Qbank - 6/10/2012

Front 1

how does bee sting cause anaphylaxis?

Back 1

cell-surface bound IgE bridging by antigen

Front 2

first contact with an allergen?

Back 2

asymptomatic; induces antibody class switching & reexposure triggers allergic response

Front 3

is it OK for a deaf person to use lip reading for doctor patient communication?

Back 3

No; whenever there is a language barrier use a trained interpreter; this is true for ASL

Front 4

alcoholic w/pneumonia, what bugs? What antibiotic?

Back 4

aspiration pneumonia - anaerobic oral flora
(Bacteroides, Prevotella, Fusobacterium, Peptostreptococcus)
admixed w/aerobic

use Clindamycin to tx - covers anaerobes & also S. Pneumo

Front 5

Vancomycin, Clindamycin, Ciprofloxacin, Cefazolin, Metronidazole for alcoholic w/pneumonia?

Back 5

Use Clindamycin; Vanco, Cipro, Cefazolin do NOT cover ANAEROBES, Metronidazole does NOT cover gram positives

Front 6

56 yo woman on recent cruise, 2 days fever, productive cough, crackle in left lung, lobar consolidation, & diarrhea -- what is it?

Back 6

Legionella; suspect legionella in water supplies - cruise, hotel; cough high fever confusion, diarrhea

Front 7

Characteristic lab finding with legionella?

Back 7

Hyponatremia; 2nd to inappropriate secretion of ADH

Front 8

what is nesiritide?

Back 8

recombinant BNP, used to tx decompensated LV dysfxn --> CHF; BNP activate guanylate cyclase, increase cGMP --> vasodilation, diuresis, decrease BP; COUNTERACT ENDOTHELIN, sympathetics, & AT II

Front 9

what does bradykinin do to the kidney?

Back 9

produced by kidney when adrenergic/RAAS stimulated, locally constricts veins & dilates arterioles --> increse renal perfusion, metabolized by ACE; implicated as cause of angioedema (risk for pts on ACE inhibitors)

Front 10

what does endothelin do to vasculature?

Back 10

vasoconstricts, increases afterload

Front 11

what is the MCC of BP 180/70 in an old man?

Back 11

ISOLATED SYSTOLIC hypertension; decrease in compliance of aorta & its proximal major branches

Front 12

what kind of vision impairment do macular lesions cause?

Back 12

central scotoma; note - neural fibers transmitted macular vision go to different area of the cortex than peripheral vision

Front 13

65 yo w/bilateral visual difficulty progressing over last year;
fundoscopy --> "small yellow retinal lesions clustered in the macula"

Back 13

Macular Degeneration;
progressive loss of central vision due to deposition of fatty tissue (drusen) behind retina (dry MD)
and neovascularization of the retina (wet MD)

Front 14

MCC blindness in ppl over 50?

Back 14

macular degeneration

Front 15

3 mos infant - irritable, feeds poorly, frequently vomits; wt 45% head circ 96%; CT - enlarged ventricles, scattered intracranial calcifications; fundoscopy - white-yellow chorioretinal lesions both eyes

Back 15

Congenital toxoplasmosis (in utero); triad - hydrocephalus, intracranial calcifications, chorioretinitis

Front 16

46 yo female w/subarrachnoid hemorrhage; few days later develops weakness in rt arm & leg?

Back 16

vasospasm; occurs 4-12 days after subarrachnoid hemorrhage,
causes cerebral ischemia - new onset confusion, FOCAL DEFICITS; tx w/nimodipine;

distinguish from rebleed - rebleed CT would show bleeding, focal deficits are characteristic of ischemic insult; vasospasm more common than rebleeding

Front 17

what cells provide major proliferative stimuli for cellular components of atherosclerotic plaques?

Back 17

Platelets; release of PDGF by platelets adherent to areas of denuded vascular endothelium plays important role -

promotes migration of SMC from media to intima & subsequent proliferation

(TGF-beta is also chemotactic for SMC, but not mitogenic)

Front 18

what are cholinomimetics indicaetd for?

Back 18

glaucoma, non-obstructive urinary retention, and paralytic ileus (post abdominal surgery?)

Front 19

pt overdosed an antihistamine and had blurred vision? Why and which antihistamine?

Back 19

antimuscarinic effect; 1st gen antihistamines (H1 blockers) -
diphenhydramine & chlorpheniramine;

easily cross BB and have antimuscarinic, anti-alpha adrenergic, & anti-serotonergic effects

Front 20

what vertebral level is the IVC formed? What level are the renal veins at?

Back 20

IVC forms at L4-L5ish; renal arteries & veins lie ~ L1

Front 21

42 yo man w/exertional dyspnea & progressive fatigue, dies, dilated LV - what caused his sx?

Back 21

decreased ventricular contraction force (NOT impaired LV filling, NOT poor compliance of ventricular walls)

Front 22

what kind of dysfxn occurs w/dilated cardiomyopathy? Hypertrophic? Restrictive?

Back 22

dilated - systolic dysfxn; hypertrophic - diastolic dysfxn; restrictive - diastolic dysfxn

Front 23

9 yo girl w/complex partial seizures, prescribed med, 3 mos later has bone marrow suppression - what med? What MOA? What other adverse effects?

Back 23

Carbamazepine (used for - simple partial, complex partial - generalized tonic-clonic seizures);

blocks voltage gated Na+ channels in neuronal membranes;

can cause: bone marrow suppression, hepatotoxicity, siADH

Front 24

what opioid effects are most resistant to tolerance?

Back 24

constipation & miosis; prophylactically tx pts w/adequate fluid & laxitives when increasing doses

Front 25

extracellular protein deposits in alzheimers?

Back 25

beta-plaques; tau neurofibrillyar tangles are intracellular (counterintuively)

Front 26

why is chloride content of erythrocytes higher in venous than arterial blood?

Back 26

"chloride shift"; activity of Carbonic Anhydrase; venous CO2 diffuses into RBC, converted to HCO3 w/H2O by carbonic anhydrase, exchanged across cell for Cl- (electroneutrality)

Front 27

what is the most common cardiac association w/lupus?

Back 27

pericarditis, occurs in ~50% of pts at some pt

Front 28

pain profile of pericarditis?

Back 28

worse on inspiration, radiates to the back (shoulder blade), alleviated partially by sitting up

Front 29

34 yo woman evaluated for proteinuria & facial rash complains of chest pain?

Back 29

SLE - pericarditis; virtually all SLE pts will have renal involvement, may be asymptomatic in beginning; serous inflammation is common in SLE

Front 30

34 yo alcoholic w/mallory weis tear found down, what is pathophys?

Back 30

metabolic alkalosis from repeated vomiting

Front 31

what med will most likely help the negative sx of schizophrenia?

Back 31

2nd gen/atypical neuroleptic; - clozapine, risperidone, olanzapine, quetiapine (improve both pos & neg sx)

Front 32

what 1st gen antipsychotics are high potency? Which are low potency?

Back 32

high potency - Haloperidol, Fluphenazine, Pimozide
(HFP - high freaking potency);

low potency - chlopromazine, thioridazine
(CT - chill time)

Front 33

high potency vs low potency antipsychotics?

Back 33

high potency - extrapyramidal symptoms; low potency - anticholinergic & antihistamine side effects

Front 34

complications of osmotic diuresis?

Back 34

mannitol; can casue PULMONARY EDEMA - rapid rise in volume increases overall hydrostatic pressure in the vasculature;

use w/caution in high risk pts (CHF, preexisting pulmonary edema);

also - dilutional hyponatremia, metabolic acidosis, hyperkalemia

Front 35

MI associated w/bradycardia?

Back 35

Inferior MI, RCA is often blocked, which supplies the SA node; tx w/atropine to counter decompensation; common side effect is increased intraocular pressure may precipate closed angle glaucoma in susceptible individuals

Front 36

kinesin & dynein are associated w/what cell structural element?

Back 36

microtubules

Front 37

on CT what might be confused for IVC at level of the renal vasculature?

Back 37

lumen of 2nd part of the duodenum, IVC is closer to vertebral bodies, lies anterior & to the right

Front 38

respiratory insufficiency following acute pancreatitis?

Back 38

ARDS - hyaline membranes will be found on autopsy (NOT alveolar destruction)

Front 39

man dies 14 days after MI, what is found on histology?

Back 39

granulation tissue; begins 7 days following ischemia, most prominent days 10-14 post infarction