Rx_Random Set #7

Question 1

Placenta previa presentation and sx

Answer 1

• placenta previa = placenta overlies internal cervical os
  
  • subtypes: complete, partial, marginal, low-lying
• major sx:
  
  • significant vaginal bleeding after 20 weeks
  • absence of pain

Question 2

Abruptio placentae definition, sx, risk factors

Answer 2

• abruptio placentae = premature separation of placenta from uterus
• presentation:
  
  • vaginal bleeding after 20 weeks
  • uterine contraction
  • pain
• risk factors
  
  • HTN
  • cocaine use
  • short umblical cord
  • trauma
  • smoking
  • uterine fibroids
  • advanced age
  • prior abruption/premature membrane rupture
  • sudden uterine decompression
  • bleed diathesis

Question 3

Tx of neonatal respiratory distress syndrome

Answer 3

• administration of exogenous surfactant
• surfactant = mixture of lipids (dipalmitoulphosphatidylcholine) & proteins

Question 4

Drug of choice for TB prophylaxis (+MOA)

Answer 4

• Isoniazid (or INH)
• MOA = inhibition of mycolic acid synthesis

Question 5

Common drugs in combination tx for TB (+MOA)

Answer 5

• Rifampin = inhibits DNA-dependent RNA polymerase
• Ethambutol = inhibition of arabinogalactan syntehsis ==> inhibition of cell wall synthesis

Question 6

Macrolides: MOA + e.g.

Answer 6

• used in tx of bacterial infection
• e.g. erythromycin
• MOA = methylation of rRNA ==> prevents ribosomal binding

Question 7

Vancomycin: MOA + common use

Answer 7

• MOA = binds to D-ala-D-ala portion of cell wall precursors ==> inhibition of cell wall peptidoglycan formation
• common use =
  
  • gram-positive infections
  • methicillin-resistant Staph. aureus

Question 8

Presentation and cause of waterhouse-friderichsen syndrome

Answer 8

• cause = N. meningitidis ==> menigitis and sepsis & W-F syndrome
• presentation
  
  • disseminated intravascular coagulation (purpura)
  • shock (hypotension)
  • adrenal failure

Question 9

Mass effects of neoplasm at pyloric zone

Answer 9

• obstruction of hepatoduodenal ligament = common bile duct, hepatic artery, hepatic portal vein ==> jaundice

Question 10

Pathologic consequences of giardia infections

Answer 10

• ==> inflammation and villous atrophy in the gut
• ==> malabsorption

Question 11

Characteristics of Reed-sternberg cells

Answer 11

• binucleate cells w/inclusion-like nucleoli
• B-cell origin
• CD15 and CD30 positive
• present in Hodgkin’s lymphoma

Question 12

Pathologic characteristics of Lymphocyte-rich Hodgkin lymphoma

Answer 12

• few Reed-Sternberg cells (more present in mixed cellularity Hodgkin’s)
  
  • binucleate cells w/inclusion-like nucleoli
• numerous lymphocytes
  
  • high lymphocyte count
  • dark-staining nuclei and little cytoplasm
• lack areas of collagen banding or lacunar cells (found in nodular sclerosis Hodgkins lymph)

Question 13

Presentation/pathologic characteristics of Kartagener’s syndrome

Answer 13

• presentation
  
  • recurrent sinusitis
  • infertility in males due to immotile sperm
  • situs inversus (=major visceral organs reversed or mirrored from normal positions)
  • bronchiectasis
• pathology
  
  • lack of dynein arms in micrtobules in cilia and flagella ==> immotile

Question 14

Presentation of Immune Thrombocytopenic Purpura

Answer 14

• low platelet count
• antiplatelet antibodies
• enlared platelets

Question 15

Common chemotherapeutic agents associated with cardiotoxicity (+MOA)

Answer 15

• doxorubicin/daunorubicin
• fluorouracil
• busulfan
• cisplatin
• mitoxantrone
• paclitaxel

Question 16

Doxorubicin: MOA

Answer 16

MOA = intercalating DNA

Question 17

Tx of bulimia

Answer 17

• psychotherapy and antidepressants
• usually SSRI ==> fluoxetine

Question 18

Presentation of bulimia

Answer 18

• calluses/scars on dorsum of hand
  
  • due to abrasian from teeth during gagging
• parotid enlargement
• erosion of tooth surfaces

Question 19

Hydralazine: MOA/use/SE

Answer 19

• MOA = potent arteriole vasodilator ==> reduced BP
• use = first-line for HTN in pregnancy
• SE
  
  • ==> reflex tachycardia
    
    • administer w/B-blocker (e.g. labetalol)

Question 20

Treatment for refractory Parkinson’s (not responsive to medication)

Answer 20

• ablative surgery pf globus pallidus

Question 21

Lab results in metabolic alkalosis

Answer 21

• increased pH (> 7.4)
• increased plasma bicarb
• increased CO₂ (due to respiratory compensation)

Question 22

Common causes of metabolic alkalosis

Answer 22

• general: loss of hydrogen ions or increase in bicarb concentation
• vomiting ==> loss of H⁺ in gastric acid
• antacid use
• diuretic use
• hyperaldosteronism

Question 23

Presentation of interruption of posterior inferior cerebellar artery

Answer 23

• ==> “lateral medullary syndrome”
• ispilateral Horner’s syndrome
  
  • ptsois, miosis, anhidrosis
• absent pain & temp on ispilateral face and contralateral body
  
  • damage to spinal trigeminal and spinothalamic tract
• ataxia
  
  • damage to inferior cerebellar peduncle
• nystagmus
  
  • vestibular nucleus
• hoarsness
  
  • nucleus ambiguus of the vagus

Question 24

Low alpha-fetoprotein (AFP) on prenatal triple triple screen ==> dx?

Answer 24

• fetus may have Down’s syndrome
  
  • “AFP goes down in Down’s”

Question 25

Congenital anomalies in Down's

Answer 25

* VSD * endocardial cusion defects * omphalocele

Question 26

Microscopic polyangitis presentation/mechanism

Answer 26

* white individuals * sx * fatigue * muscle pain * weight loss * dark brown stools * febrile * palable purpra * cough w/reddish-looking sputum * MOA * activation of neutrophils and monocytes by perinuclear antineutrophil cytoplasmic antibodies