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1
Q

Brain structure responsible for extraocular movements during REM?

A

PPRF, paramedian pontine reticular formation

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2
Q

Name teratogens

A 
ACE inhibitors (renal)
Valproate (neural tube)
Phenytoin (cleft palate, heart defects)
Lithium (Ebstein anamoly)
Tetracycline (discolored teeth)
Warfarin (hemorrhage, abortion -- use heparin!)
Excessive Vitamin A (abortion)
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3
Q

Which parts of the hypothalamus regulates ANS?

A 
anterior = para
posterior = symp
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4
Q

Bells Palsy vs. Stroke

A

Bells involves the forehead

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5
Q

Muscles of mastication

A

Masseter, temporalis, medial and lateral pterygoid

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6
Q

Horner Syndrome symptoms

A

Ptosis, miosis, and anhidrosis

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7
Q

Thyroglossal duct cyst presentation

A
  • midline neck mass
  • asymptomatic
  • ## moves with swallowing
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8
Q

Elevated ESR associated with…

A

infection, inflammation, neoplasm, RA, temporal artertits, osteomyolitis, polymyalgia rheumatica

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9
Q

Tiotropium used for

A

COPD (inhaled anticholinergic)

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10
Q

Competitive vs noncompetitive inhibitor

A

Competitive: binds active site, can be diluted out
Noncompetitive: binds elsewhere, renders inactive, irreversible

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11
Q

Km =?

A

[S] at 1/2 Vmax

related to affinity, not quantity

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12
Q

How can you increase Vmax?

A

By increasing the number of enzymes

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13
Q

Therapeutic Index = ?

A

LD50/ED50
higher is safer
low TI = seizure drugs, lithium, digoxin, warfirin

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14
Q

Vd = ?

A

D/C

iv drug/concentration of drug in plasma

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15
Q

CL = ?

A

rate of elimination/plasma concentration = (0.7)Vd/half life = K*Vd

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16
Q

LD = ?

A

Css * Vd

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17
Q

MD = ?

A

Css * CL

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18
Q

Half-life %

A 
1 = 50%
2 = 75%
3 = 87.5%
4 = 94%
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19
Q

Efficacy = ?

A

max effect a drug can produce

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20
Q

Potency = ?

A

amount of drug required to produce an effect of a given intensity

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21
Q

Partial agonists impact on efficacy and potency?

A 
Decreases efficacy (Vmax)
Potency is independent
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22
Q

Agonist + noncompetitive antagonist impact on Vmax

A

Decreases Vmax

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23
Q

Agonist + competative antagonist impact on potency

A

Decreases potency (increases Km)

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24
Q

Layers of the epidermis

A

stratum… corneum, lucidum, granulosaum, spinosum, and basalis

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25
Q

4 molds that are considered dermatophytes?

A

trichophytin, microsporum, epidermophytin, malasezia furfur

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26
Q

boot-shaped heart

A

right ventricular hypertrophy

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27
Q

continuous machine-like murmur

A

patent ductus areteriosis

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28
Q

tendon xanthomas

A

familial hypercholesterolimia

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29
Q

cafe-au-lait spots

A

neurofibromatosis type 1

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30
Q

tuft of hair on lower back

A

spina bifida occulta

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31
Q

Found in SW U.S. - fungus

A

coccidioides immitis

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32
Q

Found in Mississippi and Ohio River basins - fungus

A

histoplasma capsulatum

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33
Q

San Joaquin Valley Fever

A

coccioides immitis

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34
Q

Rural Latin America - fungus

A

paracoccidioides brasiliensis

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35
Q

Plant thorns - fungus

A

sporothrix schenckii

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36
Q

Found east of Mississippi River - fungus

A

blastomyces dermatitidis

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37
Q

bird and bat droppings

A

histoplasma capsulatum

38
Q

mold form contains barrel-shaped arthroconidia and associated with dust storms

A

coccidioides immitis

39
Q

broad-based budding of yeast

A

blastomyces dermatitidis

40
Q

Multiplebuddings of yeast form - captain’s wheel

A

paracoccidioides brasiliensis

41
Q

causes diaper rash

42
Q

45 degree branching, septate hyphae, opportunistic mold

A

aspergillis fumigatus

43
Q

irregular, nonseptate hyphae, wide angle branching

A

mucor or rhizor

44
Q

Know for causing pneumonia in AIDS patients

A

pneumocystis jirovecii

45
Q

Cause of meningitis in AIDS patients

A

cryptococcus neoformans

46
Q

Infections associated with birds

A

Chlamydophila psittaci, histoplasma capsulatum, cryptococcus neoformans, H5N1 influenca virus, west nile virus

47
Q

prophylaxis for cryptococcus in AIDS pts?

A

fluconazole

48
Q

PCP prophylaxis in AIDS patients

A

trimethoprim-sulfa

49
Q

sporothrix schenckii treatment

A

oral potassium iodide and itraconazole

50
Q

oral candidiasis treatment

A

nystatin and fluconazole

51
Q

systemic candidiasis treatment

A

amphotericin B

52
Q

criteria for major depressive disorder

A

2 or more weeks of anhedonia and/or depressed mood plus 5/9 of the following:
Sleep disturbance, Interest decreased, Guilt, Energy decreased, Concentration problems, Appetite changes, Psychomotor retardation, and Suicidal ideation

53
Q

clinical presentation suggestive of lymphoma

A
  • painless lymphadenopathy

- B symptoms: wt loss, night sweats, fever

54
Q

What histological changes occur in a smoker’s trachea

A

columnar to squamous metaplasia

55
Q

Most common leukemia in children

56
Q

Most common leukemia in adults in the US

57
Q

characteristic auer rods in leukemia

58
Q

more than 20% blasts in the marrow (leukemia)

A

ALL or AML

59
Q

Less than 5% blasts and more mature cells (leukemia)

A

CLL or CML

60
Q

PAS (+) acute leukemia

61
Q

Always positive for the Philadelphia chromosome (t 9;22)

62
Q

Acute leukemia positive for peroxidase

63
Q

Solid sheets of lymphoblasts in the marrow

64
Q

Always associated with BCR-ABL genes

65
Q

Atypical depression

A

hypersomnia, hyperphagia, mood reactivity, and hypersensitiveity to depression
(Treat with SSRIs)

66
Q

Dysthymia

A

milder depression >2 years

67
Q

Buproprion

A

atypical, inhibits NE and D2 reuptake
works well with 5H-T
lowers seizure threshold, stimulant, no sexual side effects
used for smoking cessation

68
Q

Mirtazipine

A

atypical antidepressant, alpha 2 antagonist
increases NE release and 5H-T (like SNRI)
SE = antihistamine effects (dry mouth, sedation, weight gain)

69
Q

Trazadone

A

used for insomnia and depression
inhibits 5H-T reuptake
can be added to SSRI or SNRI
SE = priapism (“trazaBONE”) and sedation

70
Q

smoker, heavy drinker, new cough and flu-like symptoms, gram stain shows no organisms, but silver stain of sputum shows GNR. DX?

A

Legionella pneumophila (Legionnaire’s dz)

71
Q

temporal arteritis – symptoms and lab for dx?

A

unilateral headache, jaw claudication, blindness/impaired vision
lab = increased sed rate or temporal artery biopsy

72
Q

30 yo woman presents with low grade fever and a rash that worsen with sun exposure, and widespread edema. Dx and labs?

73
Q

SSRIs

A

inhibit 5-HT reuptake (longer in synapse)
depression, anxiety, bulimia, OCD, PTSD
take 1 month to start working
fluoxetine, cirtriline, etc.
SE = sexual dysfunction, serotonin syndrome (avoid SSRI, SNRI, MAOIs, Kava kava, St. John’s Wort, Tryptophan, cocaine, amphetamines) [hyperthermia, hyperclonus, HTN, THR, flushing, diarrhea, anxiety, delirium] – mental status, ANS instability, and neuromuscular abnormalities –> treat with cooling and benzos

74
Q

SNRIs

A

Inhibit 5H-T and NE reuptake
venlofaxaine, duloxitine (- diabetic neuropathy and fibromyalgia)
depression and anxiety
SE = increase in BP, nausea, sedation

75
Q

TCAs

A

blocks reuptake of NE and 5HT
“-triptylines,” “-ipramines,” and “-doxapin”
alpha blocking sx, anticholinergic symptoms
SE = sedation, hypotension, dizzy, (hot as a hare, dry as a bone,) lower seizure threshold
overdose= convusions, coma, cardiotox, resp depression, hyperpyrexia, confusion, hallucination (RX with sodium bicarb for urinary excretion.)

76
Q

MAOIs

A

hinders enzyme that breaks down dopamine and NE
phenylziene, isocarboxazid, tranylcypromine, selegine (Parkinsons)
SE= hypertensive crisis (with tyramine ingestion from foods –increase in BP -> hemorrhage, arrhythmia, stroke,) tachy, arrythmia, serotonin synd. (CV collapse, hyperthermia, muscle rigidity)

77
Q

buproprion

A

inhibits NE and D2 reuptake
works well with 5-HT
lowers seizure threshold, stimulant, no sexual SE
used in smoking cessation

78
Q

mirtazipine

A

alpha2 antagonist
increases NE release and 5HT (like SNRI)
SE = antihistamine effects (dry mouth, sedation, weight gain.)

79
Q

trazadone

A

trazaBONE (SE = priapism and sedation)
used for insomnia
inhibits 5hT reuprtake
can add to SSRI or SNRI

80
Q

Hypothyroidism

A

Sx: wt gain, wold intolerance, feel tired, skin/hair changes, constipation, lower voice, menorrhagia, slowed mental/physical, slow return phase in reflexes
levothyroxine - synthetic T4 analog
triiodothronine - T3, more unpredictable
T4 converted to T3 in body

81
Q

Cretinism

A

hypothyroidism in fetus/infant
causes=iodine-deficient diet, thyroid-related enzyme deficiency, thyroid developmental defect, thyroid doesnt descend, transfer of antibodies form mom
sx= impaired physical growth, enlarged tongue, mental retardation, enlarged abdomen

82
Q

Hashimotos’s

A

autoimmune thyroiditis
painless goiter
dense infiltrates of lymphocytes into thyroid (dx=antithyroglobulin or antithyroid peroxidase atb)
5:1 females, increases with ages
HLA-DR5 and HLA-B5
can have transient hyperthyroidism when cells spill T4
increased risk of Bcell lymphoma

83
Q

Subacute (de Quervan) Thyroiditis

A 
hyper --> hypo
painful goiter
HLA-B35
females 3:1
recent viral infection causes it
84
Q

Thyroid Surgery Complications

A

recurrent laryngeal nerve injury (hoarseness)

parathyroid glands

85
Q

Struma Ovarii

A

thyroid hormone-secreting teratoma

86
Q

Somatostatin’s clinical uses

A

diarrhea and splanchnic circulation (cirrhosis)
pituitary excess: acromegaly, TSH-secreting tumor, ACTH-secreting tumor
GI endocrine excess: carcinoid syndrome, zollinger ellison syndrome, VIPoma, glucagonoma, insulinoma

87
Q

Propylthiouracil

A

blocks addition of iodine to tyrosine groups on the thyroglobulin –> decreses the synthesis of thyroid hormone
SE = rash, agranulcytosis, aplastic anemia

88
Q

most common thyroid cancer

A

papillary carcinoma

89
Q

cold intolerance

A

hypothyroidism

90
Q

enlarged thyroid cells with ground glass nuclei

A

papillary cancer of the thyroid

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