenal atresia, anencephaly, maternal diabetes
Fetus bilateral renal agenesis cause oligo so cant grow get malformations POTTER Pulmonary hypoplasia Olivia Twisted skin Twisted face Extremity or limb deformities Renal agenesis
MOA strychnine
Glycine antagonist
-important inhibitory in spinal cord, block inhibitory function wide spread muscle spasm and asphyxia
MOA tetanus toxin
Bind inhibitory cells rinshaw which release glycine and gaba
Block get muscle spasm and tetanus
blocks inhibitor function of glycine and gaba
MOA black widow spider toxin
Accessible release Ach muscle cramp pain
MOA botulinum toxin
Inhibits release of ach and the neuromuscular junction
3 year old girl presents with fever of 102 for 3 days. On the 4th days she develops red macular rash over entire trunk and her fever resolves abruptly. What viral infection`
Roseola from HHV6
Sudden high fever for several days and diffuse macular rash as fever resolves
25 year old woman presents to 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
Endometriosis
Cyclic proliferation and shedding with menstrual cycle bleeding in unusual locations bad to surrounding tissue and cause pain
Blood filled chocolate cysts on ovaries
Meds for adHD
Stimulants methylphenidate
Dextroamphetamine
Atomoxetine -selective NE reuptake inhibitor
If insomnia then clonidine
MOA methylphenidate?
Indirect sympathomimetics
Release stored catecholamines
Signs of intoxication of amphetamine
Stimulants
-mood elevation, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety
Amphetamine
Impaired judgement, pupil dilation, prolongation wakefulness and attention, delusions, hallucinations fever
When implantation
Day 6
When organogenesis
3-8
When heart beat
Week 4
When see male and female genitalia
Week 10
When gastrulation
3 weeks
When form primitive streak and neural plate
3-4 week
Pediatric patient right flank mass. Mother also reports blood in urine. What malignancy would be most likely . What is wagr
Wilms tumor(nephroblastoma)
2-4 yo with flank mass and hematuria
WAGR-wilms, aniridia, genitourinary malfornation, mental motor retardation, WT1 tumor suppressor deletion
24 year old man is fired from his job and when explaining the chin of events to his roommate he says “it doesn’t really matter. I didn’t even need that job” his roommate is perplexed, wondering how thy will pay rent. Of which immature ego defense could this be
Rationalization
What is the composition of a nucleosome? Which histone ties nucleosome together
H2A H2B H3 H4 2 of each for 8 in core whihc dna wraps around…they are positive charged with lysine and arginine to bind DNA which is negative
H1 link
Which complement protein is an opsonin? Which complement protein aids in neutrophil chemotaxis? Which complement proteins form the membrane attack complex
C3b (also igg)
C5a
C5b-C9
When screening a population for a particular disease, would you rather have a high sensitivity of a high specificity? What test is used to screen HIV? What is confirm test
Sensitivity (probability that test positive)
ELISA -sensitive but high false positive,
Western blot needs to be done if positive (high specificity and false negative)
If both positive have HIV
A child is noticed to be yellow by a visiting relative, so he was brought to the clinic. His exam revealed jaundice and splenomegaly. The patients lab results reveal anemia and spherocytes. What test is used to confirm the diagnosis of hereditary spherocytosis? What findings are associated with hereditary spherocytosis
-condition defect in RBC cytoskeleton proteins
-spearing, band 3, pallidus, ankyrin
RBC not normal disc shape become spherical why called spherocytes
- osmotic fragility test, put red cells in hypotonic solutions and these one lyse more readily than normal tests.
- red cells microcytic and roun no central Paulo, increase MCH and RDW
Extravascular hemolysis cause spleen takes out
Coombs test negative
Spleonmegaly, gallstones, aplastic crisis with stress (after parvovirus)
What is the initial medical treatment for the arrhythmia know as torsades de pointes
Ventricular arrhythmia sinusoidal pattern of wide QRS pattern
IV Mg sulfate rapid
Urge def and cause
Urinary inctinence from uninhibited bladder contraction
Detrusor overactivity
Comes on fast, do UA do make sure no uti but dont need imaging
Anticholinergic meds give
Stress def and cause
-involuntary leak in ay maneuver that increases abdominal pressure
Decreased support and function of the urinary sphincter
- ask if wear pads and how many during the day
- obese, female, multiparity, men if urethral or prostate surgery
Overflow
Urinary incontinence due to incomplete bladde emptying
Bladder outlet obstruction , neurogenic detruser contractility
Can palpate bladder
With what PE finding must u presume a scaphoid fracture despite a normal initial x ray? What might result in a proximal fracture of scaphoid if not treated
Tenderness in anatomic snuff box presume scaphoid fracture even if x ray negative
Avasular necrosis of proximal fragment cause blood supply from distal to proximal
What enzymes do obligate anaerobes lack
Catalase (breaks down H2O2 to form water and oxygen) and/or superoxide dismutase( oxygen radials to water and H2O2)
A 24 year old woman reports having two miscarriages over the past 6 months and has been trying to become pregnant over the past year. What embryological structural abnormalities might account for her multiple miscarriages? What structures arise from the paramesonephric ducts? What other name is given to the paramesonephric ducts
Incomplete fusion of the paramesonephric ducts cause bicornate uterus
Fallopian tubes, uterus, upper portion of vagina
Mullerian
What organism causes Hansen disease? What animal serves as a Respir for this organism in the US? Where int he body does it live
Leprosy
Mycobacterium leprae
Armadillo
Skin and superficial nerves-warm spot
What is BNP, and how is it useful in cases of heart failrue?
B type natriuretic peptide
Stored in ventricular myocardium and released when myocytes are excessively stretches
Active acute heart failure diagnostic (SOB not sure if COPD or heart failure)
Which adrenergic antagonist can be used to treat HTN as well a s urinary retention, in patients with bhp? What is the difference between the prostate finding in BPH and adenocarcinoma of the prostate
A1 antagnoist
-terazosin, prazosin, doxazosin
BPH-symmetric smooth enlarged
Adenocarcinoma-asymmetric with hard nodule
How many half lives does it take for an infused drug at a constant rate to reach 94% of steady state? What variables determine the half life of a drug
4-5 HL to reach steady state
2 HL -75% of steady state
3 HL 87.5% of steady state
4 HL 93.75% of steady state
T.5=(.7xVd)/CL
Volume of distribution and clearance
Des
Outer deeming, darts fascia, deep bucks fascia , two dorsolateral corpora cavernosa and one corpus spongiosum , then urethra in surplus spongiosum
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 MOA of disulfiram? Wat other drugs have a disulfiram like effect
How is ethanol metabolized
Inhibits acetaldehyde dehydrogenase which with NAD converts acetaldehyde to acetate
Ethanol—alcohol DH and NAH—>acetaldehyde—-acetaldehyde DH and NAD—> acetate
Disulfiram-acetaldehyde build up cause NV flushing sweating low bp and HA
Give to recovering alcoholics get sick condition sick when drink
—metronidazole, cefoperazone and cefotetan, griseofulvin, 1st gen sulfonylureas
What is PPAR-y? How is it relevant to the treatment of DM
Peroxisome proliferator activator receptor gamma
Nuclear receptor and transcription factor found in adipose tissue
Plays a role in adipocyte differentiation
Thiazolidines bind PPARy and improve insulin sensitivity
A kidney transplant patient begins to experience renal failure seven years after receiving her kidney transplant. What type of rejection si this and how is it mediated
Chronic rejection
T cell and antibody mediated vascular damage
Obliterating vascular fibrosis
What are the effects of stimulating the amygdala
Increases and decreases of arterial BP
Increases and decreases of HR
Increases and decreases in GI motility and secretion
Defectation or micturition
Pupillary dilation or constriction
Piloerection
Secretion of various anterior pituitary hormones
Movements related to eating, such as licking, chewing and swallowing
Negative emotions including rage, escape, punishment, severe pain and fear
Sexual responses such as erection, copulatory movements, ejaculation, vulation, uterine activity, and premature labor
From where does the amygdala receive input? To where does it send output
Limbic cortex
Neocortex of parietal temporal and occipital lobes espicially auditory and visual areas
To cortical areas from which it received, hippocampus, septum, thalamus and hypothalamus
What anatomical structure in hematoma formation as a sequela of vulvar trauma?
Blunt trauma (saddle, bike, track hurdle, sexual assault)
Highly vascular area called bulbs of vestibule (erectile tissue) damage leak blood
Dear to labia majora, in females a fat pad not present in kids so over laba majora edema
*similar to bartholin gland cyst so ask about trauma
What are some of the reasons a woman might have primary amenorrhea?
Secondary if had kid
Primary never before
Turner, imperforate hymen, androgen insensitivity syndrome, Müllerian duct agenesis, delayed puberty
What is the underlying cause of digeorge? What are the manifestations of digeorge
3 and 4th brachial pouches fail to develop
Aphasia of thymus and parathyroid
Gene deletion chromosome 22 (22q11 delation)
Get tetany (no pth), recurrent viral and fungal infections, chromosome 22q11 deletion (cleft palate, abnormal facial features, congenital defects of the heart and great vessels)
An 18 year old man is brought to your office for delayed onset o puberty. PE confirms a small penis and testicle as well as lack of facial pubic and underarm hair. The the patient also cant smell.
Kallmann syndrome
Amos is an dhypogonadism
-decrease synthesis gnrh in hypothalamus , lack of secondary sexual characteristics
Describe the flow of blood into and out of thyroid gland?
External carotid artery->superior thyroid artery
Thyrocervical trunk->inferior thyroid artery
Superior thyroid middle and inferior thyroid vein.
A 30 year old man is at an inpatient facility for opioid addiction. What symptoms might this patient experience while discontinuing opioids>
Tremor chills, muscle and bone pain, perspiration, flu like, yawning, vomit, diarrhea, restless leg syndrome
In performing a lumbar puncture to obtain a sample of csf , what structures are pierced, starting with the most exterior
Skin, superficial fascia, supraspinatus interspinous ligament
Ligamentum flavor
Epidural space
Dura matter
Subdural space
Arachnoid matter
Subarachnoid space
In which phase of meiosis is a primary oocyte arrested until prior to ovulation? In which phase of meiosis is an oocyte arrested until fertilization
Prophase
Metaphase
What are some of the signs and symptoms of pericarditis
Sharp, pleuritic chest pain
Worse with inspiration
Better with sitting up and leaning forward
JVD-right ventricle e prob
Restrictive-kussmaul (JVD with inspiration0
Pericardial friction rub
Ekg-diffuse sT elevation and PR depression
A 42 year old obese man presents with a complaint of severe pain in his right knee. He believes he injured it while dancing at his cousins wedding last night. You suspect gout. How would you differentiate between gout and pseudogout upon exam of synovial fluid aspirate
Gout-monosodium urate crystal, needle shaped and birefringenet so yellow under-under Paralell light
Pseud-calcium pyrophosphate crystal , rhomboid shape, positive bifiregement blue parallel yellow perpendicular light
A patient with crohn disease fails traditional therapy (5-aaa, steroids, and immunosuppressants). What other drugs are used to treat crohn disease that target tnf-a
Infliximab, adalimumab, sertolizumab
What is cholesteatoma, and how does it present
Overgrowth of desquamated keratin debris within middle ear
Can erode the ossicles in the middle ear and the external auditory canal and can lead to hearing loss
-chronic middle ear infection see grey pearly lesion behind TM and conductive hearing loss or vertigo
Preventative vaccines have been developed for which encapsulated bacteria? What test can be used to detect encapsulated bacteria
Neisseria meningitidis
Strep pneumonia
HI type B
——add a serum that contains anticapsular antibodies and look for quallung reaction (swelling)
A child presents with nephritis, deafness and ocular dysfunction. What is the diagnosis? A gene defect in what type of collagen contributes to the dysfunctions associated with this syndrome? What type of collagen organizes bone, skin, and tendons? What type of collagen organizes cartilage
Alport syndrome
Can’t see cant hear cant pee cant hear hi see
——type IV collagen makes BM of basal laminae
—-type I collagen
—-type II collagen
What are the carpal bones of the wrist
Ok
Breast pathology most common tumor in women under 25
Fibroadenoma
Breast path most commmon breast mass in postmenopausal women
Invasive ductal carcinoma
Breast path most common breast mass in premenopausal women
Fibrocystic change of the breast
Breast path most common form of breast cancer
Invasive ductal carcinoma
Which diuretics are most appropriate for patients with hyperaldosteronism? What are their important side effects
K sparking
-spironolactone, triamterene, amiloride, eplerenone
Sa competitve aldosterone antagonist
In CTT
Block Na transport channel in CTT TE
Hyperkalemia
Pironolactone-gynecomastia in males menstrual irregularities in females
What structure gives rise to the bbb
Tight junction
BM
Astrocytes foot processes
What physiology accounts for the automaticity of the AE and sa nodes
Gradually increasing Na channel conductance
Slow spontaneous depolarization during diastole
When the threshold is reached, an action potential is generated
What is p value what is an acceptable p value
Probability that the study results occurred by chance alone
A 37 year old patient with refractory peptic ulcer disease undergoes an esophagogastroduodenoscopy. Biopsies of the duodenum reveal hypertrophied submucosal glands. What are these glands? What are Peters patches? How can these structures help you identify the location from which a histological specimen was taken
Brunners glands secrete alkaline mucus to neutralize stomach acid (hypertrophyfrom excessive acid)-in duodenum
Discrete patches of lymphoid tissue of ileum in lamina propria and submucosa
-MALT
Which antifungal drug causes gynecomastia and by what mechanism? Which diuretic causes gynecomastia and ya what mechanism
Ketoconazole, inhibiting cholesterol to pregnelolone
Reduce testosterone give gynecomastia
Also a weak androgen receptor antag
Spironolactone-increasing conversion of T to E, block t syn, antagonist androgen receptor
Stacked
Spironolactone, THC< alcohol, cymetadine, ketoconazole, estrogen, digoxin
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 profoundly informed you that he got this great jacket by redeeming his cigarette cartons. At what stage of change is overcoming his smoking habit
Precontemplation
A 23 year old man comes to the physician with a 39 degree fever, HA< and myalgia. This is the second fever in last 2 weeks. He recently finished treatment to eradicate the lice infestation that he acquired during a trip to Mexico. What organism might be responsible for this mans recurrent fever
Borrelia recurrentis
Sudden fever, chills, HA< muscle of joint aches, nausea, rash, 2-9 days and disappear,
Cycle continue for several weeks if untreated
Improve within 24 hours of antibiotics
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 kids/. In adults? Elderly?
Genetic, febrile from infection, trauma, metabolic
Brayan tumor, trauma, stroke, infection
Stroke, brain tumor, trauma, metabolic (hyponatremia), infection
What are the adverse reactions of exogenous testosterone in males
Premature puberty
Premature closure of epiphyseal plate, erythrocytosis,
Worsening of sleep apnea
Suppression of spermatogenesis
Increases ldl decrease HDL
A 34 year old woman develops. Apainful right eye with decreased visual acquits. Exam demonstrates a firm right eye. What type of glaucoma is the patient experiencing? What are the differences between the mechanism of closed and open angle glaucoma? What is the fundoscopic funding associated with glaucoma? What is the treatment for closed and open angle glaucoma
Narrow angle/acute closure angle glaucoma
Closed angle -between cornea an iris, lens and iris touch aqueous humor cant from from iris into anterior chamber into meshwork
Open-angle wide open but in canal of schlemm where meshwork drain, have microscopic blockage(most chronic tunnel vision, no hard eye, no pain, gradual vision loss in elderly)
Fundoscopic-increase cup to disc ration (cupping) normally flat and have optic disc and see optic cup in it (1/3 size of disc), if larger hten suspect glaucoma
Closed-topical B blocker (timolol) , topical a2 agonist (apraclonidine0, topical muscarinic agonist (pilocarpine)
May add acetazolamide(reduce production aqueous humor)
Mannitol draw fluid out
Laser iridotomy
Open angle-topical prostagladins (latanoprost), topical B blocker, topical a2 agonists, topical acetazolamide, topical muscarinic agonists, surgery
A 1 year old boy is brought to the clinic for evaluation of his skin. The patients skin was normal at birth but now is erythematous, scaly, and has many new freckles. Workup and an astute atttending reveal that this child has zeroed RA pigmentosum. What cancers will this kid be at risk of developing
Skin cancer
-melanoma, basal cell carcinoma, squamous cell carcinoma
Nucleotide excision repair
Anterior arm dislocation:
Arm position, neuromuscular compromise, classic scenario, PE
External rotation and abduction
Axillary artery and nerve
Blow to arm while abducted, externally rotated and extended
If thin, prominent acromion process
Loss of normal roundness of shoulder, looks angular
Posterior shoulder dislocation: arm position, neuromuscular compromise, classic scenario, PE
Internal rotation
Addiction
Unable to external rotate
No neurovasc comp
Seizure, electrocution
Bulge in posterior shoulder
Anterior shoulder flat
Hippaa
Health insurance portability and accountability act
Payers provides and clearing houses to store and handle health care information
Only sensitive health infor go to people organizing care
Describe anatomy of 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
Tube of facia deep to inguinal ligament find femoral artery vein, femoral nerve is outside and not in sheath
From lateral to medial navel
Nerve artery vein empty space lymphatics
Nerve is lateral to artery vein is medial
Palate femoral pulse and put medial
Which area of the brain is damaged in kluver bucy syndrome. What are symptoms
Amygdala damaged bl
Herpes simplex 1 encephalitis causes it
Hypersexuality and disinhibited behavior, hyperorality, extreme curiosity, forget things, sex drive up with disinhibition dangerous
You are performing a radical mastectomy and exercise extreme caution as you dissect laterally along their serratus anterior. What nerve are we not hitting. What is hit
Long thoracic nerve
Winged scapula stick out at back
Long term complication is associated with having to receive multiple blood transfusions
Iron overload
Sickle cell patient are anemic and get transfusion getting more iron.
Iron overload can cause hemosiderosis, hemochromatosis
E4 apo e is a known risk factor for AD. What is the primary function of
Apo a-1
Apo b-48
Apo b-100
Apoc-11
Apo e
- activates LCAT for maturation of HDL
- mediates chylomicron secretion from enterocytes, get a beta lipoproteinia with prob
=lipoproteins from livers (vldl, ldl, idl)
- cofactors for lipoprotein lipase that removes FFA from lipid particles
- on all lipoprotein particles, mediates extra intake , dysfunction related to AD
A mutation in which protooncogene is most commonly associated with hirschsprung
RET gene mutation
Help ncc move through digestive tract through embryo
How do primary and secondary hyperaldosteronism differ in their effect on plasma renin levels? What agent is used to treat primary hyperaldosteronism
Primary-decrease renin by neg feedback
Secondary-high plasma renin
K sparing diuretic spironolactone
G cell
Gastrin
Antrum of stomach
I cell
Cck in duodenum and jejunum
S cell
Oksecretin duodenum
D cell
Somatostatin
Pancreatic islet
Parietal cell
Stomach
Gastric acid and IF
Chief cells
Pepsinogen
What are the most common locations of lung cancer metastases
Liver obesity adrenal glands brain
What are some of the functions of bile produced by hepatocytes and stored into e gallbladder? Which hormone is the most potent stimulator of gallbladder contraction
Emulsifiers large fat particles into small pat particles
AIDS in the absorption of digested fat end products
Essential for the absorption of fat soluble vitamins
Excretion of bilirubin, copper and cholesterol
CCK
In a 30 year old Asian woman, what signs ANS symptoms would be suggestive of takayasu arteritis
Vasculitis effects aorta and bridged (arms and carotid)
Light headedness, vision problems, claudication in arms, diminished pulse in arms
THE PULSELESS DISEASE
A 6 yo bo is receiving poor grades in school. He has normal intelligence but is distractabl. What meds
ADHD
Methylphenidate and amphenidate
Atomoxetine
Behavioral intervention
By age 12 and need symptoms in 2 settings
If strolevolume determines CO and contractibility determines stroke volume, what determines contractility
Increased by:
Catecholamines, sympathetic, increase intracellular Ca, decreased extracellular Na, digoxin
Decreased by:
B1 block, HF< acidosis, hypoxia, verapamil, dilitazem, decreased intracellular ca, increased extracellular Na
A 48 yo 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 non smokers. Which cancer is this? What other lung cancers ar not associated with smoking? Which lung cancers are associated with smoking and where are they located, central or peripherally
Nonsmokers
Bronchial adenocarcinoma
Bronchioalveolar adenocarcinoma
Malignant mesothelioma
Smokers
Scc (central)
Squamous cell (central)
What are the common causes of erb ducheye alsy? Where is the brachial plexus insult with era du henna palsy
C5-c6 traction or tear
Paralysis of abductors rotator and supination
Blow to shoulder or child birth trauma
A 72 yo man has trouble falling asleep at night. Why is diphenhydramine (Benadryl) a poor medication choice in the elderly and in those with BPH
Prominent anticholinergic side effects-delirium, confusion, urinary retention,
Disrupts normal sleep architecture
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
Defiency homocysteine methyltransferase or cystathionine synapse
Have cystathionine synthase but doesn’t bind to B6 well
Homocysteine methyltransferase-give methionine supplement since can’t make it
Cystathionine synthase defiency-supplement cysteine and reduce dietary methionine and increase B12 and folate to shut back toward methionine
Mutated cystathionine synthase-supplement cysteine and give more vitamin b6
Marfan!!!!! Also subluxation of lens . Both present in similar, tall long fingers subluxation of lens
Know homocystinuria vs marfan
What converts homocysteine to cystathionine
Cystathionine synthase and B6
What does cystathionine become
Cysteine
How does homocysteine become methionine
Homocysteine methyltransferase and B12
How does methionine become homocysteine
With ATP to become SAM then lose CH3 with phosphocreatine to epinephrine and get homocysteine
A 34 yo obese white woman develops urinary retention after undergoing a laparoscopic cholesteatoma. Which cholinergic agonist can be used to treat post op ileus and urinary retention ? What conditions can be made worse by using cho;inomimetic agents
Bethanechol(direct cholinergic agonist)
Indirect cholinergic agonist (neostigmine- indirect cholinesterase inhibitor increase ach at synaptic cleft)
Both increase ach at synaptic cleft
—-can cause bronchoconstriction, asthma and COPD
—-stimulated stomach acid secretion-peptic ulcers
Which drugs are known to cause aplastic anemia? What is the treatment for aplastic anemia?
Anti cancer drugs
Chloramphenicol
NSAIDS
Propylthiouracil
Methimazole
Stop, replace rbc/platelets, G-CSF raise white count, bone marrow transplant
In a 34 year old schizophrenic patient having active hallucinations, whi is not oriented to time, place of person, able to legally agree to a pla of care? What factors must be in place in order for a patient o have the capacity to make a decision?
No. Lacks capacity
Make and communicate a choice
Informed and understand risks, benefits, and alternatives
The decision is stable over time
Decision consistent with patients values and goals
Can’t be based on hallucinations
Which cancers can cause the paraneoplastic syndrome, lambert Eaton?
Small cell lung cancer
Hodgkin lymphomamalignant thymoma
What is conductive hearing loss, and what are some causes?
Sound not conducted (vs sensorineural where nerves dont work) nerves work fine but not transmitted to cochlear apparatus
Wax build up in ear canal
Ear infection, otitis externa, otitis media
Ruptured tympanic membrane
Otosclerosis
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
Transitional cell carcinoma
Painless hematuria
Smoking, aniline dyes, phenacetin, cyclophosphamide
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 valsava maneuver. What type of hernia does this patient most likely have? What type of hernia protrudes through hesselbach’s triangle? What structures form hesselbachs triangle?
Inguinal hernia
Can’t distinguish direct vs indirect through PE
Indirect-protrude through triangle medial to epigastric
Indirect-lateral to vessels
Inferior epigastric artery, lateral border of rectus abdominis, inguinal ligament
How does a decrease in renal artery pressure cause an increase in bp?
Kidney panic secrete renin to RAAS to raise BP
Renin cleave angiotensinogen to ang I and I to II by ACE
And II-Vasoconstrictor and stimulate aldosterone increase intravascular volume
A type 2 diabetic with HgbA1c of 10% presents to your clinic with many complaints. You are concerned about the effect of the patients long term hyperglycemia. What diabetic complications can be attributed to sorbitol inducing osmotic damage? Which enzyme converts glucose to sorbitol
Glycosylation of blood vessels in kidney retina and coronary arteries
Sorbitol induced osmotic damage
- glucose is converted to sorbitol, which cant be converted to fructose in
- schwann cells
- lends of the eye
So sorbitol is trapped in cells and draws fluid into the cells
- schwann cells-> demyelinationa nd diabetic neuropathy
- lens->cataracts
Glucose—-aldosterone reductase with NADPH—>sorbitol—-sorbitol DH with NAD—-> fructose
What is type II B error
Study results demonstrate no difference between 2 groups when a difference exists.
Type I-rejection of a true null hypothesis
A child in India is brought to the doctor with symptoms of msucle weakness, malaise, HA, 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 pathogenvia the fecal oral route. Which area of the body is this pathogen attacking to give the neurologic symptoms seen?
Polio virus
Replicates in oropharynx and hematogenous spread to CNS where desctory anterior horn spinal cord…lower motor neuron issues
A child arrives at the ER in hypotensive shock after taking his dads phenoxybenzamine. The intern on call orders the nurse to get her a pressor STAT. The nurse informs the intern that there are two pressor available int he ER, epinephrine and phenylephrine. Whihc one will be able to increase the bp of the pediatric patient?
Phenoxybenzamine-a blocker irreversible decrease bp due to decrease peripheral vasoconstriction
Epinephrine-a and b agonist
Phenylephrine-pure alpha agonist
Epi-act b1 and b2 cause peripheral vasodilation, which is problem
Give phenylephrine pure a agonist wont get b2 vasodilation
What condition may occur if a monoamine oxidase inhibitor is given to a patient already taking SSRI? What is the treatment for this condition
Serotonin syndrome
-tremor, hyperreflexia, muscle rigidity(clonus), hyperthermia, diaphoresis, flushed skin ,agitation, seizures, cvd collapse
Stop drug, sedate with benzodiazepine (lorazepam), supportive care, cyproheptadine (block 5ht 1 and 2 a)
MAOI-inhibit enzyme breaks down serotonin which is helpful for depression
A 46 year old man comes to the physician for advice about taking a daily asprin. How does taking an asprin a day prevent platelet aggregation and MI? Which two arachidonic acid products affect platelet aggregation?
Permanently inhibit COX1 and COX2->less production of thromboxane a2->less platelet aggregation/thrombosis
=thromboxane a2 stimulates platelet aggregation, prostacyclin inhibits platelet aggregation
Which GI filament” ligaments that separate the greater and lesser sacs
Gastrohepatic and gastrosplenic ligament
May be cut during surgery to access the lesser sac
Gastrohepatic ligament
2 ligaments that connect the spleen to other structures
Splenorenal, gastrosplenic
Contains the portal triad
Hepatoduodenal ligament
Connects the liver to the anterior abdominal wall
Falciform
A 65 yo woman with primary pulmonary HTN is in severe respiratory distress, and she has cyanosis and signs of right sided heart failure. What medications are used int he treatment of pulmonary HTN? What are their MOA?
Endothelin1 1 receptor antagonist
-bosentan and ambrisentan
Prostagladin vasodilation
-iloprost and epoprostenol (all have Prost)
CGMP phosphodiesterase inhibitors
-vardenafil, tadalafil, sildenafil
Dihydropyridine calcium channel blockers
-nifedipine
A 35 year old man develops hallucinations just before sleep, episodes of excessive sleepiness and cataplexy during times of laughter and sadness. In whihc stage os sleep do narcoleptic sleep episodes begin? What are the different stages of normal sleep? How do they differ from one another?
REM sleep
Awake and alert
-beta waves high freq low amp
Awake closed eyes
-alpha waves
N1-light sleep, theta waves
N2-deeper, sleep spindles and K complexes (brutish teeth grinding)
N3-deepest slow wave sleep low freq high amplitude delta waves, sleep walking, night terrors, bed wetting
REM-dreaming, beta waves,
What are the jones criteria for the diagnosis of acute rheumatic fever
Acute group a strep infections ith immune reaction and antibodies cause problems
-strep infection + 2 major criter OR 1 major and 2 minor
Major-joints (polyarthritis), pancarditis, nodules, erythema marginatum (ring likerrash), sydenham chorea
Minor-fever, arthralgias, elevated seed crate or CRP< prolonged PR interval
MOA pralidoxime
Regenerates cholinesterase
MOA neostigmine
Cholinesterase inhibitor
MOA bethanechol
Direct cholinergic agonist
MOA hexamethonium
Nicotonic ach receptor antagonist
MOA atropine
Muscarinic antagonist
MOA carbachol
Muscarinic agonist
Which glycogen storage disease has severe hypoglycemia with elevated blood lactate
Von fierce disease (type I)
Which glycogen storage disease has hypoglycemia without elevated blood lactate
Cori disease (type III)
Which glycogen storage disease has cardiomegaly
Pompe disease (type II)
Which glycogen storage disease has myoglobinuria associated with exercise
Mcardle disease (type IV)
Treatment for pulmonary embolism
IV heparin or LMWH (enoxaparin) activate antithrombin to haunt clot progression
If HIT can use lepirudin or bivalirudin which directly inhibit thrombin
What is the mechanism of action of penicillin? Is it a bacteriostatic or bactericidal antibiotic?
Blocks synthesis of bacterial cell wall inhibit cross linking peptidyl glycans
Bactercidal
What is the adult remnant gubernaculum
Ovarian ligament and round ligament of uterus
Adult remnant processus vaginalis male
Tunica vaginalis
Foramen ovale
Fossa ovalis
Notochord
Nucleus pulposus
For what conditions is hyperbaric oxygen therapy particularly helpful
Severe CO poisoning
Decompression sickness
Arterial gas emboli
Gas gangrene (clostridium perfringens)
Osteomyelititis acute MI
What is the pressure in the potential spaces of the body including the pleural cavity, the joint spaces, and pericardial cavity?
Negative facilitate fluid into spaces
Pleural -7 -8 cmH20
- 3 -5 cm h20
- 5 -6 cm h20
Which anatomic structures are found in the retroperitoneum
Sad pucker
Suprarenal Aorta and ivc Duodenum Pancrease not tail Ureters Colon Kidney Esophagus Rectum
A central line is often placed in the subclavian vein to administer fluids and medications or to measure central venous pressures. What landmarks are used when placing a subclavian central line
Thumb on middle third of clavicle and finger on top jugular notch and insert medially aim under thumb to tip of finger
What is the mechanism of action of glucagon like peptide 1 agonist
Exenatide
Liraglutide
Acts to increase glucose dependent insulin release and decrease glucagon release
Delay gastric empty
Loose weight
Liraglutide-weight loss
You are performing a well child exam 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
Short, dental carries, scabies
Long term-poor msucle tone, poor language socialization, lack of eye contact, weight loss, failure to thrive
Diagram the pathway by which cochlea communicates a signal to the primary auditory cortex
Cell body of spiral ganglia->cochlear nuclear->contralateral superior olivary nucleus->lateral lemniscus->inferior colliculus->medial geniculate body->primary auditory cortex
Metastasis to brain from where
Lung Breast Skin Kidney GI
Metastasis to liver from where
Colon stomach pancrease breast lung
Metastasis to bone from where
Prostate
Thyroid testes
Breast lung kidney
What pulmonary artery pressures indicate pulmonary HTN
> 25 mmHg at rest
What is the difference between malingering and fictitious disorder
Malingering-faking to gain. Secondary gain
Factitious-fakes without secondary gain, enjoy being a patient and getting medical attention, aware faking may not no why
What are the three endogenous androgens in order from the most potent to the least potent
DHT>T>A
T and A can be turned to E by fat
What is Osler Weber tendu syndrome
Hereditary hemorrhagic telangiectasia
Autosomal dominant disorder
Causes telangiectasia in the skin and mucous membranes and possibly in organs
High output heart failure
What is the fibrous band attached to the testis and scrotum that aids in normal testicular descent what is this structure called in females
Gubernaculum
Ovarian ligament and round ligament of uterus
What disorders can cause cotton wool spots on the retina
Pale areas on retina infarcts of nerve fiber layer of retina
Chronic HTN and diabetes, AIDS, lupus, vasculitis (giant cell arteritis, polyangitis with granulomatosis, polyarthritis nodosum)
Which cardiac valve is most commonly involved in infective endocarditis and acute rheumatic fever
Mitral valve
IV drug users get tricuspid
What are the early cyanosis heart disease? What are the late cyanosis heart disease?
Early-5T persistent truncus arterious
Transposition of great vessel
Tricuspid atresia
TOF
Total anomalous pulmonary venous return
Late-atrial septal defect, vsd, pda
How does standard deviation differ from standard error of the mean?
Which one is used inc accusations confidence intervals
Sd-how much variation between dae points of sample ……1 sad 68%, 2 95% , 3 Sd 99.7%
Standard error how well mean predict mean of population
Estimate average height of adult male in US so measure sample ten men calculate their average heigh
How far off are from actual mean of pop so larger sample size closer get to true mean
SD/square root of sample size=standard error of mean
Confidence interval-range on either side confident subsequent studies calcuting same fall in range
CI=range from {mean-Z(sem)] to {mean+Z(SEM)}
90% Z=1.645
95% Z=1.96
99% Z=2.58
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 in HbH production?what is the structure of hb Bart’s ?what disease results in hb Bart’s production
Italian, Greece, Spain-alpha and beta cause micro
But beta in Mediterranean dont make as much hemoglobin
Hemoglobin H (4 beta globin chains, alpha thalassemia (3 defective alleles (usually get 2 from mom and 2 from dad) Hemoglobin Bart’s-4 gamma globins, alpha thalassemia (4 defective alleles) cant make any alpha and fetus cant make hemoglobin F so make Bart’s since gamma chains pair up together
Barts-no hemoglobin F have poor oxygen delivery in utero hydrops fetalis
Most severe alpha thalassemia-spontaneous abortion
A p 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?
(FA18 p437) (FA19 p440) (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
Radial nerve neuropathy Saturday night palsy
No. Regeneration not in cns but can occur in PNA (white matter from myelin schwann cells secrete chemotropic growth factor can regenerate, oligodendrocytes secrete chemical inhibit axonal growth)
1-2mm per day
Women with polycystic ovarian syndrome can have decreased levels of sex hormonebinding 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
Binds estradiol and T if a lot mroe free t bound making inactive and male patient have gynecomastia or fatigue
Steroid hormones work inside nucleus through cytoplasm cross nuclear membrane and effect gene expression
What effect does stress have on adipocyte
Bisphosphnate use-esophagitis and esophageal ulcers, avoid remain upright for 30 min
Osteonecrosis of jaw after invasive dental or atypical femur fractures
Heavy exercise results in sympathetic activation
E and ne released from adrenal medulla
Activation of hormone sensitive triglyceride lipase in fat cells
Rapid breakdown of triglycerides and mobilization of fatty acids to be used bymuscles as energy
Stress induces the release of corticotrophin from anterior pituitary int he adrenal cortex glucocorticoid secretion is stimulated
Stimulation of hormone sensitive triglyceride lipase in fat cells
Which type of health insurance plan requires a referral form a primary care provider to see a specialist: the Health Maintenance Organization (HMO) or the Preferred Provider Organization (PPO
HMO
SET 18
6. What does a patient’s life expectancy have to be in order to qualify for hospice care
Less than 6 months but if physician wrong patient can stills tay as long as estimated continues to be less
- What are the componets of metabolic syndrome
3 of 5
Waist circumference Tb Hdl Blood pressure Fasting serum glucose
- What medications are commonly used in the treatment of hyperemesis gravidarum
IV fluids Vitamin B6 Ginger Doxylamine Phenergan Metoclopramide Promethazine Ondasetron
- What condition is commonly referred to as housemaid’s knee? What condition is commonly
referred to as clergyman’s knee
Prepatellar bursitis
Infrapatellar brusitis
What organisms are the most common cause of uncomplicated UTI cystitis
E. coli klebsiella
Proteus m
Staph saphrophyticus
What is the difference between zero order elimination of a drug and first order elimination? Which type of elimination behaves as though the enzymes responsible for the elimination are saturated?
Zero-constant amount eliminated per unit of time
Graph-linear
First-constant fraction of drug metabolized per unit of time but not constant amount
Graph curved
Depending on starting conc and rate elination either can be faster
Zero order
What ratio indicates fetal lung maturity? What is the name for the main component of pulmonary surfactant
2:1 lecithin sphingomyelin ratio
Dipalmitoylphosphatidylcholine
Which nutrient defiency is associated with spooning of the nails (koilonychia)
Iron defiency
Clubbing-oxygen deprivation
Sertoli cells release a substance that acts on the paramesonephric ducts in order to prevent the formation of what structures in a normal male fetus? What other name is given to the paramesonephric ducts
Mullerian inhibitory factor
Inhibits paramesonephric/Müllerian ducts to become Fallopian tubes, uterus, proximal vagina
A 54 year old man presents with a bp 200/160 mmHg, and the examination reveals right sided abdominal bruit suggestive of renal artery stenosis. What is the mechanism by which renal artery stenosis causes HTN? What are some other common causes of secondary hyperaldosteronism
The kidney is perceiving low intravascular volume->activation fo the renin angiotensin aldosterone system
Chronic renal failure, CHF, cirrhosis, nephrotic syndrome
Perceive low intravascular volume!
What artery supplies the distal third of the colon? What artery supplies the proximal 1/3 of colon/ from what embryonic structures are the distal third and proximal 2/3 of the colon derived?
Distal 1/3inferior mesenteric artery
Proximal 2/3Superior mesenteric artery
Distal 1/3 hindgut
Proximal 2/3 midgut
What anticonvulsants are used to treat absence seizure? What anticonvulsants are for status epilepticus
Ethosuximide-FIRST LINE
Valproic acid
- Break seizure acute with benzodiazepines (lorazepam, diazepam)
2phenytoin/fosphenytoin to prevent
Where would you expect to find B cells in a lymph nodes? Where are T cells, plasma cells and macrophages
B cortex follicles
T cells paracortex
Plasma cells medullary chord
Macrophages medullary sinus
A 50 yr old roofing worker develops a cough for the past month that is now associated with hemoptysis . The patient denies a smoking history or prolonged exposure to secondhand smoke. An c ray reveals a left sided lower lung coin shaped lesion.w hat type of lung cancer is suspectedin this individual? What is the appearance of asbestos fibers in the lung? What cancers are associated ith asbestosis
Bronchogenic adenocarcinoma ! Most common in non smokers
Peripheral coin shape lesion suggest this
Look like golden brown rods that resemble dumb bells
Asbestos ferruginous bodies
Asbestos-bronchogenic adenocarcinoma and malignant mesothelioma
When performing a femoral arterial line placement or femoral venous catheter placement, it is important to palpate the femoral artery to determine where the inguinal structures are located. What structures are found under and just inferior to the inguinal ligament? List them in order from lateral to medial
Navl
Nerve artery vein lymphatics
What is the clinical presentation of plantar fasciitis
Heel pain worse with initiation in walking
First steps of day limp out of bed at breakfast gets better
Sit more pain when start walking
Gradual worsening throughout day
Point tenderness on heel or forefoot more apparent with dorsiflexion palpate plantar surface and forefoot
What is the difference between a. Case control , cohort and clinical trial? Which studies are used to calculate odds ratios and which are used to calculate relative risks
Case control -retrospective study comparing people with a disease to those without disease
Odds ratio
Cohort-start with the risk factor and see if people develop the disease
Usually prospective can be retro
Relative risk
Clincial trial-prospective experimental study comparing the outcome of two different treatments or comparing a treatment to a placebo
No OR or RR
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 1 and 2
TH1- IL2 and IFNy
4,5,6,10,13
Which diuretics lower serum ca? What is the mechanism by which these cause hypocalcemia
Loop diuretics
Loops loose calcium thiazides contain
Block nak2cl loose electrochemical gradient reduce ca reabsorption loss in urine hypocalcemia kidney stone
What are the rings of right sided heart failures? What ae the signs of left sided heart failure? What is the most common cause of right sided heart failure?
Right-blood backs up into IVC and SVC
JVP, peripheral edema, hepatic congestion
Left-backs up into pulmonary vein and lungspulmonary edema, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea
Most common cause of right side HF is left sided HF back up into pulmonary nor right ventricle pushed harder and right ventricle weak to left right pressure lower already than left to rleft pressure up go way back
Right sided often result with systemic problems edema and JVD
Left-pulmonary problems
Name the syndromes that cause elevated cortisol and central obesity
Cushing
Common anovulation
Name syndrome causes amenorrhea and hirsutism and obesity
PCOS
Amenorrhea
Which NT schizophrenia
Increase dopamine in mesolimibic pathway
Which NT parkinson
Decrease dopamine in substantia nigra
Decrease serotonin
Increase ach
Which NT Alzheimer’s
Decrease ach
Which NT huntington
Decrease gaba ach
Increase dopamine
Which NT anxietyincrease NE
Decrease GABA and serotonin
SSRI
Which NT depression
Decrease NE, serotonin dopamine
SSRI
- 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?
(FA18 p405) (FA19 p407) (SU p257)
Asplenic patients are susceptible to which encapsulated organisms?
(FA18 p98) (FA19 p98) (SU p367)
What vaccines for these encapsulated organisms should be given to asplenic patients
Howell jolly bodies-basophils nuclear remnants in some cells
If spleen gone see this
HI, pneumococcal, meningitis, salmonella, klebsiella
HI, pneumococcal, meningitis
Which phase f drug metabolism do geriatric patients lose first? Which phase of drug metabolism makes a slightly polar metabolite by oxidation, reduction or hydrolysis
Lose phase I reactions first
Phase I -oxidation eduction hydrolysis by P450
A patient complained of intense thirst and profuse urination. After further testing a diagnosis of diabetes insipidus is suspected. What would be the most likely urine specific gravity and serum osmolality findings in this patient
Specific gravity <1.006
Urine osmolality low
Can’t concentrate uring
Serum osmolality>290
You recommend that your patient , a 51 yo woman begin taking calcium and a 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? What mechanism does vitamin d help prevent osteoporosis
Liver Vd to 25 oh Vd (calcidiol)
Kidney to 125 OH2 vd calcitriol
Vd stimulate calcium a p absorption from gut for bones l
What is compartment syndrome and how treated
Injury to leg traum aburn or exercise tissue swell
Increase pressure in fascial compartment
Fasciotomy
ET 21
3. Thiazolidinediones (TZDs) increase expression of one type of GLUT receptors—those in adipose tissue—as one of their antidiabetic actions. Which GLUT receptors would you expect to find on skeletal muscle and fat
Glut4 insulin dependent
- Which cell types do not require insulin for the uptake of glucose
Brain rbc intestines cornea kidney liver
Does the notochord become the neural tube
No derived from mesoderm neural tissue comes from ectoderm but induced it
- What is the cause of hypertrophic cardiomyopathy
Different gene segments all of which encode sarcomeric proteins
- B myosin heavy chain
- cardiac troponin T
- a tropomyosin
- myosin binding protein C
AD with variable petrancy
Myocyte hypertrophy and disarray decrease compliance and poor chamber filling reduce SV
uring fetal development, what structure traps the inferior poles of the kidney resulting in a horseshoe kidney? Do patients with horseshoe kidneys have abnormal renal function?
Inferior mesenteric problem
No but uti, and blocks
- 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?
Menopausal symptoms from lack of estrogen
Patient getting estrogen in ocp
Hot flash, sleep disturbance, vaginal atrophy dryness, increased risk osteoporosis, CVD disease stroke
SET 21
9. An 18-year-old woman has seasonal allergies. She complains that her eyes water and her nose runs constantly during the spring. Which cell type is responsible for her symptoms, and what drug inhibits these cells’ actions? What WBCs descend from the myeloblast (granulocyte) lineage
Mast cells release histamine and other things dilate capillaries and draw other
Cromolymn sodium prevents mast cell degrnulation
Antihistamine (diphenhydramine, loradamine) block the downstream effects of histamine not mast cells
-N, E, B (blood)
Mast cells different lineage in tissue
- 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”
Enterotoxigenic E. coli watery diarrhea toxins no blood
- 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
Prevent platelet aggregation irreversibly blocking adp receptors not he platelets
- Which bacteria are known for being obligate intracellular bacteria
Rickettsia
Chlamydia
Coxiella burnetti
What is the equation for determining a drug’s clearance
.7xVd/t(1/2)
The protein derived from what gene serves as a transcription factor for the development and function of regulatory T cells?
(R p784)
FOXP3 on X chromosome encodes forehead box protein p3
For treg
Absence in autoimmune
Mutation IPEX
. What are the causes of iatrogenic Creutzfeldt-Jakob disease (CJD)? What measures can be taken to avoid iatrogenic CJD
Neurodegenerative prion
Resistant to normal sterilization
Transplant procedures-cornea or liver
Dural grafts
Cadaveric pituitary hormones -why not use these and use more recomibant
Surgical procedures
-automated surgical instment washers
Then autoclave and NaOH
Keep in moist env after use
DRY NOT AS RESPONSIVE TO sterilizatiOn
SET 22
6. On which cells would you find CD4 molecules? On which cells would you find CD8 molecules? What actions do the CD8+ cells accomplish
Helper T cells
Cytotoxic T cells-kill foreign from a transplant donor
Female homologous to corpus spongiform
Vestibular bulbs
Female homologous to coppers glands (bulbourethral glands)
Bartholin glands (vestibular glands)
Female homologous to prostate
Urethral and paraurethral glands
Gland penis
Clit
Ventral pencils shaft
Labia minora
Scrotum
Labia majora
Which aa for purine
Glycine
Aspartate
Glutamine
What is difference between promoter and enhancer region
Promoter-site on DNA where RNA polymerase and other transcription facrots bind
Enhancer-sequence of DNA that enhances gene expression by binding transcription factors
What abnormal lab values would lead you to suspect alcoholic hepatitis
AST>alt
Ggt
The body uses both the cell-mediated and the humoral immune system to fight infection. Which T cell type regulates the humoral response
T helper 2 cells make il4 and 5 to promote growth and diff B cells
T1 cell mediated cytotoxic il2 and IFNy
- Coal miners are at an increased risk for skin cancer because of their exposure to arsenic. Which type of skin cancer is associated with this exposure
Squamous cell carcinoma
hat is syringomyelia? What symptoms are commonly seen in patients with syringomyelia?
Degernative cystic cavity in spinal cord
Late complication spinal cord trauma
Compress c8-t1 in anterior white commissure
-loss of sin and temp in upper and touch unaffected
Cape like distribution
Anterior horn-motor deficits
hat potentially fatal autoimmune skin disorder is caused by IgG antibodies against desmosomes? What is the difference between a desmosome and a hemidesmosome
Pemphigus vulgaris
Desmosome-cell to other cel
Hemidesmosome -epithelial to bm (bulbous pemphigus )
- What is the classic presentation of granuloma annulare
Granular annulare
Asymptomatic
Non scaly slightly erythematous annular plaque
Irregular well defined
Thick rope like border
Start small and grow outward
Localized to wrists, ankles, or dorsal hands/feet
Not palms or soles
60-year-old man comes to the physician for sexual dysfunction. What is the differential diagnosis? What drugs are known for causing sexual dysfunction
Hormonal disturbances ow T hyperprolactinemia Depression Diabetes Psychological Meds ——neuroleptic, SSRI, ethanol,
SET 23
7. A 44-year-old woman is brought to the emergency department 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?
(FA18 p664) (FA19 p668) (S
Strep pneumonniae dense consolidation
Maybe staph HI, klebsiella
Atypical-mild , cough, fever, walking around, patchy interstitial
-mycoplasma, chlamydophila, legionalla, viral from RSV adenovirus or influenza
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
Advance directive
Living will
SET 23
9. 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
Exogenous steroids most common
Primary adrenal adenoma
Nodular adrenal hyperplasia
Secondary too much acth , pituitary adenoma cushing DISEASE
Or ectopic from scc
Acth high in tumor but cortisol producing tumor acth low
Syndrome is glucocorticoid effects
- 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
IFfrom parietal cells
Absorbed in terminal ileum
. Which type of lymphoma is identical to chronic lymphocytic leukemia (CLL) ?
Small lymphocytic lymphoma
Lymphoma-hodgkin and non hodgkin (one is small lymphocytic lymphoma which is Sam a as CLL lymphoma is lymph node and leukemia is in peripheral blood)
Does a partial agonist always have a lower maximal efficacy than a full agonist? Does a partial agonist always have a lower potency than a full agonist
Yes
Partial agonist dont cause as strong response so maximum response always lower with partial agonist
Potent deal with how much need to get maximal response s with partial potency can be increased or decreased
- What are the common causes of metabolic acidosis with an elevated anion gap?
(FA18 p576) (FA19 p580) (SU p150)
MUDPILES
You are conducting a study to determine the reduction in risk of developing a relapsing depressive episode with antidepressant X when compared to a placebo treatment. What is this determination called? What is attributable risk, and how is it calculated
Absolute risk reduction
Difference in risk exposed and unexposed groups
Proportion disease caused by that exposure
Out of everyone with lung cancer what proportions aused by smoking
AR=A/(A+B)-C/(C+D)
-number smokers with lung cancer divided by all smokers minus non smokers with cancer divided by all non
Asthma exacerbation ok
1
Poison ivy dermatitis
4
Good pasture
2 with autoantibodies
Arthus
3
Anaphylaxis
1
Serum sickness
III
Autoimmune hemolytic anemia
II
Liver transplant rejection
Liver transplant rejection
Rh incompatibility
Rh incompatibility (erythroblastosis fetalis)
Tb
IV
67 yo man treated with leuprolide for prostate cancer. What is MOA
Bind GnRH receptos in anterior pituitary and activates receptors for a long period of time to downregulat receptors dont get LH or FSH we want this for prostate cancer
Injection suppress LH and FHS slows growth of prostate cancer
A chronic alcoholic with cirrhosis begins to experience a tremor and blurred vision. You feel like these symptoms might be due to hyperammonemia from his liver disease. What are some other findings of hyperammonemia? What is a hereditary cause of hyperammonemia
Tremor Slurred speech Somnolence Vomiting Cerebral edema Blurred vision
Urea cycle enzyme deficiencies-ornithine transcarbamoylase defiency x linked-elevated ammonia levels early life
Excessive converter to orotic acid in blood and urine, decreased BUN, symptoms of hyperammonia(lethargy coma)
- A 46-year-old woman with schizophrenia has been treated with an atypical antipsychotic with good results for several years. Routine labs reveal a precipitous drop in her WBCs. Which drug is this patient most likely taking, and how frequently should her labs be drawn to monitor for this problem
Clozapine (atypical antipsychotics) causes agranulocytosis
If take it monitor absolute neutrophil count weekly for 6 months
. What are the most common manifestations of Zika virus infection? What are the most worrisome complications of Zika virus infecti
Low grade fever Pruritis rash Joint pains in hand feet Nonpurluenct conjucntivitis Myalgia and ha
Congenital microcephaly or miscarriage*
. What are the roles of ghrelin and leptin in appetite regulation
Peptide hormone produced by stomach stimulated hunger and release GH
Hormone produced by adipose tissue mediates satiety
