prometric practice

Question 1

role of ADH (2)

Answer 1

1: responds to high osmolarity
V2 receptors: decrease serum osmolarity, increase urine osmolarity

2: respond to low BP
V2 receptors: vasoconstriction

Question 2

what drains to the popliteal lymph nodes? (2)

Answer 2

1. dorsolateral foot

2. posterior calf

Question 3

rx for cluster headaches

Answer 3

oxygen and sumatriptan

Question 4

rx for migraine abortive?

Answer 4

sumatriptan, NSAID

Question 5

rx for migraine prophylaxis?

Answer 5

propanolol, topiramate, amitryptaline, Ca2+ channel blockers

Question 6

rx for tension headaches

Answer 6

NSAID, analgestics, amitryptaline, acetaminophen

Question 7

acute megakaryocytic leukemia

Answer 7

proliferation of megakaryoBLASTS

AML M7

Question 8

ITP etiology

Answer 8

antibodies against GpIIbIIIa

SPLENIC macrophage destruction!

Question 9

ITP blood / bone marrow smear

Answer 9

blood -> thrombocytopenia

marrow -> many mature megakaryocytes

Question 10

TTP & HUS vs. ITP

Answer 10

all three = thrombocytopenia
TTP / HUS: schistocytes
ITP: splenic destruction

Question 11

TTP etiology

Answer 11

deficiency of ADAMSTS-13

large platelet vWF -> abnormal platelet aggregation

microthrombi –>

schistocytes & thrombocytopenia

Question 12

normal anion gap

Answer 12

8-12 mEq/dl

Question 13

what columns are affected by B12 deficiency?

Answer 13

1. dorsal column: SENSORY
2. lateral corticospinal: MOTOR
   (spinocerebellar can be too)

Question 14

dry beri beri

Answer 14

B1 thiamine deficiency

peripheral polyneuritis, symmetric muscle wasting

Question 15

vomit pathway

Answer 15

valine
odd chain fatty acids
methionine
isoleucine
threonine

branched amino acids & odd chain fatty acids breakdown into..

methylmalonyl-CoA
—> (methylmalonyl-CoA mutates
succinyl-CoA

• • either TCA, myelin synthesis
    or. . heme synthesis!

Question 16

acid/base disturbance after salicylate ingestion

Answer 16

first: 
respiratory alkalosis (hyperventilate)

then SUPERIMPOSED by..
metabolic acidosis (anion-gap)

ultimately:
low bicarb (metabolic acidosis)
low pH (acidemia)
low CO2 (still hyperventilate)

Question 17

colchicine used for…

Answer 17

GOUT

not RA

Question 18

etanercept used for..

Answer 18

rheumatoid arthritis

Question 19

caudal medulla: location of hypoglossal nuc? where does n. leave?

Answer 19

nuc is dorsal

BUT

n. leaves between medial lemniscus & olive! (ventral)

Question 20

skin ulceration after a vaccine (i.e. tetanus immunization)

Answer 20

due to arthus reaction

edema, necrosis, activation of complement
type III HSR

deposition of antibody, antigen complex

“localized” serum sickness

Question 21

when does serum sickness occur?

Answer 21

5-10 days post-exposure

antibody against foreign protein –> deposits in membranes

fever, urticaria, arthralgia, proteinuria, lymphadenopathy

Question 22

wiskot-aldrich vs. chediak-higashi

Answer 22

wiskot-aldrich

• actin issues
• combined T cell/B cell
• x-linked recessive

chediak-higashi

• microtubule issue
• neutrophil
• autosomal recessive

Question 23

wiskot-aldrich syndrome presentation

Answer 23

x-linked recessive
defect in actin reorganization

WATER
thrombocytopenic purpura
eczema
recurrent infxn

increased risk of malignancy
and autoimmune disease

Question 24

B cell immunodeficiency presenting later in life ~20-30 y/o associate w/ autoimmune & RA?

Answer 24

common variable deficiency

Question 25

Job syndrome presentation

Answer 25

Th17 deficiency due to less STAT3
impaired recruitment of neutrophils

FATED

abnormal facies
abscesses (cold, no neutrophils)
RETAINED TEETH
hyper IgE
dermatologic problems (eczema)

Question 26

chediak-higashi presentation

Answer 26

autosomal recessive
neutrophil problem
defective LYST gene (lysosomal trafficking regulator gene)

microtubule dysfunction in phagosome-lysosome fusion

BALIN

bleeding and bruising (platelet problem)
partial albinism
leukopenia & infiltrative lymphohistiocytosis
recurrent infxn (staph, strep)
PERIPHERAL NEUROPATHY & NEURODEGENERATION

lots of neutrophils, but have giant granules
pancytopenia

Question 27

pre-eclampsia criteria

Answer 27

20wk -> 6 wk postpartum

1. HTN (>140/90)
2. proteinuria (>300mg/24hr)

severe would be
1. HTN (>160/110)
w/ or w/o end-organ damage:
headache, scotoma, oligouria
& HEELP: hemolysis, elevated liver enzymes, low platelets

Question 28

cause of pre-eclampsia

Answer 28

abnormal formation of placental spiral arteries –> maternal endothelial dysfunction

Question 29

key things an infant can do (0-12)

Answer 29

Parents Start Observing

motor:
primitive reflexes disappear
posture: crawl by 8, stand by 10, walk by 12-18
pincer grasp
points

social:
smile by 2mo
stranger anxiety by 6mo
separation anxiety by 9mo

observing:
oriten to voice, name, gestures
object permanence by 9
oratory: mama dada by 10mo

Question 30

key things a toddler can do (12-36 month)

Answer 30

child rearing working

motor
climb stairs, stack cubes, feeds self, kicks

social

recreationg: parallel play
rapproachment: leave but comes back to mom
realization: core gender identity

working:
200 works by 2
(2 zeroes)
2-word sentences

Question 31

key things a preschooler can do (3-5)

Answer 31

Don’t Forget they’re still Learning

motor
drive (tricycle), draw (copies, stick figure), dexterity (hop on a foot, groom)

social:

freedom: spend time from mom
friends: cooperative play

learning:
1000 words by 3 (3 zeroes)
legends: detailed stories

Question 32

adalimumab

Answer 32

antibody against TNF-a

Question 33

infliximab

Answer 33

antibody against TNF-a