Failure to Thrive

Question 1

on gel electrophoresis, M spike represent overproduction of […]

Answer 1

Monoclonal Ig

Starr: “monoclonal spike = monoclonal protein when talking about SPEP”

Question 2

what would you expect to see on bone marrow biopsy in multiple myeloma?

Answer 2

clusters of plasma cells with clock face chromatin
intracytoplasmic Ig inclusions

Starr: “Recognize eccentric nucleus of a plasma cell.”

Question 3

You will get a vignette of multiple myeloma with two clonal spikes: recognize that […] could occur within a clonal line, causing this phenomenon

Answer 3

switching

Question 4

Would the rough Endoplasmic reticulum be active in Multiple Myeloma?

Answer 4

Yes - extensive synthesis of monoclonal proteins

Question 5

what is the role of NF-kB?

Answer 5

transcription of pro-inflammatory mediatiors

TNF, IL-1, IL-6

Question 6

what drugs inhibit NF-kB?

Answer 6

glucocorticoids

Question 7

CRAB criteria for multiple myeloma

Answer 7

hyperCalcemia
Renal insufficiency
Anemia
Bone lytic lesions

Question 8

Osteolytic lesions will have less bone appearing […] on x-ray or CT in multiple myeloma.

Answer 8

darker

Question 9

MOA: Reversibly inhibits cyclooxygenase, mainly in the CNS

Answer 9

acetaminophen

Question 10

MOA of hydrochlorothiazide

Answer 10

inhibit NaCl reabsorption in the early DCT

Question 11

adverse effects of thiazide diuretics

Answer 11

hyperGLUC

hyperglycemia
hyperlipidemia
hyperuricemia –> uric acid stones
hypercalcemia

Question 12

MOA of furosemide

Answer 12

loop diuretic
inhibit NKCC channels of thick ascending loop of Henle

Question 13

MOA of fluoxetine

Answer 13

SSRI
inhibit serotonin reuptake at the 5-HT receptors

Question 14

the more common use for this drug is peripheral neuropathy, although it is an effective anti-epileptic, and is used in alcohol withdrawal and abstinence therapy

Answer 14

Gabapentin

Question 15

Gabapentin blocks […] channels

Answer 15

Ca2+

Question 16

What would DKA look like on an arrow pushing table

pH:
PCO2:
HC03-:

Answer 16

pH: low
pCO2: low
HCO3-: low

(MUDPILES: anion gap acidosis)
(respiratory compensation occurs very quickly)

Question 17

MOA: irreversibly blocks COX, downregulating TXA2 release

Answer 17

aspirin

Question 18

MOA: Inhibition of P2Y12 receptor on platelets (ADP receptor) → ↓ expression of Gp IIb/IIIa receptors on platelets → inhibition of platelet aggregation

Answer 18

Clopidogrel

Question 19

MOA of losartan

Answer 19

ARB

angiotensin receptor blocker

Question 20

MOA of atorvastatin

Answer 20

HMG coA reductase inhibitor

unable to convert HMG-CoA to mevalonate (the rate-limiting step of cholesterol synthesis) → reduced intrahepatic cholesterol biosynthesis → upregulation of expression of LDL receptor gene via sterol regulatory element-binding protein (SREBP) → increased LDL recycling

Question 21

MOA of omeprazole

Answer 21

Irreversible inhibition of H+/K+ATPase in parietal cells → increases stomach pH

Question 22

Do not treat […] with verapamil or clonidine as first line therapy

Answer 22

hypertension

Question 23

the buzzword when looking at a biopsy of hemochromatosis is […]

Answer 23

Prussian blue

Question 24

dietary iron is absorbed in the […]

Answer 24

duodenum

Question 25

[...] transports iron in the blood

Answer 25

transferrin

Question 26

[...] is the primary iron storage protein of the body

Answer 26

ferritin

Question 27

The enzyme [...] decreases intestinal absorption of iron by inhibiting ferroportin

Answer 27

hepcidin (upregulated in inflammatory states --> anemia of chronic disease)

Question 28

[...] transports ferrous iron (Fe 2+) from the enterocytes to the bloodstream.

Answer 28

Ferroportin

Question 29

describe the absoprtion of non-heme iron

Answer 29

1. ascorbate ferrireductase reduces non-heme iron Fe3+ to Fe2+ 2. DMT cotransports Fe2+ with H+ 3. Fe2+ transfers to mobilferrin 4. Fe2+ leaves cell via ferroportin and hephaestin oxidizes it to Fe3+ 5. iron binds to transferrin in plasma

Question 30

why does hephaestin oxidize Fe2+ to Fe3+ ?

Answer 30

keeps it in interstitial space allowing it to bind to transferrin

Question 31

describe the absoprtion of heme iron in the duodenum

Answer 31

1. Heme Fe2+ enters cell (unknown mechanism) 2. Fe2+ transfers to mobilferrin 3. Fe2+ leaves cell via ferroportin and hephaestin oxidizes it to Fe3+ 4. iron binds to transferrin in plasma

Question 32

[...] transports non-heme iron into the enterocyte

Answer 32

DMT-1

Question 33

patients with hemochromatosis are at an increased risk for developing

Answer 33

cirrhosis HCC restrictive cardiomyopathy

Question 34

Plasma [...] is a marker of total body iron stores

Answer 34

ferritin

Question 35

A liver biopsy showing macrophages with cytoplasmic granules that stain golden-yellow with hematoxylin describes [...] deposits.

Answer 35

hemosiderin (due to chronic iron overload)

Question 36

In [...], the HFE gene is mutated; this leads to defective binding of transferrin to its receptor, which signals decreased iron stores

Answer 36

hemochromatosis (liver stops producing hepcidin)

Question 37

seen on peripheral blood smear in MM

Answer 37

rouleux formation

Question 38

MM can cause foamy urine due to [...] proteinuria

Answer 38

light chain (Bence Jones proteins)

Question 39

plasma cell dyscrasia characterized by abnormal proliferation of terminally differentiated B cells that produce monoclonal IgM antibodies

Answer 39

Waldenstrom macroglobulinemia

Question 40

[...] acting insulins do not produce an observable peak in serum insulin concentration

Answer 40

long (glargine)

Question 41

high doses of [...] especially in patients with underlying renal insufficiency, carry a risk of sensorineural hearing loss

Answer 41

loop diuretics

Question 42

what HTN med can be used in the setting of osteoporosis to increase Ca reabsorption?

Answer 42

thiazide diuretic

Question 43

enhances bicarbonate elimination in the proximal convoluted tubule

Answer 43

acetazolamide (used to treat altitude sickness)

Question 44

what HTN medication can cause gynecomastia?

Answer 44

spironolactone

Question 45

ACE inhibitors inhibit [...] arteriole constriction

Answer 45

efferent (decrease GFR)

Question 46

used for the treatment of stable angina pectoris in patients with aspirin allergy as well as adjunctive therapy in acute coronary syndromes

Answer 46

clopidogrel (patient develops signs of acute asthmatic attack (wheezing, dyspnea) shortly after initiating therapy with aspirin)

Question 47

most common adverse effect of aspirin

Answer 47

GI bleed

Question 48

oral ulcers, sore throat, fever, and a low neutrophil count following initiation of a new medication

Answer 48

drug induced neutropenia

Question 49

key mediator of platelet-induced coronary artery stenosis and thrombosis

Answer 49

TXA2