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Flashcards in High Yield factoids and Clinical Situations Deck (74):
1

Measurement of 17-hydroxyprogesterone is the preferred diagnostic technique in patients with congentical adrenal hyperplasia. 17-hydroxyprogesterone is a steroid precursor that builds up in______ deficiency.

21-hydroxylase

2

Tumors in this area typically present with headaches, symptoms of pituitary dysfunction secondary to compression of the healthy pituitary tissue by the mass including decreased linear growth velocity and diabetes insipidus, and visual field disturbances, classically a bitemporal hemianopsia. SEen in children

cranipharyngiomas

3

Viruses are the most common cause of gastroenteritis in young children. The most common cause of viral gastroenteritis is_______, although the incidence has decreased with the advent of vaccinations. infection occurs most frequently in children aged 3-15 months. NONbloody diarrhea

rotavirus

4

most common during the first two year of life. The cause is often unknown. It presents with the abrupt onset of colicky abdominal pain, knee flexing, emesis, and bright red blood per rectum. On exam, it is sometimes possible to palpate a sausage-shaped mass in the right upper quadrant.

intussusepction; get abdominal CT if you suspect!!

5

what do you do to reduce intussuseption in a kid?

air-contrast barium enema

6

is the best test for diagnosing PSC. The exam shows a characteristic beaded appearance that is caused by segments of duct fibrosis that alternate with areas of dilation.

Endoscopic retrograde cholangiopancreatography

7

presents insidiously with non-specific symptoms such as fatigue, pruritus, abdominal pain, fever, weight loss, and intermittent jaundice. Physical exam can show scleral icterus, jaundice, and hepatomegaly. Laboratory evaluations are notable for an elevated alkaline phosphatase, direct and total bilirubin, and gamma globulin. Transaminases are normal or mildly elevated.

PSC

8

exam shows a characteristic beaded appearance that is caused by segments of duct fibrosis that alternate with areas of dilation.

PSC

9

A two-year-old boy presents to your clinic with one week of blood in his stools. The child is otherwise well. He has not have any fevers, anorexia, emesis, abdominal pain, diarrhea, constipation, hematuria, gingival bleeding or rash. He has no significant medical history and is growing and developing normally. On physical exam, he is afebrile with normal vital signs. He is well-appearing, conjunctivae are rosy, there is no heart murmur, abdomen is soft, non-tender, non-distended, and there are no anal fissures. What test, what do you expect?

Tc-99m pertechnetate is taken up by the gastric mucosa. It is non-invasive and involves minimal radiation: Meckels2

10

fatigue, pruritus, abdominal pain, fever, weight loss, and intermittent jaundice. Laboratory evaluations are notable for an elevated alkaline phosphatase, direct and total bilirubin, and gamma globulin. Transaminases are normal or mildly elevated and is strongly associated with Inflammatory Bowel Disease, particularly Ulcerative Colitis.

PSC

11

Designed by selecting individuals, determening exposure status, then follow forward in time or from point in past to the present for devo of diseaese

Cohort study

12

Select individuals with a particular disease (cases) and individuals without (control) adn eval previous exposure status

Case control

13

Exposure and outcomes are measured simultaneously at particular point of time (snapshot)

Cross sectional
limitation is that a temporal relationship betwen exposure and outcome isn't always clear

14

You just find out you roommate has N.meningitis. You're freaking out but your doctor prescribes you this for prophylaxsis

Rifampin (or Ciprofloxcin or ceftriaxone)

15

What do you prescribe to a pregnant lady to prevent transmission of N.Gonorhea to her baby

Erythromycin: macrolide

16

What do you tx someone with N. Gonorrhea with?

Ceftiraxone (+azithromycin bc you know they got Chlamydia!)

17

What do you treat person with N. Menigitis with?

Ceftriaxone or Pen G

18

What is the MOST COMMON mutation in CF?

F508 which is abnromal post translational processing of transmembrane protein; will still see elevated sweat Cl-

19

What type of anti-inflammatory drug would be preferred for pt with bleeding tendencies?

Celcoxib; COX-2 inhibitor that reduces inflammation; Platelets mostly express COX 1 so you would not exacerbate bleeding

20

What drug would you give to old person that has BPH with a itchy rash?

2nd Gen H1 blockers (Loratadine, Fexofenadine, Desloratadine, Cetirizine)!
good for allergies, don't cause sedation (no CNS penetration) or urinary retention like the Gen 1s (Diphenhydramine, dimenhydrinate, chlorpheniramine)

21

Nonselective Irreversible alpha 1 and alpha-2 adrenergic antagonist that effectively reduces number of receptors available for Nepi to bind

Phenoxybenzamine; irreversible antagonist; even at high conc Nepi can't overcome it's inhibitory effects

22

reversible, competitive antagonist of alpha1, B2, B2 adrenergic receptors with minor B2 receotpr agonist activity; used to tx severe HTN adn sympathomimetic overdose; reversible thus high dose Nepi can be overcome

Labetalol

23

What is the equation for Filtration Fraction in kidney

FF = GFR/RBF
thus decreased RBF (seen in efferent arteriole conx) results in increased FF and increased GFR

24

65 yo man comes in with fatigue and wt loss. He has Fe deficiency anemia when you work up labs. What's your can't miss Dx?

Fe deficiency anemia in adult is COLON CANCER till proven otherwise. Right sided masses cause Fe defieciency anemia

25

Myxomatous changes in the media of large arteries found in cystic medial degeneration; predisposes you to aortic dissections and aortic aneurysm seen in which disorder

Marfans has Myxomatous changes

26

Granulomatous inflammation of media and fragmentation of internal elastic lamina d/t autoimmunity to elastin.

Seen in giant cell arteritis

27

Big difference between Nephrotic and Nephritic syndromes

Nephrotic: see heavy proteinuria (>3.5 g/day) lipiduria, no RBC casts
Nephritic: RBC casts, dysmorphf red cells in urine, azotemia, hypertension

28

Pt passes out at the mall, her glucose is 45mg/dL. What do you need to tx her with

Intramuscular glucagon right away followed by IV dextrose
In a medical setting you can tx with IV glucose

29

Th1 cells secrete____ activating macrophages. ____ from macrophages induces and maintains granuloma formation. Anti-TNF drugs can, as a side effect, cause sequestering granulomas to break down, leading to disseminated disease. Always test for latent TB before starting anti-TNF therapy.

IFN-γ,
TNF-α

30

What diseases do you see granulomatous formation in?

Bartonella henselae (cat scratch disease) Berylliosis
Eosinophilic granulomatosis with polyangiitis
(Churg-Strauss syndrome)
Crohn disease (noncaseating granuloma) Foreign bodies
Francisella tularensis
Fungal infections (caseous necrosis) Granulomatosis with polyangiitis (Wegener) Listeria monocytogenes (granulomatosis
infantiseptica)
M. leprae (leprosy; Hansen disease)
M. tuberculosis (caseous necrosis) Treponema pallidum (3° syphilis) Sarcoidosis A (noncaseating granuloma) Schistosomiasis

31

What are the signs of Fe poisoning? What is the mechanism of cell death leading to Iron poisoning?

Acute nausea, vomiting, gastric bleeding and lethargy. cell death d/t peroxidation of membrane lipids
Tx with Deferoxamine or Oral defoaxirox and dialysis

32

Patient exhibits signs of foot drop. The disease is caused by decreased nerve conduction velocity, in this case on the common peroneal nerve... What is the disease and what is the mutation? What will the individual look like as the disease progresses

Charcot-Marie-Tooth: mutation of genes responsible for myelin synthesis
Later develops and see stork legs, and see weakness in hands and feet later. High arches

33

65 yo woman is admitted to the hospital for dysnea and fatigue. She has a history of heart fail exacerbations, hypercholesterolemia, and 36 pack year smoking history. Her exam shows tachycardia, distended neck veins and bilateral crackels. Therapy is started and labs show her hematocrit went from 44% to 50%. She has normal red blood cell mass and PaCO2 is 70 mmHG. What is the cause of pts polycythemia?

Relative Erythrocytosis
Polycythemia in female >48% and in male >52%. You need to look at RBC mass. If its increased, then it's either Poly-Vera in which case you would see elevation in all three cell lines or Secondary Erythrocytosis from EPO tumor.
Relative is when you ahve high Hct and normal RBC mass. Causes are volume depletion from diuresis (duh, you gave her a loop to tx heart fail) or dehydration

34

What medication would you give for pt that has a horrible headache behind his right eye, sees halos in vision field and feels nauseous. What 's the MOA

Pt has acute closed angle glaucoma. Give pt Acetazolamide= carbonic anhydrase inhibitor thus blocks NaHCO3 and water resorption in proximal tubule of the proximal tubule.
In the eye, carbonic anhydrase modulates HCO3 formation in aqueous humor. End up with urinary bicarb wasting and get alkaline urine

35

What is the best way to initially help out individual with hypoglycemia from DM?

Give individual glucagon to rapidly increase blood glucose levels. Gives liver the signal to produce glucose

36

What type of insulin do you recommend for pts to use right before a meal for short acting effects?

aspart-insulin

37

What insulin will be given every 12 hours?
What one lasts 24 hours?

12 hrs = NPH
24 hr coverage = Glargine

38

What is the mechanism of steptomycin

blocks initiation of protein synthesis by binding to and distorting structure of prokaryotic 30s ribosomal subunit

39

What form of hemoglobin dominates in newborns? What is the structure? When do you see normal hemoglobin in babies?

HbF is dominant form: Alpha-2, Gamma-2 and switches to a-2/B-2 at 6 months

40

Shown to induce a wasting syndrome (cachexia) that mediates paraneplastic cachexia in humans by suppressing appetite, inhibiting lipoprotein lipase and increasing insulin resistance in peripheral tissues

TNF-alpha

41

Brown pigment stones in the gall bladder are usually caused by what?

Arise secondary to infection of biliary tract
this results in release of B-glucuronidase by hepatocytes and bacteria--> causes hydrolysis of bilirubin glucoronides and increased unconjugated bilirubin in bile

42

What cytokines are key in mediating systemic inflammatory response ant stimulates hepatic secreation of acute-phase proteins like fibrinogen. High levels of fibrinogen increase the ESR (nonspecific marker of inflammation)

IL-1, IL-6, and TNF-Alpha

43

Metabolite of AA and fnx to stimulate neutrophil migration to site of inflammation

Leukotriene B4

44

What is the Structure, Location and Function of MHC class I molecules

Heavy chain and B2 microglobulin, in all nucleated cells and presents antiG to CD8+ cytotoxic T cells

45

What is the location, structure and function of MHC class II molecules

Located in APC cells (B cells, macrophages, DCs, Langerhans), function is to present antiG to CD4+ T helper lymphocytes
Structure is alpha and Beta polypeptides

46

What presents viruses, and tumor proteins to CTLs and what does this result in?

MHC class I--> causes apoptosis of presenting cell

47

What presents bacterial antigens that are phagocytosed and digested to Thelper cells and what does this result in?

MHC class II cells--> stimulation of humoral and cell-mediated immune response

48

Pt is getting worked up for peripheral edema. She isn't on meds and has no other medical history. Urinalysis shows protein in her urine and serum contains IgG4 antiB to phospholipase A2 (PLA2R) Whats the Dx

Phospholipase A2 IgG antiB are indicative of membranous nephropathy

49

What drug is a neuramidase inhibitors there-by decreasing release of virion particles?
What disease does it tx and prevent?

Oseltamivir
tx Influenza A and B

50

Inability of B lypmhocytes to undergo isotype switching. You see lymphoid hyperplasia and recurrent sinopulmonary infections. Often d/t absence of CD-40 ligand on T lymphocytes from genetic deficiency in enZ reponsible for DNA modification.
What is the Diseaes?

Hyper IgM syndrome
B lymphs can't switch from IgM to other immunoglobin types

51

Which TB drug requires and acidic environment to work as an antimicrobial

Pyrazinamide

52

Which TB drug inhibits mycobacterial DNA-dependent RNA polymerase

Rifampin

53

Which TB drug inhibits mycobacterial cell wall synthesis by blocking arabinosly transferase

Ethambutol

54

Which TB drug inhibits synthesis of mycolic acid which is a key component of mycobacterial cell walls

Isoniazid

55

The drugs are useful for treating BPH and hypertension. What three drugs are they and what is the MOA

Doxazosin, Prazosin adn Terazosin; they block the alpha-1-adrenergic receptor--> leads to relaxation of smooth muscle in arterial and venous walls = decrease in peripheral vascular resistance. The alpha-1 receptor in smooth muscle of bladder induce relaxation

56

Drug of choice for pts with diabetes and HTN?

ACE inhibitors

57

Drug of choice for pts with HTN and have evidence of CAD and CHF

Beta blockers

58

First line tx for patients with essential hypertension

Hydralazine

59

These work by inhibiting the Na/Cl co transporter in the distal convoluted tubule thereby reducing peripheral vascular resistance to tx HTN. How does the body respond to this?

Thiazide diuretics--> body will respond to low intravascular volume by releasing aldosterone--> this will decrease reabsorption of potassium and hydrogen ions

60

1.Primary pigment found w/in bile from hemoglobin but lacking in iron
2. Insoluble yellow-brown pigment with lipids and phospholipds complexed to proteins and associated with wear and tear
3. brown black pigment formed in melanocytes when tyrosine is oxidized to form dihydroxyphenylalanine
4. protein is pink-red extracellular substance that can accumulate and cause damage by placcing pressure on adjacent cells

1 . Bile
2. lipofuscin
3. Melanin
4. AMyloid

61

What are the structures from the Dorsal pancreatic bud?
What about the Ventral pancreatic bud?

Dorsal = Body, tail and most of the head and the small accessory duct
Ventral = Uncinate, inf/posteror part of head adn the Major pancreatic duct

62

1. mutation here are responsible for acquired resistance to HIV reverse transcriptase inhibitors and HIV protease inhibitors
2. Mutations here enable escape from host neutralizing antiBs

1. Pol gene
2. Env gene

63

What Changes to PT, aPTT, Plat count and Bleeding time do we see in vWB deficiency? What sypmtoms do they have?

PT = normal, aPTT = normal or increased, Plats = Normal and Bleed time is INCREASEd
Symptoms = hx of mucosal bleeding; gingival, epistaxis and menorrhagia.
*normal plat levels but prolongued bleed d/t impaired plat fnx

64

ssDNA virus transmited by respiratory route.
What diseases does it cause?
What do we worry about in Sickel Cell pts?

Parvovirus B 19 (only ssDNA virus)
Causes 5th disease in children
Aplastic crisis in people with hemolytic disease
Hydrops fetalis from mother-->fetus

65

What do you prescribe for individual with RA for acute relief of symptoms?
What about long term?

Acute = glucocorticoids
Long term = Methotrexate

66

A man recently recieved a kidney transplant. His T-lymphocytes quickly recognize the foreign HLA molecules from transplant renal cells. Inhibition of which substance would specifically reduce the proliferation and differentiation of these T lymphocytes?
How?
What meds would do this?

Calcineurin
= phosphatase that is activated when stimulaiton of appropriate cell receptor occurs. Calcineurin then phosphorylates NFAT which allows it to enter the nucleas and bind IL-2 promoter. IL-2 stims growth + dif of T cells
Cyclosporine and TAcrolimus inhibit calcinuerin acitvation

67

3 yo presents to office with FTT, ataxia and can't see in the dark. Mom says he has oily, fatty looking stools. You notice dark pigmented skin in his armpit area and the crease of his neck. What is the dx?

Abetalipoproteinemia: decreased synthesis of apolipoprotein B--> inability to make chylomicrons--> decreased secreation of cholesterol and see VLDL in blood and fat accumulation in enterocytes

68

What is the difference between Microsopic morphology in Cronhs vs UC?

Crohns: noncaseating granulomas and lymphoid aggregates (Th1 mediated)
UC: Crpyt abscesses and Ulcers, bleeing with no granulomas (Th2 mediated)

69

Pt has colon cancer in the PROXIMAL colon. This is an AD disease. What is it, what gene is responsible?

Hereditary nonpolyposis CR or Lynch; always involves proximal and from DNA mismatch repair gene

70

What lab can help you tell the difference bween viral hepatitis and Alcoholic hepatitis

Viral: ALT > AST
Alcoholic: AST> ALT (A Scotch and Tonic)

71

How do you tx esophageal varices that are bleeding vs those that aren't?

Bleeding give Octreotide
non: either do Banding or B-blocker

72

What is the mechanism of disease in Reye sydnrome?
What symptoms does child present with?

Viral infection + Aspirin: aspirin metabolites decrease B-oxidation by reversible inhibition of mitochondrial enZ--fatty liver with MICROvascular change, mitochondrial abnormalities and child presents with hypoglycemia, vomiting, hepatomegaly and coma

73

Lab worker comes in with rapid onset breathing difficulty, palpitations and flushed skin. You find out he works in a lab and likely has accidental poisoning. You administer amyl nitrate. What was the poisoning and why does this work?

Cyanide poisoning
Cyanide binds to cytochrome a3 which is key in ECT thus inhibits aerobic metabolism. Nitrates take hemoglobin from Fe2+ to Fe3+ state or methemoglobin
Methhemoglobin binds tight to cyanide and sequesters it from ETC

74

measure of potency of inhaled anesthetic. Its the minimal conc of the anesthetic in the alveoli that renders 50% of pts unresponsive to painful stimuli

Minimal alveolar Concentration (MAC); Potency is inversely proportional to MAC--> lower the MAC, more potent the anesthetic