Rx_Random Set #6

Question 1

Examples of live attenuated vaccines

Answer 1

• MMR
• Sabin polio
• intranasal influenza
• varicella
• yellow fever

Question 2

Examples of inactivated vaccines

Answer 2

• Rabies
• injected Influenza
• Salk Polio
• HAV (Hep A)

Question 3

Cremaster muscle innervation & muscular derivation

Answer 3

• innervation: genitofemoral n.
• m. derivation: internal abdominal oblique

Question 4

Presentation/mechanism of meckel’s diverticulum

Answer 4

• meckel’s diverticulum = persistence of vitelline duct (omphalomesenteric duct)
  
  • ==> small bulge in small intestine
  • can ==> GI bleed, obstruction, volvulus, intussusception
  • “rule of 2’s”
    
    • present in 2% of population; 2% are symptomatic
    • 2:1 male to female prevalence
    • 2 ft. from ileocecal valve
    • 2 inches in length
• general presentation
  
  • often asymptomatic
  • can present w/rectal bleeding or intestinal obstruction

Question 5

Cells that secrete IL-2 + important cell marker

Answer 5

• T-lymphocytes secrete IL-2 ==> B cell maturation/differentiation
• T-cells secretion mediated by CD3 receptor

Question 6

andrenergic receptor type @ bronchi

Answer 6

Beta2

Question 7

Types of malaria infections + causative organism

Answer 7

• Plasmodium = protozoa that infect humans; transmitted by female Anopheles mosquito
• Plasmodium falciparum
  
  • Africa
  • cerebral malaria
• P. knowlesi
  
  • primarily macaques
  • humans in SE Asia
• P. ovale
  
  • 48 hour cyclic fever
  • form hypnozoites ==> dormant
  • no cerebral
• P. vivax
  
  • 48 hour cyclic fever
  • form hypnozoites
  • no cerebral
• P. malariae
  
  • 72 hour cyclic fever
  • no cerebral

Question 8

Leading cause of cancer death + histologic findings

Answer 8

• lung cancer (both genders)
• adenocarcinoma
  
  • gladular differentiation or mucin production (most common)
  • possible bronchoalveolar spread

Question 9

child w/high fever, drooling, difficulty breathing, inspiratory distress ==> dx? + findings + most common etiology/organism type

Answer 9

• Dx: epiglottitis
• Xray = thumbprint sign, aryepiglottic folds
• most common: H. influenzae
  
  • gram-negative coccobacilli

Question 10

Characteristics/presentation of Zollinger-Ellison syndrome

Answer 10

• gastrin overproduction ==> gastric hypersecretion and peptic ulcers @ distal duodenum and jejunum
• negative H. pylori

Question 11

Croup vs. Epiglottitis

Answer 11

Question 12

Thymoma paraneoplastic syndrome association

Answer 12

• predominantly autoimmune/endocrine
• MG
• pure RBC aplasia
• hypogammaglobulinemia

Question 13

Characteristics of glucose-6-phosphate dehydrogenase deficiency

Answer 13

• X-linked
• enzyme deficiency in hexose monophosphate shunt pathway
  
  • protects RBCs from oxidative damage
• setting of oxidative drugs (sulfa-containing, antimalarials), fava beans, or infection ==>
  
  • hemoglobin precipitation = small round inclusion in RBC = “Heinz body”
  • ==> hemolysis ==> increased indirect bilirubin

Question 14

Niacin MOA + adverse effects

Answer 14

• MOA: reduced hepatic TG synthesis and VLDL secretion + significant increase in HDL cholesterol
• SE:
  
  • flushing
  • myopathy

Question 15

DM drug ==> endogenous insulin release (& MOA + Adverse rxn)

Answer 15

• sulfonylurea drugs, e.g. Tolbutamide
• MOA: close K channels @ pancreatic beta cells ==> cell depolarization ==> calcium influx ==> insulin release
• SE:
  
  • disulfiram-like rxn: flushing, tachycardia, naseau, hyperventilation

Question 16

Findings in Patau’s syndrome

Answer 16

• Patau’s = trisomy 13
• microcephaly
• micropthalmia
• polydactyly
• hypotonia/CNS defects
• congenital heart disease

Question 17

Purpose of direct coombs’ vs. indirect coombs’

Answer 17

• direct = detects antibodies attached to patient’s RBCs
• indirect = detects antibodies circulating in patient’s serum

Question 18

Gemfibrozil MOA

Answer 18

• gemfibrozil = fibric acid derivative
  
  • increases activity of lipoprotein lipase by acting on peroxisome proliferator-activated receptor-alpha protein
• ==> large decrease in triglycerides, small reduction in LDL cholesterol, small increase in HDL cholesterol

Question 19

Griseofulvin: MOA

Answer 19

• antifungal agent
• binds to alpha/beta-tubulin dimers during M phase of cell cylce
  
  • tubulin dimers = major structure along which kinetochore-attached kinesin motors carry sister chromatids

Question 20

Common causes of antepartum (late-term) hemorrhage

Answer 20

• antepartum hemorrhage = significant vaginal bleeding after 20 weeks gestation not related to labor and delivery
• placenta previa
• abruptio placentae

Question 21

Factors ==> right shift in hemoglobin curve

Answer 21

• right shift = decreased oxygen affinity ==> more unloading at tissue
• e.g during exercise
  
  • increase temp
  • decreased pH
  • increased CO₂
• increased 2,3 - diphosphoglycerate levels
• decreased fetal hemoglobin/increased adult hemoglobin

Question 22

Factors ==> left shift in hemoglobin curve

Answer 22

• left shift = increased affinity for oxygen
• increased fetal hemoglobin/decreased adult hemoglobin
• increased pH (“decreased H⁺)
• decreased 2,3 - diphosphoglyerate
• decreased temperature
• decreased carbon dioxide
• carbon monoxide exposure ==> increased carboxyhemoglobin levels

Question 23

Weak handshake + difficulty spreading fingers + inability to extend digits 4 and 5 ==> Dx?

Answer 23

• “Handbar palsy” = ulnar neuropathy
  
  • hook of hamate compresses ulnar nerve
• results from extended amounts of time w/wrist extended

Question 24

Tacrolimus: MOA

Answer 24

• immunosuppressant
• MOA: complexes w/FK-binding protein 12 ==> inhibition of clacineurin ==> inhibition of T-lymphocyte signaling

Question 25

Presenation of pancoast tumor

Answer 25

* pancoast tumor = carcinoma @ lung apex ==\> compression of cervical sympathetic plexus (second-order, preganglionic) * Horner syndrome * ispilateral ptsosis, miosis, anhidrosis * SVC syndrome * sensorimotor deficits * hoarseness

Question 26

Hypersexuality + hyperorality + disinhibited behavior ==\> Dx?

Answer 26

* Kluver-Bucy Syndrome * due to bilateral amygdala insult * usually 2^o to ischemic stroke