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RR: LENS SHAPED LESION ON HEAD ON CT SCAN

Epidural Hematoma

RR: COMMON UNDERLYING CAUSE OF INTUSSUSCEPTION

Meckels Diverticulum
Adenovirus infection causing Peyer's patches

RR: NO MILK PRODUCTION IN THE POSTPARTUM PERIOD

Sheehan's Syndrome

RR: PIGMENTED HAMARTOMAS IN THE IRIS

Lisch Nodules of neurofibromatosis

RR: HOWEL-JOLLY BODIES

DNA remnants in asplenia

RR: CANCER A/W ASBESTOS

Mesothelioma
Bronchogenic Carcinoma

RR: OWL'S EYE INCUSIONS

CMV

RR: OWL'S EYE NUCLEUS

Hodgkins Reed Sternberg Cells

RR: OWL'S EYE PROTOZOAN

Giardia Lamblia

RR: 50 YO MALE WITH NEW UNEXPLAINED SKIN YELLOWING AND NO OTHER SYMPTOMS

Cancer of the head of the Pancreas

What category does the drug belong to: Cholestyramine?

Bile Acid Binding Resin (Cholesterol lowering drug)

What category does the drug belong to: Venlafaxine?

SNRI

What category does the drug belong to: Fluphenazine?

Typical Neuroleptic (increased potency)

What category does the drug belong to: Phentolamine?

Reverse Non-Selective alpha blocker

What category does the drug belong to: Captopril?

Ace Inhibitor

What category does the drug belong to: Trazadone?

Anti-Depressant

What category does the drug belong to: Carteolol?

Beta Blocker (Glaucoma tx)

What category does the drug belong to: Clarithromycin?

Macrolide

What category does the drug belong to: Famotidine?

H2 blocker

What category does the drug belong to: Fluvoxamine?

SSRI

What category does the drug belong to: 6-mercaptopurine?

AntiCancer drug (inhibits purine synthesis)

What category does the drug belong to: Selegiline?

MAOI (parkinsons tx)

What category does the drug belong to: Terbinafine?

Anti Fungal (Onymonoch; nail fungus tx)

What category does the drug belong to: Clozapine?

Atypical Antipsychotic

What type of information does the Ventral Posterior Lateral (VPL) of the thalamus relay?

Somatosensory information from the body

What type of information does the lateral geniculate of the thalamus relay?

Visual retinal information to the occipital lobe

What type of information does the VPM (ventral posterior medial) of the thalamus relay?

Somatosensory information from the face

What type of information does the ventral anterior of the thalamus relay?

Motor basal ganglia to the cortex

What is the antidote for copper, gold and arsenic?

Penicillamine

What is the antidote for Arsenic, mercury, and gold?

Dimercaprol
Succimer

What is the antidote for t-PA and streptokinase?

AMinocaproic Acid

What is the antidote for digitalis?

Stop digitalis
Normalize Potassium levels
Lidocaine or anti digitalis fragments

What are the 4 main pharmocokinetic equations?

Vd = amt of drug in body / plasma drug conc
CL = .7 X Vd / t1/2; LD = Css X Vd; MD = Css X CL

Where does fetal erythropoiesis take place?

(Young Liver Synthesizes Blood)
Yolk Sac
Liver
Spleen
Bone Marrow

What adult bones are involved with erythropoeisis?

Vertebrae
Sternum
Pelvis
Ribs
Cranial Bones
Tibia and femur

What aneurysm causes the eye to look down and out?

Posterior Communicating Artery

What aneurysm causes bilateral loss of lateral visual fields?

Anterior Communicating Artery

What artery is damaged in Broca's or Wernicke's Aphasia?

Middle Cerebral Artery

What artery is damaged when there is unilateral lower extremity sensory and/or motor loss?

Anterior Cerebral Artery

What artery is damaged when there is unilateral facial and arm sensory and/or motor loss?

Middle Cerebral Artery

What hormones use steroid receptors?

Steroid Hormones
Estrogen
Progesterone
Testosterone
Aldosterone
Vitamin D
Thyroxine T3 T4
Glucocorticoids

What hormones use tyrosine kinase receptors?

Insulin
IGF 1
FGF
PDGF
Prolactin
Growth Hormone

What histological change takes place in the trachea of a smoker?

Metaplasia: Ciliated columnar to squamous

A pt is in the ER having anaphylaxis; you make an incision beneath the thyroid cartilage to establish an airway; what structure was cut?

Cricothyroid membrane

What structures transverse the diaphragm and at what vertebral angle do they pass?

IVC at T8
Esophagus and Vagus at T10
Aorta, Thoracic Duct, Azygous Vein at T12

What type of cell proliferates during lung damage?

Type II pneumocytes

What amniotic fluid measurement is indicative of fetal lung maturity?

Lecithin to Sphingomyelin ratio > 2

A young woman has infertility; recurrent URI's; and dextrocardia; which of her proteins is defective?

Dyenin Arm Defect due to Kartagner's syndrome

The following lung capacities are obtained from an elderly smoker:
FRC 5.0 L
IRV 1.5L
IC 2.0L
VC 3.5L
What is the TLC?

TLC = FRC + IC
5.0 + 2.0 = 7.0

What substances are known for causing methemoglobinemia?

Chloroquine Primaquine; Dapsone Sulfonamides; Local Anesthetics; Metoclopramide; Nitrates

A 42 yo woman with fibroids is chronically tired; what is the most likely dx and what changed have occured in the O2 content and saturation?

Hypochromic Microcytic Anemia
No change in O2 content or saturation; but not as much Hemoglobin to be saturated

A pt is shown to have hypoxia and CXR reveals an enalrged heart; what is the most likely cause of hypoxia?

CHF; lungs are not perfused well enough to get O2 to the rest of the body.

What is the differential diagnosis for eosinophilia?

(DNAAACP)
Drugs
Neoplasms
Atopic disease (allergy/asthma/churg strauss)
Addisons
Acute interstitial nephritis
Collagen Vascular disease
Parasites (lofflers eosinophilic pneumonitis due to ascaris lumbricoides)

A pt presents with an asthma attack; what immunological reaction is taking place that is responsible for the anaphylaxis in the pt?

Mast Cell mediate; antigen cross linking of mast cells and IgE; Type I Hypersensitivity

What asthma medication is the inhaled tx of choice for chronic asthma?

Inhaled steroids

What asthma medication is the inhaled DOC for acute exacerbations?

Albuterol
(with Ipratroprium)

What asthma medication has a narrow therapeutic index; drug of last resort?

Theophylline

What asthma medication blocks conversion of arachidonic acid to leukotriene?

Zileutin

What asthma medication inhibits mast cell release of mediators, used for prophylaxis only?

Cromolyn

What asthma medication is an inhaled treatment that blocks muscuranic receptors?

Ipratropium

What asthma medication is an inhaled long acting beta 2 agonist?

Salmuterol

What asthma medication blocks leukotriene receptors?

Zafirlukast
Montelukast

A pt has extended expiratory phase; what is the disease process?

Obstructive Lung Disease

H&E of a lung biopsy from a plumber shows elongated structures with clubbed ends in tissue; what is the dx and what is he at risk for?

Asbestosis leading to mesothelioma and bronchiogenic carcinoma

A preterm infant has difficulty breathing. An xray reveals a diffuse ground glass appearance with air bronchograms; what is the dx and what would've prevented this?

Neonatal Respiratory Distress Syndrome
Prevented with tx mother with steroids before birth.

A pt develops ARDS from an occupational inhalation of NO2; what histo change is likely to be seen in a pt recovering from ARDS?

Proliferation of type II pneumocytes

A CXR shows pleural effusions; what are the clinical findings?

Decreased breath sounds over the effusion
Dull resonance
Decreased fremitus

A tall thin male teenager has abrupt onset dyspnea and left sided chest pain. Percussion on the affected side reveals hyperresonance and breath sounds are diminished; what is the dx?

Spontaneous pneumothorax

A CXR shows collapse of the middle lobe of the right lung and mass in the right bronchus; pt has history of recurrent pneumonias; what is the dx?

Bronchial Adenocarcinoma

A pt of yours develops bronchogenic lung cancer but has never smoked. He is a coal miner. Exposure to what substance has put him at risk for developing lung cance?

Radon

What complications can arise from lung cancer?

(SPHERE)
Superior Vena Cava Syndrome
Pancoast Tumor
Horner's Syndrome
Endocrine (paraneoplastic syndrome)
Recurrent Laryngeal Nerve Symptoms (Hoarseness)
Effusions (pleural or pericardial)

What is the most common cause of pneumonia in immunocompromised pts?

Pneumocystis Jirovecci

What is the most common cause of atypical/walking pneumonia?

Mycoplasma

What is the most common causative agent of pneumonia in alcoholics?

Klebsiella

What can cause an interstitial pneumonia in bird handlers?

Chlamydia Pstici

Pneumonia a/w bats and bat droppings?

Histoplasma

Often cause of pneumonia in a pt visiting SW USA?

Coccicioides

Pneumonia a/w "currant jelly" sputum?

Klebsiella

Q fever is a/w what organism?

Coxiella Burneti

A/w pneumonia acquired from ACs?

Legionella

Most common cause of pneumonia in children 1 yo and younger?

RSV

Most common cause of pneumonia in neonate (B to 28 days old)?

Group B Strep
E coli

Most common cause of pneumonia in children and young adults (college students; recruits; prison inmates)?

Mycoplasma

Common cause of pneumonia in pts with other health problems?

Klebsiella

Most common cause of viral pneumonia?

RSV

Causes wool-sorter's disease (life threatening pneumonia)?

Bacillus anthracis

Endogenous flora in 20% of adults?

Strept Pneumoniae

Common bacterial cause of COPD exacerbation?

H. Influenzae

Common pneumonia in ventialtor pts and those with cystic fibrosis?

Pseudemonas Aeriginosa

Pontiac fever is a/w what organism?

Legionella

Examination of a lung at autopsy reveals peripheral lesion with caseous necrosis; dx?

TB

A 30 yo comatose man on ventilatory support in the ICU develops an infection and dies; Autopsy reveals pus filled cavity in the right lung; what is the likely etiology?

Aspiration leading to Lung Abscess

A 55 yo man who is a smoker and heavy drinker presents with a new cough and flu-like symptoms; gram stain shows no organisms; silver stain of sputum shows gram negative rods; what is the dx?

Legionella Pneumophilia

Causes of transudate effusions?

CHF
Cirrhosis
Nephrotic Syndrome
Pulmonary Embolism
Fluid Overload

Causes of Exudate effusions?

Pneumonia
Infections
TB
Cancer
Uremia
Connective Tissue Disease

RR: MOST COMMON CAUSE OF SIADH

Small Cell Cancer of the lung

RR: MOST COMMON TESTICULAR TUMOR

Seminoma

RR: MOST COMMON TUMOR OF INFANCY

Strawberry Hemangioma

RR: TRANSLOCATION 9;22 AND DRUG USED TO TX

CML tx with Imatinib

Kartagener's syndrome triad and underlying defect?

Triad: Sterility; Bronchiectasis; Recurrent infections
Dyenin arm defect

3 most common locations of lung cancer mets?

Brain
Bone
Liver

What is the V/Q at the apex of the lung?

3

What is the V/Q at the base of the lung?

0.6

What is the V/Q during airway obstruction?

0

What is the V/Q during blood flow obstruction?

Infinity

How does emphysema in smoking differ from emphysema caused by alpha-1-antitrypsin deficiency?

smoking - Centriacinar
alpha-1-antitrypsin def - panacinar

What is the hallmark sign of COPD?

Decreased FEV1/FVC

What is the hallmark sign of restrictive lung disease?

Decreased TLC
Normal or slightly increased FEV1/FVC

Which lung tumors arise centrally and are linked to smoking?

Squamous Cell Cancer
small cell cancer

What lung tumors arise peripherally and are less linked to smoking?

Adenocarcinoma
Large Cell Carcinoma

How does the body compensate for hypoxia at high altitude?

Increased ventilation
Increased erythropoeitin
Increased Mitochondrial activity
Increased renal excretion of bicarbonate

Cause of pneumonia a/w Gram + cocci in clusters?

S aureus

Cause of pneumonia a/w Gram + cocci in pairs?

S pneumo

Cause of pneumonia a/w Gram - rods in 80 yo?

E coli

Cause of pneumonia a/w Gram + cocci in neonate?

Grp B strep

Cause of pneumonia a/w Gram - rods in neonate?

E coli

What are common causes of ARDS?

Shock
Infection
Toxic Gas inhalation
Acute pancreatitis
Aspiration
Heroine Overdose
Increase O2 consumption

A 75 yo pt with a 60 pack a year history comes to teh office complaining of difficulty standing up from his bed when he wakes in the morning and difficulty raising his arms in the morning to wash his hair; what do you suspect?

Lambert-Eaton Syndrome due to Small Cell Cancer

What is pulsus paradoxus?

Systemic BP drops by more than 10 mmHg with inspiration.

What causes pulsus paradoxus?

Asthma
COPD
Cardiac Tamponade

What immunosuppressant is a/w being a precursor of 6-mercaptopurine?

Azathioprine

What immunosuppressant is a/w being able to prevent nephrotoxicity with mannitol diuresis?

Cyclosporine

What immunosuppressant is a/w an antibody that binds to CD3 on T cells?

Muromonab

What immunosuppressant is a/w an antibody that binds to IL-2 receptors on activated T Cells?

Daclizumab

What immunosuppressant is a/w inhibiting inosine monophosphate dehydrogenase?

Mycophenylate

What immunosuppressant is a/w inhibiting calcineurin leading to the loss of IL 2 production and the blockage of T cell differentiation and activation?

Cyclosporine

What immunosuppressant is a/w inhibiting FK-binding protein leading to the loss of IL-2 production?

Tacrolimus

What immunosuppressant is a/w being used for lupus nephritis?

Mycophenylate

What immunosuppressant is a/w being metabolized by xanthine oxidase, there fore allopurinol can increase its toxicity?

Azathioprine

What genetic syndrome is a/w a 1000 fold increased risk of developing skin cancer?

Xeroderma Pigmentosa

What genetic syndrome is a/w Alcoholics leading to a B1 deficiency and neurological deficits?

Pyruvate dehydrogenase deficiency

What genetic syndrome is a/w abnormal collagen type 1 synthesis?

Osteogenesis Imperfecta

What genetic syndrome is a/w an absence of HGPRTase?

Lesch-Nyan Syndrome

What genetic syndrome is a/w a deficiency of aldolase B?

Fructose Intolerance

What genetic syndrome is a/w defective excision repair leading to thymidine dimer formation?

Xeroderma Pigmentosa

What genetic syndrome is a/w a deficiency of cystathionine synthase?

Homocystinuria

What genetic syndrome is a/w Heinz bodies?

G6PD

What genetic syndrome is a/w must/mousy odor, albinism, MR, and eczema?

PKU

What genetic syndrome is a/w Galactose-1-P uridyl transferase deficiency leading to MR, HSM, and cataracts?

Galactosemia

What genetic syndrome is a/w being treated by avoiding NutraSweet and increasing dietary tyrosine?

PKU

What genetic syndrome is a/w a deficiency of tyrosinase?

Albinism

What genetic syndrome is a/w hyperextensible skin, loose joints, and bleeding tendency?

Ehlers-Danlos Syndrome

What genetic syndrome is a/w decreased NADPH due to lack of HMP enzyme?

G6PD

What genetic syndrome is a/w an inherited defect in tubular amino acid transporter?

Cystinuria

What genetic syndrome is a/w treatment with decreased methionine and increased cystine and Vit B6?

Homocystinuria

What genetic syndrome is a/w a deficiency in homogentisic acid oxidase?

Alkaptonuria

What genetic syndrome is a/w hypoglycemia, jaundice and cirrhosis?

Fructose intolerance

What genetic syndrome is a/w self-mutilation, gout, aggression, and choreoathetosis?

Lesch Nyan Syndrome

What genetic syndrome is a/w blocked degradation of branched chain amino acids?

Maple Syrup Urine Disease

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