Firecracker practice test

Question 1

Tay Sachs inheritance and what enzyme is deficient and what accumulates

Answer 1

Autosomal Recessive

-hexosaminidase A. This leads to the accumulation of GM2 gangliosides

Question 2

Henoch-Schönlein purpura (HSP)

Answer 2

small-vessel vasculitis that is characterized by immunoglobulin A (IgA), C3, and immune complex deposition in arterioles, capillaries, and venules

• most common systemic vasculitis in children.
• triad of palpable purpura on the buttocks and legs, arthralgias, and abdominal pain
• About half of cases follow an upper respiratory infection

Question 3

ASA overdose presentation and treatment

Answer 3

agitation, confusion, vomiting, and vertigo. Other symptoms include gastrointestinal distress and tinnitus Aspirin stimulates the respiratory center and initially causes a drop in the pCO2 and a subsequent respiratory alkalosis. This is followed by an anion-gap metabolic acidosis Tx: Sodium Bicarb (alkalizes the serum and urine), and potentially dialysis if severe

Question 4

Growth media used to confirm Cholera infection

Answer 4

grows flat yellow colonies on thiosulfate citrate bile salts sucrose (TCBS) agar (V. cholerae is an oxidase-positive, motile organism)

Question 5

Chorda Tympani

Answer 5

Branch of facial nerve responsible for taste of anterior 2/3 of tongue

Question 6

Uniparental disomy

Answer 6

inheritance of both chromosomes of a homologous pair from a single parent.

-UPD causes about 25% of Prader-Willi cases. UPD usually arises when a trisomic cell line early in embryogenesis converts to a disomic cell line (trisomic rescue). In the case of Prader-Willi syndrome, if the disomic pair is maternally inherited, they will both be imprinted and no functional paternal copies will be inherited, thus causing Prader-Willi syndrome.

Question 7

the best test for iron deficiency anemia (best sensitivity and specificity)

Answer 7

serum ferritin, NOT serum iron levels

Question 8

Treatment of giant cell arteritis (temporal arteritis)

Answer 8

Prednisone (promptly!), or any high dose corticosteroids

Question 9

most common form of SCID is caused by a mutation in

Answer 9

interleukin 2 receptor subunit gamma (IL2RG) gene on the X chromosome. This gene encodes a common subunit for the following cytokine receptors: IL-2, IL-4, IL-7, IL-9, IL-11, IL-15, and IL-21. Lack of signaling through multiple cytokine receptors impairs lymphocyte development, maturation, and function. IL-2, in particular, is essential for the proliferation and differentiation of T cells

Question 10

With emphysema, lung compliance is?

Answer 10

Lung compliance is increased, not decreased, in emphysema.

The pathological hallmark of emphysema is destruction of alveolar walls due to increased elastase activity. Because of this, elastic recoil fibers are lost and lung compliance increases. This results in enlarged airspaces and a barrel shaped chest

Question 11

Adverse effects of loop diuretics (Furosemide, bumetanide, torsemide)

Answer 11

OHHH DANG):
· Ototoxicity
· Hypokalemia
· Hypocalcemia
· Hypomagnesemia
· Dehydration
· Allergy (sulfa)
· Nephritis
· Gout

Question 12

approximately 50% of people with giant-cell arteritis also have____

Answer 12

polymyalgia rheumatica (a rheumatologic disorder that causes pain and stiffness of the large muscle groups, most frequently the shoulders and hips. Patients typically present with weakness and soreness in the morning and after rest, along with overall fatigue)

Question 13

Renal blood flow (starting at renal artery, ending at R atrium)

Answer 13

Renal artery → segmental artery → interlobar artery → arcuate artery → interlobular artery → afferent arteriole → glomerular capillaries → efferent arteriole → peritubular capillaries → interlobular vein → arcuate vein → interlobar vein → renal vein → IVC (inferior vena cava) → right atrium

Question 14

first line treatment for Torsades De Pointes

Answer 14

Magnesium sulfate (used for treatment of Long QT syndrome, which predisposes to an increased risk of sudden cardiac death that is secondary to torsades de pointes)

Question 15

Treatment of Bipolar 1 Disorder (ideas of grandeur, irritable and intense mood), and what needs to be checked prior to administering med?

Answer 15

1. Lithium: most commonly causes HYPOthyroidism so thyroid studies are recommended before treatment is begun. Also causes Nephrogenic DI, resulting in a hyperosmotic volume contraction
2. Valproic Acid
3. Carbamezapime

Question 16

What do Bacillus Cereus, Escherichia coli (ETEC) and Vibrio cholerae all have in common?

Answer 16

The enterotoxin works through ADP ribosylation that activates Gs and increases cAMP, leading to watery diarrhea from secretion of sodium cations, chloride anions, and water

Bacilus Cereus: reheated rice, cause food poisoning (an aerobic spore-forming Gram-positive bacillus. Bacillus cereus can contaminate uncooked food)

Question 17

Cranial bleed that extends across multiple suture lines

Answer 17

Subdural hematoma: tearing of the cerebral bridging veins due to tensile or shear forces. On CT scan, these lesions are readily identified as large, crescent shaped collections surrounding the brain

Question 18

Baby is born with protrusion of abdominal contensts outside of abdominal wall is called….(with no overlying sac)

Answer 18

gastroschisis (congenital malformation characterized by a defect in the anterior abdominal wall, allowing abdominal viscera to protrude freely with no overlying sac. One cause of gastroschisis is abnormal involution of the right umbilical vein, resulting in ischemia and weakness of abdominal wall on the right side of the umbilicus)

Question 19

H. influenzae

Answer 19

gram-negative pleomorphic coccobacilli. The organism is fastidious and grows on chocolate agar supplemented with factors V (NAD) and X (hematin)

• the most common cause of mucosal infections (otitis media, conjunctivitis, bronchitis)
• The initial stage in the development of bacterial meningitis in infants and young children is frequently a URI, then invades the bloodstream, where its capsule allows it to evade phagocytosis. The organism is able to cross the blood-brain barrier and infect the meninges.
• HaEMOPhilus causes Epiglottitis (“cherry red” in children), Meningitis, Otitis media, and Pneumonia.

Question 20

Ewing’s sarcoma

Answer 20

Anaplastic small blue cell malignant tumor D . Extremely aggressive with early metastases, but responsive to chemotherapy.

• commonly affects the pelvis and metaphysis of long tubular bones
• It is classically associated with an “onion-skin” appearance on radiographic imaging, which represents reactive periosteum
• Associated with t(11;22) translocation causing fusion protein EWS-FLI 1. 11 + 22 = 33 (Patrick Ewing’s jersey number)

Question 21

Ewing Sarcoma vs Osteosarcoma

Answer 21

Osteosarcoma: 2nd most common 1° malignant bone tumor (after multiple myeloma). Bimodal distribution: 10–20 years old (1°), > 65 (2°). Predisposing factors: Paget disease of bone, bone infarcts, radiation, familial retinoblastoma, Li-Fraumeni syndrome (germline p53 mutation). Metaphysis of long bones, often around knee

Ewing Sarcoma: Boys < 15 years old. Commonly appears in diaphysis of long bones, pelvis, scapula, ribs. Anaplastic small blue cell malignant tumor D . Extremely aggressive with early metastases, but responsive to chemotherapy. “Onion skin” periosteal reaction in bone. Associated with t(11;22)

Question 22

idiopathic pulmonary fibrosis (IPF)

Answer 22

Dypsnea on exertion, Bilateral crackles in base of the lungs, clubbing of the fingertips and honeycombing of the lungs in addition to reticular opacities on CT scan

• IPF occurs when an environmental insult (smoking in some cases) causes repeated cycles of alveolar epithelial damage that leads to pathologic repair in genetically predisposed individuals
• decreased vital capacity on spirometry, decreased residual volume and total lung capacity could be expected

Question 23

internuclear ophthalmoplegia

Answer 23

caused by a lesion involving the medial longitudinal fasciculus (MLF), often a demyelinating lesion in the context of multiple sclerosis. As a result, the motor nuclei of the abducens nerves (cranial nerve VI) are unable to communicate with the motor nuclei of the oculomotor nerves (cranial nerve III)

Question 24

Monday disease

Answer 24

industrial exposure: development of tolerance for the vasodilating action during the work week and loss of tolerance over the weekend tachycardia, dizziness, headache upon reexposure.

sx are very similar to nitroglycerin toxicity

Question 25

Cystic Fibrosis inheritance and likelihood of passing on to child

Answer 25

Autosomal Resessive (remember, if a family member has affected siblings, the chances of this individual being a carrier is 2/3. This number needs to be multiplied by the prevelence of CF (say 1/25 as well as 1/4 if both husband and wife are carriers). In total the chance of having a kid is: 2/3 x 1/25 x 1/4 = 1/150

Question 26

Dermatomyositis (triad, lab findings)

Answer 26

- symmetric proximal muscle weakness, (the distinctive feature of this disease) - heliotrope rash, (which is reddish-purple in color with a mask-like distribution involving the cheeks, nasal bridge, and eyelids) - Gottron's papules (which are flat-topped, erythematous, hyperkeratotic papules usually overlying the metacarpophalangeal or interphalangeal joints) - Elevated creatine phosphokinase, aldolase, alanine aminotransferase, aspartate aminotransferase, and lactic acid dehydrogenase reflect the presence of muscle inflammation

Question 27

angiofibroma

Answer 27

a benign vascular tumor and is typically found in adolescent males. Presenting symptoms include recurrent nosebleeds and unilateral nasal obstruction. Although benign, these tumors are aggressive and may erode into adjacent structures such as the cranial cavity and cause diplopia -may also obstruct the eustachian tube, causing conductive hearing loss

Question 28

specificity

Answer 28

specificity is defined as the proportion of subjects with a negative test result who truly do not have the disease (TN), over the total number of subjects who truly do not have the disease (TN+FP)

Question 29

autosomal dominant polycystic kidney disease (ADPKD)

Answer 29

cystic dilation of the renal tubular epithelium in both the renal cortex and medulla. Beginning in young adulthood (20-25 years of age), the kidneys enlarge, resulting in destruction of the renal tubules and parenchyma. This presents as flank pain and gross hematuria, ultimately progressing to renal failure - also presents with Berry aneurysms, hepatic cysts, and mitral valve prolapse - due to mutation in the PKD1 gene, encoding polycystin-1. This protein facilitates cohesion between renal tubular epithelial cells

Question 30

Principal cells in the kidney respond to?

Answer 30

BOTH aldosterone (Na reabsorption, K excretion) and ADH (aquaporin insertion)

Question 31

Ménière’s disease

Answer 31

caused by a paroxysmal accumulation of endolymph fluid Treated with diuretics

Question 32

Ménétrier disease

Answer 32

rare, acquired, premalignant disease of the stomach characterized by massive gastric folds, excessive mucous production with resultant protein loss, and little or no acid production

Question 33

Neutrophil demargination

Answer 33

seen when treating with prednisone, a glucocorticoid. Demargination is the release of neutrophils from the pulmonary vasculature endothelium, where they are usually attached. In this process, neutrophils, found along the vessel walls, move into circulation, raising the apparent white blood cell count

Question 34

How do you intensify the murmur of HOCM and why?

Answer 34

Valsalva or standing up: decrease preload This occurs because reduced ventricle size further narrows the LVOT and enhances the ability of the mitral valve to obstruct the LVOT

Question 35

Alkaptonuria (ochronosis)

Answer 35

Congenital deficiency of **homogentisate oxidase** in the degradative pathway of **tyrosine to fumarate** pigment-forming homogentisic acid accumulates in tissue. Autosomal recessive. Usually benign. **\*CANNOT BREAK DOWN TYROSINE FULLY AND HOMOGENISTATE OXIDASE BUILDS UP\*** Findings: dark connective tissue, brown pigmented sclerae, urine turns black on prolonged exposure to air. May have debilitating arthralgias (homogentisic acid toxic to cartilage). Excess tyrosine worsens this condition

Question 36

Von Gierke disease

Answer 36

Type 1 glycogen storage disease. Deficient Glucose-6-phosphatase, Autosomal resessive Findings: Severe fasting hypoglycemia, glycogen in liver, blood lactate, triglycerides, uric acid, and hepatomegaly Treatment: frequent oral glucose/cornstarch; avoidance of fructose and galactose

Question 37

Mitral Stenosis (murmur and future risk)

Answer 37

Follows opening snap (due to abrupt halt in leaflet motion in diastole, after rapid opening due to fusion at leaflet tips). Delayed rumbling late diastolic murmur (interval between S2 and OS correlates with severity). LA \>\> LV pressure during diastole. Often occurs 2° to rheumatic fever. Chronic MS can result in LA dilatation. -patients with mitral stenosis are at risk for thromboembolic disease due to stasis of blood in the left atrium. Clots can be disseminated throughout the systemic circulation, although stroke is of obvious concern. An embolic stroke may cause unilateral limb paresis

Question 38

Dead space in lung

Answer 38

the area that is not participating in gas exchange -When there is ventilation of the alveoli but inadequate perfusion of the lungs relative to the ventilation, the V/Q ratio increases and a functional (alveolar) dead space is created.

Question 39

Otosclerosis

Answer 39

autosomal dominant disorder in which the ossicles of the middle ear become fused. This is the most common cause of conduction hearing loss in the elderly

Question 40

Presbycusis

Answer 40

age related loss of inner hair cells at the base of the basilar membrane. It is characterized by a progressive loss in high frequency hearing and is the most common cause of sensorineural hearing loss in the elder

Question 41

Damage to the neck of the humerus most likely results in damage to what artery and what nerve ?

Answer 41

**artery**: posterior circumflex humeral artery **nerve**: axillary nerve (deltoid and teres minor) resulting in inability to abduct the shoulder, deltoid atrophy, and numbness over the lateral shoulder

Question 42

amyotrophic lateral sclerosis (ALS)

Answer 42

progressive degeneration of the lateral corticospinal tracts as well the neurons of the anterior horns. Pathologic section of these cells may demonstrate inclusion bodies that stain positive for superoxide dismutase 1 (SOD1) and ubiquitin -Combined UMN and LMN deficits with no sensory or oculomotor deficits

Question 43

illusion

Answer 43

a misperception of external stimuli. The key here is that someone having an illusion actually does hear/see something that is real, but misinterprets what it is. For example, seeing a shadow in a corner and mistaking it for a person is an illusion

Question 44

What drug used to prevent recurrance of cluster headache? what drug used to prevent recurrance of migraine headache?

Answer 44

Cluster: Calcium channel blocker --\> Verapamil Migraine: B-blocker --\> propanolol

Question 45

sensitivity vs specificity

Answer 45

**Sensitivity** (true- positive rate): probability that a test detects disease when disease is present. **Specificity** (true-negative rate): probability that a test indicates no disease when disease is absent

Question 46

Thiazide diuretics (names, location, mechaism, and side effects)

Answer 46

Chlorthalidone, hydrochlorothiazide Thiazide diuretics act to inhibit the sodium-chloride channels of the distal convoluted tubule of the nephron. They are first line for essential HTN HF, idiopathic hypercalciuria, nephrogenic diabetes insipidus, osteoporosis Side effects : Decreased serum levels of: - K+ (hypokalemia) - Na+ (hyponatremia) - H+ (metabolic alkalosis) Increased serum levels of (mnemonic: GLUC): - **G**lucose (hyperglycemia) - **L**ipids (hyperlipidemia) - **U**ric Acid (hyperuricemia may precipitate gout) - **C**a2+ (hypercalcemia) -Also, sulfa allergy

Question 47

Autoimmune Hemolytic Anemia

Answer 47

Extrinsic, Hemolytic, Normocytic anemia where antibodies attack red blood cells. 2 versions: cold or warm **Cold**: (IgM)—acute anemia triggered by cold; seen in CLL, Mycoplasma pneumonia infections, and infectious Mononucleosis (“**cold weather is MMMiserable**”) **Warm**: (IgG)—chronic anemia seen in SLE and CLL and with certain drugs (e.g., α-methyldopa) (“**warm weather is Great**”) usually Coombs + Sx: fatigue following a viral illness, livedo reticularis (lacy, purple rash involving the lower extremities) and acrocyanosis (dark, purple to gray skin discoloration seen on the most distal parts of the body)

Question 49

Name the syndromes associated with these mutaitons 1. BRCA 2. p53 3. p16 4. BCL-2 5. APC

Answer 49

1. mutations are associated with familial breast and ovarian cancer. BRCA1 is a tumor suppressor gene that is involved in DNA repair and cell cycle control 2. seen in many cancers. The gene product, p53, delays cell cycle progression (blocks G1--\>S phase), which allows for repair of damaged DNA or apoptosis. Inherited TP53 mutations predispose to multiple tumor types early in adulthood (Li-Fraumeni syndrome) 3. tumor suppressor gene, the product of which is involved in cell cycle control, are associated with hereditary melanoma 4. BCL-2 blocks apoptosis. BCL-2 overexpression is thus associated with chronic lymphocytic leukemia and lymphoma 5. familial adenomatous polyposis (FAP). FAP is the result of a mutation in a key tumor suppressor gene, adenomatous polyposis coli (APC).

Question 50

Functions of these different parts of thalamus: 1. Medial Geniculate Nucleus 2. Ventral Posterolateral Nucleus (VPL) 3. Ventral Posteromedial Nucleus (VPM) 4. Anterior nucleus 5. Lateral geniculate nucleus

Answer 50

1. relays sensory information from the auditory system to the primary auditory cortex of the temporal operculum 2. somatosensory information from the contralateral body and neck 3. somatosensory, taste, and vestibular information from the contralateral head 4. relays information from the mammillary body of the hypothalamus to the anterior cingulate gyrus of the cortex 5. relays visual information from the ipsilateral hemiretinas

Question 51

Treatment of beta-blocker overdose and hyperkalemia

Answer 51

1. for B-blocker use **GLUCAGON** (stimulates cAMP synthesis independent of the beta-adrenergic receptor. Glucagonhas shown positive inotropic and chronotropic effects despite beta-receptor blockade) 2. for hyperkalemia use **Calcium gluconate** (it does not have an effect on potassium levels in the blood, it reduces the excitability of cardiomyocytes thus lowering the likelihood of developing cardiac arrhythmias)

Question 52

Brown-Sequard Syndrome

Answer 52

Hemisection of the spinal cord - **ipsilateral** signs of upper motor neuron damage (hyperreflexia, positive Babinski sign) due to the severing of the lateral corticospinal tract - **ipsilateral** loss of proprioception, fine touch, and vibration sensation due to damage of the dorsal columns - **Contralaterally**, patients experience a loss of pain and temperature sensation below the lesion due to spinothalamic tract trauma

Question 53

The relationship between lead levels and vitamin C intake?

Answer 53

Increasing vitamin C, will increase absorption of Iron, which will decrease absorption of lead from GI tract.

Question 54

Direct vs indirect hernias

Answer 54

**Direct**: medial to epigastric artery. More common in older men as abd wall weakens with age. Goes through the external (super cial) inguinal ring only. Covered by external spermatic fascia **Indirect**: Goes through the internal (deep) inguinal ring, external (super cial) inguinal ring, and into the scrotum. Enters internal inguinal ring lateral to inferior epigastric artery. Occurs in infants owing to failure of processus vaginalis to close (can form hydrocele). Covered by all 3 layers of spermatic fascia * *MDs don’t LIe:** * *M**edial to inferior epigastric artery = **D**irect hernia. * *L**ateral to inferior epigastric artery = **I**ndirect hernia.

Question 55

Oppositional defiant disorder vs. Conduct disorder

Answer 55

**Oppositional defiant disorder:** Enduring pattern of hostile, defiant behavior toward authority gures in the absence of serious violations of social norms **Conduct disorder:** Repetitive and pervasive behavior violating the basic rights of others (e.g., physical aggression, destruction of property, theft). After age 18, many of these patients will meet criteria for diagnosis of antisocial personality disorder Both are treated with CBT

Question 56

Lenticulostriate artery stroke (lacunar stroke)

Answer 56

the internal capsule carries descending corticospinal and corticobulbar tracts as well as ascending somatosensory information. The absence of any cortical signs, such as aphasia, spatial neglect, or motor apraxia, suggests a small lacunar stroke affecting a deep subcortical structure rather than a full vascular territory infarct (such as a middle cerebral artery infarct) -often due to unmanaged HTN. sx are Contralateral hemiparesis/ hemiplegia.

Question 57

calculating odds ratio

Answer 57

OR = (exposed cases/unexposed cases)/(exposed non-cases/unexposed non-cases). The numerator of an odds ratio consists of the odds that the exposure occurred among patients with the condition. These odds are defined as the probability that the exposure occurred among patients with the condition divided by the probability that the exposure did not occur among patients with the condition:

Question 58

Cushing reflex to head injury

Answer 58

the physiologic response to **increased intracranial pressure**, which leads to insufficient blood flow to the brain due to compression of the cerebral vasculature. There are three main components of this reflex: **1. bradycardia** **2. hypertension** **3. hypoventilation** all in an attempt to maintain cerebral perfusion

Question 59

How to calculate GFR

Answer 59

GFR≈C​CR​​=​(PCr​​/UCr)​​xV Ucr is the urine concentration of creatinine, PCr is the plasma concentration of creatinine, and V is the flow rate of urine (in mL/minute).

Question 60

Primary Biliary Cirrhosis (what is it, presentation, labs, ONE defining test)

Answer 60

Disease of middle aged women, Autoimmune reaction lymphocytic infiltrate, + granulomas destruction of intralobular bile ducts. presentation: present with itching, fatigue, jaundice, unexplained weight loss, right-upper-quadrant pain, and hepatosplenomegaly Lab: cholestatic pattern of injury with elevated alkaline phosphatase, direct and total bilirubin, IgM, and cholesterol **Anti-mitochondrial antibody** has 95 percent sensitivity and 98 percent specificity

Question 61

cystinuria

Answer 61

autosomal recessive defect in a membrane transporter in the renal proximal tubule for the amino acids cysteine, ornithine, arginine, lysine (**COAL**). Cysteine concentration is high in the urine, and cysteine precipitates form. Causes nephrolithiasis (kidney stones) Treatment: alkalization of the urine and hydration

Question 62

Ataxia-Telangiectasia

Answer 62

Defects in ATM gene p failure to repair DNA double strand breaks p cell cycle arrest. typically develop normally for the first few years of life, but have difficulty developing a normal gait Triad (AAA): 1. cerebellar defects (**A**taxia) 2. spider **A**ngiomas (telangiectasia) 3. Ig**A** defciency. Dx: serum alpha-fetoprotein (AFP) at least two standard deviations **above** normal for age is diagnostic of the disorder, with a sensitivity of approximately 95 percent

Question 63

Renal tubular acidosis Type 1 Type 2 Type 4

Answer 63

disorder of the renal tubules that leads to normal anion gap (hyperchloremic) metabolic acidosis. **Type 1 (distal) :** Defect in ability of α intercalated cells to secrete H+ no new HCO3− is generated metabolic acidosis. Associated with **hypokalemia** **Type 2 (proximal):** Defect in PCT HCO3− reabsorption excretion of HCO3− in urine and subsequent metabolic acidosis. Urine is acidi ed by α-intercalated cells in collecting tubule. Associated with hypokalemia. Caused by Carbonic Anhydrase inhibitors (acetazolamide) **Type 4 (hyperkalemic):** Hypoaldosteronism hyperkalemia NH3 synthesis in PCT NH4+ excretion. Causes: aldosterone production

Question 64

Diseases associated with... 1. Absent plasma cells 2. Absent T cells 3. Absent lymphocytes 4. Hypergammaglobulinemia 5. Increased IgE, IgA, decreased IgM IgG, fewer, smaller platelets

Answer 64

1. Bruton’s X-linked agammaglobulinemia (primary humoral immunodeficiency caused by a defect in B cell development) 2. **DiGeorge** (22q11.2 deletion failure to develop 3rd and 4th pharyngeal pouches absent thymus and parathyroids) 3. **SCID** (two causes: an X-linked mutation in the IL-2 receptor and an X-linked adenosine deaminase deficiency) 4. **Chronic Granulomatous Disease (CGD)**. (CGD is a disorder affecting macrophages’ and neutrophils’ destruction of bacteria (decreased absolute neutrophil count: most common neutrophil defect) with radical oxygen species (impaired H2O2), and commonly presents with a history of recurrent infections with catalase positive organisms. Deficiency in the production of superoxide by NADPH oxidase). X-LR 5. **Wiskott-Aldrich syndrome** (an X-linked disorder that causes B and T-cell dysfunction. **WATER**: Wiskott-Aldrich: Thrombocytopenic purpura, Eczema, Recurrent infections)

Question 65

sarcoidosis

Answer 65

Sarcoidosis is an autoimmune, inflammatory disease of unknown etiology that causes the development of granulomas in various organs. The lungs are most commonly affected, and the presence of bilateral hilar lymphadenopathy is highly suggestive of sarcoidosis. Serum angiotensin converting enzyme has relatively poor sensitivity and specificity for sarcoidosis, however if elevated it is also suggestive of the disease 5% of patients develop involvement of the nervous system

Question 66

Vestibular Schwanoma (acoustic neuroma)

Answer 66

benign tumor of the Schwann cells surrounding the eighth cranial nerve. It most commonly presents with unilateral hearing loss or vertigo, but when large can compress the seventh nerve, resulting in a peripheral pattern of facial weakness Bilateral acoustic schwannomas -\> Neuro fibromatosis type 2

Question 68

Calculating half life (T 1/2) and then calculating hours to steady state

Answer 68

t1/2 = (0.693 × Vd)/Cl Multiply this number by 4-5 to get to steady state