Term
| A mutation in which proto-oncogene is most commonly associated with Hirschsprung disease? |
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Definition
| RET (neural crest development) |
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Term
| A 48-year-old man presents to your office with a persistent cough that has begun to become bloody. CXR reveals a coin lesion within the lung parenchyma. Further work up reveals that the patient has the most common type of lung cancer in non-smokers. Which cancer is this? What other cancers are not associated with smoking? Which lung cancers are associated with smoking, and where are they located, centrally or peripherally? |
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Definition
Non-smokers (located peripherally): bronchial adenocarcinoma (also bronchioalveolar adenocarcinoma and mesothelioma)
Smokers (located centrally): Small cell carcinoma, squamous cell carcinoma |
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Term
| What is the mechanism of action of the hyperosmolar laxatives? What are some examples of hyperosmolar laxatives? |
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Definition
Hyperosmolar substances not absorbed, stay in the gut, draw fluid into the bowel
Examples: Magnesium citrate, polyethylene glycol (Miralax, GoLytely, NuLytely), Lactulose, Sorbitol, Glycerine |
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Term
Which fungal infection fits the following descriptions?
- Causes diaper rash
- Opportunistic mold with septate hyphae that branch at less than a 45 degree angle
- Opportunistic mold with irregular nonseptate hyphae that branch at angles more than 90 degrees
- Dimorphic fungi common to the southwest United States San Joaquin Valley or “valley” fever
- Causes thrush in immunocompromised patients and vulvovaginitis in women
- Dimorphic fungi with broad-based budding yeast
- Known for causing pneumonia in AIDS patients. Treatment includes TMP-SMX prophylaxis when CD4 <200
- Common to Mississippi and Ohio river valleys. Found in bird and bat feces.
- Dimorphic fungi. Causes a skin infection in those pricked by a thorn
- Yeast known for causing meningitis in AIDS patients |
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Definition
- Causes diaper rash – Candida albicans
Opportunistic mold with septate hyphae that branch at less than a 45 degree angle – Aspergillus fumigatus
Opportunistic mold with irregular nonseptate hyphae that branch at angles more than 90 degrees - Mucor
Dimorphic fungi common to the southwest United States San Joaquin Valley or “valley” fever – Coccidioides mycosis
Causes thrush in immunocompromised patients and vulvovaginitis in women – Candida albicans
Dimorphic fungi with broad-based budding yeast - Blastomyces
Known for causing pneumonia in AIDS patients. Treatment includes TMP-SMX prophylaxis when CD4 <200 – Pneumocystis jirovecii
Common to Mississippi and Ohio river valleys. Found in bird and bat feces. - Histoplasma
Dimorphic fungi. Causes a skin infection in those pricked by a thorn – Sporothrix schenckii
Yeast known for causing meningitis in AIDS patients – Cryptococcus neoformans |
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Term
| A 43-year-old man develops osteomyelitis. What is the causative organism of osteomyelitis in most patients? What organism would you suspect in a patient with osteomyelitis and sickle cell anemia? What about a drug addict with osteomyelitis? |
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Definition
Most common: Staph aureus
Sickle Cell: Salmonella
Drug addict: Pseudomonas aeruginosa |
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Term
| A motorcycle crash causes the rider’s spinal cord to be severed. How can you distinguish a lower motor neuron lesion from an upper motor neuron lesion? |
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Definition
LMN: Muscle atrophy and flaccidity, fasciculations, decreased reflexes, negative Babinski sign
UMN: Increased muscle tone, spasticity, increased reflexes, positive Babinski sign |
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Term
| A 58-year-old man develops a tremor, slow movements and a change in gait. On exam, the patient demonstrates a tremor at rest that improves with intention, and a shuffling gait. The patient begins treatment with a combination of levodopa and carbidopa and experiences motor symptom improvement. Which type of neuron is lost in Parkinson disease? Activity of what neurotransmitter is elevated in Parkinson disease? What treatment strategies help modulate these derangements in neurotransmitter activity? Describe how a surgical lesion of the subthalamic nucleus might help improve the symptoms of Parkinson disease. |
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Definition
PD: Deterioration of dopamine-producing neurons in the substantia nigra pars compacta
- Decreased dopamine, increased acetylcholine
- Increase dopamine synthesis: levodopa, carbidopa
- Prevent dopamine breakdown: selegiline, entacapone, tolcapone
- Dopamine agonists: bromocriptine, parmipexole, ropinirole
- Anticholinergic drugs: benztropine, trihexyphenidyl
Lesion of subthalamic nucleus might help by inhibiting the inhibitory pathway: STH stimulates the interal globus pallidus, which inhibits movement |
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Term
| A 3-year-old child develops a right wrist drop and confusion. Considering lead poisoning as a possible diagnosis, you have the patient tested with a serum lead level, CBC, and a peripheral RBC smear. What peripheral smear finding is consistent with lead poisoning? What is the treatment for lead poisoning in this patient? |
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Definition
- Basophilic stippling of RBCs
- Succimer for children (EDTA and dimercaprol for adults) |
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Term
| A 67-year-old man with new-onset hepatic failure and normal renal function is currently taking a drug metabolized and excreted by the kidneys. Would you need to change the loading dose or maintenance dose of this medication because of this hepatic failure? If this patient were to develop hepatorenal failure, would you need to change the loading dose or maintenance dose of the medicine? |
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Definition
- Don’t change either dosages initially because drug isn’t dependent on hepatic clearance
- Only change the maintenance dose if the patient developed renal failure, which is dependent on drug clearance
- Loading dose gets plasma levels up |
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Term
| What are the side effects of atropine? Differentiate between the side effects expected with ophthalmologic use and systemic administration. |
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Definition
- Anticholinergic syndrome: Hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter, bloated as a toad
- Ophthalmologic: mydriasis and cycloplegia
- Systemic: Anticholinergic syndrome |
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Term
Which vitamin fits the following descriptions?
- Constituent of visual pigments
- Constituent of NAD⁺
- Cofactor in oxidation and reduction FADH2 and FMN
- Constituent of CoA |
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Definition
Constituent of visual pigments : Vitamin A
Constituent of NAD⁺ : Vitamin B3 (Niacin)
Cofactor in oxidation and reduction FADH2 and FMN: Vitamin B2
Constituent of CoA : Vitamin B5 |
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Term
| What is Rendu-Osler-Weber syndrome? |
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Definition
Hereditary hemorrhagic telangiectasia
Autosomal dominant
Telangiectasias in the skin/mucous membranes, possibly other organs
Small aneurysms of the telangiectasias
Bleeding (nosebleeds and GI bleeds) |
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Term
| A 70-year-old woman comes to the office complaining of jaw claudication. She likely has inflammation of a vessel that supplies one of her muscles of mastication. What are the other muscles involved in mastication? |
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Definition
Jaw claudication: Giant cell arteritis
Three M’s to close:
Temporal
Masseter
Medial Pterygoid
To open: Lateral Pterygoid |
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Term
| A type 2 diabetic with a HgbA1c of 10% (86 mmol/mol) presents to your clinic with many complaints. You are concerned about the effect of the patient’s long term hyperglycemia. What diabetic complications can be attributed to sorbitol-induced osmotic damage? What enzyme converts glucose to sorbitol? |
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Definition
Glucose gets converted to sorbitol, which then gets converted to fructose
The sorbitol-induced osmotic damage because the sorbitol gets trapped in the cells and draws water in
Enzyme aldose reductase is missing, which causes sorbitol-induced osmotic damage
Damage to Schwann cells (diabetic neuropathy), to lenses: cataracts |
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Term
| A 50-year-old man complains of intermittent hematuria over the past four weeks. However, he says that what brought him in today was right-sided flank pain. On exam you notice a palpable right-sided flank mass. What is the most common renal malignancy in adults? What is the associated gene deletion with this malignancy? |
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Definition
| Renal cell carcinoma, gene deletion in chromosome 3 |
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Term
| What foods, typically high in mercury, should be avoided during pregnancy? |
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Definition
| Fish: fish that eat other fish: Shark, swordfish, king mackeral, tilefish |
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Term
| A patient presents complaining of a chronic cough and recently coughing up blood. On the x-ray you note a coin lesion. Lung cancer is high on your differential diagnosis list. What are the most common locations of lung cancer metastases? |
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Definition
| Liver, bones, adrenal glands, brain |
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Term
| A person eating fugu sashimi in Japan is at risk of what toxicity? What is the mechanism of this toxicity? |
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Definition
Tetrodotoxin; binds to voltage-gated Na+ channels, prevents depolarization
Causes coma, respiratory arrest, cardiovascular collapse |
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Term
| A 23-year-old G1P0 refuses to take any medications during her pregnancy despite having a mild, constant nausea. When is a fetus most susceptible to damage from teratogens? What drug used in the treatment of hypertension is a teratogen? What effect does this have on the fetus? |
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Definition
Embryonic period (weeks 3-8)
ACE inhibitors: captopril, lisinopril, enalapril
Angiotensin receptor blockers (ARBs): Losartan, valsartan, candesartan
Cause fetal kidney damage |
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Term
| Sertoli cells release a substance that acts on the paramesonephric ducts in order to prevent the formation of what structures in a normal male fetus? What other name is given to the paramesonephric ducts? |
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Definition
Sertoli cells release Mullerian inhibitory factor that inhibits formation of: fallopian tubes, uterus, proximal vagina
Mullerian ducts |
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Term
| You are performing a radical mastectomy and exercise extreme caution as you dissect laterally along the serratus anterior muscle. You do this in order to avoid severing which motor nerve, which would result in what sequelae? |
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Definition
| Long thoracic nerve that would cause a winged scapula |
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Term
| Three days ago, you hospitalized a 40-year-old man for myocardial infarction. He has been given all of the usual medications. Today you notice that his platelet count is 30,000. What do you suspect is the cause of his low platelets? |
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Definition
| HIT: heparin induced thrombocytopenia |
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Term
| A trauma patient is rushed to the ER. She has a cervical collar in place, and there is high suspicion that the patient has a broken neck, as well as bilateral clavicle fractures. The patient has bled a lot, and central venous access is needed to resuscitate. Because of her injuries the best location for such a line is the groin. Describe the anatomy of the femoral sheath. When placing a femoral line for central venous access you palpate a femoral pulse. Where do you place the guide needle in relation to this pulse: medially or laterally? |
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Definition
“NAVEL”: Nerve, artery, vein, empty space, lymphatics
Palpate femoral pulse, insert needle medial to the pulse |
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Term
| A young man presents with gynecomastia secondary to heavy marijuana use. Other drugs are known to cause gynecomastia. Which antifungal drugs do this and by what mechanism? What diuretic drug does this and by what mechanism? |
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Definition
Ketoconazole: inhibits first step of steroid hormones sythesis (desmolase), also a weak androgen receptor antagonist
Spironolactone: increases conversion of testosterone to estradiol, blocks testosterone synthesis
“Some drugs cause awesome knockers”: Spironolactone, digitalis, cimetidine, alcohol, ketoconazole |
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Term
| IFN-γ stimulates macrophages and inhibits T2 helper cells. What cell type releases IFN-γ? |
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Definition
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Term
| How does standard deviation differ from standard error of the mean? Which one is used in calculating confidence intervals? |
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Definition
SEM = SD/(square root of n)
SEM is used for confidence intervals |
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Term
| A patient suffers a traumatic brain injury after a motor cycle crash, and the neurosurgery resident orders phenytoin for seizure prophylaxis. What are the toxic side effects of phenytoin? |
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Definition
Neurologic: Diplopia, sedation, ataxia, nystagmus, dizziness
Lupus-like syndrome
Induces P450
Megaloblastic anemia
Gingival hyperplasia
Hirsutism
Fetal hydantoin syndrome
Stevens-johnson syndrome |
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Term
| How does MRI differ from CT imaging? |
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Definition
MRI: more expensive, no radiation, better for soft tissue, no metal, bones look gray (T2 for bleeds, fat is dark), take about 1 hour
CT: better for bone and blood, bones look white, take about 10 min |
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Term
| During morning rounds you check on a 70-year-old man with congestive heart failure. You observe marked jugular venous distention. What gives rise to the jugular venous a, c, and v waves? |
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Definition
a: atrial contraction, end of diastole
c: ventricular contraction
v: atrial filling against closed tricuspid valve |
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Term
| A 35-year-old man develops hallucinations just before sleep, episodes of excessive sleepiness, and cataplexy during times of laugher and sadness. Narcoleptic sleep episodes begin with what stage of sleep? What are the different stages of normal sleep? How do they differ from one another? |
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Definition
Start at REM sleep
Awake (alert): beta waves (high frequency and low amplitude)
Awake (relaxed): alpha waves
Stage N1 (light sleep): theta waves
Stage N2 (deeper sleep): sleep spindles and K complexes
Stage N3 (slow-wave sleep): delta sleep (low frequency, high amplitude)
REM sleep: beta waves (high frequency, low amplitude) |
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Term
| Describe the anatomical layers of the penis. |
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Definition
Outer dermis
Dartos muscle layer
Deep fascia (Buck’s fascia)
3 masses of cavernous erectile tissue encased and separated by tunica albuginea: 2 dorsolateral corpora cavernosa, 1 ventral corpus spongiosum
Urethra (within the corpus spongiosum) |
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Term
| A 50-year-old man roofing worker develops a cough for the past month that is now associated with hemoptysis. The patient denies a smoking history or prolonged exposure to second-hand smoke. An X-ray reveals a left-sided lower lung coin-shaped lesion. What type of lung cancer is suspected in this individual? What is the appearance of asbestos fibers in the lung? What cancers are associated with asbestosis? |
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Definition
Mesothelioma, bronchogenic adenocarcinoma (associate with coin shaped lesion)
Asbestos fibers look like golden-brown rods that resemble dumbbells |
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Term
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Definition
Reflex of the pubococcygeus muscle
Muscles in the vagina tense up suddenly
Treatment: relaxation |
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Term
| A young child has weakness of his extremities and is found to have an Arnold-Chiari II malformation with a syringomyelia. What is a syringomyelia? What symptoms are commonly seen in patients with syringomyelia? |
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Definition
Arnold-Chiari malformation: herniation of cerebellum through the foramen magnum
Syringomyelia: central canal of spinal cord is compressed, dilation of the canal distal to the compression
Dilated canals compress nearby tracts
Loss of pain and temperature sensation in upper extremities; touch is unaffected; cape=like distribution
+/- motor deficits |
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Term
| What branchial arch derivative abnormality causes facial abnormalities by affecting Meckel’s cartilage? What cranial nerves are affected in this abnormality? What is the derivative of the branchial arches? |
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Definition
| What branchial arch derivative abnormality causes facial abnormalities by affecting Meckel’s cartilage? What cranial nerves are affected in this abnormality? What is the derivative of the branchial arches? |
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Term
| A 21-year-old man suffered a lateral blow during a football game and he now complains of pain in his right knee. Which structures were likely injured in what is commonly termed “unhappy triad” knee injury? |
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Definition
| MCL, ACL, medial meniscus |
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Term
| What B-cell surface protein does the monoclonal antibody rituximab target? |
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Definition
| CD20; treat lymphomas, RA |
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Term
| What popular non-benzodiazepine hypnotic is often avoided in the elderly because of the very undesirable side effect of confusion, to which elderly patients are very susceptible? |
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Definition
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Term
| Where would you expect to find B cells in a lymph node? Where would you find T cells, plasma cells, and macrophages? |
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Definition
B cells – cortex
T cells – paracortex
Plasma cells – medullary cords
Macrophages – medullary sinuses |
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Term
| T cells are found in the paracortex of the lymph node between the follicles and the medulla. Which cytokines are secreted by the two different types of helper T cells (Th1 and Th2)? |
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Definition
Th1: IL-2, IFN-gamma
Th2: IL-4, IL-5, IL-10 |
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Term
| A 49-year-old trauma patient comes into the ER unconscious and in need of surgery. What are the exceptions to informed consent? |
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Definition
Emergent situations
Lacks decision=making capacity
Therapeutic privilege
Waiver |
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Term
| A 24-year-old young man is fired from his job and when explaining the chain of events to his roommate he explains that “it doesn’t really matter. I didn’t even need that job.” His roommate is perplexed, wondering how they will pay their rent. Of which immature ego defense could this be an example? |
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Definition
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Term
| A patient comes to the clinic complaining of severe low back pain that radiates down the back of her leg. What is the most likely explanation for her pain? |
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Definition
| Herniated intervertebral disc, nucleus pulposus protrudes into the vertebral canal and compresses the spinal nerve roots |
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Term
| A 45-year-old woman presents to the ER with complaints of chest pain, a racing heart beat and dizziness. Examination reveals a heart rate of 120 beats/minute, BP of 116/74, and 20 respirations/minute. The patient is diaphoretic and anxious. An initial EKG reveals ventricular tachycardia with shifting sinusoidal waveforms. What is this classic EKG finding? What are the possible causes of this patient’s condition? |
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Definition
Torsades de Pointes
Drugs that prolong the QT interval
Hypokalemia
Hypomagnesemia
Congenital long QT syndromes |
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Term
| A 15-year-old boy is rushed into the ER. He is tall and thin, and CXR reveals a pneumothorax. He is having severe dyspnea, and his hemodynamics are in danger of becoming unstable. He needs a chest tube now, but his parents have not yet arrived to the ER to sign a consent form. Can the procedure be done before the parents arrive? |
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Definition
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