Ms2 - Test 3 Week 1

Front 1

What are the two common causes of meningitis in neonates?

Back 1

E. coli

Group B Streptococcus (Strep. agalactiae)

Front 2

What is the most common cause of meningitis in infants/children?

Back 2

H. influenzae

Front 3

What is the most common cause of meningitis in adolescents/young adults?

Back 3

Neisseria meningitis

Front 4

What is the most common cause of meningitis in the elderly/debilitated?

Back 4

Strep. pneumoniae

Listeria monocytogenes

Front 5

If a patent presents with fever and lethargy and states he swam in a nasty looking pond a few days ago, what might be the causative agent of his meningitis?

What kind of WBC would you mostly seen in CSF?

Back 5

Naegleria

Eosinophils

Front 6

What are the two common causes of infections of the brain in AIDS patients?

Back 6

Cryptoccocus

Toxoplasmosis

Front 7

In primary hyperaldosteronism, why does ECF volume and Na serum levels remain in the normal reference range?

Back 7

The increased volume caused by aldosterone causes stretch in atria & ventricles = release of BNP = natriuresis

Front 8

What is the drug of choice in the treatment of primary hyperaldosteronism?

Back 8

Spironolactone

Front 9

What is the major contributor for secondary HTN due to renovascular dz?

Back 9

Over activity of RAAS

Front 10

What are the six situations which lead one to suspect renovascular dz as the cause of HTN?

Back 10

HTN develops prior to age 30 or after 50

Sudden worsening of previously benign HTN

Bruits detected over large arteries

Diastolic HTN refractory to medication

HTN w/ accompanied abnormal renal fxn

HTN w/ accompanied unprovoked hypokalemia

Front 11

What is the most common cause of secondary HTN in the US?

Back 11

Chronic Kidney Dz

Front 12

What are the three situations which lead one to suspect chronic kidney dz as the cause of HTN?

Back 12

HTN occuring in the setting of decreased renal function

HTN following recurrent UTI's

HTN in the presence of anatomically small kidneys

Front 13

What are two lab values that may suggest primary hyperaldosteronism?

Back 13

Unprovoked hypokalemia

Metabolic Alkalosis

Front 14

True of False

Pt w/ hyperaldosteronism have low plama renin, low ATN II, and high aldosterone?

Back 14

True

Front 15

If a patient presents with a PAC/PRA ratio of > 50, a brother who died of HTN related hemorrhagic stroke at the age of 14, and metabolic alkalosis, what is the diagnosis?

What is the cause of this dz?

What is the inheritance pattern?

Back 15

Glucocorticoid-Remediable Aldosteronism

Hybrid protein that causes aldosterone synthase activity in the zona fasciculata

Aut. Dominant

Front 16

What is the normal stimulus for increase of aldosterone?

What is the normal stimulus for increase of cortisol in the zona fasciculata?

Back 16

High ATN III & Hyperkalemia


Increased ACTH

Front 17

In "conventional" viral CNS infections, in what two places do you see lymphocytic cuffing?

Back 17

Around Blood Vessels

Virchow-Robin Spaces

Front 18

Herpes Simplex virus mostly affects what part of the brain when it causes an encephalitis?

Where are rabies virus particles usually found in the brain?

Back 18

Mesial Temporal lobe - causing hemorrhage and necrosis

Brainstem & Cerebellum

Front 19

Creutzfeldt-Jakob Disease mostly manifests as what? Where does it mostly affect?

Kuru disease mostly manifests as what? Where does it mostly affect?

Back 19

Dementia, Mostly Cerebrum


Ataxia, Mostly Cerebellum

Front 20

What % of the US gross Domestic product is health care cost?

How many people are uninsured in the US?

Back 20

17.6%

50 million (16%)

Front 21

What are the three criteria for someone to be eligible for medicare?

Back 21

Over the age of 65

Under 65 w/ disabilities

People with ESRD

Front 22

Who does Medicaid cover?

Back 22

Pregnant women

Children & Teens

Aged, blind, other disabilities

Very low income individuals

Front 23

Payments into the Social Security Fund cover what two insurance programs?

Back 23

Medicare

Retirement Benefits

Front 24

What is the most common organism responsible for contamination of contact lens solution?

Back 24

Pseudomonas aueroginosa

Front 25

In primary tuberculosis what is the characteristic pathologic finding?

What is it composed of?

Back 25

Ghon Complex

Ghon focus + enlarged casseous lymph nodes

Front 26

Where do primary tubercolosis Ghon complexes mostly focus to in the lung?

Why?

Back 26

MIddle to lower lobe

B/c site of increased air flow

Front 27

Where does primary TB mostly concentrate in the lung?


Where does secondary TB mostly concentrate in the lung?

Back 27

Lower lobe b/c of increased air flow

Upper lobe b/c site of high oxygen tension

Front 28

True or False

Cavity formation is mostly associated with primary TB

Back 28

False

Mostly secondary TB, which causes increased risk of person-person spread

Front 29

What are the two filtration forces that are clinically relevant in causing compression atelectasis?

Back 29

Capillary hydrostatic pressure (arterial side)

Capillary oncotic pressure (venous side)

Front 30

Normally the pleural space has fluid coming in from?

Going out to?

Back 30

Parietal pleura

Visceral pleura & lymphatics

Front 31

What are the four basic causes of accumulation of fluid in the plueral space (pleural effusion)?

Back 31

Increased hydrostatic pressure (CHF)

Decreased oncotic pressure (liver failure)

Occluded pleural lymphatics (cancer, ID)

Capillary membrane disruption (infection, cancer, ID)

Front 32

If upon doing a thoracentesis the pleural fluid protein/serum prot. ratio < 0.5 & the pleural fluid LDH/serum LDH ratio < 0.6, what kind of process is causing the effusion?

Back 32

Transudate = CHF, liver cirrhosis, hypoalbunemia

Front 33

What are the three major causes of exudative fluid causing a pleural effusion?

Back 33

Trauma

Inflammation

Tumor

Front 34

If a 50 yr old patient presents with shallow breathing, reluctant to change position, & production of viscous secretions after a major surgery, what is the cause of his condition?

Back 34

High-dose supplemental oxygen & anesthesia agents -> absorptive atelectasis

Front 35

What is the most common postoperative complication?

If it occurs less than 48 hours after surgery, what should you suspect?

Back 35

Fever


Atelectasis

Front 36

What are the 4 W's for the cause of sustained fevers after surgery?

Back 36

Wind - Atelectasis (<48 hrs)
Wound - Wound infection (5-7 days)
Water - Urinary infection (5-8 days)
Walk - Thrombophlebitis (7-14 days)

Front 37

What is the major difference between hyperaldosteronism and syndrome of apparent corticoid steroid excess?

Back 37

Hyperaldo = increased Aldosterone

SAME = decreased Aldosterone

Front 38

If a 25 yr old patient comes in with HTN and says that his father and grandfather also had HTN. His lab values are: normal cortisol, hypokalemia, Met. Alkalosis, low Renin, low ATN II, low Aldo. What dz would you suspect?

What is the Tx?

Back 38

Liddle Syndrome

Amiloride & Triameterene
Also lowering Na intake would help

Front 39

What two diseases should you suspect if a patient comes in with a sudden new development of HTN & DM at the same time?

Back 39

Glucocorticoid Excess (Cushing's)

Epinephrien Secreting Pheochromocytoma

Front 40

What does the "rule of ten" in sporadic pheochromocytomas refer to?

Back 40

10% bilateral
10% extra-adrenal location
10% malignant at time of diagnosis
10% occur in children
10% are familial

Front 41

If a 40 yo patient comes in with sporadic spells of blood pressure elevation, a pounding HA, anxiety, and tachycardia w/ pallor & cool distal extremities. What dz would you suspect?

What is causing the pallor?

Back 41

NE secreting pheochromocytoma

Alpha 1

Front 42

What is the classic presentation of a pt. with pheochromocytoma?

Back 42

Spells of BP elevation
Pounding HA
Sweating
Anxiety
Tachycardia that lasts 15-20 min

Front 43

If a 40 yo patient comes in with sporadic spells of blood pressure elevation, a pounding HA, anxiety, and tachycardia w/ sweating & flushing. What dz would you suspect?

What is causing the tachycardia?

What is causing the flushing?

Back 43

Epi secreting pheochromocytoma

Beta 1

Beta 2

Front 44

If a 40 yo pt comes in complaining of having HTN when sitting or laying down, but upon standing up gets hypotensive and passes out. What dz would you suspect

Back 44

NE secreting pheochromocytoma

Front 45

Plasma or urine metanephrine screens for?

Plasma or urine normetanephrine screens for?

Plasma or urine VMA screens for?

Back 45

Epinephrine-secreting tumors

NE-secreting tumors

Both NE and Epi secreting tumors

Front 46

What is the enzyme involved in Glucocorticoid Remediable Aldosteronism?

What is the enzyme invovled in Syndrome of Apparent Mineralocorticoid Excess?

Back 46

11-Beta-Hydroxylase


11-Beta-Hydroxysteroid Dehydrogenase II

Front 47

Why does consuming too much black licorice cause aquired SAME?

Back 47

The glycyrrhetinic acid inhibits 11-Beta-HSD2

Front 48

An increased ratio of cortisol-to-cortisone metabolites in a 24 hour urine collection is a hallmark lab value for what dz?

Back 48

SAME (Syndrome of Apparent Mineralocorticoid Excess)

Front 49

Pheochromocytoma occurs in 50% of patients with what syndrome?

What tumors would you suspect?

Back 49

MEN 2A (Multiple Endocrine Neoplasia)

Medullary carcinoma of the thyroid
Parathyroid adenoma

Front 50

What is the clinical manifestation of SIRS?

Back 50

Temp >38 C or < 36 C

HR > 90

RR > 20 or PaCO2 < 32 mmHg

Decreased WBC count

Front 51

If a pt presents with dyspnea, tachypnea, hypoxemia, decreased lung compliance, & pulmonary infiltrates, what dz do they most likely have?

What are the two major causes of this dz?

Back 51

ARDS

Sepsis & Multiple Trauma

Front 52

What are the clinical risk factors for PE?


What are special risk factors for women?

Back 52

Immobilization, Surgery, Malignancy, Chronic Heart Disease

Obesity, Smoking, HTN

Front 53

Would you expect a high or low V/Q in ARDS?

Would you expect a high or low V/Q in PE?

Back 53

Low V/Q


High V/Q

Front 54

What are the two most common symptoms of a PE?

What are the two most common signs of a PE?

Back 54

Sudden onset dyspnea or sudden death
Pleuritic pain

Tachypnea (70%) and Rales (50%)

Front 55

What are the four major mechanisms leading to secondary pulmonary HTN?

Back 55

Left ventricular failure

Increased pulmonary flow (VSD, PDA)

Obstruction of pulmonary vasc. bed (PE)

Hypoxic vasoconstriction (COPD)

Front 56

What is the most common cause of secondary pulmonary artery hypertension in adults?

Back 56

COPD

Front 57

At what histiologic stage is secondary pulmonary HTN reversible?

At what histiologic stage is secondary pulmonary HTN irreversible?

Back 57

Hypertrophic muscularis


Intimal Fibrosis

Front 58

What are the 5 findings of respiratory distress syndrome?

Back 58

Tachypnea
Nasal flaring
Grunting
Intercostals & subxiphoid retractions
Cyanosis

Front 59

What is difference in the rash between Rickettsia and Typhus?

Back 59

Rickettsia on the wRist (spreads inward)

Typhus on the Trunk (not on palms or soles)

Front 60

What serotype of chlamydia causes the STD?

Back 60

Serotype D-K

Front 61

What organisms are the only bacteria that contain choletserol in their membrane?

Back 61

Mycoplasma

Front 62

What is the leading microbial cause of blindness worldwide?

Back 62

Chlamydia trachomatis serotype A-C

Front 63

How does Chlamydia trachomatis cause inflammation and cell necrosis?

Back 63

T helper 17 -> IL -17

Front 64

What is the only Rickettsia that is not spread by a vector?

How is it spread?

Back 64

Coxiella


Via aerosol

Front 65

If a patient comes in with a fever, a rash that started at the palms and is moving towards the trunk, and a recent tick bite what organism would you suspect?

How is this organism transmitted?

Back 65

Rickettsia rickettssii – Rocky Mt. spotted Fever


Transovarian passage in ticks

Front 66

What bacteria has slow growth on media that contains sterols and looks like a "fried egg"?

What is its major virulence factor?

Back 66

Mycoplasma


Adhesin

Front 67

What test should be ordered if one has a high suspicion of a PE?

Back 67

Spiral CT pulmonary angiogram

Front 68

What is the DOC for asthma prophylaxis?

Back 68

Beclamethasone

Front 69

What are three common causes of the common cold?

Back 69

Rhinovirus - 50%

Coronavirus

Adenovirus

Front 70

What Gram negative coccobacilli that is the most common cause of a cough?

Back 70

Bordetella pertussis

Front 71

What are the three common causes of acute otitis media?

What other dz do these three cause?

Back 71

Strep. pneumonia

H. influenza

Moraxella catarhalis


Sinusitis

Front 72

If a 15 year old comes in with exudative pharyngtitis, a diffuse pruritic maculopapular rash on truck & extremities with NO FEVER, what organism would you suspect?

Back 72

Arcanobacterium hemolyticum

Front 73

What are the four most common causes of atypical pneumonia?

Back 73

H. Influenza

Mycoplasma pneumonia

Chlamydophila pneumonia

Legionella pneumophiliia

Front 74

What are the three common causes of lobar pneumonia?

Back 74

Streptococcus pneumonia

Staphylococcus aureus

Coccidiodes immitis

Front 75

A 50 year old man has ascites from a large hepatic tumor composed of vascular spaces lined by pleomorphic cells that are positive for CD34, CD31 and Von Willebrand factor. What two agents are most likely the cause?

Back 75

Thorotrast

Vinyl Chloride