Term
| Describe the manner in which iodide is taken into thyroid follicular cells as well as the role of thyroid peroxidase. Additionally, in what disease are antibodies against thyroid peroxidase (anti-TPO antibodies) generated? |
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Definition
Iodide enters follicular cell via a Na+/I- symporter. Thyroid peroxidase oxidizes iodide to iodine, which is bound to thyroglobulin “organification.” T4 – primary thyroid hormone
anti-TPO: Hashimoto’s (primary hypothyroidism) |
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Term
| 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? |
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Definition
| Chronic bronchitis: hypertrophy of mucus secreting glands: gland depth/total bronchial wall thickness |
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Term
| What is the mechanism of action and clinical use for varenicline? |
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Definition
| Partial agonist at nicotinic ACh receptors; used for smoking cessation |
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Term
| Which branchial arch has derivatives that begin with “S”? What are these derivatives? |
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Definition
Branchial arch 2: derived from mesoderm
Stapes
Styloid process
Lesser horn of hyoid
Stylohyoid ligament
Cranial nerve VII
Stapedius
Stylohyoid
Posterior belly of digastric muscles |
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Term
| 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? |
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Definition
Umbilical vein (becomes ligamentum teres)
Umbilical arteries
Ductus arteriosus
Ductus venosus
Foramen ovale |
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Term
| 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? |
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Definition
Paclitaxol also used for breast cancer (stabilize microtubules)
SERM: tamoxifen, raloxifen
Treat osteoporosis
Tamoxifen causes endometriosis |
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Term
| 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? |
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Definition
Stratum corneum
Lucidum
Granulosum
Spinosum
Basalis
Bleeding when scales scraped off – psoriasis |
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Term
| A 15-year-old girl 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? |
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Definition
| Hyperglycemia, ketones in blood and urine, anion gap metabolic acidosis, leukocytosis, hyperkalmeia that then goes to hypokalemia in the serum |
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Term
| A 3-year-old patient who presented with splenomegaly and jaundice undergoes a splenectomy after being diagnosed with hereditary spherocytosis. What encapsulated organisms are patients susceptible to after a splenectomy? What lab findings would you expect in this patient after the splenectomy? |
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Definition
E. coli
S. pneuomoniae
K. pneumoniae
H. influenze
P. aeruginosa
N. meningitidis
C. neoformans
Howell-Jolly bodies |
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Term
| 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? |
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Definition
Zidovudine (AZT) causes megaloblastic anemia
Zidovudine and didanosine are NRTIs, compete for nucleotide binding at reverse transcriptase enzyme, terminate HIV DNA transcription
Ritonavir is a protease inhibitor: HIV polypeptides cannot be properly cleaved to make functional HIV proteins |
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Term
| 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? |
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Definition
Assess seriousness
Evaluate risk factors for completion
Recommend voluntary hospitalization
Involuntary hospitalization |
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Term
What neurotransmitter levels in the brain are either increased or decreased in the following diseases?
• Schizophrenia
• Parkinson disease
• Alzheimer disease
• Huntington disease |
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Definition
• Schizophrenia
- Increased dopamine
• Parkinson disease
- Decreased dopamine
- Increased serotonin
- Increased ACh
• Alzheimer disease
- Decreased ACh
• Huntington disease
- Decreased GABA
- Decreased ACh
- Increased dopamine |
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Term
| What organisms are particularly known for causing infective endocarditis? |
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Definition
S. aureus (30%)
Viridans strep (20-30%)
Enterococci (10%)
Coagulase-negative Staph (5 - 10%)
If nothing is growing out: HACEK organisms
- Haemophilus
- Actinobacillus
- Cardiobacterium
- Eikenella
- Kingella |
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Term
| A 23-year-old man is a victim of a motor vehicle collision. He suffered a traumatic brain injury and is in a coma. The attending surgeon tells the intern on ICU call to monitor the patient for the Cushing reaction. What is the Cushing reaction? |
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Definition
Increased intracranial pressure causes respiratory depression
Hypertension
Reflex bradycardia |
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Term
| In your own words, describe what type II error is. |
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Definition
| Stating no effect or difference when one actually exists |
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Term
| What arteries supply the adrenal glands? From what arteries do these arteries arise? |
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Definition
Inferior phrenic -> superior adrenal
Aorta (near SMA) -> Middle adrenal
Renal -> Inferior adrenal artery |
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Term
| An adult trauma patient begins to experience shortness of breath on day 3 of his hospital stay. The patient had an open reduction internal fixation of a right femur fracture. You are concerned the patient’s shortness of breath might be attributed to an embolus. The patient is certainly at risk for an embolus because of prolonged immobility. Why else might the patient be at risk for an embolus? What are the different types of emboli? |
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Definition
Risks: Immobility, long bone and pelvic fractures increase risk of fat emboli
Different types: fat, thromboembolus, septic, air, amniotic fluid embolus |
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Term
| How is cystic fibrosis diagnosed? |
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Definition
Sweat chloride test -> 60mEq/L on two or more occasions
Genetic testing for CFTR gene mutations
Nasal transepithelial chloride secretion |
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Term
| What medications are used in the treatment of the pulmonary component of cystic fibrosis? |
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Definition
| Give B2 agonists, DNaseI (dornase alfa), hypertonic ssaline, N-acetylcysteine, azithromycin, ibuprofen |
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Term
| A 35-year-old man 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? |
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Definition
Aminoglycoside
Mechanism – inhibits formation of the initiation complex, causing misreading of mRNA
Toxicity – nephrotoxic, ototoxic, tetratogenic |
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Term
| 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? |
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Definition
Charcot’s triad: dysarthria, intention tremor, nystagmus
Disorders: optic neuritis, internuclear ophthalmoplegia, hemiparesis, sensory disturbances, bowel or bladder incontinence |
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Term
| 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? |
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Definition
Anklyosing spondylitis
Other symptoms: Inflammation of the eye – uveitis, iritis; generalized fatigue, nausea
Is a seronegative spondyloarthropathies: Psoriatic arthritis, Ankylosing spondylitis, Inflammatory bowel disease, Reactive arthritis |
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Term
| A 24-year-old HIV-positive woman presents with lymphadenopathy of 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? |
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Definition
| Small lymphocytic lymphoma |
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Term
| A 7-year-old boy presents to the ER immediately after the parents found him eating his grandfather’s digoxin pills. What is the antidote for digoxin toxicity? |
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Definition
Digoxin immune fragments (Fab)
Normalize potassium, normalize magnesium, give lidocaine for arrythmias |
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Term
| A 53-year-old asthmatic man undergoes 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? |
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Definition
B2 receptors in the lungs
B2 blockage can cause bronchospasm in asthmatics
B1 selective: Acebutolol, Butaxolol, Esmolol, Atenolol, Metoprolol |
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Term
| 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? |
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Definition
Type IV collagen in basement membrane
Type I collagen: Bone, skin, tendons
Type II collagen: Cartilage |
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Term
| Patients with renal artery stenosis have elevated blood pressure. How does a decrease in renal artery pressure cause an increase in blood pressure? Other than renin secretion, what are the other endocrine functions of the kidney? |
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Definition
Renal artery pressure drops – juxtaglomerular cells secrete renin
Renin activates the renin angiotensin-aldosterone system
Renin cleaves angiotensinogen to angiotensin I, ACE converts angiotensin to angiotensin II
- Angiotensin II is a potent vasoconstrictor
- Angiotensin II stimulates secretion of aldosterone
Aldosterone causes kidneys to retain Na and H2O
Kidney:
- Make erythropoeitin
- Convert 25-OH Vitamin D to 1,25 – (OH)2 Vitamin D
- Target tissue for PTH |
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Term
| You are doing some missionary medicine in Mexico and encounter a patient that the attending describes as having “leonine facies.” The patient says that he looks this way because he used to eat armadillos. What organism has caused this patient’s condition, and where in the body does it inhabit? |
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Definition
| Mycobacterium leprae – skin and superficial nerves |
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Term
| 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? |
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Definition
Hepatic congestion
Increased CVP, increased resistance to portal flow |
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Term
Which lysosomal storage disease fits the following clinical feature?
- Peripheral neuropathy of hands and feet, angiokeratomas
- Corneal clouding + mental retardation
- No corneal clouding + mental retardation, Aggressive behavior
- Demyelinating disease affects peripheral nerves
- Sphingomyelin buildup
- Accumulation of galactocerebroside in the brain |
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Definition
- Peripheral neuropathy of hands and feet, angiokeratomas:Fabry disease
- Corneal clouding + mental retardation: Hurler Syndrome
- No corneal clouding + mental retardation, Aggressive behavior: Hunter Syndrome
- Demyelinating disease affects peripheral nerves: Metachromatic leukodystrophy
- Sphingomyelin buildup: Niemann-Pick disease
- Accumulation of galactocerebroside in the brain: Krabbe disease |
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Term
| The protein derived from what gene serves as a transcription factor for the development and function of regulatory T cells? |
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Definition
FOX P3 gene: found on X chromosome, Forkhead Box protein P3
Mutation causes “immune dysregulation, polyendocrinopathy, enteropathy, X-linked” IPEX syndrome |
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Term
| A 70-year-old patient is in the hospital suffering from right ventricular failure and respiratory distress. These have resulted from years of living with a stenotic mitral valve, which resulted from a streptococcal infection the patient had at a young age. The respiratory distress is in part due to pulmonary hypertension. What pulmonary artery pressures indicate pulmonary hypertension? |
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Definition
Normal: between 10-14
Htn: >= 25 mmHg at rest, >=35 mmHg during exercise |
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Term
| What are the symptoms of decompression sickness? |
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Definition
Pain in joints/muscles of legs and arms, neurologic symptoms (dizziness, paralysis, syncope)
The chokes (bubbles occluding pulmonary capillaries) |
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Term
| 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 flecks of mucus. What organism is most likely responsible in this case? |
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Definition
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Term
Describe the rash presentation (timing, description, location) associated with the following diseases.
- Rubella
- Varicella zoster
- HHV-6
- Parvovirus B19
- Coxsackievirus type A
- Streptococcus pyogenes |
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Definition
- Rubella: Rash begins at head, moves inferior
- Varicella zoster: Unilateral dermatomal rash; grouped vesicles on erythomatous base
- HHV-6: Macular rash over body; appears after several days of high fever
- Parvovirus B19: “Slapped cheek” facial rash; reticular, lace-like pattern
- Coxsackievirus type A: Vesicular rash on palms and soles; ulcers in oral mucosa
- Streptococcus pyogenes: Erythematous, sandpaper-like rash; fever and sore throat |
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Term
| What is the cause of Horner syndrome? What symptoms are seen in Horner syndrome? |
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Definition
Sympathectomy of the face
Ptosis
Miosis (constricted pupil)
Anhydrosis
Lesion of spinal cord above T1: pancoast tumor, Brown-Sequard syndrome, syringomyelia |
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Term
| Age-related changes in touch sensitivity are related to the number of sensory nerve endings lost. What is the difference between a Meissner corpuscle and a Pacinian corpuscle? |
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Definition
Meissner: glabrous skin; senses: position sense, dynamic fine touch, adapt quickly
Pacinian: deep skni layers, ligaments and joints, senses: vibration, pressure |
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Term
| 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? |
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Definition
| Increased urine hemosiderin; complement mediated RBC lysis |
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Term
Metastasis to the brain, liver, and bone commonly come from which locations?
- Brain
- Liver
- Bone |
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Definition
- Brain: Lung, breast, skin (melanoma), kidney (renal cell carcinoma), GI
- Liver: Colon, stomach, pancreas, breast, lung
- Bone: Prostate, thyroid, testes, breast, lung, kidney (renal cell carcinoma) |
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Term
| A 40-year-old woman 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? |
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Definition
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Term
| N-acetylcysteine is used to loosen mucus plugs associated with cystic fibrosis. What are the common pulmonary infections seen in cystic fibrosis? What are the other, extrapulmonary effects of mucus thickening? |
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Definition
Pseudomonas
Staph aureus
Pancreatic insufficiency |
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Term
A 36-year-old man is found to have an elevated blood pressure at the dentist’s office. Today, the patient’s blood pressure is 155/94 and urinalysis reveals hematuria and proteinuria. Further urine microscopic evaluation reveals RBC casts indicating nephritic syndrome. What nephritic syndromes are characteristic of the following clinical features and glomerular changes? How does nephritic syndrome differ from nephrotic syndrome?
1) Malar rash; Wire-loop appearance (light microscopy)
2) After acute gastroenteritis; Mesangial deposits of IgA (electron microscopy)
3) Hemoptysis; Crescent-moon shaped lesion (light microscopy)
4) Pediatric patient with recent infection; Enlarged, hypercellular glomeruli with neutrophils |
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Definition
1) SLE or MPGN
2)Berger disease
3)RPGN
4)Minimal change disease
Nephritic: inflammatory process
Nephrotic: massive proteinuria, hyperlipidemia, fatty casts, edema |
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Term
| What are Cheyne-Stokes respirations? |
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Definition
Repeating cycles:
Apnea and hypercapnia
Compensatory hyperventilation |
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Term
| 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 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? |
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Definition
Heavy smoker, intermittent claudication, superficial nodular phlebitis, Raynaud phenomenon, severe pain in the affected body part
- Treatment: quit smoking |
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Term
| A 45-year-old man with albinism is seeing you for the first time for a physical exam and to establish care. You know that an important aspect of this patient’s preventative care will be frequent skin cancer screenings. Why is this patient at higher risk for skin cancer? What are the congenital deficiencies that lead to a lack of melanin? |
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Definition
Lack of melanin
Congenital deficiencies: tyrosinase defect, defective tyrosinase transporter |
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