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DIT Phase I Sets > Week 7 > Flashcards

Week 7 Flashcards

1
Q

A 17 year old girl is brought to the emergency room for abdominal pain and vomiting. She has a fever, and further questioning and exam reveal that the pain is in the right lower quadrant and has rebound tenderness. She says the pain began around the umbilicus. She is very nauseated and vomits again during the exam.

What must be ruled out prior to coming to the final diagnosis in this patient?

A

You must rule out pregnancy!
Check beta-hCG

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2
Q

A 35 year old woman is being treated with leuprolide for infertility issues. Her father is also being treated with leuprolide for prostate cancer. Describe how variations in administration of leuprolide can modify its effects and, therefore, usage.

A

Infertility - Pulsatile leuprolide stimulates production of FSH, stimulates the ovaries, Stimulates the follicle development

Prostate Cancer - Continuous (depot) leuprolide - suppresses production of LH and FSH, Reduces production of testosterone, Helps slow the growth of prostate cancer

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3
Q

What are omega 3 fatty acids, and what are their current clinical applications?

A

Polyunsaturated fatty acids, double bond at the 3rd carbon

Present in fish oils/flaxseed oils

Eicosapentaenoic acid (EPA)
Docosahexaenoic acid (DHA)
α-linolenic acid

Treatment of hypertriglyceridemia

Other possible uses

Decreasing arrhythmias in heart disease
Augment Nerve/eye development in utero
Improving inflammation (RA)

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4
Q

Your patient is experiencing bloody diarrhea. What are bacteria that can cause bloody diarrhea? Given the different bacterial causes of bloody diarrhea, how might MacConkey’s agar help you identify the specific bacteria?

A

Invade the wall of the gut:

Campylobacter - easy to identify visually (S-shaped)
Salmonella - Do not ferment lactose
Shigella - Do not ferment lactose
Enterohemorrhagic E. coli
Enterotoxigenic E. coli
Y. enterocolitica - coccobacillus
E. histolytica
C. difficile- gram (+)

MacConkey’s agar identifies lactose fermenters:

Citrobacter
Serratia
Klebsiella
E. coli - does ferment lactose
Enterobacter

MacConkey’s agar can help you differentiate between E. coli and Salmonella and Shigella which do not ferment lactose!

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5
Q

Which antibiotics fit each of the following descriptions?

**Treatment for Gram (-) rods in patients with renal insufficiency **

A

Aztreonam

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6
Q

Which antibiotics fit each of the following descriptions?

**”Big gun” antibiotic (effective against Gram (+) cocci, Gram (-) rods, and anaerobes) **

A

Imipenem + cilastatin, or meropenem

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7
Q

Which antibiotics fit each of the following descriptions?

**Prophylaxis in AIDS patients against P. jirovecii pneumonia **

A

TMP-SMX

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8
Q

Which antibiotics fit each of the following descriptions? **Used as solo prophylaxis against TB **

A

Isoniazid

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9
Q

Which antibiotics fit each of the following descriptions? Prophylaxis for those exposed to someone with meningococcal meningitis

A

Ciprofloxacin or rifampin

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10
Q

You are performing a well child examination on a 4 year old girl. The patient was recently adopted after being removed from the biological mother for abandonment. What changes might you see in your evaluation? What are the effects seen in an infant when there is long-term deprivation of affection?

A

Poor care

  • Neglect
  • Depression
  • Malnutrition
  • Short stature
  • Low weight
  • Dental caries
  • Skin infection - scabies

Deprivation of Affection

  • Poor muscle tone
  • Poor language skills
  • Poor socialization skills
  • Lack of eye contact
  • Weight loss
  • Failure to thrive
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11
Q

A 43-year-old male coal miner complains of a single, non-healing lesion on his right hand. Coal miners are at increased risk of skin cancer because of their exposure to arsenic.

What type of skin cancer is associated with this exposure?

A

Squamous cell cancer

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12
Q

A 27-year-old pregnant woman, G2P1, develops lower abdominal pain and vaginal bleeding in her 24th week of gestation. An ultrasound reveals a partial detachment of the placenta from the uterine wall. What is this condition called?

A

Placental Abruption

(Abruptio Placentae)

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13
Q

A patient with placental abruption is at high risk for developing disseminated intravascular coagulation (DIC). What are the common causes of DIC? What is the primary mechanism of DIC?

A

Causes of DIC - STOP Making New Thrombi -

  • Sepsis (gram-negative)
  • Trauma
  • Obstetric complications (amniotic fluid embolism, abruptio placenta)
  • acute Pancreatitis
  • Malignancy
  • Nephrotic syndrome
  • Transfusion

Mechanism: Widespread activation of clotting factors -> Consumption of clotting factors -> excessive bleeding

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14
Q

What important intracellular proteins are common to both the extrinsic and intrinsic apoptotic pathways?

A

Caspases - cysteine protease that cleaves after aspartic acid

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15
Q

A 60-year-old man who has avoided routine prevention is experiencing worsening urinary symptoms. He states that he has trouble starting a urinary stream and he has to wake sometimes up to 5 times a night to urinate. Upon digital rectal exam you notice a symmetric enlargement of the lateral and middle lobes of the prostate. An elevated blood pressure of 146/96 is also noted.

Which adrenergic antagonists can be used to treat hypertension as well as urinary retention in patients with benign prostatic hyperplasia (BPH)?

**What is the difference between the prostate exam findings in BPH versus adenocarcinoma of the prostate? **

A
  • α1 antagonists - Terazosin, Prazosin, Doxazosin
  • BPH - symmetric, smooth, enlarged
  • Adenocarcinoma - Asymmetric, hard nodule on prostate
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16
Q

A 28-year-old man known as the “elastic-skinned man” at the circus visits your clinic for a check-up. What are the features of Ehlers-Danlos syndrome?

A

Ehlers-Danlos Syndrome

  • Type III collagen defects
  • Hyperextensible skin
  • Tendency to bleed/bruise easily
  • Hypermobile joints
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17
Q

A type 1 diabetic patient presents to the emergency room in distress. A third year resident checks the patient’s arterial pH; the pH is 7.3 and the patient’s pCO2is 38 mmHg. What are the common causes of metabolic acidosis with an elevated anion gap?

A

Anion gap metabolic acidosis: MUDPILES

  • *M**ethanol
  • *U**remia
  • *D**KA
  • *P**araldehyde
  • *I**ron tablets/isoniazid
  • *L**actic acidosis
  • *E**thylene glycol
  • *S**alicylates
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18
Q

What is BNP, and how is it useful in cases of heart failure?

A
  • B-type natriuretic
  • High BNP helps confirm the diagnosis of heart failure
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19
Q

A 36-year-old woman has had multiple syncopal episodes recently and after her initial work-up, there is some concern for a cardiac tumor.

What is the most common primary cardiac tumor in adults? In children?

A
  • Adults - Left atrial myxoma
  • Children - Rhabdomyoma
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20
Q

A 1-year-old boy is brought to the ER for seizure activity. The seizure was quickly identified as being attributed to severe hypoglycemia. After stabilizing the seizure activity, the initial laboratory work reveals a metabolic acidosis. The patient’s exam reveals hepatomegaly. You think this patient might have a glycogen storage disease (GSD).

What GSD is most consistent with this clinical picture?

What is the difference between Cori disease (GSD-type III) and Von Gierke disease (GSD-type I)?

A

Von Gierke Disease (Type I Glycogen Storage Disease)

Deficient in glucose-6-phosphatase (glucose can’t exit the liver)
No effective gluconeogenesis/glycogenolysis

  • Severe fasting hypoglycemia
  • Lactic acidosis (cells make lactic acid when glucose is not available)
  • Seizures

Cori Disease (Type III Glycogen Storage Disease)

Milder form of Von Gierke (type I)
Capable of gluconeogenesis

  • Hypoglycemia is less severe
  • No lactic acidosis
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21
Q

A 43-year-old man complains of fatigue and a petechial rash. Laboratory evaluation reveals a normocytic, normochromic anemia.

What are the causes of normocytic, normochromic anemia?

A

Nonhemolytic Anemia

  • Anemia of chronic disease
  • Aplastic anemia
  • Kidney disease

Hemolytic Anemia

  • Intravascular hemolysis - Mechanical destruction (aortic stenosis, prosthetic valve)
  • Extravascular hemolysis - Autoimmune diseases, Hereditary diseases (present with jaundice)
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22
Q

What breast pathology fits the following description? Most common breast tumor in women under 25

A

Fibroadenoma

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23
Q

What breast pathology fits the following description? Most common breast mass in postmenopausal women

A

Invasive ductal carcinoma

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24
Q

What breast pathology fits the following description? Most common breast mass in premenopausal women

A

Fibrocystic change of the breast

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25
Q

What breast pathology fits the following description? Most common form of breast cancer

A

Invasive ductal carcinoma

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26
Q

How can a skull fracture at the base of the brain lead to pulsating exophthalmos (protrusion of the eye)?

A

Skull fracture ->
Torn ICA in cavernous sinus ->
High blood pressure in sinus ->
Blood fills the ophthalmic vein and orbit ->
Exophthalmos which pulses

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27
Q

A 25-year-old man is evaluated in the clinic for red, swollen, and painful right wrist and left knee joint. During the exam, the patient brags about his sexual conquests.

What sexually-transmitted organism can cause osteomyelitis as well as this patient’s septic arthritis?

A

*Neisseria gonorrhoeae - *Most common cause of septic arthritis in a young sexually active individual

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28
Q

Which respiratory infectious agent fit the following descriptions? Common cause of pneumonia in immunocompromised patients

A

Most common cause of pneumonia in immunocompromised patients

  • Staphylococcus
  • Enteric Gram (-) rods
  • Fungi
  • Pneumocystis jirovecii
  • Viruses
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29
Q

Which respiratory infectious agent fit the following descriptions? Most common cause of atypical/walking pneumonia

A

Most common are viral:

RSV
Adenoviruses

Bacterial causes:

Chlamydia
Mycoplasma
Legionella

30
Q

Which respiratory infectious agent fit the following descriptions? Common causative agent for pneumonia in alcoholics

A
  • S. pneumoniae
  • Klebsiella
  • Staphylococcus
  • Anaerobes (aspiration pneumonia)
31
Q

Which respiratory infectious agent fit the following descriptions? Can cause an interstitial pneumonia in bird handlers

A

Chlamydophila psittaci

32
Q

Which respiratory infectious agent fit the following descriptions? Often the cause of pneumonia in a patient with a history of exposure to bats and bat droppings

A

Histoplasmosis

33
Q

Which respiratory infectious agent fit the following descriptions? Fungal cause of pneumonia in a patient who has recently visited Southern California, New Mexico, or West Texas

A

Coccidioides - systemic mycoses remains as a spherule, not a yeast

34
Q

A 60-year-old man with a family history of Parkinson disease is concerned that he may be in the early stages of the disease. What are some of the signs and symptoms of Parkinson disease?

A
  • *T**remor - pill rolling
  • *R**igidity
  • *A**kinesia - inability to initiate movement
  • *P**ostural instability
35
Q

A child in India is brought to the doctor with symptoms of muscle weakness, malaise, headache, fever, and hyporeflexia. For the past few weeks he had been swimming in a water way known to contain sewage. You think this boy has contracted an organism via the fecal-oral route.

What area of the body is this organism attacking to give the neurologic symptoms seen?

A

Poliovirus - replicates in oral pharynx and spreads to the blood to the CNS Destruction of cells in the anterior horn of the spinal cord -> lower motor neuron destruction

36
Q

A 30-year-old man who is experiencing shortness of breath is diagnosed with obstructive lung disease on pulmonary function test. The patient does not have a history of asthma and has never smoked. The patient is subsequently diagnosed with α1-antitrypsin deficiency using protein electrophoresis.

How does the emphysema caused by smoking differ from the emphysema caused by α1-antitrypsin deficiency?

A

α1-Antitrypsin deficiency causes Panacinar destruction, genetic codominant trait associated with hepatocellular carcinoma

Smoking - Centriacinar emphysema

37
Q

Atropine should be avoided in men with BPH. In which patients can atropine be used for the treatment of which conditions?

A

Avoid in: Glaucoma, gastric obstruction or dementia
Atropine blocks SLUD:

Salivation
Lacrimation
Urination
Defecation

Used fro Cycloplegia and mydriasis
↓ Airway secretions
↓ Gastric acid secretion
↓ Gut motility
↓ Urinary urgency

38
Q

You have just received the labs back on a patient who was evaluated for pronounced fatigue, constipation and weight gain. Her lab profile appears normal, except her thyroid stimulating hormone (TSH) is elevated. You decide to start her on levothyroxine for hypothyroidism. You should wait for approximately 6 weeks to have the patient redraw her TSH because of the long half-life of levothyroxine.

How many half-lives does it take for a drug infused at a constant rate to reach 94% of steady state?

What variables determine the half-life of a drug?

A

4-5 half lives for a drug to reach steady state

2 half lives = 75%
3 half lives = 87.5%
4 half lives = 93.75%

T1/2 = (0.7 x Vd)/CL

Variables that determine half life are:

Volume of distribution (Vd)
Clearance (CL)

39
Q

A 15-year-old boy is considering becoming vegetarian and wants more information from you about how to get enough protein. What are the essential amino acids?

A

Gluconeogenic:

Methionine
Valine
Arginine
Histidine

Gluconeogenic/Ketogenic:

Isoleucine
Phenylalanine
Threonine
Tryptophan

Ketogenic

Leucine
Lycine

PVT TM HALL

  • Phenylalanine
  • Valine
  • Trytophan
  • Threonine
  • Methionine
  • Histidine
  • Arginine
  • Leucine
  • Lycine
40
Q

What are the 3 endogenous androgens, in order from the most potent to the least potent?

A
  • *1. DHT**
  • *2. Testosterone** (can be converted to estrogen by peripheral fat cells)
  • *3. Androstenedione** (can be converted to estrogen by peripheral fat cells)
41
Q

What does the Eustachian (auditory) tube connect? What is its purpose? What drug is commonly prescribed for Eustachian tube dysfunction?

A
  • Connects the middle ear to the nasopharynx
  • Equalizes pressure in the middle ear
  • Intranasal steroids (Fluticasone)
42
Q

A 34-year-old woman is being evaluated for multiple kidney stones, persistent nausea, and depression. Routine labs reveal hypercalcemia; and an ultrasound of the anterior neck reveals a mass near the lower left lobe of the thyroid.

**What are the three main ways that PTH increases serum calcium levels (directly and indirectly)? **

A
  • Bone resorption of calcium and phosphate
  • Reabsorption of Calcium in the distal convoluted tubule
  • Vitamin D production -> ↑ absorption of calcium in the intestine
43
Q

A 5-year-old girl undergoes genetic testing to try to determine if there is an explanation for her heart murmur and mental retardation. On appearance the patient has “elfin” facies, and she has a friendly demeanor.

What syndrome and corresponding chromosomal abnormality do you suspect this patient might have?

What lab abnormality can be seen with this syndrome?

A

Williams syndrome - Deletion of the long arm of chromosome 7, region carries gene for elastin (elfin facies, cardiovascular problems) Verbal skills are vey well developed with extreme friendliness with strangers.

Hypercalcemia - increased sensitivity to vitamin D

44
Q

A 40-year-old patient with cholelithiasis is being prepped for a cholecystectomy. What risk factors are associated with cholesterol gallstones? What risk factors are associated with pigment gallstones?

A
  • Fat
  • Female
  • Forty
  • Fertile

Pigmented Gallstones -

  • Chronic hemolysis
  • alcoholic cirrhosis
  • Advanced age
  • Biliary infection
45
Q

What breast pathology fits each of the following description? Small, mobile, firm mass with sharp edges in 24-year-old woman

A

Fibroadenoma

46
Q

What breast pathology fits each of the following description? Histologic “leaf-like appearance”

A

Phyllodes tumor - usually benign but may become malignant

47
Q

What breast pathology fits each of the following description? Commonly presents with nipple discharge

A

Intraductal papilloma

48
Q

What breast pathology fits each of the following description? Eczematous patches on nipple

A

Paget disease

49
Q

What breast pathology fits each of the following description?

Multiple bilateral fluid-filled lesions with diffuse, cyclical breast pain

A

Fibrocystic breast change (neoplasms)

50
Q

What breast pathology fits each of the following description?

Firm, fibrous mass in a 55-year-old woman

A

Invasive ductal carcinoma

51
Q

For what conditions is hyperbaric oxygen therapy particularly helpful?

A
  • Severe CO poisoning
  • Decompression sickness
  • Arterial gas emboli
  • Gas gangrene
  • Osteomyelitis (not standard)
  • MI (not standard)
52
Q

Given the following clinical presentation, explain the protozoal infection and pharmacologic agent used to treat the infection.

A 25-year-old man with cardiomyopathy after returning from South America

A
  • Chagas disease from Trypanosoma cruzi
  • Rx: Nifurtimox
53
Q

Given the following clinical presentation, explain the protozoal infection and pharmacologic agent used to treat the infection. A 44-year-old HIV patient with a brain abscess

A
  • Toxoplasma gondii
  • Rx: Sulfadiazine + pyrimethamine
54
Q

Given the following clinical presentation, explain the protozoal infection and pharmacologic agent used to treat the infection. A 20-year-old man with a liver abscess

A
  • Entamoeba histolytica
  • Metronidazole
55
Q

Given the following clinical presentation, explain the protozoal infection and pharmacologic agent used to treat the infection.

A 24-year-old woman with a greenish vaginal discharge

A
  • Trichomonas vaginalis
  • Rx: Metronidazole (treat sexual partners)
56
Q

Given the following clinical presentation, explain the protozoal infection and pharmacologic agent used to treat the infection.

A 34-year-old hiker with foul-smelling diarrhea

A
  • Giardia lambilla
  • Metronidazole
57
Q

A 3-year-old child with a history of febrile seizures is in your office because she has had a fever of 102°F for 3 days despite scheduled acetaminophen use every 6 hours. The child is otherwise asymptomatic and has not had a seizure with this episode. You feel this might be a viral illness, but given the patient’s history of febrile seizures, you have the patient follow up. The following day your patient has a red macular rash over her trunk, but the fever has improved.

Does this patient have roseola or rubeola?

Roseola is commonly called sixth disease; what viral illness causes fifth disease?

A

Roseola

  • High fevers lasting several days (sometimes causing seizures)
  • Diffuse macular rash
  • HHV-6

Fifth disease

  • “Slapped-cheek” rash
  • Parvovirus
58
Q

A 27-year-old man is brought to the ER after having been struck on the side of the head by a softball. He was briefly “knocked out” but regained consciousness for several minutes before losing consciousness again. Non-contrast CT of the head reveals a lens-shaped radiopaque lesion in the left temporal region.

What vessel was ruptured in this injury?

A
  • Epidural hematoma
  • Middle meningeal artery
59
Q

The part of the brain responsible for attention and alertness has been implicated in schizophrenia, PTSD, Parkinson disease, narcolepsy, progressive supranuclear palsy, depression, and ADHD. What part of the brain is this? (Hint: Lesion results in coma)

A

Reticular Activating System

60
Q

An 18-year-old woman has seasonal allergies. She is tired of having her eyes water and her nose run all the time during the spring. Which cell type is responsible for her symptoms, and what drug inhibits these cells’ action? What WBCs descend from the myeloblast (granulocyte) lineage?

A

Mast cells
Cromolyn sodium - stabilizes cell membrane of mast cells so they can’t release their granules of histamine

Neutrophils, Eosinophils, Basophils

(mast cells similar to basophils, but come from different cell line)

61
Q

Does a partial agonist always have a lower maximal efficacy than a full agonist? Does a partial agonist always have a lower potency than a full agonist?

A
  • A partial agonist always has a lower maximal efficacy
  • Potency could be increased or decreased (independent of efficacy)
62
Q

An 11-year-old boy is rushed into the ER from a farming community. His pupils are constricted and he is having difficulty breathing because of excess airway secretions and bronchospasm. He also lost control of his bowels and bladder.

What is the likely explanation for these symptoms?

Name five or more drugs that inhibit acetylcholinesterase. What is the clinical application for each?

A

Organophosphate poisoning - inhibit acetylcholinesterase (keep ACh around longer) looking like excessive parasympathetic activation

Neostigmine

  • Reversal of neuromuscular blockade
  • Ileus
  • Bladder atony

Physostigmine - Atropine overdose

Edrophonium (Tensilon) - Diagnosis of myasthenia gravis

Pyridostigmine - Treatment of myasthenia gravis

Echothiophate - Open-angle glaucoma

Donepezil - Alzheimer disease

Rivastigmine - Alzheimer disease

Galantamine - Alzheimer disease

63
Q

A 30-year-old man is undergoing the Schilling test to investigate his B12 deficiency. What must be present in the enteric system in order for vitamin B12 to be absorbed?

A

Intrinsic Factor produced by parietal cells of the stomach

64
Q

What is the site of action of the following diuretic? Thiazide diuretics

A

Thiazide diuretics - Distal convoluted tubule

65
Q

What is the site of action of the following diuretic? Loop diuretics

A

Ascending loop of Henle

66
Q

What is the site of action of the following diuretic? Carbonic anhydrase inhibitors

A

Proximal convoluted tubule

67
Q

What is the site of action of the following diuretic? Osmotic diuretics

A
  • Proximal convoluted tubule
  • Thin descending limb
  • Mannitol: collecting duct
68
Q

What is the site of action of the following diuretic? Potassium-sparing diuretics

A

Collecting tubules

69
Q

How is thyroid hormone made and stored?

A
  • Epithelial cells bring in I- (Na+/I- co-transporter)
  • I- is transported into the follicle, oxidized to I2
  • Iodine is bound to tyrosine residues on thyroglobulin (organification in the colloid)
    • Monoiodotyrosine (MIT) is first molecule made
    • Diiodotyrosine (DIT)
    • T3 (links these together) Active thyroid hormone
    • T4 (4 iodines) most is released in this form
  • T3 and T4 are stored in the colloid, attached to thyroglobulin (store a 2-3 month supply of thyroid hormone in follicle)
  • TSH stimulates the thyroid
  • Epithelial cells endocytose colloid
  • Lysosomal enzymes break down thyroglobulin, leaving T3 and T4
  • Thyroid hormone released by exocytosis
70
Q

A patient has a hypertensive episode while in the hospital. The intern on call orders hydralazine. The intern is later called about the same patient, who now has tachycardia due to the baroreceptor response to the lowered blood pressure. Where are the main arterial baroreceptors located? Which nerves transmit information from these baroreceptors?

A

Aortic baroreceptors - Aortic arch
Carotid baroreceptors - Carotid sinus

Aortic baroreceptors - Aortic arch

Vagus nerve (sends info to medulla about high pressure only!)

Carotid baroreceptors - Carotid sinus

Glossopharyngeal nerve (transmit info to medulla regarding high and low pressure)

71
Q

A 36-year-old man is brought to the ER by his wife because of altered mental status. His liver is markedly enlarged, he has spider nevi on the upper chest, and he demonstrates asterixis. His wife reports that he is a long-time heavy drinker. Lab studies reveal hypoglycemia. What is the likely cause of his hypoglycemia?

A

Metabolism of EtOH increases NADH/NAD+ ratio

  • Shunts pyruvate –> lactate
  • Shunts oxaloacetate –> malate

Inhibits gluconeogenesis and stimulates fatty acid synthesis (you need pyruvate, you need oxaloacetate for gluconeogenesis)

DIT Phase I Sets (8 decks)

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