Term
| 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? |
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Definition
| Rule out ectopic pregnancy (child-bearing age) |
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Term
| A 35-year-old woman is being treated with leuprolide for infertility issues. Her father is also being treated with leuprolide for prostate cancer. Describe how variations in administration of leuprolide can modify its effects and, therefore, usage. |
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Definition
Leuprolide: synthetic analog of GnRH
Pulsatile: promotes production of FSH, stimulates ovaries, stimulates follicle development
Continuous: suppresses LH and FSH, reduce testosterone, slow growth of prostate cancer |
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Term
| What are omega-3 fatty acids, and what are their current clinical applications? |
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Definition
Polyunsaturated fatty acids, double bond at the 3rd carbon, present in fish oils/flaxseed oil
Eicosapentaenoic acid (EPA)
Docosahexaenoic acid (DHA)
alpha-Linolenic acid
Treatment of hypertriglyceridemia
Decrease arrhythmias in heart disease
Nerve/eye development in utero
Improving inflammation (RA) |
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Term
| Your patient is experiencing bloody diarrhea. What are bacteria that can cause bloody diarrhea? Given the different bacterial causes of bloody diarrhea, how might MacConkey’s agar help you identify the specific bacteria? |
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Definition
Campylobacter
Salmonella
Shigella
EHEC
EIEC
Yersinia
Entamoeba histolytica
C. diff
MacConkey’s agar identifies lactose fermenters:
Citrobacter, Serratia, Klebsiella, E. coli, Enterobacter |
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Term
Which antibiotics fit each of the following descriptions?
1. Treatment for Gram (-) rods in patients with renal insufficiency
2. ”Big gun” antibiotic (effective against Gram (+) cocci, Gram (-) rods, and anaerobes
3. Prophylaxis in AIDS patients against P. jirovecii pneumonia
4. Used as solo prophylaxis against TB
5. Prophylaxis for those exposed to someone with meningococcal meningitis |
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Definition
1. Aztreonam
2. Imipenem/Cilastatin or Meropenem
3. TMP-SMX
4. Isoniazid
5. Ciprofloxacin or rifampin |
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Term
| You are performing a well-child examination on a 4-year-old girl. The patient was recently adopted after being removed from the biological mother for abandonment. What changes might you see in your evaluation? What are the effects seen in an infant when there is long-term deprivation of affection? |
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Definition
Look for:
Poor care
Neglect
Depression
Malnutrition
Short stature
Low weight
Dental caries
Skin infections
Infant:
Poor muscle tone
Poor language skills
Poor socialization skills
Lack of eye contact
Weight loss
Failure to thrive |
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Term
| A 43-year-old male coal miner complains of a single, non-healing lesion on his right hand. Coal miners are at increased risk of skin cancer because of their exposure to arsenic. What type of skin cancer is associated with this exposure? |
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Definition
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Term
| A 27-year-old pregnant woman, G2P1, develops lower abdominal pain and vaginal bleeding in her 24th week of gestation. An ultrasound reveals a partial detachment of the placenta from the uterine wall. What is this condition called? This patient is at high risk for developing disseminated intravascular coagulation (DIC). What are the common causes of DIC? What is the primary mechanism of DIC? |
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Definition
Placental abruption (Abruptio placentae)
STOP Making Thrombi
Sepsis, Trauma, Obstetric complications, Pancreatitis, Malignancy, Transfusion
Widespread activation of clotting -> Consumption of clotting factors -> Excessive bleeding |
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Term
| What important intracellular proteins are common to both the extrinsic and intrinsic apoptotic pathways? |
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Definition
| Caspases: cysteine proteases that cleave after aspartic acid |
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Term
| A 60-year-old man who has avoided routine prevention is experiencing worsening urinary symptoms. He states that he has trouble starting a urinary stream and he has to wake sometimes up to 5 times a night to urinate. Upon digital rectal exam you notice a symmetric enlargement of the lateral and middle lobes of the prostate. An elevated blood pressure of 146/96 is also noted. Which adrenergic antagonists can be used to treat hypertension as well as urinary retention in patients with benign prostatic hyperplasia (BPH)? What is the difference between the prostate exam findings in BPH versus adenocarcinoma of the prostate? |
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Definition
Alpha-1 antagonists: “-zosins”
Terazosin
Prazosin
Doxazosin
BPH: symmetric, smooth, enlarged
Adenocarcinoma of the prostate: asymmetric, hard nodule on the prostate |
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Term
| A 28-year-old man known as the “elastic-skinned man” at the circus visits your clinic for a check-up. What are the features of Ehlers-Danlos syndrome? |
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Definition
Type III collagen defect
Hyperextensible skin
Tendency to bleed/bruise easily
Hypermobile joints |
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Term
| A type 1 diabetic patient presents to the emergency room in distress. A third year resident checks the patient’s arterial pH; the pH is 7.3 and the patient’s pCO2 is 38 mmHg. What are the common causes of metabolic acidosis with an elevated anion gap? |
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Definition
MUD PILES
Methanol
Uremia
DKA
Paraldehyde
Iron tablets/isoniazid
Lactic acidosis
Ethylene glycol
Salicylates |
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Term
| What is BNP, and how is it useful in cases of heart failure? |
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Definition
B-type natriuretic peptide: stored in ventricular myocardium, released when myocytes excessively stretched
High BNP helps confirms diagnosis of heart failure |
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Term
| A 36-year-old woman has had multiple syncopal episodes recently and after her initial work-up, there is some concern for a cardiac tumor. What is the most common primary cardiac tumor in adults? |
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Definition
Adults: Cardiac myxoma in left atrium
Children: Rhabdomyoma |
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Term
| A 1-year-old boy is brought to the ER for seizure activity. The seizure was quickly identified as being attributed to severe hypoglycemia. After stabilizing the seizure activity, the initial laboratory work reveals a metabolic acidosis. The patient’s exam reveals hepatomegaly. You think this patient might have a glycogen storage disease (GSD). What GSD is most consistent with this clinical picture? What is the difference between Cori disease (GSD-type III) and Von Gierke disease (GSD-type I)? |
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Definition
GSD: Von Gierke Disease (Type 1)
Deficient in glucose-6-phosphatase
No effective gluconeogenesis/glycogenolysis
Severe fasting hypoglycemia
Lactic acidosis
Seizures
Cori: Milder form of Von Gierke; capable of gluconeogenesis, hypoglycemia is less severe, no lactic acidosis. No hepatomegaly, normal lactose
Von Gierke: high lactose, hepatomegaly |
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Term
| A 43-year-old man complains of fatigue and a petechial rash. Laboratory evaluation reveals a normocytic, normochromic anemia. What are the causes of normocytic, normochromic anemia? |
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Definition
Nonhemolytic anemia:
Anemia of chronic disease
Aplastic anemia
Kidney disease
Hemolytic anemia:
Intravascular: mechanical destruction
Extravascular: autoimmune diseases, hereditary diseases |
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Term
What breast pathology fits the following description?
1. Most common breast tumor in women under 25
2. Most common breast mass in postmenopausal women
3. Most common breast mass in premenopausal women
4. Most common form of breast cancer |
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Definition
1. Most common breast tumor in women under 25: Fibroadenoma
2. Most common breast mass in postmenopausal women: Invasive ductal carcinoma
3. Most common breast mass in premenopausal women: Fibrocystic change
4. Most common form of breast cancer: Invasive ductal carcinoma |
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Term
| How can a skull fracture at the base of the brain lead to pulsating exophthalmos (protrusion of the eye)? |
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Definition
| Torn ICA in cavernous sinus -> high blood pressure in sinus -> blood fills the ophthalmic vein and orbit -> exophthalmos which pulses |
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Term
| A 25-year-old man is evaluated in the clinic for red, swollen, and painful right wrist and left knee joint. During the exam, the patient brags about his sexual conquests. What sexually-transmitted organism can cause osteomyelitis as well as this patient’s septic arthritis? |
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Definition
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Term
Which respiratory infectious agents fit the following descriptions?
1. Common cause of pneumonia in immunocompromised patients
2. Most common cause of atypical/walking pneumonia
3. Common causative agent for pneumonia in alcoholics
4. Can cause an interstitial pneumonia in bird handlers
5. Often the cause of pneumonia in a patient with a history of exposure to bats and bat droppings
6. Fungal cause of pneumonia in a patient who has recently visited Southern California, New Mexico, or West Texas |
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Definition
1. Common cause of pneumonia in immunocompromised patients: Staphylococcus, enteric Gram (-) rods, fungi, Pneumocystis jirovecii, viruses
2. Most common cause of atypical/walking pneumonia: RSV, Adenoviruses, Chlamydia, Mycoplasma, Legionella
3. Common causative agent for pneumonia in alcoholics: S. pneumoniae, Klebsiella, Staphylococcus, Anaerobes (aspiration pneumonia)
4. Can cause an interstitial pneumonia in bird handlers: Chlamydophila psittaci
5. Often the cause of pneumonia in a patient with a history of exposure to bats and bat droppings: Histoplasmosis
6. Fungal cause of pneumonia in a patient who has recently visited Southern California, New Mexico, or West Texas: Coccidioides |
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Term
| A 60-year-old man with a family history of Parkinson disease is concerned that he may be in the early stages of the disease. What are some of the signs and symptoms of Parkinson disease? |
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Definition
| TRAP: tremor, rigidity, akinesia, postural instability |
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Term
| A child in India is brought to the doctor with symptoms of muscle weakness, malaise, headache, fever, and hyporeflexia. For the past few weeks he had been swimming in a water way known to contain sewage. You think this boy has contracted an organism via the fecal-oral route. What area of the body is this organism attacking to give the neurologic symptoms seen? |
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Definition
| Poliovirus: replicates in oropharynx, spreads to CNS, destruction of cells in anterior horn of the spinal cord |
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Term
| 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 using protein electrophoresis. How does the emphysema caused by smoking differ from the emphysema caused by α1-antitrypsin deficiency? |
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Definition
Alpha1-antitrypsin deficiency: panacinar destruction
Smoking: centriacinar emphysema |
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Term
| Atropine should be avoided in men with BPH. In which patients can atropine be used for the treatment of which conditions? |
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Definition
Cycloplegia and mydriasis
Decrease the following: Airway secretions, gastric acid secretion, gut motility, urinary urgency |
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Term
| You have just received the labs back on a patient who was evaluated for pronounced fatigue, constipation and weight gain. Her lab profile appears normal, except her thyroid stimulating hormone (TSH) is elevated. You decide to start her on levothyroxine for hypothyroidism. You should wait for approximately 6 weeks to have the patient redraw her TSH because of the long half-life of levothyroxine. How many half-lives does it take for a drug infused at a constant rate to reach 94% of steady state? What variables determine the half-life of a drug? |
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Definition
4-5 half lives to reach steady state
4 to reach 94%
Volume of distribution and clearance affect half life |
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Term
| A 15-year-old boy is considering becoming vegetarian and wants more information from you about how to get enough protein. What are the essential amino acids? |
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Definition
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Term
| What are the 3 endogenous androgens, in order from the most potent to the least potent? |
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Definition
| DHT, Testosterone, Androstenedione |
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Term
| What does the Eustachian (auditory) tube connect? What is its purpose? What drug is commonly prescribed for Eustachian tube dysfunction? |
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Definition
Middle ear to nasopharynx, equalizes pressure in the middle ear
Use intranasal steroids |
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Term
| A 34-year-old woman is being evaluated for multiple kidney stones, persistent nausea, and depression. Routine labs reveal hypercalcemia; and an ultrasound of the anterior neck reveals a mass near the lower left lobe of the thyroid. What are the three main ways that PTH increases serum calcium levels (directly and indirectly)? |
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Definition
PTH increases bone resorption of Ca and phosphate
Reabsorption of Ca in the distal convoluted tubule
Vitamin D production, increases absorption of Ca in the intestine |
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Term
| A 5-year-old girl undergoes genetic testing to try to determine if there is an explanation for her heart murmur and mental retardation. On appearance the patient has “elfin” facies, and she has a friendly demeanor. What syndrome and corresponding chromosomal abnormality do you suspect this patient might have? What lab abnormality can be seen with this syndrome? |
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Definition
Williams syndrome
Congenital microdeletion of long arm of chromosome 7, elastin affected
See hypercalcemia: increased sensitivity to vitamin D |
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Term
| A 40-year-old patient with cholelithiasis is being prepped for a cholecystectomy. What risk factors are associated with cholesterol gallstones? What risk factors are associated with pigment gallstones? |
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Definition
Cholesterol: obesity, Chron’s, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, Native American origin
Fat Fertile Female Forty
Pigmented: Chronic hemolysis, alcoholic cirrhosis, advanced age, biliary infection. Black – hemolysis; brown - infection |
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Term
What breast pathology fits each of the following descriptions?
1. Small, mobile, firm mass with sharp edges in 24-year-old woman
2. Histologic “leaf-like appearance”
3. Commonly presents with nipple discharge
4. Eczematous patches on nipple
5. Multiple bilateral fluid-filled lesions with diffuse, cyclical breast pain
6. Firm, fibrous mass in a 55-year-old woman |
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Definition
1. Small, mobile, firm mass with sharp edges in 24-year-old woman: Fibroadenoma (benign)
2. Histologic “leaf-like appearance”: Phyllodes tumor (benign)
3. Commonly presents with nipple discharge: Intraductal papilloma (benign)
4. Eczematous patches on nipple: Paget's disease
5. Multiple bilateral fluid-filled lesions with diffuse, cyclical breast pain: Fibrocystic change
6. Firm, fibrous mass in a 55-year-old woman: Invasive ductal carcinoma |
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Term
| For what conditions is hyperbaric oxygen therapy particularly helpful? |
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Definition
Decompression sickness
Severe CO poisoning
Arterial gas emboli
Gas gangrene
Osteomyelitis
MI |
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Term
Given each of the following clinical presentations, complete the appropriate protozoal infection and pharmacologic agent used to treat the infection.
1. A 25-year-old man with cardiomyopathy after returning from South America
2. A 44-year-old HIV patient with a brain abscess
3. A 20-year-old man with a liver abscess
4. A 24-year-old woman with a greenish vaginal discharge
5. A 34-year-old hiker with foul-smelling diarrhea |
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Definition
1. A 25-year-old man with cardiomyopathy after returning from South America: Chagas' disease, Trypanasoma cruzi, Nifurtimox
2. A 44-year-old HIV patient with a brain abscess: Toxoplasma gondii, Sulfadiazine+pyrimethamine
3. A 20-year-old man with a liver abscess: Entamoeba histolytica, metronidazole, iodoquinol
4. A 24-year-old woman with a greenish vaginal discharge: Trichomonas vaginalis, metronidazole
5. A 34-year-old hiker with foul-smelling diarrhea: Giardia, metronidazole |
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Term
| A 3-year-old child with a history of febrile seizures is in your office because she has had a fever of 102°F for 3 days despite scheduled acetaminophen use every 6 hours. The child is otherwise asymptomatic and has not had a seizure with this episode. You feel this might be a viral illness, but given the patient’s history of febrile seizures, you have the patient follow up. The following day your patient has a red macular rash over her trunk, but the fever has improved. Does this patient have roseola or rubeola? Roseola is commonly called sixth disease; what viral illness causes fifth disease? |
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Definition
Roseola causes high fevers that can cause seizures
Roseola – sixth disease – HHV6
Erythema infectiousum - Fifth disease – Parvovirus B19, “slapped-cheek rash” |
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Term
| A 27-year-old man is brought to the ER after having been struck on the side of the head by a softball. He was briefly “knocked out” but regained consciousness for several minutes before losing consciousness again. Non-contrast CT of the head reveals a lens-shaped radiopaque lesion in the left temporal region. What vessel was ruptured in this injury? |
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Definition
| Rupture of middle meningeal artery causing epidural hematoma |
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Term
| The part of the brain responsible for attention and alertness has been implicated in schizophrenia, PTSD, Parkinson disease, narcolepsy, progressive supranuclear palsy, depression, and ADHD. What part of the brain is this? (Hint: Lesion results in coma) |
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Definition
| Reticular activating system (midbrain) |
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Term
| An 18-year-old woman has seasonal allergies. She is tired of having her eyes water and her nose run all the time during the spring. Which cell type is responsible for her symptoms, and what drug inhibits these cells’ action? What WBCs descend from the myeloblast (granulocyte) lineage? |
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Definition
Mast cells releasing IgE
Cromolyn sodium: stabilizes cell membrane, stops degranulation
Myeloblasts give rise to Neutrophils, Eosinophils, and Basophils
Mast cells similar to basophils, but come from different cell line |
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Term
| Does a partial agonist always have a lower maximal efficacy than a full agonist? Does a partial agonist always have a lower potency than a full agonist? |
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Definition
Partial agonist always has lower maximal efficacy than full agonist.
Partial agonist can have lower OR higher potency than full agonist, independent of maximal efficacy |
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Term
| An 11-year-old boy is rushed into the ER from a farming community. His pupils are constricted and he is having difficulty breathing because of excess airway secretions and bronchospasm. He also lost control of his bowels and bladder. What is the likely explanation for these symptoms? Name five or more drugs that inhibit acetylcholinesterase. What is the clinical application for each? |
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Definition
Cholinesterase inhibitor poisoning caused by organophosphates
Neostigmine: postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of NMJ blockade (postoperative)
Pyridostigmine: Myasthenia gravis (long acting); does not penetrate CNS
Edrophonium: Diagnosis of myasthenia gravis (extremely short acting)
Physostigmine: Glaucoma (crosses blood-brain barrier -> CNS) and atropine overdose
Echothiophate: Glaucoma (open angle)
Donepezil, Rivastigmine, Galantamine: Alzheimer’s disease |
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Term
| A 30-year-old man is undergoing the Schilling test to investigate his B12 deficiency. What must be present in the enteric system in order for vitamin B12 to be absorbed? |
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Definition
| Intrinsic factor produced by parietal cells of stomach, terminal ileum |
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Term
What is the site of action of each of the following diuretics?
1. Thiazide diuretics
2. Loop diuretics
3. Carbonic anhydrase inhibitors
4. Osmotic diuretics
5. Potassium-sparing diuretics |
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Definition
1. Thiazide diuretics: Distal convoluted tubule
2. Loop diuretics: Ascending loop of Henle
3. Carbonic anhydrase inhibitors: Proximal convoluted tubule
4. Osmotic diuretics: Descending loop of Henle, Proximal convoluted tubule, mannitol acts on collecting tubule
5. Potassium-sparing diuretics: Collecting tubule |
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Term
| How is thyroid hormone made and stored? |
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Definition
Epithelial cells bring in I (using Na/I co-transporter)
Iodide transported into follicle, oxidized to I2
Iodine bound to tyrosine residues on thyroglobulin (organification)
Monoiodotyrosine (MIT), Diiodotyrosine (DIT), linked to make T3 and T4
T3 and T4 stored in colloid, attached to thyroglobulin
TSH stimulates the thyroid
Epithelial cells endocytose colloid
Lysosomal enzymes break down thyroglobulin, leaving T3 and T4
Thyroid hormone released by exocytosis |
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Term
| A patient has a hypertensive episode while in the hospital. The intern on call orders hydralazine. The intern is later called about the same patient, who now has tachycardia due to the baroreceptor response to the lowered blood pressure. Where are the main arterial baroreceptors located? Which nerves transmit information from these baroreceptors? |
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Definition
Arterial baroreceptors located in the aortic arch, carotid sinus
Vagus nerve from aortic arch to medulla (about high pressure)
Glossopharyngeal nerve from carotid sinus to solitary nucleus of the medulla (about high or low bp) |
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Term
| A 36-year-old man is brought to the ER by his wife because of altered mental status. His liver is markedly enlarged, he has spider nevi on the upper chest, and he demonstrates asterixis. His wife reports that he is a long-time heavy drinker. Lab studies reveal hypoglycemia. What is the likely cause of his hypoglycemia? |
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Definition
Ethanol hypoglycemia ->hepatic fatty change
Shunt of pyruvate to lactate, oxaloacetate to malate
Inhibits gluconeogenesis
Overproduction of lactate leading to acidosis
Depletion of oxaloacetate which shuts down the TCA cycle, shunting aCoA into ketone production.
Overproduction of malate increases NADPH and fatty acid synthesis |
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