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DIT Week #10

Terms in this set (30)

What is Kallmann syndrome? (FA14 p575)
hypogonadism due to failure of GnRH neurons fail to migrate to the hypothalamus. Failure to go through, or complete, puberty. X linked disorder, much more common in men. Low FSH/LH. fail to develop secondary sex characteristics. Can be seen with anosmia and midline facial defects.
A 67-year-old male CHF patient lost his job and medical insurance, so he stops buying and taking his digoxin, and develops dyspnea. What will this do to his cardiac output (CO)? What are the mechanisms behind his development of dyspnea? (FA14 p268, 291)
cardiac output will decrease due to the loss of positive inotropic effect of digoxin. decreased CO, decreased blood form LB and back up to pulmonary edema to create dyspnea.
A 17-year-old girl 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? (FA14 p355)
Pregnancy must be ruled out (B-hCG, could be ectopic pregnancy).

This is likely acute appendicitis.
A 31-year-old man is post-op day 1 after an exploratory laparotomy. The surgery was performed emergently for intraperitoneal hemorrhage after a motorcycle crash. His creatinine today is elevated to 2.0 mg/dL. His pain is currently uncontrolled. Explain why an NSAID could lead to a potential complication in this patient. (FA14 p526, 529)
NSAIDS can make renal insufficiency worse. inhibit COX and block PGE synthesis. PGE dilate BV's, won't be able to keep afferent arterioles open. NSAIDS can reduce renal perfusion.
Which phagocyte dysfunction disease increases patient susceptibility to S. aureus and E. coli? What is the cause of this disease? (FA14 p213)
chronic granulomatous disease. NADPH oxidase deficiency.
What is the mechanism of action of local anesthetics? Which nerve fibers are blocked first with local anesthesia? (FA14p495)
local anesthetics block Na channels and prevent nerve firing. first blocked are small myelinated fibers (small then large, myelinated then unmyelinated)
What medications are used in the treatment of urge incontinence?
anticholinergic drugs- oxybutinin, tolterondine, etc.
What are the 3 different eukaryotic RNA polymerases? What type of RNA does each make? (FA14 p73)
mRNA- polymerase II
tRNA- polymerase III
rRNA- polymerase I
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? (FA14p308)
without insulin you do not express GLUT4 and can't get glucose in (muscles and fat)

brain, RBC, intestines, cornea, kidney, liver do not need insulin
What are the layers of the epidermis beginning with the most superficial layer? What is Auspitz sign?
(FA14 p410, 432)
Californians Like Girls in String Bikinis

Stratum: corneam, lucidum, granulosm, spinosum, basalis.

Auspitz- bleeding spots when scales peel off. psoriasis sign.
A patient comes to the clinic complaining of severe low back pain that radiates down the back of her leg. What is the most likely explanation for her pain?
compressed nerve (from herniated vertebral disc). L5 or S1- sciatic nerve to radiate down the back of the leg.
What problem/abnormality is associated with the following buzzwords? Calf pseudohypertrophy (FA14 p616), Gower maneuver (FA14 p89), Subluxation of lenses (FA14 p87), Café-au-lait spots (FA14 p87), Tuft of hair on lower back (FA14 p445)
muscular dystrophy (duchenne)
Gower- cannot stand up without using arms
lenses- Marfan syndrome, fibrillin-1 gene mutation, connective tissue disorder affecting skeleton, heart, and eyes
Cafe- neurofibromatosis type 1 (auto dominant, NF1 gene on 17)
spina bifida occulta- failure of bony spinal canal to close, no structural herniation
What type of cell differentiation and maturation takes place at the thymus? (FA14 p197) (FA15 p199) (SU15 p367, 372-373) 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? (FA14 p198)
Thymus= site of T-cell differentiation and maturation. Encapsulated. Outer, migrate to medulla and mature at corticomedullary junction (where they are checked to see if they are good T cells)
MHCI- CD8+, most all nucleated cells
MHCII- CD4+, antigen presenting cells.
A 59-year-old man with a 50-pack-year history of smoking sees you for management of his COPD. What is the clinical definition of chronic bronchitis? (FA14 p604)
Chronic bronchitis- hyperplasia of mucus secreting glands in the bronchi. Associated with an increase of the Reid index. Productive cough >3mo/yr for >2yrs
A 50-year-old woman 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? (FA14 p393)
M spike of serum protein electrophoresis (monoclonal spike of whatever immunoglobulin those particular ones are producing)
blood smear has Rouleaux formation (RBCs in stacked coin). In the urine, find Ig light changes (Bence jones proteins, requires urine protein electrophoresis)
In your own words, describe what type I error is. (FA14 p57)
(alpha error) False positive error. shows a difference between two groups when there is no real difference
(type II is false negative error)
What trace element is essential to the function of carbonic anhydrase and lactic dehydrogenase?
Zinc. Is needed for certain types of protein folding.
A 30-year-old man 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. How does the emphysema caused by smoking differ from the emphysema caused by α1-antitrypsin deficiency? (FA14 p363, 604)
smoking- centriacinar, only center of acinus is destroyed
panacinar (A1- antitrypsin deficiency, protects lungs normally from elastase. In this there is destruction) has the whole acinus destroyed
In what clinical scenarios would you see a "nutmeg" liver? (FA14 p291, 362)
Hepatic congestion. RH failure and budd-chiari syndrome aka increased central venous pressure/increase resistance to portal flow.
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 sequela? (FA14 p413)
Long thoracic nerve,e with would present with winged scapula due to serratus anterior muscle defect. Inability to cancer scapula to the rib cage = winged, also cannot abduct above horizontal position.
What organisms are particularly known for causing infective endocarditis? (FA14 p130-131, 148)
Staph aureus 30-%,
staph epidermidis 5-10%, s. mutans= viridans 20-30%
group D strep (enterococci) 10%.

HACEK: (nothing on culture)
haemophilus
cardiobacterium
eikenella
kingella
A 60-year-old male long-time patient of yours comes to your office complaining of sexual dysfunction. What is the differential diagnosis? What drugs are known for causing sexual dysfunction? (FA14 p512)
The differential diagnosis is erectile dysfunction, hormonal disturbances, depression, DM, psychiatric, ME side effect.
Drugs known to cause ED are SSRIs, anti-HTNs (B blockers), neuroleptics, and ethanol.
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? (FA14 p611)
lobar- s. pneumoniae
walking- viruses (influenza, RSV, adenoviruses) and mycoplasma/legionella/chlamydia
Which type of lymphoma has a presentation that is very similar to CLL and fewer constitutional signs/symptoms? (FA14p394)
non-hodgkin's: SLL (small lymphocytic lymphoma) is the same as CLL except CLL has an increased peripheral blood lymphocytosis or bone marrow involvement.
A 30-year-old man is at an inpatient facility for opioid addiction. What symptoms might this patient experience while discontinuing opioids? (FA14 p514)
sweating, dilated pupils, piloerection, fever, rhinorrhea, yawning, nausea, cramps, diarrhea, restless leg syndrome (flu-like sx)
What is the difference between a promoter region and an enhancer region? (FA14 p72)
Promoter- site where RNA polymerase and multiple other transcription factors bind to DNA upstream from the gene locus [ex TATA box, it PROMOTES gene expression and transcription. place to latch to get started].
Enhancer- stretch of DNA that alters gene expression by binding transcription factors. Doesn't have to be upstream from actual gene
What medications are considered first-line in the treatment of ADHD?
Ritalin (methylphenidate)
dextroamphetamine (adderall)
OR
atomextine
clonidine ( w/ insomnia)
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? (FA14 p291)
RH failure (SYSTEMIC sx): edema, JVD, hepatomegaly (nutmeg liver)
LH failure (can't get into the aorta, back up into the lungs, PULMONARY sx): pulmonary edema, orthopnea, and paroxysmal nocturnal dyspnea
RH heart failure is most often caused by left sided heart failure. Isolated, cor pulmonate.
What abnormal lab values would lead you to suspect alcoholic hepatitis? (FA14 p361)
increased GGT, AST:ALT >2:1, low albumin
How many umbilical vessels are there? Which umbilical vessel has the highest oxygen content? (FA14 p557)
2 arteries (return deox blood from fetal internal iliac arteries)
1 vein (brings oxygenated blood from placenta to fetus, drains into IVC via liver/ductus venous)
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