First Aid: High Yield

Front 1

A gardener presents with SOB, salivation, miosis and diarrhea - what caused this and what's the mechanism?

Back 1

Most likely organophosphate poisoning.
Acetylcholinesterase inhibitor

Front 2

What drug can you use if atropine alone does not reverse an organophosphate poisoning? What does that drug do?

Back 2

Pralidoxime - regenerates acetylcholinesterases.

Front 3

What drug helps to improve FEV1 in a patient with COPD?

Back 3

Ipratroprium

Front 4

What autonomic drug would you use to treat a schizophrenic suffering from urinary retention 2ary to neuroleptic tx? Mechanism?

Back 4

Bethanecol - direct cholinomimetic.
Neostigmine - AChE inhibitor (good because it won't cross CNS)

Front 5

What autonomic drug classes (and specific drugs) causes mydriasis?

Back 5

Muscarinic blockers (atropine, homatropine, or tropicamide)
Alpha1 agonists (phenylepherine)

Front 6

What autonomic drug that is used to tx shock also maintains renal blood flow?

Back 6

Dopamine

Front 7

What are you thinking if a 60 y/o pt comes to you complaining of eye pain when looking at oncoming headlights at night?

Back 7

Cataracts

Front 8

What nerve is most likely to be injured with anterior dislocation of the shoulder?

Back 8

Axillary (=no abduction or deltoid sensation)

Front 9

What was fractured and what nerve did it affect is someone has numbness in the medial palm after a fall?

Back 9

Ulnar - usually due to a medial epicondyle fracture ( = hand of benediction)

Front 10

What nerve and artery are most at risk with a mid-shaft fracture of the humerus?

Back 10

Radial nerve
Deep Brachial artery

Front 11

What are you thinking when a pt presents with numbness and tingling of the lateral digits with thenar wasting?

Back 11

Carpal tunnel syndrome (median nerve injury)

Front 12

What organisms are most commonly the cause of subacute endocarditis?

Back 12

Viridans strep, staph epidermidis, and enterococci

Front 13

What is the most common organism in acute endocarditis?

Back 13

Staph aureus

Front 14

What are you thinking if a breast-feeding female complains of redness and swelling of her right breast in the last 24 hrs? What do you do?

Back 14

Mastitis secondary to a staph aureus infection
Keep pumping milk until it goes away

Front 15

What is the most common aerobic skin flora?

Back 15

Staph epidermiditis

Front 16

What compliment factor is responsible for neutrophil chemotaxis?

Back 16

C5a

Front 17

What is the most likely defect in a kid that gets reccurent lung infections and granulomatous lesions?

Back 17

Chronic granulomatous disease = deficiency of NADPH oxidase (impairs PMN respiratory burst = increased susceptibility to catalase positive organisms)

Front 18

A hypocalcemic child with recurrent viral and fungal infections had a defect from which of the germ cell lines?

Back 18

Endoderm in the 3rd and 4th pharyngeal pouchs didn't develop = DiGeorge's Syndrome

Front 19

What is the most likely immune disorder in a kid who gets recurrent staph abscesses? What is the pathogenesis?

Back 19

Hyper-IgE (Job's syndrome = no INFalpha = no PMN chemotaxis)

Front 20

What compliment proteins are most likely deficient in a patient that suffers recurrent Neisseria infection?

Back 20

C5-8

Front 21

What ab are most specific to dx SLE in a female with malar rash and arthritis?

Back 21

anti-dsDNA
anti-Smith

Front 22

What are you thinking if a patient suffers from dermatitis, enteritis and hepatitis after a bone marrow transplant?

Back 22

Graft vs. Host Disease (a type IV hypersensitivity)

Front 23

What type of study is being conducted if a group of hospitalized pts with pancreatitis and a group without are being interviewed to ID potential risk factors?

Back 23

Case-control study (retrospective to identify risk factors comparing a group with to a group without)

Front 24

What is the description of a test that gets similar numbers each time but they aren't near the true value?

Back 24

Good precision but poor accuracy

Front 25

What type of study is it if a group of people is followed over 20 years and every 2 years it's determined who develops cancer and who doesn't

Back 25

Cohort study (following over time and asking, "what will happen")

Front 26

What is the sensitivity if the false negative rate is 1%?

Back 26

99%

Front 27

What can you say about disease duration if population A has twice the prevalence but the same incidence as population B?

Back 27

Duration in A is twice that of B

Front 28

What should you say to an exercising smoker diagnosed with lung cancer?

Back 28

Educate on the risk factors, avoid belittling and validate their good habits

Front 29

What do you do if you're attracted to one of your patients?

Back 29

Never date (even if no longer a patient) and use a chaperone

Front 30

What should you do if the patient's friend says he never wanted surgery but the wife insists you save his life regardless?

Back 30

"substituted judgement" - get a court order so you can do what the patient would want

Front 31

What should you do if you've diagnosed a fatal disease and the family requests you don't tell the patient?

Back 31

Do what would be best for the patient's health

Front 32

What should you do if a pt with a strong family history is refusing a mammogram?

Back 32

Informed consent - Explain the risks and benefits and leave the decision up to her

Front 33

What should you do if a post-MI patient is refusing aspirin because it makes him feel "funny"?

Back 33

Investigate the "funny" feeling and possible alternatives and explain risks/benefits

Front 34

What should you do if you smell alcohol on a Dr's breath while he's working?

Back 34

Report it.

Front 35

Is a 1 yr old developing normally if they can walk and know 5 words? When can toilet training start?

Back 35

Yes.
2-3 years old

Front 36

Is it normal if a 2 y/o can speak in short 2-3 word sentences but can't ID colors or say the ABC's?

Back 36

Yup (colors and ABCs = by 5 years)

Front 37

How old is a girl if she can speak in complete sentences, has an imaginary friend and considers boys gross?

Back 37

6-11 years

Front 38

What is the differential for a 60 year old that's 1 yr post MI that comes to you complaining of failure to achieve a full erection?

Back 38

atherosclerosis versus drugs (like beta blockers) versus fear of dying/psych issues

Front 39

What stage of sleep is a man in if he has variable BP and EEG and penile tumenscence (erection)?

Back 39

REM

Front 40

What are you thinking if a 6mo old becomes flaccid after being given honey?

Back 40

ACh release prevention due to botulinin toxin

Front 41

A family gets vomitting for 10 hrs after eating potato salad and then recovers, what are you thinking?

Back 41

Staph aureus's preformed enterotoxins in the mayo

Front 42

Gram negative, oxidase positive diplococci?

Back 42

Neisseria

Front 43

Gram negative rods in the stomach of patient c/o burning after meals?

Back 43

H.pylori

Front 44

50 y/o smoker c/o cough with flu like sx with rods in sputum on silver stain?

Back 44

Legionella pneumo

Front 45

40 y/o with acute onset unilateral knee pain and bilateral Bell's palsy - what organism is most likely?

Back 45

Borrelia burgdorferi (lyme disease from tick bite)

Front 46

21 y/o with 5 day hx of fever and an enlarged painful knee?

Back 46

Neisseria Gonorrhea if he's getting action - tx with ceftriaxone

Front 47

Adult with toxic megacolon and diarrhea after antibiotic tx?

Back 47

C.Difficle - injures mucosal membrane via actin depolymerization

Front 48

What defense mechanism is seen a in pt that asks her husband to spend the night in the hospital with her because she's afraid to be alone?

Back 48

Regression

Front 49

Which defense mechanism underlies all other defense mechanisms?

Back 49

Repression

Front 50

What defense mechanism is illustrated by a patient that jumps out of bed and does push-ups after being told he has an MI?

Back 50

denial

Front 51

What human problem's illustrated by a baby monkey that becomes withdrawn, socially isolated and grooms poorly after separation from it's mommy?

Back 51

Anaclitic Depression

Front 52

15 y/o old girl with enlarged parotids and laxatives in her closet?

Back 52

Bulemia

Front 53

4 y/o with n.gonorrhea?

Back 53

Sexual abuse

Front 54

72 y/o with decreased memory, poor judgement, and lack of abstraction ability (he doesn't know why I wish I hadn't payed for Milad when the milk was free)?

Back 54

Dementia

Front 55

72 y/old that's been napping excessively for the past few weeks and is not able to focus on your questions?

Back 55

Delerium

Front 56

Elderly demented patient needs sleep meds - what's not ok to give?

Back 56

Don't give diphenhydramine or benzos. Ok = haloperidol or trazadone

Front 57

What should you ask a patient who has attempted suicide that will help you assess their need for hospitalization?

Back 57

What did you do after you slit your wrists?

Front 58

What's the dx if a woman has 2/9 sx of depression + sadness for the past 6 years? What if she has sx of mild mania?

Back 58

Dysthymia

Cyclothymia

Front 59

What's our dx if a patient has problems eating and sleeping 1 month after the death of her spouse?

Back 59

Normal bereavement (get 2 months)

Front 60

What can you do if a patient doesn't want to undergo a MRI because of claustrophobia?

Back 60

Drug with him with benzo's

Front 61

Young woman who's scared about her first pap is told to imagine it happening - what technique is this?

Back 61

Somatic desensitization

Front 62

What if a patient has hypoglycemia but no elevation in c protein?

Back 62

She's dosing exogenous insulin = facticious disorder

Front 63

What are you thinking if a 40y/o female tries to commit suicide after you switch her to a different doc after she hits on you?

Back 63

Borderline

Front 64

What are you thinking if a woman is dressed provocatively and is very flirtatious?

Back 64

histrionic

Front 65

What are you thinking if a patient says she can only have the best doctor in town?

Back 65

Narcissistic

Front 66

Why would a pt with mycoplasma have anemia?

Back 66

IgM cold agglutinins

Front 67

What's the most likely cause of an aspiration pneumonia?

Back 67

Klebsiella or an anarobe (like bacteriodes) = foul smelling sputum

Front 68

What other findings are expected in a patient with aganglionic colon and other neural crest derivative deficiencies?

Back 68

Albinism (failure of melanocyte migration)

Front 69

Name the drugs drugs that are contraindicated in pregnancy?

Back 69

Retinoic acid, alcohol, ace inhibs, aminoglycosides, alkylating agents, DES, cocaine, folate antags, iodide, tetracycline, thalidomide, valproate, vitamin A, Warfarin, anticonvulsants.

Front 70

What are you thinking if a pt presents with hypertension in both arms but no palpable pulses in ankles/feet?

Back 70

coarctation of aorta

Front 71

What is the direction of blood flow through a PDA after birth?

Back 71

From the aorta to the pulmonary artery

Front 72

List fetal blood flow from the umbilical cord and back?

Back 72

Umbilical vein to ductus venosis to inferior vena cava (where it mixes with systemic circulation) to superior vena cava to the rt ventricle to pulm/foramen ovale to aorta to inferior iliac to umbilical artery to mommy

Front 73

What can cause one twin to have a 15% hematocrit and the other to have a 55%? Which one typically does better?

Back 73

Monozygotic twins sharing placenta = twin-twin transfusion.
The 15% does better because intrauterine stress = increased lung development

Front 74

What are the nerves associated with each of the brachial arches?

Back 74

I = 5 = muscles of mastication
II = 7 = muscles of facial expression
III = 9 = stylopharyngeus
IV/VI = 10 = swallow/speech muscles

Front 75

23 year old with an undescended testicle = increased risk for what?

Back 75

Germ cell cancer

Front 76

Testicular cancer spreads through what routes?

Back 76

Para-aortic lymph nodes

Front 77

What are you thinking if a female presents at 16 with lack of a uterus and amenorrhea?

Back 77

Androgen insensitivity syndrome (male pseudohermaphroditism)

Front 78

Fungal cause of pneumonia in a patient who vacationed in new mexico?

Back 78

Coccidiomycosis

Front 79

"Cauliflower" lesions with broad-based budding yeast?

Back 79

Blastomycosis

Front 80

HIV+ pt with yeast in his CSF is most likely?

Back 80

Cryptococcus

Front 81

Thron prick = ulcers along lymphatic drainage is caused by?

Back 81

Sporothrix

Front 82

Parasitic infection from mexico that = bloody diarrhea?

Back 82

Entamoeba histolytic (check from trophozoites/cysts in stool)

Front 83

32 year old man who contracted diarrhea while camping and now has liver damage with jaundice - most likely causative?

Back 83

Entamoeba histolytica

Front 84

What's the cause of the cyclical fever of plasmodium infection?

Back 84

Merozoite release into blood when the RBCs rupture

Front 85

How does increasing the diameter of a vessel by 2 affect the resistance?

Back 85

Decreased by 16

Front 86

What changes in capillary/interstitial pressures can cause edema?

Back 86

Increased capillary pressure or permeability
Decreased plasma proteins
Increased interstitial colloid osmotic pressure

Front 87

What is the equation for net filtration pressure?

Back 87

(Capillary - interstitial fluid pressure) - (Plasma - interstitial colloid osmotic pressure)

Front 88

What's a good replacement drug for a patient on an ACE inhibitor that can't tolerating the coughing? Why doesn't it have the same effects?

Back 88

Losartan - angiotensin II receptor blocker - doesn't inhibit the breakdown mechanism for bradykinins

Front 89

What lipid lower drug is a patient on if they get first dose rash, pruritis, and diarrhea?

Back 89

Niacin

Front 90

How can the flushing reaction of niacin be prevented?

Back 90

Dose with aspirin

Front 91

What is the mechanism of action of the cardiac glycosides (digoxin/digitoxin)?

Back 91

Inhibits Na/K ATPase = decreased extracellular Na = no Na/Ca exchanger activity = increased intracellular calcium = increases contractility and stimulates the vagus nerve depressing the SA and AV nodes

Front 92

What is the most likely underlying cause of an abdominal aortic aneurysm?

Back 92

atherosclerosis

Front 93

What are the 5 deadly causes of chest pain?

Back 93

MI, aortic dissection, unstable angina, pulmonary embolism, tension pneumothorax

Front 94

What are you thinking if a patient with poorly managed htn has acute substernal sharp chest pain that radiates to the back and progresses to death in a few hours?

Back 94

ascending aortic dissection

Front 95

What type of cardiac disease is most suspected in a young athlete that collapses and dies?

Back 95

Hypertrophic cardiomyopathy

Front 96

What murmurs are heard best in the left lateral decubitus position?

Back 96

S3 and S4

mitral stenosis

Front 97

What's the most likely cause of a systolic crescendo-decrescendo murmur following an ejection click in and 80 year old man?

Back 97

aortic stenosis caused by senile calcifications (can lead to syncopal episodes)

Front 98

What's the most likely cause of a stroke in a patient that recently suffered many long bone fractures in a trauma?

Back 98

Fat embolism or DVT via paradoxical embolism

Front 99

What are you thinking if you hear a high pitched holosystolic blowing murmur?

Back 99

Mitral or tricuspid regurg

Front 100

What are you thinking if you hear a holosystolic harsh-sounding murmur loudest at the tricuspid area?

Back 100

VSD

Front 101

What are you thinking if you hear a late systolic crescendo murmur with midsystolic click?

Back 101

mitral prolapse

Front 102

What are you thinking if you hear a high-pitched blowing diastolic murmur with wide pulse pressure and head bobbing?

Back 102

aortic regurg

Front 103

Opening snap with delayed rumbing late diastolic murmur?

Back 103

mitral stenosis

Front 104

What are you thinking if you hear a continuous machine-like murmur loudest at S2?

Back 104

PDA

Front 105

What the most likely cause of chest pain with dyspnea, tachycardia, and tachypnea in an IVDU?

Back 105

Staph aureus endocarditis with pulmonary bacterial embolism

Front 106

What's the most likely cause of chest pain with dyspnea, tachycardia, and tachypnea in a patient after an MVA

Back 106

tension pneumothorax

Front 107

What's the most likely cause of chest pain with dyspnea, tachycardia, and tachypnea in a patient after surgery?

Back 107

Pulmonary embolism

Front 108

What should you use in a patient with bacterial endocarditis due to a congenital valve disease?

Back 108

Vancomycin

Front 109

Under what conditions do you see pulsus paradoxus?

Back 109

cardiac tamponade or increased inspiratory effort (COPD, asthma, croup, etc)

Front 110

What would you see on CXR if a htn pt presents with sudden, sharp tearing pain radiating to the back?

Back 110

Mediastinal widening due to aortic dissection

Front 111

What are you thinking if a 3rd trimester prego has a normal BP when standing and sitting but it's 90/50 when supine?

Back 111

Compression of inferior vena cava

Front 112

What was 45 year old with squamous cell ca of the penis exposed to?

Back 112

HPV

Front 113

20 y/o student with LAD, fever and HSM who's blood agglutinates sheep RBCs - what type of cells are infected?

Back 113

B cells (with EBV)

Front 114

How does rabies virus travel through the CNS so it can cause fatal encephalitis with seizures?

Back 114

Retrograde up the axons

Front 115

What is the characteristic shape of the rabies virus?

Back 115

bullet

Front 116

What will a gram stain show in an adolescent with cough and rust colored sputum?

Back 116

gram positive diplococci

Front 117

What heavily encapsulated organism is responsible for meningitis in AIDs pts?

Back 117

Cryptococcus

Front 118

What is the most likely causative organism if an older patient has blood in his urine and renal stones?

Back 118

Proteus - especially if it's a staghorn caluculi

Front 119

50 y/o has an abdominal surgery 3 days ago, has been catheterized, and now has a fever - what's the cause?

Back 119

UTI

Front 120

Which of the nonepithelial/nonjunctional adhesion mechanism joins only cells of the same type and doesn't attach to the basement membrane?

Back 120

cadherins

Front 121

Where does new bone formation take place in growing long bones?

Back 121

epiphyseal plate

Front 122

A player was kicked in the leg and suffers damage to the medial meniscus - what else is likely to have been damaged?

Back 122

The ACL and MCL

Front 123

What's the diagnosis if a man has swelling in his big toe joint and the bx has needle-like crystals?

Back 123

gout

Front 124

What's the treatment for acute gout?

Back 124

NSAIDs and chochicine

Front 125

What else would you expect to see if a patient with anti-centromere antibodies and has difficulty swallowing and distal cyanosis in cold temperatures?

Back 125

Dry mouth and eyes with SubQ calcinosis (CREST)

Front 126

A patient has photosensitivity, arthritis, renal disease, and recurrent oral ulcers. She's taking primaquine and NSAIDs - what type of check should she be receiving twice a year?

Back 126

Renal disease screen

Front 127

30 y/o with low grade fever, rash across her nose, and wide spread edema - what lab tests would confirm diagnosis?

Back 127

anti-dsDNA and anti-smith

Front 128

What's the dx if you see bilateral hilar lymphadenopathy on CT?

Back 128

sarcoidosis

Front 129

X-ray of a joint in a 75 y/o man with acute knee pain and swelling shows no erosion of the joint space - what are you thinking and what would you see?

Back 129

Pseudogout with positively bifringent rhomboid crystals

Front 130

50 y/o female complains of double vision, amenorrhea, and headaches - what is the most likely diagnosis?

Back 130

pituitary adenoma (prolactinoma)

Front 131

Patient's MRI reveals sella turcica filled with CSF?

Back 131

Empty sella syndrome - usually asymptomatic but can cause deficiencies in pituitary hormones

Front 132

What hormones arise from the anterior pituitary?

Back 132

TSH, GH, prolactin, ACTH, LH, FSH, and MSH

Front 133

Which hormones share a common alpha subunit?

Back 133

TSH, LH, FSH, and betaHCG

Front 134

Young woman has short stature and shortened 4th and 5th metacarpals - what's the most likely endocrine disorder?

Back 134

Albright's hereditary osteodystrophy - kidney doesn't respond to PTH

Front 135

35 y/o female with diffuse goiter and hyperthyroid - what are the expected TSH and TH?

Back 135

Decreased TSH
Increased thyroid hormone

Front 136

48 y/o female suffering from progressive lethargy and extreme sensitivity to cold - diagnosis?

Back 136

hypothyroid - most likely Hashimoto's

Front 137

Adult male with elevated serum cortisol and signs of Cushing's undergoes dexamethasone suppression test - if 1mg doesn't decrease but 8mg does - what's the dx?

Back 137

pituitary adenoma

Front 138

Tan child with pale mother presents to clinic as hypotensive - dx?

Back 138

Addison's

Front 139

28 y/o male comes in with DKA - he's recently been taking cold medicine - what's the cause of his current condition?

Back 139

infection stress

Front 140

How is hemoglobin glycosylated in DM to form HA1c?

Back 140

Non-enzymatically

Front 141

How dose UV damage DNA?

Back 141

thymine dimers on the same DNA strand

Front 142

What are the sourced of carbon in purines? What about pyrimidines?

Back 142

Purine = glycine and THF
Pyrimidine = CO2 and aspartate

Front 143

What aa has more mRNA coding sequences than are represented in peptides from the mRNA?

Back 143

methionine

Front 144

How is hnRNA processed before it leaves the nucleus?

Back 144

Ploy a tail
5' cap (7 methyl guanosine)
Introns spliced

Front 145

What medications can cause cardiotox and bone marrow suppression?

Back 145

Danorubicin
Doxirubicin

Front 146

Patient tries to commit suicide with digoxin OD - how do you tx it?

Back 146

anti-dig Fab
Normalize Mg and K
Lidocaine

Front 147

What are the inducers of P450?

Back 147

BCEG PQRS: barbituates, carbamazepine, chronic ethanol use, griseofulvin, phenytoid, quinidine, rifamipin, and st. johns wort

Front 148

What are the inhibitors of P450?

Back 148

PICK EGS: protease inhibitors, isoniazid, cimetidine, ketoconazole, erythromycin, grapefruit juice, and sulfonamides

Front 149

What enzyme is a black man deficient in if he develops anemia after taking malaria prophylaxis?

Back 149

G6PD

Front 150

Which of the man boob causing drugs is the worst offender?

Back 150

spironolactone

Front 151

What drugs could a patient be on if they develop tinnitus, dizziness, h/a and GI upset?

Back 151

Quinidine (IA antiarrhythmic)
Quinine (antimalarial)

Front 152

Obese woman with amenorrhea and increased testosterone most likely has?

Back 152

polycystic ovarian disease

Front 153

What type of cancer has increased risk in patients with polycystic ovarian disease?

Back 153

endometrial

Front 154

Why is estrogen combo'd with progesterone in HRT?

Back 154

To decrease the risk of endometrial cancer

Front 155

Under what conditions would you expect to see an increase in LH?

Back 155

PCOS, menopause, prior to ovulation, premature ovarian failure, androgen insensitivity disorder

Front 156

What is a prego with hx of c-section at increased risk for?

Back 156

placenta previa and accreta (placenta either covering the os or in the muscle layer)

Front 157

A 16 wk prego has atypically large abdomen and hypertension - what's a possible cause (if she's not prego with multiples)?

Back 157

Complete mole - would see very elevated Hcg

Front 158

What substance is present at high levels in the case of a hyatidiform mole?

Back 158

BetaHCG

Front 159

23 y/o on rifampin and birth control gets prego - why?

Back 159

Rifampin (used in TB prophylaxis) induces P450 = lower levels of hormones

Front 160

What's the best type of birth control for the mentally retarded?

Back 160

IM depo provera (medroxyprogesterone)

Front 161

What does the drug Tamoxifen increase the risk of?

Back 161

Endometrial cancer

Front 162

What cells are responsible for maintaining high testosterone concentrations in the seminiferous tubules?

Back 162

Although Leydig cells make the testosterone, it's kept in high concentration by ABP from sertoli cells

Front 163

What BPH med can case increased testosterone, decreased DHT, gynecomastia and edema?

Back 163

finasteride

Front 164

Where does testicular cancer met to?

Back 164

the para-aortic lymph nodes

Front 165

A patient with a cortical lesion is unaware of this neuro deficit - where's the lesion?

Back 165

Right parietal lobe

Front 166

What are the findings of Brown-Sequard syndrome?

Back 166

Ipsilateral = UMN sx and loss of tactile and proprioception
Contralateral = loss of pain and temperature
At level of the lesion = no sensation and LMN sx

Front 167

40 y/o develops dementia and uncontrollable movements - what is the gross change in his brain?

Back 167

Atrophy of the caudate (huntington's)

Front 168

Male presents with involuntary flailing of one arm - where's the lesion?

Back 168

contralateral subthalamic

Front 169

Pt is exposed to MPTP - what neurotransmitter is depleted?

Back 169

dopamine

Front 170

Patient can't abduct left eye by convergence is normal and she's having difficulty smiling - where's the lesion?

Back 170

CN VI and VII = pontine

Front 171

What bone and vessel was injured if CT shows an intracranial hemorrhage that doesn't cross suture lines?

Back 171

temporal bone fracture - tearing the middle meningeal artery

Front 172

Marfan's pt presents with severe h/x and nl CT but bloody CSF - what's the deal?

Back 172

Ruptured berry aneurysm causing subarachnoid hemorrhage

Front 173

Alzheimer's pt falls and presents 3 days later with n/v and h/a - what the deal?

Back 173

Tearing of bridging veins = subdural hematoma

Front 174

After trauma, pt can't turn head to left and has a right shoulder droop - where's the injury?

Back 174

Accessory nerve on the right (CN XI)

Front 175

What neuro deficits could be seen with infection of the cavernous sinus?

Back 175

EOM deficits
Increased or decreased facial sensation

Front 176

Patient can't blink eye or seal lips - where's the lesion and what's the dx?

Back 176

Facial nerve lesion = Bell's palsy

Front 177

Pt has leftward deviation of the tongue on protrusion and right sided spastic paralysis - where's the lesion?

Back 177

Left medulla at the hypoglossal nucli and corticospinal tract

Front 178

What's most at risk with an anterior should dislocation?

Back 178

axillary nerve
posterior circumflex artery

Front 179

what's most at risk with a mid-shaft humerus fracture?

Back 179

Radial nerve (main extensor)
Deep brachial artery

Front 180

Where's the lesion if a patient presents with bilateral decreased pain and temp sensation over the lateral arm?

Back 180

Anterior white commisure = Syringomylia (seen with Arnold - Chiari)

Front 181

Decreased prick sensation over lateral foot and leg - what nerves injured and what motor deficits would be seen?

Back 181

Common peroneal nerve
Lack of foot eversion and dorsiflexion

Front 182

Patient hits elbow then can't feel medial palm - what's damaged and how?

Back 182

Medial epicondyle fracture = ulnar nerve injury

Front 183

What nerve's most at risk with a fibularneck fracture?

Back 183

deep peroneal

Front 184

What's the dx on a patient that has numbness on their lateral digits and thenar eminence wasting?

Back 184

Carpal tunnel = medial nerve injury

Front 185

Pt has decreased sensation over the back of their leg and lateral half of the foot with weak plantar flexion - what's damaged?

Back 185

Tibia

Front 186

What's damaged if a patient can't adduct their eye but convergence is normal?

Back 186

MLF

Front 187

what eye abnormality is seen with MS and internuclear opthalmoplegia?

Back 187

Inability to adduct eye and nystagmus during abduction but normal convergence (MLF)

Front 188

Where's the defect if a patient has paradoxical bilateral pupillary dilation when a light's shone into the left eye but bilateral constriction when it's shone into the right?

Back 188

Right optic damage prior to the pretectal afferents

Front 189

Dx if a patient has h/a, visual distrubances, and amenorrhea?

Back 189

pituitary adenoma

Front 190

Dizziness and tinnitus with enlarged internal acoustic meatus on CT - dx?

Back 190

acoustic schwannoma

Front 191

Child with proximal muscle weakness and enlarged calves - dx?

Back 191

Duchenne's - xlinked

Front 192

25 y/o with sudden uniocular vision loss and slurred speech with hx of transient weakness and paresthesias: dx?

Back 192

MS

Front 193

10 y/o that "spaces out" during class - dx?

Back 193

absence seizures

Front 194

Patient presents with vertigo, tinnitus, and hearing loss - what's the dx?

Back 194

VIII issue = Meniere's disease

Front 195

A patient has an extended respiratory phase on a PFT, what's the dx?

Back 195

COPD

Front 196

A tall, thin teenager has abrupt onset of dyspnea and left sided chest pain with hyperresonance and decreased breath sounds on the left side - dx?

Back 196

Spontaneous pneumothorax

Front 197

How do you calculate total lung capacity?

Back 197

= Inspiratory reserve + Tidal + expiratory reserve + reserve
= Functional reserve capacity + Inspiratory capacity
= vital capacity + reserve volume

Front 198

Collapse of right middle lobe with right bronchial mass in a patient with history of recurrent pneumonia - dx?

Back 198

Bronchogenic carcinoma

Front 199

What's the immuno reaction behind asthma?

Back 199

mast cell and basophil degranulation due to crosslinking of IgE's = release of leukotrienes C3/4/5 (type I hypersensitivity)

Front 200

What's the dx if a premie has SOB with diffuse ground glass appearance on xray?

Back 200

Neonatal ARDS (should have given mommy steroids - now give artificial surfactant to the baby)

Front 201

What's the likely eitology of fatal lung abcesses in a ventilated patient?

Back 201

Aspiration pneumonia

Front 202

What is seen histologically in a patient recovering from ARDS?

Back 202

proliferation of type II pneumocytes to regenerate the damaged type I's

Front 203

Coal miner is a risk for bronchogenic carcinoma due to exposure to?

Back 203

Radon

Front 204

What protein is defective if a patient has infertility, recurrent UTI, and dextrocardia?

Back 204

Dyneine arm defect (Kartagener's)

Front 205

Causative organism if a sputum from pneumonia in an older male doesn't gram stain but has rods on silver stain?

Back 205

Legionella pneumophilia

Front 206

What happens to the trachea of a smoker?

Back 206

Metaplasia from columnar to squamous cells

Front 207

What are the clinical findings of a pneumothorax?

Back 207

Hyperresonance with decreased lung sounds and no fremitus. In a tension pneumo, the trachea deviates away from the affected side

Front 208

Caseous necrosis = ?

Back 208

TB

Front 209

Most likely diagnosis if a patient with fibroids is chronically tired?

Back 209

Anemia = decreased O2 content but normal saturation

Front 210

Dx in a patient with a normal cxr and no hx of COPD but recent tibial fracture? What can this mimic?

Back 210

Pulmonary embolism - can mimic MI

Front 211

Most likely cause of hypoxia in a patient with an enlarged heart on CXR?

Back 211

heart failure

Front 212

Plumber's lung biopsy shows elongated structures with clubbed ends in tissue? What's this man at increased risk of?

Back 212

Asbestosis
Increased risk of bronchogenic ca and mesothelioma

Front 213

What is cut when cutting through the thyroid cartilage to establish an airway?

Back 213

Crichothryroid ligament

Front 214

What genetic principle do praderwilli and angelman's demonstrate?

Back 214

Imprinting = praderwilli's a paternal deletion, angelman's a maternal deletion

Front 215

Patient on NSAIDs gets an ulcer - what drug would most directly address the mechanism behind their current problem?

Back 215

Misoprostol (PGE1 analog)

Front 216

Newborn with difficulty feeding has gastric airbubble on xray - dx?

Back 216

tracheoesophageal fistula

Front 217

What's the most likely type of esophageal cancer in a patient with GERD?

Back 217

Adenocarcinoma

Front 218

Middle aged man has diarrhea and hematochezia with transmural inflam on intestinal biopsy - dx?

Back 218

Crohn's

Front 219

Weight lifter has emergency surgery to remove section of small bowel with focal hemorrhages - what's the problem?

Back 219

Incarcerated hernia

Front 220

40 year old has to poo 4 times a day for the past several months with low grade pain that's somewhat relieved by defecation has a nl colonoscopy - dx?

Back 220

Irritable bowel syndrome

Front 221

What drug should you give a pt with ataxia, tremors, and a ring at the periphery of his cornea?

Back 221

Penicillamine

Front 222

Pt has yellowing of palms and soles but no scleral icterus - what are you thinking?

Back 222

Excess consumption of carrots

Front 223

Idiopathic hyperbilirubinemia in an otherwise healthy patient with a recent hx of flu - dx?

Back 223

Gilbert's disease

Front 224

Fate of bilirubin after being excreted into the GI tract?

Back 224

80% excreted in stool as urobilinogen
20% reabsorbed - 90% back to liver, 10% excreted by kidney as urobilin

Front 225

Right upper quadrant pain that can be localized with one finger and is tender to light touch - dx?

Back 225

Muscle tear or malingering/ factitious disorder

Front 226

What vitamin deficiency can cause convulsions and irritability?

Back 226

B6 (pyridoxine)

Front 227

What vitamin deficiency = gum bleeding , bruising, anemia, and poor wound healing?

Back 227

C

Front 228

Vitamin C is necessary for the hydroxylation of which amino acids in collagen synthesis?

Back 228

Prolyl
Lysylo

Front 229

Which vitamins in excess can cause hypercalcemia?

Back 229

D and A

Front 230

What vitamins have functions similar to reduced glutatione?

Back 230

A, C, and E

Front 231

What's the vitamin deficient in an alcoholic that develops rash, diarrhea, and altered mental status?

Back 231

B3 (this is pellegra)

Front 232

How does acidosis affect extracellular K concentrations?

Back 232

Increases them

Front 233

What drug should be avoided when txing a fungal infection in a patient taking cyclosporin?

Back 233

ketoconazole

Front 234

What dosage changes need to be made to a patient's digoxin and digitoxin if they go into renal failure?

Back 234

Decrease digoxin
No change in digitoxin (not renally excreted)

Front 235

What affect will an obstructive renal stone have on GFR and FF?

Back 235

Decrease in GFR and in FF (since PFR isn't changed)

Front 236

When do the renal glucose reabsorbtion mechanisms become saturated?

Back 236

350

Front 237

What BMP changes can be expected in a patient treated for status asmaticus

Back 237

Decreased pH and HCO3 due to the hypoxia. Beta blocker given = decreased K

Front 238

What are the causes of anion gap acidosis?

Back 238

MUD PILES = methanol, uremia, DKA, paraldehyde/phenformin, INH/iron, lactic acidosis (shock), ethylene glycol, or salicylate poisoning

Front 239

What drug can you switch a patient to if they get coughing after taking lisinopril?

Back 239

ARBs like losartan or valsartan

Front 240

What diuretic can be used if a patient with an exacerbation of CHF has a sulfa allergy?

Back 240

Ethacrymic acid

Front 241

What's the dx if a patient presents with HTN, hypokalemia, metabolic alkalosis and low plasma renin? Tx?

Back 241

Primary hyperaldosteronemia
Give aldosterone antagonist like spironolactone

Front 242

What are you thinking if you see a glomerulus with multiple mesangial lesions?

Back 242

diabetic GN

Front 243

Dx if a teenager presents with nephrotic syndrome + hearing loss?

Back 243

Alport's (abnl type IV collagen)

Front 244

4 y/o with facial edema and proteinuria - dx? tx?

Back 244

Nephrotic syndrome/minimal change disease - tx with steroids

Front 245

What's a patient at increased risk of if they have a UTI caused by proteus vulgaris?

Back 245

Stuvite stones causing a staghorn calculi

Front 246

What's a patient with hx of long term acetominophen use at risk for?

Back 246

renal papillary necrosis
transitional cell cancer

Front 247

What artery prevents the ascent of a horseshoe kidney?

Back 247

Inferior mesenteric

Front 248

What CMP changes will be seen in a patient with renal failure?

Back 248

Increased: BUN, Creatinine, Na, and K
Decreased: pH and Ca
Other labs = anemia and increased TGs

Front 249

What's the dx is U/S shows massively enlarged kidneys bilateral?

Back 249

APCKD

Front 250

What's the primary energy source in a patient that hasn't eaten in 2 days?

Back 250

Ketones

Front 251

What's the gibb's free energy equation?

Back 251

DeltaG = DeltaH - T(DeltaS)

Front 252

What's the most to least exergonic out of AMP, ATP, and PEP?

Back 252

PEP then ATP then AMP

Front 253

Why does someone who drinks a lot without eating become hypoglycemic?

Back 253

Increased liver NADH causes OAA to be shunted to malate and Pyruvate to lactate (away from gluconeogenesis/energy production)

Front 254

Dx if a patient develops intense muscle cramps and dark urine after exercising?

Back 254

McArdel's (myophosphatase defect/deficiency)

Front 255

What allows RBCs to change shape as they pass through vessels?

Back 255

spectrin

Front 256

What's the dx if a patient that's had hemolytic anemia since birth is cured by a splenectomy?

Back 256

Hereditary spherocytosis (ankrin or spectrin defect = increased MCHC)

Front 257

Why wouldn't you just give folate to a patient wiht a megaloblastic anemia?

Back 257

They could have a B12 deficiency which can result in permanent neuro damage

Front 258

What's the dx if a patient with anemia, hypercalcemia and bone pain has large round cells with off center nuclei on bone marrow bx? What could a UA show?

Back 258

MM
UA will be normal but Urine elctrophoresis may show the presence of bence-jones proteins

Front 259

What neoplasms are associated with AIDs?

Back 259

B cell lymphoma (CNS lymphoma), kaposi's sarcoma and invasive cervical carcinoma

Front 260

Which chemotherapeutic agents should be avoided in a patient with CHF?

Back 260

Doxyrubicin
Danorubicin (both are cardiotoxic)

Front 261

Chromosomal analysis of leukemia pt = t(9:22). What is the treatment?

Back 261

Imantinib (binds bcr-abl to tx CML)

Front 262

After a normal delivery a new mom bleeds profusely from her vagina and gums: What abnormal lab values would you suspect?

Back 262

DIC - Increased BT, PT, PTT and D-dimer with a decrease in platelets, clotting factors and fibrin.

Front 263

Pt = chronic non-healing ulcer on his foot and imaging shows a small calcified spleen: what drug can improve his symptoms?

Back 263

Pt has sickle cell so tx with hydroxyurea to increase HbF levels

Front 264

NSAIDS inhibit the production of which substance important in platelet aggregation?

Back 264

Thromboxane

Front 265

Does HbF have more or less affinity for 2,3-bisphosphosphoglycerate?

Back 265

Less = greater O2 affinity

Front 266

What's the defect in familial hypercholesterolemia?

Back 266

absent or decreased LDL receptors

Front 267

What dietary changes should a PKU patient make?

Back 267

No phenylalanine, increased tyrosine.
Pt with malignant form needs to replace THB in body

Front 268

Dx if 2 y/o has increased abdominal girth with failure to thrive and skin/hair depigmentation?

Back 268

Kwashorkov

Front 269

Dx if a man has dark spots on his sclera and his urine turns black on standing?

Back 269

Alkapturia = homogenistic acid oxidase deficiency

Front 270

Dx if a patient must restrict protein so they don't get mental retardation, ketoacidosis and death?

Back 270

maple syrup urine disease

Front 271

18 y/o has moderate generalized abdominal pain and paresthesias in her lower extremities with normal WBCs and no fever - dx?

Back 271

Acute intermittent porphyria = defective porphobilinogen deaminase = increase in porphobilinogen and ALA

Front 272

What's the treatment for homocysteinuria?

Back 272

Depends on the type but decreased methionine with increased cysteine, B12, B6 and folate should cover all bases.

Front 273

What's the dx if an alcoholic gets blistering lesions in sun exposed areas and hypertrichosis of the face?

Back 273

Porphyria cutanea tarda (defective uroporphyrinogen decarboxylase = uroporphyrin in urine = tea colored)

Front 274

Artery closest to the mid-shaft of the femur?

Back 274

Deep femoral

Front 275

Artery running behind the knee?

Back 275

Femoral to popliteal

Front 276

Artery closest to the mid-shaft tibia?

Back 276

More proximal = anterior tibial
More distal = posterior tibial

Front 277

Sensory to dorsum of foot and anterolateral leg?

Back 277

Common peroneal (injured with lateral leg trauma or fibular neck fracture). Does foot eversion, dorsiflexion, and toe extension

Front 278

Sensory to the sole of the foot?

Back 278

Tibial nerve (injured with knee trauma). Does foot inversion, plantarflexion and toe flexion

Front 279

Nerve injured if you have a positive Trendelenburg?

Back 279

Superior gluteal - injured with posterior hip dislocation or polio. Does Thigh abduction

Front 280

Venous drainage of thigh?

Back 280

Femoral, deep femoral and greater saphenous combine to form external iliac to IVC

Front 281

Dermatomes around the bum?

Back 281

S3-5

Front 282

Dematomes around back of legs and thigh?

Back 282

S1 and 2 (S2 also does genitals!)

Front 283

Dermatomes at front of leg?

Back 283

L3 and L2 = thigh
L4 at knee
L5 at ankle

Front 284

CYP system that breaks down statins?

Back 284

CYP3a4 (inhib by grapefruit juice!)

Front 285

Main mutation involved with Hirschprung's disease?

Back 285

RET on chromosome 10

Front 286

Virus present in 80% of normal urinary tracts that can cause hemorrhagic cystitis with immunosuppression?

Back 286

BK virus (polyomavirus = naked DS circular DNA)