Day 4 Flashcards
Clavulanic acid, sulbactam, and tazobactam aid penicillins in their activity against bacteria through
what mechanism? (FA15 p181) (FA16 p171) (SU p337)
Beta-lactamase inhibitors – protects antibiotics from destruction by beta-lactamase (penicillinase)
C & A: Clavulanic Acid
S: Sulbactam
T: Tazobactam
Which bacteria are most commonly responsible for sialadenitis? What condition most commonly
predisposes a patient to sialadenitis? (SU p119) (R p743)
Sialadenitis – infection of the salivary glands
**
Staphylococcus Aureus
Viridans Streptococci
Stone obstruction of the salivary gland duct (sialolithiasis)
Membranous glomerular diseases involve thickening of which structure? (FA15 p540) (FA16 p544) (SU
p152, 156)
Thickening of the glomerular basement membrane
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) (SU p271)
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) (SU p117, 119) Source Secretory products G cells I cells S cells D cells Parietal cells Chief cells
G cells : Gastrin --------------------------------- I cells : Cholecystokinin --------------------------------- S cells : Secretin --------------------------------- D cells : Somatostatin --------------------------------- Parietal cells : HCl & Intrinsic Factor --------------------------------- Chief cells : Pepsinogen --> Pepsin for protein digestion
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) (SU p174)
D3 - from exposure to sun, ingestion of fish and plants
D2 - from ingestion of plants, fungi, yeast
Both are converted to 25-OH in liver and to 1,25-(OH)2 in the kidney, which is the active form
Vitamin D increases absorption of dietary Ca++ and PO4—, and thus enhances bone mineralization
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) (SU p77)
Phenoxybenzamine - Irreversible alpha-blocker Epinephrine - alpha-agonist - beta-agonist - will stimulate beta2 receptors on vascular smooth muscle and cause peripheral vasodilation
Phenylephrine
- alpha-agonist - pure alpha-agonist and will not induce beta2-mediated vasodilation
Thus, we want phenylephrine
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) (SU p55)
Serotonin Syndrome
- Tremor - Hyperreflexia - Muscle rigidity (clonus) - Hyperthermia - Diaphoresis - Flushed skin - Agitation - Seizures - Cardiovascular collapse
Tx: Cyproheptadine (5-HT2 receptor antagonist)
Stop serotonergic drugs
Benzos
Supportive care
What landmarks are used when placing an internal jugular central venous catheter? (COA p1011)
Sternocleidomastoid muscle (sternal head / Clavicular head) Clavicle
Place need at apex of triangle at 30 degree angle towards the nipple
Palpate carotid artery that should me medial to the vein
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) (SU p41, 119)
Pleomorphic Adenoma (benign mixed tumor) - MC salivary gland tumor composed of chondromyxoid stroma and epithelium and recurs if incompletely excised or ruptured intraoperatively
Mucoepidermoid Carcinoma – MC malignant tumor, has mucinous and squamous components
Warthin tumor (papillary cystadenoma lymphomatosum) – benign cystic tumor with germinal centers
CN VII (Facial nerve) "To Zanzibar By Motor Car" T: Temporal Z: Zygomatic B: Bucal M: Marginal mandibular C: Cervical
What are the most common locations of lung cancer metastases? (FA15 p619) (FA16 p626) (SU p114)
Adrenals
Brain
Bone
Liver
What are some of the functions of bile produced by hepatocytes and stored in the gallbladder? (Phys p783) Which hormone is the most potent stimulator of gallbladder contractions? (Phys p785)
Functions of bile
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) (SU p58, 397)
Lithiuim use == Ebstein anomaly (apical displacement of tricuspid valve
Carbamazepine
- Neural tube defects - Craniofacial defects - IUGR - Developmental delay - Hypoplastic fingernails
Valproic acid
- Neural tube defects
Aripoprazole / Risperidone (atypical antipsychotics)
- Extrapyramidal symptoms
Which anatomic structures are found in the retroperitoneum? (FA15 p343) (FA16 p339)
SAD PUCKER S: Suprarenal A: Aorta and IVC D: Duodenum (2nd and 4th parts) P: Pancreas (except tail) U: Ureters C: Colon (descending and ascending) K: Kidneys E: Esophagus (thoracic portion) R: Rectum
What are the common causes of Erb-Duchenne palsy? Where is the brachial plexus insult with Erb-
Duchenne palsy? (FA15 p419) (FA16 p420) (SU p238)
Severe traction or tear of the upper portion of the brachial plexus (C5-C6) roots
Infants – lateral traction on neck during delivery (shoulder dystocia)
Adults – trauma
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? (COA
p1008)
Thumb of clavicle, forefinger on sternal/jugular notch
Needle goes rough at the tip of thumb
Metastasis to the brain, liver, and bone commonly comes from which locations? (FA15 p240) (FA16 p233) (SU p50) Brain Liver Bone
Brain: Lung Breast Prostate Melanoma GI
Liver:
COLON
Stomach
Pancreas
Bone:
Prostate / Breast
Lung / Thyroid / Kidney
Which glycogen storage disease fits each of the following features? (FA15 p110) (FA16 p99) (SU p302-
304)
Severe hypoglycemia with elevated blood
lactate
Hypoglycemia without elevated blood
lactate
Cardiomegaly
Myoglobinuria associated with exercise
Von Gierke diease ----------------------------------- Cori Disease ----------------------------------- Pompe disease (type II) ----------------------------------- McArdle disease (Type V) -----------------------------------
***** "Very Poor Carbohydrate Metabolism" V: Von Gierke disease (type I) P: Pompe disease (type II) C: Cori disease (type III) M: McArdle disease (type V)
What is the mechanism of organophosphate poisoning? What are the symptoms of cholinergic
excess? (FA15 p250) (FA16 p244) (SU p402)
Irreversibly inhibit AChE / toxic buildup of too much ACh "DUMBBELSS" D: diarrhea U: urination M: miosis B: bronchospasm B: bradycardia E: excitation of skeletal muscles & CNS L: lacrimation S: sweating (perspiration) S: salivation
TX: atropine (competitive inhibitor) + pralidoxime (regenerates AChE if given early)
What is the treatment for a pulmonary embolism? (FA15 p405, 609) (FA16 p405, 617) (SU p270) (R
p697)
IV Heparin
LMWH
Which cancers can cause the paraneoplastic syndrome Lambert-Eaton syndrome? (FA15 p238) (FA16 p229) (SU p115)
Lambert Eaton Syndrome - antibodies against presynaptic (P/Q-type) Ca++ channels at NMJ
Small Cell Lung Cancer
Hodgkin Lymphoma
Malignant thymoma
What is conductive hearing loss, and what are some causes? (H p248)
Sound is not conducted to the cochlear apparatus
Causes include:
- Wax buildup in ear canal
- Ear infection
- Ruptured TM
- Otosclerosis (abnormal growth of ossicles in the middle ear
vs. Sensorineural hearing loss
What is the most common tumor of the urinary tract? What is the usual presenting complaint of a patient with this tumor? What substance exposures increase the risk of developing this tumor? (FA15 p547) (FA16 p551) (SU p163)
Transitional Cell Carcinoma
Painless hematuria
No casts
"problem in your Pee SAC" P: phenacetin S: smoking A: aniline dyes C: cyclophophamide
What pulmonary artery pressures indicate pulmonary hypertension? (FA15 p614) (FA16 p622)
Pulmonary Artery Pressures >25 mmHg at rest
What conditions are associated with oligohydramnios, and what conditions are associated with polyhydramnios? (FA15 p583) (FA16 p589) (SU p144) What is Potter sequence? (FA15 p526) (FA16 p530) (SU p144)
Polyhydramnios fetal malformations -- inability to swallow amniotic fluid - esophageal atresia - duodenal atresia - anencephaly Association - Maternal diabetes - Fetal anemia - Multiple gestations
Oligohydramnios placental insufficiency bilateral renal agenesis posterior urethral vales (males) resultant inability to excrete urine can cause Potter Sequence
Potter Sequence -- "POTTER" P: pulmonary hypoplasia O: oligohydramnios T: twisted face T: twisted skin E: extremity defects R: renal failure
What are the mechanisms of action of each of the following toxins? (SU p27) (H p1197, 1200, 3580)
Strychnine
Tetanus toxin
Black widow spider toxin
Botulinum toxin
Glycine antagonist
(glycine is an important inhibitory substance in the spinal cord)
————————————-
Blocks gylcine and GABA
Exotoxin acts at Renshaw cells ------------------------------------- Causes excessive release of ACh ------------------------------------- Inhibits release of ACh at the NMJ
A 3-year-old girl presents with a fever of 102°F for the last three days. On the fourth day, the patient develops a red macular rash over the entire trunk, and her fever resolves abruptly. What viral infection is most likely in this case? (FA15 p158-159) (FA16 p149) (SU p345)
Roseola == HHV-6 & HHV-7
What is the difference between malingering and factitious disorder? (FA15 p514) (FA16 p518) (SU p58)
Malingering – secondary (external) gain, such as avoiding work, obtaining compensation
Factitious – primary (internal) gain, in order to assume “sick role” and to receive medical attention
