Mix3

Question 1

Why do you use Epi in treating anaphylactic shock?

Answer 1

Stimulation of a1-AR counteracts vasodilation of cutaneous and viscera vasculature thus ^ BP. Epi ^ HR and CO through B1-AR activity to improve BP and peripheral perfusion. Stimulation of B2-AR&raquo_space; bronchodilation, which is beneficial for severe asthmatic reaction.

Question 2

Site of action of dobutamine:

Answer 2

Primarily B1-AR agonist. Used for HF (inotropic > chronotropic effect)

Question 3

What blood vessel is responsible for the rapid onset hemarthrosis in ACL injury?

Answer 3

middle geniculate artery (primary blood supply to the ACL)

Question 4

If a child with flaccid lower extremities, absent ankle reflexes bilaterally, and a poorly developed lumbar spine and sacrum is born to a woman with uncontrolled DM, then what is this condition?

Answer 4

Caudal regression syndrome

• Pt are born with agenesis of the sacrum and occasionally lumbar spine&raquo_space; flaccid paralysis of the legs, dorsiflexed contracture of the feet, and urinary incontinence.

Question 5

Mutation responsible for Huntington’s Disease:

Answer 5

CAG expansion in HTT gene (Chr 4p)

Question 6

The L renal vein receives drainage from the L gonadal vein and courses anterior to the aorta, but posterior to the SMA before draining into the ___

Answer 6

IVC

Question 7

The renal veins join the IVC at level ___

Answer 7

L1/L2

Question 8

What type of transporter is the glucose transporter (simple diff, primary active, carrier mediated)?

Answer 8

carrier mediated

Question 9

Why do you need to add primaquine to malaria treatment?

Answer 9

Primaquine is effective against hypnozoites (the latent form of malaria) and is used to prevent relapses of infection.

Question 10

What is the MOA of the primary drug used to treat malaria?

Answer 10

Chloroquine blocks plasmodium heme polymerase.

Question 11

What drugs could you use in chloroquine resistant strains of malaria?

Answer 11

mefloquine or atovaquone/proguanil

Question 12

What’s meant by the “CAMP” test for S agalactiae?

Answer 12

S agalactiae is a type of group B strep. Causes neonatal meningitis and sepsis. Colonies produce a narrow zone of beta-hemolysis that enhances when plated perpendicular to S aureus (indicates pos CAMP test)

Question 13

Ankylosing spondylitis is assoc with what HLA serotype?

Answer 13

HLA B27

Question 14

Rheumatoid arthritis is assoc with what HLA serotype?

Answer 14

HLA DR4

Question 15

What cardiac manifestation is assoc with ankylosing spondylitis?

Answer 15

Ascending aortitis&raquo_space; dilation of aortic ring and aortic insufficiency.

Question 16

What ophthalmic manifestation is assoc with ankylosing spondylitis?

Answer 16

Anterior Uveitis = blurred vision, photophobia, and conjunctival erythema

Question 17

___ is the enzyme responsible for loading the appropriate AA to the (3’/5’) terminal hydroxyl group of the CCA tail onto a correct tRNA molecule.

Answer 17

aminoacyl tRNA synthetase, 3’ terminal hydroxyl group is the acceptor stem of the tRNA molecule.

Question 18

What’s the function of the t-loop in the tRNA molecule?

Answer 18

t loop is needed for binding tRNA molecules to the ribosome. T loop contains pseudouridine, ribothymidine, and cytidine.

Question 19

Why are methicillin resistant strains of certain bacteria also resistant to cephalosporins?

Answer 19

Because the mechanism of methicillin resistance (mecA chromosomal gene) involves alterations in the penicillin binding protein PBP2a, which is used by both penicillins and cephalosporins.

Question 20

Selection bias created by selecting hospitalized Pt as the control group is known as ___

Answer 20

Berkson’s bias (study pop from hospital is less healthy than general pop)

Question 21

What’s the mutation in sickle cell disease?

Answer 21

Nonpolar AA valine replaces charged AA glutamate at position 6 in the Beta globin chain&raquo_space; exposure of hydrophobic portion of Beta globin chain fitting into complementary site on alpha globin chain on another hemoglobin molecule.

Question 22

What part of the digestive system is the most common site for ulcers caused by H pylori?

Answer 22

The duodenum. H pylori resides in the antrum of the stomach in the prepyloric area where there are few acid secretory cells. Colonization of the gastric antrum&raquo_space; ^ gastric acid secretion, and the duodenum is the first area affected by the increased acid production.

Question 23

The defects seen in Patau syndrome are the result of a defect in the fusion of the ___ during development.

Answer 23

prechordal mesoderm&raquo_space; catastrophic midline defects (i.e. holoprosencephaly, cleft lip/palate, omphalocele, etc)

Question 24

What are the cardiovascular manifestations of Pt with William’s syndrome?

Answer 24

supravalvular aortic stenosis

Question 25

Direct inguinal hernias pass through Hesselbach's triangle through the superficial inguinal ring due to a weakness of what structure?

Answer 25

weakness of transversalis fascia ** This is why direct hernias tend to happen in older people. Failure of this fascial layer is generally due to acquired connective tissue abnormalities or chronic abdominal wall injury.

Question 26

Why should you consider co-administering a benzo when starting a patient on an SSRI?

Answer 26

SSRI sometimes take 4 weeks before any noticeable therapeutic effect occurs and their initial activating effects can lead to an increased agitation and anxiety during this period. Temporary course of Benzos is sometimes used during SSRI initiation if there is a significant increase in anxiety related symptoms.

Question 27

Triazolam, oxazepam, and midazolam would all be considered (short/intermediate/long) acting Benzos:

Answer 27

short (t1/2 < 6 hr)

Question 28

Diazepam, chlordiazepoxide, and flurazepam would all be considered (short/intermediate/long) acting Benzos:

Answer 28

long (t1/2 > 24 hr)

Question 29

alprazolam, lorazepam, and temazepam would all be considered (short/intermediate/long) acting Benzos:

Answer 29

intermediate (t1/2 6-24 hr)

Question 30

Azathioprine is a purine analog used for BM suppression in transplant patients. Co-admin with ___ may allow for lower doses of azathioprine because this drug helps prevent it's breakdown into inactive metabolites.

Answer 30

Allopurinol. Azathioprine is converted to inactive metabolites with XO and allopurinol inhibits XO.

Question 31

What's the MOA of ganciclovir in treating CMV infection?

Answer 31

Ganciclovir = competitive inhibitor of deoxyguanosine triphosphate into viral DNA.

Question 32

What's the MOA of trimethoprim as an antibacterial agent?

Answer 32

Inhibits DNA synthesis by acting as a competitive inhibitor for dihydrofolate reductase >> decreased availability of thymidine from de novo synth.

Question 33

What's the MOA of tacrolimus in causing immunosuppression?

Answer 33

tacrolimus inhibits calcineurin (protein used in activation of transcription factors related to T lymphocyte proliferation).

Question 34

What's the MOA of prednisone in causing immunosuppression?

Answer 34

Binds glucocorticoid R and upregulates expression of anti-inflammatory proteins and decreases expression of proinflammatory proteins.

Question 35

What's the MOA of isoniazid in treating mycobacterial infections (TB)?

Answer 35

Isoniazid can decrease the synth of mycolic acids. Bacterial catalase peroxidase (encoded by KatG) is needed to convert INH to active metabolite.

Question 36

Porcelin gallbladder is assoc with increased risk of what type of cancer?

Answer 36

adenocarcinoma of the gallbladder Porcelin gallbladder = complication of chronic cholecystitis. Due to dystrophic intramural deposition of calcium salts in the setting of chronic inflammation.