Q Banks: Week of 03/13/17 Flashcards
1
Q
In general, when should you use a broad-spectrum antiepileptic and when should you use a narrow-spectrum antiepileptic?
A
Narrow-spectrum anticonvulsants (carbamazepine, phenytoin) should be used in focal seizures. Focal seizures predominately involve one hemisphere of the brain (like the waitress in the Sketchy scene shaking just her right arm). Broad-spectrum antiepileptics are given in generalized seizures –those that involve both hemispheres from the onset (like the Incans shaking both elbows).
2
Q
What happens to the hemoglobin in methemoglobinemia?
A
It is oxidized and cannot bind oxygen (mimicking anemia).
3
Q
Which nerve is in the lateral compartment of the lower leg?
A
The superficial peroneal nerve (the deep peroneal nerve is in the anterior compartment and the tibial nerve is in the deep posterior compartment)
4
Q
Explain the role of P bodies.
A
P bodies are proteins in the cytosol of eukaryotic cells that regulate mRNA. They can degrade mRNA or store mRNA for later use.
5
Q
Part of true patient confidentiality means that physicians are not able to tell people even ________________.
A
whether someone is or isn’t their patient
6
Q
True or false: benzodiazepines bind to the same site as GABA while barbiturates bind to an allosteric site.
A
False. Both bind to an allosteric site.
7
Q
The main risk factor for aortic dissection is _________________.
A
hypertension
8
Q
Differentiate postpartum blues and postpartum depression.
A
Postpartum blues is an extremely common condition (80% of women after giving birth) that involves tearfulness and depression in the first week after delivery. If this doesn’t go away within two weeks, postpartum depression may be considered.
Any consideration of suicidality indicates postpartum depression.
9
Q
What is the main difference between uterine didelphys and failure of septal dissolution?
A
Persistent septums will present with a normal outer shape of the uterus, whereas uterine didelphys will have an abnormal outer shape.
10
Q
Other than macrophages, what cell type proliferates in atheromatous plaques?
A
Smooth muscle cells!
Platelets, endothelial cells, and macrophages release growth factors for smooth muscle cells that enter the plaque area and lead to further swelling.
11
Q
A patient appears icteric after getting surgery in a third-world country. What might have happened?
A
Halothane is still used in many poorer countries for surgical anesthesia and can cause hepatotoxicity. This often presents days later with a shrunken liver and elevated transaminases.
12
Q
Through which foramen do the EOM nerves enter the orbit?
A
Through the superior orbital fissure (along with the ophthalmic branch of the trigeminal nerve)
Note: recall that the three branches of the trigeminal nerve enter through the Superior orbital fissure, foramen Rotundum, and foramen Ovale (“Standing Room Only”)
13
Q
Which ECM proteins does integrin bind?
A
fibronectIN and laminIN (also collagEN)
14
Q
Why is blood in the left atrium less oxygenated that blood in the pulmonary vessels?
A
Because the bronchial arteries empty deoxygenated blood into the pulmonary veins
15
Q
What kind of receptor is thyroid hormone?
A
Nuclear receptor
16
Q
Fecal incontinence after labor is often due to _______________.
A
stretch injuries of the pudendal nerve
17
Q
Explain the pathogenesis of rickets.
A
Without vitamin D, calcium levels drop. As such, bone cannot be mineralized and the bones will primarily be osteoid.
18
Q
Botulinum can be tested for by _______________.
A
looking in stools for toxin
19
Q
There are four different etiologies of genital ulcers. Talk about how each can be distinguished.
A
- HSV: multiple shallow painful ulcers that recur
- H. ducreyi: multiple deep painful ulcers
- C. trochomatis: painless ulcers that go away followed by painful inguinal swelling
- T. pallidum: single painless ulcers
20
Q
What bicarb values are typical of chronic (compensated) and acute (uncompensated) respiratory acidosis?
A
- Chronic: bicarb greater than 30
* Acute: bicarb less than 30
21
Q
What components make up metabolic syndrome?
A
At least three of the following: •HDL less than 40 (women) or 35 (men) •Elevated triglycerides •Increased waist circumference •Insulin resistance (as detected on fasting glucose) •Hypertension
Notice that LDL or total cholesterol is not on there!
22
Q
Cytogenetic studies often show _____________ in boys with fragile X syndrome.
A
a gap near the tip of the X chromosome
23
Q
Proline and lysine are hydroxylated in the ______________.
A
endoplasmic reticulum
24
Q
_______________ in the stool is strongly suggestive o S. stercoralis.
A
Rhabditidiform larvae
Rhabditidiform larvae are the non-infectious larvae. Strongyloides larvae can convert to the filariform larvae in the intestine, however, and reinfect the host.
25
What happens to arterial pH during strenuous exercise?
You might think it would go up due to hyperventilation, but the arterial pH generally stays the same. If the strenuous exercise is weight lifting and is extreme, then lactate production can lower the pH.
26
Both ____________ and ___________ increase cholesterol synthesis.
(Dyslipidemia drugs)
cholestyramine; ezetimibe
27
Diffuse erythema and epidermis that sloughs off easily is indicative of ______________ (particularly common in young children).
Staphylococcal scalded skin syndrome
28
Low levels of oxygen lead to decreased activity of pyruvate ______________.
dehydrogenase
Pyruvate dehydrogenase is the last enzyme before the TCA cycle. Low levels of oxygen lead to increased activity of lactate dehydrogenase and decreased conversion of pyruvate to acetyl CoA.
Note: you might confuse this enzyme with pyruvate kinase. Pyruvate kinase converts PEP to pyruvate and will thus NOT be decreased in lactate production, because pyruvate gets converted to lactate.
29
Those with Graves' disease often have exophthalmos. Why does this occur?
Stimulation of TSH receptors in the retro-orbital space leads to inflammatory infiltrate. That inflammatory infiltrate – Th cells – leads to stimulation of fibroblasts.
30
Once again, differentiate erosion and ulcer.
* Erosions are extremely simple: they are damages to stomach/intestinal tissue that only go into the mucosa – the topmost layer.
* Ulcers are any erosion that goes deeper than the mucosa (the next layer down would be muscularis mucosa and the one beyond that is the submucosa).
31
Thiazide diuretics block the NaCl cotransporter. Why do they lower potassium?
Lowering blood pressure with any diuretic – thiazides included – will stimulate the release of aldosterone which can lower potassium. Chlorthalidone appears to do this more than indapamide or hydrochlorothiazide.
32
Why do those who've had gastrojejunostomies need to take iron?
Because that procedure creates a hole between the stomach and the jejunum – bypassing the duodenum in which Fe is absorbed.
33
Other than metaplasia, what histologic signs indicate GERD?
* Presence of neutrophils and eosinophils in the mucosa
| * Elongation of the lamina propria
34
When has the neural tube finished closing?
22 days
35
True or false: complete molar pregnancies have to be either 46, XX or 46, YY.
False. There has never been a 46, YY complete molar pregnancy observed. Furthermore, there can also be 46, XY pregnancies in which two sperm fertilize one egg, although that is much less common than one sperm dividing inside an empty egg (leading to 46, XX).
36
How might a complete molar pregnancy be described compared to a partial molar pregnancy?
Complete molar pregnancies will be entirely cystic, while partial molar pregnancies will have fetal parts or normal placenta.
37
In what form does Candida exist in the blood?
As single-celled yeast with pseudohyphae (remember the snowcone in the Sketchy scene!)
38
Hereditary pulmonary fibrosis is due to what pathology?
Smooth muscle proliferation leading to occlusion of the pulmonary arteries that leads to "capillary tufts"
39
A patient presents 11 days after starting a new, experimental drug with pruritis and joint pain. What might be going on?
Serum sickness
"New treatments" might indicate monoclonal antibodies that can deposit in tissues as immune complexes. This will present with arthralgia, pruritus, and neutrophil infiltration of small blood vessels with fibrinoid necrosis.
40
The ophthalmic artery branches off the ______________ artery.
internal carotid
41
The external carotid ultimately forks into the __________________.
maxillary and superficial temporal arteries
42
Which kind of galactosemia causes cataracts?
Both!
Deficiency in galactose 1-phosphate uridyl transferase produces the more severe phenotype, usually leading to hepatic and renal damage in infancy. Galactokinase deficiency, however, leads to a less severe phenotype. In both states, however, galactitol accumulates and damages the lens.
43
Surprisingly, ______________ are not required for a diagnosis of bipolar I disorder.
depressive episodes
44
______________ is absolutely required for a diagnosis of bipolar I disorder.
Greater than one week of elevated or irritable mood with increased energy
45
Why are those with PCOS at increased risk of endometrial carcinoma?
One of the components of PCOS is increased estrogen without progesterone. The estrogen results from the increased enzyme activity of androgen-synthesizing enzymes which increases the amount of androgens that can be converted to estrone peripherally.
Normally, the menstrual cycle leads to periods of estrogen withdrawal and progesterone surge. The progesterone surge decreases the risk of endometrial carcinoma. Without this, the risk of endometrial cancer rises.
46
You're pretty familiar with the fact that metoprolol and atenolol are B1 selective. List the two other B1-selective beta blockers.
Bisoprolol and nebivolol
| Good way to remember this: B1soprolol and neB1volol
47
Blood cultures and _____________ are the most sensitive tests for osteomyelitis.
MRI
"MrI for osteoMYE!"
48
Suspect _____________ in a patient with back pain who's recently had bacteremia or endocarditis.
vertebral osteomyelitis
49
A patient presents with renal failure. Kidney biopsy reveals bipyramidal crystals (like one pyramid on another). What substance might he have ingested?
Ethylene glycol leads to precipitation of oxalate crystals (described in the stem), which are a downstream metabolite.
This causes acute tubular injury.
50
The median nerve passes between which two muscles in the forearm?
Flexor digitorum profundis and flexor digitorum superficialis
51
E. coli is indole-____________.
positive (think of a lazy person on a bean bag in the Sketchy scene – they're INDOLEnt-positive)
52
What does it mean to be indole-positive?
Some bacteria can convert tryptophan to indole.
53
True or false: urine catheters should be changed frequently to avoid infection.
False-ish. While changing a catheter does lead to a temporary reduction in bacterial load, it does not protect against UTI. The best prophylactic measure against catheter-associated UTI is removal of the catheter when no longer necessary.
54
Describe the typical course of RSV.
Usually, the acute illness (fever, wheezing, increased work of breathing, rhinorrhea) lasts between 3 days and one week, but the cough can persist for up to one month.
55
Homocystinuria presents with a Marfanoid body habitus and _____________.
lens subluxation
56
Why does the liver become black in Dubin-Johnson syndrome?
Because the liver is also unable to excrete epinephrine metabolites which are dark (because they are derived from tyrosine)
57
From which arteries does the ureter draw blood?
* Proximal: renal artery
| * Distal: superior vesical artery
58
A patient presents with a uniformly enlarged uterus and menorrhagia. From her clinical history, how can you distinguish between adenomyosis and endometrial hyperplasia?
Because adenomyosis is deep into the muscle, the bleeding will be painful!
59
Differentiate actinic keratosis from seborrheic keratosis.
* Seborrheic keratosis has a stuck-on look (think "StucK on").
* Actinic keratosis is a scaly macule on an erythematous base. They are often "felt more than seen." They can transition to SCC.
60
True or false: the characteristic "owl-eye" cells of Hodgkin's are derived from T cells.
False. They are B-cell derivatives. The fact that they are B cells accounts for how well they can attract macrophages, which account for the bulk of Hodgkin's lymphadenopathy.
61
Where do the internal hemorrhoids get autonomic innervation?
The hypogastric plexus
62
During excision of external hemorrhoids, sensory blockade of ______________ is usually done.
the pudendal nerve
63
Which vitamin deficiency can lead to congestive heart failure?
Thiamine
Beriberi (thiamine deficiency) can present as either wet – in which patients have congestive heart failure – or dry – in which they don't. The other key features are symmetric neuropathy and confusion.
64
True or false: those with Kartagener's disease often have fat malabsorption due to failure of pancreatic cilia.
False. Kartagener's presents with the classic triad of dextrocardia, infertility, and persistent pulmonary infection (which also presents as sinusitis).
65
Amniotic fluid embolism – which can lead to DIC after labor – will present with _______________ on historlogic exam of pulmonary vessels.
fetal squamous cells
Note: the fluid will pass through but the scant cells in the amniotic fluid will be caught.
66
For a diagnosis of schizophrenia, you must have ____________ for greater than 6 months.
2 or more symptoms, of which one must be delusions, hallucinations, or disorganized speech
67
```
Nitrates are recommended to be taken with periodic breaks to reduce which of the following effects?
• Effect potentiation
• Pharmacodynamic drug antagonism
• Tolerance
• Withdrawal symptoms
```
Tolerance
Tolerance rapidly develops to nitrates so drug holidays are recommended.
Effect potentiation refers to one drug's ability to stimulate the effect of another.
Pharmacodynamic drug antagonism is when one drug causes a physiologic effect that antagonizes another drug.
Drug holidays do not help prevent withdrawal symptoms. Those will develop if the drug is taken regularly.
68
The optic nerve is ______________ to the optic tract.
anterior
69
Impaired MLFs lead to failed adduction on the _____________ side.
ipsilateral
The MLF connects the ipsilateral medial rectus with the contralateral lateral rectus. If you disrupt the connection, then when the contralateral lateral rectus is abducted, then the ipsilateral medial rectus will not receive the proper adduction signal and fail to join the eye.
70
The inferior rectal vein (in which hemorrhoids are painful) drains to ______________.
the internal pudendal vein
The superior rectal vein drains to the inferior mesenteric vein.
71
Adrenal crisis (from Addison's disease or adrenal infarction) requires what two treatments?
* IV fluids (because the patient will likely be hypotensive secondary to aldosterone deficiency)
* Glucocorticoids such as dexamethasone or hydrocortisone (to replace the missing cortisol)
72
Aortic stenosis is heard at the _________________.
right sternal border
73
Churg-Strauss disease is also called ________________.
eosinophilic granulomatosis with polyangiitis
74
Churg-Strauss presents with what symptoms?
* Adult-onset asthma (eosinophilia)
* Polyneuropathy (vasculitis of small or medium vessels)
* Eosinophilia
* Antibodies against neutrophil myeloperoxidase
(I don't know why this helps me remember it, but churG-strAUSS reminds me of the statistician Gauss of the Gaussian distribution. The Gaussian distribution is a bell curve which looks somewhat like a bi-lobed eosinophil. Also, the slumped edges of a normal distribution look like limp extremities – this can help you remember polyneuropathy.)
75
In the developed world, the most common cause of hepatic abscess is __________________.
hematogenous spread of bacteria
76
If a patient has colon cancer but denies changes to bowel habits, then the mass is likely in the ________________.
ascending colon; a mass in the sigmoid or descending colons would produce symptoms with defecation
77
Give a brief description of Sarcoptes scabiei.
* A mite transmitted by person-to-person contact
* Produces eryethematous papules with crust on top
* Type IV hypersensitivity reaction leads to delayed pruritus – often worst at night
* Typically presents on the flexor folds of the upper extremity
78
_____________ inhibits alcohol dehydrogenase.
Fomepizole
Disulfiram inhibits the second enzyme in the metabolism of alcohol: aldehyde dehydrogenase.
79
Inhibiting the enzyme _______________ raises risk of cholesterol gallstones.
cholesterol 7 alpha-hydroxylase
This is the first enzyme in the bile-synthesis pathway. Inhibiting the creating of bile means there will be a higher cholesterol : bile ratio in the gallbladder with a higher likelihood of precipitation.
80
If a patient is a high-risk surgery patient, then _________________ can be offered to treat cholesterol gallstones.
ursodeoxycholic acid (a bile acid supplement)
81
True or false: quick weight loss decreases the risk of cholecystitis.
False. Decreased weight loss would likely entail decreased caloric intake. Eating less would mean more cholestasis for the gallbladder so an increased risk of gallstones.
82
Explain how glutamine helps maintain serum pH.
In the proximal tubule cells, glutamine is broken down to NH3 and glutamate. The NH3 is secreted into the lumen and then trapped upon binding H+. NH4+ is then excreted.
83
What anion will be increased in the urine of someone with DKA?
Phosphate
Bicarb levels are lower in the serum, so bicarb cannot be used as a buffer. In the urine, PO4 can help capture the excess protons. Thus, more PO4 will be excreted.
84
Etoposide blocks which enzyme?
Topoisomerase II
| Think of the TWO strands of hair grasped by Rapunzel or the word eTWOposide.
85
List the three most common causes of hypoglycemia in a type 1 diabetic.
* Decreased food intake
* Increased insulin dose
* Exercise
86
Impairment in which protein systems has been shown to lead to Alzheimer's and Parkinson's?
Ubiquitin
87
Enterococcus bacteremia is common after what kinds of procedures?
Cytoscopy (looking through cameras to the bladder) or anything involving the gallbladder or heart
(Think of the Sketchy protesters with the sign "do U heart trees?" to help remember that Enterococcus commonly colonizes the urinary tract, the heart, and the biliary tree.)
88
Kawasaki's disease can present with _____________ and erythema of the hands and feet.
swelling
89
If you're calculating the number needed to treat (or harm), then it's best to ___________________.
calculate the RR of the control and the intervention in percentages and then calculate the difference
So if the RR in the intervention is 45% and the RR in the control is 70%, then the number needed to treat is 4 (because 1/.25 = 4).
90
Other than the obvious signs like clenched fist or opisthotonus, what is a presenting sign of neonatal tetanus?
Difficulty feeding
The masticatory muscles (involved in the suckling response) will become spastic and the child will not be able to suck.
91
What kind of receptor is defective in familial hypocalciuric hypercalcemia?
GPCR
The G-protein inhibits the release of PTH when binding calcium and allows the release of PTH when it is not binding calcium.
92
The main antibody response to influenza vaccination is directed against what protein?
Hemagglutinin
93
Which part of the brain is injured in those with persistent central DI?
The hypothalamic nuclei!
If the central DI is transient, then the damage was likely to the posterior pituitary or the pituitary infundibulum. Persistent central DI suggests damage to the hypothalamic nuclei because the axons can release ADH from the infundibulum if it's damage to the pituitary.
Tricky.
94
To which area of the genome are primers made?
The area flanking the exon you're intending to amplify as well as the start of the exon
95
What is cDNA?
Complementary DNA
It is the DNA made by reverse transcriptase that is complementary to the RNA genome.
96
What is supportive psychotherapy?
It is a system of therapy designed to help individuals cope with chronic psychiatric illness by "bolstering psychological defenses." Not sure what it means beyond that.
97
The best therapy for _______________ is cognitive behavioral therapy.
specific phobias
98
Why do the kidneys shrink in obstructive urinary retention?
The increased hydrostatic pressure pushes on the parenchyma, leading to pressure atrophy.
99
Explain the relationship between blood/gas partition coefficient and potency of inhaled anesthetic.
Trick question: there is no relationship.
Potency correlates with the minimal alveolar concentration (MAC) needed to anesthetize 50% of patients. Having a high blood/gas coefficient, meanwhile, just means that the anesthetic is more soluble in the blood and it will take longer to reach MAC.
100
Explain the best screening test for rheumatoid arthritis.
You might be tempted to guess that rheumatoid factor (anti-IgG IgM) is the best screening test for RA. Not so. While it is present in most people with RA (high sensitivity), it is also present in 10% of healthy people (low specificity). Thus, its clinical utility is limited.
Anti-citrullinated peptides, however, have a high specificity for RA. Inflammation causes arginine to be converted to citrulline. Anti-CCP antibodies (as they're also called) are strongly suggestive of RA.
101
What urine test can help differentiate the causes of metabolic alkalosis?
Urine chloride!!
This is a complicated topic. There are three main types of metabolic alkalosis:
1) Excessive vomiting or nasogastric suctioning: in this type, HCl is lost by the stomach and the alkaline tide that results from making more acid leads to increased bicarb in the blood. Urine chloride will be low because serum chloride is low. In this case, saline will restore the balance.
2) Diuretic use: in this type, excessive furosemide/hydrochlorothiazide leads to excess aldosterone action. This leads to increased Na+ absorption and H+ excretion. Urine chloride will be high. Saline can also correct this imbalance.
3) Hyperaldosteronism: like mentioned above, excess aldosterone leads to intake of Na+ and output of H+/K+. Because of the expanded blood volume, the kidneys filter more fluid and thus high chloride levels are found in the urine. Saline does not correct this imbalance!
I didn't get into Barter syndrome, Gettelman syndrome, or diarrhea as causes of metabolic alkalosis, but hopefully with this info you can figure out what to expect.
102
What molecular mechanism mediates the effects of glucagon and epinephrine?
Serine phosphorylation
Serine phosphorylation is what induces insulin resistance by inhibiting the PI3K pathway.
103
Lesion to the ____________ nerve leads to the Trendelenburg elevation of the ____________ side (ipsilateral or contralateral?).
superior gluteal; contralateral
| Think: conTRENDeleral.
104
"Adjustment disorder" is defined as less than ___________.
six months
105
How long do symptoms need to persist for persistent depressive disorder to be diagnosed?
PDD
PDD is depression for more than 2 years.
Note: PDD is less severe than major depressive disorder, so if a patient has less than 5/9 SIGECAPS, then consider PDD.
106
True or false: the best place to culture H. pylori from a duodenal ulcer is the edge of the ulcer.
False. In almost all cases of H. pylori-associated gastric ulcers, the organism has colonized the pre-pyloric antrum. This area has the fewest acid-secreting glands. The colonization here cranks up the acid secretion in the fundus of the stomach which produces duodenal ulcers because the extra acid is primarily exposed to the duodenal bulb.
107
How do the meglitinides work?
The meglitinides (repaglinide and nateglinide) work the exact same way as the sulfonylureas: they bind to and close the ATP-sensitive potassium channel in beta cells.
Their main distinction is that they do not contain sulfur and can be given to patients with sulfur allergies. (Think of the goose with the top hat in the Sketchy scene: he's "father goose" and does not lay eggs – which represent sulfur.)
108
True or false: you must report suspected child abuse to Child Protective Services immediately upon having a suspicion.
False. While you do need to report it soon, you should complete a full examination and history first – including interviewing the child alone if they are old enough to talk.
109
What cranial findings do babies with trisomy 18 have?
Prominent occiput and macrocephaly
110
Which kind of endocarditis is associated with increased risk of colon cancer?
S. bovis
| Think of "Bovis and BUTThead."
111
The portal triad runs through the _______________ ligament.
hepatoduodenal
112
Sketchy left out an important symptom of acute HIV infection: ______________________.
tongue ulcers!
The other symptoms are a flu-like illness and lymphadenopathy.
113
What two branches innervate the sensory information from the anterior 2/3 of the tongue?
* Taste: chorda tympani (facial nerve)
| * Touch: mandibular division of trigeminal nerve
114
What landmark divides the anterior 2/3 of the tongue from the posterior 1/3?
The terminal sulcus (aka foramen cecum)
115
Although not as common as with halothane, _______________ still occurs rarely with the newer halogenated anesthestics like isoflurane and desflurane.
hepatotoxicity
116
The liver damage seen in halothane toxicity is almost indistinguishable from _______________.
that of viral hepatitis (both present with centrilobular necrosis)
117
Calcium-channel blockers like diltiazem slow phase _________ in nodal cells.
0 upstroke
118
The abnormality that leads to congenital inguinal hernia can cause what other defect?
Hydrocele
Both indirect inguinal hernias and hydroceles result from patent processus vaginalis.
119
What is the formula for "attributable risk in the exposed"?
[(relative risk in those exposed) – (relative risk in those unexposed)]
_______________________________________
(relative risk in the exposed)
This multiplied by 100 gives the risk that can be attributed to the exposure. For instance, if smokers have a RR of esophageal cancer of 5, then the attributable risk is 80%.
120
A mother gives birth to a baby girl with clitoromegaly. The baby's vital signs are normal. The mother tells you that she had to shave her upper lip during pregnancy. The baby likely is missing which enzyme?
Aromatase
The normal vital signs excludes 21-OH and 11-Beta as causes. Excess virilization excludes 17-OH as a cause.
With missing aromatase, the androgens made by the fetus accumulate because they are not converted to estrogen. The accumulated androgens virilize both the mother and daughter.
121
The mast cell inhibitors cromolyn and nedocromil are often described as "stabilizing mast cells." What is the mechanism for this?
They prevent histamine degranulation.
122
True or false: there is no asymptomatic carrier for N. meningitidis.
False. About 5% of people have N. meningitidis in their pharynx. In only about 1 in 500 of those does it spread – via the blood and choroid plexus – to the brain.
123
True or false: because it is angioinvasive, the best test for diagnosing Mucor is blood culture.
False. The only fungus that can be detected with blood culture is Candidemia. The best test for Mucor is biopsy of the lesion.
124
What is the microscopic appearance of Mucor?
BROAD, nonseptate hyphae that branch in 90º angles
| Think of the thick tire irons in the Sketchy video – completely nonseptate, haha.
125
What mechanism allows glucagon to rapidly reverse hypoglycemia in a diabetic who's overdosed on insulin?
Glucagon rapidly raises blood sugar by inducing glycogenolysis in hepatocytes.
126
What is the pigmented area in the posterior lateral pons?
The locus ceruleus
This area regulates arousal and has been implicated in anxiety disorders. It produces NOREPINEPHRINE, not dopamine.
Note: on a cross section, this is located in the ears of the cat.
127
Once a particle has made it to the respiratory (i.e., distal) bronchioles, it must be eliminated by ________________.
macrophage phagocytosis
The mucociliary clearance system functions to the level of the proximal bronchioles.
This mechanism of clearance is most commonly used to eliminate dust and plays a large role in pneumoconiosis.
128
Which cranial nerves enter the orbit through the inferior orbital fissure?
None
All of the optic and oculomotor nerves enter through the superior orbital fissure.
129
True or false: the internal carotid artery passes through the foramen spinosum.
False. The middle meningeal artery passes through this foramen.
130
Describe which sensory nerves innervate the pleura and how pleuritic pain can be felt.
* The diaphragmatic and mediastinal pleura are innervated by the phrenic nerve and will often cause shoulder pain or arm pain if irritated. For example, if someone has a lower lobe pneumonia that abuts the diaphragm, then they may experience shoulder pain due to the C3-C5 commonality of the phrenic nerve with the brachial plexus.
* The thoracic wall is innervated by the intercostal nerves. Irritation of the thoracic pleura will produce more localized pain that will present over the area that is irritated (i.e., not referred pain).
131
In a jugular venous pressure tracing, you will see the tallest peak followed by the second tallest peak followed by a trough. What are each of these?
The tallest peak (the initial a wave) occurs when the atrium contracts. The second, slightly lower peak occurs when the atria is relaxing but the tricuspid valve gets pushed back into the atria during ventricular contraction. The trough represents continued atrial relaxation.
Note: the final peak that occurring after the trough is the build up of venous pressure from continued atrial filling (not from a contraction – which is why the amplitude is less).
132
What should you look for on a CT of someone with constrictive pericarditis?
A thickened, calcified white band around the heart
133
What can cause constrictive pericarditis?
Radiation, heart surgery, or tuberculosus
134
The most common cause of cutaneous Bacillus anthracis infection is ______________.
contact with animals who have not been vaccinated
In the U.S., livestock are routinely vaccinated. Thus, patients with contact with animals in third world countries are the most common presenting cases of B. anthracis.
135
The tumor that presents with Schiller-Duval bodies causes elevation of what serum lab?
AFP (the tumor being yolk sac / endodermal sinus tumor)
Note: Schiller-Duval bodies resemble glomeruli.
136
What two cancers raise beta-HCG levels?
* Dysgerminoma (fried egg look)
| * Choriocarcinoma
137
What regulated enzyme will show increased activity in Lesch-Nyhan syndrome?
PRPP amidotransferase
(This is a hard one to come up for a mnemonic for since purine and pyrimidine are such similar words, but just think that purines have two rings just like PRPP has two P's. Sorry, best I could do.)
138
Explain the difference between malpractice and preventable medical error.
Malpractice is a legal term that is applied to all manner of medical errors. Preventable medical errors are exactly what they sound like. Importantly, preventable medical errors could become malpractice.
139
What is a hapten?
A hapten is a substance that generates an immune response when it binds to another protein. For instance, poison ivy and poison oak produce urushiol which binds to proteins to generate an immune response.
140
How does cilostozol inhibit platelet aggregation?
It inhibits phosphodiesterase which increases cAMP production. cAMP negatively influences platelets.
141
Patients with absence seizures and tonic-clonic seizures should be given _______________.
valproate or lamotrigine
142
Splenic infarction in a sickle-cell patient leads to _______________.
fibrosis and shrinking
143
What are the feared outcomes of hemachromotosis?
Cirrhosis and hepatocellular carcinoma
144
Describe Henoch-Schonlein purpura?
* GI vasculitis that can lead to bloody diarrhea
* Nephropathy with mesangial proliferation
* Joint pain
* Purpura
(Remember that purpurA results from igA. Also, to recall the GI symptoms, just remember it as Henoch-Shitpain purpura. Crude but helps. Joint pain is pretty straightforward since it's a vasculitis.
145
Spina bifida is a classic example of a multifactorial disease because there are numerous genetic and environmental causes. What are four other classic multifactorial conditions?
* Hypertension
* Diabetes
* Coronary artery disease
* Cleft palate
146
Describe the most common presentation of ventricualr rupture.
* Occurs 5-14 days after an MI
* Leads to sudden death
* Is a slit-like tear in the left ventricle (because the left ventricle has the highest pressure and is most likely to produce a tear)
147
Glucagon binds to a G___ receptor that exerts its effects through __________.
s; protein kinase A
148
Melanoma patients with mutations in BRAF have increased survival with ________________.
vemurafenib
149
Those with sickle cell anemia typically have low levels of which serum substance?
Haptoglobin
Sickle cell is a hemolytic anemia.
150
Interferon-gamma binds to what type of receptor?
Janus kinase
Just think, IFN-gamma allows macrophages to activate and kill bacteria stuck in a granuloma. It's like the macrophage develops two faces (a la the two-faced Janus): one looking outside and one looking inside.
151
True or false: in the follicular phase, estrogen peaks before LH.
True! Recall that the estrogen surge becomes positive-feedback and thus triggers the LH surge.
152
True or false: duodenal ulcers commonly lead to hemorrhage of the superior pancreaticoduodenal artery.
False! It is the gastroduodenal artery that frequently bleeds in duodenal ulcers.
153
What is the mechanism of nephrolithiasis in those with Crohn disease?
Crohn disease commonly affects the distal ileum which leads to loss of bile acids (because bile acids are normally absorbed by the distal ileum). That loss of bile acid in the feces leads to fat malabsorption because bile is needed to emulsify fat. The extra fat in the colon binds to calcium and causes loss of calcium in the feces. In a healthy person, calcium binds oxalate in the colon and both are excreted. If calcium is stuck to lipids, as in Crohn disease, then oxalate is free and gets absorbed. Thus, more calcium oxalate stones are likely.
154
There are two common subungual tumors. Describe each.
* Melanoma (appears just as melanoma would of the skin)
* Glomangiomas: literally had never heard of these until today. Glomus bodies are smooth muscles connected small arteriovenous netowrks in the skin. They function to help thermoregulation by shunting blood away from the skin when it's cold. Because these bundles have nerves, they are often described as "exquisitely tender."
155
Antibodies to the pili of N. meningitidis would most likely prevent which step in the infectious process?
Adherence to the nasopharynx
156
Thyroidectomy most commonly injures the nerve that innervates which muscle?
The external branch of the superior laryngeal nerve travels with the superior thyroid artery (a branch of the external carotid). That artery of course needs to be ligated if you're going to remove the thyroid, and ligation entails a risk of severing the external branch of the laryngeal nerve.
The external branch of the laryngeal nerve is a branch of the vagus nerve and innervates the cricothyroid muscle. That muscle helps tense the vocal chords, and as such damaging it produces voice hoarseness.
157
True or false: enoxaparin inhibits Xa directly.
False. EnoxaPARIN is a low-molecular-weight hePARIN analog that is used to treat DVTs in pregnancy because it does not pass into the fetus.
158
What is the mechanism behind glucocorticoids thinning the dermis?
They inhibit the production of ECM collagen and glycosaminoglycans.
159
How do noncaseating granulomas (such as in sarcoidosis) present histologically?
Many cleared out cells (that is, clear cytoplasm) with occasional multinucleated giant cells
160
What is one of the best ways to microbiologically distinguish M. avium from M. tuberculosis?
M. avium grows best at 41º C (like that hot hot sun in the Arizona Buttes in the Sketchy scene)
161
________________ is one of the oldest antibiotics. It has widespread resistance, so it is mainly reserved for special cases of tuberculosis, plague, and tularemia that are susceptible.
Streptomycin (an aminoglycoside)
162
What does upregulation of p27 do?
It inhibits the G1-S transition. Thus, malignant cells typically have low levels of p27.
163
Describe midgut atresia.
Vascular occlusion of the superior mesenteric artery in utero can lead to necrosis of the jejunum. Infants will often present within a couple days of birth with dehydration and malnutrition and a lack of stool. Laparoscopic examination will show the duodenum or jejunum ending in a blind pouch and then the distal ileum wrapped around a blood vessel like tinsel around a Christmas tree.
164
Why does the Weber test localize to the affected ear?
The ear that cannot conduct sound is not picking up ambient room noise. Thus, the only sound that the affected ear hears is the bone conduction and it seems louder.
165
True or false: PTH binds to Gi receptors on osteoclasts.
False. It binds to Gs receptors on osteoBLASTs and stimulates two things: increased production of RANK-L and decreased production of osteoprotegerin.
166
Which of the hemophilias are AR?
Just hemophilia C
HA: VIII deficiency (XLR)
HB: IX deficiency (XLR)
HC: XI deficiency (AR)
167
Give the diagnostic criteria and presenting signs of a learning disorder.
Learning disorders are SELECTIVE difficulties in one area (such as an isolated difficulty with writing, math, or reading). Children with LDs will usually be good at areas in which they aren't struggling. When they are required to do the thing they are not good at, children will often manifest symptoms of ADHD such as distractibility or inattention (can also present with anxiety or misbehaving).
A good way to distinguish this from ADHD is that ADHD presents in multiple settings (e.g., at home and at school), whereas LD will typically present with ADHD symptoms during the struggling task.
168
Which two events does the QT interval encompass? Which contributes more time to the interval?
Ventricular depolarization and repolarization
Repolarization contributes the bulk of time.
169
Sketchy left out something pretty important from the scene for Actinomyces israelii: _____________________.
the yellow sulfur granules turn PURPLE with H&E staining
170
What nerves innervate the vocal chords?
* External branch of the superior laryngeal nerve (X): cricothyroid muscle
* Recurrent branch of the laryngeal nerve (X): all intrinsic muscles
171
Which drugs affect both PTT and PT but not thrombin time?
Xa inhibitors (apixaban, rivaroxaban, fondaparinux, enoxaparin, LMWH)
Think about it: both the intrinsic and extrinsic pathways converge on X, yet X is needed to activate II (that is, it is "upstream" of II) so inhibiting Xa does not affect thrombin time.
172
Describe the origins of and presenting signs of pineal gland neoplasms.
* They (surprisingly) originate from germ cells.
* Because the mass occludes the cerebral aqueduct (between the third and fourth ventricles) leads to obstructive hydrocephalus. This creates papilledema and headaches.
* Leads to problems with upward gaze.
173
Which chamber of the heart is closest to the esophagus?
Left atrium
174
What might you notice on passive range of motion exercises in a person with an upper motor neuron lesion?
A phenomenon called "clasp-knife" spasticity in which there will be initial resistance to movement followed by releasing tension
This can arise from a lesion anywhere in the UMN tract – from the internal capsule to the lower spinal cord.
175
Moderate increases in central venous pressure often do not lead to peripheral edema because of compensatory __________________.
increases in lymphatic drainage
176
There are two highly suggestive signs of Zollinger-Ellison syndrome: _____________________.
* distal duodenal ulcers (proximal ulcers are usually H. pylori or NSAID overuse; ulcers distal to the duodenal bulb are indicative of gastrinoma)
* gastrin levels that rise with secretin administration (secretin usually makes gastrin levels fall, but the abnormal molecular setup of gastrinoma cells cause secretin to be a positive signal).
177
The S4 sound is best heard before _________________.
S1
You might think it would be S1 - S2... S4, but it can sound more like S4 - S1... S2.
178
Describe the pathophysiology of septic abortions.
Incomplete removal of the parts of the fetus/placenta can become infected and lead to fever, hypotension, tachycardia, a "boggy" cervix, and foul-smelling tissue in the uterus. It is most commonly caused by S. aureus, E. coli, or S. agalactiae.
179
Rifaximin is often added to lactulose in the treatment of hepatic encephalopathy. What does it do?
Rifaximin is an unabsorbed antibiotic that kills intestinal bacteria and prevents their recycling of NH3.
180
What is the difference between strawberry and cherry hemangiomas?
Strawberry hemangiomas are large proliferations of capillary endothelium that present in infancy and regress by adolescence.
Cherry hemangiomas are smaller proliferations of capillary endothelium that presents in adulthood and do not regress.
181
How are strawberry and cherry hemangiomas different from cavernous hemangiomas?
Cavernous hemangiomas present with dilated capillaries that appear blue, while strawberry and cherry hemangiomas are not as dilated and appear red.
182
You probably remember that cystic hygromas appear on the necks of girls with Turner syndrome. What are they (cellularly)?
Proliferation of lymphatic vessels
183
Fenoldapam is a dopamine-1 agonist that is especially useful in treating malignant hypertension in cases with _________________.
significant renal involvement
This is so because fenoldapam causes dilation of the afferent arteriole and thus promotes natriuresis. Thus, if a patient has kidney injury they'll likely also benefit from GFR boost.
184
If you hear "fever, bright red tongue, and erythema of the skin" you're probably jumping to Kawasaki's disease. Not so fast, partner. What other disorder could fit that profile?
Scarlet fever from S. pyogenes!!!!
If the stem mentions tonsillar exudate and says the rash is on the abdomen, S. pyogenes is the likely etiology. Don't take the bait and answer "coronary aneurysm".
Note: the rash in scarlet fever often starts out as pure erythema – the boiled lobster look – but then progresses to a goosebump/sandpapre appearance.
185
Haloperidol and fluphenazine are considered the ________________ first-generation antipsychotics.
high-potency
186
What does "ballotable" mean?
Able to be moved around
187
Radiating groin pain after a hysterectomy likely indicates ______________________.
ureteric obstruction with possibile hydronephrosis
188
What would a "decrescendo murmur over the right sternal border" indicate?
Aortic regurgitation
189
Which antibiotic can cause serotonin syndrome?
Linezolid (remember the smiley face spray painted onto the museum floor)
190
True or false: ANCA nephropathy presents with "lumpy-bumpy" immune deposits in the glomerulus.
False. Although ANCA is an autoimmune disorder, it is referred to as a "pauci-immune" conditions because there will be crescentic formation of fibrin in the glomerulus but no immune deposits.
191
List the five shapes of kidney stone crystals.
* AMP: rhomboid, coffin-lid ("because staghorn calculi scare me to the GRAVE")
* Uric acid: lemon-shaped/rounded (gout crystals are yellow like lemons)
* Cystine: hexagonal (cySTINe = STop sIgN... ok, so stop signs are actually octagonal, but they look the most like this)
* Oxalate: dipyramidal with the X through it (duh, oXalate)
* Calcium phosphate: forms rosettes of rods (like the ROSes you might throw over the finish line of the acetazolamide Sketchy track – b/c acetazolamide causes CaPO4 crystals)
192
A positive sodium-nitroprusside test indicates what autosomal recessive disorder?
Cystinuria
| Treatable with what diuretic???
193
How does 47, XXX syndrome present?
* Normal female sexual development
* Tall stature
* Lower IQ than normal but not disablingly so
194
Diabetic neuropathy of which parasympathetic nerve can lead to severe constipation?
Pelvic splanchnic
195
The hypogastric nerve provides _______________ innervation.
sympathetic
196
What is the best screening test for adrenal adenoma?
Aldosterone : renin ratio is high
197
Remember, remember, remember: lesions of the MLF produce inability to adduct the _______________ eye past midline during lateral gaze.
ipsilateral!!!!!
So a right MLF lesion will prevent the right eye from looking past midline during left lateral gaze.
198
Osteogenesis imperfecta results from what enzyme abnormality?
* Autosomal dominant
* Failure of collagen glycosylation leading to impaired helix formation
* Leads to bone malformation, macrocephaly, and fractures during child birth
199
Molluscum contagiosum – often described as shiny, umbilicated papules on areas of eczema – is caused by which virus?
Poxvirus
200
What is non-classic congenital adrenal hyperplasia?
It also results from 21-oh deficiency, but it does not present with hypotension!
201
Why is spironolactone (and other aldosterone antagonists) added to furosemide for treatment of ascites?
Recall that with loop diuretic use extra sodium is delivered to the collecting duct. In order to maximize fluid loss, aldosterone needs to be blocked. Also, the anti-androgenic effects of spironolactone can help prevent the excess testosterone effects found in ascites.
202
What will PCWP in pulmonary edema, pulmonary embolism, and sepsis?
* Edema: high (which is what causes the fluid to extravasate)
* Embolism: normal
* Sepsis: low (increased pulmonary capillary permeability causes it to leak and become lower)
203
What is keratoacanthoma?
It is a rapidly progressing form of SCC.
(I think the best way to remember this is to think of how similar this word looks to actinic keratosis – which is also a premalignant form of SCC
204
What is merkel cell carcinoma?
A neuroendocrine tumor of the skin that looks like a blueish-red nodule
205
The red, scaly skin lesion presents with what on histologic examination?
Actinic keratosis – the red scaly lesion that is usually felt more than seen – presents with an expanded basal layer with prominent parakeratosis.
206
In addition to distress on lying flat, neonatal GERD can also present as ____________________.
vomiting small amounts of milk
207
True or false: IL-8 stimulates the growth of neutrophils.
False. IL-8 is a chemotactic factor for neutrophils (like LTB4 and C5a).
208
When would you use ANOVA?
ANalysis Of VAriance is used when samples are drawn from separate populations and you need to compare the means and variance of each.
209
Bicuspid aortic valve and horseshoe kidney are features of what genetic disorder?
Turner syndrome
210
Skin dimpling in the breast indicates malignant spread into what tissue?
Suspensory ligament
There are ligaments that connect the ductal tissue to the surface skin. If these are disrupted by a malignancy, fibrosis can lead to retractions that produce dimpling.
211
What helps decrease the risk of ovarian cancer?
* Multiparity
* Oral contraceptives
* Breast feeding
212
By what two ways does capsaicin decrease nociception?
* Increased expression of cation channels that decrease the neuron membrane potential
* Sustained release of substance P vesicles which depletes their stores
213
Obstructive sleep apnea can lead to what two cardiac complications?
* The recurrent hypoxemia leads to pulmonary vasoconstriction which can progress to pulmonary hypertension with subsequent right-heart failure.
* The distress of being hypoxic causes sympathetic stimulation (increased HR and BP). If recurrent, it can lead to HTN.
214
Shiga-like toxin is also called __________________.
verotoxin
215
Other than aminocaproic acid, what can be used to reverse tPA?
Cryoprecipitate (like the ice pack on the kid's head next to the teacher)
216
In what situations can tPA be used?
* MI (kid with broken heart string guitar)
* Ischemic stroke (kid with black stripe on beret)
* PE (bird in lung tree)
217
Puncturing the external iliac artery leads to bleeding in which body cavity?
The retroperitoneal space
The iliac is a direct continuation of the aorta – which is also retroperitoneal – and thus blood from the iliacs will leak down into the retroperitoneal space.
218
True or false: in pulmonary edema, the PCWP is always increased.
False. If the pulmonary edema resulted from heart failure – such as mitral stenosis – then the PCWP would be increased. However, if the pulmonary edema resulted from a lung disorder (such as ARDS from pancreatitis), then the PCWP will be normal.
219
In a diagram of breath depth across time, how will obstructive sleep apnea differ from Cheyne-Stokes breathing?
In two ways: (1) OSA will show constant abdominal pressure even during the times during which ventilation doesn't take place; (2) OSA will present with the same volume of breaths across time, whereas CS will show gradually increasing volumes of breath followed by apnea.
220
Cheyne-Stokes is common in what patients?
Those with advanced CHF.
221
Which cells secrete the fibrous cap of atheromas in arteries?
Vascular smooth muscle cells!
This question is downright tricky. Fibroblasts usually secrete collagen, but in the case of arteries it is the VSMCs that form the fibrous cap on top of the foamy macrophages.
222
The cough that accompanies viral croup is often described as ____________.
brassy
223
Leptin lowers levels of which peptide hormone?
neuropeptide Y (which is an appetite stimulant)
224
What is the main mechanism by which oral contraceptives prevent conception?
They reduce serum LH and FSH.
Note: LOCALLY acting progestins (such as from an IUD) in the uterus stimulate mucus production.
225
True or false: linear ulcerations in the esophagus of a transplant patient is likely gastroenteritis-induced Mallory-Weiss tears.
False. This likely is CMV! Remember from the Sketchy scene that CMV can cause linear ulcerations in the esophagus (the cash register conveyor with scratches in it).
226
Give the mechanisms of mirtazapine and trazodone.
* Mirtazapine: antagonism of alpha-2 increases release of norepinephrine and serotonin (like the burnt out lightbulbs next to the smiley face and compass ballons); also, antagonizes 5HT-2 and 5HT-3.
* Trazodone: antagonizes serotonin and inhibits the uptake of serotonin
227
What are the three findings of VIPomas?
* Watery diarrhea
* Hypokalemia (from the watery diarrhea)
* Impaired gastric acid secretion
228
What do somatostatinomas cause?
* Hyperglycemia
* Cholestasis
* Steatorrhea
* Hypochlorhydria
Exactly what somatostatin does... nothing tricky.
229
What embryologic processes are disrupted in cleft palate and lip?
* Palate: failure of the palatine processes
* Lip: failure of the maxillary prominences and intermaxillary segment
• Note: the nasal prominences are completely confined to the nose – so don't be tempted to pick this.
230
What physical exam findings distinguish fat embolism from DVT embolism?
Petechiae!
It's thought that little globules of fat slip through the pulmonary network and damage microvessels elsewhere in the body, leading to petechiae.
231
True or false: sirolimus inhibits a process within macrophages.
False!
It inhibits mTOR within T cells that have been stimulated by IL-2. Likewise, tacrolimus and cyclosporine inhibit IL-2 production in T cells.
232
Endotracheal intubation can worsen or cause vertebral subluxation (malalignment of the vertebral bones with subsequent disruption of the spinal cord). What population of patients develops this chronically without trauma or inciting incident?
Those with rheumatoid arthritis! The destruction of the joints that occurs in RA can affect the atlantoaxial joint and actually progress to paralysis.
233
Which hypothalamic nuclei mediate hunger and satiety?
* Hunger: lateral nucleus ("If you destroy the LATEral nucleus, you'll be LATE for dinner.")
* Satiety: ventromedial ("If you destroy the VEntroMEdial nucleus, you'llb get VEry MEaty.")
234
Cross-sectional studies are the opposite (in terms of timing) of which other study design?
Case-control
Case-control studies take people who have the disease and people who don't have the disease and look back at past exposure. Cross-sectional studies categorize people by risk exposure and then ask what percent have the disease.
235
The form of graft rejection that is often diagnosed by surgeons who notice mottling in an organ upon vascularization is a type ___________ hypersensitivity reaction.
II preformed antibodies
236
What is the best treatment for drug-induced Parkinsonism?
* Discontinue the offending drug (if possible)
* Benztropine or trihexyphenidyl (like the pyramid in the parking spot in the anticholinergic Sketch representing extrapyramidal symptoms)
237
LH causes Leydig cells to produce what hormone?
Testosterone
238
Administering _________________ can trigger Wernicke encephalopathy.
glucose
239
Drugs that antagonize what two receptors can trigger Prinzmetal angina?
* Alpha-1
* Serotonin
Both lead to vasospasm.
240
_________________ is almost always neessary for the development of pyelonephritis.
Vesicoureteral reflux (either functional or anatomical)
241
A young boy presents with jerky movements of the hands and a rash on his abdomen. What other symptoms might he have?
This describes Sydenham chorea and erythema marginatum – both features of rheumatic heart disease. He would likely also have joint pain, wrist nodules, and fever.
242
True or false: LV ejection fraction typically decreases in mitral regurgitation.
False. The flailing valve gets backflow which then increases the amount of preload into the left atrium. (This happens in the acute state when the left atrium can respond to the increased intake of fluid... later it can fail.) The LV thus gets more fluid and increases its stroke volume with increased EF. However, because much of that fluid goes back into the LA, the output to the systemic vasculature is low and hypotension can result.
243
What is the treatment for the toxicity that presents with watery diarrhea and sulfur-smelling breath?
Dimercaprol
Arsenic poisoning – often from tainted water or insecticide – binds sulfhydryl groups which inhibits pyruvate dehydrogenase and releases sulfur. Dimercaprol treats it.
244
Cyanide poisoning is treated with ________________.
hydroxycobalamin
245
SRY targets a gene that does what?
Testis-determining factor (TDF) stimulates gonads to develop into testes
246
A male (46, XY) who lacks Sertoli cells will have what internal and external genitalia?
• Internal: the SRY gene will stimulate TDF to make testes. However, without Sertoli cells there will be no cells that make AMH, so the paramesonephric duct will fail to involute. Thus, both male and femal internal organs would be present.
• External: Leydig cells will still produce testosterone in the presence of LH even if Sertoli cells are missing, so the external genitalia will be male.
247
What is the formula for maintenance dose?
MD = (Cpss) x (Cl)
Note: this will give you an answer in mg/min as a continuous infusion. To calculate dosing intervals, just figure out how many mg to give per set number of minutes.
248
Skin lesions with macrophages full of vacuoles of fat are complications of what disorder?
Hyperlipidemia which can result from cholestatic disorders
249
Which of the beta-lactams have anaerobic coverage?
* Ampicillin (rocker with gas mask)
* Piperacillin and ticarcillin (flute players with gas masks)
* Carbapenems
250
In addition to metronidazole and vancomycin, _________________________ can also treat C. difficile infeciton.
fidaxomicin (a tricyclic that inhibits RNA polymerase)
