Day 6 June 26

Question 1

Which drug to use in someone with osteoporisis and family history of breast cancer?

Answer 1

Raloxifine

Question 2

Raloxifene MOA

Answer 2

SERM - strong ANTagonist activity in breast, with AGONIST activity on bone

Question 3

Tamoxifen MOA

Answer 3

ANTAGonist in breast, AGONIST on bone AND uterus

Question 4

Would you use tamoxifen for osteoporosis? Why?

Answer 4

No - it has agonist activity on uterus, not appropriate for treatment of osteoporosis

Question 5

microscopic pathologic changes in Alzheimer’s disease?

Answer 5

neurofibrillary tangles and extracellular amyloid-beta plaques

Question 6

how does a tissue specimen appear in an ectopic pregnancy?

Answer 6

Decidualized endometrium - dilated, coiled endometrial glands and vasculared edematous stroma

Question 7

how does a molar pregnancy tissue appear ?

Answer 7

Chorionic villi with avascular edematous stroma

Question 8

Virulence factor of N. gonorrhea?

Answer 8

pili - attach to mucosal surfaces

Question 9

Why is it difficult to form immunity against N. gonorrhea?

Answer 9

N. gonorrhea undergoes antigenic variation. At any one time, only one pilus gene is expressed. They also undergo recombination with other to produce new antigenic types of pili.

Question 10

Hydatidiform moles are at risk for transformation to what?

Answer 10

Malignant transformation to trophoblastic neoplasm

Question 11

Which type of Hydatidiform mole is associated with extremely high B-hcg levels?

Answer 11

Complete mole

Question 12

S/E of extremely high B-hcg?

Answer 12

Hyperemesis gravidarum
Preeclampsia
Hyperthyroidism
Theca-lutein cysts

Question 13

Which type o Hydatidiform mole have fetal tissue?

Answer 13

The partial mole.

Complete moles have NO fetal tissue.

Question 14

What is the karyotype found in the Hydatidiform moles?

Answer 14

Complete mole - XY or XX

Partial mole - XXY or XXX

Question 15

does a complete mole have maternal or paternal DNA?

Answer 15

paternal only

Question 16

immunohistochemistry of Hydatidiform moles?

Answer 16

Complete- p57-negative

Partial - p57 positive

Question 17

which type of Hydatidiform mole is associated with a greatest risk neoplastic transformation to trophoblastic cancer?

Answer 17

Complete (15-30%)

Question 18

How do you monitior for neoplastic transformation after removal of Hydatidiform moles?

Answer 18

Monitor H-BCG - a level that rises or plateaus is a red flag

Question 19

alpha fetal protein is a marker of WHICH types of tumour?

Answer 19

Yolk sac tumours in the ovaries or testes

Question 20

what is increased in the blood of someone with sickle cell disease?

Answer 20

Bilirubin and LDH (due to intra and extravascular hemolysis of red blood cells)

Question 21

what is decreased in the blood of someone with sickle cell disease?

Answer 21

haptoglobin -this protein binds bilirubin in the blood to prevent tubular kidney damage

Question 22

what does pulsus paradoxicus refer to?

Answer 22

an exaggerated drop (>10) in systolic pressure during inspiration

Question 23

how can you detect pulsus parodoxicus when using a blood pressure cuff?

Answer 23

You inflate the cuff above systolic pressure and gradually deflate it. The first sounds you hear will be the systolic pressure. If you only hear it on expiration and the pressure at which you hear it on inspiration is >10mgg difference, then it is pulsus paradoxicus.

Question 24

How does pericardial effusion cause pulsus paradoxicus?

Answer 24

Normally during inspiration there is increased venous return to the right heart, and so it expands into the pericardium. If there is pericardial restriction, then it is forced to expand into the left ventricle, decrease the amount of filling in the left ventricle and thus the stroke volume, leading to a decreased systolic pressture on inspiration.

Question 25

Where are M2 receptors found?

Answer 25

Heart

Question 26

What effect does M2 agonist have?

Answer 26

Relaxes heart, decreasing contraction and HR

Question 27

Where are M1 receptors found?

Answer 27

Brainf

Question 28

What are M1 receptors important for?

Answer 28

Memory formation and cognitive functioning (inhibition leads to confusion)

Question 29

Where are M3 receptors found?

Answer 29

Peripheral vasculature, lung, bladder, eyes, GI system, skin

Question 30

How does M3 agonism effect peripheral vasculature?

Answer 30

-> NO synthesis and relaxation

Question 31

How does M3 agonism effect the lungs?

Answer 31

bronchoCONSTRICTION

Question 32

How does M3 agonism effect the bladder?

Answer 32

increased Ca and SM CONTRACTION

Question 33

How does M3 agonism effect the GI system?

Answer 33

increased peristalsis

Question 34

How does M3 agonism effect the eyes?

Answer 34

causes sphinctor muscle contraction ->miosis

Question 35

How does M3 agonism effect the skin?

Answer 35

increased sweat production

Question 36

What is muscarine?

Answer 36

a toxic found in some mushrooms, which acts on the M3 receptors and M2 receptors Leads to decreased heart rate, shock, etc.

Question 37

osteoporosis caused by excess PTH primarily affects which areas in the bone?

Answer 37

Corticol bone leads to subperisteol erosions (as compared to osteoporosis, which has trabecular thinning)

Question 38

How does bone appear in osteoporosis?

Answer 38

trabecular thinning

Question 39

Milirone MOA

Answer 39

PDE-3 inhibitor -leads to decreased breakdown of caMP

Question 40

How is milirone useful in heart failure ?

Answer 40

In the heart, this increase Ca results in more actin-myosin-troponin action and thus increased inotrophy In the smooth muscle, this activates PKA which increases SR uptake of Ca, leading to vasodilation

Question 41

what type of drug is fluoxetine?

Answer 41

SSRI

Question 42

what drugs are used to treat PAINFUL diabetic neuropathy ?

Answer 42

SNRI's TCA's Gabapentinoids

Question 43

what type of drug is amitriptyline?

Answer 43

TCA

Question 44

how does amitriptyline help treat painful neuropathy?

Answer 44

it inhibits volate gated Na channels in sensory nerves, , blocks NMDA receptors in the spinal cord and alters NE signalling in the brain

Question 45

what type of drug is ciprofloxacin?

Answer 45

Fluoroquinalone

Question 46

What should not be taken with fluoroquinalones?

Answer 46

Cations (ca, iron, aluminum, magnesium)

Question 47

Antacids may decrease the bioavailability of which antibiotics?

Answer 47

Fluoroquinolones and tetracyclines, since antacids contain cations

Question 48

Which type of cell is important in preventing superfical candida infections? (oral/esophageal, cutaneous, vulvovaginitis)?

Answer 48

T cells

Question 49

Which type of cell is important for defending against hematogenous spread of candidiasis? (disseminated candida - endocarditis, candidemia)

Answer 49

Neutrophils

Question 50

Pseudohyphae-producing yeast that cannot form germ tubes?

Answer 50

Candida

Question 51

patients with a gastrin-secreting pancreatic tumour (zollinger-ellison syndrome) should be assessed for what?

Answer 51

Signs of MEN1 syndrome/family history of MEN1

Question 52

What cancers arise in MEN1?

Answer 52

Primary hyperparathyroidism Pancreatic tumours Pituitary tumours

Question 53

What cancers arise in MEN2A?

Answer 53

Primary hyperparathyroidism Pheochromocytoma Medullary thyroid cancer

Question 54

What cancers arise in MEN2B?

Answer 54

Medullary thyroid cancer Pheochromocytoma Mucosal neuromas / marfanoid habitus

Question 55

What. isthe main toxin of C. perfringens?

Answer 55

lecithinase - cleaves phospholipids leading to cell lysis

Question 56

Is sotalol a beta blocker?

Answer 56

Yes and its an antiarrhythmic

Question 57

What adverse cardiac effect is sotalol associated with?

Answer 57

QT prolongation and torsades de points

Question 58

what will be seen on muscle biopsy of someone with a mitochondrial myopathy on gomore trichome stain?

Answer 58

splotchy red appearance (from mitochondria accumulating under the sarcolemma)

Question 59

pembrolizumab MOA?

Answer 59

Monoclonal antibodies that blocks program death ligand 1 (PD-L1) on cancer cells, making them more susceptible to cytotoxic t cells

Question 60

what is program death ligand 1 (PD-L1)?

Answer 60

a molecule that is upregulated by cancer cells -it binds to the receptor on cytotoxic t cells and suppresses their ability to induce cell death

Question 61

how does bone marrow change as you get older?

Answer 61

Higher quantity of fat and a reduced overall mass | -decreased progenitor cell diversity and response to cytokine stimulants

Question 62

in which part of the nephron do thiazide diuretics work?

Answer 62

distal convoluted tubule

Question 63

thiazides MOA

Answer 63

block NaCl uptake in DCT

Question 64

thiazides can be used to treat which type of kidney stones and why?

Answer 64

calcium kidneys stones - the decreased Na uptake into the tubular cell increases Ca Na exchange on the basolateral membrane, leading to increased Ca uptake (Decreased Ca secretion)

Question 65

MOA of loop diuretics?

Answer 65

block Na Cl K uptake transporer in ascending loop of henle

Question 66

where do K sparing diuretics work?

Answer 66

collecting duct - inhibit the effects of aldosterone

Question 67

which nerve runs right behind the right atrium?

Answer 67

right phrenic nerve

Question 68

pathophys of goodpasture syndrome?

Answer 68

autoantibodies are produced against glomerular basement membrane