DIT Questions

Created by Lilbruno145 

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How does standard deviation differ from standard error of the mean? (FA p54)Which is used in calculating confidence intervals? (FA p55)

Standard error is used to calculate CI

What problem / abnormality is associated with the following congenital buzzwords? (FA p267) boot-shaped heart

Tetralogy of Fallot

What problem / abnormality is associated with the following congenital buzzwords? - (FA p268) continuous machine-like murmur

Patent ductus arteriosus

What problem / abnormality is associated with the following congenital buzzwords?
- (FA p485) webbing of the neck

Turner Syndrome (XO)

What problem / abnormality is associated with the following congenital buzzwords?
- (FA p485) Barr body

Klinefelter's syndrome (XXY)

What problem / abnormality is associated with the following congenital buzzwords? - (FA p88) simian crease

Down's syndrome

A mother brings her infant to your clinic. The infant has markedly fair skin and a mousy odor. What are the downstream substances this child is missing because of his inborn error of metabolism? What substances are derived from the amino acid tryptophan? (FA p106, FA p107)

Patient has PKU. Child is missing phenylalanine hydroxylase or tetrahydobiopterin cofactor. Niacin and serotonin/melatonin are derived from tryptophan.

A 12-year-old female develops a rapid strep positive exudative pharyngitis and is treated with penicillin V for the 10 days. If the patient happens to have a penicillin allergy, an alternative to using penicillin V is to use a macrolide antibiotic. What is the mechanism of action of penicillin? Is it a bacteriostatic or bactericidal antibiotic? What is the mechanism of action of the macrolides? Are they bacteriostatic or bactericidal? (FA p184, p185, p188)

Penicillin: block cell wall synthesis by inhibiting peptidoglycan cross-linking
-Bactericidal

Macrolides: inhibit protein synthesis by blocking translocation; bind to 23S rRNA of the 50S ribosomal subunit
-Bacteriostatic

You are conducting a study trying to determine the reduction in risk of developing a relapsing depressive episode with antidepressant X when compared to a placebo treatment. What is this determination called? What is attributable risk, and how is it calculated? (FA p52)

Called Relative Risk (RR) = relative probability of getting a dz in the exposed group compared to unexposed group

Attributable Risk = Difference b/t exposed and unexposed group = proportion of dz occurrences that are attributable to the exposure

A 53-year-old male presents by EMS to the ER with left-sided chest pain, dyspnea, diaphoresis and left-sided arm pain. An EKG reveals a ST elevation and Q-waves in leads II, III and aVF. The patient is quickly taken to the heart catheterization lab for further evaluation and treatment of an acute myocardial infarction. Which coronary artery is most commonly involved in an acute MI? What is the most likely involved artery on this clinical situation? (FA p271 and p272)

LAD > RCA > circumflex

LAD (ant wall) = Q waves in V1-V4
LAD (anteroseptal) = V1-V2
LAX (anterolateral) = V4-V6
LCX (Lateral wall) = I, aVL
RCA (inferior wall) = II, II, aVF

Identify the following types of aphasia and location of the brain lesion with the following clinical presentations? (FA p404)

Is unable to repeat phrase, "No ifs, ands, or buts"

Arcuate fasiculus

Identify the following types of aphasia and location of the brain lesion with the following clinical presentations? (FA p404)

Nonfluent aphasia with comprehension intact

Broca's area

Identify the following types of aphasia and location of the brain lesion with the following clinical presentations? (FA p404)
Fluent aphasia with impaired comprehension

Wernicke's area

A 40-year-old female treated with lisinopril for stage I hypertension becomes pregnant. The patient's ACE inhibitor (lisinopril) should be stopped immediately. What centrally acting α2-agonist is often used to treat hypertension in pregnancy? (FA p241)

Mirtazapine?

A 23-year-old male complains of a yellowish skin and eye discoloration for the past two days. The patient otherwise has no complaints or physical exam findings. The patient's laboratory workup reveals a conjugated hyperbilirubinemia. Which hereditary hyperbilirubinemia syndromes present with a conjugated hyperbilirubinemia? Which present with an unconjugated hyperbilirubinemia? (FA p333)

Gilbert's = prob w/ bilirubin uptake --> unconjugated bilirubinemia
Crigler-Najjar = prob w/ bilirubin conjugation --> unconjugated bilirubinemia
Dubin-Johnson = prob w/ excretion of conjugated bilirubin --> conjugated bilirubinemia

A physician while working with a humanitarian aid organization in Africa is seeing a 30-year-old male patient with HIV. The patient complains of fever, weight loss and a cough associated with hemoptysis over the past two months. A chest X-ray reveals perihilar lymphadenopathy and a left lower lobe granulomatous formation. What the name for these X-ray findings? What other Mycobacteria species cause pulmonary disease? What are the potential extrapulmonary manifestations of Mycobacterium tuberculosis? (FA p148 and p149)

x-ray findings = Ghon complex = calcified focus of infection + assoc hilar lymph node

Mycobacterium TB
M. kanasii (pulm TB like sx)
M. avium

TB sx include fever, night sweats, weight loss, hemoptysis

Aztreonam and penicillins both bind to penicillin-binding proteins. Can aztreonam be used in patients with a penicillin allergy? In which patient populations is aztreonam a good choice? Against which organisms is this antibiotic effective? (FA p185 and p186)

Aztreonam works the same way as penicillins = block cell wall synthesis by inhibiting peptigoglycan cross-linking by binding to PBP3

No cross-sensitivity w/ penicillins or cephalosporins
Use against Gram-negative rods only

Wallenberg syndrome is an injury of the lateral medulla that presents with a constellation of neurologic symptoms, including difficulty with swallowing (dysphagia), hoarseness and difficulty with palate elevation. Which part of the lateral medulla is responsible for swallowing and palate elevation? What other cranial nerves can be involved with this region? (FA p417)

Nucleus ambiguus = motor innervation of pharynx, larynx, upper esophagus (swallowing, palate elevation)

CN IX, X, XI go through nucleus ambiguus

An echocardiogram reveals a dilated cardiomyopathy in the evaluation of a 53-year-old man with chest pain. You discover in the patient's history that the patient does not drink alcohol. Other than chronic alcohol abuse, what are some other potential causes of dilated cardiomyopathy? What heart sounds might be present in a patient with dilated cardiomyopathy? (FA p273)

Dilated cardiomyopathy = congestive
Alcohol abuse
Beriberi (wet)
Coxasackie B virus myocarditis
Cocaine use
Chagas' disease
Doxorubicin toxicity
Hemochromatosis
Peripartum cardiomyopathy
Expect to hear S3

A 60-year-old noncompliant male complains of shortness of breath on exertion and bilateral lower extremity edema. His family physician was constantly expressing the importance of antihypertensive treatment. The patient has an echocardiogram that reveals an ejection fraction of 30 percent. The patient is placed on a diuretic, an ACE inhibitor and digoxin. By what mechanism is digoxin a positive inotrope? What is the cause of this patient's shortness of breath on exertion and lower extremity edema? (FA p274 and p283)

CHF

Digoxin increases [Ca] by directly inhibiting Na/K/ ATPase which indirectly inhibits Na/Ca exchanger

What is p value? What is normally an acceptable level of p value? (FA p54)

p = probability of making a type I error (ie: stating that there IS an effect or difference when none exists = mistakenly accepting the experimental hypothesis and rejecting the null hypothesis)
p < 0.05

Homocystinuria is one of the few diseases that can result in subluxation of the lens. What are the different causes of homocystinuria? How does the treatment differ for each? (FA p108)

Cystathione synthase def
-DEC methionin, INC cys, INC B12, INC folate in diet
DEC affinity of cystathionine synthase for pyridoxal phosphate
-INC vit B6 in diet
Homocysteine methyltransferase def

A 50-year-old patient with gastroesophageal reflux disease (GERD) has been treated with a proton pump inhibitor for the past 10 years. The patient has an evaluation with upper endoscopy for his long-standing GERD. Why is it important to have an upper endoscopy with longstanding GERD? What are some other causes of esophageal cancer? (FA p322 and p323)

Risk of developing Barrett's esophagus

Alcohol/Achalasia
Barrett's
Cigarettes
Diverticuli (Zenker's)
Esophageal web
Esophagitis
Familial

A 1-year-old male child is brought to the ER for seizure activity. The seizure was quickly identified as being attributed to severe hypoglycemia. After stabilizing the seizure activity, the initial laboratory work reveals a metabolic acidosis. The patient's exam reveals hepatomegaly. You think this patient might have a glycogen storage disease (GSD). What GSD is most consistent with this clinical picture? Which GSDs are characterized by hypoglycemia? What is the difference between Cori's disease (GSD-type III) and Von Gierke's disease (GSD-type I)? (FA p110)

Von Gierke's = glucose-6-phosphatase def = severe fasting hypoglycemia, INC glycogen in liver, INC blood lactate, hepatomegaly
Pompe's = lysosomal alpha-1,4-glucosidase (acid maltase) = cardiomegaly + systemic findings (early death)
Cori's = Debranching alpha-1,6-glucosidase = milder form of Von Gierke's w/ nl blood lactate
McArdle's = skeletal muscle glycogen phosphorylase = INC glycogen in muscle, but cannot break it down --> painful muscle cramps, myoglobinuria w/ strenuous exercise

Sertoli cells release a substance that acts on the paramesonephric ducts in order to prevent the formation of what structures in a normal male fetus? What other name is given to the paramesonephric ducts? (FA p133)

Paramesonephric duct = mullerian duct that develops into fallopian tubes + uterus + upper 1/3 of vagina

A 60-year-old male with a family history of Parkinson's disease is concerned that he may be in the early stages of the disease. What are some of the signs and symptoms of Parkinson's disease? (FA p401)

Tremor, rigidity, bradykinesia, postural instability

Your patient develops a cough with the new antihypertensive drug you prescribed her. What are some other side effects associated with this medication? (FA p475)

Symptoms = CAPTORPRIL = cough, angioedema, proteinuria, taste changes, hypOtension, pregnancy problems, rash, increased renin, lower angiotensin II. Also hyperkalemia.

A 7-year-old child is brought to the ER with bloody diarrhea. Imaging studies and physical exam do not reveal an anatomic cause of the child's illness, but the mother mentions that the patient recently ate pork tacos at her brother's house. Her brother has been having a similar illness as well. Fecal gram staining reveals gram-negative, comma-shaped organisms. What organism is likely responsible for this patient's illness? (FA p152)

campybacter jejuni

Clopidogrel (Plavix) and ticlopidine are commonly used after MI or cardiac cath with stent placement. What is the mechanism of these drugs? (FA p363)

Inhibit platelet aggregation by irreversibly blocking ADP receptors --> inhibit fibrinogen binding by preventing glycoprotein Iib/IIIa expression.

A 31-year-old patient of yours complains of chronic back stiffness and pain. X-ray reveals a spine that looks similar to bamboo. What other symptoms may be present with this disease, and into what category of diseases does this one fall? (FA p385)

seronegative spondlyoarthropathies = arthritis without RA factor. This pt has ankylosing spondylitis

What are the potential metabolic fates of pyruvate? (FA p99)

Lactate or oxaloacetate or Acetyl-CoA

Membranous glomerular diseases involve thickening of what structure? (FA p466)

Glomerular BM

A 22-year-old man lost his leg last week in a tragic accident involving alcohol and heavy machinery. He is medically able to be discharged home tomorrow, and the paperwork is already set up so he can leave in the morning. However, the nurse pulls you aside and informs you that the patient has been very depressed about his lost limb, and she overheard him talking to a friend about just ending his life with his dad's gun when he gets out of the hospital. What must be done? (FA p59)

Suggest the pt remain in the hospital. If pt says no, then keep him against his will.

The Pneumovax vaccine contains the polysaccharide antigens of the 23 most prevalent types of Streptococcus pneumoniae. In order for the Pneumovax vaccine to confer long term immunity what must be done to the polysaccharide antigens? (FA p139)

Polysaccharide antigens must be conjugated to promote T cell activation and subsequent class switching (b/c polysaccharide antigen alone would not be recognized so it would not be presented by T cells and therefore only IgM ab would be produced)

A 10-year-old boy is receiving poor grades in school. His teachers and parents report that he has
normal intelligence but that he is very distractible and full of excess energy. What medication might
help this boy? (FA p452)

Methylphenidate (Ritalin) or amphetamines (Dexedrine)

What B-cell surface protein does the monoclonal antibody rituximab target? (FA p368)

CD20 (found on most B-cell neoplasms)

IFN-γ stimulates macrophages and inhibits T2 helper cells. What cell type releases IGN-γ? (FA p204)

Th1 cells

Many factors are involved in the proper morphogenesis of organs in utero. In the case of
oligohydramnios, lack of fluid flowing in and out of the fetal lungs leads to pulmonary hypoplasia. This is an example of which type of error in organ morphogenesis? (FA p119)

Hypoplasia

You are caring for a female with borderline personality disorder on the inpatient service. On morning rounds, she makes romantic advances towards you and comments on how soft your hands are. What should you never say in this situation? (FA p59)

Ask direct, close-ended questions.
Use a chaperone if necessary

You have an adult patient that has failed conventional treatment (5-ASA, steroids, and
immunosuppressants) for his active Crohn's disease. Another option available to you is to target TNF-α with which drug(s)? (FA p217)

Infliximab or Adalimumab - target TNF-alpha

You are educating the parents of an 8-month-old male patient with cryptorchidism. During your
explanation you use an anatomic diagram, and you point to the fibrous band attached between each
testis and the scrotum that aids in normal testicular descent. In an adult female, what does that band of tissue become? (FA p134)

Ovarian ligament + round ligament of uterus

This medicine used against helminth organisms, especially those causing river blindness
(onchocerciasis), ratchets up the neurotransmission of GABA so that the organism becomes immobilized. What is this drug? (FA p194)

Ivernectin

A 66-year-old male crashes his new motorcycle and has to be treated at the local hospital's trauma
center. Which part of Medicare will cover his inpatient needs? (FA p56)

Medicare Part A

A 55 year old alcoholic is admitted to the hospital for upper GI bleed. A ruptured esophageal varix is
found to be the cause. What is the preferred medical treatment for this condition? (FA p338)

Octreotide

A 23-year-old male comes to your clinic with a fever >39°, a headache, and myalgias. This is the
second fever he has had in the last two weeks. He recently finished treatment to eradicate the lice
infestation that he acquired during a recent trip to Mexico. What organism might be responsible for
this man's recurrent fever? (FA p154)

Borrelia recurrentis

Which antifungal drug fits the following description? (FA p192- FA p193)
swish and swallow for oral candidiasis
(thrush)

Nystatin

Which antifungal drug fits the following description? (FA p192- FA p193)
side effect: nephrotoxicity

Amphotericin B

Which antifungal drug fits the following description? (FA p192- FA p193)
deposits in keratin-containing tissue (nails)

Terbinafine

Which antifungal drug fits the following description? (FA p192- FA p193)
used for cryptococcal meningitis in AIDS

Azoles

You are working with scientists on a research study in the Rocky Mountains that is concerned with
the effects of high altitude on the human physiology. A group of subjects were moved from sea level to live at high elevation and their blood samples were measured at their arrival and then compared 2 months later after living at this new altitude. What would be the relative differences in the following blood levels of each component: plasma volume, RBC mass, O2 saturation, and endogenous erythropoietin? (FA p361)

No change in plasma
INC RBC mass
DEC O2 saturation
INC EPO production

A 40 year old man arrives at your clinic for his first physical in twenty years. He reeks of cigarette
smoke and you notice his jacket bears the logo of his favorite tobacco company. He proudly informs
you that he got this great jacket by redeeming his cigarette c At what stage of change in
overcoming his smoking habit is this man? (FA p450)

Pre-contemplation

5α-reductase deficiency leads to what physical findings (internal and external) in a male? (FA p486)

Causes the inability to convert testosterone to DHT. Ambiguous genitalia until puberty then normal growth. Internal genitalia are normal.

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 sequelae? (FA p376)

Long thoracic nerve

Injured  winged scapula

A patient has 2° glomerular disease; how many organ systems are affected? (FA p466)

Many

What are the 3 endogenous androgens, in order from the most potent to the least potent? (FA p482)

DHT>test>androstenedione

A 66-year-old male crashes on his motorcycle and suffers a head injury that leaves him in a coma.
Prior to this injury the man was met with his lawyer to write out specific instructions in case an event like this happened. What is it that this man and his lawyer put together? (FA p57)

Advance directive

A 62-year-old man complains of weak urine stream and hesitancy when trying to urinate. His
physician prescribes finasteride. How does this agent treat benign prostatic hyperplasia? (FA p498)

Blocks conversion of testosterone to DHT by inhibiting 5-alpha-reductase

You recommend a vitamin and mineral supplement to a 51-year-old woman in order to prevent osteoporosis. By what mechanism does this vitamin help prevent osteoporosis? (FA p294)

1. Vit D increases absorption of dietary Ca and phosphate
2. increases bone resorption of Ca2+ and PO4

A 63-year-old woman is seen in your office for postmenopausal vaginal bleeding. This is the first
occurrence since menopause at age 51. She has been using estrogen hormone replacement since she was 50 years old to prevent hot flashes and vaginal atrophy. However, she has never used
progesterone in addition to this. What is most likely the cause of her postmenopausal bleeding, and to what cancer could this lead? What other risk factors are associated with this cancer? (FA p489)

HRT can cause endometrial hyperplasia  INC risk for endometrial carcinoma

A college student is brought to the ER and found to be dehydrated due to a diarrheal illness she
obtained after serving as a volunteer in a developing country. . The patient describes the diarrhea as looking like water mixed with rice. What organism is most likely responsible in this case? (FA p152)

Vibrio cholera
-permanently activates Gs  INC cAMP
-comma-shaped, oxidase positive, grows in alkaline media
-tx: rehydration

A 31-year-old male is post-op day 1 after an exploratory laparotomy. The surgery was performed emergently for intraperitoneal hemorrhage after a motor cycle crash. His creatinine today is elevated to 2.0 mg/dL. His pain is currently uncontrolled on the currently high dose of narcotic medication he has ordered. The medical student suggests adding high dose ibuprofen to this patient's pain regimen.
Describe the physiological reason as to why this is a bad idea in this case? (FA p460, FA p463)

NSAIDS can cause acute renal failure inhibit renal production of prostaglandins, which normally keep the afferent arterioles vasodilated to maintain GFR

A 35-year-old man is seen in the office for his chronic, recurrent peptic ulcer disease. It has been
refractory to conventional treatment with PPIs. Your attending mentions that this might be caused by a tumor. What type of tumor may be responsible for this condition? If this patient also presented with renal stones and signs of hypogonadism, what syndrome might you suspect?(FA p302, FA p303)

Zollinger-Ellison syndrome = gastrin-producing tumor

Can be assoc with Multiple Endocrine Neoplasias (MEN1)
-parathyroid tumors
-pituitary tumors
-pancreatic/endocrine tumors
*commonly presents with kidney stones and stomach ulcers

What important intracellular proteins are common to both the extrinsic and intrinsic apoptotic pathways? (FA p220)

Activating Cystolic capsases is the last step in both pathways

A 70-year-old woman comes to the office complaining of jaw claudication. She likely has inflammation of a vessel that supplies one of her muscles of mastication. What are the other muscles involved in mastication? (FA p419, FA p279)

3 muscles close the jaw
1. masseter
2. temporalis
3. Medial pterygoid
1 muscle opens the jaw = lateral pterygoid
All are innervated by V3

How are the following relative component levels in the blood of a polycythemia vera patient different
from normal: plasma volume, RBC mass, O2 saturation, and endogenous erythropoietin? (FA p361)

INC RBC, INC WBC, INC platelets

. A 16-year-old female cystic fibrosis (CF) patient is on the inpatient service for decline in pulmonary
function due to inability to clear the mucus plugs. Another patient, a 20 year old female college
student, is in the ER for attempted suicide with acetaminophen overdose. What agent can be given as an inhaled drug to loosen mucus plugs, can be given orally to treat acetaminophen overdose, and can be given orally as prophylaxis against IV contrast-induced nephropathy in those with preexisting renal disease? (FA p243, FA p516)

N-acetylcysteine

A 22-year-male who recently immigrated from a developing country is seen at the county health clinic
with a complaint of a chronic but recently worsening productive cough and sinusitis symptoms (i.e.,
headache). He also mentions to you privately that he and his wife have not been able to have children
despite trying for two years. While you note this last complaint you order a CXR out of concern this
man may have TB given his immigration status. The CXR appears backwards on the display, but you
realize this man's heart is actually on the opposite side of his chest. What is the primary defect in this
syndrome, what are the characteristic symptoms/signs? (FA p78)

Kartagener's syndrome = immotile cilia due to dynein arm defect

Signs/sx: infertility, bronchiectasis, recurrent sinusitis, situs inversus

How does chloroquine work against plasmodium organisms that cause malaria? (FA p194)

Chloroquine enters parasite and binds heme leading to heme build up and a heme-chloroquine material that is very toxic to the cell membrane of the parasite

Which vitamin fits the following description? (FA p90 - FA p94)
deficiency causes Rickets and osteomalacia

Vit D

Which vitamin fits the following description? (FA p90 - FA p94)
deficiency causes beriberi or Wernicke-Korsakoff

Thiamine (B1)

Which vitamin fits the following description? (FA p90 - FA p94)
deficiency causes macrocytic, megaloblastic anemia

Folate deficiency (B12 def can also lead to folate def)

Which vitamin fits the following description? (FA p90 - FA p94)
deficiency causes scurvy

Vit C

Which vitamin fits the following description? (FA p90 - FA p94)
deficiency causes an increase in PT and PTT

Vit K

Which vitamin fits the following description? (FA p90 - FA p94)
deficiency causes night blindness and dry skin

Vit A

Which vitamin fits the following description? (FA p90 - FA p94)
deficiency causes cheilosis and corneal vascularization

Vit B2 (riboflavin)

A 4-month-old male infant has been diagnosed with failure to thrive. The infant has coarse facial
features and clouded corneas. The laboratory workup for this patient reveals high plasma levels of
lysosomal enzymes. You suspect the patient has mucolipidosis II, also called I-cell disease. What is
the primary pathophysiology and what are some other features of I-cell disease? (FA p77)

Inclusion cell dz = mannose-6-phosphate no added to lysosome proteins  so enzymes are secreted outside the cell instead of being directed to lysosome

A 43-year-old male presents with right-sided flank pain and hematuria. A helical abdominal CT
reveals a right-sided 1.5cm ureterovesicular calculus. The stone is passed after being treated with fluids, pain control and lithotripsy. Incidentally the abdominal CT also reveals an isthmus connecting the inferior poles of the kidneys. During fetal development what structure traps the inferior poles of the kidney resulting in a horseshoe kidney? Do patients with horseshoe kidneys have abnormal renal function? (FA p132)

Inferior poles of the kidney get trapped under the inferior mesenteric artery

Kidney function is normal

Which anticancer agent fits the following description? (FA p365-FA p367)
Given for estrogen-sensitive breast cancers

Tamoxifen

Which anticancer agent fits the following description? (FA p365-FA p367)
S-phase antimetabolite; myelosuppression
reversible with leucovorin

Methotrexate

Which anticancer agent fits the following description? (FA p365-FA p367)
S-phase antimetabolite; myelosuppression not
reversible with leucovorin

5-fluorouracil

Which anticancer agent fits the following description? (FA p365-FA p367)
Ototoxic and nephrotoxic (much like
aminoglycosides and loop diuretics)

Cisplatin and carboplatin

Which anticancer agent fits the following description? (FA p365-FA p367)
2 agents known for causing pulmonary fibrosis

Busulfan and Bleomycin

Which anticancer agent fits the following description? (FA p365-FA p367)
Inhibits topoisomerase II

Eoposide/teniposide  inhibits topo II  INC DNA degradation

Pheochromocytoma is one of the identifiable causes of hypertension. Where is this tumor found and
why does it cause hypertension? What are some other symptoms of a patient with pheochromocytoma? What hormones are generated in each zone of the adrenal cortex and in the adrenal medulla? (FA p288, 297)

Tumor of the adrenal medulla
Sx: pressure, pain, perspiration, palpitations, pallor

It is common for patients in early stages of pregnancy to present with round ligament pain that can be mistaken for various causes of abdominal pain. What structures are connected to the round ligament of the uterus? What ligaments support the female reproductive system and what are the
corresponding structures they support? (FA p478)

• Round ligament of the uterus = connects uterine fundus to labia majora
• Suspensory ligament of the ovaries = connects ovaries to lateral pelvic wall
• Cardinal ligament = connects cervix to side wall of pelvis
• Broad ligament = connects uterus, fallopian tubes and ovaries to pelvic side wall
• Ligament of the ovary = connects ovary to lateral uterus

Which viruses are responsible for causing the following clinical presentations? (FA p169, 170)
Barking cough in a child

Croup is caused by a paramyxovirus (parainfluenza)

Which viruses are responsible for causing the following clinical presentations? (FA p169, 170)
Erythematous rash, conjunctivitis, cough, Koplik
spots

Rubeola virus is the paramyxovirus that causes measles

Which viruses are responsible for causing the following clinical presentations? (FA p169, 170)
Enlarged and painful parotid glands

Mumps is caused by a paramyxovirus

Which viruses are responsible for causing the following clinical presentations? (FA p169, 170)
Gastroenteritis during the winter

Rotavirus

A 43-year-old male farmer presents to the emergency room with confusion and shortness of breath.
A family member with the patient reports the he has experienced profuse vomiting, defecation and urination. The patient has a heart rate of 44 beats/minute, blood pressure of 110/70 and respiratory rate of 20/minute. Further exam reveals pin-point pupils, excessive lacrimation, bilateral wheezing and diffuse muscle excitation. What is the mechanism of organophosphate poisoning?
How do nicotinic acetylcholine receptors differ from muscarinic acetylcholine receptors in their mechanisms of action? (FA p235, 238 and 239)

Nicotinic Ach receptors = ligand-gated Na/K channels found in autonomic ganglia and NMJ

Muscarinic Ach receptors = G protein-coupled that act through 2nd messanger

Organophosphates = potent nerve agents that inhibit acetylcholinesterase in nerve cells

An 18 year male is brought to your office for delayed onset of puberty. Physical exam confirms a small penis and testicles for his age, as well as lack of facial, pubic, and underarm hair. The patient also reveals that he has never been able to smell. What is the likely diagnosis? (FA p486)

Klinefelter's syndrome (XXY)

?

You are treating a 40-year-old female with IV vancomycin for methicillin-resistant Staphylococcus
aureus right orbital cellulitis. Vancomycin can be both nephrotoxic and ototoxic. Which other antibiotic shares these two potential toxicities? (FA p187)

Aminoglycosides like Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin

"Mean" GNATS can NOT kill anaerobes
N=nephrotoxic, O=ototoxic, T=teratogen

A 3-day-old preterm infant delivered at 34-weeks gestational age develops respiratory distress syndrome (RDS). What types of pneumocytes are affected in RDS? What is the mechanism that leads to poor O2-CO2 exchange at the gas exchange barrier in preterm infants with RDS? What structures make up the gas exchange barrier? (FA p502, 504, 511)

Surfactant - dipalmitoyl phosphatidylcholine (lecithin) is deficient in neonates with RDS

Surfactant (made by Type II pneumocytes) def  INC surface tension  alveolar collapse
-lecithin-to-sphingomyelin ratio is < 1.5

The body uses both the cell-mediated and humoral immune response to fight infection. Which T cell
type regulates the humoral response? (FA p204)

Th2 cell

A 60-year-woman has a protein electrophoresis study performed while being worked up for a persistent skin rash. The test found an elevation of a monoclonal immunoglobin incidentally. The patient denies any symptoms other than her rash and x-rays show no lytic lesions. Based on the information so far, what might this patient's condition be classified as in reference to her elevated monoclonal immunoglobulin? (FA p359)

MGUS = monoclonal gammopathy of undetermined significance is monoclonal plasma cell expansion without the symptoms of multiple myeloma

What popular non-benzodiazepine hypnotic is often avoided in the elderly because of the very undesirable side effect of confusion, to which elderly patients are very susceptible? (FA p433)

Zolpidem = Ambien
Zaleplon
eszopiclone

You are examining a slide made from the pap smear of a healthy woman which should include cells from both the ectocervix and endocervix. Assuming she has no disease, what histological types of cells should you see? (FA p478)

Ectocervix = stratified squamous epithelium

Endocervix = simple columnar epithelium

What medication targets CD3 and is used to prevent acute transplant rejection? (FA p217)

Muromonab-CD3 (OKT3)

Which penicillin fits the following description? (FA p185)
Often the drug of choice against Enterococcus sp.

Ampicillin/amoxicillin HELPS kill enterococci

Which penicillin fits the following description? (FA p185)
Effective against Pseudomonas sp.

Antipseudomonals = ticarcillin, carbenicillin, piperacillin
TCP = Takes Care of Pseudomonas

Which penicillin fits the following description? (FA p185)
Associated with interstitial nephritis

Penicillinase-resistant penicillins = methicillin, nafcillin, dicloxacillin

A 25-year-old male AIDS patient is admitted to the hospital with diffuse interstitial pneumonia. Bronchial lavage is done and on methamine silver staining yeast is identified. Describe the mechanism of action of the drug(s) of choice to treat this. Which anticancer drug works in the same manner? (FA p189, FA p365)

Trimethoprim acts by inhibiting dihydrofolate reductase.
-used w/ sulfonamides to tx UTIs, shigella, Salmonella, Pneumocystis jiroveci

Methotrexate is the same

When screening a population for a particular disease, would you rather have a high sensitivity or a high specificity? (FA p51) What test is used to screen for HIV? What test is used to confirm a positive HIV screen? (FA p173

High sensitivity

ELISA has high false-pos rate and low threshold = rule out test (SnOut)

A 22-year-old man had an exploratory laparotomy with excision of 7 cm of small bowel after sustaining a gunshot wound to the abdomen. Postoperatively he is sent to recover in the ICU because of concern for hemorrhage. That night the intern is called to the bedside because the patient has developed increasing tachycardia and decreased pulse pressure. What is pulse pressure? What is the equation for mean arterial pressure (MAP)? *Note: there is more than one equation for MAP (FA p254)

Pulse P = systolic P - diastolic P

Pulse P is proportional to stroke volume

MAP = 1/3 systolic + + 2/3 diastolic P = CO X total PR

A 45-year-old businessman arrives at the hospital with hematemesis and abdominal pain. He reports that the pain is worsened by eating and sometimes he experiences nausea. How do the symptoms of a gastric ulcer differ from the symptoms of a duodenal ulcer? What are the two most common causes of peptic ulcer disease? (FA p325)

Duodenal ulcer: pain dec with meals (weight gain)
-due to inc gastric acid secretion or dec mucosal secretion

Gastric ulcer: pain inc with meals (weight loss)
-due to dec mucosal secretion

Peptic ulcers caused by H. pylori or chronc NSAID use

While thiazide and loop diuretics are known for wasting potassium in the urine. There are other diuretics that conserve it. Which diuretics are these? What are their mechanisms of action? What are their important side effects? (FA p475)

The K STAys
Spiranolactone = competitive aldosterone receptor antagonist in the cortical collecting tubule

triamterene, amiloride = block Na channels in the CCT

SFx: hyperkalemia, endocrine effects - gyno

A 17-year-old female 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? (FA p327)

Appendicitis

A 65-year-old man arrives at the ER with complaint of sudden substernal chest pain that radiates
into his left arm and concomitant shortness of breath. This occurred while he was shoveling the snow off of his driveway. He normally doesn't get much exercise he says. What diagnostic studies need to be ordered? (FA p272)

ECG (gold standard if within 6 hours)
Cardiac troponin I
CK-MB
AST = non-specific

What are the 3 different eukaryotic RNA polymerases? What type of RNA does each make? (FA p72)

RNA pol I makes rRNA
RNA pol II makes mRNA
RNA pol III makes tRNA
(in order of how RNA products used in synthesis)

A young Caucasian male has an abnormal sweat chloride test and uses N-acetylcysteine to help break up abnormally thick mucous in his lungs. What are the complications of this patient's disease? (FA p87)

Pancreatic insufficiency, chronic sinusitis, chronic OM, chronic URIs (esp pseudomonas and s. aureus), chronic bronchitis, bronchiectasis, meconium ileus in newborns, infertility in males, ADEK deficiencies

How many umbilical vessels are there? Which umbilical vessel has the highest oxygen content? (FA p122)

2 umbilical arteries = returns deoxygenated blood from fetal internal iliac arteries to placenta
1 umbilical vein = supplies oxygenated blood from placenta to fetus

A 45-year-old obese woman comes to your clinic with complaint of polyuria and polydipsia. Glucose tolerance tests are abnormally elevated. Which cell types do not require insulin for the uptake of glucose? (FA p289)

Brain and RBCs

A female college student is seen in the ER with fever, nuchal rigidity, and decreased mental status.
A lumbar puncture is needed for definitive diagnosis. (FA p177) What landmark is level with the appropriate area for lumbar puncture? (FA p371)

Iliac crest

Metastasis to the brain, liver, and bone commonly come from which locations? (FA p230)
Brain Liver Bone

Brain: Lots of Bad Stuff Kills Glia
-lung, breast, skin (melanoma), kidney (renal cell), GI
Liver: Cancer Sometimes Penetrates Benign Liver
-Colon > Stomach > Pancreas > Breast > Lung
Bone: PT Barnum Loves Kids
-Prostate, Thyroid, Testes, Breast, Lung, Kidney

A patient has frothy urine and edema. Lab analysis reveals massive proteinuria. What is the most common cause of this problem in adults? In children? (FA p468)

Membranous glomerulonephritis in adults

Minimal change disease in children

Identify the herpes viruses given the following clinical features. (FA p167)
Owl's eye inclusions on pathology

CMV

Identify the herpes viruses given the following clinical features. (FA p167)
Temporal lobe encephalitis on CT

HSV-1

Identify the herpes viruses given the following clinical features. (FA p167)
High fever followed by a maculopapular rash

HHV-6

Identify the herpes viruses given the following clinical features. (FA p167)
Painful vaginal vesicular lesion

HSV-1

Identify the herpes viruses given the following clinical features. (FA p167)
Associated with nasopharyngeal carcinoma

EBV

Identify the herpes viruses given the following clinical features. (FA p167)
Vesicular lesions in a dermatomal pattern (shingles)

HSV

What branchial arch derivative abnormality causes facial abnormalities by affecting Meckel's cartilage? What cranial nerves are affected in this abnormality? What is the derivative of the branchial arches? (FA p127, FA p128)

Treacher Collins syndrome. 1st arch neural crest fails to migrate.
CN V2 and V3 (chewing)

A 43-year-old patient with Crohn's disease develops bilateral lower extremity paresthesias. Neurologic examination reveals loss of bilateral lower extremity vibratory sensation and proprioceptive sensation. Further laboratory evaluation indicates a macrocytic, megaloblastic anemia. What is causing the patient's paresthesias? What spinal cord pathways correspond with the loss of vibratory sensation and proprioceptive sensation? What spinal cord pathways correspond with temperature sensation? (FA p 92, FA p410, FA p411)

Vitamin B12 neuropathy or Vit E deficiency
Position + vibration = Dorsal columnar column and LCST
Temp = STT

A couple is having difficulty becoming pregnant. When you evaluate the male you notice that he has a very muscular physique and testicular atrophy. What are the consequences of using exogenous testosterone? What hormones regulate spermatogenesis? (FA p481, FA p482)

Suppresses endogenous testicular production
Testosterone and GnRH (which regulates LH and FSH)

A 63-year-old frequently visits the ER with a CHF exacerbation. His symptoms normally begin with SOB that progresses to PND followed by worsening LE edema. What are the signs of right-sided heart failure? What are the signs of left-sided heart failure? What is most often the cause of right-sided heart failure? (FA p274)

Right-sided heart failure: JVD, extremity edema
Left-sided heart failure: pulmonary edema, rales, dyspnea

A 30-year-old male who is experiencing shortness of breath is diagnosed with obstructive lung disease on pulmonary function test. The patient does not have a history of asthma and has never smoked. The patient is subsequently diagnosed with α1-antitrypsin deficiency using protein electrophoresis. How does the emphysema caused by smoking differ from the emphysema caused by α1-antitrypsin deficiency? (FA p332, FA p510)

Centriacinar - caused by smoking
Panacinar - caused by alpha1-trypsin deficiency

A 24-year-old G1P0 complains of shortness of breath and chest pain. You are concerned that she might have a pulmonary embolism because she has an elevated D-dimer. She is a poor candidate for a pulmonary CT angiography because she is allergic to contrast dye. The patient undergoes a V/Q scan to determine if the cause of her symptoms is due to a pulmonary embolism. If it is determined that she does have a pulmonary embolism, what is the standard treatment? (FA p362)

Heparin can be used during pregnancy b/c it does not cross the placenta

Warfin NOT used during pregnancy b/c it crosses placenta

A 60-year-old patient has just received a liver transplant for chronic cirrhosis and declining liver function. The patient is placed on cyclosporine to reduce the risk of possible rejection of the transplant. Which immune response is responsible for the following types of rejection: hyperacute, acute and chronic transplant rejection? What is the time frame for hyperacute, acute and chronic transplant rejection? (FA p215)

Hyperacute (within minutes of transplant) = antibody mediated due to preformed antidonor antibodies --> necrosis, ischemia

Acute (within weeks of transplant) = cell mediated due to cytotoxic T lymphocytes reacting to foreign MHCs

Chronic (months to year) = T cell and antibody-mediated vascular damage --> obliterative vascular fibrosis

Given the following clinical situations, choose the most appropriate therapy.
A 22-year-old male with drug-resistant gonorrhea urethritis (FA p186)

Ceftriaxone = 3rd gen cephalosporin

MOA: Beta lactam drugs that inhibit cell wall synthesis
-Bactericidal

Use to tx serious gram-negative infections resistant to other beta lactams

Given the following clinical situations, choose the most appropriate therapy.
Lyme disease treatment (FA p188)

Doxycycline

MOA: bind to 30S and prevent attachment of aminoacyl-tRNA
-bacteriostatic

Fecally eliminated - can use in pts with renal failure
Can't take with milk, antacids, iron - inhibits absorption from gut

Given the following clinical situations, choose the most appropriate therapy.
Child exposed to someone with influenza B virus (FA p195)

Zanamivir, oseltamivir

MOA: inhibit influenza neuraminidase --> DEC release of progeny virus

Given the following clinical situations, choose the most appropriate therapy.
UTI prophylaxis for a 44-year-old female with a history of recurrent UTIs (FA p189)

Sulfonamides

MOA: PABA antimetabolites inhibit dihydropteroate synthetase
-bacteriostatic

Given the following clinical situations, choose the most appropriate therapy.
A 33-year-old hiker with Giardia lamblia (FA p190)

Metronidazole

MOA: forms free radical toxic metabolites in the bacterial cell that damage DNA
-bactericidal

Given the following clinical situations, choose the most appropriate therapy.
A 23-year-old female with antibiotic-induced C. difficile colitis (FA p190)

Metronidazole

MOA: forms free radical toxic metabolites in the bacterial cell that damage DNA
-bactericidal

How do primary and secondary hyperaldosteronism differ in their effect on plasma renin levels? What agent is used to treat primary hyperaldosteronism? (FA p296)

primary hyperaldosteronism increases plasma renin activity
secondary hyperaldosteronism decreases plasma renin activity

Surgery to remove tumor and/or spiranolactine, a K-sparing diuretic

What is the equation for renal clearance? What will this equation tell you about reabsorption and secretion at the renal tubules? (FA p459)

C = UV/P

C<GFR = net tubular reabsorption
C>GFR = net tubular secretion

Explain the relationship between renin, angiotensin and aldosterone. What is the mechanism of action of spironolactone? What is the mechanism of action of ACE inhibitors? (FA p462, FA p475)

kidney releases renin which activates angiotensinogen to angiotensin I/II which activates the release of aldosterone

spironolactone = competitive aldosterone receptor inhibitor in the CCT

ACE inhibitors = inhibits angiotensin converting enzyme --> decreases angiotensin II levels and prevents inactivation of bradykinin (vasodilator)

During rounds you notice that a 63-year-old female that you are treating for pneumonia has developed hyponatremia. You think that this might be attributed to SIADH, so you determine the urine osmolarity in comparison to the serum osmolarity. Which would you expect to be greater—the serum, or the urine osmolarity? What are the causes and treatment of SIADH? (FA p300)

urine osmolality > serum osmolality

Causes
1. ectopic ADH (SCLC)
2. CNS disorders/head trauma
3. Pulmonary disease
4. Drugs (cyclophosphamide)

You are seeing an anxious 23-year-old G1P0 at 12 weeks gestation for a prenatal visit, and she is concerned about the baby because her sister's newborn son just died shortly after birth. What are the leading causes of neonatal death in the United States? (FA p56)

Congenital anomalies
SIDS
RDS

Patients with Budd-Chiari syndrome present with hepatomegaly and ascites. Why do these symptoms occur? Why might α-fetoprotein be an appropriate test in a patient with Budd-Chiari syndrome? (FA p331, FA p332)

Results in occlusion of IVC or hepatic veins --> congestive liver failure

INC alpha-fetoprotein

A patient with a right-sided hemisection spinal cord lesion (Brown-Sequard syndrome) experiences
loss of sensation and flacid paralysis at the level of the lesion. Describe the corresponding symptom
and the affected side (ipsilateral, contralateral) below the level of the lesion on this patient.
(FA p412)
R Corticospinal tract

ipsilateral upper motor neuron signs

A patient with a right-sided hemisection spinal cord lesion (Brown-Sequard syndrome) experiences
loss of sensation and flacid paralysis at the level of the lesion. Describe the corresponding symptom
and the affected side (ipsilateral, contralateral) below the level of the lesion on this patient.
(FA p412)
R Dorsal colum

ipsilateral loss of tactile, vibration, propioception

A patient with a right-sided hemisection spinal cord lesion (Brown-Sequard syndrome) experiences
loss of sensation and flacid paralysis at the level of the lesion. Describe the corresponding symptom
and the affected side (ipsilateral, contralateral) below the level of the lesion on this patient.
(FA p412)
R Spinothalamic tract

Contralateral pain and temperature

A 55-year-old female complains of pain and stiffness in her shoulders and hips bilaterally. You think she might have polymyalgia rheumatica. What diagnostic tests would be helpful to support the
diagnosis? What condition is associated with polymyalgia rheumatica? (FA p279 and 386

INC ESR
normal CK

Associated with temporal arteritis (giant cell arteritis) = most common vasculitis affecting med and large arterities

Tx: predisone

In cystic fibrosis thick, mucous secretions inhibit digestive enzymes, which can lead to fat soluble
vitamin deficiency. What are the fat soluble vitamins? What are the corresponding symptoms of fat soluble vitamin deficiency? (FA p90-94, FA 323)

A = night blindness, dry skin
D = ricketts in children and osteomalacia in adults, hypocalcemic tetany
E = Fragility of erythrocytes (hemolytic anemia), muscle weakness, posterior column and spinocerebellar tract demyelination
K = Neonatal hemorrhage with INC PT and INC aPTT but normal bleeding time

Which lysosomal storage disease fits the following clinical feature? (FA p111)
Peripheral neuropathy of hands and feet,
angiokeratoma

Fabry's disease (XR)
alpha-galactosidase A deficiency
ceramide trihexoside accumulates

Which lysosomal storage disease fits the following clinical feature? (FA p111)
Corneal clouding + mental retardation

Hurler's syndrome (AR)
alpha-L-iduronidase deficiency
Heparan sulfate, dermatan sulfatue accumulate

Which lysosomal storage disease fits the following clinical feature? (FA p111)
No corneal clouding + mental retardation,
Aggressive behavior

Hunter's syndrome (XR)
Iduronate sulfatase deficiency
Heparan sulfate, dermatan sulfatue accumulate

Which lysosomal storage disease fits the following clinical feature? (FA p111)
Demyelinating disease affects peripheral
nerves

Krabbe's disease (AR)
Galactocerebrosidase deficiency
Galactocerebroside accumulation

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