Day 2 Flashcards

1
Q

Does a partial agonist always have a lower maximal efficacy than a full agonist? Does a partial agonist always have a lower potency than a full agonist? (FA15 p246) (FA16 p240) (SU p12-14)

A

Partial agonist – acts on same site as full agonist / BUT lower maximal effect (decreased efficacy) Potency is an independent variable

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2
Q

How is cystic fibrosis diagnosed? (FA15 p84) (FA16 p72) (SU p113) (H p2149)

A
Sweat test : >60mEq/L Cl- on >2 occasions
Genetic testing (when sweat test equivocal)

Can present with contraction alkalosis and hypokalemia (ECF effects analogous to a patient taking a loop diuretic) because ECF H2O/Na losses and concomitant renal K/H wasting.

Increased immunoreactive trypsinogen (newborn screening)

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3
Q

What are the common causes of metabolic acidosis with an elevated anion gap? (FA15 p538) (FA16 p543) (SU p150)

A

Metabolic Acidosis with AG

M: methanol
U: uremia
D: diabetic ketoacidosis
P: propylene glycol
I: INH /iron tablets
L: lactic acidosis
E: ethylene glycol
S: Salicylates (aspirin)
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4
Q

You are conducting a study to determine the reduction in risk of developing a relapsing depressive episode with antidepressant X when compared to a placebo treatment. What is this determination called? What is attributable risk, and how is it calculated? (FA15 p50) (FA16 p34) (SU p395)

A

Relative Risk Reduction vs. Absolute Risk Reduction

**
Absolute risk reduction

Attributable risk = A/(A+B) - C/(C+D)

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5
Q
Given the following clinical situations, classify each as type I, II, III, or IV hypersensitivity. (FA15 p212) (FA16 p204-205) (SU p381)
Asthma exacerbation
Poison ivy dermatitis
Goodpasture syndrome
Arthus reaction
Anaphylaxis
Serum sickness
Autoimmune hemolytic anemia
Liver transplant rejection
Rh incompatibility (erythroblastosis fetalis)
TB skin test (PPD)
A
Type I
Type IV
Type II
Type III
Type I
Type III
Type II
Type IV
Type II
FOUR T's
Type IV
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6
Q

What effect does stress have on adipocytes? (Phys p825)

A

Stress –> Sympathetic activation –> Epi and NE released from adrenal medulla –>
Activation of triglyceride lipase in fat cells –>
Rapid breakdown of TGs and mobilization of fatty acids used by muscles as energy

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7
Q

What is the mechanism of action of leuprolide? (FA15 p596) (FA16 p601) (SU p225)

A

GnRH analog with agonist properties

Agonist = when used in pulsatile fashion

Antagonist = when used in continuous fashion (down regulates GnRH receptor in pituitary –> decreases FSH/LH)

Used for uterine fibroids, endometriosis, precocious puberty, prostate cancer, infertility

“Leuprolide can be used in lieu of GnRH”

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8
Q

A chronic alcoholic with cirrhosis begins to experience a tremor and blurred vision. You suspect that these symptoms might be due to hyperammonemia due to his progressive liver disease. What is another hereditary cause of hyperammonemia? What are some other findings associated with hyperammonemia? (FA15 p106) (FA16 p93) (SU p298)

A
Urea cycle enzyme deficiency 
	Ornithine Transcarbamylase (OTC) deficiency
	- increased ammonia levels
	- orotic acid in blood and urine
	- decreased BUN
	- symptoms of hyperammonemia
		\+tremor
		\+slurred speech
		\+somnolence
		\+vomiting
		\+cerebral edema
		\+ blurred vision

Ammonia accumulation - asterixis, slurring of speech, somnolence, vomiting, cerebral edema, blurring of vision

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9
Q

What features distinguish a thyroglossal duct cyst from a branchial cleft cyst? What is the remnant of the thyroglossal duct? Explain the development of the thyroid gland. (FA15 p312) (FA16 p306) (SU p167-168)

A

Thyroglossal duct cyst – anterior neck mass that moves with swallowing

Branchial cleft cyst – persistent cervical sinus cyst in lateral neck (does not move with swallowing)

Foramen cecum = remnant of thyroglossal duct

Thyroid tissue derived from endoderm
Thyroid diverticulum arises from primitive pharynx –> descends into neck beginning at foramen cecum –>
thyroid remains connected to tongue by thyroglossal duct –>
If duct persists it becomes the pyramidal lobe of thyroid
Parafollicular cells derived from neural crest cells

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10
Q

A 46-year-old schizophrenic woman has been treated with an atypical antipsychotic with good results for several years. Routine labs reveal a precipitous drop in her WBCs. Which drug is this patient likely taking, and how frequently must her labs be drawn to watch for this problem? (FA15 p521) (FA16 p525) (SU p54) (GG p330)

A

Atypical antipsychotic that drops WBC – Clozapine

WBC should be monitored weekly

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11
Q

Atypical antipsychotic that drops WBC – Clozapine

WBC should be monitored weekly

A

Tamoxifen & Raloxifene

SERM (selective estrogen receptor modulators) receptor antagonists in breast and agonists in bone

Other uses –
Osteoporosis

Tamoxifen - risk of endometrial cancer, also “hot flashes”
Both - risk of DVT, PE

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12
Q

How does an anterior shoulder dislocation present differently than a posterior shoulder dislocation? (COA p814-815)
Anterior Dislocation vs. Posterior Dislocation

Arm position
Neurovascular compromise
Classic scenario
Physical exam

A
External rotation
Slight abduction vs. Internal rotation
Adduction
Unable to externally rotate the arm
-----------------------------
Axillary artery
Axillary nerve vs. Unusual to have any neurovascular compromise
-----------------------------
Blow to the arm while abducted, externally rotated, and extended
(blocking a basketball shot) vs. Seizure
Electrocution

Prominent acromion process
Loss of normal roundness of shoulder
Appears more angular vs. Posterior shoulder with BULGE
Anterior shoulder relatively flat

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13
Q

Which primary bone tumor fits each of the following descriptions? (FA15 p401, 428) (FA16 p401, 429) (SU p231, 392)
 Most common malignancy arising within bone
 11;22 translocation
 Soap-bubble appearance on x-ray
 Onion-skin appearance of bone (layers of new bone in periosteum)
 Codman’s triangle (periosteal elevation) on x-ray
 May arise from osteochondroma or appear as a primary tumor
 Anaplastic small cells, aggressive mets, good chemo response
 Most common malignant bone tumor in children

A
Multiple Myeloma
--------------------------
Ewing Sarcoma
--------------------------
Giant Cell tumor (Osteoclastoma)
--------------------------
Ewing sarcoma
--------------------------
Osteosarcoma
--------------------------
Chondrosarcoma
--------------------------
Ewing Sarcoma
--------------------------
Peds: 
	Osteosarcoma

MEMORIZE LAB VALUES IN BONE DISORDERS

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14
Q

A 45-year-old woman receives a kidney transplant and receives cyclosporine as part of her anti-rejection regimen. What is the mechanism of action of cyclosporine? (FA15 p218) (FA16 p212)
(SU p385)

A

Calcineurin inhibitor
binds cyclophilin, blocks T cell activation of NFATc by preventing IL-2 transcription

Less activation of NFATc and less IL-2
Inhibits T cell growth, differentiation, and activation

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15
Q

You are treating a 63-year-old woman with small cell lung cancer who develops SIADH. She becomes disoriented secondary to hyponatremia. Consequently, you rapidly correct the low serum sodium with demeclocycline and water restriction. The patient’s sodium level and disorientation improve, but several days later the patient develops diplopia. What is the cause of this patient’s diplopia?
(FA15 p456) (FA16 p492)

A
Osmotic Demyelination Syndrome = Central Pontine Myelinolysis
	Diplopia
	Dysarthria
	Paralysis
	Locked-in syndrome
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16
Q

What are some of the possible causes of pericarditis? (FA15 p299) (FA16 p294) (SU p91) (R p573)

A
Pericarditis
	Infection (coxsackievirus, TB)
	Neoplasm
	Autoimmune (SLE, RA)
	Uremia
	Cardiovascular (acute STEMI, Dressler syndrome)
	Radiation therapy
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17
Q

A unilateral lesion to the lateral corticospinal tract results in motor deficits ipsilateral to the lesion. Where in the lateral corticospinal tract is the motor innervation to the legs located? (FA15 p469)
(FA16 p472) (SU p33)

A

Legs (Lumbosacral) are Lateral in Lateral corticospinal, spinothalamic tracts

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18
Q

In cystic fibrosis thick, mucous secretions inhibit digestive enzymes, which can lead to malabsorption of fat and fat-soluble vitamins. What are the fat-soluble vitamins? What are the corresponding symptoms of fat-soluble vitamin deficiency? (FA15 p88-94, 361) (FA16 p76-81, 358) (SU p113, 461)

A

D – Rickets in children (bone pain, deformity / osteomalacia in adults (bone pain, muscle weakness) / hypocalcemic tetany
Breast fed infants should receive oral vitamin D
Deficiency is exacerbated by low sun exposure, pigmented skin, prematurity
—————————————
E – Hemolytic anemia / acanthocytosis / muscle weakness / posterior column and spinocerebellar tract demyelination
Fragile RBCs
Muscle weakness
Demyelination of CNS
—————————————
K – neonatal hemorrhage with increased PT & PTT but normal bleeding time
Coagulation factor defects
Osteoporosis
Coronary artery disease

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19
Q

A 22-year-old man recently lost his leg in a tragic accident involving alcohol and heavy machinery. Just prior to discharge, a vigilant nurse informs you that the patient has been very depressed about his lost limb, and she overheard him talking to a friend about just ending his life with his dad’s gun when he gets out of the hospital. What needs to be done? (FA15 p58) (FA16 p42)

A

Assess seriousness of threat

Evaluate risk factors for depression

- Male sex
- Depression	
- Alcohol use
- Organized plan
- Access to gun

If it is serious, suggest that the patient remain in the hospital voluntarily

Patient can be hospitalized involuntarily if he/she refuses

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20
Q

What branchial arch derivative abnormality causes facial abnormalities by affecting Meckel’s cartilage? What cranial nerves are affected in this abnormality? From what germ layers are the branchial arches derived? (FA15 p564-566) (FA16 p568-570) (SU p226-227)

A

1st Arch
Maxillary Process
Mandibular Process
CN V2 and CN V3

Mesoderm – muscles and arteries
Neural Crest - bones and cartilage

KNOW POUCHES, ARCHES, CLEFTS

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21
Q

A 22-year-old man who recently immigrated from a developing country is seen at the county health clinic with a complaint of a chronic but recently worsening productive cough and sinusitis symptoms (e.g., headache). He also mentions to you privately that he and his wife have not been able to have children despite trying for two years. While you note this last complaint, you order a chest x-ray out of concern this man may have TB given his immigration status. The chest x-ray appears backwards on the display, but you realize this man’s heart is actually on the opposite side of his chest. What is the primary defect in this syndrome, and what are the characteristic symptoms/signs? (FA15 p74)
(FA16 p60) (SU p102)

A

Dextrocardia, recurrent respiratory infection, infertility issues

= Kartagener Syndrome (Primary Ciliary Dyskinesia)
immotile cilia due to a dynein arm defect

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22
Q

A mutation in which proto-oncogene is most commonly associated with Hirschsprung disease?
(R p751)

A

RET gene mutation

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23
Q

When screening a population for a particular disease, would you rather have a high sensitivity or a high
specificity? (FA15 p49) (FA16 p33) (SU p16) What test is used to screen for HIV? What test is used to
confirm a positive HIV screen? (FA15 p168) (FA16 p158) (SU p353)

A

High sensitivity

ELISA
Western Blot

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24
Q

How do primary and secondary hyperaldosteronism differ in their effect on plasma renin levels? What
agent is used to treat primary hyperaldosteronism? (FA15 p633) (FA16 p639) (SU p185, 165)

A

1 Hyperaldosteronism – adrenal adenoma, idiopathic adrenal hyperplasia / HIGH ALDO, low renin

2 Hyperaldosteronism – renovascular HTN, JG cell tumor/ HIGH ALDO HIGH RENIN

Hyperaldosteronism
Tx: Spironolactone

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25
Q

Amyloidosis and sarcoidosis are associated with which cardiomyopathy? What are some other
diseases or conditions associated with this cardiomyopathy? (FA15 p296) (FA16 p291) (SU p89)

A

Restrictive or Obliterative Cardiomyopathy
Sarcoidosis
Amyloidosis
Post-radiation fibrosis
Endocardial fibroelastosis
Loffler Syndrome – endomyocardial fibrosis with a prominent eosinophilic infiltrate
Hemochromatosis (also dilated cardiomyopathy)

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26
Q

What does the eustachian (auditory) tube connect? What is its purpose? What drug is commonly
prescribed for eustachian tube dysfunction? (H p248-249)

A

Eustachian (auditory) tube – connects the middle ear to the nasopharynx
Makes the pressure in the middle ear the same as atmosphere pressure
Intranasal steroids to treat

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27
Q

What is the most common renal malignancy in adults? What is the associated gene deletion with this
malignancy? (FA15 p545) (FA16 p550) (SU p163)

A

Renal Cell carcinoma
- hematuria, flank pain, palpable flank mass

gene deletion = Chromosome 3
associated with von Hippel-Lindau syndrome

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28
Q

A pediatric patient presents with a noticeable right flank mass. The patient’s mother also reports
blood in the patient’s urine. What malignancy would be most likely in this scenario? What is the
WAGR complex? (FA15 p546) (FA16 p551) (SU p163)

A
Wilm's Tumor (nephroblastoma)
	2-4 year old with:
	-Flank pain
	-Flank mass
	-Hematuria
WT1 or WT2 mutation on chromosome 11
WAGR complex
	Wilms tumor
	Aniridia (absence of iris)
	Genitourinary malformations
	Retardation mental/motor (WT1 deletion)
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29
Q

A 24-year-old young man is fired from his job, and when explaining the chain of events to his
roommate, he says that “it doesn’t really matter. I didn’t even need that job.” His roommate is
perplexed, wondering how they will pay their rent. Of which immature ego defense could this be an
example? (FA15 p505) (FA16 p509) (SU p59)

A

Denial – avoiding awareness of some painful reality

**
Rationalization – proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame

30
Q

What is the definition of tidal volume, residual volume, and vital capacity? (FA15 p602) (FA16 p610)
(SU p95)

A

Tidal volume – air that moves into lung with quiet inspiration, typically 500mL

Residual volume – air in lung after maximal expiration, cannot be measure on spirometry

Vital capacity – maximum volume of gas that can be expired after maximal expiration

31
Q

What is the difference between mean, median, and mode? What are their relationships in a positively-skewed curve and a negatively-skewed curve? (FA15 p53) (FA16 p37) (SU p19)

A

Mean = average (positively skewed curve, mean > median > mode)

Median = middle number after counting

Mode = most frequent number (negatively skewed curve, mode > median > mean)

32
Q

What foods, typically high in mercury, should be avoided during pregnancy? (R p412)

A

Large fish

- Shark
- Swordfish
- King mackerel
- Tilefish

Mercury causes brain damage

33
Q

When an infant is born and takes its first breath, the lungs expand and create negative pressure that draws blood into the pulmonary circulation. Because the pressure in the pulmonary circulation is lower than that in the aorta, blood preferentially flows into the pulmonary circulation and the ductus arteriosus closes. What other fetal blood vessels are closed in the adult circulation? (FA15 p271)
(FA16 p264) (SU p61-62) (Phys p269-271)

A

Ductus arteriosus
Foramen ovale
Ductus venosus

34
Q

You are rotating with an anesthesiologist and learning to calculate dosages of anesthetics with her. How does the rate of elimination differ between zero-order elimination and first-order elimination? Which type of elimination behaves as though the enzymes responsible for the elimination are saturated? (FA15 p244) (FA16 p238) (SU p14)

A

Zero-order elimination = rate of elimination is constant regardless of target plasma concentration at steady state / constant amount of drug eliminated per unit time
Cp decreases linearly with time
phenytoin, ethanol, aspirin

First-order elimination = rate of elimination is directly proportional to the drug concentration / constant fraction of drug eliminated per unit time
Cp decreases exponentially with time
Most drugs

35
Q

What artery supplies the distal third of the colon? What artery supplies the proximal two-thirds of the colon? From what embryonic structures are the distal third and proximal two-thirds of the colon derived? (FA15 p346) (FA16 p342) (SU p116)

A

Superior Mesenteric Artery (SMA) – proximal 2/3 of colon / EMBRYONIC - Midgut

Inferior Mesenteric Artery (IMA) – distal 1/3 of colon to upper portion of rectum / EMBRYONIC - Hindgut

36
Q

What is the mechanism of action and clinical use for varenicline? (FA15 p518) (FA16 p522) (SU p58) (GG p272)

A

Varenicline – nicotinic receptor partial agonist, and stimulates receptors more weakly than nicotine

Smoking cessation

37
Q

What anticonvulsants are used to treat absence seizures? What anticonvulsants are used to treat status epilepticus? (FA15 p496) (FA16 p500) (SU p44-45)

A

Absence seizures (zone out, no postictal state) – Ethosuximide

Status epilepticus – Benzodiazepines (acute: lorazepam, diasepam) / Phenytoin (ppx)

38
Q

What asthma medication fits each of the following statements? (FA15 p621) (FA16 p628) (SU p106)
Inhaled treatment of choice for chronic asthma

Inhaled treatment of choice for acute exacerbations

Narrow therapeutic index, drug of last resort

Blocks conversion of arachidonic acid to leukotriene

Inhibits mast cell release of mediators, used for prophylaxis only

Inhaled treatment that blocks muscarinic receptors

Inhaled long-acting β2-agonist

Blocks leukotriene receptors

A
ICS (fluticasone, Budesonide)
------------------------------
albuterol
------------------------------
Theophylline
------------------------------
Zileuton
------------------------------
Cromolyn
------------------------------
Ipratropium / Tiotropium
------------------------------
salmeterol / Formoterol
------------------------------
montelukast / zafirlukast
39
Q

Which diuretics are most appropriate for patients with hyperaldosteronism? What are their important side effects? (FA15 p554) (FA16 p558) (SU p164-165)

A

Spironolactone / Eplerenone / Triamterene / Amiloride

Hyper K
Endocrine effects
Androgen antagonist –> gynecomastia in men
Progesterone agonist –> menstrual irregularities in women

40
Q

What is the mechanism of action of neomycin? What are the toxicities with this class of medication? (FA15 p184) (FA16 p174) (SU p441)

A

Neomycin / Gentamicin / Amikacin / Tobramycin / Streptomycin (Aminoglycoside)

Bactericidal: irreversible inhibition of initiation complex through binding of the 30S subunit
Can cause misreading of mRNA
Also block translocation
Require O2 for uptake, therefore ineffective against anaerobes

41
Q

How does flutamide differ from finasteride in relation to mechanism of action and clinical use?
(FA15 p597) (FA16 p603) (SU p223)

A

Finasteride – 5alpha-reductase inhibitor (decreases conversion of testosterone to DHT)
Used for BPH and male-pattern baldness

Flutamide – Nonsteroidal competitive inhibitor at androgen receptors (competitive testosterone receptor inhibitor
Used for prostate carcinoma

42
Q

Which bone is commonly fractured when falling on an outstretched hand, resulting in deep pain in the anatomical snuffbox? (SU p242, 392) (COA p686)

A

Scaphoid

43
Q

What might you observe in a patient who presents to the emergency room with PCP intoxication? (FA15 p519) (FA16 p523) (SU p53)

A

Phencyclidine (PCP) – violent behavior / motor issues / nystagmus / increased pain tolerance / tachycardia / delirium / psychosis / seizure
NMDA receptor antagonist

44
Q

IFN-γ stimulates macrophages and inhibits Th2 cells. What cell type releases IFN-γ? (FA15 p202)
(FA16 p194) (SU p374)

A

Th1 cells secrets IFN-gamma

45
Q

How does the mechanism of action of benzodiazepines differ from the mechanism of action of
barbiturates? What toxicities of barbiturates can be fatal? (FA15 p497) (FA16 p501) (SU p44-45)

A

Barbiturates – facilitate GABA action by increasing duration of Cl- channel opening / decrease neuron firing and increasing duration / contraindicated in porphyria
Side effects - respiratory and cardiovascular depression / CNS depression

Benzodiazepines – facilitate GABA action by increasing frequency of Cl- channel opening / decrease REM sleep

46
Q

What are the symptoms of decompression sickness? (Phys p538)

A
Joint and muscle pain
Neurologic symptoms
	-Dizziness
	-Syncope
	-Paralysis
"The Chokes" -- nitrogen bubbles occlude the capillaries in the lung
	-Dyspnea
	-Pulmonary edema
	-Death
47
Q

A 40-year-old man is beginning to have symptoms of a resting tremor, postural instability, and masklike
(expressionless) facies. What is the antiviral drug that can be used against this disease, and what is
its mechanism of action? (FA15 p500-501) (FA16 p504-505) (SU p46) (GG p614)

A

Parkinsonism

Amantadine (for influenza)
increase release of dopamine

48
Q

A 28-year-old man is being treated with the combination of bleomycin, etoposide, and cisplatin for
metastatic non-seminoma testicular cancer. The patient develops shortness of breath during the
course of treatment. Pulmonary function testing indicates that he has a restrictive lung disease. Which
of the chemotherapy agents is responsible for this restrictive lung disease? Which agent in the above
regimen works by inducing free radicals to interfere with DNA structure? (FA15 p410) (FA16 p410)
(SU p409)

A

Bleomycin – used for tesitcular cancer / Hodgkin lymphoma

Adverse effects - pulmonary fibrosis / skin hyperpigmentation / minimal myelosuppression

KNOW MECHANISM OF ACTION OF CANCER DRUGS

49
Q

A 55-year-old alcoholic is admitted to the hospital for an upper GI bleed. A ruptured esophageal varix
is found to be the cause. What is the preferred medical treatment for this condition? (FA15 p378-379)
(FA16 p374-375) (SU p119)

A

Octreotide – long-acting somatostatin analog (causes vasoconstriction splanchnic vascular bed)

50
Q

A 3-day-old preterm infant delivered at 34 weeks gestation develops neonatal respiratory distress
syndrome (RDS). Which type of pneumocyte is affected in RDS? What is the mechanism that leads to
poor O2-CO2 exchange at the gas exchange barrier in preterm infants with RDS? What structures make
up the gas exchange barrier? How could you increase surfactant production in preterm neonates?
(FA15 p600, 613) (FA16 p607) (SU p96, 101-102)

A

Type II cells – secrets pulmonary surfactant / cuboidal and clustered / proliferate during damage

Sufactant deficiency leads to increased surface tension and alveolar collapse / ground-glass appearance of lung fields
Hyaline membranes impede gas exchange

Gas-Exchange barrier – Type I pneumocytes / Basement membrane of pulmonary capillaries / endothelial cells of pulmonary capillaries

maternal steroids before birth
artificial surfactant to infant

51
Q

What is the antidote for digoxin toxicity? (FA15 p220) (FA16 p214) (SU p68)

A

Digoxin immune Fab fragments (DigiFab)

52
Q

What are some of the circumstances in which information is HIPAA-exempt, meaning that your health information can be shared with another party?

A

HIPAA-exempt information

- Child abuse
- Birth or death
- State mandated reportable illnesses
- Public health disease surveillance
- State sponsored disease intervention activities
- Schools (vaccination status)
53
Q

Hydatidiform mole is the most common precursor of what ovarian germ tumor? What tumor marker is monitored after the dilation and curettage of a hydatidiform mole? (FA15 p580) (FA16 p587)
(SU p211)

A

Choriocarcinoma

Beta-hCG

54
Q

You are reading a research article about the prostate specific antigen test, and it mentions that the PSA blood test is associated with a high false positive frequency. In your own words, explain what false positive means. (FA15 p49) (FA16 p33) (SU p16-17)

A

Person who does not have disease has positive test for disease

55
Q
A young woman complaining of easy bleeding and menorrhagia was referred by her OB/GYN for work-up of her bleeding disorder. Your preceptor tasks you with determining the cause of the patient’s condition. Compare the clinical findings of platelet disorders to those of coagulation factor defects. (FA15 p397) (FA16 p396-397) (SU p268-269)
Bleeding time
PT and PTT
Clinical features
Platelet disorder
Coagulation factor defect
A
Platelet disorder
Bleeding time : prolonged
PT & PTT : normal
Clx: microhemorrhages
	mucous membrane bleeding
	epistaxis
	petechiae
	purpura
	increased bleeding time
	possible decreased platelets
Coagulation factor defect
Bleeding time : normal
PT & PTT : prolonged
Clx: Major hemorrhages
	-Hemarthrosis
	-Intracranial
56
Q

How does MRI differ from CT imaging? (COA p67-70)

A

MRI – no ionizing radiation
-soft tissue: brain, spinal cord, ligaments, cartilage (ACL tear)
Bone = gray

CT – uses ionizing radiation
Bone, blood
Bone = white

57
Q

A 45-year-old woman presents to the ER with complaints of chest pain, a racing heart beat, and dizziness. Examination reveals a heart rate of 120 /minute, blood pressure of 116/74 mm Hg, and 20 respirations/minute. The patient is diaphoretic and anxious. An initial EKG reveals ventricular tachycardia with shifting sinusoidal waveforms. What is this classic EKG finding? What are the possible causes of this patient’s condition? (FA15 p283) (FA16 p277) (SU p69)

A

Torsades de pointes

A: anti-Arrhythmic (class IA, class III)
B: anti-Biotics (macrolides)
C: anti-psyChotics (haloperidol)
D: anti-Depressants (TCAs)
E: anti-Emetics (ondansetron)
58
Q

A patient of yours with recent complaints of weakness, pallor, craving for ice chips and tachycardia has a history of chronic hemorrhoids. What do you immediately suspect is the cause of this patient’s anemia and how do you treat it? (FA15 p390) (FA16 p388) (SU p260)

A

Iron deficiency anemia due to chronic GI blood loss

treat hemorrhoids (???)

**
Iron replacement
Colonoscopy

59
Q

What enzymes do obligate anaerobes lack? (FA15 p121) (FA16 p111) (SU p318)

A

Anaerobes lack catalase and superoxide dismutase –> makes them susceptible to oxidative damage

Generally foul-smelling (short-chain fatty acids), are difficult to culture, and produce gas in tissue (CO2 and H2)

60
Q

What embryological structural abnormalities might account for multiple miscarriages? What structures arise from the paramesonephric ducts? What other name is given to the paramesonephric ducts? (FA15 p567-568) (FA16 p571-572) (SU p196, 201) (R p992)

A

Uterine anomalies
**
Incomplete fusion of paramesonephric ducts –>bicornate uterus

Paramesonephric duct – fallopian tubes / uterus / upper portion of vagina

AKA - Mullerian duct

61
Q

An elderly patient fell and struck his head on a coffee table. His family brought him to the ER. He is currently conscious and at his neurological baseline. Non-contrast CT of the head reveals a crescent shaped radiopacity that follows the contour of the skull crossing suture lines. What type of intracranial hemorrhage might this be and which vessel(s) would be involved? (FA15 p466) (FA16 p469) (SU p29-30)

A

Subdural hematoma

Vessels involved – bridging veins

62
Q

Where is most of the cerebrospinal fluid (CSF) generated? What is the function of CSF? (Phys p746)

A

Choroid plexus (derived from pia matter)

Function

- Suspend the brain
- Homeostatic medium for regulation of pH and electrolytes
- Route for chemical messengers to be distributed in the nervous system
63
Q

A child presents with nephritis, deafness and ocular dysfunction. What is the diagnosis? A gene defect in what type of collagen contributes to the dysfunctions associated with this syndrome? What type of collagen organizes bone, skin and tendons? What type of collagen organizes cartilage?
(FA15 p75, 541) (FA16 p61, 547) (SU p154)

A

Alport Syndrome – mutation in type IV collagen –> thinning and splitting of glomerular basement membrane
“Cant see, Cant pee, Cant hear high C”

STRONG Type I – bone / skin / tendon (bone)
SLIPPERY Type II – cartilage (car2lage)
BLOODY Type III – blood vessels, uterus, fetal tissue, granulation tissue (Ehlers Danlos syndrome: threE D)
BM Type IV – basement membrane / basal lamina / lens

64
Q

A child is noticed to be yellow by a visiting relative, so he was brought to the clinic. His exam revealed jaundice and splenomegaly. The patient’s lab results reveal anemia and spherocytes. What test is used to confirm the diagnosis of hereditary spherocytosis? What findings are associated with hereditary spherocytosis? (FA15 p394) (FA16 p392) (SU p256, 265, 395)

A

Osmotic fragility test

Hereditary Spherocytosis – defect in RBC cytoskeleton proteins (spectrin / band 3 / pallidin / ankyrin)

Microcytic, round, no central pallor
Increased MCH
Increased RDW
Splenomegaly -- extravascular hemolysis
Negative Coombs test

Splenomegaly
Gallstones
Aplastic crisis

65
Q

What is the composition of a nucleosome? Which histone ties nucleosomes together? (FA15 p62) (FA16 p48) (SU p281)

A

Negatively charged DNA loops twice around positively charged (lysine, arginine) histone octamer to form nucleosome
H2A / H2B / H3 / H4 (x2 of each)
Histone H1 ties nucleosomes together

In mitosis, DNA condenses to form chromosomes

DNA and histone synthesis occur during S phase

66
Q

At what positive G force does visual “black-out” occur? Why does this occur? (Phys p531)

A

Visual Black-out == 4-6G

Why? pooling blood down in the abdomen & legs, not enough blood to the heart, insufficient perfusion of the brain

67
Q

The dorsal root ganglion is considered gray matter within the spinal cord. From what embryological derivative are the dorsal root ganglia derived? (FA15 p559) (FA16 p563) (SU p23)

A
Neural Crest (derived from ectoderm)
	PNS and non-neural structures nearby
dorsal root ganglia
cranial nerves
autonomic ganglia
Schwann cells
melanocytes
chromaffin cells of adrenal medulla
parafollicular cells of thyroid
pia and arachnoid
bones of the skull
odontoblasts
aorticopulmonary septum
endocardial cushion

KNOW WHICH PART OF BODY DERIVED FROM ECTODERM, MESODERM, ENDODERM

68
Q

A 40-year-old woman treated with lisinopril for stage I hypertension becomes pregnant. Why are ACE inhibitors contraindicated in pregnancy? What centrally acting α2-agonist is often used to treat hypertension in pregnancy? (FA15 p254) (FA16 p247) (SU p76)

A

ACE inhibitors can cause oligohydronios and renal agensis in fetus
**
1st tri – cardiac &CNS malformations
2nd & 3rd tri – renal problems

HTN in pregnancy – alpha-methyldopa

69
Q

Which complement protein is an opsonin? Which complement protein aids in neutrophil chemotaxis? Which complement proteins form the membrane attack complex? (FA15 p206) (FA16 p199) (SU p370-371)

A

Opsonin – C3b and IgG are the two 1 opsonins in bacterial defense –> enhance phagocytosis / C3b also helps clear immune complexes
Opsonin (Greek) = to prepare for eating

C5a - neutrophil chemotaxis

C5b, C6, C7, C8, C9 –> MAC (membrane attack complex)

70
Q

A 42-year-old obese man presents with a complaint of severe pain in his right knee. He believes he injured it while dancing at his cousin’s wedding last night. You suspect gout. How would you differentiate between gout and pseudogout upon exam of synovial fluid aspirate? (FA15 p430-431) (FA16 p431) (SU p233) (R p1214-1217)

A

Gout
negative birefringence (yellow under parallel light)
needle shaped crystals

Pseudogout
positive birefringence
rhomboid crystals
calcium pyrophosphate