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Pathology > Doctors In Training Questions > Flashcards

Doctors In Training Questions Flashcards

1
Q

How does flutamide differ from finasteride in relation to MOA and clinical use

A

Flutamide-prostate cancer, competitive testosterone receptor inhibitor

Finasteride-BHP, or bald man, inhibits 5a reductase (convert T to DHT)

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2
Q

What is the difference between mean, median and mode? ALL SAME IN NORMAL SHAPED CURVE

A

Mean-average

Median-middle

Mode-most

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3
Q

What is a positive skewed curve and what is a negative skewed curve to mean median mode

A

+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
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4
Q

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

A

Kartagener syndrome (primary ciliary dyskinesia—non motil cilia)

Bronchiectasis (bronchioles wont stay open, recurrent sinusitis, infertility, situs invertus)

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5
Q

What foods, typically high in mercury should be avoided during pregnancy?

A

Fish -fish that eat other fish so FDA say preg no eat

Shark, swordfish, king mackerel, tilefish

Mercury-brain damage to baby

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6
Q

IFN-y stimulates macrophages and inhibits TH2 . What cell type releases IFN-y

A

TH1 release IFN y

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7
Q

Amyloidosis and sarcoidosis are associated with which cardiomyopathy? What are some othe diseases or conditions associated with this cardiomyopathy?

A

Restrictive or obliterative cardiomyopathy —-bulk up tissue restrict function of the tissue

-postradioation fibrosis, endocardial fibroelastosis, lofflers syndrome, hemochromatosis

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8
Q

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

A

Parkinson

Amantadine (same for flu)
-increase release of dopamine

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9
Q

What does the eustachian time connect? What is its purpose? What drug is commonly prescribed for Eustachian tube dysfunction?

A

Connect middle ear to nasal pharynx make pressure in middle ear same as astomspheric

Nasal steroids

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10
Q

Where do each of the following paranasal sinuses drain into the nasal cavity?
Ethmoidal air cells

Frontal sinus

Maxillary sinus
Sphenoidal sinus

A

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)

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11
Q

MOA for varenicline

A

Partial agonist at nicotine acetylcholine receptors

Smoking cessation

Black box for neuropsychiatric events depression suicide stuff

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12
Q

When is a fetus most susceptible to damage from teratogens? What antihypertensive drug class is teratogenic? What effect does this have on the fetus?

A

3-8 weeks embryonic period this is when organs formed

ACE-pril
ARB-sartan
Fetal kidney damage, act on RAAS

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13
Q

What physiological changes occur due to a prolonged stay in space at zero gravity

A

Decrease blood volume, rbc mass, muscle strength and work capacity, max CO, loss of calcium and phosphate from bones->loss of bone mass

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14
Q

Which bone is commonly fractured when falling on an outstretched hand, resulting in pain in the anatomical snuff box

A

Scaphoid-most commonly injured carpal bone

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15
Q

What is the cause of carcinoid syndrome? What are the classic symptoms

A

Secretion serotonin from carcinoid tumors (most GI or lung in bronchi)

B-FDR
Bronchospasm
Flushing
Diarrhea
Right sided valvular disease
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16
Q

What is antidote for digoxin toxicity

A

Digoxin immune Fab-expensive

Usually we normalize K and Mg, lidocaine for arrhythmias and cardiac pacing

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17
Q

What are some of the circumstances in which information is HIPPA exempt, meaning that your health information can be shared with another party

A

Child abuse, birth or death information, state mandated reportable illness, public health disease surveillance, state sponsored disease intervention activities , schools(vaccination)

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18
Q

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

A

Cirrhosis and portal venous HTN cause varices in esophagus and stomac

Octerotide-long acting somatostatin analog clamp down vascular bed

Endoscopic ligation

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19
Q

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?

A

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

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20
Q

What is the most common gynecological neoplasm? Wat is the typical histological pattern? Benign or malignant?

A

Leiomyoma-fibroid
—menorrhagia and anemia

See smooth msucle bundles in different directions

Benign do not progress

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21
Q

Acetazolamide

A

Sodium bicarb diuresis

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22
Q

Mannitol

A

Osmotic prevent resorption

Increases urine flow

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23
Q

Furosemide

A

Inhibit NaKCL cotransporter ont hick to interstitial of medulla less hypertonic so in thin limb cant concentrate urine

Prevent concentration of urine

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24
Q

Hydrochlorothiazide

A

Inhibit na cl absorption

Reduces the diluting capcity of the nephron

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25
Q

Spironolactone

A

Competitive aldosterone receptor antagonist

Incrase an water excretion without increasing k secretion

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26
Q

ADH antagonist

A

Tolvaptan

Block ADH in collecting tube

Less water reabsorbed

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27
Q

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

A

N-acetylcysteine

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28
Q

Associated with obesity, ketoacidosis, genetic, DR3/4

A

Type II
Type I
Type II
Type I

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29
Q

Platelet disorder: bleeding time, PT and PTT, clincial features

A

Hemostasis 1 platelet 2 fibrin clot

Bleeding time-prolonged

PTnormal
PTT normal

Small hemorrhage-epistaxis, petechiae, purpura

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30
Q

Coagulation factor defect: bleeding time, PT and PTT , and clincial features

A

Normal

Prolonged

Major hemorrhage-hemarthrosis, intracranial, hemorrhages

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31
Q

MRI

A

No ionizing radiaiton

Soft tissue-brain, spinal cord, joints ligaments, cartilage (brain parenchymal, acl tear

Use with caution-pacemakers metal problem

Bone grey

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32
Q

CT

A

Ionizing radiation-not on pregnant

Bone detail, recognition of blood (stroke for hemorrhage

Can have metal

Bone white

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33
Q

Weakness, pallor, craving ice chips and tachycardia and chronic hemorrhoids What is cause of anemia and how treat

A

Pica-want ice chips

-iron defiency anemia , rectal bleed cause

Treat with iron replacement and possible colonoscopy

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34
Q

62 year old with weak urine stream and hesitance when trying to urinate. He is given finasteride. How does this treat BPH

A

5 a reductase inhibitor

Can’t get testosterone to DHT

Dht make prostate tissue grow

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35
Q

Test for corneal abrasions

A

Fluorescein dye on surface of eye

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36
Q

Thalmic nuclei for auditory sensation

A

Medial geniculate nucleus

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37
Q

Thalamus nuclei for visual sensation

A

Lateral geniculate nucleus

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38
Q

Thalamus nuclei for motor to body

A

Ventral lateral nucleus

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39
Q

Thalamus nuclei for facial sensation

A

Ventral posteromedial nuclei

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40
Q

Thalami nucle for body sensation

A

Ventral posterolateral nuclei

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41
Q

Describe decompression sickness

A

Divers come to quick gases (N) that had dissolved in blood at high pressure form gas bubbbles that can occlude blood vessels

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42
Q

First line treatment for erectile dysfunction

A

Sildenafil, vardenafil, tadalafil

Phosphodiesterase inhibitors

-hypogonadism cause start testosterone replacement

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43
Q

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

A

Crescent shape cross sutures is subdural hematoma

Bringing veins

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44
Q

Where is the most of CSF generated. What is function of CSF

A

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

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45
Q

What is the most common renal malignancy in adults? What is the associated gene deletion?

A

Renal cell carcinoma

Hematuria, flank pain, palpable flank mass

Gene deletion chromosome 3 and VHL

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46
Q

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?

A

Bleomycin (busulfan and methotrexate cause interstitial pulmonary disease and fibrosis)

Bleomycin works by inducing free radicals to interfere with DNA structure

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47
Q

What might you observe in a patient who presents to the ER with PCP intoxication

A

Psychomotor agitation

Impulsiveness

Psychosis

Belligerence

Homicidality

Aggressive violent

Fever

Tachycardia

Vertical and horizontal nystagmus**

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48
Q

At what positive g force dose visual blackout occur. Why

A

4-6 G

G force pool blood in abdomen and legs

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49
Q

The dorsal root ganglion is considered gray matter within the spinal cord. From what embryological derivative are the dorsal root ganglia derived

A

Neural crest (ectoderm)

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50
Q

What is the definition of tidal volume, residual volume and vital capacity?

A

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

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51
Q

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

A

1st trimester
-cardiac and cns malformations

2 3 trimester
Renal problems

Use methyldopa in pregnancy

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52
Q

How does the mechanism of action of benzodiazepine differ from barbiturates? What toxicities of barbiturates can be fatal

A

Benzodiazepines
-increase frequency of GABAa receptor Cl channel opening

Barbiturates

Increase the duration of GABA receptor Cl channel opening

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53
Q

Toxicity barbiturates

A

CNS depression effects
Respiratory depression

Cardiovascular depression (bradycardia)

Worse with alcohol dont give with alcohol

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54
Q

Hydatidiform mole is the most common precursor of whaat malignancy? What tumor marker is monitored after the dilation and curettage of a hydatidiformmole

A

Choriocarcinoma

B HCG-if stay elevated worry not get all of it and little piece could progress to choriocarcinoma

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55
Q

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

A

Positiveeven though disease not present

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56
Q

What is the primary function of LH in the body

A

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.

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57
Q

Which complement defiency is most likely in “frequent neisseria infections”

A

C5, C6, C7, C8, C9

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58
Q

Which complement defiency is most likely in “frequent pyogenic respiratory tract infections” HI or strep pneumonia

A

C3

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59
Q

Which complement defiency is most common in “paroxysmal nocturnal hemoglobinuria”

A

CD55 , CD59 DAF

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60
Q

Which complement defiency is most likely in “increased frequency of type III hypersensitivity reaction”

A

C3

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61
Q

What viral illness is associated with Burkett lymphoma? Is Burkett lymphoma a neoplasm of mature T or B cells

A

EBV

B cell lymphoma

T-periarterial lymphatic sheath and white pulp

B white pulp

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62
Q

Where are T cells found in the spleen? Where are B cells found in the spleen

A

Ok

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63
Q

In which lobe of brain is “brocas” speech

A

Motor control speech

Frontal (inferior frontal gyrus)

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64
Q

Which lobe is wernickes “speech comprehension”

A

What lobe is primary auditory cortex(temporal)

Posterior part of superior temporal gyrus

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65
Q

What lobe is principal visual cortex

A

Occipital lobe

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66
Q

What lobe is primary sensory cortex

A

Most anterior part of parietal lobe

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67
Q

What lobe is primary motor cortec

A

Just anterior to central sulcus most posterior part of frontal lobe

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68
Q

What lobe is premotor cortex

A

Frontal lobe just anterior to primary motor cortex

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69
Q

Which neoplasm most common for ACTH paraneoplastic->cushing

A

Small cell carcinoma, carcinoid

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70
Q

Which neoplasm most common for PTH related peptide->hypercalcemia

A

Squamous cell carcinoma lung

Also other squamous cell and renal cell carcinoma and breast cancer

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71
Q

Which neoplasm most common for epo->polycythemia

A

Pheochromocytoma, renal cell carcinoma, hepatocellular carcinoma, hemangioblastomas

Possibly really high hematocrit

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72
Q

Which neoplasm most common for ADH->SIADH

A

Small cell lung cancer

Also any intracranial thing

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73
Q

In which pulmonary disease would you see na increased Reid index

A

50% in COPD and chronic bronchitis

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74
Q

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

A

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

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75
Q

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

A

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

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76
Q

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

A

21 a hydroxylase

Decreased aldosterone and cortisol increased sex hormone

Hypotension
Volume depletion
Hyperkalemia
Masculanizinging effect in female from increased androgens

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77
Q

MOA scopolamine

A

Anticholinergic drug, an antagonist of M1 muscarinic receptors

Motion sickness sea sickness transdermal patch behind ear

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78
Q

MOA promethazine

A

Antagonist of histamine receptors and D2 dopamine receptors

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79
Q

MOA prochlorperazine

A

Also phenothiazine, blocks d2

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80
Q

MOA metoclopramide

A

D2 antagonist

Often prokinetic to spread up gi tract when diabetic gastroparesis

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81
Q

MOA ondansetron

A

Serotonin receptos antagonist 5-ht3 receptos

Nausea and morning sickness if severe

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82
Q

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

A

Olivocochlear bundles from superior olive to cochlea

Get contraction OHC and stiffening basilar membrane in cochlea to sensitize inner hair cells to frequency

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83
Q

What is the result of damaging outer hair cells (gentamicin and streptomycin)

A

Wide deflection of basilar membrane so get hearing loss

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84
Q

Risk factors for osteosarcoma

A 
Bone infarcts
Radiation
Paget disease
Familial retinoblastoma (Rb)
Male
10-20
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85
Q

What conditions are associated with oligohydramnios and what conditions are associated with polyhydramnios? What is potter sequence

A

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
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86
Q

MOA strychnine

A

Glycine antagonist

-important inhibitory in spinal cord, block inhibitory function wide spread muscle spasm and asphyxia

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87
Q

MOA tetanus toxin

A

Bind inhibitory cells rinshaw which release glycine and gaba

Block get muscle spasm and tetanus

blocks inhibitor function of glycine and gaba

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88
Q

MOA black widow spider toxin

A

Accessible release Ach muscle cramp pain

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89
Q

MOA botulinum toxin

A

Inhibits release of ach and the neuromuscular junction

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90
Q

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`

A

Roseola from HHV6

Sudden high fever for several days and diffuse macular rash as fever resolves

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91
Q

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

A

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

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92
Q

Meds for adHD

A

Stimulants methylphenidate
Dextroamphetamine

Atomoxetine -selective NE reuptake inhibitor

If insomnia then clonidine

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93
Q

MOA methylphenidate?

A

Indirect sympathomimetics

Release stored catecholamines

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94
Q

Signs of intoxication of amphetamine

A

Stimulants
-mood elevation, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety

Amphetamine
Impaired judgement, pupil dilation, prolongation wakefulness and attention, delusions, hallucinations fever

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95
Q

When implantation

A

Day 6

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96
Q

When organogenesis

A

3-8

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97
Q

When heart beat

A

Week 4

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98
Q

When see male and female genitalia

A

Week 10

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99
Q

When gastrulation

A

3 weeks

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100
Q

When form primitive streak and neural plate

A

3-4 week

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101
Q

Pediatric patient right flank mass. Mother also reports blood in urine. What malignancy would be most likely . What is wagr

A

Wilms tumor(nephroblastoma)

2-4 yo with flank mass and hematuria

WAGR-wilms, aniridia, genitourinary malfornation, mental motor retardation, WT1 tumor suppressor deletion

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102
Q

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

A

Rationalization

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103
Q

What is the composition of a nucleosome? Which histone ties nucleosome together

A

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

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104
Q

Which complement protein is an opsonin? Which complement protein aids in neutrophil chemotaxis? Which complement proteins form the membrane attack complex

A

C3b (also igg)

C5a

C5b-C9

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105
Q

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

A

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

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106
Q

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

A

-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)

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107
Q

What is the initial medical treatment for the arrhythmia know as torsades de pointes

A

Ventricular arrhythmia sinusoidal pattern of wide QRS pattern

IV Mg sulfate rapid

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108
Q

Urge def and cause

A

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

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109
Q

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
A

Overflow

Urinary incontinence due to incomplete bladde emptying

Bladder outlet obstruction , neurogenic detruser contractility
Can palpate bladder

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110
Q

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

A

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

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111
Q

What enzymes do obligate anaerobes lack

A

Catalase (breaks down H2O2 to form water and oxygen) and/or superoxide dismutase( oxygen radials to water and H2O2)

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112
Q

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

A

Incomplete fusion of the paramesonephric ducts cause bicornate uterus

Fallopian tubes, uterus, upper portion of vagina

Mullerian

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113
Q

What organism causes Hansen disease? What animal serves as a Respir for this organism in the US? Where int he body does it live

A

Leprosy

Mycobacterium leprae

Armadillo

Skin and superficial nerves-warm spot

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114
Q

What is BNP, and how is it useful in cases of heart failrue?

A

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)

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115
Q

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

A

A1 antagnoist
-terazosin, prazosin, doxazosin

BPH-symmetric smooth enlarged

Adenocarcinoma-asymmetric with hard nodule

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116
Q

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

A

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

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117
Q

Des

A

Outer deeming, darts fascia, deep bucks fascia , two dorsolateral corpora cavernosa and one corpus spongiosum , then urethra in surplus spongiosum

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118
Q

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

A

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

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119
Q

What is PPAR-y? How is it relevant to the treatment of DM

A

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

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120
Q

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

A

Chronic rejection

T cell and antibody mediated vascular damage

Obliterating vascular fibrosis

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121
Q

What are the effects of stimulating the amygdala

A

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

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122
Q

From where does the amygdala receive input? To where does it send output

A

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

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123
Q

What anatomical structure in hematoma formation as a sequela of vulvar trauma?

A

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

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124
Q

What are some of the reasons a woman might have primary amenorrhea?

A

Secondary if had kid

Primary never before
Turner, imperforate hymen, androgen insensitivity syndrome, Müllerian duct agenesis, delayed puberty

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125
Q

What is the underlying cause of digeorge? What are the manifestations of digeorge

A

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)

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126
Q

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.

A

Kallmann syndrome
Amos is an dhypogonadism
-decrease synthesis gnrh in hypothalamus , lack of secondary sexual characteristics

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127
Q

Describe the flow of blood into and out of thyroid gland?

A

External carotid artery->superior thyroid artery

Thyrocervical trunk->inferior thyroid artery

Superior thyroid middle and inferior thyroid vein.

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128
Q

A 30 year old man is at an inpatient facility for opioid addiction. What symptoms might this patient experience while discontinuing opioids>

A

Tremor chills, muscle and bone pain, perspiration, flu like, yawning, vomit, diarrhea, restless leg syndrome

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129
Q

In performing a lumbar puncture to obtain a sample of csf , what structures are pierced, starting with the most exterior

A

Skin, superficial fascia, supraspinatus interspinous ligament

Ligamentum flavor

Epidural space

Dura matter

Subdural space

Arachnoid matter

Subarachnoid space

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130
Q

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

A

Prophase

Metaphase

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131
Q

What are some of the signs and symptoms of pericarditis

A

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

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132
Q

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

A

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

133
Q

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

A

Infliximab, adalimumab, sertolizumab

134
Q

What is cholesteatoma, and how does it present

A

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

135
Q

Preventative vaccines have been developed for which encapsulated bacteria? What test can be used to detect encapsulated bacteria

A

Neisseria meningitidis

Strep pneumonia

HI type B

——add a serum that contains anticapsular antibodies and look for quallung reaction (swelling)

136
Q

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

A

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

137
Q

What are the carpal bones of the wrist

A

Ok

138
Q

Breast pathology most common tumor in women under 25

A

Fibroadenoma

139
Q

Breast path most commmon breast mass in postmenopausal women

A

Invasive ductal carcinoma

140
Q

Breast path most common breast mass in premenopausal women

A

Fibrocystic change of the breast

141
Q

Breast path most common form of breast cancer

A

Invasive ductal carcinoma

142
Q

Which diuretics are most appropriate for patients with hyperaldosteronism? What are their important side effects

A

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

143
Q

What structure gives rise to the bbb

A

Tight junction

BM

Astrocytes foot processes

144
Q

What physiology accounts for the automaticity of the AE and sa nodes

A

Gradually increasing Na channel conductance

Slow spontaneous depolarization during diastole

When the threshold is reached, an action potential is generated

145
Q

What is p value what is an acceptable p value

A

Probability that the study results occurred by chance alone

146
Q

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

A

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

147
Q

Which antifungal drug causes gynecomastia and by what mechanism? Which diuretic causes gynecomastia and ya what mechanism

A

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

148
Q

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

A

Precontemplation

149
Q

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

A

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

150
Q

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?

A

Genetic, febrile from infection, trauma, metabolic

Brayan tumor, trauma, stroke, infection

Stroke, brain tumor, trauma, metabolic (hyponatremia), infection

151
Q

What are the adverse reactions of exogenous testosterone in males

A

Premature puberty

Premature closure of epiphyseal plate, erythrocytosis,

Worsening of sleep apnea

Suppression of spermatogenesis

Increases ldl decrease HDL

152
Q

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

A

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

153
Q

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

A

Skin cancer
-melanoma, basal cell carcinoma, squamous cell carcinoma

Nucleotide excision repair

154
Q

Anterior arm dislocation:

Arm position, neuromuscular compromise, classic scenario, PE

A

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

155
Q

Posterior shoulder dislocation: arm position, neuromuscular compromise, classic scenario, PE

A

Internal rotation
Addiction
Unable to external rotate

No neurovasc comp

Seizure, electrocution

Bulge in posterior shoulder

Anterior shoulder flat

156
Q

Hippaa

A

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

157
Q

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

A

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

158
Q

Which area of the brain is damaged in kluver bucy syndrome. What are symptoms

A

Amygdala damaged bl

Herpes simplex 1 encephalitis causes it

Hypersexuality and disinhibited behavior, hyperorality, extreme curiosity, forget things, sex drive up with disinhibition dangerous

159
Q

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

A

Long thoracic nerve

Winged scapula stick out at back

160
Q

Long term complication is associated with having to receive multiple blood transfusions

A

Iron overload
Sickle cell patient are anemic and get transfusion getting more iron.

Iron overload can cause hemosiderosis, hemochromatosis

161
Q

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

A
  • 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
162
Q

A mutation in which protooncogene is most commonly associated with hirschsprung

A

RET gene mutation

Help ncc move through digestive tract through embryo

163
Q

How do primary and secondary hyperaldosteronism differ in their effect on plasma renin levels? What agent is used to treat primary hyperaldosteronism

A

Primary-decrease renin by neg feedback

Secondary-high plasma renin

K sparing diuretic spironolactone

164
Q

G cell

A

Gastrin

Antrum of stomach

165
Q

I cell

A

Cck in duodenum and jejunum

166
Q

S cell

A

Oksecretin duodenum

167
Q

D cell

A

Somatostatin

Pancreatic islet

168
Q

Parietal cell

A

Stomach

Gastric acid and IF

169
Q

Chief cells

A

Pepsinogen

170
Q

What are the most common locations of lung cancer metastases

A

Liver obesity adrenal glands brain

171
Q

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

A

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

172
Q

In a 30 year old Asian woman, what signs ANS symptoms would be suggestive of takayasu arteritis

A

Vasculitis effects aorta and bridged (arms and carotid)

Light headedness, vision problems, claudication in arms, diminished pulse in arms

THE PULSELESS DISEASE

173
Q

A 6 yo bo is receiving poor grades in school. He has normal intelligence but is distractabl. What meds

A

ADHD
Methylphenidate and amphenidate
Atomoxetine
Behavioral intervention

By age 12 and need symptoms in 2 settings

174
Q

If strolevolume determines CO and contractibility determines stroke volume, what determines contractility

A

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

175
Q

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

A

Nonsmokers
Bronchial adenocarcinoma
Bronchioalveolar adenocarcinoma
Malignant mesothelioma

Smokers
Scc (central)
Squamous cell (central)

176
Q

What are the common causes of erb ducheye alsy? Where is the brachial plexus insult with era du henna palsy

A

C5-c6 traction or tear

Paralysis of abductors rotator and supination

Blow to shoulder or child birth trauma

177
Q

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

A

Prominent anticholinergic side effects-delirium, confusion, urinary retention,

Disrupts normal sleep architecture

178
Q

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

A

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

179
Q

What converts homocysteine to cystathionine

A

Cystathionine synthase and B6

180
Q

What does cystathionine become

A

Cysteine

181
Q

How does homocysteine become methionine

A

Homocysteine methyltransferase and B12

182
Q

How does methionine become homocysteine

A

With ATP to become SAM then lose CH3 with phosphocreatine to epinephrine and get homocysteine

183
Q

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

A

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

184
Q

Which drugs are known to cause aplastic anemia? What is the treatment for aplastic anemia?

A

Anti cancer drugs

Chloramphenicol

NSAIDS

Propylthiouracil

Methimazole

Stop, replace rbc/platelets, G-CSF raise white count, bone marrow transplant

185
Q

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?

A

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

186
Q

Which cancers can cause the paraneoplastic syndrome, lambert Eaton?

A

Small cell lung cancer

Hodgkin lymphomamalignant thymoma

187
Q

What is conductive hearing loss, and what are some causes?

A

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

188
Q

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

A

Transitional cell carcinoma

Painless hematuria

Smoking, aniline dyes, phenacetin, cyclophosphamide

189
Q

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?

A

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

190
Q

How does a decrease in renal artery pressure cause an increase in bp?

A

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

191
Q

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

A

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

192
Q

What is type II B error

A

Study results demonstrate no difference between 2 groups when a difference exists.

Type I-rejection of a true null hypothesis

193
Q

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?

A

Polio virus

Replicates in oropharynx and hematogenous spread to CNS where desctory anterior horn spinal cord…lower motor neuron issues

194
Q

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?

A

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

195
Q

What condition may occur if a monoamine oxidase inhibitor is given to a patient already taking SSRI? What is the treatment for this condition

A

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

196
Q

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?

A

Permanently inhibit COX1 and COX2->less production of thromboxane a2->less platelet aggregation/thrombosis

=thromboxane a2 stimulates platelet aggregation, prostacyclin inhibits platelet aggregation

197
Q

Which GI filament” ligaments that separate the greater and lesser sacs

A

Gastrohepatic and gastrosplenic ligament

198
Q

May be cut during surgery to access the lesser sac

A

Gastrohepatic ligament

199
Q

2 ligaments that connect the spleen to other structures

A

Splenorenal, gastrosplenic

200
Q

Contains the portal triad

A

Hepatoduodenal ligament

201
Q

Connects the liver to the anterior abdominal wall

A

Falciform

202
Q

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?

A

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

203
Q

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?

A

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,

204
Q

What are the jones criteria for the diagnosis of acute rheumatic fever

A

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

205
Q

MOA pralidoxime

A

Regenerates cholinesterase

206
Q

MOA neostigmine

A

Cholinesterase inhibitor

207
Q

MOA bethanechol

A

Direct cholinergic agonist

208
Q

MOA hexamethonium

A

Nicotonic ach receptor antagonist

209
Q

MOA atropine

A

Muscarinic antagonist

210
Q

MOA carbachol

A

Muscarinic agonist

211
Q

Which glycogen storage disease has severe hypoglycemia with elevated blood lactate

A

Von fierce disease (type I)

212
Q

Which glycogen storage disease has hypoglycemia without elevated blood lactate

A

Cori disease (type III)

213
Q

Which glycogen storage disease has cardiomegaly

A

Pompe disease (type II)

214
Q

Which glycogen storage disease has myoglobinuria associated with exercise

A

Mcardle disease (type IV)

215
Q

Treatment for pulmonary embolism

A

IV heparin or LMWH (enoxaparin) activate antithrombin to haunt clot progression

If HIT can use lepirudin or bivalirudin which directly inhibit thrombin

216
Q

What is the mechanism of action of penicillin? Is it a bacteriostatic or bactericidal antibiotic?

A

Blocks synthesis of bacterial cell wall inhibit cross linking peptidyl glycans

Bactercidal

217
Q

What is the adult remnant gubernaculum

A

Ovarian ligament and round ligament of uterus

218
Q

Adult remnant processus vaginalis male

A

Tunica vaginalis

219
Q

Foramen ovale

A

Fossa ovalis

220
Q

Notochord

A

Nucleus pulposus

221
Q

For what conditions is hyperbaric oxygen therapy particularly helpful

A

Severe CO poisoning

Decompression sickness

Arterial gas emboli

Gas gangrene (clostridium perfringens)

Osteomyelititis acute MI

222
Q

What is the pressure in the potential spaces of the body including the pleural cavity, the joint spaces, and pericardial cavity?

A

Negative facilitate fluid into spaces

Pleural -7 -8 cmH20

  • 3 -5 cm h20
  • 5 -6 cm h20
223
Q

Which anatomic structures are found in the retroperitoneum

A

Sad pucker

Suprarenal
Aorta and ivc
Duodenum 
Pancrease not tail
Ureters
Colon
Kidney
Esophagus
Rectum
224
Q

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

A

Thumb on middle third of clavicle and finger on top jugular notch and insert medially aim under thumb to tip of finger

225
Q

What is the mechanism of action of glucagon like peptide 1 agonist

A

Exenatide
Liraglutide

Acts to increase glucose dependent insulin release and decrease glucagon release
Delay gastric empty

Loose weight

Liraglutide-weight loss

226
Q

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

A

Short, dental carries, scabies

Long term-poor msucle tone, poor language socialization, lack of eye contact, weight loss, failure to thrive

227
Q

Diagram the pathway by which cochlea communicates a signal to the primary auditory cortex

A

Cell body of spiral ganglia->cochlear nuclear->contralateral superior olivary nucleus->lateral lemniscus->inferior colliculus->medial geniculate body->primary auditory cortex

228
Q

Metastasis to brain from where

A 
Lung 
Breast
Skin
Kidney
GI
229
Q

Metastasis to liver from where

A

Colon stomach pancrease breast lung

230
Q

Metastasis to bone from where

A

Prostate
Thyroid testes
Breast lung kidney

231
Q

What pulmonary artery pressures indicate pulmonary HTN

A

> 25 mmHg at rest

232
Q

What is the difference between malingering and fictitious disorder

A

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

233
Q

What are the three endogenous androgens in order from the most potent to the least potent

A

DHT>T>A

T and A can be turned to E by fat

234
Q

What is Osler Weber tendu syndrome

A

Hereditary hemorrhagic telangiectasia

Autosomal dominant disorder
Causes telangiectasia in the skin and mucous membranes and possibly in organs

High output heart failure

235
Q

What is the fibrous band attached to the testis and scrotum that aids in normal testicular descent what is this structure called in females

A

Gubernaculum

Ovarian ligament and round ligament of uterus

236
Q

What disorders can cause cotton wool spots on the retina

A

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)

237
Q

Which cardiac valve is most commonly involved in infective endocarditis and acute rheumatic fever

A

Mitral valve

IV drug users get tricuspid

238
Q

What are the early cyanosis heart disease? What are the late cyanosis heart disease?

A

Early-5T persistent truncus arterious

Transposition of great vessel

Tricuspid atresia

TOF
Total anomalous pulmonary venous return

Late-atrial septal defect, vsd, pda

239
Q

How does standard deviation differ from standard error of the mean?

Which one is used inc accusations confidence intervals

A

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

240
Q

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

A

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

241
Q

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

A

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

242
Q

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

A

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

243
Q

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

A

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

244
Q

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

A

HMO

245
Q

SET 18

6. What does a patient’s life expectancy have to be in order to qualify for hospice care

A

Less than 6 months but if physician wrong patient can stills tay as long as estimated continues to be less

246
Q
  1. What are the componets of metabolic syndrome
A

3 of 5

Waist circumference
Tb
Hdl
Blood pressure
Fasting serum glucose
247
Q
  1. What medications are commonly used in the treatment of hyperemesis gravidarum
A 
IV fluids
Vitamin B6
Ginger 
Doxylamine
Phenergan
Metoclopramide
Promethazine
Ondasetron
248
Q
  1. What condition is commonly referred to as housemaid’s knee? What condition is commonly
    referred to as clergyman’s knee
A

Prepatellar bursitis

Infrapatellar brusitis

249
Q

What organisms are the most common cause of uncomplicated UTI cystitis

A

E. coli klebsiella

Proteus m

Staph saphrophyticus

250
Q

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?

A

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

251
Q

What ratio indicates fetal lung maturity? What is the name for the main component of pulmonary surfactant

A

2:1 lecithin sphingomyelin ratio

Dipalmitoylphosphatidylcholine

252
Q

Which nutrient defiency is associated with spooning of the nails (koilonychia)

A

Iron defiency

Clubbing-oxygen deprivation

253
Q

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

A

Mullerian inhibitory factor

Inhibits paramesonephric/Müllerian ducts to become Fallopian tubes, uterus, proximal vagina

254
Q

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

A

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!

255
Q

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?

A

Distal 1/3inferior mesenteric artery

Proximal 2/3Superior mesenteric artery

Distal 1/3 hindgut

Proximal 2/3 midgut

256
Q

What anticonvulsants are used to treat absence seizure? What anticonvulsants are for status epilepticus

A

Ethosuximide-FIRST LINE
Valproic acid

  1. Break seizure acute with benzodiazepines (lorazepam, diazepam)
    2phenytoin/fosphenytoin to prevent
257
Q

Where would you expect to find B cells in a lymph nodes? Where are T cells, plasma cells and macrophages

A

B cortex follicles

T cells paracortex

Plasma cells medullary chord

Macrophages medullary sinus

258
Q

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

A

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

259
Q

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

A

Navl

Nerve artery vein lymphatics

260
Q

What is the clinical presentation of plantar fasciitis

A

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

261
Q

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

A

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

262
Q

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

A

TH1- IL2 and IFNy

4,5,6,10,13

263
Q

Which diuretics lower serum ca? What is the mechanism by which these cause hypocalcemia

A

Loop diuretics

Loops loose calcium thiazides contain

Block nak2cl loose electrochemical gradient reduce ca reabsorption loss in urine hypocalcemia kidney stone

264
Q

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?

A

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

265
Q

Name the syndromes that cause elevated cortisol and central obesity

A

Cushing

Common anovulation

266
Q

Name syndrome causes amenorrhea and hirsutism and obesity

A

PCOS

Amenorrhea

267
Q

Which NT schizophrenia

A

Increase dopamine in mesolimibic pathway

268
Q

Which NT parkinson

A

Decrease dopamine in substantia nigra
Decrease serotonin
Increase ach

269
Q

Which NT Alzheimer’s

A

Decrease ach

270
Q

Which NT huntington

A

Decrease gaba ach

Increase dopamine

271
Q

Which NT anxietyincrease NE

A

Decrease GABA and serotonin

SSRI

272
Q

Which NT depression

A

Decrease NE, serotonin dopamine

SSRI

273
Q
  1. 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
A

Howell jolly bodies-basophils nuclear remnants in some cells

If spleen gone see this

HI, pneumococcal, meningitis, salmonella, klebsiella

HI, pneumococcal, meningitis

274
Q

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

A

Lose phase I reactions first

Phase I -oxidation eduction hydrolysis by P450

275
Q

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

A

Specific gravity <1.006

Urine osmolality low

Can’t concentrate uring

Serum osmolality>290

276
Q

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

A

Liver Vd to 25 oh Vd (calcidiol)

Kidney to 125 OH2 vd calcitriol

Vd stimulate calcium a p absorption from gut for bones l

277
Q

What is compartment syndrome and how treated

A

Injury to leg traum aburn or exercise tissue swell

Increase pressure in fascial compartment

Fasciotomy

278
Q

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

A

Glut4 insulin dependent

279
Q
  1. Which cell types do not require insulin for the uptake of glucose
A

Brain rbc intestines cornea kidney liver

280
Q

Does the notochord become the neural tube

A

No derived from mesoderm neural tissue comes from ectoderm but induced it

281
Q
  1. What is the cause of hypertrophic cardiomyopathy
A

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

282
Q

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?

A

Inferior mesenteric problem

No but uti, and blocks

283
Q
  1. 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?
A

Menopausal symptoms from lack of estrogen

Patient getting estrogen in ocp

Hot flash, sleep disturbance, vaginal atrophy dryness, increased risk osteoporosis, CVD disease stroke

284
Q

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

A

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

285
Q
  1. 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”
A

Enterotoxigenic E. coli watery diarrhea toxins no blood

286
Q
  1. 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
A

Prevent platelet aggregation irreversibly blocking adp receptors not he platelets

287
Q
  1. Which bacteria are known for being obligate intracellular bacteria
A

Rickettsia
Chlamydia
Coxiella burnetti

288
Q

What is the equation for determining a drug’s clearance

A

.7xVd/t(1/2)

289
Q

The protein derived from what gene serves as a transcription factor for the development and function of regulatory T cells?
(R p784)

A

FOXP3 on X chromosome encodes forehead box protein p3

For treg

Absence in autoimmune
Mutation IPEX

290
Q

. What are the causes of iatrogenic Creutzfeldt-Jakob disease (CJD)? What measures can be taken to avoid iatrogenic CJD

A

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

291
Q

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

A

Helper T cells

Cytotoxic T cells-kill foreign from a transplant donor

292
Q

Female homologous to corpus spongiform

A

Vestibular bulbs

293
Q

Female homologous to coppers glands (bulbourethral glands)

A

Bartholin glands (vestibular glands)

294
Q

Female homologous to prostate

A

Urethral and paraurethral glands

295
Q

Gland penis

A

Clit

296
Q

Ventral pencils shaft

A

Labia minora

297
Q

Scrotum

A

Labia majora

298
Q

Which aa for purine

A

Glycine
Aspartate
Glutamine

299
Q

What is difference between promoter and enhancer region

A

Promoter-site on DNA where RNA polymerase and other transcription facrots bind

Enhancer-sequence of DNA that enhances gene expression by binding transcription factors

300
Q

What abnormal lab values would lead you to suspect alcoholic hepatitis

A

AST>alt

Ggt

301
Q

The body uses both the cell-mediated and the humoral immune system to fight infection. Which T cell type regulates the humoral response

A

T helper 2 cells make il4 and 5 to promote growth and diff B cells

T1 cell mediated cytotoxic il2 and IFNy

302
Q
  1. 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
A

Squamous cell carcinoma

303
Q

hat is syringomyelia? What symptoms are commonly seen in patients with syringomyelia?

A

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

304
Q

hat potentially fatal autoimmune skin disorder is caused by IgG antibodies against desmosomes? What is the difference between a desmosome and a hemidesmosome

A

Pemphigus vulgaris

Desmosome-cell to other cel
Hemidesmosome -epithelial to bm (bulbous pemphigus )

305
Q
  1. What is the classic presentation of granuloma annulare
A

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

306
Q

60-year-old man comes to the physician for sexual dysfunction. What is the differential diagnosis? What drugs are known for causing sexual dysfunction

A 
Hormonal disturbances ow T hyperprolactinemia
Depression
Diabetes
Psychological 
Meds ——neuroleptic, SSRI, ethanol,
307
Q

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

A

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

308
Q

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

A

Advance directive

Living will

309
Q

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

A

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

310
Q
  1. 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
A

IFfrom parietal cells

Absorbed in terminal ileum

311
Q

. Which type of lymphoma is identical to chronic lymphocytic leukemia (CLL) ?

A

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)

312
Q

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

A

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

313
Q
  1. What are the common causes of metabolic acidosis with an elevated anion gap?
    (FA18 p576) (FA19 p580) (SU p150)
A

MUDPILES

314
Q

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

A

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

315
Q

Asthma exacerbation ok

A

1

316
Q

Poison ivy dermatitis

A

4

317
Q

Good pasture

A

2 with autoantibodies

318
Q

Arthus

A

3

319
Q

Anaphylaxis

A

1

320
Q

Serum sickness

A

III

321
Q

Autoimmune hemolytic anemia

A

II

322
Q

Liver transplant rejection

A

Liver transplant rejection

323
Q

Rh incompatibility

A

Rh incompatibility (erythroblastosis fetalis)

324
Q

Tb

A

IV

325
Q

67 yo man treated with leuprolide for prostate cancer. What is MOA

A

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

326
Q

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

A 
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)

327
Q
  1. 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
A

Clozapine (atypical antipsychotics) causes agranulocytosis

If take it monitor absolute neutrophil count weekly for 6 months

328
Q

. What are the most common manifestations of Zika virus infection? What are the most worrisome complications of Zika virus infecti

A 
Low grade fever
Pruritis rash
Joint pains in hand feet
Nonpurluenct conjucntivitis
Myalgia and ha

Congenital microcephaly or miscarriage*

329
Q

. What are the roles of ghrelin and leptin in appetite regulation

A

Peptide hormone produced by stomach stimulated hunger and release GH
Hormone produced by adipose tissue mediates satiety

Pathology (36 decks)

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