FULLY RANDOMIZED PART IV Flashcards
Early onset Alzheimer’s is inherited in an autosomal dominant fashion. Defects may occur in the following chromosomes and genes:Chromosome 1 (PSEN2)Chromosome 21 (APP)Chromosome 14 (PSEN1)Which inheritance of these defective genes is most commonly the cause of early onset Alzheimer’s?
PSEN1, on chromosome 14
Comparing Crohn’s Disease and Ulcerative Colitis, which features remitting inflammation that is continuous?
Ulcerative Colitis
True or false: most cases of acute HBV are self-limiting.
True.
The CDC allows diagnosis of and treatment for Lyme disease based on their definition of EM and known exposure. Serological “two-tiered” testing is another way to try and diagnose this condition. Briefly describe two-tiered testing.
Start with an enzyme immunoassay (EIA) or an immunofluorescence assay (IFA). If negative, consider another diagnosis. If positive, continue to a Western Blot (for IgM and IgG if S/S less than 30 days, for IgG only if S/S for more than 30 days).
The following are isoforms of the gene APOE on chromosome 19. Which of these isoforms is detrimental, and found in late onset Alzheimer’s? What does it cause?APOE-ε2APOE-ε3APOE-ε4
APOE-ε4. It increases beta-amyloid clumping, affects microtubule function, affects choline acetyltransferase activity in the hippocampus, and is associated with vascular disease.
Wilson disease can present with liver, brain, and ocular symptoms. Name the liver symptoms.
Hepatitis, liver failure, cirrhosis
True or false: the majority of patients infected with H. Pylori develop peptic ulcers.
False; only 10-15% of patients infected with H. Pylori develop peptic ulcers.
Guidelines for starting ART are rated based on the recommendations and the evidence. What is the scale for rating recommendations?
A=strong recommendationB= moderate recommendationC=optional
What would an EEG show in a patient with Creutzfeldt-Jakob disease?
Periodic sharp wave complexes
Peripheral chemoreceptors would trigger increased respiration in resonse to what change in the blood?
Low O2 levels, high CO2 levels, or increased acidity.
The National Dysphagia Diet consists of three levels, numbered 1-3, depending on the severity of the swallowing difficulty. Which level refers to a moderate to severe difficulty, in which the patient’s foods must have a pudding/puree-like consistency?
Level 1
Treatment for specific cystic fibrosis mutations exists. Which two treatments were discussed in class, and what is their mechanism of action? What percentage of the cystic fibrosis population does each treatment reach?
Ivacaftor helps keep chloride channels open, but by itself is good for only 5% of the cystic fibrosis population.Adding lumacaftor (moves chloride channels) to ivacaftor (keeps channels open) increases the percentage to 25% of the cystic fibrosis population.
What is the 5-year survival rate for hepatocellular carcinoma in the US?
10-12%
What two conditions make up inflammatory bowel disease?
Crohn’s disease and ulcerative colitis.
What are the symptoms of Zollinger-Ellison Syndrome?
Abdominal pain (from the ulcer), heartburn, diarrhea.
What are the adverse effects of sulfa drugs?
SJS, aplastic anemia, hepatitis, ARF, pruritus, photosensitivity, hematuria, plus non-specific
What are the signs and symptoms of pancreatic cancer?
Pain*, jaundice, weight loss, dark urine, pale stools, diarrhea, vomiting.
Male patients with PPMS have the worst prognosis.
Free card.
Which Cluster A personality disorder is characterized by suspicion without reason, and being unable to forgive?
Paranoid
What ocular finding is a concern with interferon therapy?
Interferon retinopathy (CWS, superficial hemorrhages around ONH and posterior pole; also possible are subconj hemorrhages, BRAO, RD, ONH edema, and vitreous hemorrhages)
What drugs for Huntington’s disease work by blocking dopamine receptors?
Risperidone, olanzapine, haloperidol.
True or false: you should treat all patients with toxoplasmosis
False; immune competent, non-pregnant patients are usually not treated. If a patient is a newborn or immunocompromised, or if there is an ocular lesion threatening the macula, optic nerve, or papillomacular bundle, then treatment is usually pursued.
What is the main possible complication for newborns with chlamydia?
Pneumonia; occurs 4-12 weeks after birth, no fever(FYI: otitis and vaginal or rectal infections also possible)
What percentage of dementia are classified as Alzheimer’s?
60-80%
Cholelithiasis is another name for gallstones. 20% of gallstones are made of what?
Calcium bilirubinate
The diagnosis of dementia requires an acquired decline in one or more of several areas (learning/memory, language, executive function, etc.). What additional signs might be found in a patient with Alzheimer’s Disease?
Loss of insight, sleep disturbances, seizures, olfactory changes.
Cerebrovascular disease is the fifth leading cause of death in the US, second worldwide. What percentage of these events are ischemic, and what percentage are hemorrhagic?
80% are ischemic; 20% are hemorrhagic
What lab tests are available for the diagnosis of gonorrhea? Which is preferred by the CDC, and what kinds of samples can be used for it?
Gram stain, culture, NAATNAAT is preferred by the CDC; can use urine or urethral or cervical swabs.
Which individuals are at higher risk for contracting TB?
Highest risk:-Close contact of patients suspected of having TB-Immune suppressed-Recent exposureLower risk-Health care workers serving high risk patients-Residents/employees of long-term care facilities, jails, homeless shelters, mycobateriology labs-Recent immigrants from high TB prevalence countries-Injectable drug users-Patients with chronic medical conditions-Children under 4 years old
What are the prodromal symptoms of HAV?
Fatigue, nausea, upper quadrant pain, anorexia, fever
Which GI condition leads to atrophy of esophageal smooth muscle and loss of LES tone?
Scleroderma esophagus.
True or false: at least 50% of people with antisocial disorder have depressive disorders, and at least 25% have anxiety disorder.
False; at least 50% of people with antisocial disorder have anxiety disorders, and at least 25% have depressive disorder.
True or false: with basilar migraine, it is possible for a patient to have weakness
False; there should be no evidence of weakness.
How would you treat a patient with Wilson Disease?
Detoxity with chelation, and prevent accumulation of copper by avoiding shellfish, liver, mushrooms, nuts, and chocolates. You can also have the patient take zinc to decrease copper absorption in the intestines.
What are the five “A’s” of smoking cessation?
As a doctor, you need to -Ask patient about tobacco use-Advise them to quit-Assess their readiness to quit-Assist them to set goals and get help-Arrange a follow up
What is the definition of apnea?
Complete cessation of respiration for at least 10 seconds.
What are some of the chronic treatment options for cluster headaches?
Verapamil or prednisolone with taper
What is considered a normal respiratory rate for a newborn?
up to 44 cycles per minute
What is the typical transmission of Hepatitis A?
Fecal-oral
It is estimated that only 50% of individuals get recommended screening for STIs. What is the chlamydia screening recommendation for non-pregnant women?
Annual chlamydia screening if:-Sexually active AND-25 and underOR-Older AND-New or multiple sex partners
What are the 4 Cs of addiction?
Loss of Control (over drug use)Craving and Compulsive use of drugUse of drug despite adverse Consequences
What factors are taken into account when considering WNV as a diagnosis?
Symptoms consistent with the disease, having visited or lived in a high risk state.
Chronic traumatic encephalopathy is when repeated concussions cause cumulative neurologic defects, including an increase in risk for Alzheimer’s.
Free card.
What is the survival rate of patients with bacterial meningitis?
25%
How would you treat symptomatic sarcoidosis?
Anti inflammatory meds (oral corticosteroids, steroid inhalers); immune modulating meds for severe cases (methotrexate, cyclosporine, hydroxychloroquine, azathioprine)
The cutaneous lesions of secondary syphilis are most obvious on the palms, hands, and soles of feet and DO NOT ITCH. Which other disease discussed in class features a maculopapular rash that SPARES the palms and soles? Which features a rash that DOES itch?
Acquired toxoplasmosis spares the palms and soles.HIV can feature an itchy rash.
True or false: the diaphragm is dome shaped with contraction, and returns to a flat shape upon relaxation.
False; it is dome-shaped at rest. When it contracts, it flattens and moves downward, to put negative pressure on the lungs during inspiration.
What are the symptoms of jaundice, besides the yellowing of skin, conjunctiva, and mucous membranes?
Pale stools, dark urine, itching, ever, chills, abdominal pain, and weight loss.
Though most (80%) patients with diverticula are asymptomatic, what symptoms are experienced by the other 20%?
Caused by inflammation or infection of the diverticula: acute lower abdominal pain (intermittent or constant), N&V, anorexia, and diarrhea or constipation.
When would a seizure indicate that you call 911?
If it lasts more than 5 minutes, if the patient stops breathing, if there are multiple seizures in a short period of time, if the patient is injured from the seizure, or if this is their first seizure. Also if any of the following are involved: diabetes, drain infection, heat exhaustion, poisoning, high fever, head injury, or pregnancy.
What are some viral causes of aspectic meningitis?
Enterovirus, herpes simplex, HIV, WNV, herpes zoster, mumps
Comparing intracerebral hemorrhage with subarachnoid hemorrhage, which has the more sudden onset?
Subarachnoid hemorrhage
Trigeminal autonomic cephalgias (TACs) are headache disorders with _____________ (unilateral/bilateral) trigeminal pain with _____________ (ipsilateral/contralateral) cranial autonomic features. Which headache disorders fit into this category?
UnilateralIpsilateralCluster headaches, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headaches with conjunctival injection and tearing (SUNCT)
True or false: narcotics and opioids are good treatment options for acute migraines.
False; they are not recommended.
Prevention of migraines can be done with antidepressants like _________ and __________.
Amitriptyline and venlafaxine
Gastric glands in the stomach have surface mucus cells, mucus neck cells, parietal cells, chief cells, and endocrine cells. What do mucus neck cells secrete?
Mucus
Comparing Crohn’s Disease and Ulcerative Colitis, which features lower left abdominal pain?
Ulcerative Colitis
What are the symptoms of gastric cancer?
Poor appetite, weight loss, abdominal pain, sense of fullness after small meals, heartburn, nausea, vomiting, swelling or fluid buildup in abdomen, anemia.