Term
How do OCPs work?
What are its Advantages and Disadvantages?
What are the Contraindications to its use? |
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Definition
OCP –
Prevent Estrogen Surge (triggering LH surge -> ovulation)
Advantages – Reliable, Decr Risk of Endometrial/Ovarian CA, Pelvic Infections, Ectopic preg
Disadvantages – qd, No STD protection, Incr TG, Depression, Wt Gain, N, Hypercoaguable
CI – Smokers >35 yo (CV risk), Pts w Hx of Thromboembolism, Stroke, Estrogen-DependentTumor
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Term
| You start a patient on a drug that has been on the market for five years. It has excellent efficacy. However, your patient begins to have an annoying side effect one month after initiation of this drug. She contacts the manufacturer about it; and they, in turn, contact you to gather data on her course while on the drug. In what phase of the clinical trial would this example fall? |
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Definition
Phase IV – Post marketing Surveillance trial of pt after approval
Purpose – detect rare, long-tem adverse effects
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Term
What is the difference between Endometriosis and Adenomyosis?
What is the classic finding on the ovary for endometriosis? |
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Definition
Endometriosis –
Endometrial glands/stroma in abnl locations outside uterus
S/Sx – Cyclic Bleeding, “Chocolate” Cysts
Often results in Infertility
Adenomyosis –
Endometrium within the myometrium
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Term
| What is the difference between Nephritic and Nephrotic Syndrome? |
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Definition
Nephritic vs Nephrotic Syndrome –
Nephritic – Inflammatory, Hematuria -> Blood casts (Glomeruli involvement)
Azotemia, Oliguria, HTN, Mild Proteinuria (<3.5)
Nephrotic – Massive Protinuria (>3.5), Hyperlipidemia, Fatty Casts, Edema
Thromboemolism, Incr Risk of infection (Decr Ig) |
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Term
| What are the effects of Portal HTN? |
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Definition
Portal Hypertension Effects -
Esophageal Varices -> Hematemesis, Melena
Peptic Ulcer -> Melena
Splenomegaly
Caput Medusae, Ascites
Portal Hypertensive Gastropathy
Hemorrhoids |
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Term
| What is the leading cause of death in ages 15-24? 25-64? |
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Definition
Leading Causes of Death
1-14 = Injuries, CA, Congenital Abnl, Homocide
15-24 = Injuries, Homocide, Suicide
25-64 = CA, Heart Dz, Injuries
65+ = Heart Dz, CA, Stroke |
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Term
| What will a Frontal Lobe Lesion result in? |
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Definition
Disinhibition/deficit in concentration, orientation, and judgment.
Possible reemergence of primitive reflexes |
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Term
| What will a Parietal Lobe Lesion result in? |
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Definition
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Term
| How is Estrogen Synthesized? |
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Definition
Aromatization of Androgens
Androstendione -> Estrone (E1)
Testosterone -> Estradiol (E2, more potent) |
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Term
What do these Structures Develop into?
1) Gubernaculum (female)
2) Processus Vaginalis (male)
3) Foramen Ovale
4) Notochord
5) Neuroectoderm |
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Definition
1) Round Ligament and Ovarian Ligament
2) Tunica Vaginalis
3) Fossa Ovalis (in atrial septum)
4) Nucleus Pulposus (of intervertebral disks)
5) Spinal Cord |
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Term
What is MEN I?
What are some of the Common Pancreatic Tumors |
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Definition
CA of Pituitary, Parathyroid, Pancreas
Pancreatic Tumors - Zollinger-Ellison Syndrome, Insulinomas, VIPomas, Glucagonomas (rare), Commonly present w Kidney Stones and Stomach Ulcers |
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Term
What is the Medical Dz and Neoplasm associated with these Chemical Excesses?
1) ACTH
2) PTH-rP
3) EPO
4) ADH |
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Definition
1) Cushings - Small Cell Lung CA
2) Hypercalcemia - Squamous Cell Lung CA, Renal Cell CA, Breast CA
3) Polycythemia - Renal Cell CA, Hemangioblastoma
4) SIADH - Small Cell Lung CA, Intracranial Neoplasm |
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Term
What is the most common cause of Seizure in...
1) Children
2) Adults
3) Elderly |
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Definition
1) Genetic, Infections, Trauma, Congenital, Metabolic
2) Tumors, Trauma, Stroke, Infection
3) Stroke, Tumor, Trauma, Metabolic, Infection |
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Term
| What is the difference between Gout and Pseudogout? |
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Definition
Gout - Negatively Birefringent,
Yellow (paralell to light) Blue (perpendicular to light)
Pseudogout - Positively Birefringent (weakly)
Blue (parallel to light) Yellow (perpendicular to light) |
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Term
What are the Risk Factors for Athlerosclerosis?
What are the commonn locations for Buildup? |
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Definition
Risk Factors - Smoking, HTN, DM, Hyperlipidemia, Fam Hx, Sedentary lifestyle
Common Locations – Abd Aorta, Coronary AA, Popliteal AA, Carotid AA. |
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Term
What is the most common site for a Berry Aneurysm?
What are the risk factors for Berry Aneursym? |
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Definition
Most common Site - Bifurcation of the Circle of Willins (Anterior Communicating AA)
Risk Factors - Marfan's Syndrome, Ehler-Danlos, Adult Polycystic Kidney Dz (APKD), Advanced Age, HTN, Smoking, Race |
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Term
Match up the Protozoan with its Disease and Tx
1) Trypanosoma Cruzi
2) Entameoba Histolytica
3) Trichonomas Vaginalis
4) Giardia Lamblia |
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Definition
1) Trypanosoma Cruzi -> Chagas - Nifurtimox
(Dilated Cardiomyopathy/Megacolon/Megaesophagus)
2) Entamoeba Histolytica -> Amebiasis, Dysentery (bloody diarrhea) - Metronidazole
3) Trichonomas Vagnalis -> Vaginitis - Metronidazole
4) Giardia Lamblia -> Bloating, Flatulence - Metronidazole
Foul-smelling Diarrhea (campers/Hiker)
5) Leishmania donovani -> Spiking Fever, HSM, Pancytopenia - Sodium stibogluconate |
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Term
What are the features of the Types of T-helper cells?
Cytokine Induction
Cytokine Inhibition
Cytokine Synthesis |
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Definition
Th1 – CMI Response (Activates Macrophages)
Induction: IL-12
Synthsis: IL-2, IFN-gamma
Inhibited: IL-10
Th2 – Humoral Response (Helps make B cells make Ab, IgE>IgG)
Induction: IL-4
Synthesis: IL-4, 5, 10
Inhibited: INF-gamma |
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Term
What DM complications can be attributed to sorbitol osmotic damage?
What enzyme converts glucose to sorbitol? |
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Definition
| Glucose -> Sorbitol via ALDOSE REDUCTASE causing high intracellular concentrations leading to osmotic damage (Cataracts, Retinopathy, Peripheral Neuropathy) |
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Term
| What are the Signs and Symptoms of Takayasu's Arteritis? |
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Definition
Pulseless Dz, Thickened Aorta in Younger Asian Females
Sx - FAN MY SKIN On Wed -
Fever, Arthritis, Night sweats, MYalgia, SKIN Nodules,
Ocular Disturb, Weak Pulse in UEs |
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Term
What is the pathophysiology of Newborn Jaundice?
How do you treat it? |
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Definition
Immature UDP-glucuronyl transferase -> UNconjugated hyperbilirubinemia –> jaundice/kernicterus
Treat w light exposure |
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Term
Amyloidosis and Sarcoidosis are associated with which cardiomyopathy?
What are some other Dz/Conditions assoc w this cardiomyopathy? |
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Definition
Restrictive Cardiomyopathy
Other: Post Radiation Fibrosis, Endocardial Fibroelastosis, Loffler's Syndrome, Hemochromatosis |
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Term
IgG to Desmosomes lead to what fatal autoimmune disorder?
What is the Diff between Desmosome/Hemidesmosome? |
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Definition
Pemphigus Vulgaris
Desmosome - Connect Cells to one another
Hemidesmosomes - Connect Cells to Basement Membrane |
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Term
What is the Difference Between Lamber Eaton Syndome and Myasthenia Gravis?
Problem
Sx
Etiology
Dx Tests (and results) |
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Definition
Lambert-Eaton Syndrome – Auto-Ab to Presynaptic Ca Channel-> decr ACh
Sx - Proximal MM weakness
BETTER w MM use
Paraneoplastic Tumors -> Thymoma, Small-Cell Lung CA (lead to LES)
Ab against presynaptic Ca channels at NMJ
No Reversal of Sx w AChE Inhibitors alone
Myasthenia Gravis – (most common) Auto-Ab to Post-Synaptic AChR
Sx – ptosis, diplopia, general weakness
WORSE w MM use
Dx – Nerve Stim/Compound MM Test
Tx – AchE Inhibitors
Edrophonium Test (over/under dosing)
Assoc w thymoma |
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Term
| What is the Difference between Malingering and Factitious Disorder? |
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Definition
Malingering – Pt consciously fakes or claims in order to gain secondary goal.
(avoid work/gain drugs)
Factitious Disorder – Pt consciously creates physical/psychological sx.
Primary Goal - to assume “sick role”
Munchausen’s – Chronic factitious disorder. Many hosp visits, willingness to receive invasive procedures
By Proxy – typically child |
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Term
What is needed to for Purine Synthesis?
Pyrimidin Syntheiss? |
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Definition
Purine - (GAG)
Glycine, Aspartate, Glutamine
Pyrimidine - Carbamoyl Phosphate, Aspartate |
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Term
What is Tabes Dorsalis?
What are its S/Sx? |
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Definition
Tabes Dorsalis – Degeneration of the dosal columns and dorsal roots due to tertiary syphilis -> impaired propioception and locomotor ataxia.
Charcot’s Joints – shooting pain
Argyll-Robertson Pupils – reactive to accommodation but not light
Absence of DTRs, Positive Romberg, Sensory Ataxia at night
PE – Decr DTR, Positive ROMBERG, Non-Reactive Pupils |
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Term
What is Temporal Arteritis (Giant Cell Arteritis)?
Which Demographic?
S/Sx?
Tx?
Comorbidities? |
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Definition
Temporal Arteritis (Giant Cell Arteritis) – Focal Granulomatous Inflammation
Med/Large Vessels off Carotid
Elderly females
S/Sx – Rt-side HA, Visual Disturbances (occlusion of ophthalmic aa-> blindness), Pain on Mastication (Jaw Claudication)
Incr ESR
Many Pts have systemic involvement and Polymyalgia rheumatic
Tx – High Dose Steroids |
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Term
What is the pathophys with DI?
What are the Etiologies of DI?
What test would you run? |
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Definition
Diabetes Insipidus – Inability to conc Urine -> Polyuria/Polydipsia
Tests – Water Deprivation Test (Urine Osmolality doesn’t incr)
Response to Desmopressin distinguishes between Central/Nephrogenic
Etiologies –
Central – Lack of ADH -> Pituitary Tumor, Trauma, Surgery, Histiocentesis X
Nephrogenic – Lack of Renal Response to ADH ->
Hereditary or secondary to hypercalcemia, Lithium, Demeclocycline (ADH Analog) |
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Term
What is the Pathophys of a Hydatidiform Mole?
Type?
Genotype?
Tx? |
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Definition
Hydatidiform Mole –
Cystic Swelling of Chorionic Villi and proliferation of epithelium -> abnl vaginal bleeding
Enlarged Uterus w Honeycombed Uterus, Cluster of Grapes
Most common Precursor for Choriocarcinoma
Moles can lead to Uterine Rupture
Dx - Incr b-hCG
US: "Snowstorm" w no fetus
Tx – D&C and Methotrexate
Monitor b-hCG
Complete –
Karyotype = 46 chromosome (XX or XY)
Very High levels of hCG
Incr Uterine Size
2 sperm + Empty Egg
Risk of Malignant Trophoblastic Dz (15-20%)
Partial –
Karyotype = 69 chromosome (XXY)
Slightly high levels of hCG
2 Sperm + I egg
Low Risk of Malignancy |
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Term
| What are the types of Chronic Gastritis? |
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Definition
Chronic Gastritis (nonerosive) ->
Type A (fundus/body) - Autoimmune disorder characterized by auto-Ab to parietal cells, Pernicious anemia and
Achlorhydria.
Type B (Antrum) Most common type caused by H Pylori infection, incr risk of MALT
Sx – Weakness, Pallor, Craving for Ice Chips, Tachy, Hx of Chronic Gastritis |
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Term
| What are the common sites of Mets of Lung CA? |
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Definition
| Adrenals, Brain (epilepsy), Bone (Pathological Fracture), Liver (Jaundice, Hepatomegaly) |
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Term
| What are the difference between Myocardial and Pacemaker Action Potentials? |
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Definition
Myocardial Action Potential –
Phase 0 – Rapid upstroke (voltage gated Na channels)
Phase 1 – Initial Repolarization (inactivation of Na channels, activation of K)
Phase 2 – Plateau (Ca influx balances K)
Phase 3 – Rapid Repolarization – Massive K effux due to Open of K channel, close Ca
Phase 4 – Resting Potential – High K permeability through K Channel
Pacemaker Action Potential –
Phase 0 – Upstroke (Ca channels NOT Na channels) slower for AV node Conduction
Phase 2 – Plateau is absent
Phase 3 – Inactivation of Ca channels and inc r in K channels (k efflux)
Phase 4 – Slow diastolic depolarization |
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Term
What IV Anesthetics are assoc w these features?
1) Hallicinations/Bad Dreams
2) Common for Endoscopy
3) Rapid Anesthesia Induction
4) Decr Cerebral Blood Flow |
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Definition
1) Hallucinations/Bad Dreams – Ketamine (arylcyclohexylamines)
2) Most Common for Endoscopy - Benzodiazepines
3) Rapid anesthesia induction - Propofol
4) Decr Cerebral blood flow – Barbituates |
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Term
| What are the SE of Atropine? (What is its MOA) |
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Definition
Atropine - Muscarinic Antagonist (Blocks Dumbbels)
SE – Opthalmic – Incr Dilation (Miosis), cycloplegia
Systemic – Decr Secretions, acid secretion, decr motility, urgency in cystitis
Muscarininc Antagonist – Blocks DUMBBELSS
Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of CNS, Lacrimation, Sweating, Salivation |
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Term
| What are the Types of Glaucoma Medications? |
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Definition
A-Agonists – decr humor synthesis
Epinephrine
Brimonidine
B-Blocker – decr humor synthesis
Timolol, Betaxolol, Carteolol
Diuretics – decr humor synthesis due to decr bicarb
Acetaxolamide
Cholinomimetrics – Incr humor outflow (contract ciliary mm and open trabecular meshwork)
Direct – Pilocarpine, Carbachol
Indirect – Physostigmine, Echothiophate
Prostaglandin - Incr humor outflow
Latanoprost |
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Term
| What is the Notochord's Role in CNS development? |
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Definition
Notochord -> Nucleosus Pulposus of Intervertebral Discs
It induces overlying ectoderm to differentiate into neuroectoderm and form the neural plate.
Neural plate gives rise to the neural tube and neural crest cells |
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Term
What is the Electrolyte Abnl assoc w these clinical findings
1) flattened T-waves on EKG
2) kidney stones, abdominal pain
3) decreased reflexes respiratory arrest
4) peaked T-waves on EKG |
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Definition
• flattened T-waves on EKG K Def
• kidney stones, abdominal pain Ca Incr
• decreased reflexes respiratory arrest Mg Incr
• peaked T-waves on EKG K Incr
• dehydration, delirium, coma Na Incr
• neuromuscular irritability and cardiac arrhythmia Mg Def |
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Term
What causes Cholinesterase Inhibitor Poisoning?
How do you treat it? |
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Definition
Cholinesterase Inhibitor Poisoning –
Organophosphates (Parathion) – irreversibly inhibit AchE
->Antidote = Atropine + Pralidoxime (regenerates active AchE) |
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Term
| What is the Difference between Preeclampsia and Eclampsia |
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Definition
Preeclampsia –
HTN, Proteinuria, Edema
Eclampsia –
Preeclampsia, Seizures
*incr risk in pts w HTN, DM, Renal Dz, Autoimmune Disorders
Placental Ischemia due to impaired vasodialation of spiral aa -> Incr vascular tone
Can be Assoc w HELLP (Hemolysis, Elevated LFT, Low Platelets)
Mortality -> Cerebral Hemorrhage and ARDS
Tx – Deliver ASAP, Bedrest, Salt Restriction, Tx HTN
Seizures - Mg Sulfate / Diazepam |
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Term
What is a Type I error?
What is a Type II error? |
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Definition
Type 1 Error (alpha) – False Positive Error
There IS an effect/difference when NONE exists. – Convicting Innocent Man
Type 2 Error (beta) – False Negative Error
There IS NOT an effect/difference when ONE exists – Letting Guilty Man Free |
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Term
What are the part of a Lymph Node?
What cells are found in each part? |
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Definition
Lymph Node –
Follicle of Cortex (B Cell)
Paracortex (T Cells)
Medulla (Lymphocytes / Plasma Cells) |
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Term
How does Rifampin work?
What are the 4 Rs? |
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Definition
Rifampin –
Inhibits DNA-Dependent RNA Polymerase
Toxicity – Orange body fluids, minor hepatotox, Drug Interactions (Incr P450)
4 Rs – RNA Polymerase Inhibitor
Revs up Microsomal P-450
Red/Orange Body Fluids
Rapid Resistance if used alone |
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Term
| What Urine Spec Grav and Serum Osmolality would you find in DI? |
|
Definition
Diabetes Insipidus – Lack of ADH
Urine Specific Gravity - <1.006
Serum Osmolality - >290 |
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Term
| What percentage falls in 1 SD? 2 SD? 3 SD? |
|
Definition
Standard Deviations
1 SD = 68%
2 SD = 95%
3 SD = 99.7% |
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Term
| What gives rise to Jugular Venous a, c, and v waves? |
|
Definition
JVP – A wave – Atrial contraction
C wave – RV contraction
V wave – Incr RA pressure due to filling against closed tricuspid |
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Term
| What are the S/Sx of PCP intoxication? |
|
Definition
PCP Intoxication –
S/Sx – Belligerence, Impulsiveness, Fever, Psychomotor Agitation, Vertical and Horizontal
Nystagmus, Tachycardia, Homocidality, Psychosis, Delirium,
Depressing, Anxiety, Irritability, Restlessness, Anergia, Disturbances of Though/Speech |
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Term
| The mother of a pediatric patient you are evaluating states her child’s urine appears dark brown when she changes his diaper. Furthermore, you notice the patient has bilateral dark pigmented sclera. What disease could account for these physical findings? What is the cause of this disease? |
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Definition
Alkaptonuria – Def of Homogentisic Acid Oxidase (degradative pathway of Tyrosine to Fumarate)
Recessive, Benign
Dark CT, Brown Sclera, Urine turns black on standing
May have debilitating arthralgias (homogentistic acid toxic to cartilage) |
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Term
What are the Etiologies of Cushing's?
How does ACTH help Dx etiology? |
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Definition
Cushing’s – Incr Cortisol
Exogenous – Steroid -> Synthetic Cortisol -> Decr ACTH (Most common)
Endogenous – All lead to Incr ACTH, except Adrenals
-Cushing’s Dz – 70%, ACTH Secretion from Pit Adenoma
-Ectopic ACTH – From non-pit tissues making ACTH (Small Cell Lung CA),
-Adrenal – Adenoma, carcinoma, nodular adrenal hyperplasia (Decr ACTH)
S/Sx – HTN, Wt Gain, Moon Facies, Truncal Obesity, Hyperglycemia, Purple Abd Striae,
Immune suppression, Osteoporosis,
Dx – Dexamethosone (synthetic glucocorticoid) Supression Test –
Nl – Decr Cortisol post low test
ACTH-producing Pit Tumor – Incr Cortisol post low dose
Decr Cortisol post high dose
Ectopic ACTH-producing / Cortisol Producing Tumor – Incr Cortisol post low AND high dose |
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Term
| What are the Tx for Cystinuria? |
|
Definition
Cystinuria –
Hereditary defect – Autosomal Recessive
Renal Tubule transport for Cysteine, Ornithine, Lysine, Argnine (in PCT)
Excess Cystine in Urine -> Cystine Kidney Stones (Staghorn Calculi)
Tx – Acetazolamide (alkalinize the urine) |
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Term
| What are the Types of E.coli? |
|
Definition
EIEC – Shiga-like Toxin, invade mucosa and toxin causes necrosis/inflamm
Invasive, Dysentery
ETEC – Labile/Stable Toxin, No Inflamm/Invasion
Traveler’s Diarrhea (watery)
EPEC – No Toxin, Adheres to apical surface, prevents absorption,
Diarrhea in Chilred (PEDs)
EHEC – Shiga-like toxin, Hemolytic-Uremic Syndrome (Anemia, Thrombocytopenia, Acute
Renal Failure), Endothelium swells -> Mech hemolysis and reduced blood flow
Dysentery
Doesn’t ferment sorbitol |
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Term
Match up Fetal Landmark and Week of Gestation
1) Implantation
2) Organogenesis
3) Heart begins to Beat
4) Distinguish Male/Female Genetalia |
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Definition
implantation 0
organogenesis 3-8
heart begins to beat 4
can distinguish male or female genitalia 10
gastrulation 3
formation of primitive streak and neural plate 3 |
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Term
| Which phagocyte dysfunction disease increases patient susceptibility to S. aureus and E. coli? What is the cause of this disease? |
|
Definition
Chronic Granulomatous Dz –
Lack of NADPH – Oxidase -> decr ROS -> absent respiratory bursts in neutrophils
S/Sx – Incr Suceptibility to catalase Positive (Staph Aureus, S. Aspergillus, E. Coli)
Labs – Negative Nitroblue Tetrazolium Dye Reduction Test |
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Term
| What Causes Metabolic Acidosis (Anion Gap)? |
|
Definition
Metabolic Acidosis –
Elevated Anion Gap – MUDPILES
Methanol
Uremia
DKA
Paraldehyde or Phenformin
Iron Tablets or INH
Lactic Acid
Ethylene Glycol
Salicylates |
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Term
| What is the Unhappy Triad? |
|
Definition
Unhappy Triad (Knee)
ACL Tear, MCL Tear, Lateral Meniscus Tear |
|
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Term
What is the cutoff for Low Birth Wt?
What are the complication of low birth wt? |
|
Definition
Low Birth Wt –
<2500 g, Prematurity or Intrauterine growth retardation
Greater Incidence of Physical/Emotional Problems
Complications – infections, resp distress syndrome, necrotizing enterocolitis, Intraventric hemorrhage, persistent fetal circulation |
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Term
How does Leuprolide work?
How can you change its admin for different uses? |
|
Definition
Leuprolide – MOA - GnRH Analog
Agonist –
Pulsitile – Incr Gonadotropin Release (Infertility – Incr LH, FSH)
Antagonist –
Continuous - Decr Gonadotropin Release (Prostate CA (w flutamide) – Decr Androgen Synth)
Toxicity – Antiandrogen, N, V |
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