Dit Pt1 Set 7

Front 1

A 25-year-old male patient “took a sick blow” to his right shoulder after colliding into a tree narrowing while mountain biking. The patient’s right arm is hanging by his right side in pronation and medial rotation. The patient’s clavicle, right arm and shoulder x-rays do not reveal a fracture or dislocation. What are the common causes of Erb-Duchenne palsy?
Where in the brachial plexus does this occur?

Back 1

Commonly caused by a blow to shoulder or trauma during delivery
- Traction or tear of the upper trunk of the brachial plexus (C5 and C6 roots)

Front 2

A 55-year-old male crashes on his motorcycle and suffers a head injury that leaves him in a coma. Prior to this injury the man was met with his lawyer to write out specific instructions in case an events like this happened. What is it that this man and his lawyer put together?

Back 2

A living will (written advance directive): describes txs the pt wishes to receive or not receive if he/she becomes incapacitated and cannot communicate about tx decisions

Front 3

How many umbilical vessels are there?

Which umbilical vessel has the highest oxygen content?

Back 3

Three: 2 arteries, 1 vein

Vein – supplies oxygenated blood from placenta to fetus; drains into IVC

Front 4

A 27-year-old female has been experiencing 1-2 panic attacks ever y month for the past 3 months. She reports that she cannot establish a specific trigger for the panic attacks but the attacks are beginning to affect her work performance. You choose to use a benzodiazepine as needed, in combination with cognitive behavioral therapy. How does the mechanism of benzodiazepines differ from the mechanism of barbiturates?

What toxicities of barbiturate can be fatal?

Back 4

Benzodiazepines: Facilitate GABAA action by increasing frequency of Cl- channel opening.
Barbiturates: Facilitate GABAA action by increasing duration of Cl- channel opening, thus decreasing neuron firing
- Respiratory or cardiovascular depression (Hypoventilation and Bradycardia)g

Front 5

You are examining an 84-year-old woman who has just come into the hostpital for a suspected CHF exacerbation. What heart sound is associated with dilated congestive heart failure?

What heart sound is associated with chronic hypertension?

Back 5

S3 – in early diastole during rapid ventricular filling phase. (Normal in children and pregnant women)

S4 – in late diastole. Due to high atrial pressure.

Front 6

A 47 year old woman with metastatic small bowel tumors is on octreotide to control her carcinoid syndrome. What is the cause of carcinoid syndrome?
…

What are the classic symptoms of carcinoid syndrome?

NOTE: most common tumor of appendix ?

Back 6

Carcinoid tumors (neuroendocrine cells), especially metastatic small bowel tumors, which secrete high levels of serotonin (5-HT)
- symptoms-
Recurrent diarrhea, cutaneous flushing, asthmatic wheezing (bronchospasm), and right-sided valvular disease
MC tumor of appendix = carcinoid

Front 7

Which anticancer agent fits the following description?
1. Given for estrogen-sensitive breast cancers?
2. S-phase antimetabolite; myelosuppression not reversible with leucovorin?
3. S-phase antimetabolite; myelosuppression reversible with leucovorin?
4. Ototoxic and nephrotoxic (much like aminoglycosides and loop diuretics)?
5. 2 agents known for causing pulmonary fibrosis?
6. Inhibits topoisomerase II?

Back 7

1. Tamoxifen, Raloxifene (SERMs)
2. 5-Fluorouracil (pyrimidine analog)
3. Methotrexate (Folic Acid Analog)
4. Cisplatin, Carboplatin
5. Busulfan, Bleomycin
6. Etoposide, Teniposide

Front 8

You are counseling a preoperative patient who has concerns about side effects related to anesthesia. Which intravenous anesthetic fits the following description?
1. Associated with hallucinations and bad dreams?
2. Most common drug used for endoscopy?
3. Used for rapid anesthesia induction?
4. Decreases cerebral blood flow?

Back 8

1. Ketamine (Arylcyclohexylamines) PCP analog blocks NMDA receptors
2. Medazolam- Benzo
3.Propofol- killed Michael Jackson... poetentiates GABAa
4. Barbiturates (important for brain surgery) (Thiopental)

Front 9

A 60 year old male long-time patient of yours comes to your office complaining of sexual dysfunction. What is your immediate differential diagnosis?
What drugs are known for causing sexual dysfunction?

Back 9

1) Drugs- Antihypertensives, neuroleptics, SSRIs, ethanol
2) Diseases (depression, diabetes, hormonal distrubance – low testosterone or hyperprolactinemia)
3) Psychological (perfomance anxiety)

Front 10

1. A 43 year old male presents with right-sided flank pain and hematuria. A helical abdominal CT reveals a right-sided 1.5cm ureterovesicular calculus. The stone is passed after being treated with fluids, pain control and lithotripsy. Incidentally the abdominal CT also reveals an isthmus connection the inferior poles of the kidneys. During fetal development, what structure traps the inferior poles of the kidney resulting in a horseshoe kidney?
2. Do patients with horseshoe kidneys have abnormal renal function?
3. NOTE: horseshoe kidney is associated with ?

Back 10

1. Inferior mesenteric artery – get trapped as they ascend from pelvis during fetal development.
2. Hell no. Kidney functions normally
NOTE: horseshoe kidney is associated with Turner’s syndrome

Front 11

A kidney transplant patient begins to experience renal failure seven years after receiving her kidney transplant. What type of rejection is this?
How is this type of reaction mediated?

Back 11

Chronic Rejection – Months to years after transplantation. Class I MHCnon-self is perceived by CTLs as class I MHCself presenting a non-self antigen

T-cell and antibody-mediated vascular damage

Front 12

An infant is seen with failure to thrive and cyanotic spells. Diagnosis of tetralogy of Fallot is made. What cardiact defects are seen in tetralogy of Fallot?
What is the cause of teralogy of Fallot?
What is a technique to improve cyanotic symptoms?

Back 12

1) Pulmonary stenosis (most important determinant for prognosis)
2) Right Ventricular Hypertrophy
3) Overriding aorta
4) Ventricular Septal Defect
Caused by- Anterosuperior displacement of the infundibular septum
- squating makes it better because increases compression to femoral arteries which increases TPR and more pressure to lungs

Front 13

Which GI ligaments match the following descriptions?
1. Separates the greater and lesser sacs?
2. May be cut during surgery to access the lesser sac?
3. 2 ligaments that connect the spleen to other structures?
4. Containts the portal triad

Back 13

1. a. Gastrohepatic (separates right greater and lesser sacs)
b. Gastrosplenic (separates left greater and lesser sacs)
2. Gastrohepatic
3. a. Gastrosplenic (greater curvature and spleen);
b. splenorenal (Spleen to posterior abdominal wall)
4.Hepatoduodenal

Front 14

1. What is the cause of hypertrophic cardiomyopathy?
2. Explain the pathophysiology of these mutations?

Back 14

1. Mutations in any one of several genes that encode sarcomeric proteins (Beta-myosin heavy chain, Cardiac troponin T, alpha-tropomyosin, myosin-binding protein C). Usually autosomal dominant transmission with variable penetrance. Remaining cases are sporadic.
2. Myocyte hypertrophy and disarray results in a massively hypertrophied LV which leads to decreases complaince and poor chamber filling (impaired diastolic filling and reduction of stroke volume)

Front 15

What is PPAR-gamma?
How is it relevant to the treatment of diabetes mellitus?

Back 15

- Peroxisome proliferator-activated receptor gamma – a nuclear receptor and transcription factor expressed in adipose tissue, and plays a seminole role in adipocyte differentiation
- Thiazolidinediones (a class of antidiabetic meds) act as agonist ligands for PPAR-gamma and improves insulin sensitivity.