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AM- STEP1 > Endo/Msk/ Psych Review > Flashcards

Endo/Msk/ Psych Review Flashcards

1
Q

Spongiosis

A

Accumulation of edema fluid in the intercellular spaces of the epidermis

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2
Q

Islet of langerhans are a collection of what cells

A

Alpha= glucagon (peripheral)
Beta= insulin (center)
Delta= somatostatin (interspersed)

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3
Q

ADH synthesized

A

Hypothalamus (supraoptic nuclei)

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4
Q

Cortisol effects on

  • Appetite
  • Insulin resistance
  • Fibroblast activity
  • Inflammatory and Immune response
  • Bone formation
A

Increased

  • Appetite
  • Blood pressure
  • Insulin resistance
  • Gluconeogesis, lipolysis

Decreased

  • Fibroblast activity (poor wound healing)
  • Inflammatory and Immune responses
  • Bone formation
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5
Q

Things that trigger PTH secretion

A

Decreased serum Ca
Increased serum PO4
Decreased serum Mg

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6
Q

Calcitonin

A

Decrease bone reabsorption of Ca

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7
Q

Thyroid peroxidase (TPO)

A

oxidation and organification of iodide as well as coupling of MIT and DIT –> T3, T4

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8
Q

Propylthiouracil (PTU)

  • MOA
  • use
  • Adverse
A

Inhibits both thyroid peroxidase and 5’ deiodinase

Tx for hyperthyroidism

Adverse effects

  • Skin rash
  • agranulocytosis **
  • aplastic anemmia
  • hepatotoxicity
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9
Q

Methimazole

  • MOA
  • use
  • Adverse
A

inhibits thyroid peroxidase only

Tx for hyperthyroidism

Adverse effects

  • Skin rash
  • agranulocytosis **
  • aplastic anemmia
  • hepatotoxicity

Teratogenic

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10
Q

cGMP endocrine hormones

A

BNP
ANP
NO

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11
Q

IP3 endocrine hormones

A 
GnRH
Oxytocin
ADH
TRH
Histamine (H1) 
Angiotensin II
Gastrin

GOAT HAG

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12
Q

Intracellular receptor endocrine hormones

A

PET CAT on TV

Progesterone
Estrogen
Testosterone
Cortisol
Aldosterone
T3/T4
Vitamin D
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13
Q

Receptor tyrosine endocrine hormones

A 
Insulin
IGF-1
FGF
PDGF
EGF
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14
Q

Jak/Stat endocrine hormones

A

PIGGlET

Prolactin
Immunomodulators (cytokines, IL-2,IL-6, IFN)
GH
G-CSF
Erythropoietin
Thrombopoietin
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15
Q

cAMP endocrine hormones

A

FLAT ChAMP

FSH
LH
ACTH
TSH
CRH
hCG
ADH (V2)
MSH
PTH
Calcitonin
GHRH
glucagon
Histamine (H2)
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16
Q

Hyperpigmentation
Hyperkalemia
Metabolic acidosis
Hypotension

A

Primary adrenal insufficiency

Deficiency of aldosterone and cortisol

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17
Q

Tumor of adrenal medulla in child
Increased HVA and VMA in urine
N- myc
Cells are purple with dark black ring of cells around it

A

Neuroblastoma

Homer Wright rosettes

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18
Q

Thyroid histology: lymphoid aggregates with germinal centers

  • type of rxn
  • assoc with HLA
  • risk
A

Hashimoto thyroiditis

Type IV hypersensitivity

HLA DR5 HLA B5

Increased risk: B cell lymphoma of thyroid

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19
Q 
Pot belly
Pale
Puffy face child
Protruding umbilicus
Protuberant tongue
Poor brain development

Enlarged fontanelle
Dry skin
Jaundice

Tx

A

Congenital hypothyroidism (Cretinism)

6P’s

Tx: levothyroxine

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20
Q

Jaw Pain

Painful goiter

A

Subacute granulomatous thyroiditis (de Quervain)

Inflammatory disruption of follicles and multinucleated giant cells

Self limited
- viral infection

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21
Q

Fixed hard rock like goiter in young
- disease
- histology
-

A

Riedel thyroiditis

Thyroid replaced by fibrous tissue with inflammatory infiltrates (macrophages, eosinophils)

IgG related systemic disease

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22
Q

Graves disease release of what cytokines

Associated HLA

A

TNF-alpha
IFN-gamma

HLA DR3 and HLA B8

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23
Q

Thyroid masses
Empty appearance nuclei with central clearing

  • assoc seen
  • mutations
  • Causes
A

Papillary carcinoma

Orphan Annie Eyes

psamMOma bodies

Papi and Moma adopted Orphan Annie

RET and BRAF

TObacco use
Radiation exposure

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24
Q

Follicular carcinoma

  • Histology
  • Mutation
  • Spread
  • Association
A

Uniform cuboidal cells lining follicles
Invading fibrous capsule

RAS

Hematogenous spread

PAX8-PPAR gamma 1 rearrangement

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25
Q

Pseudohypoparathyroidism type 1A

A

G3 protein alpha subunit defective

Increased PTH but unresponsive
Decreased Ca

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26
Q

Tx Central DI

A

Desmopressin

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27
Q

TX Nephrogenic DI

A 
HCTZ
Indomethacin (decrease renal blood flow)

Amiloride (K sparing diuretic)
- Tx for lithium toxicity caused Nephrogenic DI

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28
Q

SIADH tx

A

Diuretics
COnivaptan
Tolvaptan
Demeclocycline

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29
Q

Diabetes histology

A

Small vessel: diffuse thickening of basement membrane

Large vessel atherosclerosis

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30
Q

Diabetes
- HbA1c
Fasting glucose

A

HbA1C= > 6.5%

Fasting glucose >126

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31
Q

Diabetic nephropathy pathophysiology

A

Increase in filtered glucose load

Increase Na resorption in PT leading to decrased NA and fluid delivery to macula densa

Activation of tubuloglomerular autoregulation

Dilation of afferent arterioles and constriction of efferent
- Increases intraglomerular capillary pressure

Increased glomerular filtrate rate –> glomerular hyeprtrophy

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32
Q

Infection associated with diabetic ketoacidosis

A

Mucor

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33
Q 
Dermatitis
Diabetes
DVT
Declining weight
Depression

Tx

A

Glucagonoma
- Tumor of pancreatic alpha cells

Over production glucagon

Octreotide tx

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34
Q

Diabetes
Steatorrhea
Gallstones
Achlorhydria

Tx

A

Somatostatinoma

Tx: Surgical resection, octreotide

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35
Q 
High serotonin
Flushing
Diarrhea
Wheezing
Tricuspid regurg/ pulmonic stenosis
A

Carcinoid sydrome

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36
Q

MEN 1

A 
Pituitary tumors (prolactin or GH)
Pancreatic endocrine tumors (ZE syn, Insulinoma, VIPomas)
Parathyroid adenomas

Mutation: Menin (tumor suppressor) Chr 11

Hypercalcemia
Hypoglycemia
Periperhal vision loss

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37
Q

MEN 2A

A

Parathyroid hyperplasia
Medullary thyroid carcinoma
- calcitonin
Pheochromocytoma

RET mutation

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38
Q

MEN 2B

A

Medullary thyroid carcinoma
Pheochromoctyoma
Mucosal neuromas

RET

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39
Q

Hypercalcemia
Hypoglycemia
Periperhal vision loss

A

MEN 1

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40
Q 
Thyroid mass
Papules on lips and tongue
Marfan's
Increased calcitonin
HTN
A

MEN 2B

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41
Q

Rapid insulin

A

Lispro
Aspart
Glulisine

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42
Q

Intermediate acting insulin

A

NPH

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43
Q

Long acting insulin

A

Detemir

Glargine

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44
Q

First line therapy in Type 2 DM

MOA

Adverse effects

A

Metformin

Inhibit hepatic gluconeogenesis and the action of glucagon
Increase peripheral glucose uptake
Increase insulin sensitivity

Weight loss
Lactic acidosis **

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45
Q

Sulfonylureas: First generation

  • examples
  • MOA
  • adverse
A

Chlorpropamide
Tolbutamide

Stimulate release of endogenous insulin in Type 2 DM

Close K channel in Beta cell membrane –> cell depolarizes –> insulin release via Ca influx

Adverse
- Disulfiram like effects

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46
Q

Sulfonylureas: Second generation

  • examples
  • MOA
  • Adverse
A

Glimepiride
Glipizide
Glyburide

Stimulate release of endogenous insulin in Type 2 DM

Close K channel in Beta cell membrane –> cell depolarizes –> insulin release via Ca influx

Adverse

  • hypoglycemia
  • weight gain
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47
Q

Closes K channels to increase insulin release

A

Sulfonylureas

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48
Q

Glitazones/ Thiazolidinediones

  • examples
  • use
  • MOA
  • adverse
A
  • glitazone
    Pioglitazone
    Rosiglitazone

Type 2 DM
Safe to use in renal impairment

Increase insulin sensitivity in peripheral tissue. Binds PPAR-gamma nuclear transcription regulator

Adverse

  • weight gain
  • edema
  • HF
  • increase risk of fractures
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49
Q

Meglitinides

  • examples
  • use
  • MOA
  • adverse
A

-glinide
Nateglinide
Repaglinide

Type 2 DM

Stimulate postprandial insulin release by binding to K channels on beta cells membranes

Hypoglcemia
Increased risk of renal failure
Weight gain

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50
Q

GLP-1 analogs

  • examples
  • use
  • MOA
  • adverse
A 
-glutide
Exenatide
Liraglutide (sc injection)
Albiglutide
Dulaglutide

Type 2 DM

Increase glucose dependent insulin release
Decrease glucagon release
Decrease gastric emptying
Increase satiety

Nausea
Vomiting
Pancreatitis **
Weight loss

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51
Q

DDP-4 Inhibitors

  • examples
  • use
  • MOA
  • adverse
A
  • gliptin
    Linagliptin (weight loss)
    Saxagliptin
    Sitagliptin

Type 2 DM

Inhibit DPP-4 enzyme that deactivates GLP-1 , thereby increasing glucose-dependent insulin release
Decrease glucagon release
Decrease gastric emptying
Increase satiety

Mild urinary and respiratory infections

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52
Q

Amylin analogs

  • examples
  • use
  • MOA
  • adverse
A

Pramlintide (SC injection)

Type 1 DM
Type 2 DM

Decrease gastric emptying
Decrease glucagon

Hypoglycemia (mistimed)
Nausea

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53
Q

SGLT2 inhibitors

  • examples
  • use
  • MOA
  • adverse
A

-flozin
Canagliflozin
Dapagliflozin
Empagliflozin

Type 2 DM

Block reabsorption of glucose in PCT

Glucosuria
UTI
Vaginal yeast infections
Hyperkalemia
Dehydration
WL
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54
Q

alpha-glucosidase inhibitors

  • examples
  • use
  • MOA
  • adverse
A

Acarbose
Miglitol

Type 2 DM

Inhibit intestinal brush border alpha-glucosidases
Delayed carbohydrate hydrolysis and glucose absorption
Decreased postprandial hyperglycemia

GI disturbances

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55
Q

Triiodothyronine

Levothyroxine

A

Thyroid hormone replacement

Levothyroxine= T4
Triiodothyronine= T3

Tachycardia
Heat intolerance
Termors
Arrhythmias

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56
Q

Conivaptan

tolvaptan

A

ADH antagonists

Tx SIADH, block ADH at V2

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57
Q

Demeclocycline

  • MOA
  • use
  • adverse effect
A

ADH antagonist

TX: SIADH

Adverse

  • nephrogenic DI
  • photosensitivity
  • abnormal teeth and bones
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58
Q

Fludrocortisone

  • MOA
  • use
  • adverse
A

Synthetic analog of aldosterone with little glucocorticoid effects

Tx of mineralocorticoid replacement in primary adrenal insufficiency

Edema
HF
Hyperpigmentation

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59
Q

Cinacalet

  • MOA
  • Use
  • Adverse
A

Sensitizes Ca sensing receptor (CaSR) in parathyroid gland to circulating Ca

Decrease PTH

Use: primary or secondary hyperparathyroidism

Adverse: hypocalcemia

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60
Q

Post partum Agalactorrhea

A

Postpartum hemorrhage –> underperfusion of the pituitary

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61
Q

Anterior lobe of pituitary from

A

Ectoderm

Rathke’s pouch

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62
Q

Posterior pituitary from

A

Hypothalamus invagination (neuroectoderm)

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63
Q

Adrenal cortex derived from

Adrenal medulla derived from

A

Cortex= mesoderm

Medulla= Ectoderm

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64
Q

3beta- hydroxysteroid dehydrogenase deficiency

A

Inability to produce

  • Glucorticoids
  • Mineralocorticoids
  • Androgens
  • Estrogens

Excessive sodium excretion in urine

Ambigous genitalia

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65
Q

Aldosterone effects

A

Increase Na reabsorption in collecting tubules
Raises blood pressure

Increase K excretion

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66
Q

Tx Hyperaldosteronism

A

Aldosterone antagonist

  • Spironolactone
  • Eplerenone
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67
Q

HTN
Hypokalemia
Metabolic alkalosis

A

Hyperaldosteronism

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68
Q

Addison disease

A

Primary adrenal insufficiency

Hypotension
Hyponatremia
Hyperkalemia
Hyperpigmentation

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69
Q

Erytopoietin secreting tumors

A

Pheochromocytoma
Renal cell carcinoma
Hemangioblastoma (vascular tumor of CNS)
Hepatocellular carcinoma

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70
Q

Homer Wright rosettes

A

Ring of black cells surrounding purple cells in center
Adrenal

Adrenal neuroblastoma

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71
Q

Thyroid development

  • begins
  • drived
  • remnants
A

Begins 3rd week gestation

Derived from endoderm from the floor of the primitive pharynx

Thyroglossal duct
Foramen cecum

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72
Q

Foramen cecum

A

Thyroid remnant

In middle of tongue

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73
Q

Thyroglossal duct

A

Retain connect from thyroid to tongue

Moves with swallowing
Midline mass

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74
Q

Hypothyroidism effect on LDL and cholesterol

A

Increased LDL and total cholesterol

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75
Q

Iodide (I-) –> Iodine (I2) enzyme

Process called

A

Peroxidase

Organification

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76
Q

How does pregnancy affect thyroid levels

A

Increases thyroid binding globulin (TBG)
- Estrogen upregulates

Binds up circulating thyroid hormone
Thyroid sense T3/T4 dropping so releases more
Total T4/T3 increased
Free T3/T4 normal
TSH decreased
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77
Q

Cause of congenital hypothyroidism that can be prevented

A

Iodine deficiency

Iodine to diet

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78
Q

Graves disease features specifically to it

A

Exophthalmos
Pretibial myxedema

connective tissue deposit in orbit, extraocular muscles, thickening of skin in front of shins due to deposition

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79
Q

Hyperthyroid tx first trimester

Hyperthyroid tx 2nd and 3rd trimester

A

1st: PTU

2nd/3rd: Methiamzole

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80
Q

Thyroiditis

  • tx
A

Transient elevation of thyroid hormone –> hypothyroidism

Tx : beta blockers

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81
Q

Mass in thyroid
Increase in calcitonin

  • Proliferation
  • Assoc
  • Mutation
  • Activation
A

Medullary thyroid carcinoma

Proliferation of parafollicular C cells

MEN2A MEN 2B

RET gene mutation
Activation of tyrosine kinase

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82
Q

Thyroid cancer activation of tyrosine kinase

A

Medullary thyroid carcinoma

Follicular thyroid carcinoma

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83
Q

GLUT1

GLUT2

GLUT3

GLUT4

GLUT5

A

GLUT1

  • RBCs
  • Brain

GLUT2

  • beta cells
  • Liver
  • Small intestine
  • Renal cells

GLUT4 (Insulin dependent)

  • Adipose tissue
  • Skeletal
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84
Q

Type 1 DM HLA

A

HLA DR3- DQ2 and HLA DR4- DQ8

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85
Q

Type 1 DM antibodies

A

Ab against glutamic acid decarboxylase (GAD)

86
Q

Kimmelstiel wilson nodules

A

Acellular nodules in glomerulus

Diabetes

87
Q

Cotton wool spots

A

DM

88
Q

Acidosis on K levels

A

Increase extracellular K concentrations

Push H into cels

89
Q

Diabetic medication to not use in patient with abnormal kidney fxn

A

Metformin
Sulfonyureas
SGLT-2 inhibitors

90
Q

Diabetic med that causes weight gain

A

Sulfonyureas

Thiazolidinediones (-glitazone)

91
Q

Diabetic med metabolized by liver, can be used in patients with renal failure

A

Thiazolidinediones
- glitazone

Pioglitazone
Posiglitazone

92
Q 
Hyperparathyroidism 
Hypocalcemia
Hyperphosphatemia
Increased BUN and Cr
Elevated Alk phos
A

Secondary hyperparathyroidism from renal failure

93
Q

ACL attachment

A

Lateral femoral condyle to anterior tibia

94
Q

PCL attachment

A

Medial femoral condyle to posterior tibia

95
Q

Unhappy triad

A

lateral force applied to planted leg

ACL
MCL
Medial meniscus

(lateral meniscus injury is more common)

96
Q

Infraspinatus movement

A

Lateral rotates

97
Q

Teres minor movement

A

Adducts and laterally rotates arm

98
Q

Subscapular

A

Medially rotates
Adducts arm

IR

99
Q

Supraspinatus

A

0-15 degress abduction

100
Q

Wrist bones

A

So Long to Pinky
Here Comes the Thumb

Scaphoid, Lunate, Triquetrum, Pisiform
Hamate, Capitate, Trapezoid, Trapezium

101
Q

Fall on outstretch hand fracture what bone

A

Scaphoid

102
Q

Midshaft fracture of humerus

A

Radial nerve

103
Q

Forearm flexion and supination

A

Musculocutaneous

104
Q

Cant extend ring finger and pinky

A

distal Ulnar nerve

105
Q

Cant flex thumb and first two fingers

A

Proximal Median n

106
Q

Cant extend thumb and first two fingers

A

Distal Median n.

107
Q

Cant flex ring finger and pinky

A

Proximal ulnar nerve

108
Q

Absent cremasteric reflex

Loss sensation in scrotum/ labia majora

A

Genitofemoral n. (L1-L2)

109
Q

Loss of sensation dorsum of foot
Foot drop

  • site
A

Common peroneal (L4-S2)

Trauma or compression of lateral aspect of leg
Fibular neck fracture

110
Q

Loss of sensation sole of foot

Can stand on tip toes

A

Tibial n.

111
Q

Nerve artery in location

1) Axilla
2) Surgical neck humerus
3) Midshaft humerus
4) Distal humerus/ cubital fossa
5) Popliteal fossa
6) Posterior to medial malleolus

A

1) Axilla
- Long thoracic n.
- Lateral thoracic a.

2) Surgical neck humerus
- Axillary n.
- Posterior circumflex a.

3) Midshaft humerus
- Radial n.
- Deep brachial a.

4) Distal humerus/ cubital fossa
- Median n.
- Brachial a.

5) Popliteal fossa
- Tibial n.
- Popliteal a.

6) Posterior to medial malleolus
- Tibial n.
- Posterior tibial a.

112
Q

What is located at the junction of the A and I bands

A

T tubule

113
Q

Estrogen effect on bones

A

Inhibits osteoblast apoptosis

Induces apoptosis in osteoclasts

114
Q

Osteonecrosis (avascualr necrosis) causes

A 
Corticosteroids
Alcoholism
Sickle cell disease
Trauma
The Bends
Legg-Calve PErthes
Gauchers disease
Slipped femoral epiphysis

CAST Bent LEGS

115
Q

HLA-DR4

A

Rheumatoid arthritis

116
Q

Ankylosing spondylitis associated with

A

Aortic regurgitation

Restrictive lung disease due to limited chest wall expansion

117
Q

Sarcoidosis

  • elevated levels
  • clinical
  • CXR
A

ACE levels
CD4/ CD8

Asymptomatic
Enlarge lymph nodes

Bilateral adenopathy and course reticular opacities
Extensive hilar and mediastinal adenopathy

118
Q

Pain in shoulders and hips
No muscle weakness
Elevated ESR and CRP
Normal CK

A

Polymyalgia rheumatic

assoc w/ GIant cell arteritis

Tx steroids

119
Q

Fibromyalgia

  • symptoms
  • tx
A

Chronic widespread Msk pain assoc w/ tender points, stiffness, paresthesias, poor sleep, cognitive disturbances

Tx: exercise regularly, antidepressants (TCA, SNRI) anti convulsants
(Amitriptyline, fluoxetine)
FDA approved: Pregabalin, milnacipran

120
Q

Polymyositis cell type

A

CD8 T cells

121
Q

Dermatomyositis cell type

A

CD4 T cells

122
Q

Myasthenia gravis vs Lambert Eaton myasthenic syndrome

A

MG

  • Ab to postsynaptic ACh receptor
  • Ptosis, diplopia, weakness
  • Worses with use
  • Thymoma, thymic hyperplasia
  • Tx pyridostigmine

Lambert Eaton myasthenic syndrome

  • Ab to presynaptic Ca channel –> decrease ACh release
  • Proximal muscle weakness, dry mouth, impotence
  • IMPROVES with muscle use
  • assoc w/ small cell lung cancer
123
Q

Puffy, taut skin no wrinkles

Fingertip pitting

A

Scleroderma

124
Q

Claudins

A

Tight junctions

125
Q

Connexons

A

Gap junctions

126
Q

Occlusins

A

Tight junctions

127
Q

Acantholysis

  • is what
  • seen in
A

Separation of epidermal cells

Pemphigus vulgaris

128
Q

Acanthosis

A

Epidermal hyperplasia

129
Q

Erysipelas

  • is what
  • causes it
  • clinical presentation
A

Infection involving upper dermis and superficial lymphatics
S pyogenes

Presents with well defined dercation between infected and normal skin

130
Q

Flaccid blisters

  • type
  • MOA
  • Type hypersensitivity
  • Immunoflorence pattern
  • Sign
A

Pemphigus vulgaris

IgG against desmoglein
Component of desmosomes

Type II hypersensitivity rxn

IF: Ab in reticular (netlike) pattern)

Nikolsky sign +

131
Q

Round smooth blisters

  • type
  • MOA
  • Immunoflorence
  • Sign
A

Bullous pemphigoid

IgG against hemidesmosomes

IF: linear pattern at epidermal-dermal junction

Nikolsky sign negative

132
Q

S-100 skin cancer

A

melanoma

133
Q

Melanoma mutation

A

BRAF

134
Q

Aspirin overdose effects

A

Gastric ulcer
Tinnitus
Interstitial nephritis

135
Q

Selectively inhibits COX2

  • use
  • adverse
A

Celecoxib

RA and osteoarthritis

Adverse

  • risk of thrombosis
  • sulfa allergy
136
Q

Alendronate

  • type
  • MOA
  • use
  • adverse
A

Bisphophonates
- binds hydroxyapatite in bone
Inhibits osteoclast activity

Use:
Osteoporosis
Hypercalcemia
Paget

Adverse

  • Esophagitis
  • Osteonecrosis of jaw
137
Q

Teriparatide

  • Type
  • MOA
  • Use
  • Risk
A

Recombinant PTH analog give SQ daily

Increase osteoblast activity

Use
- Osteoporossi

Risk
- osteosarcoma

138
Q

Allopurinol vs Febuxostat

A

Allopurinol
- competitive inhibitor of xanthine oxidase

Febuxostat
- inhibits xanthine oxidase

139
Q

Etanercept

A

Fusion protein (receptor for TNF-alpha + IgG1 Fc)

Intercepts TNF

RA, Psoriasis, ankylosing sponylitis

140
Q

TNF-alpha inhibitors

A

Infliximab
Adalimumab
Certolizumab
Golimumab

IBD, RA, Ankylosing spondylitis, psoriasis

141
Q

11;22 bone tumor

A

Ewing sarcoma

142
Q

McCune Albright

A

One side Cafe-au lait spot
Unilateral fibrous dysplasia of bone
- bone replaced by collagen and fibroblats
Precocious puberty

143
Q

Osteopetrosis deficiency of

A

Carbonic anhydrase II

144
Q

Ankle sprain injury to

A

Anterior talofibular lig (Always tears first)
Calcaneofibular lig
Posterior talofibular lig

145
Q

What is injuried in posterior hip dislocation

A

Medial and lateral circumflex femoral arteries
Femoral vein
Sciatic nerve
Head of femur

146
Q

Ab not RA

A

Rheumatoid factor

Anti-citrullinated protein Ab

147
Q

How do NSAIDS cause renal disease

A

Block prostaglandin synthesis
Constrict renal vessels
Decrease renal blood flow

148
Q

Tx of choice acute gout

A

NSAIDS

Colchicine
Steroids

149
Q

Tx chronic gout

A

Probenecid

  • increases renal excretion of uric acid
  • Inhibits reabsorption of uric acid in PCT

Allopurinol
Febuxostat

150
Q

Tx for seronegative sponyloarthropathies

A

TNF-alpha inhibitor

  • prevents activation of immune system
  • Etanercept
  • Inflixumab, Adalimumab, Golimumab, Certolizumab

Check PPD skin test before giving

151
Q

Reactive arthritis typically follows infect with

A

Chlamydia
GI infections
(Shigella, Salmonella, Yersinia, Campylobacter, clostridium)

152
Q

Skin disorders of SLE

A

Malar rash
Discoid rash
Photosensitivity
Painless oral ulcers**

153
Q

Tx SLE

A

Steroids
NSAIDS
Hydroxychloroquine
Cyclophosphamide

154
Q

Component of hemidesmosomes

A

Integrins

155
Q

Psoriasis increase and decrease in what skin layers

A

Increase stratum spinosum

Decrease stratum granulosum

156
Q

Psoriasis tx

A

Topical tx

  • steroids
  • Vit D analog
  • retinoids

Methotrexate
Cyclosporine
Systemic retinoids

Biological agents

  • Adalimumab
  • Etanercept
  • Infliximab
157
Q

Palasading nuclei of mark on skin

A

Basal cell carcinoma

158
Q

Melasma

A

Dark discoloration common in pregnant women, those taking OCP and hormone replacement

Melanocytes stimulated by estrogen and progesterone

Spontaneously resolves

159
Q

Impetigo tx

A 
Topical mupirocin (mild) 
Oral dicloxacillin , cephalexin (serious)
160
Q

Cellulitis Tx

A

Non-MRSA: oral dicloxacillin, cephalexin

MRSA: oral TMP-SMX, clindamycin

161
Q

Necrotizing fasciitis tx

A

Surgical debridement

IV carbapenem + clindamycin

162
Q

Scaled skin syndrome tx

A

Nafcillin, oxacillin, vancomycin

163
Q

Dermatitis herpetiformis

A

Chronic blistering disease
IgA in tips of dermal papillae

Assoc w/ celiac disease

164
Q

Fever
Bulla formation
Necrosis
Sloughing of skin

A

Steven johnson syndrome

Hypersensitivity rxn

Antiseizure drugs
Sulfa drugs
Penicillins
Allopurinol

165
Q

Expressing extremely positive thoughts of self and others while ignoring negative thoughts

A

Idealization

166
Q

Replacing warded off ideas or feelings by an (unconsciously derived) emphasis on its opposite

A

Reaction formation

Patient with libidinous thoughts enters a monastery

167
Q

Repetitive and pervasive behavior violating the basic rights of others or social norms. Agression to people and animals. Destruction of property, left. Under age 18.

A

Conduct disorder

168
Q

Disruptive mood dysregulation disorder

A

Severe and recurrent tempor outbursts out of proportion to situation

Child constantly angry and irritable

169
Q

Testing for what

1) Providing name, locationg, and current date
2) Following multistep commands
3) Reciting months of years backwards
4) Recalled 3 unrelated words after 5 minutes
5) Providing details of significant life events
6) Writing a complete sentence with noun-verb agreement
7) Drawing intersecting pentagons
8) Drawing a clock oriented to the time requested

A

1) Orientation
2) Comprehension
3) Concentration
4) Short term memory
5) Long term memory
6) Language
7) Visual-spatial
8) Executive function

170
Q

Brief psychotic disorder

A

<1 month

171
Q

Schizophreniform

A

1-6 months

172
Q

Schizoaffective disorder

A

> 2 weeks of hallucinations or delusions without major mood episode

173
Q

Schizophrenia tx

A

First line: Antipsychotic

- Risperidone

174
Q

Hypomanic

Manic

A

4 consecutive days

At least 1 week

175
Q

Bipolar I

A

1 manic +/- a hypomanic or depressive episdoe

176
Q

Bipolar II

A

Hypomanic and depressive episode

177
Q

Bipolar tx

A

Mood stabilizers

  • Lithium
  • Valproic acid
  • Carbamazepine
  • Lamotrigine
178
Q

Major depressive

Timeline
Tx

A

> = 2 weeks

Tx: CBT and SSRI

179
Q

Postpartum blues duration

A

2-3 days after delivery –> 10 days

180
Q

Post partum depression

TX

A

> = 2 weeks

CBT and SSRI

181
Q

Tx Aniexty

A

CBT
SSRIS
SNRIS

182
Q

Tx Panic disorder

A

CBT, SSRI, Venlafaxine are first line

183
Q

Specfiic phobia

A

Severe persistent >= 6 months fear or anxiety due to specific object

184
Q

Generalized anxiety disorder

Tx

A

> 6 months
Worry about multiple issues

Tx CBT, SSRI, SNRI first line

185
Q

Adjustment disorder

TX

A

Emotional symptoms that occur within 3 months of stressor, lasting < 6 months

CBT SNRI

186
Q

Obsessive compulsive disorder

tx

A

CBT SNRI Clomipramine

187
Q

Body dysmorphic disorder tx

A

CBT

188
Q

Acute stress disorder

A

3 days –> 1 month

189
Q

Post traumatic stress

Tx

A

Trauma
> 1 month

CBT, SSRI, venlafaxine first line
Prazosin can reduce nightmares

190
Q 
Self mutilation
Suicidal
Splitting personality
Unstable mood
Impulsive
A

Borderline

191
Q

Excessive emotionality and excitability
Attention seeking
Sexually provocative
Overly concerned with appearance

A

Histrionic

192
Q

Loss of sensory or motor function (paralysis blindness, mutism) often following an acute stressor.

A

Conversion disorder

193
Q

Excessive preoccuption with acquiring or having a serious illness, despite medical evaluation and reassurance

A

Illness anxiety disorder (hypochondriasis)

194
Q

Narcolepsy caused by

A

Decreased hypocretin (orexin) production in lateral hypothalamus

195
Q

Delirium tremens

  • due to
  • clinical features

Tx

A

Lifethreatening alcohol withdrawal 2-4 days after last drink

Tachycardia, tremors, anxiety, seizures
Respiratory alkalosis

Tx: Benzodiazepines
(chlordiazepoxide, lorazepam, diazepam)

196
Q

Tourette syndrome

TX

A

Alpha 2 agonist- clonidine

Antipsychotics (anti-dopamine)
- Fluphenazine pimozide

Tetrabenazine

197
Q

Typical antipsycotics

  • examples
  • MOA
  • High potency
A 
Haloperidol
pimozide
trifluperAZINE
fluphenazine
Thioridazine (low potency)
Chlorpromazine (low potency)

Block D2 dopamine recpetor –> Increase cAMP

High potency: Try to Fly High (Trifluoperazine, Fluphenaizne, Haloperidol)

198
Q

Atypical antipsychotics

  • examples
  • MOA
  • Adverse effects
A 
Aripiprazole
AsenAPINE
clozapine
Olanzapine
iloPERIDONE
risperidone

D2 antagonists
aripiprazole: D2 partial agonist

Varied effects on 5HT-2, dopamine and alpha and H receptors

Clozapine: agranulocytosis
Risperidone: hyperprolactinemia
Olanzapine : obesity

199
Q

LIthium side effects

A 
Tremor
Hypothyroidism
polyuria
Teratogenesis
Ebstein anomaly
200
Q

Buspirone

  • MOA
  • Use
A

Stimulates 5-HT1A receptors

Generalized anxiety disorder
No sedation, addiction or tolerance

201
Q

SSRI

  • Examples
  • MOA
  • Use
  • Adverse
A 
Fluoxetine
Fluvoxamine
Parxetine
Sertraline
Escitalopram
Citalopram

Inhbit 5HT reuptake

Depression, anxiety, panic, OCD, bulimia, PTSD…

Adverse

  • GI distress
  • SIADH,
  • Sexual dysfunction
202
Q

SNRI

  • examples
  • MOA
  • Use
  • Adverse
A 
Venlafaxine
Desvenlafaxine
Duloxetine
Levomilnicipran
milnacipran (fibromyalgia only)

Inhibit 5-HT and NE reuptake

Duloxetine: fibromyalgia

Increase BP

203
Q

Tricyclic antidepressants

  • examples
  • MOA
  • Adverse
A

-ipramine, triptyline

Inhibit NE and 5-HT uptake

TriC’s

  • Convulsion
  • Coma
  • Cardiotoxicity
  • Can prolong QT

Tx for overdose: Sodium bicarbonate

204
Q

Monoamine oxidase inhibitors

  • examples
  • MOA
  • Use
  • Adverse
A

Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline

Increase level of amine NT (NE, 5-HT, dopamine)

Atypical depression, anxiety
Parkinson disease (selegiline)

CNS Stimulation
Hypertensive crisis with ingestion of tyramine
- brown bananas, wine, aged cheese, soy sauce, aged beef

205
Q

Buproprion

  • type
  • MOA
  • Use
  • adverse
A

Atypical antidepressant

Inhibits reuptake NE adn dopamine

Smoking cessation
May help alleviate sexual dysfuntion

Seizures in anorexic/ buliemic patients

206
Q

Mirtazapine

  • type
  • MOA
  • Adverse
A

Alpha 2 antagonist
- increase release NE and 5-HT
5HT2 5HT3 receptor antagonst
H1 antagonist

Adverse
- Sedation
- Increased appetite
WG

207
Q

Trazodone

  • MOA
  • Use
  • Adverse
A

Blocks 5-HT2, alpha 1 adrenergic, H1 receptor
Weakly inhibits 5HT reuptake

Tx for insomnia

Adverse

  • Sedation
  • Priapism
  • Postural hypotension
208
Q

Nicotinic ACh recpetor partial agonist
Used for smoking cessation

Toxicity

A

Varenicline

Sleep disturbance may depress mood

209
Q

Methylphenidate and dexmethylphenidate MOA

A

block reuptake of dopamine and NE

210
Q

Tx any drug withdrawal (Cocaine, LSD)

A

Benzo

AM- STEP1 (20 decks)

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