Mixed 2

Question 1

Secretions of the different parts of the adrenal gland.

Answer 1

> Zona glomerulosa: aldosterone, induced by ATII.
Zona fasciculata: cortisol; induced by ACTH, CRH.
Zona reticularis: androgens induced by
Adrenal medulla: catecholamines from chromaffin cells; induced by ACh, CRH

Question 2

Secretions of Leydig cells and Sertoli cells

Answer 2

> Leydig: testosterone, induced by LH.

>Sertoli: inhibin, as feedback inhibition for FSH; helps regulate spermatogenesis in seminiferous tubules

Question 3

By what event does concentric LVH occur? Eccentric LVH?

Answer 3

> Concentric LVH – pressure overload (chronic HTN, aortic stenosis).
Eccentric LVH – volume overload (aortic or mitral regurgitation, MI, dilated cardiomyopathy)

Question 4

Why are kids below 2 y.o given conjugated vaccines and not simply polysaccharide vaccines (ex. Hib conjugate vaccine)?

Answer 4

Polysaccharide capsules induce B cell humoral response, but kids below 2 y.o have immature humoral immunity. A carrier protein is needed to amplify humoral response against the polysaccharide via T cell-dependent stimulation of B cells.

Question 5

Ssx of Scurvy

Answer 5

Vit C deficiency, found in malnourished (alcoholics, poor, elderly)
>Gingival swelling, ecchymoses/petechiae, poor wound healing.
>Perifollicular hemorrhages, corkscrew hairs.

Question 6

Graft-vs-Host disease

[Px, presentation, liver histo, labs]

Answer 6

Donor T cell migrate into host tissues and recognize host MHC antigens as foreign.
>Commonly affects skin, liver, GIT
>General pruritus, hepatomegaly
>Labs: inc. ALP, (+) antimitochondrial antibody.
>Liver histo: destroyed intrahepatic bile ducts, lymphocyte infiltrate.

Question 7

Carbamazepine

[MOA, SE]

Answer 7

Neuroleptic; 1st line for Trigeminal neuralgia; also for seizures.
Dec. ability of Na channels to recover from inactivation – inhibits neuronal high-freq firing (dec. propagation of AP).
SE: bone marrow suppression (agranulocytosis, aplastic anemia), SIADH (hyponatremia)

Question 8

Antibiotics contraindicated in pregnancy and their effects (CATTS)

Answer 8

> Tetracycline: teeth staining
Chloramphenicol: “Gray baby” syndrome
TMP-SMX: neural tube defects
Aminoglycosides: ototoxicity, vestibulotoxicity

Question 9

How does respiratory failure occur in DKA (or any condition w/ metabolic acidosis)?

Answer 9

Metabolic acidosis (DKA) is normally compensated by respiratory alkalosis (hyperventilation). If PaCO2 remains higher than the expected compensatory range, then patient would have superimposed respiratory acidosis (respi failure) – pulmo edema, dec. mental status.

Question 10

How is Dobutamine (B-agonist) helpful in patients w/ Acute MI complicated by cardiogenic shock?

Answer 10

Dobutamine inc. myocardial O2 consumption by inc. contractility (inc. CO) and inc. HR. Normally, this can trigger or exacerbate MI. But in Acute MI w/ cardiogenic shock, the worsened heart ischemia is outweighed by improved CO an end-organ perfusion.
*Remember that shock means poor perfusion – in this case, perfusion caused by poor work of the heart (cardiogenic)