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What is the mechanism of action of local anesthetics? Which nerve fibers are blocked first with local anesthesia? (FA15p499)

mechanism: block Na+ channels by binding to specific rec. on inner part of channel, bind to *activated* Na+ channels, so most effective in rapidly firing neurons.
3o amine local anesthetic penetrate membrane in uncharged form, then bind to ion channel in charged form
-->prevent nerve firing

*small, myelinated fibers are blocked first*


What medications are used in the treatment of urge incontinence?

muscarinic antagonists/anticholinergic: Oxybutynin, solifenacin, tolterodine, darifenacin, trospium


What are the three different eukaryotic RNA polymerases? What type of RNA does each make?
(FA15 p68) (FA16 p54)

RNA polymerase I makes rRNA (most numerous RNA, rampant).
RNA polymerase II makes mRNA (largest RNA, massive).
RNA polymerase III makes tRNA (smallest RNA, tiny).

Prokaryotes only have 1 RNA polymerase


Which cell types do not require insulin for the uptake of glucose? (FA15 p314) (FA16 p308)

GLUT-1: RBCs, brain, cornea
ƒGLUT-2 (bidirectional): β islet cells, liver, kidney, small intestine
ƒGLUT-3: brain
ƒGLUT-5 (fructose): spermatocytes, GI tract

BRICK L (insulin-independent glucose uptake): *Brain, RBCs*, Intestine, Cornea, Kidney, Liver.

GLUT-4: requires insulin for glucose uptake


What are the layers of the epidermis beginning with the most superficial layer? What is Auspitz sign?
(FA15 p436, 439) (FA16 p437, 440)

Stratum Corneum (keratin)
ƒStratum Lucidum
ƒStratum Granulosum
ƒStratum Spinosum (desmosomes) ƒ
Stratum Basale (stem cell site)

bake some good luscious cookies/ come let's get sun burned

Auspitz sign—pinpoint bleeding spots from exposure of dermal papillae when scales are scraped off. Can be associated with nail pitting and psoriatic arthritis. (psoriasis)


What is Kallmann syndrome? (FA15 p579) (FA16 p586

usually sporadic, but X-linked if familial, sometimes AD, AR
Failure to complete puberty; a form of hypogonadotropic hypogonadism. (dec. testosterone, dec. LH)
Defective migration of GnRH cells and formation of olfactory bulb; dec. synthesis of GnRH in the hypothalamus; anosmia; midline facial defects, dec. GnRH, FSH, LH, testosterone.
Infertility (low sperm count in males; amenorrhea in females).


A 67-year-old man with congestive hear failure lost his job and medical insurance, so he stops buying and taking his digoxin, and develops dyspnea. What will this do to his cardiac output (CO)? What are the mechanisms behind his development of dyspnea?

digoxin: + inotrope used for HF
stopping it will decrease his CO via decreasing contractility.

the reduced contractility can also cause a backwards bloodflow, congesting the pulmonary circulation-->dyspnea


A 17-year-old girl is brought to the emergency room for abdominal pain and vomiting. She has a fever, and further questioning and exam reveal that the pain is in the right lower quadrant and has rebound tenderness. She says the pain began around the umbilicus. She is very nauseated and vomits again during the exam. What must be ruled out prior to coming to the final diagnosis in this patient? (FA15 p363) (FA16 p360)

this is classic presentation for acute appendicitis, but MUST RULE OUT PREGNANCY (get a B-hCG)


A 31-year-old man is post-op day 1 after an exploratory laparotomy. The surgery was performed emergently for intraperitoneal hemorrhage after a motorcycle crash. His creatinine today is elevated to 2.0 mg/dL. His pain is currently uncontrolled. Explain why an NSAID could lead to a potential complication in this patient. (FA15 p530, 533) (FA16 p535, 538)

NSAIDs block renal-protective prostaglandin synthesis (via inhibiting COX-1) -->Ž constriction of afferent arteriole-->reducing RPF and GFR; this may result in acute renal failure.


Which phagocyte dysfunction disease increases patient susceptibility to Staphylococcus aureus and Escherichia coli? What is the cause of this disease? (FA15 p215) (FA16 p209)

Chronic granulomatous disease:
Defect of NADPH oxidase--> dec. reactive oxygen species (e.g., superoxide) and respiratory burst in neutrophils; X-linked recessive most common.
-inc. susceptibility to catalase ⊕ organisms (Need PLACESS): Nocardia, Pseudomonas, Listeria, Aspergillus, Candida, E. coli, S. aureus, Serratia. (due to these organisms using up H2O2, so phagocytes cannot utilize for killing)

Abnormal dihydrorhodamine (flow cytometry) test.
Nitroblue tetrazolium dye reduction test is ⊝.


In your own words, describe what type I (a) error is. (FA15 p54) (FA16 p38)

Stating that there is an effect or difference when none exists
Also known as false-positive error.
α = you saw a difference that did not exist (e.g., convicting an innocent man).


What trace element is essential to the function of carbonic anhydrase and lactate dehydrogenase?

Zinc, needed for protein folding


A 30-year-old man who is experiencing shortness of breath is diagnosed with obstructive lung disease on pulmonary function testing. The patient does not have a history of asthma and has never smoked. The patient is subsequently diagnosed with α1-antitrypsin deficiency. How does the emphysema caused by smoking differ from the emphysema caused by α1-antitrypsin deficiency? (FA15 p371, 610) (FA16 p369, 618)

α1-antitrypsin deficiency: Ž uninhibited elastase in alveoli Ž  elastic tissue-->panacinar emphysema, lower lobes

smoking: Centriacinar, upper lobes


In what clinical scenarios would you see a “nutmeg” liver? (FA15 p297, 370)

RHF, Budd-Chiari syndrome

-increased central venous pressure, increased resistance to portal flow.


You are performing a radical mastectomy and exercise extreme caution as you dissect laterally along the serratus anterior muscle. You do this in order to avoid severing which motor nerve, which would result in what sequela? (FA15 p419) (FA16 p420)

Long thoracic n., "winged scapula"


A patient comes to the clinic complaining of severe low back pain that radiates down the back of her leg. What is the most likely explanation for her pain?

disc herniation; L5, S1 nerve root compression


What problem/abnormality is associated with the following buzzwords?
Calf pseudohypertrophy (FA15 p624)
Gower maneuver (FA15 p85)

Duchenne muscular dystrophy


Subluxation of the lenses (FA15 p83) ??

Marfan's syndrom, homocysteinuria


Café-au-lait spots (FA15 p83)??

Neurofibromatosis type 1


Tuft of hair on lower back (FA15 p449)??

Spina bifida occulta


What type of cell differentiation and maturation takes place at the thymus? (FA15 p199) (FA16 p191) The thymus also functions to positively restrict major histocompatibility complex (MHC) at the corticomedullary junction. On which cells would you expect to find MHC I? MHC II? (FA15 p200) (FA16 p192)

T-cell differentiation and maturation

MHC I: on all nucleated cells (not RBCs)



A 59-year-old man with a 50-pack-year history of smoking sees you for management of his COPD. What is the clinical definition of chronic bronchitis? (FA15 p610) (FA16 p618)

productive cough for > 3 months per year (not necessarily consecutive) for > 2 years.


A 50-year-old woman develops a new onset of low back pain without a specific injury. A lumbar x-ray reveals lytic lesions which raise suspicion for multiple myeloma. What is the characteristic finding on electrophoresis with multiple myeloma? What is the classic finding in the urine of a patient with multiple myeloma? (FA15 p401) (FA16 p401)

ƒM spike on serum protein electrophoresis
ƒIg light chains in urine (Bence Jones protein)

-increased susceptibility to infection
ƒ-Primary amyloidosis (AL)
ƒ-Punched-out lytic bone lesions on x-ray A
-Rouleaux formation B (RBCs stacked like poker chips in blood smear)
-Numerous plasma cells C with “clock-face” chromatin and intracytoplasmic inclusions
containing IgG


Nematode routes of infection (154)
You’ll get sick if you EATT these!
These get into your feet from the SANd.
Lay LOW to avoid getting bitten.

Ingested—Enterobius, Ascaris, Toxocara, Trichinella
Cutaneous—Strongyloides, Ancylostoma, Necator
Bites—Loa loa, Onchocerca volvulus, Wuchereria bancrofti


Biliary tract disease, cholangiocarcinoma

Clonorchis sinensis


Brain cysts, seizures

Taenia solium (cysticercosis)


Hematuria, squamous cell bladder cancer

Schistosoma haematobium


Liver (hydatid) cysts

Echinococcus granulosus


Microcytic anemia

Ancylostoma, Necator


Myalgias, periorbital edema

Trichinella spiralis