CBSSA_17

Question 1

Presentation of MLF

Answer 1

• when looking to laterally, one eye demonstrates adduction deficit
• side of the INO is named by the side of the adduction deficit, which is ipsilateral to the medial longitudinal fasciculus (MLF) lesion
  
  • e.g. Right MLF lesion ==> inability to adduct right eye when looking left

Question 2

Structures?

Answer 2

• coronal section of middle cranial fossa
• artery = internal carotid w/in cavernous sinus
• A = CN III
• B = CN IV
• C = CN VI
• D = CN V
• E = CN V

Question 3

Sertraline: MOA, uses

Answer 3

• SSRI
• uses:
  
  • MDD
  • OCD
  • GAD
  • Panic disorder
  • PTSD

Question 4

first sign of puberty in females

Answer 4

breast bud development

Question 5

Erythromycin: MOA, SE

Answer 5

• Macrolide = binds 50S subunit ==I protein synthesis
• SE
  
  • (clarithro/eryhtro) = QT prolongation
  • (clarithro/eryhtro) = inhibit CYP450 (CYP3A4)

Question 6

Gentamicin: MOA, SE

Answer 6

• Aminoglycoside: binds 30S subunit ==I protein synthesis
• SE
  
  • neurotox
  • nephrotox

Question 7

Presentation of 11B-hydroxylase deficiency

Answer 7

• MC
  
  • decreased aldosterone
  • increased 11-deoxycorticosterone = potent MC
• decreased cortisol
• increased sex hormones
• labs = hypertension
• sex hormones
  
  • XX: viriliaztion

Question 8

Presentation of 21-hydroxylase deficiency

Answer 8

• MC: decreased aldosterone
• decreased cortisol
• increased sex hormones
• labs
  
  • hypotension
  • hyperkalemia
  • elevated renin activity
  • elevated 17-hydroxyprogesterone
• ==> XX: viriliaztion

Question 9

Type II familial hypercholesterolemia

Answer 9

• in blood: elevated LDL, cholesterol
• Pathophys
  
  • AD
  • Absent (homozygotes) or defective LDL receptors
  • heterozyg = cholesterol ~ 300
  • homozyg = cholesterol ~ 700+

Question 10

Possible manifestations of hemochromatosis

Answer 10

• hyperpigmentation
• weakness & lethargy
• elevated liver enzymes
• elevated iron levels
• DM
• hypopituitarism ==> hypogonadism ==> impotence
• arthralgia

Question 11

Location of SA node

Answer 11

• sinoatrial node is a group of cells positioned in the wall of the right atrium just lateral to the junction where the superior vena cava enters the right atrium

Question 12

Possible CV complications of cocaine abuse

Answer 12

• MI
• aortic dissection (?)

Question 13

Ibutilide: MOA, use, SE

Answer 13

• MOA: exact mechanism of action is unknown; prolongs the action potential in cardiac tissue
• Use: Acute termination of atrial fibrillation or flutter of recent onse
• SE
  
  • Ventricular extrasystoles (5.1%), ventricular tachycardia (4.9%), tachycardia/supraventricular tachycardia (2.7%)

Question 14

?? ==> internal hemorrhoids

?? ==> external hemorrhoids

Answer 14

• superior rectal vein dilation ==> internal
• inferior rectal vein dilation ==> external

Question 15

Alveolar cell types?

Answer 15

• A = endothelial cells
• B = erythrocytes
• C = Type I pneumo
• D = type II pneumo
• E = macrophages

Question 16

Anti-inflammatory/immunosuppressive actions of Prednisone

Answer 16

• Inhibition of gene transcription for COX-2, cytokines, cell adhesion molecules, and inducible NO synthase
• Blockage of Vitamin D3-mediated induction of osteocalcin gene in osteoblasts
• Modification of collegenase gene transcription
• Increase synthesis annexin-1, important in negative feedback on hypothalamus and anterior pituitary gland

Question 17

hypervascular mass @ kidney ==> dx?

Answer 17

renal cell carcinoma

Question 18

Tx of ascites

Answer 18

• furosemide + sprinolactone

Question 19

Peripheral blood smear in HELLP syndrome

Answer 19

• schistocytes <== common in microangiopathic hemolytic anemia

Question 20

Heinz bodies vs. Howell-Jolley bodies

Answer 20

• Heinz = precipitated Hb
  
  • splenic macs remove heinz ==> bite cells
• Howell-Jolly bodies = nuclear fragments in RBCs
  
  • present in patients without spleen
  • e.g. splenectomy to tx herid spherocytosis

Question 21

Drug trial phases

Answer 21

Preclinical Testing of drug in non-human subjects, to gather efficacy,toxicity and pharmacokineticinformation unrestricted

Phase I Testing of drug on healthy volunteers for dose-ranging often subtherapeutic, but with ascending doses

Phase II Testing of drug on patients to assess efficacy and safety therapeutic dose

Phase III Testing of drug on patients to assess efficacy, effectiveness and safety therapeutic dose

Phase IV Postmarketing surveillance – watching drug use in public therapeutic dose personal physician anyone seeking treatment from their physician watch drug’s long-term effects

Question 22

Sulfasalazine: MOA, use

Answer 22

Commonly used in RA & Crohn’s disease and ulcerative colitis

it is thought to be an antinflammatory drug that provides topical relief inside the intestine. It does this via a number of mechanisms such as reducing the synthesis of inflammatory mediators known as eicosanoids and inflammatory cytokines.

Question 23

CREST Syndrome

Answer 23

• = systemic sclerosis
• Calcinosis
• Raynaud’s
• Esophageal dysmotility ==> fibrous replacement of m. ==> dilation and atony of esophagus and LES
• Syndactyly
• Telangiectasias

Question 24

Rat poison toxicity + antidote

Answer 24

• contains brodifacoum = 4-hydroxycoumarin derivative ==> coagulopathy and bleeding
• tx = fresh frozen plasma + vitamin K