Qbank - 6/12/2012

Front 1

elevated acetylcholinesterase levels on 25 week amniocentesis?

Back 1

Neural Tube defect (4th week)
also alpha-fetoprtns are raised

Front 2

light microscopy shows neurons w/shrunken nuclei, no detectable nissl substance, & intensely eosinophilic cytoplasms
these findings indicate?

Back 2

irreversible damage
this is a red neuron (12-24 hours) characterized by: -shrinkage of the cell body, -pyknosis of the nucleus, -loss of Nissl substance, and -eosinophilic cytoplasm

Front 3

pt in status epilepticus, IV benzos started
what is started IV concurrently to prevent recurrence?

Back 3

phenytoin

Front 4

8 yo male w/hx recurrent pulm infections has unsteady gait, "eyes don't move steadily", has numerous superficial blanching nests of distended capillaries on sun-exposed areas, gene defect?

Back 4

Ataxia telangiectasia
ATM gene involved in DNA break repair, immunodeficiency relates to IgA
classic triad: -cerebellar ataxia, telangiectasia, increased sinopulmonary infections

Front 5

MC location of acoustic neuroma? Sx of unilateral CN V & VII involved?

Back 5

cerebellopontine angle
between cerebellum & lateral pons

Front 6

where (physically identify) is post-chemo nausea mediated?

Back 6

chemoreceptor trigger zone
area postrema of the dorsal medulla, near the 4th ventricle

Front 7

what nerve innervates salivary secretion from submandibular & sublingual gland?

Back 7

parasympathetics from superior salivatory nucleus
carried on CN VII via chorda tympani (taste)

Front 8

what nerve innervates salivary secretion from parotid gland?

Back 8

CN IX

Front 9

what is the space constant? What changes it?

Back 9

measure of ability of impulse to travel down an axon, low space constant decreases length impulse will travel
decreased by demyelination

Front 10

med recommended for motion sickness prevention? Main SE?

Back 10

Antimuscarinics & antihistamines-with antimuscarinic action are most effective
warn of dry mouth (& other such): ex - scopolamine, or meclizine & dimenhydrinate

Front 11

how does NDMA relate to morphine tolerance?

Back 11

activation of NMDA receptors by glutamate is believed to enhance morphine tolerance by increasing phosphorylation of opioid receptrs, increasing nitric oxide levels
ketamine

Front 12

what is serotonin precursor?

Back 12

tryptophan

Front 13

how do you tx serotonin syndrome?

Back 13

Cyproheptadine
anti-histamine w/antiserotonergic properties

Front 14

motile gram positive rods w/beta hemolysis?

Back 14

Lysteria
cell mediated immunity is necessary to eliminate

Front 15

hypertensive crisis following cheese or wine?

Back 15

MAO inhibitor (eg phenelzine)
prevent tyramine from being degraded by gut & it gets systemic

Front 16

how do beta blockers effect glaucoma?

Back 16

decrease aqueous humor production by CILIARY EPITHELIUM

Front 17

lady on lithium for bipolar develops involuntary movements, ataxia, & tremor acutely worsening over past 2 days, fell down getting gup from a chair
started new BP med in last 2 months, has resting tremor & difficult balance, what was BP med?

Back 17

Hydrochlorothiazide
she has lithium toxicity - lithium is exclusively excreted by kidneys, thing altering kidney fxn can cause this

Front 18

MC antibiotic for prophylaxis of n. meningitidis in close contacts?

Back 18

Rifampin

Front 19

44 yo man recently dx w/AIDS following PCP, c/o pain in arms & legs, PE - irregular unequal pupils that do not respond to light, do constrict
romberg sign positive, DTRs absent - what is causing neuro sx?

Back 19

Tabes dorsalis
found in neurosyphillis (AIDS or immigrants) - affects dorsal columsn & dorsal roots of spinal cords - loss of position, vibration, & pain sensation
argyll-robertson pupil is characteristic

Front 20

tell me about neurosyphillus signs?

Back 20

Argyll robinson pupil
TABES DORSALIS - dorsal columns & roots of spinal cord affected - loss of position, vibration, & pain sensation

Front 21

pt w/NF1 (what is eponym for this?) found to have "rubbery cutaneous tumors on his neck", what cells comprise these? Orginiated from what embryologic tissue?

Back 21

Schwann cells, from neural crest
eponym is "von Recklinghausen's dz"

Front 22

random ass associations of carpal tunnel syndrome?

Back 22

fluid retention (renal failure, hypothyroidism, pregnancy)
diabetes mellitus, acromegaly, rheum arthritis
and ofc chronic repetitive stress

Front 23

lady on dialysis develops carpal tunnel syndrome?

Back 23

dialysis associated amyloidosis
w/long hx hemodialysis may develop beta-microglobulin deposition

Front 24

PE maneuvers useful in carpal tunnel syndrome?

Back 24

Tinel's sign - sx reproduced by tapping on flexor surface of wrist
Phalen's sign - sx occur after flexion of wrist

Front 25

lead poisoning - enzymes inhibited & substances built up, useful for testing?

Back 25

ALA dehydratase & ferrochelatase are enzymes in heme biosyntheitc pathway inactivated by lead
ALA and protoporphyrin IX accumulate
production of heme is decreased --> microcytic anemia (2nd to lack of Hb)

Front 26

defect in uroporhyrinogen I synthase?

Back 26

Acute intermittent porphyria

Front 27

defect in uroporhyrinogen decarboxylase?

Back 27

porphyria cutanea tarda
MC porphyria

Front 28

vomiting, lethargy
diaper smells like "burned sugar"? How to manage?

Back 28

Maple Syrup Urine Dz (branched chains)
restrict diet, give thiamine supplementation

Front 29

what is characterized by ANA? If this is drug induced, what 2 drugs are MC? What lab feature is absent in drug induced version?

Back 29

DILE (drug induced lupus erythematosus)
Procainamide & hydralizine highest risk
unlike w/SLE anti-dsDNA antibodies rarely seen

Front 30

cause of death in TCA overdose? Mediated how?

Back 30

refractory hypotension (inhibition of peripheral alpha-1 receptors) & CARDIAC arrythmias (inhibition of fast Na channels in cardiac myocytes)

Front 31

appetite suppressing drugs? Caused sudden death, what cardiac abnormality do you find?

Back 31

fenluramine or phentermine
find RV hypertrophy b/c they cause increased incidence of pulmonary HTN

Front 32

how does silicosis predisopse to tuberculosis?

Back 32

impairs macrophage killing

Front 33

how does LV hypertrophy lead to pulmonary hypertension?

Back 33

reactive vasoconstriction secondary to pulmonary venous congestion

Front 34

congenital defects associated w/fetal alcohol syndrome?

Back 34

MCC mental retardation
assoc w/VSD, brain defects (micro/holoprosencephaly) & abnormal facies (short palpebral fissures, long smooth philtrum)

Front 35

as dopamine dose increases, receptors are agonized in what order?

Back 35

D1 > B1 > A1

Front 36

during strenuous exercise what is the major limiting factor for coronary blood flow?

Back 36

duraiton of diastole

Front 37

seizures occuring in the morning, aggrevated by sleep deprivation
never lost conciuosness, sudden-onset arrhythmic jerking movements - type? Tx?

Back 37

Myoclonic seizures
1st line tx is Valproic acid

Front 38

does carotid baroreceptor fireing increase or decrease w/carotid body massage?

Back 38

increase
low pressure environments result in decreased firing freq

Front 39

23 yo male w/sudden heart palpitations
HR 160 BP 110/70 - what is it? Tx?

Back 39

PSVT, carotid body massage

Front 40

65 yo pt on multiple meds for HTN presents w/disturbed color vision, anorexia, nausea, vomiting, & diarrhea - what med toxicity? What is another common toxicity not listed here?

Back 40

Digoxin (changes in color vision)
could see arrhythmia

Front 41

infant born to 25 yo IV drug users develops prominent oral thrush, interstitial pneumonia, & severe lymphopenia during 1st year life - what would have prevented this condition?

Back 41

baby has HIV
viral enzyme inhibitor would have helped

Front 42

ornithine transport into mitochondria is essential for what function? If this process is deficient how should it be managed?

Back 42

urea formation
protein restriction (inside mitochondria ornithine --> citrulline via ornithine transcarbamoylase, carrying NH4+ out of mitochondria into cytosol)

Front 43

which mycobacterial agent requires an acidic pH?

Back 43

Pyrazinamide, thus it is the best of the options for intracellular
the otehrs work better extracellularly

Front 44

mucicarmine staining of lung tissue in immunocompromised pt w/cough & chest pain, turns red?

Back 44

Cryptococcus neoformans