Rx_Random Set #5

Question 1

Common drug/chemotherapy for testicular cancer (+ MOA + toxicities)

Answer 1

• Bleomycin = active @ G₂ phase of cell cycle; inhibits DNA synthesis via generation of free radicals that bind DNA and cause strand breaks
• Toxicities
  
  • pulmonary fibrosis
  • myelosuppression
  • skin pigment changes

Question 2

Bleomycin: use, MOA, toxicities

Answer 2

• Bleomycin = used to tx testicular cancer and lymphoma
• Bleomycin = active @ G2 phase of cell cycle; inhibits DNA synthesis via generation of free radicals that bind DNA and cause strand breaks
• Toxicities
  
  • pulmonary fibrosis
  • myelosuppression
  • skin pigment changes

Question 3

Clomiphen citrate: MOA, use

Answer 3

• clomiphene citrate = selective estrogen receptor modulator (SERM) = antiestrogen @ hypothalamus ==> reduced feeback inhibition effect of estrogen
  
  • ==> increased GnRH ==> increased FSH/LH ==> ovulation or increased testosterone
• Use:
  
  • females: commonly used for female infertility in polycystic ovarian syndrome
  • males: off-label use to improve fertility

Question 4

Characteristics of Kawasaki’s disease

Answer 4

• acute necrotizing vasculitis of medium to small muscular arteries
  
  • suspected immune mechanism
• generally effects children < 5yo
• higher prevalence in Japanes population
• sx:
  
  • fever
  • red eyes
  • erythematous rash on palms and soles
  • tachycardia
  • mucosal inflammation
• labs:
  
  • normocytic anemia
  • neutrophillic leukocytosis
  • elevated ESR

Question 5

Tx of Kawasaki’s disease

Answer 5

• aspirin (only condition in which to give aspirin to child)
• AND intravenous immunoglobulin

Question 6

Possible complications of Kawasaki’s disease

Answer 6

• coronary artery aneurysms

Question 7

Fracture ==> lost contour and flattening of shoulder

Answer 7

• proximal humerus fracture ==>
  
  • axillary nerve damage ==>
  • atrophy of deltoid muscle ==> lost contour/flattening

Question 8

Lithium toxicity presentation

Answer 8

• physical presentation
  
  • N/V
  • dysarthria (= speech difficulties)
  • lethargy
  • coarse hand tremors
  • ataxia, incoordination
  • hyperreflexia
  • vision changes
• labs/physio presentation
  
  • nephrogenic DI ==>
  • high serum sodium
  • high serum osmolality
  • low urine osmolality

Question 9

Lithium tetragoenic effects

Answer 9

• Lithium during pregnancy ==> Ebstein’s anomaly
  
  • apically displaced tricuspid valve
  • atrialization of proximal right ventrical
  • enlarged right atrium
  • hypoplastic functional right ventricle
  • associated with atrial-septal defects

Question 10

Cyanide effects

Answer 10

• binds to iron @ final cytochrome complex in ETC
• prevents oxygen from serving as the final electron acceptor in the ETC

Question 11

Cyclophosphamide MOA + (toxicities + prevention)

Answer 11

• Cyclophosphamide = chemotherapeutic DNA alkylating agent
  
  • tx of non-Hodgkin’s lymphoma
• myelosuppression
• hemorrhagic cystitis
  
  • prevented w/mesna = binds cyclophosphamide metabolites in urine and neutralizes them

Question 12

Myelosuppression characteristics

Answer 12

• global depression of bone marrow activity ==>
  
  • overall lower cell count
  • anemia
  • decreased WBCs
  • thrombocytopenia
• side effect of some cancer treatments

Question 13

Common cause of acute bacterial endocarditis in drug-abusing patient

Answer 13

S. aureus

Question 14

Most common cause of bacterial endocarditis

Answer 14

• Viridans streptococci
  
  • usually subacute
  • colonize heart valves damaged by past rheumatic fever ==> L-side infective endocarditis
• common source: dental procudeures ==> oropharynx flora into bloodstream

Question 15

Common drug used to tx nephrogenic DI + MOA

Answer 15

• Amiloride = potassium-sparing diuretic

Question 16

Conditions associated with Marfan’s syndrome

Answer 16

• lens dislocation
• pneumothorax
• mitral valve prolapse
• aortic root dilation ==> aortic dissection

Question 17

Presentation of dissecting aortic aneurysm

Answer 17

• dissecting aortic aneurysm ==> cardiac tamponade ==>
  
  • decreased ventricular filling
  • decreased CO
• Beck’s triad
  
  • hypotension
  • increased JVP
  • distant heart sounds
• ECG:
  
  • diffuse low-voltage QRS complexes
  • electrical alternans = amplitude of QRS complex oscillates w/each beat

Question 18

Nerves blocked by transvaginal pudendal nerve bock (+ common use)

Answer 18

• pudendal nerve fibers = S2-S4 nerve roots
• commonly used for anesthesia of perineum and inferior quarter of vagina

Question 19

T-ALL presentation

Answer 19

• teenage males
• thymic lymphomas (widened mediastinum)
• elevated WBCs
• weakness, fever, anorexia
• petechiae (arms & legs)
• diffuse lymphadenopathy
• biopsy = pre-t cells, Tdt (terminal deoxynucleotidyl transferase) positive

Question 20

Tx of Pneumocystitis jirovecii pneumonia

Answer 20

• first-line: trimethoprim-sulfamethoxazole (sulfa drug)
  
  • contraindicated in sulfa allergy
• if sulfa-allergy: pentamidine

Question 21

Mechanism of induction of lac operon in bacterio

Answer 21

• Lactose (+ no glucose) stimulates lac operon
  
  • allolactose acts as inducer via binding and activation of repressor
• No glucose ==> increased cAMP ==> binds cAMP receptor protein ==> binds lac operon promoter ==> transcription initiation

Question 22

Parozysmal nocturnal hemoglobinuria: cause, consequences

Answer 22

• cause = PIG-A glycosyl phosphatidulinositol anchor protein
• consequences ==>
  
  • intravascular hemolysis (usually @ night)
  • hemosiderin in urine
  • anemia
  • episodic DVTs

Question 23

Lethary, weakenss, bony pain + lytic bone lesions + M spike in gamma-immunoglobulin regions ==> dx?

Answer 23

Multiple myeloma

Question 24

Multiple myeloma vs. …other cause of lytic bone lesions?

Question 25

Common complication in multiple myeloma that leads to systemic/renal problems + pathologic findings

Answer 25

• multiple myeloma ==> primary amyloidosis
• primary amyloidosis ==>
  
  • amyloid deposition @ mesangium and subendothelial space
  • glomerular obliteration ==> heavy proteinuria ==> end-stage renal disease
  • pathologic findings
    
    • staining w/congo red ==> positive w/apple-green birefringence

Question 26

Location of renin-producing cells

Answer 26

• juxtaglomerular cells = @ afferent arteriole

Question 27

Presentation/mechanism of Bruton’s agammaglobulinemia

Answer 27

• recurrent bacterial infections in boys older than 6 months
  
  • X-linked defect in tyrosine kinase required for production of mature B cells
• low levels of all immunoglobulin classes
• normal T-lymphocyte counts

Question 28

Immune respone: live attenuated vs. inactivated vaccines

Answer 28

• live attenuated ==> cell-mediated AND humoral immunity
  
  • capable of replicating w/in cells of recipient
• inactivated ==> b-lymphocyte (humoral) immunity w/out T-cell cell involvement