Step 1c

Question 1

Narcolepsy

Answer 1

Common symptoms:

• sleep paralysis
• cataplexy (muscle weakness upon wakening)
• sleep attacks
• hallucinations
• –> hypnagogic occur when a person falls alseep
• –> hypnopompic occur when a person is awakening

tx: modafinil, methylphenidate, amphetamines

Question 2

DIC

Answer 2

Can develop 2nd to OB complications, trauma, gram negative sepsis, or malignancy

There is a consumption of ALL coagulation factors and platelets.

• > increased PT, PTT, and BT
• > decreased palelets and fibrinogen

Dx: D-dimer tests for fibring degradation productions (FDP) and confirms dx

Question 3

Triptans

Answer 3

5Ht1b/1d agonists that are used in abortive therapy of migraines

Likely cause vasoconstriction & prevent release of CGRP and substance P from trigeminal afferents

Example: sumitriptan, almotriptain, rizatriptain, etc

Question 4

Sjogren antibodies

Answer 4

SS-A(Ro) and SS-B (La) –> antibodies against ribonucleoproteins (SS-B is more sensitive)

Question 5

SLE antibodies

Answer 5

Anti-dsDNA

Question 6

CREST syndrome antibodies

Answer 6

Anticentromere antibodies

Question 7

Tumor lysis syndrome

Answer 7

Occurs cancers with high cell turnover rates (lymphomas and leukemias)

Symptoms: flank pain, other stuff and elevated uric acid level, elevated serum potassium and phosphorus levels, and a decreased calcium level.

Tx with allopurinol or other xanthine oxidase inhibitors (febuxostat)

Question 8

Active errors (sharp end)

Answer 8

occur at point of interface between humans and a complex system

Question 9

Latent errors (blunt end)

Answer 9

Hidden issues within individual health systems

Question 10

Sirolimus

Answer 10

Inhibits T-lymphocyte activation and proliferation that occurs secondary to antigenic and cytokine (IL-2, IL-4, IL-1) stimulation. Does this by binding a specific serine-threonine kinase (mTOR)

MINIMAL nephrotoxicity
–> sirolimus saves the kidneys

Question 11

Halothane hepatitis

Answer 11

Halothane can still be used as a general anesthesitic but can cause:
hepatic failure, malignant hyperthermia, and cardiac arrhthmias

Question 12

Reiter syndrome (reactive arthritis)

Answer 12

Conjunctivitis, arthritis, urethritis (cervicitis in femalesz)

Can’t see, can’t pee, can’t climb a tree

Synovial fluid –> inflammatory arthritis with predominance of neutrophils (similar to RA)

Associated with HLA-B27

Question 13

Congenital microvillus atrophy

Answer 13

Leading cause of secretory diarrhea in first few weeks of life –> mutation in myosin 5b

Biopsy: scanty and disorganized microvilli

Microvilli are composed of microfilaments –> there is an abnormal binding of myosin to actin microfilaments

Question 14

Tx of HTN in pts with diabetes or heart failure (especially those with renal complications)

Answer 14

ACE-inhibitors

Question 15

Homocystinuria

Answer 15

Cystathionine synthase deficiency

Results in elevation of methionine and homocysteine due to a lack of production of cystathionine

Cystein decreases

Question 16

Most common cause of nephrotic syndrome

Answer 16

FSGS

Not all glomeruli are affected and there is segmental sclerosis of the glomerular tuft

Signs: edema, proteinuria

Question 17

Physiologic changes living at high altitudes

Answer 17

Diamteter of PULMONARY arterials decrease (difference from systemic vessels) – due to hypoxia

Question 18

Berger disease (IgA nephropathy)

Answer 18

Most common cause of glomerulonephritis worldwide

IgA (sometimes C3, prperdin, IgG, and IgM) deposition in the glomerular mesangium

Hematuria usually develops within days of viral infections with RBC casts

Question 19

Desmoplasia

Answer 19

Presence of excessive formation of fibrous tissue –> can surround the tumor and produce chemoresistance