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What are the positive symptoms of schizophrenia (adding a symptom)? What are the negative symptoms of schizophrenia (removing a normal finding/trait)? (FA15 p509) (FA16 p514)

Diagnosis requires 2 or more of the following (first 4 are “positive symptoms”):
􏰂 Delusions
􏰂 Hallucinations—often auditory
􏰂 Disorganized speech (loose associations)
􏰂 Disorganized or catatonic behavior
􏰂 “Negative symptoms”—flat affect, social
withdrawal, lack of motivation, lack of speech or thought


What is HIPAA?

Health Insurance Portability and Accountability Act


Describe the anatomy of the femoral sheath. When placing a femoral line for central venous access, you palpate a femoral pulse. Where do you place the guide needle in relation to this pulse: medially or laterally? (FA15p350)(FA16p347)

femoral sheath contains femoral vein, artery and femoral canal (contains deep inguinal LNs) *no femoral nerve* ("venous near the penis"

general organization lateral to medial: NAVeL:
Femoral nerve, artery, vein, empty space, lymphatic
-guide needle in medially to pulse


Which area of the brain is damaged in Klüver-Bucy syndrome? What are the symptoms of Klüver-Bucy syndrome? (FA15 p461) (FA16 p464)

bilateral amygdala
disinhibited behavior: hyperphagia, hyperorality, hypersexuality, hyperdocility
-assoc. with HSV1


What long-term complication is associated with having to receive multiple blood transfusions? (FA15 p399)

Blood transfusion risks include infection transmission (low), transfusion reactions, *iron overload* (can lead to hemosiderosis or hemochromatosis), hypocalcemia (citrate is a Ca2+ chelator), and hyperkalemia (RBCs may lyse in old blood units).


What are Cheyne-Stokes respirations?

cyclic respiration
repeating cycles of apnea and hypercapnia with a compensatory phase of hyperventilation and hypocapnia


Which type of immunodeficiency disorder is caused by DiGeorge syndrome? (FA15 p214) (FA16 p208) Development of which branchial pouches is affected in DiGeorge syndrome? (FA15 p566) (FA16 p570)

Thymic aplasia; recurrent viral/fungal infections due to T-cell deficiency

3rd and 4th pharyngial pouches


What drugs and endogenous hormones regulate the secretion of gastric acid? (FA15 p353-354) (FA16 p350-351)

^ by gastrin, histamine, ACh
decreased by somatostatin, secretin, GIP (glucose-dep. insulinotropic peptide), prostaglandin
drugs that decrease: PPIs, H2 blockers, Octreotide


The E4 variant of Apo E is a known risk factor for Alzheimer’s disease. What is the primary function of each of the following major apoproteins? (FA15 p115) (FA16 p104)
Apo A-I
Apo B-48
Apo B-100
Apo C-II

Apo A-I: Activates LCAT
Apo B-48: Mediates chylomicron secretion from enterocytes
Apo B-100: Binds LDL receptor
Apo C-II: Lipoprotein lipase (LPL) cofactor
ApoE: Mediates remnant uptake (Alz. disease)


Name five or more drugs that inhibit acetylcholinesterase. What is the clinical application for each?
(FA15 p250) (FA16 p244)

Donepezil, galantamine, rivastigmine (Alzheimer's disease)
Edrophonium (Tensilon test: dx myasthenia gravis)
Neostigmine: reversal of NM junction blockade (postop/neurogenic ileus and urinary retention, myasthenia gravis
Physostigmine (atropine OD)
Pyridostigmine (txmyasthenia gravis)
Echothiophate (tx open angle glaucoma)


Clavulanic acid, sulbactam, and tazobactam aid penicillins in their activity against bacteria through what mechanism? (FA15 p181) (FA16 p171)

inhibit β-lactamase/penicillinase


Which bacteria are most commonly responsible for sialadenitis? What condition most commonly predisposes a patient to sialadenitis? (SU p119)

(inflammation/infection of salivary gland)
S. aureus and Viridans strep
most commonly secondary to stone obstruction of salivary gland duct (sialolithiasis)


Membranous glomerular diseases involve thickening of which structure? (FA15 p540) (FA16 p544)

Thickening of glomerular basement membrane (GBM) i.e. membranous nephropathy


An 88-year-old man arrives at the ER after he fell and struck his head. He has a history of atrial fibrillation for which he takes warfarin. Noncontrast CT of the head reveals subarachnoid hemorrhage. What is the antidote for warfarin anticoagulation or warfarin overdose? For heparin overdose? (FA15 p257, 406) (FA16 p251, 406)

warfarin: vitamin K+ (delayed), FFP (immediate)
heparin: Protamine sulfate


What important secretory products are secreted from each of the following cells of the GI tract? (FA15 p353-354) (FA16 p350-351)
G cells
I cells
S cells
D cells
K cells
Parietal cells
Chief cells

G cells: gastrin (antrum)
I cells: cholecystokinin (CCK) (duodenum, jejunum)
S cells: secretin (duodenum)
D cells: somatostatin (pancreatic islets and GI mucosa)
K cells: GIP
Parietal cells: intrinsic factor, HCl
Chief cells: pepsin


You recommend that your patient, a 51-year-old woman, begin taking a calcium and vitamin D supplement in order to prevent osteoporosis. What are the steps in the conversion of vitamin D to its active form in the body? By what mechanism does vitamin D help prevent osteoporosis? (FA15 p319) (FA16 p313)

D3 from sun exposure in skin. D2 ingested from plants. Both converted to 25-OH (calcidiol) in liver and to 1,25-(OH)2 (calcitriol, active form) in kidney.

^􏰄absorption of dietary Ca2+ and PO43−.
^􏰄bone resorption-->^􏰅􏰄Ca2+ and PO43–.


A child arrives at the ER in hypotensive shock after taking his dad’s phenoxybenzamine. The intern on call orders the nurse to get her a pressor STAT. The nurse informs the intern that there are two pressors available in the ER, epinephrine and phenylephrine. Which one will be able to increase the blood pressure of this pediatric patient? (FA15 p255) (FA16 p248)

phenoxybenzamine: irreversible a-blocker
epinephrine: a and B agonist
phenylephrine: purely a agonist (want this one! do not want to induce B2 induced vasodilation with epinephrine)


What can occur if a MAO inhibitor (MAOI) is added to an SSRI? What is the treatment for this condition? (FA15 p523) (FA16 p527-528)

serotonin syndrome with any drug that 􏰄5-HT (e.g., MAO inhibitors, SNRIs, TCAs)—tremor, hyperreflexia, hyperthermia, confusion, myoclonus, CV instability, flushing, diarrhea, seizures.
tx: stop drugs, give benzos (lorazepam), supportive care
cyproheptadine (5-HT2 receptor antagonist)


What landmarks are used when placing an internal jugular central venous catheter? (COA p1011

triangle between 2 heads of SCM muscle: clavicular head and sternal head
30 degree angle at apex (top) towards nipple, also palpate carotid to ensure not going in it


A patient presents with a 1 cm, painless, mobile mass in her right parotid gland. You inform the patient that most tumors in the parotid gland are benign. What is the most common benign tumor of the salivary gland? What is a Warthin’s tumor? Which cranial nerve goes through the parotid gland? (FA15 p357, 475) (FA16 p353, 479)

most common: Pleomorphic adenoma (benign mixed tumor)—
Composed of chondromyxoid stroma and epithelium and
recurs if incompletely excised or ruptured intraoperatively.
Warthin tumor (papillary cystadenoma lymphomatosum)—benign cystic tumor with germinal centers
CN VII (facial)


What are the most common locations of lung cancer metastases? (FA15 p619) (FA16 p626)

FROM lungs: Sites of metastases from lung cancer: adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatomegaly).

TO lungs: In the lung, metastases (usually multiple lesions)
are more common than 1° neoplasms. Most often from breast, colon, prostate, and bladder cancer.


What are some of the functions of bile produced by hepatocytes and stored in the gallbladder? Which hormone is the most potent stimulator of gallbladder contractions?

-emulsifies large fat particles-->small fat particles
-absorption of fat end-products
-absorption of fat-soluble vitamins
-excretion of bilirubin, copper, cholesterol


What is the characteristic fetal complication associated with lithium use in pregnancy? What other agents used to treat bipolar disorder can be teratogenic, and what are their corresponding fetal effects? (FA15 p560) (FA16 p564)

-lithium: Ebstein anomaly (atrialized right ventricle)
-valproic acid: Inhibition of maternal folate absorption-->􏰅neural tube defects ("Valproate inhibits folate absorption")
-carbamezipine: Facial dysmorphism, developmental delay, neural tube defects, phalanx/fingernail hypoplasia
-aripiprazole/risperidone (atypicals): extrapyramidal symptoms


Which anatomic structures are found in the retroperitoneum? (FA15 p343) (FA16 p339)

"SAD PUCKER" (are so retro)
Suprarenal (adrenal) glands
Aorta and IVC
Pancreas (except tail)
Colon (descending/ascending, not transverse)
Esophagus (thoracic portion)
Rectum (partially)


What are the common causes of Erb-Duchenne palsy? Where is the brachial plexus insult with Erb- Duchenne palsy? (FA15 p419) (FA16 p420)

Infants—lateral traction on neck during delivery
-tear of UPPER (“Erb-er”) TRUNK: C5-C6 roots
-muscle deficits:
Deltoid, supraspinatus-->can't abduct (arm hangs by side)
Infraspinatus-->can't lateral rotate (arm medially rotated)
Biceps brachii-->can't flex, supinate (arm extended and pronated)


A central line is often placed in the subclavian vein to administer fluids and medications or to measure central venous pressure. What landmarks are used when placing a subclavian central line?

thumb on middle 1/3 on clavicle, index finger on jugular notch, insert needle medially below thumb (inferior surface of clavicle) aiming about to tip of index finger


Metastasis to the brain, liver, and bone commonly comes from which locations? (FA15 p240) (FA16 p233)

brain: Lung > breast > prostate > melanoma > GI
(50% of brain tumors from metastases)
liver: Colon >> stomach > pancreas
(Liver and lung are the most common sites of metastasis after the regional LNs)
bone: Prostate, breast > lung, thyroid, kidney
(Bone metastasis >> 1° bone tumors)


Which glycogen storage disease fits each of the following features? (FA15 p110) (FA16 p99)
Severe hypoglycemia with elevated blood lactate
Hypoglycemia without elevated blood lactate
Myoglobinuria associated with exercise

Severe hypoglycemia with elevated blood lactate: Von Gierke disease
Hypoglycemia without elevated blood lactate: Cori disease
Cardiomegaly: Pompe disease ("Pompe trashes the Pump"; heart, liver, and muscle)
Myoglobinuria associated with exercise: McArdle disease


What is the mechanism of organophosphate poisoning? What are the symptoms of cholinergic excess? (FA15 p250) (FA16 p244)

Acetycholinesterase inhibitor, ^^ACh
Excitation of skeletal muscle and CNS, Lacrimation
Sweating and Salivation


What is the treatment for a pulmonary embolism? (FA15 p405, 609) (FA16 p405, 617)

IV Heparin or LMWH:
Immediate anticoagulation for PE, acute coronary syndrome, MI, DVT. Used during pregnancy (does not cross placenta). Follow PTT
antidote: protamine sulfate (positively charged molecule that binds negatively charged heparin).