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S4M1 > Josh's Concepts > Flashcards

Josh's Concepts Flashcards

1
Q

Pt with meningitis symptoms. Elevated PT & PTT. Hypotensive. Water-Freidrichson syndrome. What is the cause?

A

N.meningitides (or p.aueruginosa). leads to bilateral destruction of adrenal glands (fatal)

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2
Q

Cushing’s DISEASE cause

A

Pituitary adenoma

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3
Q

Neuroblastoma. Good prognosis sign?

A

pseudorosettes

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4
Q

Arterial supply to adrenals.

A

Inf phrenic a.
Abdominal aorta
Renal a.

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5
Q

Venous drainage of adrenals

A

Left suprarenal v -> L renal v

R suprarenal v -> IVC

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6
Q

Prolactin control

A

DA in the periphery

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7
Q

GH receptor type

A

membrane-bound. uses JAK-STAT signalling

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8
Q

Hypothyroid pregnant woman taking Levothyroxine. What to do.

A

Increase dosage.

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9
Q

Initial treatment of thyroid storm

A

Esmolol

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10
Q

Craniopharyngioma. Where does the tumor arise from?

A

Rathke’s pouch

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11
Q

Where do hormones ACTING on the anterior pituitary first drain into?

A

Primary capillary plexus

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12
Q

When TSH binds the thyroid receptor, how does Iodine get taken up by the colloidal material?

A

Chloride0iodide symporter

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13
Q

Homeless person inhaled something. Low muscle tone.

A

Anesthetic– isoflurane

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14
Q

Mechanism of Open Angle glaucoma?

A

trabecular meshwork is blocked— fluid cannot drain.

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15
Q

Pathophysiology of proliferative DM retinopathy.

A

Hypoxia –> VEGF release –> angiogenesis –> increased neovascular membrane

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16
Q

Pic of Retinal a. occlusion

A

Retinal a. occlusion.

Amaurosis fugax

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17
Q

Hypothyroid symptoms. Fine needle aspiration shows lymphocytes and germinal centers. Underlying process of this condition?

A

Hashimoto’s Thyroiditis. formation of auto-antibodies against thyroperoxidase

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18
Q

Medullary Thyroid Carcinoma. Cell origin?

A

C-Cells

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19
Q

Cretinism. Diagnostic marker @ birth to prevent?

A

Increased TSH

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20
Q

Patient with meningitis. CSF report shows it’s viral. Pain in temporal regions.

A

HSV (MCC viral encephalitis in US)
– Necrotizing and hemorrhagic encephalitis
@ Temporal & frontal lobe
Show Cowdry A bodies (eosinophilic intranuc. inclusions)

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21
Q

Bit by animal. Stop rabies????

A

Dipoloid vaccine & Igs

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22
Q

Weakness, comes & goes, loss of eye sight…. What is the diagnostic marker?

A

Multiple Sclerosis: oligoclonal bands @ spinal tap

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23
Q

Tired at end of the day. Tired chewing meals. Underlying process?

A

Abs attacking ACh receptors

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24
Q

Trouble combing hair. Had the flu. Dx?

A

Guillan Barré

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25
Q

Upper AND Lower Motor problems

A

ALS

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26
Q

Girl gets tired exercising.

A

MS??

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27
Q

ADHD– parents don’t want treatment. What could happen?

A

Poor academic performance. Drug abuse.

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28
Q

Bacterial meningitis in a NEONATE. Cause?

A

S. agalactiae (MCC)

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29
Q

Alcohol withdrawal. What do you give?

A

Benzo – prevent seizures and other sx

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30
Q

Meningitis in INFANT/CHILD/ADULT. MCC?

A

S.pneumo

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31
Q

Patient wants to quit smoking. Give him partial nicotine agonist. What is it?

A

Varenicline

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32
Q

Heroine addict. You give Buprenorphine to quit. How does it work?

A

Displaces heroin & other opiates from mu receptor– decreases cravings, blocks effect of heroin
** can cause withdrawal if given while heroin still in system!

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33
Q

Patient is agitated, high-energy, hasn’t eaten in forever, sweating, aggressive, hasn’t slept in forever. What caused this?

A

Cocaine

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34
Q

Catatonic types?

A

Paranoid- delusions, aud. hallucinations
Disorganized - disorg speech/behavior, flat affect
Catatonic - extreme negativism/mutism, waxy movement, echolalia, echopraxia, excessive motor activity

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35
Q

You want to remove a piece of pancreas and you know there is an anastomoses between the gastroduodenal artery and the inferior pancreaticoduodenal artery where there is a tumor. Where is it?

A

Head of pancreas

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36
Q

Parkinson’s off period? What do you give?

A

Apomorphine– rescue

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37
Q

Parkinson’s patient is taking L-DOPA/carbidopa, having N/V. What area is this stimulating?

A

chemoreceptors

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38
Q

What drug can you give to prevent L-DOPA from breaking down in the BBB once it crosses?

A

Entacapone (or tolcapone)- COMT inhibitor

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39
Q

MOA of Phyngolomide

A

phosphoryalted into Fingolimod-phosphate by spingosine kinase 2….
-> Agonist @ spirociene-1-phosphate (S1P) receptors
For Relapsing-Remitting MS

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40
Q

Repaglinide is used only for postprandial hypoglycemia. Why?

A

Short duration

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41
Q

Man is on insulin for DM I. He knows the symptoms of hypoglycemia, so he is aware. What drug would interfere with his ability to detect hypoglycemia?

A

B-blockers

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42
Q

MS. On section of brain, what can you say?

A

Areas of demyelination. (gray)

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43
Q

50yo with Muscular dystrophy. Cousin and grandpa has it.

A

Becker’s Muscular Dystrophy

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44
Q

Being treated for bipolar disorder. Also taking ACE inhibitors for HTN. Develops hyponatremia. Why?

A

Taking Lithium for bipolar. Co-admin with ACE causes hyponatremia.

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45
Q

Anti-epileptic monotherapy or adjunct for secondary generalized tonic-clonic.

A

Lamotrigine. Blocks inactivated? Na+ channels & inhibits glutamate release

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46
Q

Arnold Chiari II. Vermis went through foramen magnum. Meningomyelocele too. What else associated?

A

Syringohydromelia

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47
Q

Pt with Chiari II dies– on 4th day, what do you see on the brain?

A

Macrophages & reactive astrocytes

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48
Q

Patient has surgery. Next day is aggressive, agitated, screaming. Within a couple days is fine again. What can she have?

A

ICU psychosis. Delirium. Acute Confusion. Encephalitis. whatev

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49
Q

What drug can you give in the middle of the night if someone can’t go back to sleep?

A

Zaleplon– shorter duration

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50
Q

Melatonin agonist

A

Rameloton

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51
Q

S/S Major Depressive Disorder

A

SIGECAPS

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52
Q

Patient has been spending money like crazy, has financial problems, loves drinking and partying. He’s been depressed for several weeks.

A

Bipolar 2?

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53
Q

Autopsy: pseudopalisading, necrosis, hemorrhage.

A

Glioblastoma

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54
Q

Child. Picture of tumor in central line in vermis. Homer-Wright Rosettes.

A

Medulloblastoma

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55
Q

Kid has ADHD. Give drug that blocks reuptake & facilitating release of NE & DA

A

Dextroamphetamine

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56
Q

ADD kid started meds, has been having tics. What drug?

A

Methylphenidate

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57
Q

Bupropion: errthang

A

Blocks reuptake sites fo NE & DA
T/U: Major depression, SAD, Nicotine, ADD & ADHD (off label)
AE: dry mouth, constipation, weight loss, anorexia

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58
Q

Conversion disorder

A

Symptoms with no medical or chemical reason.

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59
Q

Drug in patch form avoids HTN crisis

A

Selegiline. avoids GI, so won’t get HTN crisis with tyramines.

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60
Q

Patient is taking SSRI. Having AEs. What adjunct can you give that will block receptors?

A

Mirtazapine blocks 5HT2A and 2C receptors, as well as a2 heteroreceptors.
Anti–nausea :)

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61
Q

What drug works by blocking the receptors to increase the level of NE & 5HT?

A

Mirtazapine

62
Q

Woman had baby, hemorrhaged. Now has no libido. low hormone levels of ant pit stuff. What else is associated?

A

Hypogonadism (loss of hair, loss of libido, amenorrhea), weight loss (low GH), cold intolerance (low TSH), hypopigmentation (low ACTH)

63
Q

Hypothyroid with galactorrhea. Pituitary adenoma. Elevated prolactin.

A

Prolactinoma. suppresses GnRH –> amenorrhea.

64
Q

How to treat prolactinoma in pt who DOESN’T want to get preg?

A

D2 agonist. Cabergoline. (bromocriptine in woman who wants to get preg)

65
Q

Acromegaly. What else can be eleveated?

A

Hyperglycemia due to increase in gluconeogenesis.

66
Q

MOA of Pegvisomant?

A

GH receptor competitive antagonist– DOESN’T activate JAK-STAT signalling or stimulate IGF-1 secretion, so IGF-1 decreases and GH remains high.

67
Q

Craniopharyngioma. Embryologic origin?

A

Rathke’s pouch

68
Q

Hyperosmotic urine. Hypoosmotic plasma. Decreased sodium. = SIADH. What is causing it?

A

SMALL cell carcinoma

69
Q

How does Conivaptan block V2 receptors in the kidney?

A

Decreases cAMP

70
Q

Guy lives with mother in law. Goes to nursing home, and thinks the old people are after him. Otherwise, is NORMAL and a successful NEUROSURGEON.

A

Delusional disorder

71
Q

Intracerebral hemorrhage –> uncal herniation. Where is the bleed?

A

Duret hemorrhage—several small ruptures in pons.

72
Q

Lens-shaped hematoma. Patient is lucid.

A

Epidural hematoma

73
Q

Generalized Anxiety Disorder. First line treatment?

A

SSRI

74
Q

Benzos & anxiety

A

Limit to 5 weeks, often @ start of SSRI / SNRI treatment to decrease suicide risk. Used short term for siutational stress.

75
Q

Who is most likely to develop secondary obesity???
Asian BMI 24
Hispanic BMI 29
Sedative lifestyle + fast food

A 
Secondary:
rapid weight gain
Signs of hyperthyroidism (pretibial edema, delayed tendon reflex)
Signs of Cushing
Steroid treatment
Atypical antipsychotic treatment
76
Q

DM II. What is the main source of energy when not exercising? Fatty acids. When they start working out, what happens?

A

Get glucose in the muscle.

77
Q

DM II. What stain?

A

Congo red! buildup of amyloid

78
Q

Elevated glucose. What is released? Decrease in glucose? then what?

A

incr glucose -> INSULIN;

decr glucose -> glugacon

79
Q

Patient has cancer that causes hypercalcemia. What drug can you give?

A

Bisphosphanate (Zoledronic acid)– malignancy of hypercalcemia

80
Q

Parathyroids gone. What else could be?

A

Thymus (DiGeorge)

81
Q

Take BP, tetany!

A

Hypoparathyroid (Trousseau’s sign– neuromusc irritability)

82
Q

Person with stroke. Fever. What drug?

A

Acetominophen

83
Q

Man is having stroke. Wife calls ER. What to do?

A

give baby aspirin.

84
Q

What does Cinacalcet do?

A

Calcium mimetic– sensitizes Ca2+ sensing receptr. thus PTH secretion is suppressed by lower amounts of Ca2+ than normal.

85
Q

Amaurosis Fugaz: hollenhorst plaque.

A

Retinal artery occlusion.

86
Q

Man acting strange (altered consciousness??!). Had seizure the day after?.

A

Partial Compex Seizures

87
Q

Patient whose hand then arm shakes. Then loses consciousness and shakes everywhere.

A

Simple partial with secondary generalization

88
Q

Global Cerebral Ischemia: errthang

A

Pathophys: Ischemic damage of cytomembrane -> depolarization -> release of glutamate & aspartate -> blockatge of ligand-gated cation channels on postsynaptic cells -> Ca2+ & Na+ influx

Gross: Laminar necrosis in neocortex & hippocampus; watershed infarcts

Histo:
12-24h: ischemic neuron death
2-3d: neuron dissolution, leukocyte influx
4-7d: Macrophage influx & activation
>2w: Liquefaction; debris removal, reactive gliosis

89
Q

Pale infarct- thrombus; Red infarct - embolus

A

that’s all.

90
Q

Diabetes. What is found in BVs?

A

Amyloid– congo red w/apple

91
Q

Rapid hemorrhage. Sudden, severe headache. Where could it have been?

A

Bifurcation

92
Q

Left arm & face > leg. Oh wait. right shoulder is weak too.

A

Watershed. (on both sides)

93
Q

11-hydroxylase deficiency. What WON’T be elevated?

A

glucocorticoids??

94
Q

Purulent exudate of brain. ewe. cause?

A

Bacterial meningitis.

95
Q

Meningitis with HIV. Virchow-robbins space is enlarged.

A

Cryptococcal meningitis.

CAPSULATED– larger- open up lumen of vessels!

96
Q

What happens in a diabetic (pathologically)?

A

Thickening of endoneural artery wall

97
Q

Patient with schizophrenia has been taking the same drug for over 60 years. Begins to have chorea. Drug?

A

Haloperidol– causes tardive dyskinesia

98
Q

Drug blocks receptors at one location, causing increase in DA at another location… uh..

A

Aripiprazole (DA partial agonist)

99
Q

Patient takes drug. Now keeps getting infections. What drug and why?

A

Clozipine. can cause AGRANULOCYTOSIS

100
Q

mystery drug induces and metabolizes enzyme

A

Carbamazepine

101
Q

Pt taking another anti-epileptic. Gum hyperplasia– give folic acid.

A

Phenytoin

102
Q

Valproic acid— causes weight gain. What drug has least effect of weight gain?

A

Coffin’s slides say: “Don’t see weight gain in children with carbamazepine, lamotrigine, and phytoin.”
Also, TOPIRAMATE causes weight loss.
Josh said Carbamazepine.

103
Q

What anti-epileptic inhibits the release of glutamate and blocks Na+ receptors, delaying reactivation of Na+ receptors?

A

Lamotrigine

104
Q

Status epilepticus. What drug to give first?

A

BENZO

105
Q

Hyperthyroid baby, showing cretinism. What could you have screened for?

A

TSH

106
Q

Something something TRH & TSH.

A

NOT TRH because you can’t measure TRH

107
Q

Von Gierke’s kid. What enzyme is not work.

A

Glucose-6-Phosphatase (josh and jeff are WRONG bro)

108
Q

Readiness to change stages. Patient has DM. Hasn’t been taking care of herself but wants to start.

A

Contemplation.

109
Q

Abuse vs. dependence

A

Dependence– tried to and wants to stop but failed. Abuse– social, legal problems.

110
Q

Within 3 days- coarse tremors, disorientation. Alcoholic.

A

Delirium Tremens

111
Q

Cogwheel tremor, but no resting tremor.

A

Still Parkinson’s

112
Q

Polydypsia, polyphagia, polyuria associated with?

A

BOTH DM I & II

113
Q

Intensive therapy– where do you want HbA1c?

A

6.5-7.5 (according to beezle’s graph)

114
Q

What causes micro and macro-angiopathies

A

Non-enzymatic glycosilation

115
Q

Pt with diabetic foot infection. What is the worst that can happen?

A

Osteomyelitis (gangrene, amputation not option). Also, sepsis?

116
Q

Patient in coma with DM I & elevated glucose. What to do?

A

Give saline then read potassium. Aggressively give saline and insulin if normo- or hyperkalemic.

117
Q

Diabetic ketoacidosis. What is the compensation?

A

Respiratory (Kussmaul breathing)

118
Q

Patient takes Cholinesterase inhibitor. What drug can you give that blocks glutamate function?

A

Memantine

119
Q

Huntington’s tx

A

Tetrabenazine to treat chorea

120
Q

Triptans (sumatriptan). Something something AE.

A

Cardiovascular events are rare but serious.

121
Q

Persona with heart problem going to undergo sedation. Don’t give?

A

Meperidine (causes tachycardia)

also, methadone, pentazocine

122
Q

Partial agonist at mu and antagonist at delta & kappa

A

Buponorphine

123
Q

OD with opiate. Give?

A

Naloxone– an opioid antagonist

124
Q

Patient with ringing in both ears. What gene?

A

NF2 (Schwannoma)

125
Q

Axis I vs Axis II

A

Axis II presents early adulthood

126
Q

Likes to be alone. Doesn’t like people, does’n’t want friends. Likes to do complex math.

A

Schizoid Personality Disorder

127
Q

D.nozzle late to dr. appt. yelling.

A

Narcissistic (Josh says Borderline)

128
Q

Dependent Personality Disorder. Has broken ankle. What is response to doctor?

A

dunno, but
-Difficulty making decisions without excessive support
–Needs others to assume responsibility
- Difficulty disagreeing ‘due to fears of losing support
– Difficulty doing things on own’
– Volunteers for unpleasant tasks to gain nurturance from’others
– Feels uncomfortable or helpless when alone
– Urgently seeks a new relationship when one ends
– Preoccupied with fears of having to take care of self

129
Q

Glasgow Coma Scale: pupils

A

Small, reactive: Diencephalon
Midpoint: Midbrain
Pinpoint: Pons
Dilated: Medulla

130
Q

Test to check for brain dead?

A

Cerebroangiography

131
Q

Demyelination in brain. Preventricular deep white matter disease, slight atrophy, minimally enlarged ventricles. Gyri less prominent.

A

Alzheimers

132
Q

Histo of alzheimer’s

A

Neurofibrillary tangles

133
Q

Stroke. Starts to develop dementia.

A

Something vascular

134
Q

Repeated falls. Pleasant hallucinations.

A

Lewy Body dementia

135
Q

Behavioral change with hyperphagia over 1 year in older woman

A

Pick’s

136
Q

Behavioral change with hyperphagia over 1 year, in younger man

A

Picks

137
Q

Throbbing headache. Pain with movement. SLOW progression

A

Acute migraine

138
Q

Male, just drank alcohol. Worst headache ever. Watery eyes, nasal stuffiness.

A

Cluster headache

139
Q

What nucleus causes stress?

A

Locus Coeruleus

140
Q

Alcoholic patient. Doctor wants him to go to AA, but he doesn’t want to go for fear of discrimination.

A

Social Anxiety Disorder

141
Q

PTSD S/S

A

Exposure to traumatic event. Re-experience. Hyperarousal. Avoidance.

142
Q

Shadow sign used to diagnose…?

A

Acute Angle Closure Glaucoma

143
Q

Bacterial vs. Viral vs. Fungal:

  • glucose
  • leukocytes
A

Bacterial- low glucose, PMNs
Viral- normal glucose, PMNs then lymphocytes
Fungal- low glucose, lymphocytes

144
Q

AIDS patient. Cryptococcal meningitis characteristics

A

Budding yeast. encapsulated

145
Q

Sinus infection. Ring enhancement in brain.

A

S. pneumona (or any strep?)

146
Q

Meningitis + ring enhancement + tooth extraction

A

abcess

147
Q

Watery eyes, swimming pool, periauricular nodal inflammation. What virus?

A

Adenovirus

148
Q

Neonate with purpulent exudate from eyes. Other twin is fine.

A

Chlamydia

149
Q

Prednisolone causing cushing syndrome.

A

blah blah insulin not working

150
Q

Start taking prednisolone, start to get infection. What to do?

A

Lower dose.

S4M1 (3 decks)

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