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Weekly TrueLearn Questions Flashcards

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1
Q

Describe the Cushing Reflex

A
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1
Q

What are common signs of aortic regurgitation?

A

High pitch, decrescendo diastolic murmur heard best at left sternal border. Widening pulse pressure.

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2
Q

During which of the phases of a cardiomyocyte action potential are Ca++ channels open?

A

During phase 2 – K Efflux and Ca++ influx make the plateau phase

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3
Q

What occurs at point C in this pressure-volume loop of the left ventricle?

A

Isovolumetric contraction ceases as the aortic valve opens and blood leaves the left ventricle

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4
Q

What is the most likely diagnosis of a patient with worsening DOE and bilateral hilar adenopathies on CT? What pulmonary function testing will be abnormal?

A

Sarcoidosis, a restrictive lung disease will cause a decrease in residual volume (The amount of air left in the lungs after maximum forceful exhalation)

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5
Q

Describe the effects of hypoxia on peripheral vasculature and on pulmonary vasculature

A

Peripheral vasculature vasodilate while pulmonary vasculature vasoconstricts (Hypoxic Pulmonary Vasoconstriction, or HPV)

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6
Q

How is Minute Volume calculated?

A

Tidal Volume x Body weight in Kg x Respiration Rate

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7
Q

What is the most common genetic deficiency in patienets with emphysema?

A

Alpha-1 antitrypsin deficiency.

Causes unnopposed elastase activity, decreasing elastin activity and panacinar emphysema. Look for lung hyperinflation on CXR!

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8
Q

What is the primary differentiation between transudative and exudative pleural effusion?

A

Exudative pleural effusion is d/t inflammatory processes. The space between endothelial cells allow for large molecules to pass into the pleural space. Proteins, LDH, cholesterol will all be found in that fluid where it will be less present in transudative pleural effusions.

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9
Q

Patients with a history of psychotic episodes and an acute presentation of hyperthermia, HTN, tachycardia and tachypnea with dark red urine are likely experiencing a side effect of which type of medication?

A

This patient is likely suffering from neuroleptic malignant syndrome (NMS) which is mostly likely d/t typical antipsychotics such as Fluphenazine, Haloperidol or Resperidone.

Treatment is Dantrolene

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10
Q

Histologically and physiologically, describe both type 1 and type 2 pneumocytes

A

Type 1: These are simple squamous cells which make up the structural integrity of the alveoli. They are also necessary for the process of gas exchange

Type 2: These are cuboidal cells interspersed w/in the alveoli. They contain lamellar bodies which contain proteins necessary in the production of surfactant.

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11
Q

A patient that presents with calcinosis (calcinosis cutis), Reynaud phenomenon, esophageal hypomotility, sclerodactyly and telangiectasias. What autoantibody is most likely present in this patient?

A

CREST Syndrome, a constellation of symptoms associated with systemic sclerosis, is characterized by the presence of anti-centromere autoantibodies.

CREST -
(C)alcinosis
(R)eynaud Phenom.
(E)sophageal hypomotility
(S)clerodactyly
(T)elangiectasias

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12
Q

What are the symptoms and what autoantibody is present in Sjogren Syndrome?

A

Anti-Ro autoantibody

It presents with dry mouth and eyes, sticky oral mucosa, filliform papillae atrophy and enlargement of salivary and lacrimal glands

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13
Q

What diseases are associated with a malar (butterfly) rash?

A

SLE is the big one. But don’t let it fool you to not think of – Mixed tissue connective disease, cellulitis, rosacea and dermatomyositis

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14
Q

What is the mechanism of action of Gemfibrozil, Fenofibrate and Colfibrate?

A

Fibrate medications enhance the activity of lipoprotein lipase, cleaving free fatty acids from VLDL and promoting the uptake of them into adipose tissue, decreasing the circulating amount.

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15
Q

What is the primary medication used for a patient w/ Tetralogy of Fallot?

A

Phenylephrine, an alpha-1 agonist is used, followed by Propranolol.

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16
Q

What medication can be used to treat both BPH and HTN?

A

Alpha-1 adrenergic antagonists Terazosin and Doxazosin

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17
Q

Where are Alpha-1 and Alpha-2 receptors located?

A

Alpha-1 receptors are found in the peripheral vasculature and the smooth mm of other organs, including GI tract
- Stimulation = vasoconstriction

Alpha-2 receptors are found in the CNS and regulate release of Norepinephrine
- Stimulation = decreased amounts of neurotransmitters (NE)

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18
Q

Why is the EF preserved in a patient w/ HFpEF?

A

Both end diastolic LV volume AND stroke volume are reduced, maintaining the ejection fraction

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19
Q

What biomarker will be elevated w/ HFpEF but not with HFrEF?

A

Natriuretic peptide, which is released when the LV wall is stretched in HFpEF

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20
Q

What is the mechanism of action of Celecoxib?

A

Celecoxib is a COX-2 selective inhibitor, unlike NSAIDs which are non-specific COX inhibitors.

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21
Q

What is the most common cause of atypical and typical pneumonia?

A

Atypical - Mycoplasma Pneumoniae

Typical - Streptococcus Pneumoniae

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22
Q

What is the most common causative agent of pulmonary infections in a patient w/ Cystic Fibrosis?

A

Pseudomonas Aeruginosa

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23
Q

A purple gram staining organism is isolated from sputum of a patient w/ fever, dyspnea and a productive cough. Patient has a history of alcoholism. What is the most likely organism?

A

DON’T LET THE ALCOHOLISM FOOL YOU. Staph aureus is the most likely organism that is gram negative (purple) while Klebsiella Pneumoniae is gram positive (red)

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24
Where do RNA viruses duplicate?
Within the cytoplasm of the infected cell
25
What is the Opsonization process and what antibody does it most use?
Opsonization is an immune process which marks pathogens with an Opsonin for phagocytosis. The most used antibodies are IgG.
26
Which fungus colonizes the lungs of up to 10% of corticosteroid-dependent asthmatics?
Aspergillosis will lead to allergic bronchopulmonary aspergillosis, resulting in frequent recurring asthma attacks, increased serum IgE concentrations and eosinophilia.
27
Name a virulence factor for a gram-positive cocci, catalase negative, alpha-hemolytic and optochin sensitive organism
Strep pneumo has a polysaccharide capsule virulence factor
28
Explain the Gs pathway and medications that activates it
Hormone --> GPCR receptor --> Gs protein --> Stimulates Adenylyl Cyclase --> (ATP) --> (PPi + cAMP) --> cAMP activates PKA --> Protein Kinase A exerts its effect on bio tissue ## Footnote Epinephrine is a principal drug that stimulates this pathway
29
What effect does a bronchodilator have on a patient w/ an obstructive airway disease? How about corticosteroids?
Both will decrease airway oobstruction and increase FEV1. Steroids are slow acting because they work primarily on inflammation, whereas a bronchodilator will almost immediately increase air flow.
30
What is the most common mechanism of infection in septic arthritis, and what is the most commonly affected joint?
The knee is most commonly affected due to a hematogenous spread of infection. ## Footnote For septic arthritis, look for patients w/ pre-existing joint conditions and immunocompromised patients
31
What are diagnostic and laboratory findings of Psoriatic Arthritis?
Diagnostic - PITTING NAILS, warm affected joints, silver scaling plaques (esp. on elbows) Labs - NEGATIVE ANA and Rheumatoid factors
32
What is the triad of symptoms for reactive arthritis?
Arthritis Conjunctivitis/Uveitis Urethritis
33
What are "heart-failure cells" and when and where would they be found?
Heart-failure cells are macrophages laden by RBCs which spill into the alveoli d/t increased hydrostatic pressure in the pulmonary vasculature during left-sided heart failure. Commonly known as Hemosiderin-Laden macrophages
34
Name, in order, the valves of the heart
Tricuspid Pulmonary Mitral Aortic
35
What is a common symptom seen on ECG of dilated cardiomyopathy?
Premature Ventricular Contractions (PVCs)
36
In what area of a vessel wall does atherosclerosis begin?
It begins with endothelial damage to the intimal layer of the blood vessel
37
What are the identifiable rhythms in this exhibit?
A - 1st degree heart block B - Ventricular Fibrillation C - Torsades de Pointes D - Electrical alternans (Notice varying QRS amplitude, commonly seen in tamponade) E - Atrial Fibrillation
38
What is the medication that PROLONGS the opening of GABA receptors?
Barbiturates. Benzos increase the frequency with which they are opened
39
What is the mechanism of action of Mirtazapine, and what are it's primary indications?
Mirtazapine is a selective alpha-2 adrenergic ANTAGONIST, which decreases inhibition, thereby increasing release of Serotonin and NE into the synaptic cleft. It is used for MDD
40
What cardiac symptoms will be seen in a patient w/ anorexia nervosa?
Bradycardia
41
During which stage of sleep do parasomnias occur?
Parasomnias such as night terrors, sleep walking, confusional arousal states all occur during stage 3 of Non-REM sleep
42
What is the mechanism of action of Tricyclic antidepressants?
They block the transporters of NE and serotonin ## Footnote AE - Muscarinic blockade (Dry eyes, mouth, constipation Alpha1 blockade (Orthostatic hypotension) Histamine blockade (sedation, weight gain)
43
Name an identifying feature of borderline personality disorder
Marked compulsivity along w/ inability to maintain interpersonal relationships
44
What stage of sleep occupies the majority of time and what will be seen on EEG?
K-Complexes and sleep spindles are seen during stage 2 of sleep, making up 45-55% of total sleep time
45
What is the main difference between a manic and a hypomanic episode?
Hypomania does not markedly affect her functioning in daily life, result in hospitalization or invovle psychosis like mania does. It is more closely related w/ en elevated mood, decreased sleep, and increased energy.
46
What is the most common type of lung cancer, and where will it be found in the lung?
Adenocarcinoma will be found peripherally ## Footnote Associated w/ non-smokers and more common in women than men.
47
Histology of a squamous cell tumor will reveal what?
Malignant cells w/ dark, eosinophilic cytoplasm and intercellular bridges (desmosomes)
47
A 25 yo male patient w/ hemoptysis and dark red urine for a month w/ decreasing kidney function and proteinuria likely has what, and what antibody is most consistent?
Goodpasture syndrome - Anti-glomerular basement membrane antibody
48
What is the amount of air left in the lungs after a normal exhalation?
Functional reserve capacity
49
What would an ABG look like in a patient with alpha-1-antitrypsin deficiency?
Low PaO2, high PaCO2, high HCO3, low pH ## Footnote Emphysema = obstructive, can't blow CO2 off. Barrel chest!
50
In a patient w/ a history of drinking and an AST 2x the ALT, what would be seen histologically?
Mallory bodies, or eosinophilic inclusion bodies are associated w/ alcoholic hepatitis. ## Footnote Expect to see these in chronic alcoholics after a bout of heavy drinking
51
What is the etiology of pancreas divisum?
Failure of fusion of the pancreatic ductal system. Causes chronic pancreatitis in young children, if symptomatic
52
Explain the etiology of alcohol-induced hepatic steatosis
Alcohol induces hepatic steatosis increases NADH concentration through ethanol metabolization, which decreases the oxidation (breaking down) of free fatty acids into acetyl-CoA units. This increased free fatty acid concentration results in more triglyceride synthesis, which deposits into the liver, resulting in hepatic steatosis.
53
What causes "nutmeg liver" on gross inspection?
Right-sided heart failure will result in congestive hepatopathy, resulting in patchy hemorrhage and centrilobular necrosis, aka "nutmeg liver."
54
Which Hepatitis is most associated with travelling and what type of vaccine would most likely attenuate the risk?
Hep A is best avoided by the use of an inactivated/killed vaccine
55
On a Weber test, a patient has sound localize to the affected ear of hearing loss, along with bone conduction > air conduction on that affected ear. What type of hearing loss is present?
This is most likely d/t conductive hearing loss, in which a physical obstruction restricts sounds from reaching the inner ear, unlike a sensorineural hearing loss, in which there is damage to the auditory nerve or hair cells of the inner ear.
56
Which extraocular muscle is responsible for moving the eye down and in?
Sup. oblique. Remember -- the obliques move the eye INWARD and OPPOSITE their name. SUPERIOR oblique moves the eye INFERIORLY and vice versa.
57
A patient presents w/ a unilateral temporal HA, ipsilateral blurry vision and jaw claudication. What is the next step in treatment?
Glucocorticoids! Temporal arteritis (Giant Cell Arteritis) can cause permanent vision loss if not treated rapidly. Temporal artery biopsy will verify diagnosis up to weeks after initiating steroid therapy.
58
What is the most common benign cerebellar tumor in children?
Astrocytoma, more specifically a pilocytic astrocytoma ## Footnote Most common malignant cerebellar tumor in children = Medulloblastoma, which presents with a poorly defined mass, unlike the well-demarcated cyst of astrocytomas.
59
What determines the speed of onset of action from an inhaled anesthetic?
The arteriovenous gradient. The larger the gradient, the more anesthetic is absorbed in peripheral tissues, the less gets to the brain and the slower the onset of action is.
60
What toxin is regularly associated with consumption of pufferfish?
Tetrodotoxin, which results in a blockade of Na+ channels, leading to hypotension, facial parasthesias and paralysis.
61
At what age should the palmar reflex resolve?
6 months
62
At what level of the brainstem is the cutoff for decerebrate v decorticate posturing?
The level of the red nucleus within the ventral midbrain ## Footnote Below = Decerebrate Above = Decorticate
63
What will a urinalysis show for a patient w/ acute glomerulonephritis?
RBCs and RBC casts
64
What haplotype is most associated w/ elevated risk of MS?
HLA-DRB1 and HLA-DR2
65
What disease is HLA-B27 most strongly correlated with?
Ankylosing Spondylitis
66
Which necrotic process is most common in incidences of ischemic stroke?
Liquefactive necrosis
67
What paraneoplastic syndrome is most commonly associated with small cell lung cancer?
SIADH
68
What cofactor is necessary for appropriate K+ absorption?
Magnesium
69
What collagen has deficiencies in Alport syndrome?
Type IV collagen, which manifests in kidneys, eyes (lenses) and ears (sensorineural hearing loss)
70
What Gram-positive cocci is most commonly a causative agent of UTI in young women?
Staph Saprophyticus
71
What organ will have a Chapman's point at the inferior pubic ramus?
Uterus
72
Which renal disease process presents w/ "tram tracking" appearance on biopsy?
Membranoproliferative Glomerulonephritis ## Footnote "Tram-tracking" apperance d/t mesangial expansion from increased C3 deposition in the mesangium
73

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