Medical 1.1

Question 1

Pradaxa

Answer 1

Dabigitran

Question 2

Fragmin

Answer 2

Dalteparin

Question 3

Anti-Scl-70

Answer 3

Scleroderma (diffuse cutaneous version)- High specificity, but only 10-40% sensitive

Question 4

Which auto-antibody?Associated with CNS lupus

Answer 4

Anti-ribosomal P protein

Question 5

Buprenorphine: mechanism?

Answer 5

Partial opioid agonist

Question 6

Natalizumab: Mechanism?

Answer 6

Monoclonal antibody against integrin molecules

These molecules are important to adhesion and migration of cells from the vasculature into inflamed tissue. Natalizumab blocks integrin association with vascular receptors, limiting adhesion and transmigration of leukocytes. Efficacy in specific disorders may be related to reduction in specific inflammatory cell populations in target tissues. In multiple sclerosis, efficacy may be related to blockade of T-lymphocyte migration into the central nervous system

Question 7

Dalfampridine

Answer 7

Nonspecific potassium channel blocker, used in MS

Improves conduction in focally demyelinated axons by delaying repolarization and prolonging the duration of action potentials. Enhanced neuronal conduction is thought to strengthen skeletal muscle fiber twitch activity, thereby, improving peripheral motor neurologic function

Question 8

Cholecalciferol

Answer 8

Vitamin D

Question 9

Bivalirudin: Mechanism?

Answer 9

Direct thrombin inhibitor

Question 10

CADASIL: Clinical Features?

Answer 10

1) Migraine with Aura
2) Ischemic strokes/TIAs
3) Cognitive features
4) Neuropsyciatric symptoms

Question 11

Etomidate: advantages?

Answer 11

Hemodynamically neutral

Question 12

Etomidate: disadvantages?

Answer 12

• Adrenal suppression

- No analgesic properties

Question 13

Thiopental: advantages?

Answer 13

Suppresses neural activity

Good for patients with elevated intracranial pressure, seizures, or CNS bleeding

Question 14

Ursodiol: Mechanism?

Answer 14

Reduced secretion of cholesterol from liver, as well as absorption of cholesterol from intestines. This decreases the cholesterol content of bile and bile stones.

Question 15

Valproic Acid: adverse effects?

Answer 15

Hyperammoniemia

Hyperammonemia is believed due to propionic acid, a metabolite of VPA, which inhibits mitochondrial carbamoyl phosphate synthetase, an enzyme necessary for ammonia elimination via the urea cycle. If the action of this enzyme is sufficiently impaired, ammonia levels will accumulate, frequently producing encephalopathy

Question 16

Ketamine: adverse effects?

Answer 16

Emergence Reactions

These reactions vary in their intensity and have been described as disorientation, dream-like experiences, or hallucinations that may be frightening. They occur in up to 20 percent of adults but can be prevented or treated by giving a small dose of midazolam

Question 17

Cholangitis: etiology?

Answer 17

Anything that causes biliary obstruction and/or stasis

Examples:

• Biliary calculi (28 to 70 percent)
• Benign stenosis (5 to 28 percent)
• Malignancy (10 to 57 percent)

Question 18

Erythema Nodosum: associated conditions?

Answer 18

• Antecedent Streptococcal infection (most common cause worldwide)
• Sarcoidosis (will also see Hilar adenopathy)
• Tuberculosis
• Fungal (Coccidioidomycosis, Histoplasmosis)
• Inflammatory Bowel Disease
• Bechet’s disease

Question 19

Lofgren’s Syndrome

Answer 19

Triad of:

• Hilar adenopathy
• Acute polyarthritis
• Erythema Nodosum

Seen in patients with Sarcoidosis

Question 20

Calciphylaxis: AKA?

Answer 20

Calcific Uremic Arteriolopathy

Question 21

Calciphylaxis: symptoms?

Answer 21

• Excruciatingly painful ischemic necrosis in high adiposity areas (abdomen, buttock, thigh)
• Violaceous, plaque-like subcutaneous nodules

Question 22

Calciphylaxis: pathogenesis?

Answer 22

Systemic medial calcification of arterioles, leading to ischemia and necrosis

Question 23

Calciphylaxis: risk factors?

Answer 23

• Hyperphosphatemia
• Elevated plasma Ca x PO4 product
• Hyperparathyroidism
• Active Vitamin D administration

Question 24

Cerebral T waves: etiology?

Answer 24

• Stroke

- Intracranial bleeding

Question 25

Urine pH = 7.5

Answer 25

Proteus UTI (highly likely) Proteus produces the enzyme Urease, which converts ammonia (NH4+) to ammonium (NH3), causing an alkaline urine

Question 26

Staghorn calculus

Answer 26

Implies presence of Proteus bacteria in the urinary tract Proteus -> Urease, causing alkaline urine. The alkalinity promotes the precipitation of phosphate, carbonate and magnesium. This causes the formation of struvite stones, that often form large staghorn calculi.

Question 27

Pes planus

Answer 27

Flat feet