Rapid Review: Lab/Diagnostic Findings and Clinical Presentations; and MISC!

Question 1

Anticentromere antibodies

Answer 1

Scleroderma (have excessive fibrosis and collagen deposition throughout the body; 2 types. the type associated with anti-centromere antibodies is the Crest type: CREST syndrome = Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia)

Question 2

Antidesmoglein (epithelial) antibodies

Answer 2

Pemphigus vulgaris (blistering)

Question 2

List the 4 most important pharmacokinetics equations: (Vd, Cl, LD, MD)

Answer 2

1) Vd = (amount of drug given)/([drug] in plasma)2) Cl = (Vd X 0.7)/t1/23) LD = Css X Vd4) MD = Css X Cl

Question 2

List the 4 most important pharmacokinetics equations: (Vd, Cl, LD, MD)

Answer 2

1) Vd = (amount of drug given)/([drug] in plasma)2) Cl = (Vd X 0.7)/t1/23) LD = Css X Vd4) MD = Css X Cl

Question 3

Anti-glomerular basement membrane antibodies

Answer 3

Goodpasture’s syndrome (glomerulonephritis and hemoptysis)

Question 3

competitive vs noncompetitive inhibitors:1) Resemble substrate?2) Overcome by increased [S]?3) Bind active site?4) Effect on Vmax?5) Effect on Km?6) Pharmacodynamics: effect on potency? efficacy?

Answer 3

Competitive inhibitors:1) Yes2) Yes3) Yes4) Vmax does not change5) Km increases6) decreased potency (increased Km, decreased potency); no effect on efficacyNoncompetitive inhibitors:1) No2) No3) No4) Vmax decreases5) Km does not change6) decreased efficacy (decreased Vmax, decreased efficacy); no effect on potentcy

Question 3

competitive vs noncompetitive inhibitors:1) Resemble substrate?2) Overcome by increased [S]?3) Bind active site?4) Effect on Vmax?5) Effect on Km?6) Pharmacodynamics: effect on potency? efficacy?

Answer 3

Competitive inhibitors:1) Yes2) Yes3) Yes4) Vmax does not change5) Km increases6) decreased potency (increased Km, decreased potency); no effect on efficacyNoncompetitive inhibitors:1) No2) No3) No4) Vmax decreases5) Km does not change6) decreased efficacy (decreased Vmax, decreased efficacy); no effect on potentcy

Question 4

antihistone antibodies

Answer 4

drug-induced SLE. drugs:

1) hydralazine - treats severe HTN (1st line for HTN in pregnancy, with methyldopa), CHF
2) isoniazid (INH) - treatment and prophylaxis for Mycobacterium tuberculosis
3) phenytoin - anti-epileptic
4) procainamide - anti-arrhythmic

Question 4

Zero-order elimination

Answer 4

rate of elimination of drug is constant, regardless of the plasma concentration; Cp decreases linearly with time.Examples = PEA: Phenytoin, Ethanol, Aspirin

Question 4

Zero-order elimination

Answer 4

rate of elimination of drug is constant, regardless of the plasma concentration; Cp decreases linearly with time.Examples = PEA: Phenytoin, Ethanol, Aspirin

Question 5

Anti-IgG antibodies

Answer 5

Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere deformity)

Question 5

First-order elimination

Answer 5

Rate of elimination is proportional to drug concentration (a constant fraction of the drug is eliminated per unit time); the plasma concentration decreases exponentially with time.

Question 5

First-order elimination

Answer 5

Rate of elimination is proportional to drug concentration (a constant fraction of the drug is eliminated per unit time); the plasma concentration decreases exponentially with time.

Question 6

antimitochondrial antibodies (AMAs)

Answer 6

Primary biliary cirrhosis (female>male; autoimmune disease of liver - get slow progressive destruction of bile canaliculi, so bile builds up in liver = cholestasis, and damages tissue over time, leading to scarring, fibrosis, cirrhosis; portal hypertension)

Question 6

Phase I vs Phase 2 metabolism:Which phase do geriatric patients lose first?

Answer 6

Phase I: -reduction, oxydation, hydrolysis-usually yields slightly polar, water-soluble metabolites (often still active)-cytochrome P-450Phase II:-GAS: Glucuronidation, Acetylation, Sulfation-usually yields very polar, inactive metabolites (renally excreted)*Geriatric patients lose phase 1 first

Question 6

Phase I vs Phase 2 metabolism:Which phase do geriatric patients lose first?

Answer 6

Phase I: -reduction, oxydation, hydrolysis-usually yields slightly polar, water-soluble metabolites (often still active)-cytochrome P-450Phase II:-GAS: Glucuronidation, Acetylation, Sulfation-usually yields very polar, inactive metabolites (renally excreted)*Geriatric patients lose phase 1 first

Question 7

antineutrophil cytoplasmic antibodies (ANCAs)

Answer 7

vasculitis

1) c-ANCA: Wegener’s granulomatosis (a rapidly progressive (crescentic) glomerulonephritis (RPGN))
2) p-ANCA: microscopic polyangiitis (pauci-immune glomerulonerphritis, RPGN), and Churg-Strauss syndrome (pauci-immune, asthma, sinusitis, palpable purpura, peripheral neuropathy))
* “pauci-immune” = form of vasculitis associated with minimal evidence of hypersensitivity upon immunofluorescence.

Question 7

Efficacy vs Potency

Answer 7

Efficacy: -proportional to Vmax (increase Vmax, increase efficacy)-maximal effect a drug can produce-high efficacy drugs: analgesics, antibiotics, antihistamines, decongestantsPotency:-inversely proportional to Km (increase Km, decrease potency)-amount of drug needed for a given effect-increased potency, increased affinity for receptor-highly potent drugs: chemo drugs, anti-hypertensive drugs, antilipid drugs

Question 7

Efficacy vs Potency

Answer 7

Efficacy: -proportional to Vmax (increase Vmax, increase efficacy)-maximal effect a drug can produce-high efficacy drugs: analgesics, antibiotics, antihistamines, decongestantsPotency:-inversely proportional to Km (increase Km, decrease potency)-amount of drug needed for a given effect-increased potency, increased affinity for receptor-highly potent drugs: chemo drugs, anti-hypertensive drugs, antilipid drugs

Question 8

antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA)

Answer 8

SLE (type III hypersensitivity)

Question 8

Pharmacodynamics: Effects of adding competitive antagonists, noncompetitive antagonists, and partial agonists to an agonist on pharmacodynamic curves:

Answer 8

1) Competitive antagonist + agonist –> shift curve to the right = decreased potency (increased Km); no change on efficacy2) Noncompetitive antagonist plus agonist: shift curve down = decreased efficacy (decreased Vmax); no effect on potency3) Partial agonist: acts at the same site as a full agonist, but with reduced maximal effect. Get decreased efficacy (decreased Vmax); potency is variable, can be either increased or decreased.

Question 8

Pharmacodynamics: Effects of adding competitive antagonists, noncompetitive antagonists, and partial agonists to an agonist on pharmacodynamic curves:

Answer 8

1) Competitive antagonist + agonist –> shift curve to the right = decreased potency (increased Km); no change on efficacy2) Noncompetitive antagonist plus agonist: shift curve down = decreased efficacy (decreased Vmax); no effect on potency3) Partial agonist: acts at the same site as a full agonist, but with reduced maximal effect. Get decreased efficacy (decreased Vmax); potency is variable, can be either increased or decreased.

Question 9

antiplatelet antibodies

Answer 9

ITP (idiopathic thrombocytopenic purpura)

Question 9

Therapeutic Index: What is it? What’s the equation? Is it safer to have a higher or lower TI?*Examples of drugs with low TI?

Answer 9

TI = measurement of drug safetyTI = LD50/ED50 = median lethal dose/median effective dose(“TILE”)Safer drugs have higher TI valuesExamples of drugs with low TI (must monitor these patients!):-Phenobarbital-Lithium-Digoxin-Coumadin/Warfarin

Question 9

Therapeutic Index: What is it? What’s the equation? Is it safer to have a higher or lower TI?*Examples of drugs with low TI?

Answer 9

TI = measurement of drug safetyTI = LD50/ED50 = median lethal dose/median effective dose(“TILE”)Safer drugs have higher TI valuesExamples of drugs with low TI (must monitor these patients!):-Phenobarbital-Lithium-Digoxin-Coumadin/Warfarin

Question 10

anti-topoisomerase antibodies

Answer 10

diffuse systemic scleroderma

Question 10

Nicotinic vs Muscarinic ACh receptors

Answer 10

Nicotininc ACh receptors = Na+/K+ channelsMuscarinic ACh receptors = G-protein-coupled receptors, act through 2nd messengers; 5 subtypes = M1, M2, M3, M4, M5

Question 10

Nicotinic vs Muscarinic ACh receptors

Answer 10

Nicotininc ACh receptors = Na+/K+ channelsMuscarinic ACh receptors = G-protein-coupled receptors, act through 2nd messengers; 5 subtypes = M1, M2, M3, M4, M5

Question 11

anti-transglutamase/anti-gliadin/anti-endomysial antibodies

Answer 11

Celiac disease (diarrhea, distention, weight loss)

Question 11

Gq:-what receptors stimulate it?-what are its effects?

Answer 11

-Stimulated by alpha 1, M1, M3, H1, V1-stimulates phospholipase C, which stimulates lipid conversion to PIP2, which stimulates increased diacylglycerol and increased inositol triphosphate. –> increased DAG leads to increased protein kinase C–> increased

Question 11

Gq:-what receptors stimulate it?-what are its effects?

Answer 11

-Stimulated by alpha 1, M1, M3, H1, V1-stimulates phospholipase C, which stimulates lipid conversion to PIP2, which stimulates increased diacylglycerol and increased inositol triphosphate. –> increased DAG leads to increased protein kinase C–> increased

Question 12

“Apple core” lesion on abdominal x-ray

Answer 12

colorectal cancer (usually left-sided)

Question 12

Gs:-what receptors stimulate it?-what are its effects?

Answer 12

-stimulated by: B1, B2, D1, H2, V2-stimulates adenylyl cyclases –> increases cAMP –> increases protein kinase A –> increased intracellular Calcium *lots of bacterial toxins use this mechanism!

Question 12

Gs:-what receptors stimulate it?-what are its effects?

Answer 12

-stimulated by: B1, B2, D1, H2, V2-stimulates adenylyl cyclases –> increases cAMP –> increases protein kinase A –> increased intracellular Calcium *lots of bacterial toxins use this mechanism!

Question 13

Azurophilic granular needles in leukemic blasts

Answer 13

Auer rods (acute myelogenous leukemia, especially the promyelocytic (M3) type)

Question 13

Gi:-what receptors stimulate it?-what are its effects?

Answer 13

-stimulated by: alpha 2, M2, D2-inhibits adenylyl cyclase (so decreased cAMP and decreased protein kinase A)…

Question 13

Gi:-what receptors stimulate it?-what are its effects?

Answer 13

-stimulated by: alpha 2, M2, D2-inhibits adenylyl cyclase (so decreased cAMP and decreased protein kinase A)…

Question 14

Bacitracin response (what organis are sensitive? resistant?)

Answer 14

Sensitive: Streptococcus pyogenes (group A)
Resistant: Streptococcus agalactiae (group B)

Question 14

alpha 1 receptor:-which G-protein class?-Major functions?

Answer 14

GqFunctions:-increase vascular smooth muscle contraction (increase BP)-mydriasis-increase intestinal and bladder sphincter muscle contraction

Question 14

alpha 1 receptor:-which G-protein class?-Major functions?

Answer 14

GqFunctions:-increase vascular smooth muscle contraction (increase BP)-mydriasis-increase intestinal and bladder sphincter muscle contraction

Question 15

“bamboo spine” on X-ray

Answer 15

Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)

Question 15

alpha 2 receptor:-G-protein class?-major functions?

Answer 15

GiMajor functions:-decrease sympathetic outflow (decrease NE secretion)-decrease insulin release-decrease BP (vasodilation)-increase glucagon secretion from alpha cells in pancreas

Question 15

alpha 2 receptor:-G-protein class?-major functions?

Answer 15

GiMajor functions:-decrease sympathetic outflow (decrease NE secretion)-decrease insulin release-decrease BP (vasodilation)-increase glucagon secretion from alpha cells in pancreas

Question 16

Basophilic nuclear remnanats in RBCs

Answer 16

Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)

Question 16

Beta 1 receptor:-G-protein class?-Major functions?

Answer 16

GsFunctions:-increase HR-increase contractility-increase renin release-increase lipolysis

Question 16

Beta 1 receptor:-G-protein class?-Major functions?

Answer 16

GsFunctions:-increase HR-increase contractility-increase renin release-increase lipolysis

Question 17

basophilic stippling of RBCs

Answer 17

lead poisoning or sideroblastic anemia

Question 17

Beta 2 receptor:-G-protein class?-Major functions?

Answer 17

GsFunctions:-vasodilation-bronchodilation-increase HR (compensatory to increase BP)-increase contractility-increase lipolysis-increase insulin release-decrease uterine tone

Question 17

Beta 2 receptor:-G-protein class?-Major functions?

Answer 17

GsFunctions:-vasodilation-bronchodilation-increase HR (compensatory to increase BP)-increase contractility-increase lipolysis-increase insulin release-decrease uterine tone

Question 18

bloody tap on LP

Answer 18

subarachnoid hemorrhage

Question 18

M1 receptor:-G protein?-Functions?

Answer 18

GqFunctions:-CNS, enteric nervous system

Question 18

M1 receptor:-G protein?-Functions?

Answer 18

GqFunctions:-CNS, enteric nervous system

Question 19

“boot-shaped” heart on x-ray

Answer 19

tetralogy of fallot, RVH

Question 19

M2 receptor:-G-protein?-Functions?

Answer 19

GiFunctions:-decreased HR and contractility of atria

Question 19

M2 receptor:-G-protein?-Functions?

Answer 19

GiFunctions:-decreased HR and contractility of atria

Question 20

branching gram + rods with sulfar granules

Answer 20

actinomyces israelii

Question 20

M3 receptor: -G-protein?-Functions?

Answer 20

GqFunctions:-increase exocrine gland secretions (ie sweat, gastric acid)-increase gut peristalsis-increase bladder contraction-bronchoconstriction-increase miosis-accommodation (ciliary muscle contraction)

Question 20

M3 receptor: -G-protein?-Functions?

Answer 20

GqFunctions:-increase exocrine gland secretions (ie sweat, gastric acid)-increase gut peristalsis-increase bladder contraction-bronchoconstriction-increase miosis-accommodation (ciliary muscle contraction)

Question 21

bronchogenic apical lung tumor

Answer 21

pancoast tumor (carcinoma that occurs in apex of lung and may affect cervical sympathetic plexus / compress sympathetic ganglion and cause Horner’s syndrome- ptosis + miosis + anhidrosis)

Question 21

D1 receptor:-G-protein?-Functions?

Answer 21

GsFunctions:-relaxes renal vascular smooth muscle

Question 21

D1 receptor:-G-protein?-Functions?

Answer 21

GsFunctions:-relaxes renal vascular smooth muscle

Question 22

“brown” tumor of bone

Answer 22

Hemorrhage (hemosiderin) causes brown color of osteolytic cysts. Due to:

1) hyperparathyroidism
2) osteitis fibrosa cystica

Question 22

D2 receptor:-G protein?-Functions?

Answer 22

GiFunctions:-modulates transmitter release, especially in brain

Question 22

D2 receptor:-G protein?-Functions?

Answer 22

GiFunctions:-modulates transmitter release, especially in brain

Question 23

cardiomegaly with apical atrophy

Answer 23

Chaga’s disease (trypanosoma cruzi)

Question 23

H1 receptor:-G protein?-Functions?

Answer 23

GqFunctions:-increase nasal and bronchial mucus production-bronchiole contraction-pruritus-pain

Question 23

H1 receptor:-G protein?-Functions?

Answer 23

GqFunctions:-increase nasal and bronchial mucus production-bronchiole contraction-pruritus-pain

Question 24

cellular crescents in Bowman’s capsule

Answer 24

rapidly progressive crescentic glomerulonephritis

Question 24

H2 receptor:-G protein?-Functions?

Answer 24

GsFunctions:-increase gastric acid secretion

Question 24

H2 receptor:-G protein?-Functions?

Answer 24

GsFunctions:-increase gastric acid secretion

Question 25

“chocolate cyst” of ovary

Answer 25

Endometriosis (frequently involves both ovaries)

Question 25

V1 receptor:-G protein?-Functions?

Answer 25

GqFunctions:-increase vascular SM contraction

Question 25

V1 receptor:-G protein?-Functions?

Answer 25

GqFunctions:-increase vascular SM contraction

Question 26

circular grouping of dark tumor cells surrounding pale neurofibrils

Answer 26

Homer Wright rosettes (neuroblastoma, medulloblastoma, retinoblastoma)

Question 26

V2 receptor:-G protein?-Functions?

Answer 26

GsFunctions:-increase H20 permeability and reabsorption in the collecting tubules of the kidney(“V2 is found in the 2 kidneys”)

Question 26

V2 receptor:-G protein?-Functions?

Answer 26

GsFunctions:-increase H20 permeability and reabsorption in the collecting tubules of the kidney(“V2 is found in the 2 kidneys”)

Question 27

collonies of mucoid Pseudomonas in lungs

Answer 27

cystic fibrosis (AR mutation to CFTR resulting in fat-soluble vitamin deficiency and mucous plugs)

Question 27

What class of drugs are these:Bethanochol, Carbachol, Pilocarpine, Methacholine?

Answer 27

Cholinomimetic agents: Direct agonists

Question 27

What class of drugs are these:Bethanochol, Carbachol, Pilocarpine, Methacholine?

Answer 27

Cholinomimetic agents: Direct agonists

Question 28

decreased alpha-fetoprotein in amniotic fluid/maternal serum

Answer 28

down syndrome or other chromosomal abnormality

Question 28

What class of drugs are these:Neostigmine, Pyridostigmine, Edrophonium, Physostigmine, Echothiophate, Donepezil

Answer 28

Cholinomimetic agents: Indirect agonists = anti-cholinesterases

Question 28

What class of drugs are these:Neostigmine, Pyridostigmine, Edrophonium, Physostigmine, Echothiophate, Donepezil

Answer 28

Cholinomimetic agents: Indirect agonists = anti-cholinesterases

Question 29

degeneration of dorsal column nerves

Answer 29

tabes dorsalis (tertiary syphilis)

Question 29

What class of drugs are these:Atropine, homatropine, tropicamide, benztropine, scopolamine, ipratropium, oxybutynin, glycopyrrolate, methscopolamine, pirenzepine, propantheline

Answer 29

muscarinic antagonists = cholinergic antagonists

Question 29

What class of drugs are these:Atropine, homatropine, tropicamide, benztropine, scopolamine, ipratropium, oxybutynin, glycopyrrolate, methscopolamine, pirenzepine, propantheline

Answer 29

muscarinic antagonists = cholinergic antagonists

Question 30

depigmentation of neurons in substantia nigra

Answer 30

parkinson’s disease (basal ganglia disorder: rigid, resting tremor, bradykinesia)

Question 30

List the direct agonists/cholinomimetic agents (X4):

Answer 30

NAME?

Question 30

List the direct agonists/cholinomimetic agents (X4):

Answer 30

NAME?

Question 31

desquamated epithelium casts in sputum

Answer 31

Curschmann’s spirals (bronchial asthma; can result in whorled mucous plugs)

Question 31

List the indirect agonists/cholinomimetic agents = anticholinesterases (X6)

Answer 31

NAME?

Question 31

List the indirect agonists/cholinomimetic agents = anticholinesterases (X6)

Answer 31

NAME?

Question 32

dissarayed granulosa cells in eosinophilic fluid

Answer 32

call-exner bodies (granulosa-theca cell tumor of ovary)

Question 32

List the muscarinic antagonists;

Answer 32

NAME?

Question 32

List the muscarinic antagonists;

Answer 32

NAME?

Question 33

dysplastic squamous cervical cells with nuclear enlargement and hyperchromasia

Answer 33

koilocytes (HPV: predisposes to cervical cancer)

Question 33

Cholinesterase inhibitor poisoning symptoms (ie excess parasympathetic activity): Antidote to anti-AchE poisoning?

Answer 33

NAME?

Question 33

Cholinesterase inhibitor poisoning symptoms (ie excess parasympathetic activity): Antidote to anti-AchE poisoning?

Answer 33

NAME?

Question 34

enlarged cells with intranuclear inclusion bodies

Answer 34

“owl’s eye” appearance of CMV

Question 34

What’s parathion?

Answer 34

Parathion = insecticide = organophosphate; causes cholinesterase-inhibitor poisoning (DUMBBELSS)

Question 34

What’s parathion?

Answer 34

Parathion = insecticide = organophosphate; causes cholinesterase-inhibitor poisoning (DUMBBELSS)

Question 35

enlarged thyroid cells with ground glass nuclei

Answer 35

“orphan annie” eye nuclei (papillary carcinoma of the thyroid)

Question 35

When do you give atropine + pralidoxime?

Answer 35

Give as an antidote to organophosphate poisoning/ Cholinesterase-inhibitor poisoning

Question 35

When do you give atropine + pralidoxime?

Answer 35

Give as an antidote to organophosphate poisoning/ Cholinesterase-inhibitor poisoning

Question 36

eosinophilic cytoplasmic inclusion in liver cell

Answer 36

Mallory bodies (alcoholic liver disease)

Question 36

Atropine:-class of drug?-clinical uses?-effects on eyes, airway, stomach, gi, bladder?-toxicity?

Answer 36

atropine = muscarinic antagonistused to treat bradycardia and for ophthalmic applicationseffects: blocks DUMBBELSS!-Eye–> increases mydriasis, cycloplegia-Airway–>decreases secretions-stomach –> decreases acid secretions-GI –> decreases motility-bladder –> decreases urgency in cystitis*Toxicity: Hot as a hare, Dry as a bone, Red as a beet, Blind as a bat, Mad as a hatter, Bloated as a toad:-increased body temp, decreased sweating-rapid pulse-dry mouth; dry/flushed skin-cycloplegia (blurry, near vision)-constipation (and urinary retention in men with prostatic hyperplasia)-disorientation-acute angle-closure glaucoma in elderly-hyperthermia in infants

Question 36

Atropine:-class of drug?-clinical uses?-effects on eyes, airway, stomach, gi, bladder?-toxicity?

Answer 36

atropine = muscarinic antagonistused to treat bradycardia and for ophthalmic applicationseffects: blocks DUMBBELSS!-Eye–> increases mydriasis, cycloplegia-Airway–>decreases secretions-stomach –> decreases acid secretions-GI –> decreases motility-bladder –> decreases urgency in cystitis*Toxicity: Hot as a hare, Dry as a bone, Red as a beet, Blind as a bat, Mad as a hatter, Bloated as a toad:-increased body temp, decreased sweating-rapid pulse-dry mouth; dry/flushed skin-cycloplegia (blurry, near vision)-constipation (and urinary retention in men with prostatic hyperplasia)-disorientation-acute angle-closure glaucoma in elderly-hyperthermia in infants

Question 37

eosinophilic cytoplasmic inclusion in nerve cell

Answer 37

Lewy body (parkinson’s disease)

Question 37

What sympathomimetic should be used to treat:-anaphylactic shock?-cardiogenic shock?-septic shock?

Answer 37

NAME?

Question 37

What sympathomimetic should be used to treat:-anaphylactic shock?-cardiogenic shock?-septic shock?

Answer 37

NAME?

Question 38

eosinophilic globule in liver

Answer 38

Councilman body (toxic or viral hepatitis, often yellow fever)

Question 38

Epinephrine:-type of drug-what receptors does it act on?-clinical applications

Answer 38

-direct sympathomimetic-acts on alpha 1, alpha 2, beta 1, beta 2-use for anaphylaxis, open angle glaucoma, asthma, hypotension (anaphylactic shock)

Question 38

Epinephrine:-type of drug-what receptors does it act on?-clinical applications

Answer 38

-direct sympathomimetic-acts on alpha 1, alpha 2, beta 1, beta 2-use for anaphylaxis, open angle glaucoma, asthma, hypotension (anaphylactic shock)

Question 39

eosinophilic inclusion bodies in cytoplasm of hippocampal nerve cells

Answer 39

Rabies virus (Lyssavirus)

Question 39

norepinephrine:-type of drug-what receptors does it act on?-applications

Answer 39

-direct sympathomimetic-acts on alpha 1, alpha 2, beta 1-use for hypotension (septic shock)

Question 39

norepinephrine:-type of drug-what receptors does it act on?-applications

Answer 39

-direct sympathomimetic-acts on alpha 1, alpha 2, beta 1-use for hypotension (septic shock)

Question 40

extracellular amyloid deposition in gray matter of brain

Answer 40

senile plaques (Alzheimer’s disease)

Question 40

isoproterenol:-type of drug-what receptors does it act on?-applications

Answer 40

-direct sympathomimetic-acts equally on beta 1 and beta 2 receptors-used for AV block

Question 40

isoproterenol:-type of drug-what receptors does it act on?-applications

Answer 40

-direct sympathomimetic-acts equally on beta 1 and beta 2 receptors-used for AV block

Question 41

Giant B cells with bilobed nuclei with prominent inclusions (“owl’s eye”)

Answer 41

Reed-Sternberg cells (Hodgkin’s lymphoma)

Question 41

dopamine:-type of drug-what receptors does it act on?-applications

Answer 41

-direct sympathomimetic-acts on all receptors, but its effects vary by dose:low dose –> acts on D1medium dose –> acts on B1 > B2*high dose –> acts on alpha 1 and alpha 2-used for shock (increases renal perfusion), heart failure

Question 41

dopamine:-type of drug-what receptors does it act on?-applications

Answer 41

-direct sympathomimetic-acts on all receptors, but its effects vary by dose:low dose –> acts on D1medium dose –> acts on B1 > B2*high dose –> acts on alpha 1 and alpha 2-used for shock (increases renal perfusion), heart failure

Question 42

Glomerulus-like structure surrounding vessel in germ cells

Answer 42

Schiller-Duval bodies (yolk sac tumor)

Question 42

dobutamine:-type of drug-what receptors does it act on?-applications

Answer 42

-direct sympathomimetic-acts on Beta 1 mostly (also, slightly on alpha 1, alpha 2, beta 2)-used for heart failure, cardiac stress testing, cardiogenic shock

Question 42

dobutamine:-type of drug-what receptors does it act on?-applications

Answer 42

-direct sympathomimetic-acts on Beta 1 mostly (also, slightly on alpha 1, alpha 2, beta 2)-used for heart failure, cardiac stress testing, cardiogenic shock

Question 43

“hair-on-end” (crew-cut) appearance on x-ray

Answer 43

Beta-thalassemia, sickle cell anemia (marrow expansion)

Question 43

phenylephrine:-type of drug-what receptors does it act on?-applications

Answer 43

-direct sympathomimetic-acts on alpha 1 mostly (and a little on alpha 2)-used for pupillary dilation, vasoconstriction, nasal decongestion; good for stopping epistaxis

Question 43

phenylephrine:-type of drug-what receptors does it act on?-applications

Answer 43

-direct sympathomimetic-acts on alpha 1 mostly (and a little on alpha 2)-used for pupillary dilation, vasoconstriction, nasal decongestion; good for stopping epistaxis

Question 44

hCG elevated

Answer 44

choriocarcinoma, hydatidiform mole (occurs with and without embryo)

Question 44

Metaproterenol, Albuterol, Salmeterol, Terbutaline:-types of drugs?-what receptors do they act on?-Applications

Answer 44

-direct sympathomimetics-B2-agonists (also act very slightly on B1)-Metaproterenol and Albuterol –> used for acute asthma-Salmeterol –> for long-term treatment of asthma-Terbutaline –> to reduce premature uterine contractions

Question 44

Metaproterenol, Albuterol, Salmeterol, Terbutaline:-types of drugs?-what receptors do they act on?-Applications

Answer 44

-direct sympathomimetics-B2-agonists (also act very slightly on B1)-Metaproterenol and Albuterol –> used for acute asthma-Salmeterol –> for long-term treatment of asthma-Terbutaline –> to reduce premature uterine contractions

Question 45

Heart nodules (granulomatous)

Answer 45

Aschoff bodies (rheumatic fever)

Question 45

Ritodrine:-type of drug-what receptors does it act on?-applications

Answer 45

-direct sympathomimetic-acts on B2 receptors ONLY!-used to reduce premature uterine contractions

Question 45

Ritodrine:-type of drug-what receptors does it act on?-applications

Answer 45

-direct sympathomimetic-acts on B2 receptors ONLY!-used to reduce premature uterine contractions

Question 46

Heterophile antibodies

Answer 46

Infectious mononucleosis (EBV)

Question 46

List 3 indirect sympathomimetics:-What are their actions?-What are their clinical applications?

Answer 46

1) Amphetamines:-indirect general sympathetic agonist; release stored catecholamines-used for narcolepsy, obesity, ADD2) Ephedrine:-indirect general sympathetic agonist-release stored catecholamines-used for nasal decongestion, urinary incontinence, hypotension3) cocaine:-indirect general sympathetic agonist; uptake inhibitor-causes vasoconstriction and local anesthesia

Question 46

List 3 indirect sympathomimetics:-What are their actions?-What are their clinical applications?

Answer 46

1) Amphetamines:-indirect general sympathetic agonist; release stored catecholamines-used for narcolepsy, obesity, ADD2) Ephedrine:-indirect general sympathetic agonist-release stored catecholamines-used for nasal decongestion, urinary incontinence, hypotension3) cocaine:-indirect general sympathetic agonist; uptake inhibitor-causes vasoconstriction and local anesthesia

Question 47

Hexagonal, double-pointed, needle-like crystals in bronchial secretions

Answer 47

Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)

Question 47

clonidine and alpha-meythldopa:-type of drugs?-act on what type of receptor?-applications?

Answer 47

NAME?

Question 47

clonidine and alpha-meythldopa:-type of drugs?-act on what type of receptor?-applications?

Answer 47

NAME?

Question 48

High level of D-dimers

Answer 48

DVT, pulmonary embolism, DIC

Question 48

-azole =

Answer 48

anti-fungal (ie ketoconazole)

Question 48

-azole =

Answer 48

anti-fungal (ie ketoconazole)

Question 49

Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)

Answer 49

Ghon complex (Primary TB: Mycobacterium bacilli)

Question 49

-cillin =

Answer 49

penicillin (ie methicillin)

Question 49

-cillin =

Answer 49

penicillin (ie methicillin)

Question 50

“Honeycomb lung” on x-ray

Answer 50

Interstitial fibrosis

Question 50

-cycline =

Answer 50

antibiotic, protein synthesis inhibitor (ie tetracycline)

Question 50

-cycline =

Answer 50

antibiotic, protein synthesis inhibitor (ie tetracycline)

Question 51

Hypersegmented neutrophils

Answer 51

Megaloblastic anemia (B12-deficiency: neurologic symptoms; folate deficiency: no neurologic symptoms)

Question 51

-navir =

Answer 51

protease inhibitor (HIV trtmt) (ie saquinavir)

Question 51

-navir =

Answer 51

protease inhibitor (HIV trtmt) (ie saquinavir)

Question 52

hypochromic, microcytic anemia

Answer 52

iron-deficiency anemia, lead poisoning, thalassemia (HbF sometimes present)

Question 52

-triptan =

Answer 52

5-HT1B/1D-agonists (for migraines) (ie sumatriptan)

Question 52

-triptan =

Answer 52

5-HT1B/1D-agonists (for migraines) (ie sumatriptan)

Question 53

increased alpha-fetoprotein in amniotic fluid/maternal serum

Answer 53

dating error, anencephaly, spina bifida (neural tube defects)

Question 53

-ane=

Answer 53

inhalational general anesthetic (ie halothane)

Question 53

-ane=

Answer 53

inhalational general anesthetic (ie halothane)

Question 54

increased uric acid levels

Answer 54

Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics

Question 54

-caine=

Answer 54

NAME?

Question 54

-caine=

Answer 54

NAME?

Question 55

intranuclear eosinophilic droplet-like bodies

Answer 55

cowdry type A bodies (HSV or CMV)

Question 55

-operidol=

Answer 55

butyrophenone (neuroleptic) (ie haloperidol)

Question 55

-operidol=

Answer 55

butyrophenone (neuroleptic) (ie haloperidol)

Question 56

iron-containing nodules in alveolar septum

Answer 56

ferruginous bodies (asbestos: increases chance of mesothelioma)

Question 56

-azine =

Answer 56

phenothiazine (neuroleptic, antiemetic) (ie chlorpromazine)

Question 56

-azine =

Answer 56

phenothiazine (neuroleptic, antiemetic) (ie chlorpromazine)

Question 57

large lysosomal vesicles in phagocyte, immunodeficiency

Answer 57

Chediak-Higashi disease (congenital failure of phagolysosome formation)

Question 57

-barbital =

Answer 57

barbiturate (ie phenobarbital)

Question 57

-barbital =

Answer 57

barbiturate (ie phenobarbital)

Question 58

“lead pipe” appearance of colon on x-ray

Answer 58

ulcerative colitis (loss of haustra)

Question 58

-zolam =

Answer 58

benzodiazepine (ie alprazolam)

Question 58

-zolam =

Answer 58

benzodiazepine (ie alprazolam)

Question 59

linear appearance of glomeruli on immunofluorescence

Answer 59

Goodpasture’s syndrome

Question 59

-azepam =

Answer 59

benzodiazepine (ie diazepam)

Question 59

-azepam =

Answer 59

benzodiazepine (ie diazepam)

Question 60

Low serum ceruloplasmin

Answer 60

Wilson’s disease (hepatolenticular degeneration)

Question 60

-etine =

Answer 60

SSRI (ie fluoxetine)

Question 60

-etine =

Answer 60

SSRI (ie fluoxetine)

Question 61

“lumpy-bumpy” appearance of glomeruli on immunofluorescence

Answer 61

post-streptococcal glomerulonephritis (immune complex deposition of IgG and C3b)

Question 61

-ipramine =

Answer 61

TCA (ie imipramine)

Question 61

-ipramine =

Answer 61

TCA (ie imipramine)

Question 62

lytic (“hole-punched”) bone lesions on x-ray

Answer 62

multiple myeloma

Question 62

-triptyline =

Answer 62

TCA (ie amitriptyline)

Question 62

-triptyline =

Answer 62

TCA (ie amitriptyline)

Question 63

mammary gland (“blue-domed”) cyst

Answer 63

fibrocystic change of the breast

Question 63

-olol =

Answer 63

beta-antagonist (ie propranolol)

Question 63

-olol =

Answer 63

beta-antagonist (ie propranolol)

Question 64

monoclomal antibody spike

Answer 64

1) Multiple myeloma (called the M protein; usually IgG or IgA)
2) Monoclonal gammopathy of undetermined significance (MGUS; normal consequence of aging)
3) Waldenstrom’s (M protein=IgM) macroglobulinemia
4) Primary amyloidosis

Question 64

-terol =

Answer 64

beta2-agonist (ie albuterol)

Question 64

-terol =

Answer 64

beta2-agonist (ie albuterol)

Question 65

monoclonal globulin protein in blood/urine

Answer 65

Bence Jones proteins (multiple myeloma [kappa of lambda Ig light chains in urine]), Waldenstrom’s macroglobulinemia (IgM)

Question 65

-zosin =

Answer 65

alpha 1-antagonist (ie prazosin)

Question 65

-zosin =

Answer 65

alpha 1-antagonist (ie prazosin)

Question 66

mucin-filled cell with peripheral nucleus

Answer 66

Signet ring (gastric carcinoma)

Question 66

-oxin =

Answer 66

cardiac glycoside (inotropic agent) (ie digoxin)

Question 66

-oxin =

Answer 66

cardiac glycoside (inotropic agent) (ie digoxin)

Question 67

narrowing of bowel lumen on barium radiograph

Answer 67

“string sign” (Crohn’s disease)

Question 67

-pril =

Answer 67

ACE-inhibitor (ie captopril)

Question 67

-pril =

Answer 67

ACE-inhibitor (ie captopril)

Question 68

needle-shaped, negatively birefringent crystals

Answer 68

Gout (monosodium urate crystals)

Question 68

-afil =

Answer 68

erectile dysfunction (ie sildenafil)

Question 68

-afil =

Answer 68

erectile dysfunction (ie sildenafil)

Question 69

Nodular hyaline deposits in glomeruli

Answer 69

Kimmelstiel-Wilson nodules (diabetic nephropathy)

Question 69

-tropin =

Answer 69

pituitary hormone (ie somatotropin)

Question 69

-tropin =

Answer 69

pituitary hormone (ie somatotropin)

Question 70

Novobiocin response

Answer 70

on the office’s staph retreat, there was NO StRES:
Sensitive: Staphylococcus epidermidis
Resistant: Staphylococcus saprophyticus

Question 70

-tidine =

Answer 70

H2-antagonist (ie cimetidine)

Question 70

-tidine =

Answer 70

H2-antagonist (ie cimetidine)

Question 71

“nutmeg” appearance of liver

Answer 71

chronic passive congestion of liver due to right heart failure

Question 71

-dronate =

Answer 71

bisphosphonate (for osteoporosis) (ie alendronate)

Question 71

-dronate =

Answer 71

bisphosphonate (for osteoporosis) (ie alendronate)

Question 72

“onion-skin” periosteal reaction

Answer 72

“going out for EWINGS and ONION RINGS!”

Ewing’s sarcoma (malignant round-cell tumor)

Question 72

-sartan =

Answer 72

Ang II-receptor-antagonist (ie losartan, valsartan)

Question 72

-sartan =

Answer 72

Ang II-receptor-antagonist (ie losartan, valsartan)

Question 73

Optochin response

Answer 73

OVRPS (overpass):
Sensitive: Strep pneumoniae
Resistant: Viridans streptococcus

Question 73

-chol =

Answer 73

cholinergic/muscarinic agonist (ie bethanechol, carbachol)

Question 73

-chol =

Answer 73

cholinergic/muscarinic agonist (ie bethanechol, carbachol)

Question 74

Periosteum raised from bone, creating triangular area

Answer 74

Codman’s triangel on x-ray (osteosarcoma, Ewing’s sarcoma, pyogenic osteomyelitis)

Question 74

-curium or -curonium =

Answer 74

paralytic drugs (non-depolarizing NM-blocking drugs; reversed with neostigmine) (ie atracurium, vecuronium)

Question 74

-curium or -curonium =

Answer 74

paralytic drugs (non-depolarizing NM-blocking drugs; reversed with neostigmine) (ie atracurium, vecuronium)

Question 75

Podocyte fusion on EM

Answer 75

minimal change disease (child with nephrotic syndrome)

Question 75

-stigmine =

Answer 75

anti-cholinesterase (ie neostigmine, physostigmine, pyridostigmine)

Question 75

-stigmine =

Answer 75

anti-cholinesterase (ie neostigmine, physostigmine, pyridostigmine)

Question 76

polished, “ivory-like” appearance of bone at cartilage erosion

Answer 76

eburnation (osteoarthritis resulting in bony sclerosis)

Question 76

-mustine =

Answer 76

nitrosureas (cross BBB, used to treat brain cancers)

Question 76

-mustine =

Answer 76

nitrosureas (cross BBB, used to treat brain cancers)

Question 77

Protein aggregates in neurons from hyperphosphoylation of protein tau

Answer 77

neurofibillary tangles (Alzheimer’s disease and CJD)

Question 77

-statins =

Answer 77

HMG-coA reductase inhibitors (ie atorvastatin)

Question 77

-statins =

Answer 77

HMG-coA reductase inhibitors (ie atorvastatin)

Question 78

Pseudopalisading tumor cells on brain biopsy

Answer 78

Glioblastoma multiforme

Question 78

-glitazones =

Answer 78

increase target cell response to insulin (ie rosiglitazone, pioglitazone)

Question 78

-glitazones =

Answer 78

increase target cell response to insulin (ie rosiglitazone, pioglitazone)

Question 79

RBC casts in urine

Answer 79

Acute glomerulonephritis

Question 79

-bendazoles=

Answer 79

anti-parasitic (esp anti-helminthic)

Question 79

-bendazoles=

Answer 79

anti-parasitic (esp anti-helminthic)

Question 80

Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells

Answer 80

Reinke crystals (Leydig cell tumor)

Question 80

-dipine =

Answer 80

Ca-channel blockers (specifically dihyropyridine CCB’s) (ie nifedipine, amlodipine)

Question 80

-dipine =

Answer 80

Ca-channel blockers (specifically dihyropyridine CCB’s) (ie nifedipine, amlodipine)

Question 81

Renal epithelial casts in urine

Answer 81

Acute toxic/viral nephrosis

Question 81

-prost =

Answer 81

prostaglandin analogues (treat glaucoma) (ie unoprostone)

Question 81

-prost =

Answer 81

prostaglandin analogues (treat glaucoma) (ie unoprostone)

Question 82

Rhomboid crystals, positively birefringent

Answer 82

pseudogout (calcium pyrophosphate dihydrate)

Question 82

-mab =

Answer 82

monoclonal antibody (ie infliximab, daclizumab)

Question 82

-mab =

Answer 82

monoclonal antibody (ie infliximab, daclizumab)

Question 83

Rib notching

Answer 83

Coarctation of the aorta

Question 83

alpha 1 blockage leads to?alpha 2 blockage leads to?

Answer 83

alpha1-blockage –> vasodilationalpha2-blockage –> vasoconstriction

Question 83

alpha 1 blockage leads to?alpha 2 blockage leads to?

Answer 83

alpha1-blockage –> vasodilationalpha2-blockage –> vasoconstriction

Question 84

Ring-enhancing brain lesions in AIDS

Answer 84

toxoplasma gondii

Question 84

phenoxybenzamine:-type of drug?-application?-toxicity?

Answer 84

-nonselective alpha-blocker (irreversible/non-competitive)-used for pheochromocytoma (use phenoxybenzamine before removing tumor)-toxicity: orthostatic hypotension, reflex tachycardia

Question 84

phenoxybenzamine:-type of drug?-application?-toxicity?

Answer 84

-nonselective alpha-blocker (irreversible/non-competitive)-used for pheochromocytoma (use phenoxybenzamine before removing tumor)-toxicity: orthostatic hypotension, reflex tachycardia

Question 85

Sheets of medium-sized lymphoid cells (“starry sky” appearance on histology)

Answer 85

Burkitt’s lymphoma (t[8:14] c-myc activation, associated with EBV; “black sky” made up of malignant cells)

Question 85

Phentolamine:-type of drug-application?

Answer 85

-nonselective alpha-blocker (reversible/competitive)-give to patients on MAO-inhibitors who eat tyramine-containing foods

Question 85

Phentolamine:-type of drug-application?

Answer 85

-nonselective alpha-blocker (reversible/competitive)-give to patients on MAO-inhibitors who eat tyramine-containing foods

Question 86

silver-staining spherical aggregation of tau proteins in neurons

Answer 86

Pick bodies (Pick’s disease: progressive dementia, changes in personality)

Question 86

prazosin, terazosin, doxazosin:-types of drugs?-applications?-toxicity?

Answer 86

-alpha-1-selective-blockers-used for hypertension, urinary retention in BPH-toxicities: orthostatic hypotension with first dose; dizziness, headache (should give pts first dose before bed, while lying down)

Question 86

prazosin, terazosin, doxazosin:-types of drugs?-applications?-toxicity?

Answer 86

-alpha-1-selective-blockers-used for hypertension, urinary retention in BPH-toxicities: orthostatic hypotension with first dose; dizziness, headache (should give pts first dose before bed, while lying down)

Question 87

“Soap bubble” in femur or tibia on x-ray

Answer 87

Giant cell tumor of bone (generally benign)

Question 87

mirtazapine:-type of drug-application-toxicity

Answer 87

NAME?

Question 87

mirtazapine:-type of drug-application-toxicity

Answer 87

NAME?

Question 88

“Soap bubble” in femur or tibia on x-ray

Answer 88

Giant cell tumor of bone (generally benign)

Question 88

List the B1-selective antagonists (A BEAM):

Answer 88

Acebutolol (partial agonist)BetaxololEsmolol (short-acting)AtenololMetoprolol

Question 88

List the B1-selective antagonists (A BEAM):

Answer 88

Acebutolol (partial agonist)BetaxololEsmolol (short-acting)AtenololMetoprolol

Question 89

“spikes” on basement membrane, “dome-like” subepithelial deposits

Answer 89

Membranous glomerulonephritis (may progress to nephrotic syndrome)

Question 89

List the nonselective Beta-antagonists (Please Try Not being Picky)

Answer 89

PropranololTimololNadololPindolol

Question 89

List the nonselective Beta-antagonists (Please Try Not being Picky)

Answer 89

PropranololTimololNadololPindolol

Question 90

“spikes” on basement membrane, “dome-like” subepithelial deposits

Answer 90

Membranous glomerulonephritis (may progress to nephrotic syndrome)

Question 90

List the partial beta-agonists (PAPA):

Answer 90

PindololAcebutolol

Question 90

List the partial beta-agonists (PAPA):

Answer 90

PindololAcebutolol

Question 91

Stacks of red blood cells

Answer 91

Rouleaux formation (high ESR, multiple myeloma)

Question 91

Nonselective alpha and beta -antagonists:

Answer 91

CarvelidolLabetalol

Question 91

Nonselective alpha and beta -antagonists:

Answer 91

CarvelidolLabetalol

Question 92

Stacks of red blood cells

Answer 92

Rouleaux formation (high ESR, multiple myeloma)

Question 92

Clinical applications of beta-blockers:

Answer 92

-hypertension (decrease CO, decrease renin secrtion - by beta-receptor blockade on JGA cells)-angina pectoris (decrease HR and contractility, so have decreased O2 consumption of myocardium)-MI (metoprolol and carvedilol –> decrease mortality from MIs)-SV

Question 92

Clinical applications of beta-blockers:

Answer 92

-hypertension (decrease CO, decrease renin secrtion - by beta-receptor blockade on JGA cells)-angina pectoris (decrease HR and contractility, so have decreased O2 consumption of myocardium)-MI (metoprolol and carvedilol –> decrease mortality from MIs)-SV

Question 93

stippled vaginal epithelial cells

Answer 93

“clue cells” (Gardnerella vaginalis)

Question 93

Toxicity of Beta-blockers

Answer 93

-impotence!-exacerbates asthma-CV adverse effects (bradycardia, AV block, CHF)-CNS adverse effects (sedation, sleep alterations)-use caustiously with diabetics! (b/c B-blockers block sympathetically-mediated symptoms of hypoglycemia; so, patient won’t be

Question 93

Toxicity of Beta-blockers

Answer 93

-impotence!-exacerbates asthma-CV adverse effects (bradycardia, AV block, CHF)-CNS adverse effects (sedation, sleep alterations)-use caustiously with diabetics! (b/c B-blockers block sympathetically-mediated symptoms of hypoglycemia; so, patient won’t be

Question 94

stippled vaginal epithelial cells

Answer 94

“clue cells” (Gardnerella vaginalis)

Question 94

Bethanechol applications

Answer 94

Bethanecol = direct cholinomimetic-used for postoperative and neurogenic ileus and urinary retention (activates Bowel and Bladder)

Question 94

Bethanechol applications

Answer 94

Bethanecol = direct cholinomimetic-used for postoperative and neurogenic ileus and urinary retention (activates Bowel and Bladder)

Question 95

“tennis-racket”-shaped cytoplasmic organelles (EM) in Langerhans cells

Answer 95

Birbeck granules (histiocytosis X: eosinophilic granuloma)

Question 95

Carbachol applications

Answer 95

carbachol = direct cholinomimetic-used for glaucoma, pupillary contraction, relief of intraocular pressure

Question 95

Carbachol applications

Answer 95

carbachol = direct cholinomimetic-used for glaucoma, pupillary contraction, relief of intraocular pressure

Question 96

“tennis-racket”-shaped cytoplasmic organelles (EM) in Langerhans cells

Answer 96

Birbeck granules (histiocytosis X: eosinophilic granuloma)

Question 96

Pilocarpine applications

Answer 96

-pilocarpine = direct cholinomimetic-used to stimulate sweat, tears, saliva (“cry, spit, sweat on your pillow”)

Question 96

Pilocarpine applications

Answer 96

-pilocarpine = direct cholinomimetic-used to stimulate sweat, tears, saliva (“cry, spit, sweat on your pillow”)

Question 97

thrombi made of white/red layers

Answer 97

Lines of Zahn (arterial thrombus, layers of platelets/RBCs)

Question 97

Which cholinomimetics are resistant to AChE?

Answer 97

Bethanechol, Pilocarpine

Question 97

Which cholinomimetics are resistant to AChE?

Answer 97

Bethanechol, Pilocarpine

Question 98

thrombi made of white/red layers

Answer 98

Lines of Zahn (arterial thrombus, layers of platelets/RBCs)

Question 98

Methacholine applications?

Answer 98

methacholine = direct cholinomimetic-used as a challenge test to diagnose asthma

Question 98

Methacholine applications?

Answer 98

methacholine = direct cholinomimetic-used as a challenge test to diagnose asthma

Question 99

“thumb sign” on lateral x-ray

Answer 99

epiglottitis (Haemophilus influenzae)

Question 99

Neostigmine applications?

Answer 99

neostigmine - anticholinesterase (indirect cholinomimetic)-used for postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of NM jxn blockade-increases endogenous ACh; does not penetrate the CNS

Question 99

Neostigmine applications?

Answer 99

neostigmine - anticholinesterase (indirect cholinomimetic)-used for postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of NM jxn blockade-increases endogenous ACh; does not penetrate the CNS

Question 100

“thumb sign” on lateral x-ray

Answer 100

epiglottitis (Haemophilus influenzae)

Question 100

Pyridostigmine applications?

Answer 100

pyridostigmine = anticholinesterase (indirect cholinomimetic)-used for myasthenia gravis (gets RID of MG)-does not penterate CNS-increases endogenous ACh

Question 100

Pyridostigmine applications?

Answer 100

pyridostigmine = anticholinesterase (indirect cholinomimetic)-used for myasthenia gravis (gets RID of MG)-does not penterate CNS-increases endogenous ACh

Question 101

Thyroid-like appearance of kidney

Answer 101

chronic bacterial pyelonephritis

Question 101

Edrophonium applications

Answer 101

endrophonium = anticholinesterase (indirect cholinomimetic)-used to diagnose myasthenia gravis-increases endogenous Ach

Question 101

Edrophonium applications

Answer 101

endrophonium = anticholinesterase (indirect cholinomimetic)-used to diagnose myasthenia gravis-increases endogenous Ach

Question 102

Thyroid-like appearance of kidney

Answer 102

chronic bacterial pyelonephritis

Question 102

Physostigmine applications

Answer 102

physostigmine = anticholinesterase (indirect cholinomimetic)-used to treat glaucoma and atropine overdose (“phyxes” atropine OD)-crosses the BBB!-increases endogenous Ach

Question 102

Physostigmine applications

Answer 102

physostigmine = anticholinesterase (indirect cholinomimetic)-used to treat glaucoma and atropine overdose (“phyxes” atropine OD)-crosses the BBB!-increases endogenous Ach

Question 103

“tram-track” appearance on LM

Answer 103

membranoproliferative glomerulonephritis

Question 103

Echothiophate applications

Answer 103

echothiphate = anticholinesterase (indirect cholinomimetic)-used to treat glaucoma-increases endogenous Ach

Question 103

Echothiophate applications

Answer 103

echothiphate = anticholinesterase (indirect cholinomimetic)-used to treat glaucoma-increases endogenous Ach

Question 104

“tram-track” appearance on LM

Answer 104

membranoproliferative glomerulonephritis

Question 104

Donepezil applications

Answer 104

donepezil = anticholinesterase (indirect cholinomimetic)-used to treat Alzheimer’s disease-increases endogenous Ach!

Question 104

Donepezil applications

Answer 104

donepezil = anticholinesterase (indirect cholinomimetic)-used to treat Alzheimer’s disease-increases endogenous Ach!

Question 105

triglyceride accumulation in liver cell vacuoles

Answer 105

fatty liver disease (alcoholic or metabolic syndrome)

Question 105

pKa = acid dissociation constant = ?

Answer 105

pKa = pH at which amount of the non-protonated form = the amount of the protonated form

Question 105

pKa = acid dissociation constant = ?

Answer 105

pKa = pH at which amount of the non-protonated form = the amount of the protonated form

Question 106

triglyceride accumulation in liver cell vacuoles

Answer 106

fatty liver disease (alcoholic or metabolic syndrome)

Question 106

if pH < pKa…

Answer 106

acidic environment; have more of the protonated form (so, basic drugs get trapped)

Question 106

if pH < pKa…

Answer 106

acidic environment; have more of the protonated form (so, basic drugs get trapped)

Question 107

WBCs that look “smudged”

Answer 107

CLL (almost always B cell; affects elderly)

Question 107

if pH > pKa…

Answer 107

basic environment; have more of the nonprotonated form (acidic drugs get trapped)

Question 107

if pH > pKa…

Answer 107

basic environment; have more of the nonprotonated form (acidic drugs get trapped)

Question 108

WBCs that look “smudged”

Answer 108

CLL (almost always B cell; affects elderly)

Question 108

Treat acidic drug OD (ie slicylates) with?

Answer 108

NaHCO3 (traps the acidic drug in the basic urine)

Question 108

Treat acidic drug OD (ie slicylates) with?

Answer 108

NaHCO3 (traps the acidic drug in the basic urine)

Question 109

“wire loop” glomerular appearnce on LM

Answer 109

Lupus nerphropathy

Question 109

Treat basic drug OD (ie amphetamines) with?

Answer 109

NH4Cl (ammonium chloride; traps basic drug in the acidic urine)

Question 109

Treat basic drug OD (ie amphetamines) with?

Answer 109

NH4Cl (ammonium chloride; traps basic drug in the acidic urine)

Question 110

“wire loop” glomerular appearnce on LM

Answer 110

Lupus nerphropathy

Question 110

What class of drugs can cause excess parasympathetic activity (ie DUMBBELSS symptoms)?

Answer 110

Cholinomimetic agents

Question 110

What class of drugs can cause excess parasympathetic activity (ie DUMBBELSS symptoms)?

Answer 110

Cholinomimetic agents

Question 111

Yellow CSF

Answer 111

Xanthochromia (previous subarachnoid hemorrhage)

Question 111

What drug regenerates AchE after organophosphate poisoning?

Answer 111

Pralidoxime (regenerates active AchE) (also, give atropine to treat symptoms!)

Question 111

What drug regenerates AchE after organophosphate poisoning?

Answer 111

Pralidoxime (regenerates active AchE) (also, give atropine to treat symptoms!)

Question 112

Yellow CSF

Answer 112

Xanthochromia (previous subarachnoid hemorrhage)

Question 112

What are the symptoms of inhibiting parasympathetic activity?

Answer 112

(ie atropine side effects)Hot as a hareDry as a boneRed as a beetBlind as a batMad as a hatterBloated as a toad

Question 112

What are the symptoms of inhibiting parasympathetic activity?

Answer 112

(ie atropine side effects)Hot as a hareDry as a boneRed as a beetBlind as a batMad as a hatterBloated as a toad

Question 113

Erlenmeyer flask bones on X-ray (bones flare out)

Answer 113

Osteopetrosis (abnormal osteoclasts)

Question 113

In what populations is atropine contraindicated?

Answer 113

-Glaucoma (because don’t want to dilate eyes)-BPH or any urinary retention-GI obstruction (ie ileus)-Dementia or Elderly (because can cause delirium)-Infant with fever (because can cause hyperthermia)-

Question 113

In what populations is atropine contraindicated?

Answer 113

-Glaucoma (because don’t want to dilate eyes)-BPH or any urinary retention-GI obstruction (ie ileus)-Dementia or Elderly (because can cause delirium)-Infant with fever (because can cause hyperthermia)-

Question 114

“double bubble” or “soap bubble” appearance on x-ray

Answer 114

Giant cell tumor (osteoclastoma)

Question 114

List 4 classes of drugs with anti-cholinergic side effects:

Answer 114

1) First generation H1-Blockers (diphenhydramine, doxylamine, chlorpheniramine)2) Traditional neuroleptics3) TCAs4) Amantadine

Question 114

List 4 classes of drugs with anti-cholinergic side effects:

Answer 114

1) First generation H1-Blockers (diphenhydramine, doxylamine, chlorpheniramine)2) Traditional neuroleptics3) TCAs4) Amantadine

Question 115

codman’s triangle or sunburst pattern on x-ray

Answer 115

osteosarcoma (osteogenic sarcoma); pattern is from elevation of periosteum

Question 115

List 4 treatment options for Myasthenia Gravis:

Answer 115

1) Anti-cholinesterases (indirect cholinergic agonists)2) Corticosteroids (because MG = autoimmune disease)3) Thymectomy (often curative)4) Plasmapheresis

Question 115

List 4 treatment options for Myasthenia Gravis:

Answer 115

1) Anti-cholinesterases (indirect cholinergic agonists)2) Corticosteroids (because MG = autoimmune disease)3) Thymectomy (often curative)4) Plasmapheresis

Question 116

Disease associated with HLA-A3

Answer 116

Hemochromatosis

Question 116

What are the 5 classes of drugs used to treat glaucoma?

Answer 116

1) alpha-agonists2) beta-blockers3) Diuretics (Carbanic anhydrase inhibtors and mannitol)4) cholinomimetics5) prostaglandins

Question 116

What are the 5 classes of drugs used to treat glaucoma?

Answer 116

1) alpha-agonists2) beta-blockers3) Diuretics (Carbanic anhydrase inhibtors and mannitol)4) cholinomimetics5) prostaglandins

Question 117

Disease associated with HLA-B27

Answer 117

PAIR: Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, Reither’s syndrome (Reactive arthritis)

Question 117

P-450 Inducers

Answer 117

Barb Steals Phen-phen and Refuses Greasy Carbs Chronically:BarbituratesSt. John’s wortPhenytoinRifampinGriseofulvinCarbamazepineChronic alcohol use

Question 117

P-450 Inducers

Answer 117

Barb Steals Phen-phen and Refuses Greasy Carbs Chronically:BarbituratesSt. John’s wortPhenytoinRifampinGriseofulvinCarbamazepineChronic alcohol use

Question 118

Disease associated with HLA-B8

Answer 118

Graves’ disease

Question 118

P-450 inhibitors

Answer 118

Q-MAGIC RACKS:QuinidineMacrolidesAmiodaroneGrapefruit juiceIsoniazidCimetidineRitonavirAcute alcohol abuseCiprofloxacinKetoconazoleSulfonamides

Question 118

P-450 inhibitors

Answer 118

Q-MAGIC RACKS:QuinidineMacrolidesAmiodaroneGrapefruit juiceIsoniazidCimetidineRitonavirAcute alcohol abuseCiprofloxacinKetoconazoleSulfonamides

Question 119

Diseases associated with HLA-DR2

Answer 119

Multiple sclerosis, hay fever, SLE, Goodpasture’s

Question 119

acetaminophen antidote? (toxic dose = 4 g/day = 8 extra-strength tablets)

Answer 119

N-acetylcysteine (replenishes glutathione)

Question 119

acetaminophen antidote? (toxic dose = 4 g/day = 8 extra-strength tablets)

Answer 119

N-acetylcysteine (replenishes glutathione)

Question 120

Disease associated with HLA-DR3

Answer 120

Diabetes mellitus type I

Question 120

salicylates (ie aspirin) antidote?

Answer 120

NaHCO3 (alkalinizes urine)Dialysis

Question 120

salicylates (ie aspirin) antidote?

Answer 120

NaHCO3 (alkalinizes urine)Dialysis

Question 121

Diseases associated with HLA-DR4

Answer 121

Rheumatoid arthritis, Diabetes mellitus type I

Question 121

amphetamines antidote

Answer 121

NH4Cl (acidifies urine)

Question 121

amphetamines antidote

Answer 121

NH4Cl (acidifies urine)

Question 122

Disease associated with HLA-DR5

Answer 122

Pernicious anemia –> B12 deficiency,

Hashimoto’s thyroiditis

Question 122

anti-acetylcholinesterase and organophosphates antidote?

Answer 122

Atropine + Pralidoxime

Question 122

anti-acetylcholinesterase and organophosphates antidote?

Answer 122

Atropine + Pralidoxime

Question 123

Disease associated with HLA-DR7

Answer 123

Steroid-responsive nephrotic syndrome

Question 123

antimuscarinic, anticholinergic agents (ie atropine) antidote?

Answer 123

physostigmine salicylate

Question 123

antimuscarinic, anticholinergic agents (ie atropine) antidote?

Answer 123

physostigmine salicylate

Question 124

Abdominal pain, ascites, hepatomegaly

Answer 124

Budd-Chiari syndrome (posthepatic venous thrombosis)

Question 124

beta-blockers antidote?

Answer 124

(same as verapamil antidote!) = glucagon, calcium, atropine (all increase HR)

Question 124

beta-blockers antidote?

Answer 124

(same as verapamil antidote!) = glucagon, calcium, atropine (all increase HR)

Question 125

Achilles tendon xanthoma

Answer 125

familial hypercholesterolemia (decreased LDL receptor signaling)

Question 125

Iron antidote

Answer 125

deferoxamine

Question 125

Iron antidote

Answer 125

deferoxamine

Question 126

Adrenal hemorrhage, hypotension, DIC

Answer 126

Waterhouse-Friderichsen syndrome (meningococcemia)

Question 126

lead antidote

Answer 126

CaEDTA (in adults)Dimercaprolsuccimer (in kids)penicillamine

Question 126

lead antidote

Answer 126

CaEDTA (in adults)Dimercaprolsuccimer (in kids)penicillamine

Question 127

Arachnodactyly (spider-like fingers), lens dislocation, aortic dissection, hyperflexible joints

Answer 127

Marfan’s syndrome (fibrillin defect)

Question 127

mercury, arsenic, gold antidote

Answer 127

-dimercaprol (BAL) (dimes = money = gold; merc = mercury!)-succimer

Question 127

mercury, arsenic, gold antidote

Answer 127

-dimercaprol (BAL) (dimes = money = gold; merc = mercury!)-succimer

Question 128

Athlete with polycythemia

Answer 128

erythropoietin injection

Question 128

copper, arsenic, gold antidote

Answer 128

penicillamine (copper pennies!)

Question 128

copper, arsenic, gold antidote

Answer 128

penicillamine (copper pennies!)

Question 129

back pain, fever, night sweats, weight loss

Answer 129

Pott’s disease (vertebral TB)

Question 129

cyanide antidote

Answer 129

(may get cyanide poisoning from nitroprusside, used for malignant HTN; also, from house fires – see CN toxicity along with CO poisoning)-nitrite-hydroxocobalamin-thiosulfate

Question 129

cyanide antidote

Answer 129

(may get cyanide poisoning from nitroprusside, used for malignant HTN; also, from house fires – see CN toxicity along with CO poisoning)-nitrite-hydroxocobalamin-thiosulfate

Question 130

Bilateral hilar adenopathy, uveitis

Answer 130

Sarcoidosis (non-caseating granulomas)

Question 130

Carbon monoxide antidote

Answer 130

100% O2Hyperbaric O2

Question 130

Carbon monoxide antidote

Answer 130

100% O2Hyperbaric O2

Question 131

blue sclera

Answer 131

osteogenesis imperfecta (collagen defect)

Question 131

opioids antidote

Answer 131

naloxone/naltrexone

Question 131

opioids antidote

Answer 131

naloxone/naltrexone

Question 132

bluish line on gingiva

Answer 132

Burton’s line (lead poisoning)

Question 132

benzodiazepines antidote

Answer 132

flumazenil

Question 132

benzodiazepines antidote

Answer 132

flumazenil

Question 133

Bone pain, bone enlargement, arthritis, increased hat size, fractures

Answer 133

Paget’s disease of bone (increased osteoblastic AND osteoclastic activity)

Question 133

TCAs antidote

Answer 133

NaHCO3 (plasma alkalinization)

Question 133

TCAs antidote

Answer 133

NaHCO3 (plasma alkalinization)

Question 134

bounding pulses, diastolic heart murmur, head bobbing

Answer 134

aortic regurgitation

Question 134

Heparin antidote

Answer 134

protamine (H+ = Proton-amine!)

Question 134

Heparin antidote

Answer 134

protamine (H+ = Proton-amine!)

Question 135

“butterfly” facial rash and Raynaud’s phenomenon in a young female

Answer 135

SLE

Question 135

Warfarin antidote

Answer 135

vitamin Kfresh frozen plasma

Question 135

Warfarin antidote

Answer 135

vitamin Kfresh frozen plasma

Question 136

cafe-au-lait spots, polyostotic fibrous displasia, precocious puberty

Answer 136

McCune-Albright syndrome (mosaic G-protein signaling mutation)

Question 136

tPA, streptokinase, urokinase antidote?

Answer 136

Aminocaproic acid

Question 136

tPA, streptokinase, urokinase antidote?

Answer 136

Aminocaproic acid

Question 137

cafe-au-lait spots, Lisch nodules (iris hamartoma =excess of normal iris tissue)

Answer 137

Neurofibromatosis type I (and pheochromocytoma, optic gliomas) and Neurofibromatosis type II (and bilateral acoustic neuromas)

Question 137

theophylline antidote

Answer 137

Beta-blocker(theophylline is an option for COPD pts; it has a low TI with cardio-toxicity; so, give beta-blockers for the cardio-toxic effects)

Question 137

theophylline antidote

Answer 137

Beta-blocker(theophylline is an option for COPD pts; it has a low TI with cardio-toxicity; so, give beta-blockers for the cardio-toxic effects)

Question 138

calf pseudohypertrophy

Answer 138

muscular dystrophy (most commonly Duchenne’s): X-linked recessive deletion of dystrophin gene

Question 138

Verapamil antidote

Answer 138

same as beta-blocker antidote! = glucagon, calcium, atropine (all increase HR)

Question 138

Verapamil antidote

Answer 138

same as beta-blocker antidote! = glucagon, calcium, atropine (all increase HR)

Question 139

“cherry red spot” on macula

Answer 139

1) Tay-Sachs (ganglioside accumulation)
2) Niemann-Pick (sphingomyelin accumulation)
3) Central retinal artery occlusion

Question 139

Digitalis antidote

Answer 139

-Normalize K+ and Mg2+-lidocaine (if there’s tachyarrhythmia) -anti-dig fab fragments (if there’s arrhythmia)-atropine (if there’s bradycardia)

Question 139

Digitalis antidote

Answer 139

-Normalize K+ and Mg2+-lidocaine (if there’s tachyarrhythmia) -anti-dig fab fragments (if there’s arrhythmia)-atropine (if there’s bradycardia)

Question 140

chest pain on exertion

Answer 140

angina (stable: moderate exertion; unstable: minimal exertion)

Question 140

methemoglobin antidote

Answer 140

-methylene blue-vitamin C

Question 140

methemoglobin antidote

Answer 140

-methylene blue-vitamin C

Question 141

chest pain, pericardial effusion, friction rub, persistent fever following MI

Answer 141

Dressler’s syndrome (autoimmune-mediated post-MI fibrinous pericarditis; 1-12 weeks after acute episode)

Question 141

methanol, ethylene glycol (anti-freeze) antidote

Answer 141

-Fomepizole = 1st choice! (inhibits alcohol dehydrogenase)-2nd choices = ethanol, dialysis

Question 141

methanol, ethylene glycol (anti-freeze) antidote

Answer 141

-Fomepizole = 1st choice! (inhibits alcohol dehydrogenase)-2nd choices = ethanol, dialysis

Question 142

child uses arms to stand up from squat

Answer 142

Gower’s sign (Duchenne muscular dystrophy)

Question 143

child with fever develops rash on face that spreads to body

Answer 143

“slapped cheeks” (erythema infectiosum/fifth disease: parvo B19)

Question 144

chorea, dementia, caudate degeneration

Answer 144

Huntington’s disease (autosomal-dominant CAG repeat expansion)

Question 145

5 C’s of Huntington’s disease?

Answer 145

Chorea
Crazy
Caudate degeneration
CAG repeats
Choline (decrease Ach)

Question 146

chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria

Answer 146

McArdle’s disease (muscle glycogen phosphorylase deficiency)

Question 147

Cold intolerance

Answer 147

Hypothyroidism

Question 148

conjugate lateral gaze palsy, horizontal diplopia

Answer 148

internuclear ophthalmoplegia (damage to MLF; bilateral [multiple sclerosis], unilateral [stroke])

Question 149

continuous “machinery” heart murmur

Answer 149

PDA (close with indomethacin; open with misoprostol (a PG))

Question 150

decreased Ach in? increased Ach in?

Answer 150

decreased Ach: Alzheimer’s and Huntington’s

increased Ach: Parkinson’s

Question 151

cutaneous/dermal edema d/t connective tissue deposition

Answer 151

myxedema (caused by hypthyroidism, Grave’s disease (periorbital) = not a typo! :))

Question 152

dark purple skin/mouth nodules

Answer 152

Kaposi’s sarcoma (usually AIDS pts; assoc with HHV-8)

Question 153

Deep, labored breathing/hyperventilation

Answer 153

Kussmaul breathing (diabetic ketoacidosis)

Question 154

Dermatitis, dementia, diarrhea

Answer 154

Pellagra (niacin [vitamin B3] deficiency)

Question 155

Dilated cardiomyopathy, edema, polyneuropathy

Answer 155

wet beriberi(thiamine [vitamin B1] deficiency)

Question 156

dog or cat bite resulting in infection

Answer 156

Pasteurella multocida (cellulitis at inoculation site)

Question 157

dry eyes, dry mouth, arthritis

Answer 157

Sjogren’s (autoimmune destruction of exocrine glands)

Question 158

dysphagia (esophageal webs), glossitis, iron deficiency anemia

Answer 158

Plummer-Vinson syndrome (may progress to esophageal squamous cell carcinoma)

Question 159

elastic skin, hypermobility of joints

Answer 159

Ehler’s-Danlos syndrome (type III collagen defect)

Question 160

enlarged, hard left supraclavicular node

Answer 160

Virchow’s triad (commonly abdominal metastasis)

Question 161

Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T-cells

Answer 161

1) Sezary syndrome (cutaneous T-cell lymphoma)

2) Mycosis fungoides

Question 162

facial muscle spasm upon tapping

Answer 162

Chvostek’s sign (hypocalcemia)

Question 163

fat, female, forty, and fertile

Answer 163

acute cholelithiasis (bile duct blockage)

Question 164

fever, chills, headache, myalgia, following antibiotic treatment for sphyilis

Answer 164

Jarisch-Herxheimer reaction (rapid lysis of spirochetes results in toxin release)

Question 165

fever, cough, conjunctivitis, coryza (allergy symptoms), diffuse rash

Answer 165

Measles (Morbillivirus)

Question 166

fever, night sweats, weight loss

Answer 166

1) B symptoms (Lymphoma)

2) TB

Question 167

fibrous plaques in soft tissue of penis

Answer 167

Peyronie’s disease (connective tissue disorder)

Question 168

gout, mental retardation, self-mutilation behavior in a boy

Answer 168

Lesch-Nyhan syndrome (HGPRT-deficiency; X-linked recessive)

Question 169

Green-yellow rings around peripheral cornea

Answer 169

Kayser-Fleischer rings (copper accumulation from Wilson’s disease)

Question 170

Hamartomatous GI polyps, hyperpigmentaion of mouth/feet/hands

Answer 170

Peutz-Jeghers syndrome (genetic benign polyposis can cause bowel obstruction; increased cancer risk)

Question 171

hepatosplenomegaly, osteoporosis, neurologic symptoms

Answer 171

Gaucher’s disease (glucocerebrosidase deficiency; “crinkle-tissue paper cytoplasm”)

Question 172

Hereditary nephritis, sensourineural hearing loss, cataracts

Answer 172

Alport syndrome (mutation in alpha chain of collagen IV; “can’t see, can’t pee, can’t hear)

Question 173

hypercoagulability (leading to migrating DVTs and vasculitis)

Answer 173

Trousseau’s sign (adenocarcinoma of pancreas of lung)

Question 174

hyperphagia, hypersexuality, hyperorality, hyperdocility

Answer 174

Kluver-Bucy syndrome (bilateral amygdala lesion)

Question 175

hyperreflexia, hypertonia, positive Babinski

Answer 175

UMN damage

Question 176

hypertension, hypokalemia, metabolic alkalosis

Answer 176

Conn’s syndrome (primary hyperaldosteronism)

Question 177

hyporeflexia, hypotonia, atrophy

Answer 177

LMN damage

Question 178

hypoxemia, polycythemia, hypercapnia

Answer 178

“blue boater” (chronic bronchitis: hyperplasia of mucous cells)

Question 179

non-painful, indurated, ulcerated genital lesion

Answer 179

chancre (primary syphilis = treponema pallidum)

Question 180

painful, indurated, ulcerated genital lesion, with exudate

Answer 180

chancroid (hamophilus ducreyi)

Question 181

infant with ftt, hepatosplenomegaly, neurodegeneration, cherry red spots on macular disc

Answer 181

Niemann-Pick disease (genetic sphingomyelinase deficiency)

Question 182

infant with ftt, hypoglycemia, hepatomegaly

Answer 182

Cori’s disease (debranching enzyme deficiency)

Question 183

infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart defect

Answer 183

Edward’s syndrome (trisomy 18)

Question 184

Keratin pearls on a skin biopsy

Answer 184

squamous cell carcinoma

Question 185

large rash with bull’s-eye appearance

Answer 185

erythema chronicum migrans from Ixodes tick bite (Lyme disease: Borrelia)

Question 186

lucid interval after traumatic brain injury

Answer 186

epidural hematoma (middle meningeal artery rupture)

Question 187

male child, recurrent infections, no mature B cells

Answer 187

Bruton’s disease (X-linked agammaglobulinemia)

Question 188

mucosal bleeding and prolonged bleeding time

Answer 188

Glanzmann’s thrombasthenia (defect in platelet aggregation due to lack of GpIIb/IIIa)

Question 189

multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth

Answer 189

Gardner’s syndrome (subtype of FAP)

Question 190

myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance

Answer 190

Pompe’s disease (lysosomal alpha-1,4-glucosidase deficiency)

Question 191

necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

Answer 191

1) Wegener’s (c-ANCA)

2) Goodpasture’s syndrome (anti-BM antibodies)

Question 192

neonate with arm paralysis following difficult birth

Answer 192

Erb-Duchenne’s palsy (superior trunk [C5-C6] brachial plexus injury: “waiter’s tip”)

Question 193

no lactation postpartum, absent menstruation, cold intolerance

Answer 193

Sheehan’s syndrome (pituitary infarction)

Question 194

nystagmus, intention tremor, scanning speech, bilateral internuclear ophthalmoplegia

Answer 194

multiple sclerosis

Question 195

oscillating slow/fast breathing

Answer 195

Cheyne-Stokes respirations (central apnea in CHF or increased intracranial pressure)

Question 196

painful blue fingers/toes, hemolytic anemia

Answer 196

cold agglutinin disease (autoimmune hemolytic anemia caused by Mycoplasma pneumoniae, infectious mononucleosis)

Question 197

painful, pale, cold fingers/toes

Answer 197

Raynaud’s syndrome (vasospasm in extremities)

Question 198

painful, raised red lesions on palms and soles

Answer 198

Osler’s node (infective endocarditis)

Question 199

painless erythematous lesions on palms and soles

Answer 199

Janeway lesions (infective endocarditis)

Question 200

painless jaundice

Answer 200

cancer of the pancreatic head obstructing bile duct

Question 201

palpable purpur on buttocks/legs, joint pain, abdominal pain (child)

Answer 201

Henoch-Schonlein purpura (IgA vasculitis affecting skin and kidneys)

Question 202

pancreatic (Zollinger-Ellsion syndrome, insulinomas, VIPomas, glucagonomas), pituitary (prolactin or GH), parathyroid tumors

Answer 202

MEN 1 = “Wermer’s syndrome” (autosomal dominant)

Question 203

pink complexion, dyspnea, hyperventilation

Answer 203

“pink puffer” (emphysema: centroacinar [smoking], panacinar [alpha-1-antitrypsin deficiency])

Question 204

polyuria, acidosis, growth failure, electroylte imbalances

Answer 204

Fanconi’s syndrome (proximal tubular reabsorption defect)

Question 205

positive anterior “drawer sign”

Answer 205

ACL (anterior cruciate ligament) injury

Question 206

ptosis (droopy eyelid), miosis, anhidrosis

Answer 206

Horner’s syndrome (sympathetic chain lesion)

Question 207

pupil accommodates but doesn’t react

Answer 207

Argyll Robertson pupil (neurosyphilis)

Question 208

rapidly progressive leg weakness that ascends (following GI/upper respiratory infection)

Answer 208

Guillan-Barre syndrome (autoimmune acute inflammatory demyelinating polyneuropathy)

Question 209

rash on palms and soles

Answer 209

CARS:

• Coxsackie A
• Rocky mountain spotted fever
• Syphilis (secondary)

Question 210

Recurrent colds, unusual eczema, high serum IgE

Answer 210

hyper-IgE syndrome = Job’s syndrome (neutrophil chemotaxis abnormality)

Question 211

red “currant jelly” sputum in alcoholic or diabetic patients

Answer 211

Klebsiella pneumoniae

Question 212

red, itchy, swollen rash of nipple/areola

Answer 212

Paget’s disease of breast (represents underlying neoplasm)

Question 213

red urine in the morning, fragile RBCs

Answer 213

paroxysmal nocturnal hemoglobinuria

Question 214

renal cell carcinoma (bilateral), hemangioblastoma, angiomatosis, pheochromocytoma

Answer 214

von-Hippel-Lindau disease (dominant tumor suppressor gene mutation)

Question 215

resting tremor, rigidity, akinesia, postural instability

Answer 215

Parkinson’s disease (nigrostriatal dopamine depletion)

Question 216

retinal hemorrhages with pale centers

Answer 216

Roth’s spots (bacterial endocarditis)

Question 217

severe jaundice in neonate

Answer 217

Crigler-Najjar syndrome (congenital unconjugated hyperbiliribunemia)

Question 218

severe RLQ pain with rebound tenderness

Answer 218

McBurney’s sign (appendicitis)

Question 219

short stature, increased incidence of tumors/leukemia, aplastic anemia

Answer 219

Fanconi’s anemia (genetic loss of DNA crosslink repair; often progresses to AML)

Question 220

single palm crease

Answer 220

Simian crease (Down’s syndrome)

Question 221

situs inversus, chronic sinusitis, bronchiectasis, infertility

Answer 221

Kartagener’s syndrome (dynein arm defect affecting cilia)

Question 222

skin hyperpigmentation

Answer 222

Addison’s disease (primary adrenocortical insufficiency causes increased ACTH and alpha-MSH production)

Question 223

slow, progressive muscle weakness in boys

Answer 223

Becker’s muscular dystrophy (X-linked missense mutation in dystrophin; less severe than Duchenne’s

Question 224

small, irregular red spots on buccal/lingual mucosa with blue-white centers

Answer 224

Koplik spots (measles; rubeola virus)

Question 225

smooth, flat, moist white lesions on genitals

Answer 225

condylomata lata (secondary syphilis)

Question 226

splinter hemorrhages in fingernails

Answer 226

bacterial endocarditis

Question 227

“strawberry tongue”

Answer 227

1) Scarlet fever
2) Kawasaki disease
3) Toxic Shock Syndrome

Question 228

streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth

Answer 228

Turner syndrome (45XO, short stature, webbed neck, lymphedema)

Question 229

sudden swollen/painful big toe joint, tophi

Answer 229

gout/podagra (hyperuricemia)

Question 230

swollen gums, mucous bleeding, poor wound healing, spots on skin

Answer 230

scurvy (vitamin C deficiency: can’t hydroxylate proline/lysine for collagen synthesis)

Question 231

swollen, hard, painful finger joints

Answer 231

osteoarthritis (osteophytes on PIP [Bouchard’s nodes], DIP [Heberden’s nodes])

Question 232

systolic ejection murmur (crescendo-decrescendo)

Answer 232

aortic valve stenosis

Question 233

thyroid and parathyroid tumors (medullary thryoid carcinoma - secretes calcitonin), pheochromocytoma

Answer 233

MEN 2A = Sipple’s syndrome (autosomal dominant “ret” mutation)

Question 234

Thyroid tumor (medullary thyroid carcinoma - secretes calcitonin), Pheochromocytoma, Ganglioneuromatosis (oral/intestinal - associated with marfanoid habitus)

Answer 234

MEN 2B (autosomal dominant “ret” mutation)

Question 235

toe extension/fanning upon plantar scrape

Answer 235

Babinski sign (UMN lesion)

Question 236

unilateral facial drooping involving forehead

Answer 236

Bell’s palsy (LMN CN VII palsy)

Question 237

urethritis, conjunctivitis, arthritis in a male

Answer 237

reactive arthritis associated with HLA-B27

Question 238

vascular birthmark (port-wine stain)

Answer 238

hemangioma (benign, but associated with Sturge-Weber syndrome)

Question 239

vomiting blood following esophagogastric lacerations

Answer 239

Mallory-Weiss syndrome (alcoholic and bulimic patients)

Question 240

“waxy” casts with very low urine flow

Answer 240

chronic end-stage renal disease

Question 241

WBC casts in urine

Answer 241

acute pyelonephritis

Question 242

weight loss, diarrhea, arthritis, fever, adenopathy

Answer 242

Whipple’s disease (Tropheryma whippeli)

Question 243

“worst headache of my life”

Answer 243

subarachnoid hemorrhage

Question 244

Ptosis or Diplopia that worsens throughout the day?

Answer 244

Myasthenia gravis

Question 245

Signs of lead toxicity:

Answer 245

ABCDEFG!
Anemia
Basophilic stippling
Colicky pain
Diarrhea
Encephalopathy
Foot drop
Gums ("lead line")

Question 246

Which coronary artery is most often occluded and what kind of MI does it cause?

Answer 246

coronary artery occlusion most commonly occurs in the LAD (left anterior descending). this causes an anterior wall MI

Question 247

Cardiac output = ?

Answer 247

CO = SV X HR

Question 248

Fick Principle:

Answer 248

CO = (rate of O2 consumption)/(arterial O2 content - venous O2 content)

Question 249

Mean Arterial Pressure = ?

Answer 249

MAP = 2/3(DP) + 1/3(SP)
MAP = CO X TPR
P = Q X R

• TPR = total peripheral resistance
• P = MAP
• Q=CO
• R = TPR

Question 250

Pulse pressure = ?

Answer 250

Systolic pressure - Diastolic pressure

pulse pressure is proportional to SV

Question 251

Stroke Volume = ?

Answer 251

SV = CO/HR = EDV - ESV

Question 252

What factors affect stroke volume?

List 3 conditions which lead to increased SV:

Answer 252

SV CAP:
-Contractility
-Afterload
-Preload
(increased SV when increased contractility, increased preload, or decreased afterload)
-get increased SV in:
1) anxiety (b/c increased catecholamines)
2) pregnancy (b/c increased blood volume and preload)
3) exercise (b/c increased preload and catecholamines)

Question 253

List 4 factors that increase contractility (and thus SV too):

Answer 253

1) Catecholamines (via B1 receptors)
2) increased intracellular Calcium
3) decreased extracellular Sodium (and therefore decreased Na+/Ca2+-exchanger –> so increased intracellular calcium)
4) Digitalis (blocks Na+/K+-ATPase leading to decreased Na+/Ca2+-exchanger and increased intracellular calcium)

Question 254

List five factors that decrease contractility (and thus SV too):

Answer 254

1) Beta-1 Blockade
2) Heart failure
3) Acidosis
4) Hypoxia/Hypercapnea
5) non-dihydropyridine Calcium channel blockers (ie Verapamil and Diltiazem)

Question 255

List 3 ways to decrease the Oxygen demand in a heart attack (mechanism + types of drugs used to achieve mechanism)?

Answer 255

1) decrease afterload –> give Ace-inhibs or ARBs
2) decrease contractility –> Beta-blockers
3) decrease HR –> Beta-blockers

Question 256

Ejection Fraction = ?

Answer 256

EF = SV/EDV = (EDV - ESV)/EDV

basically, EF = what heart can pump out/what heart can hold

*normal EF > 55%

Question 257

Resistance: relationship to length viscosity? radius?

Answer 257

Equation: Resistance = (8nviscosity X length)/(piXr^4)
So:
*Resistance is proportional to length
*Resistance is proportional to viscosity
*Resistance is inversely proportional to radius (specifically, 1 R is inversely proportional to r^4)

Question 258

3 states in which see increased viscosity:

Answer 258

• Viscosity depends mostly on hematocrit; see increased viscosity in:
  1) Polycythemia
  2) Hyperproteinemic states (ie multiple myeloma)
  3) Hereditary spherocytosis

Question 259

List the classes of antiarrhythmic drugs

Answer 259

"No Bad Boy Keeps Clean"
Class I - Na+ channel blockers; 3 subclasses
Class 2 - Beta-Blockers
Class 3 - K+ channel blockers
Class 4 - Ca2+ channel blockers

Question 260

List the class I antiarrhythmic drugs:

What is their mechanism?

Answer 260

Na+ channel blockers
3 subclasses: “Double Quarter Pounder - Lettuce, Tomato, Mayo, (Pickles) - Fries, Please”

Class Ia: “Double Quarter Pounder”
Disopyramide
Quinidine
Procainamide

Class Ib: "Lettuce, Tomato, Mayo"
Lidocaine
Mexiletine
Tocainide
(Phenytoin)

Class Ic: “Fries, Please”
Flecainide
Propafenone

*Class I anti-arrhythmics decrease the slope of phase 0 depolarization

Question 261

List the class II antiarrhythmic drugs:

What is their mechanism?

Answer 261

Beta-Blockers

Propranolol
Esmolol
Metoprolol
Atenolol
Timolol

*Class II drugs decrease the slope of phase 4; increase the PR interval

Question 262

List the class III antiarrhythmic drugs:

Mechanism?

Answer 262

K+ channel blockers
“K IS BAD”

Ibutilide
Sotalol
Bretylium
Amiodarone
Dofetilide

*act on phase 3; increase AP duration by slowing the efflux of K from the cell; increase QT interval

Question 263

List the class IV antiarrhythmic drugs:

Mechanism?

Answer 263

Ca2+ channel blockers

Verapamil
Diltiazem

*decrease phase 0, so slow depolarization; increase the effective refractory period; increase the PR interval

Question 264

Which anti-arrhythmic drugs increase the QT interval?

Answer 264

Class IA (qunidine, procainamide, disopyramide) 
Class III 

Both cause a prolonged AP duration and increase the ERP (effective refractory period)

*Note: a side effect of increased QT interval = torsades de pointes

Question 265

Which anti-arrhythmic drug causes an increased QT interval but has a low risk of causing torsades de pointes?

Answer 265

Amiodarone

Question 266

Which anti-arrhythmic drugs decrease the AP duration?

Answer 266

Class IB: Lidocaine, Mexiletine, Tocainide (and Phenytoin)

Question 267

Which class of anti-arrhythmic drugs are contra-indicated post-MI?

Answer 267

Class IC is CI post-MI (Flecainide, Propafenone)

Question 268

Which 2 drugs can be used to treat WPW (Wolf-Parkinson-White)?

Answer 268

Procainamide (only indication for this drug; side effect = drug-induced lupus)
Amiodarone

Question 269

What should be checked before initiating Amiodarone therapy?

Answer 269

Amiodarone = a class III antiarrhythmic

Toxicities include: Pulmonary fibrosis, Hepatotoxicity, Hypothyroidism/Hyperthyroidism (because it is 40% iodine by weight); also: corneal deposits, skin deposits, photosensitivity, neurologic effects, constipation, CV effects….

So, before starting treatment: check PFTs, LFTs, TFTs (pulmonary, liver, and thyroid function tests)

Question 270

Which anti-arrhythmic drug is 40% iodine by weight?

Answer 270

Amiodarone (a class III antiarrhythmic)

Question 271

Drug of choice in diagnosing/abolishing SVT (supraventricular tachycardia)?

Answer 271

Adenosine (increases K+ out of cells –> hyperpolarizes the cell and decreases intracellular calcium)

Can block effects of adenosine with THEOPHYLLINE.

Question 272

Indications for Mg2+ as an anti-arrhythmic?

Answer 272

Torsades de pointes and Digoxin toxicity

Question 273

Drug class of choice to decrease LDL?

Answer 273

Statins = HMG-CoA reductase inhibitors (lovastatin, pravastatin, simvastatin, atorvastatin, rosuvastatin)

Question 274

Side effects of Statins?

Answer 274

Hepatotoxicity (increased LFTs)

Myopathy/Rhabdomyolysis

Question 275

Drug of choice to increase HDL?

Answer 275

Niacin = Vitamin B3

Question 276

Which lipid-lowering agent has side effects that include: 
-red, flushed face
-hyperglycemia,
-hyperuricemia
?

Answer 276

Niacin (Vitamin B3; lipid lowering agent of choice to increase HDL)

Question 277

Drug class of choice to decrease triglycerides?

Answer 277

#1 = Fibrates (gemfibrozil, clofibrate, bezafibrate, fenofibrate)
#2 = Omega 3 FAs

Question 278

Which lipid-lowering agents may lead to myositis and hepatotoxicity?

Answer 278

Statins and Fibrates (so don’t use these 2 classes together!)

Question 279

Digoxin mechanism and clinical use?

Answer 279

• inhibits Na+/K+-ATPase thereby inhibiting Na+/Ca2+-exchanger. This leads to increased intracellular Calcium and increased contractility. So can be used in CHF to increase contractility
• Also stimulates vagus nerve, so stimulates the parasympathetic NS! So, it can be used in atrial fibrillation (because slows the rate of AV node conduction and depresses the SA node)

Question 280

Digoxin toxicities (KNOW this :))

Answer 280

• cholinergic: nausea, vomiting, diarrhea, blurry yellow vision
• ECG: increased PR, decreased QT, T-wave inversion, arrhythmia, hyperkalemia, bradycardia
• worsened by renal failure (because decreased excretion), hypokalemia, quinidine (decreased digoxin clearance)

Question 281

Digoxin antidotes:

Answer 281

• normalize K+ and Mg2+
• Lidocaine (if there’s a tachyarrhythmia)
• cardiac pacer
• anti-Dig-Fab fragments (if there’s an arrhythmia)

Question 282

List 4 drugs that decrease BP (anti-hypertensives…) that are SAFE to use in PREGNANCY:

Answer 282

Hydralazine
Nifedipine
Labetalol
Methyldopa

Question 283

Anti-hypertensive treatment choice for Essential HTN?

Answer 283

• Diuretics (spec thiazides, ie hydrochlorothiazide)
• ACE-inhibs, ARBs
• CCBs

*Note: only use thiazides in essential HTN pts without CHF or diabetes; if a pt has CHF or diabetes, then ACE-inhibs = #1 choice!

Can also use Beta-Blockers

Question 284

Anti-hypertensive treatment choice in CHF?

Answer 284

• Loop Diuretics (ie furosemide; because increase Calcium excretion in urine!)
• ACE-inhibs/ARBs
• Beta-blockers in compensated CHF (use cautiously!)
• K-sparing diuretics (ie spironolactone)

Question 285

anti-hypertensive treatment choices in diabetes pts?

Answer 285

• ACE-inhibs/ARBs
• CCBs
• Diuretics
• Beta-blockers (use cautiously, because may mask symptoms of hypoglycemia!)
• alpha-blockers

Question 286

Why must one be careful when using Beta-Blockers in a diabetic pt?

Answer 286

beta-blockers may mask the symptoms of hypoglycemia; so, pt may be hypoglycemia, but won’t show normal symptoms… DANGER!

Question 287

Which CV drug vasodilates arterioles more than veins and reduces afterload?

Answer 287

Hydralazine (used for severe HTN, HTN in pregnancy, CHF)

Question 288

Calcium Channel Blockers:

• 2 types?
• actions

Answer 288

Dihyropyridines
Non-dihydropiridines

Reduce muscle contractility

*need to add more info here…

Question 289

CV drug that can cause cyanide toxicity?

Answer 289

Nitroprusside (used to treat malignant hypertension)

Question 290

CV drug that decrease preload AND afterload?

Answer 290

Nitroprusside (malignant HTN trtmnt)

Question 291

Nitroglycerin, Isosorbide dinitrate, Isosorbide mononitrate:

Answer 291

• Vasodilators (relase NO in smooth muscle cause increased cGMP and smooth muscle relaxation)
• dilate veins way more than arteries, so get decreased preload
• Uses: angina, pulmonary edema; aphrodisiac and erection enhancer!
• Isosorbide Mononitrate - active metabolite of isosorbide dinitrate; has almost 100% bioavailability

Question 292

CV drug class that may enhance erections?

Answer 292

Nitrates

Question 293

Nitrates toxicities

Answer 293

• Reflex tachycardia (side effect of all vasodilators)
• Hypotension
• Cutaneous flushing and throbbing headaches
• “Monday disease” = tolerance development during week, then on weekend lose tolerance, get tachycardia, dizziness, headache on re-exposure.

Question 294

Drugs with side of effect of coronary vasospasm:

Answer 294

cocaine
sumatriptan
amphetamines

Question 295

drugs with cutaneous flushing side effect

Answer 295

“VANC”

• vancomycin
• adenosine
• niacin (also nitrates!) (can give aspirin to prevent niacin-induced flushing)
• Ca-channel blockers

Question 296

drugs with dilated cardiomyopathy side effect

Answer 296

doxorubicin
daunorubicin
(these are both anti-cancer drugs that act by forming free radicals)

Question 297

drugs with torsades de pointes side effects

Answer 297

• anti-arrhythmics: class IA (ie quinidine) and class III (ie sotalol)
• macrolides
• haloperidol
• risperidone
• chloroquine
• methodone
• HIV-protease inhibitors
• cause torsades by prolonging the QT interval
• *treat torsades with an Mg2+ push

Question 298

drugs with side effect of agranulocytosis

Answer 298

“Agranulocytosis Could Certainly Cause Pretty Major Damage”

• Clozapine
• Carbamezapine
• Colchicine
• Propylthiouracil (hyperthyroidism trtmt)
• Methimazole (hyperthyroidism trtmt)
• Dapsone

Question 299

drugs with side effect of aplastic anemia

Answer 299

chloramphenicol
benzene
NSAIDs
propylthiouracil
methimazole

Question 300

drug with reaction of: direct coombs-positive hemolytic anemia

Answer 300

methyldopa (anti-HTN, used to treat HTN in pregnant women)

Question 301

drug that may cause gray baby syndrome

Answer 301

chloramphenicol

Question 302

drugs that may cause hemolysis in G6PD-deficient pts

Answer 302

“hemolysis IS PAIN and fava beans….”

• Isoniazid
• Sulfonamides
• Primaquine (malaria)
• Aspirin (only at high doses)
• Ibuprofen
• Nitrofurantoin (antibiotic)
• fava beans!

Question 303

drugs that may cause megaloblastic anemia

Answer 303

“having a blast with PMS”

• Phenytoin
• Methotrexate
• Sulfa drugs

Question 304

drugs that may have thrombotic complications

Answer 304

oral contraceptives (estrogens and progesterones)

Question 305

drugs that may lead to thrombocytopenia:

Answer 305

• heparin

- H2-blockers (ie antacids: cimetidine, ranitidine, famotidine, nizatidine

Question 306

drugs with side effect of cough

Answer 306

ACE-inhibitors (ARBs do NOT cause cough..)

Question 307

drugs that may cause pulmonary fibrosis

Answer 307

“BAB”

• bleomycin (anti-cancer drug)
• amiodarone (class III antiarrhythmic)
• busulfan (anti-cancer drug)

Question 308

drugs with side effect of acute cholestatic hepatitis

Answer 308

erythromycin (a macrolide; not all macrolides cause acute cholestatic hepatitis though)

Question 309

drugs with side effect of focal to massive hepatic necrosis

Answer 309

HAVA

• Halothane (inhaled anesthetic)
• Acetaminophen
• Valproic acid (anti-epileptic)
• Amanita phalloides (poisonous mushroom)

Question 310

drug that may cause hepatitis

Answer 310

INH (Isoniazid)

Question 311

drugs that may cause pseudomembranous colitis (c. diff)

Answer 311

• clindamycin

- ampicillin

Question 312

drugs that may cause adrenocortical insufficiency (ie tertiary adrenal insufficiency)

Answer 312

rapid glucocorticoid withdrawal (suppresses the HPA)

Question 313

drugs that may cause gynecomastia

Answer 313

“Some Drugs Create Awesome Knockers”

• Spironolactone
• Digitalis
• Cimetidine
• Alcohol (chronic use)
• Ketoconazole
• also estrogens

Question 314

drugs that may cause hot flashes

Answer 314

SERM: tamoxifen, clomiphene

Question 315

drugs that may cause hypothyroidism

Answer 315

• lithium
• amiodarone
• sulfanamides

Question 316

drugs that may cause hyperglycemia

Answer 316

• niacin
• tacrolimus (immunosuppressive used in transplant pts)
• protease inhibitors