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INCORRECT Flashcards

1
Q

Typical onset of psychogenic erectile dysfunction?

A

After severe medical or emotional stressors

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2
Q

Do beta blockers & thiazides cause ED?

A

Yes
nocturnal & nonsexual erections are also affected

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3
Q

Chronic granulomatous disease results from what?

A

Defective NADPH oxidase
Patients with CGD develop recurrent bacterial & fungal infections that are catalase +

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4
Q

Granuloma formation involves what?

A

Chronic Th1 & macrophage activation

Interferon gamma activates macrophages to induce granuloma formation

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5
Q

Th2 is involved in the pathogenesis of what disease?

A

Ulcerative colitis
They produce IL-5 & IL-13 which contribute to the inflammation & damage of the intestinal mucosa

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6
Q

Typical features of fetal alcohol syndrome?

A

Short palpebral fissures
Thin upper lip
Smooth philtrum
Retarded
Behavior issues

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7
Q

Pathogenesis of alcohol-induced hepatic steatosis?

A

Excess NADH production via ethanol metabolism which inhibits free fatty oxidation & promotes lipogenesis

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8
Q

Tx of myasthenia gravis?

A

Cholinesterase inhibitor

Cholinesterase inhibitors may cause adverse effects to muscarinic overstimulation – Tx with antimuscarinic agents such as glycopyrrolate or hyoscyamine

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9
Q

How does nephritic syndrome present?

A

GBM damage w/ loss of RBCs into urine (hematuria)
RBC casts in urine
Increase in renin – HTN

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10
Q

How does nephrotic syndrome present?

A

Massive proteinuria
Podocyte damage
Increase hepatic lipogenesis
Frothy urine w/ Fatty casts

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11
Q

What is Anti-GBM disease?

A

Cause nephritic syndromes (hematuria, RBC Casts)
Cause rapidly progressive crescentic disease
RPGN (Goodpasture) (Granulomatosis with polyangiitis w/ no C3 deposition)

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12
Q

Membranoproliferative glomerulonephritis is often associated with?

A

Hepatitis B or C
Thickening of GBM
Large hypercellular glomeruli are often seen (unlike Membranous nephropathy)
“tram track” appearance

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13
Q

Multiple Sclerosis pathogenesis

A

Autoimmune inflammation & demyelination of CNS w/ axonal damage
Optic neuritis (painful monocular visual loss)
Scanning speech, intention tremor
electric shock like sensation w/ neurogenic bladder
Increase in IgG level & myelin basic protein in CSF
MRI is gold standard
TX = Natalizumab

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14
Q

Hand-foot-and-mouth disease characterized by?

A

painful, vesicular mouth lesions, ulcers on extremities
Caused by enterovirus (Coxsackievirus)

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15
Q

De Quervain thyroiditis presents how?

A

Also called subacute granulomatous thyroiditis

Typically a transient hyperthyroidism - Euthyroid – Hypothyroid – back to euthyroid

Precedes viral infection

Increase in ESR

Very tender & PAINFUL THYROID

Histology = GRANULOMATOUS INFLAMMATION

Macrophages & multinucleated cells

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16
Q

Papillary thyroid cancer characterized by?

A

Branching papillary structures with concentric calcifications (psammoma bodies)
Presents with enlargement w/o pain

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17
Q

What is Riedel thyroiditis?

A

Characterized by extensive fibrosis
Hard & non tender

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18
Q

What is seen on biopsy in Grave’s disease?

A

Diffuse hyperplastic follicles with tall and crowded cells forming intrafollicular projections
Increase in radioiodine uptake due to excessive TSH receptor stimulation

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19
Q

What are the 5-alpha reductase inhibitors?

A

Finasteride & dutasteride

Used in the treatment of BPH

Block the conversion of testosterone to DHT

The excess testosterone then is available for conversion to estrogens (estradiol) by aromatase – Which then leads to GYNECOMASTIA

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20
Q

What are Flutamide & Bicalutamide used for?
MOA?

A

Nonsteroidal competitive inhibitors at androgen receptors (decreases steroid binding)
Used in Prostate cancer
Also causes gynecomastia just like Finasteride so don’t get it confused

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21
Q

Spironolactone

A

Androgen receptor & 17-alpha hydroxylase inhibitor
Used in PCOS
Amenorrhea is common SE

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22
Q

KRAS

A

Colorectal
Lung
Pancreatic cancers

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23
Q

Common complications of radiotherapy?

A

Inflammation & fibrosis
Neoplasia

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24
Q

What is congenital diaphragmatic hernia?

A

Develops in the 1st trimester
Compression of lungs results in pulmonary hypoplasia
Scaphoid abdomen

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25
Q

Pneumothorax is characterized by?

A

Loss of negative intrapleural pressure
Mediastinal shift

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26
Q

VIPomas are what type of tumors?

A

Pancreatic islet cell tumors that hypersecrete VIP which increases intestinal chloride loss into stool – causing excess losses of water, sodium, and potassium
VIP also inhibits gastric acid secretion
Somatostatin inhibits the secretion of VIP & tx’s symptoms

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27
Q

Pericardium is supplied by what nerve?

A

Phrenic nerve
Right phrenic nerve injury occurs during ablation

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28
Q

Features suggestive of pathologic gynecomastia?

A

Onset before or after midpuberty (w/ no secondary sexual characteristics)
Tanner stage 1 or 5
Findings consistent w/ systemic illness
Location eccentric to nipple areolar complex

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29
Q

How does acute pancreatitis present?

A

Acute epigastric pain often radiating to the back
Increase serum amylase or lipase (more specific)
Can cause hypocalcemia

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30
Q

How does chronic pancreatitis present?

A

Calcification of the pancreas
Major risk factor includes alcohol
Manifests with steatorrhea (fat malabsorption), fat soluble vitamin deficiency, & diabetes
Amylase & lipase may or may not be elevated (always in acute)

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31
Q

Shoulder muscles and nerves?

A

Supraspinatus – subscapular nerve – abducts arm initially right before deltoid
Infraspinatus – suprascapular nerve – externally rotates (pitching injury)
Teres Minor – axillary nerve – adducts & externally rotates
Subscapularis – subscapular nerve – internally rotates arm & adducts
Most by C5-C6

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32
Q

Trapezius action at shoulder?

A

Arm abduction past 90 degrees
Innervated by accessory nerve
Commonly injured in posterior triangle

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33
Q

Where is aortic stenosis best heard?

A

RIGHT UPPER STERNAL BORDER – radiates to carotids

Bicuspid aortic valve usually presents earlier than those who get AS from rheumatic heart disease

MCC in the US is a bicuspid aortic valve

Similar murmur in Turner’s syndrome

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34
Q

Marfan’s is associated with what cardiac dysfunction?

A

Aortic root dilation – causes aortic regurgitation

Aortic root aneurysm RUPTURE or DISSECTION is MCC of death

Increase risk in Mitral valve prolapse & spontaneous pneumothorax

UPWARD lens dislocation

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35
Q

Mitral Valve prolapse produces what type of murmur?

A

Mid systolic click
Mitral Regurgitation
Best heard at cardiac apex

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36
Q

VSD is best heard where?

A

Holosystolic murmur best heard at left lower sternal border

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37
Q

What is the most common cardiovascular manifestation associated with SLE?

A

Pericarditis
Sharp pleuritic chest pain that is relieved by sitting up & leaning forward

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38
Q

Eosinophilic granulomatosis with polyangiitis characterized by?

A

Small vessel vasculitis

Late onset asthma, rhinosinusitis, & eosinophilia + peripheral neuropathy

Antibodies against neutrophil myeloperoxidase (P-ANCA)

necrotizing vasculitis with eosinophilia

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39
Q

How does Taenia solium present?

A

Adult-onset seizure in patients from an endemic area

TX = Praziquantel
Albendazole for neurocysticercosis

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40
Q

What is a meningioma?

A

Common & benign

FEMALES more affected

May present with SEIZURES

Whorled pattern – PSAMMOMA bodies (laminated CALCIFICATIONS)

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41
Q

Chronic graft failure features?

A

Vascular wall thickening & luminal narrowing

Interstitial fibrosis & parenchymal atrophy

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42
Q

What is the first line anticoagulation therapy used in patients with pulmonary embolism, thrombosis, unstable angina pectoris, & DIC?

A

Heparin

Selectively binds to Antithrombin III to potentiate it & inhibit Factor Xa

Decrease prothrombin & fibrin

Monitor PTT

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43
Q

What is the test of choice for a DVT?

A

Compression US

D dimer level is to rule out DVT

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44
Q

What accumulates in the neuronal cells in Tay-Sachs disease?

A

GM2 gangliosides

Due to a deficiency of beta-hexosaminidase A

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45
Q

What is the hallmark sign of cold agglutinin disease?

A

Acrocyanosis in response to cold temperatures

IgM autoantibodies located on surface of erythrocytes & can lead to increase turnover of RBCs = hemolytic anemia

Dx = Direct coombs test – binds autoantibodies

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46
Q

Methylene blue staining or wright stains visualize what?

A

Ribosomal RNA

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47
Q

Signs & symptoms of cardiac myxomas?

A

Noncancerous tumor composed of connective tissue

Murmur mimicking mitral stenosis (mid-diastolic rumble @ apex)

Most common in left atrium

Myxoma secretes IL-6 causing fever

Scattered cells within a mucopolysaccharide stroma

Amorphous extracellular matrix on histopathologic exam

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48
Q

Ovarian arteries branch off directly from the?

A

Abdominal aorta just below renal arteries at the level of L2

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49
Q

Nerve most commonly damaged from anterior shoulder dislocation?

A

Axillary nerve

Dermatome is over the lateral shoulder

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50
Q

What is a hypertensive emergency?

A

Severely elevated BP usually above 180/120

In the kidneys – fibrinoid necrosis with hyperplastic arteriosclerosis “onion skin”

Microangiopathic hemolytic anemia

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51
Q

Temporal giant arteritis features?

A

Granulomatous inflammation of media

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52
Q

Mifepristone MOA?

A

Progesterone antagonist that is used with Misoprostol (prostaglandin E1 agonist) to terminate first trimester pregnancy

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53
Q

Misoprostol MOA?

A

PGE1 analog

Increases the production & secretion of gastric mucous barrier

Used to prevent NSAID-Induced peptic ulcers

Off label use for induction of labor

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54
Q

What is propionic acidemia?

A

Causes a decrease in methylmalonic acid

Low protein diet

TX - VOMIT – avoid Valine, Odd chain fatty acids, Methionine, Isoleucine, Threonine

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55
Q

What does Parathyroid hormone do?

A

Increases bone resorption

Increases serum calcium levels

Increase in renal phosphate excretion

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56
Q

Which interleukin plays a major role in pathogenesis of inflammatory bowel diseases?

A

IL-10

IL-10 attenuates the inflammatory response – Decreases expression of MHC class II & Th1 cytokines

TGF-beta & IL-10 both attenuate the immune response

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57
Q

Gabapentin MOA?

A

Inhibits high voltage Calcium channels

Used for peripheral neuropathy & postherpetic neuralgia

Blocks fusion & release of neurotransmitter vesicles

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58
Q

Spondylolysis

A

Fracture occurs at the pars interarticularis

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59
Q

Spondylolisthesis

A

Bilateral disruption of pars interarticularis that leads to anterior displacement

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60
Q

Phthirus pubis

A

Intense pruritus & associated excoriations

TX = Topical Permethrin

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61
Q

Hurler & Hunter syndrome – What enzyme is deficient & what is accumulated?

A

Alpha-L-Iduronidase is deficient in Hurler’s

Iduronate-2-Sulfatase is deficient in Hunter’s

Accumulation of Heparan sulfate in both

Corneal clouding in Hurler’s

NO clouding in Hunter’s - Hunter’s need to see (Hunter’s is XR)

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62
Q

Nursemaid’s elbow AKA Radial head subluxation is the displacement of what ligament?

A

Annular ligament

Patient presents with the elbow flexed & forearm pronated

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63
Q

Injury to the long thoracic nerve causes what? What region is associated with injury?

A

Weakness of serratus anterior muscle w/ winging of scapula

Dissection of axillary lymph nodes can injure the long thoracic nerve

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64
Q

When cells within the heart, brain, or skeletal muscle are injured, what enzyme increases?

A

Creatine kinase leaks across the damaged membranes and into circulation

Reperfusion injury

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65
Q

What is HELLP syndrome?

A

Preeclampsia with thrombotic microangiopathy of the liver

Hemolysis

Elevated liver enzymes (increased indirect bilirubin)

Low platelets

TX = immediate delivery

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66
Q

Pretreatment with what drug before administering epinephrine?

A

Propranolol – Eliminates the Beta effects of epinephrine (vasodilation & tachy)

Leaving only the alpha effects of vasoconstriction

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67
Q

What must be monitored when administering testosterone therapy?

A

Hematocrit – Can cause erythrocytosis

Also associated with increase in PSA

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68
Q

What is the MOA of drug used in prostate cancer?

A

Abiraterone – 17 Alpha hydroxylase inhibitor (SE = HTN, Hypokalemia, Increase in mineralocorticoids)

Flutamide & Bicalutamide – Non steroidal competitive inhibitors at androgen receptors

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69
Q

What is the Reid index?

A

Thickness of the mucosal gland layer to thickness of the wall between epithelium & cartilage

Seenin chronic bronchitis

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70
Q

What is Syringomyelia?

A

Cape like, bilateral, symmetrical loss of pain & temperature sensation in the UE

Associated with Chiari 1 malformation (Cerebellar tonsils)

Presents with scoliosis

Most commonly cervical

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71
Q

Where does HIV preferentially infect in the CNS?

A

Macrophages

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72
Q

MOA of Amphotericin B? What must you monitor?

A

Binds ergosterol in fungal cell membranes to form holes

Renal toxicity is the most notorious side effect – Increase hydration

Must monitor serum potassium & magnesium

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73
Q

What confirms the diagnosis of menopause?

A

Elevated serum FSH

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74
Q

What should you always think of when you hear Sarcoidosis?

A

NONCASEATING granulomas – Macrophages & multinucleated giant cells

Black females, enlarged lymph nodes & Hypercalcemia

TB shows Caseating granulomas (don’t get it confused)

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75
Q

What are the physiologic effects of ANP & BNP?

A

Released in response to increased blood volume / pressure – Increase in GFR

Causes vasodilation & decrease in Na+ reabsorption

Decreases Renin

Dilates afferent arteriole – promotes natriuresis

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76
Q

Visual loss in only one eye indicates what?

A

That the lesion is anterior to the optic chiasm

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77
Q

Rotation & sidebending for C2-C7 occur in what directions?

A

Always occur in the same direction

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78
Q

What ions increase in tumor lysis syndrome?

A

POTASSIUM & phosphorus & Uric acid

PATIENTS PRESENT WITH SX OF GOUT AND/OR NEPHROLITHASIS SECONDARY TO URIC ACID CONTAINING STONES

Uric acid precipitates in the distal tubules & collecting ducts

Prevention includes urine alkalization & AGGRESSIVE HYDRATION

High urine flow & high pH prevents crystallization & precipitation of uric acid

Allopurinol + Rasburicase

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79
Q

What findings are consistent with schizotypal personality disorder?

A

Cluster A personality disorder

Can include brief psychotic episodes (delusions)

Long-standing pattern of eccentric behavior, odd beliefs, perceptual distortions and social anxiety

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80
Q

What is avoidant personality disorder?

A

Cluster C

Hypersensitive to rejection & criticism

Timid (Cowardly)

Desires relationships with others (vs. schizoid)

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81
Q

What is borderline personality disorder?

A

Cluster B

Unstable mood & interpersonal relationships

Splitting is a major defense mechanism

Self-mutilation / impulsivity

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82
Q

What is OCD?

A

Cluster C

Perfectionism & control

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83
Q

What is paranoid personality disorder?

A

Cluster A

Pervasive distrust (Accusatory)

Hypervigilant, cynical view of the world

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84
Q

What is schizoid personality disorder?

A

Type A

Prefers social withdrawal & solitary activities (vs. avoidant)

Indifferent to others opinions

Schizoid says fuck everyone else I don’t give a fuck. Avoidant is hypersensitive to rejection but actually desires relationships

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85
Q

What should you think about when you hear Blastomyces dermatidis?

A

Dimorphic

Ohio & Mississippi river

Great lakes

Found in soil

Branching hyphae

Large round yeasts with doubly refractile wall & single broad based bud

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86
Q

What should you think about with Sporothrix Schenckii?

A

Dimorphic

Gardening

Cigar shape at 37 degrees

Presentation – Pustules, ulcer, subcutaneous nodules along lymphatics

TX = Itraconazole or potassium iodide

Think of a rose gardener who smokes a cigar & pot

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87
Q

What should you think about with Coccidioides immitis?

A

Dimorphic

Disseminated form to bones / skin

Southwestern states (desert)

Flu-like illness

Erythema nodosum or multiforme

Arthralgias

Dust exposure, earthquakes

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88
Q

What should you think about with Histoplasma capsulatum?

A

Dimorphic

Mississippi & Ohio river valleys

Soil, bird, & bat droppings

Similar to TB – Granulomas with calcifications

Oval yeasts WITHIN macrophages (histo hides within macrophages)

Palatal / tongue ulcers w/ splenomegaly

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89
Q

What should you think about with Paracoccidioides Brasilensis?

A

Dimorphic

Latin America

Budding yeast with “captain’s wheel” formation

Similar to blastomycosis

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90
Q

Organophosphate poisoning results in what?

A

Irreversibly inhibit AChE

Leads to sx of muscarinic & nicotinic cholinergic hyperstimulation

DUMBBELS

TX = ATROPINE (competitive inhibitor of acetylcholine at the muscarinic receptor)

Also give Pralidoxime (Cholinesterase reactivating agent that treats both nicotinic & muscarinic sx)

Diarrhea / Diaphoresis
Urination
Miosis (pinpoint)
Bronchospasms
Emesis
Lacrimation
Salivation

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91
Q

What are accessory nipples?

A

Most common congenital breast anomaly

Results from failed regression of the mammary ridge in utero

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92
Q

What should you think about with Ascaris Lumbricoides?

A

Giant roundworm

Transmitted via food / water

Eggs migrate to alveoli

May develop early pulmonary manifestations (Loeffler syndrome)

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93
Q

What is placental abruption?

A

Abrupt painful vaginal bleeding in the 3rd trimester

Can cause hypovolemic shock & DIC

Life threatening to mother & baby

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94
Q

Placenta Previa painful or painless?

A

Painless (unlike placental abruption)

Presents in the 3rd trimester

Placenta attaches over internal cervical os

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95
Q

Milrinone MOA?

Indications?

A

PDE-3 inhibitor

In cardiomyocytes = Increase in cAMP & Increase in calcium influx

In smooth muscle = Increase in cAMP & vasodilation = Decreased preload & afterload

Used in acute decompensated HF

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96
Q

What effect does estrogen have on Thyroxine binding globulin?

A

TBG increases in pregnancy, OCP use (estrogen increases TBG) which in turn increases total T3/T4

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97
Q

What is usually the cause of injury for the common (fibular) peroneal nerve? (L4-S2)

A

Trauma or compression of the lateral aspect of the leg / Fibular neck fracture

Peroneal nerve normally everts & dorsiflexes

If injured = FOOT DROPPED

Foot drop = Inverted & plantarflexed at rest

LOSS of Eversion & Dorsiflexion

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98
Q

What position do you place a patient in during lumbar HVLA?

A

Patient is positioned on the side that the vertebra is rotated toward (if rotated right, then right lateral recumbent)

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99
Q

GI & neuro symptoms of hypothyroid?

A

Constipation

Decreased reflexes

Diffuse alopecia

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100
Q

S3 best heard where? In what position? What makes it worse?

A

Best heard at cardiac apex

Best heard in the Left lateral decubitus position

The end of expiration exaggerates murmur

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101
Q

Fluticasone

Budesonide

MOA and indications?

A

Inhibit the synthesis of all cytokines

Inactivate NF-kappa B (needed by TNF alpha)

Both inhaled glucocorticoids used for chronic asthma

Budesonide used in Chron’s disease to reduce bowel inflammation

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102
Q

What is selective IgA deficiency?

A

Most common primary immunodeficiency

AAAAA

Asymptomatic, Airway, Autoimmune, Atopy, Anaphylaxis to IgA blood products

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103
Q

Heparin MOA?

A

Binds & activates antithrombin III

This binding decreases the actions of factors IIa & Xa

Used immediately in PE & MI or DVT

Monitor PTT

Factor Xa can no longer convert prothrombin to thrombin – less thrombin is produced resulting in an anticoagulation effect

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104
Q

What is Pott disease?

A

Typically occurs months to years following primary pulmonary infection of TB

Intermittent fever with lower lumbar / thoracic spine pain

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105
Q

What is the most common primary lung cancer?

A

Adenocarcinoma of the lung (Most common subtype in people who do not smoke)

Located in the periphery

Females

KRAS mutation

Associated with hypertrophic osteoarthropathy (clubbing)

Mucin +

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106
Q

Small cell lung cancer located where?

A

Centrally

Undifferentiated & very aggressive

Can cause neurologic & endocrine paraneoplastic syndrome (Cushing, SIADH)

MYC oncogenes

Chromogranin A (+) & Synaptophysin +

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107
Q

Squamous cell carcinoma of the lung located where?

A

Centrally – Just like SCLC

Hilar mass

Strongly associated with smoking just like SCLC

Cavitation, cigarettes, HyperCalcemia (produces PTHrP (Decrease in PTH via - feedback)

Intercellular bridges + desmosomes

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108
Q

Large cell carcinoma of the lung located where?

A

Periphery just like adenocarcinoma

Strong association with tobacco

May produce hCG – causes gynecomastia

Pleomorphic GIANT (large) cells

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109
Q

Ulcers arising in the setting of trauma or burns are called?

A

Curling ulcers

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110
Q

Ulcers caused from intracranial injury are caused by direct vagal stimulation & are called what?

A

Cushing ulcers

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111
Q

Normal anion gap metabolic acidosis

A

Anion gap around 8-12

HARDASS

Hyperchloremia / Hyperalimentation

Addison disease

RTA

Diarrhea

Acetazolamide

Spironolactone

Saline infusion

Diarrhea causes loss of bicarb in the stool

blood pH is low, paCo2 is low, and Bicarb is low

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112
Q

Increase anion gap metabolic acidosis

A

More than 12

GOLDMARK

Glycols

Oxoproline (acetaminophen chronic use)

L & D lactate

Methanol - and other alcohols

Aspirin

Renal failure

Ketones (diabetes, starvation)

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113
Q

Placenta Accreta

A

Attaches to myometrium instead of decidua basalis

Most common type

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114
Q

CN 1 foramen?

A

Cribriform plate

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115
Q

CN2 foramen?

A

Optic canal

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116
Q

CN 3, 4, V 1, & 6 foramen?

A

Superior orbital fissure

think about SO4

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117
Q

Middle meningeal artery foramen?

A

Foramen spinosum

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118
Q

CN 7 & 8 foramen?

A

Internal acoustic meatus

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119
Q

Cranial nerve 9, 10, & 11 foramen?

A

Jugular foramen

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120
Q

Cranial nerve 12 foramen?

A

Hypoglossal canal

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121
Q

PRPP is responsible for the ribose necessary for de novo synthesis of purine & pyrimidines, what disease is it involved in?

A

Gout

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122
Q

Acute gout drugs?

A

NSAIDs

Colchicine when NSAIDs contraindicated

Both inhibit neutrophils

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123
Q

Chronic gout drugs besides allopurinol?

A

Pegloticase – Makes uric acid to allantoin

Febuxostat – Inhibits Xanthine oxidase (just like Allopurinol)

Probenecid – Inhibits uric acid reabsorption in PCT (sulfa allergy)

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124
Q

Who is responsible for the increase in swelling hours after a type I hypersensitivity Rxn?

A

Major basic protein

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125
Q

When should ADHA be diagnosed?

A

Only be established after age 4

Coexists with difficulties in school but normal intelligence

TX = Methylphenidate or alpha 2 agonists such as Clonidine

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126
Q

Conduct disorder?

A

Pervasive behavior violating societal norms or basic rights of others

After age 18, classified as antisocial personality disorder

VIOLENT

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127
Q

Disruptive mood dysregulation disorder?

A

Onset before age 10

Severe recurrent temper tantrums

Constantly angry

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128
Q

Oppositional defiant disorder?

A

Pattern of anger w/ argumentative, vindictive, defiant behavior toward authority figures lasting longer than 6 months

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129
Q

Cardiac tamponade triad?

A

Hypotension, distended neck veins, distant heart sounds

Increase in HR

Pulsus paradoxus – During inspiration

Diastolic RV collapse

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130
Q

What must you monitor for patients on Clozapine?

A

Regular NEUTROPHIL monitoring due to risk of life-threatening AGRANULOCYTOSIS

CLOZAPINE is used for refractory psychotic disorders or persistent suicidality

Very high risk of weight gain

Monitor WBCs CLOZely

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131
Q

Ondansetron & Granisetron MOA? Uses? SE?

A

5-HT receptor antagonists

Used for chemo / radiotherapy

Headache, QT prolongation, Serotonin syndrome, Constipation

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132
Q

Prochlorperazine & Metoclopramide MOA? Uses? SE?

A

ANTI-EMTICS

D2 receptor antagonists

Metoclopramide also causes increase in gastric emptying and increases LES tone

Metoclopramide is also used in gastroparesis (diabetic) or persistent GERD

Extrapyramidal symptoms, hyperprolactinemia

HYPERPROLACTINEMIA IS EASY TO REMEMBER BECAUSE THIS IS A D2 RECEPTOR ANTAGONISTS YOU STUPID FUCK

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133
Q

Aprepitant & Fosaprepitant MOA? Uses? SE?

A

Neurokinin 1 receptor antagonists

Chemotherapy-induced nausea & vomiting

Fatigue

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134
Q

Most common SE of statin therapy?

A

Muscle & liver toxicity

Must monitor hepatic transaminases

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135
Q

Sacubitril MOA? Uses? SE?

A

NEPRILYSIN INHIBITOR– Prevents breakdown of bradykinin, Ang II & substance P

Increases VASODILATION & DECREASES ECF VOLUME

Used in combination with Valsartan (an ARB) to tx HFrEF

Can cause cough

Contraindicated w/ ACE inhibitors due to angioedema (both drugs INCREASE BRADYKININ)

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136
Q

What does LH stimulate in a male?

What does FSH stimulate in a male?

A

LH stimulates release of testosterone from Leydig cells of the testes

FSH stimulates the release of inhibin B from the Sertoli cells in the seminefrous tubules

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137
Q

What labs do you always get before initiating Metformin therapy? Why?

A

Always check Serum creatinine because Metformin can cause severe Lactic acidosis

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138
Q

Nutcracker syndrome and complications?

A

Compression of Left renal vein b/t SMA & aorta

Flank pain, hematuria, left sided varicocele

Varicocele refresher = Dilated veins in the prampiniform plexus due to Increase in venous pressure

MCC scrotal enlargement in adult males

Right sided indicates IVC obstruction

Infertility due to Increased temperature

Does NOT transilluminate on ultrasound

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139
Q

Anterior cerebral artery occlusion has sensory & motor deficits where?

A

Of the contralateral leg

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140
Q

Primary infection of TB affects what part of lung?

A

Lower lobe

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141
Q

Opioids pseudoallergic response?

A

They directly activate mast cells to stimulate degranulation which releases histamine

Mimics True IgE mediated type 1 Hypersensitivity

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142
Q

Dantrolene MOA? Uses? SE?

A

PREVENTS CALCIUM release from ER in inhibiting Ryanodine receptor

Used in MALIGNANT HYPERTHERMIA from toxicity of inhaled anesthetics & SUCCINYLCHOLINE & NEUROLEPTIC MALIGNANT SYNDROME from antipsychotic toxicity

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143
Q

What causes the hypercalcemia seen in Sarcoidosis?

A

Caused by parathyroid hormone INDEPENDENT formation of 1,25 dihydroxyvitamin D by activated MACROPHAGES

Leading to INCREASED intestinal ABSORPTION of calcium

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144
Q

What neuropeptides show up in CSF of patients with narcolepsy?

A

Hypocretin-1

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145
Q

Where is the most often implantation site for ectopic pregnancy?

How does ectopic present?

What is it commonly mistaken for?

A

Ampulla of the fallopian tube

Presents with 1st trimester bleeding & lower abdominal pain

Mistaken for appendicitis

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146
Q

What are the CYP450 Inducers?

A

CRAPGPS

Carbamazepine

Rifampin

Alcohol

Phenytoin

Griseofulvin

Phenobarbital

Sulfonyureas

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147
Q

What are the CYP450 Inhibitors?

A

SICKFACES

Sodium valproate

Isoniazid

Cimetidine

Ketoconazole

Fluconazole

Acute alcohol

Chloramphenicol

Erythromycin

Sulfonamides

Grapefruit juice

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148
Q

Basal cell & squamous cell – which is below & above?

A

Basal cell above UPPER lip

Squamous cell below LOWER lip

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149
Q

Basal cell carcinoma features?

A

Most common

Usually found on face – locally invasive but rarely metastasizes

Appear as nonhealing ulcers

Palisading aligned nuclei

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150
Q

Squamous cell carcinoma features?

A

Second most common skin cancer – associated with immunosuppression

Marjolin ulcer – SCC arising in chronic wounds or scars usually after 20 years

Keratin pearls

Actinic keratosis is a scaly plaque that is a precursor to squamous cell carcinoma

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151
Q

Acute dystonia is usually caused by? What’s the treatment?

A

Caused by typical antipsychotics & anticonvulsants

Presents with sudden onset muscle spasms / stiffness hours to days after medication use

TX = Benztropine – Muscarinic antagonist used in Parkinson disease

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152
Q

What type of murmur is usually present with pulmonary hypertension?

A

Due to right ventricular enlargement, a holosystolic murmur of tricuspid regurgitation is present

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153
Q

Pulmonary hypertension secondary to what 3 things?

A

Left sided HF – Ends up causing RV failure

Chronic lung disease / hypoxia

Chronic pulmonary thromboembolism

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154
Q

What is Bosentan used for? MOA? SE?

A

Used in pulmonary hypertension

Competitively antagonizes endothelin-1 receptors – lowers pulmonary arterial pressure

Hepatotoxic – Monitor LFTs

BOSE headphones for my lungs

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155
Q

How does trypsinogen form into trypsin?

A

Converted to active enzyme trypsin by enterokinase / enteropeptidase

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156
Q

Ovarian torsion pathogenesis?

A

Twisting of the ovary & fallopian tube around the infundibulopelvic ligament & ovarian ligament

Presents with acute pelvic pain w/ associated n/v

The obstructed blood flow is through the infundibulopelvic ligament

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157
Q

What ligament can be damaged during a hysterectomy?

A

Cardinal ligament

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158
Q

Does herpes have a painful inguinal lymphadenopathy?

A

Yes

Vesicular ulcers on genitals

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159
Q

What are the two 30S inhibitors?

A

Aminoglycosides & tetracyclines

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160
Q

Aminoglycosides MOA? Clinical use? SE?

A

Bactericidal – irreversible inhibition of initiation complex through binding of the 30S subunit

Misreading of mRNA

Used for severe gram - rod infections

Nephrotoxic

Neuromuscular blockade – Contraindicated in myasthenia gravis patients

Ototoxicity

Teratogenic

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161
Q

How does Pheochromocytoma present? Lab findings? Treatment?

A

Most common tumor of the adrenal medulla in adults

Derived from Chromaffin cells

Presents with the 5 P’s of Pressure, Pain (headache), Perspiration, Palpitations, Pallor

Increased catecholamines & metanephrines (homovanillic acid)

Chromogranin & synaptophysin +

Treatment is Phenoxybenzamine – irreversible alpha antagonist

Alpha blockade must be achieved before giving beta blockers to avoid hypertensive crisis

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162
Q

PFT readings for COPD?

A

Functional residual capacity, residual volume, & total lung capacity are increased

Decreased FEV1

Decreased FEV1 / FVC

Increase in TLC

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163
Q

Pathogenesis of Primary Myelofibrosis? How does it manifest?

A

Disorder of clonal megakaryocytes – secrete TGF beta which stimulates fibroblasts to produce collagen – this leads to hematopoietic stem cells migrating to liver & spleen & causes extramedullary hematopoiesis

Presents with severe fatigue, hepatomegaly + MASSIVE splenomegaly

Dacrocytes (Teardrop RBCs) on peripheral bloom smear

Dry tap aspiration due to fibrosis

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164
Q

Other than the gynecomastia seen with spironolactone, what is the major adverse effect of Potassium-sparing diuretics?

A

Hyperkalemia – lead to arrhythmias

Metabolic acidosis

These drugs are competitive aldosterone receptor antagonists in the cortical collecting tubule

Spironolactone, Eplerenone, Amiloride, Triamterene

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165
Q

MOA of clonidine? SE?

A

Stimulates central alpha 2 adrenergic receptors

Causes a decrease in presynaptic release of NE & decrease in sympathetic outflow

Can cause orthostatic syncope

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166
Q

How do you differentiate between follicular adenoma & follicular thyroid carcinoma?

A

Follicular adenoma – MC benign thyroid neoplasm, displays numerous neoplastic follicular cells & are completely encapsulated

Follicular thyroid carcinomas are characterized by invasion of the tumor capsule

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167
Q

What is often found as a precursor to malignant lesion in medullary thyroid carcinoma?

A

C cell hyperplasia that secrete calcitonin

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168
Q

What is unique about the labs for Paget disease of the bone?

A

Serum calcium, phosphorus & PTH are all normal

INCREASE IN SERUM ALKALINE PHOSPHATASE – ALP

Mosaic pattern of woven & lamellar bone

Increase risk of osteosarcoma

HEARING LOSS is common due to skull deformity

TX = Bisphosphonates

Rare SE = Osteonecrosis of the jaw

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169
Q

What are the Labs for SLE?

A

ANA +

Anti DS DNA

Anti Smith

LOW complement levels

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170
Q

Anti mitochondrial antibodies?

A

Primary biliary cirrhosis

Presents with cholestatic symptoms – Pruritus, jaundice, malabsorption

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171
Q

C5a is involved with what?

A

Neutrophil chemotaxis

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172
Q

Serum sickness is what type of hypersensitivity rxn?

A

Type III

Antibodies to foreign proteins appear 1-2 weeks later

Antibody antigen complex form & deposit in tissues

Decrease in serum C3 & C4

C3a & C5a are increased - neutrophil chemotaxis

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173
Q

Phenylephrine MOA? Applications?

A

Selective alpha 1 agonist with no effect on alpha 2 or beta receptors

Used in hypotension

Causes peripheral vasoconstriction that increases systemic vascular resistance & blood pressure but does no direct effect on the heart

Decreases HR & cardiac output

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174
Q

Cardiovascular effects of adrenergic agonists?

A

Alpha 1 – Peripheral vasoconstriction – Increase SVR

Beta 1 – Increase HR & contractility – Increase CO

Beta 2 – Peripheral vasodilation – Decrease SVR

D1 – Renal arteriolar vasodilation

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175
Q

Dobutamine MOA? Applications?

A

Primarily a beta 1 agonist with partial activity on beta 2 receptors

Increases the production of cAMP

Decreases BP

Increases HR & CO

Used for cardiac stress testing, acute decompensated HF with cardiogenic shock

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176
Q

Dopamine dosage with response to cardiovascular effects?

A

Low dose is strong dopamine 1 receptor – Decreases BP & Increases HR

High dose is alpha 1 receptor primarily – Increases BP & Decreases HR

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177
Q

Epinephrine dosing and cardiovascular effects?

A

Low dose is primarily beta 1 > beta 2 > alpha 1 – Decreases BP & increases HR

High dose is primarily alpha 1 > beta 1 > beta 2 – Increases BP & decreases HR

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178
Q

ACE inhibitors MOA? Clinical use? SE?

A

Inhibit ACE – Decreased Angiotensin II – Leads to decrease in GFR by preventing constriction of efferent arterioles – Increase in renin due to loss of (-) feedback

Inhibition of ACE also prevents inactivation of Bradykinin (potent vasodilator)

Used in HTN, HF (decreases mortality), Proteinuria, diabetic nephropathy

IMPORTANT – Prevents unfavorable heart remodeling as a result of Chronic HTN / Post-MI (attenuates left ventricular chamber dilation)

SE = Cough, angioedema (due to increased bradykinin)

Contraindicated in C1 esterase inhibitor deficiency

Teratogen

Increases Creatinine (Decrease in GFR)

Hyperkalemia & hypotension

Captopril, Enalapril, Lisinopril, Ramipril

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179
Q

Pathogenesis of sickle cell anemia? Complications? Key words?

A

Point mutation in beta-globin gene – Glutamic acid to Valine

Mutant HbA is termed HbS

Causes extravascular & intravascular hemolysis

Newborns asymptomatic because of HbF in abundance

Heterozygotes have resistance to malaria

Crew cut on skull x ray due to marrow expansion

Aplastic crisis – arrest of erythropoiesis due to Parvovirus B19

Autosplenectomy – Howell-Jolly bodies (risk of infection with encapsulated organisms such as S. Pneumoniae)

Salmonella osteomyelitis

Painful vaso-occlusive crises

Acute chest syndrome – respiratory distress, new pulmonary infiltrates on CXR – common cause of death

Sickling in renal medulla causes renal papillary necrosis & hematuria

TX = Hydroxyurea to increase HbF

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180
Q

Bipolar 1 disorder diagnosis?

A

Patients with more than 1 manic episode with or without a hypomanic or depressive episode are diagnosed with bipolar 1 disorder

Manic episodes can occur with or without psychotic features

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181
Q

Bipolar 2 disorder diagnosis?

A

Involves hypomanic episodes (less severe than mania & without psychotic features) & major depressive episodes

For at least 4 days

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182
Q

Brief psychotic disorder diagnosis?

A

Acute onset of 1 psychotic symptom lasting 1 or more days but less than a month with eventual complete resolution

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183
Q

Schizophreniform disorder diagnosis?

A

2 or more schizophrenic symptoms

Psychotic symptoms occurred only in the context of a manic episode & been present for more than a month

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184
Q

What is the most common GI disorder in patients with cystic fibrosis?

A

Pancreatic insufficiency

Thick viscous secretions in the lumens of the pancreas that result in obstruction & fibrosis

Clinical manifestations include steatorrhea, failure to thrive, & deficiency of fat soluble vitamins

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185
Q

What is prepatellar bursitis?

A

Inflammation of the prepatellar bursa in front of the knee cap

Caused by trauma or pressure from kneeling

Also called “housemaids” knee

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186
Q

What are popliteal cysts?

A

Also called Baker cyst

Fluid collection in gastrocnemius & semimembranosus bursa

Related to osteoarthritis or inflammatory joint disease

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187
Q

What is a “jersey finger” injury?

A

When an active flexed DIP joint is forcefully hyperextended

Most commonly ring finger

Results in absent DIP flexion

Flexor digitorum profundus

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188
Q

What acts as the central regulator of iron homoeostasis?

A

Hepcidin – it is synthesized in the liver

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189
Q

Alpha-fetoprotein is a serum tumor marker that is often moderately elevated in patients with?

A

CHRONIC VIRAL HEPATITIS

It can be strikingly elevated in those with HEPATOCELLULAR CARCINOMA

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190
Q

Reye syndrome findings?

A

Fatty liver, hypoglycemia, vomiting, hepatomegaly, coma

Avoid aspirin in children except KawASAki disease

Causes hepatic steatosis, hyperammonemia, & diffuse astrocyte swelling

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191
Q

Virion’s & their cellular receptors

A

CMV – Integrins

EBV – CD21 (CR2)

HIV – CD4 & CXCR4 & 5

Rabies – Nicotinic acetylcholine receptor

Rhinovirus – ICAM1 (CD54)

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192
Q

Atropine OD symptoms? Antidote?

A

Atropine is an anticholinergic medication

Physostigmine is a cholinesterase inhibitor that penetrates BBB

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193
Q

Hereditary breast cancer is most commonly associated with what mutations?

A

BRCA1 & BRCA2 – Tumor suppressor genes involved in DNA repair

Mutations lead to increase risk in breast & ovarian cancer

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194
Q

What is the MOA of Cyclosporine & Tacrolimus?

A

Calcineurin inhibitors

Blocks T cell activation by preventing IL-2 transcription

Used for RA & Immunosuppression following organ transplant

Highly nephrotoxic

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195
Q

What is the best medication to use Post MI or for acute ventricular arrthymias?

A

Class 1B – Lidocaine, Phenytoin, Mexiletine

Weak sodium channel blockade

Decreases AP duration

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196
Q

Adenosine MOA? Uses? SE?

A

Adenosine kicks potassium out of cells – hyperpolarizing the cell and decreasing intracellular calcium – causing a decrease in AV node conduction

DOC in diagnosing / terminating Supraventricular tachyarrhythmias

Effects are blunted by theophylline & caffeine

SE = Flushing, bronchospasm, sense of impending doom

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197
Q

Digoxin MOA? Uses? SE?

A

Direct inhibition of Na/K+ ATPase

Indirect inhibition of Na/CA2 exchanger

Increase in Intracellular Calcium = Positive inotropy

Stimulates Vagus nerve to decrease HR

Used in HF, Afib – Decreases conduction at AV node & depression of SA node

SE = Hypokalemia

Drugs that displace digoxin – Verapamil, Amiodarone, Quinidine

Blurry YELLOW VISION

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197
Q

Digoxin MOA? Uses? SE?

A

Direct inhibition of Na/K+ ATPase

Indirect inhibition of Na/CA2 exchanger

Increase in Calcium = Positive inotropy

Stimulates Vagus nerve to decrease HR

Used in HF, Afib – Decreases conduction at AV node & depression of SA node

SE = Hyperkalemia (poor prognosis)

Antidote = anti-digoxin & Magnesium

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198
Q

Diltiazem & Verapamil MOA? Uses? SE?

A

Class IV calcium channel blockers

Decrease conduction velocity

Increase ERP & PR interval

Used for prevention of nodal arrhythmias (SVT) & rate control in Afib

SE = Constipation, flushing, edema

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199
Q

Amiodarone, Ibutilide, Dofetilide, Sotalol MOA? Uses? SE?

A

Class III potassium channel blockers

Increase AP duration, Increase ERP, & Increase QT interval

Used for Afib & Atrial flutter & ventricular tachycardia

Sotalol – Torsades de pointes, excessive beta blockade

Ibutilide – Torsades de pointes

Amiodarone – Pulmonary fibrosis, hypo or hyper thyroidism, Corneal deposits, blue/gray skin deposits – photodermatitis

Check PFTs, LFTs, & TFTs when using amiodarone

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200
Q

Class II antiarrhythmics MOA? Uses? SE?

A

Decrease SA & AV nodal activity by decreasing cAMP, decrease calcium currents, & suppress abnormal pacemakers by decreasing slope of phase 4

Increases PR interval

Beta blockers used in patients with acute or recent MI to reduce risk of ventricular arrthymias by decreasing automaticity & reduce oxygen demand

Used in SVT, ventricular rate control, Afib, & atrial flutter

SE = Impotence, exacerbation of COPD & asthma

May MASK signs of HYPOGLYCEMIA (tx w/ glucagon)

Metoprolol can cause dyslipidemia

Propranolol can exacerbate vasospasm in vasospastic angina

Treat beta blocker overdose with saline, atropine, glucagon

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201
Q

Quinidine, Procainamide, Disopyramide MOA? Uses? SE?

A

Class I sodium channel blockers

Slow or block conduction, Decrease slope of phase 0 depolarization

Moderate sodium channel blockade

Increase AP duration, Increase effective refractory period

PROLONGED QT INTERVAL

Used in both atrial & ventricular arrhythmias – especially reentrant & ectopic SVT & VT

SE = CINCHONISM (headache, tinnitus with quinidine)

Reversible SLE like syndrome with Procainamide

HF with Disopyramide

Thrombocytopenia, Torsades de pointes due to Increase in QT interval

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202
Q

What is an Iliopsoas abscess?

A

Collection of Pus in iliopsoas compartment

Presents with flank pain, fever, (+) psoas sign (hip extension exacerbates lower abdominal pain)

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203
Q

Diagnosis criteria for schizophrenia?

A

Requires 2 of the following (at least 1 symptom has to be from numbers 1-3

Delusions (1)

Hallucinations, often auditory (2)

Disorganized speech (3)

Disorganized or catatonic behavior

Negative symptoms (flat affect, apathy, anhedonia, social withdrawal)

Symptoms have to be at least 6 months prior to diagnosis with at least 1 month of active symptoms over the past 6 months

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204
Q

Exudative pleural effusions?

A

Cloudy cellular fluid

Usually due to infection / malignancy

INCREASE IN LDH & PROTEIN

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205
Q

Transudative pleural effusions?

A

Clear hypocellular fluid

Due to INCREASE IN HYDROSTATIC PRESSURE

Usually from HF or sodium retention

Or reduced oncotic pressure i.e. cirrhosis or nephrotic syndrome

LOW PROTEIN

LOW LDH

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206
Q

What is Chiari 1 malformation?

A

Ectopia of cerebellar tonsils inferior to foramen magnum

Usually asymptomatic in childhood

Adulthood manifestations of headache & cerebellar symptoms

Associated with spinal cavitations (syringomyelia)

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207
Q

What is Chiari 2 malformation?

A

Herniation of cerebellum & medulla through foramen magnum

Noncommunicating hydrocephalus – defined as structural blockage of CSF within ventricular system

More severe than Chiari 1

Presents early in life with dysphagia, stridor, apnea, & limb weakness

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208
Q

What is a Dandy-Walker malformation?

A

Agenesis of the cerebellar vermis

CYSTIC enlargement of the 4TH VENTRICLE that fills the enlarged POSTERIOR fossa

Associated with NONCOMMUNICATING hydrocephalus & spina bifida

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209
Q

What chamber of the heart is at risk for penetrating injury?

A

The right ventricle – composes the majority anterior surface of the heart

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210
Q

Giemsa stain used for what?

A

Chlamydia

Rickettsia

Trypanosomes

Borrelia

Helicobacter pylori

Plasmodium

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211
Q

What is pseudotumor cerebri?

A

Called idiopathic intracranial hypertension

Increased ICP with no obvious findings on imaging

Risk factors – female, tetracyclines, obesity, vitamin A excess, Danazol

female TOAD

Presents with headache, tinnitus, diplopia

Papilledema & transient visual disturbances because of increased intracranial pressure compressing the optic nerves – resulting in impaired axoplasmic flow & optic disc edema

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212
Q

What is piriformis syndrome?

A

The piriformis acts to EXTERNALLY rotate the THIGH when EXTENDED & ABDUCT the thigh when FLEXED

The piriformis passes through the greater sciatic foramen & involved with EXTERNAL HIP ROTATION – injury or hypertrophy can compress the nerve causing piriformis syndrome

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213
Q

What enzymes are involved in normal tissue remodeling but also assist in tumor invasion through the basement membrane & connective tissue?

A

Metalloproteinases

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214
Q

Tumor cells detach from surrounding cells by increased or decreased E-Cadherin?

A

Decrease in E-cadherins

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215
Q

What is vasospastic angina?

A

Involves hyperreactivity of coronary artery smooth muscle

Transient ST elevation

Patients are usually young (<50) & without significant risk factors for CAD

Present with recurrent episodes of chest discomfort that typically occur during rest or sleep & resolve within 15 minutes

Treat with calcium channel blockers / nitrates

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216
Q

2nd leading cause of lung cancer after cigarette smoke?

A

Radon Gas

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217
Q

Alirocumab & Evolocumab MOA? SE?

A

LIPID LOWERING AGENTS

Inactivation of LDL-receptor degradation – INCREASED REMOVAL OF LDL FROM BLOODSTREAM

PCSK9 binds to LDL-receptor on hepatocyte cell surface increases degradation of LDL-Receptor – leading to decreased uptake of circulating LDL

Basically decrease LDL-receptor degradation – resulting in a greater uptake of LDL in the liver & lowers circulating LDL levels

SE = Myalgias & Neurocognitive effects

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218
Q

What medication is used for migraine prophylaxis?

A

Topiramate

Blocks sodium channels – Increases GABA action

SE = Kidney stones, weight loss, glaucoma

Can also use beta blockers, tricyclic antidepressants

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219
Q

What drug should you not use in patients with hereditary angioedema?

A

Since they have low c1 esterase inhibitor activity – do NOT use ACE inhibitors

Characterized by a DECREASE in C4 levels

Unregulated activation of Kallikrein Increases Bradykinin production

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220
Q

What are the positives of Bupropion? Negatives?

A

Does not cause sexual side effects or weight gain

Also used for smoking cessation

Seizure risk

MOA: Inhibits NE & dopamine reuptake (Increase in dopamine = seizure)

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221
Q

Neonatal hypoglycemia is common in infants of what mothers?

A

Diabetic mothers

Maternal hyperglycemia causes fetal hyperglycemia & compensatory hyperfunctioning of the pancreas (hyperinsulinemia)

After birth, persistently elevated insulin levels lead to transient hypoglycemia

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222
Q

Metformin MOA? Uses? SE?

A

Inhibits mitochondrial glycerol-3-phosphate dehydrogenase

Inhibition of hepatic gluconeogenesis (think about it) & action of glucagon

Increases glycolysis & peripheral glucose uptake

Increases insulin sensitivity

SE = Lactic acidosis (use with caution in renal insufficiency)

SE = Vitamin B12 deficiency

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223
Q

Thiazolidinedione’s “glits” PioGLITazone & RosiGLITazone MOA? Uses? SE?

A

Activate PPAR-kappa (a nuclear receptor) – this increases insulin sensitivity & levels of adiponectin

SE = Edema, HF, Increase risk of fractures

Delayed onset of action (weeks)

Rosiglitazone – Increase risk of MI & CV DEATH

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224
Q

Sulfonylureas MOA? Uses? SE?

Meglitinides “Glins” MOA? Uses? SE?

A

Chlorpropamide & Tolbutamide are 1st gen

GLIPIZIDE & GLYBURIDE are 2nd gen (MC)

Close K+ (potassium) channels in pancreatic beta cell membrane - cell depolarizes - insulin release via increased Ca2+ INFLUX

This class overall increases insulin SECRETION

SE = Disulfiram like reaction with 1st gen.

HYPOGLYCEMIA IN THESE BITCHES (Increased risk of renal insufficiency)

Meglitinides – NateGLINide & RepaGLINide have the same MOA & SE

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225
Q

GLP-1 Analogs MOA? Uses? SE?

A

EXENATIDE, LIRAGLUTIDE, SEMAGLUTIDE

Think GLP-ESL (fat Faiz needs insulin)

Increase GLUCOSE-INDUCED insulin secretion

Decrease glucagon release, DECREASE GASTRIC EMPTYING

SE = PANCREATITIS

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226
Q

DPP-4 Inhibitors MOA? Uses? SE?

A

GLIPS – LINA, SAXA, & SEXY SITA

LinaGLIPtin, SaxaGLIPtin, SitaGLIPtin

Inhibit DPP-4 enzyme that deactivates GLP-1, this decreases glucagon release, DECREASES GASTRIC EMPTYING

Increases glucose-dependent insulin release

SE = RESPIRATORY & URINARY infections + satiety (desired) & weight neutral

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227
Q

What are the sodium-glucose co-transporter 2 inhibitors MOA? Uses? SE?

A

GLIFS – CANA, DAPA, & EMPA

CanaGLIFlozin, DapaGLIFlozin, EmpaGLIFlozin

Block reabsorption of glucose in PCT

SE = Glucosuria (UTIs, Vulvovaginal candidiasis), dehydration (orthostatic hypotension)

Use with caution in renal insufficiency – Decreased efficacy with decreased GFR

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228
Q

Alpha glucosidase inhibitors MOA? Uses? SE?

A

Acarbose, Miglitol

Decrease glucose absorption

Inhibit intestinal brush border alpha glucosidases to delay carbohydrate hydrolysis & glucose absorption

This decreases postprandial hyperglycemia

SE = GI upset & bloating

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229
Q

Pramlintide MOA? Uses? SE?

A

Amylin analog (diabetes drug)

Decrease glucagon release, decrease gastric emptying

SE = hypoglycemia, nausea, satiety

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230
Q

Patellofemoral syndrome?

A

Overuse injury in female athletes

Presents as ANTERIOR knee pain

Exacerbated by prolonged sitting or flexed knee

Loss of strength of QUADS muscle

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231
Q

What is paraneoplastic cerebellar degeneration most commonly associated with?

A

Antibodies against antigens in purkinje cells

Most common is small cell lung cancer

Hodgkins

Small Cell Carcinoma refresher –

Central location

Undifferentiated – very aggressive

Neurologic paraneoplastic syndromes & endocrine i.e. SIADH & Cushing

Amplification of MYC oncogenes MC

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232
Q

Rituximab MOA? Uses? SE?

A

Monoclonal AB directed against CD20 – cell surface receptor on developing & mature B CELLS

Overall reduce B cell population to reduce inflammatory symptoms of a wife range of rheumatologic diseases

Used in Non-Hodgkin lymphoma, CLL, RA, Multiple sclerosis, ITP, TTP, AIHA

SE = Infusion reaction due to cytokine release w/ its target on B cells

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233
Q

Dislocation of the Lunate could impinge what nerve?

A

Median nerve – causing carpal tunnel syndrome

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234
Q

Fracture of the hook of hamate can cause what?

A

Ulnar syndrome

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235
Q

What is the most commonly fractured carpal bone?

A

Scaphoid – high risk of avascular necrosis

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236
Q

Radial nerve injury findings?

A

WRIST DROP

ABSENT TRICEP REFLEX

Weakness of forearm, hand & finger EXTENSORS

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237
Q

Hypothyroidism effect on LDL?

A

Hypothyroidism decreases expression of LDL receptors in the liver

Leads to decreased clearance of LDL & increased blood LDL levels

Also causes hypertriglyceridemia due to decreased expression of lipoprotein lipase

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238
Q

Gastric ulcer pain with meals?

A

GREATER with meals

Patients PRESENT W/ WEIGHT LOSS

H. Pylori infection or NSAIDs – decrease mucosal protection against gastric acid

INCREASED risk of carcinoma

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239
Q

Duodenal ulcer pain with meals?

A

Duodenal – DDDDD Decreases with meals

Patients have GAINED weight

H. Pylori or Zollinger-Ellison syndrome

Increase in gastric acid secretion

Generally benign

ZES = Gastrin-secreting tumor of the duodenum or pancreas

Acid hypersecretion causes recurrent ulcers in duodenum

Associated w/ MEN1

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240
Q

Treatment for both gastric & duodenal ulcers?

A

PPI (Omeprazole) & antibiotics (tetracycline, metronidazole)

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241
Q

Tamoxifen MOA? Uses? SE?

A

SERM

Blocks the binding of estrogen to estrogen receptor in ER (+) cells
ANTAGONIST at BREAST

Partial AGONIST at UTERUS, BONE

SE = Hot flashes, Increase risk of thromboembolic event – especially with tobacco

ENDOMETRIAL CANCER

Used to treat & prevent recurrence of ER/PR (+) breast cancer & to PREVENT GYNECOMASTIA in patients undergoing prostate cancer therapy

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242
Q

Raloxifene MOA? Uses? SE?

A

SERM

Antagonist at breast & Uterus

Agonist at bone

ANTAGONIST @ UTERUS IS THE ONLY DIFFERENCE W/ THIS & TAMOXIFEN (so this doesn’t cause endometrial cancer)

SE = Hot flashes, thromboembolic events

NO Increased risk of endometrial cancer (VS Tamoxifen) so you can “relax” with Tamoxifen

Used primarily for osteoporosis

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243
Q

Infant difficulty latching crazy OMM BS?

A

Treat with occipital condyle decompression

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244
Q

Burkitt lymphoma occurs in? Translocation? Important associations?

A

Young adults

I knew Daniel Burkitt (my neighborhood) @ 8 years old & we became distanced @ 14

T(8;14) – C MYC & heavy chain

Starry sky appearance w/ interspersed macrophages

Associated with EBV

Jew lesion in endemic form in Africa

Pelvis or abdomen in sporadic form

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245
Q

Iron deficiency anemia classification? Labs? Manifest into?

A

Microcytic hypochromic anemia

Decreased iron due to chronic bleeding, malnutrition or increased demand (pregnancy)

Labs – Decrease in iron, ferritin

Increase in TIBC & free erythrocyte protoporphyrin

May manifest as glossitis, cheilosis, Plummer-Vinson syndrome (triad of iron anemia, esophageal web, dysphagia)

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246
Q

Hepatitis D virus must be coated with what?

A

Must be coated by external coat hepatitis B surface antigen - HBsAg of HBV to penetrate the hepatocyte

HDV infection can arise either as an acute coinfection with HBV or as a superinfection of a chronic HBV carrier

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247
Q

Treatment for adrenal insufficiency?

A

Aggressive fluid resuscitation & glucocorticoid supplementation

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248
Q

Ventricular septal defect murmur?

A

Holosystolic, harsh sounding murmur

Loudest at tricuspid area

Congenital – Murmur increases w/ HAND CLENCHING

LEFT to RIGHT shunting of oxygenated blood from LV to RV

RV oxygen saturation is increased compared to normal

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249
Q

Typical & Atypical antipsychotics effects on endocrine for women?

A

Antipsychotics cause HYPERPROLACTINEMIA by BLOCKING D2 receptors on LACTOTROPHS

ELEVATED PROLACTIN leads to AMENORRHEA (inhibition of GnRh)

Decreased GNRH = no period bitch

Galactorrhea

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250
Q

Exogenous hyperthyroidism thyroid biopsy findings?

A

Because there is high T4 & low TSH

likely secondary to LEVOTHYROXINE misuse – overtime the lack of TSH stimulation cause the THYROID FOLLICLES to become ATROPHIC

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251
Q

The most common cause of digital clubbing in adults is what

A

Pulmonary malignancy – especially LUNG ADENOCARCINOMA

More generally, clubbing is a sign of chronic CARDIOPULMONARY disease associated with activation of hypoxic inflammatory signaling

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252
Q

What is the only thing decreased in Mitral stenosis?

A

END DIASTOLIC VOLUME because of impaired ventricular filling –

at the end of the Diastole, how much blood is in the LV?

PCWP closely reflects left atrial & left ventricular END DIASTOLIC PRESSURE

Mitral stenosis leads to increase in LA pressure that is reflected as elevated PCWP

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253
Q

Ganciclovir Use? SE?

A

Used in CMV for immunocompromised patients

Inhibits viral DNA polymerase via CMV viral kinase

SE = Myelosuppression – Leukopenia, neutropenia, thrombocytopenia, & renal toxicity

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254
Q

Complement deficiency of C5-C9 results in recurrent infections by what bacteria?

A

Encapsulated bacteria i.e. Strep. pneumo & N. Meningitidis

Unable to form Membrane Attack Complex

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255
Q

VSD Intracardiac pressure changes on heart valves?

A

Right atrium is unchanged

RV, LA, & LV all have increased intracardiac pressure due to a left to right shunt (LV into RV)

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256
Q

Syringomyelia pathogenesis? What part of the brain is damaged? What are the findings?

A

Formation of a cavity in the cervical region of the spinal cord

Syrinx damages the ventral white commissure (Spinothalamic tract) & leads to bilateral loss of pain & temperature usually in the UE

Find touch is preserved

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257
Q

What is the DOC for uncomplicated malaria?

A

Chloroquine is the DOC in a chloroquine sensitive region

Primaquine is added for P. Vivax & P. Ovale infections to eradicate intrahepatic stages (hypnozoites) – responsible for relapse

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258
Q

What usually accounts for the severity in patients infected with Dengue virus (Flavivirus, transmitted by Aedes mosquito)

A

If patient was infected with a different serotype after their initial infection due to antibody-dependent enhancement of disease

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259
Q

How do you characterize borderline personality disorder?

A

Cluster B

Persistent pattern of unstable relationships, mood lability, & impulsivity

May exhibit suicidal ideation or behavior during interpersonal crisis

260
Q

What is the MOA of Apixaban, Edoxaban, & Rivaroxaban? Uses? SE?

A

Directly inhibit factor Xa

Treatment & prophylaxis for DVT & PE

Stroke prophylaxis for patients with Afib

SE = Bleeding (Antidote is Andexanet alfa) to reverse anticoagulation effect

261
Q

TNF-alpha inhibitors

Infliximab, Adalimumab, Certolizumab, & Golimumab MOA? Use? SE?

A

Anti-TNF alpha monoclonal Antibody

Used in IBD, RA, Ankylosing spondylitis, & psoriasis

SE = predisposed to infection including latent TB since TNF is important in granuloma formation & stabilization

Can also lead to drug induced lupus / Serum sickness – Decreased C3 & C4 complement levels (Type III)

262
Q

Antifungal agent that targets Mitosis?

A

Griseofulvin

Interferes with microtubule function – disrupts mitosis

Deposits in Keratin-containing tissues

Inhibits growth of dermatophytes (tinea, ringworm)

SE = Teratogenic, carcinogenic, confusion, HA, disulfiram like reaction, Increase in CYP450, & Warfarin metabolism

263
Q

Antifungal medication that targets DNA & RNA synthesis? MOA? Uses? SE?

A

Flucytosine

Inhibits DNA & RNA biosynthesis by conversion to 5-FU by cytosine deaminase

Systemic fungal infections – especially Cryptococcus (w/ Ampho B)

SE = Myelosuppression

264
Q

Antifungal medication that targets the Cell wall? MOA? Uses? SE?

A

Caspofungin (Echinocandins)

Inhibits cell wall synthesis by inhibiting synthesis of beta glucan

Invasive aspergillosis & Candida

SE = GI upset, Flushing (histamine release)

265
Q

Antifungal medication that targets the cell membrane? MOA? Uses? SE?

A

Amphotericin B

Binds ergosterol – membrane pores form that allow leakage of electrolytes

Serious & systemic mycoses

SE = Fever / chills

Hypotension, nephrotoxic, IV Phlebitis, Arrhythmias

Supplement K+ & Magnesium because of altered renal tubule permeability

Hydrate to decrease nephrotoxicity

266
Q

Hyperoxia can increase production of what?

A

Reactive oxygen species

Leads to injury of airways & lung parenchyma

Oxygen typically manifests with substernal heaviness, cough / dyspnea within 24 hours

267
Q

Traumatic pneumothorax presents how?

A

Air in pleural space

Patients usually experience chest pain & difficulty breathing

Crepitus – caused by air in the subcutaneous tissue of the chest wall is present on physical exam

268
Q

Pneumothorax deviation?

A

Tracheal deviation away from the affected lung

269
Q

Muscle energy is used to lengthen hypertonic / shortened muscles using what type of relaxation?

A

Postisometric relaxation (Golgi tendon mediated muscle relaxation following isometric contraction

270
Q

Traumatic aortic rupture caused by? Most commonly which part of aorta?

A

Trauma & or deceleration injury

Aortic isthmus (proximal descending aorta)

271
Q

What is the most common eye related complication of congenital CMV?

A

Chorioretinitis (Also Toxo)

272
Q

Prostacyclin is secreted to inhibit what?

A

Inhibit platelet aggregation & causes vasodilation to oppose the functions of Thromboxane A2 & maintain vascular homeostasis

273
Q

Inflammatory invasive carcinoma presents how? Mistaken for what?

A

Dermal lymphatic space invasion

Itchy breast rash w/ pain & breast is warm with swollen skin around hair follicles (orange shit)

Mistaken for mastitis or Paget disease

Lacks a palpable mass

274
Q

Uncal transtentorial herniation affects what brain region? Main symptoms?

A

Affects the medial temporal lobe

Patients often develop ipsilateral CN III Palsy with a fixed & dilated pupil

275
Q

Treatment for C. Difficile?

A

Oral Fidamoxicin or oral Vancomycin

Fidaxomicin is a macrolide that inhibits RNA polymerase

276
Q

Abciximab, Eptifibatide, & Tirofiban MOA? Uses?

A

Blocks GpIIb & GPIIIa (fibrinogen receptor) on activated platelets – Decreases platelet aggregation

Abciximab is used to treat Glanzmann thrombasthenia – GPIIb or IIIa is deficient or defective in these patients

Used in unstable angina as well

277
Q

Patients with psoas syndrome have low back pain & lumbar dysfunction on what side?

A

Lumbar dysfunction on the affected side

Pelvic Shift to the opposite side

Psoas syndrome = Flexure contracture of the psoas muscle

278
Q

Digoxin toxicity presents with what symptoms? Most common complication?

A

nonspecific GI symptoms & neurologic symptoms

Changes in color vision

Life threatening ventricular arrhythmias are most serious complication

279
Q

What is countertransference?

A

Provider’s response toward a patient based on past personal relationships

Can be positive or negative

280
Q

What is the MOA of PTU & Methimazole? Uses? SE?

A

Block thyroid peroxidase – inhibiting oxidation of iodide

Inhibits thyroid hormone synthesis

PTU also blocks conversion of T4 to T3

Used in Hyperthyroidism (Grave’s)

PTU is used in 1st trimester of pregnancy because Methimazole is teratogenic

Methimazole is used in 2nd & 3rd trimester due to risk of PTU induced hepatotoxicity

SE = Rash, Agranulocytosis, hepatotoxicity

PTU has been associated with ANCA positive vasculitis

Methimazole is a possible teratogen

281
Q

What is pill esophagitis caused by?

A

Tetracyclines

Bisphosphonates (Alendronate)

Potassium Chloride

NSAIDs

Direct mucosal injury

282
Q

What is Wilson disease? What accumulates? How does it present? Treatment?

A

AR mutation in hepatocyte COPPER ATPase

COPPER accumulates especially in liver & brain cornea & kidneys

Increase in urine copper

Presents before 40 w/ liver disease

KAYSER-FLEISCHER rings on SLIT LAMP exam (Basal Ganglia Atrophy)

TX = Chelation with penicillamine

283
Q

What are the hallmark signs of PCP intoxication?

A

Ataxia & nystagmus (vertical or horizontal)

284
Q

What are the cardiovascular effects of high altitude?

A

Hypoxic pulmonary vasoconstriction – Increases pulmonary vascular resistance

Increased sympathetic activity to increase CO

Aldosterone suppression to reduce plasma volume

285
Q

Acetazolamide MOA? Uses? SE?

A

Carbonic anhydrase inhibitor – Works @ PCT

Decreases total body bicarb stores – Increased excretion of Bicarb = urine alkalized = low blood pH but HIGH urine pH

Alkalinizes urine

Used in Glaucoma, metabolic alkalosis (altitude sickness)

SE = Type 2 RTA (proximal)

HYPOKALEMIA due to Increase in urine potassium due to distal reabsorption of Na+

Renal calcium phosphate stones

286
Q

Loop diuretics’ MOA? Uses? SE?

A

Furosemide, Bumetanide, Torsemide

Inhibit cotransport system of Na/K/2CL of thick ascending limb of loop of Henle

Inhibited by NSAIDs

Increase in CALCIUM EXCRETION (Hypocalcemia) LOOPS LOSE CALCIUM

Used for HF, cirrhosis, nephrotic syndrome, edema

SE = Ototoxicity, hypomagnesemia, nephritis, Sulfa allergy

SEVERE HYPOKALEMIA

Only thing Hyper is HYPERURICEMIA = GOUT

287
Q

Ethacrynic Acid MOA? Uses? SE?

A

Nonsulfonamide inhibitor of cotransport Na/K/2CL of thick ascending loom of Henle

Used for diuresis in patients with sulfa allergy

SE = similar to furosemide but more OTOtoxic

288
Q

Thiazide diuretics MOA? Uses? SE?

A

Hydrochlorothiazide, Chlorthalidone, Metolazone

Inhibit NaCl reabsorption in early DCT

Decreases calcium excretion in urine (HYPERCALCEMIA)

Used in HTN, HF, idiopathic hypercalciuria

Hyperglycemia, Hyperlipidemia, Hypercalcemia, Hyperuricemia

289
Q

Potassium sparing diuretics MOA? Uses? SE?

A

Spironolactone, Eplerenone, Amiloride, Triamterene

Spiro & Eplerenone are competitive aldosterone receptor antagonists in cortical collecting tubule

Triamterene & Amiloride block sodium channels at the same part of the tubule

Used in hyperaldosteronism, Potassium depletion, HF, nephrogenic DI (Amiloride)

SE = Hyperkalemia

Commonly used w/ loop or thiazide diuretics to prevent hypokalemia

290
Q

Azoles MOA? Uses? SE?

A

Clotrimazole, Fluconazole, Itraconazole, Ketoconazole, Voriconazole

Inhibit fungal sterol synthesis by inhibiting the CYP450 enzyme that converts Lanosterol to Ergosterol (Ergosterol synthesis is decreased)

Fluconazole for cryptococcal meningitis & Candida infections of all types

Itraconazole for Blastomeres, Coccidioides, Histoplasma, Sporothrix

Clotrimazole for topical infections

Voriconazole for Aspergillus

Isavuconazole for serious Aspergillus

SE = Testosterone synthesis inhibited

Gynecomastia (especially ketoconazole)

QT prolongation

291
Q

What are the 2 diastolic murmurs?

A
  1. Aortic regurgitation

Early diastolic decrescendo high pitched blowing murmur

Best heard at base or left sternal border

Causes include, bicuspid aortic valve, endocarditis, aortic root dilation, rheumatic fever

Head bobbing when severe & chronic

  1. Mitral stenosis

Follows opening snap

Delayed rumbling mid to late murmur

Late sequelae of rheumatic fever

Chronic MS can result in LA dilation & pulmonary congestion

LA pressure is greater than LV pressure during diastole

Best heart at cardiac APEX (Left 5th intercostal space)

292
Q

Propranolol for the use in Grave’s disease (hyperthyroidism) not only helps blunt the adrenergic manifestations but also does what?

A

Reduce the conversion of T4 to T3 by inhibiting 5’monodeiodinase (just like PTU)

293
Q

What is Erb Palsy?

A

Traction or tear of upper trunk – C5 to C6 nerve roots

Infants – Lateral traction on neck during delivery

Adults – Trauma leading to neck traction

Deltoid / Supraspinatus deficit – Causes abduction (arm by side)

Infraspinatus, supraspinatus deficit – Causes lateral rotation

Biceps brachii deficit – Causes flexion, supination – Arm extended & pronated

294
Q

What is Klumpke palsy?

A

Traction or tear of lower trunk – C8 to T1 nerve roots

Infants – Upward force on arm during delivery

Adults – Grabbing a tree branch to break a fall

Muscle deficits – Intrinsic hand muscles, lumbricals, interossei, thenar

Results in claw hand

295
Q

Most common cause of SCID? 2nd most common cause? Presents?

A

Most common cause is X-linked IL-2R gamma mutation

2nd most common cause is adenosine deaminase deficiency

Presents with failure to thrive, thrush, recurrent infections from every microbe

Decreased T cell receptor

Absent thymic shadow & T cells

296
Q

ACTH dependent Cushing syndrome?

A

Cushing disease – ACTH secreting pituitary adenoma

Ectopic ACTH secretion

Hyperpigmentation, Hyperandrogenism, Hirsutism, amenorrhea

High ACTH

High urinary cortisol

High serum DHEAS – ACTH stimulates production of adrenal androgens (Increase in DHEAS)

297
Q

ACTH independent Cushing syndrome?

A

Adrenal mass (adenoma or carcinoma)

Exogenous glucocorticoids

Decrease levels of ACTH

298
Q

Ankylosing spondylitis is characterized by what? Findings? Most common in who? Treatment?

A

Symmetric involvement of spine & SI joints***

Joint fuses (ankylosis) Causes Uveitis & aortic regurgitation

Presents with Bamboo spine, back & buttocks pain

Pain is worse with rest (overnight & morning)

Can cause restrictive lung disease

More common in males 20-40

** Increased osteoclast activity – Erodes new bone + forms new bone

Elevated ESR & CRP + HLA-B27 positive

299
Q

Severe vomiting leads to acidosis or alkalosis?

A

Metabolic alkalosis through multiple mechanisms

Loss of hydrogen ions through GI tract

Volume & chloride depletion that induces renal retention of bicarb

Hypokalemia induced intracellular shifting of hydrogen

pH above 7.45

Bicarb more than 28

300
Q

Celecoxib MOA? Uses? SE?

A

Reversibly & selectively inhibits COX-2

301
Q

PDE-5 inhibitors MOA? Uses? SE?

A

Sildenafil, Vardenafil, Tadalafil, Avanafil

Decrease hydrolysis of cGMP

Rise in intracellular cGMP

Smooth muscle relaxation by enhancing NO

Used for ED, Pulmonary HTN, BPH (Tadalafil only)

SE = Headache, sweaty, hypotension

Sildenafil – Cyanopia (blue tinted vision) via inhibition of PDE-6 in retina

302
Q

What is actinic keratosis?.

A

Appears as a scaly erythematous lesion in sun exposed areas

Does not invade full thickness of epidermis

Premalignant lesions caused by sun exposure – Risk of squamous cell carcinoma is proportional to degree of epithelial dysplasia

303
Q

What is seborrheic keratoses? Who does it affect usually?

A

Flat, greasy, pigmented squamous epithelial proliferation with keratin filled cysts that look “stuck on”

Common benign neoplasm of older persons

Indicates possible malignancy – GI Adenocarcinoma

304
Q

Why no Neisseria vaccine?

A

Antigenic variation

305
Q

Pulmonary hypertension heart sound?

A

Loud pulmonic component of S2 & accentuated palpable impulse at left sternal border

306
Q

Treatment of Chlamydia?

A

Ceftriaxone & Doxycycline

Ceftriaxone alone for prophylaxis

307
Q

Osteogenesis imperfecta pathogenesis? Clinical findings? Treatment?

A

Defective synthesis of type 1 collagen by osteoblasts

Fractures after minimal trauma, Blue sclerae, Hearing loss

Treat with bisphosphonates to decrease fracture risk

308
Q

What is the benefit of using Apixaban, Edoxaban, or Rivaroxaban for conditions such as DVT?

A

Due to less variability in therapeutic drug effect (Vs Vitamin K antagonists)

Also do not require laboratory monitoring

309
Q

Secondary polycythemia is an expected finding in what diseases?

A

Conditions that cause significant chronic hypoxemia – COPD, Interstitial lung disease

Erythropoietin is released which stimulates bone marrow to increase production of RBCs – Increase in hematocrit is secondary polycythemia

310
Q

What is Guyon canal syndrome?

A

Ulnar nerve enters wrist between hook of the hamate & pisiform in a tunnel known as Guyon’s canal

Ulnar nerve is most commonly injured at the elbow “funny bone” but also can be at wrist through Guyon’s canal

Basically pinky has sensory loss

311
Q

Testosterone is converted to DHT by what enzyme?

A

5-alpha reductase (inhibited by Finasteride)

312
Q

In males, Androgens are converted to estrogens by what?

A

Aromatase (adipose tissue, testis)

313
Q

Anabolic-androgenic steroid use suppresses what? Presents with?

A

Androgen abuse suppresses GnRH, LH, & FSH secretion – leads to reduced endogenous testosterone secretion, impaired spermatogenesis, & testicular atrophy

Also, excess testosterone is converted by aromatase to estradiol – Gynecomastia

314
Q

What is Glioblastoma? What are the histologic findings?

A

Grade IV astrocytoma

Most common & highly malignant primary brain tumor with less than a year survival

Found in the cerebral hemispheres

Crosses corpus callosum “butterfly glioma”

Associated with EGFR amplification

GFAP (+)

Pseudopalisading necrosis with vascular proliferation

Pleomorphic tumor cells

315
Q

Aortic stenosis sound & location?

A

Crescendo-decrescendo @ right upper sternal border (heart base)

A2 soft & delayed

316
Q

Mitral / Tricuspid regurgitation sound & location?

A

Holosystolic high pitched blowing murmur @ apex & radiates to axilla

S3 gallop

317
Q

Hypertrophic cardiomyopathy sound & location?

A

Crescendo decrescendo at mid left sternal border

318
Q

Mitral valve prolapse sound & location?

A

Midsystolic click followed by late systolic murmur

Best heard over apex – Loudest just before S2

319
Q

Atrial septal defect sound & location?

A

Midsystolic with wide & fixed splitting of S2

320
Q

VSD sound & location?

A

Holosystolic @ left sternal border (tricuspid are)

321
Q

Gestational thrombocytopenia occurs due to?

A

Hemodilution (maternal plasma volume expansion) & increased sequestration of platelets in the placenta

322
Q

GERD is associated with erosive esophagitis with esophageal ulcers – Marked by what?

A

Marked by worsening of baseline GERD symptoms & development of Odynophagia (painful swallowing)

323
Q

Barrett esophagus?

A

Metaplastic COLUMNAR EPITHELIUM replaces the normal stratified squamous epithelium in the DISTAL esophagus

Premalignant condition for esophageal adenocarcinoma

324
Q

How is sarcoidosis characterized?

A

Immune mediated widespread noncaseating granulomas

Elevated serum ACE levels

Elevated CD4/CD8 ratio

Black females

Enlarged lymph nodes

Pulmonary infiltrates w/ hilar adenopathy

Associated with Bell palsy, uveitis, granulomas

Hypercalcemia / skin changes, uveitis, vitamin D activation

TX = glucocorticoids

325
Q

Lateral pterygoid are the only muscles in mastication that aid in what?

A

Depressing the mandible (opening the jaw)

326
Q

Alveolar hemosiderin-laden macrophages indicate what?

A

Alveolar hemorrhage

Most commonly result from chronic elevation of pulmonary capillary hydrostatic pressure in the setting of lead sided HF

327
Q

Fibromuscular dysplasia manifestations? Presentation? Diagnosis?

A

Fibromuscular webs alternating with areas of aneurysmal dilation

Abnormal tissue growth within arterial walls – stenotic & tortuous arteries that cause ischemia & prone to aneurysm

Loss of internal elastic lamina – women under 55

Presents as resistant hypertension (RAS)

Headache, TIA, stroke, aneurysm

328
Q

What provides major blood supply to the femoral head & neck & is prone to avascular necrosis due to injury?

A

Medial circumflex femoral artery

329
Q

Which ribs are true?

Which ribs are pump handle?

Which ribs are bucket handle?

A

Ribs 1-7 are true ribs

Ribs 1-5 are pump handle

Ribs 6-10 are bucket handle

330
Q

Syphilis causative agent? Description of pain? Diagnosis?

A

Treponema pallidum

Single, painless ulcer @ inoculation site with heaped-up borders & clean base

Bilateral, nonpainful lymphadenopathy

VDRL/RPR & Darkfield microscopy

331
Q

Herpes Causative agent? Description of pain? Diagnosis?

A

HSV

Multiple, painful, superficial vesicles or ulcerations with erythematous base

Bilateral & painful lymphadenopathy

Diagnose with PCR / Tzanck smear

332
Q

Stress incontinence pathogenesis? Associations? Treatment?

A

Urethral hypermobility or intrinsic sphincter deficiency

Leaks with increased intra abdominal pressure

Coughing / Valsalva causes leakage

Associated with obesity, pregnancy, vaginal delivery, prostate surgery

Treatment = Pelvic floor muscle strengthening – Levator Ani

333
Q

Urgency incontinence pathogenesis? Associations? Treatment?

A

Detrusor muscle overactivity – Leaks with urge to void immediately

Associated with UTIs

Treatment is pelvic floor strengthening, timed voiding, relaxation techniques

Antimuscarinics (Oxybutynin) – Block M3 receptors @ the bladder to prevent detrusor contractions. Do not give with elderly

Sympathomimetics (Stimulate Beta 3 receptors, Mirabegron) – Causes detrusor smooth muscle relaxation

334
Q

Overflow incontinence pathogenesis? Associations? Treatment?

A

Detrusor underactivity – Leak with overfilling

Increase in postvoid residual

Associated with polyuria, BPH, spinal cord injury

Treatment = Catheterization & alpha blockers for BPH

335
Q

Increased iodine uptake is what type of nodule? What diseases?

A

Hot nodule

Seen in Grave’s disease or nodular goiter

336
Q

Decreased iodine uptake is what type of nodule? What diseases?

A

Cold nodule

Adenoma / Carcinoma

Often warrants biopsy

337
Q

Papillary thyroid carcinoma risk factor? Biopsy?

A

Most common type of thyroid carcinoma

Exposure to ionizing radiation in childhood is a risk factor

Papillae lined by cells with clear “orphan Annie eye” nuclei w/ dispersed chromatin & nuclear grooves (inclusions)

Psammoma bodies – Laminated calcium deposits

338
Q

Follicular thyroid carcinoma pathogenesis? Metastasis?

A

Malignant proliferation of follicles surrounded by a FIBROUS CAPSULE w/ invasion through the capsule (distinguish b/t adenoma)

FNA cannot make the distinction – all depends on presence of capsular invasion

Metastasis occurs hematogenously

RAS mutation

339
Q

Medullary carcinoma pathogenesis? Biopsy? Mutation?

A

Parafollicular C cells produce calcitonin

Sheets of polygonal cells in amyloid stroma

Stains w/ Congo Red

Associated with MEN2A & MEN2B (RET mutations)

340
Q

Anaplastic carcinoma population? symptoms? mutation?

A

Older patients – presents with rapidly enlarging neck mass

Compressive symptoms – dyspnea, dysphagia, hoarseness

TP53 mutation

341
Q

Giant cell (temporal) arteritis pathogenesis? Labs? Treatment?

A

Patient presents with headaches w/ intermittent blurred vision & muscular symptoms

Enlarged tender temporal artery

Increase in ESR & IL-6

Granulomatous infiltrate composed of lymphocytes – CD4 (+) T cells & macrophages

Multinucleated giant cells

Associated with polymyalgia rheumatica

TX = High dose glucocorticoids prior to biopsy to prevent blindness

Tocilizumab (Monoclonal AB against IL-6)

342
Q

Takayasu arteritis pathogenesis? Presentation?

A

Asian females under 40

Pulseless disease – Weak UE pulses

Fever, night sweats, skin nodules

Granulomatous thickening & narrowing of aortic arch

Increase in ESR

343
Q

What is pathogenesis of Beurger disease? treatment?

A

Associated with heavy tobacco smoking – males over 40

Intermittent claudication

Can lead to gangrene – autoamputation of digits & superficial nodular phlebitis

Raynaud phenomenon is present

Segmental thrombosing vasculitis with vein & nerve involvement

Smoking cessation

344
Q

What is Kawasaki disease? Presentation? Treatment?

A

Asian children under 4

Bilateral nonexudative bulbar conjunctivitis

Rash

Adenopathy (cervical)

Strawberry tongue

Hand & foot changes (erythema)

Fever

Coronary artery aneurysms – rupture causes death

TX = IV immunoglobulin & aspirin

345
Q

Polyarteritis nodosa pathogenesis? associations? treatment?

A

Middle aged males

Hepatitis B (+) in 30% of patients

Abdominal pain, melena

HTN, neurologic dysfunction, cutaneous eruptions

Renal & visceral vessels

Different stages of transmural inflammation w/ FIBRINOID NECROSIS

Innumerable renal microaneurysms & spasms on arteriogram

TX = Glucocorticoids & cyclophosphamide

346
Q

What is Bechet syndrome? Associations?

A

Increased incidence with the fuckin Ayrabs

Recurrent aphthous ulcers, genital ulcerations, uveitis, erythema nodosum

Precipitated by HSV or Parvovirus

Immune complex vasculitis – HLA-B51

347
Q

What is Cutaneous small vessel vasculitis? Associations?.

A

7-10 days after medications – Penicillin’s, Cephalosporins, Sulfonamides, Phenytoin, Allopurinol, or infections such as HCV or HIV

Palpable purpura w/ no visceral involvement

Immune complex mediated leukocytoclastic vasculitis

348
Q

How does eosinophilic granulomatosis w/ polyangiitis present? associations?

A

Asthma, sinusitis, skin nodules, peripheral neuropathy (wrist/foot drop)

Heart, GI, kidney involvement

Formerly called Churg-Strauss syndrome

Granulomatous necrotizing vasculitis with eosinophilia

Myeloperoxidase (MPO) & P-ANCA (+)

349
Q

How does Granulomatosis with polyangiitis present? Triad? Associations?

A

URI – Perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis

LRI – Hemoptysis, cough

Renal – Hematuria, RBC casts

Triad of Focal necrotizing vasculitis, necrotizing granulomas in lung & upper airway

Necrotizing glomerulonephritis

PR3-ANCA (+)

Large nodular densities on X ray

TX = Glucocorticoids w/ Rituximab or cyclophosphamide

350
Q

How does immunoglobulin A vasculitis present? Associations?

A

Most common childhood systemic vasculitis

Often follows URI

Triad of Hinge pain (arthralgias), Stomach pain (intussusception), & palpable purpura on buttocks & legs

Formerly called Henoch-Schonlein Purpura – Vasculitis secondary to IgA immune complex deposition

Associated with IgA nephropathy (Berger disease)

351
Q

How does microscopic polyangiitis present?

A

Necrotizing vasculitis commonly involving lung, kidneys, & skin with Pauci-immune glomerulonephritis & palpable purpura

Presents similar to granulomatosis w/ polyangiitis but NO nasopharyngeal involvement

No granulomas

TX = Cyclophosphamide

352
Q

hat is mixed cryoglobulinemia?

A

Often due to viral infections – Especially HCV

Triad of palpable purpura, weakness, arthralgias

Peripheral nephropathy

Vasculitis due to mixed IgG & IgM immune complex deposition

353
Q

Acyclovir MOA? Uses? SE?

A

Guanosine analog

Monophosphorylated by HSV & VZV thymidine kinase

Inhibits Viral DNA polymerase by chain termination

No activity against CMV b/c CMV does not have thymidine kinase

Herpes zoster – Famciclovir

Obstructive crystalline nephropathy if not adequately hydrated

354
Q

What is gallstone ileus?

A

Mechanical bowel obstruction caused when a large gallstone erodes into the intestinal lumen

Triad of Pneumobilia, small bowel obstruction, & gall stone

Fistula b/t gallbladder & GI tract – stone enters lumen & obstructs @ ileocecal valve

Air in the biliary tree

355
Q

Albinism pathogenesis? Associations?

A

Normal melanocyte number but decreased melanin production

Due to a decrease in Tyrosinase activity

Increased risk of skin cancer

Baby has white skin & hair

Oculocutaneous albinism – abnormal development of fovea & optic nerve fivers – nystagmus & acuity issues

356
Q

Electrical stimulation of what nerve in tx of OSA?

A

Hypoglossal nerve – Increases diameter of oropharyngeal airway

357
Q

Pathogenesis of Alzheimer disease? Presentation? Findings?

A

Most common cause of dementia in older adults

Advanced age is the strongest risk factor

Increase incidence in Down syndrome

Decreased Acetylcholine

Widespread cortical atrophy

Senile plaques – Beta amyloid core – can cause intracranial hemorrhage

Neurofibrillary tangles – Intracellular hyperphosphorylated tau protein – Microtubule associated

358
Q

Alpha 1 receptor stimulated change in second messenger?

A

Increase in IP3

Peripheral vasoconstriction

Urethral constriction

Pupillary dilation

359
Q

Alpha 2 receptor stimulated change in second messenger?

A

Decrease in cAMP

CNS sympatholytic

Decrease insulin release & intestinal motility

360
Q

Beta 1 stimulated change in second messenger?

A

Increase in cAMP

Increase cardiac contractility & HR

Increase renin release by JG cells in kidney

361
Q

Beta 2 stimulated change in second messenger?

A

Increase in cAMP

Peripheral vasodilation

Bronchodilation

362
Q

Muscarinic stimulated change in second messenger?

A

Decrease cAMP

Decrease cardiac contractility & HR

363
Q

Muscarinic 3 stimulated change in second messenger?

A

Increase IP3

Bronchoconstriction

Increase insulin & intestinal

Bladder contraction

Pupillary constriction

Peripheral vasodilation

364
Q

Chronic mercury toxicity presentation?

A

Mercury impairs breakdown of catecholamines – stimulation of SNS – tachycardia, HTN, diaphoresis

Desquamating hypersensitivity rash

Tremor

365
Q

What is Locked-in syndrome? symptoms?

A

Basilar artery ischemia

Lesion in pons mostly, medulla

Corticospinal & corticobulbar tracts affected

Loss of horizontal, but NOT vertical eye movements

366
Q

Barbiturate’s MOA? Uses? SE?

A

Phenobarbital, & all Bital cousins

Increase GABA-A action by increasing DURATION of chloride channel opening

Thiopental for anesthesia induction

SE = Respiratory depression, CNS depression (alcohol exacerbates)

Induces CYP450

CI in porphyria

367
Q

Benzodiazepines MOA? Uses? SE?

A

Diazepam, Lorazepam, Triazolam, Temazepam, Oxazepam, Midazolam, Chlordiazepoxide, Alprazolam

Increase GABA-A by increasing FREQUENCY of chloride channel opening

FRENZOdiazepines = Increase FREquency

Decrease REM sleep

Used for anxiety, panic, seizure, night terrors, sleep walking

Lorazepam, Oxazepam, & Temazepam for those with liver disease who drink a LOT

SE = Addiction

Overdose = Treat with Flumazenil

Can precipitate seizures by causing acute benzodiazepine withdrawal

Never use with other sedative medications, like H1 receptor antagonists such as Diphenhydramine & Chlorpheniramine

368
Q

What is Lateral Medullary (Wallenberg) syndrome?

A

Leads to vertigo, loss of pain/temperature sensation on ipsilateral face & contralateral body (spinothalamic tract) bulbar weakness & ipsilateral Horner syndrome

Dysphagia, hoarseness, Absent gag reflex

Lateral medulla lesion is on side of affected gag reflex

PICA

369
Q

What is the role of TNF alpha?

A

Activates endothelium

WBC recruitment – vascular leak

Released from activated macrophages

Cachexia in malignancy

Granuloma maintenance in TB

Mediate fever & sepsis along with IL-1 & IL-6

370
Q

G6PD deficiency pathogenesis?

Inheritance pattern?

Histology?

A

NADPH is decreased in RBCs – Hemolytic anemia

RBCs have poor defense against oxidizing agents such as fava beans, sulfonamides, nitrofurantoin, primaquine, chloroquine, anti TB drugs

X LINKNED RECESSIVE disorder – MC human enzyme deficiency

HEINZ bodies & BITE cells (from splenic macrophages)

371
Q

Pilocytic astrocytoma description? histology?

A

Most common primary brain tumor in children (NOT the MC Supratentorial – that would be Craniopharyngioma)

Well circumscribed (Benign)

Found in posterior fossa – SUPRATENTORIAL

Astrocyte in origin – GFAP (+)

Bipolar neoplastic cells with hairlike projections

Microcysts with ROSENTHAL fibers

Differentiate from Medulloblastoma by presence of both CYSTIC & SOLID components on imaging

372
Q

Medulloblastoma description & histology?

A

Most common MALIGNANT brain tumor in childhood

Involves CEREBELLUM

Compressing 4TH VENTRICLE causing NONCOMMUNICATING hydrocephalus

Headaches & PAPILLEDEMA

TRUNCAL ATAXIA

HOMER-WRIGHT ROSETTES– small blue cells with central area of neuropil

SYNAPTOPHYSIN (+)

NOT CYSTIC like pilocytic astrocytoma

Imaging reveals a solid lesion

373
Q

Ependyoma characteristics? Histology?

A

Most commonly found in 4th ventricle (POSTERIOR FOSSA)

Can cause hydrocephalus

Ependymal cell origin

Characteristic PERIVASCULAR PSEUDOROSETTES

Rod shaped basal ciliary bodies

374
Q

Craniopharyngioma characteristics? Histology?

A

Most common childhood SUPRATENTORIAL tumor

Can be confused for pituitary adenoma – Both cause BITEMPORAL HEMIANOPIA

Remnants of Rathke pouch

CALCIFICATION is common

CHOLESTEROL crystals found in motor oil like fluid within tumor

375
Q

Pineal gland tumors description & histology?

A

Most common EXTRAGONADAL germ cell tumors

Increase incidence in MALES

Obstructive hydrocephalus upon presentation (cerebral aqueduct compression)

Parinaud syndrome – Compression of dorsal midbrain

Triad of UPWARD GAZE PALSY, convergence retraction NYSTAGMUS & light near dissociation

376
Q

How are you going to diagnose cocaine intoxication on a question?

A

Psychotic symptoms such as DELUSIONS & PARANOIA

Sympathetic stimulation

PRESSURED speech

Paranoid delusions

Physical signs indicating sympathetic stimulation assist in differentiating cocaine from psychiatric disorders

377
Q

What is the hallmark of Chron’s disease?

A

NONCASEATING GRANULOMAS

Distinguishes from UC, which does not form granulomas

Crohn’s also has transmural inflammation

RLQ pain vs LLQ with UC

378
Q

All the clues for Chron’s?

A

Any portion of GI tract – usually TERMINAL ILEUM

Skip lesions – rectal sparing

Transmural inflammation – fistulas

Cobblestone mucosa, bowel thickening – string sign

Linear ulcers, fissures

NONCASEATING GRANULOMAS*** Hallmark

Fistulas – can cause recurrent UTI

Diarrhea can or can not be bloody

Kidney stones –CALCIUM OXALATE gall stones

TX = Azathioprine, antibiotics, infliximab

379
Q

All the clues for Ulcerative colitis?

A

CONTINUOUS colonic lesions – ALWAYS with rectal involvement

Mucosal & submucosal inflammation only

Loss of haustra – Lead pipe appearance on imaging

Crypt abscesses / ulcers w/ BLEEDING– NO granulomas

Toxic megacolon, perforation

Bloody diarrhea – usually nocturnal & w/ pain

Primary sclerosing cholangitis – Myeloperoxidase/ ANCA

Mesalamine, Infliximab

380
Q

What is the first line therapy for BPH?

A

Tamsulosin

Alpha 1 ANTAGONIST selective receptors in prostate

Decrease smooth muscle tone & increase urine flow

381
Q

What is the medication responsible for decreasing prostate VOLUME in patients with BPH?

A

FINASTERIDE

5 alpha reductase inhibitor – DECREASES conversion of testosterone to DHT in the prostate

These drugs are responsible for the affect on prostate volume vs tamsulosin for the urinary symptoms

382
Q

Severe iron deficiency anemia

A

Hypochromic, microcytic erythrocytes on blood smear

Low RBC count

Low hepcidin

High transferrin (TIBC)

Increase in Erythropoietin – but not enough iron to generate erythrocytes so reticulocyte count is low

383
Q

Pituitary adenoma presentation? Histology?

A

Nonfunctioning (SILENT) or hyperfunctioning (HORMONE PRODUCING)

Nonfunctional presents with mass effect – Bitemporal hemianopia

Pituitary apoplexy – hypopituitarism

Prolactinoma classically presents as galactorrhea or amenorrhea

Decrease in bone density due to suppression of estrogen in females

Treatment = Bromocriptine, Cabergoline (Dopamine agonists)

Hyperplasia most commonly from LACTOTROPHS (prolactin) – HYPERPROLACTINEMIA

Hyperprolactinemia suppresses secretion of GnRH which leads to reduced estrogen (which leads to decreased bone density)

384
Q

What is the treatment for Wilson’s Disease?

A

Autosomal recessive disorder characterized by excessive copper deposition in the liver, basal ganglia, & cornea

Impaired hepatocellular copper transport – Decreased biliary excretion of copper – Intracellular copper causes apoptosis of hepatocytes – Liver dysfunction marked by ELEVATED TRANSAMAINASES

Excess copper goes into blood & causes ATAXIA / TREMOR

DOC is Penicillamine – Copper chelating agent that binds free copper – Overall increases urinary copper excretion

385
Q

Ruptured gastric ulcer on the lesser curvature of the stomach – which artery?

An ulcer on the posterior wall of the duodenum – Which artery?

A

Lesser curvature of stomach = Left gastric artery

Posterior wall of duodenum = Gastroduodenal artery

386
Q

What type of vaccine for rabies?

A

Inactivated

387
Q

What are the best symptoms to focus on for people that are depressed?

A

Nonsomatic symptoms such as loss of interest, anhedonia, worthlessness, guilt, & suicidality

388
Q

Defect in the common or extrinsic pathway does what to PT / PTT / bleeding time?

A

Prothrombin Time (PT) is increased

Play Tennis OUTside (Extrinsic pathway)

389
Q

Defect in the common or intrinsic pathway does what to PT / PTT / Bleeding time?

A

Defect increases Partial thromboplastin time (PTT)

Play Table Tennis INside (Intrinsic)

390
Q

Coagulation studies for Factor VIII deficiency?

A

Hemophilia A

Normal bleeding time

Normal Prothrombin time (PT)

Increase in Partial thromboplastin time (PTT) (INTRINSIC)

391
Q

Factor VII deficiency coagulation studies?

A

Increase in PT

Normal PTT

Normal bleeding time

392
Q

Mannitol MOA? Uses? SE? Contraindications?

A

Osmotic diuretic that works by increasing plasma or tubular fluid osmolality

Increased plasma & fluid osmolality causes extraction of water from the interstitial space into the vascular space or tubular lumen – subsequent diuresis

In the brain, water redistribution from the tissues into the plasma helps reduce edema & intracranial pressure in the setting of cerebral edema

Increases serum osmolality – Fluid shift from interstitial to intravascular space – Increase in urine flow & decrease intracranial pressure

Used in drug overdose / Increased intracranial or intraocular pressure

SE = Dehydration, hypo or hypernatremia, Pulmonary edema

Contraindicated in Anuria (making no pee) & HF

393
Q

Common (fibular) peroneal nerve? Innervation? Cause of injury? Presentation?

A

L4-S2

Sensory information for dorsum (top) of foot & lateral leg

INJURY DUE TO Trauma or compression of LATERAL leg – FIBULAR neck fracture

Presents – FOOT DROP, loss of sensation dorsum (TOP) of foot.

Loss of Dorsiflexion & Eversion – So foot is INVERTED & PLANTARFLEXED @ rest

Extensor Hallucis Longus weakness

394
Q

Type 1 pneumocytes description?

A

Squamous

97% of alveolar surfaces

Thinly line the alveoli for optimal gas exchange

395
Q

Type 2 pneumocytes description?

A

Cuboidal & clustered

Serve as stem cell precursors for 2 cells types – type 1 & 2 pneumocytes

Type 2 PROLIFERATE DURING LUNG DAMAGE

396
Q

Surfactant description?

A

Decrease alveolar surface tension

Decrease alveolar collapse

Decrease lung recoil

Increase lung compliance

Composed of multiple lecithin’s – mainly DPPC

Synthesis begins around 20 weeks & is mature around 35

Glucocorticoids important

397
Q

Neonatal RDS? Treatment? Complications?

A

Surfactant deficiency

Increase in surface tension leads to alveolar collapse – ground glass appearance

TX = Maternal glucocorticoids before birth; exogenous surfactant for infant

Therapeutic supplemental oxygen can result in retinopathy of prematurity, intraventricular hemorrhage or bronchopulmonary dysplasia

Screening = Lecithin-Sphingomyelin ratio

398
Q

What are the labs for Von Willebrand Factor?

A

Normal platelets

Normal PT

Prolonged PTT – Due to low levels of Factor VIII

399
Q

What is X-linked agammaglobulinemia?

A

Defect in BTK gene – Tyrosine kinase

No B cell maturation

Low or absent circulating mature B cells – CD19, CD20, & CD21

Increased in boys – X linked recessive

Recurrent bacterial & enteroviral infections after 6 months – Maternal IgG depleted

Absent B cells in peripheral blood

Decreased Ig of all classes

Absent lymph nodes

Live vaccines contraindicated (polio)

400
Q

Two drug classes and drugs for motion sickness?

A

Antimuscarinics (anticholinergics) = Scopolamine

Antihistamines – 1st & 2nd gen

1st generation – Diphenhydramine, Dimenhydrinate, Chlorpheniramine, & Doxylamine

Used for allergies, motion sickness, pregnancy nausea, & sleep aid

SE = Sedation, antimuscarinic & antiadrenergic

2nd generation – Loratadine, Fexofenadine, Desloratadine

Used for allergies

Far less sedating

401
Q

Effects of Desmopressin therapy for Mild hemophilia A or Von Willebrand disease?

A

Increases circulating factor VIII & endothelial secretion of vWF to stop bleeding

402
Q

Effects of Desmopressin therapy for Central diabetes insipidus & nocturnal enuresis?

A

Binds to V2 receptors in renal tubular cells – Leading to increased aquaporin channels

Increased water reabsorption & decreased urine output

403
Q

How does superior vena cava syndrome present?

A

Presents with facial swelling, distended collateral veins, headache, dyspnea

Extrinsic compression of the SVC by mediastinal mass – impaired venous return from upper part of body

SWOLLEN EVERYWHERE ABOVEEEE!!!

404
Q

Noise induced hearing loss damages what part of the ear?

A

Damage to sterociliated cells in the organ of Corti

Loss of high frequency first

405
Q

When do children understand the finality of death?

A

Around age 7

Before then, they may have magical thoughts that death is temporary or reversible and believe that other people’s grief is their fault

406
Q

Central venous pressure is equal to what?

A

Right heart preload

407
Q

Pulmonary capillary wedge pressure is equal to what?

A

Left heart preload

408
Q

Systemic vascular resistance is equal to what?

A

Afterload

409
Q

What is the primary disturbance in distributive shock?

A

Sepsis, anaphylaxis

The disturbance is profound peripheral vasodilation – in the case of anaphylaxis, resulted from the widespread IgE mediated release of histamine

Arteriolar vasodilation causes decreased SVR (Afterload)

Venular vasodilation causes decreased CVP (Right heart preload) & reduces venous return to RA

With reduced venous return to the RA – There is reduced RV output & reduced blood delivery to the LA & LV – This leads to decrease in PCWP (Left heart preload)

Cardiac output is often increased due to reduced SVR & a baroreceptor reflex mediated increase in HR

410
Q

What do you see on arterial blood gas for pulmonary embolism?

A

PE presents with hypoxemia due to V/Q mismatch

Acute respiratory alkalosis due to hyperventilation

411
Q

What is Wernicke encephalopathy? What can it lead to?

A

Thiamine (B1) Deficiency

The MAMMILLARY bodies in the brain are most susceptible due to high metabolic demand

Thiamine deficiency very common in patients with ALCOHOL use disorder – but also with malnutrition

Chronic effects of thiamine deficiency leads to Korsakoff syndrome

Korsakoff has triad of confusion, ophthalmoplegia, & ataxia

412
Q

When you hear dysphagia / hoarseness when it comes to stroke, what do you think?

A

Lateral medullary (Wallenberg) syndrome

Usually vertebral artery occlusion (PICA)

IPSILAERAL loss of pain & temperature sensation in the face

CONTRALATERAL loss of pain & temperature in the body

Ipsilateral Horner

Ipsilateral ataxia

413
Q

Rheumatoid Arthritis classically arises in which population? Associated with what? Hallmark?

A

Arises in women of late childbearing age

Associated with HLA-DR4

Hallmark is synovitis loading to formation of a pannus (inflamed granulation tissue)

Leads to destruction of cartilage & ankylosis (fusion) of joint

414
Q

Clinical features of RA?

Which joints are involved?

What’s spared?

A

Pain & swelling with morning stiffness that IMPROVES with activity

Symmetric involvement of the PIP joints (Swan neck)

Affects the PIP & MCP

Spares the DIP

Baker cyst – Swollen bursa behind the knee

Pleural effusions, lymphadenopathy & interstitial lung fibrosis

Rheumatoid nodules – central zone of necrosis surrounded by epithelioid histiocytes – in skin & visceral organs

Cervical subluxation – extension of the neck during intubation worsens the subluxation & leads to acute compression followed by paralysis

415
Q

Treatment for RA?

A

NSAIDs

Glucocorticoids

Methotrexate – Folic acid analog that competitively inhibits dihydrofolate reductase – Reduces dTMP & decreases DNA synthesis (SE = Myelosuppression, pulmonary fibrosis, folate deficiency, nephrotoxicity)

Sulfasalazine – Combo of sulfapyridine (antibacterial) & 5-aminosalicyclic acid (anti-inflammatory) Activated by colonic bacteria (SE = Oligospermia)

TNF-alpha inhibitors

416
Q

Lab findings for RA?

A

IgM autoantibody against Fc portion of IgG (rheumatoid factor); marker of tissue damage & disease activity

Neutrophils & high protein in synovial fluid

417
Q

Atrial septal defect characteristic auscultatory finding?

A

Fixed wide splitting of S2

Characterized by left to right shunt due to higher pressure in the LA compared to the RA

This increase in flow causes right sided volume overload – delayed closure of pulmonic valve (wide S2)

Ostium secundum defect is the most common

O2 saturation in is increased in RA, RV & pulmonary artery

Associated with down syndrome

418
Q

What is Eisenmenger syndrome?

A

Uncorrected left to right shunt (VSD,ASD,PDA)

Increase in pulmonary blood flow causes pathologic remodeling of vasculature

This causes pulmonary arterial hypertension

RVH occurs to compensate – Shunt becomes right to left when RV pressure is greater than LV pressure

Late cyanosis, clubbing, & polycythemia

Repair to prevent irreversible changes to the pulmonary vessels

419
Q

What is Acanthosis Nigricans?

A

Hyperpigmented thickening of skin – especially in neck, axilla

Associated with insulin resistance

Plaque on back of neck & skin tags (Daddy’s)

420
Q

What is Lichen Planus?

A

5 P’s

Polygonal, Planar, Pruritic, Purplish plaques on the wrists, hands, trunk & legs

White (Wickham) striae

Associated with Hepatitis C

421
Q

Vinca Alkaloids

Vincristine & Vinblastine MOA, Uses? SE?

A

Bind beta-tubulin

Prevents the FORMATION of mitotic spindle (vs. Taxanes that prevent breakdown)

Used for leukemias, lymphomas

Vincristine (Crisps the nerves) neuropathy, constipation

Vinblastine (blasts the marrow) myelosuppression

422
Q

What is the main effect of glucagon when treating hypoglycemia?

A

Increasing hepatic glycogenolysis – release of glucose from preexisting hepatic glycogen stores

423
Q

What is a major SE of Carbamazepine?

A

Causes SIADH by increasing ADH secretion & renal sensitivity to ADH

MOA = blocks Na+ channels

DOC for focal tonic-clonic seizures & Trigeminal neuralgia

SE = Blood dyscrasias such as leukopenia = AGRANULOCYTOSIS

DRESS syndrome – 2-8 weeks post exposure w/ eosinophilia (also Phenytoin)

424
Q

What is SIADH?

A

Increased ADH secretion

ADH is released by the hypothalamus & posterior pituitary & stimulates the renal collecting ducts to reabsorb more water into systemic circulation

Serum sodium & osmolality decreasing – Hypotonic hyponatremia

Urinary water excretion decreases – Increasing osmolality & concentrated urine

Clinical Euvolemic (absence of edema, lung crackles, or JVD

Elevated BUN & Creatinine

Caused by head trauma, ectopic ADH (SCLC)

Exogenous hormones (vasopressin, desmopressin, oxytocin)

Lung disease

Drugs – SSRIs, Carbamazepine, Cyclophosphamide

Treatment = water restriction & Demeclocycline (ADH antagonist)

425
Q

What lung cancer targets non-smokers & women? Location?

A

Adenocarcinoma

Peripheral

Most common primary lung cancer

Associated with clubbing & hypertrophic osteoarthropathy (arthritis)

Mucin (+)

KRAS, EGFR, & ALK mutations

426
Q

Prostate adenocarcinoma arises where on the prostate? How is it diagnosed? Labs? Metastasis?

A

Posterior, peripheral lobe

Diagnosed with needle core biopsies (transrectal, US guided) – multiple samples

Increase in total PSA

Decrease in % of free PSA

Does not produce urinary symptoms

Metastasis to the spine – Increase in serum ALP

427
Q

Dofetilide & Ibutilide SE?

A

Class III – K+ channel blocker

MOA = Increase AP duration, Increase ERP, Increase QT

Used for rhythm control & Afib

QT interval prolonged leads to increase risk of Torsade de pointes – a form of polymorphic ventricular tachycardia that can cause syncope & sudden death

428
Q

Which insurance has low monthly premiums?

A

HMO

429
Q

How does acute hepatitis B present?

A

Jaundice with mixed & unconjugated bilirubin

Dark urine, fever, malaise

Elevated liver enzymes (ALT>AST)

Joint pain, lymphadenopathy, pruritic urticarial rash

430
Q

Cluster headaches localization? duration? description? treatment?

A

Unilateral

15 minutes to 3 hours – During sleep or similar timing daily

Excruciating periorbital pain w/ autonomic symptoms

Lacrimation, rhinorrhea

Horner syndrome possible

Males > females

Sumatriptan for acute w/ 100% oxygen

Verapamil for prevention

431
Q

Migraine headache localization? duration? description? treatment?

A

Unilateral

4-72 hours

Females > males

Pulsating & throbbing pain w/ nausea or photophobia

CN V irritation

TX acute = NSAIDs, triptans, dihydroergotamine, antiemetics

TX prevention = Beta blockers, amitriptyline, Topiramate, Valproate

432
Q

Tension headache localization? duration? description? treatment?

A

Bilateral

Female > male

4-6 hours; constant (months to years)

Steady “bandlike” pain – No photophobia / aura

Dull & tight pain

Muscle tenderness in the head, neck, or shoulders

433
Q

What is a common cause of chronic mediastinitis

A

Histoplasma capsulatum

OHIOOOOOO

434
Q

Type 1 Hypersensitivity reactions?

A

IgE

Basophils / Mast cells

Cell surface bound antibody linking by antigen

435
Q

Type 2 hypersensitivity reactions?

A

IgG & IgM autoantibodies

Complement mediated cytotoxicity

NK Cells, Neutrophils, Macrophages

Autoimmune hemolytic anemia & Goodpasture

436
Q

Type 3 hypersensitivity reactions?

A

Deposition of antibody-antigen-complement complexes

Neutrophils

Serum sickness, PSGN, lupus nephritis

437
Q

Type IV hypersensitivity?

A

T cells & macrophages

CD8 cytotoxic T cells

Contact dermatitis / Tuberculin skin test

DOES NOT INVOLVE ANTIBODIES

438
Q

Cauda equina syndrome pathogenesis? findings?

A

Compression of the spinal roots L2 & BELOW – due to lumbar disc herniation or tumor

Motor deficits = Broad based shuffling gait, absent knee or ankle reflex

Saddle anesthesia – impaired sensation in butt / perianal area

Autonomic dysfunction = Bowel or bladder dysfunction or sexual dysfunction (S3-S5 damaged)

Confirm with MRI

439
Q

What is pituitary apoplexy? Presentation?

A

Acute pituitary hemorrhage

Severe headache

Bitemporal hemianopsia (compression of optic chiasm)

Usually occurs in a preexisting pituitary adenoma (patient with chronic headaches & low libido) likely due to hyperprolactinemia

Acute loss of ACTH secretion leads to adrenal crisis

TX = urgent glucocorticoids to prevent adrenal crisis

440
Q

Polycythemia Vera pathogenesis? presentation? Labs?

A

Disorder of UNCONTROLLED ERYTHROCYTE PRODUCTION

Presents with headache, facial plethora (flushed face) & splenomegaly

Itching after shower (aquagenic pruritus)

Associated w/ PUD & gouty arthritis

Acquired JAK2 mutation (Cytoplasmic tyrosine kinase)

DECREASED IN ERYTHROPOIETIN (EPO) vs. secondary polycythemia

441
Q

Sirolimus MOA? Uses? SE?

A

Also called Rapamycin

mTOR inhibitor

Blocks T cell activation & B cell differentiation by PREVENTING response to IL-2

Used specifically for kidney transplant rejection prophylaxis

SE = Pancytopenia, hyperlipidemia

442
Q

Congenital hypothyroidism pathogenesis? Findings?

A

Formerly called cretinism

Most commonly by thyroid dysgenesis (abnormal development)

Pot bellied, pale, puffy face child with protruding umbilicus & protuberant tongue

After maternal thyroxine wanes (weeks to month)

DX = Increase in TSH & Decrease in free thyroxine (T4) levels

443
Q

Above the pectinate line is what type of pathology?

A

INTERNAL hemorrhoids or adenocarcinoma

Internal hemorrhoids – Older age & chronic constipation

Receive VISCERAL innervation & therefore NOT painful

A(I)bove

444
Q

Below the pectinate line is what type of pathology?

A

External hemorrhoids, anal fissures, SQUAMOUS CELL CARCINOMA (Vs adenocarcinoma with internal hemorrhoids)

External hemorrhoids – Receive somatic innervation from PUDENDAL nerve – VERY PAINFUL

Typically without bleeding but very PAINFUL

Anal fissure – Tear in the abdomen below pectinate line, pain while pooping, blood on toilet paper, located in POSTERIOR midline because this area is poorly perfused – Associated with low fiber diets & constipation

B(E) it’s literally the first 2 letter

445
Q

Imiquimod MOA? Uses? SE?

A

Binds toll-like receptor of macrophages to activate them

Topical antitumor immune response modifier

Used in anogenital warts / actinic keratosis

446
Q

How do you treat norepinephrine extravasation?

A

Phentolamine – alpha receptor blocker that leads to vasodilation – counteracting the vasoconstrictive effects of NE

447
Q

PCOS presentation?

Which hormones are increased?

Cancer risk?

TX?

A

INCREASE in LH — DECREASE in FSH

HIRSUTISM & ACNE

INCREASE RISK OF ENDOMETRIAL CANCER

Increase in estrogen & testosterone — reason for risk of cancer due to unopposed estrogen

LH induces excess androgen production from Theca cells

Androgens are converted to Estrone in adipose tissue

Estrone feedback inhibits FSH

Common cause of infertility

Enlarged ovaries / obesity / hirsutism & acne

TX = OCPs to prevent endometrial hyperplasia due to unopposed estrogen (PCOS increases risk for endometrial cancer)

Spironolactone for hirsutism

448
Q

Acute tubular necrosis diagnosis? Findings?

A

ATN caused by renal ischemia

Oliguria, Increased serum creatinine

MUDDY BROWN CASTS

Proximal tubules & thick ascending limb are most affected

HYPERKALEMIA w/ metabolic acidosis

During the recovery stage, the GFR improves so electrolyte wasting (resulting in hypokalemia) can occur

449
Q

How does Wiskott-Aldrich syndrome present?

A

Mutation in WAS gene

6-12 months of age

Defective ANTIGEN PRESENTATION

Thrombocytopenia, ECZEMA, Recurrent (pyogenic) infections

Fewer & smaller platelets

450
Q

Trazodone MOA? SE?

A

Serotonin modulator used for insomnia

May cause priapism – Persistent erection

451
Q

What is the most common pediatric arrhythmia?

A

Supraventricular tachycardia

SVT occurs when an impulse originates at an abnormal focus above the ventricles – most likely a reentrant circuit within the AV node

HR is super elevated – above 220 in infants

Narrow QRS & absent P waves

Ventricular diastole is shortened due to persistent tachycardia = causes hypotension

452
Q

Gram positive rod that causes tissue necrosis & gas in tissues?

A

C. Perfringens

Alpha toxin of lecithinase splits phospholipids

453
Q

What is the only diuretic that causes hypercalcemia & hyperglycemia & Bicarb?

A

Thiazide diuretics

Hydrochlorothiazide, Chlorthalidone, Metolazone

Decrease calcium EXCRETION in urine — That means increase in serum calcium

Inhibits sodium chloride reabsorption in early DCT

Increase in Bicarb causes metabolic alkalosis

454
Q

What is the only diuretic that causes hyperkalemia?

A

Potassium sparing diuretics

Spironolactone, Eplerenone, Amiloride, Triamterene

Competitive aldosterone receptor antagonist in cortical collecting tubule

Triamterene & Amiloride block sodium at that same part

455
Q

Which Interleukin should you think of when you think of eosinophils?

A

Eosinophils are recruited & activated by IL-5 secreted by Th2 type T cells

456
Q

Piriformis syndrome is impingement of what nerve? What other buzzwords?

A

Sciatic nerve impingement

Pain radiating down posterior leg / thigh (S1 dermatome)

457
Q

Psoas syndrome associated with radiculopathy?

A

No – no numbness or paresthesia

Pain does radiate to the groin

Psoas is a major HIP FLEXOR – So pain is elicited on Hip EXTENSION

458
Q

Candida buzz words?

A

Pseudohyphae with blastoconidia

Mucocutaneous or invasive infections i.e. candidemia due to vascular catheter

459
Q

Blastomycoses buzz words?

A

Yeast with BROAD BASED BUDDING

Inhaled — SKIN to BONE

460
Q

Coccidioides buzz words?

A

SPHERULES with ENDOSPORES

Transient pulmonary syndrome

Meninges & bone

461
Q

Cryptococcus buzz words?

A

ENCAPSULATED (in a crypt) yeast

Meningitis in immunocompromised patients

462
Q

Histoplasma buzz words?

A

Small oval yeast within MACROPHAGES

Subclinical but can cause community acquired pneumonia with dissemination

463
Q

How does Sarcoidosis present? buzz words?

A

FEMALE, enlarged lymph nodes, HILAR LYMPHADENOAPTHY

NONCASEATING GRANULOMAS

Mild hepatomegaly with increased ACE levels

HYPER-CALCEMIA

464
Q

Anterior cerebral artery occlusion result?

Middle cerebral artery occlusion result?

A

ACA – Contralateral LOWER extremity deficits

MCA – Contralateral UPPER extremity & LOWER FACIAL deficits

465
Q

Physiologic response to hypothermia?

A

Increased Sympathetic activity

Increased thyroid hormone release

Shivering

Peripheral vasoconstriction

Reducing heat loss & increasing metabolic rate to promote thermogenesis

466
Q

If systolic pressure is high, what is the problem?

If diastolic pressure is high, what is the problem?

A

Systolic = resistance

Diastolic = volume

Both = both, but usually its a volume problem (i.e. excess aldosterone)

467
Q

Postoperative ileus OMM bull shit to reduce sympathetic chain?

A

Paraspinal inhibition – improves bowel motility

468
Q

Who produces Interferon gamma?

A

T lymphocytes

IF-Gamma activates macrophages in TB

469
Q

AA joint dysfunction is what?

A

C1 (atlas) about the dens of the axis C2 (axis)

Flex neck 45 degrees

AA joint movement is rotation

470
Q

What is the precursor to serotonin?

A

Tryptophan

471
Q

Tyrosine is a precursor for what?

A

Dopamine, epinephrine, norepinephrine

472
Q

Which interleukin stimulates immunoglobulin class switching to IgE responsible for type 1 hypersensitivity?

A

IL-4

473
Q

What is the CV4 technique?

A

Used in patients with SBS compression

Decompresses the fourth ventricle & normalizes CRI

474
Q

Atopic dermatitis begins when? Also known as? Associated with?

A

Begins in early infancy or childhood

Eczema

IgE is stimulated by plasma cells

Increases risk for allergic rhinitis, asthma, & food allergies

475
Q

Paroxysmal nocturnal hemoglobinuria pathogenesis?

How does it present?

Labs?

A

Mutated PIGA gene

Impaired GPI anchor protein – GPI attaches CD55 (CD55 inactivates complement)

So with GPI being fucked, CD55 can’t inactivate complement, which means you get uncontrolled complemented mediated intrinsic hemolysis

COOMBS NEGATIVE

Pancytopenia

PINK / RED urine in the MORNING & thrombosis @ atypical sites

Chronic hemolysis can cause iron deposition in the kidney (hemoosiderosis)

476
Q

Acute Tubular Necrosis key finding?

A

GRANULAR MUDDY BROWN casts

Can be caused by Aminoglycosides, cisplatin, ethylene glycol

477
Q

RBC casts?

A

Glomerulonephritis

478
Q

WBC casts?

A

Indicate a nephritis

Acute pyelonephritis / Transplant rejection

479
Q

Granular casts?

A

ATN – Muddy brown

480
Q

Fatty casts?

A

NEPHROTIC syndrome every single time

481
Q

Waxy casts?

A

CKD / End stage renal disease

482
Q

How does hereditary hemochromatosis present?

A

LOW HEPCIDIN production. INCREASED INTESTINAL IRON ABSORPTION

Iron accumulates everywhere

Prussian blue stain

Presents AFTER 40 when total body iron is above 20

Hyperpigmentation

Chronic fatigue

Arthritis – particularly in the 2nd / 3rd MCP joints

Chondrocalcinosis

Hepatomegaly

Diabetes / hypopituitarism

DILATED CARDIOMYOPATHY – HCC cause of death

483
Q

NON-REM sleep stages?

A

Stage N1 – Light sleep (Theta Waves)

Stage N2 – Deeper sleep, Twoth bruxism occurs here (sleep spindles & K complexes)

Stage N3 – Sleepwalking, bedwetting (Delta)

REM sleep - Beta waves

484
Q

Proto-Oncogenes 1 hit GAIN of function

RAS, MYC, EGFR, HER2, ABL, BRAF

A

RAS – Cholangiocarcinoma & Pancreatic Adenocarcinoma

MYC – Burkitt Lymphoma

EGFR – Lund adenocarcinoma

HER2 – Breast cancer

ABL – Chronic Myelogenous Leukemia (CML)

BRAF – Hairy cell leukemia & melanoma

485
Q

Tumor suppressor genes 2 hit LOSS of function

BRCA1/2, APC/Beta-Catenin, TP53, RB, WT1, VHL

A

BRCA1/2 – Breast & Ovarian cancer

APC / Beta-Catenin – Colon, Gastric & pancreatic cancer / FAP

TP53 – Most cancers / Li-Fraumeni syndrome

RB – Retinoblastoma / Osteosarcoma

WT1 – Wilm’s tumor

VGL – Renal cell carcinoma

486
Q

Galbreath can help children with Otitis Media, and also in what cases?

A

Acute rhinosinusitis

Applying anterior & medial traction on the MANDIBLE

487
Q

How does SCID present?

A

Failure to thrive

Chronic diarrhea

Oral thrush

Recurrent viral, bacterial, fungal, & protozoal infections

ABSENT thymic shadow

488
Q

Phenytoin MOA? SE?

A

Blockade of sodium channels in neurons – efflux of sodium out of cells

Hirsutism

GINGIVAL HYPERPLASIA

Megaloblastic anemia & Osteomalacia

489
Q

Vegan diet deficient in what?

A

Vitamin B12 (Cobalamin)

Calcium

Vitamin D

Iron deficiency in women

490
Q

Patients with CKD develop hyperphosphatemia – What is secreted in response?

A

FGF23 – Lowers plasma phosphate by reducing intestinal absorption & renal reabsorption of phosphate

Promotes excretion

491
Q

Turner syndrome due to?

A

Loss of X chromosome – 45 XO

Streak ovaries (replaced by connective tissue)

Primary Ovarian insufficiency

BICUSPID aortic valve

Increased risk for AORTIC DISSECTION

Horseshoe kidney – Fusion of lower poles

492
Q

Lead poisonings key findings?

A

Increased levels of D-ALA & PROTOPORPHYRIN

BASOPHILIC STIPPLING – blue granules in cytoplasm of red cells

lead lines at gum tooth line

WRIST & FOOT DROP

TX = Dimercaprol, EDTA, DMSA (Succimer)

493
Q

Acute promyelocytic leukemia characterized by?

A

Translocation 15;17

494
Q

Acute myeloid leukemia markers?

A

MPO +

Crystal aggregates seen as Auer rods

Increase risk for DIC

Treatment with Retinoic acid

495
Q

Down syndrome before 5 YO - What leukemia?

Down syndrome after 5 YO - What leukemia?

A

Before – Acute MEGAKARYOBLASTIC leukemia (Before 5 has bad manners, BM)

After – Acute LYMPHOBLASTIC leukemia

496
Q

CML characteristics?

A

Basophilia w/ granulocytes

BCR-ABL – Tyrosine kinase activity increased

9;22

Imatinib is tx

LAP (-)

497
Q

Polycythemia Vera characteristics?

A

JAK2 kinase mutation

Hype viscosity of blood

Blurry vision & headache

Itching after bathing (increased histamine from mast cells)

Thrombosis – Budd Chiari syndrome

EPO is DECREASED

In reactive polycythemia due to high altitude – EPO is INCREASED – high altitude = high EPO

498
Q

Essential thrombocytopenia

A

Proliferation of platelets

JAK2 kinase mutation

Increased bleeding risk

499
Q

Myelofibrosis characteristics?

A

Splenomegaly due to extramedullary hematopoiesis

JAK2 kinase mutation

Megakaryocytes produce excess PDGF – Causes marrow fibrosis

Tear drop

Leucoerythroblastic smear

500
Q

Painful lymphadenopathy associated with?

Painless lymphadenopathy associated with?

A

Painful = acute infection

Painless = Chronic inflammation, carcinoma, lymphoma

501
Q

Follicular lymphoma features?

A

Proliferation of small B cells

CD20 (+)

Late adulthood w/ painless lymphadenopathy

Driven by t(14;18)

BCL2 expression is INCREASED = Inhibits apoptosis

Tx = Rituximab

Differs from reactive follicular hyperplasia by disruption in lymph node architecture & BCL2 expression in follicles

502
Q

Mantle cell lymphoma features?

A

Proliferation of small B cells that expands the mantle zone

CD20 (+)

Late adulthood w/ painless lymphadenopathy

Driven by t(11;14)

Cyclin D1 is overexpressed – promotes G1/S transition – facilitating neoplastic proliferation

503
Q

Marginal zone lymphoma features?

A

Proliferation of small b cells that expands the marginal zone

CD20 (+)

Associated with Hashimoto, Sjogren, H. Pylori Gastritis

Marginal zone is formed by post-germinal center B cells

MALToma is marginal zone lymphoma in mucosal sites

Gastric MALToma may regress w/ treatment for H. Pylori

504
Q

Burkitt lymphoma features?

A

Proliferation of Intermediate sized B cells

CD20 (+)

EBV association

Extranodal mass in child or young adult

Sporadic form involves the abdomen

C-MYC translocation – t(8;14)

MYC overexpression oncogene promotes cell growth

Starry sky

505
Q

Diffuse Large B cell lymphoma features?

A

Proliferation of large B cells

CD20 (+)

Most common form of Non-Hodgkin lymphoma

High grade

Arises sporadically or from transformation i.e. follicular lymphoma

Adulthood presentation as enlarging lymph node or Extranodal mass

506
Q

Hodgkin lymphoma features?

A

Proliferation of Reed-Sternberg cells

Large B cells w/ MULTILOBED nuclei

CD15 & CD30 (+)

Reed Sternberg secretes cytokines

Can lead to fibrosis

507
Q

Nodular sclerosis subtype of HL features?

A

Enlarging cervical or mediastinal lymph node in young adult, usually female

Lymph node divided by bands of sclerosis

508
Q

Multiple Myeloma features?

A

Proliferation of plasma cells in the bone marrow

High IL-6 – stimulates plasma cell growth & Ig production

Bone pain w/ hypercalcemia

RANK receptor on osteoclasts leads to bone destruction

M spike – due to IgG or IgA

Rouleaux formation of RBCs on blood smear

Primary AL amyloidosis – Free light chains circulate in serum & deposit in tissues

Proteinuria

509
Q

Langerhans cell histiocytosis features?

A

Proliferation of Langerhans (skin) cells

Derived from bone marrow monocytes

Birkbeck granules

CD1a (+) & S-100 (+)

510
Q

Schizoid (cluster A) features?

A

Social withdrawal & solitary activities (vs. avoidant)

No motivation for relationships (vs. avoidant)

Blunt affect

511
Q

Schizotypal Personality Disorder Features?

A

Eccentric fucking MAGICAL thinking

Symptom & genetic overlap with schizophrenia

512
Q

Borderline Personality Disorder Features?

A

Unstable mood

Negative self image

Border b/t neurotic & psychotic

Cut themselves

Perceive the world as all good or all bad “splitting” – CLASSIC TEST QUESTION

Recurrent interpersonal difficulty throughout life

513
Q

Histrionic personality disorder features?

A

Highly attention seeking & outwardly emotional

Center of attention

514
Q

Antisocial personality disorder features?

A

No regard for others

Tend to be CRIMINALS, violent, “sociopaths”

Likeable due to manipulation

Associated with Enuresis (bedwetting)

MUST BE above 18

If under 18, Conduct Disorder

515
Q

Obsessive Compulsive Personality Disorder Features?

A

Overly rigid

Preoccupied with order & control

Doing things “my way”

Perfectionists

EgoSyntonic (vs. OCD)

EgoDystonic is OCD – Meaning the patient does NOT like it

516
Q

Huntington’s Disease Features?

A

Autosomal Dominant – CAG repeat – Toxic gain of function

b/t ages 20-50

Anticipation from repeats

Caudate nucleus loses ACh & GABA

Ex Vacuo Ventriculomegaly – Enlargement of lateral ventricles

Increase in Dopamine

Decrease in GABA & ACh

Neuronal death via NMDA-R binding & glutamate excitotoxicity

517
Q

Muscles responsible for Hip Flexion?

A

Iliopsoas

Rectus Femoris

TFL

518
Q

Muscles responsible for Hip Extension?

A

Gluteus maximus

Semitendinosus

Semimembranosus

Biceps Femoris – Long head

519
Q

Muscles responsible for Hip Abduction?

A

Gluteus Medius

Gluteus Minimus

520
Q

Muscles responsible for Hip Adduction?

A

Adduction Brevis

Adductor Longus

Adductor Magnus

521
Q

Celiac Disease Features?

A

Gluten (Gliadin) Consumption – Immune mediated small intestine inflammation

All leading to chronic malabsorption

Iron Deficiency anemia & Dermatitis Herpetiformis (PRERITIC VESICLAR RASH ON ELBOWS)

HLA DQ (+)

Affects DISTAL DUODENUM or PROXIMAL JEJUNUM – Steatorrhea due to malabsorption

Tissue Transglutaminase IgA

Antiendomysial antibodies

Duodenal biopsy reveals intraepithelial lymphocytes w/ crypt hyperplasia

BLUNTED OR ABSENT VILLI

Associated with T1D & T cell lymphoma

522
Q

Emphysema Pulmonary Labs?

A

Increase in FRC, RV, TLC

Increase in elastase = INCREASE in LUNG COMPLIANCE

DECREASE in ELASTICITY

Increased AP diameter

Decrease in FEV1 & Recoil

Macrophages & neutrophils activate proteases

Neutrophils are the inflammatory cells here

DLCO from destruction of alveolar walls

523
Q

Smoking associated with which emphysema?

A

Centriacinar

Destruction of Alveolar air sacs

Affects bronchioles

Spares the distal alveoli

In the UPPER lobes – Smoke rises up

524
Q

Panacinar emphysema features?

A

Affects respiratory bronchioles & alveoli

Associated with A1-antitrypsin deficiency

LOWER Lobes

525
Q

Scabies features?

A

Intensely pruritic rash (Worse at night)

Rash is on flexor surfaces of the wrist, fingers, elbows, axillary folds

Excoriations w/ red papules

Mites ova & feces under LM

TX = Permethrin cream or oral ivermectin

526
Q

Zona Glomerulosa Secretes What?

Zona Fasciculata Secretes What?

Zona Reticularis Secretes What?

Adrenal Medulla Secretes What?

A

G – Secretes mineralocorticoids – primarily Aldosterone

F – Glucocorticoids – Primarily Cortisol

R – Androgens – Primarily DHEA

M – Chromaffin cells – Stimulates ACH to secrete Catecholamines – E (80%) & NE (20%)

527
Q

Chronic Kidney Disease does what to phosphate levels?

A

Hyperphosphatemia & low vitamin D

The resulting hypocalcemia causes secondary hyperparathyroidism

528
Q

Pyuria w/ negative urine culture suggests what?

A

Urethritis due to Chlamydia or Neisseria

529
Q

Acute Pyelonephritis increased risk with what?

A

Vesicoureteral reflux

530
Q

Labs for Acute Pyelonephritis?

A

WBCs in urine w/ or w/o WBC casts

CT shows striated parenchymal enhancement

531
Q

Chronic Pyelonephritis is classically seen in who? Features?

A

Children due to Vesicoureteral reflux or obstruction

Cortical Scarring & Blunted calyces

Renal Tubules contain eosinophilic casts resembling THYROID TISSUE

532
Q

What is characteristic of Vesicureteral reflux?

A

Scarring @ Upper & Lower Pole of Kidney

533
Q

Calcium Oxalate kidney stone features?

A

Radiopaque

Envelope or dumbbell shape

MCC is idiopathic hypercalciuria – Must r/o hypercalcemia

Associated with Chron’s disease

Can result from ethylene glycol (antifreeze)

TX = Thiazides (HCZ) / Citrate

HCZ – Calcium sparing

534
Q

Ammonium Magnesium Phosphate stone features?

A

MCC is infection w/ urease (+) i.e. Proteus / Klebsiella

Alkaline urine forms the stone

Only one that causes Increase in pH

Staghorn calculi in renal calyces

TX = surgery / abx

535
Q

Uric Acid Stone Features?

A

Radiolucent – NOT VISIBLE ON X RAY

ACIDIC pH

Rhomboid / Rosette shape

Strong association with hyperuricemia i.e. gout

Also seen w/ high cell turnover i.e. leukemia

TX = Alkaliniziation of urine – Hydration & Potassium BiCarb

ALLOPURINOL for Gout patients

536
Q

Consequences of Renal Failure?

A

MAD HUNGER

Metabolic Acidosis w/ anion gap

Dyslipidemia – Especially TGs

High potassium – Secondary hyperparathyroidism

Uremia

Na+ retention – HF / Pulmonary edema = Hyperkalemia

Growth retardation

Erythropoietin deficiency – anemia – EPO is produced by renal peritubular interstitial cells

Renal osteodystrophy

PHOSPHATE is NORMAL in early stages due to Increase in FGF23 – Fights Fosphate – Hyperphosphatemia

Hyperphosphatemia – Increase in free serum phosphate due to Decreased excretion (i.e. renal failure)

537
Q

Serum calcium in renal failure?

A

Hypocalcemia

Hyperphosphatemia – Phosphate behinds to the free calcium

Hypocalcemia causes PTH levels to rise – osteitis fibrosa

538
Q

How does Tracheoesophageal fistula present?

A

Polyhydramnios due to inability of fetus to swallow amniotic fluid

Significant DROOLING

Cyanosis w/ Feeds

X ray shows failure to pass nasogastric tube into stomach

539
Q

Cataracts presentation?

A

Painless, bilateral opacification of lens

Decreased night vision

ABSENT red reflex

Prolonged steroid use

Congenital risk factors – Trisomy 13,18,21

Rubella, Marfan, Alport, NF-2

540
Q

Alcohol (Ethanol) does what to glucose?

A

Ethanol is metabolized by alcohol dehydrogenase

NADH/NAD+ ratio is INCREASED

Inhibits gluconeogenesis & causes hypoglycemia

541
Q

S1 Heart Sound

A

Closure of Mitral & Tricuspid valve

542
Q

S2 Heart Sound

A

Aortic & pulmonary valve closure

543
Q

2 Drugs used for Hypertensive emergency?

A

Nitroprusside – Short acting vasodilator – Increases cGMP via direct release of NO – SE = Cyanide toxicity

Fenoldopam – Dopamine 1 receptor agonist

Decreases BP & Increases Natriuresis

544
Q

Does Nitroglycerin & the Isosorbide medications affect arteries or veins?

A

Vasodilate by Increase in NO in vascular smooth muscle

Increases cGMP

Dilates VEINS more than arteries

DECREASES Preload

545
Q

Isoniazid MOA? SE? HY?

A

Decreases Mycolic Acid synthesis – Requires bacterial Catalase peroxidase by KatG to convert into active metabolite

ALWAYS GIVE PYRIDOXINE (B6)

SE = Hepatoxic & toxic to neurons

SEIZURES in high doses that is refractory to Benzodiazepines

546
Q

Tetralogy of Fallot pathology? What improves the cyanosis?

A

Anterosuperior displacement of the infundibular septum

MCC of early childhood cyanosis

Pulmonary stenosis

RVH

Overriding aorta

VSD

Pulmonary stenosis forces right to left flow across VSD – RVH = “tet spells”

SQUATTING Increases SVR & decreases the right to left shunt

547
Q

Carcinoid tumors arise from what type of cells? complications? Labs?

A

Arise from Neuroendocrine cells – Commonly in intestine or lung

5-HT undergoes hepatic first pass metabolism & enzymatic breakdown by MAO in the lung

Carcinoid syndrome is when 5-HT reaches systemic circulation via liver metastasis

SYNDROME presents w/ flushing, diarrhea, right sided valve disease

Niacin Deficiency

INCREASE in 5-HIAA

Prominent Rosettes – Chromogranin A (+) & Synaptophysin (+)

Tx = Octreotide

548
Q

High Dose Dexamethasone Test results in Suppression, what is it?

A

Cushing Disease – ACTH secreting pituitary adenoma

549
Q

High Dose Dexamethasone test results in NO Suppression, what is it?

A

Ectopic ACTH secretion – Skin hyperpigmentation

Due to either SCLC or Carcinoid

550
Q

Stellate (Ito) cells?

A

Cells in the space of Disse – Store vitamin A

Responsible for hepatic fibrosis

551
Q

BPH complication?

A

Bladder outlet obstruction

Overtime, Increased urinary pressures can cause hydronephrosis

Leading to renal parenchymal atrophy with scarring – Eventual CKD

552
Q

Preeclampsia diagnosis made how?

A

New-onset HTN w/ either proteinuria or end organ dysfunction AFTER 20 weeks gestation

Before 20 – Consider molar pregnancy

553
Q

Preeclampsia pathogenesis?

A

Abnormal placental spiral arteries

Leads to endothelial dysfunction – Vasoconstriction

TX = IV magnesium sulfate to PREVENT seizures – Always check DTR

554
Q

How is Ecclampsia diagnosed?

A

Preeclampsia w/ seizures

TX = IV magnesium sulfate

555
Q

HEELP syndrome diagnosis?

A

PREECLAMPSIA w/ Thrombotic microangiopathy of the LIVER

Hemolysis

Elevated Liver enzymes (Increase ALT, AST)

Low Platelets

Can lead to hepatic subscapular hematomas

DIC due to release of tissue factor from injured placenta

556
Q

Beta Blocker side effect that you keep forgetting?

A

Masks hypoglycemia – Due to beta2 receptor antagonism

TX = Glucagon – Increases cAMP

557
Q

Aspirin toxicity presentation?

A

TINNITUS

Fever

Respiratory alkalosis early

Metabolic Acidosis late

Antidote == Sodium Bicarb

558
Q

Acetaminophen toxicity presentation?

A

RUQ pain

Centrilobular necrosis of liver

Antidote = N-acetylcysteine

559
Q

Warfarin or rat poision toxicity presentation?

A

Bleeding from nose, stool, urine

Elevated PT

Antidote - Vitamin K (minor bleed) or FFP

560
Q

Von Willebrand disease HY?

A

Increase in BT & PTT (intrinsic)

Intrinsic pathway coagulation defect that causes a Decrease in vWF

vWF carries & protects factor VIII

TX = Desmopressin – Releases vWF in endothelium

561
Q

What is the most common valvular disease associated w/ rheumatic heart disease?

A

Mitral stenosis – Loud S1 w/ mid diastolic rumble

Cardiac apex

562
Q

Torsade de Pointe etiology & treatment?

A

Excessive QT prolongation

Procainamide, Sotalol, Flecainide

Macrolides

Haloperidol

TX = Magnesium Sulfate

563
Q

Imaging of Bone metastases & diagnoses

A

Blastic – Prostate cancer & SCLC & HL

Lytic – Multiple Myeloma, NONsmall cell lung cancer, NON-Hodgkin lymphoma, thyroid cancer, Renal cell carcinoma, Melanoma

Mixed – GI & breast

564
Q

Sciatic Nerve innervation? Injury?

A

Motor innervation to semitendinosus, semimembranosus, biceps Femoris, adductor magnus

Herniated disc or POSTERIOR HIP DISLOCATION MC injuries

Impaired knee flexion

565
Q

Femoral Nerve L2-L4 Injury?

A

Pelvic fracture

Decrease in leg extension

Absent patellar reflex

Sensory innervation to anterior thigh & medial leg

566
Q

Axillary nerve (C5-C6) Injury? Presentation?

A

Surgical neck of humerus

Anterior dislocation of humerus

Flattened Deltoid

Loss of arm abduction @ shoulder (>15 degrees)

Loss of sensation over deltoid & lateral arm

567
Q

Musculocutaneous (C5-C7) Injury? Presenation?

A

Upper trunk compression – usually lifting weights

Decreased biceps reflex (C5-C6)

Loss of forearm flexion & supination

Loss of sensation over radial & dorsal forearm

568
Q

Radial (C5-T1) Injury? Presentation?

A

Compression of axilla

Due to crutches or sleeping w/ arm over chair

MIDSHAFT fracture of humerus

Repetitive pronation/supination of forearm due to screwdriver use = “Finger Drop”

Associated injury to deep brachial artery

Injury can occur @ supinator muscle

Wrist drop – Loss of elbow, wrist, & finger EXTENSION

DECREASED grip strength

BELOW the elbow causes paresthesias W/O wrist drop

Triceps function & Posterior arm sensation SPARED if midshaft fracture

569
Q

Median (C5-T1) Injury? Presentation

A

Supracondylar fracture of humerus – Proximal lesion of nerve

Carpal tunnel syndrome & wrist laceration – Distal lesion of nerve

Loss of wrist flexion

Impaired function of 2 lateral lumbricals, Opponens pollicis, & Flexor pollicis Brevis

570
Q

Ulnar (C8-T1) Injury? Presentation?

A

Fracture of medial epicondyle of humerus – Proximal lesion

Fracture of hook of hamate – Distal lesion (outstretched hand)

Ulnar nerve compresses against hamate as the wrist rests on handlebar during cycling

Radial deviation of wrist upon flexion – Proximal lesion

Decreased flexion of ulnar fingers

571
Q

Bisphosphonates MOA? SE?

A

Alendronate ( & other Dronates)

Pyrophosphate analogs

Bind to hydroxyapatite in bone – INHIBITS OsteoCLAST activity

SE = Esophagitis (take w/ water)

OSTEONECROSIS OF JAW

Atypical femoral stress fractures

572
Q

Scaphoid fractures?

A

Anatomic snuff box

Fall on an outstretched hand

Complications – Proximal scaphoid fractures include AVASCULAR NECROSIS & nonunion due to retrograde blood supply from radial artery

DOES NOT always show on initial x ray

573
Q

Scaphoid fractures?

A

Anatomic snuff box

Fall on an outstretched hand

Complications – Proximal scaphoid fractures include AVASCULAR NECROSIS & nonunion due to retrograde blood supply from radial artery

DOES NOT always show on initial x ray

574
Q

McMurray Test for Lateral Meniscal tear? Medial Meniscal tear?

A

Popping on internal rotation & VARUS force = Lateral meniscal tear

Popping on External rotation & VALGUS force = Medial meniscal tear

575
Q

Valsalva CV changes? What murmurs increase? What murmurs decrease?

A

Decreases Preload – Decreases LV volume

Murmurs that increase – MVP & HCM

Murmurs that decrease – Almost all – Decreases flow through stenotic or regurgitant valve

576
Q

Passive Leg Raise CV changes? What murmurs increase? What murmurs decrease?

A

Increase preload

Murmurs that increase – Most

Murmurs that decrease – MVP & HCM

577
Q

Squatting CV changes? What murmur increases? What murmur decreases?

A

Increase in preload & afterload

Murmurs that increase – Most

Murmurs that Decrease – MVP & HCM

578
Q

Handgrip CV changes? What murmurs increase? What murmurs decrease?

A

Big increase in afterload – Increases SVR

Murmurs that increase – Most left-sided murmurs (AR>MR>VSD)

579
Q

Seated flexion test is (-) when?

A

Symmetrical sacral dysfunction

i.e. bilateral sacral flexion or extension

Bilateral sacral FLEXION most associated with pregnancy

580
Q

Patients with tumor lysis syndrome present with hyperkalemia – How do you manage this?

A

ECG – Peaked T waves

Treat w/ CALCIUM GLUCONATE
(only if there are ECG changes)

Sodium Bicarb is also used

Or Loop diuretics

581
Q

Internuclear Ophthalmoplegia?

A

Medial Longitudinal Fasciculus

Pair of tracts that interconnect CN VI & CN III nuclei

Coordinates both eyes to move in the same horizontal direction

Classically seen in MS or stroke

582
Q

MLF lesion – Which side has the what?

A

Whichever side has the nystagmus – The lesion is OPPOSITE to the side

i.e. left nystagmus = RIGHT MLF lesion

583
Q

MS treatment? SE?

A

Pyridostigmine – Acetylcholinesterase inhibitor (increases acetylcholine)

SE = Increased salivation, lacrimation, miosis (pinpoint), diarrhea, urination, bradycardia, bronchoconstriction

ASTHMA exacerbation

584
Q

Saccular (also called Berry) Aneurysm features? Presentation?

A

Occurs @ bifurcations in circle of Willis

Most common site is junction of Anterior communicating & Anterior cerebral

Associated with ADPKD, & Ehlers-Danlos syndrome

Causes SUBARACHNOID HEMORRHAGE

ACom compression = BITTEMPORAL HEMIANOPIA (compression of optic chiasm) Ischemia in ACA – contralateral LE hemiparesis & sensory deficits `

585
Q

Pancoast tumor can cause what?

A

Thoracic outlet syndrome

Atrophy of intrinsic hand muscles

Can affect the T2 nerve root w/ pain along ulnar nerve distribution & numbness & atrophy of 4th & 5th digits

586
Q

Niacin – Lipid lowering agent MOA & SE?

A

Decreases secretion of VLDL by hepatocytes & prevents lipolysis (HSL)

Flushed face (prostaglandin mediated) Decreased w/ NSAIDs

Hyperglycemia

HYPERURICEMIA – GOUTY

587
Q

Innervation to Latissimus Dorsi?

A

Thoracodorsal nerve

588
Q

Innervationto Levator Scapulae?

A

Dorsal Scapular nerve

589
Q

Innervation to Serratus Anterior?

A

Long thoracic

590
Q

Innervation to Trapezius muscle?

A

Spinal accessory nerve

Cranial Nerve XI

591
Q

L4 Nerve root

A

Courses anterior across the knee & into the MEDIAL FOOT

Weakness of Knee EXTENSION

DECREASED PATELLAR REFLEX

592
Q

L5 Nerve root

A

Laterally across the thigh & Knee

Into the DORSUM of the foot

Weakness in DORSIFLEXION

Difficulty in HEEL WALKING

L5 innervates all 3 gluteus muscles

NO spinal reflex associated

593
Q

S1 Nerve Root

A

Posterolateral aspect of thigh & leg

Weakness of PLANTAR FLEXION

Difficulty in TOE WALKING

DECREASED ACHILLES reflex

594
Q

Oculomotor nerve innervates the?

A

Pupillary sphincter muscle

Causes pupil constriction

Innervates all extraocular muscles EXCEPT superior oblique & lateral rectus

595
Q

High levels of Uric acid in the urine indicate what tx?

Low levels of uric acid in the urine indicate what tx?

A

High levels = Allopurinol

Low levels = Probenecid

596
Q

Omega 3 FA (Fish oil) MOA?

A

Inhibits delivery of free FA to liver

Decreases activity of enzymes that produce TG

SE = Belching & fishy mouth taste

Slightly Increases LDL & HDL – but decreases TG

597
Q

SE of Loop Diuretics?

A

Ototoxicity – tinnitus

Hypokalemic metabolic alkalosis

Hypomagnesemia

HYPOCALECEMIA

Hyperuricemia

Good for acute HF exacerbations

598
Q

Indication for Clopidogrel use? SE?

A

Blocks Adenosine Diphosphate Receptor

Decreases ADP induced expression of GPIIb/IIIa

Same clinical use as ASA (Acute coronary syndrome, stroke risk, coronary stenting)

Used for patients with ASA allergy

SE = Neutropenia (Ticlopidine)

TTP

599
Q

What is Hemiballismus? What is the MCC?

A

Unilateral flailing of a limb

Caused by disruption of the contralateral subthalamic nucleus

MCC is LACUNAR stroke

600
Q

What medication closes PDA?

What medication keeps PDAs open?

A

NSAIDs – Indomethacin or ibuprofen CLOSE the PDA – Ligamentum arteriosum

Prostaglandins E1 & E2 kEEp PDA Open (Alprostadil)

601
Q

Always check what before starting a patient on magnesium sulfate?

A

DTRs

Hyporeflexia indicates imminent diaphragm paralysis & respiratory failure

602
Q

Beta-thalassemia minor labs?

A

Increased Hemoglobin A2

Misleadingly low hemoglobin A1c Level

603
Q

Methamphetamine intoxication presentation?

A

Diaphoresis

Agitation, psychosis

Physical signs of tooth decay &injections marks on arm

Skin excoriations

Withdrawal = vivid dreams & hyperphagia

604
Q

Histoplasmosis located where? pathologic features? unique signs?

A

Mississippi & Ohio River Valleys

DIMORPHIC= MOLD IN THE COLD (20), YEAST IN THE HEAT (37)

Macrophage filled – SMALLER than RBCs

Ovoid bodies

Palatal / tongue ulcers

HEPATOSPLENOMEGALY W/ CALCIFICATIONS (Disseminated)

ERYTHEMA NODOSUM – PAINFUL NODULES ON SHIN

Birds & Bats

Histo Hides within macrophages

Can mimic TB in presentation

DX via urine / serum antigen

605
Q

Blastomycosis located where? pathologic features? unique signs?

A

Located in Eastern & Central US – GREAT LAKES

Pigeon droppings

BROAD BASED BUDDING (same size as RBC)

Inflammatory lung disease – Patchy alveolar infiltrate

Disseminates to BONE & SKIN w/ Verrucous lesions (Black Skin nodules)

Dimorphic

606
Q

Coccidioidomycosis located where? Pathologic features? Unique signs?

A

Southwest US – California

SPHEREULE RELEASES ENDOSPORES (Not yeast) in tissue – HUGE - much larger than RBC

Disseminates to bone & skin

Erythema nodosum or multiforme

Arthralgias

Meningitis

Dust exposure in endemic areas – earthquakes

607
Q

If the bone tumor starts with an O, it is more common in who?

A

bOys

608
Q

If you hear Epiphysis as a description for bone tumor, what is it automatically?

A

Giant cell tumor

MC in females in their 20-40s

Often in the knee

Neoplastic mononuclear cells that express RANKL & reactivate multinucleated giant cells

609
Q

Whipple Disease presentation? unique features?

A

Infection w/ Tropheryma Wipplei (Intracellular Gram (+))

PAS (+) *****

FOAMY MACROPHAGES in intestinal lamina propria

Cardiac symptoms w/ Arthralgias

Neurologic symptoms

Diarrhea late in disease course

610
Q

SCID defect? Presentation? Findings?

A

Defective IL-2r Gamma chain or adenosine deaminase deficiency

Presents with failure to thrive, chronic diarrhea, thrush

Current viral, bacterial, fungal, protozoal infections

Decreased T-Cell receptor excision circles

ABSCENCE of THYMIC SHADOW

Germinal centers

611
Q

Hypocalcemia leads to what symptoms?

A

Peripheral neuromuscular excitability – paresthesias & muscle spasms

MCC w/ very rapid transfusion rates

612
Q

Facial nerve functions?

A

Facial movement + eye closure

Taste from anterior 2/3 of tongue

Parasympathetic innervation to submandibular & lacrimal glands

Sound dampening

613
Q

Tricyclic antidepressants MOA & SE?

A

Amitriptyline, Nortriptyline, Imipramine, PRAMINES

MOA – Inhibit 5-HT & NE reuptake

CCC – Convulsions, coma, cardiotoxicity – due to sodium (Na+) blockade

Overdose TX = Sodium Bicarbonate

614
Q

Patau (13)

Edwards (18)

Down’s (21)

A

13 – Midline facial defects (cleft palate), Polydactyly, Umbilical hernias

18 – Fetal growth retardation, HYPERtonia, clenched hands w/ overlapping fingers, rocker bottom feet

21 – Flat facies, up slanting palpebral fissures, low set small ears, single PALMAR CREASE, HYPOtonia

615
Q

What presents as wet, wobbly, & wacky?

A

Normal pressure hydrocephalus

Older adults; idiopathic

CSF elevates episodically

Ventricle expansion

Stretching of the descending cortical fibers (corona radiata)

Triad of urinary incontinence, gait apraxia, & cognitive dysfunction

616
Q

Primary Sclerosing Cholangitis presents how?

A

Middle aged males w/ UC or IBD

Inflammation & fibrosis of the extrahepatic (common bile duct) & intrahepatic) biliary tree

617
Q

Primary Sclerosing Cholangitis presents how?

A

Middle aged males w/ UC or IBD

Inflammation & fibrosis of the extrahepatic (common bile duct) & intrahepatic) biliary tree

618
Q

Which nerve roots from brachial plexus damaged from a fall & medial side of arm is numb?

A

C8-T1

619
Q

Hashimoto presentation? Findings? Serology? Histology?

A

HLA-DR3 association

Increase risk of primary thyroid lymphoma

Nontender thyroid

(+) Antithyroid peroxidase

(+) Antimicrosomal

(+) Antithyroglobulin antibodies

Hurthle cells – Lymphoid aggregates w/ GERMINAL CENTERS

620
Q

Serotonin syndrome treatment?

A

Cyproheptadine – 1st generation anti-histamine

Patient’s taking MAOIs are especially vulnerable to serotonin syndrome

621
Q

Lenticulostriate artery area of lesion? Symptoms?

A

Striatum & Internal Capsule

Contralateral paralysis

Absent cortical signs (i.e. Visual & speech intact)

622
Q

Lewy Body Dementia description?

A

2nd MC type of degenerative dementia next to Alzheimer’s

Progressive cognitive decline

VISUAL HALLUCINATIONS

Spontaneous parkinsonian features

Urinary incontinence

REM sleep disorders (Sleepwalk & Sleep Talk)

Defect in Alpha-Synuclein

Called Lewy if the cognitive & motor symptoms are less than a year apart

623
Q

Achalasia pathology?

A

Failure of the LES to relax due to degeneration of inhibitory neurons

Destruction of Nitric oxide producing neurons in the esophagus

Increased LES resting pressure

624
Q

21 Hydroxylase deficiency labs?

A

DECREASE IN mineralocorticoids

DECREASE in Blood pressure

DECREASE in Cortisol

INCREASE in potassium & Sex hormones

Adrenal cortex can not produce glucocorticoids & mineralocorticoids — This leads to HYPOTENSION (Salt wasting)

In turn, Renin system activated & Angiotensin II is elevated

Increase in 17

625
Q

CAH disorders:

If the deficiency begins with a 1 i.e. 11B-hydroxylase or 17A-hydroxylase?

If the deficiency ends with a 1 i.e. 21 or 11?

A

Begins with 1 = HYPERTENSION

Ends with 1 = VIRILIZATION

626
Q

Left side of Ovarian / Testicular Vein drains where?

A

Left Renal Vein (Also MC site for varicocele)

Right = Directly into IVC

627
Q

How is Compartment syndrome diagnosed?

A

Pain w/ tense swollen compartments with passive stretch of muscles in that compartment

Decreased pulses

628
Q

Cocaine effects on birth?

A

Preterm birth – Fetal growth restriction

629
Q

Dermatomyositis key findings & facts?

A

Gottron papules – Papules on the extensor surfaces of the joints of the hands

Heliotrope eruption – Rash on the upper eyelids w/ occasional edema of the eyelid

Increased risk of Interstitial lung disease (Adenocarcinoma)

Perimysial inflammation & atrophy with CD4 T+ cells

Symmetric proximal muscle weakness – Deltoids, neck flexors, hip flexors

630
Q

Tumor Markers Association

CA 19-9

CA 15-3

CA 125

HER2

AFP

hCG-beta

S100

Calcitonin

CEA

A

CA 19-9 = Liver / Biliary / Pancreatic

CA 15-3 = Breast Cancer

CA 125 = Ovarian Cancer

HER2 = Breast & Gastric Cancer

AFP = Hepatocellular & Yolk Sac Tumor

hCG-B = Choriocarcinoma

S-100 = Melanoma

Calcitonin = Medullary Thyroid Cancer

CEA = Colorectal & Pancreatic Cancer

631
Q

Hypovolemic Shock MOA? Heart changes?

A

Caused by hemorrhage, dehydration, & burns

ONLY SVR (AFTERLOAD) is INCREASED

Makes sense because you are not pumping out

632
Q

Cardiogenic Shock MOA? Heart changes?

A

Caused by MI, HF, & Inadequate ventricular function

LEFT heart dysfunction

Severe decrease in CO

Increase in Preload & Afterload

633
Q

Obstructive shock MOA? Heart changes?

A

Cardiac tamponade, PE, Tension pneumothorax

RIGHT heart dysfunction

Same heart changes as cardiogenic shock

Severe decrease in CO

Increase in Preload & Afterload

634
Q

Distributive shock MOA? Heart changes?

A

Due to sepsis & anaphylaxis

Systemic Vasodilation

Skin is WARM

INCREASE IN CO

635
Q

What is the only thumb movement not controlled by the median nerve?

A

Thumb ADDuction

Controlled by Ulnar Nerve

Associated with weakness of fingers 4 & 5

636
Q

Piriformis Counterstrain treatment?

A

Flexion of the hip & ABduction

637
Q

Inferior Gluteal (L5-S2) cause of injury?

Presentation?

A

Posterior hip dislocation

Difficulty climbing stairs & rising from seated position

LOSS of hip extension

638
Q

Chronic Lymphocytic leukemia HY?

A

Men above 60 YO

CD20 ++

Autoimmune hemolytic anemia – COOMBS test +

639
Q

Acute lymphocytic Leukemia HY?

A

MC in children

B lineage is most common

Down syndrome association

12;21 = good

9;22 = very bad

640
Q

Hairy cell leukemia HY?

A

Adult males

B cell tumor

Marrow fibrosis – dry tap on aspiration

MASSIVE SPLENOMEGALY & PANCYTOPENIA

TRAP stain ++

641
Q

Acute Myelogenous leukemia HY?

A

Onset 65 YO

Myeloperoxidase ++

Responds to vitamin A

DIC is common presentation

Auer rods

642
Q

Chronic Myelogenous Leukemia HY

A

9;22 BCR-ABL

High number of basophils

Imatinib is TX – BCR-ABL tyrosine kinase inhibitor

643
Q

Angiodysplasia poop color?

Association with what murmur?

A

Maroon colored stool (Melena)

Aortic stenosis

Dilated submucosal veins – Right side of colon

644
Q

Diverticulosis HY?

A

Most commonly in the SIGMOID

Increase in INTRALUMINAL PRESSURE

Obesity & low fiber diet

Painless Hematochezia

OSIS bleeds

645
Q

Diverticulitis HY?

A

1 cause of FISTULA in elderly patients

LLQ PAIN

Leukocytosis

“left sided appendicitis”

646
Q

Meckel Diverticulum HY?

A

Rule of 2’s

2x likely in males

2 inches long

2 feet from ileocecal valve

First 2 years of life

Persistence of the Vitelline duct

MC congenital anomaly of the GI tract

RLQ pain – TERMINAL ILEUM

647
Q

Zenker Diverticulum HY?

A

False diverticulum

Inferior pharyngeal constrictor

Dysphagia, FOUL BREATH & Neck mass – Older males

648
Q

Cholecystitis HY?

A

Murphy sign – Inspiratory arrest on RUQ palpation due to pain

Pain radiates to right shoulder – Phrenic nerve

Gallstone impaction in the CYSTIC DUCT

Gallstone Ileus – @ Ileocecal valve w/ AIR in the biliary tree

INCORRECT (4 decks)

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