MODEL QS FOR FUTURE ALL INDIA PRE PG EXAM

Discussion in 'NEET 2013 All india Exam' started by Guest, Jan 25, 2010.

  1. Guest

    Guest Guest

    Weight base dosing for heparin
    Patients weight in KG infusing 80 units per kg as an IV bolus.

    What are the standard tests for determining the general effect of heparin on clotting?
    - Lee-White Coagulation Time
    - Whole blood activated partial thromboplastin time (WBAPTT)
    - Activated partial thromboplastin time aPTT

    Which test is most commonly used?
    Activated Partial Thromboplastin Time aPTT

    What is the typic INR goal?
    2.0-3.0, except in mechanical cardiac valve replacement when a higher number is needed.

    Can Heparin be given orally?
    NO!! it is not effective if given orally, it should be given by IV, IV infusion, Deep Subcut

    What are the molecules of the T cell transduction complex
    CD3

    Define VDJ recombination
    It’s the process by which B cell Ig heavy chain gene's (and T cell β chain gene's) V, D and J segments are randomly recombined and spliced to form the unique N terminal sequence or idiotype of the B and T receptors

    What is VJ recombination
    It’s the process by which the B cell light chain gene's (and T cell α chain gene's) V and J segments are randomly recombined and spliced to form a unique N terminal sequence or idiotype on the B and T cell receptors

    terminal deoxyribonucleotidyl transferase (Tdt)
    Inserts random bases (N-nucleotide addition without a DNA template) at the junctions of the V, D and J segments of Ig heavy chain and T cell receptor β chain. It is only active duting the formation of the Ig heavy chain in the B cell or the formation of both α and β chains of the T cell receptor, therefore it can be used as a marker for B and T cell maturation

    Does VDJ recombination always produce a functional protein?
    No. If it does not produce a functional protein from recombination of one of the gene alleles, it can try to make a functional protein from the complimnentary allele. If both attempts fail, apoptosis is induced. If a good protein is achieved, the other allele will shut down by allelic exclusion

    At what stage of gene expression are the variable and constant domains merged?
    They are spliced together at the RNA level
  2. Guest

    Guest Guest

    Name the antimicrobial agent whose major side effect is listed.
    • CN VIII damage (vestibulotoxic)
    Aminoglycosides

    Name the antimicrobial agent whose major side effect is listed.
    • Teratogenicity
    Metronidazole

    Name the antimicrobial agent whose major side effect is listed.
    • Cholestatic hepatitis
    Erythromycin

    Name the antimicrobial agent whose major side effect is listed.
    • Hemolytic anemia
    Nitrofurantoin
  3. Guest

    Guest Guest

    BURNS
    What are the major electrolytes affected during the hypovolemic stage?
    sodium and chloride

    What can imbalanced chloride cause?
    blisters and edema

    What occurs physiologically immediately post injury?
    vasocontriction occurs to compensate for the burn but only lasts 1-2 hours.
    -increased bp
    -increased hr
    -"stress response"
    -decreased UOP

    How do you treat acidosis in the burn patient?
    volume resuscitation

    How can dysrhythmias occur during the hypovolemic stage?
    Hyperkalemia occurs because cells are leaking K+ and this can eventually lead to V fib. Give Ca+ to stabilize the cell membranes to treat the arrhythmias
  4. Guest

    Guest Guest

    Name the antimicrobial agent whose major side effect is listed.
    • Dental staining in children
    Tetracycline

    Name the antimicrobial agent whose major side effect is listed.
    • Altered folate metabolism
    Trimethoprim

    Name the antimicrobial agent whose major side effect is listed.
    • Auditory toxicity
    Vancomycin

    Name the antimicrobial agent whose major side effect is listed.
    • Cartilage abnormalities
    Quinolones

    What are the two side effects of opioids to which the user will not develop tolerance?
    Constipation and miosis
  5. Guest

    Guest Guest

    Behçet’s syndrome (BS) is a chronic inflammatory disorder of unknown
    cause.
    Clinical Features
    ● Onset – Mean age 25–30 years.
    ● Sex – Equal distribution in Eastern Mediterranean countries, the Middle East, and East Asia. Females more commonly affected in Japan, Korea, and Western countries.
    ● Ulcers – Oral ulcers are the first and most prominent feature of BS. Genital and perianal ulcers also occur.
    ● Pathergy – Reflects neutrophil hyperreactivity and is highly specific for BS.
    ● Skin lesions – Erythema nodosum, pseudofolliculitis, papulopustular lesions, or acneform nodules can occur.
    ● Ocular inflammation – Typically anterior uveitis associated with a hypopyon, panuveitis with posterior chamber involvement and retinal vasculitis, and associated complications.
    ● Cerebral venous thrombosis – Patients usually present with symptoms of raised intracranial pressure: headache, visual obscurations, and papilledema

    ● Central nervous system (CNS) involvement – Aseptic meningitis or parenchymal lesions can result in focal or diffuse brain dysfunction. Focal or multifocal nervous system involvement reflects the predilection of BS for diencephalon, midbrain, and brainstem. Closely mimics multiple sclerosis.
    ● Deep venous thrombosis (DVT) – The most common large vascular lesion.
    ● Arterial complications – Stenoses, occlusions, and aneurysms occur in the systemic circulation or the pulmonary arterial bed. The risk of aneurysm rupture is high.
    ● Gastrointestinal (GI) – Symptoms include melena and abdominal pain. GI tract inflammation can mimic inflammatory bowel disease (IBD).
    ● Arthritis – Intermittent, symmetric oligoarthritis of the knees, ankles, hands, or wrists; arthralgia is also common.
    ● Epididymitis – Occurs in 5% of patients with BS.
  6. Guest

    Guest Guest

    Laboratory Features Behçet’s syndrome
    ● Acute-phase reactants – May be normal or may be increased, particularly in patients with large-vessel vasculitis.
    ● Human leukocyte antigen (HLA)-B51 – Associated with BS in areas of high prevalence and in patients with ocular disease.
    Diagnosis
    ● Pathergy – The sensitivity of the test is lower in Western countries than in Silk Road countries, but a positive test adds great support for the diagnosis of BS.
    ● Aphthosis – Suggests BS when found in association with other disorders associated with large vessel disease or acute CNS infarction.
    ● CNS symptoms – The clinical combination of stroke, aseptic meningitis with cerebrospinal fluid pleocytosis, and mucocutaneous lesions is highly suggestive of BS.
  7. Guest

    Guest Guest

    Hemophilia A (Factor VIII Deficiency)

    FVIII is a 320-kD glycoprotein that circulates in plasma as a stable complex with von Willebrand factor (vWF). Its function, when proteolytically activated by Xa or thrombin, is as a cofactor to accelerate the activation of X by factor IXa (FIXa). The genetic deficiency of FVIII is known as hemophilia A, and the incidence is 1:5000 live male births. The gene is located on the long arm of X chromosome at Xq28. Approximately 50% of persons with severe FVIII deficiency (<1% level) have an inversion mutation as the causative defect. Clotting factor is dosed in units of activity. One unit of FVIII per kg of body weight raises the plasma level of FVIII by approximately 2%. The half-life of FVIII is approximately 12 hours.
  8. Guest

    Guest Guest

    Which anticonvulsant is also used in the treatment of bipolar disorder and for migraine headaches?
    Valproic acid

    What antitubercular agent causes loss of red-green visual discrimination?
    Ethambutol

    Name the insulin preparation based on the peak effect and duration of action.
    • Peak, 8 to 16 hours; duration, 24 to 36 hours
    Ultralente

    Name the insulin preparation based on the peak effect and duration of action.
    • Peak, 0.5 to 3 hours; duration, 5 to 7 hours
    Regular insulin

    Name the insulin preparation based on the peak effect and duration of action.
    • Peak, 8 to 12 hours; duration, 18 to 24 hours
    Lente or NPH insulin (neutral protamine Hagedorn insulin)

    Name the insulin preparation based on the peak effect and duration of action.
    • Peak, 0.3 to 2 hours; duration, 3 to 4 hours
    Lispro insulin

    Is digoxin or digitoxin renally eliminated?
    Digoxin is renally eliminated; digitoxin is hepatically eliminated.

    What is the drug of choice for steroid-induced osteoporosis?
    Alendronate
  9. Guest

    Guest Guest

    Can Heparin be given intramuscularly?
    NO!! because it can produce hematomas, irritation, and pain.

    Heparin Injectios
    - do not aspirate before injection.
    - do not massage injection site.
    - If heparin in vial has solid at the bottom or is discolored do not use it.

    S/S of Internal Bleeding
    abdominal pain, swelling of abdomen, back pain, bloody/tarry stools, blood or cloudy urine, constipation, coughing up blood, dizziness, severe headaches, vomiting up blood or coffee ground substance.

    Patient Teaching for Anticoagulant Therapy:
    - need regular INR time or coagulation blood tests.
    - pressure should not be used to stop bleeding from cuts.
    - AVOID EATING EXCESSIVE AMOUNTS OF FOOD CONTAINING VITAMIN K.- tomatoes, onions, dark leafy greens, bananas, fish.
    - Avoid alcohol

    What are the first signs of overdose from phenobarbitals?
    Nystagmus and ataxia

    How are lipid solubility and potency related for inhaled anesthetics? How do they affect onset and recovery?
    Inhaled anesthetics with low lipid solubility have low potency (directly related), so they have rapid induction and rapid recovery; vice versa for drugs with high lipid solubility.

    What α1-agonist, not inactivated by catechol-O-methyl transferase (COMT), is used as a decongestant and for treatment of paroxysmal atrial tachycardia?
    Phenylephrine

    Which laxative is used in the treatment of hepatic encephalopathy ?
    Lactulose

    What does AMYOTROPHY mean?
    Loss of muscle - the LMN involvement in ALS

    What does LATERAL mean?
    Involvement of the LATERAL corticospinal tracts (UMN) in ALS

    What does SCLEROSIS refer to?
    The secondary gliosis from UMN axon loss in the Lat corticospinal tracts

    So what distinguishes ALS?
    BOTH umn and lmn involvement

    In what race is ALS esp UNcommon?
    Blacks

    What is the peak age of onset of ALS?
    55-75 yrs old

    What type of ALS is esp underdiagnosed in elderly?
    Progressive bulbar palsy - PBP type

    What is the incidence of ALS per 100,000 in the USA? Prevalence?
    Incidence is 3-5/100000
    Prevalence 6-8/100000

    How many years do patients with ALS usually survive?
    Only 3-5 yrs

    What are the rates of progression and patterns of onset of ALS like in general?
    Highly variable

    What are 3 'patterns' of onset of ALS? How does each differ in how its manifested??
    -LMN onset - spinal mm atrophy
    -UMN onset - primary lateral sclerosis
    -Bulbar onset - progressive bulbar palsy
  10. Guest

    Guest Guest

    Are hydrolysis, oxidation, and reduction phase I or II biotransformations?
    Phase I

    What β-blocker is also an α-blocker?
    Labetalol

    What agent is used IM to treat acute dystonias?
    Diphenhydramine

    True or false? Anaerobes are resistant to the effects of aminoglycosides.
    True. Aminoglycosides use O 2-dependent uptake and therefore are ineffective for treatment of anaerobic infections.

    What two β-blockers decrease serum lipids?
    Acebutolol and Pindolol

    Promatine Sulfate
    basic alkaline protein acts as heparin antagonist to reverse heparin action, can also serve as an anticoagulant.

    Protamine Sulfate USE
    treat heparin overdose, also used after surgery to neutralize effects of heparin given during extracorporeal circulation on heart/lung machine.

    Protamine Sulfate ADVERSE REACTIONS
    bradycardia, lassitude (weariness), sudden drop in blood pressure, flushing of face/neck, feeling of warmth.

    Overdose of Protamine Sulfate
    produces anticoagulant effects.

    How is Protamine Sulfate given?
    slowly by IV injection over 1-3 min in doses of 50 mg during a ten minute period
  11. Guest

    Guest Guest

    Generic drug name
    (Demerol
    Meperidine

    Drug trade name
    (Meperidine)
    DEMEROL

    CLASS
    (DEMEROL)
    Opiate Analgesic

    ACTIONS / PHARMACODYNAMICS
    (DEMEROL)
    1. Depresses pain impulse transmission at the spinal level
    2. Antagonizes opioid receptors

    INDICATIONS
    (DEMEROL)
    1. Moderate to severe pain

    CONTRAINDICATIONS
    (DEMEROL)
    1. Allergy
    2. Addiction
  12. Guest

    Guest Guest

    ADULT DOSAGE
    (DEMEROL)
    PO/SQ/IM: 50-150 mg q 3-4 hours, decrease dose if given IV

    ROUTE
    (DEMEROL)
    IV / SQ / IM / PO

    CHILD DOSAGE
    (DEMEROL)
    PO/SQ/IM: 1 mg/kg q 3-4 hours

    SIDE EFFECTS
    (DEMEROL)
    1. Increased intracranial pressure
    2. Drowsiness, dizziness
    3. Bradycardia, hypotension
    4. Respiratory depression

    PRECAUTIONS
    (DEMEROL)
    1. Pregnancy, Lactation
    2. Respiratory depression
    3. Hepatic disease
    4. Renal disease

    PHARMACOKINETICS
    (DEMEROL)
    1. Distributed into extracellular fluid
    2. Excreted in the urine and breast milk
    3. SQ/IM: Onset 10 minutes, duration 2-4 hours
    4. IV: Onset 5 minutes, duration 2 hours
  13. Guest

    Guest Guest

    pregnant woman in 3rd trimester has normal BP when standing and sitting. When supine BP drops to 90/50. what is the dx?
    compression of the IVC

    35 y/o man has high BP in arms and lowBP in his legs. what is the dx
    coarction of teh aorta

    5 y/o boy presents with a systolic murmur and a wide fixed split S2. what is the dx
    ASD

    During a game a young football player collapses and dies immediately. What is the most likely type of cardiac dz
    hypoertrophic cardiomyopathy

    pt has a stroke after incurring multiple long bone fractures in trauma stemming from a MVA. What caused the infarct
    fat emboli
  14. Guest

    Guest Guest

    elderly woman presents with a headache and jaw pain. labs show elevated ESR. what is teh dx
    temporal arteritis

    80 y/o man presents w/ systolic crescendo-decrescendo murmur. What is the most likely cause?
    aortic stenosis

    Man starts a medication for hyperlipidemia. He then develops a rash, pruritis, and GI upset. What drug was it
    Niacin

    Pt developes a cough and must discontinue captopril. What is a good replacement drug and why doesn't it have the same side effects?
    losartan, an angiotensin II receptor antagonist, does not increase bradykinin as captopril does.

    What are the 3 struct inside the carotid sheath
    1) Internal jugular Vein (lateral) 2) Common carotid Artery (medial) 3) Vagus Nerve (posterior) mneu: VAN

    In the majority of cases, the SA and AV nodes are supplied by this coronary artery?
    Right coronary artery
  15. Guest

    Guest Guest

    80% of the time the ____ coronary artery is "dominant", suppplying the inferior left ventricle via the _________ branch
    RCA, Posterior descending artery

    Which coronary is most commonly occuluded? What does it supply?
    LAD, antierior interventricular septum

    Enlargement of this chamber may cause dysphagia?
    Left atrium (most posterior chamber)

    cardiac output =
    SVxHR

    During exercise, CO ↑ as a result of an ↑ in _____. After prolonged exercise, CO ↑ as a result of an ↑ in ____
    SV HR
  16. Guest

    Guest Guest

    Promatine Sulfate
    basic alkaline protein acts as heparin antagonist to reverse heparin action, can also serve as an anticoagulant.

    Protamine Sulfate USE
    treat heparin overdose, also used after surgery to neutralize effects of heparin given during extracorporeal circulation on heart/lung machine.

    Protamine Sulfate ADVERSE REACTIONS
    bradycardia, lassitude (weariness), sudden drop in blood pressure, flushing of face/neck, feeling of warmth.

    Overdose of Protamine Sulfate
    produces anticoagulant effects.

    How is Protamine Sulfate given?
    slowly by IV injection over 1-3 min in doses of 50 mg during a ten minute period.

    What happens if Protamine Sulfate is given to rapidly?
    severe hypotension and anaphylactic like reactions are provoked.

    Thrombolytic Agents
    convert plasminogen to the enzyme plasmin which breaks down fibrin clots, fibrinogen, and other plasma proteins.

    Thrombolytic Agents are used to...
    LYSIS- DISSOVLING OF THROMBI

    Thrombolytic Agents USES
    - acute myocardial infaction for lysis of thrombi blocking coronary arteries.
    - in acute pulmonary emboli for clot lysis when patient is hemodynamically unstable.
    - in acute ischemic stroke and acute arterial occlusion.
  17. Guest

    Guest Guest

    Urothelial cancers of the upper urinary tract are more common in men than in women. Is this trend also true for bladder cancer?

    What about racial biases for bladder cancer?
    Yes, it is about three times more common in men than in women.

    More common among whites, about twice, than African Americans and Hispanic Americans

    The incidence of bladder cancer has increased significantly over the past 2‐3 decades. With the incidence among men increasing even faster than that of women. Why is this trend confusing?
    The incidence of bladder cancer increases with age and women live on average about 5 years longer than men. As the population ages you would think that this would cause the incidence to increase in women more than in men.

    Women are now engaged in roles that that weren’t necessarily exposed to 20‐30 years ago, such as environmental agents that are known to cause bladder cancer, chemicals, tobacco, etc.

    How does the incidence data differ from mortality data for bladder cancer in regards to ethnicity and gender?
    Even though whitey males get it more commonly than all others, the mortality from the disease is much higher in Caucasian women, and even higher still in African American women. Women have a higher than 30% increased risk of dying from bladder cancer than men do.

    The prognosis for bladder cancer in Hispanics is better than Caucasians.
  18. Guest

    Guest Guest

    What are risk factors for bladder cancer?
    *Age, as well as Caucasian race and male gender

    *Occupations with increased risk – barbers, beauticians, physicians, drill press operators, autoworker, painter, truck driver, leather worker, metal worker, machiner, dry cleaner, etc.

    *Cigarette smoking & exposure – fourfold higher incidence

    *Infections & long term irritation such as chronic foley catheterization or bladder calculi

    *Analgesic abuse, particularly with phenacetin

    *Schistosoma cystitis

    *Pelvic irradiation – twofold to fourfold increased risk

    *Cyclophosphamide treatment – up to 9x increased risk

    *Misc stuff such as Blackfoot disease, being a renal transplant patient, some chinese herb

    *Interestingly, genetics do not appear to be a risk factor
  19. Guest

    Guest Guest

    * Chagas disease is a parasitic infection that occurs in Central and South America.
    * Chagas disease is usually spread by the feces of the reduviid bug, an insect that infests mud, adobe, or thatch houses. People get infected when they unknowingly rub bug feces into their eyes or mouth or into a bite wound. Infection can be also be transmitted by blood transfusions or organ transplants. An infected woman can pass the infection to her baby during pregnancy, at delivery, or while breastfeeding.
    * Chagas disease can cause symptoms soon after infection, but many people do not become ill until many years later. Persons with weakened immune systems are at greatest risk of severe infections and complications.
    * Most travelers to Central and South America are not at risk for Chagas disease. To prevent getting Chagas disease: 1) avoid sleeping in thatch, mud, or adobe houses, 2) use insecticides, and 3) be aware of the risk of blood transfusions.
  20. Guest

    Guest Guest

    What two β-blockers decrease serum lipids?
    Acebutolol and Pindolol

    If a drug is ionized, is it water or lipid soluble? Can it cross a biomembrane?
    Ionized drugs are water soluble, and since only lipid-soluble drugs can cross biomembranes, an ionized drug cannot cross them without the help of a carrier.

    What are the longest-acting and shortest-acting benzodiazepines?
    Diazepam is longest acting and midazolam is shortest acting.

    What is the DOC for severe infections with Sporothrix, Mucor, Histoplasma, Cryptococcus, Candida, and Aspergillus?
    Amphotericin B

    What neurotransmitter is presynaptically inhibited by reserpine and guanethidine?
    NE

    Which two cephalosporins cross the blood-brain barrier?
    Cefuroxime and cefaclor

    What agent, in combination with a MAOI inhibitor, can cause hypertensive crisis?
    Tyramine
  21. Guest

    Guest Guest

    Define osteosarcoma
    A primary malignant tumor of the bone

    How is osteosarcoma distinguished from other bone tumors?
    Production of osteoid substance (osteoblastic, chondroblastic, & fibroblastic differentiation)

    In what population is Osteosarcoma considered the most common bone tumor?
    Children

    T or F: After leukemia & lymphoma, osteosarcoma is the 3rd most frequent neoplasm in adolescents & young adults
    True - 5.6 cases per 1 million children of European ancestry <15yrs in US/yr

    During what period of growth is the peak incidence of osteosarcoma?
    in second decade of life, during adolescent growth spurt

    Does osteosarcoma occur earlier in boys or girls?
    Girls - they have growth spurt earlier

    Is Osteosarcoma more common in girls than boys?
    No, boys are more common d/t large bone volume

    What percentage of Osteosarcoma is identified in bone tumors in children & adolescents?
    56%
  22. Guest

    Guest Guest

    What percentage of osteosarcomas result from irradiation?
    3% - applies to older population, 4 to 40yrs (median is 12-16yrs) after radiation

    In what premalignant condition will 2% of the patient's develop Osteosarcoma after age 50?
    Those w/Paget's disease

    What 2 other hereditary conditions have a predisposition to develop osteosarcoma?
    1. Hereditary Retinoblastoma
    2. Carriers of p53 gene mutation

    What gene mutation does LiFraumini refer to?
    p53 gene mutation

    Those with LiFraumini have what percentage of developing a malignancy by age 30? and what percentage develop a cancer by age 70?
    By Age 30 = 50% chance
    By Age 70 = 90% chance
    (usu. bone or breast cancer)

    What is an inverted papilloma and what conditions is it associated with?
    This is a benign lesion that is the same as a papilloma however instead of growing into the lumen it is inverted into the stroma of the bladder. It is associated with conditions such as chronic inflammation or obstruction, as such it may be covered with squamous metaplasia or cystitis cystica as well as normal urothelium.

    What is vesical leukoplakia that can be seen on cystoscopy?
    It is squamous metaplasia with marked keratinization. It is believed to be a response to a noxious stimulus in the bladder and is believed to be a pre‐malignant lesion with transformation to SCC in 20% of cases.

    You are doing a survellience cysto on a patient with a history of bladder cancer s/p TURBT. They have a lesion on their bladder that is a velvety plaque concerning for CIS. You think in your mind that I need to set this patient up for bladder biopsy. Should you do anything at the time of the survelleince cysto?

    What percentage of patients with CIS have positive cytology?
    Take cytology with barbitage while in the bladder. Cytopathology is positive in 80‐90% of patients with urinary CIS.

    Diminished visual acuity (usually 2 lines) not due to an organic pathological condition
    Amblyopia

    Etiology of amblyopia
    Lack of neurosensory stimulation due to conflicting images (strabismus) or blurred retinal image

    which eye do you patch if there is lazy eye
    the good eye

    sign of intraocular tumor
    white reflex

    Most common cause of amblyopia
    Strabismus Amblyopia

    Amblyopia ex anopsia?
    Results from inadequate sensory input due to opacities in ocular media
    Cataract, corneal scarring, ptosis
    Rarely, prolong patching of normal eye can cause amblyopia

    AKA Form-Deprivation/ Occlusion Amblyopia

    What is amlyopia?
    Lazy eye; loss of visual acuity not correctable by glasses

    What are 3 types of amblyopia?
    refractive
    occlusion
    strabismic

    What happens in refractive amblyopia?

    How do you treat?
    Uncorrected refractive errors (from birth) --> better seeing eye takes over all sight, poorer eye will not develop visual pathways


    Treat with glasses for 4-8 weeks, after which, use a patch on the 'good' eye

    What is occlusion amblyopia?
    Opacities in ocular media prevents adequate sensory input, disrupts visual development

    At weeks 12, 20, and 36, where is the uterus at?
    week 12 - at the pelvis
    week 20 - umbilicus
    week 36 - costal margin

    What happens to a mother's cardiac output at 10th week gestation?
    increase 1-1.5L/min
    Vena Caval compressoin - decrease by 30-40%

    What happens to a mother heart rate in the 3rd trimester?
    heart rate increases 15-20 beats per minute

    In the 2nd trimester, what happens to a mother's blood pressure? CVP?
    decreases 5-15 mm Hg SBP and DBP
    CVP - normal
    - venous HTN lower extremeties at term

    What would you expect to see on an EKG of a pregnant woman?
    left axis shift 15 degrees
    flat or inverted T-waves
    increased ectopy

    True or False: Fibrogen and clotting factors are increased in pregnant women.
    True
  23. Guest

    Guest Guest

    Diminished visual acuity (usually 2 lines) not due to an organic pathological condition
    Amblyopia

    Etiology of amblyopia
    Lack of neurosensory stimulation due to conflicting images (strabismus) or blurred retinal image

    which eye do you patch if there is lazy eye
    the good eye

    sign of intraocular tumor
    white reflex

    Most common cause of amblyopia
    Strabismus Amblyopia

    Amblyopia ex anopsia?
    Results from inadequate sensory input due to opacities in ocular media
    Cataract, corneal scarring, ptosis
    Rarely, prolong patching of normal eye can cause amblyopia

    AKA Form-Deprivation/ Occlusion Amblyopia

    What is amlyopia?
    Lazy eye; loss of visual acuity not correctable by glasses

    What are 3 types of amblyopia?
    refractive
    occlusion
    strabismic

    What happens in refractive amblyopia?

    How do you treat?
    Uncorrected refractive errors (from birth) --> better seeing eye takes over all sight, poorer eye will not develop visual pathways


    Treat with glasses for 4-8 weeks, after which, use a patch on the 'good' eye

    What is occlusion amblyopia?
    Opacities in ocular media prevents adequate sensory input, disrupts visual development

    At weeks 12, 20, and 36, where is the uterus at?
    week 12 - at the pelvis
    week 20 - umbilicus
    week 36 - costal margin

    What happens to a mother's cardiac output at 10th week gestation?
    increase 1-1.5L/min
    Vena Caval compressoin - decrease by 30-40%

    What happens to a mother heart rate in the 3rd trimester?
    heart rate increases 15-20 beats per minute

    In the 2nd trimester, what happens to a mother's blood pressure? CVP?
    decreases 5-15 mm Hg SBP and DBP
    CVP - normal
    - venous HTN lower extremeties at term

    What would you expect to see on an EKG of a pregnant woman?
    left axis shift 15 degrees
    flat or inverted T-waves
    increased ectopy

    True or False: Fibrogen and clotting factors are increased in pregnant women.
    True

    What androgen receptor blocker is used in the treatment of prostatic cancer?
    Flutamide

    What are the first signs of phenobarbital overdose?
    Nystagmus and ataxia

    Which virus is treated with the monoclonal antibody palivizumab?
    RSV

    Which medication used in the treatment of bipolar disorder decreases the release of T 4 from the thyroid gland?
    Lithium

    Which class of antiarrhythmics are potassium channel blockers?
    Class III

    Which muscarinic receptor uses a decrease in adenyl cyclase as its second messenger?
    M 2

    What antiepileptic agent has SIADH as a side effect?
    Carbamazepine
  24. Guest

    Guest Guest

    Disease Vector
    Carries the disease between people or species

    ex: mosquitoes, tics, fleas

    Epidemeologist
    Scientist who studies epidemics

    Animal Reservoir
    Animal that carries the disease without experiencing its effects

    Resurging Disease
    Disease that was once conquered but is coming back

    Haemmorhagic Fever
    High infectivity, high mortality

    ex: E. bola, Marburg, Lassa, Rift Valley,

    Zoonosis
    A disease originating in non-human animals
  25. Guest

    Guest Guest

    Biohazard Containment
    No physical contact btwn sick & healthy, air from hospital room is filtered, clothes etc. put in autoclave.

    Crowd Disease
    Disease associated w/ high population density

    Marburg
    A Haemorrhagic fever that originated in Germany from imported African Green Monkeys. Causes blood to flow from eyes, nose, mouth.

    SARS
    Severe Acute Respiratory Syndrome.
    flu --> pneumonia --> death
    Index case in Guangzhou, China. Patients contagious late in disease. Quarantine effective
  26. Guest

    Guest Guest

    What is occlusion amblyopia?
    Opacities in ocular media prevents adequate sensory input, disrupts visual development

    What is strabismic amblyopia?

    How do you check for alignment?
    Eyes are misaligned at birth, (eso or exotropia), but never achieve alignment

    Check for centration of the corneal light reflex

    How do you treat strabismic amblyopia?
    realign eyes, patch ood eye, spectacles


    may need to realign eyes with surgery

    What is strabismus?

    What is the compensation in kids?
    Eyes not properly aligned

    Brain suppresses vision in deviated eye to avoid double vision --> kids develop amblyopia

    How does strabismus in kids differ from that in adults?
    kids --> suppress bad eye, develop amblyopia

    adults --> misalignment causes diplopia

    BURN
    How can dysrhythmias occur during the hypovolemic stage?
    Hyperkalemia occurs because cells are leaking K+ and this can eventually lead to V fib. Give Ca+ to stabilize the cell membranes to treat the arrhythmias.

    What causes the diuretic stage?
    18-24 hours after the initial burn there is a return of vascular integrity, this is when the 3rd space fluid returns to the vasculature
    The Diuretic stage then begins at 48-72 hours and is characterized by a reversal of the fluid shift.

    What can creates a potential volume overload?
    During the hypovolemic stage as many as 10-12L of fluid may be infused.
    This can cause volume overload when vascular integrity returns during the diuretic stage

    What causes metabolic acidosis during the diuretic stage?
    The breakdown of protein in the body due to a lack of carbohydrates because they haven't been eating. Give nutrition to correct/prevent.

    What are some assessment findings of the diuretic stage?
    bounding pulses
    increased UOP
    crackles in lungs
    hemodilution

    Trypanosome
    Protozoan that causes african sleeping sickness

    Endemic
    Present in the natural environment

    Tse-Tse Fly
    Transmits East African Sleeping Sickness

    Vaccinated Diseases
    Polio, tetanus, diphtheria, whooping cough (pertussis), measles/mumps/rubella

    Skin
    First line of defense, well-adapted to prevent bacteria from entering the body

    Mucous Membrane
    First line of defense, lines the throat, mouth, nose, eyelids

    Stomach Acid
    First line of defense, prevents bacteria from surviving with low pH level (high acidity)

    East African Sleeping Sickness
    Most severe type, transmitted from antelopes by tse-tse fly, in Uganda and W. Kenya

    CpG-containing DNA
    DNA containing unmethylated C followed by G. Note that the sequence of bases adjacent to the CG motif also affects the stimulatory activity.

    leucine-rich repeat
    Unit of protein structure in which there are many repeats of a basic unit of approximately 25 amino acids.
    LRR

    lipoarabinomannan
    A major immunostimulatory component of the lipid-rich mycobacterial cell wall, containing phosphatidyllinositol linked to the carbohydrates mannose and arabinose.
  27. Guest

    Guest Guest

    Inflammatory Response
    Second line of defense against pathogens

    Interstitial Space
    Space in between the skin and the organs, filled with interstitial fluid

    Interstitial Fluid
    AKA Blood Plasma (blood w/o the cells), Lymph; occupies Interstitial Space

    Mast Cells
    Bind to the entering bacteria by surface receptors; recognize "PAMP sequences"; release histamine

    PAMP sequences
    Pathogen Associated Molecular Patterns; things that alert mast cells that these are pathogens.
    ex: flagella

    Histamine
    Cytokine that causes the capillary to "leak", so plasma floods the interstitial space. Causes swelling & reddening (inflammation)

    Macrophage
    Cell that engulfs other cells (pathogens) -- phagocytic; make a "coat" of bacteria on surface

    What therapies are effective for patients with autoimmune hepatitis?
    Prednisone in combination with azathioprine or a higher dose of prednisone alone are the established therapies. Both regimens are equally effective in inducing clinical, laboratory, and histologic remission and prolonging immediate life expectancy. The combination regimen is associated with a lower frequency of drug-related side effects than the regimen using higher doses of prednisone alone (10% versus 44%), and it is preferred. Azathioprine has a corticosteroid-sparing action in the treatment of autoimmune hepatitis, and its combination with prednisone achieves the same results as twice the dose of prednisone alone

    therapies autoimmune hepatitis?
    Postmenopausal women and patients with labile hypertension, brittle diabetes, emotional instability, exogenous obesity, acne, or osteoporosis are candidates for the combination regimen . Women who are pregnant or contemplating pregnancy and patients with active neoplasia or severe cytopenia are candidates for the single-drug regimen. The single-drug regimen also may be used in patients in whom a short treatment trial (≤6 months) is anticipated and in patients with thiopurine methyltransferase deficiency. Azathioprine has a delayed onset of action (≥3 months), and its advantages as a corticosteroid-sparing agent are evident only after protracted treatment.
    Combination Regimen
    Preferred therapy
    Postmenopausal women
    Obesity
    Osteopenia
    Brittle diabetes
    Labile hypertension
    Acne
    Long-term (>6 months) treatment


    How do the medications work?
    Corticosteroids limit T-cell activation by inhibiting cytokine production and the expression of adhesion molecules. They are lipophilic and can diffuse into the cytosol of cells to bind the glucocorticoid receptor. The complex of drug and receptor then translocates to the nucleus, where it inhibits cytokine gene expression, including the production of key mediators such as interleukin (IL)-2, IL-4, IL-5, IL-6, IL-8, IL-12, interferon-γ, and tumor necrosis factor-α. The activity of nuclear factor-κB, which is an important transcription factor that promotes RNA polymerase activity and cytokine production, is also reduced. Type 1 and type 2 cytokine pathways are affected, and corticosteroids can thereby impair both cellular and humoral immune responses. Continuous administration of corticosteroids is required to achieve these results since the drug has a short biological half-life.


    What terminology is useful in categorizing HIV infection?
    1. HIV infection is classifed by numbers 1, 2, 3 depending on CD4 acount.

    1: greater than 500
    2: between 200 and 499
    3: less than 200

    2. the letters A, B or C depends on the occurrence of specific conditions.

    A = asymptomatic, or persistent generalized lymphadenopathy
    B = bacillary angiomatosis, oral thrush, cervical dysplasia/carcinoma, oral hairy leukoplakia, herpes zoster (recurrent or multi-dermatomal) and ITP.
    C = PCP, cryptococcal meningitis, toxoplasmosis, CMV retinitis, AIDS dementia complex, TB recurrent bacterial pneumonias, Kaposi's sarcoma, CNS lymphoma, and other non-Hodgkin's lymphomas

    What has a halo on india ink?
    Cryptococcus neoformans. The organism has amucopolysaccharide capsule that provides a "halo" around it that pushes away the india ink.

    When is Cryptococcus neoformans the answer?
    Answer india ink as the best initial test for cryptococcus, wehn you see a patient with AIDS with <100 CD4 cells who presents with fever, headache, and possibly a stiff neck. CSF will show a mild elevation of lymphocytes. the presentation is "subacute," which means it is slower in onset and milder than bacterial meningitis.

    Caution: Normal CSF protein and white cell counts do not eclude cryptococcal meningitis.

    What is the most accurate diagnostic test for cyrptococcus neoformans?
    The most accurate test for cryptococcal meningitis is either a cryptococcal antigen or fungal culture of the CSF.


    Burns
    What is the serum electrolyte profile during the diuretic stage?
    -Hypokalemia, because potassium is being dumped form the kidneys
    -hyponatremia, d/t excretion by kidneys and leaking out of wound
    -hypoproteinemia, lost from wounds
    -hemodilution- fluid volume overload

    What is the serum electrolyte profile during the hypovolemic stage?
    -hyperkalemia- cells are leaking K+
    -hyponatremia- leaking from vessels into insterstitial spaces
    -hypoproteinemia
    -hemoconcentration, fluid has left vasculature

    What is the main electrolyte difference between the hypovolemic stage and the diuretic stage?
    POTASSIUM
    hyper in hypovolemic stage
    hypo in diuretic stage

    What is considered to constitute 1% of body surface area?
    palm of hand including fingers=1%
  28. Guest

    Guest Guest

    regarding the common bile duct
    a) empties into the duodenum about 9 cm from the pylorus
    b) passes behind the first part of the duodenum
    c) lies anterior to the portal vein when it runs through the free edge of the lesser momentum
    d) is closely related to the gastroduodenal artery
    e) does not come into contact with the superior mesenteric artery in any part of its course
    The correct answer is T T T T T

    The following are true of the adrenal glands
    a) the right adrenal gland is usually triangular in cross-section
    b) at birth the adrenal glands are one third the size of the kidney
    c) the adrenal glands are derived soley from the neural crest
    d) the right adrenal gland usually drains to the IVC by means of a single vein
    e) the left adrenal gland usually extends anterior to the kidney
    correct answer is F T F T T

    regarding the small intestine
    a) the root of its mesentery is about 25cm long
    b) the entire small intestine is supplied by the superior mesenteric artery
    c) meckel's diverticulum represents the persistent part of the vitello-intestinal duct
    d) a diameter of 4cm in the jejenum during a small-bowel enema may be regarded as normal
    e) normal valvulae conniventes should not exceed a thickness of 1mm in the ileum
    answer is F T T T T

    regarding the hip joint
    a) the acetabular labrum lines the whole of the acetabulum
    b) the iliofemoral ligament usually has an attachment to the anterior superior iliac spine
    c) an accessory ossicle is often seen at the superior margin of the hip joint
    d) irregularity of the inferior margin of the acetabulum in children should be considered as a normal variant
    e) in infants the iliac angle should be between 65 and 97 degrees
    answer is F F T F T
  29. Guest

    Guest Guest

    What are clue cells associated with?
    The smear is a wet mount and it shows clue cells. Clue cells are abnormal epithelial cells with ground-glass appearance and a hazy border. The tiny dark dots are bacteria stuck to the surface of the epithelial cells.

    When do you answer wet mount?
    Answer wet mount and clue cells when you see a woman with a thin, grayish/white vaginal discharge or vaginal itching. She may also describe dyspareunia. She may also describe a strong fishy odor (positive "whiff" test) adding KOH to slide. The pH in BV is usually >4.5.

    What is the most common organism causing bacterial vaginosis?
    Gardnerella vaginalis

    Why is it important to treat this disease in pregnant women?
    Pregnant women with BV are at increased risk for miscarriage, early (preterm) delivery, and infection after the pregnancy.

    Case: A 19-year-old sexually active female presents complaining of a yellowish-green discharge adn dyspareunia. The wet mount of her discharge shows cells with flagella.

    What is her diagnosis?
    Trichomonas vaginitis

    Case: A 19-year-old sexually active female presents complaining of a yellowish-green discharge adn dyspareunia. The wet mount of her discharge shows cells with flagella.

    What is the treatment?
    Trichomonas vaginitis is treated with oral metronidazole with concurrent treatment of the sexual partner. Single-dose therapy is preferred because of increased patient adherence.

    Case: A 19-year-old sexually active female presents complaining of a yellowish-green discharge adn dyspareunia. The wet mount of her discharge shows cells with flagella.

    What is the treatment?
    the pelvic examination will show a "strawberry cervix," which is caused by multiple punctate hemorrhages visible on the cervix.

    Case: A 19-year-old sexually active female presents complaining of a yellowish-green discharge adn dyspareunia. The wet mount of her discharge shows cells with flagella.

    What is different about the organism on wet mount from every other cause of STD?
    Trichomonas vaginalis is the only organism to be mobile on the wet mount as the flagella has it swim across the slide.

    When do you answer bone biopsy?
    Look for a patient with diabetes and peripheral vascular disease with leg pain, warmth, and an ulcer who has an abnormality on X-ray or MRI consistent wiht osteomyelitis.

    For which disease(s) is bone biopsy the gold-standard diagnostic test?
    A needle aspirate sample examined under a microscope is the gold-standard diagnostic test for the following diseases:

    Osteomyelitis
    Bone tumors
    Metastatic osseous disease

    What tests can replace bone biopsy if osteomyelitis is suspected?
    Radiographic evidence of osteomyelitis and positive blood cultures can replace the bone biopsy if osteomyelitis is suspected.
  30. Guest

    Guest Guest

    What is Bone Scan or Technetium Pyrophosphate Nuclear Bone Scan?
    Bone scan is a method of detecting occult disease that has deposited in bone.

    How does Bone Scan or Technetium Pyrophosphate Nuclear Bone Scan work?
    Technetium is picked up by osteoblasts and deposited in teh bone as they lay down new matrix. You must have osteoblastic activity in order for it to light up.

    What makes Bone Scan or Technetium Pyrophosphate Nuclear Bone Scan abnormal?
    Bone scans can be abnormal from both infections and malignancies. Osteomyelitis and cancer are detected by bone scans. Bone scans lack specificity and often cannot distinguish soft-tissue infection nearby from involvement fo the bone.

    What is the most accurate test for osteomyelitis and cancer?
    The precise etiology of the abnormality on a bone scan often requires a bone biopsy to confirm the diagnosis.

    What is a CD4 (T-cell) count?
    CD4 count is used to monitor HIV-positive patients. Serum measurement of CD4 (T-cell_ markers is representative of the number of helper T lymphocytes in the blood count. CD4 is used to determine the need for prophylactic antibiotics and to monitor the response to treatment. Start antiretrobiral therapy: CD4,350 or viral load >55,000

    When is CD4 count the right answer?
    Answer CD4 count as the best test to determine the severity of immunosuppression in HIV/AIDS.

    What prophylactic medications should be started based on a CD4 cell count?
    Prophylaxis should be initiatd in the following scenarios:

    CD4 counts less than 200 cells/ul: TMP/SMX for pneumocystis jiroveci

    CD4 counts less than 100 cells/ul: TMP/SMX for Toxoplasma and itaconazole for Histoplasmosis in endemic areas

    CD4 counts less than 50 cells/ul: azithromycin for Mycobacterium avium complex (MAC)

    What is darkfield microscopy?
    The darkfield is the most accurate test of primary syphilis.

    How is darkfield microscopy done?
    A scraping of swab from the syphilitic chancre is rubbed on a slide.

    When do you answer darkfield microscopy?
    Answer darkfield microscoopy for primary syphilis when the question asks for the most accurate diagnostic test. In primary syphilis, there is a false negative rate of about 25% for the RPR or VDRL. The darkfield is more sensitive than an RPR.

    How does a callium scanning test work?
    Gallium is a nuclear scan that detects infection and some cancers. Gallium builds up in areas where white blood cells are present and there is increased iron metabolism. Gallium is transported on transferrin Gallium is a nonspecific test that can help localize teh site for subsequent CT or MRI scanning.
  31. Guest

    Guest Guest

    Coagulase negative Staph
    Assoc. with:
    - Bacterial meningitis in premature infants
    - Commensal flora of the skin

    ID:
    Gm+
    Coag negative

    Streptococcus pneumoniae
    Assoc. with:
    - Bacterial meningitis in infants and children

    Usually sporadic. Nasopharyngeal colonization can leading to bacteremia, seeding, and meningitis.

    ID:
    Encapsulated (requires specific IgG for good phagocytosis)

    Treatment: Penicillin works, but need 20x the minimum inhibitory concentration for it to work in the CSF (10x the blood level).

    So, the pneumococcal vaccines are used preventatively.
  32. Guest

    Guest Guest

    when is gallium scan the answer?
    Answer gallium scan when you see a patient with persistent fever without localizing symptoms and the initial blood cultures, chest X-ray, and urinalysis are negative. Gallium detects the source of fevers of unknown origin, lymphoma, and abscesses.

    What is the most accurate test to confirm an abnormal gallium scanning result?
    Ultimately, a biopsy is the most accurate way to determine the etiology of an abnormal gallium scan. Cancers require histology and infections require that the culture be confirmed.

    What is Herpes Simplex PCR?
    Herpes simplex PCR is done on cerebrospinal fluid and is the single most accurate test for herpes encephalitis.
  33. Guest

    Guest Guest

    LPS-binding protein
    A lipid transfer protein of serum that can extract monomers of LPS from bacterial membrane and deliver them to the innate immune receptor CD14.
    LBP

    MD-2
    A polypeptide that associates with the extracellular domain of the Toll-like receptor TLR4 and is required for LPS responsiveness
  34. Guest

    Guest Guest

    What agent would you administer to a suspected morphine overdose patient? Be specific as to route of administration and duration of treatment.
    Naloxone
    IV
    Treat with Naloxone until you are sure the effects of morphine will not come back because of the short half life of Naloxone

    Describe the three predominant characteristics of morphine overdose.
    Pin point pupils
    Sedation or coma
    Low respiratory rate (respiratory depression)

    Which of the following agents would increase sedation caused by morphine?

    A. ethanol
    B. diazepam
    C. chlorpromazine
    D. clomipramine
    E. All of the above
    E. All of the above

    Name two parts of the brain involved in mediating analgesia?
    Spinal cord, Thalamus, cortex, Limbic system, Spinothalamic tract, Periaquductal grey, substantioa gelatinosa

    Which of the following agents would increase sedation caused by morphine?

    A. acetominophen
    B. chlomipramine
    C. methylphenidate
    D. citalopram
    E. All of the above
    B. chlomipramine


    What gland is found in the muscular triangle of the neck?
    Thyroid gland

    Is an afferent or efferent pupillary defect described as B/L pupillary constriction when light is shined in the unaffected eye and B/L paradoxical dilation when light is shined in the affected eye?
    Afferent pupillary defect (CN II lesion); in an efferent pupillary defect (CN III), B/L constrict when light is shined in the unaffected eye and consentual pupil constriction occurs when light is shined in the affected eye.

    What is the name of the spinal cord passing within the subarachnoid space and forming the spinal nerves that exit the lumbar and sacral foramina?
    Cauda equina

    Name the laryngeal muscle described by the following:
    • Pulls the arytenoids cartilages closer to the thyroid, relaxing the vocal ligaments and thereby decreasing the pitch
    Thyroarytenoid muscles
  35. Guest

    Guest Guest

    1. One of the following is not derived from the neural crest:

    a. Pia mater.
    b. Arachnoid mater.
    c. Dura mater.*******
    d. Spinal ganglia.
    e. Schwann cells.

    2. One of the following is not derived from the neural crest:

    a. Dorsal root ganglia.
    b. Suprarenal cortex.********
    c. Geniculate ganglion of the facial nerve.
    d. Gracile tract.
    e. Sympathetic chain.

    3. The 3rd ventricle is the cavity of the:

    a. Metencephalon.
    b. Myelencephalon.
    c. Mesencephalon.
    d. Telencephalon.
    e. Diencephalon.*******

    4. The lateral ventricle communicates with the 3rd ventricle through:

    a. Aqueduct of Sylvius.
    b. Foramen of Magendie.
    c. Foramen of Monro.***
    d. Foramen of Luschka.
    e. Central canal.

    5. The presence of the following in the amniotic fluid indicates anencephaly:

    a. Glucose.
    b. Blood.
    c. Lymphocytes.
    d. Alpha fetoprotein.*******
    e. None of the above.

    6. Failure of the neural tube to close causes:

    a. Hydrocephalus.
    b. Anencephaly.***********
    c. Meningocele.
    d. All of the above.
    e. None of the above.

    7. Regarding spina bifida, one of the following is incorrect:

    a. Usually occurs in the cervical region.********
    b. Spina bifida occulta is the commonest type.
    c. May be associated with meningocele.
    d. Is due to failure of fusion of the vertebral arches.
    e. The spinal cord may project through the defect.

    8. Regarding the meningeal spaces:

    a. Extradural hemorrhage is usually arterial.****
    b. Subdural hemorrhage is usually venous.
    c. Subarachnoid hemorrhage is usually arterial.
    d. All are correct.
    e. a and b only are correct

    9. These cranial nerve nuclei are present in the floor of the 4th ventricle EXCEPT:

    a. Abducent nucleus.
    b. Facial nucleus in the facial colliculus.******
    c. Dorsal motor nucleus of the vagus.
    d. Hypoglossal nucleus.
    e. Vestibular nuclei.

    10. Regarding the cerebellar arteries, one of the following is INCORRECT:

    a. The superior cerebellar artery supplies the superior cerebellar peduncle.
    b. The anterior inferior cerebellar artery supplies the middle cerebellar peduncle.
    c. The posterior inferior cerebellar artery supplies the inferior cerebellar peduncle.
    d. The anterior inferior cerebellar artery supplies the choroid plexus of the 3rd ventricle.*******
    e. The posterior inferior cerebellar artery supplies the choroid plexus of the 4th ventricle.
  36. Guest

    Guest Guest

    Neisseria meningitidis
    Assoc. with:
    - Bacterial meningitis in infants and children

    ID:
    Gram negative (LPS!)

    Rapid uptake by epithelial cells via receptor-mediated endocytosis.

    Encapsulated (requires specific IgG plus complement for good phagocytosis).

    Some people are carriers, and are asymptomatic.

    Because N. meningitidis is Gram-negative, LPS causes a fulminant meningitis with a rapid progression (violent host response to LPS).

    "Meningitis belt" in Africa where N. meningitidis is endemic.

    Vaccine exists for Types A, C, Y, and W135. Type B is associated with sporadic cases, and has sialic acid epitopes that look like self.

    Prophylaxis includes Rifampin, Ciprofloxacin, Ceftriaxone (these all reach high enough levels in nasal secretions to work).

    What is Herpes Simplex PCR?
    Herpes simplex PCR is done on cerebrospinal fluid and is the single most accurate test for herpes encephalitis.

    When is Herpes Simplex PCR the answer?
    Look for a patient wit fever, headache, and confusion of less than 2 weeks' duration. The PCR of CSF is more accurate than an EEG, head CT, MRI, or even brain biopsy.

    How does Indium-Labled Leukocyte Scan work?
    Indium is a nuclear medicine test of occult infection or FUO. A sample of the patient's blood is drawn and incubated with indium. The indium-tags the white cells. The blood is re-injected into teh patient. The indium-tagged white cells then localize to the site of infection.

    When is an indium scan the right answer?
    Look for a case of occult infection not found on routine testing such as blood cultures, chest X-ray, or urinalysis. Indium is also useful when gallium is inaccurate, such as with intra-abdominal infections
  37. Guest

    Guest Guest

    Subcortical (e.g., internal capsule) versus cortical lesion:
    • Motor weakness (paresis) usually affects the face, arm, and leg equally.
    • Primary sensory deficits (paresthesia, numbness) are more prominent because of involvement of the posterior limb of the internal capsule. Cortical lesions affect higher cortical sensory, manifesting as agnosia, agraphesthesia, and impairment of double simultaneous stimulation.
    • Visual field defects are more common because visual tracts travel through the posterior limb of the internal capsule. Occipital lobe lesions produce visual field defect, but usually are not associated with motor or sensory deficit.
    • Speech dysarthria is more common. A dominant cortical lesion produces aphasia and apraxia.
  38. Guest

    Guest Guest

    2. Gerstmann’s syndrome. This syndrome is commonly caused by a stroke affecting the left angular and supramarginal gyrus and clinically characterized by finger agnosia, left–right disorientation, agraphia, and dyscalculia.

    3. Watershed or border zone infarcts. Watershed areas are end-artery zones between superficial branches of a major cortical blood supply such as between the anterior cerebral artery–middle cerebral artery and middle cerebral artery–posterior cerebral artery. Bilateral watershed infarcts occur in severe hypotension or hypoxia, and unilateral watershed infarcts occur when the affected artery is stenotic, and collateral irculation cannot compensate in a hypotensive episode.
  39. Guest

    Guest Guest

    Pathophysiology of CGD
    Deficiency of NADPH oxidase with no production of superoxide radical and H2O2 which is the substrate for myeloperoxidase to produce bleach. In catalase(-) infections myeloperoxidase uses H2O2 produced by the bacteria. If it's catalase(+), H2O2 is degraded by the bacterial catalase and theres insuficient respiratory burst response to kill Staph, pseudomona, serratia, aspergillus. Dx.: with negative nitroblue tetrazolium test

    MHC-I and MHC-II coreceptors on T cells
    MHC-I --> CD8; MHC-II --> CD4

    LFA-1
    On T cells binds ICAM-1 on macrophages to increase cell-cell adherence during antigen presentation

    CD2
    On T cells binds LFA-3 on macrophages to increase cell-cell adherence

    CD28
    On T cells binds B7 on macrophages to trigger transcription of cytokines

    IL-2
    Secreted by T cells promote their on proliferation after activation.

    Superantigens
    Crosslink TCR with MHC-II in the absense of specific antigen producing policlonal activation and excess production of IFN-γ which activates macrophages with release of IL-1, IL-6 and TNF-α and systemic shock. Staph enterotoxin, TSST-1 and strep exotoxin are superantigens.Superantigens (SAgs) are a class of antigens which cause non-specific activation of T-cells resulting in polyclonal T cell activation and massive cytokine release. SAgs can be produced by pathogenic microbes (including viruses, mycoplasma, and bacteria)[1] as a defense mechanism against the immune system.[2] Compared to a normal antigen-induced T-cell response where .001-.0001% of the body’s T-cells are activated, these SAgs are capable of activating up to 20% of the body’s T-cells.Furthermore, Anti-CD3 and Anti-CD28 Antibodies (CD28-SuperMAB) have also shown to be highly potent superantigens (and can activate up to 100% of T cells).
  40. Guest

    Guest Guest

    The subarachnoid space:

    a. Contains the cerebrospinal fluid.
    b. Dilates in some areas to form the subarachnoid cisterns.
    c. Subarachnoid hemorrhage is usually due to rupture of superficial cerebral veins.
    d. All of the above are correct.*********
    e. A and B only are correct.

    The subdural space:

    a. Contains the cerebrospinal fluid.
    b. Dilates in some areas to form the subarachnoid cisterns.
    c. Subdural hemorrhage is usually due to rupture of superficial cerebral veins.******
    d. All of the above are correct.
    e. A and B only are correct.

    Gold salts when used in the treatment of progressive rheumatoid
    arthritis:
    a) Are usually administered daily by intravenous injection
    b) If effective, benefit should be observed after the first week of
    treatment
    c) Produce objective improvement in about 75 per cent of patients
    d) Can cause skin rashes which can necessitate treatment cessation
    e) If they cause stomatitis this may be due to neutropenia

    FFTTT

    Penicillamine is used in the management of:
    a) Rheumatoid arthritis
    b) Systemic lupus erythematosus (SLE)
    c) Wilson’s disease
    d) Cystinuria
    e) Lead poisoning
    a) True
    b) False
    c) True
    d) True
    e) True

    Adverse effects associated with penicillamine include:
    a) Thrombocytopenia
    b) Leucopenia
    c) Immune complex glomerulonephritis
    d) Loss of taste
    e) Myasthenia gravis
    Etanercept:
    a) Is a humanized monoclonal antibody against tumour necrosis factor
    alpha (TNF-α)
    b) Can cause life-threatening hypersensitivity reactions
    c) Has a half-life of 5–13 days
    d) Can cause pancytopenia
    e) Is rarely associated with a demyelinating syndrome

    a) True The toxicity of penicillamine is such that it should only be
    b) True used by clinicians with experience of the drug and with
    c) True meticulous patient monitoring
    d) True
    e) True
    a) False – Etanercept is a recombinant protein that has two soluble
    TNF receptors joined to an Fc fragment; this is in contrast
    to infliximab, a humanized murine monoclonal against
    TNF-α used in Crohn’s disease. Both are licensed for the
    treatment of adult rheumatoid arthritis
    b) True – Like all proteins it can cause hypersensitivity reactions
    c) True – It has a long half-life in plasma and is administered every
    two weeks
    d) True – It can cause bone marrow suppression (all lineages) and
    sepsis
    e) True – Rarely, demyelinating syndromes like multiple sclerosis
    have been reported with its use
  41. Guest

    Guest Guest

    Medial Longitiduinal fasciculus
    ascending from medulla, a connection b/w vestibular nucleus and motor nuclei of 3,4, & 6

    What is function of the MLF
    ensures that they eyes do not track with the head but stay directed at a point as the head moves

    In the spinal cord what is the MLF a combination of?
    vestibulospinal tract and the tectospinal tract

    What info is carred by the dorsal column?
    touch, vibration, proprioception fromt he body

    What info does the Spinothalamic tract carry?
    Pain and temperature from body

    Where does the pain and temp info deccusate?
    w/in 1-2 segements

    Where is the lateral geniculate body and what does it carry?
    in the thalamus, recieves the optic sensory information about the contralateral field of view
  42. Guest

    Guest Guest

    Haemophilus influenzae
    Assoc. with:
    - Bacterial meningitis in infants and children.

    Also causes otitis.

    ID:
    Encapsulated with polyribose phosphate capsule (requires specific IgG for good phagocytosis). Acquires a Type B capsule.

    Conjugate vaccine (diphtheria toxin, meningococcal OMP) has virtually eliminated this disease in children
  43. Guest

    Guest Guest

    When is an indium scan the right answer?
    Look for a case of occult infection not found on routine testing such as blood cultures, chest X-ray, or urinalysis. Indium is also useful when gallium is inaccurate, such as with intra-abdominal infections.

    What is the most accurate test for FUO or occult infection.
    Biopsy is more accurate.

    What is KOH (Potassium Hydroxide) Prep?
    KOH is the best initial test to diagnose superficial fungal infections. KOH is applied to a wet mount sample of vaginal discharge/secretions or to a skin scraping to identify fungi. This is seen under a microscope. Epithelial cells dissolve and the fungal structures remain behind and are visible.

    When do you answer KOH?
    KOH prep is indicated for the following:

    Tinea (pedis, manus, corporis, cruris, capitis)
    Onychomycosis
    Tinea versicolor
    Candidiasis
  44. Guest

    Guest Guest

    What is the rule of nines?
    used to estimate burned area in the field, not very accurate. body is divided into multiples of 9% (eg, posterior thigh is 9%, anterior chest is 18%, etc).
    Lund-Browder and Burkow methods are more accurate

    What is the priority concern for a burn on the perineum?
    contamination

    What are indicators of possible inhalation burns/injuries?
    soot around nose and mouth, singed eyebrows

    What is the o2 sat of someone with carbon monoxide poisoning?
    Normal or high. Hemoglobin is full, but of carbon monoxide, not oxygen
  45. Guest

    Guest Guest

    BURNS
    Following a major burn injury, heart rate and peripheral vascular resistance increase. This is due to the release of catecholamines from injured tissues, and the relative hypovolemia that occurs from fluid volume shifts. Initially cardiac output decreases. At approximately 24 hours after burn injuries, cardiac output returns to normal if adequate fluid resuscitation has been given. Following this, cardiac output increases to meet the hypermetabolic needs of the body
    What do you do for someone with carbon monoxide poisoning?
    O2 at 12-14 L with a non-rebreather. The oxygen decreases the 1/2 life of the carbon monoxide

    When do you begin fluid resuscitation and why?
    Ideally, begin within 1 hour of injury. This stays ahead of the impending failed compensation. It is given to maintain circulating blood volume.

    What is the preferred IV fluid for resuscitation?
    Ringer's because it has potassium and sodium and lactate (which turns to bicarb in the body and addresses acisosis)

    What is the parkland formula?
    A formula for determining how much fluid someone needs:
    4ml Lactated Ringers X weight in Kg X TBSA burned= total ml to be given in 1st 24 hours.
    Half this volume must be given in the first 8 hours!!! (remember this)
  46. Guest

    Guest Guest

    How should fluid status be determined after the first 24 hours? by looking at electrolytes. look for lactate, and don't use UOP alone.
    Infection is a major complication of burns. Infection is linked to impaired resistance from disruption of the skin's mechanical integrity and generalized immune suppression. The skin barrier is replaced by eschar. This moist, protein rich avascular environment encourages microbial growth. Migration of immune cells is hampered, and there is a release of intermediaries that impede the immune response. Eschar also restricts distribution of systemically administered antibiotics because of its avascularity.

    Risk factors of burn wound infection include:

    * Burn > 30% TBS
    * Full-thickness burn
    * Extremes in age (very young, very old)
    * Preexisting disease e.g. diabetes
    * Virulence and antibiotic resistance of colonizing organism
    * Failed skin graft
    * Improper initial burn wound care
    * Prolonged open burn wound
  47. Guest

    Guest Guest

    What is the reflex pathway associated with the tectospinal tract?
    Activated whenever something moves from medial to lateral across field of view. Causes head to turn toward the stimuli.

    What happens if the tectospinal reflex pathway is damaged?
    the person ignores peripheral visual cues.

    What info does the Vestibulospinal Tract carry?
    It is the connection from the vestibular nucleus to the motor neurons in the spinal cord to help movement be coordinated relative to the orientation of the body/head.

    What is the general function of the Locus Ceruleus and where is it found?
    Awakens/ heightens awareness of sensation coming up SC

    What is the Rubrospinal Tract do?
    It is a projection from the red nucleus that inhibits extensors
  48. Guest

    Guest Guest

    What is the pathogenesis of meningitis?
    Hematogenous route (most common)

    Extension from infection adjacent to the nervous system

    How do meningitis-causing organisms enter the body?
    - Attach to specific surface structures of nasopharyngeal/epithelial cells.

    - Transported into blood stream via vacuole
    Three major pathways exist by which an infectious agent (ie, bacteria, virus, fungus, parasite) gains access to the central nervous system (CNS) and causes meningeal disease.

    Initially, the infectious agent colonizes or establishes a localized infection in the host. This may be in the form of colonization or infection of the skin, nasopharynx, respiratory tract, gastrointestinal tract, or genitourinary tract. Most meningeal pathogens are transmitted through the respiratory route, as exemplified by the nasopharyngeal carriage of Neisseria meningitides (meningococcus) and nasopharyngeal colonization with S pneumoniae (pneumococcus).

    From this site, the organism invades the submucosa by circumventing host defenses (eg, physical barriers, local immunity, phagocytes/macrophages) and gains access to the CNS by (1) invasion of the bloodstream (ie, bacteremia, viremia, fungemia, parasitemia) and subsequent hematogenous seeding of the CNS, which is the most common mode of spread for most agents (eg, meningococcal, cryptococcal, syphilitic, and pneumococcal meningitis); (2) a retrograde neuronal (ie, olfactory and peripheral nerves) pathway (eg, Naegleria fowleri, Gnathostoma spinigerum); or (3) direct contiguous spread (ie, sinusitis, otitis media, congenital malformations, trauma, direct inoculation during intracranial manipulation).
  49. Guest

    Guest Guest

    How does IgA protect against meningitis? What defenses do bacteria have?
    IgA in mucosal secretions inhibits adhesion of bacteria that cause meningitis.

    This IgA is cross-reactive, having encountered similar organisms before.

    Some bacteria (including S. pneumoniae) produce IgA proteases that cleave IgA at the hinge region, inactivating it.

    Pathogenic bacteria also have capsules that evade complement-mediated phagocytosis.

    What are some virulence factors of bacteria that cause meningitis?
    - IgA proteases

    - Anti-complement, anti-phagocytic polysaccharide capsules.
  50. Guest

    Guest Guest

    What cytogenetic associations do CIS and muscle-invasive bladder cancers have in common that supports their direct relationship?
    Loss of chromosome 17p, deletions and/or mutations of the TP53 gene and its products

    What is the difference between the following lesions histologically?
    Papilloma – rare, but if it truly is a benign papilloma it is usually found by itself. It has a fibrovascular stalk with no histological abnormalities and no more than 7 cell layers. Benign, almost never recurs.
    Well differentiated tumors (papillary urothelial neoplasm of low malignant potential, or PUNLMP) – contains more than 7 cell layers, mild anaplasia, rare mitotic figures, base to surface maturation, slightly irregular; often recur.
    Moderately differentiated tumors (Low grade urothelial carcinomas) – greater disturbance of base to surface cellular maturation, loss of cellular polarity, nuclear to cytoplasm ratio is greater, prominent nucleoli
    Poorly differentiated tumors (High grade urothelial carcinomas) – no differentiation from base to surface layer of cells, frequent mitotic figures, high nuclear to cytoplasm ratio

    What are risk factors for nonbilharzial SCC of the bladder?
    Chronic infections, bladder stones, chronic indwelling catheters, bladder diverticulae, cigarette smoking

    You are seeing a patient in Dr. Sutherland’s clinic with bladder cancer who was born with exstrophy. What type of cancer are they most likely to have? In patients with adenocarcinoma of the bladder that are not primary what are potential origins?
    Adenocarcinoma.
    Adenocarcinoma found in the bladder is either primarily vesical, which is rare, from the urachus, or is a metastatic lesion. Potential origins include the rectum, prostate, stomach, ovary, endometrium, and breast.

    A patient with urachal carcinoma s/p excision has what stage by definition?
    Dr. Pruthi states that by definition these patients are T3 disease at least.

    The next patient in Dr. Sutherland’s clinic is a small boy that was referred to you because he had a bloody mucoid discharge from his umbilicus as well as some mucous looking stuff in his urine. What is his probable diagnosis? What might you see on a plain film of his pelvis?
    This patient most likely has urachal carcinoma based on the presentation. A plain film might show some calcifications at the area of the dome of the bladder or level of the urachus.

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