Term
| What is the classic presentation of granuloma annulare? |
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Definition
Asymptomatic
Non-scaly, slightly erythematous plaque
Annular (ring-shaped)
Edges are irregular, but well-defined
Thick, rope-like border
Starts small, grows outward (centrifugally), usually localized, wrists, ankles, the dorsal surfaces of the hands or feet |
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Term
| A 500-lb man has to be mechanically ventilated in the ICU after having a pontine stroke. The intern setting up the ventilator is surprised that the usual ventilator settings are inadequate for this patient despite his lack of lung pathology or smoking history. The attending aids the intern and explains that the patient has significant extra weight sitting on his chest that affects the ability of the lungs to expand. What are some other extrapulmonary causes of restrictive lung disease? |
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Definition
Poor muscular effort – polio, myasthenia gravis
Poor structural apparatus – scoliosis or severe kyphosis, morbid obesity |
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Term
| What medications are known for causing erectile dysfunction? |
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Definition
Diuretics (thiazides)
Blood pressure medications (clonidine, methyldopa, guanethidine, beta-blockers)
Antidepressants
Antipsychotics
Spironolactone
Ketoconazole
Cimetidine |
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Term
| What is the first-line treatment for a patient with erectile dysfunction? |
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Definition
PDE inhibitors: Sildenafil, vardenafil, tadalafil
Testosterone replacement: only if hypogonadism is present |
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Term
| A 34-year-old bipolar woman 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? |
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Definition
Ebstein’s sign: atrialization of the right ventricle
Tricuspid valve leaflets are displaced into the right ventricle
Tricuspid regurg or stenosis
Use anti-epileptic drugs or antipsychotics for bipolar
Carbamazepine (anti-epileptic): neural tube defects, craniofacial defects, IUGR, developmental delay, hypoplastic fingernails
Valproate – neural tube defects
Lamotrigine – reduces folate levels
Aripiprazole and risperidone (antipsychotics) – extrapyramidal symptoms in newborns |
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Term
| Clopidogrel (Plavix) and ticlopidine are commonly used after MI or cardiac cath with stent placement. What is the mechanism of these drugs? |
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Definition
Block platelet activation
Irreversibly block platelet ADP receptors
Prevent glycoprotein IIb/IIIa from binding to fibrinogen |
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Term
| An 18-year-old man 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? |
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Definition
Inferior trunk of brachial plexus (C8, T1)
Atrophy of: thenar eminence, hypothenar eminence, interosseous muscles |
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Term
| Which type of diabetes mellitus is associated with obesity |
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Definition
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Term
| Which type of diabetes mellitus may cause ketoacidosis? |
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Definition
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Term
| Which type of diabetes mellitus has a strong genetic predisposition? |
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Definition
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Term
| Which type of diabetes mellitus is associated with HLA DR3 and 4? |
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Definition
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Term
| On which cells would you find CD4 molecules? On which cells would you find CD8 molecules? What do the CD8+ cells accomplish? |
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Definition
CD4 molecules on T helper cells
CD8 molecules on cytotoxic T cells
CD8+ cells target virus-infected cells, tumor cells, donor cells |
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Term
| A patient with an epilepsy diagnosis is pregnant with her first child. She is concerned that her child may also have seizures. What are the most common causes of seizures in children? In adults? In the elderly? |
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Definition
Children – genetic, infection, trauma, congenital, metabolic
Adults – tumors, trauma, stroke, infection
Elderly – stroke, tumor, trauma, metabolic, infection |
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Term
| The parents of a 5-year-old girl are concerned because their daughter has night terrors, sleepwalking, and enuresis (bedwetting). 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? |
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Definition
Stage N3 sleep
Use benzodiazepines |
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Term
| 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? |
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Definition
Negative symptoms: flat affect, lack of motivation
Positive: disorganized speech
Atypicals address both negative and positive symptoms.
Typical antipsychotics block D2 dopamine
Atypicals affect dopamine, serotonin, histamine, and alpha-adrenergic receptors |
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Term
| A 28-year-old G2P1 woman 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? |
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Definition
Oligohydramnios: placental insufficiency, bilateral renal agenesis, posterior urethral valves (males)
Polyhydramnios: esophageal/duodenal atresia, anencephaly
Potter syndrome: Pulmonary hypoplasia, oligohydramnios, twisted skin (excessive, wrinkled skin), twisted face (facial deformities), extremities deformities, renal agenesis |
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Term
| 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 syndrome. Describe how this syndrome develops. |
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Definition
Uncorrected VSD, ASD, PDA
Increased right heart pressures -> progressive pulmonary HTN
Flow reveral -> right-to-left shut -> cyanosis |
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Term
| A 42-year-old obese man presents with a complaint of severe pain in his right knee. He believes he injured it while dancing at his cousin’s wedding last night. You suspect gout. How would you differentiate between gout and pseudogout upon exam of synovial fluid aspirate? |
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Definition
Gout: uric acid crystals, needle-shaped, negatively birefringent
Pseudogout: calcium pyrophosphate crystals, rhomboid, positively birefringent |
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Term
| What nutrient deficiency is associated with spooning of the nails (koilonychia)? |
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Definition
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Term
| One of the potential complications of a preterm birth (delivery prior to 34 weeks gestational age) is neonatal respiratory distress syndrome (RDS). The main defect with neonatal RDS is a surfactant deficiency. How does a surfactant deficiency cause hypoxia? Which lung cells secrete surfactant? What treatment can be given to the mother prior to delivery of a preterm neonate to help prevent neonatal RDS? |
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Definition
Surfactant secreted by type II pneumocytes prevents collapse of the terminal air-spaces in the alveoli
Corticosteroids mature the type II pneumocytes |
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Term
| What are the most common viral causes of myocarditis? |
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Definition
Coxsackie virus A and B
Echovirus
Influenza
HIV
CMV |
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Term
| A 12-year-old boy 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? |
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Definition
Diabetic ketoacidosis
Kussmaul’s breathing
Acetone
Acetone and acetoacetate |
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Term
| 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 is the name for these X-ray findings? What other Mycobacteria species cause pulmonary disease? What are the potential extrapulmonary manifestations of Mycobacterium tuberculosis? |
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Definition
Ghon complex
Mycobacteria kansasii
Mycobacteria avium
Pott’s disease, parenchyma tuberculoma, meningitis, lymphadenitis, renal, GI manifestations |
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Term
| 5α-reductase deficiency leads to what physical findings (internal and external) in a man? |
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Definition
Ambiguous genitalia until puberty
At puberty: external genitalia develops, secondary sex characteristics
Internal genitalia are normal |
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Term
| A 35-year-old G1P0 has been hospitalized for observation of vaginal bleeding from a placental abruption. Her most recent labs represent an increase in bleeding time (BT), prothrombin time (PT) and partial thromboplastin time (PTT). You are concerned this patient might be at risk for disseminated intravascular coagulation (DIC). What is this patient’s risk factor for having DIC? What additional risk factors and lab findings are associated with DIC? |
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Definition
This patient: pregnancy (placental abruption)
“STOP Making Thrombi”: Sepsis, trauma, obstetric complications, pancreatitis, malignancy, transfusion |
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Term
| A patient of yours with recent complaints of weakness, pallor, craving for ice chips and tachycardia has a history of chronic hemorrhoids. What do you immediately suspect is the cause of this patient’s anemia and how do you treat it? |
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Definition
Pica, caused by iron deficiency anemia
Iron replacement, colonoscopy to evaluate |
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Term
| 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? |
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Definition
Yes, no cross-reactivity
Penicillin allergic patients, those with renal insufficiency
Gram negative rods |
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Term
| 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? |
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Definition
Thymic aplasia and parathyroid aplasia
3rd and 4th brachial pouches don’t develop
Get tetany (hypocalcemia), recurrent infections (T-cell deficiency)
Cleft palate, abnormal facial features, congenital defects of heart and great vessels |
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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 4: post-marketing surveillance |
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Term
| A 43-year-old man 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? |
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Definition
LMN lesion
Idiopathic, AIDS, Lyme, HSV, Sarcoidosis, Tumors, Diabetes |
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Term
| How is the body affected by a prolonged stay in space at zero gravity? |
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Definition
| Decrease in blood volume, RBC mass, muscle strength and work capacity, maximum cardiac output, loss of bone mass |
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Term
| A 32-year-old man is in the hospital for a minor vehicle crash. Overnight, you are called by the nurse because 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 antagonists should be used to treat this patient? |
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Definition
Patient has adrenal pheochromocytoma
Give phenoxybenzamine or phentolamine |
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Term
| What are the important functions of vitamin C? |
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Definition
| Facilitates iron absorption, hydroxylation of proline and lysine in collagen synthesis, conversion of dopamine into NE |
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Term
| A 35-year-old white woman presents with a dull ache in her jaw that is made worse by chewing. She states that this pain corresponds to her recent promotion and increase in responsibilities. What is the most likely diagnosis? |
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Definition
TMJ syndrome
Young femaile in 3rd or 4th decade, 2nd most common cause of facial pain, commonly exacerbated by stressful life events |
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Term
| A 59-year-old man with a 50-pack-year history sees you for management of his COPD. What is the clinical definition of chronic bronchitis? |
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Definition
| Productive cause for 3 months, at least 2 years |
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Term
| A central line is often placed in the subclavian vein to administer fluids and medications or to measure central venous pressure. What landmarks are used when placing a subclavian central line? |
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Definition
| Thumb on middle third of clavicle, index finger on jugular notch |
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Term
| What landmarks are used when placing an internal jugular central venous catheter? |
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Definition
| Sternal and clavicular heads of the SCM, aim needle at ipsilateral needle |
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Term
| You are educating the parents of an 8-month-old boy 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? |
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Definition
In male: gubernaculum
In female: Ovarian ligament, round ligament |
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Term
| A 50-year-old man crashes on a motorcycle on the highway and sustains a right anterior hip dislocation and knee trauma. Now he cannot adduct his hip or plantar flex on that side. Which nerves are injured? |
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Definition
| Obturator nerve, tibial nerve |
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Term
| 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? |
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Definition
| Increased plasma, markedly increased RBC mass, normal O2 saturation, low epo |
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Term
| A 55 year-old patient is admitted for IV fluid resuscitation secondary to diarrhea. He also has gastric reflux and a peptic ulcer, which even prescription proton pump inhibitors cannot control. What drugs and endogenous hormones regulate the secretion of gastric acid? |
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Definition
PPI, H2 blockers, Antimuscarinic drugs, somatostatin analogues
Stimulation: histamine, gastrin, acetylcholine
Inhibition: prostaglandins, somatostatin, secretin, GIP |
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Term
| A 55-year-old woman 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? |
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Definition
Bactrim
SMX: inhibits dihydropteroate synthetase
Trimethoprim: inhibits dihydrofolate reductase
Bacteriostatic
Methotrexate acts in same manner as trimethoprim |
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Term
| A 22-year-old woman 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? |
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Definition
IgG and C3b are opsonins
C5a: neutrophil chemotaxis
MAC: C5b, C6, C7, C8, C9 |
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Term
| In your own words, describe what type I error is. |
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Definition
| Study shows difference or effect, but no effect exists |
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Term
| An 18-year-old woman 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? |
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Definition
Absence: Ethosuximide, valproic acid
Status epilepticus: Acute: benzodiazepines
Prophylaxis: Phenytoin |
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Term
| The dorsal root ganglion is considered gray matter within the spinal cord. From what embryological derivative are the dorsal root ganglia derived? |
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Definition
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Term
| 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? |
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Definition
Digoxin is positive inotrope
Stopping decreases CO
Dyspnea: blood backed up into LA and pulmonary vasculature; pulmonary edema causes dyspnea |
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Term
| What is the composition of a nucleosome? Which histone ties nucleosomes together? |
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Definition
Histone core: 8 histone proteins, H2A, H2B, H3, and H4
Histone H1 ties nucleosomes together |
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