Incorrects Week 4

With scoliosis, what is mild scoliosis considered and what is the treatment?

mild = <20 degree cobb angle → treat with observation

(note OMM is good for all severities, but is NOT standalone treatment and probably isn’t the answer to the question)

with scoliosis, what is moderate scoliosis and what is the treatment?

moderate: 20-45 degree Cobb angle → treat with bracing

(note OMM is good for all severities, but is NOT standalone treatment and probably isn’t the answer to the question)

what is severe scoliosis and what is the treatment?

severe = >50 degree Cobb angle → surgical referral due to increased cardiopulmonary risks

Biliary colic occurs after fatty meals in pt who have cholelithiasis, what substance and secretory cell are implicated in this? (F,F,F, F with severe RUQ pain after a meal)

I cells → CCK (cholecystokinin)

what is the next step for a pt with postmenopausal bleeding in women with a normal PE, history of prolonged bleeding, and are at risk of endometrial cancer?

endometrial biopsy (doesn’t matter is the PE is normal, the bleeding is not normal and you have to get to the bottom of the cause)

what is this and what confirms the diagnosis?

pt presents with early signs of pregnancy and a strong belief that she is pregnant but is not

pseudocyesis → thin endometrial stripe on US and a negative urine pregnancy test

A pt has either hepatitis B or C, so they are predisposed to what and what screening should be done?

hepatocellular carcinoma → alpha-fetoprotein (tumor marker)

What is this and what embryological structure gives rise to the vessel that caused this?

child presents status post scoliosis surgery and now has n/v and sharp stabbing pain, pt is fearful to eat and pain is better lying on left side but worse lying on back

superior mesenteric artery syndrome → duodenum becomes entrapped by SMA → vitelline arteries give rise to the SMA

What is this? describe it

older man presents with pearly papule with a translucent edge beneath eye, pt worked as a farmer, and has had similar lesions removed in the past

basal cell carcinoma → it is usually cured by surgical resection and rarely metastasizes

(note the pearly look and common on head and neck on sun exposed areas)

which airway level has the lowest overall airway resistance before eercise?

terminal bronchioles (note that this seems counterintuitive because they are so small, but since they are in parallel and their are so many, then they make up for being small)

where is the AT12 tender point?

anterior superior surface of the iliac crest at the midaxillary line

What Brodmann area goes with Broca’s aphasia?

Brodmann areas 44 and 45

What Brodmann area goes with Wernicke aphasia?

Brodmann area 22

what is this? what area is affected? what structure is affected?

pt can produce and understand language and her fluency and comprehension are normal, but she cannot repeat “no ifs, ands, or buts”

conduction aphasia → arcuate fasciculus → MCA (think stroke man mouth)

A pt presents with a fungal meningitis, how do we treat?

amphotericin B (likely have coccidiodal meningitis)

What structure yields the penis in males and the clitoris in females?

genital tubercle

what is the treatment and MOA for treating PTSD?

SSRIs → inhibit the 5-HT (serotonin) transporters

what is this and what is involved?

pt presents with weakness and numbness of one side of his body, he has hemiparesis and hemianesthesia of the right upper and lower extremities but normal on left

capsular stroke of the internal capsule → left lenticulostriate arteries

what is this?

pt presents with anterior knee pain that worsens with prolonged sitting and pt has a positive J-sign

patellofemoral pain syndrome

what happens in the kidneys when a pt has metabolic acidosis to help the body eliminate the excess acid?

increased secretion of NH4+ (ammonia) at the PCT

where are the cytochrome P450 enzymes located?

smooth endoplasmic reticulum

a pt has thyroid surgery and now presents with hypocalcemia, what are her PTH, calcium, phosphate, and alk phos levels?

accidental removal of the parathyroid glands is a complication of thyroid surgery ans can result in hypocalcemia

PTH: decreased

calcium: decreased

phosphate: increased

alk phos: neutral/no change

what is the most frequent pathogen to cause acute otitis media?

strep pneumo

what is the treatment for acute typical grief?

reassurance

What is this? underlying cause?

pt presents with nodding of the head during systole and diastolic murmur best heard at the 3rd left ICS

aortic regurg → bicuspid aortic valve

where do RNA viruses replicate? DNA?

RNA: in the cytoplasm (except influenza)

DNA: in the nucleus

what is the MOA of iranotecan?

inhibiting topoisomerase I in order to prevent DNA unwinding and replication

What pathogen?

pt presents with severe and rapidly progressing pneumonia and was in Arizona and around mouse droppings and dead mice

hantavirus

for treating the ankle with CS, what is the set up for medial malleolus vs lateral malleolus?

pt on side with affected leg up and towel under ankle, then either invert (medial) or evert (lateral) the foot (good old fold and hold method)

what time period is the developing embryo most susceptible to multiple severe congenital malformations resulting from teratogenic exposure?

weeks 3-8

When do type II pneumocytes proliferate

24 weeks gestation

what do we see on kidney biopsy for a pt with poststrep/postinfectious glomerulonephritis?

subepithelial humps of IgG and C3 on basement membrane (lumpy bumpy)

If a pt presents with chronic lymphocytic leukemia and now has a positive direct Coombs test, low platelets, anemia, elevated serum lactate dehydrogenase, what is this and what is most likely associated with this?

autoimmune hemolytic anemia → spherocytes on peripheral blood smear

If a pt is being treated for a resp infection, UTI, or gonorrhea and also takes theophylline and now has difficulty breathing, anxiety, and palpitations, what is the likely abx that caused this presentation?

ciprofloxacin (a fluoroquinolone) → it inhibits CYP1A2 so the pt has theophylline toxicity because it is not being metabolized by the CYP

In pts with asthma that are prescribed a non-selective beta-blocker, what is the most likely adverse effect?

bronchospasm

What drug(s) are first-line treatment for glaucoma but can darken the iris of a pt with lighter eyes (blue eyes change to brown)?

prostaglandin analogs like latanoprost and travoprost

what is this? what else do we see?

child with seizure, hypopigmented skin, and heart murmur and developmental delay

tuberous sclerosis complex → associated with cardiac rhabdomyoma (causing the murmur) and renal angiomyolipoma (look at pic for mnemonic)

pathogen and description?

bulls-eye rash on pt with history of hiking in the woods

Lyme disease → Borrelia burgdorferi → gram negative spirochete

What is this and how do we treat it?

pt presents with ascending weakness and decreased/absent deep tendon reflexes following an immune stimuli (like a GI infection)

Guillain-Barre syndrome (immune mediated demyelination of peripheral nerve fibers) → treat with plasmapheresis or IVIG

dx and pathophys?

5 day old baby presents with yellow skin and conjunctiva, irritability, poor feeding, and light-colored stools

neonatal jaundice → deconjugation of bilirubin by beta-glucuronidase and reabsorption into circulation (think Lauren)

what is this? deficiency?

pt presents with dysmorphic facial features, hypotonia, cataracts, sensorineural hearing loss, and elevated very-long chain fatty acids

Zellweger syndrome → deficiency in peroxisomal beta oxidation ( focus on the peroxisome)

what is this? inheritance?

newborn with meconium ileus, poor weight gain with normal food intake

cystic fibrosis (the meconium ileus occurs due to abnormally thick mucus secretions in the GI tract) → autosomal recessive

if you suspect your pt is going to harm someone who do you contact?

local law enforcement AND the intended victim

what is this? what else would we see?

pt presents with upper abdominal pain radiating to back, weight loss, fatigue, scleral icterus, and lymphadenopathy

pancreatic cancer → also see Courvoisier sign (painless enlarged gallbladder)

what is this? what would you see?

pt presents with recurrent epistaxis, iron deficiency, and family history

Osler-Weber-Rendu syndrome → dilated blood vessels (telangiectasias)

What is this? How to treat it?

pt presents with hemarthrosis (bleeding into the joint), bleeding after minor trauma, elevated PTT, and maternal grandfather with bleeding disorder

hemophilia A → in preparation for surgery you treat prophylactically with desmopressin

what is this and what do we see in the kidney?

pt presents with flank pain radiating to testicles, fever, and CVA tenderness

likely has pyelonephritis due to urethral obstruction by a kidney stone → this causes increased hydrostatic pressure within Bowman space (kidney stone impedes urine flow) (not increased pressure in the capillaries)

if we have an abduction SD of the ulna, what do we see with the carrying angle and wrist?

increased carrying angle and wrist adducted (restricted in abduction)

*I don’t know why, but the ulna and wrist are opposite, think about it like a seesaw with the ankle and fibular head)

pt with serotonin syndrome, what is the antidote?

cyproheptadine (serotonin antagonist)

pt with peptic ulcer disease is treated with an H2 receptor antagonist? what is the drug?

famotidine, cimetidine, or nizatidine

explain the histamine blockers and their suffix

H1 blockers (antihistamines) → “tadine” (like loratadine)

H2 blockers (treat stomach issues) → “tidine” (like famotidine)

oocytes arrested in what stage for: before puberty vs before fertilization

before puberty (prophase I) before fertilization (metaphase II)

If a pt has hypertrophic cardiomyopathy, what is the mutation?

pt presentation: athletic activity, heart murmur, family history of sudden death at young age during athletic activity, and hypertrophy of interventricular septum)

beta-myosin heavy chains

Pt presents with anemia and noticed that her stools are dark and “look like gravel”, what is this? what do we see with serum iron, serum ferritin, serum transferrin, and transferrin saturation?

iron deficiency anemia (likely due to blood loss from GI bleed) → decreased serum iron, increased serum ferritin, decreased serum transferrin, and decreased transferrin saturation

If a baby presents with neonatal respiratory distress syndrome, what is a complication of this?

treatment with supplemental oxygen may cause retinopathy

what is this?

child presents with cardiac abnormalities and recurrent infections

DiGeorge syndrome → the recurrent infections are from hypoplastic thymus leading to T cell deficits → see hypocalcemia on labs

What is this? what lab finding is associated?

pt presents with dyspnea, asthma, rales and wheezes, serum eosinophilia, and neuropathy

eosinophilic granulomatosis with polyangiitis → P-ANCA abs

what do we see with Brown-Sequard syndrome (hemisection of spinal cord)

ipsilateral: paralysis and loss of touch/vibration sensation

contralateral: loss of pain and temp sensation

if you see abnormally high aldosterone levels, you have to look at the renin levels to determine primary vs secondary, explain

primary: low renin and high aldosterone → due to issue with adrenal zona glomerulosa

secondary: high renin and high aldosterone → due to defect in the juxtaglomerular apparatus

if we see postmenopausal bleeding without observable masses on exam, we should suspect ____. describe

endometrial hyperplasia → tall columnar cells with nuclear atypia lining crowded glands

Petrissage vs effleurage

outline the face → effleurage

massage the points on the face → petrissage

describe bacillus anthracis

spore forming gram + rod (interesting that its a gram + rod)

How to treat bacillus anthracis?

ciprofloxacin or doxycycline

with intususception we see what?

peyer patch hypertrophy and target sign

high pitched lung sound with expiration vs inspiration

expiration: wheezing

inspiration: stridor

what is the pathogen and description?

preterm neonate presents with neonatal meningitis

strep agalactiae (GBS) → cat-neg, beta-hemolytic, bacitracin-resistant, gram + cocci

how do we treat pts with hyperthyroidism even before confirming the cause?

beta-blocker

what is this? treatment?

child swallows a bunch of pills, has n/v, hematemesis, and metabolic acidosis

iron intoxication → treat with deferoxamine

GLUT receptors all bring glucose into cells via

facilitated diffusion

Describe Coxsackie virus

naked icosahedral capsid, single stranded RNA

what is the MOA of the PPIs (like omeprazole)

inhibit primary active transport

How to calculate GFR/clerance?

(urine concentration of substance x urine output/formation rate)/ plasma concentration of substance)

achalsia pathophys?

degeneration of inhibitory neurons

Thoracic outlet syndrome is caused by compression of the brachial plexus and subclavian vein which all occurs where?

between the anterior and middle scalene muscles

acute gout attack is treated with what? what is the MOA?

non-aspirin NSAID, glucocorticoid, or colchicine

colchicine → MOA binding to tubulin to prevent microtubule polymerization

type-3 spondylolisthesis most frequently involves what level? type 1?

type 1: L5-S1

type 3: L4-L5

what is this? pathophys?

pt presents with asthma, chronic rhinosinusitis with nasal polyps, and bronxhospasm

NSAID-exacerbated respiratory disease (note that the stem will talk about the pt taking a medication for fever or muscle pains before this occurs which is the NSAID) → this is due to leukotriene excess

what is the pathophys for lactose intolerance?

hyperosmotic intraluminal gradient (because the lactose sugars can’t be broken down and hang out in the gut lumen)

what is the first line for PUD disease? what is the likely adverse affect?

PPIs which inhibit the hydrogen-potassium ATP pump (“prazole”) → they cause hypomagnesemia and hypocalcemia

what drugs? what is this called?

drugs that are eliminated at a constant rate regardless of plasma concentration (linear curve)

zero-order kinetics → phenytoin, ethanol, aspirin, salicylates, fluoxetine, omeprazole, and cisplatin

PEAS Fast Or Constant

for organ donation of a recently deceased pt, what is the protocol? example: the pts husband states that she wanted to donate her organs

since you were the physician taking care of the pt who died it is not a good look to inquire about the organ donation status of the pt → instead you just contact the local organ procurement organization to notify them and let them take it from there

Pt presents with diarrhea that is antibiotic-resistant after surgery, what is the pathogen and treatment?

C diff → treat with oral fidaxomicin

dopamine is derived from what? serotonin?

dopamine: tyrosine

serotonin: tryptophan

Gardner syndrome (impacted teeth, osteomas, FAP, etc) also has what?

congenital hypertrophy of the retinal pigment epithelium

what is the treatment and MOA of bacterial vaginosis?

metronidazole → inhibition of nucleic acid synthesis by causing DNA strand breakage (via its toxic metabolites)

pt has a nerve injury and the claw hand when trying to extend fingers, what else do we suspect?

ulnar claw → impaired thumb adduction (all other thumb movements are controlled by the median nerve)

so overall ulnar claw = weakness of 4th and 5th digits (causing the claw hand) and thumb adduction

what is the most common organism known to cause acute bacterial parotitis (inflamed parotid gland)?

staph aureus

if it seems like pt might have molluscum contagiosum due to description (lesions with indentation in center) but they have known contact with bioterrorism agents, what is the pathogen and description?

smallpox → DNA virus with cytoplasmic replication (note this is an exception to DNA replication)

The angle of Louis is also the level of what?

second rib, bifurcation of trachea, and aortic arch

what is this? defect?

pt presents with recurrent abscesses and an unreactive (negative) nitroblue tetrazolium test

chronic granulomatous disease → defect in NADPH oxidase

Vitiligo is what type of disease? what else is assocaited?

autoimmune disease → associated with other autoimmune diseases like thyroid disease (Hashi or graves), addison’s, diabetes, etc

scleroderma goes with what antibodies?

anti-centromere abs

what is this?

pt presents with confusion and disorientation and sleeping during the daytime and awake at night after surgery

delirium

when administering local anesthetics, what is important to remember about infections?

if administering a local anesthetic to a site of infection then need higher dose because the drug cannot penetrate the membrane as effectively

what is the MOA of macrolides (azith, clarith, eryth)?

bind to the 50S ribosomal subunit to inhibit translocation

what pneumoconiosis goes with naval shipyards? what do we see?

asbestos lung disease → the asbestos bodies are coated with iron and protein (so they show up golden-brown)

a positive apley scratch test means what?

reduced rotator cuff function

If we see positive anti-Saccharomyces cerevisiae antibodies, what GI disease? what finding?

Crohn disease → transmural inflammation and noncaseating aggregations of macrophages within the mucosa

what is this? pathophys?

pt presents with heavy menses, normal platelet count, PTT normal, prolonged bleeding time and PT

Von Willebrand disease → deficiency of a platelet adhesion protein (the von willebrand factor)

what drug?

pt treated for TB now has weakness, dizziness, numbness and paresthesia in lower extremities and elevated aspartate aminotransferase and alanin aminotrasferase

isoniazid → pyridoxine (B6) deficiency causing the peripheral neuropathy