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

    Lymphomas: Hodgkin's Versus NHL: Which one presents with Reed-Sternberg cells?
    Hodgkin's

    Lymphomas: Hodgkin's Versus NHL: Which one is associated with HIV and immunosuppression?
    NHL

    Lymphomas: Hodgkin's Versus NHL: Which one involves multiple, peripheral nodes, with common extranodal involvement?
    NHL

    Lymphomas: Hodgkin's Versus NHL: Which one is localized to a single group of nodes, with contiguous spread and rare extranodal involvement?
    HL

    Lymphomas: Hodgkin's Versus NHL: Which one presents with constitutional signs/symptoms: low-grade fever, night sweats, weight loss?
    HL (NHL has few signs/symptoms)
  2. Guest

    Guest Guest

    Hereditary breast cancer represents ___ - ___ % of all breast cancers?

    Name some genes involved
    5-10%

    - BRCA1 and 2; p53, HER2

    ___ - ___ fold risk if mother or sister has/had breast cancer
    1.5 - 3

    Risk Factor: Estrogen Exposure
    - early age of _____
    - late age of natural _____
    - age at birth of first child > ___
    - menarche (<12)
    - menopause
    - 30

    True or False:
    The Gail model is an effective assessment tool for all women with limited family Hx to assist with decisions regarding cancer prevention?
    False, only useful for caucasian women

    Length of external auditory canal
    2.5 cm in adults

    Secreted by sebaceous glands in distal 1/3 of canal
    Cerumen

    Most of tympanic membrane is __ while superior portion is __
    Tense (pars tensa); flaccid (pars flaccid)

    Bone that can be seen through tympanic membrane
    Malleus

    Organ of corti (part of cochlea) transmits impulses to:
    8th cranial n

    Path of hearing
    Sound waves enter external auditory canal → tympanic membrane → vibrates attached malleus → vibrates incus and stapes → oval window of inner ear (where stapes attached) → endolymph fluid of chochlea → round window → hair cells of Organ of Corti → 8th cranial n → temporal lobe

    2 bones that form nasal bridge
    Frontal and maxillary bones

    2 bones that form roof of nose
    Frontal and sphenoid bones

    Convergence of small fragile arteries and veins superficially on anterior superior portion of the septum
    Kiesselbach plexus

    Lie on the posterior wall of the nasopharynx
    Adenoids

    Drainages of nasolacrimal duct, paranasal sinuses and posterior ethmoid sinus
    Inferior, medial and superior meatus (respectively)

    Development of sinuses by age
    Maxillary & ethmoid (birth), sphenoid (tiny cavity at birth but develops at puberty), then frontal sinus (develops 7-8 yrs old)

    Tongue is anchored to what 2 structures
    Base to back of oral cavity; floor of mouth by frenulum

    Outlets of the parotid gland; open on buccal mucosa opposite the 2nd molar on each side of upper jaw
    Stensen ducts of parotid gland

    Age-Related Maculare Degeneration (AMD): Definition
    Acquired diseas of the outer retina (RPE-choriocapillaris) resulting in central vision loss due to atrophy of the neurosensory retina and/or pathologic choroidal neovascularization

    Age-Related Maculare Degeneration (AMD): Epidemiology
    Leading cause of vision loss in Canadians >65

    Age-Related Maculare Degeneration (AMD): Anatomy
    RPE
    Bruch's Membrane
    Choroid

    Age-Related Maculare Degeneration (AMD): Types
    Dry AMD: 90% of cases, good vision
    Wet AMD = advanced AMD = Central GA (central vision loss) - 10% of cases

    Dry AMD: Clinical Presentation
    Symptoms: modest central visual blur/distortion
    Signs: Drusen, pigmenary abnormalitis, geographic atrophy, serous pigment epithelial detachment

    Wet AMD: Symptoms
    central scotoma, progressive central and paracentral vision blurring (metamorphopsia), loss of visual acuity, altered colour vision

    Wet AMD: Signs
    choroidal neovascularizaton, subretinal hemorrhage/fluid/fibrosis

    HLA A 3
    Hemochromatosis (too much Fe)

    HLA B 27
    PAIR:
    Psoriasis
    Akylosing spondylitis
    Inflammatory Bowel Disease
    Reiter's Syndrome (reactive arthritis)

    HLA B 8
    Graves' Disease

    HLA DR 2
    MS
    Hay Fever
    SLE
    Goodpasture's

    HLA DR 3
    DM Type 1

    HLA DR 4
    DM Type 1
    Rheumatoid Arthritis

    HLA DR 5
    Pernicious anemia (b12 deficiency)
    Hshimoto's thyroiditis

    HLA DR 7
    Steroid-responsive nephrotic syndrome
  3. Guest

    Guest Guest

    What does IL-7 do?
    It is important in B and T cell development.

    What does IL-15 do?
    It is important for NK cell development.

    What cytokines are important for NK cells?
    IL-15 for the development of NK cells. IL-22 and 23 for NK cell activity.

    Explain the role of negative feedback loops in T cell polarization.
    The products from one line of T cells inhibits the development of other types of T cells. For instance, IFN-gamma from Th1 cells inhibits the development of Th2 cells and other forms of CD4 T cells.

    What is IL-2 activity important for?
    The activation and medicinal suppression of the immune response

    What is the IL-2 receptor composed of?
    Alpha, beta, and gamma chains

    Describe the IL-2 autocrine loop
    -Resting T cells express only a moderate-affinity IL-2 receptor (beta and gamma chains only)
    -Activated T cells express a high-affinity IL-2 receptor (alpha, beta, gamma chains) and secrete IL-2
    -Binding of IL-2 to its receptor signals the T cell to enter the cell cycle
    -IL-2 induces T cell proliferation

    Explain TCR-mediates signal transduction
    The TCR, through a series of tyrosine kinases including ZAP70 activate a number of signaling cascades. Particular important is the activation of PLCgamma, which cleaves PIP2 into IP3 and DAG. IP3 releases intracellular calcium stores which activates specific proteins, such as calcineuron. At the end of these cascades are transcription factors. These transcription factors synergize to regulate the expression of cytokines.

    What is the end result of TCR-mediates signal transduction?
    Activation of transcription factors NFAT, NFkappaB, AP-1

    BURNS
    What is an advantage in using fentanyl for pain?
    It does not drop BP

    When are systemic antibiotics given?
    Only if signs of an infection are present

    Wound care for burns includes:
    Open wounds- keep moist for healing
    semi-open: apply layer of ointment with a layer of gauze
    Closed: ointment with antibiotic gauze and curlex

    Where is Silvadene never used?
    on the face, it leaves a shiny appearance

    What do we no longer use when there is no eschar present (medication wise)?
    Silvadene, don't use when eschar is no longer present , then we want the burn to epithelialize(sorry about the spelling) and have new growth

    What is a side effect of sulfamylon (mafenide acetate)?
    Painful when applied. It inhibits epithelial tissue development
  4. Guest

    Guest Guest

    Who is most commonly found to have head injuries and what two factors are often involved?
    Men.Motor Vehicle Crashes and Alcohol

    Skull fracture with just a crack in the skull and no other damage.
    simple

    Skull fracture at the base of the skull that can occur anterior or posterior.
    Basilar

    Skull fracture when bone is pushed into the brain tissue and is usually repaired immediately.
    Depressed

    Skull fracture that involves bone and skin and can be very susceptible to infection.
    Compound

    A man presents with dark pooling of blood around his eyes...what kind of fracture has he sustained and what other symptoms may you find?
    Raccoon eyes are an indication of an anterior basilar skull fracture. CSF leakage via the nose could be observed along with cranial nerve one damage.

    A man presents with bruising behind his ear after a head injury. What type of fracture has he had?
    Battle's Sign- Middle Basilar

    What environmental exposures are acute leukemias associated with?
    radiation, benzene, cytotoxic drugs, smoking

    Who gets AML?
    bimodal (neonates and adults)

    What is a t(15;17) ass with?
    Acute Promyelocytic Leukemia (PML /RARa)

    What are Auer rods?
    condensed granules in AML cells

    Tx for APL?
    alpha Trans Retinoic Acid (to induce maturation) followed by chemo

    When do you use ARA-C? Cytarabine
    if your AML has a t(8; 21) or an inv16

    Who gets ALL?
    bimodal (2-5 and >60)

    Name the dz: fever, bone pain, fatigue, night sweats, high LDH?
    ALL

    What are the stages of therapy for ALL?
    induction (hematoligic remissionw/anthra, vincri, prednisone) Intensification (antimetabolites in adults) Maintenance (long term MTX)
  5. Guest

    Guest Guest

    Key microscopic features: psoriasis vulgaris
    • Parakeratosis
    • Neutrophils in stratum corneum or epidermis
    • Diminished or absent granular layer
    • Uniform epidermal hyperplasia
    • Suprapapillary plate thinning
    • Dilated and tortuous papillary dermal blood vessels
  6. Guest

    Guest Guest

    Pheochromocytoma -
    What is it
    MC primary tumor of
    adrenal gland in adults
    from chromaffin cells
    secretes epi & NE
    associated with -
    von Hippel Lindau syn
    MEN II & III
    neurofibromatosis

    Pheochromocytoma -
    What is Rule of 10
    10% bilateral
    10% malignant
    10% extra-adrenal
    10% calcify
    10% kids
    10% familial

    Pheochromocytoma -
    Hx/PE
    The 5 P's -
    Pressure (inc. BP)
    Pain (HA)
    Perspiration/Diaphoresis
    Palpitations
    Pallor

    intermittent tachycardia
    chest pain
    anxiety
  7. Guest

    Guest Guest

    Advantages of regional anesthesia in the ODS setting include
    a) shorter recovery time than those of GA
    b) reduced unanticipated admission to hospital
    c) immediate postop pain relief
    d) decreased N/V, dizziness
    e) all of the above
    e) all of the above

    Brachial plexus anesthesia can involve which approaches
    a) axillary
    b) popliteal
    c) interscalene
    d) supraclavicular
    e) a, c & d
    e) a, c & d

    While regional anesthesia such as brachial plexus lends it self to earlier discharge from the ODS one of its drawbacks is_________________ length of time (longer than 15 minutes) required until complete anesthesia is achieved

    True/False In order to decrease the amount of time it takes for a brachial plexus block to take effect, one could add Sodium Bicarb to either lidocaine or bupivacaine
    False, there is no evidence that supports this

    A supraclavicular block has a ______
    chance of developing a pneumothorax than and interscalene block
    a) lower
    b) higher
    c) equall
    b) higher
  8. Guest

    Guest Guest

    where is the border between upper/lower GI bleeding?
    ligament of Treitz (duodenum)

    what test should you order first in a pt with hematemesis?
    upper GI endoscopy

    what test should you order first in a pt with hematochezia?
    r/o anorectal cause (hemorrhoids)
    colonoscopy (colon CA main concern)

    what test should you order first in a pt with melana?
    upper GI endoscopy (upper bleed mc > lower) colonoscopy if upper is nl

    what test should you order first in a pt with occult blood?
    colonoscopy (colon CA main concern)
    upper endoscopy if nl

    what is the mc cause of lower GI bleeding in a pt younger/older than 60?
    (<60) - diverticulosis
    (>60) - angiodysplasia
  9. Guest

    Guest Guest

    what can cause dark stools?
    melana
    bismuth
    iron
    spinach
    charcoal

    how far down the GI tract is the furthest you can expect a bleed to cause melana?
    ascending colon

    what should you always ask pts who have GI bleeding?
    if they take NSAIDS/aspirin or anticoagulants

    what finding on CBC is suggestive of iron deficiency anemia?
    low mean corpuscular volume (MCV)

    what happens to the BUN-creatinine ratio in upper GI bleeding?
    it becomes elevated

    what is the most accurate diagnostic test in the evaluation of upper GI bleeding?
    upper GI endoscopy

    what is often the initial procedure for determining whether GI bleeding is from and upper vs lower GI source?
    nasogastric tube

    how does a bleeding (radionuclide) scan aid in the diagnosis of GI bleeding?
    identifies low rate continuous bleeding
    (however, does not localize the lesion)
  10. Guest

    Guest Guest

    what study definitively locates the point of GI bleeding?
    arteriography:
    - mainly for lower GI bleeding
    - perform during active
    bleeding
    - therapeutic with vasopressin infusion

    what is the treatment of choice in an upper GI bleed?
    EGD w/ coagulation=Esophagogastroduodenoscopy may be abbreviated EGD
    (if bleeding continues, try again or surgical vessel ligation)
  11. Guest

    Guest Guest

    what are the (3) possible treatments in a lower GI bleed?
    colonoscopy
    arteriographic vasoconstrictor infusion
    surgical resection

    what are the indications for surgery for a GI bleed?
    unresponsive hemodynamic instability
    severe initial/recurrent bleed
    >24hrs
    visible vessel
    continuous transfusion req (5U w/in 5hrs)
  12. Guest

    Guest Guest

    From innermost to outermost, what are the three layers of blood vessels (both veins and arteries)?
    1. Tunica intima
    2. Tunica media
    3. Tunica adventitia

    Of what is tunica intima composed?
    Endothelial cells

    Of what is tunica media composed?
    Smooth muscle and collagen

    Of what is tunica adventitia composed?
    A thin fibrous layer

    Which layer is markedly different between arteries and veins, and in what way?
    The tunica media layer is much thicker in arteries than in veins.

    What are the two portions of the descending aorta?
    1. The thoracic aorta
    2. The abdominal aorta

    What are three names for the first branch off the abdominal aorta?
    1. Celiac axis
    2. Celiac trunk
    3. Celiac artery

    In what direction, and how far from the diaphragm, does the celiac artery branch from the aorta?
    It branches anteriorly, about 2 cm below the diagphragm
  13. Guest

    Guest Guest

    marfan's
    autosomal dominant disorder-defect in extracellular microfibrils in cells

    life span with marfans
    32

    comps with marfans
    abnormalties of skeletal, ocular prbs, cardiopulmonary & CNS prbs

    s/s marfans
    scoliosis, funnel-shaped chest,loss of cervical curve, lens subluxation

    usual cause of death with marfans
    CV prbs r/t mitral valve prolapse & aortic aneurysm
  14. Guest

    Guest Guest

    Gabapentin
    -MOA
    GABA analog

    Topiramate
    blocks Na channels

    renal stones
    mental dullness
    weight loss

    Ethosuximide
    blocks thalamic T-Ca channels

    Dantrolene MOA
    prevents release of Ca from SR of skeletal muscle

    Bromocriptine
    -MOA
    dopamine receptor agonist

    Amantadine
    -MOA
    increases dopamine release

    Ldopa/carbidopa

    -MOA
    increases dopamine concentration in synapse

    Selegline
    -MOA
    selective MAO B inhibitor
    prevents dopamine degradation

    Benztropine
    antimuscarinic (like atropine)

    improves parkinsonian tremor
  15. Guest

    Guest Guest

    Arthrocentesis and synovial fluid (SF) analysis yields valuable information that is important for the diagnosis of arthritis; arthrocentesis may help relieve signs and symptoms of arthritis, particularly if large joint effusions are present.
    Indications
    ● Infection – Arthrocentesis must be performed immediately if there is any suspicion of infection. An inflammatory monarticular arthritis should be considered infectious until proven otherwise.
    ● Crystal-induced disease – Arthrocentesis and SF analysis are the only way to identify unequivocally.
    ● Post-traumatic – Analysis of joint fluid is the only way to distinguish post-traumatic hemarthrosis from post-traumatic arthritis with bland SF. Arthrocentesis and synovial fluid (SF)
    ● Inflammatory versus noninflammatory arthritides – SF analysis enables the clinician to differentiate inflammatory and noninflammatory arthritides.
    ● Therapeutic – Arthrocentesis can be therapeutic, and can increase the efficacy of intra-articular glucocorticoids. Therapeutic arthrocentesis is indicated in any patient with a hemarthrosis.
    Technique
    ● Anesthesia – Local anesthesia with 1% lidocaine without epinephrine significantly reduces discomfort associated with the procedure. A number 25 or 27 needle should be used to infiltrate the skin, subcutaneous tissue, and pericapsular tissue.
  16. Guest

    Guest Guest

    SF Analysis
    ● Color – Normal SF is colorless and clear. The yellow color characteristic of SF from people with arthritis is due to xanthochromia.
    ● Opacity – Generally, it is the number of white blood cells (WBCs) that determines the opacity of inflammatory SF. Synovial fluid from people with osteoarthritis is clear, whereas the SF in inflammatory arthropathies is translucent, and SF from a septic joint will be opaque.
    ● Viscosity – Normal joint fluid is viscous due to the presence of hyaluronic acid. Enzymes present in inflammatory arthropathies digest hyaluronic acid, resulting in a decrease in fluid viscosity.
    ● Blood – The presence of blood in a joint usually is the result of acute trauma.
    ● Crystals – Although crystals can be identified in SF a few days old, optimal examinations for crystals are performed on wet preparations
    of SF soon after aspiration.
    ● Classes – There are four classes of SF, defined by differences in gross examination, total WBC count, WBC differential, the presence of absence of blood, and results of Gram stain and culture.
  17. Guest

    Guest Guest

    Dendrite
    phagocytic cell

    Neutrophil
    phagocytic cell

    Puss
    Build up of dead & dying bacteria and phagocytes in the interstitial fluid

    Acquired Immunity
    (humoral immunity); Third line of defense, involves the lymphatic system (b-lymphocytes)

    Humoral Immunity
    (acquired immunity); involves the lymphatic system

    Dendritic cell
    Phagocyte

    Neutrophil
    Phagocyte that targets pathogens

    Puss
    Dead bacteria & phagocytes that build up in the interstitial fluid

    What diagnostic test is used to assess for soft-tissue, nerve, and vessel involvement & tumor boundaries, when Osteosarcoma has been diagnosed?
    MRI

    What purpose does an arteriography have when someone is diagnosed with Osteosarcoma?
    May help determine extent of blood or vascular flow to tumor

    What is the most important prognostic factor in Osteosarcoma diagnosis?
    Extent of disease at diagnosis

    What do pulmonary metastasis indicate at the time of diagnosis?
    1. Greatly decreases survival time
    2. Impact the mgmnt of disease

    What dictates the surgical procedure of an Osteosarcoma tumor?
    Location, location, location
    Limb salvage vs resection

    Why does Spinal Osteosarcoma typically have a poor prognosis?
    Usu. cannot resect entire tumor
  18. Guest

    Guest Guest

    List the three strains of influenza that will be vaccinated against
    H1N1 New Caledonia
    H3N2 Wyoming
    JIangsu

    List the 8 symptoms of influenza
    Fever
    Muscle Aches
    Headache
    Severe Malaise
    Non-productive cough
    Sore throat
    Rhinitis
    N/V

    What is thimerosal?
    A mercury derivative
    Added in very small amounts
    Acts as a preservative
    Prevents bacteria and other organisms from contaminating the vial
  19. Guest

    Guest Guest

    the first order neuron cell bodies for all pain pathways are located where?
    dorsal root ganglia

    another name for the neospinothalamic tract is...?
    lateral spinothalamic tract (LST)

    the neospinothalamic tract contains what type of primary afferent neurons?
    A delta

    what does the neospinothalamic pathway sense?
    "fast" pain, well localized, sharp, cutting

    the trigeminal ganglion is located in what structure?
    pons

    Diabetic foot ulcer
    Negative pressure wound therapy

    Main article: Negative pressure wound therapy

    This treatment uses vacuum to remove excess fluid and cellular waste that usually prolong the inflammatory phase of wound healing. In spite of very straightforward mechanism of action, there are lots of inconsistent results of negative pressure wound therapy studies. Research needs to be carried out to optimize the parameters of pressure intensity, treatment intervals and exact timing to start negative pressure therapy in the course of chronic wound healing.
  20. Guest

    Guest Guest

    DIABETIC FOOT ULCERS:
    May start small, but they are a significant cause of amputation and death for people with diabetes.

    DIABETES THAT LOOSE ONE LEG:
    Over half of diabetics that loose one leg, will loose the other within 5yrs. Only about 40% of patients who've had a foot or leg amputated live for another 5 years.

    DIABETIC PATIENTS AT A HIGHER RISK FACTOR FOR FOOT ULCERS AND AMPUTATIONS:
    Male/sex, smoking, having diabetes for more than 10 years, poor blood glucose control, previous foot ulcer or amputation, other complications of diabetes such as peripheral neuropathy.

    PERIPHERAL NEUROPATHY AND PERIPHERAL NERVOUS SYSTER:
    Peripheral neuropathy is the term for damage to nerves of the peripheral nervous system, which may be caused either by diseases of the nerve or from the side-effects of systemic illness.
    The Peripheral nervous system resides or extends outside the "CNS" central nervous system (the brain and spinal cord) to serve the limbs and organs. Unlike the central nervous system, however, the PNS is not protected by bone, leaving it exposed to toxins and mechanical injuries.
  21. Guest

    Guest Guest

    What is hemoglobin A1c (HgA1c)? What should be your target HgA1c?
    Hemoglobin A1c is the average blood glucose level over 3 months. The target HgA1c is <6.5%.

    What is the ideal diabetic fasting or pre-meal blood glucose level?
    An ideal fasting and premeal blood sugar is 70-130mg and 100-140mg at bedtime.

    What is the ideal 2-hour post-meal blood glucose level?
    The ideal 2-hour post-meal blood glucose level is <160mg.

    What are the target lipid goals (Cholesterol, LDL, TG, and HDL) in someone with diabetes?
    Target lipid goal:
    Total Cholesterol <200
    LDL <100*
    TG <150
    HDL >40 (men)
    HDL >50 (women)
    *Less than 70 mg/dl may be goal in those with heart disease

    What is the ideal blood pressure for someone with diabetes?
    An ideal blood pressure for someone with diabetes is <130/80.

    How do sulfonylurea agents work?
    Sulfonylurea agents stimulate the pancreas to secrete insulin.

    How does metformin work?
    Metformin decreases the output of glucose from the liver, increases the uptake of glucose, and decreases the absorption of glucose from the gut.
  22. Guest

    Guest Guest

    Podiatric debridement of neuropathic ulcers
    • All callus surrounding the wound is removed by sharp
    debridement
    • If the ulcer is subungual, overlying nail is cut back to expose the base of the ulcer
    • Undermined areas detected by probing are cut out
    • Sloughy or discoloured areas of the wound bed are sharp debrided down to healthy bleeding tissue. Local discolouration of the wound bed is often a marker for an underlying track or fluctuant area containing pus.
    Sometimes the track has not yet broken through to the surface and the only indication of its presence is that the tissue of the wound bed which overlies the track may be a different colour, often greyish or purple. The discoloured area should be debrided away using scalpel and forceps to explore the underlying area

    diabetic-surgery
    • It is important that a meticulous wound exploration is carried out, with removal of infected sloughy tissue and laying open of all sinuses. It is rare to find a well-defined abscess
    • The usual presentation is of heavily infected sloughy, grey tissue which needs to be removed down to healthy, bleeding tissue
    • All dead tendon and necrotic tissue should be removed. Wide excision is necessary: small incisions with drains should be avoided
    • Fragmented infected and non-bleeding bone should be removed
    • Deep infected tissue should be sent urgently to the microbiology laboratory
    • The wound should not be sutured but left to heal by secondary intention.

    Vacuum-assisted closure (VAC)
    This is topical negative pressure therapy and can be used to achieve closure of diabetic foot wounds.
    The pump applies subatmospheric pressure, through a tube and foam sponge applied to the wound over a dressing and sealed in place with a plastic film. The dressing is replaced every 2–3 days
    • Negative pressure improves the dermal blood supply, and stimulates granulation which can form over bone and tendon. It reduces bacterial colonization and diminishes oedema and interstitial fluid
    • The technique is useful in healing large postoperative wounds in the diabetic foot, particularly in ischaemic feet and also in patients with renal impairment.
    In a recent study 162 patients with postoperative wounds, following partial foot amputation, were enrolled in a 16- week, 18-centre, randomized clinical trial in the USA

    Wet necrosis in a neuropathic foot
    Key points
    • Untreated neuropathic ulcers which become infected lead to septic vasculitis and gangrene of the toes. This is the true ‘diabetic gangrene’ which can occur in the neuropathic foot with a good arterial supply
    • Diabetic gangrene is preventable if infected ulcers are treated early. If intravenous antibiotics are given when the toe first takes on a blueish tinge, it is possible to prevent deterioration
    • Patients who are strangers in a foreign land are very vulnerable as they may have difficulty in finding help sufficiently early.
  23. Guest

    Guest Guest

    60. What does the kidney usage of oxygen vary in relation to?
    a. Rate of renal tubular sodium reabsorption.

    61. Where is the vast majority of renal blood flow?
    a. In the cortex. The medulla only accounts for 1-2% of totally renal blood flow.

    62. What supplies blood flow to the renal medulla?
    a. Vasa Recta.

    63. What is the affect of sympathetic activation on GFR?
    Decreases it by constricting the renal arterioles and decreasing renal blood flow.
    b. Moderate or mild sympatethetic stim has little influence on GFR.

    64. What hormones constrict renal blood vessels and decrease GFR?
    a. Norepi and Epi
    b. Endothelin-vasoconstricting peptide that can be release by damaged vascular endothelial cells.
  24. Guest

    Guest Guest

    Fucidin
    This is active against penicillin-resistant staphylococci. It has good bone penetration and is useful in osteomyelitis. Resistance to it develops quickly if it is given alone and therefore it should be given with another antistaphylococcal agent. It is useful in combination therapy to treat MRSA infections. Liver function should be monitored if therapy is prolonged and it should be given with caution in patients with liver disease.

    Doxycycline
    This antibiotic can be used in treating MRSA infections. It should be used with caution in patients with hepatic impairment.

    Rifampicin
    This is active against staphylococci and streptococci and has good soft tissue and bone penetration. Patients should be warned that if they develop nausea, vomiting or malaise they should report this immediately as it may reflect liver dysfunction, which is a well described but rare side-effect of rifampicin therapy. It should be given with caution in patients with existing liver disease. Patients should be warned that their body secretions will turn red. Rifampicin should not be given alone because resistance can develop rapidly.

    Clindamycin
    This has very good soft tissue and bone penetration and is active against staphylococci, streptococci and anaerobes including Bacteroides fragilis. However, historically it has been linked with antibiotic-associated colitis caused by Clostridium difficile infections although this can occur with many antibiotics.
  25. Guest

    Guest Guest

    Diabetic foot
    With all the above presentations of infection, it is important to X-ray the foot to detect
    • Signs of osteomyelitis
    • Gas in the deep tissues
    • Radio-opaque foreign body.
    In the initial stages of osteomyelitis, X-ray may be normal. Signs of osteomyelitis such as localized loss of bone density or cortical outline may not be apparent for at least 14 days. MRI may be useful to look for the presence of osteomyelitis and also to detect collections of fluid in the foot. Intravenous injection of gadolinium-containing contrast agent heightens the sensitivity of the diagnosis of these clinical features. However, this contrast should not be used in patients with renal failure. The sequences employed in MRI for detection of soft tissue and bony abnormalities may include T1, short tau inversion recovery (STIR) and postgadolinium with fat suppression.
  26. Guest

    Guest Guest

    Between what two structures is the PV located?
    RV & PA

    What are the names of the PV cusps?
    1. Anterior
    2. Right Posterior
    3. Left Posterior

    What is the normal PV velocity?
    0.6 - 0.9 m/sec

    Compared to the AV cusps, are the PV cusps thinner or thicker?
    Thinner

    What is the direction of blood flow through the PV?
    From the RV
    Through the PV
    To the PA
  27. Guest

    Guest Guest

    What groups have a higher incidence of OM?
    Boys and Native American children

    What is the likely pathogenesis of AOM?
    Most cases of AOM occur when nasopharyngeal pathogens enter the warm, moist middle-ear space via the eustachian tube. Eustachian tubes in children under age 6 tend to be short, narrow, and more horizontal, resulting in poor drainage and ventilation, and are easily obstructed by enlarged adenoids, nasopharyngeal irritation and/or infection, and allergies. The presence of pathogens leads to mucosal swelling in the middle ear and inflammatory obstruction of the eustachian tube. The resultant purulence and pressure usually lead to pain and fever.

    Why is there a reduced incidence of AOM in later childhood?
    As the child grows, the eustachian tube elongates and angles downward, improving drainage. In addition, the pediatric immune system is strengthened in time.
  28. Guest

    Guest Guest

    What is the most common predisposing factor for acute otitis media?
    URI

    What are the risk factors for acute otitis media?
    1. URI
    2. day-care attendance
    3. allergies
    4. enlarged adenoids
    5. bottle-feeding instead of breast-feeding
    6. exposure to secondary smoke
    7. low SES

    How common is viral AOM?
    Up to 25% of of middle-ear cultures are sterile and are felt to be viral.

    What symptoms of AOM are often present in young children?
    1. Non-specific irritability
    2. Crying
    3. Malaise
    4. Fever
    5. Diminished appetite
    6. Ear-pulling
    7. concurrent URI
    8. concurrent allergic symptoms (runny nose, congestion, conjunctival inflammation, etc.)

    What are some less commonly associated symptoms of AOM?
    1. Purulent ear discharge (from a perforation)
    2. Diarrhea
    3. Vomiting

    In older children or adults, what is the most common symptom of AOM?
    Well-localized otalgia

    What are the objective findings of AOM?
    On otoscopic examination, the TM appears red, bulging, or opacified, having decreased motility and poorly visible landmarks.
    *Decreased motility of the TM appears to be more predictive than are color changes in diagnosing AOM. As OM develops, pain may precede eardrum redness. Also, many children are examined before strong clinical signs are evident, and so OM often is diagnosed and treated simply on the basis of symptomatology and suspicion.
  29. Guest

    Guest Guest

    A glioma is a type of tumor that starts in the brain or spine. It is called a glioma because it arises from glial cells. The most common site of gliomas is the brain.[1]Gliomas are classified by cell type, by grade, and by location.
    By type of cell

    Gliomas are named according to the specific type of cell they share histological features with, but not necessarily originate from. The main types of gliomas are:

    * Ependymomas — ependymal cells.
    * Astrocytomas — astrocytes (glioblastoma multiforme is the most common astrocytoma).
    * Oligodendrogliomas — oligodendrocytes.
    * Mixed gliomas, such as oligoastrocytomas, contain cells from different types of glia.
  30. Guest

    Guest Guest

    Q. EBV causes (1999)
    a. burkitt lymphoma
    b. nasopharyngeal angiofibroma
    c. hodgkin's lymphoma
    d. all the above

    Ans. Burkitt lymphoma > Hodgkin'd lymphoma
    Reference: Harrisons's
    "EBV is also associated with several human tumors, including nasopharyngeal carcinoma, Burkitt's lymphoma, Hodgkin's disease, and (in patients with immunodeficiencies) B cell lymphoma."

    If the question stated Nasopharyngeal 'carcinoma' in place of 'angiofibroma', the answer would be 'All the above'

    Q. True about trichuris trichiura (1999)
    a. inhabit small intestine
    b. autoinfection seen
    c. may cause appendicitis
    d. non bile stained eggs

    Ans. May cause appendicitis (By exclusion & logical inference) NOT MENTIONED IN ANY STANDARD TEXTBOOK & ON THE NET (Open for discussion)

    Ref: Harrison's
    "Adult Trichuris worms reside in the colon and cecum, the anterior portions threaded into the superficial mucosa. "
  31. Guest

    Guest Guest

    What cells are produced in bone marrow to provide immunity?
    B and T cells

    an abnormal clonal proliferation of B cells/T cells
    non-Hodgkin's lymphoma

    5th most common cancer in US
    NHL

    which lymphoma (Hodgkin's or Non) is more common
    NHL has a 7x greater incidence than HL

    2 primary lymphoid tissues
    thymus and bone marrow

    5 secondary lymphoid tissues
    lymph nodes, tonsils, adenoids, spleen, Peyer's patches of guy

    How do we classify lymphomas?
    WHO Classification

    which subtype of NHL has the reed-sternberg cell associated with it?
    NONE!

    what percentage of NHL patients present with B symptoms
    20-30%

    most common type of NHL
    diffuse large cell B-cell

    Hemostasis is broken into what two categories?
    Primary and Secondary

    This is a form of hemostasis that has vasoconstriction and formation of platelet plug
    Primary

    This is a form of hemostasis that has the formation of fibrin through the clotting cascade
    Secondary

    Characterized by mucocutaneous bleeding with petechiae, purpura, epistaxis, GI bleed or menorrhagia.
    Multiple causes include viruses, drugs, alcohol.
    Usually resolves once underlying problem corrected or infection clears.
    Life threatening bleeding at levels <20,000
    Thrombocytopenia

    Thombocytopenia: There is a decreased number of platelets due to what three things?
    Decreased Bone Marrow Production

    Increased Splenic Sequestration

    Increased destruction

    What is the definition of Von Willebrand Diease?
    An inherited bleeding disorder that results from quantitative or qualitative defects of von willebrand factor, a multimeric glycoprotein required for normal hemostasis.

    What is the pathophysiology of Von Willebrand Diease?
    Serves two major roles in hemostasis. Platelet adhesion to sites of vascular injury and platelet aggregation during conditions of high shear stress. Second Von Willebrand Diease factor circulates as a noncovalent complex with factor VIII; it protects factor VIII from proteolysis through the body's enzymatic processes.

    Manufactured in endothelial cells and megakaryocytes, vWf is required in both primary and secondary hemostasis. vWf can be released when needed and is an acute-phase reactant. Levels are elevated during pregnancy, with increased stress and when inflammatory processes are present.

    subconjunctival hemorrhage
    from sudden increase in intrathoracic pressure passing through canal; resolves spontaneously

    skull fractures of newborn
    linear --> most common; no symptoms nor treatment needed
    depressed --> elevate to prevent cortical injuries
    basilar --> fatal

    brachial palsy
    Erb-Duchene --> C5-C6; no sholder abduction, external rotation or supination of arm
    Klumpke --> C7/C8 +- T1; paralyzed hand +- Horner syndrome
    most will recover
  32. Guest

    Guest Guest

    Phase Three Study
    Compares new treatment to standard therapy

    Prevalance
    The proportion of subjects in a group with a certain disease, includes new and old cases (a snapshot in time)

    Incidence
    New cases occurring over a defined period of time

    Cumulative Incidence
    aka Attack Rate

    Attack Rate
    aka Cumulative Incidence

    Incidence Rate
    aka Density

    Density
    aka Incidence Rate

    Relationship of Prevalence to Incidence Rate
    Prevalence = (Incidence Rate)(Average Duration of Disease)

    Absolute Risk
    The probability of going from a healthy state to an ill state (eg the probability that person x will develop condition y over the next z years when they don't have it already)

    Absolute Risk
    The probability of going from a healthy state to an ill state (eg the probability that person x will develop condition y over the next z years when they don't have it already)

    Relative Risk
    The strength of association between an exposure and outcome.

    (xy): x: exposure, y: disease
    0=negative, 1=positive

    Relative Risk (calculated from prevalances)
    Relative Risk = Prevalence of disease in population A divided by Prevalence of disease in population B

    Odds Ratio
    An approximation of relative risk used in case control studies.

    (xy): x: exposure, y: disease
    0=negative, 1=positive

    Attributable Risk
    Excess disease in the exposed population that can be attributed to the exposure

    (xy): x: exposure, y: disease
    0=negative, 1=positive

    Confounding
    An erroneous study conclusion when a factor is associated with an exposure and is itself an independent risk factor for the outcome

    Ways to control for confounding
    Restriction (subjects with known risk factors are excluded)
  33. Guest

    Guest Guest

    What is and EEG good for?
    It gives good regional infor on the brain. It is able to localize discrepancies in lobes

    What is a Hz?
    number of cycles/sec

    4 types of brain waves?and jobs?
    Alpha - (Awake/resting)
    Beta - (Busy)
    Theta - (Stress)
    Delta - (Deep sleep)

    What creates an EEG?
    Cortical EPSP and IPSPs

    Types of EEG diagnoses
    Good for differential diagnoses
    Bad for Causative(etiological)

    What's epilepsy?
    The most common neuro disorder, characterized by recurrent seizures

    What is postictal period?
    Immediately after a seizure where the patient is physically and mentally exhausted

    How are the basal ganglia involved with movement?
    They are involved in the control of movement

    What are the five subcortical nuclei of the basal ganglia?
    1. Caudate
    2. Putamen
    3. Globus Pallidus (internal and external segments)
    4. Subthalamic nuclei
    5. Substantia nigra

    The striatum is composed of what two structures? How else are they related?
    The caudate and putamen; they have similar function

    Chlamydia and Rickettsia survive in the host by what mechanism?
    They are obligate intracellular parasites, and they establish "residence" inside animal cells. These "energy parasites" steal ATP from host via ATP/ADP translocator.

    What is a key difference between Chlamydia and Rickettsia in terms of energy utilization?
    Rickettsia can oxidize certain molecules and create ATP (via oxidative phosphorylation). Chlamydia does not appear to have this cytochrome system and no mechanism for ATP production.

    Can we culture chlamydia and rickettsia?
    Obligate intracellular existance makes it impossible to culture these organism on a media that is "not alive."

    We can inoculate Chlamydia or Rickettsia into living cells (usually chick embryo yolk sac or cell culture).
  34. Guest

    Guest Guest

    43 obese F
    presents with RUQ abdom pain, fever and jaundice.
    She was diagnosed with asymptomatic gallstones
    one year ago.

    What is Workup?
    Rectal exam
    CBC
    AST/ALT/bilrubin/alk phos
    vral hepatitis serologies
    US - abdomen
    MRCP
    ERCP

    25 y/o M
    presents with RUQ pain, fever, anorexia, n/v.
    He has dark urine and clay-colored stool.

    What is Differential?
    Acute hepatitis
    acute cholecystitis
    ascending cholangitis
    choledocholithiasis
    pancreatitis
    acute glomerulonephritis
  35. Guest

    Guest Guest

    Longissimus
    Innervation: Dorsal rami of spinal nerves

    Grouping: Intermediate layer (erector spinae group) lies between iliocostalis and spinalis in intermediate layer

    Action:
    (1) Extend vertebral column

    Spinalis
    Innervation: Dorsal rami of spinal nerves

    Grouping: Intermediate layer (erector spinae group) most medial muscle in intermediate layer

    Action:
    (1) Extend vertebral column
  36. Guest

    Guest Guest

    What are the two names that actually matter regarding IBS?
    1. IBS for lower GI
    2. Functional Dyspepsia for upper GI

    What is the definition of IBS?
    -abd discomfort a/w altered bowel habits
    -Diarrhea predominant
    -Constipation predominant
    -Mixed

    What are the demographics of IBS?
    -10-20% of pop qualify, 1/2 get help
    -2:1 F:M and mostly young pts
    -Expensive HC problem $30 billion/yr
    -BIG negative impact on quality of life

    the first order neuron cell bodies for all pain pathways are located where?
    dorsal root ganglia

    another name for the neospinothalamic tract is...?
    lateral spinothalamic tract (LST)

    the neospinothalamic tract contains what type of primary afferent neurons?
    A delta

    what does the neospinothalamic pathway sense?
    "fast" pain, well localized, sharp, cutting

    the trigeminal ganglion is located in what structure?
    pons

    the trigeminal nucleus is located in what structure?
    medulla

    another name for the paleospinothalamic tract is... ?
    anaterior spinothalamic tract (AST)

    where do the first order afferents of the neospinothalamic tract synapse?
    Rexed layer I
    Nucleus Posteromarginalis

    where do the neospinothalamic secondary afferents decussate?
    immediately via the anterior white commissure

    where do the first order afferents of the paleospinothalamic tract synapse?
    Rexed layer II
    substantia gelatinosa

    what does the paleospinothalamic pathway sense?
    dull aching, temp, simple touch

    where do the secondary afferents in the paleospinothalamic tract synapse?
    nucleus proprious

    What cytokines are in the IL-12 family?
    IL-12, IL-23, IL-27, IL-35

    Describe the cytokines of the IL-12 family.
    Each ligand consists of two components: a classical 4 helix bundle cytokine and a cytoplasmic or shed receptor chain. The IL-12 and 23 receptors share one component. They share receptor chains so they have similar responses, but they also have different chains so they have different responses.

    What chemokine is associated with Th1?
    CXCL2

    What chemokine is associated with Th2?
    CCL11
    CCL17

    What chemokine is associated with Th17?
    CCL2
    CXCL10
    CCL5

    What chemokine is associated with Tregs?
    CCL20
  37. Guest

    Guest Guest

    What are the main components of the limbic system?
    1. Limbic Cortex
    2. Hippocampal Formation
    3. Amygdala
    4. Diencephalon
    5. Basal ganglia
    6. Basal forebrain
    7. Septal nuclei
    8. Brainstem
    9. Olfactory cortex

    What are the main functions associated with the limbic system?
    Homeostasis, Olfaction, Memory, Emotions and Drives

    Mneumonic: HOME

    What are the main functions of the Limbic Cortex?
    Structures involved share immunological markers and is affected in diseases such herpes encephalitis
  38. Guest

    Guest Guest

    Q. opsonin is
    a. C3a
    b. C3b
    c. C5a
    d. C5,6,7


    Ans. C3b
    Ref: Robbins
    "The efficiency of phagocytosis is greatly enhanced when microbes are opsonized by specific proteins (opsonins) for which the phagocytes express high-affinity receptors. As described above, the major opsonins are IgG antibodies, the C3b breakdown product of complement, and certain plasma lectins, notably mannan-binding lectin, all of which are recognized by specific receptors on leukocytes."
  39. Guest

    Guest Guest

    definition of fenestrated tracheostomy tube
    a double cannulated tracheotomy tube that has an opening in the posterior wall of the outer cannula above the cuff; removal of the inner cannula allows free breathing through the tube

    definition of MacIntosh blade
    a curved blade that is attached to a laryngoscope. the tip of the blade is inserted into the valecullar to lift the epiglottis indirectly during tracheal intubation

    definition of Miller blade
    A straight blade that is attached to laryngoscope. The tip of the blade lifts the epiglottis directly to aid endotracheal intubation

    definition of obturator
    a device used to block a passage or a canal or to fill in a space, as the obturator used to insert a tracheostomy tube

    Three cell types with regard to cell cycle
    Permanent, Stable, Labile

    Rough Endoplasmic Reticulum rich cells
    -Mucus-secreting goblet cells of small intestine
    -Antibody-secreting plasma cells
    (ie lost of secretory protein)

    Cell cycle: Permanent cells
    Remain in G0. If they regenerate, they regenerate from stem cells.

    Cell cycle: Stable cells
    Enter G1 from G0 when stimulated

    Cell cycle: Labile cells
    Never go to G0, divide rapidly with a short G1

    Smooth Endoplasmic Reticulum: Functions
    -Steroid synthesis
    -Detoxification of drugs and poisons

    Permanent cells: cell types
    -Neurons
    -Skeletal and cardiac muscle
    -RBCs (regenerate from stem cells)

    Stable cells: cell types
    -Hepatocytes
    -Lymphocytes

    Smooth Endoplasmic Reticulum rich cells
    -Liver hepatocytes
    -Steroid hormone-producing cells of the adrenal cortex

    what is the stressed volume?
    the blood volume contained in the arteries

    what is the site of highest resistance of the cardiovascular system?
    arterioles

    what ANS receptors are found in the arterioles of the skin, splanchnic and renal circulations?
    alpha-1 adrenergic receptors

    what ANS receptors are found in the arterioles of skeletal muscle?
    Beta-2 adrenergic receptors

    Which vessels have the lowest vascular resistance? Why?
    capillaries, due to their parallel arrangement (highest cross-sectional area).

    Describe the histology of large arteries
    thick-walled, with extensive elastic tissue and smooth muscle

    describe the histology of arterioles
    smooth muscle wall that is highly innervated by ANS

    describe teh histology of capillaries
    consist of a single layer of endothelial cells surrounded by basal lamina. thin-walled

    Hyperplasia
    Cells have increased in number—hyperplasia

    Dysplasia
    Abnormal proliferation of cells with loss of size, shape, and
    orientation

    In Situ Carcinoma
    * Neoplastic cells have not invaded basement membrane
    • High nuclear/cytoplasmic ratio and clumped chromatin
    • Neoplastic cells encompass entire thickness
    • Tumor cells are monoclonal

    Invasive carcinoma
    * Cells have invaded basement membrane using collagenases and hydrolases
    • Can metastasize if they reach a blood or lymphatic vessel

    Metastases
    Spread to distant organs
    • Must survive immune attack
    • “Seed and soil†theory of metastasis
    • Seed = tumor embolus
    • Soil = target organ—liver, lungs, bone, brain . . .
    • Angiogenesis allows for tumor survival
    • decreased cadherin, increased laminin, integrin receptors

    Metaplasia
    1 adult cell type is replaced by another. Often 2° to irritation and/or environmental exposure (e.g., squamous metaplasia in trachea and bronchi of smokers)

    Dysplasia
    Abnormal growth with loss of cellular orientation, shape, and size in comparison to normal tissue maturation; commonly preneoplastic

    Name reversible cellular - plasias
    Hyperplasia, metaplasia and dysplasia

    Anaplasia
    Irreversible change. Abnormal cells lacking differentiation; like primitive cells of same tissue, often equated with undifferentiated malignant neoplasms. Little or no resemblance to tissue
    of origin.

    Neoplasia
    A clonal proliferation of cells that is uncontrolled and excessive

    Desmoplasia
    Fibrous tissue formation in response to neoplasm.

    Grade
    Degree of cellular differentiation based on histologic appearance of tumor
    (The character of the tumor)

    Stage
    Degree of localization/spread based on site and size of 1° lesion, spread to regional lymph nodes

    Tumor staging system (TNM)
    T = size of Tumor
    N = number of involved lymph nodes
    M = metastases

    What are benign and malignant tumors of bone?
    Rhabdomyoma Rhabdomyosarcoma

    Name malignancies associated with Down syndrome
    ALL (we ALL fall Down),
    and AML

    Name malignancies associated with Xeroderma pigmentosum, Albinism
    Melanoma, basal cell
    carcinoma, and especially
    squamous cell carcinomas
    of skin

    Name malignancies associated with chronic atrophic gastritis, pernicious anemia, postsurgical gastric remnants
    Gastric carcinoma

    Name malignancies associated with Tuberous sclerosis
    Astrocytoma, angiomyoma, lipoma, and cardiac
    rhabdomyoma

    Name malignancies associated with Barrett’s esophagus (chronic GI reflux)
    Esophageal
    adenocarcinoma

    Paget’s disease of bone associated with
    2° osteosarcoma and
    fibrosarcoma

    Autoimmune diseases (e.g., Hashimoto’s thyroiditis and myasthenia gravis are associated with
    Lymphoma

    Dysplastic nevus is commonly associated with what?
    Malignant melanoma

    Radiation exposure is associated with what types of malignancies
    Sarcoma, papillary thyroid
    cancer

    What are oncogenes?
    Gain of function cancer genes. Need damage to only 1 allele to start malignant growth
  40. Guest

    Guest Guest

    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

    True or false? Cocaine-induced coronary ischemia should not be treated with β-blockers.
    True. β-Blockade would result in unopposed-adrenergic stimulation and worsen the patient's symptoms. Calcium channel blockers are the way to go.

    What antimuscarinic is used as an inhalant for asthma?
    Ipratropium

    What two forms of insulin, if mixed together, precipitate zinc?
    Lente insulin and either NPH or protamine zinc insulin (PZI)

    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

    What is the monospot test?
    The monospot test is the initial test used to diagnose infectious mononucleosis (IM). It detects heterophile antibodies that are characteristic of EBV.

    When do you answer monospot test?
    Monospot test is the best initial test when the question shows a patoent with sore throat, fever, lymphadenopathy, and malaise. A total of 50% of patients will have splenomegaly. Rash is present in 15% unless they have been given ampicillin, when it is present in closer to 90% of patients. Exudative pharyngitis may occur.

    What is the most accurate test for EBV?
    The most accurate test acutely is the IgM to EBV viral capsid antigen (VCA). Antibodies to EBV nuclear antigen (EBNA) rise in 3-4 weeks.

    What is Legionella Urine Antigen?
    Legionella urine antigen is the antigen found in Legionella pneumonia. It is the best initial test to make a specific diagnosis of Legionella.

    What is the best test for legionella?
    Legionella urine antigen has 100% specificity with L. pneumophilia type 1. Only 70-80% of disease is caused by L. pneumophilia type 1. Sputum culture or a culture of hte tracheal aspirate on specialized charcoal/yeast extract remains the definitive test.

    When do I answer legionella urine antigen?
    Answer Legionella antigen when you are shown a nursing home resident admitted for pneumonia that presents with fever, confusion, diarrhea, and hyponatremia. CPK, liver function tests, and creatinine can also be elevated.

    What is polymerase Chain Reaction HIV RNA Viral Load (PCR HIV RNA VL)?
    The PCR HIV viral load is a quantitative measurement of the amount of virus in circulation in the patient's blood.

    When (PCR HIV RNA VL) is in the question, what should you think of?
    This test is the first thing to change in response to treatment. PCR HIV viral load is also the first thing to become bnormal if the patient stops taking medication or the treatment fails. The viral load test tells how fast the CD4 cells will drop. The higher the viral load, the faster the person's disease will progress. Thelower the viral load, the slower the disease progresses.
  41. Guest

    Guest Guest

    Q. bronchiectasis is common in (1997)
    a. right lower lobe
    b. left lower lobe
    c. right upper lobe
    d. right middle lobe

    Ans. Left lower lobe
    Reference: General Thoracic Surgery By Thomas W. Shields

    Q. in TB of kidney all are seen except (1997)
    a. acidic urine
    b. pyuria
    c. bacteriuria
    d. casts in urine

    Ans. Bacteriuria

    Ref: Harrison's
    "Genitourinary tuberculosis, which accounts for ~15% of all extrapulmonary cases in the United States, may involve any portion of the genitourinary tract. Local symptoms predominate, and up to one-third of patients may concomitantly have pulmonary disease. Urinary frequency, dysuria, nocturia, hematuria, and flank or abdominal pain are common presentations. However, patients may be asymptomatic and the disease discovered only after severe destructive lesions of the kidneys have developed. Urinalysis gives abnormal results in 90% of cases, revealing pyuria and hematuria. The documentation of culture-negative pyuria in acidic urine raises the suspicion of tuberculosis. "

    Current diagnosis and treatment: Nephrology and hypertension By Allen R. Nissenson, Jeffrey S. Berns, Jeffrey S Berns, Edgar V. Lerma
    Table 1-5
    WBC Casts - Renal tuberculosis

    "Pyuria also accompanies other inflammatory conditions of the genitourinary tract in patients with negative urine culture results. These may be either infectious, such as renal tuberculosis and sexually transmitted diseases, or noninfectious, such as interstitial nephritis"

    "Clinical suspicion arises after failure of response to antibiotics and the presence of a sterile pyuria (without bacteria in the urine or growth in the cultures)."
  42. Guest

    Guest Guest

    Rb gene mutation is associated with what malignancies?
    Retinoblastoma, osteosarcoma

    BRCA1 and BRCA2 are associated with which malignancies?
    BRCA1 - Breast and ovarian cancer,
    BRCA2 - breast cancer

    p53 mutation is associated with which malignancies?
    Most human cancers, Li-Fraumeni syndrome

    What type of malignancy is colon cancer associated with?
    DCC—Deleted in
    Colon Cancer.

    What type of malignancy is pancreatic cancer associated with?
    DPC—Deleted in
    Pancreatic Cancer.

    CEA is a tumor marker for which malignancies?
    Carcinoembryonic antigen. Very nonspecific produced by 70% of colorectal and pacreatic cancers; also produced by gastric and breast
    carcinomas

    What is the treatment for a kid with shock, acidosis, lethargy, poor feeding, nasal flaring and sweating while eating at DOL 4 ?
    prostaglandins (CHF from coarc)

    If a child has formula mixed with well water, what could their cyanosis be from?
    methemoglobinemia

    What's the lesion? cyanosis, pulmonary edema, single S2 and short systolic murmur, normal sized heart with pulmonary congestion
    TAPVR

    What are normal o2 sats on the right side of the heart?
    close to 70

    What's the lesion? precordial hyperactivity and loud S2, severe CHF and marked cardiomegaly; normal until PDA closes (no murmur)
    hypoplastic left heart syndrome (no murmur even with open PDA)

    What's the lesion? single 2nd heart sound, egg shaped heart, increased pulmonary vascularity, cyanosis
    Transposition of the great arteries

    Tay-Sachs Disease -
    (lysosomal storage disease)
    What is it
    AR
    absence of hexosaminidase A
    GM2 ganglioside accums
    cherry-red spot on macula
    death by age 3
    MC lysosomal storage disease
    that causes MR

    Metachromatic leukodystrophy -
    (lysosomal storage disease)
    What is it
    AR
    def. of arylsulfatase A
    sulfatide accums in brain,
    kidney, liver, periph n.

    Hurler's Syndrome -
    (lysosomal storage disease)
    What is it
    AR
    def. of a-L-iduronidase
    corneal clouding
    MR

    Hunter's Syndrome -
    (lysosomal storage disease)
    What is it
    X-linked recessive
    def. of iduronate sulfatase
    mild form of Hurler's
    no corneal clouding
    mild MR

    Fragile X Syndrome -
    What is it
    X-linked
    3rd MCC of MR
    FMR1 gene affected
    anticipation
    triple repeat of CGG
    autism
    large testes, jaw, ears
    floppy/prolapsed mitral valve

    What are the essentials of diagnosis for acute renal failure?
    Increase in BUN (azotemia) or serum creatinine
    Oliguria

    What are the general signs and symptoms of acute renal failure?
    azotemia which may lead to n/v, malaise, altered sensorium
    arrhythmias with hyperkalemia
    rales on pulmonary exam with hypervolemia
    abdomnal pain/ileus
    platelet dysfunction therefore bleeding
    asterixis and confusion

    What are the signs and symptoms occur with prerenal renal failure?
    increased thirst
    decreased urinary output
    orthostatic hypotension (hypovolemic)

    What is the most common cause of acute renal failure?
    Prerenal
    - dehydration, diuresis, hemorrhage, decreased CO, pancreatitis, burns, decreased perfusion
  43. Guest

    Guest Guest

    What are the 4 different insulin types?
    Rapid, Short, Intermediate, Long-Lasting

    What are some names of RAPID insulin?
    Humalog, Insulin Lispro, Novolog

    What are some names of SHORT insulin?
    Regular

    What are some names of INTERMEDIATE insulin?
    NPH, Lente

    What are some names of LONG-LASTING insulin?
    Ultralente, Lantus

    What is the ONSET time for RAPID insulin?
    5-10 minutes

    What is the PEAK time for RAPID insulin?
    30 - 90 minutes

    ▪ Hypercalciuria is the most common cause of calcium-based nephrolithiasis.
    ▪ Familial idiopathic hypercalciuria (FIH) is its most common subset and is inherited in an autosomal dominant fashion but with incomplete penetrance.
    ▪ Several genetic forms of hypercalciuria are also important causes of stones.
    ▪ Urinary tract infections with urease-producing organisms such as Proteus species, Providencia species, Klebsiella species, Pseudomonas species, and various Enterococci species are associated with struvite stones (magnesium ammonium phosphate or carbonate apatite).
    ▪ Hyperuricosuria is a rarer cause of stones or hematuria in children compared to those composed of calcium salts.

    ▪ Hyperoxaluria may be primary or secondary, and lead to stone disease in either circumstance.
    ▪ Cystinuria, an autosomal recessive disease of disordered dibasic amino acid transported in the kidney and gastrointestinal tract, is present in 3% to 10% of children with kidney stones.
    ▪ Hypocitraturia is another contributory cause of nephrolithiasis, as citrate is needed to form a soluble calcium salt, preventing calcium oxalate stone formation.
    ▪ Stones are common in patients with cystic fibrosis who are undergoing therapeutic use of protease inhibitors or a ketogenic diet and who have had bladder augmentation with defunctionalized intestinal segments.
  44. Guest

    Guest Guest

    1)Annual incidence of kidney stones
    2) peak onset?
    3) more common in men or women
    1) 1:1000
    2) third decade
    3)Men

    What is he medical term for flank pain of kidney-stone origin?
    Renal colic

    4 Symptoms of nephrolithiasis
    (2 are just in some cases)
    Renal Colic
    hematuria
    UTI
    Renal falure in severe cases due to obstruction

    1) Describe the time course of renal colic

    2) Where does it radiate
    1) abrupt in onset. lasts 30-60 minutes
    2) down the path of the ureter to the groin/testicles/labia

    The basic DDx fr acute abdominal or flank pain (6 Things)
    Ectopic pregnancy
    Nephrolithiasis
    GI obstruction
    Appendicitis
    Testicular Torsion
    Diverticulitits

    Nephrolithiasis with a chief complaint of pain usually presents with other symptioms such as...
    microscopic or macroscopic hematuria
    Frequency
    Urgency
    Nausea
    Vomiting

    Can plain films see?
    1) Calcium phosphate crystals
    2) Cacium oxalate stones
    3) Struvite (Maagnesium ammonium phosphate)
    4) uric acid stones
    5) cysteine stones
    1) yes
    2) yes
    3) yes
    4) no
    5) no

    What two imaging modalities an see all types of crystals?
    US and CT

    Frequency of Urinary Stones... given the frequency, name the stone
    1) 80%
    2)10%
    3) 8%
    2) 1%
    1) Calcium
    2) Uric acid
    3) struvite
    4) Cysteine
  45. Guest

    Guest Guest

    What are some names of INTERMEDIATE insulin?
    NPH, Lente

    What are some names of LONG-LASTING insulin?
    Ultralente, Lantus

    What is the ONSET time for RAPID insulin?
    5-10 minutes

    What is the PEAK time for RAPID insulin?
    30 - 90 minutes

    What is the DURATION time for RAPID insulin?
    3 - 5 hours

    What is the ONSET time for SHORT(regular) insulin?
    30 minutes

    What is the PEAK time for SHORT(regular) insulin?
    1 - 2 hours

    What is the DURATION time for SHORT(regular) insulin?
    4 - 6 hours

    What is the ONSET time for INTERMEDIATE(NPH) insulin?
    1 - 2 hours

    What is the PEAK time for INTERMEDIATE(NPH) insulin?
    4 - 6 hours

    What is the DURATION time for INTERMEDIATE(NPH) insulin?
    8 - 24 hours

    What is the ONSET time for LONG ACTING insulin?
    4 to 6 hours

    What is pneumolysin?
    A virulence factor released by lysing S. pneumoniae cells. Pneumolysin binds to cholesterol in host cells and creates a pore that lyses the host cell. In meningitis, pneumolysin causes neuronal apoptosis.

    How can you improve the clinical outcome during treatment of meningitis with antibiotics?
    Give corticosteroids first.

    Steroids prevent the secondary increase in TNF due to the release of bacterial cell wall fragments when they're being killed by antibiotics.

    Thus, there is less inflammation and a better outcome.

    How do pili affect what parts of the body are affected by bacterial infections?
    Pili mediate attachment to cell surfaces.

    Pili can be very specific, so they only bind to certain types of tissue. This is why infections can be limited (e.g., only upper urinary tract infections).

    What is the glycocalyx, and what does it do for bacteria?
    Glycocalyx is a polysaccharide layer on the surface of the cell capsule.

    The glycocalyx helps the bug attach to certain surfaces, especially slippery surfaces like plastic or prosthetics.

    What two imaging modalities an see all types of crystals?
    US and CT

    Frequency of Urinary Stones... given the frequency, name the stone
    1) 80%
    2)10%
    3) 8%
    2) 1%
    1) Calcium
    2) Uric acid
    3) struvite
    4) Cysteine

    There are three kinds of Ca++ based stones. Name them and give their frequency (should add up to 80% because Ca++ stones are 80% of stones)
    1) Calcium oxalate- 35%
    2) Calcium oxalate and Calcium phosphate MIXED- 40%
    3) Just Calcium phosphate- 5%

    Name a drug which can ppt. to cause stones
    TRIAMTERENE (in lecture)
    Acyclovir

    Three steps needed for stone formation
    1) nidus formation
    2) retention of nidus in tract
    3)Growth of nidus to the size where it can be seen radiographicaly or symptoms

    The level of saturation where solid is in equilibrium with solute (liquid) is called the...
    Solubility product
  46. Guest

    Guest Guest

    vermis hypoplasia
    cystic dilation of lateral, 3rd,sylvian, 4th ventricles,
    hydrocephalus
    obstructed foramen Luska/Magn
    Dandy Walker

    loss of pain, T in hands
    atrophy of intrinsic hand muscles
    fluid filled cervical cord enlargement
    anterior horn destruction
    +/- Chiari herniation
    syringomyelia

    port wine stains
    leptominingeal angioma, AVM
    glaucoma
    seizure
    hemiparesis
    MR
    Sturge-Weber

    cafe au lait
    pigmented iris harmartomas
    neurofibromas
    auto d
    neurofibromatosis 1

    Hemoglobin A (HgA) is replaced by ? in sickle cell disease.
    (HgS)abnormal sickled Hemoglobin

    The 4 most common diseases related to sickle cell disease in the US are?
    Sickle cell anemia, Sickle cell C disease, Sickle cell hemoglobin E disease, Sickle cell thalassemia disease.

    This, the most common form, is said to the result of selective protection afforded trait carriers against one type of malaria.
    Sickle Cell Anemia

    HgS is on an autosome & is always detectable(when present) and dominant. People who have both HgA & HgS are considered?
    to be carriers of the sickle cell trait

    If both parents have the sickle cell trait there is a ___% chance for each preg to have SCA.
    25%

    The HgS is usually not apparent until later in infancy because of ___ that is given by the mother in utero.
    HbF- fetal hemoglobin & it takes the place of the HbS so there is less to cause problems.

    Sickle-cell gene mutation probably arose spontaneously in different geographic areas, as suggested by restriction endonuclease analysis. These variants are known as Cameroon, Senegal, Benin, Bantu and Saudi-Asian. Their clinical importance springs from the fact that some of them are associated with higher HbF levels, e.g., Senegal and Saudi-Asian variants, and tend to have milder disease.[24]
    In people heterozygous for HgbS (carriers of sickling haemoglobin), the polymerisation problems are minor, because the normal allele is able to produce over 50% of the haemoglobin. In people homozygous for HgbS, the presence of long-chain polymers of HbS distort the shape of the red blood cell from a smooth doughnut-like shape to ragged and full of spikes, making it fragile and susceptible to breaking within capillaries. Carriers have symptoms only if they are deprived of oxygen (for example, while climbing a mountain) or while severely dehydrated. Under normal circumstances, these painful crises occur about 0.8 times per year per patient.[citation needed] The sickle-cell disease occurs when the seventh amino acid (if the initial methionine is counted), glutamic acid, is replaced by valine to change its structure and function.

    The HbF will last about ___ and then the infant may begin to show s/s of SCA.
    about a year

    SCA is considered a disease of A.obstruction/destruction B.construction/destruction C.destruction/instruction
    Obstruction & destruction

    The sickle shaped cells get all tangled up and cause vaso-occlusion. Results are 3 major issues.
    Hypoxia/Ischemia/Infarction (cell death
  47. Guest

    Guest Guest

    Sickle-cell conditions are inherited from parents in much the same way as blood type, hair colour and texture, eye colour, and other physical traits. The types of haemoglobin a person makes in the red blood cells depend on what haemoglobin genes are inherited from his parents. If one parent has sickle-cell anaemia (SS) and the other has sickle-cell trait (AS), there is a 50% chance of a child's having sickle-cell disease (SS) and a 50% chance of a child's having sickle-cell trait (AS). When both parents have sickle-cell trait (AS), a child has a 25% chance (1 of 4) of sickle-cell disease (SS), as shown

    The sequence of events following occlusion to organs are:123
    1.Stasis with enlargement 2.Infarction w/ischemia & destruction 3.Replacement with fibrous tissue (scarring)

    The most acute symptom of SCA is?
    exacerbation called "crisis"

    The 5 types of SCA crisis are?
    Vaso-occlusive, Sequestration, Aplastic, Hyperhemolytic, Chest Syndrome (like pneumonia)

    Lehann said to remember that the blood can filter on through, its just tangled up. So it's not considered a ?
    Clot- it is blood & it is an occlusion but not a clot

    Which is the main or #1 crisis & the more often cause of going to ER w/SCA?
    Vaso-Occlusive

    The FIRST symptom in kids is usually?
    Pain in the extremities

    Because of its narrow vessels and function in clearing defective red blood cells, the spleen is frequently affected. It is usually infarcted before the end of childhood in individuals suffering from sickle-cell anaemia. This autosplenectomy increases the risk of infection from encapsulated organisms;[7][8] preventive antibiotics and vaccinations are recommended for those with such asplenia.* Splenic sequestration crises: are acute, painful enlargements of the spleen. The sinusoids and gates would open at the same time resulting in sudden pooling of the blood into the spleen and circulatory defect leading to sudden hypovolaemia. The abdomen becomes bloated and very hard. Splenic sequestration crises is considered an emergency. If not treated, patients may die within 1–2 hours due to circulatory failure. Management is supportive, sometimes with blood transfusion. These crises are transient, they continue for 3–4 hours and may last for one day.
    The syndrome noted for symmetrical swelling of hands/feet, painful joints, abdominal pain & you may think they have appendicitis
    Hand and Foot syndrome (clinical name is dactylitis)

    vaso-occlusion where? 1.causing vision chgs & stroke 2.episodes of pulmonary disease/pneumonia
    3.jaundice/hepatic coma
    1.Cerebrum 2.Acute chest syndrome 3.liver

    VO crisis where? if: 1.hematuria 2.priapism
    1.kidneys 2.genitals

    Sickle-cell anaemia is the name of a specific form of sickle-cell disease in which there is homozygosity for the mutation that causes HbS. Sickle-cell anaemia is also referred to as "HbSS", "SS disease", "haemoglobin S" or permutations thereof. In heterozygous people, who have only one sickle gene and one normal adult haemoglobin gene, it is referred to as "HbAS" or "sickle cell trait". Other, rarer forms of sickle-cell disease include sickle-haemoglobin C disease (HbSC), sickle beta-plus-thalassaemia (HbS/β+) and sickle beta-zero-thalassaemia (HbS/β0). These other forms of sickle-cell disease are compound heterozygous states in which the person has only one copy of the mutation that causes HbS and one copy of another abnormal haemoglobin allele.
    Crisis of pooling of large amounts of blood in the liver & spleen, <blood volume, poss shock, poss spleenectomy
    Sequestration crisis

    Dont produce RBC's, severe anemia, Hgb is low
    Aplastic crisis

    accelerated rate of destruction of RBC's- faster than you can make them, anemia, jaundice
    Hyperhemolytic crisis
  48. Guest

    Guest Guest

    Regarding the imaging modalities of the chest:
    (a) High resolution computed tomography (HRCT) uses a slice thickness of 4–6 mm to identify mass lesions in the lung.
    (b) Spiral CT ensures that no portion of the chest is missed due to variable inspiratory effort.
    (c) MRI shows excellent detail of the lung anatomy.
    (d) Bronchography is the technique of choice to visualize the bronchial tree
    (e) CT pulmonary angiography (CTPA) is performed using catheters placed in a femoral vein.
    (a) False – HRCT uses 1–2 mm slice thickness and a high resolution computer algorithm to show fine detail of the lung parenchyma, pleura and tracheobronchial tree. It is not used to delineate masses in the lung.
    (b) True
    (c) False – currently MRI is a poor technique for showing lung detail. It allows visualisation of the chest wall, heart, mediastinal and hilar structures.
    (d) False – this invasive technique has largely been superseded by HRCT.
    (e) False – CTPA is performed to diagnose major pulmonary emboli using a cannula placed in any peripheral vein and is relatively non-invasive compared to conventional pulmonary angiography.

    Regarding the development of the lung:
    (a) The tracheobronchial groove appears on the ventral aspect of the caudal end of the pharynx.
    (b) The primary bronchial buds develop from the tracheobronchial diverticulum.
    (c) The epithelium lining the alveoli is the same before and after birth.
    (d) A persistent tracheo-oesophageal fistula (TOF) is commonly associated with an atresia of the duodenum.
    (e) Uni-lateral pulmonary hypoplasia is usually due to a congenital diaphragmatic hernia.
    (a) True
    (b) True – the bronchial buds differentiate into bronchi in each lung.
    (c) False – during embryonic life the alveoli is lined by cuboidal epithelium that lines the rest of the respiratory tract. When respiration commences at birth the transfer to the flattened pavement epithelium of the alveoli is accomplished.
    (d) False – TOF indicates the close developmental relationship between the foregut and the respiratory passages. It is usually associated with an atresia of the oesophagus and the fistula is situated below the atretic segment.
    (e) True

    Regarding the blood supply to the chest wall:
    (a) The posterior intercostal arteries supply the 11 intercostal spaces.
    (b) The internal thoracic artery arises from the subclavian artery and supplies the upper six intercostal spaces.
    (c) The neurovascular bundle passes around the chest wall in the subcostal groove deep to the internal intercostal muscle
    (a) False – there are usually nine pairs of posterior arteries from the postero-lateral margin of the thoracic aorta, distributed to the lower nine intercostal spaces. The first and second spaces are supplied by the superior intercostal artery, branches of the costocervical trunk from the subclavian artery.
    (b) True
    (c) True
  49. Guest

    Guest Guest

    What is the significance of EGFR mutations as it relates to drug therapy?
    EGFR mutations (especially exon 19 deletion, exon 21 mutation) are associated with response to Tyrosine Kinase Inhibitors (TKI) such as erlotinib.

    What is the significance of K-ras mutations as it relates to therapy?
    K-ras mutations are associated with TKI resistance. If this is the case, do no use TKI.

    What are the early signs of lung cancer?
    Cough, hoarseness, wheezing, dyspnea

    What are the signs of metastatic spread of lung cancer?
    Hemoptysis, Pancoast's syndrome, Bone pain, Jaundice

    What are the major features of paraneoplastic syndrome? (6)
    SIADH
    Elevated ANP
    Cushings Syndrome
    Lambert-Eaton Syndrome
    Superior Vena Cava Syndrome
    Hypercalcemia

    What is are the symptoms of Pancoast's Syndrome?
    Shoulder/arm pain due to tumor compression of the brachial plexus

    How do you manage SIADH? (3 things)
    Fluid restriction
    Saline infusion for symptomatic patients
    Demeclocycline
  50. Guest

    Guest Guest

    What is hemophilia?
    Characterized by a deficiency or absence of clotting factors that results in prolonged bleeding. It is caused by the inherintance of a functional defect in the factor VIII or IX protein that has an X-linked inheritance pattern.

    How is hemophilia classified?
    According to the missing or deficient protein. Hemophilia A is known as factor VIII deficiency or classical hemophilia.

    Hemophilia B is known as factor IX deficiency or Christmas disease. T/F
    True

    Hemophilia occurs only in females. T/F
    False- X-linked

    Hemophilia is known as "royal disease" in Europe. T/F
    True- All of the affected males of European royal families were direct descendants of Queen Victoria of England

    If an egg is fertilized by an X-bearing sperm with a mutation occuring on the factor VII or factor IX gene on an X chromosome if an egg, the male offspring will have hemophilia. T/F
    True

    If an egg is fertilized by an X-bearing sperm, the female offspring will be a carrier. If a mutation occurs in an X-bearing sperm, the female offspring will also be a carrier.

    What is the clinical presentation of a patient with hemophilia?
    - bleeding from circumcision
    - multiple raised bruises
    - prolonged mouth bleeding or bleeding from finger/heel stick
    - intercranial hemorrhage

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