Final Exam Flashcards

Question 1

Q

For thrombi treatment, what drug is primarily a platelet aggregate inhibitor?

Answer

A

Clopidagrel

Is an anti-platelet aggregation agent, inhibits ADP pathway irreversibly.

Question 2

Q

What are the delivery forms of contraceptives?

Answer

A

Combinations:
- Monophasics- constant doses of both estrogen and progesterone
- Biphasic- dosage of one or both change one time during cycle
- Triphasic-dosages change 2 times
Progestin only—referred to as the “minipill” (no estrogen); fewer side effects, but less effective
Implantable
Injections (i.m., sustained effects)
Intravaginal rings
IUDs with and without estrogen/progestin
Transdermal combinations

Question 3

Q

Age-related Macular Degeneration occurs in 90% of patients >80 years old. True or False?

Answer

A

False

Age-Related Macular Degeneration =
• >10% of patients > 80 years old
Most common cause of severe loss of sight in 60+ pts.
Almost never occurs in individuals < 50 years of age
Smoking is a risk factor
Associated with gene polymorphisms, smoking, cardiovascular disease
Loss of central vision
Progress of disease faster in wet (hemorrhage and fluid present) than dry (large majority) macular degeneration
Pharmacological options minimal; some evidence that antioxidants (e.g., vit. C or zinc oxide may help reduce development, but benefit is minimal) for wet AMD. No treatment for dry AMD.
Treatment: monoclonal Ab (anti-angiogenic Ab)- e.g., bevacizumab (Avestatin)
Inject into vitreous humor; 1-2x/ month, for wet AMD

Question 4

Q

A 27 year old woman has recently developed severe headaches, and was found to have episodic severe hypertension. The episodes of hypertension are accompanied by the headaches, along with flushing, nervousness, and excessive sweating. 24-hour urine catecholamines are substantially increased. There is a 24 cm diameter right adrenal mass. This patient most likely has:

A. Adrenal cortical adenoma

B. Adrenal cortical carcinoma

C. Neuroblastoma

D. Paraganglioma

E. Pheochromocytoma

Answer

A

E. Pheochromocytoma

Pheochromocytoma = • It is a tumor of adrenal medulla (usually benign) –increases secretion of catecholamines • Can be episodic or sustain secretion • Effects typically look like increased sympathetic nervous system function • Hypertension • Flushing • Increased urine catecholamines
Adrenal Cortex makes = Mineralcorticoids, glucocorticoids and sex steroids.
Adrenall Medulla makes = Makes and releases catecholamines (epinephrine and norepinephrine)
Acute adrenal cortex insufficiency = Weakness • Nausea • Hyponatremia, hyperkalemia • Hypotension • Skin pigmentation (get increase of MSH with the ACTH) • May cause ‘adrenal crisis’- a sudden requirement for increased steroid, which is not available; e.g., ‘Waterhouse-Friderichson syndrome’ caused by hemorrhaging into the adrenal cortex caused by sepsis from meningococcal infection
Chronic adrenal cortex insufficiency = Addison’s Disease. • Cause: autoimmune • More common in white women • 65% of adrenal insufficiency cases • Adrenals reduced • Increased infection ACTH is increased Caused by infections such as TB
Neuroblastoma = Usually children - Metastatic Can secrete catecholamines
Three adrenocorticosteroids = 1. Glucocorticoids - Regulate intermediary metabolism and immunity. Cortisol synthesized from cholesterol (hydrocortisone). 2. Mineralocorticoids - Aldosterone (Na retention/K+ loss). 3. Androgens - Dehydroepiandrosterone, DHEA, can be converted to estrogens.

Question 5

Q

Orderly cell death without inflammation:

Answer

A

Apoptosis

Reversible and Irreversible (cell death). An example of reversible is mild acute tubular necrosis of kidney, toxic livery injury, severe exercise. An example of irreversible is holes in cell membrane, long Ca++ influx, mitochondrial loss, and the two types of irreversible are necrosis and apoptosis.

Question 6

Q

The cardiovascular effects of epinephrine in a person treated with propranolol and prazosin will most likely resemble the response after the administration of:

A. Pilocarpine

B. Phenylephrine

C. Clonidine

D. Isoproterenol

Answer

A

C. Clonidine

Clonidine is an Alpha2 receptor agonist, so it decreases NE release, helps treat hypertension and ADHD, and can also dilate pupils, used for glaucoma. Remember that epinephrine increases aqueous humor outlofw.
Propranolol is a Beta1 and Beta2 receptor antagonist (beta blocker), and Prazosin is an alpha 1 antagonist that helps block vasoconstriction so essentially causes vasodilation and is used to treat hypertension.
Pilocarpine is a muscarinic receptor agonist. Used for radiation therapy xerostomia, glaucoma, myasthenia gravis.
Phenylephrine is an alpha-1 receptor agonist and it causes vasoconstriction to sinus vessels in order to act as a decongestant, helps with mydriasis for eye exams. Also causes a decreased heart rate from baroreceptor reflex essentially.
Isoproterenol is a Beta-1 and Beta-2 receptor agonist. So it increases heart rate.

Question 7

Q

Elevated dome or flat topped < 5mm

Question 8

Q

Your patient is having a recurrent episode of shingles on her face. When she had her first outbreak the antiviral drug prescribed was useless. Her doctor explained this likely was due to the fact that her shingles was caused by a resistant form of Varicella-Zoster virus and if shingles occured, she would require a more expensive drug. Which one?

A. Acyclovir

B. Foscarnet

C. Famcyclovir

D. Zovirax

Answer

A

B. Foscarnet

Acyclovir = (Zovirax, Denavir ointments):
- most effective for herpes simples virsus (HSV-1 and HSV-2)
cold sores on mouth and nose; less potent on Varicella-zoster virus (VZV-chickenpox–shingles).-Requires activation by the HSV thymidine kinase enzyme
Foscarnet =
- Used for shingles and herpes. selectively inhibits viral DNA polymerase enzymes (not kinases).
- Unlike acyclovir and ganciclovir, foscarnet is not activated by viral protein kinases, making it useful in acyclovir- or ganciclovir-resistant HSV and CMV infections.
Famciclovir—effective against VZV virus and shingles and herpes viruses. Longer acting than acyclovir

Question 9

Q

Case Question:

78 year old female, 5’ 6”, 90 lbs, BP is 140/90, chief complaint is that husband explains that his wife moans and makes a strained facial expression when trying to eat, especially when she tries to chew her food. In addition, she has a severe drooling problem and sometimes chokes on the accumulated saliva.

The patient was diagnosed with Alzheimer’s disease at the age of 70, although the husband claims that his wife’s memory had been deteriorating for the previous 5 years. According to the husband, the patient also started to struggle with mood problems approximately 3 years ago and was recently prescribed a mediation to deal with this problem as well as medication to control the drooling. He claims that while the medications seemed to help his wife’s mood and reduce the drooling, they also appeared to cause her memory to deterioriate significantly.

The patient has difficulty communicating with you and the spouse continually holds her hand to try and calm her down as she seems very anxious and not quite aware what is going on. Significant muscle atrophy and body wasting has occurred in the patient, likely due to poor nutrition. The husband is hoping that you can help his wife so that she can start to eat and feel better.

Current medications: Sertraline, Benztropine, Ibuprofen, Vitamins

The patient is diagnosed as edentulous except for teeth #3, 14, 19, 30 with significant maxillary and mandibular bone atrophy. All surviving teeth have severe periodontal involvement and are unstable. Examination of mucosal tissues reveals several areas of extreme inflammation on top and on both the buccal and lingual sides of the ridges with occasional ulceration present. The patient resists placement of her well-worn partial dentures when you ask her to put them into her mouth.

Which of the following is most likely responsible for a worsening of the patient’s memory?

A. Sertraline

B. Benztropine

C. Ibuprofen

D. Vitamins

What is the most likely mechanism for your answer in #37 above?

A. Overdose of calcium and vitamin C

B. Agitation

C. Anticholinergic activity

D. Antiinflammatory

Answer

A

B. Benztropine and C. Anticholinergic activity

Benztropine can cause memory loss apparently because it is an anticholinergic drug.

Question 10

Q

Which of the following are the survival rates for breast cancers classified as stage 0 and stage IV.

A. 40% and 85%

B. 99% and 5%

C. 55% and 10%

D. 92% and 13%

Answer

A

D. 92% and 13%

Based on size, axillary node status, and distant metastasis
5 year Survival rate of stage 0 (early stage)=92%, stage IV (late)= 13%
If tumor expresses estrogen/progesterone receptors, it often responds to hormonal treatment
Types of Breast Carcinoma =
Invasive carcinoma: 75-85%
Most are ductal and the incidence increases with age and have invasive and non-invasive types
Can do lumpectomies to remove smaller masses.

Question 11

Q

Which of these drugs is associated with ADHD? (may be more than one)

A. entacapone

B. prednisone

C. Buproprion (BuSpar)

D. Chlorpromazine

E. Donepezil

F. Fluoxetine (Prozac)

G. Clozapine

H. Modafinil

I. Carbamazepine

J. Lithium carbonate

K. Alprazolam (Xanax)

Answer

A

H

Modafinil = It is a minor stimulant, or non-stimulant, to treat ADHD, called the “smart drug.” Has few side effects, biggest complaint is that it alters sleep patterns, and it is also used for narcolepsy.

Question 12

Q

Methyltrexate is a folic acid analog that interferes with the formation of key DNA in cancer cells such as those associated with breast cancer. True or False?

Answer

A

True

Methyltrexate = Treats cancer, is an antimetabolite, anti-inflammatory.
1. Acts on intermediary metabolism of proliferating cells
1. E.g., methyltrexate-folic acid analog
• Inhibits tetrahydrofolate–Interferes with formation of DNA, key proteins
• Treats head and neck cancers, breast cancer
• Toxicity: mucositis, diarrhea

Question 13

Q

Concerning addison’s disease, administration of mifepristone worsens the symptoms. True or False?

Answer

A

True

Mifepristone = Used for Cushing’s syndrome. Is an antagonist at steroid receptors.
Ketoconazole = Used for Cushing’s syndrome. Inhibits adrenal steroid synthesis.
Metyrapone = Used for Cushing’s syndrome. Reduces cortisol synthesis by inhibiting steroid 11-hydroxylation.

Question 14

Q

Can result in kyphosis and scoliosos:

Answer

A

Osteoporosis

Genetic: age, low estrogen, fair hair and skin, tall and thin
Behavior: inactivity, smoking/alcohol, malnutrition, medication (chronic corticosteroids)
10 million have osteoporosis in US, mostly women
• 1/3 women >50 years old have at least one osteoporitic fracture

Question 15

Q

Which of these is diabetes insipidus associated with?

A. Insulin receptors are resistant to activation by insulin

B. Diuresis

C. Severe abnormal lipid metabolism

D. No insulin

E. Increased thirst

F. Long-term increased risk of atherosclerosis and hypertension

Question 16

Q

The main cause of COPD (congestive obstructive pulmonary disease) is car emissions. True or False?

Answer

A

False

Main causes of COPD
•Cigarret smoke is main cause, Long smoking hx, or exposure to environmental irritants • Airflow limitations-due to progressive, irreversible airway remodeling • Not fully reversible in contrast to asthma which can be at least partially reversible
How to Treat COPD? =
- Longer acting bronchodilators such as tiotropium bromide (Spireva)
- Longer acting beta 2 agonists such as salmeterol
- Theophylline with glucocorticoids (glucocorticoids alone not very effective)
- Typically responses not as good as with asthma

Question 17

Q

A patient experiencing major psychosis caused by an automobile accident is most likely to be classified in which of the following psychiatric dimensional axes?

A. Axis I

B. Axis II

C. Axis III

D. Axis IV

Answer

A

C. Axis III

Axis I - All psychological diagnostic categories except mental retardation and personality disorder
- Axis I = Depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa, schizophrenia and drug dependence (usually).
Axis II - Personality disorders and mental retardation
- Axis II = Personality disorders: paranoid personality disorder, schizoid personality disorder, antisocial personality disorder, narcissistic personality disorder, dependent personality disorder, obsessive-compulsive personality disorder; and intellectual disabilities.
Axis III - General medical condition; acute medical conditions and physical disorders (Meningitis, which means I have inflammation, a fever, cause symptoms that look like psychiatric disorders)
- Axis III = Brain injuries and other medical/physical disorders which may aggravate existing diseases or present symptoms similar to other disorders, (sometimes drug abuse?). (-So if you get schizophrenia from a brain injury from a car crash, it is axis III, If you have schizophrenia coming from drug abuse, it is also axis III)
Axis IV - Psychosocial and environmental factors contributing to the disorder (e.g. stress)
Axis V - Global Assessment of Functioning or Children􏰃s Global Assessment Scale for children and teens under the age of 18

Question 18

Q

Concerning cardiac arrhythmias, procainamide is the first choice for ventricular arrhythmias. True or False?

Answer

A

False

Four drugs used to treat arrhythmias:
Class I - Sodium channel blockade
Class II - Block sympathetic autonomic effects on heart (beta blocker = Propanolol)
Class III - Prolong refractory period
Class IV - Ca channel blockade (Verapamil and Diltiazem)
Procainamide = Class I anti-arrhythmic drug. It blocks sodium channels. Involved with cocaine, and local anesthetics, so if you inject it into an artery, can cause problems. Usually not first choice drug because it can precipitate new arrhythmias. It slows action potential conduction.
Lidocaine is the first choice for ventricular arrhythmias! Also a Class I.

Question 19

Q

A newly diagnosed diabetic patient (has hyperglycemia) has presented to your office. Which of the following would favor type 2 rather than type 1 diabetes?

A. Age < 15 years

B. Experiences polydypsia and polyphagia

C. Serum insulin is normal

D. Thin rather than obese

Answer

A

C. Serum insulin is normal

Type II Diabetes = 2. Type II DM, “adult onset”, Non-insulin dependent DM a. Features • 95% diabetics are type II • Insulin levels often normal, problem is resistance of insulin receptors to insulin stimulation • Correlates with excessive visceral fat (80-90% are obese): restricted diet controls ~20% of diabetic expression • Correlates with hypertension and risk for atherosclerosis • Metabolic syndrome (see below for details) • Some genetics-likely polygenic autosomal • Most over 30 yrs old, but increasing numbers of younger Type I DM patients due to obesity • Minimal ketones or acidosis, but very high glucose –Hyperosmolar coma—enough insulin to prevent lipolysis, but still have elevated glucose
Typical symptoms of type I = Polydipsia ; polyphagia (hunger and thirst) • Polyuria (lots of diluted urine) • Unexplained weight loss
Type I = ketoacidosis

Question 20

Q

A heart failure patient presents with hypertension. He has some breathing problems that seem to be associated with pulmonary edema. He experienes dyspnea even when lying down. Palpitation revelas a liver of normal size. Which of the following is most likely the cause of these symptoms?

A. Left sided heart failure

B. Right sided heart failure

C. Proportionate left and right sided heart failure

D. Angina pectoris

Answer

A

A. Left sided heart failure

When left heart isn’t doing its job, it backs up and you get pulmonary edema.
How does left-sided heart failure occur? It is caused by ischemic heart disease, hypertension, aortic and mitral valve disease, myocardial disease like cardiomyopathy. You get pulmonary edema and breathing problems, dyspnea (breathlessness), orthopnea (dyspnea while lying down due to vascular congestion and it develops within minutes), paroxysmal nocturnal dyspnea (extreme dyspnea, develops over a few hours, due to pulmonary edema from heart failure while lying down). You also get reduced perfusion to organs like kidneys, ending up with prerenal azotemia (high BUN with less high or normal creatinine) or ischemic tubular necrosis.
Right-sided heart failure: Can be caused by right-sided heart disease or cor pulmonale (abnormal enlargement of right side), and can be a consequence of left-sided failure, or due to myocarditis, cardiomyopathy. You end up getting chronic passive congestion to the liver, congestive splenomegaly, congestion and hypoxia to the kidneys, peripheral edema and anasarca (extreme edema), pleural effusions, venous congestion and hypoxia, and ascites.
What causes angina pectoris? It is due to ischemia-related metabolites like glucose and other factors.

Question 21

Q

Prevented by consuming citrus fruit:

Answer

A

Scurvy

Vitamin deficiencies : scurvy (vit. C), rickets (vit. D)
Endocrine factors—hyperparathyroidism
Osteoporosis—common in elderly women, after menopause
Osteomalacia—vitamin D deficiency

Question 22

Q

Drug: Diminishes fat absorption in intestines:

Answer

A

Orlistat

Is used for weight loss, is a lipase inhibitor. It diminishes fat absorption by the intestines.

Question 23

Q

Which of the following side effects is least likely to be associated with high doses of Cox 1/2 nonselective inhibiting NSAID, like that used to treat inflammatory disorders?

A. Diabetes

B. Hypertension

C. Altered liver functions

D. Asthma

E. Renal insufficiency

Answer

A

A. diabetes

(a) CNS-tinnitis
(b) CVS-hypertension
(c) GI-nausea, ulcers or bleeding
(d) Hepatic-altered liver functions
(e) Pulmonary-asthma
(f) Skin-rashes
(g) Renal- insufficiency, in extreme can have failure

Question 24

Q

Concerning Addison’s disease, it is typically associated with weight gain. True or False?

Answer

A

False

Addison’s—adrenal glands produce too little cortisol (chronic)—often insufficient aldosterone as well • Symptoms • Weakness • Fatigue • Weight loss • Hyperpigmentation • Treatment—corticol supplements: cortisones (hydro-) or prednisone

Question 25

Q

Case Question:

78 year old female, 5’ 6”, 90 lbs, BP is 140/90, chief complaint is that husband explains that his wife moans and makes a strained facial expression when trying to eat, especially when she tries to chew her food. In addition, she has a severe drooling problem and sometimes chokes on the accumulated saliva.

The patient was diagnosed with Alzheimer’s disease at the age of 70, although the husband claims that his wife’s memory had been deteriorating for the previous 5 years. According to the husband, the patient also started to struggle with mood problems approximately 3 years ago and was recently prescribed a mediation to deal with this problem as well as medication to control the drooling. He claims that while the medications seemed to help his wife’s mood and reduce the drooling, they also appeared to cause her memory to deterioriate significantly.

The patient has difficulty communicating with you and the spouse continually holds her hand to try and calm her down as she seems very anxious and not quite aware what is going on. Significant muscle atrophy and body wasting has occurred in the patient, likely due to poor nutrition. The husband is hoping that you can help his wife so that she can start to eat and feel better.

Current medications: Sertraline, Benztropine, Ibuprofen, Vitamins

The patient is diagnosed as edentulous except for teeth #3, 14, 19, 30 with significant maxillary and mandibular bone atrophy. All surviving teeth have severe periodontal involvement and are unstable. Examination of mucosal tissues reveals several areas of extreme inflammation on top and on both the buccal and lingual sides of the ridges with occasional ulceration present. The patient resists placement of her well-worn partial dentures when you ask her to put them into her mouth.

Which of the following would be the dental treatment for this patient most likely to have a satisfactory outcome if she were a healthy patient and 20-30 years younger?

A. Treat all residual teeth with root canals and full crown restorations plus permament molar-to-molar bridges.

B. Extract the remaining teeth. Attempt to build up the atrophied ridges using bone augmentation procedures followed by tooth implants to serve as abutments for new partials.

C. Extract the remaining teeth and inform the patient and her spouse that due to the severe bone loss of the boney ridges there is not much that can be done and she will need to consume a liquid diet the rest of her life.

D. Extract the teeth and make dentures even though it is obvious they will be poorly retained and not very functional, but at least they will help with cosmetics.

Answer

A

B. Extract the remaining teeth. Attempt to build up the atrophied ridges using bone augmentation procedures followed by tooth implants to serve as abutments for new partials.

Question 26

Q

Linaclotide is FDA-approved to treat the diarrhea associated with Irritable Bowel Syndrome. True or False?

Answer

A

False

Linaclotide = Used for irritable bowel syndrome (treats constipation. b. Treatment: (1) Typically symptomatic (i.e., deal with diarrhea or constipation with diet and anti-stress changes) (2) Drugs: only linaclotide (Linzess) is FDA-approved for IBS with constipation • It is a guanylate cyclase-C agonist-it increases bowel movement, fluid secretion and reduces pain • Side effects: diarrhea, gas

Question 27

Q

Imatinib (Gleevec) is a tyrosine hydroxylase inhibitor used to treat multiple types of cancer such as myelogenous leukemia. True or False?

Answer

A

True

Imatinib = Cancer treatment strategy. Tyrosine hydroxylase inhibitor used for multiple types of cancers such as myelogenous leukemia.
Erlotinib = Cancer treatment strategy. Blocks ECGR (epidermal growth factor receptor): treatment, non-small cell lung and pancreatic cancer.
Retinoic acid = -induced differentiation of some leukemias (e.g., promyelocytic leukemia)

Question 28

Q

An elderly, hypertensive man with type II diabetes has retrosternal chest pain every time he climbs stairs or otherwise exerts himself. The pain resolves 2 to 5 minutes after he rests. It is also relieved when he takes nitroglycerin. This symptom pattern has been unchanged for the last 6 months. What is the likely cause of the pain?

A. Thrombus in a coronary artery

B. Fixed (stable) atherosclerotic stenosis of a coronary artery

C. Aortic dissection

D. Pulmonary embolus

E. Atrial fibrillation

Answer

A

B. Fixed (stable) atherosclerotic stenosis of a coronary artery

Resistance to flow is inversely proportional to diameter^4 (i.e. inversely proportional to cross sectional area^2). You must have 75% stenosis (decreased cross sectional area) to clinically impede flow. This increases resistance 16-fold. Slow stenosis causes stable angina while abrupt stenosis or occlusion can cause infarcts/sudden death and is associated with a thrombus or embolus. A rupture/erosion causes a complicated lesion, and is the most common cause of most infarcts.
Main three types of angina: 1. Stable angina 2. Variant angina 3. Unstable angina (most dangerous, prolonged pain)
Stable = Pain that feels like pressure for 2-5 minutes and associated with exertion. Relieved by rest or vasodilators (nitroglycerine). It is subendocardial ischemia, and you get a ST-segment depression. Usulaly due to fixed coronary stenosis.
Variant = It classically occurs at rest. Brief, like stable angina. Reversible spasm, ST-segment elevation (instead of depression with stable angina).
Unstable = New or worsening angina, prolonged pain or pain at rest. You get an ST-segment depression, and often due to acute plaque change. Most dangerous.
Abrupt stenosis usually causes a thrombus in a coronary artery or pulmonary embolus
Atherosclerosis Key Points =
- Exremely common cause of death. Due to endothelial damage, lipid deposits, inflammation, fibrosis/smooth muscle, and rupture or erosion causing thrombosis. Thrombosis (not stenosis) is the main cause of infarcts. Often happens in areas of only mild/moderate stenosis. Stenosis (not thrombosis) is the main cause of predictable pain with exertion, like angina and claudication (leg pain).

Question 29

Q

Obstruction caused by gallstones can result in cholecystitis. True or False?

Answer

A

True

Cholecystitis (bile is common mechanism for excretion of toxins and drugs)

Acute often caused by gallstones and obstruction. Can become chronic
Cholestasis causes jaundice

Question 30

Q

Valvular heart disease can be caused by streptococcal infection. True or False?

Answer

A

True

Post infective endocarditis or rheumatic fever (strep sequelae). It is also common in congenital bicuspid valves or normal valves of elderly people.
Main causes of aortic regurgitation: Postinflammatory scarring, syphilitic aortitis, ankylosing spondylitis, rheumatoid arthritis, Marfan’s syndrome
These cause calcific aortic valve stenosis
Infective Endocarditis: Usually takes place in Mitral valve and aortic valve - 25-35% of time Tricuspid valve, valve prosthesis, congenital defect - 10% of time. It consists of friable vegetations containing RBCs, fibrin, inflammatory cells and organisms. Caused by Staph aureus, strep, pseudomonas, HACEK, polymicrobial. Fever and murmur are common, and mortality is as high as 70% if staphylococcal.

Question 31

Q

Cancer typically found in younger patients and associated with Reed Sternberg cells:

Answer

A

Hodgkin’s Lymphoma

Hodgkin’s lymphoma much better controlled today
B-cell neoplasm (Reed-Sternberg cell)
EBV virus found in ~80%
Tx: anthracycline, doxorubicin, bleomycin, vinblastine

Question 32

Q

What main seven things do muscarinic agonists do? And what are the main three muscarinic agonists?

Answer

A

Increase stomach acid secretion
Decrease heart rate via the SA node
Decreases action potential duraction and contractility in the atria
Decrease conduction velocity in the heart
Decrease contractility in the ventricle
Contract GI smooth muscle (except sphincters (so poop comes gushing out))
Increase secretions of secretory glands
Acetylcholine
Bethanechol
Pilocarpine

Question 33

Q

Cell death occurring in a granuloma:

Answer

A

Caseous necrosis

Caseous -See this in tuberculosis -Due to the body trying to wall off and kill the bug with macrophages -Gross: White, soft, cheesy-looking (“caseous”) material -Micro: fragmented cells and debris surrounded by a collar of lymphocytes and macrophages (granuloma)

Question 34

Q

Which is a DAT or NET blocker but mostly a non-stimulant?

A. entacapone

B. prednisone

C. Buproprion (BuSpar)

D. Chlorpromazine

E. Donepezil

F. Fluoxetine (Prozac)

G. Clozapine

H. Modafinil

I. Carbamazepine

J. Lithium carbonate

K. Alprazolam (Xanax)

Answer

A

H

Dopamine transporter and Norepinephrine transporter blocker. Similar to cocaine.

Question 35

Q

Invasive colonic adenocarcinoma is responsible for 15% of all cancer deaths in the USA. True or False?

Answer

A

True

Invasive colonic adenocarcinoma

Responsible for 15% of all cancer related deaths in USA
Dietary features: increased risk with low fiber, high intake carbohydrates/fats Affects small bowel/colon

Question 36

Q

Clonidine is an alpha-1 antagonist. True or False?

Answer

A

False

Clonidine = Is an alpha-2 agonist in the medulla that reduces sympathetic tone, resulting in decreased blood pressure. Remember that alpha-2 can be an autoreceptor. Dry mouth, sedation are common. Both effects are centrally mediated and dose-dependent.

Question 37

Q

Concerning open-angle glaucoma, african americans are especially vulnerable. True or False?

Question 38

Q

Case Question:

78 year old female, 5’ 6”, 90 lbs, BP is 140/90, chief complaint is that husband explains that his wife moans and makes a strained facial expression when trying to eat, especially when she tries to chew her food. In addition, she has a severe drooling problem and sometimes chokes on the accumulated saliva.

The patient was diagnosed with Alzheimer’s disease at the age of 70, although the husband claims that his wife’s memory had been deteriorating for the previous 5 years. According to the husband, the patient also started to struggle with mood problems approximately 3 years ago and was recently prescribed a mediation to deal with this problem as well as medication to control the drooling. He claims that while the medications seemed to help his wife’s mood and reduce the drooling, they also appeared to cause her memory to deterioriate significantly.

The patient has difficulty communicating with you and the spouse continually holds her hand to try and calm her down as she seems very anxious and not quite aware what is going on. Significant muscle atrophy and body wasting has occurred in the patient, likely due to poor nutrition. The husband is hoping that you can help his wife so that she can start to eat and feel better.

Current medications: Sertraline, Benztropine, Ibuprofen, Vitamins

The patient is diagnosed as edentulous except for teeth #3, 14, 19, 30 with significant maxillary and mandibular bone atrophy. All surviving teeth have severe periodontal involvement and are unstable. Examination of mucosal tissues reveals several areas of extreme inflammation on top and on both the buccal and lingual sides of the ridges with occasional ulceration present. The patient resists placement of her well-worn partial dentures when you ask her to put them into her mouth.

Which of the following is least likely to cause significant problems for the dental management of this patient?

A. Xerostomia

B. Patient’s endurance

C. Stage of disease

D. Use of Sertraline

Answer

A

D. Use of Sertraline

Sertraline has no dry mouth side effects, it is an SSRI.
Alzheimer’s = anywhere from 3-4 million people have it at any given time -Once diagnosed, 10-20 years usually they live -It is broken down into three stages, and all of this relates to eliminating extra capacity of the brain -The brain determines what kind of capacity it will have later on when we are children and adolescents. Brain regions involved are frontal cortex, which is intelligence, judgement, and behavior, memory in the temporal lobe, and language right behind it in the parietal lobe. -Early stage is annoying stage, they have memory lapses and forget names, don’t like change -Moderate stage is when they have problems functioning, normal routine is disrupted -Late stage the motor system gets disrupted, they get less mobile, no judgment, immobile and stop eating.

Question 39

Q

Concerning breast carcinoma, there is no apparent racial link. True or False?

Question 40

Q

Concerning struvite (magnesium ammonium phosphate) kidney stones, Trimethoprim-sulfamethoxazole is often given to prevent or control the underlying UTI in these patients. True or False?

Answer

A

True

Use AHA, acetohydydroxamic acid, or TMP-SMX

Question 41

Q

Wilson’s disease is a hepatitis caused by a calcium metabolic defect. True or False?

Answer

A

False

Metabolic Disease of the Liver
• Often associated with iron overloads
• Wilson’s disease: copper metabolic defect goes to hepatitis then cirrhosis

Question 42

Q

With acne, its inflammatory state typically consists of opened comedones known as blackheads. True or False?

Answer

A

False

Should be closed comodones and whiteheads

Question 43

Q

Drug: Reduces insulin resistance in muscle cells:

Answer

A

Rosiglitazone

Used to treat type II diabetes, is a Thiazolidinedione. reduces insulin resistance (especially muscle and fat cells) in type II DM by targeting PPAR-y receptor. Also increased GLUT-4 expression. Side effect: bone loss in women, weight gain.

Question 44

Q

Somatic pain typically responds to NSAID analgesics. True or False?

Answer

A

True

Somatic pain = Pain associated with musculo-skeletal system and skin - it is well defined. We will see mostly somatic pain in the dental office.
NSAIDS and Opioids help

Question 45

Q

Which of the following has been shown to most likely be a genetic explanation for elevated risk of becoming addicted to cocaine?

A. Elevated activity of GABA receptors

B. Diminished activity of D2 receptors

C. Diminished activity of D1 receptors

D. Elevated activity of NMDA receptors

Answer

A

B. Diminished activity of D2 receptors

D2 receptor is more involved with the pleasure than D1, and if you activate these too much, it could start to look like Schizophrenia (to treat Schizophrenia you use a D2 antagonist)
After long time drug use, The ability to experience rewards is damage, the receptors are not as receptive or plentiful because the body is trying to get rid of them because of the increased synapses that have been taking place bcause of the drug addiction. If their D2 receptors are not receptive, they are not getting the same high from something that we might be getting high from.
Which tissue types and what effect does Dopamine have on D2 receptors? It decreases neurotransmitter release in post-ganglionic sympathetic nerve terminals It causes nausea and vomiting in the chemoreceptor trigger zone CNS effect.
With Schizophrenia, Dopamine mechanism, D2 receptor in excess, and early anti-psychotics are D2 antagonists
Huntington’s Disease = Increase in dopamine and a decrease in GABA because the cell bodies in GABA die. Patients have lost most of the cell bodies because the caudate has been lost, which sits right next to the ventricles on the outside. The hunting gene seems to alter NMDA/AMPA receptors for Glutamate, and you end up killing these receptors from over-excitation of the glutamate system. The hunting gene is found in the GABA neurons.

Question 46

Q

Diltiazem is a calcium channel blocker. True or False?

Answer

A

True

Diltiazem = This drug (along with Verapamil and Nifedepine) is a direct vasodilator that reduces calcium influx, is a calcium channel blocker. All the vasodilators that are useful in hypertension relax smooth muscle of arterioles, thereby decreasing systemic vascular resistance. Decreased arterial resistance and decreased mean arterial blood pressure elicit compensatory responses, mediated by baroreceptors and the sympathetic nervous system, and because these are still intact, vasodilator therapies generally do not cause orthostatic hypotension. This drug is also used to treat angina by prevent Ca influx through L-type channels and blocking contraction of smooth and cardiac muscles while reducing O2 demand. Can cause cardiac depression, bradycardia, flushing. This drug is also considered a class IV anti-arrhythmia drug.

Question 47

Q

Which three of the following are most important to consider in determining best treatment for this patient?

A. Cosmetic

B. History of poor compliance

C. Poor prognosis for extended survival

D. Need to avoid infection complications during cancer treatment

E. The expectation of a dentist is to save all possible teeth for as long as possible

F. This is your decision, don’t talk to oncologist about it

Answer

A

B. History of poor compliance

C. Poor prognosis for extended survival

D. Need to avoid infection complications during cancer treatment

Question 48

Q

Which of these drugs is associated with Bulimia? (may be more than one)

A. entacapone

B. prednisone

C. Buproprion (BuSpar)

D. Chlorpromazine

E. Donepezil

F. Fluoxetine (Prozac)

G. Clozapine

H. Modafinil

I. Carbamazepine

J. Lithium carbonate

K. Alprazolam (Xanax)

Answer

A

F

Is an SSRI. They are popular but can give GI upset, sexual dysfunction, and depression in adolescents. They have no anti-cholinergic activity, so you don’t get dry mouth.

Question 49

Q

Fatty liver disease and resulting cirrhosis is caused entirely by alcoholism. True or False?

Answer

A

False

Fatty liver disease (not an inflammatory disease)
Caused by ETOH, obesity, diabetes mellitus etc.

Question 50

Q

Which is a non-addicting substitute for sedatives?

A. entacapone

B. prednisone

C. Buproprion (BuSpar)

D. Chlorpromazine

E. Donepezil

F. Fluoxetine (Prozac)

G. Clozapine

H. Modafinil

I. Carbamazepine

J. Lithium carbonate

K. Alprazolam (Xanax)

Question 51

Q

Postganglionic sympathetic neurons can release dopamine. True or False?

Answer

A

True

Sympathetic neurons release dopamine at dopamine receptors in renal vascular smooth muscle.

Question 52

Q

Autoimmune disorder often associated with ulcers and carditis:

Answer

A

Rheumatoid arthritis

a. Autoimmune- 1% prevalence
b. Most common in Caucasians/ uncommon in Asians
c. Onset age: 25-50 yrs.-75% female/ can have juvenile RA
d. Joint swelling, pain and tenderness—often cause extreme distortions of joints and surrounding bone—deforming and debilitating
e. Other areas also affected:
- • Ulcers
- • Pulmonary nodules and fibrosis
- • Carditis and pericarditis
- • Vasculitis

Question 53

Q

Concerning pyelonephritis, it is often associated with flank pain. True or False?

Answer

A

True

Pyelonephritis = Due to retrograde spread from cystitis or hematogenous spread, commonly seen with urinary obstruction, stenosis, can cause flank pain, fever, or asymptomatic, it is more severe in diabetics and with obstruction, can cause scarring.

Question 54

Q

Concerning alcohol, men tend to be more sensitive to its effects than women. True or False?

Answer

A

False

Binge Drinking = NIAAA defines binge drinking as a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This usually occurs after 4 drinks for women and 5 drinks for men—in about 2 hours.

Question 55

Q

Obesity has been determined to be a link in which of the following?

A. Cervical cancer and breast cysts

B. Endometrial polyps and endometrial carcinoma

C. Endometrial polyps and endometritis

D. Ovarian cysts and ovarian carcinoma

Answer

A

B. Endometrial polyps and endometrial carcinoma

Polyps = hypertension, obesity, and late menopause
Endometrial Carcinoma = obesity, hypertension, diabetes
Characteristics of breast cysts =
Fibrolytic changes
• Higher risk of breast cancer
• Occurs 20-40 years old
• Doesn’t typically occur after menopause
• Can calcify
• Can look like cancer on mammogram

Risk factors for cervical cancers =

Risk factors -

multiple sex partners
-Immunosuppression
-early age of first sexual contact
-oral contraception for >5 years
-nicotine use

Question 56

Q

Which is a COMT inhibitor?

A. entacapone

B. prednisone

C. Buproprion (BuSpar)

D. Chlorpromazine

E. Donepezil

F. Fluoxetine (Prozac)

G. Clozapine

H. Modafinil

I. Carbamazepine

J. Lithium carbonate

K. Alprazolam (Xanax)

Question 57

Q

Regarding myocardial infarctions, they are typically precipitated by an atrial premature beat. True or False?

Answer

A

False

Main complications of MI’s:Most to least common 1. Arrhythmias 75-95% 2. Congestive heart failure and pulmonary edema 60% 3. Pericarditis 4. Mural thrombosis 5. None 10-20% 6. Cardiogenic shock 7. Rupture of ventricle or papillary muscle 4-8%
Symptoms of MI’s = Retrosternal chest pain, dyspnea, diaphoresis (sweating), nausea/vomiting, palpitations, anxiety, or can be asymptomatic or present as sudden death.

Question 58

Q

Severe orthostatic hypotension is a consequence of which of the following?

A. Dopamine beta hydroxylase insufficiency

B. Tryptophan hydroxylase insufficiency

C. Pheochromocytoma

D. Propranolol administration

Answer

A

A. Dopamine beta hydroxylase insufficiency

Big side effect of Monoamine Oxidase inhibitors and Non-selective alpha antagonists.
Dopamine Beta Hydroxylase = For this to happen, it all starts with Tyrosine again, which is converted to Dopamine and Dopamine’s same process takes place but once it enters the synaptic vesicle via VMAT, Dopamine is then converted to NE by Dopamine Beta Hydroxylase.
Tryptophan Hydroxylase = tryptophan enters the neuron, is then converted by Tryptophan Hydroxylase to 5-HTP, and 5-HTP is then converted by AAD to 5-HT (Serotonin)
Phenoxybenzamine and Phentolamine. Uses of non-selective α antagonists (often cause orthostatic hypotension) include treatment of pheochromocytoma (catecholamine secreting tumor)
Propranolol is a Beta-1 and Beta-2 receptor antagonist (beta blocker)

Question 59

Q

Aluminum salts are not very effective in the treatment of GERD. True or False?

Answer

A

True

Used for GERD. Antacids-neutralize gastric HCl •
Types: magnesium salts (can cause diarrhea);
bicarbonate (causes gas);
calcium carbonate (chalky and constipation);
aluminum salts (not very effective)

Question 60

Q

Fibrosing lung diseases are often associated with rheumatoid arthritis. True or False?

Answer

A

True

Main types of lung diseases =
1. Restrictive: caused by fibrosis or chest wall abnormalities; gas exchange impaired; difficulty inhaling and expanding lungs
2. Vascular: gas exchange impaired by obstruction or hemorrhage; may be abrupt or insidious
3. Obstruction: blocked airways; gas exchange through septal walls not impaired; unable to exhale
Fibrosing lung diseases = Associated with collagen vascular diseases such as rheumatoid arthritis-restrictive lung disease: stiff lung and hard to expand lungs. Usual Interstitial Pneumonitis is UIP and is idiopathic pulmonary fibrosis and this type has the worst prognosis. RB-ILD and DIP is common in smokers, but good prognosis if they quit.
Occupational lung diseases = They are restrictive, and are mineral dust induced lung injury and fibrosis (restrictive), e.g., mineral dust-induced, silicosis [inhalation of crysalline silica by sandlblasters and miners], asbestosis [mesothelioma].

Question 61

Q

Which of the following best describes urticaria?

A. Cellular memory of a reaction to an antigen such that future repeated exposures causes increased dermatitis reaction

B. A wide range of reactions to infections and drugs including listers and necrosis with varying severities of expression

C. Delayed hypersensitive reaction that can be pruritic, edematous and oozing

D. Hypersensitivity-related hives in response to antigens such as pollens and drugs mediated by IgE

Answer

A

D. Hypersensitivity-related hives in response to antigens such as pollens and drugs mediated by IgE

Allergic contact dermititis is A
Erythemia multiforme is B. Erythema multiforma (hypersensitivity to infections and drugs-dermal edema-can have blisters and necrosis)-wide range of expressions and severity -can be severe life-threatening reaction known as Stevens-Johnson Syndrome—generalized all over the body—reaction to medicines (e.g., sulfonamides, salicylates)—can also be a reaction to infections such as herpes virus or fungal infections
Eczematous dermatitis isC (e.g, contact dermatitis most common, delayed hypersensitivity reaction, can be pruritic, edematous or oozing plaques/vesicles),

Question 62

Q

The secondary cancer most likely to occur as a complication of cancer treatment with alkylating agents is myelogenous leukemia. True or False?

Answer

A

True

Late complication of alkylating agents
Most frequent is acute myelogenous leukemia—observed as early as 2-4 years after; also see Non-Hodgkin’s lymphoma and bladder cancer
Treat with Imatinib

Question 63

Q

Regarding breast carcinoma, it is a 50% chance to be the diagnosis of a lump found in the breast of a 23 year old female. True or False?

Answer

A

False

Breast Carcinoma Stats = Rarely occurs

~30% incidence by 70 yrs of age
No racial influence, but there is environmental influences
Inherited=5-10% (BRCA 1 and 2 the most common inherited genes)
~250,000 new breast cancers in U.S./yr.

Question 64

Q

Regarding myocardial infarctions, the majority of these patients experience pulmonary edema. True or False?

Answer

A

True

Main complications of MI’s:Most to least common 1. Arrhythmias 75-95% 2. Congestive heart failure and pulmonary edema 60% 3. Pericarditis 4. Mural thrombosis 5. None 10-20% 6. Cardiogenic shock 7. Rupture of ventricle or papillary muscle 4-8%

Answer 59

A

D. Alpha-synuclein lewy bodies

Lewy bodies = They are abnormal aggregates of protein that develop inside nerve cells in Parkinson’s disease (PD), Lewy body dementia, and some other disorders. The primary structural component of which is alpha-synuclein. These are associated with Genetics.
Alzheimer’s = Senile plaques (they are inside of the neuron), associated with the B-amyloid plaques -Neurofibrillary tangles, associated with a tau protein -Protein aggregates precipitate and cause inflammation and kills cells. Diminish capacity of brain, not able to do multiple tasks concurrently.

Answer 60

A

Acarbose

Used to treat type II diabetes, is an alpha-glucosidase inhibitor. Slows the digestion and absorption of starch, disaccharides, etc. by inhibiting alpha-glucosidase in the brush border of the small intestines and pancreatic alpha-amylase. Side effects are bloating and flatulence.

Answer 61

A

D. Female, diagnosed at 30, neither parent has history of schiz, has positive symptoms

Best prognosis =

Chronic equals poor
Residual = poor prognosis
Institutionalized a lot, that is indication of severity, not a good sign
Life expectancy is shortened = 10% suicide, not taking care of selves
Best prognosis = temporary, cause-related, principally positive symptoms, If onset is later than 30 years, if person is female, and if there is no family history

Types =
1. Disorganized type - -Blunted affect, nothing to read about facial expressions -They are incoherent, don’t make sense -Not particularly dellusional -Bizarre mannerisms
1. Catatonic type - -Nonresponsive, but aware of what is going on -Rigid/bizarre posture
1. Paranoid type - -Positive symptoms, so they are ofen delusional, halllucinations -Aggressive and uncooperative -You would actually want this type if you were a doctor giving medications because of the positive symptoms, most likely to respond
1. Residual type - -Negative symptoms, so no delusions, socially withdrawn -Flat affect -Later stages is when these all get worse -This type is most difficult to treat

Answer 62

A

A. Prostaglandin receptors

Four basic processes in nociception: Transduction, transmission, modulation, and perception. Transduction happens in primary afferent nociceptor, then transmission happens when action potential passes through dorsal root ganglia to actual spinal cord, where modulation takes place, crosses the midline, and goes up spinothalamic tract to the thalamus, and then into the cortex where pain perception takes place.
What are the four different subtypes of specific ion channels on free nerve endings that respond to actual or potential tissue damage?
1. Mechanical 2. Chemical 3. Thermal 4. Polymodal
MODULATION = Nociceptive input is heavily modulated at the dorsal horn both facilitatory and inhibitory influences
Central sensitization is when dorsal horn projection neurons become sensitized and hyper-responsive to nociceptive input, which contributes to hyperalgesia, and to touch input, which contributes to allodynia. Prostaglandins released from neurons and/or glia in the dorsal horn in response to neural input and inflammatory mediators are probably involved in central sensitization as well. And NSAIDS can inhibit the synthesis of prostaglandins in the dorsal horn that participate in central sensitization, this is considered a second mechanism for the anti-nociceptive action of NSAIDS.

Answer 63

A

True

No structural defect –not sure of the exact cause

Typically episodic pain and bloating
Could be 5HT-dependent neuromuscular disorder
20% of population have suffered (most common GI disorder)
Most common in young adults and ~50 Years old—possible association with stress and poor diet

Answer 64

A

C. Infections of the periodontal tissues may be a particular problem with this patient

D. With proper treatment, the HbA1c value can be returned to a normal range.

What does HbA1c measure? When the body processes sugar, glucose in the bloodstream naturally attaches to haemoglobin. The amount of glucose that combines with this protein is directly proportional to the total amount of sugar that is in your system at that time. Because red blood cells in the human body survive for 8-12 weeks before renewal, measuring glycated haemoglobin (or HbA1c) can be used to reflect average blood glucose levels over that duration, providing a useful longer-term gauge of blood glucose control. If your blood sugar levels have been high in recent weeks, your HbA1c will also be greater.
Pre-Diabetes state = 14%, 41 million in US. • 75 gm glucose tolerance test: glucose >200 mg/dL after 2 hours • HbA1c>6.5% (this determines the extent to which your hemoglobin is glucosylated-it provides a good estimate of the average level of glucose for the previous 3 months:
Type I diabetes symptoms = Polydipsia, polyphagia (hunger and thirst) • Polyuria (lots of diluted urine) • Unexplained weight loss 1. Type 1 (insulin-requiring) a. features: young (3-20 yrs old), loss of islet beta cells, 5% of cases, typically thin • no natural insulin • loss of beta cells an autoimmune process-probably triggered by environment such as a viral infection • ketoacidosis (Use of fatty acids in metabolism results in formation of ketone bodies (acetone)) (ketone bodies such as acetone)-dehydration; deep labored breathing (caused by acidosis); nausea, coma
Type II diabetes = 2. Type II DM, “adult onset”, Non-insulin dependent DM a. Features • 95% diabetics are type II • Insulin levels often normal, problem is resistance of insulin receptors to insulin stimulation • Correlates with excessive visceral fat (80-90% are obese): restricted diet controls ~20% of diabetic expression • Correlates with hypertension and risk for atherosclerosis • Metabolic syndrome (see below for details) • Some genetics-likely polygenic autosomal • Most over 30 yrs old, but increasing numbers of younger Type I DM patients due to obesity • Minimal ketones or acidosis, but very high glucose –Hyperosmolar coma—enough insulin to prevent lipolysis, but still have elevated glucose
Type III diabetes = Pancreatitis
Type IV diabetes = Gestational
Oral problems associated with diabetes = 1. Increased gingivitis and periodontitis and abscesses 2. Poor wound healing (issue with oral surgery or implants) 3. Abnormal infections such as thrush/candida 4. Xerostomia (increased caries) 5. Hypoglycemic event if patients don’t eat before experiencing the stress of a dental procedure
Addison’s Disease = Chronic adrenocortical insufficiency. Addison’s Disease. • Cause: autoimmune • More common in white women • 65% of adrenal insufficiency cases • Adrenals reduced • Increased infection ACTH is increased Caused by infections such as TB

Answer 65

A

Kaposi’s Sarcoma

HHV 8 herpes virus- Kaposi sarcoma (often linked with AIDS)

Answer 66

A

D. Beta-Blocker and radioactive iodine

Methimazole = Is a thioamide that is used to treat hyperthyroidism. It inhibits thyroid peroxidase reactions, blocks iodine organification.
Also = Beta Blockers like Propranolol can inhibit T4 to T3 conversion, and help treat hyperthyroidism, and Radioactive iodine can destroy some of the gland to help out. A simple iodide can be given as well to inhibit organification and hormone release.
Levothyroxine = Simulates T4 and is used to treat hypothyroidism. The T4 products are prescribed more frequently and have fewer side effects because less potent.
Liothyronine = Simulates T3 and is used to treat hypothyroidism.

Answer 67

A

True

a. HBV infection most significant occupational dental hazard (vectors: blood, saliva, nasopharyngeal secretions)
b. In mouth, highest concentration is gingival sulcus
c. Manifestations (infections and bleeding based): • Lichen planus • Periodontal disease • Candidiasis • Increased oral bleeding • Increased incidence of type II diabetes • Sjogrens syndrome
Accidental exposure:
- • Carefully wash wound-don’t rub (embeds viruses)
- • Use antiviral disinfectant (e.g., iodine or chlorine formulations)
- • Initiate HBV vaccine series
- • Don’t be judgmental

Answer 68

A

A. Diarrhea

Main side effects:
1. Respiratory depression/decreased pulmonary reflex
1. Constipation/slow bowel movement
1. Sedation/additive or synergistic with other CNS depressants (e.g., alcohol, antianxiety, sleep aids and natural sleep
1. Euphoria/dependence, addiciton
-Mostly Mu opioid receptor mediated

Answer 69

A

Lispro

Is a rapid-acting insulin, mimics after meal insulin, rapid onset, early peak action, can be taken right before a meal, duration is about 4 hours so it prevents post-meal hypoglycemia.

Answer 70

A

F

Fluoxetine and Sertraline are the two main SSRI’s

Answer 71

A

Dysplasia.

It is an ambiguous term used in pathology to refer to an abnormality of development or an epithelial anomaly of growth and differentiation. It is disordered hyperplasia without maturation.
What type of cell change is the uterine cervix, bowel in IBS, esophagus with Barrett’s = Dysplasia

Answer 72

A

K

Benzodiazepenes = They are agonists on BDZ receptors (allosteric modulators of GABA A receptors). BDZ doesn’t directly activate the GABA receptor, isn’t an agonist, but it indirectly regulates the sensitivity of the receptor so making it more or less receptive to GABA. These have little effect on respiration, most popular CNS depressants, anxiolytic, helps with alcohol withdrawal, treats insomnia (is short-acting, so they don’t sleep the whole day). Tolerance is common with long-term use, interacts synergistically with other depressants, drowsiness, motor impairment, kids can have paradoxical reaction, don’t use with people with intellectual disability to avoid suicide.
Two sedative benzodiazepene drugs = 1. Diazepam 2. Alprazolam -Sedative are longer-lasting (8-12 hours), while hypnotic are shorter lasting (2-4 hours).
Buproprion is not a sedative.

Answer 73

A

B. Denosumab

Alendronate = Is a bisphosphonate taken daily that inhibits osteoclasts, thereby slowing bone loss. Used in the prevention and treatment of osteoporosis, Paget’s disease, bone metastasis (with or without hypercalcemia), multiple myeloma, primary hyperparathyroidism, osteogenesis imperfecta, fibrous dysplasia, and other conditions that feature bone fragility. Be careful of osteonecrosis of the jaw though after IV administration of bisphosphonates.
Denosumab = Is a monoclonal anti-RANKL antibody treatment of excess bone resorption in osteoporosis and some cancers. it prevents RANKL from stimulating osteoclast differentiation and activity.

Answer 74

A

A. Increased gastric acid secretion

Muscarinic receptors:
Ach Agonists: Bethanechol (Specifically, is a cholinesterase inhibitor) and Pilocarpine
Antagonists: Atropine and Scopalamine
So Bethanechol decreases heart rate, contracts GI smooth muscles (except sphincters), decreases the heart working, increases bodily secretions, muscarinics also work for sympathetic sweat glands.
Urinary retention = Phenylephrine, and non-selective, alpha agonists
Alpha-1 contracts sphincters
Beta-2 relaxes bladder wall

Answer 75

A

True

Usually immunosuppressed (often Herpes, Candida, and cytomegalovirus [CMV])

Often ulcers
CMV:
Affects entire GI tract
Neonates acquire thru birth canal or infected breast milk
Adults acquire through sexual transmission or needles
Multiple discrete, well-circumscribed superficial ulcers.

Answer 76

A

Hyperplasia

It is the increase in the volume of an organ or tissue due to the enlargement of its component cells. It is distinguished from hyperplasia, in which the cells remain approximately the same size but increase in number. You are born with about all of the cardiac myocytes that you will get, but they can get bigger, this is hypertrophy.

Answer 77

A

True

Asthma = It is a reactive airway disease and narrowing of airways-hyperreactivity: hyperinflated lungs, thick mucus plugs in airways, smooth muscle hypertrophy • Types: • Atopic- childhood onset often with allergic rhinitis, type I hypersensitiviy response. • Non-atopic- non-immune, occupational exposures, like aspirin or viral infections.

Answer 78

A

Lung cancer

Lung cancer, followed by prostate (elevated PSA and acid phosphatase) in men and breast in females.

Answer 79

A

True

It exhibits passive diffusion, gets everywhere, food slows its absorption, it is distributed everywhere, even through placental barrier and breast milk. it exhibits zero order kinetics, meaning constant rate, and independent of original concentration.

Answer 80

A

Hypertrophy

It is the increase in the volume of an organ or tissue due to the enlargement of its component cells. It is distinguished from hyperplasia, in which the cells remain approximately the same size but increase in number. You are born with about all of the cardiac myocytes that you will get, but they can get bigger, this is hypertrophy.

Answer 81

A

Dyskeratosis

Answer 82

A

C. Anterior pituitary adenoma

four common kinds of pituitary adenoma = . Prolactinoma (32%, galactorrhea, mass effects) 2. Growth Hormone (20%, acromegaly, gigantism) 3. Null cell / unclassified (30%, mass effects, can make clinically trivial amounts of FSH/LH) 4. Corticotroph (14%, Cushing disease)
Most common cause of hypopituitarism = Most common cause are nonsecretory pituitary adenomas
Anterior pituitary insufficiencies = • Loss of sex characteristics-sterility • Retard growth in children • Hypothyroidism
Posterior pituitary insufficiencies = Diabetes insipidus –no glucose or insulin involved • Polydipsia (thirst) • Inappropriate ADH secretion from pituitary • Consequences : alters kidney function-volume (water) expansion, hyponatremia (low blood sodium levels) and hemodilution • Causes: metastasized carcinoma, CNS infection But problems can correct with administration of ADH.
Anterior Pituitary = 1. TRH - TSH - Thyroid, T4 2. CRH - ACTH - Adrenal Cortex, Cortisol 3. GNRH - FSH, LH - Reproductive tissues 4. GHRH - GH - Liver, IGF-1 5. GIH 6. Dopamine And Prolactin is released from the anterior pituitary and is for lactation.
Posterior pituitary = The posterior pituitary receives axons of nerves from hypothalamus, where ADH and oxytocin are produced. ADH (for water retention) & oxytocin (for nursing) are stored and released from neurohypophysis into systemic circulation, avoiding blood-brain barrier.
Cushing’s Disease = Leading cause of hypercortisolism: women 5X more likely • Adrenal hyperplasia • ACTH low, cortisol high • Adrenals act autonomously • Symptoms: moon face, osteoporosis, hypertension, buffalo hump, obesity, thin skin, amenorrhea, muscle weakness, mood changes, poor wound healing (remember: this looks like someone on chronic corticosteroid treatment-e.g., for chronic major arthritis or other inflammatory diseases)

Answer 83

A

D. Simple partial

A complex partial is localized onset, spreads bilaterally usually, either awareness, memory, or consciousness is lost during seizures, and they usually last 15 sec to 3 minutes.
An absence seizure probably represents abnormal interactions between cortical and thalamic transmissions. 2-15 seconds.
What is the main difference between tonic-clonic actions happening with secondary generalized seizures and generalized tonic-clonic seizures? And how long does tonic-clonic usually last? The two are synchronized with generalized tonic-glonic seizures. Lasts 1-2 minutes. Tonic clonic also have postictal phase after, confusion. Tonic is stiff, clonic is jerking.

Answer 84

A

True

What percentage of patients with a history of myocardial infarctions have arrhythmias? 80% because of all the scar tissue
Usual cause of sudden death? Arrhythmias, most often from coronary atherosclerosis, although infarct is not needed.

Answer 85

A

Increase heart rate via SA node
Increase conduction velocity and contractility of atria
Increase automaticity and conduction velocity of AV node
Increase automaticity and conduction velocity of His-Purkinje System
Increase automaticity, conduction velocity, and contractility of ventricles
Isoproterenol
Dobutamine
Propranolol
Atenolol
Metoprolol

Answer 86

A

A. Nopaine improved the gastric mucosal protection against acid reflux

Should have caused GI problems
COX-1 usually does GI protection, platelet aggregation, renal activities, vasoconstriction.
COX-2 usually does Cardiovascular protection, renal activities, pain, fever, inflammation, vasodilation. The pain, fever, and inflammation are the inducible activities of COX-2, while the others are constitutive.

Answer 87

A

Warfarin

Vitamin K is reversal agent for the extrinsic pathway
Warfarin Works everywhere you have vitamin K - 2, 7, 9, and 10
Dabigatran = Is an alternative drug for warfarin, has fewer side effects and is more popular than heparin or warfarin, it affects PTT sensitive pathway, but has unique mechanisms that makes it distinct from heparin and warfarin, used on out patient basis.

Answer 88

A

True

The Plexus of Raschkow, or Sub-Odontoblastic Plexus. It consists of sensory afferents of the trigeminal nerve and sympathetic branches from the superior cervical ganglion.

Answer 89

A

C. Haloperidol

Parkinson’s = you have low dopamine so you want to increase it, and you want to decrease ACh, and Haloperidol has no anti-cholinergic effects.
Six main drugs used to treat Parkinson’s disease:
- 1. L-dopa + Carbidopa (L-dopa gets across blood-brain barrier much better than dopamine, and Carbidopa blocks the metabolism of L-dopa and dopamine so it can last longer.)
- 1. Benztropine
- 1. Trihexyphenidyl
- 1. Selegiline (This is an MAO inhibitor, blocking monoamine oxidase B from metabolizing dopamine in the brain, so prolonging the effects of levodopa)
- 1. Entacapone
- 1. Pramipexole (This is a dopamine agonist, a D2 agonist, which bypasses the depleted neurons int he substantia nigra and provides long-lasting direct stimulation of dopamine receptors)
Selegiline = MAOI so it increases dopamine
Haloperidol is a butyrophenone that is used to treat Psychotic disorders. High extrapyramidal side effects, lacks anticholinergic action.

Answer 90

A

True

Atrial Fibrillation
It is the most common sustained arrhythmia in adult clinical cardiology. Atrial flutter is different and involves very rapid atrial contractions, and can turn into atrial fibrillation. AF increases with age and often co-exists with other cardiovascular diseases like congestive heart failure, valvular heart disease, and hypertension. 10% of Americans older than 65 years old have AF. It is associated with electrical and structural changes of the atrium. You get electrical remodeling, meaning shorter atrial action potentials, loss of rate of adaptation to action potential duration, and loss of myocytes and replacement with collagen and fibroblasts. AF causes inefficient atrial contraction, which causes decrease in cardiac output, due to loss of atrial contribution to ventricular filling, and is also involved with a high risk of thrombosis and embolization.

Answer 91

A

A. He is legally compromised

0.08 is legal limit
.05-.1 = slower reflexes, sedation, lower reaction time
.1-.2 = impaired motor function, slurred speech
.2-.3 = Stupor, throw up
.3-.4 = coma
>.4 = Respirtaory depression, death

Answer 92

A

D. Increases bone adsorption

Diethylstilbesterol = It is a non-steroidal synthetic estrogen that decreases bone adsorption
Ethinyl estradiol is the steroidal synthetic estrogen
Estrogen functions:

Sexual maturity
Increased CNS excitability (seizure inducing?)
Increased endometrial and uterine growth
Maintain skin elasticity
Reduce bone adsorption
Increase blood coagulability

What are the natural estrogens at different ages?

Estrone (predominant during menopause)- E1
Estradiol (predominant during productive years)—E2
Estratriol (predominant during pregnancy)—E3

Clinical uses for estrogens =
Primary hypogonadism
• Postmenopausal
(1) Guidelines for use
• Always use the smallest dose for the shortest period of time possible
• Sometimes local creams are preferred to minimize exposure

Answer 93

A

Heb B virus, 2 billion chronically exposed in world, 350 infected. 15-25% of infected will go into chronic phase and most will die from complications. Can lead to cancer of liver (hepatocarcinoma)
-important to get vaccinated.
Caused by DNA virus
Cirrhosis (chronic phase)= portal hypertension; causes ascites 85% of time in chronic phase with cirrhosis

Answer 94

A

C. Sleep

The nine main seizure precipitants are:

Metabolic and/or Electrolyte Imbalance (People’s blood glucose too high or too low, too low sodium, calcium, magnesium, potassium too high)
• Stimulant or other pro-convulsant intoxication
• Sedative or ethanol withdrawal
• Sleep deprivation
• Reduction or inadequate ASD treatment
• Hormonal variations
• Stress
• Fever or systemic infection (HSV can be linked)
• Concussion and/or closed head injury

Answer 95

A

B. Calcium oxalate

Four main types =
1. Calcium oxalate (75%) Use hydrochlorthiazide
1. Magnesium ammonium phosphate (struvite, triple phosphate, 15% stones, alkaline urine), correlated with UTI’s, Use AHA, acetohydydroxamic acid, or TMP-SXS
1. Uric acid stones (5%), half are gout associated Use Allopurinol
1. Cystine stones (5%), defective tubular transport of cystine Use Penicillamine or sodium bicarb for this and uric acid
a. Calcium/oxylate: excess calcium and oxalate in urine (~80% of stones) -men more likely than women Alkalinize urine (stop drinking carbonated soft drinks) b. Struvite (~10% of stones)-magnesium ammonium phosphate crystals-often associated with urinary infections- only type where treatment is to acidify urine. -more common in females (the only type)
c. Uric acid- excess waste, uric acid, in urine mineralizes into stones when urine is too acidic-often associated with gout -more common in men, must decrease uric acid production and alkanize urine pH d. Cysteine - excess cystine production causes hypercystinuria and deposition when urine is too acidic. Must dissolve cystine, thus alkanize urine and increase water consumption to flush kidneys.

Answer 96

A

True

What can an ectopic focus that is firing rapidly or multiple ectopic foci collectively causing a fast rhythym end up causing? Tachycardia and Tachy-arrhythmias

Answer 97

A

Osteogenesis imperfecta

1. Osteogenesis imperfecta
  a. Deficient or defective type 1 collagen—too little bone
  b. Generalized osteopenia
Multiple fractures and bone deformities
Malformed teeth (dentin deficiency)

Answer 98

A

True

Vincristine and Vinblastine = Is a natural product cancer, chemotherapy drug.
1. Inhibits tubulin polymerization-cytoskeleton component—arrests in cell division and causes cell death
1. Toxicity: mucositis, myelosuppression
1. Treat: breast cancer and Kaposi’s lymphoma

Answer 99

A

D + G

Chlorpromazine = Phenothiazine, anti-psychotic drug. Least expensive, older, more sedation and weight gain, less extrapyramidal side effects, antiemetic action. Anticholinergics mask the effects of tardive dyskinesias but the damage is still being done. Anticholinergics are also used to treat Parkinson’s Disease. Remember that Parkinson’s need anti-cholinergics (heavy drooling)
Clozapine = Atypical anti-psychotic drug. Can cause serious agranulocytosis. Besides D2 antagonism, these typically are also good 5HT2A antagonists. Little extrapyramidal side effects. Most effective against the 􏰂negative􏰄 symptoms in some forms of schizophrenia.

Answer 100

A

False

92%, Stage IV = 14%

Answer 101

A

True

Both para and sympathetic use Nicotinic receptors at the pre-ganglionic stop as well, and Para uses muscarinic at the post-ganglionic while sympathetic uses alpha/beta, some dopamine, and even muscarinic for sweat glands.

Answer 102

A

Protamine

Intrinsic pathway, PTT and Heparin

Answer 103

A

False

Essential (primary) Hypertension: No obvious cause, very common, nearly 50 million in US, 95% of all hypertensive patients. Possible causes include increased sodium retention; intravascular volume, narrowing of arteries, high TPR lowers blood pressure in kidneys, kidneys sense lower pressure and signal to retain sodium to increase BP, vicious cycle.
Risk factors:

Risk factors for essential hypertension: Increasing age. Black. Family history of hypertension. Obesity and metabolic syndrome. High salt diet. Lack of physical activity.

Answer 104

A

Muscle Relaxants-enhance levels of inhibition, usually via CNS (GABA-mediated)

Antispasmotics (muscle relaxants)-reduce muscle stretch reflex

Diazepam
Baclofen (GABA B agonist)
Dantrolene (alters Ca++ trafficking)
Carisoprodol (Soma)- muscle relaxant/sedative; may have some dependence problems

Non-deplolarizing neuromuscular blocking

D-tubocurarine—blocks ganglionic nicotinic receptor
Acetylcholinerase inhibitor blocks by overwhelming the blockade with increased ACh

Depolarizing neuromuscular blocking
* Succinylcholine—block ganglionic nicotinic receptors by desensitizing (overstimulating?)

fast acting, get initial twitching before paralysis
acetylcholinesterase inhibitor does not reverse.

Answer 105

A

False

Hirschsprung disease

Congenital defect in colonic innervation
Failure to pass meconium The small bowel, colon.

Answer 106

A

True

Renal Cell Carcinoma = 80-90% of all renal maligancies
Most common in Male, >40, smoker, analgesic users, obesity
Often clinically silent until large, painless hematuria, dull flank pain, fever, fatigue. Most likely metastasized to lungs or bones.
Two types = 1. Papillary (If you see a bunch of macrophages, think papillary RCC) 2. Clear cell (abundant glycogen or lipid), and you see a lot of vascular background with RBC’s in clear cell RCC.

Answer 107

A

False

The ones that treat Meniere’s disease are H1 blockers.
Meclizine, Promethazine,
Cimetidine and Ranitidine are Used for GERD. H2 receptor blockers-not effective at the H1 receptors (i.e., not good antihistamines)-reduce gastric secretions by blocking H2 receptors in gut.
Side effects: headaches, diarrhea, drowsiness.

Answer 108

A

True

Addison’s Disease = Addison’s—adrenal glands produce too little cortisol (chronic)—often insufficient aldosterone as well • Symptoms • Weakness • Fatigue • Weight loss • Hyperpigmentation • Treatment—corticol supplements: cortisones (hydro-) or prednisone

Answer 109

A

False

I think it is diabetes, obstruction, spread from cystitis

Answer 110

A

True

Opioids do somatic and visceral, are antitussive, and antidiarrheal

Answer 111

A

True

A pathophysiological process resulting from abnormal sensory processing, which does not signal actual or potential tissue damage, does not promote healing or repair, and may be considered a disease. Fibromyalgia is an example of neuropathic pain.
Five examples of neuropathic pain:

Phantom Limb
Shingles
Fibromyalgia (9 common points of pain)
Diabetes Neuropathies
Trigeminal Neuralgia (tic douloureux)

Answer 112

A

A. Remova all teeth, let heal for 1-2 weeks before cancer treatment

Answer 113

A

Intestinal malabsorption of vitamin D or calcium • Chronic reduction of serum of Ca++ usually a consequence of chronic renal failure Stimulates PTH secretion, causes hyperplasia

Answer 114

A

D. Effects are blocked by tamoxifen

Tamoxifen blocks just estrogen, Estrogen receptor antagonist. Blocks actions of estrogen in breast-used to treat breast cancers.
Effects of progestins =
- Increase fat deposition
- Decrease CNS excitability (e.g., antiseizure—opposite of estrogen)
- Increase aldosterone—increase Na+ retention—increase BP—increase water retention and blood volume
- Increase body temperature
Clinical uses of progestins =
- Replacement therapy
- • Oral contraception
- • Long-term ovarian suppression (e.g., dysmenorrhea or endometriosis)—in contrast to estrogens, no problem with bleeding or clotting
• Contraindications:
- • Breast cancer is a risk
- • Severe hypertension or heart disease is risk

Answer 115

A

False

It is TMP-SMX

Answer 116

A

A. The most likely status of the two sensitive teeth (2 and 3) is that there is pulap caries involvement and they are no longer viable

D. Based on the presentation of this patient he most likely is being prescribed a promethazine-like drug

Dexamethasone = Given as a shot in the ear for otitis media, Treats Meniere disease. Long-acting steroid/inject into the ear—it reduces fluid.
Not amoxicillin because not otitis media, Antibiotics used to treat acute otitis media. Second level drugs include Trimethoprim or macrolides.

Answer 117

A

B. She is using clomiphene

Clomiphene = Clomifene or clomiphene is a selective estrogen receptor modulator that has become the most widely prescribed drug for ovulation induction to reverse anovulation or oligoovulation. Ovulation-inducing; for promoting fertilization and pregnancy (increased risk of multiple births—e.g., twins). Clomed.
Danazol = Danazol is a derivative of the synthetic steroid ethisterone that suppresses the production of gonadotrophins and has some weak androgenic effects. Suppresses ovarian function (has a masculinizing effect). Treats endometriosis, fibrocystic breast disease, and hereditary angioedema.
Progestin only—referred to as the “minipill” (no estrogen); fewer side effects, but less effective

Answer 118

A

Necrosis

Reversible and Irreversible (cell death), with inflammation. An example of reversible is mild acute tubular necrosis of kidney, toxic livery injury, severe exercise. An example of irreversible is holes in cell membrane, long Ca++ influx, mitochondrial loss, and the two types of irreversible are necrosis and apoptosis.

Answer 119

A

True

Hepatitis C

Source: blood body fluids
Route of Transmission: Percutaneous, permucosal
Chronic Infection: Yes
Prevention: blood screening, risk behavior modification 6. Hep C virus found in >170 million carriers worldwide • Acute phase usually asymptomatic and not diagnosed • Chronic phase, Ab present at 5-20 weeks • 60% related to parenteral exposure • Caused by RNA virus • Can lead to hepatocarcinoma • No vaccines, but there is a very expensive cure

Answer 120

A

Acanthosis

Answer 121

A

D. Asprin

A. Lyrica

D. Prescribe celecoxib (celebrex)

Aspirin and other Cox-1 inhibitors can cause ulcers, stomach problems, and aspirin is a blood thinner. Salicylates are a COX-1 and COX-2 inhibitor. Analgesia is 600 mg Anti-inflammation is 1 gm Antipyretic is 300-600 mg Duration is 4h -Causes GI irriation, anti-clotting (-You are permanently damaging the platelet when you take these, and you have to regrow platelets, and this anti-clotting can happen with less than 100 mg of salicylates. Don’t prescribe salicylates when you are doing surgery on patients. -When the acetyl group breaks off, this turns into an acid. It has direct and indirect effects on this.), ringing in ears, and Reyes Syndrome in children (With Reyes- You can have permanent damage done to the brain, that is why aspirin-containing products are forbidden in children)
Lyrica and Gabapentin are two drugs used to treat neuropathic pain. Both are anti-convulsant.
Duloxetine, Nortryptiline are also used for neuropathic pain. And Tramadol is a next-in-line treatment for it.
Prescribe Celebrex because it is a selective Cox-2 inhibitor and doesn’t have GI side effects. Celebrex. Cox-2 selective antagonist. • Prescription only • Same analgesia as ibuprofen • Lacks GI and anti-clotting action • Warning about cardiovascular side effects

Answer 122

A

B. Do careful plaque removal and root planing to reduce the discomfort on the right mandibular quadrant and help relieve the periodontal problems

Lyrica and Gabapentin are two drugs used to treat neuropathic pain. Both are anti-convulsant.

Answer 123

A

False

Used to treat peptic ulcer disease.
Cure if H pylori-related –H pyloria is contagious especially within family members
• Prevpac; combination of lansoprazole (a PPI) and the antibiotics amoxicillin and clarithromycin

Answer 124

A

True

When does urinary obstruction cause severe, irreversible renal damage if it is a complete obstruction? Partial?
3 weeks, 3 months
Get dilated ureter and hydronephrosis (unable to concentrate urine)
If distal to bladder can get dilated bladder with a thickening of the bladder wall
What are the main renal diseases? =
1. Single or fused kidney
  * —horse shoe kidney (congenital)
1. Renal dysplasia
  * Multiple cysts, cartilage, etc
  * Urinary tract dysfunction
1. Adult polycystic kidneys –genetic
  * Renal insufficiency
  * Linked to intracranial aneurysm
  * Other organs also have cysts
  * Enlarged kidneys

Answer 125

A

C. Cyclothymia

Cyclothymia = Cycles of dysthymia to minor state of mania-minor bipolar-longer than two years-no gender bias -No drugs for these usually, some of our most brilliant people like Einstein entered this manic part of cyclothymia and was productive. Minor bipolar, not treated with meds.
Autism = 1. Problem with social interactions 2. Verbal or non-verbal communication problems 3. Problems with repetivie behavior. Causes = Genetics and environment. It tends to associate with certain medical conditions, like Fragile X syndrome, congenital rubella syndrome, PKU. They are also more vulnerable to toxins because they can’t metabolize them as well.

Answer 126

A

True

• Opened comodones (blackheads)
• Closed comodones (white heads)
• Cysts, pustules and abscesses -vulgaris:
• Hormone changes (i.e., sex hormones)-increases testosterone influence
• Blocks hair follicle and sebaceous gland
• Hair follicle have proliferation of lining cells and cellular sloughing—forms a cellular plug and traps bacteria, cellular debris and sebum
• Gland ruptures and contents spreads to form cysts, abscesses and scarring—area is inflamed and swollen • Treatments: -antibiotics -keratolytics -drying agents -vitamin A (topical and systemic-Accutane)

Answer 127

A

Meniere disease
- Symptoms: vertigo, hearing loss, nausea, sometimes migraine headaches, hearing loss, swimming feeling, tinnitus, balance problems
Pathology:
- endolymphatic hydrops—swelling/excess fluid in labyrinth
Risks-
- Improper inner ear fluid drainage
- Allergies
- Viral infections
- Head trauma
- Migraines
Diagnostic tests:
- Hearing and balance assessments
- Some surgical interventions, but extreme
Pharmacology:
- Meclizine (Antivert): H1 blocker, anticholinergic, CNS depressant-antimotion sickness medication, xerostomia
- Diazepam
- Promethazine: H1 blocker, anticholinergic, antinausea and motion sickness, xerostomia
- Hydrochlorothiazide: diuretic-regulate fluid volume and pressure in inner ear
- Dexamethasone; long-acting steroid/inject into the ear—it reduces fluid.

Answer 128

A

False

Hep A
Source: Feces
Route of Transmission: Fecal/oral
Chronic Infection: No
Prevention: pre/post exposure, immunization
Hep E
Source: feces
Route of Transmission: fecal/oral
Chronic Infection: oral
Prevention: ensure safe drinking water

Answer 129

A

Atrophy

Cell shrinkage or loss, caused by lack of hormonal signals, loss of innervation, lack of use, loss of blood supply, starvation, individual cell death

Answer 130

A

A. Enhanced GABA receptor activity

Ca2+/Mg2+ can kill neurons and result in degenerative disorders
Main Causes = 1. Hypoxia 2. Excitatory Amino Acids 3. Ion Fluxes 4. Free Radicals 5. Immune Responses 6. Infections 7. Apoptosis 8. Protein Aggregation
Huntington’s disease = Increase in dopamine and a decrease in GABA because the cell bodies in GABA die. Patients have lost most of the cell bodies because the caudate has been lost, which sits right next to the ventricles on the outside. The hunting gene seems to alter NMDA/AMPA receptors for Glutamate, and you end up killing these receptors from over-excitation of the glutamate system. The hunting gene is found in the GABA neurons.
Parkinson’s is abnormal protein aggregation

Answer 131

A

False

b. Struvite (~10% of stones)-magnesium ammonium phosphate crystals-often associated with urinary infections- only type where treatment is to acidify urine. -more common in females (the only type)
Use AHA, acetohydydroxamic acid, or TMP-SXS

Answer 132

A

D. Lovastatin

Triglicerides: 200 high
Total Cholesterol = >200 mg/dL desirable 200-239 mg/dL borderline high >240 mg/dL high
Primary Hypercholesterolemia = Also called familial, and it is an autosomal dominant gene. LDL ranges from 260-500 mg/dl, but triglycerides are usually normal. Coronary disease is often premature, and you have defects in LDL receptors.
Fenobrate = This drug, used to treat hypercholesterolemia, is a fibrate that increases oxidation of fatty acids in liver and muscles (causes lipolysis). It reduces VLDL and has modest effect on LDL, and a moderate increase in HDL while reducing triglycerides. It’s main side effects are GI symptoms.
Cholesteramine = This drug is used to treat hypercholesterolemia and it is a bile acid-binding agent. It reduces absorption of bile acids and metabolites. It all goes to the stool though so you end up getting constipation and bloating.
Ezetimibe = This drug is used to treat hypercholesterolemia and it is an inhibitor of intestinal sterol absorption. It inhibits intestinal absorption of cholesterol and reduces LDL. If you have a genetic problem though, this won’t do much good. This is great if you have a diet problem.
Lovastatin = This drug is a competitive inhibitor of HMG-COA reductase, which helps form cholesterol. These should be avoided during pregnancy. Statins reduce synthesis of cholesterol and have most effect on LDL. These drugs have liver toxicity, and give weakness in skeletal muscles because of increased creatine kinase. If you use them for months, you can have permanent damage to skeletal muscle.

Answer 133

A

True

Mannitol = It is an osmotic agent. It draws free water out of tissues (including the brain) and into the intravascular space, and can transiently decrease cerebral edema (until excreted by the kidneys). Mannitol is freely filtered in the glomerulus, but cannot be reabsorbed. Thus, it remains in the lumen of the nephron and lowers osmotic pressure. Water then “follows” mannitol into the lumen due to the osmotic pressure.

Answer 134

A

False

Treats diarrhea. Imodium; mild opioid agonist: if severe, can use strong opioid agonists

Answer 135

A

False

Crohn’s is an IBS.
(1) Crohn’s disease
(a) Symptoms: • Chronic diarrheal problems • Can affect entire GI, but more intense in ileum and colon and intermittent areas with strictures between -ulcerations -swelling and scarring • Hypogastric pain • Perianal fissures/fistules • Higher incidence of arthritis • Fatty liver • Possible genetic link • Perhaps abnormal inflammatory response to normal flora • Has remission • Increase incidence of colon cancer• It skips lesion and has intermediate constrictures • Granulomas • Fistulas and perianal disease • Also affects upper GI tract • Transmural inflammation • Fistulas, perianal
• Oral manifestation: ➢ 0.5% have oral lesions ➢ Usually males ➢ Linear and deep ulcerations
Ulcerative colitis • More continuous especially in the colon • No transmural inflammation • No fistulas and not perianal
• Oral manifestation: ➢ Less common than in CD ➢ Usually males ➢ Edematous oral submucosa

Answer 136

A

Excoriation
- Traumatic breakage of the skin from scratching
Lichenification
- Thickened skin due to repeated rubbing
Papule
- Elevated dome or flat-topped lesion < 5mm
Patch
- Flat circumsribed area > 5mm
Pustule
- Discrete, pus-filled raised lesion
Scale
- Dry, plate-like excresence, due to imperfect cornification
Vesicle
- Fluid filled raised area < 5mm
Bulla
- Fluid filled raised area > 5mm
Acantholysis
- Loss of intracecllular adhesion keratinocytes
Acanthosis
- Diffuse epidermal hyperplasia, regular or irregular
Dyskeratosis
- Abnormal keratinization occurring prematurely within individual cells below stratum granulosa
Hyperkeratosis
- Hyperplasia of stratum cornum
Lentiginous
- Linear proliferation along basal cell layer
Papillomatosis
- Surface elevation caused by hyperplasia and enlargement of dermal papillae
Parakeratosis
- Keratinization characterized by retention of nuclei in stratum corneum
Spongiosos
- Intercellular edema of epidermis
Macule
- flat, circumscribed (5 mm)
Plaque
- elevated flat-topped lesion (> 5mm)
Nodule
- elevated dome (> 5mm)

Answer 137

A

B. Huntington’s disease

MS = It all comes down to oligodendrocytes getting damaged and the myelin is then lost, which results in abnormal or missing conduction. They believe that a virus might trigger it causing acute inflammation and an auto-immune response.
Huntington’s disease = Increase in dopamine and a decrease in GABA because the cell bodies in GABA die. Patients have lost most of the cell bodies because the caudate has been lost, which sits right next to the ventricles on the outside. The hunting gene seems to alter NMDA/AMPA receptors for Glutamate, and you end up killing these receptors from over-excitation of the glutamate system. The hunting gene is found in the GABA neurons.
Major anxiety disorder = It is a natural response but in excess. Involves adrenaline and the sympathetic nervous system

Answer 138

A

E

Donepezil = Cholinesterase inhibitor. Used to treat Alzheimer’s. We need for ACh with Alzheimer’s!!

Answer 139

A

C. 85%

The remaining you find by palpation, 10-15%

Answer 140

A

True

Stones, catheter, other foreign objects, reflux, short female urethra, obstructing lesions, diverticula.

Answer 141

A

True

Bronchiectasis = Results from obstruction of the bronchi and persistent necrotizing infections.
You get destruction of elastin and muscles in bronchial walls-congenital expression often caused by cystic fibrosis. You get persistent productive cough, and the infection which causes the suppurative pneumonia is usually caused by TB, Staph, Klebsiella (Alcoholics).

Answer 142

A

A. Succinylcholine

Non-depolarizing blockers are reversed by acetylcholinesterase (AChE) inhibitors, since they are competitive antagonists at the ACh receptor.
Succinylcholine = Depolarizing blocking (paradoxical depolarizing blockade (desensitization) (succinylcholine) of the ganglionic nicotinic ACh receptor) = not reversed by ACh inhibitors
Non-depolarizing blocking (produce muscle paralysis by either nondepolarizing blockade (d-tubocurarine))
Spasmolytics (reduce spasticity by modifying the stretch reflex arc and/ or interfering directly with excitation-contraction coupling of the skeletal muscles. (Diazepam, Baclofen, Tizanidine, Dantrolene)
Dantrolene = An anti-spasmotic that is used as a muscle relaxant. is a postsynaptic muscle relaxant that lessen excitation-contraction coupling in muscle cells by inhibiting Ca2+ ions release from sarcoplasmic reticulum stores by antagonizing ryanodine receptors.-It is the primary drug used for the treatment and prevention of malignant hyperthermia, a rare, life-threatening disorder triggered by general anesthesia.-Its direct effect is peripheral only.
Carisoprodol = Muscle relaxant/sedative; may have some dependence problems, works by blocking pain sensations.
D-tubocurarine = Is a non-depolarizing neuromuscular blocker. Blocks ganglionic nicotinic receptor.

Answer 143

A

A. Stimulates DNA induction of apoptosis

Develop a signal to proliferate
Avoid apoptosis
Invade stroma (if carcinoma)
Metastasize
Induce angiogenesis
Alter DNA in order to allow continued mitosis (normally cells stop dividing after 15X doubling)
Develop telomerase to prevent cellular senescence

Genetic Targets for Tumors

Oncogenes (promote proliferation)-e.g. growth factors or corresponding receptors
• Tumor suppressor genes (inhibit tumor growth-e.g., BRCA-1 and BRCA-2 (breast and ovary)
• P53 gene is most common suppressor gene mutation (lost in 50% of malignancies)
• WT-1 gene- regulates apoptosis such as in Wilms tumor
• APC-adenomatous polyposis coli-tumors in bowel and pancreas
• Apoptosis regulating genes (P53 gene also affects apoptosis)
• DNA repair genes
• Mismatched repair genes- e.g., HNPCC gene (hereditary nonpolyposis colon cancer)
• Angioneogenesis (tumors release vascular endothelial growth factor)
• Develop properties for invasiveness

Answer 144

A

True

1. Calcium oxalate (75%) 2. Magnesium ammonium phosphate (struvite, triple phosphate, 15% stones, alkaline urine) 3. Uric acid stones (5%), half are gout associated 4. Cystine stones (5%), defective tubular transport of cystine

Answer 145

A

C. Complex partial seizure

All generalized seizures involve loss of awareness or lack of responsiveness:

• Primary Generalized Seizure
• Absence, or “petit mal”
• Tonic-Clonic,or“grandmal”
• Atonic,Myoclonic(jerking/spasms),or Tonic (stiffening)

Secondary generalized: They begin as simple or complex partial seizures, and when it continues to spread, it becomes generalized. Has tonic (stiffening) and clonic (jerking) phases once it becomes generalized. And all of this is finishes with a postictal phase.

Answer 146

A

A. entacapone

Azilect inhibits dopamine breakdown while Entacapone improves the effect of Carbidopa-levodopa by inhibiting COMT, Catecholamine Methyl Transferase, which metabolizes neurotransmitters like MAO does.

Answer 147

A

True

Secondary Hypertension: Uncommon, 5% of all hypertensive patients, possible causes include endocrine (steroid, pheochromocytoma), drugs, pregnancy, renal failure, sleep apnea, pain, stress.

Answer 148

A

B. ACh, NE, ACh

Beta and Alpha are called adrenergic receptors.
Both para and sympathetic use Nicotinic receptors at the pre-ganglionic stop as well, and Para uses muscarinic at the post-ganglionic while sympathetic uses alpha/beta, some dopamine, and even muscarinic for sweat glands
So remember that ACh and Nicotinic receptors are involved in every pre-ganglionic receptor stop
And ACh and Nicotinic receptors are at somatic skeletal muscle junctions, where there are no pre- and post-ganglionic axons.

Answer 149

A

B

C

D

E

F

G

Diabetes insipidus = increased thirst and diuresis becaues of low ADH and glucocorticoids

Answer 150

A

A. basal cell carcinoma

BCC = least aggressive and slow growing
Squamous Cell - next most common, intermediate aggression, no metastasis -red scaling plaques—locally aggressive, can form keratin pearls
Melanoma = least likely, typically aggressive and metastasizes -warnings: rapid enlargement of nevus; new pigmented lesion-not from pre-existing nevi; irregular borders; irregular surface and colors -caused by UV exposure and genetics -prognosis: poor if metastasized (common sites are lungs, liver and brain)

Answer 151

A

C. Generalized absence

Answer 152

A

Contract the radial muscle of the iris, causing dilation
Constrict the GI and GU sphincters
Constrict vasculature

Phenylephrine

Prazosin
Terazosin

Answer 153

A

B. Arthritis

Causes include: -diabetes -UV exposure -aging
• Treatment is typically surgical removal
Diabetic Retinopathy = associated with hemorrhaging and ischemic spots (expressed as cottonwool spots) -hypertension causes similar retinopathies as diabetes

Answer 154

A

D. Lorcaserin

Phentermine = inhibits NE and dopamine uptake
- Is used for weight loss, is an amphetamine. Phentermine inhibits norepinephrine and dopamine uptake • Side effect: weight loss, dry mouth, hypertension, palpitation • Interactions with sympathomimetics like MAOIs and SSRIs (including vasoconstrictors in local anesthetics)
Qysmia = anti-convulsant that induces weight loss
- It is a drug used for weight loss and it is a combination of Phentermine and Topiramate (anti-convulsant). Qysmia is contraindicated during pregnancy. Topiramate can give feeling of “fullness” through decreased GI motility, increased taste aversion, increased energy expenditure.
Lorcaserin = Is used for weight loss, 5-HT2C agonist, suppresses appetite in hypothalamus.
Glucagon = Is produced in alpha cells of pancreas. It increases gluconeogenesis. Used to treat severe hypoglycemia, a side effect of diabetes drugs usually in an emergency setting.

Answer 155

A

True

Due to retrograde spread from cystitis or hematogenous spread, commonly seen with urinary obstruction, stenosis, can cause flank pain, fever, or asymptomatic, it is more severe in diabetics and with obstruction, can cause scarring.

Answer 156

A

True

A delta and C fibers are the main two types of sensory nerve fibers that transmit pain. They carry nociceptive transmission to the spinal cord.
A delta fibers are small, myelinated, fast conducting, associated with mechanical, thermal nociceptors, and they transmit “first” or “fast” pain, diameter of 1-6 mm, sharp localized pain when dentin is first exposed, and more associated with a reflex than C fibers. C fibers are small, unmyelinated, slow conduting, associated with polymodal nociceptors, and they transmit “slow” or “second” pain, diameter of 2 mm, associated with conduction of dull, difuse pain.

Answer 157

A

B. Promotes glucose uptake in kidney cells

Functions of insulin (physiological) = Promote transport of glucose and amino acids through membranes of skeletal/smooth/cardiac muscle cells, fibroblasts, FAT cells (this is most important because can cause diabetes by selectively blocking insulin effects in fat cells ; it is an anabolic hormone • Does not affect glucose uptake in: neurons, kidney and red blood cells, retina, lens
• Insulin and C-peptide (are linked in precursor peptide) are secreted from beta cells in islets of Langerhans (pancreas) in response to glucose

Answer 158

A

Calcium oxylate, uric acid, and cysteine (all but struvite)

Answer 159

A

True

A delta fibers are small, myelinated, fast conducting, associated with mechanical, thermal nociceptors, and they transmit “first” or “fast” pain, diameter of 1-6 mm, sharp localized pain when dentin is first exposed, and more associated with a reflex than C fibers. C fibers are small, unmyelinated, slow conduting, associated with polymodal nociceptors, and they transmit “slow” or “second” pain, diameter of 2 mm, associated with conduction of dull, difuse pain.

Answer 160

A

True

Benzoyl peroxide (5%)-containing preparations also work as peeling agents to increases skin turnover, clearing pores (comedolyDc) and reducing the bacterial count (P. acnes) as well as acting directly as an antimicrobial.

Benzoyl peroxide is an oxidant and may cause local irritation, dryness and, rarely, bleaching of the hair or colored fabrics it contacts.Higher concentrations available by prescription

Answer 161

A

False

Chronic gastritis
a. H. pylori gastritis-duodenal and pyloric ulcers; may lead to cancer
b. Autoimmune gastritis

The main eight diseases associated with the stomach

Reactive (erosive gastritis) gastropathy a. Induced by: alcohol, NSAIDS, iron, Stress, bile reflux
Acute injury a. Acute gastritis—asymptomatic with possible significant blood loss
Acute peptic ulceration a. Nausea, vomiting, NSAIDs, stress
Chronic gastritis a. H. pylori gastritis-duodenal and pyloric ulcers; may lead to cancer b. Autoimmune gastritis
Peptic Ulcer Disease a. H. pylori and NSAIDs causative b. Increased acid c. Punched our ulcers-potential for perforation and hemorrhage d. Likely also involved in adenocarcinoma development
Polyps a. Hyperplastic, sporadic • Response to gastric injury, around ulcers
Gastric carcinoma • Looks like intestinal tissue, and diffuse • Some have hereditary connection
Autoimmune atrophic gastritis • Genetic factors • No ulcers • Decreased gastric acid • Intestinal metaplasia • Long-term effects relate to malabsorption of B12 (pernicious anemia)

Answer 162

A

D. Cognitive therapy

Cognitive therapies help out with the frontal cortex.
Motivational enhancement therapies help out with the Orbital Frontal Cortex, where your saliency or your priority list is kept
Contingency management therapies help out with the cortical-amygdala region, this is saying, if you stay drug-free, I am going to give you a reward.

Answer 163

A

A. Alpha-1 agonist

Phenylephrine is an alpha-1 receptor agonist and it causes vasoconstriction to sinus vessels in order to act as a decongestant, helps with mydriasis for eye exams. Also causes a decreased heart rate from baroreceptor reflex essentially.

Answer 164

A

D. An alpha-1 agonist or a muscarinic antagonist

Phenylephrine and other alpha-1 anogists cause the radial muscle of iris to contract, which causes dilation.
Pilocarpine (muscarinic agonist) is used for open-angle glaucoma and it causes the iris sphincter muscle to contract the pupil, so a muscarinic antagonist will dilate the pupil.
Beta-blockers lower the amount of fluid your eyes produce, so they can help with glaucoma, and pilocarpine increases aqueous outflow (ACh1 agonist). Epinephrine can treat glaucoma as well.
Acetazolamide (carbonic anhydrase inhibitor) can reduce aqueous humor secretion.
ANTICHOLINERGICS AND STIMULANTS WORSEN GLAUCOMA, so anything that DILATES will WORSEN GLAUCOMA

Answer 165

A

Growth and metastasis
Involve vital organs
Get a flood of cytokines that shut down organ functions
Cachexia

Answer 166

A

True

Captopril = This drug is an ACE inhibitor (any drug that ends with pril, is usually an ACE inhibitor). It inhibits the converting enzyme (peptidyl dipeptidase) that hydrolyzes angiotensin I to angiotensin II, so you can’t get increased blood pressure through the ACE pathway. This also allows bradykinin to stay active (because ACE turns it off usually), which is a potent vasodilator that stimulates the release of nitric oxide and prostaglandins. You also get major hyperkalemia with these drugs. Also used to treat heart failure.

Answer 167

A

D. Parathyroid adenoma

Primary Hyperparathyroidism = A very common endocrine disorder; usually an adenoma (80% of time) • Symptoms: osteoporosis (fractures), constipation, nonspecific weakness, anorexia, stones, peptic ulcers, depression, or even coma. Bones, stones, groans, and moans. • Arrhythmias (1) Treatments usually surgical (2) Metastasis and carcinomas are rare
Secondary hyperparathyroidism = Intestinal malabsorption of vitamin D or calcium • Chronic reduction of serum of Ca++ usually a consequence of chronic renal failure Stimulates PTH secretion, causes hyperplasia
Ibandronate and Alendronate are bisphosphonates used for multiple myeloma

Answer 168

A

False

Reflux Esophagitis

Relaxation of gastroesophageal sphincter

b. Symptoms: Burning, Excessive salivation, Choking
c. Aggravating factors: obesity, pregnancy, (decrease esophageal pressure: alcohol/tobacco, narcotics, nicotine patch) use
d. Medical treatment: antacids, H2 blockers, PPI -lose weight, stop smoking/drinking
e. lifestyle treatment: lose weight, stop smoking and drinking
f. Complications: ulceration, stricture, Barrett esophagus (long tongues of extended columns of epithelium cells into esophagus

Answer 169

A

Enoxaparin

Low molecular weight heparin. Improved morbidity and mortality for cancer patients for DVT as compared to warfarin.

Answer 170

A

True

Omeprazole = (prazoles are PPI’s)

Used for GERD. Proton pump inhibitors (PPIs) –available OTC and by Rx
• Mechanism: disrupts hydrogen exchange for K in parietal cells, which blocks production and release of HCl into gut.
• Side effects: diarrhea, interferes with digestion, increases food allerges, oral sores/ulcers
• Often combined with H2 blockers - Can also add sodium bicarbonate for fast release.

To Treat Peptic Ulcer Disease

Treatments:
Suppress acidity to heal sores (but not cure)
* Antacids, PPIs, H2 blockers
Cure if H pylori-related –H pyloria is contagious especially within family members

Prevpac; combination of lansoprazole (a PPI) and the antibiotics amoxicillin and clarithromycin
Milk of Magnesia (magnesium based) may also help kill Bacteria

Answer 171

A

C + K

Alprazolam = Sedative benzodiazipene drug used to treat anxiety disorder. Sedative are longer-lasting (8-12 hours), while hypnotic are shorter lasting (2-4 hours).
Buproprion = It is used to treat anxiety disorders, and it is a non-sedating sedative, not a depressant, but still has anxiolytic activity. We use it for everyday stress and anxiety. Usually for short-term use. Not very addicting, can interact with MAO inhibitors or anti-seizure medicines.

Answer 172

A

False

Mesalamine = Used for Crohn’s disease. Is an anti-inflammatory. Corticosteroids-act systemically and Metronidazole has an antibiotic mechanism and they can also be used for Crohn’s. b. Ulcerative colitis • Similar to Crohn’s disease but limited to colon and more generalized (no strictures) • Medications are similar to Crohn’s disease
Metronidazole = Antibiotic used for acne, but mainly Crohn’s Disease. nitroimidazole antibiotic for anaerobic bacterial; parasitic infections and the inhibition of Demadex brevis (parasitic mites) – Demodex mites are ~3x more prevalent in acne vulgaris patients than in healthy controls. – Anti-inflammatory effect (inhibits neutrophils) –
Corticosteroids = act systemically

Answer 173

A

True

Heart rate of less than 60 beats per minute
Disturbances in impulse generation to the sinus node, impulse propagation from the sinus node to the atria, impulse propagation through the AV node/His-Purkinje system. Bradycardia due to abnormal impulse propagation is known as a conduction block.

Answer 174

A

False

Slow closure of drainage canals

Open-angle glaucoma: wide space between iris and cornea

most common-90%
slow clogging of drainage canals
symptoms subtle and often undetected
3 million cases in US
African Americans especially vulnerable

Increased risk with diabetes and HP

Closed-Angled Glaucoma =
Closed-angle glaucoma: iris fused to cornea, Rapid closure of drainage canals

Symptoms typically noticeable

Surgery usually necessary

Answer 175

A

J + I

Lithium Carbonate = Used for Bipolar Disorder. Slow onset, likely works by altering 2nd messenger systems such as those involving adenylyl cyclase and G proteins, often combined with anti-depressants, still among the most potent mood stabilizers, has many side effects, requires monitoring blood levels (narrow therapeutic window), tremors are common, kidney damage, weight gain, edema, high rate of compliance problems.
Carbamezepine = anti-epileptic, along with 1. Valproic Acid 2. Carbamazepine 3. Lamotrigene, these all treat bipolar. These have fewer side effects, better compliance, more expensive, usually for maintenance after lithium starts, GABA/Glutamate pathways might be responsible for some of the bipolar cycling, depression and manic staging, and that is why antiepileptic agents work.

Answer 176

A

B. A muscarinic antagonist

Atropine and Scopalamine are the muscarinic antagonists. Used for Parkinson’s disease (adjunctive therapy), motion sickness, COPD, urinary urgency……
Sarin (nerve gas), Donepezil (Alzheimer’s), and Physostigmine are the main acetylcholinesterase inhibitors.
A sympathomimetic is NE, amphetamines, anything that mimics the action of NE is sympathomimetic.
You only transport choline, not acetylcholine, so that is bull crap.

Answer 177

A

False

evidence that antioxidants (e.g., vit. C or zinc oxide may help reduce development, but benefit is minimal) for wet AMD. No treatment for dry AMD.

Answer 178

A

Metaplasia

It is the reversible replacement of one differentiated cell type with another mature differentiated cell type. The change from one type of cell to another may generally be a part of normal maturation process or caused by some sort of abnormal stimulus. In simplistic terms, it is as if the original cells are not robust enough to withstand the new environment, and so they change into another type more suited to the new environment.

Answer 179

A

E. Fluticasone

Theophylline = Is a type of methylxanthine drug used as an add-on controller for asthma, it is a phosphodiesterase inhibitor and increases cAMP and relaxes airway smooth muscle. Available as tablet or inhaler through tea. Monotherapy for mild asthma. Combine with corticosteroids to reduce steroid doses and side effects. Also helps relax diaphragmatic fatigue in COPD. Toxicity: nausea, headache and anxiety. Requires plasma level monitoring.
Montelukast = Selective leukotriene receptor antagonist (leukotrienes are associated with the pathophysiology of asthma (airway edema, smooth muscle contraction)). Used for prophylaxis and chronic treatment of asthma. So this blocks the synthesis of leukotrienes, this would be good for patients who comply poorly to inhaled therapies.
Cromolyn = This drug is considered a mast cell stabilizer, is used to treat asthma, inhibits release of inflammatory mediators such as histamine (mast cell stabilizer). Prophylactic use often before exercise and allergen exposure—no rescue action (i.e., not a replacement for albuterol).
Omalizumab-inhibits IgE binding to mast cells-very expensive, only for severe non-responsive asthma
Albuterol = Fast acting reliever, the only true “rescue” reliever, acts within 15 minutes and is effective for 4-6 hours. directly relax airway smooth muscle and bronchodilate. Salmeterol is same thing but longer acting.
Fluticasone = Inhaled steroid for controlled asthma, prevents transcription of inflammatory mediators in the nucleus, resulting in a decrease in inflammation. Side effects: nose bleeds, sores in nose, mouth, tongue that don’t heal, oropharyngeal candidiasis (thrush), interfere with growth in children.
Don’t Forget the Antimuscarinics
- Ipratropium (related to tiotropium-Spriva-which is not approved for asthma, but is approved to treat COPD) –reverses contraction of smooth muscle from vagal activity-usually backup for beta 2 agonists-sometimes combine antimuscrinics with b2 agonists (eg, albuterol)
- Side effect of dry mouth
- Used as an inhalant for bronchospasms

Answer 180

A

False

Premature atrial or ventricular contractions are the most common cause for arrhythmias and they can be ignored if infrequent, no heart disease, or EKG normal.
Ventricular is the most dangerous.

Answer 181

A

Relaxes the ciliary muscle for far vision
Relaxes vasculature, especially skeletal muscle (vasodilation)
Relaxes lungs (tracheal and bronchial smooth muscle
Relaxes urinary bladder, uterine wall
Isoproterenol
Albuterol
Terbutaline
Propranolol

Answer 182

A

False

Most hepatotoxic events occur around the ‘central vein’
Drugs are the #1 cause of liver toxicity!
Biopsy of liver can be potentially dangerous due to major hemorrhaging
1. Fatty (fat globules in hepatocytes) liver-steatosis • Worst destruction is fibrosis. It leads to collagen scar and permanent injury. End stage is cirrhosis • Causes—alcohol, obesity and diabetes (known as the metabolic syndrome)
1. If hepatocytes die in large sheets, the areas fill up with blood. Blood can build up due to heart failure and cause backflow around the central vein
1. If cannuliculi in liver fill with bile due to cholestasis, the person becomes jaundiced (often caused by drugs)
1. Acute more lobular, chronic is more portal with fibrosis and collagen bridges
1. Hepatitis is inflammation of liver. If caused by viruses can be contagious and dentists must be very careful with these patients • Can also be caused by toxins and drugs • Acute can often resolve itself. Chronic less likely to recover (fibrosis often a part of this) • Acute caused by Hepatitis A and E viruses (1-3 months) • Hep B and C viruses start with acute hepatitis and progress to chronic with fibrosis progressing to cirrhosis and hepatocellular carcinoma: tend to be the more severe
  *

Answer 183

A

False

Allodynia = pain evoked by normally non-painful stimuli. On same line as hyperalgesia.
Hyperalgesia is an increased perception of pain in response to painful stimuli. On same line as allodynia.

Answer 184

A

D. Valproic acid

Ethosuximide is used for uncomplicated absence seizures. Has a very narrow clinical spectrum. It’s MOA is reduces T-type Ca+ channel currents in thalamic pacemaker neurons to quiet rhythmic discharges.
Perampanel is a newer anti-epileptic drug, similar actions to topiramate.
Carbamazepine, Used for all Partial seizures as well as Tonic-Clonic seizures. Although rare, Steven-Johnsons Syndrome is a side effect. This drug may also activate spike-wave seizures. It is also associated with toxic levels when patients drink grapefruit juice. It is a great drug for epilepsy but the potential for a drug-to-drug interaction is high. It’s MOA is it blocks Na+ channels to inhibit repetitive firing from neurons. Also used for Bipolar Disorder.
Valproic acid is used for all Partial seizures as well as uncomplicated absence seizures, atypical absence seizures, primary tonic-clonic seizures, and myoclonic epilepsy.

Answer 185

A

True

Physioloic affect = Affects GABA A receptors (although not an agonist)—ethanol interacts with other sedative/hypnotic drugs in a synergistic manner and can lead to OD deaths due to respiratory depression. • Increases release of dopamine and endorphin • Affects almost all organs: e.g., • Liver toxin-increases fat deposits and can cause fatty livers in the extreme -causes cirrhosis in ~5-10% alcoholics -bad combination with acetaminophen • Kidneys- it is a diuretic • G.I.- irritating to mouth through the intestines—causes inflammation and enhances chances of cancer -stimulates gastric secretions -food slows its absorption • Suppresses immune system/perhaps partially due to malnutrition • CVS- low doses increase HDL—high doses increase hypertension, coronary artery disease, and arrhythmias • Brain: order of effects— cortex (cognition)-limbic (emotions and reward)-cerebellum (motor and balance)-hypothalamus (endocrine)-medulla (respiration and CV regulation) • Disrupts lipid membranes

Answer 186

A

False

Loss of central vision

Answer 187

A

Rapidly acting
Dramatic effect on inflammation and slowing bone erosions in rheumatoid arthritis
Side effect: loss of muscle mass, osteoporosis, diabetogenesis, peptic ulcers, round face, buffalo hump
Drugs:
dexamethasone: long-acting
-cortisone, prednisone: short- to medium-acting

Answer 188

A

A. Docusate

Docusate =
Laxative used for constipation. Loperamide treats diarrhea, and Linaclotide (for IBS) treats constipation.
• Water retention in stools, softens stools
• OTC (e.g., Dulcelax)
Bismuth =
Treats diarrhea. Is Pepto-Bismol.
Anti-cholinergics such as atropine can also be used to treat diarrhea.

Answer 189

A

True

Main complications of MI’s:Most to least common 1. Arrhythmias 75-95% 2. Congestive heart failure and pulmonary edema 60% 3. Pericarditis 4. Mural thrombosis 40% 5. None 10-20% 6. Cardiogenic shock 7. Rupture of ventricle or papillary muscle 4-8%
Mural Infacrts = It is due to an anuerysm in the heart wall and it has full thickness, endocardium to epicardium. Usually involving left ventricle anterior and posterior free wall or septum with extension into right ventricle wall in 15-30% of cases. More severe than MI, correlates with ST segment elevation myocardial infarct on EKG.

Answer 190

A

B. dynorphins

Three main classes of opioid receptors and what are the three endogenous opioid peptides that interact with them = Mu, Delta, and Kappa. Enkephalin, Beta-Endorphin, and Dynorphin.
Dynorphins = Act on Kappa receptors. 17 amino acids long. There are A and B Dynorphins, they are inhibitory, they tend to block a lot of the typical reward functions. The kappa receptors are antagonistic to mew and delta, but they still have analgesic properties.
Enkephalins = Act on Delta and Mu receptors. 5 amino acids long. Made up of Methionine and Leucine.
Beta-Endorphins = Act on Delta and Mu receptors. 91 amino acids long. -You can’t give a Beta-endorphin therapeutically, it would be proteased too quickly, but we have drugs that have opioid agonist properties that have a number of naturally occurring narcotics that have selective activities that act on mu or delta receptors.
Substance P is a neuropeptide, helps with pain sensitization, along with glutamate, is an important pain neurotransmitter that is released from A delta and C fibers in order to excite the projection neurons to go up into the thalamus from the dorsal horn

Answer 191

A

True

Addison’s—adrenal glands produce too little cortisol (chronic)—often insufficient aldosterone as well • Symptoms • Weakness • Fatigue • Weight loss • Hyperpigmentation • Treatment—corticol supplements: cortisones (hydro-) or prednisone

Mifepristone = Used for Cushing’s syndrome. Is an antagonist at steroid receptors.Also called the “morning after” contraceptive. Blocks progesterone and glucocorticoid receptors—suppresses ovarian function (has a masculinizing effect)

Answer 192

A

A. What medications are you taking?

E. Do you have a history of osteoporosis or Paget’s disease?

___________________________________

B. I have osteoporosis and I am taking alendronate

Answer 193

A

Metformin

Used to treat type II diabetes, also called Metformin. Mechanism not fully understood—decreases glucose production in the liver and likely increases efficiency of insulin binding • Advantage: insulin-sparing, does not provoke hypoglycemia when used alone • May prevent some of the CVS effects of type II DM • Side effect: GI irritation, B12 deficiency, not for use in alcoholics

Answer 194

A

True

It is the most common sustained arrhythmia in adult clinical cardiology. Atrial flutter is different and involves very rapid atrial contractions, and can turn into atrial fibrillation. AF increases with age and often co-exists with other cardiovascular diseases like congestive heart failure, valvular heart disease, and hypertension. 10% of Americans older than 65 years old have AF. It is associated with electrical and structural changes of the atrium. You get electrical remodeling, meaning shorter atrial action potentials, loss of rate of adaptation to action potential duration, and loss of myocytes and replacement with collagen and fibroblasts. AF causes inefficient atrial contraction, which causes decrease in cardiac output, due to loss of atrial contribution to ventricular filling, and is also involved with a high risk of thrombosis and embolization.
Ventricular Fibrillation = It is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract properly. P waves are absent here, and can quickly lead to sudden cardiac arrest or death.

Answer 195

A

Adenoid carcinoma

Adenocarcinoma (eg, colon or breast adenocarcinoma) • forms glands • tumors of cuboidal or columnar cells • types include: ➢ colon ➢ prostate-fairly innocuous looking ➢ breast-many positive for estrogen receptors ➢ lung-small cell carcinomas are aggressive with poor prognosis -large cell carcinomas are slower with better prognosis

Answer 196

A

D. Acetylcholine

The main monoamines are Dopamine, Epinephrine, Norepinephrine, and Serotonin. Histamine is also a monoamine. But remember, serotonin is not a catecholamine like the first three are. Neither is acetylcholine.

Dopamine, Epinephrine, NE are catecholamines

Answer 197

A

B. A reduction in cardiac stroke volume

What is congestive heart failure? It is when the cardiac output is insufficient for metabolic needs of the body. You can get systolic dysfunction, which is decreased myocardial contractility (heart pumps weakly), diastolic dysfunction, which is insufficient expansion (heart does not fill with blood between beats). And problems are accentuated by increased demand.
5 main methods of Compensation:
1. Tachycardia
1. Frank-Starling (increased end diastolic volume results in increased stroke volume)
1. Myocardial hypertrophy
1. Increased catecholamine activity leading to positive ionotropic effect (they tell the myocytes to keep contracting the best you can), as well as renin-angiotensin-aldosterone system
1. Redistribution of blood flow

Answer 198

A

False

Doesn’t destroy, just dries and opens
Salicylic acid (3-6%) has been extensively used in dermatologic therapy . Salicylic acid works as a keratolytic, comedolytic, and bacteriostatic agent, causing the cells of the epidermis to shed more readily, opening clogged pores and neutralizing bacteria within, preventing pores from clogging up again by constricting pore diameter, and allowing room for new cell growth. Higher concentrations available by prescription.

Answer 199

A

True

Laxative used for constipation.

Stimulant of smooth muscles
Fast acting
OTC
Suppository/oral
Cramps

Answer 200

A

B. Neurons

The cells that are most prone to injury are those that have a high metabolic activity and those that proliferate rapidly
High Metabolic Activity 1. Cardiac myocytes 2. Renal tubular cells 3. Hepatocytes
Proliferate Rapidly 1. Testicular germ cells 2. Intestinal epithelium 3. Hematopoietic cells

Answer 201

A

B

Prednisone = Prednisone is most common, it is a steroid used for anti-inflammation. Interferons are more extreme, as well as methyltrexate, which are both anti-cancer treatments. Drug that treats Multiple Sclerosis. Bladder dysfunctions, bowel dysfunction, depression, fatigue, pain, tremors.

Answer 202

A

D. Monoamine oxidase

Tyrosine hydroxylase = Tyrosine is converted to DOPA by this
Tryptophan enters the neuron, is then converted by Tryptophan Hydroxylase to 5-HTP, and 5-HTP is then converted by AAD to 5-HT (Serotonin)
Dopamine can be metabolized by MAO, Monoamine Oxidase, which converts dopamine into DOPAC.
Dopamine, NE, epinephrine, serotonin, histamine could all be degraded by monoamine oxidase.

Answer 203

A

True

Furosemide = It is a loop diuretic. It inhibits the luminal Na/K/2Cl transporters in the thick ascending limb of the loop of Henle, thus reducing NaCL reabsorption and increasing its secretion. Can also cause hypokalemia, because it increases luminal sodium and thus stimulates the aldosterone-sensitive sodium pump to increase sodium reabsorption in exchange for potassium and hydrogen ions, which are lost to the urine. Also this drug can be inhibited by NSAIDs under certain conditions. Diuretics, especially furosemide, can also be used to treat heart failure. Does not have positive ionotropic effect, but you are getting fluid accumulation because heart is not working very well, which will cause problems to whole body so you use a potent diuretic like furosemide.
Hydrochlorthiazide = It is a loop diuretic and it is a thiazide. It inhibits NaCl reabsorption from the luminal side of epithelial cells in the distal convoluted tubule by blocking the Na/Cl transporter. Can also cause hypokalemia, and this is a problem because of cardiac arrhythmias, because it increases luminal sodium and thus stimulates the aldosterone-sensitive sodium pump to increase sodium reabsorption in exchange for potassium and hydrogen ions, which are lost to the urine. Also this drug can be inhibited by NSAIDs under certain conditions.

Answer 204

A

B. Tuberculosis

Usually lungs but can affect other organs
Flourishes in crowded, impoverished areas
Non-contagious during long periods of dormancy
Problems with multidrug antibiotic resistance
Forms necrotizing granulomas

Answer 205

A

True

Endocarditis can cause Cardiac complications, which are coronary artery emboli, abscesses, erosion of valve or chordae tenineae. Non-cardiac complications, which are septic emboli, immune complex diseases in vessels or kidneys.

Answer 206

A

Non-responsive to normal physiologic cues
Lack of response to growth inhibitory signals
Avoid normal cell cycle mediated death
Develops own angiogenesis
Evades immune detection
Develop a signal to proliferate
Avoid apoptosis
Invade stroma (if carcinoma)
Metastasize
Induce angiogenesis
Alter DNA in order to allow continued mitosis (normally cells stop dividing after 15X doubling)
Develop telomerase to prevent cellular senescence

Answer 207

A

True

Usual MI symptoms: Retrosternal chest pain, dyspnea, diaphoresis (sweating), nausea/vomiting, palpitations, anxiety, or can be asymptomatic or present as sudden death.
Main complications of MI’s:Most to least common 1. Arrhythmias 75-95% 2. Congestive heart failure and pulmonary edema 60% 3. Pericarditis 50% 4. Mural thrombosis 40% 5. None 10-20% 6. Cardiogenic shock 7. Rupture of ventricle or papillary muscle 4-8%

Answer 208

A

False

A delta fibers are small, myelinated, fast conducting, associated with mechanical, thermal nociceptors, and they transmit “first” or “fast” pain, diameter of 1-6 mm, sharp localized pain when dentin is first exposed, and more associated with a reflex than C fibers. C fibers are small, unmyelinated, slow conduting, associated with polymodal nociceptors, and they transmit “slow” or “second” pain, diameter of 2 mm, associated with conduction of dull, difuse pain.

Answer 209

A

B. Phenytoin

Phenytoin, Used for all Partial seizures as well as Tonic-Clonic seizures. It masculinizes (hirsuitism) and causes severe gingival hyperplasia, osteopenia, anemia, acne. This drug is special because it has zero-order kinetics at high doses. Most drugs have first-order kinetics.
Carbamezepine = CYP3A4, liver enzyme, grapefruit with drug increases amount. Steven Johnsons syndrome. Sodium blocker.
Phenytoin = sodium blocker
Ethosuximide = reduces Ca currents
Barbiturates increase the duration of opening time of GABA channels

Answer 210

A

Choriocarcinoma

TNM grading -T, size and extent of primary tumor -N, presence and number of lymph node metastases -M, presence of distant mestatses
Serological tests- most useful for assessing cancer recurrence after treatment
-PSA: prostate specific antigen
-CBA: carcinoembryonic antigen-colon carcinoma
-CA-125: serous ovarian carcinoma
-HCG: Choriocarcinoma

Answer 211

A

False

Doxorubicin/Bleomycin =
- Is an antitumor antibiotic, in the class of anthracyclines, that treat breast cancer.
- Mechanism: formation of free radicals that bind to DNA, causing breaks
- Treat: lymphomas, breast cancer and thyroid cancer
- Toxicity: nausea and red (not blood) urine
Fluorouracil = Treats cancer.
- 1.Inhibits thymidine synthase, decreases NDA synthase and decreases DNA synthesis and function
- 1. treats: colorectal, anal, breast, head neck, and hepatocellular cancers

Answer 212

A

Liver disease (slows metabolism)
Breast/endometrial cancers
Thromboembolytic disorders

Answer 213

A

D (not G because clozapine is an atypical, not phenothiazine)

Increased activity of D2 is associated with Schizophrenia, so we treat it with D2 antagonists.

Answer 214

A

False

Procarbazine should be this one.
Procarabazine = Treats cancer, is a nitrosourea. Used for combination regimens for Hodgkin’s Lymphoma. Passes blood brain barrier and used to treat brain tumors.
Cyclophosphamide is an alkylating agent.
Cyclophosphamide =
Treats cancer, is an alkylating agent.
1. E.g, Cyclophosphamide • Hodgkin’s lymphoma • Multiple myeloma • Leukemia • Breast cancer
1. Mechanism: Transfer their alkyl groups to various cell constituents such as DNA, alkylation of DNA in nucleus—cause miscoding—can break DNA strands
1. Resistance: increased capacity to repair damaged DNA
1. Adverse effects: • Nausea, vomiting • Damage to rapidly growing tissues (bone marrow, G.I. tract, reproductive tissue) • Carcinogenic in nature (increases risk of secondary cancer)

Answer 215

A

D. Pemphigus

Impetigo = Staph infection. Impetigo: staph and strep infections superficial) on face and extremities, contagious through contact, –primarily kids; honey color crust-pustules
Stevens-Johnson syndrome = medicine, or herpes or fungal infections.
Lichen planus = -middle age -extremities and oral cavity -lace-like white markings. -resolve after 1-2 years although often persists in oral cavity Hyperkerotosis, and epidermal hyperplasia -Unknown inciting mechanisms
Pemphigus = Bulbous blistering prominent feature: pemphigus (painful flaccid blister like-deep erosions and crust after rupture-hypersensitivity reaction), dermatitis herpetiformis-use immunosuppressive treatment -tend to be auto-immune responses

Answer 216

A

Burkitt’s Lymphoma

Burkitt’s Lymphoma- a type of non-Hodgkin’s lymphoma linked to Epstein-Barr infection and can affect maxilla and mandible; very aggressive from B lymphocytes. Prognosis can be poor.

Answer 217

A

True

Complications of reflux esophagitis: ulceration, stricture, Barrett esophagus (long tongues of extended columns of epithelium cells into esophagus

Answer 218

A

Constrict vasculature
Decrease NE release from NE terminals
Decrease NE release from brainstem
Clonidine
Guanfacine

Answer 219

A

B. Albuterol

Albuterol is a beta-2 agonist, so it relaxes the lungs and causes vasodilation to skeletal muscle, along with terbutaline and isoproterenol.
Phentolamine is a non-selective α antagonist that is in treatment of pheochromocytoma & hypertensive emergencies, vasodilator, decreases TPR and Blood pressure
Atenolol is a beta-1 blocker, treatment of hypertension, angina, open- angle glaucoma.
Epinephrine = NE favors Beta more, whereas Epi likes both. At lower doses of epi, may see decrease TPR and diastolic pressure. At higher doses, see increased TPR and blood pressure.

Answer 220

A

Succinylcholine = Depolarizing (desensitizing), and non-competitive
D-Tubocurarine = Non-Depolarizing, and competitive. ACh inhibitor can increase the levels of this.

Answer 221

A

Tolbutamide

Is a 1st generation sulfonylurea that is used to treat type II diabetes by increasing insulin release from beta cells by blocking potassium channels on their membranes. Side effects include hypoglycemia and weight gain because they can bind to carrier proteins in the blood, be dislodged by other drugs, leading to rapid increase in their activity and hypoglycemia

Answer 222

A

False, the opposite is true

Answer 223

A

B. acute lymphoblast leukemia

Most common acute form of leukemia in adults = Acute Myelogenous Leukemia (AML). Cytarabine is the most single active agent.
Most common GI malignancy -= Colorectal cancer
Hodgkins lymphoma -younger patients -usually good prognosis -sometimes characterized by Reed Sternberg cells (large, multinucleated B lymphocytes)
Acute Lymphoblast Leukemia = most common cancer in children
Multiple Myeloma =
1. Plasma cell malignancy, primarily in bone marrow
1. Symptoms: • Bone pain • Fractures • Anemia
• Tx: alkylating agent; prednisone

Answer 224

A

True

Main Five Diarrheal Diseases

a. Celiac sprue • Immune mediated—triggered by ingestion of gluten • Malnutrition: • Fe, B12 malabsorption • Atrophic glossitis • Dental effects: enamel defects, delayed tooth eruption, recurrent aphthous ulcers, cheilosis,
b. Lymphocytic colitis • Increased intraepithelial lymphocytes
c. Irritable bowel syndrome • Relapsing pain, bloating, relapsing and alternating constipation/diarrhea • Diet, abnormal motility and stress are factors • No gross microscopic abnormalities
d. Infectious self-limiting colitis • Caused by microorganisms such as salmonella, E. coli, shigella, clostridium
e. Pseudomembranous colitis, cells slough off • Usually caused by clostridium difficile • Spread via person to person • Often follows broad spectrum antibiotic therapy • Most common nosocomial infection in older adults

Answer 225

A

A. Metoprolol

Metoprolol = Beta-1 antagonist used to lower blood pressure, angina, glaucoma. Effects include decreased HR and contractility, increased TPR because of beta-2 blockage in skeletal muscle (seems counterintuitive, what decreased HR is more important factor), decreased renin release, bronchial constriction, decreased glycogenolysis in response to hypoglycemia, decreased aqueous humor production. Also used to treat heart failure.
Dobutamine = This drug is a beta-1 agonist that is used to treat heart failure. Can cause arrhythmias, and it increases HR.
Captopril = This drug is an ACE inhibitor (any drug that ends with pril, is usually an ACE inhibitor). It inhibits the converting enzyme (peptidyl dipeptidase) that hydrolyzes angiotensin I to angiotensin II, so you can’t get increased blood pressure through the ACE pathway. This also allows bradykinin to stay active (because ACE turns it off usually), which is a potent vasodilator that stimulates the release of nitric oxide and prostaglandins. You also get major hyperkalemia with these drugs. Also used to treat heart failure.
Hydralazine = This drug is a direct vasodilator that releases nitric oxide from the drug or from endothelium. All the vasodilators that are useful in hypertension relax smooth muscle of arterioles, thereby decreasing systemic vascular resistance. Decreased arterial resistance and decreased mean arterial blood pressure elicit compensatory responses, mediated by baroreceptors and the sympathetic nervous system, and because these are still intact, vasodilator therapies generally do not cause orthostatic hypotension. Also used to treat heart failure.
Digitalis = This drug is a positive ionotropic drug, and digitalis is a genus plant name that provides cardiac glycosides such as digoxin. It increases intracellular Ca and cardiac contractility, only temporarily though. It helps treat heart failure. It increases blood ejection. It is not just selective for cardiac calcium channels so its side effects are that it affects all excitable tissues. Can cause premature depolarizations and ectopic beats.

Answer 226

A

False

Birth defects
etinoid (Vitamin A) used for acne. Isotretinoin (Accutane) – oral retinoid used for severe cystic acne and acne that has not responded to other treatments. • Considered the only true “cure” for acne. It also reduces the amount of oil secreted by glands in the skin. • Isotretinoin has been associated with bowel diseases (Crohn’s disease), liver damage, depression, teratogenicity and miscarriage. • contraindicated during pregnancy as they have been shown to cause CNS, craniofacial, cardiovascular and other birth defects. – At least two negative pregnancy tests are required and either signed statement of abstinence (iPledge contract) or confirmation of 2 forms of contraception is required to obtain a prescription.

Answer 227

A

True

No treatment for Dry Age-Related Macular Degeneration

Answer 228

A

True

Psoriasis = Auto-rejection or environmentally induced, it is a form of acanthosis

Answer 229

A

C. Determines the carcinogenic properties of a chemical by measuring the bacterial DNA responses to this substance

Answer 230

A

Drugs:
(1) Topical keratolytics
- -removes keratin layer and opens sebaceous glands (also used as wart removers)
- Salicylic acid
- Benzoyl peroxide
(2) Antibiotics:
- erythromycin, tetracycline, clinidimycin and Dapson,
- -eliminate the bacteria that cause the infection and inflammation associated with acne. Can use either topical or systemic. Drugs concentrate in skin.
(3) Retinoids:
- vitamin A-derivatives; tretinoin (retin A: topical); isotretinoin (Accutane: systemic)
- Side effects: dry skin, sores, major birth defects with isotretinoin
Non-drug treatments
- UV phototherapy—acne-causing bacteria are UV sensitive

Answer 231

A

Osteoarthritis

a. Loss of articular cartilage with secondary changes in bone
b. Presents in some degree in most persons >65 years of age. Symptoms worsen with excessive use.
c. Due to wear and tear

d. No inflammatory changes

Answer 232

A

False

Preganglionic sympathetic neurons are thoracolumbar in origin.
The cell bodies of the parasympathetic nervous system are in the craniosacral region.
Parasympathetic pre-ganglionic axons are long, they extend to ganglia near effector organs, so the post-ganglionic are short. These are all coming out of the craniosacaral region.
Sympathetic pre-ganglionic axons are short.

Answer 233

A

A. Inadvertent removal of parathyroid glands during thyroid surgery

Chief cells of the parathyroid glands secrete parathyroid hormone.
Parafollicular cells of the thyroid gland secrete calcitonin
Its main action is to mobilize calcium from bone to increase serum Ca2+ and and increase urinary phosphate excretion.
Parathyroid Gland = Secrete parathyroid hormone (PTH) regulated by free calcium in blood-reverse relationship (low calcium increases PTH) • PTH activates osteoclasts and bone resorption and increases serum calcium; also increases tubular reabsorption of calcium, activates vitamin D and increases GI absorption • Usually 4 glands close to thyroid poles
Primary Hyperparathyroidism = A very common endocrine disorder; usually an adenoma (80% of time) • Symptoms: osteoporosis (fractures), constipation, nonspecific weakness, anorexia, stones, peptic ulcers, depression, or even coma. Bones, stones, groans, and moans. • Arrhythmias (1) Treatments usually surgical (2) Metastasis and carcinomas are rare
Secondary hyperparathyroidism = Intestinal malabsorption of vitamin D or calcium • Chronic reduction of serum of Ca++ usually a consequence of chronic renal failure Stimulates PTH secretion, causes hyperplasia
Most common cause of hypoparathyroidism = Very uncommon. Most often accidental removal at thyroid surgery, congenital absence of all glands. Symptoms: hypocalcemia, anxiety, depression, decreases PTH, tetany, dental changes in children (poor enamel, brittle teeth, missing teeth).

Answer 234

A

False

Treated with NSAIDS

The two main chronic inflammatory skin conditions = psoriasis and lichen planus

Psoriasis =

inciting antigen—auto-rejection or environmentally induced -1-2% in US -can be accompanied by increased heart attacks and arthritis -treatment includes NSAIDS and immunosuppressant drugs -well-marked by pink to salmon colored plaques -regular acanthosis in epidermis

Answer 235

A

Streptokinase

Dissolve clot • Drugs include: streptokinase and urokinase • Are potentially very dangerous and can cause hemorrhagic strokes • Don’t use unless formed clot is in a very dangerous place

Answer 236

A

B. Fentanyl

Fentanyl at 0.1 mg equipotent IM dose, most potent opioid narcotic
Fentanyl at 0.1 mg
Oxymorphone at 1 mg
Hydromorphone at 1.5 mg
Morphine at 10 mg
Oxycodone at 20 mg
Hydrocodone at 30 mg
Codeine at 200 mg
Tramadol = (Ultram). It is a schedule 4 drug. Low drug abuse potential, but some minor opioid action. Works at brain level. Is the “next-line” of drug treatment for neuropathic pain like Trigeminal neuralgia.

Answer 237

A

B. Graves disease

Elevated free T4 or T3. Low TSH. Presence of serum TSI (immunoglobulins) is diagnostic of Graves disease.
What causes 90% of hyperthyroidism cases? Graves Disease, found in 2% of adult females. The other cases are from toxic multinodular goiter (plummer’s disease).
Causes = Autoimmune-antibodies function as agonists to thyroid-related receptors-causing excessive thyroid receptor activation. T-cell related autoimmune reaction
Symptoms = Find elevated Ab to TSH receptor. Thyroid gland has a diffuse enlargement (2-3 times normal size). Symptoms: • Hyperthyroidism • Exophthalmos (protrusion of eyeballs), 1/3 of the cases
DeQuervain thyroiditis = also called subacute granulomatous thyroiditis = • Viral cause (e.g., flu virus) • Painful • Usually self-limited and surgery not advised
Hashimoto’s = • Autoimmune; usually females –antithyroid peroxidase Ab present • May start as hyperthyroidism followed by permanent hypothyroidism • Thyroid enlarges- then atrophies over years • Most often in females • Radiation may cause • Most common cause of thyroid deficiency • High TSH, low free T3 and T4.
Gioter = Most common lesion of the thyroid-usually a thyroid enlargement • Rarely associated with hypothyroidism • Not a cancer • Usually associate with deficiency of iodine • Diagnosed with fine needle aspiration (versus biopsy) to determine if have large follicles filled with colloid and relatively few cells • Can be confused with thyroid neoplasm—usually very cellular and little colloid

Answer 238

A

D. Methamphetamine

Amphetamines cause the most dopamine release, by far, so it causes the greatest amount of neurotixicity. 1000 for meth and 350 for cocaine.
Amphetamines work by they release dopamine from vesicles and then they pump them in reverse out of the dopamine transporter so they can be in the synaptic cleft and activate dopamine receptors.
All abused substance enhance dopamine activity in the nucleus accumbens
Nicotine causese dopamine release by activating nicotinic receptors.
Methylphenidate is an indirect adrenergic agent, similar to amphetamine, cocaine, SNRI’s and TCA’s. This drug blocks DA reuptake. It is Ritalin, is used for ADHD, it is a stimulant.

Answer 239

A

Gangrenous necrosis

Gangrenous necrosis -See this when an entire limb loses blood supply and dies (usually the lower leg) -This isn’t really a different kind of necrosis, but people use the term clinically so it’s worth knowing about -Gross: skin looks black and dead; underlying tissue is in varying stages of decomposition -Micro: initially there is coagulative necrosis from the loss of blood supply (this stage is called “dry gangrene”); if bacterial infection is superimposed, there is liquefactive necrosis (this stage is called “wet gangrene”)

Answer 240

A

C. Transduction

Starts at injury, the noxious stimuli activate the sensitive peripheral ending of the primary afferent nociceptor by the process of transduction. The message is then transmitted over the peripheral nerve to the spinal cord, projection neurons send axons across the midline, where it synapses with cells of origin of the major ascending pain pathway, the spinothalamic tract. The message is relayed in the thalamus to the somatosensory cortex 1 and 2.
Transduction happens in primary afferent nociceptor, then transmission happens when action potential passes through dorsal root ganglia to actual spinal cord, where modulation takes place, crosses the midline, and goes up spinothalamic tract to the thalamus, and then into the cortex where pain perception takes place.
Transient Receptor Potential (TRP) = They are a group of ion channels located mostly on the plasma membrane of numerous animal cell types. They are indirect mediators of pain, making things more or less sensitive. They are involved with transduction.

Answer 241

A

D. Meperidine

The three other NSAIDS that are prescription only:
1. Indomethacin - potent non-selective NSAID/ due to side effects not a common analgesic
1. Meloxicam - preferentially inhibits Cox-2 over Cox-1/ means less GI problems
1. Diflunisal - Related to salicylates- supposed to be good for bone pain
The two Ibuprofen-like NSAIDS are Ketoprofen and Naproxen. Ketoprofen is same properties, but more potent; 50 mg is recommended analgesic dose. Naproxen is longer-lasting and slower-acting (Aleve)
Other Opioid Narcotic:
1. Meperidine (for moderate pain, demerol)

Answer 242

A

Osteomyelitis

Osteomyelitis (inflammation of bone/marrow)

a. blood-born or direct
b. trauma from compound fractures
c. pyogenic infections (e.g., staph aureus or salmonella)
d. granulomatous (TB or fungal)- called “Pott disease” when associated with TB
e. Diabetes—due to poor circulation in the extremities-if chronic can form a drainage site and can even become osteosarcoma

Answer 243

A

Decrease their effectiveness

Answer 244

A

• Loss of interest in performing daily routines (brushing, flossing)
• Cariogenic diet (increase in refined sugars)
• Rampant caries
• Medica5on related xerostomia

Answer 245

A

Systolic = 120 Diastolic = 80

Systolic goes up by 20’s Diastolic goes up by 10’s

Normal <120/80
Pre-Hypertensive
Mild
Moderate
Severe >180/110

Answer 246

A

Don’t exceed 0.04 mg/apt of epinephrine (4 carpules)
1. Each carp of 1:100,000 has 0.01 mg/ml of epi
Avoid use of Marcaine 0.5% (Bupivicaine)
Consider using Carbocaine 3% plain (Mepivicaine) (no epi so you have to work fast because it runs out faster)

Answer 247

A

Severe Hypertension
- • Defer elective treatment until BP is better controlled
- • Consider referral to OMFS for emergencies
• Hypertensive Urgency or Crisis
- • Send pt. to emergency room immediately
- • Life threatening (don’t adopt an “I can manage the situation” aftude)
Patients on Nifedipine may have gingival overgrowth

Answer 248

A

Hypo = < 50 mg/dL

Hyper = >180 mg/dL

Answer 249

A

Signs and symptoms of hypoglycemia
- • <50 mg/dL
- • Bizarre behavior/changes in personality
- • Weakness, dizziness
- • Pale, moist skin
- • Normal or depressed respira>ons
- • Headache
- • Altered level of consciousness (syncope)
- • Monitor pt. for at least 1 hour before leang them leave office
• Signs and symptoms of hyperglycemia
- • >250 mg/dL blood glucose
- • Dry, warm skin
- • Kussmaul’s respirations
- • Fruity, sweet breath odor
- • Rapid, weak pulse
- • Normal to low blood pressure
- • Altered consciousness

Answer 250

A

Hypoglycemia
- • Terminate dental tx
- • Posi>on pa>ent comfortably
- • Administer 100% Oxygen
- • Administer Oral carbs if conscious:
- • Icing, juice, soda, glucose tablets etc
- • Administer if unconscious: •
- Icing under the tongue
- • 50% dextrose (20-50 ml) IV
- Glucagon 1 mg IM or IV
- • Epineprnine 1/1000 o.5 mg IM
- • Get medical assistance if needed
• Hyperglycemia (conscious) ASA IV
- • No dental treatment should be rendered
- • Refer to physician
• Hyperglycemia (unconscious) ASA IV
- • Terminate dental tx
- • Posi>on Supine (legs elevated)
- • BLS
- • Summon Emergency Assistance(call 911)
- • Administer 100% Oxygen
Schedule morning appointments for diabe>c pa>ents
• If fas>ng blood glucose is <70mg/dL, defer or give carbs
• If fas>ng blood glucose is >200mg/dL, defer and refer to physician
• If pa>ent is uncontrolled diabe>c, has open skins sores, in a wheel chair, or amputa>on of limbs, MED CONSULT prior to any procedures

Answer 251

A

́ Pocket depths 6 mm or more
́ Excessively mobility or purulence
́ Periapical inflammation
́ Broken down, non-restorable teeth
́ Non-functional, partially erupted (pt. is non-compliant with OH measures)
́ Pt. is uninterested in saving a particular tooth or teeth
́ Tooth is associated with an inflammatory, infectious or osseous disease

Answer 252

A

́ Perform extractions with minimal trauma
́ At least 2-3 weeks prior to initiation of radiation therapy (3 is ideal)
́ At least 5 days (in maxilla) before initiation of chemotherapya
́ At least 7 days (in mandible) before initiation of chemotherapy
́ Trim bone at wound margins to eliminate sharp edges
́ Obtain primary closure
́ Avoid intra-alveolar hemostatic packing agents (nidus for bacteria)
́ Delay if white blood cell count is less than 2,000/mm3 or absolute neutrophil is less than 1,000/mm3, or expected to be this level within 10 days
́ Antibiotic Prophylaxis can be used with extractions that are mandatory
Also if they have or are suspected of osteoradionecrosis, Use non-lidocaine local anesthetic (e.g., Prilocaine plain or forte) for dental procedures. Minimize or avoid vasoconstrictor, if must use low concentration of epi (1:200,000). Consider Hyperbaric oxygen. Minimize hypovascularity after radiation therapy, and do Endo over Extraction, less trauma.

Answer 253

A

Consists of 6 licensed dentists, 2 licensed dental hygienists, and 1 member of the general public

Answer 254

A

• Class I permit- Allows for local anesthesia (topical and local anesthetics)
• Class II permit- Allows for minimal sedation (Nitrous Oxide)
• Class III permit- Allows for moderate sedation
• Class IV permit- Allows for deep sedation

Answer 255

A

Dental professional should recommend use of OTC drugs with cau<on>
<li>• OTC drugs are intended for short-term use • Never recommend off-label use of OTC drugs</li>
<li>• Never recommend higher doses than indicated</li>
</on>

Answer 256

A

• Acetaminophen
- • 500 mg q4-6h prn pain
- • Not to exceed 3,000 mg per day
• Ibuprofen (mild to mod pain)
- • 400-600 mg q6h prn pain
- • Not to exceed 3200 mg per day
• Ibuprofen (severe pain)
- • 800 mg q8h prn pain
- • Not to exceed 3200 mg per day

Answer 257

A

Prostatic adenocarcinoma is most common malignancy (except skin cancers) in older men; 60% of men >80 years old—
- Most often detected by rectal exams
- Many are small and not clinically significant
- Most metastasize to bone and occasionally to regional lymph nodes
- However, can be deadly in some patients, especially in younger men
PSA (prostate specific antigen)-only associated with prostate tissue
- >4-6 mg/ml is abnormal (usually higher with age)
- Rapidly increasing PSA means high risk for cancer
- The more PSA bound to alpha-1-antichymotrypsin, the greater the risk of cancer
Treatment
- Prostatectomy (affects bladder function)
- Radiation
- Hormonal: block androgen receptors-affects male functions
- Chemotherapy or bisphosphonate