Mix17

Question 1

The portal triad runs through the hepatoduodenal ligament and is composed of:

Answer 1

hepatic artery, portal vein, common bile duct. The hepatoduodenal ligament is compressed in the Pringle maneuver during repair of traumatic liver injury with heavy bleeding.

Question 2

Why could bosentan be used to help treat pulmonary artery hypertension?

Answer 2

Bosentan is an endothelin R antagonist that blocks the effects of endothelin (vasoconstrictor that stimulates endothelial proliferation)

Question 3

What’s the drug of choice for paroxysmal supraventricular tachycardia?

Answer 3

Adenosine. Slows conduction through AV node by hyperpolarizing the nodal pacemaker.

Can cause flushing, chest burning, hypotension and AV block

Question 4

What are 3 diff ways to treat cyanide toxicity (as from overuse of nitroprusside)?

Answer 4

1. Direct binding of intracellular cyanide ions (hydroxycobalamin)
2. Induction of methemeglobinemia (sodium nitrate)
3. Detoxifying sulfur donors (sodium thiosulfate)

Question 5

___ is a disease characterized by calcification of the rim of the hilar nodes (eggshell calcification) and also ^ susceptibility to TB infection:

Answer 5

silicosis. (Impairs Macs by preventing phagolysosome fusion)

Question 6

Hindgut derivatives include the distal 1/3 of the transverse colon, descending colon, sigmoid colon, and the rectum. These structures receive their blood supply from the ___

Answer 6

IMA.

Question 7

What’s the reason for the urge incontinence in normal pressure hydrocephalus?

Answer 7

Bladder control is achieved by the descending cortical fibers that run in the distended paraventricular area and project to the sacral micturition center. Loss of cortical inhibition (because periventricular white matter is distorted and pulls on the cortical fibers)&raquo_space; development of urge incontinence.

Question 8

Inheritance pattern of osteogenesis imperfecta:

Answer 8

AD. Defective collagen type I

Question 9

Why is potassium citrate prescribed to prevent recurrent Ca2+ stones from forming?

Answer 9

A high urine citrate [ ] has stone preventing effects because citrate binds to free (ionized) Ca2+ , preventing precipitation and facilitating its excretion.

Question 10

Inheritance pattern of sickle cell

Answer 10

AR

Question 11

peau de orange rash is assoc with what type of cancer?

Answer 11

inflammatory breast cancer

Question 12

What would you give to treat adrenal crisis/adrenal insufficiency?

Answer 12

Dexamethasone, along with aggressive fluid resuscitation.

People with adrenal insufficiency can’t produce glucocorticoids in response to acute stress.

Question 13

Anemia in lead poisoning is due to inhibition of what 2 enzymes in the heme synth pathway?

Answer 13

ALA synthase and ferrocheletase

Question 14

What could you give to someone to dissolve cholesterol gallstones in a Pt who doesn’t want surgery?

Answer 14

Hydrophilic bile acids (ursodeoxycholic acid) can be given to improve cholesterol solubility, reduce the amount of cholesterol secreted into bile, and ^^ biliary bile acid [ ]

Question 15

What are the effects of estrogen and progesterone on bile acid secretion?

Answer 15

Estrogen ^ cholesterol secretion while progesterone decreases bile acid secretion&raquo_space; bile to become supersaturated with cholesterol. Progesterone also slows gallbladder emptying&raquo_space; bile stasis/gallstone formation.

Question 16

What are the extrarenal manifestations of autosomal dominant polycystic kidney disease?

Answer 16

Formation of liver cysts and cerebral aneurysms.

Question 17

What role does the “Vi” antigen play in Salmonella infection?

Answer 17

Vi antigen = capsule that prevents opsonization and phagocytosis of the bacteria

Question 18

How does niacin improve hyperlipidemia?

Answer 18

Improves hyperlipidemia by decreasing hepatic synth of VLDL and triglycerides, and increasing synth of HDL.

BUT, it can cause flushing, hyperglycemia, and hepatotoxicity. Niacin can also decrease renal excretion of uric acid&raquo_space; elevated uric acid blood levels and promotion of acute gouty arthritis.

Question 19

Function of ezetimibe in cholesterol mgmt.:

Answer 19

selectively inhibits cholesterol reabsorption at small intestine brush border

Question 20

Does DLCO increase or decrease in emphysema?

Answer 20

DLCO = diffusing lung capacity for carbon monoxide.

Decreases because there is a decrease in alveolar-capillary surface area due to the interalveolar wall destruction.

Question 21

What’s the function of haptoglobin?

Answer 21

serum protein that binds free Hb and causes its uptake by the reticuloendothelial system (RES). Haptoglobin levels decrease when significant quantities of Hb are released into circulation (i.e. intravascular hemolysis)

Question 22

Why is there a “nitrate free period” of the day in Pt taking long term daily acting nitrates?

Answer 22

Want to avoid tolerance. generally scheduled at night when cardiac work is lowest.

Question 23

Why should Pt with G6PD avoid NSAID use?

Answer 23

NSAIDS uncouple Ox-phos and can cause glutathione depletion with subsequent lipid peroxidation&raquo_space; damage in tubular and vascular endothelial cells. Chronic use can cause chronic interstitial nephritis as they concentrate in the renal medulla.

Note: NSAIDS can also prevent prostaglandin synth&raquo_space; constriction of medullary vasa recta&raquo_space; ischemic papillary necrosis

Question 24

Superior sulcus (Pancoast) tumors can cause shoulder pain due to compression of the ___ and Horner’s syndrome (ptosis, miosis, anhydrosis) due to compression of ____

Answer 24

brachial plexus and cervical sympathetic ganglia

Question 25

What would you see on histology of Hashimoto’s?

Answer 25

Intense mononuclear infiltrate consisting of lymphocytes and plasma cells, often with germinal centers. Residual follicles are often surrounded by Hurthle cells (large oxyphilic cells with granular cytoplasm), which represent follicular epithelial cells that have undergone metaplastic change in response to inflammation.

Question 26

Dapsone is an alternative Rx to TMP/SMX and can be used in people with sulfa allergies. What major side effect should you look out for with dapsone use?

Answer 26

Check for G6PD deficiency because dapsone puts oxidative stress on the body. Want to avoid hemolytic anemia.