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Imhotep > RX Flash 252 > Flashcards

RX Flash 252 Flashcards

1
Q
  • EBV virus
  • Demonstrates atypical (reactive) lymphocytes on a blood smear
  • Soar throat, fever, fatigue, LAD, and hepatoslenomegaly
  • Spleen susceptible to trauma
A

Infectious mononucleosis

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2
Q
  • Defect in left-right dynein
  • Poorly functioning dynein arms on all cilia in the body
  • Triad: chronic sinusitis (sinus pressure headaches), bronchiectasis, and situs inversus
  • Also associated: Nasal polyps in 30%, recurrent otitis media, infertility, chronic bronchitis, and recurrent pneumonia
  • Children and adults may have unremitting asthma
A

Kartagener’s Syndrome (AR)

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3
Q

-Menstrual irregularities, insomnia, diarrhea, proptosis and tachycardia
-Presence of TSI
-Diffuse goiter
-Radionuclide scans of thyroid:
TSH: low
T4: High
Palpation of thyroid: diffuse
Radionuclide uptake on thyroid scans: High

A

Graves’ Disease

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4
Q

Gastric ulcers

A
  • Often caused by H. pylori infections

- Require triple therapy for complete eradication: Omeprazole, clarithromycin, and amoxicillin

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5
Q

-First-line GI PROMOTILITY drug
-D2 receptor antagonist
-Increase resting tone, contractility, LES tone, motility
-Does not influence colon transport time
-Diabetic and post-surgery gastroparesis
-Antiemetic
Adverse Effects: increase Parkinson effects, tardive dyskinesia, restlessness, drowsiness, fatigue, depression, and diarrhea
Drug interactions: digoxin and diabetic agents
Contraindications: patients with small bowel obstruction or Parkinson’s (due to D2-receptor blockade)

A

Metoclopramide

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6
Q

3 C’s: Coma, Convulsions, and Cardiotoxicity
-Others: Hypotension, anticholinergic*, respiration depression, hyperpyrexia, sinus tachycardia, seizures, cardiac conduction defects→fatal arrhythmias
Tx: NaCHO3 to prevent arrhythmias
*Amitriptyline>Nortriptyline for anticholinergic effects. Use Nortriptyline in elderly

A

TCA Overdose

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7
Q

Most common site of metastasis after lymph nodes:

A
  • LIVER and LUNG (due to high blood flow)

- Colon cancer would metastasize to liver

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8
Q
  • High cortisol levels
  • Truncal obesity, moon face, buffalo hump, skin thinning and stria, hyperpigmentation (in cases of increased ACTH secretion), menstrual irregularities, hirsutism, proximal muscle weakness, glucose intolerance, hypertension, and osteoporosis (leading to pathological fractures)
A

Cushing’s Syndrome

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9
Q
  • Gram-positive obligate anaerobes
  • Majority of normal flora in vagina→keep pH low (3.5-4.2)
  • Reduced during antibiotic treatment (ex: tetracyclines)
  • Vagina pH will increase to 4.0 -4.5 → yeast Canidida albicans can now grow
A

Lactobacilli

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10
Q
  • Can occur at anytime but most likely in first 3 months (due to HLA differences)
  • More common in highly vascularized organs (kidney and liver)
  • MEDIATED BY CD8+ T-cells → cytotoxic graft cell death and release of proinflammatory cytokines
A

Acute Rejection

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11
Q

When monotherapy with a statin fails to control mixed hyperlipidemia what drug should be adder to regimen?

A
  • Niacin (lower risk of myopathy)

- Fibrate offers significant therapeutic advantage but higher risk of myopathy with a statin

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12
Q

Patient presents with a urine dipstick revealing blood but the urinalysis shows zero RBC’s on microscopy…

A
  • Think rhabdomyolysis-induced ATN (acute tubular necrosis)

- Dipsticks rxn test for heme in the urine and not intact red blood cells.

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13
Q

What is the most common chronic blood-borne infection in the United States?

A
  • Hepatitis C
  • Acute hepatitis C commonly goes undetected, and 60-85% of patients will eventually manifest chronic hepatitis. A subset of those patients may develop cirrhosis or liver cancer. Happily, there are now antiviral treatments for hepatitis C
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14
Q

Male urethra three parts:

A

1) Prostatic urethra runs through prostate
2) Membranous urethra runs through urogenital diaphragm
3) Penile urethra runs through penis
Note: “Saddle injury” → rupture of the urethra below urogenital diaphragm (at membranous-penile junk-tion (lol) → urine flow into scrotum and the perianal region

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15
Q

-Fractured pelvis (anterior bladder wall rupture)

OR improper insertion of catheter

A

Urethral rupture above the urogenital diaphragm (prostatic-membranous junction)
-Urine flow into RETROPUBIC space

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16
Q
  • Crush injury (FUCK)

- Urine flow deep in fascia of BUCK within penis

A

Penile urethra rupture

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17
Q
  • Uses: hypoglycemic agent that suppresses hepatic glucose production and decreases intestinal glucose absorption
  • Improved insulin sensitivity→ decreased blood glucose
  • Adverse: Increased susceptibility to lactic acidosis, especially after surgery
A

Metformin

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18
Q
  • Alpha-glucosidase inhibitor that acts at brush boarder to decrease absorption of starches and other polysaccharides.
  • Side effect: GI disturbances such as diarrhea and FLATULENCE
A

Acarbose

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19
Q

Zileuton

A
  • Selectively inhibits lipoxygenase and subsequent leukotriene synthesis
  • Used to treat asthma
  • Side effects: headache and elevated liver enzymes
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20
Q 
Where are the following absorbed?
Iron and calcium?
Folate?
Vit. B12?
Fat soluble vitamins, fatty acids, and carbs?
Water?
A 
Iron and calcium- Duodenum 
Folate- Jejunum
Vitamin B12- Ileum
Fat-soluble vitamins, fatty acids, and carbs- Ileum
Water- sigmoid colon
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21
Q

Where is oxytocin produced and stored?

A
  • Endogenously produced in hypothalamic neurons in PARAVENTRICULAR NUCLEUS
  • Stored in the terminal swellings of specialized nerve endings in the posterior pituitary called HERRING BODIES
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22
Q
  • Sulfonylurea that acts by stimulating insulin production by pancreatic ACINAR BETA CELLS via inhibition of K+ channel depolarization
  • Side effects: hypoglycemia and DISULFIRAM-like aldehyde syndrome
A

Glipizide and Tolbutamide

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23
Q

Know the unique toxicities to inhaled anesthetics: Halothane

A

Hepatotoxicity and has the biggest propensity for causing malignant hyperthermia

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24
Q
  • Markedly elevated WBC counts
  • Fatigue, night sweats, low-grade fever, abdominal fullness secondary to splenomegaly and STERNAL tenderness.
  • Philadelphia chromosome; t (9; 22)
A

CML

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25
Q

Know the unique toxicities to inhaled anesthetics: Enflurane

A

pro-convulsant and CNS excitement (less potent than halothane but quicker induction and quicker recovery)

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26
Q

Know the unique toxicities to inhaled anesthetics: Desflurane

A

airway irritability

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27
Q
  • Synthetic version of oxytocin
  • Dilation of cervix and contraction of the uterus during labor
  • Let down of milk during breast feeding
  • Can be applied topically to cervix
A

Misoprostol

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28
Q

Know the unique toxicities to inhaled anesthetics: Methoxyflurane

A

Nephrotoxicity

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29
Q

Wilms’ Tumor

A
  • Most common renal malignancy of childhood
  • Presents with enlarged mass on flank
  • Girls with Turner’s syndrome (45XO) have a higher incidence of Wilms’ tumor
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30
Q

Most common form of thyroid cancer

A
  • Papillary carcinoma
  • Patient in 20-40s with history of ionizing radiation
  • Histo: branching papillae with fibrovascular stalk lined by epithelial cells with empty-Orphan Annie eye nuclei
  • Concentrically calcified PSAMMOMA BODIES
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31
Q
  • Antiepileptic drug that inactivates sodium channels
  • Also inhibits N-methyl-D-aspartate receptors
  • Side effects: liver toxicity, diplopia, ataxia, teratogenesis and blood dyscrasias such as agranulocytosis and aplastic anemia
A

Carbamazepine

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32
Q
  • 30-ish black female
  • Noncaseating granulomatous infiltration of the lungs
  • TLC, FEV1, FVC, RV, and DLCO are all reduced
  • FEV1/FVC ration may be normal or increased
  • Deregulation of CD4+ (Th) helper cells.
  • Shortened QT interval is a manifestation of hypercalcemia secondary to increased 1,25-dihydroxyvitamin D. (Macs secrete 1alpha-hydroxylase)
A

Sarcoidosis

33
Q
  • Anti-epileptic drug that blocks T-TYPE calcium channels
  • STEVEN JOHNSON SYNDROME, GI distress, HA, lethargy, and uticaria
  • Absence seizures
A

Ethosuximide

34
Q

Hypocalcemia classic symptoms and signs:

A
  • Perioral numbness/tingling
  • Chvostek sign (facial spasm)
  • Trousseau sign (carpal spasm)
35
Q

What is the most common complication of malignancy?

A

-Hypercalcemia

36
Q
  • Increase frequency of chloride channel opening to stimulate GABA activity
  • First line for status epilepticus
  • Tolerance and addiction prevent daily prescription for seizures
A

Benzodiazepines (ex: lorazepam)

37
Q

Functions of T3 = 4Bs

A
  • Brain maturation
  • Bone growth
  • Beta-adrenergic effects
  • Increased basal metabolic rate
38
Q

-Malaise, fatigue, delirium, kidney stones, and diffuse aches and pains

A

Symptoms of hypercalcemia

39
Q

Most common fetal neoplasm

A

-Teratoma

40
Q

Milestones for three-year old child:

A
  • Name common objects
  • Walk up the stairs one at a time
  • Begin using the toilet
41
Q

Preeclampsia symptoms and signs:

A
  • 3rd TRIMESTER
  • Hypertension
  • Edema in the face and extremities
  • Delivery is treatment of choice for term patients
  • Risk for progression to Eclampsia with occurrence of GRAND MAL SEIZURE
  • For preterm patients→ bed rest, blood pressure monitoring and control, and seizure prophylaxis with magnesium
42
Q
  • Cerebral hemorrhage
  • Thromboembolic events
  • Hypoxic encephalopathy
  • Delivery is treatment of choice for term patients
  • For preterm patients→ bed rest, blood pressure monitoring and control, and seizure prophylaxis with magnesium
A

Eclampsia= medical emergency with severe complications

43
Q
  • Symptoms of preeclampsia (hypertension, proteinuria, and pitting edema)
  • Presents before 20 WEEKS
  • Empty egg with no DNA (complete mole)
  • Normal egg fertilized by 2+ sperm
A

Molar pregnancy

44
Q

Panacinar Emphysema

A
  • AAT deficiency can present with Panacinar emphysema and/or cirrhosis.
  • Build- up of intracellular, misfolded AAT presents as PAS-positive globules on histo
  • INTRACELLULAR PERIODIC ACID-SCHIFF-POSTIVE GLOBULES (PAS-positive)
45
Q
  • Presents with painless hematuria and constitutional symptoms
  • Risk factors: smoking, aniline dye exposure, and cyclophosphamide use
A

Transitional cell carcinoma

46
Q
  • Plays a key role in pathogenesis of hepatic encephalopathy
  • High levels of ammonia will deplete alpha-ketoglutarate
  • High levels of ammonia will INCREASE glutamine
A

Hyperammonemia

47
Q
  • Relatively benign tumors
  • Arise from the ARACHNOID CELLS (arachnoid layer of leptomeninges)
  • PSAMMOMA BODIES
A

Meningiomas

48
Q
  • Type I collagen production is decreased because of defects in PROCOLLAGEN
  • Mutations in COL1A1 (aplha1 collagen chain) and COL1A2 (alpha2 collagen chains)→ leads to posttranslational modification errors in procollagen triple-helix formation
A

Osteogenesis Imperfecta (AD)

49
Q

What are PSMAMMOMA bodies? Name what they are seen in?

A
  • Areas of calcification surrounded by concentric whorls

- Papillary thyroid carcinoma, meningiomas, serous papillary carcinoma of the ovary, and malignant mesothelioma

50
Q
  • Anti-tumor antibiotic (commonly used in breast cancers)
  • MOA: intercalates into DNA, inhibiting topoisomerase II and results in DNA damage and cell death
  • ADVERSE: congestive heart failure
A

Doxorubicin

51
Q

Bevacizumab

A

-Monoclonal antibody
-Binds VEGF to decrease cancer cell angiogenesis
-Treatment for: metastatic colon cancer and non-small cell lung cancer
Off label uses: slow progression of macular degeneration and diabetic retinopathy
Think: neonates with too much O2 (ROP)

52
Q
  • Deficiency in hexosaminidase A enzyme
  • Accumulation of GM2 ganglioside
  • Progressive neurodegeneration, cherry red spots on the retina, and developmental delay
A

Tay-Sachs Disease (AR)

53
Q
  • Alkylating agent that cross-links DNA→ APOPTOSIS

- Commonly used to treat non-Hodgkin’s lymphoma and breast/ovarian cancer

A

Cyclophosphamide

54
Q
  • Treatment for bacterial vaginosis
  • Inhibits acetaldehyde dehydrogenase and other alcohol-oxidizing enzymes
  • Disulfiram- like reactions (N/V, HA, palpations, and flushing)
  • Acetaldehyde builds up and is hepatotoxic, cardiotoxic, and arrhythmogenic
A

Metronidazole

55
Q
  • MOA during metaphase disrupts mitotic spindle by preventing microtubule depolymerization
  • Stabilizes the mitotic spindle and disallows the migration of chromatids
  • Mitosis remains incomplete→ cell death ensues
  • Used to primarily treat: ovarian cancer and metastatic breast cancer.
A

Paclitaxel

56
Q

MOA: Intercalates DNA during G2 phase of the cell cycle and causes scission of DNA by oxidative process
Used for: testicular tumors, lymphomas and squamous cell carcinomas.

A

Bleomycin

57
Q

Bleomycin ADR

A

ADR: pulmonary related (interstitial fibrosis). Rales, cough, and restrictive disease

58
Q
  • Ciprofloxacin, levofloxacin, and ofloxacin
  • Inhibit DNA gyrase (topoisomerase II-bacterial enzyme that relaxes positive supercoils during DNA replication)
  • Rare ADR: tendonitis and spontaneous tendon rupture (more prevalent in children and elderly)
A

Fluoroquinolones

59
Q
  • Arrests the cell cycle in S phase→ impaired DNA synthesis
  • Pyrimidine atom with a stable fluorine atom in place of H+ atom at position 5 or uracil ring
  • Interferes with conversion of deoxyuridylic acid→ thymidylic acid
  • Used in slow-growing solid tumors such as breast, pancreatic, colorectal and gastric carcinomas
A

5-Fluorouracil (5-FU)

60
Q

Cyclophosphamide ARD

A

ADRs: hemorrhagic cystitis, which can be prevented through adequate hydration and intravenous injection of Mensa (organosulfur compound) before the administration

61
Q

DNA alkylator that is activated by cytochrome p450

A

cyclophosphamide

62
Q
  • Pathognomonic for an immunodeficient state (HIV, etc.)

- Presents w/ sore throat and dysphagia, with friable white plaques and erythematous buccal mucosa

A

Esophageal candidiasis and Candida stomatitis:

63
Q
  • Supply DORAL COLUMS (light touch, vibration, and positional sense)
  • Posterior (dorsal) 1/3 of spinal columns
  • Two arteries = low chance of infarct
A

Posterior spinal arteries

64
Q

Brown-Sequard Syndrome

A
  • Hemi-section of spinal cord:
  • Dorsal column defects (ipsilateral to and below the lesion)
  • Spinothalamic (contralateral to and below the lesion as well as ipsilateral side up to one dermatome above and below)
  • Corticospinal tract and ventral horn ipsilateral to and below lesion (motor)
65
Q

Anterior spinal artery Infart deficits:

A

-Deficits include: pain and temp (spinothalamic), voluntary motor control (lateral corticospinal) and autonomic motor control (bladder and bowel control) below the lesion

66
Q
  • Provides circulation for ventral (anterior) 2/3 of spinal cord
  • Only one artery (more vulnerable to infarction than posterior chord)
  • INFART most likely occurs during a period of hemodynamic instability that required transfusions
A

Anterior spinal artery

67
Q

Treatment for cryptosporidium in immunocompromised:

A
  • Treatment with nitazoxanide is not considered essential in immunocompromised
  • Treatment consists of HAART and supportive care (fluids and electrolytes)
68
Q

50s ribosomal subunit inhibitors:

A

Macrolides (erythromycin), Clindamycin, Chloramphenicol, Streptogramins, Linezolid
-Buy AT 30 SCCEL at 50

69
Q

Amoebas in spinal fluid confirm diagnosis of?

A

Naegleria flowleri infection

70
Q

Encapsulated cysts on Indian ink stain confirm diagnosis of?

A

-Cryptococcus infection

71
Q

Motile trophozoites on wet mount confirm?

A

Diagnosis of Trichomonas infection

72
Q

-Most common CNS complication of HIV infection
-Generally occurs late in infection
-Early symptoms (subtle): depression and apathetic withdrawal
-Later symptoms: global dementia and motor deficits
Imaging will rule out mass lesion (CNS lymphoma) and other opportunistic infections.

A

HIV-associated dementia (AIDS dementia complex)

73
Q
  • Affects patients with AIDS w/ CD4+ cell counts below 50/mm3
  • One or more enhancing lesions on MRI (50% single & 50% multiple)
  • Focal signs earlier in course of illness
  • Can present with a positive EBV in CSF
A

CNS lymphoma

74
Q
  • Most common CNS complication of HIV infection
  • Elevated IgG on CSF exam (45-80%)
  • MRI→ global cerebral atrophy with multiple non-enhancing, ill-defined areas of hyperintensity of T2 image in deep white matter (20-40%)
A

HIV-associated dementia (AIDS dementia complex)

75
Q
  • Late stage AIDS complication (CD4+ less than 50/mm3)

- Constitutional signs and symptoms: fever, night sweats, LAD, HSM, weight loss, and pancytopenia

A

Disseminated Mycobacterium avium complex infection

76
Q

Can result in accidental ligation of the vas deferens (or obstruction by scar tissue can cause this)

  • Results in disordered sperm transport.
  • Often presents with infertility with normal sperm production
A

Inguinal surgery in a male

77
Q

MAC Treatment

A

-REC (rifabutin, ethambutol, clofazamine)

78
Q
  • Alcoholic beverage ingestion that exceeds 2 drinks/day

- Heavy WEED usage

A

Decreased sperm production

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