Josh's Concepts Flashcards
(150 cards)
1
Q
Pt with meningitis symptoms. Elevated PT & PTT. Hypotensive. Water-Freidrichson syndrome. What is the cause?
A
N.meningitides (or p.aueruginosa). leads to bilateral destruction of adrenal glands (fatal)
2
Q
Cushing’s DISEASE cause
A
Pituitary adenoma
3
Q
Neuroblastoma. Good prognosis sign?
A
pseudorosettes
4
Q
Arterial supply to adrenals.
A
Inf phrenic a.
Abdominal aorta
Renal a.
5
Q
Venous drainage of adrenals
A
Left suprarenal v -> L renal v
R suprarenal v -> IVC
6
Q
Prolactin control
A
DA in the periphery
7
Q
GH receptor type
A
membrane-bound. uses JAK-STAT signalling
8
Q
Hypothyroid pregnant woman taking Levothyroxine. What to do.
A
Increase dosage.
9
Q
Initial treatment of thyroid storm
A
Esmolol
10
Q
Craniopharyngioma. Where does the tumor arise from?
A
Rathke’s pouch
11
Q
Where do hormones ACTING on the anterior pituitary first drain into?
A
Primary capillary plexus
12
Q
When TSH binds the thyroid receptor, how does Iodine get taken up by the colloidal material?
A
Chloride0iodide symporter
13
Q
Homeless person inhaled something. Low muscle tone.
A
Anesthetic– isoflurane
14
Q
Mechanism of Open Angle glaucoma?
A
trabecular meshwork is blocked— fluid cannot drain.
15
Q
Pathophysiology of proliferative DM retinopathy.
A
Hypoxia –> VEGF release –> angiogenesis –> increased neovascular membrane
16
Q
Pic of Retinal a. occlusion
A
Retinal a. occlusion.
Amaurosis fugax
17
Q
Hypothyroid symptoms. Fine needle aspiration shows lymphocytes and germinal centers. Underlying process of this condition?
A
Hashimoto’s Thyroiditis. formation of auto-antibodies against thyroperoxidase
18
Q
Medullary Thyroid Carcinoma. Cell origin?
A
C-Cells
19
Q
Cretinism. Diagnostic marker @ birth to prevent?
A
Increased TSH
20
Q
Patient with meningitis. CSF report shows it’s viral. Pain in temporal regions.
A
HSV (MCC viral encephalitis in US)
– Necrotizing and hemorrhagic encephalitis
@ Temporal & frontal lobe
Show Cowdry A bodies (eosinophilic intranuc. inclusions)
21
Q
Bit by animal. Stop rabies????
A
Dipoloid vaccine & Igs
22
Q
Weakness, comes & goes, loss of eye sight…. What is the diagnostic marker?
A
Multiple Sclerosis: oligoclonal bands @ spinal tap
23
Q
Tired at end of the day. Tired chewing meals. Underlying process?
A
Abs attacking ACh receptors
24
Q
Trouble combing hair. Had the flu. Dx?
A
Guillan Barré
25
Upper AND Lower Motor problems
ALS
26
Girl gets tired exercising.
MS??
27
ADHD-- parents don't want treatment. What could happen?
Poor academic performance. Drug abuse.
28
Bacterial meningitis in a NEONATE. Cause?
S. agalactiae (MCC)
29
Alcohol withdrawal. What do you give?
Benzo -- prevent seizures and other sx
30
Meningitis in INFANT/CHILD/ADULT. MCC?
S.pneumo
31
Patient wants to quit smoking. Give him partial nicotine agonist. What is it?
Varenicline
32
Heroine addict. You give Buprenorphine to quit. How does it work?
Displaces heroin & other opiates from mu receptor-- decreases cravings, blocks effect of heroin
** can cause withdrawal if given while heroin still in system!
33
Patient is agitated, high-energy, hasn't eaten in forever, sweating, aggressive, hasn't slept in forever. What caused this?
Cocaine
34
Catatonic types?
Paranoid- delusions, aud. hallucinations
Disorganized - disorg speech/behavior, flat affect
Catatonic - extreme negativism/mutism, waxy movement, echolalia, echopraxia, excessive motor activity
35
You want to remove a piece of pancreas and you know there is an anastomoses between the gastroduodenal artery and the inferior pancreaticoduodenal artery where there is a tumor. Where is it?
Head of pancreas
36
Parkinson's off period? What do you give?
Apomorphine-- rescue
37
Parkinson's patient is taking L-DOPA/carbidopa, having N/V. What area is this stimulating?
chemoreceptors
38
What drug can you give to prevent L-DOPA from breaking down in the BBB once it crosses?
Entacapone (or tolcapone)- COMT inhibitor
39
MOA of Phyngolomide
phosphoryalted into Fingolimod-phosphate by spingosine kinase 2....
-> Agonist @ spirociene-1-phosphate (S1P) receptors
For Relapsing-Remitting MS
40
Repaglinide is used only for postprandial hypoglycemia. Why?
Short duration
41
Man is on insulin for DM I. He knows the symptoms of hypoglycemia, so he is aware. What drug would interfere with his ability to detect hypoglycemia?
B-blockers
42
MS. On section of brain, what can you say?
Areas of demyelination. (gray)
43
50yo with Muscular dystrophy. Cousin and grandpa has it.
Becker's Muscular Dystrophy
44
Being treated for bipolar disorder. Also taking ACE inhibitors for HTN. Develops hyponatremia. Why?
Taking Lithium for bipolar. Co-admin with ACE causes hyponatremia.
45
Anti-epileptic monotherapy or adjunct for secondary generalized tonic-clonic.
Lamotrigine. Blocks inactivated? Na+ channels & inhibits glutamate release
46
Arnold Chiari II. Vermis went through foramen magnum. Meningomyelocele too. What else associated?
Syringohydromelia
47
Pt with Chiari II dies-- on 4th day, what do you see on the brain?
Macrophages & reactive astrocytes
48
Patient has surgery. Next day is aggressive, agitated, screaming. Within a couple days is fine again. What can she have?
ICU psychosis. Delirium. Acute Confusion. Encephalitis. whatev
49
What drug can you give in the middle of the night if someone can't go back to sleep?
Zaleplon-- shorter duration
50
Melatonin agonist
Rameloton
51
S/S Major Depressive Disorder
SIGECAPS
52
Patient has been spending money like crazy, has financial problems, loves drinking and partying. He's been depressed for several weeks.
Bipolar 2?
53
Autopsy: pseudopalisading, necrosis, hemorrhage.
Glioblastoma
54
Child. Picture of tumor in central line in vermis. Homer-Wright Rosettes.
Medulloblastoma
55
Kid has ADHD. Give drug that blocks reuptake & facilitating release of NE & DA
Dextroamphetamine
56
ADD kid started meds, has been having tics. What drug?
Methylphenidate
57
Bupropion: errthang
Blocks reuptake sites fo NE & DA
T/U: Major depression, SAD, Nicotine, ADD & ADHD (off label)
AE: dry mouth, constipation, weight loss, anorexia
58
Conversion disorder
Symptoms with no medical or chemical reason.
59
Drug in patch form avoids HTN crisis
Selegiline. avoids GI, so won't get HTN crisis with tyramines.
60
Patient is taking SSRI. Having AEs. What adjunct can you give that will block receptors?
Mirtazapine blocks 5HT2A and 2C receptors, as well as a2 heteroreceptors.
Anti--nausea :)
61
What drug works by blocking the receptors to increase the level of NE & 5HT?
Mirtazapine
62
Woman had baby, hemorrhaged. Now has no libido. low hormone levels of ant pit stuff. What else is associated?
Hypogonadism (loss of hair, loss of libido, amenorrhea), weight loss (low GH), cold intolerance (low TSH), hypopigmentation (low ACTH)
63
Hypothyroid with galactorrhea. Pituitary adenoma. Elevated prolactin.
Prolactinoma. suppresses GnRH --> amenorrhea.
64
How to treat prolactinoma in pt who DOESN'T want to get preg?
D2 agonist. Cabergoline. (bromocriptine in woman who wants to get preg)
65
Acromegaly. What else can be eleveated?
Hyperglycemia due to increase in gluconeogenesis.
66
MOA of Pegvisomant?
GH receptor competitive antagonist-- DOESN'T activate JAK-STAT signalling or stimulate IGF-1 secretion, so IGF-1 decreases and GH remains high.
67
Craniopharyngioma. Embryologic origin?
Rathke's pouch
68
Hyperosmotic urine. Hypoosmotic plasma. Decreased sodium. = SIADH. What is causing it?
SMALL cell carcinoma
69
How does Conivaptan block V2 receptors in the kidney?
Decreases cAMP
70
Guy lives with mother in law. Goes to nursing home, and thinks the old people are after him. Otherwise, is NORMAL and a successful NEUROSURGEON.
Delusional disorder
71
Intracerebral hemorrhage --> uncal herniation. Where is the bleed?
Duret hemorrhage---several small ruptures in pons.
72
Lens-shaped hematoma. Patient is lucid.
Epidural hematoma
73
Generalized Anxiety Disorder. First line treatment?
SSRI
74
Benzos & anxiety
Limit to 5 weeks, often @ start of SSRI / SNRI treatment to decrease suicide risk. Used short term for siutational stress.
75
Who is most likely to develop secondary obesity???
Asian BMI 24
Hispanic BMI 29
Sedative lifestyle + fast food
```
Secondary:
rapid weight gain
Signs of hyperthyroidism (pretibial edema, delayed tendon reflex)
Signs of Cushing
Steroid treatment
Atypical antipsychotic treatment
```
76
DM II. What is the main source of energy when not exercising? Fatty acids. When they start working out, what happens?
Get glucose in the muscle.
77
DM II. What stain?
Congo red! buildup of amyloid
78
Elevated glucose. What is released? Decrease in glucose? then what?
incr glucose -> INSULIN;
| decr glucose -> glugacon
79
Patient has cancer that causes hypercalcemia. What drug can you give?
Bisphosphanate (Zoledronic acid)-- malignancy of hypercalcemia
80
Parathyroids gone. What else could be?
Thymus (DiGeorge)
81
Take BP, tetany!
Hypoparathyroid (Trousseau's sign-- neuromusc irritability)
82
Person with stroke. Fever. What drug?
Acetominophen
83
Man is having stroke. Wife calls ER. What to do?
give baby aspirin.
84
What does Cinacalcet do?
Calcium mimetic-- sensitizes Ca2+ sensing receptr. thus PTH secretion is suppressed by lower amounts of Ca2+ than normal.
85
Amaurosis Fugaz: hollenhorst plaque.
Retinal artery occlusion.
86
Man acting strange (altered consciousness??!). Had seizure the day after?.
Partial Compex Seizures
87
Patient whose hand then arm shakes. Then loses consciousness and shakes everywhere.
Simple partial with secondary generalization
88
Global Cerebral Ischemia: errthang
Pathophys: Ischemic damage of cytomembrane -> depolarization -> release of glutamate & aspartate -> blockatge of ligand-gated cation channels on postsynaptic cells -> Ca2+ & Na+ influx
Gross: Laminar necrosis in neocortex & hippocampus; watershed infarcts
Histo:
12-24h: ischemic neuron death
2-3d: neuron dissolution, leukocyte influx
4-7d: Macrophage influx & activation
>2w: Liquefaction; debris removal, reactive gliosis
89
Pale infarct- thrombus; Red infarct - embolus
that's all.
90
Diabetes. What is found in BVs?
Amyloid-- congo red w/apple
91
Rapid hemorrhage. Sudden, severe headache. Where could it have been?
Bifurcation
92
Left arm & face > leg. Oh wait. right shoulder is weak too.
Watershed. (on both sides)
93
11-hydroxylase deficiency. What WON'T be elevated?
glucocorticoids??
94
Purulent exudate of brain. ewe. cause?
Bacterial meningitis.
95
Meningitis with HIV. Virchow-robbins space is enlarged.
Cryptococcal meningitis.
| CAPSULATED-- larger- open up lumen of vessels!
96
What happens in a diabetic (pathologically)?
Thickening of endoneural artery wall
97
Patient with schizophrenia has been taking the same drug for over 60 years. Begins to have chorea. Drug?
Haloperidol-- causes tardive dyskinesia
98
Drug blocks receptors at one location, causing increase in DA at another location... uh..
Aripiprazole (DA partial agonist)
99
Patient takes drug. Now keeps getting infections. What drug and why?
Clozipine. can cause AGRANULOCYTOSIS
100
mystery drug induces and metabolizes enzyme
Carbamazepine
101
Pt taking another anti-epileptic. Gum hyperplasia-- give folic acid.
Phenytoin
102
Valproic acid--- causes weight gain. What drug has least effect of weight gain?
Coffin's slides say: "Don’t see weight gain in children with carbamazepine, lamotrigine, and phytoin."
Also, TOPIRAMATE causes weight loss.
Josh said Carbamazepine.
103
What anti-epileptic inhibits the release of glutamate and blocks Na+ receptors, delaying reactivation of Na+ receptors?
Lamotrigine
104
Status epilepticus. What drug to give first?
BENZO
105
Hyperthyroid baby, showing cretinism. What could you have screened for?
TSH
106
Something something TRH & TSH.
NOT TRH because you can't measure TRH
107
Von Gierke's kid. What enzyme is not work.
Glucose-6-Phosphatase (josh and jeff are WRONG bro)
108
Readiness to change stages. Patient has DM. Hasn't been taking care of herself but wants to start.
Contemplation.
109
Abuse vs. dependence
Dependence-- tried to and wants to stop but failed. Abuse-- social, legal problems.
110
Within 3 days- coarse tremors, disorientation. Alcoholic.
Delirium Tremens
111
Cogwheel tremor, but no resting tremor.
Still Parkinson's
112
Polydypsia, polyphagia, polyuria associated with?
BOTH DM I & II
113
Intensive therapy-- where do you want HbA1c?
6.5-7.5 (according to beezle's graph)
114
What causes micro and macro-angiopathies
Non-enzymatic glycosilation
115
Pt with diabetic foot infection. What is the worst that can happen?
Osteomyelitis (gangrene, amputation not option). Also, sepsis?
116
Patient in coma with DM I & elevated glucose. What to do?
Give saline then read potassium. Aggressively give saline and insulin if normo- or hyperkalemic.
117
Diabetic ketoacidosis. What is the compensation?
Respiratory (Kussmaul breathing)
118
Patient takes Cholinesterase inhibitor. What drug can you give that blocks glutamate function?
Memantine
119
Huntington's tx
Tetrabenazine to treat chorea
120
Triptans (sumatriptan). Something something AE.
Cardiovascular events are rare but serious.
121
Persona with heart problem going to undergo sedation. Don't give?
Meperidine (causes tachycardia)
also, methadone, pentazocine
122
Partial agonist at mu and antagonist at delta & kappa
Buponorphine
123
OD with opiate. Give?
Naloxone-- an opioid antagonist
124
Patient with ringing in both ears. What gene?
NF2 (Schwannoma)
125
Axis I vs Axis II
Axis II presents early adulthood
126
Likes to be alone. Doesn't like people, does'n't want friends. Likes to do complex math.
Schizoid Personality Disorder
127
D.nozzle late to dr. appt. yelling.
Narcissistic (Josh says Borderline)
128
Dependent Personality Disorder. Has broken ankle. What is response to doctor?
dunno, but
-Difficulty making decisions without excessive support
–Needs others to assume responsibility
- Difficulty disagreeing 'due to fears of losing support
– Difficulty doing things on own'
– Volunteers for unpleasant tasks to gain nurturance from'others
– Feels uncomfortable or helpless when alone
– Urgently seeks a new relationship when one ends
– Preoccupied with fears of having to take care of self
129
Glasgow Coma Scale: pupils
Small, reactive: Diencephalon
Midpoint: Midbrain
Pinpoint: Pons
Dilated: Medulla
130
Test to check for brain dead?
Cerebroangiography
131
Demyelination in brain. Preventricular deep white matter disease, slight atrophy, minimally enlarged ventricles. Gyri less prominent.
Alzheimers
132
Histo of alzheimer's
Neurofibrillary tangles
133
Stroke. Starts to develop dementia.
Something vascular
134
Repeated falls. Pleasant hallucinations.
Lewy Body dementia
135
Behavioral change with hyperphagia over 1 year in older woman
Pick's
136
Behavioral change with hyperphagia over 1 year, in younger man
Picks
137
Throbbing headache. Pain with movement. SLOW progression
Acute migraine
138
Male, just drank alcohol. Worst headache ever. Watery eyes, nasal stuffiness.
Cluster headache
139
What nucleus causes stress?
Locus Coeruleus
140
Alcoholic patient. Doctor wants him to go to AA, but he doesn't want to go for fear of discrimination.
Social Anxiety Disorder
141
PTSD S/S
Exposure to traumatic event. Re-experience. Hyperarousal. Avoidance.
142
Shadow sign used to diagnose...?
Acute Angle Closure Glaucoma
143
Bacterial vs. Viral vs. Fungal:
- glucose
- leukocytes
Bacterial- low glucose, PMNs
Viral- normal glucose, PMNs then lymphocytes
Fungal- low glucose, lymphocytes
144
AIDS patient. Cryptococcal meningitis characteristics
Budding yeast. encapsulated
145
Sinus infection. Ring enhancement in brain.
S. pneumona (or any strep?)
146
Meningitis + ring enhancement + tooth extraction
abcess
147
Watery eyes, swimming pool, periauricular nodal inflammation. What virus?
Adenovirus
148
Neonate with purpulent exudate from eyes. Other twin is fine.
Chlamydia
149
Prednisolone causing cushing syndrome.
blah blah insulin not working
150
Start taking prednisolone, start to get infection. What to do?
Lower dose.
