Axon
07-08-2005, 02:32 PM
1431
We just said RESERPINE blocks NE release by destroying storage vesicles. Thus, it is a good prototype sympathoplegic. It lowers HTN, but what are the main side effects?
(Remember, also try to GUESS first.)
a) Bradycardia, urination, defecation, miosis, sweating.
1432
What is the MOA of Dipyridamole?
a) This antiplatlet blocks phosphodiesterase and adenosine uptake.
1433
Former Prime Minister of Finland Antti Tapani Kalliomäki has become increasingly obtunded over the past day. She was found by her daughter in a stuporous condition and brought to the emergency department. You are in Finland, not sipping on their famous Vodka, but a third year med student on an away rotation. Oh NO! On PE, she has poor skin turgor. She is afebrile. Her vital signs reveal a blood pressure of 90/40 mm Hg, respirations 15 and shallow, pulse 95, and temperature 36 C. Labs show a hemoglobin A1C of 10%. Her serum electrolytes show sodium 144 mmol/L, potassium 5 mmol/L, chloride 95 mmol/L, pCO2 22 mmol/L, and glucose 940 mg/dL. What is the dx? Quick!
Hyperosmolar coma
Hyperlipidemia
Ketoacidosis
Stress from previous governmental rule
a) Hyperosmolar coma. This is common. Treat her, quick!
1434
On a trip to Washington D.C. USA, you meet former President Bill Clinton. After discussing current politics, he asks you about his "70 yr old white friend" who has had increasing R lower leg swelling along with reduced exercise tolerance for the past 4 years. He sometimes has chest pain on exertion. He has not experienced dyspnea. He has experienced 4 episodes of transient ischemic attacks in the past year. He has experienced abdominal pain in the past 2 months. He has pitting edema to the knees bilaterally. An abdominal CT scan shows dilation of the abdominal aorta to 6 cm, filled with mural thrombus. Other family members have had similar problems. Which does he (his friend) have?
Factor V Leiden mutation
Adenocarcinoma of the colon
Multiple blunt trauma
Vasculitis
Diabetes mellitus
a) Diabetes Mellitus, family history supports this. Don't get too caught up with all the details....
1435
You guys n' gals know that some cells demonstrate glucose uptake regardless of the plasma insulin level. In a person who has had persistent hyperglycemia for years, cellular injury can occur. Which of the following cell types is most likely to show injury from hyperglycemia:
Cardiac muscle cells
Fibroblasts
Steatocytes
Neurons
Smooth muscle cells
a) Neurons! Remember that RBCs, the brain, liver, don't need insulin for glucose uptake. PERFECT EXAMPLE of a BOARD question. You will see this.
1436
The cousin of President Luiz Inacio Lula da Silva of Brazil is your first patient of the day. She has a disorder that affects the blood vessels in the fingers, toes, ears, and nose. This disorder is characterized by episodic attacks, called vasospastic attacks, that cause the blood vessels in the digits (fingers and toes) to constrict (narrow), esp. in the colder areas in Brazil. What dx is this? What other disease is this OFTEN related to that starts with the letter S?
a) Raynaud's phenomenon can occur on its own, or it can be secondary to SLE, Scleroderma, CREST syndrome.
1437
You are treating a close friend of the Sultan of Brunei while on vacation on the oil rich land. The pt. is 17 years old with WBCs in his urine, but there are no organisms in the gram stain. What dx could this be that is a major worldwide cause of blindness (starts with letter C)?
a) Chlamydia trachomatis (DO NOT CONFUSE WITH TRICHOMONAS, one of the med students DID get confused on his test)
1438
Your next patient also has a Chlamydia trachomatis infection. But, this time the male pt. complains of a one sided painful abscess behind his left testicle. What dx does he likely have?
a) Chlamydia is responsible for nearly 50-60% of cases, while Neisseria gonorrhoeae is the second most common organism responsible for epididymitis. Ouch!
1439
What is an antiarrhythmic drug (name starts with letter "P") that should never be mixed with antihypertensives and causes SLE-like symptoms?
a) Procainamide (Procan SR-Brand Name)
1440
What other drugs can cause such Lupus symptoms? Name at least one.
a) Phenytoin (common), Isoniazid, and Hydralazine
1441
You are tired to death after a 36 hour call. You did NOT read the pt warning about sulfa drug allergies. He gets massive hemolysis after you give him some ibuprofen and Lasix. What likely dx does he have that you will have to pay malpractice premiums for?
a) He was likely G6PD deficient. Watch out! What diuretic should you have given instead of Lasix?
1442
Hey, an African-American female (53 yrs old) presented to your emergency room (E R) with symptoms of fever, chills, abdominal pain, diarrhea, severe nausea and vomiting. She reported "feeling bad" for several days prior to presenting to the E R. Initial vital signs were BP 120/60, HR 92, and Temp 102.6. Her past medical history was significant for Type 2 diabetes, hypertension and depression. At home she was taking glyburide 5 mg bid. She is also taking a cancer drug. What is the "most likely" reason for this?
a) She is having a disulfiram-like reaction. Also, the famous metronidazole will do this too, esp with alcohol.
1443
You are dating a guy (or girl) that is taking high doses of chlorpromazine that was administered for many years. You notice his or her hand tremoring during a date night watching Star Wars: Revenge of the Sith. What is the disease?
a) Drug induced Parkinson's (Haloperidol will do this too, along with the wooden "love lines" by Anakin)
1444
You are asked by an auntie to figure out why your teenage cousin Susie with acne (taking meds) feels that she must wear sunglasses acutely because her eyes feel "blinded" by the light. Could this be the meds? If so, what med class (starts with letter "T")
a) She is getting a common photosensitivity rxn with oral tetracyclines for the acne.
1445
Your auntie's husband (your uncle) calls you later because she died a horrible death involving lesions erupting in crops for as long as 2-3 weeks. Mucosal pseudomembrane formation led to her mucosal scarring and loss of function. Esophageal strictures occurred with extensive involvement of the esophagus. Mucosal shedding in the tracheobronchial tree led to respiratory failure. She was taking TMP-SMX for a bacterial infection. What HAPPENED? What was the disease name (Initials, S.J.)
a) The SULFA drug caused an allergy known as Steven-Johnson syndrome. ARRGH! It also looks like T.E.N.
1446
Your patient, a well known drug dealer, had hypokalemia and hypomagnesemia. He was also taking fluconazole for an fungal infection. He also was taking drugs for arrhythmias. He died suddenly. What occurred? (Hard question)
a) He died of Ventricular-tachycardia. That drug combo is diagnostic. Polymorphous VT, in which the morphology of the QRS complexes varies from beat to beat. The ventricular rate can range from 150 beats per minute (bpm) to 250 bpm. The original report described regular variation of the morphology of the QRS vector from positive to net negative and back again. Some call this "Torsades de pointes" or "twisting around a point" or something like that...
1447
Your pt. has a gram negative infection, Pseudomonas as he has cystic fibrosis. You fearfully give him a POLYMYXIN for the bug. What is a common dangerous side effect?
a) Neurotoxicity and Nephrotoxicity
1448
Your best friend who is a guy slowly grows breasts like a girl. He is has hypertension so he has been on hydrochlorothiazide and spironolactone (popular combo). Which one is responsible for his new girlishness?
a) spironolactone, also -azoles do this, etc. etc.
1449
Your mother has CHF and you prescribe an ACE inhibitor (along with other stuff). What is the MOA? She complains that she is losing her sense of taste and starts to cough. What drug do you change her to?
a) MOA...So many...no angiotension II so you can vasoDILATE (good thing). Also no release of aldosterone and ADH (more good things). The side effects are hurting mom so give her LOSARTAN instead...MOA of this please...
Like Arnold says,"I'll be back"...tis 4:30 am and I'm sleepy...sorry.-- Tommy
1450
Your pt. presents with hyperspasticity and loss of contralateral pain and temperature sensation. Can you find the lesion if given a CROSS SECTION of the midbrain? (They love common brain stem cross sections).
We just said RESERPINE blocks NE release by destroying storage vesicles. Thus, it is a good prototype sympathoplegic. It lowers HTN, but what are the main side effects?
(Remember, also try to GUESS first.)
a) Bradycardia, urination, defecation, miosis, sweating.
1432
What is the MOA of Dipyridamole?
a) This antiplatlet blocks phosphodiesterase and adenosine uptake.
1433
Former Prime Minister of Finland Antti Tapani Kalliomäki has become increasingly obtunded over the past day. She was found by her daughter in a stuporous condition and brought to the emergency department. You are in Finland, not sipping on their famous Vodka, but a third year med student on an away rotation. Oh NO! On PE, she has poor skin turgor. She is afebrile. Her vital signs reveal a blood pressure of 90/40 mm Hg, respirations 15 and shallow, pulse 95, and temperature 36 C. Labs show a hemoglobin A1C of 10%. Her serum electrolytes show sodium 144 mmol/L, potassium 5 mmol/L, chloride 95 mmol/L, pCO2 22 mmol/L, and glucose 940 mg/dL. What is the dx? Quick!
Hyperosmolar coma
Hyperlipidemia
Ketoacidosis
Stress from previous governmental rule
a) Hyperosmolar coma. This is common. Treat her, quick!
1434
On a trip to Washington D.C. USA, you meet former President Bill Clinton. After discussing current politics, he asks you about his "70 yr old white friend" who has had increasing R lower leg swelling along with reduced exercise tolerance for the past 4 years. He sometimes has chest pain on exertion. He has not experienced dyspnea. He has experienced 4 episodes of transient ischemic attacks in the past year. He has experienced abdominal pain in the past 2 months. He has pitting edema to the knees bilaterally. An abdominal CT scan shows dilation of the abdominal aorta to 6 cm, filled with mural thrombus. Other family members have had similar problems. Which does he (his friend) have?
Factor V Leiden mutation
Adenocarcinoma of the colon
Multiple blunt trauma
Vasculitis
Diabetes mellitus
a) Diabetes Mellitus, family history supports this. Don't get too caught up with all the details....
1435
You guys n' gals know that some cells demonstrate glucose uptake regardless of the plasma insulin level. In a person who has had persistent hyperglycemia for years, cellular injury can occur. Which of the following cell types is most likely to show injury from hyperglycemia:
Cardiac muscle cells
Fibroblasts
Steatocytes
Neurons
Smooth muscle cells
a) Neurons! Remember that RBCs, the brain, liver, don't need insulin for glucose uptake. PERFECT EXAMPLE of a BOARD question. You will see this.
1436
The cousin of President Luiz Inacio Lula da Silva of Brazil is your first patient of the day. She has a disorder that affects the blood vessels in the fingers, toes, ears, and nose. This disorder is characterized by episodic attacks, called vasospastic attacks, that cause the blood vessels in the digits (fingers and toes) to constrict (narrow), esp. in the colder areas in Brazil. What dx is this? What other disease is this OFTEN related to that starts with the letter S?
a) Raynaud's phenomenon can occur on its own, or it can be secondary to SLE, Scleroderma, CREST syndrome.
1437
You are treating a close friend of the Sultan of Brunei while on vacation on the oil rich land. The pt. is 17 years old with WBCs in his urine, but there are no organisms in the gram stain. What dx could this be that is a major worldwide cause of blindness (starts with letter C)?
a) Chlamydia trachomatis (DO NOT CONFUSE WITH TRICHOMONAS, one of the med students DID get confused on his test)
1438
Your next patient also has a Chlamydia trachomatis infection. But, this time the male pt. complains of a one sided painful abscess behind his left testicle. What dx does he likely have?
a) Chlamydia is responsible for nearly 50-60% of cases, while Neisseria gonorrhoeae is the second most common organism responsible for epididymitis. Ouch!
1439
What is an antiarrhythmic drug (name starts with letter "P") that should never be mixed with antihypertensives and causes SLE-like symptoms?
a) Procainamide (Procan SR-Brand Name)
1440
What other drugs can cause such Lupus symptoms? Name at least one.
a) Phenytoin (common), Isoniazid, and Hydralazine
1441
You are tired to death after a 36 hour call. You did NOT read the pt warning about sulfa drug allergies. He gets massive hemolysis after you give him some ibuprofen and Lasix. What likely dx does he have that you will have to pay malpractice premiums for?
a) He was likely G6PD deficient. Watch out! What diuretic should you have given instead of Lasix?
1442
Hey, an African-American female (53 yrs old) presented to your emergency room (E R) with symptoms of fever, chills, abdominal pain, diarrhea, severe nausea and vomiting. She reported "feeling bad" for several days prior to presenting to the E R. Initial vital signs were BP 120/60, HR 92, and Temp 102.6. Her past medical history was significant for Type 2 diabetes, hypertension and depression. At home she was taking glyburide 5 mg bid. She is also taking a cancer drug. What is the "most likely" reason for this?
a) She is having a disulfiram-like reaction. Also, the famous metronidazole will do this too, esp with alcohol.
1443
You are dating a guy (or girl) that is taking high doses of chlorpromazine that was administered for many years. You notice his or her hand tremoring during a date night watching Star Wars: Revenge of the Sith. What is the disease?
a) Drug induced Parkinson's (Haloperidol will do this too, along with the wooden "love lines" by Anakin)
1444
You are asked by an auntie to figure out why your teenage cousin Susie with acne (taking meds) feels that she must wear sunglasses acutely because her eyes feel "blinded" by the light. Could this be the meds? If so, what med class (starts with letter "T")
a) She is getting a common photosensitivity rxn with oral tetracyclines for the acne.
1445
Your auntie's husband (your uncle) calls you later because she died a horrible death involving lesions erupting in crops for as long as 2-3 weeks. Mucosal pseudomembrane formation led to her mucosal scarring and loss of function. Esophageal strictures occurred with extensive involvement of the esophagus. Mucosal shedding in the tracheobronchial tree led to respiratory failure. She was taking TMP-SMX for a bacterial infection. What HAPPENED? What was the disease name (Initials, S.J.)
a) The SULFA drug caused an allergy known as Steven-Johnson syndrome. ARRGH! It also looks like T.E.N.
1446
Your patient, a well known drug dealer, had hypokalemia and hypomagnesemia. He was also taking fluconazole for an fungal infection. He also was taking drugs for arrhythmias. He died suddenly. What occurred? (Hard question)
a) He died of Ventricular-tachycardia. That drug combo is diagnostic. Polymorphous VT, in which the morphology of the QRS complexes varies from beat to beat. The ventricular rate can range from 150 beats per minute (bpm) to 250 bpm. The original report described regular variation of the morphology of the QRS vector from positive to net negative and back again. Some call this "Torsades de pointes" or "twisting around a point" or something like that...
1447
Your pt. has a gram negative infection, Pseudomonas as he has cystic fibrosis. You fearfully give him a POLYMYXIN for the bug. What is a common dangerous side effect?
a) Neurotoxicity and Nephrotoxicity
1448
Your best friend who is a guy slowly grows breasts like a girl. He is has hypertension so he has been on hydrochlorothiazide and spironolactone (popular combo). Which one is responsible for his new girlishness?
a) spironolactone, also -azoles do this, etc. etc.
1449
Your mother has CHF and you prescribe an ACE inhibitor (along with other stuff). What is the MOA? She complains that she is losing her sense of taste and starts to cough. What drug do you change her to?
a) MOA...So many...no angiotension II so you can vasoDILATE (good thing). Also no release of aldosterone and ADH (more good things). The side effects are hurting mom so give her LOSARTAN instead...MOA of this please...
Like Arnold says,"I'll be back"...tis 4:30 am and I'm sleepy...sorry.-- Tommy
1450
Your pt. presents with hyperspasticity and loss of contralateral pain and temperature sensation. Can you find the lesion if given a CROSS SECTION of the midbrain? (They love common brain stem cross sections).