Axon
07-08-2005, 02:42 PM
Tommy’s High Yield Concepts 1501 - 1515
1501
Many boards questions come up about the MORBIDITY of this BAD dx (Herpes). What are some of them please?
a) Severe complications may be associated with herpes simplex. This is especially true in females who are pregnant and in individuals with immunosuppression who may develop disseminated infection and encephalitis.
The most common complication of primary HSV-2 genital infection is bacterial superinfection. In women, systemic complications, such as urinary retention and aseptic meningitis (seen in up to 25% of women), can occur. The associated pain, paresthesia, and discomfort, as well as the psychosocial impact, of herpes simplex outbreaks cause significant morbidity to the individuals who are affected.
· Individuals co-infected with HSV and HIV and who have herpetic mucosal lesions are more likely to transmit HIV during sexual contact. Organ transplant recipients and patients with HIV/AIDS may develop herpetic lesions that exhibit an unusual morphology. Moreover, patients with Darier disease, severe atopic dermatitis, and mycosis fungoides may develop life-threatening disseminated Kaposi varicelliform eruption.
· Another serious consequence of HSV is the transmission of the virus to a neonate by a mother who is infected. Asymptomatic maternal shedding occurs approximately 7% of the time and is responsible for most neonatal HSV infections. HSV infections in neonates are most commonly due to HSV-2 and most are acquired peripartum, although in utero and postpartum transmission also occur. Transmission is estimated to occur at a rate of 1 case in 3500-5000 deliveries in the United States. Neonatal infection can cause long-term sequelae and rarely death. They will test you on these...
1502
You best friend, after a frat party, settles down into bed with a soroity girl. That is sinful. But....you see on BOTH friend and one night stand's genitals what you think is HSV II.
Being a 2nd year med student, what tests do you run in the middle of your dorm room lab?
A] Detection and typing of HSV can be completed by obtaining a viral culture from skin vesicles. Early in the course of recurrent infection, 80-90% of viral cultures of untreated lesions are positive, but the false-negative rate increases after 48 hours of lesion onset.
· HSV DNA detection is performed in specific instances by polymerase chain reaction (PCR).
· The virus may be isolated from cerebrospinal fluid (CSF) (in newborns), stool, urine, throat, anogenital mucosa, nasopharynx, and conjunctivae.
· In the office, a Tzanck smear can be performed as a rapid test for the presence of multinucleated giant cells, though the findings are not specific for the type of herpes virus. A Tzanck smear is prepared by scraping the floor of the herpetic vesicle; samples may be stained with either a Wright stain or a Papanicolaou stain. Approximately 50% of the results are positive.
· Direct fluorescent antibody testing may be used on air-dried smears, and approximately 75% of the results are positive.
Look for any of those in the answer choices. esp. the ones I bolded.
1503
Both of your HSV II infected friends are embarrassed and asks you to ask your mom (who is a doctor, for the right meds) What will you give them?
a) Treatment of herpes labialis and herpes genitalis generally consists of episodic courses of oral acyclovir and prodrugs valacyclovir and famciclovir. Oral antiviral medications, acyclovir, valacyclovir, and famciclovir, may be used (off label) as therapy for other uncomplicated HSV conditions (eg, herpes whitlow), and the same doses as those used for herpes genitalis treatment are commonly recommended. Also, tell them not to have so much sex. Tell them to read the Bible and abstain...(my personal opinion. But don't answer this on the Boards)
1504
Why hang thiamine in an alcoholic (IV drip) before glucose infusion and why thiamine?
a) Boards says so (think why), and thiamine is a cofactor for pyruvate dehydrogenase and alpha ketoglutarate. dehydrogenase.
1505
Your exam will have questions on collagen synthesis because it is SO important. Did you ever get a cut???
So, here is what they ask:
You are a plastic surgeon and have done a lot of work to make a 70 year old actress look 29 and sexy again. She pays you 100K as a bonus. But, she asks you how her wounds will heal. You answer:
"Well, Ms. Movie Star, it is about Collagen type III turning into Collagen type I. Listen, there are fibroblasts the make alpha chains. Vitamin C HYDROXLATES proline and lysine and help cross linking. Next, The 3 pro alpha chains assemble at the C TERMINUS making the tight triple helix. Then, outside the cell, Procollagen peptidases cleave N and C terminal peptides, form fibrils, and CROSS LINKING OCCURS with the help of LYSYL OXIDASE."
Wow, you have made a grandma a sex symbol again. That is good for Hollywood.
1506
A lot of students reported back that they HAD to calculate the ODDS ratio. To make it simple, it is the formula:
A/B
___
C/D
(See, simple as ABCD..)
You were asked to know it calculates the Relative Risk of having a disease within an exposed group....
1507
KNOW sick cell anemia, many students got this on their exam. You know that sickle cell disease results from a single amino acid substitution (valine for glutamate) in position 6 of the beta-globin chain of hemoglobin. This genetic alteration yields an unstable RBC with a shortened survival that under stress becomes sickle shaped. Those were already asked on previous versions. But...what kind of mutation is this? Nonsense, Missense, Silent, etc?
a) MISSENSE. Approximately 8-10% of African Americans carry the gene (S) in the population. Homozygous (SS) sickle disease occurs in about 0.15% of African American newborns.
1508
NBME asks what exactly happens to a sickle celler in aplastic crisis?
a) Infants and children are susceptible to an aplastic anemia crisis.
· During these episodes, the degree of anemia worsens, and jaundice decreases due to a profound reticulocytopenia, resulting in no erythrocyte precursors in the bone marrow.
· The patient appears acutely ill, tachycardic, and pale, yet nonicteric. Occasionally, recovery occurs in several days. These symptoms usually are due to an infection by the parvovirus B19 prototype.
1509
A question came up on what to tell mothers about what precipitates sickling in their children. What is the right answer?
a) The sickling process that frequently occurs with sickle cell anemia may be precipitated by multiple factors.
· A crisis may be induced by local tissue hypoxia, dehydration secondary to a viral illness, or nausea and vomiting, all of which lead to hypertonicity of the plasma. SOME DRUGS can do this too.
· Any process that can lead to acidosis, such as infection or extreme dehydration, can cause sickling.
· More benign factors and environmental changes, such as fatigue, exposure to cold, and psychosocial stress, can elicit the sickling process that prompts a crisis.
1510
q) Was how do you diagnose sickle cell?
a) Specific diagnosis is confirmed with hemoglobin electrophoresis performed in specialized reference laboratories.
AND
· The patient with homozygous sickle cell disease normally has a hemoglobin level between 5-9 g/dL, with a hematocrit level decreased to 17-29%.
· The total leukocyte count is elevated to 12,000-20,000 with a predominance of neutrophils.
· The platelet count is increased, and the sedimentation rate is low.
· The reticulocyte count usually is elevated but may be variable, depending on the extent of baseline hemolysis.
· Examination of the peripheral blood smear demonstrates target cells, elongated cells, and characteristic sickle erythrocytes.
· The hemoglobin solubility test result is positive, but it does not distinguish between sickle cell disease and sickle cell trait.
1511
Your pt has white patches on the surface of the oral mucosa, tongue, or other parts of the body after taking corticosteroids for years. Looks white like thrush. This is not a trick question. You know what this is. Nystatin is oft. used, but what drug starting with the letter "F" is more used? And what is the MOA?
a) Fluconazole is often used for CANDIDA, it inhibits fungal ergosterol production essential in cell wall formation by inhibiting the cytochrome c-dependent demethylation step in formation of ergosterol. Has little affinity for mammalian cytochromes, which is believed to explain its low toxicity.
1512
Pt. comes in with severe epigastric pain...(does NOT radiate). Worse with meals. She has been taking NSAIDS for back pain for years and smokes and drinks. What is the disease?
a) Peptic ulcer dx. (easier question)
1513
This was an easy one. Someone got a picture of a histology slide and was asked to point to a TYPE II pneumocyte, in the lung. can you do it?
1514
Someone else got a picture of the brainstem, and a few others in the class got similar questions where they had to point to structures (no secondaries asked). Stuff like, where is CN III, where is the raphe nucleus, nucleus ambiguous, etc. Sounds easy, but if you did not do a quickie review, then...ouch....
1501
Many boards questions come up about the MORBIDITY of this BAD dx (Herpes). What are some of them please?
a) Severe complications may be associated with herpes simplex. This is especially true in females who are pregnant and in individuals with immunosuppression who may develop disseminated infection and encephalitis.
The most common complication of primary HSV-2 genital infection is bacterial superinfection. In women, systemic complications, such as urinary retention and aseptic meningitis (seen in up to 25% of women), can occur. The associated pain, paresthesia, and discomfort, as well as the psychosocial impact, of herpes simplex outbreaks cause significant morbidity to the individuals who are affected.
· Individuals co-infected with HSV and HIV and who have herpetic mucosal lesions are more likely to transmit HIV during sexual contact. Organ transplant recipients and patients with HIV/AIDS may develop herpetic lesions that exhibit an unusual morphology. Moreover, patients with Darier disease, severe atopic dermatitis, and mycosis fungoides may develop life-threatening disseminated Kaposi varicelliform eruption.
· Another serious consequence of HSV is the transmission of the virus to a neonate by a mother who is infected. Asymptomatic maternal shedding occurs approximately 7% of the time and is responsible for most neonatal HSV infections. HSV infections in neonates are most commonly due to HSV-2 and most are acquired peripartum, although in utero and postpartum transmission also occur. Transmission is estimated to occur at a rate of 1 case in 3500-5000 deliveries in the United States. Neonatal infection can cause long-term sequelae and rarely death. They will test you on these...
1502
You best friend, after a frat party, settles down into bed with a soroity girl. That is sinful. But....you see on BOTH friend and one night stand's genitals what you think is HSV II.
Being a 2nd year med student, what tests do you run in the middle of your dorm room lab?
A] Detection and typing of HSV can be completed by obtaining a viral culture from skin vesicles. Early in the course of recurrent infection, 80-90% of viral cultures of untreated lesions are positive, but the false-negative rate increases after 48 hours of lesion onset.
· HSV DNA detection is performed in specific instances by polymerase chain reaction (PCR).
· The virus may be isolated from cerebrospinal fluid (CSF) (in newborns), stool, urine, throat, anogenital mucosa, nasopharynx, and conjunctivae.
· In the office, a Tzanck smear can be performed as a rapid test for the presence of multinucleated giant cells, though the findings are not specific for the type of herpes virus. A Tzanck smear is prepared by scraping the floor of the herpetic vesicle; samples may be stained with either a Wright stain or a Papanicolaou stain. Approximately 50% of the results are positive.
· Direct fluorescent antibody testing may be used on air-dried smears, and approximately 75% of the results are positive.
Look for any of those in the answer choices. esp. the ones I bolded.
1503
Both of your HSV II infected friends are embarrassed and asks you to ask your mom (who is a doctor, for the right meds) What will you give them?
a) Treatment of herpes labialis and herpes genitalis generally consists of episodic courses of oral acyclovir and prodrugs valacyclovir and famciclovir. Oral antiviral medications, acyclovir, valacyclovir, and famciclovir, may be used (off label) as therapy for other uncomplicated HSV conditions (eg, herpes whitlow), and the same doses as those used for herpes genitalis treatment are commonly recommended. Also, tell them not to have so much sex. Tell them to read the Bible and abstain...(my personal opinion. But don't answer this on the Boards)
1504
Why hang thiamine in an alcoholic (IV drip) before glucose infusion and why thiamine?
a) Boards says so (think why), and thiamine is a cofactor for pyruvate dehydrogenase and alpha ketoglutarate. dehydrogenase.
1505
Your exam will have questions on collagen synthesis because it is SO important. Did you ever get a cut???
So, here is what they ask:
You are a plastic surgeon and have done a lot of work to make a 70 year old actress look 29 and sexy again. She pays you 100K as a bonus. But, she asks you how her wounds will heal. You answer:
"Well, Ms. Movie Star, it is about Collagen type III turning into Collagen type I. Listen, there are fibroblasts the make alpha chains. Vitamin C HYDROXLATES proline and lysine and help cross linking. Next, The 3 pro alpha chains assemble at the C TERMINUS making the tight triple helix. Then, outside the cell, Procollagen peptidases cleave N and C terminal peptides, form fibrils, and CROSS LINKING OCCURS with the help of LYSYL OXIDASE."
Wow, you have made a grandma a sex symbol again. That is good for Hollywood.
1506
A lot of students reported back that they HAD to calculate the ODDS ratio. To make it simple, it is the formula:
A/B
___
C/D
(See, simple as ABCD..)
You were asked to know it calculates the Relative Risk of having a disease within an exposed group....
1507
KNOW sick cell anemia, many students got this on their exam. You know that sickle cell disease results from a single amino acid substitution (valine for glutamate) in position 6 of the beta-globin chain of hemoglobin. This genetic alteration yields an unstable RBC with a shortened survival that under stress becomes sickle shaped. Those were already asked on previous versions. But...what kind of mutation is this? Nonsense, Missense, Silent, etc?
a) MISSENSE. Approximately 8-10% of African Americans carry the gene (S) in the population. Homozygous (SS) sickle disease occurs in about 0.15% of African American newborns.
1508
NBME asks what exactly happens to a sickle celler in aplastic crisis?
a) Infants and children are susceptible to an aplastic anemia crisis.
· During these episodes, the degree of anemia worsens, and jaundice decreases due to a profound reticulocytopenia, resulting in no erythrocyte precursors in the bone marrow.
· The patient appears acutely ill, tachycardic, and pale, yet nonicteric. Occasionally, recovery occurs in several days. These symptoms usually are due to an infection by the parvovirus B19 prototype.
1509
A question came up on what to tell mothers about what precipitates sickling in their children. What is the right answer?
a) The sickling process that frequently occurs with sickle cell anemia may be precipitated by multiple factors.
· A crisis may be induced by local tissue hypoxia, dehydration secondary to a viral illness, or nausea and vomiting, all of which lead to hypertonicity of the plasma. SOME DRUGS can do this too.
· Any process that can lead to acidosis, such as infection or extreme dehydration, can cause sickling.
· More benign factors and environmental changes, such as fatigue, exposure to cold, and psychosocial stress, can elicit the sickling process that prompts a crisis.
1510
q) Was how do you diagnose sickle cell?
a) Specific diagnosis is confirmed with hemoglobin electrophoresis performed in specialized reference laboratories.
AND
· The patient with homozygous sickle cell disease normally has a hemoglobin level between 5-9 g/dL, with a hematocrit level decreased to 17-29%.
· The total leukocyte count is elevated to 12,000-20,000 with a predominance of neutrophils.
· The platelet count is increased, and the sedimentation rate is low.
· The reticulocyte count usually is elevated but may be variable, depending on the extent of baseline hemolysis.
· Examination of the peripheral blood smear demonstrates target cells, elongated cells, and characteristic sickle erythrocytes.
· The hemoglobin solubility test result is positive, but it does not distinguish between sickle cell disease and sickle cell trait.
1511
Your pt has white patches on the surface of the oral mucosa, tongue, or other parts of the body after taking corticosteroids for years. Looks white like thrush. This is not a trick question. You know what this is. Nystatin is oft. used, but what drug starting with the letter "F" is more used? And what is the MOA?
a) Fluconazole is often used for CANDIDA, it inhibits fungal ergosterol production essential in cell wall formation by inhibiting the cytochrome c-dependent demethylation step in formation of ergosterol. Has little affinity for mammalian cytochromes, which is believed to explain its low toxicity.
1512
Pt. comes in with severe epigastric pain...(does NOT radiate). Worse with meals. She has been taking NSAIDS for back pain for years and smokes and drinks. What is the disease?
a) Peptic ulcer dx. (easier question)
1513
This was an easy one. Someone got a picture of a histology slide and was asked to point to a TYPE II pneumocyte, in the lung. can you do it?
1514
Someone else got a picture of the brainstem, and a few others in the class got similar questions where they had to point to structures (no secondaries asked). Stuff like, where is CN III, where is the raphe nucleus, nucleus ambiguous, etc. Sounds easy, but if you did not do a quickie review, then...ouch....