Dit Week 9 Monday

Front 1

What are the signs and symptoms of digoxin toxicity? What is the antidote for digoxin toxicity?

Back 1

Class: cardiac glycoside
Mech: direct inhibition of Na/K ATPase leads to indirect inhibition of Na/Ca exchanger antiport. Increased Ca leads to positive inotropy. Also stimulates vagus nerve.
To x sx: nausea, vomiting, diarrhea, blurry yellow vision
Antidote: slowly normalize K, lidocaine, cardiac pacer, anti-dig Fab fragments, Mg

Front 2

What GI ligament separates the greater and lesser sacs?

Back 2

Gastrohepatic (R)
Connects liver to lesser curvature of the stomach
Contains gastric arteries
May be cut during surgery to access the lesser sac

Gastrosplenic (L)
Connect greater curvature and the spleen
Contains short gastric arteries

Front 3

What GI ligaments connect the spleen to other structures?

Back 3

Gastrosplenic, splenorenal

Front 4

What GI ligament contains the portal triad?

Back 4

Hepatoduodenal
Connects liver to duodenum
Portal triad: hepatic artery, portal vein, common bile duct
May be compressed between thumb and index finger placed in omental foramen to control bleeding

Front 5

What is the mechanism of action of the drug lanosoprazole? What other drug works in the same manner?

Back 5

PPI (omeprazole, lansoprazole)
Mech: irreversibly inhibit H/K ATPase in stomach parietal cells
Use: peptic ulcer, gastritis, esophageal reflux, Zollinger-Ellison syndrome

Front 6

What is the basic difference between endometriosis and endometrial hyperplasia? How does the clinical presentation of each differ?

Back 6

Endometriosis: non-neoplastic endometrial glands and stroma in abnormal locations outside the uterus
Characterized by cyclical bleeding with chocolate cysts
Present with several menstrual-related pain
Can be due to ascending infection or retrograde menstrual flow and may result in infertility
Endometrial hyperplasia: abnormal endometrial gland proliferation from excess estrogen
Increased risk for endometrial cancer
Present with post-menopausal vaginal bleeding
Risk factors: anovulatory cycles, HRT, polycystic ovarian syndrome, late menopause, granulosa cell tumor

Front 7

What is the clinical use of clomiphene? How does this drug work?

Back 7

Estrogen partial agonist at the hypothalamus
Prevents normal feedback inhibition leadint to increased release of LH and FSH to stimulate ovulation

Front 8

What are the causes of aplastic anemia? What is the treatment for aplastic anemia?

Back 8

Causes:
Radiation/drugs (benzene, chloramphenicol, alkylating agents, antimetabolites)
Viral infections (parvo B19, EBV, HIV)
Fanconi's anemia (inherited defect in DNA repair)
Idiopathic (immune mediated, primary stem cell defect)
Tx: stop offending agent, immuno suppress, allogenic bone marrow transplant, RBC and platelet transfuse, G-CSF or GM-CSF

Front 9

A smear of your patient’s blood reveals target cells. What diseases do you immediately suspect?

Back 9

HbC disease
Asplenia
Liver disease
Thalassemia

Front 10

What hormone that is associated with hyperphagia in Prader-Willi syndrome is lost after gastric bypass surgery?

Back 10

Ghrelin
Source: P/D1 cells in stomach
Action: increases GH, ACTH, cortisol, and prolactin secretin
Increases before meals and decreases after meals

Front 11

Which skin cancer has a histopathology revealing keratin pearls?

Back 11

Squamous cell carcinoma
Locally invasive but rarely mets
Preceded by actinic keratosis
Keratoacanthoma is a variant that grows quickly and recedes spontaneously

Front 12

Which skin cancer does a dysplastic nevus precede?

Back 12

Melanoma
Significant risk of mets
S-100 tumor marker
Depth of tumor correlates with risk of mets
Dark with irregular borders

Front 13

Which skin cancer has a histopathology revealing palisading nuclei?

Back 13

Basal cell tumors
Locally invasive but rarely mets
Rolled edges with central ulceration

Front 14

Which skin cancer appears as pearly papules with subepidermal blood vessels?

Back 14

Basal cell carcinoma
Commonly with telangiectasias
Locally invasive but rarely mets
Rolled edges with central ulceration

Front 15

Which skin cancer is associated with sun exposure and arsenic exposure?

Back 15

Squamous cell carcinoma
Locally invasive but rarely mets
Preceded by actinic keratosis

Front 16

What type of collagen is abnormal in patients with Alport’s syndrome?

Back 16

Abnormal type IV collagen (basement membrane of kidney, ears, eyes)
Most common form is X-linked recessive
Characterized by rpgressive hereditary nephritis and deafness
May be associated with ocular disturbances

Front 17

A woman presents to your clinic with vaginal irritation and greenish vaginal discharge. You take a sample of the discharge and notice Clue cells under the microscope. What drug would you use to treat this infection?

Back 17

Tx: metronidazole
Gardnerella vaginalis
Pleomorphic gram-variable rod causing vaginosis
Associated with sexual activity but not an STD

Front 18

What is the most common tumor of the salivary gland? What is the most common malignant tumor of the salivary gland?

Back 18

Pleomorphic adenoma (benign)
Painless movable mass with high rate of recurrance

Mucoepidermoid carcinoma (malignant)

Front 19

How does the drug dose response curve change with the addition of a competitive antagonist compared to a noncompetitive antagonist?

Back 19

With a competitive antagonist, the curve shifts to the right which decreases potency and increases EC50.
A non-competitive antagonist shifts the agonist curve downward, decreasing efficacy.

Front 20

What is the mechanism of action of bleomycin?

Back 20

Mech: G phase specific. Induces the formation of free radicals which cause breaks in DNA strands
Use: testicular cancer, Hodgkins lymphoma
Tox: pulmonary fibrosis, skin changes

Front 21

What is the mechanism of action of cyclophosphamide?

Back 21

Mech: covalently X-link (interstrand) DNA at guanine N-7. Must be activated by liver
Use: Non-Hodgkin's lymphoma, breast and ovarian cancers, immunosuppression
Tox: myelosuppression, hemorrhagic cystitis (prevent with mesna)

Front 22

What is the mechanism of action of doxorubicin?

Back 22

Mech: generate free radicals, noncovalently intercalate in DNA causing breaks and decreasing replication
Use: Hodgkins, myelomas, sarcomas, solid tumors
Tox: cardiotoxicity, myelosuppression, alopecia. Toxic to tissues with extravasation

Front 23

What is the mechanism of action of 6-mercaptopurine?

Back 23

Mech: purine (thiol) analog causing decreased de novo purine synthesis. Activated by HGPRTase
Use: leukemias, lymphomas (not CLL of Hodgkins)
Tox: bone marrow, GI, liver. Metabolized by xanthine oxidase to increasing toxicity with allopurinol

Front 24

What are the first generation cephalosporins? What organisms do they kill?

Back 24

Cefazolin, cephalexin
Kill gram positive cocci (PEcK)
Proteus mirabilis, E coli, Klebsielle pneumoniae

Front 25

What are the second generation cephalosporins? What organisms do they kill?

Back 25

Cefoxitin, cefaclor, cefuroxime
Kill gram positive cocci (HEN PEcKS)
Haemophilus, Enterobacter aerogenes, Neisseria, Proteus, E. coli, Klebsiella, Serratia marcescens

Front 26

What are the third generation cephalosporins and what organisms do they kill?

Back 26

Ceftriaxone, cefotaxime, ceftazidime
Kill serious gram negative infections resistant to other beta lactams, meningitis
Pseudomonas killed by ceftazidime
Gonorrhea killed by ceftriaxone

Front 27

What are the fourth generation cephalosporins? What organisms do they kill?

Back 27

Cefepime
Increased activity against Pseudomonas and other gram positive organisms