Part 2

Question 1

Multiple Myeloma

Answer 1

Most common primary malignancy of bone, high in IL-6 (plasma cell growth factor), can produce osteoclast activating factor (bone pain, skull and vertebrae lytic lesions, hypercalcemia), increased risk of fracture, elevated serum proteins (globulins) which presnts as M spike on SPEP. High risk of infection due to low Ab diversity. Rouleaux formation on smear due to altered blood charge. Free light chain in serum will lead to amyloidosis (Kidney)

Question 2

Monocolonal Gammopathy of Undetermined Significance

Answer 2

M spike on SPEP no other signs of cancer, found most commonly in the elderly, may progress to Multiple Myeloma.

Question 3

Waldenstrom Macroglobulinemia

Answer 3

B cell lymphoma with monoclonal IgM. LAD, M spike, visual and neurodeficits due to hyperviscosity, bleeding, Tx: plasmapheresis

Question 4

Langerhans Cell Histiocytosis

Answer 4

Dendritic cells of the skin, CD1a+ and S100+, will see Birbeck granules on EM (Tennis Racket). 3 subtypes:
Letterer-Siwe: Rapidly fatal, skin rash and skeletal defects, found in infantss.
Eosinophilic Granulom: Pathologic Fracture in adolescents, benign, biopsy shows Langerhans cells and eosinophils.
Hans-Schuller-Christian Dz: Malignant, scalp rash, lytic skull lesions, diabetes insipidus, exophthalmos, found in children.

Question 5

Protamine

Answer 5

Heparin Reversal agent

Question 6

Fomepizol

Answer 6

Ethylene glycol toxicity agent

Question 7

Aspirin Intolerant Asthma Triad

Answer 7

Asthma, brochospasm (aspirin), and eczema

Question 8

Angiofibroma

Answer 8

Benign nasal tumor of blood vessels and fibrous tissue mostly seen in adolescent males. Presents with profuse epistaxis.

Question 9

Nasopharyngeal Carcinoma

Answer 9

EBV driven tumor that presents in African children and chinese adults. Histology shows pleomorphic keratin positive epithelial cells in a background of lymphocytes.

Question 10

Causitive agent of Acute Epiglottitis

Answer 10

H flu (B)

Question 11

Laryngotracheobronchitis causitive agent

Answer 11

Parainfluenza virus

Question 12

Small Cell Lung Carcinoma

Answer 12

Poorly differentiated, male smokers, central lesion, early metastasis, may secrete ADH, ACTH or cause Eaton-Lambert Syndrome

Question 13

Squamous Cell Carcinoma

Answer 13

Keratin pearls or intercellular bridges, most common tumor in male smokers, central lesion. May secrete PTHrP.

Question 14

Adenocarcinoma

Answer 14

Glands or mucin production, most common lung tumor in a nonsmoker/female smoker. Peripheral

Question 15

Large Cell Lung Carcinoma

Answer 15

Poorly differentiated large cells, related to smoking, central or peripheral. Poor prognosis.

Question 16

Reye’s Syndrome

Answer 16

Aspirin following viral infection in kids that causes fatty liver change with cerebral edema.

Question 17

VSD Murmur

Answer 17

Holosystolic murmur at LLSB

Question 18

Sensory ganglion for CNVII

Answer 18

Geniculate Ganglion

Question 19

Aortic Stenosis

Answer 19

Harsh blowing murmur at the RUSB or LUSB. Calcification is most common cause.

Question 20

Class IA Antiarrhythmics

Answer 20

Quinidine, procainamide, disopyramide

Widen QRS and prolong AP. Good for SVAs and VAs. Good for WPW.

Question 21

Class IB Antiarrhythmics

Answer 21

Lidocaine, phenytoin, mexilitine

Shorten phase 2 and 3, highly selective for open Na channels (ventricles and ischemic tissues)

Question 22

Class IC Antiarrhythmics

Answer 22

Flecanide, propafenone
Afib, SVAs, VAs
Contraindicated in hx of ischemia or structural defect.

Question 23

Class II Antiarrhythmics

Answer 23

Beta blockers
Decrease sympathetic imput to the SA/AV
prolong refractory period
Good for SVas, Afib

Question 24

Class III Antiarrhythmic

Answer 24

Amiodarone, sotalol, dofetilide, ibutalide. K+ channel blockers. Prolong phase 2 and 3. Amiodarone has class 1, 2, 3, and 4 activity. Sotalol has class 2 and 3 activity. Good for SVAs, VAs, and Afib. All can cause TdP.

Question 25

Class IV Antiarrhythmic

Answer 25

CCBs (Nondihyropyradine) Verapamil and Diltiazem

Effects at SA and AV nodes prolonged conduction and refractory peroid. Good for Afib. Can cause heart block.

Question 26

Class V Antiarrhythmic

Answer 26

Digoxin, Mg2+, K+, Adenosine

Digoxin: parasympathetic effects, good for afib

Mg2+: Tx for TdP

Adenosine: prolongs refractory period at AV, increases outward K+, inward Ca2+. Treatment of choice for conversion of SVTs. Sense of impending doom. Counteracted by caffeine.