Dit Question Set 4

Front 1

1. A 60--‐year--‐old male has noticed worsening urinary complaints. He is having to urinate more frequently and has a decreased urinary stream. A digital rectal exam reveals a smooth, symmetrical, enlarged prostate. You begin patient treatment with a medication that relaxes the prostatic smooth muscle. What class of medication is used to relax smooth muscle in BPH?

Back 1

alpha antagonist= terazosin, tamsulosin
tamsulosin best because it wont cause hypotension

Front 2

how do smooth muscles contract?

Back 2

smooth muscle membrane depolarizes--> voltage gated Ca channel opens -->increased Ca in cytoplasm from sarcoplasmic reticulum--> Ca binds to calmodulin--> activates myosin light chain kinase which phosphorylats myosin P + actin causing cross-bridge formation with contraction

Front 3

What is the p value? and what is the normal number for p?

Back 3

p= the probablility that the results are ontained from a study were obtained by chance alone-so you can reject the null hypothesis
usually <.05

Front 4

. A 22--‐year--‐old female law student is in your office for prenatal counseling and a well--‐woman check up. She knows that she needs to begin taking folic acid supplements to prevent neurologic defects before she begins to try conceiving a child with her husband. She did some research on the
Internet and asks, “Does the notochord become the neural tube?”

Back 4

No! The neural tube is from ectoderm- the notochord induces the ectoderm to differentiate into the neuroectoderm and makes neural plate which becomes neural tube.
notochord is mesoderm that becomes nucelus pulposus in intervertebral disks

Front 5

. A homeless alcoholic is brought to the hospital with shortness of breath, high fever, and decreased
Mental status. What is the clinical use of clindamycin?

Back 5

In this case clindamycin would be used for anaerobic infections like aspiration pneumonia or lung abscesses
can also be used for acne and MRSA

Front 6

What is the most common side effect of clindamycin? MOA?

Back 6

pseudomembranous colitis- C diff
binds to 50s subunit of ribosome and blocks peptide formation

Front 7

A 67--‐year--‐old woman is brought to the ER by her concerned husband. For the past 2hours, she has been very nauseated, weak, lightheaded, and somewhat short of breath. Though she denies chest pain, the resident suspects a cardiac etiology for the symptoms and orders an EKG and cardiac enzymes. What are the branches of the right and left coronary arteries?

Back 7

RCA- Posterior descending and acute marginal artery
LCA- LAD and circumflex artery ( diagonal and obtuse marginal come off these)

Front 8

A 67--‐year--‐old woman is brought to the ER by her concerned husband. For the past 2hours, she has been very nauseated, weak, lightheaded, and somewhat short of breath. Though she denies chest pain, the resident suspects a cardiac etiology for the symptoms and orders an EKG and cardiac enzymes.? What is the most commonly occluded artery of the heart?

Back 8

LAD

Front 9

A 67--‐year--‐old woman is brought to the ER by her concerned husband. For the past 2hours, she has been very nauseated, weak, lightheaded, and somewhat short of breath. Though she denies chest pain, the resident suspects a cardiac etiology for the symptoms and orders an EKG and cardiac enzymes.What is particularly dangerous about an occlusion of the RCA?

Back 9

RCA supplies SA and AV node so you can have a higher risk of arrythmias

Front 10

. You can use two different types of medication in the treatment of diabetes insipidus: desmopressin (ADH analog) or hydrochlorothiazide (diuretic). What determination must be made for selecting an effective treatment for diabetes insipidus? Which drug will help you make this determination?

Back 10

• Desmopressin is for neurologic diabetes insipidus so if you do the demopressin challenge and urine osmolality goes up its neurologic and you can use desmopressin. If urine osmolality doesn’t go up then its nephrogenic and use hydrochlorothiazide.

Front 11

translocation (9;22)

Back 11

philadelphia chromosome
CML
bcr-abl hybrid

Front 12

translocation (8;14)

Back 12

Burkitt's lymphoma
c-myc activation

Front 13

transolcation (14;18)

Back 13

follicular lymphoma
bcl-2 activation

Front 14

translocation (15;17)

Back 14

M3 type of AML
all trans retinoic acid responsive

Front 15

translocation (11;22)

Back 15

ewings sarcoma

Front 16

translocation (11;14)

Back 16

mantle cell lymphoma

Front 17

A 65--‐year--‐old female reports decreased vision. During her exam, you begin suspecting open--‐angle glaucoma. What are the 5 classes of medications used to treat glaucoma?

Back 17

alpha agonists- epinephrine, brimonidine
B blockers- timolol, betaxolol, carteolol
Diuretic- acetazolamide
cholinomimetics- direct agoinst- pilocarpine, carbachol; indirect- inhibits Ach-esterase- physostigmine, echthiophates
prostaglandin- lantanoprost

Front 18

What are the 3 different eukaryotic RNA polymerases? What type of RNA does each make?

Back 18

RNA polymerase I- rRNA
RNA polymerase II- mRNA
RNA polymerase III- tRNA

Front 19

. It is recommended to vaccinate 11--‐12 year--‐old patients against Neisseria meningitis to reduce the incidence of bacterial meningitis. What are other examples of encapsulated bacteria that
Have a preventative vaccine?

Back 19

s. pneumoniae- pneumoccocal vaccine
h. influenza type b vaccine
n. meningitis vaccine

Front 20

. It is recommended to vaccinate 11--‐12 year--‐old patients against Neisseria meningitis to reduce the incidence of bacterial meningitis. What test can be used to detect encapsulated bacteria?

Back 20

encapsulated bacteria test= quellung test= capsule swelling to antibodies introduced

Front 21

Your really cute 4 year old pt keeps having neisseria infections. What is the complement deficiency?

Back 21

deficiency in C5-C8= MAC complex

Front 22

Your not so cute 4 year old patient has recurrent pyogenic respiratory infection with h influenza and strep pneumonia. What complement deficiency does this not so cute patient have?

Back 22

deficiency in C3

Front 23

you are an awesome doctor. you found your patient has paroxysmal noctural hemoglobinuria. What is their compliment deficiency?

Back 23

CD55 and CD59- overactive compliment- deficinecy in DAF

Front 24

increased frequency of type III hypersensitivity reaction

Back 24

deficiency in C3- with type III glomerulonephritis

Front 25

A 65--‐year--‐old Man arrives at the ER with complaint of sudden substernal chest pain that radiates into his left arm and concomitant shortness of breath. This occurred while he was shoveling the snow off of his driveway. He normally doesn’t get much exercise he says. What diagnostic studies need to be ordered?

Back 25

CK-MB
ECG is gold standard
CBC
CXR
blood chemistries

Front 26

A 37--‐year--‐old patient with refractory peptic ulcer disease undergoes an esophagogastric duodenoscopy (EGD). Biopsies of the duodenum reveal hypertrophied submucosal glands. What
Are these glands?

Back 26

Brunner's glands- secrete alkaline mucus are hypertrophied in peptic ulcer disease due to increased acid in the stomach

Front 27

You decide to visit WVSOM and you find Dr. Dickinson and she starts talking about Peyer's patches. What are peyer's patches?

Back 27

peyers patches are unencapsulated lymph tissue founf in lamina propria and submucosa of small intestines in ileum! M cells take up antigen and dendritic cells carry antigen. B cells in here make secretory IgA for protection

Front 28

What is HIPAA

Back 28

health insurance portability and accountability act in 1996- storage and handling of medical information

Front 29

When can you discuss medical info and not get in trouble due to HIPAA?

Back 29

child abuse
birth or death records
state-mandated reportable illness
public heath disease surveillance
state-sponsored disease intervention
schools- illness and student health status
employers are exempt- conditions that affect capatability of work