Mixed 5

Question 1

What are the adverse effects of protease inhibitors?

Answer 1

> lipodystrophy (buffalo hump, central obesity).
hyperglycemia (insulin resistance).
inhibition of CYP450.

Question 2

How does aromatase deficiency present in the newborn girl and then when she’s older?

Answer 2

Aromatase deficiency manifests in embryonal life. Newborn girls will have normal internal genitalia and ambiguous external genitalia. At puberty, impaired ovarian estrogen synthesis will present w/ amenorrhea, osteoporosis, and tall stature.

Question 3

Why are patients w/ polycystic ovary syndrome at risk of endometrial hyperplasia or carcinoma?

Answer 3

The increased activity of 17-hydroxylase results in inc. androgens. Excess androgens prevents development of dominant follicle, causing anovulatory cycles. This menstrual irregularity further results in dec. progesterone, w/c is meant to inhibit endometrial growth. As such, these pts are at risk of endometrial hyperplasia or adenoCA.

Question 4

How does blood solubility determine the speed of induction of general anesthetics?

Answer 4

The speed at w/c blood becomes saturated depends of the gas’ blood solubility. Highly soluble gases (large blood/gas coefficient) dissolve easily in blood, so large amounts of the gas are absorbed before blood becomes saturated. This delays saturation of the CNS and slowing induction.

Question 5

What happens when a patient is given both Lithium and Thiazide diuretics?

Answer 5

Lithium is reabsorbed in the PCT, excreted by kidneys. Thiazide diuretics limit NaCl reabsorption in the DCT, inducing mild hypovolemia, w/c prompts sodium/lithium and H2O uptake in the PCT. This can lead to lithium toxicity over time.
*ACEi and NSAIDs (not aspirin) also inc. lithium toxicity.

Question 6

What causes deep, painful ulcers w/ ragged borders that are associated w/ grey exudate and inguinal lymphadenopathy?

Answer 6

> Chancroid caused by H. ducreyi.

>Dx: G(-) curved rod, often in clumping pattern.

Question 7

What teratogenic complication is Lithium associated with?

Answer 7

Ebstein’s anomaly, in w/c there is apical displacement of the tricuspid valve leaflets, decreased volume of RV, and atrialization of RV.

Question 8

What meds have Anticholinergic toxicity?

Answer 8

>Antihistamines (diphenhydramine).
>TCAs (amitriptyline, imipramine).
>Chlorpromazine, Clozapine.
>Antiparkinsons (benztropine, trihexyphenidyl).
>Atropine

Question 9

What is Opsoclonus-myoclonus syndrome associated with?

Answer 9

This is associated w/ Neuroblastoma, the most common extracranial childhood cancer involving neuroblasts of the adrenal medulla.