Medical 1.2

Question 1

Factor II

Answer 1

Thrombin

Question 2

Integrilin: Mechanism?

Answer 2

Glycoprotein IIb/IIIa inhibitor

Eptifibatide is a cyclic heptapeptide which blocks the platelet glycoprotein IIb/IIIa receptor, the binding site for fibrinogen, von Willebrand factor, and other ligands. Inhibition of binding at this final common receptor reversibly blocks platelet aggregation and prevents thrombosis

Question 3

Bivalirudin: Mechanism?

Answer 3

Direct thrombin inhibitor

Question 4

Ticagrelor: Mechanism?

Answer 4

P2Y12 receptor blocker

Reversibly and noncompetitively binds the adenosine diphosphate (ADP) P2Y12 receptor on the platelet surface which prevents ADP-mediated activation of the GPIIb/IIIa receptor complex thereby reducing platelet aggregation. Due to the reversible antagonism of the P2Y12 receptor, recovery of platelet function is likely to depend on serum concentrations of ticagrelor and its active metabolite

Question 5

Mitral valve papillary muscle: blood supply?

Answer 5

RCA

Question 6

Coronary artery dominance

Answer 6

The artery from which the posterior descending artery (PDA) arises

70% of people are right heart dominant

Question 7

CAP: typical organisms?

Answer 7

1) Strep pneumo
2) Moraxella
3) H. flu

Question 8

Adalimumab: Mechanism?

Answer 8

Anti-TNF antibody

Question 9

HNPCC: diagnosis?

Answer 9

3-2-1 rule: 3 affected family members, 2 generations, 1 under 50

Question 10

Lewy-Body Dementia: initial features?

Answer 10

Early impairments in attention and executive/visuospatial function (memory is usually affected later in the disease)

Early symptoms include driving difficulty (eg, getting lost, misjudging distances, or failing to see stop signs or other cars) and impaired job performance. The early appearance of impaired figure copying (overlapping pentagons), clock drawing, and serial sevens (or spelling WORLD backward) is suggestive of DLB, while AD patients generally show impaired short-term memory and orientation as the earliest deficits on the MMSE

Question 11

Lewy-Body Dementia: symptoms?

Answer 11

• Dementia
• FLUCTUATING cognition
• Visual hallucinations
• Parkinsonism

Fluctuations — Fluctuations in cognition and levels of alertness may occur early in the course of DLB and are estimated to be a feature in 60 to 80 percent of cases. The severity, duration, and type of symptoms involved in fluctuations is quite varied, even for a given patient. Episodes can be subtle, as in a brief decline in ability to perform an activity of daily living, or they may be dramatic enough to raise the question of a stroke or seizure. Caregivers often describe episodes in which patients appear to “blank out” or lose consciousness, become confused or behave in a bizarre manner, have speech or motor arrest, or become excessively somnolent. These episodes can last seconds to days, and they can be interspersed with periods of near-normal function.

This feature of DLB has been considered the most difficult of the core clinical features for inexperienced clinicians to evaluate. Family members may not volunteer this history. At the same time, questions to elicit this history, if too general, are likely to obtain false positive responses in patients with other forms of dementia.

Question 12

Visual hallucinations in Lewy-Body Dementia

Answer 12

Visual hallucinations occur in approximately two-thirds of patients with DLB, and are relatively rare in AD [20-22]. These are also an early sign in DLB and may precede parkinsonism. In one study with neuropathologic confirmation, visual hallucinations at presentation was the most useful clinical feature to distinguish DLB from AD, with 83 percent positive predictive value [7]. Among patients with DLB, those with visual hallucinations appear to have more severe deficits in visual attention and executive function compared with those without visual hallucinations, but similar degrees of visuospatial and visual-perceptual impairment [23].

Descriptions range from well-formed images of people or animals, to more abstract visions such as shapes or colors. Patients have described such simple hallucinations as seeing something briefly out of the corner of their eye, or extremely complex hallucinations, such as an ongoing dialog with a deceased loved one. Patients may also describe visual misperceptions, in which an object seems to move, zoom toward or away from the patient, or change shape.

Question 13

Propofol-related infusion syndrome: clinical manifestations?

Answer 13

• Type B lactic acidosis
• Hypertriglyceridemia
• Rhabdomyolysis
• Myocardial abnormalities (J-point elevation)

This rare syndrome occurs in approximately 1% of critically ill patients receiving propofol and most commonly occurs in those receiving doses above 4 mg/kg/h administered for more than 48 hours. The proposed mechanism involves the uncoupling of oxidative phosphorylation and energy production in mitochondria by propofol, coupled with the normal stress response to critical illness, to cause the characteristic findings of the syndrome.

Question 14

Lichen Planus: associated diseases?

Answer 14

Hepatitis C

Question 15

Lichen Planus: pathogenesis?

Answer 15

Immune-mediated mechanism involving T-cells against basal keratinocytes

Question 16

CDiff: causative antibiotics?

Answer 16

Fluoroquinolones, Clindamycin

Question 17

CDiff: how is severe disease defined?

Answer 17

1 point for each of the following:

• WBC > 15
• Age > 60
• Temp > 38.3
• Albumin < 2.5

Patients with 2 or more points are considered to have severe disease

Question 18

Tumor Lysis Syndrome: Criteria?

Answer 18

LABORATORY TLS: 2 or more of the following:

• Hyperuricemia
• Hyperkalemia
• Hyperphosphatemia
• Hypocalcemia

CLINICAL TLS: Lab TLS + one of the following:

• AKI
• Symptomatic hyperkalemia
• Symptomatic hypocalcemia

Question 19

Lateral pressure on nonblistered skin leads to denudation

Answer 19

Nikolsky sign

Question 20

Also known as “Wisdom spots”

Answer 20

Seborrheic Keratosis

Question 21

Morgan Freeman spots

Answer 21

Dermatosis Papulosa Nigra