Random Q set 3

Question 1

What does bullous impetigo look like? What are the 2 organisms associated with this? Which is more serious & why?

Answer 1

golden yellow crust periorally
staph aureus or strep pyogenes
**strep can turn into acute post strep glomerulonephritis

Question 2

T/F A child could get rheumatic fever from a strep pyogenes bullous impetigo.

Answer 2

False. This can only arise from strep pharynx infection. Not the skin infection.

Question 3

What is the equation for positive predictive value?

Answer 3

PV=True Positives/(True Positives + False Positives)

Question 4

Is it possible to increase sensitivity & decrease positive predictive value?

Answer 4

Yes, b/c the false positives increase with greater sensitivity as well as true positives.

Question 5

Which cranial nerve arises from the pons @ the level of the middle cerebellar peduncle?

Answer 5

trigeminal nerve

Question 6

What are the advantages to using COX2 selective inhibitors over NSAIDs for a chronic inflammatory condition? Give an example of a COX2 selective inhibitor.

Answer 6

celecoxib
COX1 inhibition can mess with the GI tract & platelet aggregation, whereas COX2 is only expressed in inflammatory tissues

Question 7

Describe the characteristics of a partial hydatidiform mole.

Answer 7

69XXX or 69XXY
higher beta hCG
some fetal parts & villi
normal uterine size
cramping & bleeding

Question 8

Describe the characteristics of a complete hydatidiform mole.

Answer 8

46XX
**basically mother's chromosomes disappear, and the sperm that enters doubles.
**if 46YY nonviable
no fetal parts present
big uterus
bleeding & cramping
super high beta hCG
huge villi, trophoblastic tissue
"friable mass of cystic, thin-walled, grape-like structures"

Question 9

What is ethambutol used to treat? What is a very neg. potential side effect?

Answer 9

TB, with a bunch of other drugs

optic neuritis

Question 10

The internal & external pathways of apoptosis converge at which step?

Answer 10

activation of caspases
initiator caspases activate effector caspases
break down the proteins etc of the cell.

Question 11

What kind of pathology would be present with occlusion of the anterior cerebral artery?

Answer 11

supplies medial frontal & parietal lobes
it would mess with sensory & motor function of the contralateral leg & foot
could cause behavioral problems or urinary incontinence
will spare the contralateral face & arm.

Question 12

What kind of pathology would be present with occlusion of the middle cerebral artery?

Answer 12

loss of motor function of hand, face, throat.
maybe Broca’s aphasia
contralateral homonymous hemianopsia
other things too…

Question 13

Which nerves come off of the lower trunk of the brachial plexus?

Answer 13

start off as C8-T1
gives rise to median & ulnar nerves
damage to lower trunk will affect hand function

Question 14

What is Potter Syndrome?

Answer 14

results from oligohydramnios, typically bilateral renal agenesis
club feet
classic facies
pulmonary hypoplasia
Respiratory failure is the cause of death.

Question 15

What is the function of the ventromedial hypothalamic nuclei?

Answer 15

mediates satiety

stimulated by leptin

Question 16

What is the function of the lateral hypothalamic nuclei?

Answer 16

mediates hunger

inhibited by leptin

Question 17

What is the function of anterior hypothalamic nuclei?

Answer 17

heat dissipation via parasympathetics

Question 18

What is the function of the posterior hypothalamic nuclei?

Answer 18

heat conservation via sympathetics

Question 19

What is the function of the arcuate hypothalamic nuclei?

Answer 19

secretion of dopamine
GHRH
gonadotropin

Question 20

What is the function of the paraventricular hypothalamic nuclei?

Answer 20

secretion of ADH, CRH, TRH, oxytocin

Question 21

What is the function of the supraoptic hypothalamic nuclei?

Answer 21

secretion of ADH & oxytocin

Question 22

What is the function of the suprachiasmatic nuclei?

Answer 22

circadian rhythm regulation

pineal gland function (modulate body temp & hormone secretion)

Question 23

What are the fine motor & social expectations of a 3 yo?

Answer 23

fine motor–copies a circle, uses utensils
social–imaginative play, knows age/gender
NOT necessarily cooperative play

Question 24

What is the name of the skin condition that often results from immunocompromised patients with pseudomonas?

Answer 24

ecythema gangrenosum

Question 25

What is the inheritance pattern of xeroderma pigmentosum? Which enzyme is messed up? What is the mechanism of damage?

Answer 25

autosomal recessive
symptoms–photosensitivity, increased risk for skin cancer, poikiloderma, hyper pigmentation w/ sun exposure
UV-specific endonuclease deficiency which recognizes thymine dimers from UV radiation & excises them so that DNA pol can lay down fresh DNA

Question 26

Once again, what are the findings of Down’s syndrome?

Answer 26

flattened facies
epicanthal folds
oblique palpébral fissure
single palmar crease
shortened fifth digit
large tongue
sometimes congenital heart defects involving the endocardial cushion

Question 27

What does COPD do to expiratory flow rate, FEV1/FVC ratio, FRC, RV afterload, EPO?

Answer 27

expiratory flow rate (FEV1) decreases
FEV1/FVC decreases
FRC increases
RV afterload increases & can get pulmonary HTN & Right sided heart failure
the hypoxia can sometimes be sufficient to trigger EPO production

Question 28

Describe the urea cycle.

Answer 28

CO2, NH4, 2 ATP form carbamoyl phosphate (rate-limiting step) in the mitochondria. Form citrulline & transferred to cytosol.
Then argininosuccinate–>arginine–ornithine + urea. Ornithine transferred into mitochondria for another round.

Question 29

Describe the details of the rate-limiting step of the urea cycle. Note: if this cycle is dysfunctional get buildup of ammonia & protein intolerance.

Answer 29

CO2 + NH4+ + 2ATP–>carbamoyl phosphate
Enzyme: carbamoyl phosphate synthetase I
Essential activator: N-acetylglutamate

Question 30

What are some of the symptoms of too much ammonia in the body?

Answer 30

lethargy
vomiting
seizures

Question 31

Give a Class III anti arrhythmic (K+ channel blocking) drug that can result in QT interval prolongation & PR interval prolongation.

Answer 31

Sotalol
also has beta adrenergic blocking properties
used for ventricular tachycardia & a fib

Question 32

Why do patients taking nitrates need a nitrate-free period? when should they take this time off?

Answer 32

to prevent tolerance

nighttime is best b/c cardiac work is least at this time.

Question 33

What is the most common cause of meningitis in adults? Shape of this organism?

Answer 33

Strep pneumonia

lancet shaped, gram + cocci in pairs

Question 34

What is the MOA of aspirin & clopidogrel?

Answer 34

aspirin–irreversible cyclooxygenase inhibitor, inhibits thromboxane A2 synthesis, platelet aggregation
clopidogrel–antiplatelet by inhibiting platelet surface ADP receptors–no aggregation.
**can work synergistically or clopidogrel is good when patients have an aspirin allergy

Question 35

What forms of HTN can obstructive sleep apnea cause?

Answer 35

systemic HTN most common

longstanding OSA can lead to pulmonary HTN

Question 36

What are the 3Ds of botulism?

Answer 36

diplopia
dysphonia
dysphagia
**inhibits release of Ach from nerve terminals

Question 37

What negative side effect do you sometimes see with trazodone? What is a good antidepressant when you want to avoid sexual dysfunction?

Answer 37

priapism!!

Wellbutrin is good/Bupropion

Question 38

If you see a kid squatting to cure shortness of breath…what do you think of?

Answer 38

increasing systemic vascular resistance to decrease R–>L shunting & increase pulmonary blood flow

Question 39

Which interleukin is responsible for isotype switching to IgE?

Answer 39

IL4 produced by Th2 cells

Question 40

Which interleukins are made by macrophages? T cells?

Answer 40

macrophages–IL1, IL12

T cells–IL2, IL3, IL10

Question 41

What is a good initial test to see if you have the sickle cell trait, HbS?

Answer 41

hemoglobin electrophoresis

HbS will travel more slowly than other hemoglobin b/c it has lost its neg. charge from loss of glutamate

Question 42

What is the paradoxical effect associated with nitrate use? How can this be fixed?

Answer 42

long-term use of nitrates can cause reflex tachycardia.

beta blocker can fix this

Question 43

Describe infliximab.

Answer 43

IgG1 monoclonal antibody to TNFalpha

management of rheumatoid arthritis, ankylosing spondylitis, Crohn’s

Question 44

Describe rituximab.

Answer 44

monoclonal antibody targets CD20

treatment of some lymphomas

Question 45

Give the equation for the A-a gradient & PAO2.

Answer 45

A-a gradient = PAO2 - PaO2
PAO2 = [FiO2 X (Pb-PH2O)] - (PaCO2/R)
R=0.8
FiO2 usu 0.21

Question 46

Describe the findings & usual causative organism for bacterial vaginosis.
What is the med to treat?

Answer 46

grayish-white vaginal discharge
fishy odor
clue cells
lose lactobacilli & get overgrowth of mixed anaerobes
Usual organism: gardnerella vaginalis
treatment: metronidazole

Question 47

Describe a hamartoma benign lung tumor.

Answer 47

asymptomatic
coin lesion in patients 50-60 yo
composed of disorganized cartilage, fibrous, and adipose tissue

Question 48

Describe some of the weird symptoms of Conn’s syndrome?

Answer 48

hyperaldosteronism
keep Na+, lose K+ & H+
get metabolic alkalosis & hypokalemia
**these 2 things can cause muscle weakness & paresthesias

Question 49

What can happen with gestational diabetes after the baby is born?

Answer 49

baby in utero exposed to excessively high blood sugar from mom & baby makes a bunch of insulin to compensate (doesn’t come from mom)
get a big baby (macrosomia) & transient hypoglycemia as the baby is no longer exposed to high blood glucose but still has some insulin rolling around in their system.