1. What is bulimia nervosa?
    • Binge eating (whole cakes, pizzas) with recurrent inappropriate compensatory behaviors:
    • Purging type- laxative, diuretics, enemas, self-induced vomiting
    • Nonpurging type- excessive exercising, dieting, fasting
    • Calluses on the back of hands
    • Dental erosion
  2. What is Factitious disorder?
    Patient consciously creates physical and/ or psychological symptoms in order to assume "sick role" and to get medical attention.
  3. What is Malingering?
    Involves the voluntary fabrication of symptoms for the purpose of obtaining an external reward (eg. avoiding different situations, obtaining drugs, acquiring financial compensation).
  4. What is the most specific marker for diagnosis of acute hepatitis B?
    • anti-HBc IgM
    • It is present in the window period and it is an important tool for diagnosis when HBsAg has been cleared and anti-HBs is not yet detectable.
  5. Ovoid cells within macrophages are characteristic of?
    Histoplasma capsulatum
  6. This fungi is endemic to Ohio River valleys.
    Histoplasma capsulatum
  7. How can Histoplasma capsulatum be transmitted?
    • Bird or bat droppings
    • Patients may report a history of exploring caves (exposure to bats) or cleaning bird cages/ coops.
  8. Spherules packed with endospores are found in?
    Coccidioides immitis
  9. Budding yeast with a thick capsule is characteristic of?
    Cryptococcus neoformans
  10. Septate hyphae with V-shaped branching is characteristic of?
    Aspergillus fumigaus
  11. What is an essential tremor and how can we treat?
    • Tremor worsens with sustained posture (eg outstretched arms) or while holding objects.
    • Tx: β-blockers (eg Propranolol), Primidone
  12. What is the MOA and use of Benztropine?
    • Antimuscarinic
    • Improves tremor and rigidity in Parkinson disease as well as to counteract the extrapyramidal side effects of antipsychotics such as haloperidol.
  13. This drug improves the tremor and rigidity in Parkinson disease.
    Benztropine- antimuscarinic
  14. This drug is used to counteract the extrapyramidal side effects of antipsychotics such as haloperidol.
  15. Primary amenorrhea in a patient with fully developed secondary sexual characteristics suggest?
    Mullerian agenesis or Imperforate hymen
  16. What is Mullerian agenesis?
    May present as primary amenorrhea in females with fully developed secondary characteristics (functional ovaries)
  17. What does the Mullerian duct give rise to?
    Fallopian tubes, uterus, cervix, upper vagina
  18. What causes superior gluteal nerve injury?
    Pelvic trauma, hip surgery, buttocks injections
  19. Injury to this nerve is caused by buttocks injections.
    Superior gluteal nerve
  20. Which muscles are innervated by the superior gluteal nerve? What are their functions?
    • Gluteus medius
    • Gluteus minimus
    • Tensor fasciae latae
    • These muscle function to stabilize the pelvis and abduct the thigh
  21. What is the Trendelenburg sign?
    • Injury to the superior gluteal nerve causes weakness of the gluteus medius, gluteus minimus and tensor fasciae latae muscles.
    • When standing, the pelvis tilts toward the unaffected (contralateral) side.
    • Image Upload 1
  22. What are the manifestations of injury to the superior gluteal nerve?
    • When standing the pelvis tilts toward the unaffected (contralateral side)Tendelenburg sign
    • When walking, the patient will lean toward the affected (ipsilateral) side to compensate for hip drop.
  23. This nerve innervates the gluteus minimus.
    Superior gluteal nerve (L4-S1)
  24. This nerve innervates the gluteus medius
    Superior gluteal nerve (L4-S1)
  25. This nerve innervates the gluteus maximus.
    Inferior gluteal nerve
  26. Which nerve root is the Pudendal nerve derived from? What is its function?
    • S2-S4
    • Innervates perineum (area between the anus and vulva/scrotum)
  27. How can a pudendal nerve block be performed?
    By injecting anesthetic intravaginally in the region of the ischical spine
  28. This nerve is usually blocked with local anesthetic during childbirth when a woman has progressed too far in labour to receive epidural anesthesia.
    Pudendal nerve (S2-S4)
  29. Describe the presentation of a pulmonary embolus.
    Sudden onset dyspnea tacypnea, tachycardia, chest pain especially in hospitalized patient.
  30. Why does hypoxemia develop in patients with pulmonary embolism?
    V/Q mismatch
  31. A hospitalized patient experiences sudden onset dyspnea, chest pain, tachypnea and tachycardia. What is the pathology? What causes the hypoxemia?
    • Pulmonary emboli
    • Ventilation/ perfusion mismatch
  32. What does Pulmonary capillary wedge pressure measure?
    Left atrial pressure
  33. What causes PCWP to greater than LV diastolic pressure?
    Mitral stenosis
  34. What is the DOC for retinitis in HIV patients?
  35. What can be used to treat CMV retinitis in immunocompromised patients when ganciclovir fails?
  36. The most common type of kidney stones are those composed of?
    Calcium salts, such as calcium oxalate and calcium phosphate
  37. Describe the level of Ca2+ (serum/urine) in calcium kidney stone disease.
    Normocalcemia, hypercalciuria
  38. Hypercalcemia, hypercalciuria is characteristic of?
    • Vitamin D excess
    • Granulomatous disease eg sarcoidosis (↑activation of Vitamin D by epithelioid macrophages)
    • Primary hyperthyroidism
  39. What is the MOA of Fenoldopam?
    • Dopamine D1 receptor agonist
    • Arteriolar dilation
    • Improves renal perfusion
    • ↑Natriuresis - loss of Na2+
  40. This drug causes arteriolar dilation, improves renal perfusion and promotes natriuresis.
    Fenoldopam- D1 agonist
  41. What is the MOA of Hydralazine?
    cGMP → smooth muscle relaxation. Vasodilates arterioles
  42. What is the MOA of Nitroprusside?
    cGMP via direct release of NO
  43. What are the dangers of the use of Nitroprusside?
    Can cause cyanide toxicity
  44. This antihypertensive medication can cause cyanide toxicity.
  45. What is the MOA of Nicardipine?
    Dihydropyridine calcium channel blocker that works by blocking calcium channels in the vascular smooth muscle and the myocardium, resulting in relaxation of smooth muscles and coronary arteries.
  46. What is the function of osteoprotegerin? What secretes it?
    • Secreted by osteoblasts.
    • Acts as a decoy receptor to RANK-L; thus prevents activation of osteoclasts
  47. How does the parathyroid hormone stimulate osteoclasts?
    PTH stimulates the secretion of macrophage colony-stimulating factor and RANK-ligand by osteoblasts; which then stimulates osteoclasts
  48. What are dextrans and how are they made?
    Insoluble extracellular polysaccharide produced by Viridans streptococci that are produced from glucose/ sucrose.
  49. What complications can arise from infection with Campylobacter jejuni?
    • Guillain-Barre syndrome
    • Reactive arthritis
  50. Anti nuclear antibodies are diagnostic of?
    SLE/ drug induced SLE
  51. Which drugs cause SLE-like syndrome?
    • Having lupus is SHIPP-E
    • Sulfa drugs
    • Hydralazine
    • Isoniazid
    • Procainamide
    • Phenytoin
    • Etanercept
  52. What is the MOA of Vancomycin?
    Binds to D-alanyl-D-alanine termini in cell wall and prevents the formation of peptidoglycan.
  53. What is the mechanism of vancomycin resistance?
    Alters the vancomycin-binding site from D-alanyl-D-alanine terminus to D-alanine-D-lactate terminus
  54. What is the mechanism of resistance of Tetracycline?
    • ↓uptake or ↑efflux out of bacterial cells by plasmid-encoded transport pumps
    • Production of a protein that allows translation to take place even in the presence of Tetracycline
  55. Bacterial cells resist this drug by causing increased efflux of the drug by plasmid-encoded transport pumps.
  56. What is the mechanism of resistance to Aminoglycosides- gentamycin, neomycin, amikacin, tobramycin, streptomycin?
    Bacterial transferase enzymes inactivate the drug by acetylation, phosphorylation, or adenylation.
  57. A mechanism of resistance to this drug is by acetylation, phosphorylation or adenylation.
    Aminoglycosides- mycin
  58. What is the MOA and use of RU-486?
    • Mifepristol
    • Competitive inhibitor of progestins at progesterone receptors
  59. What is the MOA and use of Mifepristol?
    • RU-486
    • Competitive inhibitor of progestins at progesterone receptors
  60. This drug is a competitive inhibitor of progestins at progesterone receptors.
    Mifepristol (RU-486)
  61. Why is the hepatitis C virus genetically unstable?
    It lacks proofreading 3'→ 5' exonuclease activity in its RNA polymerase and its envelope glycoprotein contains a hypervariable regionprone to frequent genetic mutation.
  62. What is the glomerular pathology?
    Image Upload 2
    • Kimmelstiel Wilson lesions
    • Diabetic glomerulonephropathy
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