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538 Cards in this Set
- Front
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what is the triad of Wernicke's encephalopathy?
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confusion, opthalmoplegia, ataxia
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Triad for Korsakoff?
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personality change, confabulation and memory loss
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how does a GBM (glioblastoma multiforme) present on CT?
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serpentine (snake like) border and central areas of necrosis - pseudopalisading (a line of clifs)
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histologic findings of Parkinsons
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cytoplasmic inclusion's consisting of aggregated a - synuclein, ubiquitin, and neurofilament proteins. -- aka Lewy bodies
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what type of renal anomalies are present w/ Turner's?
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horshoe kidney, pelvic kidney or duplicated collecting system. Pt's w/ horseshoe kidney are 4x more likely to develop Wilm's tumor
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how does transitional cell carcinoma of the lbadder present?
risk factor? |
painless hematuria
cigarette smoking PeeSAC - phenacitine, Smoking, Analine dye (beta napthaline), Cyclophosphamide |
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how does ALL present?
similar presentation but w/ macrophages engulfing RBC's? |
younger child w/ fever, weightloss pallor, hepatosplenomegaly
HLH - hemophagocytic lymphohistiocytosis |
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what is a complication of septic shock that can effect the kidneys causing decreased urine output and possibly death?
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cortical necrosis - you could tell by the necrosis being confined to the cortex
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how would cervical cancer present histologically?
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increased nuclear to cytoplasm ratio, open chromatin, and mitotic figures (actively dividing cells)
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the virus that can cause cervical cancer is what type of virus (type and describe?)
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dble stranded DNA
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HNPCC (lynch syndrome) is a rare AD that is associated w/ which types of cancers?
name others in this category |
Colorectal (80% progress to CRC), endometrial, ovarian, ruinary tract, small intestine, stomach and biliary cancer.
genetically are at risk for CRC = FAP, Gardner's syndrome, Turco'ts syndrome, HNPCC/lynch |
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ADPKD is a mutation on which chromosome?
pp? |
16: - 16 Letters in Polycystic kidney" -90% of cases
ALWAYS BILATERAL, hematuria, hypertension, progressive renal failure. |
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How does a child w/ Angleman's syndrome present?
what type of genetic issue does this display? |
microcephaly, maxillary hypoplasia, deep set eyes, large mouth, protruding tongue and inappropriate laughter, seizures, "happy puppet"
imprinting |
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DMD is a mutation in which protein?
PP? |
dystrophin
calf pseudohypertrouphy - elevated creatine kinase level, gowers sign |
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which cancer is associated w/ EBV
which type of virus |
nasophyrangeal carcinoma
DNA in herpes virus family |
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most common environmental exposure for bladder cancer
which type of cancer?? |
cigarrette smoking
Transistional cell SSC |
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most common cause of bladder cancer in the world?
Caused by? |
SSC (rare in US, transistional more common in us)
Schistosoma haematobium (don't let them swim up your peeter) |
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what are the owl's eyes called that is associated w/ CMV?
How does CMV present in Aids, what CD 4 count? what is CD4 count less than 50 prone to? less than 200? |
cowdry A bodies (also seen w/ HSV, VZV)
retinitis, pneumonitis, < 100 cd4 count mycobacterium avium pneumocystis jiroveci |
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hemochromatosis PP?
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AR disease, CHF, Diabetes Mellitus, brown pigmentation of skin (assoc w/ pseudogout)
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what is a feared complication of HPV types 6 and 11
which tumor suppressor gene is affected? |
condylomata acuminata (the 6,11) can cause anorectal cancer
p53 |
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how does meduloblastoma present?
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generally in children, exclusively in the cerebellum, -- to know which location of cerebellum, remember (L to M) --> dentate, emboliform, globus, fastigial
Medial is balance and ataxia Lateral is voluntary movement |
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shipyard worker indanger of which cancer?
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mesothelioma is the cancer .... asbestosis is the material that can cause it
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what is a complication that can happen 4-10 days after initial MI?
how will PP? |
ventricular free wall rupture
signs of cardiac tamponade (hypotenstion, distant heart sounds and elevated JVP) and signs of shock |
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which class of drugs can cause fat redistribution and GI intolerance in a pt taking anti-retroviral therapy?
What is the memory device? Name them |
protease inhibitors can cause those symptoms
Navir (never) TEASE a proTEASE Saquinavir, ritonavir, indinavir, nefinavir, amprenavir |
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which drug for hyperthyroidism?
what is a thyroid storm? |
propylthioruacil (can cause agranulocytosis), methimazole
a medical emergency where you get thyrotoxicosis (basically fever, palpitations etc..) |
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first line treatment for GAD?
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I thought busperione/venloflaxin but actually it is a benzodiazapine (such as diazepam) first since you can't have a disorder unless it persists for >6months
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what impact would taking BB have on the following:
1) contractility, blood presure, and heart rate 2) EDV and systolic ejection |
1) decrease (basically asking what A2 would cause)
2) increase EDV b/c more time for diastolic filling and increasing ejection time (slower hr) Beta blockers, also known as beta-adrenergic blocking agents, are drugs that block norepinephrine and epinephrine (adrenaline) from binding to beta receptors on nerves. There are three types of beta receptors and they control several functions based on their location in the body. Beta-1 (β1) receptors are located in the heart, eye, and kidneys; beta (β2) receptors are found in the lungs, gastrointestinal tract, liver, uterus, blood vessels, and skeletal muscle; and beta (β3) receptors are located in fat cells. Beta blockers primarily block β1 and β2 receptors. By blocking the effect of norepinephrine and epinephrine, beta blockers reduce heart rate; reduce blood pressure by dilating blood vessels; and may constrict air passages by stimulating the muscles that surround the air passages to contract. |
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what is a complication of diabetics that involves the esophagus?
What drug would u use to treat this? What type of drug is it? what does the drug do? |
gastroparesis (also can happen post surgery)
metoclopramide, D2 antagonist or an anti-emetic increases LES tone and motility |
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how does nitroglycerine withdrawl present?
what complication can arise? |
since it is a vasodilator, possibly vasoconstriction symptoms...they call it Monday Disease for people who are exposed to nitroglycerin during week and then get reexposed on Monday
cardiac failure |
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a question hints at diabetic patient w/o saying their diabetic...how might they do this?
what drug is best used to delay the progression of this type of disease? |
by saying kidney disease or renal failure and describing retinopathy like trouble seeing
Ace inhibitors have been shown to delay the time of end-stage renal disease by 50% in type 1 and helps w/ type 2 as well. |
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which chromosome is defective w/ CF?
which type of channel is effected? |
7
chloride channel |
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what is an adverse effect of NSAID use?
what is the mechanism behind why it would cause this |
Renal failure
the kidneys release prostaglandins at both afferent and efferent arterioles an act as vasodilators when the kidneys need to keep the perfusion constant... COX inhibitors can block the prostaglandins that are regulating this process and so the kidneys are unable to stay perfused |
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what class of drug would you take for BPH?
name one |
one that inhibits 5a reductase (a1 blocker)
finasteride - that enzme is what converts test to dihydrotestosterone ------Tamsulosin a1-antagonist |
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what is the cause of Graves disease?
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thyroid stimulating IgG antibodies bind to the TSH receptor and lead to thyroid hormone production
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really tricky question decribing a horrible wound when after treated caused diarrhea in pt, I get that it is an antibiotic that caused pseudomembraneous colitis but they wanted to know which antibiotic
how could you treat Pcollitis? |
the answer was clindamycin since it causes PColiits
vanco |
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which lipid lowering agent is known to decrease triglycerides the most?
What is the MOA? |
fibrates (gemfibrozol)
basically increasing lipoprotein lipase --increasing the expression PPAR-a prtoein results in increases expression of liprotein lipase on endotehlial cells and thus increased clearance of triglyceride-rich lipoproteins. (the agents are called fibrates) - reduece by 35%-50% peroxisome proflerator-activated receptor |
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pt presenting w/ signs of CHF, which drug combo would be deadly
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digoxin and a thiazide diuretic
digoxin works by inhibiting the Na/K pump which then shuts off the na/ca exchanger leaving more Ca in the cell so you get positive inotropy. digoxin is given to increase cardiac output in CHF but the thiazide can cause hypokalemia and is permissive for digoxin binding at K+ binding site on Na+/K+ ATPase |
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chronic afib can cause what complication
what drug would you use to treat how does it work? |
clot formation and embolization
warfarin used for chronic anti-coagulation inhibits vitamin K dependent clotting factors |
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what is the formula for Clearance of a drug?
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rate of drug elimination/Plasma concentration
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which drug can cause bodily fluids orange?
what is it used to treat? what are 2 known special notes Others in this category |
rifampin
tuberculosis induces the cytochorme P450 system so it eliminates durgs like OC's, warfarin and ktoconazole Inducers: Queen Barb Steals Phen-Phen and Refuses Greasy Carbs Chronically (Quinidine, Barbituates, St. John's Wort, Phenytoin, Rifampin, Griseofulvin, Carbamezepine, Chronic Alcohol Use |
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how is the loading dose impact w/ a pt w/ liver or kidney disease, NS why?
the maintenance dose |
it is the same since the loading dose has more to do w/ volume of distribution, since excretion and metabolism have not yet occurred
would be lower if it is a drug that gets excreted in teh urine |
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which lipophilic drug can cross the BBB and is used to treat brain tumors?
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Nitrosoureas- carmustine,
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a pp w/ a seizure after ODing on aspirin, what is treatment?
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administer a bicarb to alkalinize the urine.
I messed this one up b/c I picked N-acetylcysteine which is used to treat acetaminophen toxicity |
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how would you treat ankylosing spondylitis what type of drug?
what test should be done b4 giving? |
w// infliximab (an antitumor necrosis factor a monoclonal antibody)
a PPD test - b/c it is immunosuppressive and can cause a flare up of dormant TB |
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counteract iron poisoining?
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deferoxamine - chelates iron
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how would someone present if they had low erythropoietin?
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microcytic anemia w/ iron sequestration in bone marrow, a hemoglobin under 11 g/dL (usually a sign of renal failure)
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how does a non-competitive inhibitor shift the curve?
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shifts down (or irreversible antagonist), same potency
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name some class IA antiarrhythmics
how does it work on the action potential? |
procainamide - easy to answer since non of the others were class IA drugs (the queen proclaims disos pyramide)
will increase both the action potential and the effective refractory period? |
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which drug used to treat Crohns disease should not be mixed w/ a drug used to treat gout, what is the outcome?
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Azathioprine -an antimetabolite precursor of 6-mercaptopurine, this metabolite is is metabolized by xanthine oxidase.
Allpurinol is a xanthine oxidase inhibitor so should not be taken w/ this. |
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acute transplant rejections are mediated by what cell? (time frame?)
chronic transplat rejections? timeframe? which serum sign would be elevated in acute rejection? |
Cytotoxic T lymphocytes (weeks or months after)
antibody complex formation and T cell (months to years) creatinine levels |
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which condition would cause recurrent bacterial, fungal and viral infections?
what is the cause? pg 212 |
SCID - Severe combined immunodeficiency
a defect in early stem cell differentiation that can have many causes and leads to a total lack of a cellular immune response. Defect in IL-2 is most common --Also Adenosine Deaminase deficiency. |
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which ctyokine is responsible for dampening the immune response after it is no longer needed, aka: anti inflammatory?
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TGF-b
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what is the function of the MAC complex?
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the C9 polymer of the MAC complex forms pores in the membrane allowing the passage of ions and small molecules into the cell, causing the cell to lyse
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Name the test to determine the RH test?
how would you know the test is positive? what would this mean? |
indirect Coomb's test
the RBC's would agglutinate the mother is RH- and has been previously pregnant w/ an RH + fetus |
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which anti-body can cross the placenta?
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IgG - protect fetus for first few months
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why is the vaccination against H.IB and N.mening contain a protein carrier when they are both composed of a polysaccharide coat?
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to help recruit T lymphocytes, this allows the B lymphocytes to recognize the polysaccharide to be actived by a T-helper cell that recognizes epitopes present within the protein carrier
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what type of rejection would happen when a Type B+ recipient is given a Type A- kidney?
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a hyperacute rejection (within minutes to hours) mediated by preformed recipient antidonor antibodies in teh recipient.
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how does Chediak-Higashi present?
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albino w/ recurrent pyogenic strep and staph infections due to deficiency in lysosomal emptying of phagocytic cells
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how would a B12 deficiency present?
which lab values would be elevated int eh serum? what is another name for Vitamin B12? what biochemical pathway is it involved in? |
megoblastic anemia - failure to absorb vitamin B from autoimmune against IF
homocysteine and methyl malonic acid to be converted into methionine and THF fatigue, pallor, mild to moterat jaundice, glossitis and neuropathies Cobalamin - Cofactor for homocysteine methyltransferase |
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which cellular location would a selfpeptide by loaded onto an MHC class I molecule?
name the steps? |
in the RER
self and virally derived proteins are targeted for degradation by the proteasome. After degradation, peptides enter the RER by TAP proteins. they then bind to teh MHC lass I molecule which transports to the surface where it can interact w/ a T-lympocyte and CD8 co-receptor |
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boy w/ recurrent staph infections and pruritic papluovesicular dermatitis, which syndrome?
what is the defect? memory device? |
Job's syndrome aka Hyper IgE (recurrent staph, eczema and high levels of IgE)
failure of helper T lymphocytes to produce IFN-gamma, so failure of neturophils to respond to chemotactic stimuli. FATED: coarse Facies, staph Abscesses, retained primary Teeth, increased IgE, Dermatologic problems (eczema) |
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how does Hyper IgM usually present?
what is the defect? |
severe pyogenic infections
defect in the CD40L on the CD4 t helper cell so in anability to class switch btwen differnt isotypes |
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what diseases are associated w/ the identification of anti-myeloperoxidase? aka?
anti-proteinase-3 antibodies? |
microscopic polyangitis - this stains in a perinuclear pattern and is therfore commonly called P-ANCA
Wegener's granlumatosis - stains in a cytoplasmic distribution and is commonly called C-ANCA ANCA - anti0neutrophil cytoplasmic antibody |
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organ transplant from an identical twin is called?
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syngeneic graft (a type of allogenic graft)
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how does JRA present vs RA
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JRA begins b4 16 and involves more systemic onset like fevers and also have more large joint involvement and will present w/ antinuclear antibody seropositivity but less likely to have rhematoid factor
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which interleukin is responsible for stimulating teh growth of helper and cytotoxic T lympocytes?
what would a deficiency cause? |
IL-2
increased viral infections (Hot T-Bone stEAk IL -1 fever IL-2 stiumulates T cell IL-3 stimulates Bone marrow IL-4 stimulates IgE productin IL-5 stimulates IgA production |
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which CD marker is present in all lymphocytes of thymic origin (T-cells, and NK cells)
What if t-cell only |
CD 2
CD3 |
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how does a pp w/ celiac sprue?
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sensitive to gluten - foul-selling diarrhea and weakness
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how would a pt w/ Brutons' agammalobulinemia present?
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**no IgA - AR disease
recurrent bacterial infections |
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IgG antibodies in a linear fashion?
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Goodpasture's
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what type of immune reaction is Erythroblastosis fetalis
Test used? |
Type II - Cy-2-toxic. Antibody and complement attack a cell.
Direct and indirect |
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How does Wiskott-Aldrich present?
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Triad (TIE)
Throbocytopenic purpura, Infections, Eczema "Aldrich"...increased igA (and E) and low iGM |
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What is the cause of MS?
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demyelinating CNS lesions - oligodendrocyte problem of demyelination of axons
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SLE is what type of immune response
Why do women get effected more than men? |
type III - immune complex (3 types of type III reactions
b/c estrogen has an inhibitory role on the process of clearing immune complexes |
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contact dermatitis is which type of immune reaction?
memory device |
4th - Delayed
4T's: T lymphocytes, Transplant rejections, TB skin tests, Touching (contact dermatits) |
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which bond holds heavy and light chains together in an antibody?
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disulfide bonds
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what is the defect in Ataxia-telangiectasia?
what is the defect? Presentation? |
DNA repair enzymes
Triad: cerebellar defects (ataxia), spider angiomas (telangiectasia), IgA defieiency |
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which type of anti-bodies are seen in Wegeners
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C-ANCA - one of the types of microscopic polyangitis
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*R*
what is a type II error? How would you calculate the probabiity of the difference between 2 disease treatments? |
one in which the P value is >.05 - which means we cannot reject the null hypothesis and therefore there is a possibility for a type II error
Power = 1- beta (B) which is statistical power in percentage. *Only can calculate this in a type II error. |
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what drug can be taken for narcolepsy or excessive daytime sleepiness?
Define Hypagogic, hypopompic, and Cataplexy. |
Modafinil - a psychostimulant
also: Sodium Oxybate (GHB) or Amphetamines hypnagogic and hypnopompic. 3 conditions associated w/ narcolepsy. Frightening Hallucinations associated w/ sleep paralysis. Gogic = going to sleep. Pompic = at the end of sleep. Bilateral weakness associated w/ strong emotions like fear or laughter. |
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What is negative transferance
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when a pt projects feelings from his or her personal life onto a doctor - (countertransferance is the opposite, Dr. on pt)
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major difference in dythymia vs major depression
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major depression has a greater number of symptoms and is episodic... be careful, I choose at least 2 years by that would by dysthymia if it is chronic
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what will a pt present if od on phencyclidine?
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PCP - tachy, fever, hyperacusis, horizontal nystagums
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**MR**
what is prevalence? what would a formula be? |
number if individuals w/ a disease ina g given pop @ a given time
# of true postives plus false negatives / total # of pt's TP + FN / TP+ FP + TN + FN |
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Good Samaritan law
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use standard procedures - basically always let most qualified perform task.
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Which intelligence test should be used for children?
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Kids WISC cookie crumbs off the table.
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What is the name of the equation you would use to determine if a pt's + test result is to have the disease?
what is the equation? |
postivie predicitve value (PPV)
TP/(TP + FP) |
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what is a cohort study?
Name the types. Compare and Contrast the 3 types of psych./behavorial studies. |
asks what will happen, so forward in time.
Retrospective and Prospective Case Control: looks at the people w/ the disease and ask what happened (backwards). What happened? Odds. Looks at the disease. Cohort: looks at the risk factor/action. Cross-Sectional: What's happening right now. Prevalence. |
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which tanner stage do women grow the most vertically, what else happens?
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3 - pubic hair darkens and becomes curly; penis size/length increases
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What is a confounding error?
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an error when a variable other than the one being studied is influencing the results
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explain the ego of "splitting"
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seeing people as all good or all bad.... like if they like doctors but hate nurses
Seen w/ borderline personality disorder |
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what is the equation for specificity?
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TN/(TN+FP) also = 1- false-negative rate
specificity rules in (SPIN) -- this test is a confirmatory test pg 53 |
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Describe "relative risk" for cohort studies
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describes the probability of getting the disease (or incidence) vs somone not exposed
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Name the 3 types of Cluster A personality disorders
briefly describe each |
Weird (wild, worried are B and C respectively)
1. Paranoid - generally uses projection as a defense mechanism (aloof, awkward) 2. Schizoid - SchizoiD = Distant 3. Schizotypical - SchizoTypal = majical Thinking |
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what is the rate-determining enzyme in glycolysis?
which enzyme in the Kreb cycle inhibits this? |
PFK-1
citrate synthase |
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what is the site of pathology in someone w/ nephrogenic diabetes insipidus?
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V2 receptor
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Too much calcium in the cell can lead to which damaging effect?
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enzyme activation of ATPases, which decrease ATP supply; phospholipases, which decrease membrane stability; endonucleases, which induce DNA damage; and several proteases
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what are porphyrias?
How does a pt w/ acute intermittent poprphyria present? what enzyme is deficient? |
conditions of defective heme synthesis that lead to the accumulation of heme precursors.
5 P's: Painful abdomen Pink urine Polyneuropathy Pshycological distrubance Precipitated by drugs like barbituates porphobilinogen deaminase (aka uroporphyrinogen I-synthase) |
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how does B thalessemia major present?
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pt has severe hemolysis and inefective erythropoesis. Pt develops 2ndary hemochromatosis b/c of frequent blood transfusions
Be careful! I keep choosing hemochromatosis for this answer when I am missing the hemolysis hint to differientiate it w/ hemochromatosis |
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which defective biochemical pathway could cause a pt to present w/ cataracts when they have chronic diabetes
which enzyme would be deficient in this pathway? |
the sorbitol pathway in which glucose is converted to sorbitol. A deficency in
aldose reductase or sorbitol dehydrogenase could cause sorbitol accumulation leading to the previous outcome. |
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which type of cell uses SGLUT for transporting glucose?
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nephrons and enterocytes
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which lab technique is used to identify a defective gene?
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PCR - NOT western blot which is presense or absense of a particular protein
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which HLA type is associated w/ hashimotos thyroiditis?
what are other associated diseases w/ this subtype? another name for hashimotos? |
HLA DR5 (p200)
pernicious anemia, B12 deficiency myxedema |
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what is vancomycin generally used to treat?
which molecular change is responsible for resistance to vanco? |
only gram positive cocci
D-ala D-ala to D-ala D-lac |
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how does sinusitis present?
what is the most common urea cycle disorder? what are the symptoms of ammonia intoxication? |
facial tenderness and green foul-smelling nasal discharge
ornithine transcarbamolyase deficiency (OTC) tremor, slurring of speech, somnolence, vomiting, cerebral edema, blurring of vision |
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how does OTC deficiency present?
how does this differ from orotic aciduria? what type of disease is this? What's the problem w/ OTC deficiency? |
usually in first few days of life w/ hyperammoneum symptoms and increased orotic acid
no hyperammonemia w/ the orotic aciduria it's a defect in de novo pyrimidine synthesis pathway - can't convert orotic acid to UMP OTC, can't make citrulline. pg 68 |
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how can you tell which type of jaundice based of the bilirubin levels?
what enzyme is usually increased in obstuctive? |
Normally, liver cells convert uncon (indirect) bilirubin into conjugated (direct) bilirubin. Direct bilirubin is water soluable and can be excreted into urine and by the liver into bile to be converted by gut bacteria to urobilinogen (some of which is reabsorbed). Some urobilinogen is also formed directly from heme metabolism
1) increased conjugated (direct) in obstructive 2) incrased unconjugated (indirect) in hemolytic 3) increased both in hepatocellular alkaline phosphatase pg 326 |
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Name the function of the 2 Histamine receptors
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H1 - sesonal allergies
H2- increase gastric secretion |
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what is the enzyme deficiency in Pompe's disease?
what accumulates? |
a1,4-glucosidase/acid maltase
glycogen to a toxic level |
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why does glucokinase (turns glucose to G6P in liver and pancreatic B cells) continue to make G6P rather than stop after the carb meal is done?
what is the function of glucokinase? |
because glucokinase has a lower affinity for glucose than G6P that will help to handle large increases in glucose from the gut....it's a GLUTTON.... it phosphorylates excess glucose after a meal to sequester it in the liver.
phosphorylation of glucose to g6p as the 1st step of glycolysis (and first step of glycogen synthesis in the liver) -- reaction is catalyzed by either hexokinase or glucokinase depending on the location |
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there are 3 types of familial dyslipidemias, type 1 has which defiency?
name the 3 familial dyslipidemias |
lipoprotein lipase deficiency
type I - hyperchylomicronemia type IIa - familial hypercholesterolemia type IV - hypertriglyceridemia pg 115 |
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name a mediator involved in causing DVT's, why?
what is Homan's sign |
thromboxane A2 - b/c it stimulates platelet aggregation and vasoconstriction and will be elevated at the site of the clot
dorsiflexion of foot gives you tender calf muscle |
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APKD is associated w/ which other anomality?
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berry aneurysms
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which subunit in the 50s is responsible for making the peptide bond for bacteria
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the 23s
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which 2ndary messenger controls hypothalmic hormones?
Name all in this category of 2ndary messengers. |
IP3 w/ phospholipase C later down the road
GGOAT GnRH GHRH Oxytocin ADH (V1) TRH |
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what are the 2 forms of hemoglobin and what are their affinities for O2??
which substances favor the T form of hemoglobin over the R form? |
R form (300x higher affinity) and T form (low affinity - Taut form)
CO2, and 2,3 BPG and temperature (shifts curve to right leanding to increased O2 unloading) - CADET R form has a higher affinity or better carrying capacity for O2 - When your "relaxed", you do your job better (carry O2) |
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which type of receptors are used for steriods?
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hormone-receptor complex
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what are the 2 signs seen w/ hypocalcemia?
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Chvostek's sign (tapping of the facial nerve causes contraction of the facial muscles
Trousseaus sign - occlusion of the brachial artery in the upper arm causes a carpal spasm |
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a deficiency in gamma-aminolevullinic acid dehydratase would cause an accumulation of what?
which disease would be associated? |
gamma-aminolevulinic acid
lead poisoning |
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name an anti-cancer drug that works by preventing microtubule depolymerization
What cell cycle phase would this inhibit? what is it commonly used to treat? name other drugs that have the same MOA |
paclitaxel (it's taxing to stay polymerized)
***metaphase anti-breast cancer Vincristine/vinblastine (anti-cancer) --pg 362 |
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phenylalanie get converted into which amino?
how would pku present? |
tyrosine
musty odor |
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which deficiency in megoblastic anemia can cause neuologic defieciencies?
which type of anemia is megoblastic? what are the others in this category? |
b12
a macrocytic anemia (MCV>100) megoblastic caused by folate, b12 and non megaloblastic macrocytic anemia |
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which protein is microtubules made of?
|
tubulin...duh!
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how does I-cell disease present?
what is defecient? what accumulates |
skeletal abnormalities, restricted joint movemnt, death by 8 years
M6P all types of enzymes like hexosaminidase, idruonate sulfatase and arylsulfatase A |
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most common cause of congenital albinism is due to a def in which enzyme?
|
tyrosinase - melanin is a deriv. of tyrosine
pg 108 |
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what are the lab values for obstructive jaundice?
what are the normal values for total bilirubin and direct bilirubin? what are other names for direct/indirect bilirubin? |
increased conjugated, increased urine bilirubin and decreased urobilinogen** (Hepatocellular is normal urine urobilinogen and Obstructive is decreased, and Hemolytic is increased).
total = .1-1, direct .0-.3 unconjugated (indirect), conjugated (direct) |
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which enzyme when activated (** actually an answer on another question: phyosphorylates myosine) and then allows it to bind to actin
what does this cause? what activates this? which type of muscle has this process? |
myosin light-chain kinase (pg 374)
leads to contraction and shortening of the mucsle fiber the binding of calcium to calmodulin or the ca/calodulin complex smooth muscle contraction |
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name the triad for acute pancreatitis
what is the problem w/ enzymes? |
nausea, pain raiting to back and vomitting
inappropriate activation of amylase and lipase |
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which metabolic cycle is disrupted in PKU?
how do you treat? |
THF tetrahydrobiopterin
diet low in phenylalanine |
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One cause for SCID is a deficiency in which enzyme?
what type of disease? |
adenosine deaminase - presents w/ all types of infections
purine salvage defienciency (lesch-nyhan is the other) pg 69 |
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steriod hormones regulate what?
|
the rate of transcription
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name a heriditary thrombosis disease that would cause increased hypercoagulability (thus dvt's)
what is this degraded by? |
factor V leiden (pg 350)
factor V is degraded by protein C (normally) and is the most common cause of inherited hypercoagulability when protein c cannot degrade this mutant form of Factor V |
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name the 2 enzymes that would cause a fructose def.
Name the issue w/ malignant? name the 2 disorders of fructose metabolism |
fructokinase - benign
aldolase B - need to decrease fructose and sucrose pg 103 Sequestion of phosphate, there's an overabundanc of G1P enzyme, so G1P won't go to G3-P and DHAP, so ATP production is prevented. fructose intolerance (def of aldolase B) and essential fructosuria (defect in fructokinase) |
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what if OD'd could cause pt to become cynosed?
what counterdrug? What is this class of drugs usually used to treat? what is methemoglobinemia? |
they could have an adverse effect w/ sulfonamides causing methemoglobinemia
methylene blue bacteria Methemoglobin is an oxidized form of hemoglobin that has a decreased affinity for oxygen, resulting in an increased affinity of oxygen to other heme sites and overall reduced ability to release oxygen to tissues. The oxygen–hemoglobin dissociation curve is therefore shifted to the left. When methemoglobin concentration is elevated in red blood cells, tissue hypoxia can occur. |
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which type of pneumocyte is responsible for secreting surfactant?
|
type II - dipalmitoyl phophatidylcholine
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which cells have short G1 phases?
|
bone marrow, gut epitelium, skin, and hair - basically asking which cells divide rapidly
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southern blot vs PCR vs gel electrophoresis
|
both use DNA but PCR produces many copies whereas s blot they use gel electrophoresis and a DNA probe
gel electrophoresis - uses an electric field to separate molecules based on their sizes |
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which type of cyst is commony found the base of the tongue and the tyroid and is benign?
how does this affect the thyroid hormones? pt presents? |
thyroglossal duct cyst
it doesn't but they remove it anyway to guard against infection it moves w/ swallowing and is in midline of neck pg 131 |
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what is the anterior pituitary derived from
|
rathke's pouch
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what is hypospadias?
caused by? |
where peepee hole is on ventral side of penis
incomplete union of the urethral folds |
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turners syndrome would present w/ which hormone deficiency
|
estrogen
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if a mother has the flu during pregnancy what would the baby present w/ that would tell you the flue she had was CMV?
|
microcephaly, cns damage, earing and sight impairments, bluberry muffin rash (be careful with presentation of the rash... They may say "petichial" instead of blueberry muffin
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what is the cause w/ a meckel's diverticulum?
how would you differ between a meckel's, inussesception, and volvulous? |
gastric epitheluum ina a persistent omphalomesenteric duct
meckel's is the rule of 2's: 2 inches long, 2 feet from ileocecal valve, 2% of population, Intussusception presents more sudden and w/ pain vovulus won't present w/ bloody diahrrea |
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a diaphragmatic hernia present in an infant would cause what type of death if not treated?
|
a pulmonary hypoplasia since this is cause be failure of pleuroperitoneal membranes to develop
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transposition of the great vessells is caused by what 2 things
|
maternal diabetes and fialure of the aorticopulmonary septum to spiral
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which mature structure is a derivative of the fetal allantois and urachus?
|
the mediaN (allaNtois) umbilical ligament pg 125
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the ventral pancreatic bud becomes what structures?
|
main pancreatic duct, pancreatic head pg 133
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failure to pass meconium
|
hirschsprung's disease
|
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micrognalthaorticoia (small jaw), clenched hands
|
Edwards 18
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name the 4 components of tetrology of fallot
Caused from? what helps? |
Pulomonic stenosis
RVH Overidign aorta VSD results from pulmonary septum being displaced anterosuperiorly squatting helps |
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what is the pattern of blood flow in a PDA
|
shunts blood from left pulmonary artery to the aorta
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PP w/ Potter's syndrome
|
the failure of both kidneys to develop leading to oligohydramnios (little amniotic fluid) b/c fetus cannot excrete urine into the amniotic sac and leads to wrinkly skin and death
babies who can't Pee in utero develop Potter's |
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which brachial arch has innervation from CN 9 and 10?
|
3 and 4
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which weeks of embryonic development is most susceptible to teratogens?
|
weeks 3-8
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name a type of obsturctive hyperbilirunbinemia in infants
lab? |
biliary atresia (abnormal opening)
increased congugated bilirubin (results in acholic stools and dark colored urine) |
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where does blood develop in 11th week of fetal life? (pg 125)
|
liver (Yolk sac, Liver, spleen, BoneMarrow) - weeks 6-30
Young Liver Synthesizes Blood |
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Tx for hemophilis ducreyi
|
cefttriaxone
|
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what serologic findings would present in someone completely recovered from Hep B?
How does the window phase present? |
HBsAb and IgG HBcAb
Anti-HBcAg only (the patient has the surface antibody, but it's not detected because it's bound to Ag) |
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which bug would cause dilated cardiomyopathy, megacologn and megesophagus
|
reduvid bug - kissing bug
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increased TVF?
which bug would cause broncopneumo that is a gram negative rod that ferments lactose? what would be found @ autopsy? Also, know this the other way (back-to-front) |
lobar pneumonia
kleb acute inflammatory infiltrates from bronchioles into adjacent alveoli *** pg 512 |
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what is the cause of hemiparesis, visual field defects and cognitive impairment in a pt w/ Aids?
|
JC virus (cause of PML) and encphalopathy ((cmv causes hiv retinitis)
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molluscum contagiosum is which type of virus?
|
pox
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|
|
mononucleosis in college student, what does virus look like?
|
DS DNA w/ envelope linear
|
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which is the only species of plasmodium tha causes cerebral malaria?
how would PP? |
faciparum - most severe
daily cyclic fever, spenomegaly, anemia, headache |
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how does babesia look?
|
maltese cross formation on RBC's
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which virus works by inactivating tumor suppressor genes such as p53 and Rb through the actions of viral proteins E6 and E7
|
HPV - no other virus is associated w/ causing cancer
|
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|
what is the main difference between antigenic shift and antigenic drift and which virus?
|
Sudden shift (pandemic)is more deadly than a graDual Drift (epidemic)
influenza virus |
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name a gram positive, catalase positive bacteria.
what would it do to the vagina? |
staph aureus
TSST - fever, hypotension and a diffuse macular(skin) rash that desquamates after a few days |
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|
bordetella pertussis is cultured in what medium?
|
Bordet-Gengou medium
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|
how does botulism present?
|
diplopia and dysphagia
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arizona pneumonia that is sperules when warm and when cold is brached hyphae
|
coccidiodes immitis (one of the dimorphic fungis pg 158)
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|
well-demarcated skin lesion w/ a black base, which organism?
|
Francisella tularensis (rabbit fever or deer fly fever)
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|
which 3 enzymes are postive w/ helicobacter pylori?
|
urease, catalase and oxidase
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|
how would you treat Bacillus cereus infections?
|
supportive care only since it is a preformed enterotoxin
|
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|
common cause of strep in a child from 6 months to 6 years
|
Strep pneumo
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|
which layer of skin is lost in SSS scalded skin syndrome?
|
stratum granulosum
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which bacteria is a common cause of nosocomail urinary tract infections and subacute endocardidtis (diastolic murmer)
tx... other possible choices and why other possible choices and why how would you treat? |
enterococci
ampicillin HELPS kill enterococci (same as penicllin) (Haemophilis, E. Coli, Listeria, Proteus mirabilis and Salmonella, enterococci) 1st line is Imipenem which is given always w/ cislastin... can also give cephalosporin but if killer strain of entercocci then you better give imipenem |
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which 2 bugs would cause uretritis and purelent discharge?
how would you distingish? Important to know for drugs. tx for both? |
N. gon and Chlamydia. trachomatis
intracellular inclusions in chlam (EBs and RBs) Azithromycin is a macrolide, where ceftraxone is a cephalosporin N. Gon (ceftriaxone), Chlam (Azithromycin) |
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|
Tx for Blastomycosis?
|
Ampthotericin B (systemic), Flucoconazole (local)
(broad based budding tells you it's a fungus) |
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|
what is the mechanism for how tetani works?
|
blocks release of inhibitory neuro glycine
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|
nonbloody diahreea that causes electrolyte imbalances?
|
Vib Cholera
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|
which mediator contributes to hypotension and edema seen in gram negative shock?
|
C3a (anaphylaxis)
C5a is also anaphylactic is also neutrophil chemo tactic |
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|
which Torch infection causes congenital abnormalities such as hearing loss and seizures, what else would it cause?
|
CMV
"blueberry muffin rash" |
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|
which childhood rash begins on palms and soles and spreads inwards?
organism? |
Rocky Mountain spotted fever
Rickettsia rickettsia |
|
|
tx for trichomonas vaginalis?
|
metronidazole (GET GAP on the Metro)
Giardia, Entamoeba, Trichomonas, Gardnerella, Anaerobes and Pylori |
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|
meningoencephalitis from swimming in fresh water lake, which bug?
|
Naegleria fowleri (think Nalgene w/ fresh water)
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|
what are seen histologically w/ yellow fever?
PP? |
councilman bodies
vomitting black |
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|
which hepatits is common w/ blood transfusions?
|
C
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monospot test w/ EBV?
|
postivie
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when do you see schistocytes?
how does pseudo present as a bug? tx for pseudo? |
helmet cells when there is mechanical destruction of RBC like in DIC
areobic, non-lactose fermenting, oxidase positive, gram-negative rod Azetronam (pg 186) |
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when does Oxygen-hemoglobin dissociation curve shift right?
what does this mean? |
CADET face Right
Co2 Acid/Altitude DPG (2,3 - DPG) Exercise Temperature when the curve shifts right, you have a decreased affinity for each subsequent O2 molecule bound, so more unloading of O2 |
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|
what effect would epi (alpha agonist) have if first given phenoxybenzamine (a blocker)
|
B would rein suppreme so hyptension cause epi would have no effect when alpha was already blocked
** On boards, Epi is always given w/ an alpha or bb....if epi w/ a non-selective BB than you will get unopposeed alpha so increased BP |
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|
what is a complication of measles that happens years later?
|
SSPE - subacute sclerosing panencephalitis ( is a rare chronic, progressive encephalitis that affects primarily children and young adults, caused by a persistent infection of immune resistant measles virus (which can be a result of a mutation of the virus itself). No cure for SSPE exists, but the condition can be managed by medication if treatment is started at an early stage)
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|
how do you treat heritditary spherocytosis?
PP? |
splenectomy
splenomegaly, anemia, jaundice - sphere shaped RBC'S (howell jowly bodies maybe present--which are clusters of DNA) |
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pp w/ nystagumus, ataxia and diplopia after taking which drug for sezures?
special feature? |
phenytoin
induces cytochrome p450 pg 429 |
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|
what is PaCO2?
what happens if it is low? (give value) when would it be low? |
CO2 that is dissolved in blood
normal value is 22-28 - if low you get an increase in pH or respiratory alkalosis anytime you are hyperventalating |
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if a pt has a high PaCO2, how would you determine if the cause?
|
look at pCO2. If less than 40, hypoventilation or aspirin ingestion
if greater than 40 mmHg then it's metabolic alkalosis w/ compesation (hypoventilation ) from diuretic use, vomiting, antacid use, hyper aldosteronsim pg 463 |
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what would be one of the best things a person could do to prevent DVT's
|
quit smoking - 3 causes are stasis, endothelial enjury and hypercoagulablle state
|
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|
name a possible cause of having increased direct and indirect bilirubin levels?
|
oral contraceptive-associated cholestasis
|
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|
what are some common causes of delirium in the elderly?
|
infection, metabolic disturbances,
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|
how does Asperger's present?
|
milder form of autism, repetitve behavior, normal intelligence,
|
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|
which cardiac malformation is associated w/ tuberous sclerosis?
|
cardiac rhabdomyoma
|
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|
which ischemic heart disease would cause pain @ rest
|
prinzmetal's angina... could be in young person and smokers
|
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|
which type collagen effected w/ Alport syndrome?
|
type 4 - basement membrane
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|
Glut 4 transporters are seen in which tissue?
|
adipose, skeletal muscle (pg 285)
|
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|
which structures are found in femoral sheath?
|
VAC(canal) NOT nerve!!!
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|
pt presents like marfans but question asks for metabolic error of which amino acid?
|
homocysteine
CYSTEINE BECOMES ESSENTIAL! |
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|
what is the role of SAM in the synthesis of phosphatidylcholine?
what are two vitamins required for regeneration of methionine and therefore SAM? what is SAM what is the other essential role of SAM? |
to donate methyl groups (methionine required)
folate and B12 - SAM is methionine +ATP conversion of NE to epi |
|
|
what is the triad associated w/ Kartagener's syndrome?
|
sinusitis, bronchiectasis, situs inversus and male infertility
|
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|
what is a complication of removing the thyroid?
what two signs will be present? |
hypoparthyroidism b/c of accidental removal of the parathyroid glands - can cause hypocalcemia and therefore postivive Trousseau sign and Chvostek's sign
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|
pt's w/ PKU are unable to convert phenylalanine to tyrosine due to a deficiency in which two possible enzymes?
|
phenylalanine hydroxylase or tetrahydrobiopterin
|
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|
which calcium channel blocker is most effective in reducing heart rate and contractility?
|
Heart - Verapamil>diltiazem>Nifedipine
|
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|
PP w/ Fever, weightloss, Hep B past exposure...what type of vasculitis?
Other Signs? |
Polyarteritis nodosa = fibrinoid necrosis
Fever, Weight Loss, Malaise, Abdominal Pain, Melena, Headache, Myalgia, Hypertension, Neurologic Dysfunction, Cutaneous Eruptions. pg 275 |
|
|
MOA of statins?
|
HMG-CoA reductase is the drug and the MOA is the inhibit the cholesterol precursor, mevalonate
|
|
|
what changes are seen on an ECG w/ hyperkalemia?
what would the urinalysis show of someone suffering from hyperkalemia due to taking spironolactone? |
peak T waves and widened QRS interval - indicates recent MI
low K+, High Na+ and high normal volume |
|
|
most common cause of early cyanosis
|
Tetrology of fallot
|
|
|
what is the type of channel in phase 2 of a ventricular cardiac action potential?
|
voltage-gated Ca++ chanels opening
|
|
|
what is the gold standard for diagnosing an MI within the first 6 hours of symptom onset?
|
ECG to look for ST-segment elevation (signifying transmural infarct)
ST depression - subendothelial infarct Q waves - signifying transmural infarct |
|
|
which set of drugs would cause an immediate increase of bp (drug x), followed by no change (drug Y), followed by hypo tension (drug x again).
Name their MOA |
epi - no selective agonist of a and b = this would cause increase in bp via an incrased in heart rate and contractility through stimulation of B1 receptors (the B2 effect is minimal) and increased systemic vascular resistance through a1 mediated vasoconstriction.
drug Y would be phentolamine which blocks the a effects of epinephrine so readministration leaves only the B1 receptor actions (increased contractility and heart rate) ad the B2 mediated increase in vasodilation, causing a net decrease in blood pressure |
|
|
mecnaism/selectivity of epi?
a1? |
a1, a2, b2, b2 (low dosed selective for B1 (BLOW)
increase BP |
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|
a2?
b1? B2? |
a2 - decrease sympathetic , decrease norepi
B1 - increase hr B2 - increase contractility, decrease bp |
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|
what is a mechanism used by the heart during exercise to deal w/ increased work demand
|
increased coronary blood flow
* tricky - I though it was incrased O2 extraction but I guess the heart already has high O2 extraction and does not have the ability to increase it further - not sure what this would be in FA |
|
|
how does Takayasu's arteritis present?
what would you find in labs? Memory device? |
FAN MY SKIN On Wed
Fever, Arthritis, Night sweats, MYalgia, Skin nodules, Ocular disturbances, Weak pulses in upper extremities "pulseless" inc. ESR |
|
|
what is the defect in Factor V Leiden disease?
|
a mutant factor V which cannot be degraded by protein C. Most inherited casue of hypercoagulability.
|
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|
tricky question about what are possible causes that lead to a high pitched, holosystolic murmur, loudest at the apex and radiating to the axilla 3-10 days post MI
name all possible causes |
risks 5-10 days post MI are:
Free TIP free wall rupture, tamponade, Intervetnricular septal rupture, and Papillary Muscle Rupture *but the answer was papillary mucle rupture since the murmur was lowdest at the apex and radiated to axilla, which shows evidence of pulmonary edema. #13 of cardio...hard question |
|
|
which drugs can cause torsades de pointes?
|
any drug the prolongs the QT interval.... for instance Quinidine
|
|
|
what are causes of Dilated (congestive) cardiomyopathy?
PP? cause? |
Alcohol abuse
wet Beriberi, Coxsackie B virus myocardidiis, Cocaine, Chaga's Doxorubicin toxicity S3, presents as CHF (so like unstable angina), weight gain direct cytotoxicity via receptor-mediated entry of virus into cardiac myocytes |
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|
what would be a cause of a pregnant woman getting light headed when lying but fine when supine?
|
compression of IVC
|
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|
pt experiencing intermittant claudication releived w/ rest, which vessells are most likely effected?
|
arteries - due from atherosclerosis pg 266. it's a disease of elastic arteries
|
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|
which wave in a JVP would show the most changes in a tricuspid regurg?
|
C - RV Contraction (tricuspid valve bluging into atrium)
X wave...after C wave |
|
|
how can you tell constictive pericarditis from cardiac tamponade and CHF
|
constrictive pericarditis - interferes w/ ventricular fillng b/c of granulation tissue formation in pericardium. Can follow viral infections, trauma, neoplastic diseases, ...
Cardiac tamponade 0 simiar but there is absence of Kussmalul's sighn (failure of cervical venous distention to subside on inspiration) and pulsus paradoxus (decrease in systolic pressure by > 10 mm Hg during inspiration . CHF - similar to constrictive pericarditis but significant enlargement of the ventricles |
|
|
which vessell can be sacrificied to repleace the diseased aorta in an infrarenal aortic aneurysm repair?
|
inferior mesentric artery because there is enough collateral flow to the hindgut from the superior mesenteric artery and the hypogastric arteries
|
|
|
what is the possilbe consequence of having 3 syphilis of the heart?
|
it will dirupt the vasa vasorum of the aorta and cause death (tertiary syphillis)
|
|
|
what would Rubella cause in a baby?
|
triad of PDA, cataracts, deafness +/- "blueberry muffin rash" (be careful, sounds like measles)
|
|
|
which drug would you use to treat and PSVT?
why? |
adenosine
it's extremely useful in abolishing av nodal arrhythmias when given as an IV bolus and doesn't cause toxicities because it's duration of action is only 15 seconds |
|
|
how does Norepi work in septic shock patients?
|
it's a potent direct-acting a-agonist and a moderate B-agonist b/c it stimulates peripheral vasoconstriction
however, coronary vasculature expresses both a and b adrenergic receptors so you get vasodilation of the coronary vessels when catecholamines are present in high levels |
|
|
what would you njormally expect to find in an 85 year old heart?
|
lipofusion, "brown atrophy"
|
|
|
how would a pt present who has temporal arteritis, what is the other name?
|
unilateral headache, jaw claudication, impaired vision, increased ESR
|
|
|
a pt experiencing pericarditis due to uremia secondary to chronic kidney disease (b/c of diabetes) would have what on ECG?
Tx? |
ST elevation, pleurtic chest pain..
dialysis |
|
|
which coronary artery supplies the posterior septum?
|
Posterior descending - do not confuse w/ the LAD that supplies the anterior intraventricular septum
|
|
|
how would actue bacterial endocarditis present?
what bug would cause this in an IV drug user? |
FROM JANE
fever Roths supots (retinal hemm) Osler's nodes (fingers and toe pads) Mumur Janeway lesions (painless) Anemia Nail0bed hemorrhage Emboli (septic) staph (tricuspid) - don't tri drugs subacute would be viridans |
|
|
MOA behind cholestyramine?
|
decreases LDL and slightly increases HDL by preventing intestinal reabsorption of bile acids (ally oops!)
|
|
|
how does a pt w/ Von Hippel-lindau present?
what is teh chromosome? gene? |
overgrowth of blood vessels in retinga, brain, spinal cord and overgrowths in kidneys pancreas, pheochromocytomas, islet cell tumors and clear cell renal carcinoma
3 chromosome (AD) VHL tumor suppressor gene |
|
|
name a disease other than lyme disease that the Ixodes tick can cause?
|
babesiosis - hemolytic anemia
this tick can also spread Babesia and can often co-infect humans |
|
|
how would right sided CHF present differently than left sided CHF?
what else would you expect to find? |
Righ - increased JVP, splenomegaly, hepatomegaly, pitting edema, pulmonary hypertension
Left - anxiety, tachypnea, orthopnea, hemoptysis, cardiomegally, gi upset... incrased aldosterone secretion since there is a decrease in effective arterial blood volume due to the inability of the heart to effectively pump blood Memory device for RHF and LHF: RHF: big as a SHIPP LHF: GO H CAT ( think of a wound up cat) |
|
|
name the 4 enzymes that peak after an MI and the duration of onset?
|
Troponin - first 4 hours (elevated for 7-10 days after)
CK-MB - peaks in first 24 hours then wears off AST - increases over first 2 days then slowly declines LDH - 2 days post MI and elevated for up to 7 days |
|
|
which aortic arch does the caotid artery and proximal part of internal carotid artery come off of?
|
3rd.... C is 3rd letter of alphabet
|
|
|
what is it called when pulse dissapears on inspiration?
seen in? tx? |
pulsus paradoxis
cardiac tamponade pericardiocentesis |
|
|
describe MS as a murmur?
|
sharp, high-pitched sound in early ventricular dyastole - then crescendo, decrescendo murmur
fish-mouth |
|
|
describe kawaskaki disease
memory device? Associated w/? another name for Kawasaki's? |
acute, self-limiting "necrotizing" vasculitis. may develop coronary aneurysms. PP w/ measles like symptoms but possibly asian.
FEEL My Conjunctivitis Fever and Desquamated Skin Rash Erythematous Tongue ("Strawberry Tongue") Edema Lymphadenitis Mucosal Invasion (Lips and Oral Mucosa changes) y Conjunctivitis Associated w/ Coronary aneurysms. Mucocutaneous Lymphoid Syndrome |
|
|
how would you treat step viridans after it causes a subacute bacterial endocardidtis after a dental procedure?
|
penicillin - gram positive cocci and rods
|
|
|
what is a common adverse effect of taking a bblocker as an antiphypertensive?
|
depression and fatigue
|
|
|
cuatenous hypopigmented lesions, epistaxis, loss of eyebrows...
cause? |
weird but mycobacterium leprae...too me it sounded like tuberous
failed interferon gamma...failure of Th1 cells and so there is Th2 instead of Th1 |
|
|
TSST is caused by which part of S. Aureus?
|
the exotoxin TSST and not the bacterium itself
|
|
|
what is the memory device for inguinal hernias?
|
MD's don't LIe
to epigastric artery...most likely in older men |
|
|
what is the MOA behind why Guillain Barre hits peripheral nerves
what is a common infection that it is associated with? |
b/c an excessive immune response can lead to an autoimmune process against peripheral nerves due to molecular mimicry
Campylobacter jejuni or herpesvirus |
|
|
old man has backpain and elevated alkaline phosphatase levels, suspect?
|
metastatic carcinoma from prostate
|
|
|
what is the triceps innervated by?
|
C6 - C8 - this question required knowledge of brachial plexus... prob should draw it out
|
|
|
PP w/ RMSF? pg 156
treatment? memory device? |
headache, red conjunctivae, rash on palms and soles
immediately treat w/ a tetracycline such as doxy, even before diagnosis as it can lead to death VACcUUM THe BedRoom Vibrio cholerae, Acne, Chlamydia, Ureaplasma Urealyticum, Mycoplasma pneumoniae, Tularemia, H. pylori, Borrelia Burgdoferi, Rickettsia |
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most common ligament in a sprained ankle
|
the anterior talofibular ligament
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what is the defect in OI?
which structures would be most impacted? |
type 1 collagen - bone
bone, tendons, skin, eyes, ears and teeth |
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which disease can give false postitives on a syphilis test?
which test is most specific |
SLE RPR/VDRL 0 due to antiphospholipid antibodies
anti-smith |
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DMD has which inheritance pattern?
name the other's in this category |
X-linked recessive (frame-shift mutation , deleted dystrophin)
Be Wise, Fool's GOLD Heeds Silly Hope Brutons, Wiscott-Al, Fabry's, G6PD, Ocular albinism, Lesch-Nyhan Duchenne's, Hunter's Hemophilia A and B |
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what is a manifistation of Chron's disease that involves the skin?
desribe it |
erythma nodosum
inflammation of subcutaneus fat that is often accompanied by fever and malaise |
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Erlos Danlos is defect in which type of collagen?
what is an associated finding? |
type III
berry anerysms |
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what is a common presentation that would help you to distinguish osteoarthritis over RA?
|
pain worse at end of day, noninflmmatory, more common in weight bearing joints
(Pippy has bog Boobs (PIP w/ Bouchard's) and He wants to take a DIP (Heberden's nodes w/ DIP) |
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what is the syndrome called when they can't see, pee or climb tree?
which HLA? Cause? |
Reiter's
B27 usually an autoimmune reaction within several weeks of a gi or genitourinary infection |
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describe the crystals seen with Gout
what is used for acute treatment? |
negatively birefringent - yellow crystals under parallel light (blue when perp)
NSAIDS/colchincine |
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if you secrete renin, what would the outcome on your blood pressure be?
which structure in the kidney would be responsible for sensing the inadequate perfusion and therby secrete renin? what happens during renl artery stenosis? |
increased
the juxtaglomerular (JG) cells in the afferent arteriole and the macula densa in the distal convoluted tubule together make up the JG apparatus, which is responsible for controlling renal blood flow via renin release... the low pressure is detected by JG cells in the afferent and then you get renin released through the rening-angiotensin system |
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granular casts would mean which defect?
what would the treatment be? what is the cause? |
acute tubular necrosis (muddy brown casts)
fluids and dialysis, if kidneys don't recover, then dialysis MC of acute renal failure in hospital ...shock and sepsis. |
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what are the adverse effects of taking a statin drug?
|
hepatoxicity and Rhabdomyolysis
Rhabdomyolysis would cause excretion of myoglobin by the kidneys...which is nephrotoxic and can cause ATN (acute tubular necrosis) |
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what are the indications in respiratory acidosis?
|
ph <7.4,
PC02>40mg HCO3>22-28 basically low ph, high PC02 and high HCO3 (arrows different is respiratory) pg 463 |
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what combination of drugs would cause metabolic alkalosis?
|
thiazides and furosemide (or a loop). In hypokalemia you get metabolic alkalosis pg 462
there are 3 mechanisms for behind why it does this...but the question wasn't asking that :) |
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what is a major risk factor with someone with nephrotic syndrome?
|
that they could lose their antithrombin III, protein C and protein S which all function as anti-coagulants..
they are than hypercoagulable... can lead to strokes....etc |
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how does someone w/ acute pyelonephritis present?
what would be found in urine? what is most likely the cause? |
fever, CVA tenderness, nausea and vomitting
white cell casts most often from an e. coli infection from periurethral/perianal area |
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what is a sign of renal artery stenosis?
what would this cause? what would be contraindicated in this patient? |
renal bruits
decrease in perfusion and a drop in GFR (which causes release of renin-angotensin-aldosterone system. ace inhibitors b/c you will lose the increase effective GFR and will lose more perfusion |
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what structure prevents a horseshoe kidney from developing normally?
|
inferior messenteric artery
pg 134 |
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in a normal nephron what is reabsorbed?
what is not? what is a strong indicator of a post renal obstruction? |
BUN
Creatinine FEna <4% |
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what are the 3 primary types of acute renal failure?
how would a neoplasm give rise to an obstructed urethra? |
prerenal, renal and postrenal
when leukemic cells are lysed (tumor lysis syndrome) toxic contents can be released into kidneys (can't be detected on x-ray b/c they are radiolucent). |
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what is the effect of angiotensin II on the kidneys?
|
it works on efferent arterioles as a vasoconstrictor
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what are the two neoplasms associated with small cell lung carcinoma?
|
ACTH (causing cushings) and ADH (causing SIADH)
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V2 receptors is which type of G protein?
name the memory device? for the others? |
Stimulatory
a1,a2,b1,b2 (quiss) M1,M2,M3 (qiq) D1,D2,H1 (siq) H2,V1,V2 (sqs) Kiss (quiss) and Kick (qiq) until you're sick (siq) of sex (sqs) A boy must die high V |
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what does activation of the V2 receptor cause in small cell lung carcinoma?
what would you see in the lab values? |
causes insertion of aquaporins into the renal collecting duct;activation of V1 receptors leads to an increase in total peripheral resistance
in pt's w/ ADH secretion (SIADH) you get concentrated urine rich in sodium (causing hyponatremia and decreased serum osmolality without potassium or acid-base disturbances |
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which drug would cause elevated BUN and cratinine and oliguria (little urine) in someone recovering from a gram-negative infection
memory device |
any aminoglycoside
Mean GNATS canNOT kill anaerobes used for gram - (genamicin, Neomycin, Amikacin, Tobramycin, Streptomycin) |
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what is the MC cause of nephrotic syndrome?
what would you find on kidney biopsy? |
membraneous glomerulonephritis
spike and dome" pattern of depostition on em |
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what is the cause of WBC in urine?
what cell would predominate? |
it means that the pt has acute pyelonephritis and not just a UTI and that it ascended
since it's acute you would find a predominance of PMN's |
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which diuretic as an adverse effect that limits calcium excretion by the kidney?
where in the nephron does it act? |
thiazide diuretics
the early distal tubule |
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|
how would you treat an amphetamine overdose?
|
ammonium chloride (NH4CL) - it's a weak base
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pt presents:
pH <7,4 CO2 < 40 mmHg anion gap greater than 8-12 vomitting and diarrhea |
metabolic acidosis w/ compensation (hyperventilation)
mixed metabolic alkalosis and metabolic acidosis |
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|
how would you determine the anion gap?
|
Na - (Cl + HCO3)
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if a diabetic patients renal failure progresses, what is a possible associated condition?
|
osteomalacia occurs in renal failure due to the kidney's inability to maintain its normal vitamin D production
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what would you find on LM of a pt w/ Berger's?
|
IC deposits in mesangium
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how would you treat diffuse cortical necrosis and what is it caused by?
|
caused by DIC, septic shock... so possibly after pregnancy
dialysis |
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if a pt has gout, which type of kidney stones would they have?
|
uric acid - hyperurcemia - RadiolUcent so not seen on xray
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where does angiotensin II work and what does it do?
how does the above affect the handling HCO3- and H+ in the proximal tubule? |
stiumulates Na+H+ exchanger in teh proximal tubule
when you increase the activity of Na+H+ in the proximal tubule you are facilitating an increase in H+ in the tubular lumen ...dude this is a fucking hard concept... #24 of renal ---basically you increase bycarb resorptin and no effect on H+ resorptin |
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|
what is the mc cause of interstitial nephritis?
how would PP? |
drug induced (such as antibiotics)
fever, rash, hematuria and CVA tenderness |
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|
which muscle would most likely be affected in a wrist slashing of the medial part??
|
ulnary nerve, artery and adductor pollis, lumbricles 3 and 4, dorsal interossei, palmar interossei and the hypothenar
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|
what is the most common muscle injured in a rotator cup injury?
what motion would be effected? |
the supraspinatus tendon
helps deltoid abduct the arm |
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|
which drugs could cause SLE-Like symptoms?
|
Hydralazine, INH, Procainamide, Phenytoin (it's not HIPP to have lupus)
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what are the muscles involved with jaw movement and their specific function
|
lateral pterygoid, masseter, temporalis, and medial pteygoid
lateral opens while the other 3 close "m's munch" and "lateral Lowers".... |
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how does scarlet fever present?
which bug causes this? |
erythematous, sandpaper-like rash, with fever and sore throat
strep pyo |
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which type of bug causes osteoarthritis in a pt w/ sickle cell?
|
salmonella
*sort of tricky b/c the pt presents w/ bone pain after fever but the only clue they have sickle is that they are A.American. I picked an incapsulated organism but didn't pick up on the bone pain |
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|
what is the name of the process that causes long bones to form?
|
they ossify via endochondral ossification. (as opposed to membranous ossification of flat bones) pg 375
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|
which type of fracture would suggest child abuse?
|
a spiral fracture as it is caused by twisting, rotational force of the bone
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|
what is the triad for Sjorgren's sydnrome?
which auto-antibodies? |
dry eyes, conjunctivitis, "sand in eyes", arthritis
SS-A (RO), SS-B (La) |
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|
which ligaments are assoc w/ the unhappy triad?
what is the cause? what is a positve drawer sign? |
ACL, MCL and medial meniscus
by clipping from the lateral side tearing of the ACL ...the femur will move anteriorally |
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|
bug from cat bite?
what can arise? |
pasteurella (as opposed to bartonella from cat scratch)
cellulitis at site of bite and maybe even osteomyelitis |
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|
what is autoregulation?
which metabolites regulate autoregulation in the heart? |
process by which blood flow is altered to meet demands of tissue.
O2, adenosine and NO (metabolites are not the same as the actual Neurotransmitter) pg 262 |
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|
draw out cardiac cycle (which valves are open and closed)
|
bottom right - mitral vavlve closess
Top right - Aortic valve opens Top left - Aortic vave closes Bottom left - mitral valve opens pg 253 |
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what is the normal physiologic response to hypotension?
what is the difference between a chemoreceptor and a baroreceptor? |
decreased baroreceptor afferent firing in the carotid sinus leads to increased sympathetic efferent firing
baroreceptors sense changes in pressure...whereas chemoreceptors sense changes in metabolites such as CO2 (so pH) |
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|
how would a pt present who has Dresslers syndrome?
describe the path |
w/ a friction rub over the fifth intercostal space and midclavicular line and elevated JVP several weeks after a MI
it is an autoimmune phenomenon resulting in fibrinous pericarditis (friction rub is diagnostic) |
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|
what is a side effect of taking Hydralazine?
what is the clinical use? |
angina
severe hypertension, CHF |
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|
what is responsible for a mobitz II, 2nd degree heart block?
describe |
a defect in the His-Purkinje system is responsible
dropped beat...same PR length |
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what is the most common cause of death following a recent MI?
tx? |
a fatal arrhythmia aka sudden cardiac death
defib and maintain K+ and Mg++ levels |
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|
how does retinal artery occlusion present?
what are some common causes? |
as acute, painless monocular loss of vision; pale retinal and cherry-red macula (it has it's own blood supply - choroid artery)
endocarditis or any hypercoagulable state or any type of vascular disease or bacteremia (<25% regain full vision) |
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what do you want inside the cell to increase CO (positive inotropy)
what is one way you could accomplish this? mechanism? |
you want increased intracellular sodium because it will then increases the ca++ inside the cell which increases the contractility and thus CO.
by giving a cardiac glycoside such as digoxin (which stops na/k pump which then shuts of na/ca exchanger and wont let ca excape) |
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what is the formula for net filtration pressure? (write out)
name the 4 causes of edema |
Pnet = [(Pc-Pi) -(pic-pii)]
Pc - capillary pressure - pushes fluid out of capillary Pi = interstitial fluid pressure - pushes fluid into capillary pi c = plasma colloid osmotic pressure - pulls fluid into capillary pi i = interstitial fluid colloid osmotic pressure - pulls fluid out of capillary 1. increased capillary pressure (pc) such as heart failure 2. decreased plasma proteins (pi c;nephrotic syndrome, liver failure) 3. increased capillary permeability (increased Kf; toxins, infections, burns) 4. increased interstitial fluid colloid osmotic pressure (pi i; lymphatic blockage) |
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how does Guillian- Barre present
what would you find in the labs? common organisms |
ascending muscle weakness beginning in lower extremities
increased protein in csf, normal cell cnt, albuminocytologic dissociation Camp jejuni, HIV, mycoplasma pneumo (that was the answer...weird) pg 423 |
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weird question asking which organism causes septic arthritis (septic is of the joint whereas osteo is near the joint)
how does the organism present graphically? |
they say staph but I only know of it being osteomyelitis (N. gon causes septic) I looked it up and staph is mcc
coag pstiv, catal pstiv |
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which type of virus is the measles? and family?
how would PP? |
rubeola (paromixo)
Cough, Coryza, Conjunctivitis and Koplik spots |
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|
how does Step pyo present?
describe it graphically |
Pyo for fire, so you're in a fire and run away so fast that you FALLS and rip ass (GAS for group a strep)
fever, anterior (cervical) lymphadenopathy, lack (of cough), sore (throat) group a = catalase negative, b-hemolytic bacitracin senstive |
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which disease is most likely for an HIV pt whos tcell is below 50/mm3
|
mycobacterium avium-intracellae
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which endocrine disorder can lead to elevated blood pressure, decreaed potassium, sodium and water reteintion and decreased renin activity?
|
primary hyperaldosteronism (aka Conn's) -- secondary would have high plasma renin and is from an overactive rening-angiotensin system
triad: 1) hypertension 2) hypokalemia 3) metabollc alkalosis an aldosterone-producing adenoma of the adrenal gland pg 291 |
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|
wtf is a glucanoma? PP?
which type of skin rash would be seen w/ these pt's? |
a rare glucagon-secreting tumor - hyperglycemia, diarrhea, and weightloss and won't respond to hypoglycemic agents b/c of the uncontrolled excess glucagon production despite insulin levels
a necrolytic migratory erythema, a skin rash consiting of migratory painful, pruritic erythematous papules that blister |
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|
what is the most common ectopic thyroid tissue site?
how might it present later in life? |
the tongue
it does not affect thyroid function and is a common ectopic gland and can result in menstual abonormalities |
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|
describe which type of nephropathy a diabetic pt might have?
how would a type 2 diabetic present? |
diabetic neuropathy w/ Kimmelstiel-Wilson glomeruloscerosis aka nodular
polyphagia, polydipsia and polyuria, fatigue and weight loss |
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What is the clinical uses of prednisone?
what is the toxic effect? |
it's the most common glucocorticoid (so a corticsteroid) in cancer chemo but also used against autoimmune diseases (my question a pt was using it for ulcerative colitis)
predinsone indused cushing's syndrome which is associated w/ diabetes mellitus (the answer to my question was diabetes mellitus....and not insipidus)!!! tricky pg 362 |
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which sensory corpuscles are damaged in a pt w/ type II diabetes mellitus?
|
pacinian corpuscles (large, myelinated fibers) that sense vibration and pressure
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|
how does a disulfiramlike reaction present?
which diabetic drug is most likely to cause this issue? |
vomitting, severe headache, dizziness, blurry vision, and difficulty breathing after contact w/ alcohol
tolbutamide (a sulfonylurea) |
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|
what is the blood supply to the head of the pancreas and the duodenum?
|
gastroduodenal artery and the superior mesenteric artery
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|
tx for acromegaly? MOA
path? |
Octreotide is a somatostating analog that acts at the anterior pituitary to suppress GH secretion
excessive GH |
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|
describe operant conditioning
what is Pos reinforcement? what is negative reinforcement? |
behavior can be modified through reward or punishment
can be used in operant conditioning by rewarding desired behavior used to increased desired behavior by allowing escape from punishment punishments and extinction decreased behavior |
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|
continually worried for greater than 6 months?
less than 6 months? |
GAD
adjustment disorder |
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|
what is a drug that you can give a pt w/ bipolar that has a higher therapeutic windown than lithium?
bipolar presents? |
carbamezepine or valproic acid (anticonvulsants)
1 manic episode or hypomania (in bipolar II) |
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|
what's the difference between schzoid and avoidant
which type of personality disorder is this? others in this category? |
avoidant wants to interact but thinks everyone won't like them and schizoid they want to be alone
cluster c (worried) cowardly (avoidant), compulsive (obsessive compulsive), Clingy (dependent) |
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|
a pt who presents w/ a delusion has which type of broad disorder?
others in this category? |
thought content
Cluster C - worried- avoidant, OCD, dependent ideas of reference and delusions (ideas of reference Cis the idea that one is the subject of attention by other people or in the media delusions are ideas not shared by the culture) |
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|
how would a disorganized schizophrenic present?
|
w/ disorganized speech, behavior and inappropriate affect
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|
name the mature defense mechanisms and the memory device
|
Mature women wear a SASH
Sublimation, Altruism, Suppresion, and Humor |
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|
what is the firstline treatment for social phobia disorder?
PP? |
SSRI's such as fluoxetine
exaggerated fear of embarrassment in social settings |
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|
which drugs can cause tardive dyskinesia?
name them |
long term use of an older antipsychotic
thioridizine, chlorpromazine, haloperidol, trifluoperazine and fluphenazine (remember story about stephanie) |
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|
how would a pt present w/ pheochromocytoma?
what is the cause and what does it affect? what must you always consider? |
5 P's:
Pressue (elevated bp) Pain (headache) Perspiration Palpitations Palllor There is also the rule of 10's 10% malignant, bilateral, extra-adrenal, calcify, kids and familial ** Presents alot like hyperthyroidism... most common tumor of the adrenal medulla in adults you must always consider a MEN that has pheocromocytoma such as II and I.(Pa-pa pi, pa-phi, phi) pg 297 |
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|
what is a stimulus for the secretion of GH?
explain the MOA |
hypoglycemia - GH is critical in the stress response to starvation and is released in response to hypoglycemia and acts directly to decrease glucose uptake by cells and increase lipolysis, resulting in an increase in blood sugar levels
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|
which type of cell induce a rise in serum calcium levels?
what do they look like? what are the 3 ways in which they act? |
parathyroid chief cells
small, pale cells w/ round central nuclei 1) directly on bone to increase osteoclastic resorption 2) acts on kidney to increase resorption of calcium and inhibit resorption of phosphate 3) it promotes gi absorption of calcium via increased levels of activated vitamin D pg 288 |
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|
if a pt present w/ signs of lung cancer, what other hormone would be likely increased? suffers seizure in ER
MOA which lung cancer? |
ADH*** tricky... both ACTH and ADH where options but if ACTH were elevated the vignette provided no symptoms or signs of cushings so you have to assume water retention in the kidneys is happening
ADH is secreted from the pos. pitiuitar and stimulates expression of aquaporins in the rnal collecting ducts, resulting in transport of water into the renal medulla from the ductal lumen and hence water retention in the kidneys ...can cause hyponatremia and thus seizures small cell (oat cell) inoperable b/c it's central |
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|
what would a pt's TSH, T3, and T4 levels be respectively in a person w/ hypothyroidism?
|
decreased t3 and t4 and increased TSH due to the absence of negative feedback by t4
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|
how does a person present w/ albright's hereditary osteodystropy?
path? |
(aka) pseudohypoparathyroidism
hypocalcemia, shortened 4th/5th digits, short stature and unresponseive to PTH AD disease w/ variable penetrance the kidney is unresponsive to PTH and can lead to increased (but inability) to use PTH |
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|
pp w/ hypothyroidism what other autoimmune diseases will this patient most likely have?
|
type 1 diabetes and celiac disease...
dude, I totally thought this question was going to relate to HLA subtypes but I guess it's just a fact that people w/ hashimotos have a 20 times greater prevalence of celiac disease and type 1 diabetes than the general population |
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PP w/: backpain, polyuria, polydipsia, hypertension, weight gain and an L4-L5 compression fraction...which hormone would be elevated?
disease? |
cortisol
Cushings disease - the hypercortisol can lead to an increase in hyperglycemia and insulin resistance, immune supression and hypertension (a consequence of salt retention b/c of secondary elevation of aldosterone) |
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|
which diabetic drug could cause abdominal cramps, diarrhea and flatulence?
MOA |
Acarbose an alpha glucosidase inhibitor that decreases the hydroysis and absorption of disaccharides and polysaccharides in the intestinal brush border
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|
which type of tumor would cause a pt to present w/ bitemporal hemaniopia
what would be secreted? |
pituitary adenoma
GH |
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|
which type of thyroid cancer would a pt have that has psammoma bodies?
what are the other diseases? what is the most common association for this disease? |
papillary thyroid carcinoma (most common thyroid cancer) - excellent prognosis - finger like projections
prior radiotherapy to the head or neck (PsaMMoma) = Papillary (thyroid), Serous (ovary), Meningioma, Mesothelioma |
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|
high doses of glucocorticoids can cause which type of ECG change?
|
can change the electrolyte level and cause sodium retention and potassium depletion == causing hypokalemia = u wave (a small wave that follows the twave)
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|
what is the function of calcitonin?
|
calciTONin Tones down calcium -- opposes actions of PTH
|
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|
the right adrenal gland is drained via which vein? from there goes to?
left adrenal gland? |
right adrenal vein then to IVC
via the left adrenal vein into the left renal vein then to IVC |
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|
what is the most common tumor in females? PP?
made of? stain? |
leiomyoma(fibroid) a type of myometrial tumor. mentral pain and menorrhagia (increased bleeding) estrogen sensitive. Most often in AA women.
muscle fibers desmin |
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|
18 year old girl presents w/ nausea, vomitting and generalized weakness, periods have stopped.
K+ levels of 2.2 (3.5-5 is normal) she suffers from a condition that affects the production of 2/3 adrenal hormones which area of adrenal gland is the 1 produced? disease? |
wtf? congenital adrenal hyperplasia - defects in glucocorticoid and sex steriod synthesis...increased mineralocorticoid ...results in low serum cortisol and sex steriod levels w/ elevated mineralocorticoid levels that cause hypertension, hypokalemia and femal phenotype w/ no sexual maturaltion
aldosterone is produced in the zona glomerulosa (gfr salt, sugar and sex) pg 287 1/3 congenital bilateral adrenal hyperplasias |
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|
PP w/ weight loss, hypotension, and hyperpigmented skin, decreased sodium, chloride and cortisol but increased potassium and aCTH and decreased 17-hydroxypregnenolone is decreased....explain?
|
okay, def of aldosterone and cortisol causing hypotension...
addisons' disease Memory device: Adrnal Atrophy and Absense of hormone production involves all 3 coritcal divisions. |
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|
how does a pt present who has Addison's?
what would lab values show? path? |
weight loss (not mandatory), hypotension, skin pigmentation
low serum sodium, potassium, 17-hydroxypregneolone. (High Levels of ACTH, which stimulate MSH-melanin stimulating factor from POMC in Primary Addisons, that's why you have the hyperpigmentation). As for secondary Addisons, there isn't hyperpigmentation, so low ACTH) autoimmune distruction of adrenal glands You need to "add" hormones in addison's |
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|
what are the prodominant cells in the adrenal medulla?
what is their function? |
chromaffin cells (pg 284)
they secrete catecholamines (epi and norepi into blood steam |
|
|
which hormones act via a nuclear hormone receptor?
function? question asking how would you determine how active a hormone is within the cell |
PET CAT (progesterone, estrogen, test, cortisol, aldosterone and Thyroxine, T3)
to regulate gene expression and transcription access Na/K ATPase mRNA levels (answer looks hard but it's the only one that has mRNA in the answer) |
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|
where are pituitary adenomas located in the brain?
name how a pituitary adenoma could impact other hormones? what would it not impact? which hormones are secreted from post pit? ant? |
in the sella turcica
it would impact LH (surges right b4 menstral cycle) - secreted by AP. lead to a def other pituitary hormones it would not cause salt retention b/c aldosterone is secreted by kidneys but inresponse to ACTH from the AP...so you would be deficient in aldosterone and no water retention Those giant gonads prolong the action (TSH, GH, LH, FSH, prolactin, ACTH) --anterior (vasopressin (ADH) and oxy |
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|
how would MEN 1 present?
genetics? |
parathyroid tumors (so increased calcium), pituitary humors (prolactin or GH secreting), pancreatic, endocrine tumors (ZE syndrome or something), kidney stones and stomach ulcers
3 P's in Men 1 = pancrease, pituitary and parathyroid aka wermer's syndrome all MEN syndromes are AD |
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|
what drug for hypothyroidism?
toxicity? |
levothyroxine
thyrotoxicosis |
|
|
how does DI present?
path? urine osmolality? Serum osmolality? Site of Pathology? |
intense thirst and polyruia and inability to concentrate urine
lack of ADH (CDI) or to lack of renal response to ADH (NDI) urine osmolality would be low (less than 290mOsm/L) but serum would be >290mOsm/L CDI: Neurohypophysis NDI: V2 |
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|
which hypertension drug is contraindicated in a pt w/ diabetes?
which other diabetic drug class is known to cause hypoglycemia over the others? |
BB's b/c they may mask the botties ability to produce a sympathetic response so it would be hard for them to recognize they are hypoglycemic
sulfonylureas such as glyburide, glimepiride, glipizide |
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|
name which of the pituitary hormones are acidophilic/basophilic
how would the cells of someone w/ acromegaly appear? |
Acidophils - GH, prolactin
Basophils: B-FLAT (basophils - FSH, LH, ACTH, TSH) |
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|
name the 3 common etiologies for a person w/ hypoparathyroidism?
PP? lab values? |
thyroidectomy, metastatic cancer, and DiGeorge's syndrome.
Hypocalcemic TIN-tin needs some AID b/c he has PTH anxiety, irritabiltiy, neuromuscular exctabilty, tetany, intracranial calcificaltions, dental abnormalities and hypocalcemia low calcium, low PTH and increased phosphate |
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|
a pt presents w/ pH: 7.25, Pco2 - 28, anion gap is 20...what does this indicate? normal anion gap?
which drug could cause this in a type 2 diabetic? |
pH<7.4 - acidemia, Pco2<40mmHg...check anion gap which if greater than 8-12 causes are MUDPILES (methanol, Uremia, Diabetic Ketoacidosis, Paralydehyde or Phenformin, Iron tabs or INH, lactic acidosis, ehylene glycol, salicylates (draw out)
metformin pg 298 it can cause lactic acidosis so is contraindicated in renal failure |
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what drug do you give to someone who has BPH?
classification? function? |
finasteride (propecia)
antiandrogen stops conversion of test to DHT (which is even more potent) 5a-reductase inhibitor |
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name the steps for hormone mechanisms pg 290
question asked for last step |
hormone binds to receptor on nucleus or cytoplasm, tranformation of receptor to expose dna-binding domain, binding to enhancer like element in DNA, transformation of the hormone-receptor complex
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diabetes is assoc w/ which HLA subtype? which type of diabetes?
pp? test? |
DR3 and DR4, diabetes mellitus type 1 (juevinle)
skinny kid w/ polydipsia, polyuria, polyphagia and weightloss fasting serum glucose, glucose tolerance test and HbA1c (measures long-term diabetic control) |
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which diabetic drug for type 2 diabetes mellitus w/ hypertension
toxicity? and mnemonic |
an ace inhibitor
CAPTOPRIL (and happened to be the answer to the question) pg 474 Cough, Angioedema, Proteinuria, Taste changes, hypOtension, Pregnancy problems (fetal renal damage), Rash, Increased renin, Lower angiotensin II. Also hyperkalemia. |
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how would a pp w/ Waterhouse-Friderichsen syndrome? (triad)
path? and assoc |
1) adrenal hemmorage - often nonspecific and may include fever, nausea, vomiting, diffuse abdominal tenderness and hypotension
2) Hypotension 3) DIC it's associated w/ disseminated menigococcal infection, caused by bilateral adrenal hemorrage |
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which syndrome would you preform a dexamethasone (synthetic glucocorticoid) suppression test?
which drug would you use for SIADH? toxicity of previous drug? how would pt present who has had this toxicity? |
cushings - increase cortisol (caused by pitutiary adenoma (70%) and ectopic ACTH
demeclocycline - ADH antagonist...for instance when someone has lung cancer nephrogenic DI pt w/ lung cancer, taking the drug, but has dilute urine even when not drinking any liquids |
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what is the cause of renal osteodystrophy?
which cell would be overfunctioning? lab values would show? |
hyperparathyroidism due to renal disease so pt would have increased bone lesions secondarily
osteoclasts b/c they are responsible for bone resorption increase in serum calcium and alkaline phosphatase (renal failure would first cause decrease in serum calcium thus a compensatory increase in PTH) |
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what drug choce would you give for hyperthyroidsim?
how would the toxicity present? |
propylthiouracil
skin rash, agranulocytosis (sudden infections), aplastic anemia |
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how does a pt w/ cushing present?
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increase cortisol, hypertension, weight gain, moon facies, truncal obesity, buffalo hump, hyperglycemia (insulin resistance), skin changes (thinning, straie), osteoporosis, amenorrhea, and immune supression
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explain the test results of applying dexamethasone (syntetic glucocorticoid) supression test and the outcomes in each of the following conditons:
Healthy: ACTH-producing pituitary tumor: Ectopic ACTH-producing tumor Cortisol-producing tumor |
healthy: low cortisol after low dose
ACTH-producing pituitary tumor: increased cortisol after low dose; decreased cortisol after high dose ectopic ACTH- producing tumor (small cell carcinoma), incrased cortisol after low dose; increased cortisol after high dose cortisol -producing tumor: icnreased cortisol after low and high dose chart: low high healthy decreased ACTH incr dec Cort incr inc Ectopic incr inc **BS question since the answer stem stated there was a mass on CT scan so you atomatically pick adrenal adenoma even if the lab values showed neither low nor high dose of dex |
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which conditions are associated w/ hypercalcemia?
what would be cause of hypercalcemia in someone w/ following lab values: serum calcium 14.2 serum phosphate 81 U/L alkaline phosphatasae of 81 U/L ...location? |
CHIMPANZEES -
calcium injestion, hyperparathyroid, Hyperthyroid, Iatrogenic (thiazides), Multiple myeloma, Paget's disease, Addison's dissease, Neoplasms, ZE syndrome, Excess vitamin D, Excess vitamin A, sarcoidosis renal tubules and bones (mimicking PTH increased so increasen bone and renal absorption) |
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name the signaling pathway used for insulin?
name others in this category...pg 289 |
tyrosine kinase
IGF-1, FGF, PDGF, prolactin, GH |
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pheochromocytoma is a tumor of which cells in which location?
what does it cause? what is treatment, explain... |
chromaffin cells in the adrenal medulla
increased secretion of NE and E so it presents alot like hyperthyroidism alpha blockade followed by a beta blockade -- a non selective a like phenoxybenzamine to normalize bp followed by a bb to control the eachy it would result in unopposed a receptor stiumlation leading to a further elevation in bp |
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what is pernicious anemia?
path? function*the question was this |
a megaloblastic anemia caused by a vitamin B12
a def of intrinsic factor produced by gastric parietal cells (prob from autoimmune against these cells) complex w/ free vitamin B in the small intestine and then binds to receptors on the wall of the ileum |
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how does Wilms tumor generally present?
Path? aka? most likely where was the origin of the lesion ** |
mc solid tumor of childhood generally pp's from 2-4 years of age w/ huge palpable flank mass and is seen w/ hemiphypertrophy (abnormal enlargement of one side of the body).
associated w/ deletion of tumor suppressor gene WT1 on ch 11, it distorts the kidney calyces as it grows nephroblastoma malignant transformation of renal tubular cells** incorrect! look up~ |
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what is the cause of Paroxysmal nocturnal hemoglobinuria?
PP in labs/ |
it's caused by RBC susceptibility to complement-mediated cell lysis...due to synthesis of GPI anchors, which anchor proteins that protect RBC's from this process...
intravascular hemolyss and hemoglobin released into the blood and subsquent hemoglobinuria, thrombotic omplications and aplastic anemia |
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which chemo drug is contra in a person w/ transition cell carcinoma of the bladder?
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cisplatin b/c it causes nephrotoxicity and acoustic nerve damage and so they would need to be vigorously hydrated in order to prevent kidney damage.
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what is the MCC of thrombocytopenia in childhood?
cause? presents? pt and Ptt times? PC and BT name the other platelet disorders |
ITP - idiopathic thrombocytopenia in childhood
an autoimmune disease comonly instegated by a viral illness. Any bleeding disorder due to platelet defects or deficiencies will present w/ microhemorrhage of the mucous membranes of the skin (purple skin lesions), antiplatelet antibodies and large platelets normal PT and normal PTT time Platlet count will be low, bleeding time will be increased pg 349 Bernard-Soulier, Glanzmann's thrombastenia, ITP and TTP |
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what is another presentation associated w/ someone who has cushings from a neoplasm?
|
hirsutism and poor wound helaing due to inhibition of collagen synthesis by glucorticoids (since increased glucocorticoids)
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how does heritary spherocytosis present?
what test would you use? what would you find? Path? classified? others in the is category? |
hemolytic crisis (intrinsic) resulting in jaundice and pigmented gall stones (GI pain that relapses). can proceed B19 infection causing aplastic crisis
Coombs test negative small RBCs w/ no central pallor mutation in gene that codes for either ankyrin or spectrin intrinsic hemolytic normocytic anemia.....g6pd def, pyruvate kinase def, sickle cell anemia, HbC defect and paroxysmal nocturnal hemoglobinura |
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what is the formula for incidence?
* not a question but I nailed the prevalance one so I thought I'd do this one instead |
= new cases in a pop over a given time period/totat population at risk during that time
incidence is new incidents |
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what are the symptoms of multiple myeloma?
what would you see histolgically? |
think CRAB: hyperCalcemia, Renal insufficiency, Anemia, Bone/Back pain
rouleaux formaion in RBC's or fried-egg appearance of plasma cells whenever an elderly person has back pain, think MM or metastasis |
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what is a drug commonly used for recurrent UTI's?
toxicity? Name common causes. For the common UTI's, list the treatment and pathogen. Swarming on agar and produces urease. Large mucous capsule and viscous colonies. Metallic sheen on EMB agar. Blue-green pigment. Red pigment |
trimethoprim-sulfamethoxazole TMP-SMX
Trimethoprim - TMP: "Treats Marrow Poorly" ...so megaloblastic anemia SSEEK PP Serratia Staph. Saphro. E. Coli Enterobacter Klebsiella Pseudomonas Proteus Swarming-Proteus Mucous-Kleb Metallic-E. Coli Blue green-Pseudo. Red-Serratia |
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60 year old presents w/ blood in stool? next step
|
it gives labs and such but that is not needed to answer this since rectal bleeding in anyone over the age of 50 is considered colorectal cancer until proven otherwise and you would need to do a colonoscopy w/ possible tissue biopsy of suspicious lesions.
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what is another name for corticosteriods?
toxicity? which disease might this be given to in heme |
glucocorticoids
Iatrogenic Cushing's syndrome - buffalo humb, moon facies, easy bruisability, but also prednisone can cause mood changes known as glucocorticoid psychosis (nfa) hodgkins (tricky since pp w/ weigh gain, foot ulcers, vision problems, elevated blood sugar, oral candidiasis and mood changes) |
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which type of mole causes extreme increase in hCG
karyotype? |
complete
46 xx, 46 xy - 2 sperm and an empty egg |
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which thallesemia can cause hydrops fetalis?
MOA what is hydrops fetalis? |
a - thalassemia -- deletion of 4 genes is incompatible with life - Hb Barts (gamma 4), which causes hydrops fetalis
excess gamma-globin chains binding tighter to oxygen (an abnormal fluid accumulation in at least 2 fetal compartments)...b/c gamma holds too tightly |
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elevated alpha fetal protein is a common marker in which two types of diseases?
|
liver disease - like a hepadenoma
and yolk sac carcinoma ** tricky b/c the vine did not mention increase AFP but hinted at a liver problem |
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MC non-hodgkin's lymphoma?
pp? |
B lymphocytes are the cells of origin in most NHL's (90 percent) w/ the exception of lymphomas that dominate t lympocytes
weight loss, weakness, fatigue, lymphadenopathy and hepatosplenomegaly |
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which lymph nodes drain the testes?
scrotum? |
the same as the abdomen since they started there so the para-aortic lymph nodes in the lumbar region just inferior to the renal arteries
scrotum is superficial inguinal ** question just said increased HCG, which lymph nodes |
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PP w/ increased ptt and increasd bt and bleeding gums?
what is the normal function of the thing that is def? classify this disease? tx to alleviat the symptoms? |
von willebrand's disease (most common inherited bleeding disorder)
vWF has 2 functions- ligand for platelet adhesion to a damaged vessel wall, and it also is the plasma carrier of factor VIII cryoprcipitate - the precipitate that remains when fresh frozen plasma is thawed...it has vWF in it. mixed platelet and coag disorder pg 350 |
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how would DIC present?
which condtions? type of disorder |
oozing blood from iv lines and bleeding from gums, petechiae and prolonged PT time
STOP Making New Thrombi Sepsis (gram -) Trauma Obstetric complications acute Pancreatitis Malignancy Nephrotic syndrome, Transfusion mixed platelet and coag |
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MCC of meningitis in a 5month old?
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groub B strep
e. coli (this was the question) Listeria |
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pp in DI?
how would you determine which type? tx? |
unquenchable thirst, polyuria, hyperosmolar serum,
give desmopressin determins central or nephrogenic (v2 receptor) -- Uosm>50% is C, less than 45% is N central - desmo (adh analog) nephrogenic - hydrochlorothiazide, indomethacin and amiloride #2 in neuro...read again. |
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how would you determine a subarachnoid hemorrage post mordem?
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blood trapped in the arachnoid mater cannot be scraped off whn dura matter is removed
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which change in the brain is associated w/ huntingtons?
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gliosis of the caudate nucleus - loss of motor inhibition
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what is the quadrad (haha) of Gerstmann's syndrome?
location? |
1. an inabiltiy to distinguis right from left
2. in inability to identify fingers 3. writing disability known as agraphia or dysgraphia 4 . lack of understanding the rules for calculation or arithmetic known as acalcuria or dyscalculia...reading still intact angular gyrus and contra homon hemian |
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name the foramen of the branches of the trigeminal nerve?
which cn would be harmed in a pt who can't feel over jaw? |
Standing Room Only
Superior orbital vissure (v1) Rotundum (v2) Ovale (v3) v3 as it innervates sensory/motor of the masseter |
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pathology of ALS?
pp? |
neuronal loss in the region of the anterior horn cells and corticospinal tracts in the spinal cord
both UMN and LMN signs, |
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POS = HbsAg, anti-ABc IgM
NEG = HBsAb, anti-HAV IgM pt reports multiple episodes of jaundice in the past which lab values would be decreased? which lab values would be increased? |
chronic hep b if HBsAg greater than 6 months
albumin would be decreased b/c it's made by liver alkaline phosphatase (b/c decrease function of biliary tree) serum bilirubin (difficulty to release into bile) PTT (all major coag factors made in liver except VIII) Transaminases (indicate hepatocellular damage |
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what is volvulus?
differentiate between volvulus and duodenal atresia in an infant pg 322 |
twisting of portion of bowel around its mesentery
obstruction and infartion duodenal atresion and volvulus will both present w/ double bubble and bilious vomitting but think duodenal atresia w/ Downs and there would not be twisting of the superior mesenteric artery and vein like there would be in volvulus |
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PP w/ pregnant, painful blood stools
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external hemmorrhoids (thromboses or blood clots in the veins of the external rectal venous plexus below pectinate line.
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how would cholelithiasis present?
what is the role of somatostatin and which cells secrete it? |
female, fat, fertile, forty
triad: jaundice, fever and RUQ pain D cells of the pancrease and gi mucosa. It stops gastric acid, pepsinogen, insulin, glucagon, pancreatic and small intestine flud secretion |
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pp
serum bilirubin of 4 mg/dL direct bilirubin of .3mg/dL liver function tests are normal deficiency? |
high serum but normal direct in a 24 year old would be Gilbert's, in new born Criegler-Najjar type I (fatal)
functional glucuronosyl-transferase (GST) |
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how would Budd-Chiari present?
cause? association? (pg 326) |
classic triad: abdominal pain, hepatomegaly and acites
occulsion of IVC or hep veins w/ centrilobular congestion and necrosis, leading to congestive liver disease ** tricky question, woman presented w/ poly vera, RUQ pain and hepatomegaly |
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path in Achalasia?
|
failure of relaxation of LES due to loss of myenteric (Auerbach's plexus)
Bird's beak on barum swallow |
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which vessells anastomoses is responsible for esophageal varices bleeding?
|
Left gastric vein and azygos vein
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which extraintestinal manifestation is associated with ulcerative colitis?
how could this pt present? what is ERCP and what would you find? |
primary sclerosing cholangitis
pruritis, icteric sclera endoscopic retrograde choliangiopancreatography (ERCP) - would show alternating strictures and dilations of the bile ducts...called "beading" pg 328 |
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how does pseudomembranous cholitis present?
|
after antibiotic w/ intractable watery diarrhea and cramps
cause: clostridium difficile |
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what would be a sign of a history of gall stones?
what could this lead to in the elderly |
gallbladder thickening of the wall on CT
gallbladder adenocarcinoma (common in elderly) |
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which type of hepatocellular injury is commonly seen after acetaminophen overdose?
what else can cause this? antidote? |
centriloular necrosis
carbon tetrachloride, bromobenzene, halothane, and rifampin n-acetylcysteine - regenerates glutathione |
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PP w/ malabsorption?
which conditions in this category? |
diarrhea, steatorrhea, weight loss, weakness
celiac sprue, tropical sprue, whipples, disaccharidase def., pancreatic insuff, abetalipoproteinemia...pg 317 |
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which type of cancer can be caused from an H. Pylori infection?
prognosis |
gastric adenocarcinoma
good prognosis in early stages |
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which parasite would be responsible for the following symptoms? fever, diarrhea, weight loss and "funny looking stools" commonly found in fresh waters in S. America?
what is a complication of chronic infection? |
Shistosoma manosoni (not to be confused w/ haematobium
portal hypertension |
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acute cause of pt presenting w/ epigastric pain, nausea, vomitting blood when they also have RA?
|
nonsteriodal anti-inflammatory drug
*I thought amyloidosis (chronic gastritis, not acute) b/c of presentations similar to pancreatitis but didn't catch she had RA |
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what is the MOA for infliximab?
clinical use? toxicity? |
binding and neutralizing to the cytokine, TNF (INFLIXimab INFLIX pain on TNF), it's and anti-TNF anitbody
Crohn's disease, RA and Ankylosing spondylitis reactivation of latent TB pg 389 |
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2month old pp w/ poor appetite, weightloss, narrow rectosigmoid w/ a dilation of the segment above the narrowing, absense of actylcholinesterase positive ganglion cells?
path? differentiate w/ another disease risk w/ which disease? |
hirchsprungs diease
lack of ganglion/enteric nervous plexuses (auerbach's and Meissner's plexuses = failure of neural crest migration duodenal atressia would present w/ bious vomiting w/ proximal stomach distention down's |
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PP w/:
pH of 7.5 bicarb 34 partial CO2 of 40mmHg after vommitting? others in this category? |
metabolic alkalosis/respiratory comp
diuretic use, vomiting, antacid, hyperaldosteronism |
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pp w/ diarrhea, abdominal cramps, occult blood tested postivie, swimming in a lake 2 days ago
|
entamoeba histolytica
* I picked Naegleria fowleri but that causes rapidly fatal meningoencephalitis pg 161 |
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if a liver presents w/ fatty changes, mallory bodies and neutrophilic infiltrate? what is most likely causee?
|
alcoholic hepatitis ( just fatty change if reversible)
mallory bodies (intracytoplasmic eosinophilic inclusions) know picture, pg 218 |
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which location is involved w/ someone w/ FAP?
genetics? which type of cancer is associated? |
always involves rectum
AD 100% progress to CRC |
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comma or S shaped organisms?
common vector? degrees grown? pt presents? possiblity down the road? |
campylobacter jejuni
42 (campylobacter likes the "hot campfire") bloody diarrhea Guillian - Barre (also cmv, ebv, hiv, Myco pneumo, gastroenter) |
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young adopted child w/ problems seeing, which vitamin?
how is the vitamin get absorbed ? |
A def.
via micelle-mediated transport (b/c it's fat soluable) |
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PP for primary biliary cirrhosis?
cause? |
triad: jaundice (icteric sclera), hypercholsetolemia (palpebral xanthomas), and pruiritus w/ postiive AMA and elevated akaline phosphatase
destruction of intrahepatic bile ducts |
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how does celiac sprue present?
|
the same as all other malabsorption issues...diarreha, steatorrhea, weighloss, weakness...
but the distinguishing factor is dermatitis herpetiformis and blunting of microvilli |
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what drug is commonly used in the xment of Hep B and C?
toxicity? |
IFN-a - chronic hep b and heb c (aka pegylated interferon) --used to slow the progression
flu-like symptoms, depression, suicidality |
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what sign do you use to determine if a pt has appendicitis?
what cell count will be high? what is McBurney's point? how do you diagnose? |
psoas sign - pain on hip flexion and rebound tenderness
whit cell count 1/3 the distance from iliac crest to umbililicus ct scan |
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name the lactose-fermenting enteric bacteria
name the causitive species that cause bloody diarrhea how can you distinguish between the 2 non-lactose fermenters? |
Lactose is KEE, Test w/ MacConKEE'S agar
grow pink on MacConkey's: Citrobackter, Clebsiella, E.Coli, Enterobacter, Serratia Campylobactor (, shaped) Salmonella (non-lactose) Shigella (non-lactose) Enterohemmorhagic E. coli (0157 can cause HUS, lactose +) Enteroinvasive E. Coli (invades mucosa, lactose +) Yersinia enterocolitica (day-care outbreak, pseudo appendicitus) C. Defficile Entamoeba histolytica (protozoan) Salmonella produces gas and HS (hydrogen Sulfide) whereas Shigella does not |
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what drug would you use for someone w/ elevated LDL and triglyceride levels
labs in 1 month would show? why? |
gemfibrozil (or any other fibrate)
triple arrow decrease in triglycerides and a slight increase in HDL ... b/c you upregulate LPL and therefore increase TG clearance |
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PP w/ copd and a duodenal ucler, what is strongest risk factor for the duodenal ulcer? How do you know duodenal ulcer?
|
tobacco
pain decreases w/ meals so weight gain |
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what is normal serum albumin level?
PP w/ high albumin levels and fever, vomitting and diarrhea, which condition most likely |
3.5-5.5 g/dL
dehydration from vomiiting.. other than that, you don't need to worry about high albumin levles |
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which substance used to treat ge reflux can decrease effectiveness of drugs such as tetracycline?
if someone has an allergy to penicillin, what can they be given instead? which family toxicity? |
Calcium carbonate (tums)
ciprofloxacin , family of fluroquinolones must not be taken w/ antacids, can cause GI upset pg 190 |
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alcoholic presents w/ chronic bouts of stomach pain, pain radiating between shoulder blades and nasusea?
what would you find on CT? name the 2 types of chronic pancreatitis? which one is more at risk for pancreatic cancer? |
pancreatitis
pancreatic calicifications chronic pancreatitis - steatorrhea, fat-soluble vitamin deficiency and diabetes mellitus chronic calcifying pancreatits (increased risk of cancer, often w/ alcoholism) |
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which drug family, if chronically used is known to cause atrohic gatritis
normal clinical use of this drug? MOA? |
a PPI such as omeprazole
for esophageal reflux, ZE, peptic ucler irreversibly inhibit :/Katpase in stomach parietal cells, pg 331 |
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got this while camping
what caused the pt's symptoms? pp? |
giardia lamblia
small bowell inflammation and villous atrophy bloating, flatulence, foul-smelling diarrhea |
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how would a pt present w/ IBD?
2 types? which one more common in adolescent pt's? location of each? tx? |
w/ a history of recurrent RLQ pain w/ diarrhea, fevers, weight loss
chrohn's and ulcerative colitis chron's is any portion of GI but usually terminal illeum and colon chron's: steriods or infliximab wheras uc could require colectomy |
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how would brucella present?
|
Unpasteurized dairy products give you Undulant fever (rising and falling at night) ... like eating fresh goat cheese. Weight loss and loss of apetitie
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massive hematemesis in an alcoholic?
differentiate w/ esophageal varices? |
Mallory - Weiss syndrome
esophageal varices is lower esophagus and is painless, MW is painful and is at the gastroesophageal junction |
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|
how does IBS present?
what would you find on colonoscopy? |
must have 2 or more of the following:
1) pain improves w/ defecation 2. change in stool frequency 3. change in appearance of stool diarrhea, constipation or alternating normal biopsy, no structural abnormalities |
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farmers or anyone who could come in contact w/ dog feces are likely to develop which nasty helmithic organism?
how does pt present? |
Echinococcus granulosus, very lethal!
cycsts in any organ like liver, lungs, kidney...probably alot like cancer from anaphylactic shock b/c of a spontaneous rupture of a cyst |
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how would a pleomorphic adenoma present?
what is a special feature? differentiate? |
benighn, well-differntiated, well circumscribed mass that grows slowly over course of months to years. Painless and high rate of recurrence
most common parotid gland tumor and 50% of salivary gland tumors warthin's - most common malignant salivary gland tumor |
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if a pt has problems swallowing in CREST syndrome, which muscle and were in the esophagus is damaged?
describe the other locations within the esophagus |
atrophy of smooth muscle in the lower 2/3 of the esophagus
upper 1/3 is striated muscle middle is striated and smooth lower is smooth |
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70 year old presents w/ signs of appendicitis, most likely etiology?
|
increased intramural pressure leading to perforation of a bowel out pouching (diverticulum)
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pt presents w/ parkinson's symptoms, serum aminotransferase levels evevated, what is genetic factor?
|
Wilson's disease!!!! careful! I just went straight for parkinson's
AR inheritance |
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|
what are the species that cause watery diarrhea?
which one has an enterotoxin that is preformed and has a short incubation time? |
enterotoxigenic E.coli
Cholera, C. Perfringens Protozoa (giardia..) viruses (rota, aden, norwalk) S. aureus from mayo foods - more vomiting than diarrhea |
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which enzyme is def in Crigler-Najjar syndrom I
Crigler-Najjar and Gilbert's both present like? |
UDP-Glucuronylsyl transferase (UDP-GST)
pt dies within a few years - jaundice, kernicterus (bilirubin deoposition in brain, increased unconj. bilirubin Hemolytic, so inc. unconj./indirect bilirubin |
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which factor is most abundant in the pus of a pt suffering from IBS, allergies, asthma, psoriasis, RA?
|
Leukotreine B4 (neutrophils arrive B4 anyonelse) a neutrophil chemotactant and is predominant in acute inflammatory processes.
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PP w/ retrosternal chest pain after meals not relieved by antacids...ecg is normal but ther is a hiatal hernia..which cancer?
|
adenocarcinoma from barretts esophagus from gerd...I have no idea what the hiatal hernia is about
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|
what are the tumor markers associated w/ Pancreatic adenocarcinoma?
PP? |
CA-19-9, CEA
abdominal pain radiating to back weight loss migratory thrombophlebitis (trousseaus syndrome) obstructive jaundice w/ palpable gallbladder |
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|
what is normal PT time?
PTT time? hematocrit? WBC count? platelet count? what is the difference btwn PT time and PTT time? |
PT - 11-15 sec
PTT 25-39 seconds hematocrite male - 41-53%, F 36-46% WBC Cnt - 150,000-400,000 They both measure time for blood to clot. The PT measures the extrinsic coagulation pathway by calculating the prothrombin ratio The clotting factors like I, II, V, VII and X are looked into in the prothrombin time. The PT also determines the warfarin levels and the vitamin K position. The PTT is a measurement of the intrinsic coagulation pathway and the common coagulation pathway. The partial thromboplastin time test also measures the heparin level in the body in case a patient is on anti-coagulation therapy. The clotting factors that are noted in a PTT test are: I, II, V, VIII, IX, X, XI and XII. |
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If PT time is increased, what is the issue?
what is vitamin K's role? |
a def in one of the factors in the extrinsic pathway
it's a fat-soluable vitamin that is a cofactor for the gamma carboxylation of glutamate residues of prothrombin; factors 7,9,10 and proteins C and S. (must know all!) |
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|
what is the most common drug allergy?
which disease would it cause hemolysis? |
sulfonamides
G6PD def. |
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|
which drug binds to IIb/IIIa receptors?
used for? which 2 drugs work by inhibiting the ADP pathway involved in binding of fibrinogen to platelets during platelet agg. |
Abciximab
preventing fibrinogen from binding and interfering w/ platlet aggregation - for acute coronary syndrome and angioplasty clopidogrel and ticlopidine |
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|
what sign would be positive in a person w/ pancreatic cancer in the head of the pancreas?
|
Courvoisier's sign: jaundice, palpable enlarged, nontender gallbladder (I choose cholelithiasis, which just means stones...generally painless and does not cause jaundice or enlarged gallbladder)
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what would DIC do to PT and PTT time?
what does a dilated common bile duct suggest in a person w/ pancreatitis? |
during DIC there is a massive activation of the coagulation cascade that results in throbus formation throughout the microvascularature so there is rapid consumption of platelets and coagulation factors and easy brusing and bleeding. (so elevated PT and PTT time)
that gallstones may have been the cause of the pancreatitic episode. be able to apply common causes of DIC along w/ the disease! |
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what does MGUS stand for?
dx? tx? |
monoclonal gammopathey of undetermined significance
defined by prsence of a monoclonal antibody called M protein in the serum or urine of persons without evidenc of multiple myeloma. -- it's a preneoplastic condition no treatment b/c one cannot predict which patients will progress to develop multiple myeloma |
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how would both major and minor B thallesemia present on electrophoresis?
how could you tell diff btwn major and minor? |
increased HbF (a2gamma2) (can also say increased in HbA2 and decrease in A1 (showing synthesis of A is intact). Absence of HbA1 (a2b2) supports and absence of Bchain synthesis and therefore a diganosis of B thalassemia major
B you need blood transfusions -- triad for thalassemia is hemolytic anemia, hepatosplenomegaly and "chipmunk facies" |
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what would be positive in someone w/ a schwannoma?
assoicated w/ which other disease? |
S-100
NF2 w/ bilateral schwannomas |
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Men IIa is aka?
pt present? which oncogene has a mutation |
Sipple's sundrome
parathyroid hyperplasia or tumor leading to hypercalcemia, medullarry carcinoma of thyroid and pheochromocytoma (increased catecholamines) Ret (along w/ men IIb and III) |
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adopted child presents w/ widened wrists, ankles and enlarged costochondral junctions, which condition?
how would the lab findings show? |
vitamin D deficient rickets
decreased serum calcium --> Dec. PO4, inc. PTH, dec. 1,25-(OH)2, & inc. AP Increased intact parathyroid hormone (PTH) levels* (the answer) |
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42 year old pp w/ pain and swelling in pip joints, which serum marker elevated?
which DR? |
IgM and anti-IgG -- RA
symmetric!!! DR4 |
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Describe Trendelenburg gait
which nerve damaged? cause? |
steps w/ one leg, swings all the way over to the right so they can swing other leg
Superior gluteal polio or hip dislocation |
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How might carpal tunnel mainfest w/ labs?
what sensory defect? |
increased ESR and WBC count
palmar aspect of second digit, (NOT VOLAR of medial wrist which is innervated by medial cutaneous nerve of the forearm) |
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paget's is a dysfunction of which cells?
which embryo origin? which virus suspected? |
osteoblasts/clasts
mesoderm (from blood or marrow) paramxyo |
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Tennis player p's w/ tennis elbow, which muscles
which syndrome? |
overuse of superficial extensor muscles of forearm and wrist
Pt has lateral epicondylitis |
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which organism is responsible for the plague?
aka? vector? disease? |
yersinia pestis
black death flea/rodents/prarie dogs (vs. anthrax which is painless) tuleremia |
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translocation in Ewings sarcoma?
pt presents? location on bone? |
T (11,22)
young boy, bone pain, small blue cell malignant tumor diaphysis |
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PP w/ finger joint swelling and "sausage like fingers" and plaques on skin?
what on xray? lab? |
psoriasstic arthritis
"pensil in a cup"-PA -- differ w/ RA (Boutenierre Deformity and Swan-Neck Deformity) increased ESR |
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PP w/ actinomyces israle?
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branching rods, sulfur granules, slow growing mass that eventually evolves into a draining sinus tract
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what is the main reservoir for Borrellia Burgdoferi?
name the stages for lime memory device |
white footed mouse
1) erythema chronicum migrans 2) cardiac and neuro involvement 3) joints, progressive CNS BAKE a Key Lime Pie Bells, arthritis, Kardiac block, Erthema migrans |
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differ pemphigus vulgaris w/ bulous pemphigoid
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Pemphigus - Ig against desmosomes (anti-epithelial cell antibody), + Nikolsky's sign (separation of epidermis upon manual stroking of skin)
BP - IgG against hemisdesmosomes (epidermal basement membrane antibodies are "bellow" epidermis know picture of epidermis |
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what generally gets damaged in a punch?
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metacarpals (experienced first 2, inexperienced 5th) -- good blood supply so heal's rapidly
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A pt w/ RA which hypersensitivity?
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III - subtype is immune complex hypersensitivty
symmetrical joints |
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PP w/ ankylosing spondylitis
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low back pain, stiffness > 3months, can be seen w/ uveitis, chronic inflammation, aortic regurg
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PP w/ nephritic syndrome?
presentation if after strep? |
hematuria, hypertension, oliguria, azotemia (increased BUN), RBC casts in urine
epithelial humps "lumpy bumpy" |
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what is a complication after meningitis has resolved?
|
scarring and decreased absorption of CSF resulting in hydrocephalus
communicating (not obstructive) pg 404 |
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where is the area postrema located?
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in medulla
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stroke arteries?
cause? supply? |
lateral striate
usually long standing hypertension Internal capsule, caudate, putamen and globus pallidum |
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which CN for uvula?
deviated? |
10
contra (lmn) ipsi (UMN) |
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triad for ms?
histo? |
SIIIN - scanning speech, intention tremor, incontinence, internuclear opthalmopalegia, nystagumus
gray plaques of demyelination in the white matter of CNS - lipid laden macrophages |
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cause of dementia in elderely
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Alzheimer, b12 def, thyroid, syphilis, hepatic enchephalopathy
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Name some causes of dementia in the elderly?
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alzheimers, b12 def, thyroid, syphillis, hepatic encephalopathy
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How does lumbar spine stenosis present?
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Lumbar disc degeneration generally in the aged population
Neurologic claudication (pain in butt or back) induced by walking or prolonged standing relieved by rest & forward flexor (pain for anterior things) |
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vertigo for >1 hr
triad? what is the disfunction? |
Meniers
sensorineural hearing loss, equilibrium disturbances, tinnitus the endolymphatic sac - if CN 8 you would have high frequency loss |
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PP w/ right-sided paralysis of face, sensitivity to loud sounds, what might also develop?
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pt has Bell's palsy which is complete loss of facial nucleus, so you need to know the functions of cn7
taste to anterior 2/3 of ipsi tonge and stapedius - dryness of ipsi eye and eyelid closing problems |
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Meyers loop corresponds to which lobe of the brain?
draw eye chart, what would happen in a right temporal lesion? |
temporal which sees upper
L. upper quandranopia |
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Parkinsons memory device on presentation?
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Trap
Tremor @ rest, Rigidity, akensia, postural instability |
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PP w/ pica? aka?
where is the lesion? |
wallengburg syndrome
horseness, ipsi dysphagia, horners (ipsi), contra loss of p&T, dorsal-lateral medulla, nucleus ambiguous, infra cerebellum |
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How does syringomyelia present?
association/ |
weakness in upper extremity, no pain and temp
arnold chiari |
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which nerve in midshaft fracture of humurous?
|
radial
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guillian barre can progress to which respiratory issue?
|
respiratory paralysis, hypoventilation so respiratory acidosis
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which vessell does the supply?
a lesion would cause? |
anterior cerebral
medial sufface of brain contra leg and foot ares of motor and sensory |
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differentiate and name the different types of headaches
|
migrane - unilateral, nausea and aura
tension - bilateral, no aura cluster - unitlateral periorbital pain |
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what is an opiod antagonist?
|
naloxone - used for herioin overdose
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child presents w/ palpable flank and increased catecholmines
histo? oncogene? |
neuroblastoma (willms) - MCC of adrenal tumor in children
small cells in pseudorosette pattern n-myc |
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which anti-seizure drug can cause steven-johnson syndrome?
what is SJS? |
carbamezepine (or lamotrigine)
hypersensitivity erthema multiform w/ mucocutaneous lesions and blisters, systemic fevers, epidermal detachment |
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spina bifida oculta
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tuft of hair
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serotonnin syndrome?
which drug combo? |
fever, tachy, diaphoresis
SSRI: fluoxetine, paroxetine, sertraline, citalopram mao inhibitor - phenylzine (alpha and beta), tranylcypromine (TCP)* |
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schizo's:
<1 month 1-6 mnths >6 mnths |
brief psychotic disorder - usually stress related
schizophreniform schizophrenia |
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what is schizoaffective disorder?
|
schizophrenic psychotic symptoms and bipolar or depressive mood disorder
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differentiate between ilusions, delusions and hallucinations and loose association
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hallucination - perceptions in absence of external stimuli
Illusions - misinterpretations of actual stimuli delusions - false beliefs not shared w/ other members of culture or subculture w/ proof of the contrary loose association - disorders in the form of thought |
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PP w/ all types of sleep disorders, which drug should they take?
time spent in REM what happens time spent |
fluoxetine -they have depresssion
25% - like sex, increased pulse, penile and decreases w/ age |
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what drug is used for + and - symptoms of schizophrenia?
name the others in this category toxicity |
clozapine (atypical antipsychotic)
it's atypical for old closets to quietly risper from a-z: olanzapine, clozapine, quetiapine, risperidone agranulocytosis: severe depression of PMN leukocytes (weekly WBC monitoring) |
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ADHD vs conduct disorder, vs anti-social disorder?
|
b4 age 7 - ADHD (impulsivity)
<18 agression, harm serious violations - conduct disorder >18 anti-social disorder |
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anorexics/bulemics should not take which atypical antidepressent?
why classify anorexia |
bupropion
risk of seizures <85% of bodyweight |
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SSRI's are 1st line for which disorder?
|
depression, anxiety, OCD, eating disorders
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name the eps adverse effects of taking anti-psychotics?
what to give if they can't take atypical? adverse of above? |
how cn after 4 months of therapy - usuallhy irreversible
acute dystonia (4 days) - muscle spasm akinesia (4 days) - parkinsons akathisia (4 wks) - restlessness closapine agranulocytosis |
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how can you tell if someone is in renal failure?
normal? |
elevated creatinine
.6-1.2 |
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drug used for severe gram - infection?
memory device? |
aminoglycosides
"mean" GNATS canNot kill anaerobes gentamycin, neomycin, amikacin, tobramycin streptomycin |
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which drug should not be combined w/ an aminoglycoside?
used for? toxicity? |
cephalosporins? begin w/ ceph or cef
1st line for PeCK (Proteus mirabilis, e.coli, Kleb) nephrotoxicity |
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cause of recurrent bladder infections in young boy?
why not Bruton's? |
vesicouteral reflux (more prevalant than nephroblastoma)
generally lungs, ears, and skin |
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why would a pt who has been vommitting not want to toake celecoxb?
used for? |
person is dehydrated and there is release of angio II celecoxib is a cox-2 inhibitor and can cause renal failure in dehydrated pt's
ra and osteoarthr |
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what is the function of ADH (mechanism)
|
ADH binds to the V2 receptors on the basolateral side of the principle cell and activates the Gs mediated cycic adenosine monophosphate cascade
D - net waters may now occur from the collecting duct lumen to the hyperosmolar in resistance to decrease urine output #28 of renal |
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How might you increase renal blood flow
which renal failure is blocked? |
release prostaglandins @ afferent and efferent to dilate in compensation for when angio II is released (cox 1 or 2 releases prostaglandins)
prerenal |
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renal blood flow equation?
which substance increases RBF? where does it act? |
flow = change pressure/resistance
dopamine = cerebral, cardiac, splanchnic, renal arterioles, brady by reducing resistance and thus increasing RBF |
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how would u know if a pt had intrarenal failure?
w/ WBC casts? Cause? If allergy pt would present? what is urolithiasis? |
fractional excretion of sodium btwen 2-4%
interstitial nephritis (usually allergy to meds) fever, rash, eosinophilia kidney stones - a sign of post-renal |
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how do kidneys respond to increased sodium?
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incrased sodium = volume expansion and increased stretch in baroreceptors located in teh afferent arteriole. The baroreceptors response to increased plasma volume is decreased sympathetic activity producing vasodilation of glomerular afferent arterioles . This increases the GFR whiel decreased sodium resorption in the proximal tubule
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what is the course of the ureters in the female pelvis
memory? |
anterior to the external iliac artery and posterior to the uterine artery (I picked anterior to both, be careful)
"water (ureters) under the bridge (artery, ductus deferens) |
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which property of glomerular basement membrane prevents albumin from being filtered in the urine?
these are lost in which syndrome name the components of the glomerular filtration barrier |
a combo of small pore size and neg. charged pore-forming molecules prevents albumin from being freely filtered in urine
lost in nephrotic syndrome -fenestrated capillary endothelium (size barrier) - fused basement membrane (neg charge) - epi layer consisty of podocyte foot processes |
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pp w/ acidosis and increased anion gap ...name the causes
decrease HCO3- (23 is normal) non-anion gap? |
MUD PILES - methanol, Uremia, Diabetic ketoacidosis, Paraldehyde or Pehnformin, Iron Tabs or INH, Lactic acidosis, Ethylene glycol, salicyclates
metabolic acidois (arrows same) means she is hyperventilating to increase pH diarrhea, glue-sniffing, increased chloremia, renal tubular acidosis |
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which diuretic can decrease intracranial pressure?
what is the site of action? |
mannitol
loop of henle (COLT) |
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which diuretic can decrease calcium excreted by the kidney?
|
hydroclorothiazide (decreases calcium excretion)
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focal nephrotic on biopsy?
|
parts of glomerular tufts <50% of glomerular affected
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how is glucose reabsorbed?
How do they work in Diabetes mellitus |
from the PT by a sodium/glucose contratransport system
they are able to reabsorb all the glucose up to 200 then become staruated and glucose starts to spill into urine at 350mg/dL all xporters are occupied and all filtered is excreted |
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how does BPH impact the kidneys?
name 3 types? |
post renal failure (<350 urine osm)
prerenal -- lack of perfusion of kidney intrinsic renal (dueto acute tubular necrosis from ischemia or toxins) post renal - obstruction of outflow |
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Calculation for urine flow rate
what is freely filtered and neither reabsorbed nor secreted? |
GFR x plasma conc of inulin/urinary inulin concentration = 120 m./min x 1.5mg/ml divided by 50 mg/ml = 3.6mL/min
inulin |
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what is the primary driving force for Calcium reabsorption in thick ascending loop?
|
a functioning sodium-potassium-chloride xporter (Ca++ is reabsorbed in 3 areas in nephron: pt, dt and loop)
DT - PTH PT - coupled to sodium TAL(thick ascending loop) - dependent of the (NKCC) electrogradient |
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what mechanism explains why there are 2 GFR measurements one by measuring inulin and compound x?
|
D - Inulin clearance is an accurate estimate of GFR because it is freely filtered and niether reabsorbed nor excreted in teh nephron. Becuase it overestimates true GFR, compound X must therefore undergo net secretion in the nephron. That is, more compound X is excreted in teh urine than is filtered at the glomerulus. Indeed, it is precisely this mechanism that is repsonsible for the characteristec overestimation of gFR by measuring creatinine clearance
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benefits of HRT?
risks? |
decreased: risk hip fracture, crc, hotflasthes, vaginal atrophy (more estrogen = low osteoclast activity)
increased: risk of breast cancer, stroke, MI, DVT, PE (progesterone is added to decrease risks) |
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hormones in menopause?
risk factors for breast cancer? how does Pagets of breast present? |
low estrogen, increased FSH, increased LH, increased GnRH
nulliparity, early menarche, late menopause, obesity, high fat diet, family history exzematous patches |
