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541 terms

DIT Questions

STUDY
PLAY
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
Which lysosomal storage disease fits the following clinical feature? (FA p111)
Sphingomyelin buildup, progressive neurodegeneration, hepatosplenomegaly, cherry-red spot on macula, foam cells
Niemann-Pick disease
Sphingomyelinase deficiency
Sphingomyelin accumulates
Which lysosomal storage disease fits the following clinical feature? (FA p111)
Accumulation of galactocerebroside in the
brain
Krabbe's disease (AR)
Galactocerebrosidase deficiency
Galactocerebroside accumulation
A 25-year-old male presents with an anterior midline neck mass that moves with swallowing. The
most common midline mass of the neck is a thyroglossal duct cyst. What feature of this neck mass distinguishes the mass from a branchial cleft cyst? What is the remnant of the thyroglossal duct?
Explain the development of the thyroid gland. (FA p130)
Thyriod diverticulum arises from floor of primitive pharynx, descends into neck. Connected to tongue by thyroglossal duct.
Remnant = foramen cecum
Brachial cleft cyst is a persistent cervical sinus
A 28-year-old G2P1 is determined to have an amniotic fluid index (AFI) of 3 (6-19 normal) at 18
weeks gestational age on ultrasound. Which conditions are associated with oligohydramnios, and
which are associated with polyhydramnios? (FA p488) What is Potter's syndrome? (FA p132)
Oligo < 0.5L of amniotic fluid
-placental insufficiency, bilateral renal agenesis, posterior urethral valves in males --> inability to excrete urine

Poly < 1.5-2L of amniotic fluid
-esophageal/duodenal atresia --> inability to swallow amniotic fluid
-anencephaly

Potter's results from bilateral renal agenesis (malformation of ureteric bud) --> oligohydramnios --> limb deformities, facial deformities, pulmonary hypoplasia
An 18-year-old male athlete complains of an insidious onset of a dull pain over his distal anterior right femur over the past month. The patient denies any recent injury. An exam reveals a normal
appearing right leg without any joint abnormalities. An x-ray of the right upper leg shows a distal
bony tumor over the metaphysis causing elevation of the periosteum. You consult the radiologist who
is concerned that this bony tumor might represent osteosarcoma. What are the risk factors for
osteosarcoma? What is the classic x-ray finding with osteosarcoma? (FA p381)
Risk factors
Male, 10-20 yo
Pagat's bone disease
bone infarcts
Radiation
Familial retinoblastoma

x-ray findings: Condman's triangle or sunburst pattern from elevation of periosteum
A 40-year-old female had a blood pressure of 180/120 just before undergoing a dental procedure.
The dental procedure was delayed until there was an improvement of her blood pressure. In your
office, the patient has a normal exam aside from an elevated blood pressure of 176/116. Her initial
lab work reveals hypokalemia and hypernatremia. You are concerned that this patient's hypertension
is due to hyperaldosteronism. What diagnostic test allows you to distinguish between primary
hyperaldosteronism (Conn's syndrome) and secondary hyperaldosteronism? (FA p296) Bonus:
What food substance in excess can cause hyperaldosteronism? (answer: licorice)
Test plasma renin activity
-low in primary
-high in secondary
A 25-year-old G2P1 female develops heart palpitations and heat intolerance. The patient has a
decreased TSH and elevated free T4. You start the patient on propylthiouracil (PTU) and propranolol
for hyperthyroidism. Can methimazole be used in pregnancy with hyperthyroidism? What is a rare
but potentially fatal toxicity associated with PTU? What is the mechanism of action of PTU?
(FA p297 and p305)
Do NOT use methimazole in pregnant women

PTU and methimazome = inhibit organification of iodide and coupling of thyroid hormone synthesis
-PTU also DEC peripheral conversion of T4 to T3

Toxicity = skin rash, agranulocytosis, aplastic anemia
You are treating a 63-year-old female with small cell lung cancer who develops SIADH. She becomes
disoriented secondary to hyponatremia. Consequently, you rapidly correct the low serum sodium with demeclocycline and water restriction. The patient's sodium level and disorientation improve; however, soon after the patient develops diplopia. What is the cause of this patient's diplopia?
(FA p403 and p464) What are the possible causes of SIADH? (FA p300)
Causes:
Ectopic ADH (small cell lung cancer)
CNS disorders/head trauma
Pulmonary disease
Drugs (cyclophosphamide)

Diplopia caused by central pontine myelonolysis
-acute paralysis, dysarthria, dysphagia, loss of consciousness
-caused by rapid correction of hyponatremia
Which vitamin fits the following descriptions?
constituent of visual pigments (FA p90)
Vit A
Which vitamin fits the following descriptions?
constituent of NAD⁺ (FA p91)
Vit B3 = niacin

NAD derived from Niacin
B3 = 3 ATP
Which vitamin fits the following descriptions?
cofactor in oxidation and reduction FADH2 and FMN (FA p91)
Vit B2 = riboflavin

FAD and FMN are derived from riboFlavin
B2 = 2 ATP
Which vitamin fits the following descriptions?
constituent of CoA (FA p91)
Vit B5 = pantothenate

Pantothen-A is in Co-A
Patients with DiGeorge syndrome frequently develop viral and fungal infections secondary to immunodeficiency. What type of immunodeficiency disorder is caused by DiGeorge syndrome? (FA p213) Development of what branchial pouches are affected in DiGeorge syndrome? (FA p129)
T-cell disorder due to 22q11 deletion
3rd + 4th pharyngeal pouches fail to develop --> thymus + parathyroid fail to develop --> low T cells, low PTH, low Ca, absent thymic shadow on CXR

Sx: tetany (low Ca), recurrent infections (low T cells), congenital heart + great vessel defects
A 25-year-old G1P0 develops vaginal bleeding prior to her first scheduled ultrasound at 7 weeks. The patient has an ultrasound that has no fetus and a "snow storm" appearance. The patient goes on to have a dilation and curettage of the hydatidiform mole. Hydatidiform mole is the most common precursor of what ovarian germ tumor? What tumor marker is monitored after the dilation and curettage of a hydatidiform mole? (FA p485 and p491)
Hydatidiform mole = cystic swelling of chorionic villi + proliferation of chorionic epithelium

Causes chorioCA

Sx: honeycombed uterus, cluster of grapes, snowstorm on US + abnl vaginal bleeding

Tumor marker: hCG
Psoriasis is characterized by an increase in the stratum spinosum and a decrease in the stratum granulosum. What are the layers of the epidermis beginning with the most superficial layer? What is Auspitz sign? (FA p370 and p388)
Surface to base: Californians Like Girls in String Bikinis
stratum corneum
stratum lucidum
stratum granulosum
stratum spinosum
stratum basalis

Auspitz sign = bleeding spots when scales scraped off = psoriasis
A 54-year-old white male presents with a single non-healing skin lesion on the right ala of the nose x 6 months. The skin lesion has a rolled border with central ulceration and associated telangiectasia. You decide to use 5-flurouracil (5-FU) a topical treatment for this skin lesion. What type of cancerous lesion does this patient have? What are some other uses for 5-FU? (FA p365 and p390)
topical basal cell CA

5-FU used to tx colon cancer, solid tumors, topical basal cell CA

synergy w/ MTX
A 45-year-old male complains of epistaxis, shortness of breath, hemoptysis and hematuria for two days. A urine analysis identifies RBC casts and proteinuria. The patient also undergoes pulmonary function testing which reveals restrictive lung disease. What renal pathology is characteristic of RBC casts and proteinuria? (FA p467)
NephrItic syndrome = Inflammatory process = hematuria + RBC casts and azotemia + oliguria + HTN +proteinuria < 3.5 g/d
Diagram the phases of a myocardial ventricular action potential and describe which ion channels are responsible for each phase. (FA p260)
Phase 0 = rapid upstroke - voltage-gated Na channels open
Phase 1 = initial repolarization - voltage-gated Na channels inactivated + voltage-gated K channels open
Phase 2 = plateau - voltage-gated Ca channels open --> Ca influx triggers Ca release from SR --> myocyte contraction
Phase 3 = rapid repolarization - voltage-gated slow K channels open (massive K efflux) + voltage-gated Ca channels close
Phase 4 = resting potential - high K permeability through K channels
Diagram the phases of a myocardial pacemaker action potential and describe which ion channels are responsible for each phase. (FA p260)
Phase 0 = upstroke - voltage-gated Ca channels open (cells lack voltage-gated Na channels)
*lacks phase 1 (initial repol) and phase 2 (plateau)
Phase 3 = Ca channels inactivated + K channels open --> K efflux
Phase 4 = slow diastolic depolarization - membrane potential spontaneously depolarizes
A 33-year-old male is diagnosed with Hodgkin's lymphoma and treated with doxorubicin, bleomycin, vincristine, cyclophosphamide and etoposide. While undergoing treatment, the patient develops a paralytic ileus and neurotoxicity from the treatment regimen. Which chemotherapy agent most likely is the cause of these sequelae? What is the characteristic pathology finding of Hodgkin's lymphoma? (FA p366, FA p367, FA p 357)
Reed-Sternberg cells, localized group of nodes, "B" signs (fever, night sweats, weight loss), mediastinal lymphadenopathy

Vincristine causes neurotoxicity + paralytic ileus
MOA: alkaloids that bind to tubulin in M phase --> blocks polymerization of microtubules
A 50-year-old male complains of intermittent hematuria over the past four weeks. However, he says that what brought him in today was right-sided flank pain. On exam you notice a palpable right-sided flank mass. What is the most common renal malignancy in adults? What is the associated gene deletion with this malignancy? (FA p469)
renal cell carcinoma

associated with von Hippel-Lindau syndrome and gene deletion in chrom 3 (3p)
Describe how the following diuretics affect the nephron function? (FA p473-475)
Acetazolamide
carbonic anhydrase inhibitor --> causes self-limited NaHCO3 diuresis and DEC total body HCO3 stores
Describe how the following diuretics affect the nephron function? (FA p473-475)
Mannitol
Osmotic diuretic
INC tubular fluid osmlolarity --> INC urine flow
Describe how the following diuretics affect the nephron function? (FA p473-475)
Furosemide
Sulfonamide loop diuretic.
Inhibits cotransport system (Na, K, 2Cl) of thick ascending limb of loop of henle
Describe how the following diuretics affect the nephron function? (FA p473-475)
Hydrochlorothiazide (thiazides)
Inhibits NaCl reabsorption in early distal tubule --> reduces diluting capacity of the nephron, DEC Ca excretion
Describe how the following diuretics affect the nephron function? (FA p473-475)
Potassium sparing
Spiranolactone, triamterene, amiloride, eplerenone
Spiranolactone = Competitive aldosterone receptor antagonist in the CCT
Triamterene + amildoride = Block Na channels in the CCT
Describe how the following diuretics affect the nephron function? (FA p473-475)
ADH antagonists
?
A 1-month-old female presents with an anterior neck enlargement. Your exam reveals a pale infant with enlarged abdominal girth and a protruding umbilicus. You think this patient might have cretinism. In cretinism, would the patients TSH be elevated or decreased? What is the cause of endemic cretinism? What is the cause of sporadic cretinism? (FA p297, FA p298)
Cretinims is due to severe fetal hypothyroidism

TSH would be elevated

Endemic = Iodine deficiency
Sporadic = defect in T4 formation or developmental failure in thyroid formation
A 43-year-old male presents with visual difficulties and decrease in libido. The patient reports that he is unable to see in the outer half of both sides of his visual fields. A brain MRI reveals a tumor. Would you expect the patient's GnRH to be decreased or increased? (FA p300) This tumor will often cause infertility. What is the role of LH and FSH in spermatogenesis? What is an easy way to remember which cells LH and FSH stimulate during spermatogenesis? (FA p481)
This pt has a prolactinoma -->> DEC GnRH

LH stimulates Leydig cells to make testosterone
FSH stimulates Sertoli cells --> causes spermatogenesis

"Gonium" is going to be a sperm
"Zoan" is "zooming" out of cell
In patients with a prolactinoma, what pharmacologic agent can be used to inhibit the release of prolactin? In normal physiology, how is prolactin secretion regulated? (FA p290)
Dopamine agonists like bromocriptine and cabergoline inhibit release of prolactin

Normally negatively inhibited by dopamine release
An 85-year-old female has been on long-term medical therapy for seizure disorder with phenytoin, a cytochrome 450 inducer. She has been stable with her dosage of the medication and has a serum level checked every three months. However, her most current phenytoin level is elevated. You will need to decrease her phenytoin dosage because she is beginning to lose her ability to metabolize the medication. What phase of drug metabolism do geriatric patients lose first? Which phase of drug metabolism makes a slightly polar metabolite by oxidation, reduction, or hydrolysis? (FA p233)
Geriatrics lose Phase I first

Phase I metabolism = reduction, oxidation, hydrolysis = yields slightly polar, water-soluble metabolites (often still active)
A 34-year-old obese white female develops urinary retention after undergoing a laparoscopic cholecystectomy. Which cholinergic agonist can be used to treat post-op ileus and urinary retention? What conditions can be made worse by using cholinomimetic agents? (FA p238)
Bethanechol = activates Bowel and Bladder smooth muscle
-resistant to AChE

All cholinomimetics can worsen COPD, asthma, peptic ulcers
A 37-year-old obese white male complains of inflammation and pain in his first right toe joint (1st MTP) after having a steak dinner and three glasses of red wine the previous night. He is not currently on any medications for this condition but had been on chronic treatment with allopurinol that worked well in the past. This is the third flare-up in six months and he wants to begin taking allopurinol again because it reduced the number of flares he had in the past. What agents are used for the acute treatment versus chronic treatment of this condition? Why is allopurinol sometimes used in patients with leukemia and lymphoma? (FA p384, FA p392)
Acute tx:
-colchicine = binds/stabilizes tubulin to inhibit polymerization
-NSAIDS (indomethicin)
Chronic tx:
-Allopurinol = inhibits xanthine oxidase = DEC conversion of xanthine to uric acid
-uricosurics (probenicid)

Allopurinol used in leukemia/lymphoma to prevent tumor lysis
*INC concentrations of azathioprine + 6-MP which are metabolized by xanthine oxidase
A 22-year-old international student from Uganda presents to the emergency room complaining of worsening chest and abdominal pain. He reports that he has experienced several similar episodes in the past. The peripheral smear shows sickled RBCs, anisocytosis and poikilocytosis. What is the definition of anisocytosis and poikilocytosis? Describe the RBC life cycle. (FA p342, I-5 and FA p352)
Anisocytosis = varying sizes
Poikilocytosis = varying shapes

Life span = 120 days
A 50-year-old female develops a new onset of lower 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? (FA p358)
M spike of gamma on protein electrophoresis

Rouleaux formation on blood smear (RBCs
stacked like poker chips)

Ig light chains in urine

Punched-out lytic bone lesions on x-ray
The different hereditary hyperbilirubinemias can all present with jaundice and scleral icterus. What is the underlying cause in the following hyperbilirubinemias, and what form of bilirubin is elevated in the serum in each disease? (FA p333)
Gilbert's syndrome
Mildly DEC UDP-glucuronyl transferase or DEC bilirubin uptake

INC unconjugated bilirubin

No clinical consequences
The different hereditary hyperbilirubinemias can all present with jaundice and scleral icterus. What is the underlying cause in the following hyperbilirubinemias, and what form of bilirubin is elevated in the serum in each disease? (FA p333)
Crigler-Najjar syndrome (type I)
Absent UDP-glucuronyl transferase

INC unconjugated bilirubin, jaundice, kernicterus (bilirubin deposited in brain)

Patients die within a few years
The different hereditary hyperbilirubinemias can all present with jaundice and scleral icterus. What is the underlying cause in the following hyperbilirubinemias, and what form of bilirubin is elevated in the serum in each disease? (FA p333)
Dubin-Johnson syndrome
Defective liver excretion of conjugated bilirubin

INC Conjugated bilirubin

Grossly black liver, benign
A 35-year-old patient is on highly active antiretroviral therapy (HAART) including zidovudine, didanosine and ritonavir. A routine CBC to monitor the HAART reveals a megaloblastic anemia. Which medication is the most likely cause of the ill effect? What is the mechanism of action of zidovudine and didanosine? What is the mechanism of action of ritonavir? (FA p197)
HAART initiated when CD4 count < 350 or high viral load; consists of:
2 nucleoside reverse transcriptase inhibitors + 1 protease inhibitor OR
2 NRTIs + 1 non-NRTI

zidovudine (NRTI) = competitively inhibits nucleotide binding to reverse transcriptase --> terminates DNA chain
-sfx: BM suppression, peripheral neuropathy, lactic acidosis, rash, megaloblastic anemia

didanosine = same as ZDV, but not megaloblastic anemia

ritonavir (PI) = prevents maturation of new viruses by blocking HIV-1 protease (pol gene) from cleaving polypeptide products of HIV mRNA into fxnal parts
-sfx: hyperglycemia, nausea, diarrhea, lipodystrophy
A 60-year-old male CHF patient is on a combination of ACE inhibitor, β-blocker, K+ sparing diuretic, and a cardiac glycoside to optimize his cardiac function. The patient has been stable for some time on this regimen but begins to develop declining renal function. The patient goes to the ER for nausea, vomiting, and diarrhea. An EKG reveals an increased PR interval, a decreased QT interval, and T-wave inversion. Which medication accounts for this patient's symptoms and what is the antidote for overdose in this situation? (FA p283)
Digoxin = cardiac glycoside = directly inhibits Na/K ATPase --> causes indirect inhibition of Na/Ca exchanger --> INC Ca --> positive ionotropy

Toxicity: INC PR interval, DEC QT interval, Twave inversion, hypokalemia
-Need to slowly normalize K, give lidocaine, cardiac pacer, anti-dig Fab fragments, Mg
Which GI ligaments match the following descriptions? (FA p309)
Separates the greater and lesser sacs
Right side = gastrohepatic

Left side = gastrosplenic
Which GI ligaments match the following descriptions? (FA p309)
May be cut during surgery to access the lesser sac
Gastrohepatic
Which GI ligaments match the following descriptions? (FA p309)
2 ligaments that connect the spleen to other structures
Splenorenal

connects spleen to posterior abdominal wall and
Which GI ligaments match the following descriptions? (FA p309)
Contains the portal triad
Hepatoduodenal
A 53-year-old male has just been diagnosed with peptic ulcer disease (PUD) visualized on endoscopy. Ranitidine and lansoprazole are the medications available on your hospital formulary for treatment of PUD. Describe the different ways in which ranitidine and lansoprazole decrease parietal cell acid secretion. Why is ranitidine preferred over cimetidine? What other conditions can you treat with lansoprazole and ranitidine? (FA p337)
Ranitidine = reversibly blocks histamine H2 receptors --> DEC parietal cell secretion
-preferred over crimetidine which is a potent P450 inhibitor

Lansoprazole = irreversibly inhibits H/K-ATPase in stomach parietal cells
Perimenopausal symptoms are frequently treated with hormone replacement therapy (HRT). Why is progesterone added to estrogen HRT formulations? Unopposed estrogen stimulation can lead to two specific endometrial diseases. How would these two diseases most commonly present? How is bone health affected by HRT? (FA p489 and p498)
Unopposed estrogen tx INC risk of:
1. endometrial cancer (sx: postmenopausal vaginal bleeding) so also give progesterone
2. INC CV risk

ERT improves osteoporosis
A 43-year-old male coal miner complains of a single, non-healing lesion on his right hand. Coal miners are at increased risk of skin cancer because of their exposure to arsenic. What type of skin cancer is associated with this exposure? (FA p390)
Squamous cell carcinoma
You are seeing a 32-year-old female for the first time who complains of a cough, nasal congestion and fever for the past two days. During the patient's medical history, you note the patient is taking clomiphene and metformin for polycystic ovarian syndrome (PCOS). What is the mechanism of action of clomiphene? (FA p498)
Clomiphene

MOA: partial agonist at estrogen receptors in hypothalamus --> prevents normal feedback inhibition --> INC LH and FSH release from pituitary
A 21-year-old female patient with Epstein-Barr virus (EBV) presents with fatigue, a petechial rash and anemia. Which drugs are known to cause aplastic anemia? What is the treatment for aplastic anemia? (FA p351)
aplastic anemia = pancytopenia

Causes:
1. Benzene, chloramphenicol, alkylating agents, antimetabolites
2. parvo, EBV, HIV, HCV
3. Fanconi's anemia
4. immune-mediated, primary stem cell defect

Tx: withdraw drug, immunosuppressive regimens like cyclosporine, BM transplant, RBC/platelet transfusion, G-CSF or GM-CSF
A 23-year-old male undergoes a splenectomy due to splenic rupture from blunt abdominal trauma. What would you expect to find on this patient's peripheral RBC smear after the splenectomy? (FA p349) Asplenic patients are susceptible to which encapsulated organisms? (FA p201) What vaccines for these encapsulated organisms should be given to asplenic patients? (FA p139)
Howell-Jolly bodies = basphilic nuclear remnants found in RBC

Susceptible to "S SHiN"
Salmonella, S. pneumonia, H. influenza, N. meningitidis

Vaccines for encapsulated bacteria involve a protein conjugated to the polysaccharide antigen to promote T cell activation and class switching
A 34-year-old male with recurrent peptic ulcers is diagnosed with Zollinger-Ellison syndrome. What GI hormone is secreted by the pancreatic and gastric tumors of Zollinger-Ellison syndrome? (FA p317) Which MEN syndrome is associated with Zollinger-Ellison syndrome? (FA p302) What GI hormone is secreted by a VIPoma? (FA p317)
ZES = Gastrin

Associated with MEN I

VIPoma = vasoactive intestinal polypeptide
-sx: diarrhea, hypokalemia
A child presents with nephritis, deafness and ocular dysfunction. A gene defect in what type of collagen contributes to the dysfunctions associated with Alport syndrome? What type of collagen organizes bone, skin and tendons? What type of collagen organizes cartilage? (FA p79, 80)
Type 1 = Bone, Skin, Tendons (Type 1: bONE)
Type 2 = Cartilage (Type 2: carTWOlage)
Type 3 = reticulin
Type 4 = Basement membrane (Type 4: under the floor)

Alport's syndrome = abnormal Type IV collagen
A 23-year-old female thinks that she might have an STD because she noticed gray vaginal discharge over the past two days. You inspect the vaginal fluid under a microscopic and it reveals bacteria covering vaginal epithelial cells. When you tell her she has vaginosis she asks you if it is an STD. Which drug would you use to treat this infection? What are the sexually-transmitted bacterial causes of vaginal discharge? What are the bacterial causes of vaginal discharge that are not sexually transmitted? (FA p150, 154 and 156)
STD causes of discharge
-N. gonorrhea
-c. trachomatis,

non-STD
-Gardnerella vaginalis (tx: metronidazole)
A 28-year-old male is being treated with combination of bleomycin, etoposide and cisplatin for metastatic non-seminoma testicular cancer. The patient develops SOB during the course of treatment. Pulmonary function testing indicates that the patient has a restrictive lung disease. Which of the chemotherapy agents is responsible for this restrictive lung disease? (FA p366 and p511) Which of the chemotherapy agents in the above regimen work by inducing free radicals to interfere with DNA structure? (FA p366)
Bleomycin: induces free radical formation --> causes DNA strands to break
-sfx: pulm fibrosis, skin changes

Etoposide: inhibits topoisomerase II --> INC DNA degradation
-sfx: myelosuppression, GI irritation, alopecia

Cisplatin: cross-link DNA
-sfx: nephrotoxicity, acoustic nerve damage
A 45-year-old white female presents with a 1cm x 1cm, painless, mobile mass in her right parotid gland. You inform the patient that most tumors in the parotid gland are benign. What is the most common benign tumor of the salivary gland? What is a Warthin's tumor? What cranial nerve goes through the parotid gland? (FA p321 and 318)
pleomorphic adenoma = most common benign

mucoepidermoid = most common malignant

Warthin's = heterotropic salivary gland tissue trapped in a lymph node

CN VII
A 48-year-old woman with pheochromocytoma is on phenoxybenzamine when she experiences cardiac arrest. During her resuscitation, she is given norepinephrine. Phenoxybenzamine is a noncompetitive α-antagonist. What is the effect of phenoxybenzamine on the efficacy of norepinephrine? How does a competitive antagonist affect a drug's potency? (FA p234)
phenoxybenzamine DEC efficacy of NE b/c it's a noncompetitive antagonist of alpha-receptors

competitive antagonist DEC potency
A 17-year-old male comes to the clinic complaining of painful urination and purulent penile discharge. Ceftriaxone is used for the treatment of sexually-transmitted N. gonorrhea infections. What generation of cephalosporin is ceftriaxone? Which generation of cephalosporins is effective against Pseudomonas? Are cephalosporins bacteriostatic or bacteriocidal? (FA p186)
MOA: beta-lactam drugs that inhibit cell wall synthesis; bactericidal

ceftriaxone = 3rd gen

4th gen effective against pseudomonas
A 44-year-old female develops a sudden change in personality and is referred to psychiatry for further evaluation. The patient's husband explains that his wife developed uninhibited sexual behavior almost overnight and is very aggressive when confronted over minor issues. The patient has no prior history of bipolar disorder and is not experiencing distractibility, grandiosity, flight of
ideas, agitation, or a decreased need for sleep. She also denies any prior depressive episodes. Prior to this episode the patient's behavior was described as calm and prudent. The psychiatrist
orders an MRI of the head, which reveals a brain lesion. What area of the brain would you expect to be damaged in this patient? What are the symptoms of Klüver-Bucy syndrome? (FA p403)
Amygdala (bilateral)

Sx: hyperorality, hypersexuality, disinhibited behavior
A 35-year-old male develops hallucinations just before sleep, episodes of excessive sleepiness, and cataplexy during times of laugher and sadness. Narcoleptic sleep episodes begin with what stage of sleep? What are the different stages of normal sleep? How do they differ from one another?
(FA p62, p 63)
Can begin just before sleep = hypnagogic hallucinations

1 = light sleep (theta waves)
2 = deeper sleep; longest duration (sleep spindles + K complexes)
3-4 = deepest, non-REM sleep (delta waves)
REM = dreaming (beta waves)
You are seeing a 12-year-old male for an ER follow-up appointment for a new onset seizure. Your
neurological exam is normal but you notice that patient has several scattered hypopigmented
plaques and macules over his skin. You are concerned that a combination of the hypopigmented
lesions and seizures might point towards a diagnosis of tuberous sclerosis. What are these
hypopigmented lesions called? What other dermatologic findings are associated with tuberous
sclerosis? What neoplasms are patients with tuberous sclerosis at risk of developing? (FA 427)
hypopigmented "ash leaf" spots
facial angiofibromas = sebaceous adenoma
periungal fibromas = cysts under fingernails + toenails
shagreen patches = leathery patch of skin

harmatomas in CNS, skin, organs

cardiac rhabdomyoma
renal angiomyolipoma,
subependymal giant cell astrocytoma
A 24-year-old G1P0 is in for a routine third-trimester prenatal evaluation. The patient is without
complaints today but exhibits a blood pressure of 150/92, 2+ proteinuria and facial edema.
Would these symptoms be indicative of preeclampsia or eclampsia? Although this patient is
without complaints, what are some symptoms that patients might complain of with pregnancyinduced hypertension? What factors increase a woman's risk of developing pregnancy-induced
hypertension? What is HELLP syndrome? (FA p487)
Preeclampsia = HTN, proteinuria, edema
Eclampsia = preeclampsia + seizures

Sx: HA, blurred vision, abdominal pain, edema of face + extremities, AMS, hyperreflexia
Labs: thrombocytopenia, hyperuricemia
Risks: HTN, DM, CKD, autoimmune disorders
HELLP = Hemolysis, Elevated LFTs, Low Platelets

Caused by placental ischemia = impaired vasodilation of spiral arteries
A 12-year-old male is taken to the ER for confusion associated with vomiting and abdominal pain.
On exam you note a fruity breath odor and that the patient is experiencing rapid deep breathing.
The patient's random blood glucose is 522mg/dl. What condition is the patient experiencing?
What are the rapid, deep breaths called? What ketone body is the cause of the patient's fruity
breath odor? Which ketone body is detected by a urine test in diabetic ketoacidosis?
(FA p112, p302)
DKA
rapid, deep breaths = Kussmaul respirations

breath smells like acetone (fruity) = acetoacetate production
urine ketone test = tests for acetyl-CoA
* urine test does NOT detect beta-hydroxybutyrate
A 66-year-old male currently taking warfarin for atrial fibrillation is instructed to avoid food products that contain vitamin K to optimize anticoagulation. For what clotting factors is vitamin K necessary? (FA p94)
II, VII, IX, X

also protein C and protein S
Is a 34-year-old schizophrenic patient having active hallucinations, who is not oriented to time,
place, or person, able to legally agree to a plan of care? What factors must be in place in order for
a patient to have the capacity to make a decision? (FA p57)
No

1. Pt makes and communicates a choice
2. Pt is informed
3. Decision remains stable over time
4. Decision is consistent with their values and goals
5. Decision is not results of delusion or hallucination
Given the following clinical situation, classify each as either type I, II, III, or IV hypersensitivity.
(FA p211)
Asthma exacerbation
type I = free antigen cross links IgE on presensitized mast cells and basophils
-immediate reaction
Given the following clinical situation, classify each as either type I, II, III, or IV hypersensitivity.
(FA p211)
Poison ivy dermatitis
type IV = delayed (T-cell-mediated) = sensitized T cells encounter antigen and then release lymphokines
-4 Ts = T cells, Transplant rejections, TB skin tests, Touching (contact dermatitis)
Given the following clinical situation, classify each as either type I, II, III, or IV hypersensitivity.
(FA p211)
Goodpasture's syndrome
type III = immune complex, serum sickness, arthus reaction
-associated w/ vasculitis and systemic manifestations
Given the following clinical situation, classify each as either type I, II, III, or IV hypersensitivity.
(FA p211)
Arthus reaction
type III = immune complex, serum sickness, arthus reaction
-associated w/ vasculitis and systemic manifestations

Arthus reaction = local subacute Ab-mediated hypersensitivity reaction = intradermal injection of antigen induces Ab, which form antigen-Ab complexes in the skin
-causes edema, necrosis, complement activation
Given the following clinical situation, classify each as either type I, II, III, or IV hypersensitivity.
(FA p211)
Anaphylaxis
type I = free antigen cross links IgE on presensitized mast cells and basophils
-immediate reaction
Given the following clinical situation, classify each as either type I, II, III, or IV hypersensitivity.
(FA p211)
Serum sickness
type III = immune complex, serum sickness, arthus reaction
-associated w/ vasculitis and systemic manifestations

Serum sickness = immune complex disease = Ab to foreign proteins produced (takes 5 days) --> immune complexes form that are deposited in membranes where they fix complement --> causes tissue damage
Given the following clinical situation, classify each as either type I, II, III, or IV hypersensitivity.
(FA p211)
Autoimmune hemolytic anemia
type II = antibody mediated = IgG, IgM bind fixed antigen on "enemy" cell --> lysis or phagocytosis
-test: direct and indirect Coombs
Given the following clinical situation, classify each as either type I, II, III, or IV hypersensitivity.
(FA p211)
Liver transplant rejection
type IV = delayed (T-cell-mediated) = sensitized T cells encounter antigen and then release lymphokines
-4 Ts = T cells, Transplant rejections, TB skin tests, Touching (contact dermatitis)
Given the following clinical situation, classify each as either type I, II, III, or IV hypersensitivity.
(FA p211)
Rh incompatibility (erythroblastosis fetalis)
type II = antibody mediated = IgG, IgM bind fixed antigen on "enemy" cell --> lysis or phagocytosis
-test: direct and indirect Coombs
Given the following clinical situation, classify each as either type I, II, III, or IV hypersensitivity.
(FA p211)
TB Skin Test
type IV = delayed (T-cell-mediated) = sensitized T cells encounter antigen and then release lymphokines
-4 Ts = T cells, Transplant rejections, TB skin tests, Touching (contact dermatitis)
A 34-year-old male has had an elevated BUN and creatinine for the past 4 days. The patient's
urine osmolality is 600mOsm/L, urine Na 5mmol/24hours, FeNa 0.5%, and Serum BUN/Creatinine 25:1. What type of azotemia does this patient have? What is the primary mechanism of this patient's azotemia? What are some causes of postrenal azotemia? (FA p471)
Pre-renal azotemia - due to DEC RBF like hypotension

Post-renal azotemia - due to bilateral outflow obstruction like stones, BPH, neoplasia, congenital abnormalities
A 55-year-old patient with CHF develops hypocalcemia after being placed on a diuretic. Which diuretics lower serum calcium levels? What is the mechanism by which this patient developed
hypocalcemia? (FA p475)
Loop diuretics = abolish lumen-positive potential in thick ascending limb of loop of henle --> DEC paracellular Ca reabsorption --> hypocalcemia
A 53-year-old asthmatic male has a myocardial infarction (MI). Routinely patients are placed on a β-blocker to reduce mortality post MI. Why should you use caution with starting a β-
blocker in a patient with asthma? What are the β1 selective beta-blockers? (FA p242)
Beta blockers exacerbate by causing bronchoconstriction

B1 selective = A BEAM = Acetobutolol, Betaxolol, Esmolol (short-acting), Atenolol, Metoprolol

alpha + beta nonselective = carvedilol, labetalol
A 34-year-old female with myasthenia gravis undergoes a thymectomy for an associated thymoma. What type of cell differentiation and maturation takes place at the thymus? (FA p201)
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?
(FA p201, p202)
T-cell differentiation and maturation
* T cells = Thymus and B cells = Bone marrow
Cortex contains immature T cells
Medulla contains mature T cells

MHC I = all nucleated cells
- HLA-A, HLA-B, HLA-C
- binds TCR and CD8
MHC II = antigen presenting cells like macrophages, B cells, monocytes
- HLA-DR, HLA-DP, HLA-DQ
- binds TCR and CD4
A 45-year-old female presents to the ER with complaints of chest pain, a racing heart beat and dizziness. Examination reveals a heart rate of 120 beats/minute, BP of 116/74, and 20 respirations/minute. The patient is diaphoretic and anxious. An initial EKG reveals ventricular tachycardia with shifting sinusoidal waveforms. What is this classic EKG finding? What are the
possible causes of this patient's condition? (FA p262)
Torsades de pointes
Caused by anything that prolongs QT interval like defects in cardiac Na and K channels
A 53-year-old electrician develops a gradual onset of poorly localized right shoulder pain that improves with ibuprofen and rest. The patient has full range of motion in his right shoulder but
has pain with overhead movements. The patient exhibits weakness when performing the "empty can" test which isolates the supraspinatus portion of the rotator cuff. This finding most likely
indicates an impingement syndrome of the right shoulder. What muscles compose the rotator cuff? (FA p371)
supraspinatus
infraspinatus
teres minor
subscapularis
A 35-year-old male is having a partial colectomy for diverticular disease. The patient is placed on neomycin prior to the bowel surgery. What class of medication is neomycin? What is the mechanism of action of neomycin? What are the toxicities with this class of medication?
(FA p187)
Aminoglycosides = Gentamicin, Neomycin, Amikan, Tobramycin, Streptomycin (GNATS)
-Bactericidal
MOA: inhibits formation of initiation complex and cause misreading of mRNA
-require O2 for uptake so ineffective against anaerobes
SFX: nephrotoxicity, ototoxicity, teratogen (NOT)
Resistance: transferase activity that inactivate the drug by acetylation, phosphorylation, adenylation
A 5-year-old boy is treated with mebendazole for a pinworm infection. Mebendazole acts on microtubules to inhibit the helminthic infection. What other medications act on microtubules? What syndrome demonstrates a defect in microtubule polymerization? (FA p78)
Mebendazole/thiobendazole
Griseofulvin (antifungal)
Vincristine/viblastine (anti-cancer)
Colchicine (anti-gout)

Chediak-Higashi syndrome = MT polymerization defect --> DEC phagocytosis --> recurrent pyogenic infections, partial albinism, peripheral neuropathy
A 3-year-old child develops a right wrist drop and confusion. Considering lead poisoning as a possible diagnosis, you have the patient tested with a serum lead level, CBC and a peripheral RBC smear. What peripheral smear finding is consistent with lead poisoning? What is the treatment for lead poisoning in this patient? (FA p350)
L = lead lines on gingivae (Burton's lines) and on epiphyses of long bones on x-ray
E = encephalopathy and erythrocyte basophilic stippling
A = Abdominal colic and sideroblastic anemia
D = wrist and foot drop

Tx: Succimer
A 57-year-old male with BPH is on terazosin when he is stung by a bee and taken to the ER for anaphylaxis. How does blood pressure response to epinephrine administration change if an α-blocker is administered beforehand? Why? (Hint: Review the adrenergic receptors in vascular smooth muscle.) (FA p241)
epinephrine response exhibits a reversal of the mean BP change, from a net increase (due to alpha response) to a net decrease (due to beta response b/c alpha receptors are blocked)
Given the following clinical presentations, complete the appropriate protozoal infection and pharmacologic agent used to treat the infection. (FA p160- FA p161)
A 25-year-old male with cardiomyopathy after returning from South America
Trypanosoma cruzi
Complications: dilated cardiomyopathy, megacolon, megaesophagus
Transmission: reduviid (kissing) bug
dX: blood smear
Tx: nifurtinox
Given the following clinical presentations, complete the appropriate protozoal infection and pharmacologic agent used to treat the infection. (FA p160- FA p161)
A 44-year-old HIV patient with a brain abscess
Toxoplasmosa gondii
Complications: ring-enhancing brain abscess, "classic triad" of chorioretinitis, hydrocephalus, intracranial calcifications
Transmission: cysts in meat or cat feces
Dx: serology, biopsy
Tx: sulfadiazine + pyrimethamine
Given the following clinical presentations, complete the appropriate protozoal infection and pharmacologic agent used to treat the infection. (FA p160- FA p161)
A 20-year-old male with a liver abscess
Entamoeba histolytica
Complications: blood diarrhea (dysentery), liver abscess, RUQ pain
Transmission: cysts in water
Dx: serology, cysts in stool
Tx: metronidazole, iodoquinol
Given the following clinical presentations, complete the appropriate protozoal infection and pharmacologic agent used to treat the infection. (FA p160- FA p161)
A 24-year-old female with a greenish vaginal discharge
Trichomonas vaginalis
Complications: foul-smelling, green discharge, itching, burning
Transmission: sex
Dx: Trophozoites (motile) on wet mount
Tx: metronidazole
Given the following clinical presentations, complete the appropriate protozoal infection and pharmacologic agent used to treat the infection. (FA p160- FA p161)
A 34-year-old hiker with foul smelling diarrhea
Giardia lamblia
Complications: bloating, gas, foul-smelling diarrhea
Transmission: cysts in water
Dx: Trophozoites or cysts in stool
Tx: metronidazole
A 60-year-old male has noticed worsening urinary complaints. He is having to urinate more frequently and has a decreased urinary stream. A digital rectal exam reveals a smooth, symmetrical, enlarged prostate. You begin patient treatment with a medication that relaxes the prostatic smooth muscle. What class of medication is used to relax smooth muscle in BPH? (FA p495) What are the steps involved in the contraction of smooth muscle? (FA p378)
alpha antagonists like terazosin and tamsulosin cause relaxation of smooth muscle

action potential --> smooth muscle membr depolarization --> voltage-gated Ca channels open --> INC Ca in cytoplasm --> Ca binds to calmodulin --> activates myosin light-chain kinase (MLCK)
A-18 year-old male develops diminished sensation on the medial side of his distal right arm and hand. Upon exam you notice a reduction in the right radial pulse when moving his head toward the right side. What region of the brachial plexus is affected in thoracic outlet syndrome? What muscles can atrophy as a result of thoracic outlet syndrome? (FA p375)
Affects inferior trunk of the brachial plexus (C8, T1)

Atrophy of thenar and hyopthenar eminences
Atrophy of the interosseous muscles
Sensory deficits on medial side of forearm and hand
Loss of radial pulse upon moving head to ipsilateral side
A 50-year-old male complains of intermittent left sided chest pain for the past 2 months, without dyspnea on exertion or syncope. The chest pain worsens with twisting movements and occurs sporadically. The patient has a normal cardiovascular and pulmonary examination and a normal chest x-ray. An EKG reveals first degree heart block. What are the symptoms of first degree heart block? What is the definition of first-degree heart block? (FA p263)
PR interval is prolonged (> 200 msec)

Asymptomatic
A 43-year-old male complains of right-sided facial drooping. When you examine the patient you notice an upper and lower face drooping. Does this patient have a lower or upper motor neuron lesion? What diseases are associated with Bell's palsy? (FA p419)
Lower motor lesion = cannot wrinkle forehead

AIDS, Lyme disease, HSV, sarcoidosis, tumors, diabetes (ALexander graHam Bell with STD)
What important secretory products are secreted from the following cells of the GI tract? (FA p317-318)
G cells
Gastrin
What important secretory products are secreted from the following cells of the GI tract? (FA p317-318)
I cells
CCK
What important secretory products are secreted from the following cells of the GI tract? (FA p317-318)
S cells
Secretin
What important secretory products are secreted from the following cells of the GI tract? (FA p317-318)
D cells
Somatostatin
What important secretory products are secreted from the following cells of the GI tract? (FA p317-318)
Parietal cells
Intrinsic factor
What important secretory products are secreted from the following cells of the GI tract? (FA p317-318)
Chief cells
Pepsin
A 53-year-old male diabetic patient develops osteoarthritis of the left knee and needs to be on chronic NSAID treatment. What are the effects of NSAIDs' inhibition of PGE2? (FA p391) What role do prostaglandins and angiotensin II play on the renal arterioles? (FA p463)
INC vascular tone, DEC pain, DEC uterine tone, DEC temp

NSAIDS can cause acute renal failure by inhibiting renal production of prostaglandins that keep the afferent arterioles vasodilated to maintain GFR
A 54-year-old male presents with headaches and blurred vision. The patient's blood pressure is 200/160. In your evaluation, you hear a right-sided abdominal bruit suggestive of renal artery stenosis. What is the mechanism by which renal artery stenosis causes hypertension? Would you expect high or low renin levels with secondary hyperaldosteronism? What are some other common causes of secondary hyperaldosteronism? (FA p296)
Kidneys start producing more renin --> increased angiotensin --> aldosterone release --> retention of Na and water

Expect high renin

other causes: chronic renal failure, CHF, cirrhosis, nephrotic syndrome
Hashimoto's thyroiditis can present with hyperthyroidism in the early stages of the disease. Given the following presentations, distinguish between which are associated with hyper- and hypothyroidism. (FA p297-298)
Elevated TSH
hypothryroidism
Hashimoto's thyroiditis can present with hyperthyroidism in the early stages of the disease. Given the following presentations, distinguish between which are associated with hyper- and hypothyroidism. (FA p297-298)
Fine hair
hyperthyroidism
Hashimoto's thyroiditis can present with hyperthyroidism in the early stages of the disease. Given the following presentations, distinguish between which are associated with hyper- and hypothyroidism. (FA p297-298)
Brittle hair
hypothyroidism
Hashimoto's thyroiditis can present with hyperthyroidism in the early stages of the disease. Given the following presentations, distinguish between which are associated with hyper- and hypothyroidism. (FA p297-298)
Dry skin
hypothyroidism
Hashimoto's thyroiditis can present with hyperthyroidism in the early stages of the disease. Given the following presentations, distinguish between which are associated with hyper- and hypothyroidism. (FA p297-298)
Pot-bellied, pale neonate
hypothyroidism - specifically cretinism (severe fetal hypothyroidism) caused by defect in T4 formation or developmental failure in thyroid formation
Hashimoto's thyroiditis can present with hyperthyroidism in the early stages of the disease. Given the following presentations, distinguish between which are associated with hyper- and hypothyroidism. (FA p297-298)
Proptosis
Hyperthyroidism - specifically Graves' disase
You are seeing a 3-year-old boy while on an international rotation in Uganda. The patient is experiencing right sided jaw edema. What viral illness is associated with Burkitt's lymphoma? Is Burkitt's lymphoma neoplasm of mature T- or B-cells? (FA p358) Where are T-cells found in the spleen? Where are B-cells found in the spleen? (FA p201)
EBV

affects B cells primarily

B cells are found in follicles within white pulp of the spleen

T cells are found in the peirarterial lymphatic sheath (PALS) and in white pulp of the spleen
Your 46-year-old male patient is asking your advice on whether to take a daily aspirin. How does taking an aspirin a day prevent platelet aggregation and a myocardial infarction? Which two arachidonic acid products decrease platelet aggregation? (FA p391)
Aspirin irreversibly inhibits COX --> DEC synthesis of thromboxanes and prostaglandins (both cause platelet aggregation normally)

Prostacyclin decreases platelet aggregation
A 27-year-old G2P1 develops lower abdominal pain and vaginal bleeding in her 24th week of gestation. An ultrasound reveals a partial detachment of the placenta from the uterine wall. What is this condition called? (FA p488) This patient is at high risk for developing disseminated intravascular coagulation (DIC). What are the common causes of DIC? What is the primary mechanism of DIC? (FA p356)
Abrupto placentae

DIC causes = STOP Making New Thrombi = Sepsis, Trauma, Obstetrics, Pancreatitis, Malignancy, Nephrotic syndrome, Transfusions

Widespread activation of clotting leads to a deficiency in clotting factors --> creates a bleeding state
Hashimoto's thyroiditis can present with hyperthyroidism in the early stages of the disease. Given the following presentations, distinguish between which are associated with hyper- and hypothyroidism. (FA p297-298)
Constipation
hypothyroidism

diarrhea = hyperthyroidism
A non-compliant 59-year-old hypertensive patient develops an S4 heart sound. What might this indicate about this patient's left ventricular function? When in the cardiac cycle is a S4 heart sound heard? What causes the S1, S2 and S3 heart sounds? (FA p257)
Suggests increased left ventricle P = LVH

S4 = "atrial kick" in late diastole (just before S1) - high atrial pressure b/c left atrium must push against stiff LV wall

S1 = tricuspid and mitral valves closing
S2 = pulmonic and aortic valves closing
S3 = in early diastole during rapid ventricular filling = suggests increased left ventricle volume --> INC filling pressures and dilated ventricles
-normal in children and pregnant women
A 67-year-old male patient with new-onset hepatic failure and normal renal function is currently taking a drug metabolized and excreted by the kidneys. Would you need to change the loading dose or maintenance dose of this medication because of this hepatic failure? If this patient were to develop hepatorenal failure, would you need to change the loading dose or maintenance dose of the medicine? (FA p233)
loading dose is unchanged

maintenance dose is DEC
A 30-year-old male patient is at an inpatient facility for opioid addiction. What symptoms might this patient experience while discontinuing opioids? The same patient is seen in the ER for relapse of drug abuse. The patient has pupillary dilation, hallucinations and impaired judgment. What type of intoxication does this presentation suggest? (FA p450)
opioid withdrawal sx: sweating, dilated pupils, piloerection, fever, rhinorrhea, nausea, stomach cramps

Amphetamine sx: impaired judgment, pupillary dilation, prolonged wakefulness and attention, delusions, hallucinations, fever
A 23-year-old patient is with his mother, who is concerned because she has noticed her son having a lack of motivation and difficulty with speech. She reports she first noticed the symptoms 6 months ago, but they became so severe the patient had to drop out of college because he was not going to class. Upon examination, the patient has a flat affect and demonstrates disorganized speech. The patient is started on an atypical antipsychotic and is able to return to school after 6 weeks of being on treatment. Which of the patient's symptoms are negative symptoms and which are positive symptoms? Do atypical antipsychotics primarily address the negative or positive symptoms? How does the mechanism of action of typical antipsychotics differ from the mechanism of action of the atypical antipsychotics?
(FA p444, p453)
Negative sx: lack of motivation, difficulty with speech,
You are doing a research rotation and your chief investigator has you working on mapping a gene. What is the difference between a promoter region and an enhancer region? (FA p72)
Promoter = site where RNA pol and other transcription factors bind to DNA upstream from gene locus = AT-rich upstream sequence with TATA and CAAT boxes)

Enhancer = stretch of DNA that alters gene expression by binding transcription factors
Which glycogen storage disease fits the following features? (FA p110)
Severe hypoglycemia with elevated blood lactate
Von Gierke's disease (Type I glycogen storage disease)
- glucose-6-phosphatase deficiency
Which glycogen storage disease fits the following features? (FA p110) Hypoglycemia without elevated blood lactate
Cori's disease (Type III)
-debranching enzyme (alpha-1,6-glucosidase) deficiency
Which glycogen storage disease fits the following features? (FA p110)
Cardiomegaly
Pompe's disease (Type II)
-lysosomal alpha-1,4-glucosidase
*Pompe's trashes the Pump (heart, liver, muscle)
Which glycogen storage disease fits the following features? (FA p110)
Myoglobinuria associated with exercise
McArdle's disease (Type IV)
-glycogen phosphorylase deficiency
*McArdles' = Muscle
A 34-year-old bipolar female becomes pregnant while taking lithium for mood stabilization. What is the characteristic fetal complication associated with lithium use in pregnancy? What other agents used to treat bipolar disorder can be teratogenic, and what are their corresponding fetal effects? What is the leading cause of teratogenicity in the United States? (FA p120, p445, p432)
Lithium causes Ebstein's anomaly = atrialized right ventricle

Valproate causes NTD

Fetal alcohol syndrome
A 25-year-old male complains of a scrotal mass and pain made worse by coughing or sneezing. A scrotal exam reveals a palpable scrotal protrusion with Valsalva. What type of hernia is this patient experiencing? What type of hernia protrudes through Hesselbach's triangle? What structures form Hesselbach's triangle? (FA p316)
Indirect inguinal hernia goes thru the INternal deep inguinal ring, external inguinal ring and INto the scrotum

Direct inguinal hernia goes thru Hesselbach's triangle and bulges thru abdominal wall medial to inferior epigastric ring

Hesselbach's triangle is formed by inferior epigastric artery + lateral border of rectus abdominis + inguinal ligament
A 34-year-old develops a painful right eye with decreased visual acuity. Exam demonstrates a firm right eye. What type of glaucoma is the patient experiencing? What is the difference between the mechanism of closed- and open-angle glaucoma? What is the fundoscopic finding associated with glaucoma? What is the treatment for closed- and open-angle glaucoma? (FA p420-p421, p238, p242)
Closed angle = obstruction of flow between iris and lens --> pressure builds up behind iris = very painful, DEC vision, rock-hard eye

Optic disk atrophy with cupping

indirect cholinomimetic agent (anticholinesterases) = Physostigmine, Echothiophate

cholinomimetic (direct agonist) = carbachol

Beta blocker = timolol DEC secretion of aqueous humor
A 58-year-old male develops a tremor, slow movements and a change in gait. On exam, the patient demonstrates a tremor at rest that improves with intention and a shuffling gait. The patient begins treatment with a combination of levodopa and carbidopa and experiences motor symptom improvement. Which type of neuron is lost in Parkinson's disease? Activity of what neurotransmitter is elevated in Parkinson's disease? What treatment strategies help modulate these derangements in neurotransmitter activity? (FA p401-p402, p435)
Dopaminergic neurons are lost
Excess cholinergic activity

Agonize dopamine receptors = bromocriptine, pramipexole, ropinirole
INC dopamine = amantidine, L-dopa/carbidopa
Prevent dopamine breakdown = selegiline (selective MAO type B inhibitor), entacapone, tolcapone (COMT inhibitors)
Curb excess cholinergic activity = benztropine (antimuscarinic) to improve tremor and rigidity
Which antibiotic fits the following description?
Treatment for G(-) rods in patients with renal insufficiency (FA p186)
Aztreonam
Which antibiotic fits the following description?
BIG GUN (effective v. G(+) cocci, G(-) rods, and anaerobes) (FA p186)
imipenem/cilastatin, meropenem
Which antibiotic fits the following description?
Drug of choice for Enterobacter (FA p186)
2nd gen cephalosporins = cefoxitin, cefotaxime, ceftazidime
Which antibiotic fits the following description?
Prophylaxis in AIDS patients against P. jiroveci pneumonia (FA p191)
TMP-SMX
Which antibiotic fits the following description?
Used as solo prophylaxis against TB (FA p191)
isoniazid
Which antibiotic fits the following description?
Prophylaxis for those exposed to someone with meningococcal meningitis (FA p191)
rifampin (drug of choice)
minocycline
Given the following scenarios describe the corresponding complement deficiency? (FA p207)
Frequent Neisseria infection
C5-C8 deficiency
Given the following scenarios describe the corresponding complement deficiency? (FA p207)
Frequent pyogenic respiratory tract infections
C3 deficiency
Given the following scenarios describe the corresponding complement deficiency? (FA p207)
Paroxysmal nocturnal hemoglobinuria
DAF (GPI-anchored enzyme) deficiency
Given the following scenarios describe the corresponding complement deficiency? (FA p207)
Increased frequency of type III hypersensitivity reaction
C3 deficiency
A 34-year-old male begins treatment with vancomycin for a MRSA septic arthritis in his right knee. The patient develops a red flushing over his whole body. What is this reaction called? How could the reaction been prevented? What are the other toxicities of vancomycin? (FA p187)
"Red man syndrome"

Nephrotoxicity, ototoxicity, thrombophlebitis
You are seeing a 24-year-old patient for the first time who states she has Turner's syndrome. What physical findings would you expect to find in this patient? What common vascular tumor is associated with Turner's syndrome? (FA p485, p279)
short stature, streak ovaries, shield chest, bicuspid aortic valve, preductal coarctation of aorta, primary amenorrhea

Associated with cystic hygroma (webbing of neck) = cavernous lymphangioma of the neck
A 56-year-old male develops right lower extremity edema after a returning from Europe from a business trip. An exam of the right lower extremity demonstrates a red, warm, lower leg with a positive Homan's sign. What is the patient's diagnosis? What is a positive Homan's sign? What is Virchow's triad? What is the most common inherited hypercoagulability syndrome? (FA p510) (FA p356)
DVT

Homan's sign = tender calf muscle when dorsiflex foot

Virchow's triad = venous stasis, hypercoaguable state, endothelial damage

Factor V Leiden = produce mutant factor V that cannot be degraded by protein C
A 12-year-old male presents to the ER with confusion and abdominal pain. Upon exam, you notice deep, rapid breathing and a fruity, odorous breath. The patient has a random blood sugar of 557mg/dl. An arterial blood gas is preformed, which reveals a pH of 6.4, a PCO2 of 30mmHg (normal 35-45mmHg), and a [HCO3-] of 20mmol/L (normal 22-26mmol/L). What is this patient's diagnosis? What type of acid-base abnormality is this patient experiencing? What equation is used to calculate the anion gap? Describe what PCO2 and what [HCO3-] you would find in an anion gap metabolic acidosis. What are the causes of anion gap metabolic acidosis? (FA p465)
DKA

uncompensated metabolic acidosis

AG = Na - [Cl + HCO3]
-you would find DEC HCO3 and DEC pCO2 (i think)

MUDPILES
-Methanol
-Uremia
-DKA
-Paraldehyde or Phenformin
-Iron tablets or INH
-Lactic acidosis
-Ethylene glycol
-Salicylates
A patient of yours was diagnosed with diabetes mellitus 30 years ago and comes to you today for a general wellness exam. What would you pay particular attention to on your physical exam of this patient (i.e., chronic manifestations of diabetes)? (FA p301)
Retinopathy (from small vessel disease)
Nephropathy (from small vessel disease)
Glaucoma (from small vessel disease)
Large vessel atherosclerosis
CAD
PVD
Gangrene
Cerebrovascular disease
Peripheral neuropathy (osmotic damage)
Cataracts (osmotic damage)
Patients with renal artery stenosis have elevated blood pressure. How does a decrease in renal artery pressure cause an increase in blood pressure? (FA p463) Other than renin secretion, what are the other endocrine functions of the kidney? (FA p463)
Juxtaglomerular apparatus thinks body is hypovolemic b/c of decreased pressure in renal arteries --> RAAS activation to increase BP

Renin release
Erythropoeitin release in response to hypoxia in endothelial cells in peritubular capillaries
alpha 1 hydroxylase converts Vit D to active Vit D in proximal tubule to increase Ca and phosphate reabsorption in GI
Prostaglandins = paracrine secretion vasodilates the afferent arterioles to INC GFR
Which types of cancer are associated with the following chromosomal translocations?
(FA p360)
t (9;22)
Philadelphia chromosome = bcr-abl chromosome

CML
Which types of cancer are associated with the following chromosomal translocations?
(FA p360)
t (8;14)
c-myc activation

Burkitt's lymphoma
Which types of cancer are associated with the following chromosomal translocations?
(FA p360)
t (14;18)
bcl-2 activation

Follicular lymphoma
Which types of cancer are associated with the following chromosomal translocations?
(FA p360)
t (15;17)
M3 type of AML
Which types of cancer are associated with the following chromosomal translocations?
(FA p360)
t (11;22)
Ewing's sarcoma
Which types of cancer are associated with the following chromosomal translocations?
(FA p360)
t (11;14)
Mantel cell lymphoma
A 50-year-old male roofing worker develops a cough for the past month that is now associated with hemoptysis. The patient denies a smoking history or prolonged exposure to second-hand smoke. An
X-ray reveals a left-sided lower lung coin-shaped lesion. What type of lung cancer is suspected in this individual? What is the appearance of asbestos fibers in the lung? What cancers are associated with asbestosis? (FA p511, FA p513)
Asbestosis is assoc with INC risk of mesothelioma and bronchogenic carcinoma

Asbestos bodies = golden-brown fusiform rods (dumbbells) located in macrophages
An 18-year-old female has seasonal allergies. She is tired of having her eyes water and her nose run all the time during the spring. Which cell type is responsible for her symptoms, and what drug inhibits these cells' action? What WBCs descend from the myeloblast (granulocyte) lineage? (FA p343)
Eosinophils

Antihistamines

myelobasts (granulocytes) --> basophils, eosinophils, neutrophils
-these are all a type of leukocyte along with mononuclear cells which include monocytes and lymphocytes
A 55-year-old female patient with recurrent UTIs is prescribed TMP-SMX as prophylaxis. Describe the mechanism of action of this drug combination. Which anticancer drug works in the same manner as trimethoprim? (FA p189, p365)
SMX = PABA antimetabolites inhibit dihydropteroate synthetase (bacteriostatic)

TMP = inhibits bacterial dihyrofolate reductase (bacteriostatic)

Methotrexate (folic acid analog) also inhibits dihydrofolate reductase
You are reading a research article about the prostate specific antigen test, and it mentions that the PSA blood test is associated with a high false positive frequency. In your own words, explain what false positive means. (FA p51)
when the test appears positive, but should actually be negative (patient does not have the condition even thought the test appears positive)
A 22-year-old man suffers a stabbing injury to the chest. He has lost a lot of blood due to the stabbing injury, and you are concerned that his cardiac output is very low. What are the calculations related to cardiac output? (FA p254)
CO = SV X HR
CO = rate of O2 consumption/(arterial O2 - venous O2)
MAP = CO X PVR
MAP = 2/3 diastolic P + 1/3 systolic P
Pulse P = systoli P - diastolic P
A 45-year-old businessman complains of abdominal pain that is worsened by eating and is sometimes accompanied with nausea. What are the most common causes of gastric ulcers? (FA p325, p391)
H. pylori
NSAIDS
You've just gotten the labs back from a new patient with hyperaldosteronism and are trying to decide on which diuretic to start the patient. While thiazide and loop diuretics are known for wasting potassium in the urine, there are other diuretics that conserve it. Which diuretics are these and what are their important side effects? (FA p475)
Spiranolactone, triamterene, amiloride, eplerenone (The k STAEs)

Hyperkalemia, endocrine effects (spiranolactone - gyno), antiandrogen effects
A 38-year-old female presents with complaints of nausea, fever, and abdominal pain somewhat localized to the lower left region. What conditions are on your differential diagnosis list? (FA p327, p488)
Ectopic pregnancy
appendicitis
Diverticulitis
A 24-year-old young man is fired from his job and when explaining the chain of events to his roommate he explains that "it doesn't really matter. I didn't even need that job." His roommate is perplexed, wondering how they will pay their rent. Of which immature ego defense could this be an example? (FA p440)
Reaction formation
A pregnant woman has her first ultra sound and two distinct heart beats are detected. Unless twins are conjoined, what intra-utero structure should all twins never share? (FA p121)
amniotic sac
When an infant is born and takes its first breath, the lungs expand creating negative pressure that draws blood into the pulmonary circulation. Because the pressure in the pulmonary circulation is lower than that in the aorta, blood preferentially flows into the pulmonary circulation and the ductus arteriosus closes. What other fetal blood vessels are closed in the adult circulation? (FA p125)
ductus venosus and foramen ovale
A child arrives at the ER in hypotensive shock after taking his dad's phenoxybenzamine. The intern on call orders the nurse to get her a pressor STAT. The nurse informs, the intern that there are two pressors available in the ER, epinephrine or phenylephrine. Which one will be able to increase the blood pressure of this pediatric patient? (FA p241)
Neither b/c phenoxybenzomine (a non-selective alpha blocker) is irreversible
A kidney transplant patient begins to experience renal failure seven years after receiving her kidney transplant. What type of rejection is this, and how is it mediated? (FA p202, p215)
Chronic rejection (occurs months to years after transplantation)

T-cell and antibody-mediated vascular damage (obliterative vascular fibrosis)
-class I-MHC recognized by CTLs
A 40-year-old male is beginning to have symptoms of a resting tremor, postural instability, and mask-like (expressionless) facies. Name the antiviral drug and its mechanism of action that could be used against this disease. (FA p195)
Amantadine

-"A man to dine" takes off his coat = blocks viral penetration/uncoating (M2 protein)
-Also causes release of dopamine from intact nerve terminal
A female college student is seen in the ER with fever, nuchal rigidity, and altered mental status. A lumbar puncture is needed for definitive diagnosis. What CSF findings are associated with bacterial, viral, and fungal meningitis? (FA p177) What landmark indicates this correct level of the spinal cord for an LP? (FA p371)
Bacterial = INC PMNs, INC protein, DEC sugar
Fungal/TB = INC lymphocytes, INC protein, DEC sugar
Viral = INC lymphocytes, N protein, N sugar
A 44-year-old woman is rushed to the ER after her brother found her passed out on the floor with pills scattered about and a bottle of liquor opened on the table. The patient is cyanotic, withdraws to painful stimulus, and has poor respiratory effort: so she is intubated. The brother does not know the name of the pills, but he tells you they are a prescription for his sister's anxiety. What prescription medication(s) might be the cause of this clinical picture and what antidote/treatment is available? (FA p243, p432, p433, and p450)
Treat benzodiazepine OD with flumazenil = competitive GABA antagonist
A 46-year-old schizophrenic woman has been treated with an atypical antipsychotic with good results for several years. Routine labs reveal a precipitous drop in her WBCs. Which drug is this patient likely taking, and how frequently must her labs be drawn to watch for this problem? (FA p453)
Clozapine causes agranulocytosis

Get WBC weekly
What physiology accounts for the automaticity of the AV and SA nodes? (FA p261)
slow diastolic depolarization --> membrane potential slowly depolarizes as Na conductance INC
A young man presents with gynecomastia secondary to heavy marijuana use. Other drugs are known to cause gynecomastia. Which antifungal drugs do this and by what mechanism? What diuretic drug does this and by what mechanism? (FA p192 - p193, p475)
Azoles cause gyno via hormone synthesis inhibition

Spiranolactone b/c of antiandrogen effects
A 55-year-old woman is diagnosed with estrogen receptor-positive breast cancer. What class of drugs would be used to treat her? What is another use for these drugs? What is the main concern when using tamoxifen? (FA p367)
SERMs = tamoxifen, raloxifene

Uses:
1. ER+ breast cancer
2. osteoporosis

Tamoxifen can increases pt risk of endometrial cancer via partial agonist effects on endometrium
A 15-year-old boy is brought to the pediatric ER with change of mental status and vomiting. Capillary blood glucose (CBG) is 550 mg/dL. What are the signs and symptoms of diabetic ketoacidosis (DKA)? What is the treatment? (FA p302)
AMS, high serum glucose, hyperglycemia, INC H (acidosis), DEC HCO3 (anion gap metabolic acidosis), INC blood ketone levels, INC urine ketone levels, leukocytosis, hyperkalemia with DEC intracellular K due to transcellular shift from osmotic diuresis

Fluids, IV insulin, K, glucose if necessary to prevent hypoglycemia
Most common malignancy in children (FA p359);
acute lymphocytic leukemia
Most common solid tumor location in children (FA p428);
brain tumor
Second most common brain tumors in children (FA p428);
astrocytoma and medulloblastoma
Most common supratentorial brain tumor in children (FA p428);
craniopharyngioma
Most common malignant bone tumor in children and the 2nd most common 1° malignant tumor of bone (FA p381);
osteosarcoma
Most common tumor of adrenal medulla in children (FA p297);
neuroblastoma
Most common renal tumor in children (FA p469);
Wilm's tumor
Most common primary cardiac tumor in kids (FA p277);
rhabdomyoma
A 17-year-old female comes to the ER with abdominal pain and vomiting. What hormone is detected in a positive urine pregnancy test? How long after conception will this hormone first appear in the urine? (FA p484)
hCG will be positive 6-8 days after conception
A child is noticed to be yellow by a visiting relative, so he was brought to the clinic. His exam revealed jaundice and splenomegaly. The patient's lab results reveal anemia and spherocytes. What test is used to confirm the diagnosis of hereditary spherocytosis? What findings are associated with hereditary spherocytosis? (FA p352)
INC MCHC

splenomegaly, jaundice, mild pallor (all associated with chronic hemolytic state)
A 24-year-old HIV-positive woman presents with lymphadenopathy to multiple nodes, including inguinal and axillary nodes. Which type of lymphoma has a presentation that is very similar to CLL and fewer constitutional signs/symptoms? (FA p357)
SLL
A newborn is noted to have cyanosis, which prompts echocardiography that reveals transposition of the great vessels. What substance should be given when a newborn is diagnosed with transposition of the great vessels to maintain a shunt? (FA p268 - p269)
PGEE (prostaglandin E) keeps a shunt open
Following an episode of orbital cellulitis, the patient develops right ophthalmoplegia, ophthalmic and maxillary sensory loss. What is this called? What structures can be found in the cavernous sinus? (FA p418)
Cavernous sinus syndrome (due to mass effect)

CN 3, 4, V1, V2, 6
A 1-year-old child is evaluated for painless, rectal bleeding. What is the rule of 2s associated with Meckel's diverticulum? (FA p327)
2 inches long
2 ft from the ileocecal valve
2% of population
What breast pathology fits the following descriptions? (FA p492-p494)
Small, mobile, firm mass with sharp edges in 24-year-old woman
fibroadenoma
What breast pathology fits the following descriptions? (FA p492-p494)
Histologic "leaf-like appearance"
phyllodes tumor
What breast pathology fits the following descriptions? (FA p492-p494)
Commonly presents with nipple discharge
intraductal papilloma
What breast pathology fits the following descriptions? (FA p492-p494)
Eczematous patches on nipple
paget's disease
What breast pathology fits the following descriptions? (FA p492-p494)
Multiple bilateral fluid-filled lesions with diffuse, cyclical breast pain
fibrocystic changes
What breast pathology fits the following descriptions? (FA p492-p494)
Firm, fibrous mass in a 55-year-old woman
phyllodes tumor or invasive ductal carcinoma
A 34-year-old man presents with a URI, including a cough, without signs of bronchitis. You recommend over-the-counter medications for symptomatic relief. What common over-the-counter medication is used to remove excess thick sputum by stimulating the vagus nerve to generate low viscosity secretions in the bronchial tree? (FA p516)
Guafenisin (robitussin)
An 18-year-old female is told by her boyfriend that sometimes she just "zones out" for about 15 seconds and does not respond to anything he says. He says that she picks at her shirt during this time, and that she doesn't remember it, nor does she seem to have any decreased mental status afterward. What anticonvulsants are used to treat absence seizures? What anticonvulsants are used to treat status epilepticus? (FA p431)
Absence:
Ethosuximide (first line)
Valproic acid

Status epilepticus
phenytoin (prophylactic)
benzos (acute)
A 65-year-old woman with COPD is in severe respiratory distress, has cyanosis and signs of RVH. What medication is used in the treatment of pulmonary hypertension? What is its mechanism of action? (FA p516)
Bosentan = competitively antagonizes endothelin-1 receptors --> decreases pulm vascular resistance
An 18-year-old female is seen for lower abdominal pain, nausea, and vomiting. She has vaginal discharge and reports having multiple sex partners. Upon palpation of the cervix during bimanual vaginal exam, the patient screams in agony. Which bacteria are well known for being obligate intracellular bacteria? Why can't these bacteria replicate extracellularly? (FA p139)
Rickettsia and Chlamydia (stay inside when it's Really Cold)
-obligate intracellular bacteria b/c they can't make their own ATP
On which cells would you find CD4 molecules? On which cells would you find CD8 molecules? What actions do the CD8+ cells accomplish? (FA p203)
CD4 - helper T cells; binds MHC II on APCs
CD8 - cytotoxic T cells; binds MHC I on virus-infected cells
Often following vasectomy, men develop an autoimmune response to their own sperm because of damage to the blood-testis barrier. What structure forms the blood-testis barrier? What is the purpose of this barrier? (FA p480)
Formed by tight junctions b/t adjacent Sertoli cells to isolate gametes from autoimmune attack
The E4 variant of Apo E is a known risk factor for Alzheimer's disease. What is the primary function of the following major apoproteins? (FA p115)
Apo A-I
Activates LCAT
The E4 variant of Apo E is a known risk factor for Alzheimer's disease. What is the primary function of the following major apoproteins? (FA p115)
Apo B-48
Mediates chylomicron secretion
The E4 variant of Apo E is a known risk factor for Alzheimer's disease. What is the primary function of the following major apoproteins? (FA p115)
Apo C-II
Co-factor for lipoprotein lipase
The E4 variant of Apo E is a known risk factor for Alzheimer's disease. What is the primary function of the following major apoproteins? (FA p115)
Apo B-100
Binds to LDL receptor; mediates VLDL secretion
The E4 variant of Apo E is a known risk factor for Alzheimer's disease. What is the primary function of the following major apoproteins? (FA p115)
Apo E
Mediates Extra (remnant) uptake
A 56-year-old man develops diarrhea after a course of clindamycin while in the hospital. For which infections is vancomycin a good choice? How is vancomycin resistance brought about? (FA p187)
Use to tx Gram-positives only
MOA: inhibits cell wall mucopeptide formation by binding D-ala-D-ala of cell wall
-bactericidal
Resistance occurs with aa change of D-ala-D-ala to D-ala-D-lac
A 49-year-old trauma patient comes into the ER unconscious and in need of surgery. There is a research study being conducted at this institution on a new orthopedic device. What are the exceptions to informed consent? (FA p57)
1. Pt lacks decision-making capability or is legally incompetent
2. Implied consent in emergency
3. Therapeutic privilege - withholding info when disclosure would severely harm the pt or undermine informed decision-making capacity
4. Waiver
An elderly man is in the ICU after a joy ride on his classic American motorcycle went horribly wrong. The patient was placed in the ICU because of multiple rib fractures that resulted in a flail chest which, combined with his mild COPD, made his respiratory status very fragile. During the first few days in the ICU, the patient was clear-headed. However, now he is uncooperative and is trying to crawl out of bed and leave the unit. He also doesn't seem to have any idea where he is or why is in the hospital. What are the main differences between delirium and dementia? Which is more commonly reversible? (FA p443)
Delirium - waxing and waning level of consciousness with acute onset; rapid drop in attention span and level of arousal
-acute AMS changes
-disorganized thinking
-hallucinations/illusions
-reversible

Dementia = gradual drop in cognition with no change in level of consciousness
-memory deficits
-aphasia, apraxia, agnosia
-loss of abstract thought
-behavioral/personality changes
-pt is alert
A 36-year-old female has had multiple syncopal episodes recently and after her initial work-up, there is some concern for a cardiac tumor. What is the most common primary cardiac tumor in adults? In children? (FA p277)
Adults - myxomas
Children - rhabdomyosarcoma
A 42-year-old man with a significant smoking history complains of his fingers becoming painful and pale in cold weather. Also his hand muscles will become very painful after too much continuous use playing high-intensity shooter video games. Physical exam also reveals an ulcer on his foot. The patient's has no history of diabetes and his blood sugar is within normal limits. What is the classic presentation of a patient with Buerger's disease? What is the treatment? (FA p278)
Thromboangiitis obliterans
-idiopathic, segmental, thrombosing vasculitis of small and medium peripheral arteries and veins
-seen in heavy smokers
-Intermittent claudication, superficial nodular phlebitis, cold sensitivity (Raynaud's)
Tx: smoking cessation
A 40 year-old female patient was involved in a motor vehicle collision and had massive blood loss from a lacerated spleen. Intraoperatively, the patient was mistakenly given ketorolac, a very strong NSAID. After the surgery the patient went to the ICU and postoperative labs were drawn which revealed critically-high potassium, BUN, and creatinine levels as well as acidosis. What are the complications of renal failure? (FA p471)
Na/H20 retention --> CHF, pulm edema, HTN
Hyperkalemia
metabolic acidosis
Uremia
-sx: nausea, anorexia, pericarditis, asterixis, encephalopathy, platelet dysfunction
Anemia
Renal osteodystrophy
Dyslipidemia
Growth retardation and developmental delay (children)
In terms of congenital conditions, what is the:
Most common cause of early cyanosis (FA p267)
Tetralogy of Fallot
In terms of congenital conditions, what is the:
Most common cause of late cyanosis (FA p267)
Eisenmenger's syndrome
-uncorrected VSD, ASD, PDA causes compensatory vascular hypertrophy, which causes progressive pulm hypertension
In terms of congenital conditions, what is the:
Most common cause of primary amenorrhea (FA p485)
Turner's (XO)
In terms of congenital conditions, what is the:
Most common chromosomal disorder (FA p88)
Down's
In terms of congenital conditions, what is the:
Most common cause of congenital mental retardation (FA p88)
Down's
In terms of congenital conditions, what is the:
Second most common cause of congenital mental retardation (FA p87)
Fragile X
In terms of congenital conditions, what is the:
Most common lethal genetic disease of Caucasians (FA p87)
CF
In terms of congenital conditions, what is the:
Most common cause of congenital malformations in US (FA p120)
Alcohol (FAS)
On your neurology rotation, a 27-year-old woman comes in for a check-up and renewal of her prescription for β-interferon therapy. What is the classic triad of symptoms in multiple sclerosis? With what disorders do patients with multiple sclerosis commonly present? (FA p425)
SIN = scanning speech, intention tremor, incontinence, internuclear ophthalmoplegia, Nystagmus

Present with:
-optic neuritis (sudden loss of vision)
-MLF syndrome
-hemiparesis
-hemisensory sx
-bladder/bowel incontinence
A young child has weakness of his extremities and is found to have an Arnold-Chiari II malformation with a syringomyelia. What is a syringomyelia? What symptoms are commonly seen in patients with syringomyelia? (FA p127)
Enlargement of the central canal of the spinal cord

"Cape-like", bilateral loss of PAIN and TEMP in upper extremities with preservation of touch
A 57-year-old man comes to his internist complaining of peripheral edema, flushing, and constipation after starting a calcium-channel blocker for his hypertension. Which calcium channel blockers work primarily on the heart? Which ones work on vascular smooth muscle? (FA p280)
Heart: verapamil > diltiazem > nifedipine

Vascular sm: nifedipine > diltiazem > verapamil
A young woman complaining of easy bleeding and menorrhagia was referred by her OB/GYN for work-up of her bleeding disorder. Your preceptor tasks you with determining the cause of the patient's condition. Compare the clinical findings of platelet disorders to those of coagulation factor defects. (FA p355)
A young man with sickle cell anemia comes in for periodic blood transfusions as part of his therapy. What long-term complication is associated with having to receive multiple blood transfusions? (FA p349)
An elderly Japanese man comes to your clinic with a suspicious skin lesion. He admits to a diet high in fish and seaweed, including hijiki, which you know to be high in arsenic. Which skin cancer is associated with arsenic exposure? (FA p390)
squamous cell carcinoma
New guidelines recommend supplementation of all newborns with vitamin D. What are the steps in the conversion of vitamin D to its active form in the body? (FA p294)
Converted to 25-OH Vit D in the liver and then to 1,25-OH vit D in the kidney
A 60-year-old man is evaluated for an enlarged prostate. How does flutamide differ from finasteride in relation to mechanism of action and clinical use? (FA p498)
Finasteride - inhibits 5-alpha reductase that converts testosterone --> DHT
used to treat BPH

Flutamide - competes with testosterone
-used to treat prostate cancer
What breast pathology fits the following description? (FA p492-494)
Most common breast tumor in women under 25
fibroadenomas
What breast pathology fits the following description? (FA p492-494)
Most common breast mass in postmenopausal women
Ductal carcinoma in situ
What breast pathology fits the following description? (FA p492-494)
Most common breast mass in premenopausal women
Fibrocystic disease
What breast pathology fits the following description? (FA p492-494)
Most common form of breast cancer
Invasive ductal carcinoma in situ
A 40-year-old patient with cholelithiasis is being prepped for a cholecystectomy. What risk factors are associated with cholesterol gallstones? What risk factors are associated with pigment gallstones? (FA p335)
Cholesterol gallstones
-obesity
-Crohn's
-CF
-Older age
-Clofibrate
-estrogens
-Mulliparity
-Rapid weight loss
-Native American

Pigment stones
-Chronic hemolysis
-Alcoholic cirrhosis
-Age
-Biliary infection
A 37-year-old patient with refractory peptic ulcer disease undergoes an esophagogastric duodenoscopy. Biopsies of the duodenum reveal hypertrophied submucosal glands. What are these glands? What are Peyer's patches? (FA p320)
Peyer's patches = unencapsulated lymphoid tissue in lamina propria and submucosa of small intestine
A 40-year-old woman comes to the ER with a painful, red right eye. The eye is rock hard on gentle palpation. What is the diagnosis and what's the next step? (FA p421, FA p238)
Acute angle glaucoma

Carbachol = direct agonist of acetylcholine receptors (cholinomimetic agents)
Physostigmine = anticholinesterase
Echothiopate = anticholinesterase
A 32-year-old man is trying to quit his dependence on alcohol by using disulfiram. One day he falls off the wagon and begins drinking. Awhile later he is doubled over the commode with nausea and vomiting. What is the mechanism of action of disulfiram? Why would this drug make you feel so terrible when taken with alcohol? What other drugs have a disulfiram-like reaction? (FA p94, FA p246)
Inhibits acetylaldehyde dehydrogenase --> accumulation of acetylaldehyde -> hangover symptoms if you drink alcohol

Metronidazole has disulfiram-like reactions
What primary hormone is increased or decreased in the following diseases? (FA p296, FA p298)
Cushing's syndrome
INC cortisol
What primary hormone is increased or decreased in the following diseases? (FA p296, FA p298)
Conn's syndrome
Primary hyperaldosteronism
INC aldosterone
What primary hormone is increased or decreased in the following diseases? (FA p296, FA p298)
Addison's disease
Chronic primary Adrenal insufficiency

DEC alodsterone and cortisol
What primary hormone is increased or decreased in the following diseases? (FA p296, FA p298)
Graves' disease
Hyperthyroidism
A 30-year-old man is evaluated for progressive weakness. CBC reveals anemia and further studies show an elevation of lactate dehydrogenase (LDH) and decreased haptoglobin levels, which are markers for intravascular hemolysis. What is an additional lab finding that would be present in paroxysmal nocturnal hemoglobinuria? (FA p352)
INC urine hemosiderin

Decay-accelerating factor inhibits complement on RBC membrane
Glitazones increase expression of one type of GLUT receptors—those in adipose tissue—as one of their antidiabetic actions. Which GLUT receptors would you expect to find on skeletal muscle and fat? (FA p289)
GLUT 4
A 45-year-old man finally decides to get an annual exam from the doctor. His lab studies come back with an elevated LDL cholesterol level. What enzyme catalyzes the rate-limiting step in cholesterol synthesis? What class of drugs inhibits this enzyme? (FA p113)
HMG-CoA reductase - converts HMG-CoA to mevalonate

Inhibited by STATINS
Which primary bone tumor fits the following description? (FA p381)
Most common primary malignant bone tumor in men 30-60
Chondrosarcoma
Which primary bone tumor fits the following description? (FA p381)
11;22 translocation
Ewing's sarcoma
Which primary bone tumor fits the following description? (FA p381)
Soap-bubble appearance on x-ray
giant cell tumor = osteoclastoma
Which primary bone tumor fits the following description? (FA p381)
Onion-skin appearance of bone (layers of new bone in periosteum)
Ewing's sarcoma
Which primary bone tumor fits the following description? (FA p381)
Codman's triangle (periosteal elevation) on x-ray
Osteosarcoma
Which primary bone tumor fits the following description? (FA p381)
May arise from osteochondroma or appear as a primary tumor
Chondrosarcoma
Which primary bone tumor fits the following description? (FA p381)
Anaplastic small cell, aggressive mets, good chemo. response
Ewing's sarcoma
Which primary bone tumor fits the following description? (FA p381)
Most common malignant bone tumor in children
Ewing's sarcoma
A 6-week-old child is referred to the pediatric cardiologist for failure to thrive, exertional cyanosis, and washing machine-like heart murmur. What are the early cyanotic heart diseases? What are the late cyanotic heart diseases? (FA p267)
Early = right-to-left shunts = "baby blues"
-tetralogy of fallot
-transposition of great vessels
-truncus arteriosus
-tricupsid atresia
-total anomalous pulmonary venous return (TAPVR)

Late = left-to-right = "blue kids"
-VSD
-ASD
-PDA
If stroke volume determines cardiac output, and contractility determines stroke volume, what determines contractility? (FA p255)
Contractility INC by catecholamines, INC intracellular calcium, DEC extracellular Na, digitalis

Contractility DEC by beta-blockade, heart failure, acidosis, hypoxia, hypercapnia, non-dihydropyridine Ca channel blockers
What problem / abnormality is associated with the following buzzwords?
Calf pseudohypertrophy (FA p87)
DMD
What problem / abnormality is associated with the following buzzwords?
Gowers' maneuver (FA p87)
DMD
What problem / abnormality is associated with the following buzzwords?
Subluxation of lenses (FA p86)
Marfan's
What problem / abnormality is associated with the following buzzwords?
Café-au-lait spots (FA p86)
NF1
What problem / abnormality is associated with the following buzzwords?
Tuft of hair on lower back (FA p126)
Spina bifida occulta
A 32-year-old woman is being evaluated for palpitations. She is a thin woman that describes herself as always full of energy. She is currently on an SSRI for mild anxiety. What drug used to treat hyperthyroidism inhibits the organification and coupling steps of thyroid hormone synthesis? (FA p305)
Propylthiouracil
Methimazole
A 25-year-old woman presents to clinic with scanning speech, intention tremor, intermittent incontinence, and internuclear ophthalmoplegia. What is internuclear ophthalmoplegia? (FA p424-425)
Lesion in the medial longitudinal fasciculata (MLF) --> medial rectus palsy on attempted lateral gaze and nystagmus in abducting eye
You are rotating with an anesthesiologist and learning to calculate dosages of anesthetics with her. How does the rate of elimination differ between zero-order elimination and first-order elimination? Which type of elimination behaves as though the enzymes responsible for the elimination are saturated? (FA p233)
Zero-order = rate of elimination constant regardless of Cp = constant amount of drug eliminated per unit time

First order = rate of elimination is proportional to the drug concentration (constant fraction of drug eliminated per unit time)
Atropine should be avoided in men with BPH. In which patients can atropine be used for the treatment of which conditions? (FA p239)
INC pupil dilation, cycloplegia
DEC secretions in airway
DEC acid section in stomach
DEC gut motility
DEC bladder urgency in cystitis
A 23-year-old woman has missed her period and is found to be pregnant at a local clinic. As part of their usual counseling, they warn her against handling cat litter. Which protozoal organism is associated with cat feces? What diseases does this organism commonly cause? (FA p160)
Toxoplasmosis
-brain abscess in HIV (ring-enhancing)
-"classic triad" = chorioretinitis + hydrocephalus + intracranial calcifications
A 20-year-old man is stabbed in the back at a party. He is brought to the ER and taken to the OR by the neurosurgeon. The knife blade is found to have hemisected the spinal cord. Which division of the dorsal column relays sensory information from the lower extremities? (FA p409, FA p411)
Dorsal column = Pressure, Vibration, Touch, Proprioception
-fasciculus gracilis relays info from lower extremities
A young married couple is having difficulty conceiving their first child. They go to a local fertility clinic for an evaluation. In which phase of meiosis is a primary oocyte arrested until just prior to ovulation? In which phase of meiosis is an oocyte arrested until fertilization? (FA p484)
Meiosis I
-"Meiosis I is arrested in prOphase for years until Ovulation"

Meiosis II
-"Meiosis II arrested in METaphase until fertialzation"
The thalamus is a relay station that conducts signals to and from the brain. Which thalamic nuclei are the relay stations for the following body sensations/activities? (FA p399)
1. Auditory sensation
2. Visual sensation
3. Facial sensation
4. Body sensation
Auditory = MGN
Visual = LGN
Facial sensation = VPM
Body sensation = VPL
A 30-year-old man is undergoing the Schilling test to investigate his B12 deficiency. What must be present in the enteric system in order for vitamin B12 to be absorbed? (FA p92)
Intrinsic factor
A 22-year-old female patient suffers from recurrent purulent upper respiratory tract infections. She is at your clinic for evaluation. Which complement protein is an opsonin? Which complement protein aids in neutrophil chemotaxis? Which complement proteins form the membrane attack complex? (FA p207)
C3b = opsosin
C5a = neutrophil chemotaxis
MAC = C5b-9
On autopsy of an infant with Crigler-Najjar syndrome (Type I), bilirubin deposition was noted in the brain. What is the name of the condition that is responsible for this baby's death? (FA p333)
kernicterus
A patient of yours awakes one morning unable to move from the bed. His arms, legs, and torso just don't seem to work. The patient reports progressively worsening weakness over the previous two days that seemed to start in the legs. Peripheral sensation is intact. What study would help you confirm your clinical suspicion of this patient's diagnosis? (FA p426)
INC CSF protein with normal cell count = albuminocytologic dissociation
INC protein --> papilledema
A 32-year-old man is in the hospital for a minor vehicle crash. Overnight, you are called by the nurse b/c the patient's blood pressure went from 125/80 to 201/111, and he is now tachycardic. The patient now appears diaphoretic and reports feeling a little anxious. Though, he says that this happens once or twice per week. Suspecting the diagnosis, you check his abdominal CT scan which does, in fact, show an adrenal mass. What α-adrenergic antagonist should be used to treat this patient? (FA p241)
phenoxybenzamine (irreversible)
phentolamine (reversible)
What is the equation for determining a drug's clearance? (FA p232)
CL = (rate of elimination of drug) / (plasma drug concentration) = Vd x Ke (elimination constant
An active 31-year-old female patient who frequently hikes comes to your office on Monday. A few days ago she went hiking and now has diarrhea. From what she describes, you begin to suspect Giardia infection. What are the typical symptoms of a Giardia infection of the GI tract? (FA p160)
bloating, flatulence, foul-smelling fatty diarrhea
A 44-year-old male hepatitis C patient is undergoing recombinant interferon treatment for his disease. In what ways do interferons interfere with viral protein synthesis? (FA p208)
Interferons induce the production of a ribonuclease that inhibits viral protein synthesis by degrading viral mRNA (but not host mRNA)

1. alpha and beta interferons inhibit viral protein synthesis

2. gamma interferon INC MHC I and II expression and antigen presentation in all cells

3. Activates NK cells to kill virus-infected cells
The neonatologist you're working with on your pediatrics rotation suspects a newborn to have DiGeorge syndrome. What is the underlying cause of DiGeorge syndrome? What are the manifestations of DiGeorge syndrome? (FA p213)
deletion of 22q11.2

large nose, small ears, micrognathia, tetany (hypocalcemia), recurrent viral/fungal infections (T-cell deficiency), congenital heart and great vessel defects
On a research rotation, you are reviewing literature pertinent to the study you will be assisting with, and are trying to decide which studies are appropriate to include in your literature review. What is the difference between a case-control study, a cohort study, and a clinical trial? (FA p50) Which studies use odds ratios, and which use relative risks? (FA p52)
Case-control: compares a group of people with disease to a group without
-looks for prior exposure or RF
-measures OR

Cohort study: compares a group with a given exposure or RF to a group without
-looks to see if exposure increases the likelihood of disease
-measure RR

Clinical trial: experimental study that compares therapeutic benefits of >=2 treatments or of treatment and placebo
-measures absolute risk reduction
What neurotransmitter levels in the brain are either increased or decreased in the following diseases? (FA p442)
1. Schizophrenia
2. Parkinson's
3. Alzheimer's
4. Huntington's
1. Schizophrenia = INC dopamine
2. Parkinson's = DEC dopmamine, INC 5HT + ACh
3. Alzheimer's = DEC ACh
4. Huntington's = DEC GABA, DEC ACh
A 28-year-old man known as the "elastic-skinned man" at the circus visits your clinic for a check-up. What are the features of Ehlers-Danlos syndrome? (FA p80)
Faulty collagen synthesis causing:
hyperextensible skin
tendency to bleed
hypermobile joints
A 15-year-old boy is considering becoming vegetarian and wants more information from you about how to get enough protein. What are the essential amino acids? (FA p104)
Glucogenic: Met, Val, Arg, His
Glucogenic/ketogenic" Ile, Phe, Thr, Trp
Ketogenic: Leu, Lys
An 18-year-old female gives birth to her first child at 34 weeks gestation. What ratio indicates fetal lung maturity? What is the proper name for the main component of pulmonary surfactant? (FA p502)
lecithin-to-sphingomyelin ration > 2.0 in amniotic fluid

dipalmitoyl phosphatidylcholine
A 67-year-old woman is brought to the ER by her concerned husband. For the past 2 hours, she has been very nauseated, weak, lightheaded, and somewhat short of breath. Though she denies chest pain, the resident suspects a cardiac etiology for the symptoms and orders an EKG and cardiac enzymes. What are the branches of the right and left coronary arteries? What is the most commonly occluded artery of the heart? What is particularly dangerous about an occlusion of the RCA? (FA p254)
LCA -->
Circumflex artery - supplies post left ventricle
LAD - supplies apex and ant interventricular septum

RCA -->
Acute marginal artery - supplies right ventricle
Post descending interventricular artery - supplies post septum

LAD - most commonly occluded
RCA - occlusion dangerous b/c it supplies the SA and AV nodes
The part of the brain responsible for attention / alertness has been implicated in schizophrenia, PTSD, Parkinson's disease, narcolepsy, progressive supranuclear palsy, depression, and ADHD. What part of the brain is this? (FA p403) (Hint: Lesion results in coma.)
Reticular activating system = midbrain
A 34-year-old AIDS patient is brought to the ER by his partner. The patient is sleeping when you arrive but his partner reports that over the past few days the patient has been increasingly confused and lethargic. What opportunistic CNS infections are common in AIDS patients? (FA p174)
Cryptcoccal meningitis
Toxoplasmosis
CMV encephalopathy
AIDS dementia
PML (JC virus)
A 19-year-old female at 30 weeks gestations arrives to her OB/GYN for her scheduled appointment. She complains that her vision seems blurry since yesterday. The OB/GYN immediately takes a manual blood pressure. What are the clinical features of preeclampsia and eclampsia? What is the treatment for each? (FA p487)
Pre-eclampsia = HTN + proteinuria (>300mg) + edema
Eclampsia = Seizures +/- HTN

sx: HA, blurred vision, edema, AMS, hyperreflexia
labs: thrombocytopenia, hyperuricemia
tx: delivery of fetus asap, bed rest, salt restriction, tx of hypertension, mg sulfate and diazepam to prevent seizures
An 80-year-old man, who continues to smoke despite his COPD, has had a productive cough for almost 4 months. He even had to be hospitalized during the past December for respiratory infection that severely compromised his ability to oxygenate. In which pulmonary disease would you see an increased Reid index? (FA p510)
Chronic bronchitis (blue bloater)

hypertrophy of mucus-secreting glands in the bronchioles --> INC Reid index (>50%) = gland depth/total thickness of bronchial wall
A male college student is seen at the student clinic. He complains of one week of malaise, myalgias, and sore throat. Physical exam reveals cervical lymphadenopathy, enlarged spleen, and a fever. A heterophile antibody test is ordered but is negative, but other lab tests confirm CMV infection. Which two antiviral agents can be used to treat CMV infection? (FA p196)
Ganciclovir - preferentially inhibits viral DNA polymerase
-activated by 5-monophosphate for by a CMV viral kinase

Foscarnet - viral DNA polymerase inhibitor that binds to the pyrophosphate-binding site of the enzyme
-do not require an activatory
A 34-year-old man comes to the clinic for evaluation of new -nset symmetrical arthritis of his large joints: knees, elbows, and ankles. He mentions that he had a very bad sore throat several weeks ago, but he did not seek treatment for it. The doctor suspects the sore throat was due to a streptococcal infection, which would put this patient at risk for acute rheumatic fever. What are the Jones criteria for the diagnosis of acute rheumatic fever? (FA p146)
Dx of rheumatic fever can be made when two of the major criteria, or one major criterion plus two minor criteria, are present along with evidence of streptococcal infection

Major
Migratory polyarthritis
Carditis
Subcutaneous nodules
Erythema marginatum: a long lasting rash that begins on the trunk or arms as macules and spreads outward to form a snake like ring while clearing in the middle. This rash never starts on the face and it is made worse with heat.
Sydenham's chorea (St. Vitus' dance): a characteristic series of rapid movements without purpose of the face and arms. This can occur very late in the disease.

Fever
Arthralgia
Raised erythrocyte sedimentation rate or C reactive protein
Leukocytosis
ECG showing features of heart block
A 43-year-old homeless man believes tells you a vivid and complex story of how he was abducted by aliens, single-handedly aided the United States President in winning the last election, and now is hiding from the government who may be spying on him at this very moment. What are the positive symptoms of schizophrenia (adding a symptom)? What are the negative symptoms of schizophrenia (removing a normal finding/trait)? (FA p444)
Positive signs: hallucinations, delusions, disorganized speech, disorganized or catatonic behavior

Negative signs: flat affect, social withdrawal, lack of motivation, lack of speech or thought
A 25-year-old man has a painless, enlarged cervical neck mass. Work-up reveals Hodgkin's lymphoma. What are other signs/symptoms typical of the presentation of a patient with Hodgkin's lymphoma? (FA p357)
Reed Sternberg cells
Constitutional (B) sx = fever, chills, night sweats, weight loss
Localized, single group of nodes
Age-related changes in touch sensitivity are related to the number of sensory nerve endings lost. What is the difference between a Meissner's corpuscle and a Pacinian corpuscle? (FA p397)
Meissner's = position sense, dynamic fine touch

Pacinian's = Vibration, pressure
An infant is seen with failure to thrive and cyanotic spells. Diagnosis of tetralogy of Fallot is made. What cardiac defects are seen in tetralogy of Fallot? What is the cause of tetralogy of Fallot? (FA p267)
PROVe

Pulmonary stenosis
RVH
Overriding aorta (overrides the VSD)
VSD

Caused by anterosuperior displacement of the infundibular septum

RVH --> "boot-shaped" heart
A patient arrives at the surgery clinic for removal of a small lipoma on the forearm. The surgeon cleans and preps the area and injects lidocaine. What is the mechanism of action of local anesthetics? Which nerve fibers are blocked first with local anesthesia? (FA p434)
Block Na channels by binding to receptors on inner portion of the channel

small diameter fibers > larger diameter fibers
pain > T > touch > P
A 56-year-old man is found to have significant lower extremity edema and hepatomegaly. In what clinical scenarios would you see a "nutmeg" liver? (FA p274, p331,& p332)
Right-sided heart failure and Budd-Chiari syndrome

Due to backup of blood into liver
What is the site of action of the following diuretic? (FA p473)
• Thiazide diuretic-
• Loop diuretic-
• Carbonic anhydrase inhibitor-
• Osmotic diuretic-
• Potassium sparing diuretic-
• ADH antagonist-
• Thiazide diuretic-Distal convoluted tubule
• Loop diuretic- Loop of Henle
• Carbonic anhydrase inhibitor- ?
• Osmotic diuretic- Proximal convoluted tubule
• Potassium sparing diuretic- Collecting tubule
• ADH antagonist- Collecting duct
A 40-year-old female is seen in the clinic. She complains of gradually increasing fatigue, weakness, and nausea. Lab tests reveal hyponatremia with hyperkalemia. The patient is on no blood pressure medications. It appears this patient has cortical adrenal insufficiency. How can Addison's disease be distinguished from a secondary aldosterone deficiency? (FA p296)
Secondary - associated with HIGH plasma renin
A 24-year-old woman has trouble with heavy and prolonged menses. She has also noticed a pressure that feels like it is inside of her pelvis. Her OB/GYN diagnosis her with uterine leiomyoma (fibroid). What analog of GnRH can be used to treat uterine fibroids? Is it used in a continuous or pulsatile manner for this application? (FA p497)
Leuprolide (continuous to suppress GnRH activity)
An 18-year-old girl comes into clinic with a cold sore on her lip. The physician orders a Tzanck test. What viruses are indentified with a Tzanck test? (FA p167)
HSV
An 88-year-old man arrives at the ER after he fell and struck his head. He has history of atrial fibrillation, for which he takes warfarin. Noncontrast CT of the head reveals subarachnoid hemorrhage. What is the antidote for warfarin anticoagulation or warfarin overdose? For heparin overdose? (FA p243, FA p362)
Warfarin - give Vit K
Heparin - give Protamine
The dorsal root ganglion is considered gray matter within the spinal cord. Given that, from what embryological derivative are the dorsal root ganglia derived? (FA p119)
Neural crest
There are two drug classes that, when combined, can better treat Gram-negative infections, but that combination also increases likelihood of nephrotoxicity. What drug classes are these? (FA p187)
Aminoglycosides and cephalosporins
A 75-year-old patient of yours comes to office complaining of pain and morning stiffness in her MCP and PIP joints. What lab value might you use to help confirm your clinical suspicion of this patient's diagnosis? (FA p383)
anti-IgG Ab to rheumatoid factor (80% of pts are positive)
A 30-year-old woman is evaluated because of her loss of interest in her job, family, and hobbies. She says she sleeps all the time, cannot concentrate, and has very little energy. Compare the neurotransmitter changes seen with depression to those seen with anxiety. (FA p442)
Anxiety - INC NE, INC GABA, DEC 5-HT

Depression - DEC NE, DEC 5-HT, DEC dopamine
A 38-year-old man's AIDS is being managed by his infectious disease physician, who has decided to start him on TMP-SMX. Why would you place an AIDS patient on Bactrim (TMP-SMX) when his CD4 count drops below 200? (FA p159)
Prophylaxis for pneumocystis jiroveci
A 15-year-old boy is rushed into the ER. He is tall and thin, and CXR reveals a pneumothorax. He is having severe dyspnea, and his hemodynamics are in danger of becoming unstable. He needs a chest tube now, but his parents have not yet arrived to the ER to sign a consent form. Can the procedure be done before now before the parents arrive? (FA p57)
Parental consent is not required in emergency situations
A homeless alcoholic is brought to the hospital with shortness of breath, high fever, and decreased mental status. What is the clinical use of clindamycin? What is its most well-known side effect? (FA p188)
Treats anaerobic infections in aspiration pneumonia or lung abscesses

Causes pseudomembranous colitis (C. difficile overgrowth)
A 47-year-old woman with metastatic small bowel tumors is on octreotide to control her carcinoid syndrome. What is the cause of carcinoid syndrome? What are the classic symptoms of carcinoid syndrome? (FA p302)
Caused by carcinoid tumors (neuroendocrine cells)
-esp small bowel tumors --> secrete high levels of 5-HT
-most common tumor of appendix

Results in recurrent
-diarrhea
-cutaneous flushing
-asthmatic wheezing
-right-sided valvular disease
You are asked to perform a pulmonary function test on a young asthmatic. What is the definition of tidal volume? Of residual volume? Of vital capacity? (FA p504)
TD = air that moves into lung with each quiet inspiration
RV = air left in lungs after maximal expiration
VC = TV + IRV + ERV
A 67-year-old male CHF patient lost his job and medical insurance, so he stops buying and taking his digitalis, and develops dyspnea. What will this do to his cardiac output (CO)? What are the mechanisms behind his development of dyspnea? (FA p255, FA p274)
Digitalis INC Ca indirectly by INC intracellular Na

CO will drop
LV failure --> pulmonary edema --> dyspnea
A high school-aged star football player collapses suddenly towards the end of a intense day of practice. An ambulance is called immediately, and he rushed to the hospital. What is the most common cause of sudden death in young athletes (15-20 years of age)? (FA p273)
Hypertrophic cardiomyopathy
Which respiratory infectious agents fit the following descriptions? (FA p157, FA p176, FA p514)
Common cause of pneumonia in immunocompromised patients
Staphylococcus
Pneumocystis jiroveci - HIV
Which respiratory infectious agents fit the following descriptions? (FA p157, FA p176, FA p514)
Most common cause of atypical/walking pneumonia
Mycoplasma
Legionella
Chlamydia
Which respiratory infectious agents fit the following descriptions? (FA p157, FA p176, FA p514)
Common causative agent for pneumonia in alcoholics
S. pneumonia
Klebsiella
Staphylococcus
Which respiratory infectious agents fit the following descriptions? (FA p157, FA p176, FA p514)
Can cause an interstitial pneumonia in bird handlers
chlamydia psitacci
Which respiratory infectious agents fit the following descriptions? (FA p157, FA p176, FA p514)
Often the cause of pneumonia in a patient with a history of exposure to bats and bat droppings
Histoplasmosis
Which respiratory infectious agents fit the following descriptions? (FA p157, FA p176, FA p514)
Fungal cause of pneumonia in a patient who has recently visited Southern California, New Mexico, or West Texas
Coccidioidomycosis
Name the syndromes below that are common causes of anovulation: (FA p489)
• Elevated cortisol, central obesity
• Amenorrhea + hirsuitism + obesity
cushing's disease
adrenal insufficiency
Does a partial agonist always have a lower potency than a full agonist? Does a partial agonist always have a lower maximal efficacy than a full agonist? (FA p234)
Potency can be greater or lower
maximal efficacy is always lower
In your own words, describe what type II (β) error is. (FA p54)
stating that there is not an effect when there is one
A 41-year-old female patient receives clindamycin to help prevent infection from an open fracture she obtained while driving an ATV intoxicated. The patient begins to have watery diarrhea and fever. She is suspected to have Clostridium difficile colitis. Clostridium is an obligate anaerobe. What enzymes do obligate anaerobes lack? (FA p139)
Lack catalase and/or superoxide dismutase
A 40-year-old woman is brought into the psych ER. On physical exam her pupils do not react to light, but they do accommodate when the examiner's finger is brought near her nose. What are the clinical manifestations of the different stages of syphilis? (FA p153)
primary - painless chancre
secondary - disseminated disease
-constitutional sx, maculopapular rash, condylomata lata
tertiary - gummas (chronic granulomas), aortitis (vasa vasorum destruction), neurosyphilis (tabes dorsalis)
An 11-year-old boy is rushed into the ER from a farming community. His pupils are constricted and his he his having a difficulty breathing because of excess airway secretions and bronchospasm. He also lost control of his bowels and bladder. What is the likely explanation for these symptoms? Name five or more drugs that inhibit acetylcholinesterase. What is the clinical application for each? (FA p238)
Organophosphate poisoning

Antidote - atropine + pralidoxine (regenerates active AchE)

Neostigmine - postop and neurogenic ileus and urinary retention, myasthenia gravis, reversal of NMJ blockade

Pyridostigmine - myasthenia gravis (long acting)

Edrophonium - Dx of myasthenia gravis (short acting)

Physostigmine - glaucoma (crosses blood-brain barrier --> CNS)

Echothiophate - glaucoma
A 60-year-old male long-time patient of yours comes to your office complaining of sexual dysfunction. What is your immediate differential diagnosis? What drugs are known for causing sexual dysfunction? (FA p61)
Medications - antiHTN, neuroleptics, SSRIs, ethanol
Diseases
Psychological
What is the composition of a nucleosome? Which histone ties nucleosomes together? (FA p66)
consist of a segment of DNA wrapped around histone protein core
A 23-year-old G1P0 refuses to take any medications during her pregnancy despite having a mild, constant nausea. When is a fetus most susceptible to damage from teratogens? What drug used in the treatment of hypertension is a teratogen? What effect does this have on the fetus? (FA p120)
3rd-8th weeks

ACE inhibitors - cause renal damage in fetus
A 37-year-old man is involved in a high-speed motor vehicle collision and is brought to the trauma ER. On the way the patient became progressively tachycardic. On arrival he was hypotensive. Because of his unstable vital signs, he is rushed to the OR where exploratory laparotomy is performed. A massive retroperitoneal hemorrhage is discovered. What anatomic structures are found in the retroperitoneum? (FA p308)
Duodenum (2nd, 3rd, 4th parts)
Descending colon
Ascending colon
Kidney
Ureters
Pancreas (except tail)
Aorta
IVC
Adrenal glands
rectum
A motorcycle crash causes the rider's spinal cord to be severed. How can you distinguish a lower motor neuron lesion from an upper motor neuron lesion? (FA p410)
LMN --> everything is lowered
-DEC muscle mass, DEC muscle tone, DEC reflexes, downgoing toes

UMN --> everything goes up
-INC muscle tone, INC DTRs, upgoing toes
A previously healthy 43-year-old man is brought to the ER by his family. He has a terrible headache. During the exam he loses consciousness and has a seizure. An MRI reveals a brain tumor. What are the three most common primary brain tumors in adults? What are the three most common primary brain tumors in children? (FA p428)
Adults
-Glioblastoma
-Meningioma
-Schwannoma

Children
-Pilocytic astrocytoma
-Medulloblastoma,
-Ependymoma
A patient is evaluated for progressive lethargy, weakness, anorexia, and fever. On physical exam you find splinter hemorrhages in the nail beds; Roth spots; painful, violet nodules on the finger pads; and painless, blanching macular lesions. Transesophageal echocardiography reveals vegetation on a heart valve. Which valve is most commonly involved in bacterial endocarditis and acute rheumatic fever? (FA p275)
Mitral valve
In Freud's structural theory of the mind, describe the following: (FA p439)
• Id -
• Ego -
• Superego -
Id - primal urges, food, sex, drives instinct
Ego - mediator b/t primal urges and behavior accepted in reality
Superego - moral values, conscience; can lead to self-blame and attacks on ego
Three days ago, you hospitalized a 40-year-old male for myocardial infarction. He has been given all of the usual medications. Today you notice that his platelet count is 30,000. What do you suspect is the cause of his low platelets? (FA p362)
Side effect of heparin
A 25-year-old male is evaluated in the clinic for red, swollen, and painful right wrist and left knee joint. During the exam, the patient brags about his sexual conquests. What sexually-transmitted organism can cause osteomyelitis as well as this patient's septic arthritis? (FA p177)
Gonorrhea
A 45-year-old woman receives a kidney transplant and as part of her anti-transplant rejection regimen receives cyclosporine. What is the mechanism of action of cyclosporine? (FA p215)
Binds to cyclophilins

Complex blocks the differentiation and activation of T cells by inhibiting calcineurin --> preventing production of IL-2 and its receptor
A female infant is brought to the clinic for evaluation of her genitalia. On exam clitoromegaly and labial fusion is noted. Lab studies reveal elevated 17-hydroxyprogesterone levels. What is the most common form of adrenal hyperplasia? Which hormone levels are altered as a result of this enzyme deficiency? What are the clinical manifestations of this enzyme deficiency? (FA p291)
Most common: 21-hydroxylase deficiency

INC progesterone and INC 17-hydroxyprogesterone --> INC androgens and DEC 11-deoxycorticosterone (DEC mineralcorticoids) and DEC 11-deoxycortisol (DEC cortisol)

Masculinization, female pseudohermaphroditism, HYPOtension, hyperkalemia, INC plasma renin activity, volume depletion
A 30-year-old African-American woman develops heavy menses and develops fatigue as a result. She if found to have anemia, and further work-up reveals an abnormality in her uterus. What is the most common gynecologic neoplasm? What is the typical histological pattern? Is it benign or malignant? (FA p489)
Leiomyomas (fibroids)

Benign
Which type of diabetes mellitus fits the fits the following descriptions? (FA p301)
• Associated with obesity
• May cause ketoacidosis
• Strong genetic predisposition
• Associated with HLA DR 3 & 4
• Associated with obesity = Type 2
• May cause ketoacidosis = Type 1
• Strong genetic predisposition = Type 2
• Associated with HLA DR 3 & 4 = Type 1
A 55-year-old alcoholic is seen in the ER for altered mental status despite not having alcohol for the past 2 days. He demonstrates asterixis and spider nevi. What abnormal lab values would lead you to suspect alcoholic hepatitis? (FA p331)
AST > ALT (ratio usually > 1.5)
A 44-year-old woman is seen in the ER for shortness of breath, malaise, and high fever. CXR reveals a right-sided consolidation and her labs reveal a WBC count of 12,000. Which organism is overall the most common cause of lobar pneumonia? What organisms are the most common causes of interstitial (walking) pneumonia? (FA p514)
Lobar pneumonia = pneumococcus

Interstitial pneumonia = viruses (RSV, adenovirus), Mycoplasma, Legionella, Chlamydia
A patient has a hypertensive episode while in the hospital. The intern on call orders hydralazine. The intern is later called about the same patient, who now has tachycardia due to the baroreceptor response to the lowered blood pressure (FA p280). Where are the main arterial baroreceptors located? Which nerves transmit information from these baroreceptors? (FA p265)
1. Aortic arch - transmits via vagus nerve to medulla
2. Carotid sinus - transmits via glossopharyngeal nerve to solitary nucleus of medulla
A 30-year-old woman is being evaluated in the clinic. She reports that for the past several weeks she has had a progression of the symptoms of fatigue, weight loss due to postprandial pain and nausea, muscle and joint aches, neuralgias of the digits, and some black stool. Eventually, a diagnosis of polyarteritis nodosa is established. What infection is associated with polyarteritis nodosa? (FA p278)
HBV
A 22-year-old woman has severe headache that coincides with a increased sensitivity to light. What serotonin agonist can be used to treat migraine headaches? In which patient populations is this category of drugs contraindicated? (FA p436)
Sumatriptan

MOA: causes vasoconstriction, inhibition of trigeminal activation and vasoactive peptide release

Contraindicated in pts with CAD or Prinzmetal's agina
In regard to seizures, what do the terms partial, simple, complex, and generalized mean? (FA p426)
Partial = 1 area of the brain (usually originates in mesial temporal lobe)
Simple partial = consciousness intact
Complex partial = impaired consciousness
Generalized = diffuse
Absence = petit mal, blank stare
Myoclonic = quick, repetitive jerks
Tonic-clonic = grand mal, alternating stiffening and movement
Tonic = stiffening
Atonic = "drop" seizures
A 30-year-old man begins to develop shortness of breath and cyanosis even at rest. Exam reveals clubbing and a systolic murmur. He mentions that he has had a murmur since childhood. Further work-up reveals a large ventricular septal defect and pulmonary hypertension. The patient is diagnosed with Eisenmenger's syndrome. Describe how this syndrome develops. (FA p267)
VSD uncorrected --> vascular hypertrophy --> increased pulm hypertension --> as pulm resistance INC, the shunt reverses from L --> R to R --> L
A unilateral lesion to the lateral corticospinal tract results in motor deficits ipsilateral to the lesion. Where in the lateral corticospinal tract is the motor innervation to the legs located?
(FA p409)
Lateral
Inclusion-cell disease results from a defective enzyme in the Golgi apparatus. What are the functions of the Golgi apparatus? (FA p77)
1. distribution center of proteins and lipids from ER to the plasma membrane, lysosomes, and secretory vesicles
2. modifies N-oligosaccharides on asparagine
3. adds O-oligosaccharides to serine and threonine residues
4. adds mannose-6-phosphate to specific lysosomal proteins --> targets the protein to the lysosome
5. proteoglycan assembly from core proteins
6. sulfation of sugars in proteoglycans and selected tyrosine on proteins
A 24 yo woman presents with 2 months of lymphadenopathy to her neck, fevers, and night sweats. Compare the age distribution of those affected by Hodgkin's lymphoma to those affected by non-Hodgkin's lymphoma. (p357)
Hodgkin's = young and old
non-Hodgkin's = 20-40 yo
A 9 yo child is brought into the clinic for evaluation. Recently he has been progressively irritable and lethargic. He is also having problems with constipation. PE reveals bluish lines on the gingiva. What might you see under a light microscope that would lead you to suspect lead poisoning as a cause of microcytic, hypochromic anemia? (p349-350)
basophilic stippling
A 29 yo woman complains of anxiety and unintentional weight loss. She has palpitations and cannot stand the heat. What is the pts dx? (p297). What are the functions of the thyroid hormone? What cells secrete thyroid hormone? (p295)
Hyperthyroidism

Thyroid hormone controls the body's metabolic rate.

T3 functions = 4 B's
1. Brain maturation
2. Bone growth
3. Beta-adrenergic effects
4. BMR INC

Secreted by follicular cells
What is the female homologue to these male structures? (p134)
1. Glans penis
2. Corpus spongiosum
3. Bulbourethral glands (of Cowper)
4. Prostrate gland
5. Ventral shaft of penis
6. Scrotum
1. Glans penis - Glans clitoris
2. Corpus spongiosum - Vestibular bulbs
3. Bulbourethral glands (of Cowper) - Greater vestibular glands (of Bartholin)
4. Prostrate gland - Urethral and paraurethral glands (of Skene)
5. Ventral shaft of penis - Labia minora
6. Scrotum - Labia majora
A 64 yo woman with CRF presents to your clinic. You are unsure of her current kidney function and would like to know to see if the dosages of any of her renally-excreted medications need to be changed. What is the equation for calculating the GFR? (p459)
GFR = Uinulin X V/Pinulin = Cinulin
What is the most common tumor of the urinary tract? What is the usual presenting complaint of a patient with this tumor? What substance exposures increase the risk of developing this tumor? (p470)
Transitional cell CA

Associated with probs in your Pee SAC:
Phenacetin
Smoking
Aniline dyes
Cyclophosphamide
A 54 yo man with mets to his small bowel presents with diarrhea, flushing, wheezing, and right sided valvular disease. What drug can be used to treat carcinoid syndrome? (p302)
octreotide
A 59 yo man with a 50 pack hx sees you for management of his COP. What is the clinical defn of chronic bronchitis? (p510)
Blue Bloater

Productive cough > 3 consecutive months in > 2 years
You are examining a 84 yo woman who has just come into the hospital for a suspected CHF exacerbation. What heart sound is associated with dilated CHF? What heart sound is associated with chronic hypertension? (p257)
S4 = atrial kick = in late diastole = high atrial P
-associated with LVH
A 35 yo pt is evaluated for hemoptysis and hematuria. Exam reveals a necrosis of his soft palate. His findings are classic for a specific vasculitis. Which vasculitis is associated with elevations in p-ANCA? In c-ANCA? (p277)
p-ANCA = microscopic polyangiitis (affects all small vessels) and Chrug-Strauss syndrome

c-ANCA = Wegner's granylomatosis
A pt suffers a TBI after a motor cycle crash and the neurosurgery resident orders phenytoin for seizure prophylaxis. What are the toxic side effects of phenytoin? (p432)
nystagmus, ataxia, diplopia, sedation, SLE-like syndrome, induction of cytochrome p450

chronic use: gingival hyperplasia in children, peripheral neuropathy, hirsutism, megaloblastic anemia (DEC folate absorption)

teratogenic
What is the cause of Horner's syndrome? What sx are seen in Horner's syndrome? (p413, p513)
Sympathectomy of face:
1. ptosis
2. anhidrosis
3. miosis

-associated with lesion of SC above T1
A 27 yo man comes into the clinic with facial paralysis. What sounds might you ask a pt to generate when testing cranial nerve fxn? (p419)
KLM sounds

kuh = tests palate elevation (CN X)
la = tests tongue (CN XII)
mi = tests lips (CN VII)
A trauma pt is rushed to the ER with a cervical collar. There is high suspicion that she has a broken neck, as well as bilateral clavicle fracture. The pt has bled a lot and central access is needed to resuscitate. Because of her injuries the best location for such a line is the groin. Describe the anatomy of the femoral sheath. What placing a femoral line for central venous access you palpate the femoral pulse. Where do you place the guide needle in relation to this pulse: medially or laterally? (p314)
Femoral sheath = fascial tube 3-4 cm below the inguinal ligament.
-contains femoral vein, artery, canal (deep inguinal lymph nodes) but NOT femoral nerve

Lateral to medial = Nerve-Artery-Vein-Empty space-Lymphatics
-you go from lateral to medial to find your NAVEL
The parents of a 5 yo girl are concerned b/c their daughter has night terrors, sleepwalking and enuresis. In which stage of sleep do these occur? What medications shorten this stage of sleep, and thus are useful in treating night terrors, sleepwalking and enuresis (p62)?
Sleep stages 3-4
-delta waves (lowest freq, highest amplitude)
-slow-wave sleep
-deepest, non-REM sleep

Imipramine is used to treat enuresis - shortens stage 4 sleep
Benzos used to treat night terrors and sleepwalking
What nerve is damaged when a pt presents with:
1. Claw hand
2. Ape hand
3. Wrist drop
4. Scapular winging
5. Unable to wipe bottom/anus
6. Cannot abduct or adduct fingers
7. Loss of arm abduction
8. Weak lateral rotation of arm
9. Loss of arm/forearm flexion
10. Loss of forearm extension
11. Trouble initiating arm abduction
12. Unable to abduct arm beyond 10 degrees
13. Unable to raise arm
above horizontal
14. Loss of forearm pronation
1. Claw hand - Ulnar
2. Ape hand - Median
3. Wrist drop - Radial
4. Scapular winging - Long thoracic
5. Unable to wipe bottom/anus - Thoracodorsal
6. Cannot abduct or adduct fingers - Ulnar
7. Loss of arm abduction - Axillary
8. Weak lateral rotation of arm - suprascapular and/or axillary
9. Loss of arm/forearm flexion - Musculocutaneous
10. Loss of forearm extension - Radial
11. Trouble initiating arm abduction - Suprascapular
12. Unable to abduct arm beyond 10 degrees - Axillary
13. Unable to raise arm above horizontal - Long thoracic
14. Loss of forearm pronation - median
A 50 yo female is dx with Alzheimer's disease. Family hx investigation reveals that several family members are affected with relatively early AD. What gene might the members of this family share? Which trisomy syndrome is also associated with INC risk of contracting AD? (p425)
Trisomy 21
A 27 yo man is brought to the ER after having been struck on the side of the head by a softball. He was briefly "knocked out" but regained consciousness for several min before losing consciousness again. Non-contrast CT of the head reveals a concave lens-shaped radiopaque lesion in the left temporal region. What vessel was ruptured in this injury? (p406)
Middle meningeal artery --> Epidural hematoma
An elderly pt with postural instability, a pill rolling tremor, and cogwheel rigidity fell down and struck his head on a coffee table. His family brought him to the ER. He is currently conscious and at his neurological baseline. Non-contrast CT of the head reveals a crescent shaped radiopacity that follows the contour of the skill crossing suture lines. What type of intracranial hemorrhage might this be and which vessel(s) would be involved? (p406)
Rupture of bridging arteries --> subdural hematoma
A 45 yo man is seen in the ER complaining of the "worst HA of my life". Medical records indicate that he has a hx of polycystic kidney dz. A non-contrast CT reveals radiopacity in the basal cisterns. What vessel abnormality did this pt have? What is the likely site of rupture from this abnormality? (p405-406)
Berry aneurysm rupture --> subarachnoid hemorrhage
A 36-‐year-‐old AIDS patient is seen because of new and progressive symptoms of ataxia,aphasia, hemiparesis, unilateral blindness, and headaches. The resident informs you that this is a pattern of demyelination and given the patient&#039;s comorbidity may be due to an infectious cause. Of what cause might the resident be speaking? (p166, 426)
PML caused by JC virus
You are finishing up on a cholecystectomy, and the attending surgeon tells you to be sure to order a good anti-‐emetic for the patient post-‐operatively. What drug should you order, in what other scenario
can it be used? (FA p339)
Odansetron
Also used to prevent vomiting in chemo
An elderly man is being observed in the hospital after falling and sustaining a concussion. He has been doing well and his non-contrast CT was negative for blood. At about mid-night though his heart monitor begins to show tachycardia with widened QRS segments. The pt rapidly becomes unconscious and cardiac resuscitation is initiated. However, despite the quick action by the medical team, the man dies. What was the immediate cause of the man's death? (p270)
Sudden cardiac death = death from cardiac causes within 1 hour of onset of symptoms
-most commonly due to lethal arrhythmia (v-fib)
The risk factors for esophageal cancer can be remembered with the mnemonic ADCDEF. Fill this out below.
(FA p323)
Alcohol
Barrett's esophagus
Cigarettes
Diverticuli
Esophageal web/Esophagitis
Familial
A 66 yo woman is being treated in the ER for an acute MI. Nitro is given in the expectation that it will vasodilate which vessels preferentially? Another pt in the ICU on hydralazine for acute treatment of hypertension. How does hydralazine function? (p280)
Nitro: dilates veins >> arteries
Hydralazine: INC cGMP --> smooth muscle relaxation --> DEC afterload
-vasodilates arterioles > veins
A 23 yo male patient is a victim of an MVC. He suffered a TBI and is in a coma. The attending surgeon tells the intern on ICU call to monitor the patient for Cushing reaction. What is the Cushing reaction (p265)
Cushing triad
1. Hypertension
2. Bradycardia
3. Respiratory distreess
What is the difference between variable expression, incomplete penetrance, pleiotropy and anticipation (p83)
Variable expression = nature and severity of phenotype vary from one individual to another
Incomplete penetrance = not all individuals with a mutant genotype show the mutant phenotype
Pleiotrophy = one gene has > one effect on individual's phenotype
Anticipation = severity of disease worsens or age of onset of disease is earlier in succeeding generations
Other than the obvious use for pain control, what are the other common uses for opioid analgesics? (p430)
Ex) morphine, fentanyl, codeine, heroin, methadone, meperidine, dextromethorphan

Uses: cough suppression (dextromethorphan), diarrhea (loperamide and diphenoxylate), acute pulmonary exam, maintenance programs for addicts (methadone)
What is the rate-limiting enzyme for glycolysis? For gluconeogenesis? (p95)
Glycolysis = phosphofructokinase-1 (PFK-1)
Gluconeogenesis = Fructose-1,6-bisphophatase
A 34 yo man is seen in the office. On exam he has corneal arcus and tendon xanthomas. Lab studies reveal markedly elevated LDL. What genetic disease does this patient like have, and what is the pathophysiology? For what else is the pt at risk? (p 115)
Familial hypercholesterolemia - Type IIa
At risk for atherosclerosis
A 36 yo man is brought to the ER because of DEC mental status. His liver is enlarged; he has spider nevi on the upper chest; and he demonstrates asterixis. His wife reports that he is a long-time heavy drinker. Lab studies reveal hypoglycemia despite this pt having no diabetes. Why is this? (p94)
Ethanol hyperglycemia = ethanol metabolism INC NADH/NAD+ ratio in liver, causing diversion of pyruvate to lactate and OAA to malate, thereby inhibiting gluconeogenesis and stimulating fatty acid synthesis
-leads to hypoglycemia and hepatic fatty change (hepatocellular steatosis)
You are finishing up on a cholecystectomy, and the attending surgeon tells you to be sure to order a good anti-‐emetic for the patient post-‐operatively. What drug should you order, in what other scenario
can it be used? (FA p339)
Odansetron
Also used to prevent vomiting in chemo
An elderly man is being observed in the hospital after falling and sustaining a concussion. He has been doing well and his non-contrast CT was negative for blood. At about mid-night though his heart monitor begins to show tachycardia with widened QRS segments. The pt rapidly becomes unconscious and cardiac resuscitation is initiated. However, despite the quick action by the medical team, the man dies. What was the immediate cause of the man's death? (p270)
Sudden cardiac death = death from cardiac causes within 1 hour of onset of symptoms
-most commonly due to lethal arrhythmia (v-fib)
The risk factors for esophageal cancer can be remembered with the mnemonic ADCDEF. Fill this out below.
(FA p323)
Alcohol
Barrett's esophagus
Cigarettes
Diverticuli
Esophageal web/Esophagitis
Familial
A 66 yo woman is being treated in the ER for an acute MI. Nitro is given in the expectation that it will vasodilate which vessels preferentially? Another pt in the ICU on hydralazine for acute treatment of hypertension. How does hydralazine function? (p280)
Nitro: dilates veins >> arteries
Hydralazine: INC cGMP --> smooth muscle relaxation --> DEC afterload
-vasodilates arterioles > veins
A 23 yo male patient is a victim of an MVC. He suffered a TBI and is in a coma. The attending surgeon tells the intern on ICU call to monitor the patient for Cushing reaction. What is the Cushing reaction (p265)
Cushing triad
1. Hypertension
2. Bradycardia
3. Respiratory distreess
What is the difference b/t variable expression, incomplete penetrance, pleiotropy, anticipation?
Variable expression = nature and severity of phenotype vary from one individual to another
Incomplete penetrance = not all individuals with a mutant genotype show the mutant phenotype
Pleiotrophy = one gene has > one effect on individual's phenotype
Anticipation = severity of disease worsens or age of onset of disease is earlier in succeeding generations
What are the other uses of opioods besides pain?
Ex) morphine, fentanyl, codeine, heroin, methadone, meperidine, dextromethorphan

Uses: cough suppression (dextromethorphan), diarrhea (loperamide and diphenoxylate), acute pulmonary exam, maintenance programs for addicts (methadone)
What is the rate-limiting enzyme for glycolysis? For gluconeogenesis? (p95)
Glycolysis = phosphofructokinase-1 (PFK-1)
Gluconeogenesis = Fructose-1,6-bisphophatase
A 34 yo man is seen in the office. On exam he has corneal arcus and tendon xanthomas. Lab studies reveal markedly elevated LDL. What genetic disease does this patient like have, and what is the pathophysiology? For what else is the pt at risk? (p 115)
Familial hypercholesterolemia - Type IIa
At risk for atherosclerosis
A 36 yo man is brought to the ER because of DEC mental status. His liver is enlarged; he has spider nevi on the upper chest; and he demonstrates asterixis. His wife reports that he is a long-time heavy drinker. Lab studies reveal hypoglycemia despite this pt having no diabetes. Why is this? (p94)
Ethanol hyperglycemia = ethanol metabolism INC NADH/NAD+ ratio in liver, causing diversion of pyruvate to lactate and OAA to malate, thereby inhibiting gluconeogenesis and stimulating fatty acid synthesis
-leads to hypoglycemia and hepatic fatty change (hepatocellular steatosis)
A child in India is brought to the doctor with symptoms of muscle weakness, malaise, headache, fever, and hyporeflexia. For the past few weeks he had been swimming in a water way known to contain sewage. You think this boy has contracted an organism via the fecal-oral route. What area of the body is this organism attacking to give the
neurologic symptoms seen? (FA p411)
Poliomyelitis

caused by poliovirus - destroys cells in the anterior horn of the spinal cord --> LMN destruction
What are the important functions of vitamin C? (FA
p79, p93)
Antioxidant
Facilitates iron absorption by keeping iron in Fe reduced states
Necessary for hydroxylation of proline and lysine in collagen synthesis
Necessary for dopamine beta-hydroxylase = converts dopamine to NE
Which brachial arch has derivatives that begin with "S"? What are these derivatives? (FA p128)
brachial arch derivative 2 = stapes, styloid process, stylohyoid ligament
muscles of fascial expression = stapedius, stylohyoid
A patient crashed his bicycle on a mountain trail. During the crash he landed on the lateral aspect of his leg. Now he has foot drop. Which nerve was injured? (FA p376)
Peroneal nerve - PED = everts and dorsiflex
A 50-year-old man crashes on a motorcycle on the highway and obtains a right anterior hip dislocation and knee trauma. Now he cannot adduct his hip or plantar flex on that side. Which nerves are injured? (FA p376)
Obturator nerve - adduct hip
Tibial nerve - planter flex (+ inverts)
A 36-year-old malnourished woman comes to the ER with abdominal pain. She has a fever, abdominal tenderness (but no rebound), and anorexia. Her WBC is markedly elevated and her RDW is high. The patient reports having had a bowel
movement this morning and is not nauseated. A small bowel follow through reveals skip lesions (discontinuous areas of focal narrowing) and a string sign (significant narrowing) in the terminal ileum. What disease does this patient likely have?
What drugs can be used to treat it? (FA p326)
Crohn's disease

Corticosteroids
Infliximab
48-year-old man presents to your office with a persistent cough that has begun to become bloody. CXR reveals a coin lesion within the lung parenchyma. Further work up reveals that the patient has the most common type of lung cancer in
non-smokers. Which cancer is this? What other cancers are not associated with smoking? Which lung cancers are associated with smoking, and where are they located, centrally or peripherally? (FA
p513)
Bronchialveolar AND Bronchial adenocarcinoma

Squamous cell CA - central
A 15-year-old female is brought to the pediatric ER. She is in some distress and has the following symptoms: rapid, deep breathing; vomiting; abdominal pain; and dry mucous membranes. Finger stick glucose is >500 mg/dL. What other
lab abnormalities do you expect to find? (FA p302)
INC H, DEC HCO3, INC blood ketones, leukocytosis, hyperkalemia (but DEC intracellular K b/c of transcellular shift from DEC insulin)
A 34-year-old woman is being evaluated for multiple kidney stones, persistent nausea, and depression. Routine labs reveal hypercalcemia; and an ultrasound of the anterior neck reveals a mass near the lower left lobe of the thyroid. What are the three main ways that PTH increases serum calcium levels (directly and indirectly)? (FA p293)
INC GI absorption
INC renal resorption (+ DEC renal resorption of PO4)
INC bone resorption (+ INC bone resorption of PO4)
Levodopa is often given to Parkinsonian patients to treat their symptoms. It can cross the blood brain barrier whereas dopamine itself cannot. What structures give rise the blood brain barrier?
(FA p398)
Formed by 3 structures:
1. tight junctions b/c nonfenestrated capillary endothelial cells
2. basement membrane
3. astrocyte processes
NT changes in anxiety
INC NE
DEC GABA
DEC 5HT
NT changes in depression
DEC NE
DEC dopamine
DEC 5HT
NT changes in Alzheimer's
DEC ACh
NT changes in Huntington's
DEC GABA
DEC ACh
NT changes in Schizophrenia
INC dopamine
NT changes in Parkinson's
DEC dopamine
INC 5HT
INC ACh