Kaplan dx exam

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Kaplan dx exam
2012-09-26 19:16:47

Dx exam
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  1. What kind of drug is cyclobenzarapine?
    Relief of muscle spasms, structurally similar to TCA's, hence causes anticholinergic affects: dry eyes, dry mouth, flushing, tachycardia, confusion, constipation. Anticholinergic drugs can worsen glaucoma. 
  2. Cigarettes causes thromboangitis obliterans, which presents as?
    Severe pain in hands and feet at rest, cold blue hands in the winter, painful ulcers on the tip of his fingers, and weaker distal pulses than proximal. 
  3. How is active tension calculated?
    Total tension - passive tension at a given muscle length. 
  4. Which value remains normal in a COPD?
    Forced vital capacity (TLC and RV are both increasing).
  5. Spironolactone can cause what adverse affects?
    Aldosterone antagonist: hyponatremia, hyperkalemia (K sparing diuretic), metabolic acidosis, increased renin levels. 
  6. Parathyroid gland agenesis and trucus arteriosus suggest what immunodeficiency and of what cell type?
    DiGeorge syndrome: T cells. 
  7. In PCR, where do the primers bind?
    Both forward and reverse primers bind the 3' sequence on the coding and the template strand.
  8. Glucose administration without which vitamin can worsen the symptoms if it's the vitamin deficiency?
    Thiamine (B1): used in DH reactions and transketolases.
  9. Translocation (11;22) associated with what cancers?
    • 1. Ewing's sarcoma
    • 2. PNET (gene product from a transcription factor)
  10. 1. What is an indirect coomb's test?
    2. What is a direct coomb's test?
    • 1. Indirect test: tests for the presence of antibody in serum. Used for an Rh- mom to determine if she is sensitized to the Rh antigen. 
    • 2. Direct: tests for the presence of antibody attached to RBCs. Used to test for a baby of an Rh+ mom if maternal antibodies have bound to the fetal RBCs
  11. Mechanism of Chediak Hegashi syndrome?
    • Microtubule dysfunction: impaired functioning of phagocytes, NK cells, cytotoxic T cells which causes recurrent pyogenic infections.
    • Neutrophils show abnormally large lysosomes with granules. 
    • Presents with partial albinism and peripheral neuropathy. 
  12. Drug of choice for Rocky Mountain spotted fever caused by Rickettsia rickettsi in a pregnant woman?
    • Chloramphenicol
    • (Doxycycline is 1st choice therapy otherwise)
  13. P450 inhibitors such as erythromycin has what effect on benzos?
    Benzos are metabolized by P450's: hence, increase in [drug] will cause prolonged sedation effects.
  14. Patient presenting with a 2 year history of episodic chest pain lasting for 10-12 minutes that occurs at rest or during exercise. Also has an ejection murmur, and ECG shows ST segment elevation and T wave inversions. Dx and drug of choice?
    Prinzmetal's angina: Tx = calcium channel blockers (Nifedipine)
  15. Phenotypically normal female has primary amenorrhea, no axillary or pubic hair, no uterus, but testosterone is normal adult ranges at puberty.In childhood, can present with inguinal hernias that are testes. 
    Dx and karotype?
    Androgen insensitivity: 46XY
  16. Behavioural stress will cause what NT abnormalities?
    • Increased cortisol
    • Increased dopamine
    • Increased TSH
    • Decreased GH
    • Decreased immune response (decreased lymphocytes)
  17. Muscarinic receptors do not affect what cell types? 
    • 1. Skeletal muscle
    • 2. Vascular smooth muscle (only at high levels, agonists can produce vasoconstriction)

    n.b. they relax cardiac muscle and contract GI muscle (gut motility increases)
  18. Small cell carcinoma has what identification markers?
    • 1. NSE (neuron specific enolase)
    • 2. chromogranin
    • 3. synaptophysin
  19. Which anti-diabetic drug increases methylation around insulin-responsive promoters?
  20. Viruses sensitive to alcohol are transmitted via what mechanism?
    Enveloped: sexual/parenteral - protects from dessication or change in temperature
  21. What does the capsid and genomic material of a virus determine?
    • Capsid determines the tropism of the virus (which host cell will be infected) and the genomic material determines the progency. 
    • (-) progeny viruses without a RNA-dependent RNA polymerase will not be able to produce progeny; hence, abortive result. 
  22. Besides axillary nodes, what other nodes drain breast cancer and its location? 
    • Internal mammary chain nodes (parasternal nodes) drain the inner breast. 
    • Superior part of the breast drained by supraclavicular nodes. 
  23. What happens to the thyroid levels during pregnancy?
    • Thyroid binding globulin increases, which increases total T3 and T4, transiently reducing the free levels of both hormones. But feedback mechanism between TSH and free T3 and T4 are normal to balance it out. 
    • Only TOTAL T3 and T4 increase. 
  24. Most common form of nephrotic syndrome?
    Focal segmental glomerulosclerosis.
  25. What is the mechanism of action of SLE and treatment?
    • Type III H.S: complement activation following complement deposition in the blood vessels.
    • Tx: Prednisone decreases inflammation 
  26. A patient presents with gycenomastia, small penis, small testes and azospermia. Dx and what is found on testicular biopsy?
    Kleinfelter syndrome: hyalinization of the seminiferous tubules
  27. What is found on testicular biopsy on patients with testicular atrophy?
    Tubules with well-preserved Sertoli cells but no sperm. 
  28. Treatment for septic athritis?
    3rd generation cephalosporin: Ceftriaxone, Cefotaxime
  29. 1. Antibody to which influenza viral molecule would block the entrance of the virus into the cell?
    2. Antibody to which inflenza viral molecule would block the release of the virus from the cell?
    • 1. Hemagluttinin
    • 2. Neuraminidase
  30. Mechanism of action of Maraviroc?
    CCR5 antagonist that blocks the entry of HIV into macrophages
  31. Most common form of anastomoses in the colon?
    Middle colic (from the SMA) with the left colic (from the IMA)
  32. Severe hypoglycemia with decreased ketone levels classifies what metabolic disease?
    B-oxidation such as MCADD (conversion of fatty acids to acetyl coA)
  33. Paraoxsmal nocturnal hemoglobinuria is related to a defect in what gene product?
    • Phosphatidnyinositol glycan A.
    • Deficiencies of CD55 and CD59 that both inactivate complement
    • Hence, complement mediated RBC lysis.
  34. Patient with postive PPD, and has generalized malaise along with orthostatic hypotension. Dx?
    Addison's disease due to TB destroying the adrenal cortex. 
  35. Patient who went camping and now has motile organisms in his CSF is infected by what organism?
    N. fowleri: parasites are eukaryotes with no cell wall and a cholestrol-containing cell membrane
  36. Destroying the activity of telomerase will result in what problem?
    Cells will undergo apoptosis sooner (telomerase maintains telomeres) as chromosomes become shorter with replication.
  37. Patient with CHF presents with pulmonary edema.What happens to his PO2, PCO2, Hb saturation, and total O2 content?
    Pulmonary edema is a diffusion defect: hence, PO2 decreases, PCO2 increases (gas exchange difficulty), Hb saturation decreases as low O2, and total O2 content decreases. 
  38. Baby with RDS has what major problem?
    Restrictive problem causing a decrease in compliance which leads to decreased volumes in the lung. Increased alveolar resistance thus occurs, causing atelectasis. 
  39. Patient with orthostatic hypotension will have what mechanisms occurring when he stands up?
    • 1. Increased pooling of blood in the leg veins which increases hydrostatic pressure hence, increasing capillary filtration.
    • 2. Reduced venous returns (= decreased central venous pressure) occurs which causes a decrease in preload and decreased CO. 
    • 3. Decreased CO = decreased BP will stimulate the baroreceptor reflex to decrease C.N. IX firing which increases SNS and decreases PNS. 
    • 4. SNS increase causes tachycardia, but cannot cause efficient vasoconstriction to increase the BP.
  40. What happens to the arterial oxygen levels in a patient with a pulmonary embolism?
    • There is a decrease of blood flow = no arterial O2 and CO2 in that part of the lung; hence, overall O2 decreases and CO2 increases.
    • Alveolar O2 cannot diffuse down its gradient, hence, the PAO2 inspired equals the same amount expired. 
  41. What happens to the arterial oxygen levels in a patient with a bronchial obstruction? 
    In a bronchial obstruction, there is no ventilation. Oxygen cannot move into the alveoli and then to the blood. Hence, the venous O2 = arterial O2 (i.e. right to left shunt). 
  42. Why is the V/Q high at the apex of the lung and what are its arterial O2 levels?
    • There is greater ventilation, but less perfusion at the apex. Greater ventilation = more O2 entering the lungs (i.e. more in the blood) and less CO2 in the blood. 
    • Low perfusion allows all the blood to be saturated with oxygen and still have a remainder of oxygen left over. 
  43. Why is the V/Q low at the base of the lung and what are its arterial O2 levels?
    • There is less ventilation and greater perfusion. Less ventilation allows less O2 to reach the base, but more CO2 to remain at the base. 
    • Greater perfusion cannot allow all the blood to be saturated with O2 (as there's too much blood flow and less oxygen). and carries a greater amount of CO2. Hence, supplemental O2 would help a patient here.
  44. 1) What placental parts are made from the fetus?
    2) What placental parts are made from the mom?
    • 1) Chorionic plate, amion, chorion, chorionic blood vessels
    • 2) decidua basalis (where placenta adheres to uterus), blood vessels in intervillous spaces, placental septae 
  45. A patient has a seizure where she falls to the floor and her muscles stiffen and then she has jerky movements. When she regains consciousness, she does not remember the event. Type of seizure and tx?
    • Tonic-clonic seizure
    • Tx: Phenytoin, carbamezapine, valproate = all block Na+ gated channels.
  46. How does the factor V leiden mutation cause hypercoagulabilty?
    Factor Va causes resistance to protein-C mediated inactivation of factor V. 
  47. In a HIV patient, what values will decrease over the next 5-10 years? 
    CD4 T cells decrease, hence granuloma formation decreases. Serum macroglobulin increases because there are no TH2 cytokines to promote isotype switching (patient cannot make any immunoglobulin other than IgM). 
  48. A patient with pneumonia is treated with Clindamycin. The pneumonia is treated but he develops diarrhea. 
    Mechanism of resistance?
    • Bug: Clostridium difficile
    • Mechanism: produces spores that allow it to grow in areas of antibiotic resistance, hence causing diarrhea
  49. What confirmatory diagnositic test is used in Down Syndrome and what test would be used to detect Alzheimers in these patients when they're older?
    • FISH.
    • AchE assay
  50. Treatment for uncomplicated acute cystitis?
    Treatment for pyelonephritis?
    • Acute cystitis:
    • TMP- SMX (new drug that is as effective: Nitrofurantoin)
    • Ciprofloxacin

    • Pyelonephritis: 
    • Gentamicin
  51. 1. Which antibody dominates in killed vaccines?
    2. Which antibody dominates in live vaccines?
    • 1. CD4+ as it allows for class switching 
    • 2. CD8+
  52. A patient has recurrent necrotic lesions on his legs and arms, and a history of protracted wound healing and scarring. Dx and leukocytes will show an absence of what factor? 
    • Leukocyte adhesion deficiency: white blood cells are unable to extravacate, hence protracted wound healing and scarring.
    • CD18.
  53. Patients will be more prone to gram negative organisms when they have a deficiency in what marker?
    CD14 due to lack of macrophages
  54. An example when increased interstital [protein] increases GFR causing non-pitting edema?
    Blocked lymphatic drainage