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Round Review
Round 3 Rx Review
| Question | Answer |
|---|---|
| What are common symptoms of Left-sided heart failure? | Respiratory failure and the subjective sensation of SOB |
| What is a result of elevated LV diastolic filling pressures? | Transudation of fluid into the pulmonary interstitium |
| What is the result of Transudation into the Pulmonary interstitium? | Causes area of V/Q mismatch and overall decrease in lung compliance. |
| Common long-acting B-2 agonist? | Salmeterol |
| In refractory asthma, what medication are co-administrated with Salmeterol? | Inhaled glucocorticoid and short-acting B-agonist |
| What causes a stimulation of B-2 agonists? | Inhibition of Myosin light-chain kinase (MLCK) |
| What system is used to stage Hodgkin Lymphoma? | Ann Arbor staging system |
| What are the parameters taken in account in Ann Arbor Staging system? | - Content of lymph node involvement - Extranodal involvement |
| What is a common cause of HTN emergency or urgency? | Fibromuscular dysplasia |
| What is the most typical or characteristic of Fibromuscular Dysplasia? | "Beads on a string" appearance |
| Fibromuscular dysplasia is often the cause of __________________. | Hypertensive emergency |
| What does "B" represents in statistics? | 1. The chance of a Type II error to occur or, 2. Failure to reject a null hypothesis when the alternative hypothesis is actually correct. |
| (1-B) = | Statistical power of a test |
| How can B (statistics) be enhanced? | Increasing the sample size |
| What is Null Hypothesis (Ho)? | Hypothesis of NO DIFFERENCE or relationship. No association with disease and risk factor |
| Alternative hypothesis (H1)? | Hypothesis of SAME difference or relationship |
| What is the equation for Power of statistics? | 1-B |
| What does B (stats) represent? | Type II error |
| What symbol is used to represent Type 1 error? | alpha (A) |
| Study does not reject Ho + Ho = | Correct hypothesis |
| Which phase are oocytes arrested until ovulation? | Prophase I |
| Which phase are oocytes arrested until Fertilization? | Metaphase II |
| What is anergy? | Occurs when a T-cell receives a FIRST signal (peptide-MHC II) but NOT second signal. |
| What signal is missing in Anergy? | Second signal which represents the co-stimulation via interaction of B7 on APCs and CD28 on the T-cell |
| What is the second signal in T-cell stimulation ? | Interaction of B7 on APCs and CD28 on the T-cell |
| What causes anergy on the cell? | Cell refractory to any further stimulation |
| When can you suspect of anergy? | In a cell that does not respond to stimulation |
| How does anergy aid or help the immune system? | 1. Maintain effective T-cells 2. Remove self-tolerant or overactive T-cells |
| How is A and B blood types expressed? | Codominantly |
| Type O blood is expressed ___________________. | Recessively. |
| What is associated with Duodenal ulcers? | Hyperplasia of Brunner glands |
| At what times in the course of the day is the abdominal pain usually worst in patient with Duodenal ulcers? | Night-time and upon waking up in the morning |
| What kind of medication are associated with exacerbation G6PD deficiency? | Oxidizing agents, such as Sulfonamides |
| What is the mode of action of Sulfonamides? | Inhibit Dihydropteroate synthase |
| What is the translocation associated with CML? | Philadelphia chromosome (t(9:22)) |
| What is the Philadelphia chromosome? | t(9:22) |
| What characteristics are associated with CML? | - Philadelphia chromosome (t(9:22)) - Production of BCR-ALB fusion protein |
| What is the treatment of CML? | Imatinib |
| What is the BCR-ALB fusion protein? | A constitutively active Tyrosine Kinase receptor that promotes proliferation of malignant cells in CML. |
| What kind of antibiotics are usually used in prevention of surgical site infections in cardiac procedures? | Cephalosporins (first and second generation) |
| Cephalosporins are excellent against gram_______________ bacteria. | Positive |
| What is a complication of Aortic dissection? | Cardiac tamponade |
| Clinical presentation of Aortic dissection? | Tearing chest pain radiating to the back and asymmetric pulses |
| What is the characteristic pulse description aortic dissection? | Asymmetric pulses |
| What drug is used for anesthesia to tissues locally? | Bupivacaine |
| MoA of Bupivacaine | Binds to the intracellular portion of voltage-gated Na+ channels and clox the influx of Na+ into neurons, which prevent neuron from depolarizing. |
| Bupivacaine prevents the neuron's | Depolarization |
| What is a serious side effect of Hydralazine? | Reflex tachycardia |
| What is the clinical presentation of Reflex tachycardia? | Increased myocardial demand and Angina |
| Which patients are contraindicated to use Hydralazine? | Coronary artery disease |
| What percentage indicates lymphoblastic leukemia? | 20% |
| What kind of WBC deficiency is seen in Lymphoblastic leukemia? | Neutropenia |
| What are the Inactivated or killed vaccines? | Rabies Influenza (IM) injection Polio (Salk) Hepatitis A Typhoid (Vi polysaccharide, IM) |
| What kind of immunity is stimulated with killed vaccines? | Humoral immunity |
| Aminoglycosides work exclusively on what kind of organisms? | Gram negative bacteria |
| What is the mode of action of Aminoglycosides? | 1. Irreversible inhibition of Initiation complex through binding of the 30S subunit 2. Can cause misreading of mRNA 3. Block translocation 4. Rqures O2 for uptake |
| Why are aminoglycosides ineffective to anaerobes? | Aminoglycosides require oxygen for uptake |
| What kind of bacteria is not affected by aminoglycosides? | Anaerobes |
| What is reflection in an medical interview? | Reflective listening and empathic with the patient |
| Denervation atrophy is commonly seen in ____________. | ALS |
| How are muscular fibers in denervation atrophy biopsy? | Small, angular muscle fibers |
| The Stylopharyngeus muscle is derived form which Pharyngeal arch? | 3 |
| What nerve innervates the Stylopharyngeus muscle? | Glossopharyngeal nerve |
| Mode of action of TSST-1? | Activates large population of T-lymphocytes by cross-linking MHC-II and T-cell receptors |
| Toxic Shock syndrome Toxin presents with a triad of? | 1. Fever 2. Shock 3. Desquamating rash |
| alpha-1 antagonists are first line of treatment of _____________. | BPH |
| What is a common 5a- reductase used in treatment of BPH? | Finasteride |
| What enzyme commonly stimulates prostate stromal hyperplasia seen in BPH? | DHT |
| In a negative skew graph, which is value his the highest number? | Mode |
| Acute, autoimmune demyelinating polyradiculopathy that affects the PNS, usually manifesting as ascending paralysis, loss of deep tendon reflexes,and autonomic dysfunction. | Guillain-Barre syndrome |
| What is the treatment for Guillain-Barre syndrome? | IV immunoglobulins and plasmapheresis |
| What is measured in patient on Warfarin? | Prothrombin time and INR |
| Which kind of cardiac arrhythmia is most related to the formation of a thrombus? | Atrial fibrillation |
| What is the MC treatment for chronic prevention of thrombus formation? | Warfarin |
| What common animal is usually the carrier of Francisella Tularensis? | Rabbit |
| What condition is caused by Francisella Tularensis infection? | Ulceroglandular tularemia |
| Description of Ulceroglandular tularemia | Characterized by skin lesion with a black base, along with systemic symptoms |
| Xeroderma pigmentosum is due to a defect in ____________________________ repair. | Nucleotide excision |
| What is affected by the defective nucleotide excision repair in Xeroderma pigmentosum? | Cell's ability to repair damage induced by UV radiation |
| What are the 2 MC H-2 blockers? | Cimetidine and Ranitidine |
| Ranitidine is a __________________ blocker. | H-2 |
| Ranitidine and _________________ are H2 blockers. | Cimetidine |
| What is a common condition treated with H-2 blockers? | Peptic ulcer disease |
| What is an advantage of Ranitidine over Cimetidine? | Ranitidine does not produce the anti-androgenic effects |
| Clomiphene is a ____________. | SERM |
| What is the MOA of Clomiphene? | Acts as anti-estrogen, which leads to increased secretion of GnRH and ultimately increased testosterone |
| What hormone level is elevated with Clomiphene that aids in male fertility treatment? | Testosterone |
| What are two results or complication of Renal Artery stenosis (RAS)? | 1. Resistant hypertension 2. Hypokalemia |
| The activation of the RAAS system by RAS, causes: | 1. Resistant hypertension 2. Hypokalemia |
| The Ulnar nerve originates from which nerve roots? | C8- T1 |
| The C8 - T1 nerve roots form the ____________________ of the Brachial plexus. | Lower trunk |
| What muscles are innervated by the Ulnar nerve? | 1. Hypothenar muscles 2. 2 of the lumbrical muscles 3. All interosseous muscles |
| Injury to the Ulnar nerve causes? | Sudden upward pulling on an abducted arm |
| What kind of palsy is due to damaged or injured Ulnar nerve? | Klumpke's palsy |
| Upper trunk injury causes: | Erb's palsy |
| Posterior cord of the brachial plexus damage causes: | Wrist drop |
| What nerve is injured in "Pope's blessing" hand deformity? | Median nerve |
| Median nerve injury cause a decrease in function of which finger? | Thumb |
| What kind of intracranial hematoma is most commonly in elderly due to rupture of Bridging veins? | Subdural Hematoma |
| Subdural hematomas have _________________-shaped areas in the CT scan. | Crescent |
| What levels of metabolism are elevated in fasting states? | Glucagon and Epinephrine |
| Glucagon and Epinephrine act via which pathway? | Gs pathway |
| Elevation of glucagon and Epinephrine causes activation of Gs pathway, leading to: | Increase Fructose 2, 6- bisphosphate levels, which decreases the PFK-2 level, and decreases the breakdown of glucose . |
| What are the criteria for Systemic Inflammatory responses Syndrome (SIRS)? | 1. Heart rate > 90/min 2. Respiratory rate >20/min 3. WBC count <4,000 or > 12,000 4. Temperature <36 C or > 38 C |
| How many findings of the SIRS criteria are needed to make diagnosis? | 2 or more |
| First aortic arch gives | Part of the Maxillary artery |
| The second aortic arch give rise to: | Stapedial and Hyoid arteries |
| What arteries are derived from the 3th aortic arch? | Common Carotid and proximal parts of the Internal Carotid artery |
| What is formed by the 4th aortic arch? | 1. LEFT --> aortic arch 2. RIGHT --> Proximal part of the Right Subclavian artery |
| What structure is formed by the Left side of the 6th Aortic arch? | Ductus arteriosus |
| Which aortic arch gives rise to the Proximal part of the Pulmonary artery? | Sixth Aortic arch |
| What kind of granulomas are seen in Crohn's disease? | Non-caseating |
| What are the MC extraintestinal manifestation seen with Crohn's disease? | Arthritis, erythema nodosum, ankylosing spondylitis |
| Placenta previa occurs as: | The placenta overlies the cervical os |
| What is the common presentation of Placenta Previa? | PAINLESS bleeding in the 3rd trimester |
| What are the two most common risk factors for Placenta previa? | Multiparity and prior C-section. |
| Defective Bruton Tyrosine Kinase (BTK) leads to development of? | X-linked Agammaglobulinemia |
| What is the role of BTK? | Essential in the maturation of B-cells, and its absence leads to a decreased immune function and increased risk of bacterial infections |
| Which cells are mot affected in X-linked agammaglobulinemia? | B-cells |
| What is the treatment of X-linked agammaglobulinemia? | IV g-globulin injections |
| What labs or levels are seen with Hemochromatosis? | 1. Serum Iron surplus 2. Elevated LFTs 3. Diabetes, arthralgias, impotence, weakness, and lethargy |
| Why is TIBC decreased in Hemochromatosis? | Due to downregulation and saturation of transferrin |
| Which gene is affected/mutated in Hemochromatosis? | HFE gene |
| Which muscle is not supplied by the 6th Branchial arch? | Cricothyroid muscle |
| Which branchial arch supplies all the muscles required for speaking? | 6th Branchial arch |
| A prolactinoma cause what type of ocular condition? | Bitemporal hemianopsia |
| What is compressed in Prolactinoma that cause a vision deficit? | Optic chiasm |
| What are the effects of increased prolactin in men? | Decreased libido, erectile dysfunction, and gynecomastia |
| What are the adverse effects of increased prolactin levels in women? | 1. Decreased libido 2. Galactorrhea, amenorrhea, and Infertility. |
| What is the cause of Uterine prolapse? | Loss of support of by the Cardinal, Uterosacral, or Pubocervical ligaments that suspend the uterus in the pelvic cavity. |
| What ligaments are weakened in Uterine prolapse? | Cardinal, Uterosacral, and Pubocervical ligaments |
| What are the serie of complications of Uterine prolapse? | Bilateral hydronephrosis ---> ---> Pyelonephritis |
| Aromatase function | Converts TESTOSTERONE to ESTRADIOL and Androstenedione to Estrone |
| What drug is usually used to form an irreversibly to aromatase? | Exemestane |
| What condition is exemestane usually used for? | Hormone-responsive Breast cancer in Postmenopausal women |
| What kind of carcinoma is seen in the upper 2/3 of the esophagus worldwide? | Squamous cell carcinoma |
| Squamous cell carcinoma of the esophagus stains positive to: | Cytokeratin |
| What conditions are associated with development of Squamous cell carcinoma of the Esophagus? | Ethanol, hot liquids, elastic strictures, smoking, and achalasia |
| Which carcinoma type is most commonly seen in the lower 1/3 esophagus? | Adenocarcinoma |
| Esophageal adenocarcinoma's risk factors: | Chronic GERD, Barrett's esophagus, obesity, smoking, achalia |
| What type of Esophageal carcinoma is most common in the United States? | Adenocarcinoma |
| What is the role of Vitamin C in collagen synthesis? | Cofactor in the HYDROXYLATION of Proline and Lysine residues and thus is an integral component of collagen synthesis |
| What type of chemical reaction is aided by Vitamin C during collagen synthesis? | Hydroxylation |
| Vitamin C deficiency ---> | Scurvy |
| What kind of deficiency is suspected in a patient with swollen, bleeding gums, as well as poor healing. | Vitamin C |
| Where does the hydroxylation of Proline and Lysine of collagen synthesis occur? | Rough Endoplasmic Reticulum (RER) |
| What are the two significant CBC findings of mild Thalassemia? | - an increased RBC - Normal RDW |
| What kind of RBCs are seen in Thalassemia? | Target cells |
| What area of the brain is affected of Wernicke Aphasia? | Superior Temporal Gyrus of the Left-temporal lobe and limits comprehension. |
| What aphasia presents with articulate, yet nonsensical speech? | Wernicke aphasia |
| Lesion to the Arcuate Fasciculus ---> | Conduction aphasia |
| Broca aphasia: | Lesion of Left-posterior inferior frontal lobe adjacent to the primary motor cortex. |
| What is the cause of Antidepressant Discontinuation Syndrome (ADS)? | Result of abrupt cessation of an SSRI |
| What are the symptoms of Antidepressant Discontinuation syndrome? | Dysphoria, fatigue, insomnia, myalgias |
| What is the the least likely SSRI to cause ADS? | Fluoxetine |
| Chronic alcoholism leads to inefficient Estrogen metabolism and is manifested with: | Spider angiomas, gynecomastia, loss of sexual hair, testicular atrophy, and palmar erythema. |
| What is the inheritance mode of Hemophilia A and B? | X-linked recessive |
| Deficiency of factor 8 ---> | Hemophilia A |
| What are the symptoms and signs of Hemophilia? | Spontaneous hemarthrosis, excessive soft-tissue bruising, and spontaneous bleeding |
| What are the drugs of acute gout treatment? | NSAIDs, corticosteroids, or colchicine for improvement of symptoms |
| What are the long term drugs used in treatment of Gout? | Allopurinol, Fexobustat, and Probenecid |
| What is the overall role of Allopurinol, Fexobustat, and Probenecid? | Decrease uric acid levels |
| Epinephrine acts ----> | Non-selectively on ALL adrenergic receptors subtypes |
| If Epinephrine is given alone it causes: | 1. Increase in systolic pressure via a-receptors 2. Decrease in diastolic pressure via b-receptors |
| How does the systolic pressure is increased by Epinephrine administration? | It stimulates the a-receptors |
| Which receptors are stimulated or affected by Epinephrine that cause a decrease in diastolic pressure? | B-receptors |
| What would be the result of a patient that is pretreated with an alpha-blocker prior to Epinephrine administration? | Decrease in Blood pressure (diastolic) |
| What is the mode of action of Aminocaproic acid? | Blocks conversion of Plasminogen to Plasmin |
| tPA induced bleeding is often reversed with: | Aminocaproic acid |
| What is the first line of treatment of Acute Coronary syndrome? | Nitroglycerin |
| Why is chest pain reduced with Nitroglycerin? | It reduces the preload by causing venodilation and thus reducing myocardial Oxygen demand. |
| What milestones are to be seen in a 6 month old baby? | 1. Palmar reflex disappears 2. Stranger anxiety 3. Rolls and sits 4. Passes toy hand to hand 5. Babble |
| Why is a daily chlorhexidine bath performed in ICU patients? | Reduces the incidence of catheter-related bloodstream infections |
| A Root-cause analysis: | Useus medical records and participants interviews to identify the underlying problems that lead to the medical error. |
| Duodenal atresia is associated with Trisomy _____ | 21 |
| What is the cause of Duodenal atresia? | Failure of Recanalization of the GI tract during embryogenesis |
| What is the cause of Hirschsprung's disease? | Failure of migration of neural crest cells |
Created by:
rakomi
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