Wed 23

Question 1

what is the best way to manage somatic symptom disorder?

Answer 1

schedule regular visits with the same primary care provider - minimize unnecessary tests and specialist referrals

Question 2

Even with respiratory and metabolic compensation, will someone at a high altitude have a normal paO2?

Answer 2

NOOO

Question 3

explain the pathophys of how levator ani damage can lead to consipation later on?

Answer 3

the levator ani support the pelvic organs, keeping them in stable positions. With damage, it can become more lax and this can result in a change of the angle of the rectum, leading to constipation. It may prolapse into the posterior wall of the vagina.

Question 4

how does allergic pulmonary aspergillosus appear on chest imaging?

Answer 4

• recurrent, fleeting infiltrates (come and go)

- proximal bronchiectasis on CT

Question 5

what will be found in the blood of someone with allergic pulmonary aspergillosis?

Answer 5

• eosinophilia

- antibodies against aspergillus

Question 6

how may histoplasma spread to organs other than the lungs?

Answer 6

it may spread through the lymphatic system and effect other organs especially those in the reticuloendothelial system

Question 7

how will the nodules change over time in someone with histoplasma?

Answer 7

In a healthy person, granulomas will form and contain the fungi making the patient asymptomatic. The nodules will calcify, and may be discovered incidentally

Question 8

which antibodies are present in someone with drug-induced-lupus?

Answer 8

ANA antibodies - anti-nuclear antibodies
Antihistome antibodies

Rarely anti ds-dna antibodies

Question 9

name 3 drugs highly associated with drug induced lupus?

Answer 9

Procainamide
Hydralazine
Isoniazid

Question 10

what does a sudan III stain identify?

Answer 10

unabsorbed fat - this confirms malabsorption - stool should contain no fat

Question 11

which nutrient is typically malabsorbed first in someone with a malapsorption problem?

Answer 11

fat

Question 12

what is a very sensitive test to identiy a malabsorption problem?

Answer 12

sudan III stain

Question 13

how to treat acute agitation and psychosis associated with delirium?

Answer 13

First gen antipsychotics (haloperidol) and some second gen antipsychotics, for a short period of time

Question 14

what is doxepin?

Answer 14

a TCA

Question 15

Explain the effects of ketamine

Answer 15

NMDA receptor ANTagonist that is used for anesthesia. It preserves respiration and has an analgesic effect. It also stimulates release of catelcholamines that cause bronchodilation

Question 16

why is ketamine particularly useful for intubation sediation in someone with an asthma attack?

Answer 16

Because in addition to its anesthetic effects and analgesic effects, it has sympathetic activity that leads to bronchidilation

Question 17

which type of t cell is involved in ulcerative colitis and what cytokines are secreted in response?

Answer 17

Th2 t cells -> IL13 and IL5

Question 18

which type of t cell is involved in granuloma formation and what cytokines are secreted in response?

Answer 18

Th1 -> they produce IL2 and IFNgamma

Question 19

clinical manifestations of hereditary hemochromatosis?

Answer 19

• Hyperpigmentation of skin
• Diabetes
• Arthritis
• Elevated liver enzymes, hepatomegaly, cirhosis
• Hypopituitarism -> hypogonadism, hypothyroid
• restrictive or dilated cardiomyopathy & conduction abnormalities

Question 20

what kind of receptor is the HER2 receptor?

Answer 20

its a growth factor receptor - tyrosine kinase