Set 26

Question 1

What are some of the possible causes of pericarditis?

Answer 1

Idiopathic
TB
Uremia
Coxsackievirus A or B
Lupus
RA
Scleroderma
Radiation of the chest
Acute rheumatic fever (pancarditis)
Dressler syndrome (inflammation following an acute MI - weeks after, pancarditis)
Cancer mets

Question 2

A unilateral lesion to the lateral corticospinal tract results in motor deficits ipsilateral to the lesion. Where in the lateral corticospinal tract is the motor innervation to the legs located?

Answer 2

Legs (Lumbosacral) are Lateral in the Lateral corticospinal, spinothalamic tracts (arms medial, legs lateral)

Question 3

What are the fat-soluble vitamins?

Answer 3

A
D
K
E

Question 4

What are the corresponding symptoms of fat-soluble vitamin deficiency?
A

Answer 4

Night blindness (nyctalopia); dry, scaly skin (xerosis cutis); alopecia; corneal degeneration (keratomalacia); immune suppression

Question 5

What are the corresponding symptoms of fat-soluble vitamin deficiency?
D

Answer 5

Rickets in children (bone pain and deformity)

Osteomalacia in adults (bone pain and muscle weakness)

Question 6

What are the corresponding symptoms of fat-soluble vitamin deficiency?
K

Answer 6

Fragile RBCs
Muscle weakness
Demyelination of CNS

Question 7

What are the corresponding symptoms of fat-soluble vitamin deficiency?
E

Answer 7

First Aid: Hemolytic anemia, acanthocytosis, muscle weakness, posterior column and spinocerebellar tract demyelination
E for erythrocytes!
DIT: Coagulation factor defects, osteoporosis and CAD

Question 8

A 22-year-old man recently lost his leg in a tragic accident involving alcohol and heavy machinery. Just prior to discharge, a vigilant nurse informs you that the patient has been very depressed about his lost limb, and she overheard him talking to a friend about just ending his life with his dad’s gun when he gets out of the hospital. What needs to be done?

Answer 8

Assess the seriousness of the threat; if it is serious, suggest that the patient remain in the hospital voluntarily; patient can be hospitalized involuntarily if he/she refuses

Suicide risk factors: male sex, depression, OH use, organized plan and access to a gun

Question 9

What branchial arch derivative abnormality causes facial abnormalities by affecting Meckel’s cartilage? What cranial nerves are affected in this abnormality? From what germ layers are the branchial arches derived?

Answer 9

Treacher Collins syndrome: 1st-arch neural crest fails to migrate —> mandibular hypoplasia, facial abnormalitiess
CN V2 and V3 (chew)
Derived from mesoderm (muscles, arteries) and neural crest (bones, cartilage)

Question 10

What class of drugs can be used to treat estrogen receptor-positive breast cancer? What is another use for these drugs? What is the main concern when using tamoxifen?

Answer 10

(SERMS) Selective estrogen receptor modulators - receptor antagonists in breast and agonists in bone. Block the binding of estrogen to ER positive cells [Tamoxifen, Raloxifene]

Raloxifene is also used to prevent osteoporosis (agonist in the bone)

Tamoxifen is a partial agonist in the endometrium, which increases the risk of endometrial cancer. Can cause hot flashes

Question 11

How does an anterior shoulder dislocation present differently than a posterior shoulder dislocation?
ANTERIOR
Arm position
Neurovascular compromise
Classic scenario
PE

Answer 11

Arm position: External rotation, Slight abduction

Neurovascular compromise: Axillary artery, Axillary nerve

Classic scenario: Blow to the arm while abducted, externally rotated and extended (blocking a shot in basketball)

PE: It thin, prominent acromion process. Loss of normal roundness of the shoulder. Appears more angular

Question 12

How does an anterior shoulder dislocation present differently than a posterior shoulder dislocation?
POSTERIOR
Arm position
Neurovascular compromise
Classic scenario
PE

Answer 12

Arm position: Internal rotation,
Adduction, Unable to externally rotate the arm

Neurovascular compromise: Unusual to have any neuromuscular compromise

Classic scenario: Seizure, Electrocution

PE: Bulge in the posterior shoulder area. Anterior aspect of the shoulder is relatively flat

Question 13

Which primary bone tumor fits each of the following descriptions?

Most common malignancy arising within bone

Answer 13

Multiple myeloma

Question 14

Which primary bone tumor fits each of the following descriptions?

11;22 translocation

Answer 14

Ewing sarcoma

Question 15

Which primary bone tumor fits each of the following descriptions?

Soap-bubble appearance on x-ray

Answer 15

Giant cell tumor (osteoclastoma)

Question 16

Which primary bone tumor fits each of the following descriptions?

Onion-skin appearance of bone (layers of new bone in periosteum)

Answer 16

Ewing sarcoma

Question 17

Which primary bone tumor fits each of the following descriptions?

Codman’s triangle (periosteal elevation) on x-ray

Answer 17

Osteosarcoma

Question 18

Which primary bone tumor fits each of the following descriptions?

May arise from osteochondroma or appear as a primary tumor

Answer 18

Chondrosarcoma

Question 19

Which primary bone tumor fits each of the following descriptions?

Anaplastic small cells, aggressive mets, good chemo response

Answer 19

Ewing sarcoma

Question 20

Which primary bone tumor fits each of the following descriptions?

Most common malignant bone tumor in children

Answer 20

Osteosarcoma

Question 21

A 45-year-old woman receives a kidney transplant and receives cyclosporine as part of her anti- rejection regimen. What is the mechanism of action of cyclosporine?

Answer 21

Calcineurin inhibitor; binds cyclophilin and inhibits caclineurin which normally activates Nuclear Factor of Activated T-cells cytoplasmic (NFATc) which up-regulates IL-2. Overall, blocks T cell activation by preventing IL-2 transcription

Question 22

You are treating a 63-year-old woman with small cell lung cancer who develops SIADH. She becomes disoriented secondary to hyponatremia. Consequently, you rapidly correct the low serum sodium with demeclocycline and water restriction. The patient’s sodium level and disorientation improve, but several days later the patient develops diplopia. What is the cause of this patient’s diplopia?

Answer 22

Central pontine myelinolysis: acute paralysis, dysphagia, diplopia and loss of consciousness. Can cause “locked-in” syndrome. Massive axonal demyelination in the pontine white matter tracts. Secondary to osmotic forces and edema. Common iatrogenic, caused by overly rapid correction of hyponatremia
“From low (NA+) to high, your pons will die (CPM)”

When she was hyponatremic (fluid went into the brain where there was more sodium vs. in the serum). Addition of sodium too quickly sucked the fluid back out of the brain tissue (damage pons)