April 4

Question 1

Aortic dissection presentation

Answer 1

Classic presenting symptom is tearing chest pain radiating to back and widened mediastinum on chest pain. There can be BP differential between arms and BP can be high or low.

If involves aortic root, can see aortic regurg or pericardial effusion/tamponade.

If involves aortic arch, can see stroke, Horner syndrome, vocal cord paralysis due to compression of recurrent laryngeal nerve, which runs under the aorta

Question 2

Ibutilide

Answer 2

Class III antiarrhythmic

Question 3

Actinic keratosis gross pathology

Answer 3

Scaly plaque

Question 4

SCC gross pathology and risk factors

Answer 4

Gross: Ulcerated, nodular mass, classically involving lower lip

Risk factors: immunosuppression, arsenic poisoning, chronic inflammation

Question 5

BCC gross and micro

Answer 5

Gross: elevated nodule with central ulcerated crater. Surrounded by dilated vessesl (telangiectasias). Classically on upper lip.

Micro: Nodules of basal cells with peripheral palisading

Question 6

Seborrheic keratosis micro

Answer 6

Circular spaces with abundant pink keratin, proliferation of keratinocytes

Question 7

Herniation: which nerve root

Answer 7

Posterolateral disc herniation most common: affects nerve root below (L4-L5 herniation affects L5 nerve root)

Foraminal herniation affects nerve root above (L4-L5 herniation affects L4 nerve root)

Question 8

Precontemplation vs contemplation

Answer 8

Precontemplation: not yet acknowledging that there is a problem behavior
Contemplation: acknowledging a problem but not yet ready to make a change

Question 9

Theophylline

Answer 9

Phosphodiesterase inhibitor that increases cAMP leading to bronchodilation to treat asthma.

Narrow therapeutic index drug thtat is cardiotoxic and neurotoxic. OD treated with cardioselective beta blocker

Question 10

Ipratropium

Answer 10

Competitive muscarinic antagonist. Prevents bronchoconstriction in asthma and COPD.

Question 11

Montelukast

Answer 11

Blocks leukotriene receptors. Good for aspirin-induced asthma

Question 12

Zafirlukast

Answer 12

Blocks leukotriene receptors. Good for aspirin-induced asthma

Question 13

Zileuton

Answer 13

Blocks 5-lipoxygenase, preventing formation of leukotrienes. Used for asthma

Question 14

Digitalis/anti-arrhythmic interaction

Answer 14

Quinidine blocks digitalis clearance and displaces digitalis from binding sites

Question 15

Anti-psuedomonal cephalosporin

Answer 15

Ceftazidime

Question 16

Isoproterenol

Answer 16

Agonist at beta1 and beta2 receptors

Question 17

Dobutamine

Answer 17

Beta1 agonist

Question 18

Norepinephrine

Answer 18

Dominantly alpha agonist

Question 19

Phenylephrine

Answer 19

Alpha agonist

Question 20

Pseudoephedrine

Answer 20

Alpha agonist

Question 21

Terbutaline

Answer 21

beta agonist used in obstetrics to decrease contractions

Question 22

Ritodrine

Answer 22

beta agonist used in obstetrics to decrease contractions

Question 23

Clonidine

Answer 23

Alpha2 agonist, decreases sympathetic tone

Question 24

Methyldopa

Answer 24

Alpha2 agonist, decreases sympathetic tone

Question 25

Amphetamine

Answer 25

Blocks reuptake and promotes release of norepi

Question 26

Ephedrine

Answer 26

Promotes release of NE

Question 27

Treatment of cocaine intoxication

Answer 27

Benzos, no beta blockers

Question 28

Phentolamine

Answer 28

Blocks alpha1 and alpha2 receptors. USed for MAOi tyramine reaction

Question 29

Musc agonist effect on BP

Answer 29

Indirect effect: activate guanylate cyclase, decreasing Ca++ leading to vasodilation

Question 30

Bethanechol

Answer 30

Muscarinic agonist.

Question 31

Methacholine

Answer 31

M agonist, used to cause bronchoconstriction and test for asthma

Question 32

Pilocarpine

Answer 32

M agonist, used to decrease IOP

Question 33

Carbachol

Answer 33

M agonist, used to decrease IOP

Question 34

Myasthenia gravis exacerbation

Answer 34

Two causes 1) insufficient AChE dose 2) cholinergic crisis: too much AChE making NMJ refractory Give edrophonium to distinguish

Question 35

M receptor effect on sweating

Answer 35

Agonists increase sweating | Antagonists decrease sweating, increasing temp leading to reflexive flushing of skin

Question 36

Pralidoxime

Answer 36

Regenerates AChEI

Question 37

Benztropine

Answer 37

Anti-M for PD

Question 38

Scopolamine

Answer 38

Anti-M for motion sickness

Question 39

Oxybutynin

Answer 39

Anti-M for overacitive bladder

Question 40

TRAP

Answer 40

Marker of B cell neoplasms

Question 41

Cluster hedache

Answer 41

Severe headache, lacrimation, conjunctival injection, ptosis, congestion, abortive O2 therapy

Question 42

I cell disease

Answer 42

Defective phosphotransferase - can't phosphorylate mannose so golgi doesn't recognize mannose-6-phosphate on hydrolase enzyme and traffic it to lysosome and it instead gets secretd. Without hydrolase, lysosomes fill up with stuff that can't be degraded Presents iwth dev delay, club foot, joint contractures, hernias, coarse facial features, gingival hypertrophy, hoarse voice

Question 43

Diffuse vs perfusion limited gases

Answer 43

CO: diffusion limited NO: perfusion limited O2: normally perfusion limited; becomes diffusion limited during excercise