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Drugs that can prolong QT?

Sotalol (beta blocker)
Risperidone (antipsychotics)
Macrolides
Chloroquine
Protease inhibitors (-navir)
Quinidine (class Ia; also class III)
Thiazides

[Some Risky Meds Can Prolong QT]
and lead to torsades de pointes (polymorphic ventricular tachycardia)

hypokalemia
hypomagnesemia
(check electrolytes! IV admin if necessary)

1

Enzymes that obligate anaerobes lack?

superoxide dismutase
(converts superoxide radicals into hydrogen peroxide)

catalase
(converts hydrogen peroxide into water and oxygen gas)

2

Patient with craving for ice chips, weakness, pallor, tachycardia, with history of chronic hemorrhoids?

iron deficiency anemia

pica - craving of nonfood substances like ice chips

3

Antidote for digoxin toxicity?

Digoxin immune Fab

4

Bicornuate uterus results from what process?

results from INCOMPLETE fusion of the paramesonephric/Müllerian ducts.
Can lead to anatomic defects, leading to recurrent miscarriages.

also called a "heart-shaped" uterus - composed of two "horns" separated by a septum

(Complete failure of fusion leads to double uterus and vagina.)

5

Hyatidiform mole is the most common precursor of what ovarian germ tumor? What tumor marker is monitored after D&C of mole?

Choriocarcinoma (malignant tumor composed of cytotrophoblasts and syncytiotrophoblasts -- mimics placental tissue but villi are absent)

Monitor hCG levels to ensure adequate mole removal and screen for choriocarcinoma development.

Two pathways of choriocarcinoma:
- germ cell tumor (NO association with gestation; poor chemo response)
- complication of pregnancy/gestation (molar pregnancy, spontaneous abortion, post-normal pregnancy; responds well to chemo)

6

Polymorphic V-tach, shifting sinusoidal waveform, variable amplitude V-tach?

torsades de pointes

7

MRI vs. CT?

MRI - no ionizing, visualize soft tissues, caution with metal, bone is GRAY

CT - ionizing radiation, bone detail, recognition of blood, bone is WHITE

8

What structures arise from the paramesonephric ducts? What's another name for these ducts?

Müllerian ducts:
- Fallopian tubes
- Uterus
- Upper portion of vagina

9

Definition of first-degree heart block? Symptoms?

prolonged PR interval >200ms (five little boxes/one big box), asymptomatic

10

IgG autoantibodies against desmosomes? Difference between desmosome and hemidesmosomes?

Desmosome - keratin interactions between cells
Autoantibodies result in pemphigus vulgaris

Hemidesmosome - keratin in basal cells connected to underlying BM
Autoantibodies result in bullous pemphigoid

11

Delirium vs. dementia?

Delirium - acute onset of "waxing and waning" level of consciousness; usually secondary to acute illness and usually reversible

Dementia - gradual/slow decline in intellectual ability or "cognition" without affecting consciousness
NOT associated with acute illness, usually irreversible

12

18yo delayed onset of puberty, small penis/testicles, lack of facial, pubic, and underarm hair; also no sense of smell (anosmia)?

Kallmann syndrome
defective migration of GnRH cells and formation of olfactory bulb
decreased GnRH synthesis in hypothalamus, decreased GnRH, FSH, LH, testosterone, sperm count

13

Blood flow into thyroid? out of thyroid?

Flow IN:
- superior thyroid artery from external carotid
- inferior thyroid artery from thyrocervical trunk

Flow OUT:
- superior thyroid vein
- middle thyroid vein
- inferior thyroid vein

14

Lesion of what causes coma?

Reticular activating system of midbrain

15

What is Virchow's triad? Homan's sign?

Virchow's triad: stasis, hypercoaguability, endothelial damage

Homan's sign: calf pain upon dorsiflexion of foot

16

What enzyme catalyzes the rate-limiting step of cholesterol synthesis? What class of drugs inhibits this enzyme?

HMG-CoA reductase, inhibited by statins

17

Where does benign prostatic hyperplasia arise from in the prostate? Where does prostatic adenocarcinoma usually arise from?

BPH characterized by smooth, elastic, firm nodular enlargement of the periurethral (lateral and middle) lobes.
smooth, symmetric, enlarged

Adenocarcinoma usually arises from the posterior lobe (peripheral zone) of the prostate gland.
asymmetric, hard nodule

18

Which adrenergic antagonists are used to treat HTN as well as urinary retention in pts with benign prostatic hyperplasia?

alpha1-antagonists (terazosin and tamsulosin) cause relaxation of the smooth muscle

19

What is the difference between agenesis and aplasia? What is oligohydraminos due to?

Agenesis - absent organ due to absent primordial tissue
Aplasia - absent organ despite presence of primordial tissue
Hypoplasia - incomplete organ development; primordial tissue present

20

What cancers produce EPO as their paraneoplastic syndrome?

renal cell carcinoman
hemangioblastoma
hepatocellular carcinoma
pheochromocytoma

21

ADH paraneoplastic sydnrome?

small cell lung cancer
intracranial neoplasms

22

Complement deficiency associated with: Neisseiria? frequent pyogenic resp. infections? paroxysmal nocturnal hematuria? type III sensitivity?

Neisseiria: C5-C9
pyogenic: C3
PNH: CD55 or 59 - decay accelerating factor
increased frequency of type III sensitivity (glomerulonephritis): C3

23

Pt can't extend the wrist for 3 days, fell asleep with arm draped over chair 4 days ago - what does he have?

Radial nerve neuropathy - Saturday night palsy

24

Does regeneration happen in the CNS? PNS?

Schwann cells secrete growth factor that allows regeneration; oligodendrocytes secrete inhibitory factor

1-2mm per day growth in the PNS

25

Pt with "skip" lesions (discontinuous areas of focal narrowing) and "string" sign (significant narrowing) in the terminal ileum? Treatment?

Crohn's disease
also transmural inflammation and cobblestone appearance

Treatment:
- 5-ASA (salicylates)
- glucocorticoids
- azathioprine
- 6MP
- infliximab, adilumab

26

Night terrors, sleepwalking, enuresis phase of sleep? Treatment?

Stage N3 (delta waves)

Benzodiazapenes get rid of this stage!

27

What causes traveller's diarrhea?

ETEC (E. Coli) - watery diarrhea!!

28

2's of Meckel's diverticulum?

- 2 inches long
- within 2 feet of the ileocecal valve
- 2% of the population
- presents in first 2 years of life

29

Most common renal malignancy? Associated gene deletion?

Renal cell carcinoma
(presents as flank pain, palpable flank mass, hematuria)

Gene deletion on chromosome 3 (sporadic or inherited as von Hippel-Lindau syndrome)