FULLY RANDOMIZED PART III Flashcards
1
Q
Comparing sigmoidoscopy and colonoscopy, which evaluates the descending colon?
A
Sigmoidoscopy
2
Q
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat antisocial disorder?
A
Sociotherapy
3
Q
Which of the pancreatic and biliary system conditions discussed in class are more common in males?
A
Primary sclerosing cholangitis, chronic pancreatitis, pancreatic cancer (just barely)
4
Q
What would show in the CSF of a patient with Creutzfeldt-Jakob disease?
A
14-3-3 protein
5
Q
An ischemic stroke that is caused by a thrombus can be atherosclerotic or an artery dissection. What are the symptoms of an artery dissection thrombus?
A
Headache, amaurosis fugax, Horner’s
6
Q
Comparing angina and myocardial infarction, which is relieved by rest and/or nitroglycerin and is usually of short duration?
A
Angina
7
Q
A panic attack by itself is not considered a mental disorder. How does a panic attack specifier differ from a panic attack?
A
Panic attack specifier is a panic attack in the context of a mental disorder such as PTSD.
8
Q
Toxocariasis usually doesn’t warrant treatment unless the side effects are severe. What medications could be given then?
A
VLM: Albendazole, mebendazole, corticosteroids.OLM: corticosteroids, possibly surgery
9
Q
There are different types of delusional disorder. Briefly describe the persecutory subtype.
A
Belief that they are being conspired against, cheat, spied on, followed, poisoned/drugged, or obstructed in pursuit of their long time goals.
10
Q
What techniques are used to diagnose cholecystitis?
A
Ultrasound, CT.
11
Q
TST results are made by measuring the induration of the resulting reaction, not the redness. In which individuals would an induration of 10 mm be considered posittive?
A
Any high risk individual who doesn’t meet the 5mm criteria (health care worker)
12
Q
How would you treat bacterial meninfitis?
A
IV vancomyin with ceftriaxone
13
Q
Define: functional residual capacity.
A
The volume of air remaining in the lungs at the end of normal expiration.
14
Q
For women under 65 and adults over 65, what is the number of standard drinks that would indicate an increase in health risks?
A
7/week, or 3/day
15
Q
Psychotic disorders are characterized by delusions, hallucinations, disorganized thinking, catatonia, and/or negative symptoms.
A
Free card.
16
Q
Emphysema is characterized by the formation of bullae. What are bullae, and how do they form?
A
They are large spaces where there should be many small alveoli. Repeated and prolonged inflammation causes release of proteolytic enzymes (such as tryptase) that digests the alveolar septal walls.
17
Q
There are five classes of HIV medications (plus pharmacokinetic enhancers). Describe what entry/fusion inhibitors do, as well as any specific points made during class about this class of medication.
A
Inhibit fusion with or entry of the virus into the cell. This class is used when other medications have failed.
18
Q
MG can be exacerbated by medications. Which medications or classes of medications can do this?
A
Antibiotics (especially gentamycin, tobramycin, telithromycin), fluoroquinolones, hydroxychloroquine, botulinum toxin, penicillamine, beta blockers, anesthetics, and high dose steroids.
19
Q
The spectrum of schizophrenia has several sub-categories, based on how long they symptoms last. Delusional disorder involves having at least one delusion for how long?
A
Greater than one month.
20
Q
_______________ cancer is the 4th leading cause of cancer related deaths among men and women in the US.
A
Pancreatic
21
Q
Comparing subdural vs epidural hematomas, which has a slower onset?
A
Subdural
22
Q
Gallstones are mostly asymptomatic, although biliary colic sometimes happen. What is biliary colic?
A
Occurs typically after a fatty meal when the gall bladder contracts and a gallstone blocks the cystic duct. This causes an attack of upper right abdominal pain, N&V, and sometimes pain in the right shoulder/back.
23
Q
True or false: visceral larva migrans is more common in kids.
A
True.
24
Q
How does schizoaffective disorder differ from schizophrenia?
A
It includes a major mood episode, and the schizophrenia must be uninterrupted.
25
What visual symptom occurs with a retinal migraine, and how long does it typically last?
Monocular scotoma or blindness*Lasts from minutes to less than an hour
26
Medications for COPD are pretty similar to asthma. What are a few key differences?
Anticholinergics are FDA approved for COPD (they aren't for asthma), glucocorticoids are most useful during exacerbations and not as a maintenance med (as with asthma), and aspirin is okay to use because it decreases the platelet count (there is an increased risk of clotting in COPD).
27
Anticholinergics prevent contraction of airway smooth muscle and are inhaled. Their onset is 3-4 weeks and they are typically less effective than beta 2 agonists.
Free card.
28
What are the treatment options for choledocholithiasis?
Lithotripsy, cholecystectomy, biliary stenting, ERCP.
29
What ocular findings might you find in a neonate that would indicate neonatal inclusion conjunctivitis?
Bilateral presentation5-14 days after birthSwelling, hyperemiaChemosis, pseudomembranePapillae, no follicles
30
Three types of laboratory tests were discussed in class for diagnosis of chlamydia. Which is the historical standard? When would this test be used?
McCoy cell tissue culture. It has high specificity and so is used in court for cases of suspected sexual abuse.
31
BP above _______________ is considered an emergency.
200/120
32
What treatments are used for early Lyme disease when the symptoms include meningitis or acute febrile polyneuritis?
IV Ceftriaxone or Penicillin G for 14 days (oral doxy for 28 days if allergic)
33
Treatment for tension headaches can include analgesics (ibuprofen, naproxen, aspirin) and acetaminophen. Which of these (analgesics vs acetaminophen) is less effective and should be limited in use to 9 days/month and limited to 2 doses/day?
Acetaminophen
34
Manometry on a patient with scleroderma esophagus would show ___________ (hypotensive/hypertensive) LES and ____________ (poor/strong) peristaltic contraction.
Hypotensive; poor
35
What do you do if your patient is experiencing diabetic ketoacidosis?
Measure their blood glucose, administer insulin, and keep them hydrated (and correct the electrolyte disturbances), and call 911 or take them to the hospital.
36
What two conditions qualify as seroconversion, in terms of a TST?
A change from a negative to a positive reaction, or an increase of 10 mm or more in size.
37
True or false: the only treatment for pancreatic cancer is surgery, but the prognosis is low.
True. The 5-year survival is only 25-30%, and only 15-20% of patients are good candidates for surgery anyway.
38
True or false: the typical migraine headache lasts less than a day, is uilateral and involves a throbbing or pulsatile pain.
Mostly true--the duration can be anywhere from 4 hours to several days (so not "typically" less than a day)
39
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat schizoid disorder?
Psychotherapy or sociotherapy
40
What is considered a normal respiratory rate for a child?
up to 20 cycles per minute
41
What non-surgical treatment options are there for a patient with sleep apnea?
Weight loss, tongue retaining devices, oral mandibular advancement devices, tennis balls on pajamas, anti-inflammatory meds for kids, constant positive airway pressure (CPAP), oropharyngeal exercises.
42
Name the possible indicators of need for a lumbar puncture, if you are suspicious of neurosyphilis.
Neurological S/S, ophthalmic S/S, HIV infection, failure of treatment, and children with syphilis.
43
Stress gastritis is caused by a decreased defense mechanism to gastric acid, which can be caused by a reduction in blood flow, mucus, and bicarbonate secretion.
Free card.
44
Psychotherapy is a general term for the process of treating a condition by talking about it with a mental health provider. There are three specific subdivisions mentioned in class--cognitive behavioral therapy, psychodynamic psychotherapy, and psychoeducation.
Free card.
45
True or false: toxocara canis completes its life cycle in humans.
False; it stays a larva while in humans.
46
For acute therapy, treatment should start within how long of the onset of the migraine symptoms?
15 minutes
47
A CDC diagnosis of AIDs is made whenever a person is HIV+ and ______________ (list all that apply)
CD4 cell count below 200/mm3ORCD4 T-cell % of total lymphocytes below 14%ORDevelopment of an AIDS defining illness (huge list, pneumocystis jirovecii pneumonia is the most common cause of death in AIDS patients)
48
Comparing cluster headaches and paroxysmal hemicranias, one of them can switch sides between attacks and the other always affects the same side. Which always affects the same side?
Paroxysmal hemicranias
49
What common medication should be avoided in asthmatics?
Aspirin; it blocks the prostaglandin side of the arachidonic acid metabolism pathway, shunting products toward the leukotriene side. Attacks can be triggered by aspirin (aspirin exacerbated respiratory disease (AERD).
50
Workup for Zollinger-Ellison Syndrome involves endoscopy (for diagnosis of the ulcer), imaging to locate the gastrinoma, and testing of serum gastrin level. What is considered a normal serum gastrin level?
Less than 100 pg/mL
51
Describe the treatment for genital chlamydial infections. When would you follow up with the patient to check how treatment went?
Azithromycin 1 g po single dose ORDoxy 100 mg po bid for 1 weekF/U in 3 weeks if pregnant, 3-4 months if not
52
In what percent of neurologic manifestations of Wilson Disease will the patient also have a Kayser-Fleisher Ring?
98%
53
How does obesity affect respiration?
The diaphragm and chest wall are mechanically compressed, leading to decreased ventilation of lung bases and hypoxemia, especially when lying down.
54
What are a few classes of medications used for COPD that are not used for asthma?
Phosphodiesterase inhibitors, aspirin, and antibiotics (due to increased risk of infection).
55
Asthma can be categorized based on frequency of symptoms, lung function tests (FEV1), and peak flow variability. What are the severity classes of asthma?
Intermittent, mild persistent, moderate persistent, and severe persistent.
56
In which form of hepatitis are pregnant women more likely to get fulminant hepatic failure, which a higher rate of mortality?
HEV
57
There are a few different types of syncope: vasovagal, orthostatic, cardiovascular, and cerebrovascular. Which is the most common and due to emotional stress
Vasovagal
58
What are the symptoms of celiac disease?
Diarrhea, weight loss, fatigue, flatulence, anorexia, abdominal discomfort, and greasy, foul-smelling, voluminous pale stools. The patient may be asymptomatic, however.
59
Where does copper deposition occur in Wilson disease?
Liver, brain, and cornea
60
What disease makes up 90% of prion diseases?
Creutzfeldt-Jakob disease
61
Tranquilizers cause euphoria and sluggishness. Which tranquilizers were asterisked in the presentation?
Benzodiazepines.
62
What tests are used to diagnose asthma?
Spirometry with postbronchodilator response, pulse oximetry if acute, chest radiograph, and exercise spirometry.
63
Comparing tension headaches to migraines, which does worsen with exercise?
Migraine
64
What is the acute treatment for SUNCT?
IV lidocaine
65
There are five classes of HIV medications (plus pharmacokinetic enhancers). Describe what NNRTIs (non-nukes) do, as well as any specific points made during class about this class of medication.
They attach to and stop reverse transcriptase. Nevirapine is used for infants and pregnant women.
66
Which is more affected by obstructive pulmonary disease, expiration or inspiration?
Expiration.
67
What are some of the long term effects of anorexia?
Leukopenia, low bone mineral density, dehydration, dry/yellowish skin, severe constipation, brittle hair/nails, brain damage, internal body temperature drop, infertility.
68
Name the associated grading scale for the following conditions:TBIMSIIH
TBI: Glasgow coma scaleMS: McDonald criteriaIIH: Modified Dandy criteria
69
Besides pulmonary and ocular, what other symptoms may a patient cystic fibrosis experience?
Poor digestion of fats (blocked pancreas ducts), poor absorption of proteins and carbs, infertility, cirrhosis, sleep apnea.
70
The National Dysphagia Diet consists of three levels, numbered 1-3, depending on the severity of the swallowing difficulty. Which level refers to a mild difficulty, in which the patient can still eat most foods but needs them cut into small, bite-sized pieces first?
Level 3
71
True or false: there is no provent treatment to slow the progression of primary sclerosing cholangitis, though you can do IV fluids and antibiotics for sepsis, and balloon dilation for short term relief. Liver transplant can be used if cirrhosis develops.
True.
72
Which type of delusional disorder is most common?
Persecutory.
73
HIV is a retrovirus. What three enzymes does it carry in its capsid? What does each do?
Reverse transcriptase: makes viral DNA from viral RNAIntegrase: pulls viral DNA into cell nucleus and integrates it into host DNAProtease: clips resultant viral protein to form more viral enzymes
74
Which Cluster C personality disorder is characterized by a difficulty making decisions, a need for others to take charge, a difficulty expressing disagreement, and urgently seeking another relationship for care and support in case the current one ends?
Dependent
75
What are some of the symptoms of anaphylaxis?
Shakiness, nervousness/anxiety, sweating, chills, clamminess, irritability or impatience, rapid heartbeat, lightheadedness/dizziness, hunger and nausea, sleepiness, headaches, weakness or fatigue, lack of coordination.
76
Ambulatory pH monitoring, barium swllow, esophageal manometry, and endoscopy are all tests that can be used to evaluate GERD. Which test is used for the detection of complications from GERD?
Endoscopy
77
Which obstructive pulmonary disease is the most lethal genetic disease affecting Caucasians? What is its inheritance trait?
Cystic fibrosis. It is autosomal recessive, so there are a lot of carriers (1/30 Caucasians).
78
Fill in the blanks: old hemoglobin is broken down in the ___________, releasing ____________ (unconjugated/conjugated) bilirubin, which is transported by _____________ to the _____________, where it is converted to ________________ (unconjugated/conjugated) bilirubin and exceted into the bile.
Old hemoglobin is broken down in the spleen, releasing unconjugated bilirubin, which is transported by albumin to the liver, where it is converted to conjugated bilirubin and exceted into the bile.
79
Comparing tension headaches to migraines, which does not worsen with exercise?
Tension
80
List the treatment options for acute pancreatitis.
Pain control, IV fluids, ICU (if severe), pancreatic debridement (if necrosis), and treatment of the underlying cause.
81
What is the most common trigger for a tension headache?
Stress*
82
Cluster headache attacks typically occur 1-3 times daily. How quickly do they onset, and how long do they typically last?
Onset is rapid (5 minutes)*, and duration is between 15 minutes to 3 hours
83
True or false: though there is no treatment for Creutzfeldt-Jakob disease, patients usually live for 5 years after diagnosis.
False; patients live for about 6 months (and there is no treatment)
84
The cortical spreading depression (CSD) theory of migraine pathophysiology states that aura are caused by a wave of excitation in parts of the brain. CSD is also said to activate trigeminal
Calcitonin gene-related peptide (CGRP)*, substance P, neurokinin A
85
ABCDD is an acronym used to estimate the risk of a stroke in the first two days after a transient ischemic attack. What do these letters stand for?
Age (over 60)Blood pressure after TIA (over 140 systolic OR over 90 diastolic)Clinical features (unilateral weakness, speech disturbance)DurationDiabetes
86
What sort of workup can be done for a patient who has had a transient ischemic attack?
MRI (with diffusion weighted imaging), CT, MRA, CTA, ECG, CBC, metabolic panel, coagulation screening, lipid profile, ESR, CRP, Doppler and carotid Doppler
87
What effect does the sympathetic nervous system have on the lungs?
Very mild arteriolar constriction, bronchial smooth muscle dilation, and inhibition of mucous glands.
88
Which of the stomach/intestine conditions discussed in class has a higher prevalence in men?
Gastric cancer, Zollinger-Ellison Syndrome, colorectal cancer, and peptic ulcer disease (though just barely)
89
Briefly outline the disease process of histoplasmosis.
Spores are inhaled and fungi proliferate in the lungs. PMNs and macrophages infiltrate the lungs and phagocytotize the fungi but don't kill it. They carry it throughout the body. An immune resopnse develops, leading to granuloma formation, necrosis, and fibrotic encapsulation, which can later calcify (histoplasmoma).
90
The incubation period for chlamydia is around 7-21 days. How is the disease transmitted? What is the co-infection rate?
Transmitted by direct contact with urine or genital secretions. 50% co-infection rate
91
What are the most common adverse effects of glucocorticoids? Which of these effects are less likely with inhaled glucocorticoids?
Osteoporosis, impaired wound healing, increased risk of infection, HTN, edema, ulcers, psychoses, Cushing-like syndrome, oral candidiasis. Decreased growth in children, glaucoma, cataracts, and increased risk of DM are less likely in inhaled vs. oral glucocorticoids.
92
What are the roles of the pulmonary system?
Acquire O2, get rid of CO2, and provide fast adjustment to blood pH.
93
IBS has between 50% and 70% comorbidity with psychiatric disorders, chronic pelvic pain, temporomandibular joint disorder, and chronic fatigue sydrome, and 20-50% with fibromyalgia.
Free card.
94
Cluster headaches feature excruciating unilateral orbital or temporal pain, accompanied by autonomic symptoms. Its overall prevalence is less than 1%. What percetage of patients experience autonomic symptoms? What sorts of autonomic symptoms are they?
97%*; parasympathetic symptoms such as lacrimation, injection, ptosis, miosis, etc.
95
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Which form has a later age of onset and has a worse prognosis?
PPMS
96
True or false: ethosuximide and gabapentin are both acceptable drugs for absence seizures
False; only ethosuximide; gabapentin is contraindicated.
97
Comparing angina and myocardial infarction, which is not relieved by rest or nitroglycerin and can last hours?
Myocardial infarction.
98
What are some of the acute treatment options for cluster headaches?
100% oxygen therapy, subcutaneous or nasal sumatriptan
99
The most common type of aura is visual. It occurs over 5 minutes and may be a zig-zag pattern or a shimmering scintillating appearance. It may be a C-shape and will leavea a central scotoma
Free card.
100
True or false: eradication of H. Pylori decreases ulcer recurrence to less than 10%
True.
101
Leukotriene inhibitors are not used for immediate bronchodilation and are taken orally. Their most concerning side effect is impact on liver function, though they can cause HA, fever, sore throat, sinus infection, and SJS.
Free card.
102
What are the symptoms of scleroderma?
Dysphagia, dry mouth, calcific skin deposits, tight skin, severe GERD, and chest pain.
103
There are neurologic, iatrogenic, structural, muscular, infectious, and metabolic causes of oropharyngeal dysphagia. What structural causes are possible?
Neoplasia, Zenker's diverticulum, cricopharyngeal bar
104
______________________ is chronic inflammation, fibrosis, and stricturing of the biliary tree inside and/or outside of the liver.
Primary sclerosing cholangitis.
105
Transient ischemic attacks involve no infarction (tissue death) and there is full recovery of function. How long does a TIA usually last?
About 1 minute, but possible up to under 24 hours.
106
What sort of lab tests could you run on a patient with scleroderma?
ANA, anti-scl-70, anticentromere antibodies
107
Inhaled glucocorticoids should be used with caution in patients with what conditions?
Parasitic infection, active or inactive TB, ocular herpes simplex, or increased IOP.
108
True or false: about 2/3 of IBS patients experience decreased pain sensitivity in gut stimulation.
False; 2/3 have increased pain sensitivity in gut stimulation
109
Which of the stomach/intestine conditions discussed in class has a higher prevalence in women?
Celiac disease and irritable bowel syndrome
110
10-35% of heavy drinkers have ___________.
Alcoholic hepatitis (aka alcoholic steatohepatitis), inflammation of a fatty liver
111
In terms of classifying the severity of bulimia, how many episodes per week is considered extreme?
Fourteen or more
112
The diagnostic criteria for a migraine without aura includes the headache lasting how long?
4 to 72 hours
113
If the early/localized form of Lyme disease is untreated, early disseminated infection can develop days to weeks after the bite. This stage can include more erythema migrans as well as the following three categories of symptoms:-Rheumatoid-Neurological-CardiacWhat percentage of patients in the early disseminated form experience each of these categories? What specific symptoms occur in these stages?
Rheumatoid = 30%-arthalgia with swellingNeurological (15%)-CN palsies (especially Bell's palsy with a fever)-meningitis-acute febrile polyneuritisCardiac (1%)-myopericarditis-AV conduction defects or tachyarrythmias
114
Which class of medication is first option when treating moderate to severe asthma?
Inhaled glucocorticoids, due to their ability to decrease remodeling. They can be either aerosol or powdered.
115
Which patients with histoplasmosis may find themselves on anti-fungals for life?
Immunosuppressed
116
In order for chronic bronchitis to be diagnosed, what must a patient have experienced?
Persistent, productive cough on most days for at least 3 consecutive months in two consecutive years.
117
What is the treatment for chronic pancreatitis?
Pain management, lifestyle changes (smaller meals, low-fat meals, no alcohol or tobacco), pancreatic lithotripsy, surgery.
118
Nearly 90% of headaches fall into one of these categories: migraine, tension-type, chronic daily, and cluster. Which of these types of the most commonly diagnosed?
Migraine
119
Which Cluster B personality disorder is characterized by shifts between idealization and devaluation ("splitting")?
Borderline
120
What is the medical treatment for a myasthenic crisis?
Intubation, stop anticholinesterase meds, do plasma exchange or IV immunoglobulin, and begin immunomodulatory drugs (prednisone)
121
Chronic pancreatitis is progressive inflammation of the pancreas that leads to ______________ (reversible/irreversible) structural damage.
Irreversible
122
What is the name of the study in which you swallow barium and the camera can construct a video of how the swallowed foods move into the stomach?
Videofluoroscopic swallowing study (VFSS) or modified barium swallow
123
If you have a patient and you suspect they have meningitis or encephalitis due to WNV, what lab screening tests could you send for? What situations may cause false positives?
Antibody tests (EIA, IFA, Western Blot) looking for IgM in the serum or the CSF (CSF preferred, since IgM in the CSF indicates presence of the virus in the CSF too).St. Louis encephalitis virus or yellow fever vaccination can cause false positives.
124
There are two major forms of toxocariasis: visceral larva migrans and ocular larva migrans. Visceral larva migrans involves some general non-specific symptoms and non-specific pulmonary symptoms, as well as what not so general symptoms?
Enlargement of spleen and liver, and seizures or epilepsy.
125
True or false: an embolytic stroke has symptoms that are more acute than thrombolytic.
True.
126
Which class of drugs for Parkinson's disease works by slowing the breakdown of existing dopamine?
Monoamine Oxidase-B inhibitors (drugs end in -giline)
127
What is the cause of postherpetic neuralgia?
Herpes zoster virus
128
There are different types of delusional disorder. Briefly describe the unspecified subtype.
Delusion doesn't match any of the other categories.
129
Irritable bowel syndrome (IBS) is characterized by abdominal pain or discomfort linked with bowel function and persists at least 6 months. What relieves the pain or discomfort?
Defecation
130
Asthma is associated with what type of hypersensitivity?
Type I
131
__________ cells have an exocrine function, and their enzymes drain into the duodenum.
Acinar
132
True or false: Prevention of migraines can be done with beta agonists.
False; it can be done with beta blockers.
133
Gastric glands in the stomach have surface mucus cells, mucus neck cells, parietal cells, chief cells, and endocrine cells. What do chief cells secrete?
Pepsinogen
134
The National Dysphagia Diet consists of three levels, numbered 1-3, depending on the severity of the swallowing difficulty. Which level refers to a mild to moderate difficulty, in which the patient's foods must have a consistency similar to minced meat?
Level 2
135
What four disorders make up Cluster B personality disorders?
Borderline, narcissistic, histrionic, and antisocial
136
Pulmonary capillaries surround each alveoli and are lined with a single layer of endothelial cells, to allow for easy and fast gas exchange. What influences capillary size?
If the O2 levels in the alveoli are low, or if they are high enough in the capillary, the lumen will contract because there is no reason to shunt blood that direction. Conversely, if there is high O2 in the alveoli but low in the capillary, the lumen will relax to shunt blood to where the O2 is. This is how blood flow is "matched" to where oxygen happens to be in the lungs.
137
What are some non-infectious causes of aspectic meningitis?
Lupus
138
Visual Variant Alzheimer's Dementia (VVAD), also called posterior cortical atrophy, involves hypometabolism of glucose in the occipital-parietal area. What symptoms might a patient with this condition experience?
Simultagnosia (inability to see more than one object at a time), prosopagnosia (inability/difficulty recognizing faces), visual agnosia (inability/difficulty recognizing objects), and difficulty with depth perception.
139
What are some of the signs of anaphylaxis?
Skin reaction, hives, flushed or pale skin, feeling of warmth, sensation of a lump in the throat, constriction of airways, swollen tongue or throat, weak and rapid pulse, N&V, dizziness or fainting, reduced blood pressure.
140
What is the name for an area of cerebral bruising with localized edema?
Contusion. This is the most common finding of a TBI.
141
True or false: the FDA requires Western Blot or IFA to confirm initial positive HIV immunoassay results.
False; they used to require confirmation, but not anymore.
142
Migraines are associated with depletion of which endogenous substances? With excess of which substance?
Depletion of serotonin and estrogen; excess dopamine.
143
What sign might be seen on a chest x-ray of a patient with achalasia?
"Bird beak"
144
Toxic optic neuropathy can occur if there is severe nutrient depletion (especially of B12 and folate), such as can occur with alcohol abuse. What findings are associated with toxic optic neuropathy?
Pale nerve, color vision reduction, central or cecocentral scotoma, and reduced VA.
145
Testing for giant cell arteritis includes a temporal artery biopsy, ESR, and CRP levels. What is a normal CRP level?
Less than 1 mg/dL (or less than 10 mg/L)
146
How does kyphoscoliosis affect respiration?
The spine is curved, reducing lung volumes and increasing the stiffness of the chest wall. This allows the alveoli to collapse. All of these increase the work of breathing. Respiratory failure due to elevated CO2 eventually occurs.
147
What are the signs and symptoms of asthma?
Chronic cough, wheezing and shortness of breath are the classic triad. Also possible are tightness in chest, sympathetic discharge, tachypnea, and, in severe cases, cyanosis of nail beds, confusion, agitation, and nasal flaring.
148
In order to diagnose Lewy Body dementia, two of which three features are required?
Fluctuations or "blanking out"Recurrent, detailed visual hallucinations (67%)Parkinsonism features
149
The three types of clinical syndromes caused by chlamydia trachomatis are local, complications and sequelae. What are the findings of sequelae for men, women, and children?
Men: chronic arthritis (rare), infertility (rare)Women: Infertility, ectopic pregnancy, chronic pelvic pain, chronic arthritis (rare)Children: Rare, if any
150
What are the screening recommendations for colorectal cancer?
Begin at age 50 and do either a sigmoidoscopy every 3-5 years or a colonoscopy every 10 years.
151
Though most patients with HBV are asymptomatic, what symptoms are possible?
Flu-like symptoms, jaundice, and liver failure (these last two are rare)
152
What treatments are used for late Lyme disease when the symptoms include arthritis?
Treat as in the early stage; if patient doesn't respond, retreat with another 28 day course of oral meds or switch to IV ceftriaxone for 14-28 days. If still no response, treat with anti-inflammatories (NSAIDs, corticosteroids, DMARDs).
153
What are the major roles of the large intestine?
Water absorption and electrolyte exchange.
154
Which type of dysphagia arises from the oropharynx, larynx, and/or UES?
Oropharyngeal dysphagia.
155
There are a few different types of syncope: vasovagal, orthostatic, cardiovascular, and cerebrovascular. Which is the second most common?
Orthostatic.
156
Non-ocular symptoms of MS include muscle fatigue/weakness/spasms, numbness, tingling, pain, cognitive decline, bladder, bowel, and sexual dysfunction.
Free card.
157
Testing for peptic ulcer disease can be done with an antibody test (for H. Pylori antibodies), urea breath test, stool antigen test, and endoscopy. Which of these tests does not differentiate an active vs past infection of H. Pylori?
Antibody test.
158
Which headaches discussed in class are typically in older patients (over age 50)?
Trigeminal neuralgia*GCA headache (72)*Postherpetic neuralgia ("older age")Sinus headache is from 45-75
159
What are the causes of peptic ulcer disease?
H. Pylori, NSAIDs, or aspirin
160
Fill in the blank:_________ dementia may be the second most common form of dementia.
Vascular.
161
Some predisposing factor for GERD include hiatal hernia, certain foods and medications, direct mucosal damage, and certain lifestyle habits. Which foods tend to predispose to GERD?
Caffeine, chocolate, peppermint, alcohol, and tomato-based products.
162
Persistent depressive disorder, aka dysthymia, is a depressed mood for at least 2 years in adults (1 year in children), during which time symptoms must be consistent for more than 2 months. Patients must meet two or more of what criteria to be diagnosed with dysthymia?
Poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness.
163
True or false: there is evidence linking closed-angle glaucoma and Alzheimer's Disease.
False; the evidence links primary open angle glaucoma and Alzheimer's.
164
Paroxysmal hemicranias last 2-30 minutes and typically occur 11-14 times/day. What feature is required to confirm diagnosis?
Resolution in 1-2 days with indomethacin* confirms diagnosis
165
Which adverse effect of adrenergic bronchodilators is paradoxical?
Bronchospasm can occur with repeated use due to sensitization (your body needs more of the drug to get the same result).
166
True or false: when using triptans to treat an acute migraine, they should be taken early on, but not more than 3 times per week*
True.
167
What sort of prognosis might you expect for a patient with sarcoidosis?
Rule of 1/3's:33% spontaneous remission33% remain stable33% have progression (with 10% developing severe pulmonary fibrosis)
168
In which gender and age range are scleroderma more common?
Women; 30-50 years
169
Idiopathic intracranial hypertension is due to an increase in CSF and is caused by what?
Trick question; there is no underlying cause (diagnosis is of exclusion)
170
IV methylprednisolone can be used for an acute attack of MS. You can use oral prednisone, but only if which symptom is absent?
Optic neuritis.
171
What is the name of the set of criteria used to determine needed clinical findings for diagnosis of MS?
McDonald criteria.
172
Avoiding triggers of migraines, getting regular sleep, regular meals, and regular exercise, and keeping a headache diary can all help with migraine management. What two other options were listed in lecture?
Acupuncture and transcutaneous electric nerve stimulation (TENS)
173
True or false: 50% of patients with a myocardial infarction will die within the first two hours.
True.
174
Fill in the blank: _____________ is the repeated involuntary regurgitation of food over a period of at least 1 month that is not attributed to a GI or other medical issue.
Rumination disorder
175
There should be a chain of command established in case of an emergency in your office. Who should be the usher for EMS?
The least medically trained staff member
176
What three disorders make up Cluster C personality disorders?
Avoidant, dependent, and obsessive compulsive
177
In order to consider a diagnosis of status epilepticus, what must be true?
There must have been a seizure lasting more than 30 minutes, OR at least two seizures without full recovery between.
178
What is the only drug approved to treat HDV?
Interferon alfa (IFNa)
179
HIV rapid tests look for antibodies and so are dependent on the patient's immune response. Each of the following rapid tests had one feature that was highlighted in class. Name said features.OraQuick ADVANCE:Reveal G-3:MultiSpot:Alere Determine:
OraQuick ADVANCE: can use oral fluidReveal G-3: 3-5 minutes for the entire testMultiSpot: differentiates HIV-1 from HIV-2Alere Determine: also looks for an HIV-1 antigen
180
The spectrum of schizophrenia has several sub-categories, based on how long they symptoms last. How long do the symptoms have to last for the condition to be termed schizophrenia?
At least 6 months
181
Transmission of toxoplasmosis can be as high as 60%. True or false: the earlier in the pregnancy the mother is infected, the worse the manifestations in the fetus (if the fetus is indeed infected).
True.
182
HAV is diagnosed from the typical clinical presentation, as well as detection of what?
IgM anti-HAV antibodies
183
True or false: most patients with Crohn's disease are well controlled with medicine and never end up needing surgery.
False; most CD patients require surgery at least once in their lifetime.
184
How would you treat giant cell arteritis?
IV methylprednisolon if vision loss is present, and oral prednisone, and low dose aspirin.
185
The 5 year survival rate for a person with a gastrinoma drops severely if there has been metastasis to the liver.
Free card.
186
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat narcissistic disorder?
Psychotherapy
187
How long does it take for injected cocaine (dissolved in water) to reach the brain? How long is its effect?
Reaches brain in 15-30 seconds, lasts 20-60 minutes
188
Patients with vascular dementia may experience multiple strokes, CV risk factors, and white matter lesions on MRI. Get their CV risk factors under control, and use the same treatment as in Alzheimer's.
Free card.
189
Reynold's pentad is a group of symptoms of acute cholangitis. Name the features of this pentad.
Charcot triad (pain, fever/chills, jaundice) plus altered mental status and hypotension.
190
List the treatment for late latent or tertiary syphilis. (No neurological involvement.)
Penicillin G benzathine, 2.4 million U IM q1week for 3 weeksORIf allergic to penicillin and not pregnant-Doxy 100 mg po bid for 28 days-Tetracycline 500 mg po qid for 28 days
191
Define: total lung capacity
Maximum volume of lungs
192
Which lung volumes/capacities are measured indirectly (mathematically)?
Functional residual capacity, residual volume, and total lung capacity.
193
What might imaging show that could be due to IIH?
Empty sella turcica, flattening of posterior sclera, enlargement of subarachnoid space around the optic nerve, turtuosity of the optic nerve, slit-like ventricles, narrowing of venous sinus.
194
What are the cardinal signs of hemorrhagic stroke?
Headache, N&V, seizures.
195
What are the causes of esophageal dysphagia?
Abnormality of peristalsis and/or deglutitive inhibition or abnormality of LES (achalasia, scleroderma, chronic GERD).
196
What are some treatment options for IBS?
Dietary modification, fiber supplements, psychotherapy, antidiarrheals, laxatives, suppositories, SSRIs, TCAs
197
What clinical syndromes can occur with gonorrhea?
Local and complications/sequelae
198
Your patient has experienced a seizure. What do you do after the seizure?
Lay them on their side to keep the airway clear (Recovery Position) and make sure they are still breathing.
199
Comparing sigmoidoscopy and colonoscopy, which does not require that the patient be sedated?
Sigmoidoscopy
200
What is the treatment for postherpetic neuralgia?
Amitriptyline or gabapentin. Capsaicin may help (decreases substance P)
201
What would an MRI show in a patient with Creutzfeldt-Jakob disease?
Hyperintensity lesions at caudate, putamen, cortex
202
What would a chest X-ray show on a patient with esophageal dysphagia?
Widened esophagus, and bird beak sign toward the end of the esophagus.
203
Is there a vaccine for Hepatitis A?
Yes
204
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Which form makes up 5-10% of cases?
PPMS
205
Sweat chloride tests and genetic testing may need to be done if the cystic fibrosis newborn screening test comes up with uncertain results.
Free card.
206
Manometry is used to evaluate esophageal dysphagia. What does it measure?
Measures the strength, duration, and sequential nature of esophageal contraction.
207
True or false: cirrhosis is mostly irreversible, so all you can do is limit the further damage done, manage the symptoms, and decide whether transplantation is a good fit.
True.
208
Which Cluster B personality disorder is characterized by failure to conform to social norms, deceitfulness, impulsivity, and lack of remorse?
Antiocial
209
A lumbar puncture on a patient with MS might contain what kind of antibodies?
IgG
210
What is pneumothorax?
Air escaping into the thoracic cavity; this can occur in emphysema due to the bullae, which have weak walls.
211
What is the classic triple therapy for toxoplasmosis? What alternatives exist?
Classic: Pyrimethamine, sulfadiazine, and leucovorin calcium.Alternatives-Trimethoprim, sulfamethoxazole, leucovorin calcium-Pyrimethamine, clindamycin, leucovorin calcium
212
Sarcoidosis is characterized by the development of _____________ throughout the body.
Granulomas
213
The ticks that transmit Lyme disease have three life stages after they hatch: larva, nymph, and adult. Which is the stage which most commonly affects human beings? What reasons were given in class for this?
Nymph; they're smaller (less noticeable) than adults. They also outnumber adults 10:1, and they're outside during spring and summer, which is when we are outside most.
214
How is West Nile Virus transmitted to humans?
Typically through mosquitoes (they bite infected birds then pass it on to humans), though it can occur through blood transfusions or organ transplantations, breast milk, transplacentally.
215
Some medications can be used to manage the symptoms of MS. Which medication is for anti-convulsion and is also the drug of choice for general seizures?
Valproate
216
Chronic bronchitis and emphysema both start the same way, with inflammation. What remodeling occurs in chronic bronchitis that makes it different from emphysema?
The mucous glands in the airways undergo hypertrophy and hypersecrete mucous.
217
What is the name of the organism that causes syphilis? About what ratio of exposed individuals will acquire the organism?
Treponema pallidum; about 1/3 exposed individuals acquire the organism.
218
An MRI on a patient with MS might show what?
Plaques (demyelination and accumulation of macrophages and T cells)
219
What is the most common location for an intracerebral hemorrhage?
Basal ganglia.
220
Briefly outline the pharmacologic therapy for a peptic ulcer.
Withdraw from NSAIDs and aspirin if possible; if not, add a proton pump inhibitor or misoprostol. Also eradicate H. Pylori with triple therapy (PPI and 2 different antibiotics for 7-14 days).
221
True or false: you should always avoid the use of penicillin in treating syphilis if the patient is penicillin sensitive.
False; in pregnant patients, penicillin is still the treatment used (even if the patient is sensitive) because it's the only drug effective against syphilis that crosses the placental barrier.
222
In early neurosyphilis, what symptoms are possible? About how long after infection does early neurosyphilis tend to occur?
CN involvement (all but CN V; also, Bell's palsy could be accompanied by a fever), meningitis, strokes/seizures, tingling/weakness of legs, loss of vibratory sense, auditory/ophthalmic involvement.Occurs within one year of infection.
223
What is the most common manifestation of chlamydia in men? In women? What are the symptoms for each?
Men: urethritis (occurs in 50%); mucoid or clear discharge, dysuria, urethral pruritis, meatal erythema/tendernessWomen: cervicitis (occurs in 20-30%); mucopurulent discharge, cervix bleeds easily from minor trauma
224
If you believe you've been exposed to TB, what testing should you seek?
If you've had a previous negative TST within the last year, test in 8 weeks. If you haven't had a TST within the last year, get a TST immediately and then again in a few weeks.
225
What age group (comprising 16% of the US population) makes up 26% of new HIV infection in the US?
13-24 years
226
What testing can be used in the diagnosis of lung diseases?
X-ray (for structural abnormalities or trapped air), pulmonary angiography (for emboli), pulse oximetry (for hemoglobin saturation), spirometry (for rates, volumes, and easy of respiration).
227
Comparing the upper esophageal sphincter (UES) and the lower esophaegeal sphincter (LES), which is under voluntary control and which is not under voluntary control?
UES is under voluntary control; LES is not under voluntary control.
228
True or false: achalasia is associated with the degeneration of postganglionic inhibitory neurons.
True.
229
Jaundice is the discoloration of skin, conjunctiva, and mucous membranes resulting from elevated plasma bilirubin. What is a normal bilirubin serum level? How much of an increase is typical in jaundice?
Normal levels are less than 1-1.5 mg/dL.Jaundice levels are around 3-4 mg/dL.
230
Acquired toxoplasmosis can feature maculopapular rash. What makes this rash different from the rash that appears in another condition mentioned in class?
This rash spares the palms and soles, whereas the rash of secondary syphilis does NOT spare the palms and soles.
231
What treatments are used for early Lyme disease when the symptoms include EM, Carditis, Facial Nerve Palsy, or arthritis?
Oral doxycycline*, amoxicillin, or cefuroxime axetil for 14 days (28 days if arthritis)Note: if patient is a child, no doxy
232
Which medication for Parkinson's is an antiviral that can also be used to manage the fatigue of multiple sclerosis?
Amantadine
233
How would you treat primary acute and benign histoplasmosis?
No treatment.
234
Comparing subdural vs epidural hematomas, which involves the arterial blood supply?
Epidural
235
Does Bell's Palsy typically involve an acute or chronic onset?
Acute (within about 48 hours)
236
What is the most effective medication for MS?
Natalizumab infusion
237
Which upper GI order is the most common in the Western World, consisting of 75% of esophageal diseases?
Gastroesophageal reflux disease (GERD)
238
In terms of classifying the severity of bulimia, how many episodes per week is considered mild?
One to three
239
If a woman is pregnant and is diagnosed with toxoplasmosis, what test will be run to help determine the time of infection?
IgG avidity test
240
Typically avoid beta blockers and triptans in basilar, hemiplegic, and retinal migraines.
Free card.
241
Some medications can be used to manage the symptoms of MS. Which medication helps with fatigue?
Amantadine. This is also a drug used for Parkinson's.
242
Fill in the blank: ________ is a depressive disorder screening questionnaire, scored from zero to 27, with zero being no depression, and 27 being severe.
PHQ-9
243
Wilson disease can present with liver, brain, and ocular symptoms. Name the eye symptoms.
Kayser-Fleisher Ring, sunflower cataract
244
True or false: emphysema and chronic bronchitis both start with narrowing and loss of small airways.
True; they eventually have much different results.
245
What is the typical transmission of Hepatitis E?
Fecal-oral
246
In how many patients with scleroderma is the esophagus involved?
75-85%
247
Briefly outline the recommended lab HIV testing algorithm.
Do HIV-1/2 antigen/antibody combination immunoassay-If negative, true negative-If positive, continue to HIV-1/2 antibody differentiation immunoassayHIV-1/2 antibody differentiation immunoassay-If positive, diagnosis is according to whichever type of antibodies you found (HIV-1, HIV-2, or both)-If negative or indeterminate, run an HIV-1 NAATHIV-1 NAAT-If positive, acute HIV-1 infection-If negative, true negative for HIV-1
248
Where would PrPsc plaques show up in a patient with kuru? What symptoms might occur in a patient with this disease?
Cerebellum; symptoms would include postural instability, myoclonus, and late onset dementia
249
There is an 11% chance of developing IBS following what type of sickness?
Stomach flu
250
True or false: a complex partial seizure usually lasts three minutes or less, during which time the patient either remains motionless or engages in automatisms.
True.
251
Disruptive Mood Dysregulation Disorder (DMDD) is a type of depression disorder in children. There are four criteria must be present for at least 12 months, with all four for at least three months, and in at least two settings. Name the criteria.
Severe recurrent temper outbursts; temper outbursts inconsistent with developmental age; temper outbursts 3 or more times per week; mood between outbursts is irritable/angry
252
What test detects and quantifies the level of hepatic steatosis?
MRI
253
How would you treat Bell's Palsy?
Treat with 60-80mg of prednisone for 1 week (beginning within 3 days of start of symptoms). If the presentation is severe, you can add valacyclovir 1,000 mg TID.
254
True or false: more than 50% of patients with MG present with ocular symptoms, and 50% of these will develop generalized MG within 2 years.
True.
255
What are the signs of Creutzfeldt-Jakob disease?
Rapidly deteriorating mental status and myoclonus.
256
Comparing Crohn's Disease and Ulcerative Colitis, in which is abdominal pain more prominent?
Crohn's Disease
257
Charcot triad is a group of symptoms of acute cholangitis. Name the features of this triad.
Pain, fever/chills, and jaundice.
258
Recurrent painful ophthalmoplegic neuropathy is characterized by paralysis of the ocular cranial nerves and ipsilateral headache*. Which cranial nerve is most often affected?
CN III*
259
Alveoli have thin walls and a single layer of epithelial cells, to aid in gas exchange. What role does surfactant play in the alveoli?
It keeps the alveoli from collapsing and allows them to open easier.
260
People who live in northern latitudes have a higher risk of developing multiple sclerosis. True or false: once you have lived in a northern latitude, you carry the higher risk with you no matter where else you go.
False; your risk is thought to be associated with where you lived prior to puberty.
261
Are sinus headaches typically unilateral or bilateral?
Bilateral*
262
Which migraine subtype involves the brainstem or bilateral occipital hemispheres?
Migraine with brainstem aura (aka basilar migraine)
263
True or false: encephalitis has a better survival rate than meningitis.
True.
264
What is the gold standard for diagnosis of celiac disease?
Mucosal intestinal biopsy* and response to dietary withdrawal of gluten*.
265
Cholecystitis is inflammation of the gall bladder. True or false: it is more commonly due to tumors.
False; it is most commonly related to gallstones.
266
Proteins are digested by what pepsin from the stomach, trypsinogen from the pancreas, and trypsin/chymotrypsin/elastase from the small intestine.
Free card.
267
What are the common side effects of anti-epileptic drugs?
N&V, diarrhea, dizziness, weight gain, skin rash, blood dyscrasias, interaction with other medications, diplopia, blurred vision, nystagmus, color changes.
268
What are the goals of TB treatment?
Eradication of the infectionPrevention of drug resistancePrevention of transmissionPrevention of reactivation
269
Patients with Alzheimer's live an average of 10 years from the time of diagnosis. What is a common cause of death?
Aspiration pneumonia.
270
Besides the symptoms of excessive daytime sleepiness and being tired upon awakening, what other symptoms might a patient with sleep apnea have?
Loud snoring, morning headaches, and cognitive impairment.
271
What are some of the early signs of diabetic ketoacidosis?
Thirst or dry mouth, frequent urination, high blood glucose, high level of ketones in urine.
272
What uncommon practice is associated with kuru?
Cannibalism
273
What are the adverse effects of INH?
Chiefly hepatotoxicity; also anemia, GI symptoms, peripheral neuropathy, SEIs, optic neuritis, VF defects, EOM paresis.
274
Where would an MRI show hyperintensity in vCJD?
Pulvinar
275
How long do the symptoms last in Creutzfeldt-Jakob disease compared to variant CJD?
CJD: 6 months; vCJD: 14 months
276
True or false: acute Hepatitis E has a 20% mortality for middle-aged males
False; it has a 20% mortality in pregnant women.
277
Acute cholangitis is a bacterial infection caused by an obstruction of the biliary tree, elevation of intraluminal pressure, and infection of bile. It is most commonly caused by a gallstone.
Free card.
278
What type of infarcts are common with emboli in arteries with acute right angles?
Lacunar
279
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Which form involves gradual worsening and may or may not include relapses?
SPMS
280
True or false: a lumbar puncture of a patient with IIH would show CSF that is normal in composition, but highly elevated in opening pressure.
True; can elevate to more than 250 mmH20
281
What rating scale, from 0 to 15, is used to rank a patient's TBI symptoms and decide whether or not they need an ER visit?
Glasgow Coma Scale
282
In Bipolar I and II, a major depressive episode is a change in previous functioning for 2 weeks and can include features such as fatigue every day, insomnia or hypersomnia every day, depressed mood most of the day every day, significant weight loss or gain, dimished interest/pleasure in all things, and others. How many of these features does a person need to have for it to be termed "major depressive episode"? Which two features are REQUIRED for the diagnosis?
Five; depressed mood most of day every day, and dimished interest/pleasure in all things.
283
Achalasia consists of non-peristaltic esophageal contractions and __________ (increased/impaired) relaxation of the LES.
Impaired.
284
What is the treatment for a bacterial sinus headache?
Augmentin
285
Acute cholangitis is concerning due to the potential for sepsis. What are the treatment options for this condition?
Hospital admission, antibiotics, establish biliary drainage, and cholecystectomy.
286
Which of the schizophrenia spectrum disorders requires one or more of the characteristics of psychotic disorders? Which require two or more?
One: brief psychotic disorder; Two: schizophreniform, schizophrenia, and schizoaffective disorder.
287
What two findings were discussed in class that should make WNV rise to the top of your list of possible diagnoses?
Linear choroidal pattern on the retina and paralysis plus muscle weakness.
288
Treatment for acute HBV is supportive. In chronic, treat with antivirals.
Free card.
289
What causes pneumoconiosis? How do you treat it?
Inhalation of inorganic dust. No treatment except remove from the offending environment.
290
What are the risk factors for Barret's esophagus?
High BMI, male, age, tobacco smoking, heavy alcohol use, poor diet with low fruits and vegetables, and poor compliance with proton pump inhibitors.
291
True or false: since two-tiered testing looks for antibodies, it can be used to determine success of treatment.
False; the organism can hide outside of the blood supply, so treatment success cannot be measured with serologic testing.FYI: non-treponemal testing for syphilis is the only test discussed in class can be used to determine treatment success.
292
Why does less gas exchange occur in the lungs with emphysema?
There is less surface area for the exchange (alveoli are lost).
293
Variant CJD involves amyloid plaques with PrPsc.
Free card.
294
Late congenital syphilis has manifestations between ages five and twenty. What manifestations can occur?
Hutchinson triad (defective adult teeth, interstitial keratitis, deafness), poorly formed bones, neurosyphilis possible.
295
What percentage of patients who are infected with WNV develop the neuroinvasive form? What symptoms can occur in this stage?
Less than 1%; symptoms may include meningitis, encephalitis, acute flaccid paralysis, and rarely optic neuritis or CN abnormalities.
296
True or false: damage due to diffuse axonal injury is not as bad as it looks on imaging.
False; it is worse than appears on imaging.
297
What enzyme is released by both the mouth and the pancreas and is used for the digestion of carbohydrates?
Amylase.
298
Which age range is most common to develop sarcoidosis? Which gender? Which ethnic group?
20-40 years, women, African American
299
What part of the basal ganglia is damaged in Huntington's disease?
The caudate and putamen
