Term
| What medications are commonly used in the treatment of mild-moderate Crohn disease in adults? |
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Definition
1. Oral 5-aminosalicylates: sulfasalazine, mesalamine
2. Antibiotics: ciprofloxacin, metronidazole
3. Conventional glucocorticoids: prednisone
4. Non-systemic glucocorticoids: budesonide
5. Immunomodulators: azathioprine, 6-mercaptopurine, methotrexate
6. Biologic therapies: infliximab, adalimumab |
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Term
| A 60-year-old man is evaluated for an enlarged prostate. How does flutamide differ from finasteride in relation to mechanism of action and clinical use? |
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Definition
Flutamide: used in prostate cancer, competitive inhibitor of androgens
Finasteride: used in BPH, inhibits 5-alpha reductase, which converts testosterone to dihydrotestosterone, used for male-pattern baldness |
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Term
| Which bacteria are most commonly responsible for sialadenitis? What condition most commonly predisposes a patient to sialadenitis? |
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Definition
Staph aureus and viridans Strep
Due to sialolithiasis (stone obstruction of the salivary gland duct) |
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Term
| A 37-year-old man is fasting for religious reasons. What energy metabolites does the liver secrete in the fed state vs. in the fasting state? |
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Definition
Fed state: storage of lipids, proteins, and glycogen
Fasting: glycogenolysis, gluconeogenesis, ketone bodies released |
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Term
| A 23-year-old man undergoes a splenectomy due to splenic rupture from blunt abdominal trauma. What would you expect to find on this patient’s peripheral RBC smear after the splenectomy? Asplenic patients are susceptible to which encapsulated organisms? What vaccines for these encapsulated organisms should be given to asplenic patients? |
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Definition
Target cells, Howell-Jolly bodies
Salmonella, S. pneumoniae, K. pneuomoniae, H. influenzae type B, N. meningitidis
Vaccines: S. pneumo, Hi type B, meningitidis vaccines |
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Term
| A 65-year-old woman with COPD is in severe respiratory distress, has cyanosis and signs of right-sided heart failure. What medications are used in the treatment of pulmonary hypertension? What is its mechanism of action? |
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Definition
Patient has cor pulmonale
1. Endothelin-1 antagonists: bosentan, ambrisentan
2. Prostaglandins: iloprost, epoprostenol
3. cGMP phosphodiesterase inhibitors: vardenafil, tadalafil, sildenafil
4. Dihydropyridine CCBs: nifedipine
All cause vasodilation |
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Term
| A 56-year-old man develops right lower extremity edema after a returning from Europe from a business trip. An exam of the right lower extremity demonstrates a red, warm, lower leg with a positive Homan’s sign. What is the patient’s diagnosis? What is a positive Homan's sign? What is Virchow’s triad? What is the most common inherited hypercoagulability syndrome? |
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Definition
Patient has DVT
Homan’s sign: pain in calf muscle upon dorsiflexion of foot
Virchow’s triad: stasis, endothelial damage, hypercoagulability
Most common: Factor V Leiden |
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Term
| A 45-year-old white woman presents with a 1cm x 1cm, painless, mobile mass in her right parotid gland. You inform the patient that most tumors in the parotid gland are benign. What is the most common benign tumor of the salivary gland? What is a Warthin’s tumor? What cranial nerve goes through the parotid gland? |
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Definition
Most common benign tumor: pleomorphic adenoma
Warthin’s tumor: benign, heterotopic salivary gland tissue trapped in a lymph node
CN VII |
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Term
Given the following clinical situations, choose the most appropriate therapy.
1) A 22-year-old man with drug-resistant gonorrheal urethritis
2) Lyme disease treatment
3) UTI prophylaxis for a 44-year-old woman with a history of recurrent UTIs
4) A 33-year-old hiker with Giardia lamblia
5) A 23-year-old woman with antibiotic-induced C. difficile colitis |
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Definition
1) A 22-year-old man with drug-resistant gonorrheal urethritis: Cetriaxone
2) Lyme disease treatment: Tetracyclines
3) UTI prophylaxis for a 44-year-old woman with a history of recurrent UTIs: TMP-SMX, Nitrofurantoin, Cephalosporins (1st and 2nd), Amoxicillin
4) A 33-year-old hiker with Giardia lamblia: Metronidazole
5) A 23-year-old woman with antibiotic-induced C. difficile colitis: Metronidazole, oral Vancomycin |
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Term
| You are reading a research article about the prostate specific antigen test, and it mentions that the PSA blood test is associated with a high false positive frequency. In your own words, explain what false positive means. |
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Definition
| False positive: test is positive even though disease is not present |
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Term
| A 25-year-old woman presents to clinic with scanning speech, intention tremor, intermittent incontinence, and internuclear ophthalmoplegia. What is internuclear ophthalmoplegia? |
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Definition
Lesion in medial longitudinal fasciculus
Medial rectus palsy on attempted lateral gaze
Nystagmus in abducting eye
Convergence is normal
Classic for MS
Older patients: also stroke as cause |
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Term
| What effect does stress have on adipocytes? |
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Definition
Sympathetic activation -> Epi and NE
Activates hormone-sensitive triglyceride lipase in fat cells
Rapid breakdown of triglycerides, and mobilization of fatty acids
Corticotropin release from anterior pituitary
Adrenal cortex secretes more glucocorticoids
Stimulates lipase in fat cells |
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Term
| You are seeing a 54-year-old man six months after a percutaneous coronary intervention for an anterior myocardial infarction. Consequently, the patient was placed on aspirin 81 mg per day, atorvastatin 20 mg per day, and atenolol 100 mg twice a day. The patient reports feeling better but has been bothered by difficulty with achieving and sustaining an erection. What would be a common reason for this patient’s erectile dysfunction? What are the common side effects of β-blockers? Which patient populations should use caution when taking β-blockers? |
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Definition
Reasons for erectile dysfunction:
Adverse effect atenolol
Atherosclerosis of arteries supplying penis
Fear of heart attack
Side effects of Beta-blockers:
Impotence, exacerbation of asthma, bradycardia, AV block, CHF, sedation, sleep alterations
People who should avoid beta blockers: diabetics, asthma, bradycardia or AV block, acute CHF |
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Term
| A 5-year-old boy is treated with mebendazole for a pinworm infection. Mebendazole acts on microtubules to inhibit the helminthic infection. What other medications act on microtubules? What syndrome demonstrates a defect in microtubule polymerization? |
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Definition
Griseofulvin
Vincristine
Vinblastine
Paclitaxel
Colchicine
Chediak-Higashi syndrome: deficiency of phagocytosis because macrophages have poor microtubule function. |
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Term
| A 33-year-old man is diagnosed with Hodgkin lymphoma and treated with doxorubicin, bleomycin, vincristine, cyclophosphamide and etoposide. While undergoing treatment, the patient develops a paralytic ileus and neurotoxicity from the treatment regimen. Which chemotherapy agent most likely is the cause of these sequelae? What is the characteristic pathology finding of Hodgkin lymphoma? |
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Definition
Vincristine
Reed-Sternberg cells: clear area around cell on slides; CD 15 and CD30 |
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Term
| You are seeing a 32-year-old woman for the first time who complains of a cough, nasal congestion and fever for the past two days. During the patient’s medical history, you note the patient is taking clomiphene and metformin for polycystic ovarian syndrome (PCOS). What is the role of clomiphene in the treatment of PCOS? What is the mechanism of action of clomiphene? |
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Definition
PCOS: polycystic ovaries, androgen excess, anovulation
Clomiphene: partial estrogen agonist, blocks normal feedback inhibition in the hypothalamus; induces ovulation; increases release of LH and FSH |
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Term
| How much does the H&H change in a person that has acclimatized to a hypoxic environment for weeks? |
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Definition
Hct goes from 40-45 to 60
Hgb goes from 15g/dL to 20 g/dL |
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Term
| A 17-year-old boy comes to the clinic complaining of painful urination and purulent penile discharge. Ceftriaxone is used for the treatment of sexually-transmitted N. gonorrhoeae infections. What generation of cephalosporin is ceftriaxone? Which generation of cephalosporins is effective against Pseudomonas? Are cephalosporins bacteriostatic or bacteriocidal? |
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Definition
Ceftriaxone is a 3rd gen
4th gen (cefepime) and some 3rd gen (ceftazidime and cefoperazone) are effective against Pseudomonas
Cephalosporins are bacteriocidal |
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Term
| A patient begins to experience fever, night sweats, cough and weight loss after traveling in a European bus tour. The patient’s chest x-ray reveals middle and lower lung infiltrates and sputum culture reveals Mycobacterium tuberculosis. The patient is subsequently placed on isoniazid, rifampin, pyrazinamide and ethambutol for active tuberculosis. Why can rifampin not be taken as a single agent for tuberculosis? What are the Rs of rifampin? |
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Definition
Rifampin: rapid resistance
R’s: rapid resistance, RNA polymerase inhibitor, causes Red/orange body fluids, Revs up cytochrome P450 |
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Term
| A 21-year-old man is seen in the clinic for joint pain. His right wrist is painful and mildly swollen. He said that last week his left elbow had similar symptoms but he didn’t seek treatment at that time. History reveals that the patient is a healthy athlete in college with many sexual partners. What are the other manifestations that could appear with this disease? |
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Definition
Migratory, painful arthritis: septic arthritis from N. gonorrhoeae
Synovitis, tenosynovitis, pustular skin eruption |
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Term
| A patient of yours awakes one morning unable to move from the bed. His arms, legs, and torso just don’t seem to work. The patient reports progressively worsening weakness over the previous two days that seemed to start in the legs. Peripheral sensation is intact. What study would help you confirm your clinical suspicion of this patient’s diagnosis? |
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Definition
Guillain-Barre Syndrome: ascending muscle weakness
Lumbar puncture to look at CSF for high protein, normal cell count |
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Term
| A 36-year-old malnourished woman comes to the ER with abdominal pain. She has a fever, abdominal tenderness (but no rebound), and anorexia. Her WBC is markedly elevated and her RDW is high. The patient reports having had a bowel movement this morning and is not nauseated. A small bowel follow through reveals skip lesions (discontinuous areas of focal narrowing) and a string sign (significant narrowing) in the terminal ileum. What disease does this patient likely have? What drugs can be used to treat it? |
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Definition
Crohn’s disease
Treatment:
- 5-ASA
- Glucocorticoids
- Immunosuppresants (azathioprine, 6-MP)
- Anti-TNFalpha drugs (infliximab, adalimumab) |
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Term
| A 44-year-old woman is rushed to the ER after her brother found her passed out on the floor with pills scattered about and a bottle of liquor opened on the table. The patient is cyanotic, withdraws to painful stimulus, and has poor respiratory effort: so she is intubated. The brother does not know the name of the pills, but he tells you they are a prescription for his sister’s anxiety. What prescription medication(s) might be the cause of this clinical picture and what antidote/treatment is available? |
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Definition
| Benzodiazepines: give flumazenil for overdose |
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Term
| You have an adult patient that has failed conventional treatment (5-ASA, steroids, and immunosuppressants) for his active Crohn disease. Another option available to you is to target TNF-α with which drug(s)? |
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Definition
Infliximab or adalimumab (monoclonal antibodies for TNF-alpha
Certulizamab
Note: Etanercept: molecule that looks like TNF-alpha receptor BUT NOT USED FOR CROHNs |
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Term
Which glycogen storage disease fits each of the following features?
1) Severe hypoglycemia with elevated blood lactate
2) Hypoglycemia without elevated blood lactate
3) Cardiomegaly
4) Myoglobinuria associated with exercise |
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Definition
1) Severe hypoglycemia with elevated blood lactate: Von Gierke's disease (Type 1)
2) Hypoglycemia without elevated blood lactate: Cori disease (Type III)
3) Cardiomegaly: Pompe disease (Type II)
4) Myoglobinuria associated with exercise: McArdle disease (Type V) |
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Term
| A patient presents to the obstetrical emergency room with complaints of abnormal vaginal bleeding. On bimanual exam, the physician notes an enlarged uterus. What lab value is elevated in a patient with a hydatidiform mole? What is the genotype of a hydatidiform mole (complete vs. partial)? |
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Definition
Beta-hCG is elevated
Partial mole: 2 sperm in 1 egg – 69XXX, 69XXY, or 69XYY
Complete mole: 46XX or 46XY |
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Term
| What trace element is essential to the function of carbonic anhydrase and lactate dehydrogenase? |
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Definition
| Zinc: important for protein folding (zinc fingers) |
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Term
| A 1-month-old girl presents with an anterior neck enlargement. Your exam reveals a pale infant with enlarged abdominal girth and a protruding umbilicus. You think this patient might have cretinism. In cretinism, would the patients TSH be elevated or decreased? What is the cause of endemic cretinism? What is the cause of sporadic cretinism? |
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Definition
TSH is elevated
Cretinism is severe fetal hypothyroidism
Endemic cretinism: Inadequate maternal iodine intake during pregnancy
Sporadic cretinism: Developmental malformation of the thyroid; intrinsic defect of T4 formation |
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Term
You are evaluating a 74-year-old woman for progressive dyspnea. The patient looks younger than her stated age and reports a family history of autoimmune disease. Given the patient’s presentation, you think the patient might have scleroderma. In scleroderma, what systems can be affected by fibrosis of collagen? Which collagen type is found in the following locations?
1) Bone and tendons
2) Epiphyseal plate
3) Main constituent of the basement membrane
4) Granulation tissue
5) Late wound repair
6) Cartilage
7) Vitreous body and nucleus pulposus
8) Also known as reticulin |
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Definition
Scleroderma causes sclerosis of skin, renal tissue, pulmonary, cardiovascular, GI tissue
CREST syndrome: calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly, Telangiectasia
Anti-centromere antibodies
1) Bone and tendons: Type 1
2) Epiphyseal plate: Type 2
3) Main constituent of the basement membrane: Type 4
4) Granulation tissue: Type 3
5) Late wound repair: Type 1
6) Cartilage: Type 2
7) Vitreous body and nucleus pulposus: Type 2
8) Also known as reticulin: Type 3 |
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Term
| You can use two different types of medication in the treatment of diabetes insipidus: desmopressin (ADH analog) or hydrochlorothiazide (diuretic). What determination must be made for selecting an effective treatment for diabetes insipidus? Which drug will help you make this determination? |
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Definition
Nephrogenic (renal tubule doesn’t respond to ADH/lack of responsiveness) vs. Central diabetes insipidus (lack of ADH)
Water deprivation test
Desmopressin will help you decide: central will respond, nephrogenic won’t
Nephrogenic: treat with hydrochlorothiazide (diuretic) |
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Term
| A 24-year-old woman has trouble with heavy and prolonged menses. She has also noticed a pressure that feels like it is inside of her pelvis. Her OB/GYN diagnosis her with uterine leiomyoma (fibroid). What analog of GnRH can be used to treat uterine fibroids? Is it used in a continuous or pulsatile manner for this application? |
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Definition
| Leuprolide or goserelin (GnRH analog) used in continuous manner (inhibit secretion of FSH and LH) |
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Term
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Definition
Health Insurance Portability and Accountability Act of 1996
Establishes standards for the handling of certain health care information
All about privacy |
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Term
| What are some of the circumstances in which information is HIPAA-exempt, meaning that your health information can be shared with another party? |
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Definition
Child abuse
Birth or death information
Reporting of state-mandated reportable illnesses
Public health disease surveillance
State-sponsored disease intervention
Schools are exempt: record of illness, student health status
Employers are exempt: conditions that affect the employee’s capability to work (but can’t discriminate) |
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Term
| It is recommended to vaccinate 11-12 year-old patients against Neisseria meningitidis to reduce the incidence of bacterial meningitis. What are other examples of encapsulated bacteria that have a preventative vaccine? What test can be used to detect encapsulated bacteria? |
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Definition
Also vaccines for S. pneumo and H. influenzae type B
SHiN SKiS
Salmonella, H. influenzae type B, Neiserria m., Group B strep, Strep penumo, Klebsiella
Quellung reaction: add anticapsular antibodies, capsule swells |
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Term
| A 60-year-old man has noticed worsening urinary complaints. He is having to urinate more frequently and has a decreased urinary stream. A digital rectal exam reveals a smooth, symmetrical, enlarged prostate. You begin patient treatment with a medication that relaxes the prostatic smooth muscle. What class of medication is used to relax smooth muscle in BPH? What are the steps involved in the contraction of smooth muscle? |
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Definition
Alpha-1 antagonists: “-zosin”: block smooth muscle contraction (also active at alpha-1-ab receptors in vessels)
Tamsulosin selective for alpha-1-ad adrenergic receptors in prostate
Smooth muscle contraction:
1. cell membrane depolarizes, voltage-gated Ca channels open, Ca binds to calmodulin, which activates MLCK, phosphorylates myosin, myosin-P interacts with actin |
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Term
Which types of cancer are associated with the following chromosomal translocations?
1. t (9;22)
2. t (8;14)
3. t (14;18)
4. t (15;17)
5. t (11;22)
6. t (11;14) |
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Definition
1. t (9;22): Philadelphia chromosome: CML, bcr-abl
2. t (8;14): Burkitt’s lymphoma, c-myc, jawline lesion in Africa
3. t (14;18): Follicular lymphoma, bcl-2 gene, almost always negative for CD5
4. t (15;17): AML (M3)
5. t (11;22): Ewing sarcoma
6. t (11;14): Mantle cell lymphoma |
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Term
| A 37-year-old patient with refractory peptic ulcer disease undergoes an esophagogastric duodenoscopy (EGD). Biopsies of the duodenum reveal hypertrophied submucosal glands. What are these glands? What are Peyer’s patches? How can these structures help you identify the location from which a histological specimen was taken? |
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Definition
Brunner’s glands found in duodenum
Peyer’s patches: lymphoid tissue in the ileum, interact with antigen-presenting M cells, dendritic cells carry antigen to the rest of the immune system, generate B cells which will become IgA-secreting plasma cells
Peyer’s patches in ileum, Brunner’s glands in the duodenum |
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Term
| A homeless alcoholic is brought to the hospital with shortness of breath, high fever, and decreased mental status. What is the clinical use of clindamycin? What is its most well-known side effect? |
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Definition
Clindamycin for anaerobic lung infections, MRSA infections, acne
Aspiration pneumonia
Most well known side effect: C. diff colitis |
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Term
Given the following scenarios describe the corresponding complement deficiency?
1. Frequent Neisseria infections
2. Frequent pyogenic respiratory tract infections
3. Paroxysmal nocturnal hemoglobinuria
4. Increased frequency of type III hypersensitivity reaction |
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Definition
1. Frequent Neisseria infections: C5, C6, C7, C8
2. Frequent pyogenic respiratory tract infections: C3
3. Paroxysmal nocturnal hemoglobinuria: CD55 or CD59, K activating factor DAF
4. Increased frequency of type III hypersensitivity reaction: C3 (associated with glomerulonephritis) |
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Term
| A 65-year-old woman reports decreased vision. During her exam, you begin suspecting open-angle glaucoma. What are the 5 classes of medications used to treat glaucoma? |
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Definition
Alpha-agonists
Beta-blockers
Diuretics (acetazolamide, mannitol)
Cholinergic drugs
Prostaglandins (latanoprost) |
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Term
| A 22-year-old female law student is in your office for prenatal counseling and a well-woman check up. She knows that she needs to begin taking folic acid supplements to prevent neurologic defects before she begins to try conceiving a child with her husband. She did some research on the internet and asks, “Does the notochord become the neural tube?” |
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Definition
No, notochord derived from mesoderm, stimulates development of neural plate
Neural plate -> neural tube, neural crest cells |
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Term
| A 67-year-old woman is brought to the ER by her concerned husband. For the past 2 hours, she has been very nauseated, weak, lightheaded, and somewhat short of breath. Though she denies chest pain, the resident suspects a cardiac etiology for the symptoms and orders an EKG and cardiac enzymes. What are the branches of the right and left coronary arteries? What is the most commonly occluded artery of the heart? What is particularly dangerous about an occlusion of the RCA? |
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Definition
RCA -> PDA, Acute marginal artery
Left main artery -> LAD, circumflex
Most commonly occluded: LAD
RCA provides blood supply to the SA node and AV node, high risk for arrhythmias |
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Term
| What are the 3 different eukaryotic RNA polymerases? What type of RNA does each make? |
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Definition
Eukaryotes have 3, prokaryotes have 3
RNA polymerase I: rRNA
RNA polymerase II: mRNA
RNA polymerase III: tRNA |
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Term
| A 44-year-old male hepatitis C patient is undergoing recombinant interferon treatment for his disease. In what ways do interferons interfere with viral protein synthesis? |
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Definition
Interferons induce cellular antiviral defenses:
1. RNA protein kinase (ribonuclease)
2. Pro-apoptotic pathways |
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Term
| What is p value? What is normally an acceptable level of p value? |
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Definition
Probability of making a type 1 error
p<0.05 |
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