Tommy’s High Yield Concepts 1361 – 1380

[Axon]

Tommy’s High Yield Concepts 1361 – 1380

1361
Everyone uses Lasix, known as Furosemide. What is the MOA? What are the overdose features? Can you point to a picture of where it acts?

The MOA of this SULFA drug is it blocks Na, Cl, and K at the ascending loop of Henle. The URINE becomes less concentrated as the ions leave the tubule.
The overdose rxns are Allergy to sulfa drugs, OTOTOXICITY, GOUT, and HYPOkalemia. KNOW this COLD. (Everyone loves Lasix...)


1362
The next favorite drug is HTZ Hydroclorothiazide. This actually is used to PREVENT gout as well as reabsorbing K+. So...tell me the MOA, overdose effects? You already know this is used as a "water pill".

a) The MOA is it blocks Na+ and Cl- reabsorption in early distal tubule. It lowers Ca excretion. Many of the diuretics are used to manage hypertension and congestive heart failure.
on OVERDOSE, it causes hyperlipidemia, hyperuricemia, hyperglycemia, hypercalcemia.


1363
Ahhh....Spironolactone. With Triamterene and Amiloride, the K+ sparing diuretics BLOCK what compound in the collecting tubule?

a) It blocks ALDOSTERONE while Triamterene and Amiloride block Na channels there and and thus keeps in the K+. Too much of it causes hyperkalemia and GYNECOMASTIA. (Watch out male friends...)


1364
Patient comes in after a workout in a gym. Which is most likely to DECREASE in her muscles during exercise (Pick either "sympathetic activity OR arteriolar resistance"?

a) Read careful please. Ans is arteriolar resistance. During exercise, the blood flow increases in the arterioles due to production of lactic acid, ADENOSINE, and CO2.


1365
KNOW the cardiac cycle from memory, know where all the heart sounds occurs, where the EDV and ESV is maximal, how to calculate stroke volume, know where the S3 and S4 heart sound will occur. Know the overlap of the jugular veinous pulse with an EKG diagram. Know at what point systole and diastole occur. KNOW what would happen to the cardiac cycle if a person had Congestive Heart Failure, etc. etc. EVERYTHING!!!!


1366
Patient, a middle aged man with PMH (past med history) of ulcers, diarrhea, FH (family history) of duodenal ulcer dx is suspected of having a gastrinoma. You administer secretin to test for gastrinoma. Which one would support your diagnosis? (Pick either increased serum gastrin OR inhibition of gastric secretion.)

a) Tricky. The answer is INCREASED serum gastrin. Recall that gastrinomas are tumors in the pancreas. Note we are talking about SERUM gastrin levels.


1367
q) Patient's ratio of urine concentration to plasma concentration of inulin (U/P) goes down. If the GFR is constant, which one is true? (Pick either inulin clearance goes down OR increased urine flow rate)

a) Because INULIN is filtered and NOT reabsorbed or secreted, all will show up in the urine. So, since water in urine determines inulin conc., the U/P inulin will decrease as urine flow increases. Hard question...so think about it a while...


1368
Patient presents with bacterial meningitis (he is a 12 yr old male). The CSF has elevated neutrophils. Do these release more LYSOZYME or PEROXIDASE?

a) lysozyme!
It is Eosinophils that typically carry more peroxidase and is associated more with cancer, parasites, allergies.


1369
Patient, a 30 yr old woman came back from a trip to Southeast Asia.
HPI: She has sudden onset of shaking chills and fever. You test her blood and she has Plasmodium vivax. Should you give PRIMAQUINE or CHLOROQUINE to kill the extraerythrocytic phase?

A) Primaquine! It also attacks da sexual forms.


1370
Patient presents with lymphadenopathy, she is 25 yrs old, one of the lymph nodes has lots of reactive T cells with BIG nucleoli. If shown a DIAGRAM of the lymph node on your test, can you POINT to where the reactive T cells are located?

a) paracortex.


1371
Patient walks in and stares at you while having a seizure. You find out he has AIDS and a temporal lobe lesion. You can see on film multinucleated giant cells with intranuclear inclusions, and vesicles on his skin. Is this LIKELY from:
a, Coxsackie virus
b, Parvovirus
c, Listeria
d, Herpes
? Don't peek without guessing first!!!!!!!!!!!!!!!!!!!!!!!!!!!!

a) HERPES!!! Note the skin lesions, GIANT multinucleated cells and encephalitis.



1372
Hey, Sir Lord Goljan is aware of many of these posts and likes them. I am not sure if he will personally remember me though even though I too am trying to go into the mind of the NBME after jumping over Step 1. But I DID talk to oceans of post Step 1ers. I agree with them. This is the HARDEST test ever created by mankind. So do NOT feel bad if you fail over and over. It is the TEST that is hard (and unfair), it is NOT that you are stupid.
Point is, don't EVER give up. Even if you have to take the test 20 times. As long as you can provide for your family and be healthy and you prayed to God that He wants you to be a doctor, you should NOT go off and be a dentist because you won't like it and you may be one of the many suicides. But, if you are like 55 years old or over, you may pray that God Tells you to stop. After 60, it will be hard to go through residency.
However...if you pray and God Tells you, "Enough", and He Wants you to be a physical therapist or school teacher or administrator or a lawyer, then LISTEN and then stop trying to tackle Boards. The issues of the universe are MUCH bigger than all of the failures you face...
Just keep smiling. Life is an illusion...but God is not an illusion.
OK, let me stop babbling. A 60 yr old woman comes to you with left hip and thigh pain. The course started 6 months ago and gets WORSE when she stands OR walks. The labs show HIGH alk-phosphatase, HIGH urine hydroxPROLINE. X-*** shows osteolytic breaks and lots of osteoblasts!
What is this? Is it
a) multiple myeloma
b) paget's disease
c) osteoporosis
d) hypoparathyroidism OR
e) Paget's disease
Guess first!!!

a) This is PAGET's dx.or osteitis deformans. Classic presentation...osteolytic lesions and high urine hydroxyproline and alk phos and high osteoid. HINT is always an enlargement of the head!!!!!!!!


1373
REMEMBER, the boards are always SO tricky. You may think you know the enzyme, but the name is slightly different, like an alpha- instead of a Beta-. That totally throws you off. You HAVE TO BE CAREFUL AND READ EVERY SINGLE ANSWER CHOICE.
OK, Your patient is a swinging single who DOES NOT use a condom. But he comes to clinic feeling weak, with a fever and sore throat. His PE has swollen lymph nodes and a positive Monospot test. You guess this is infectious mononucleosis before you punch him for being such a jerk, and womanizer. Will he likely have an enlarged stomach or spleen?

a) spleen (OK OK, don't hit him)


1374
A female patient presents with a positive pregnancy test. Which of the two events should happen properly?
1) Corpus luteum MUST make progesterone for the endometrium
2) The placenta MUST make FSH to maintain ovary function.

a)....1...The Corpus luteum, then....the placenta must make PROGESTERONE for a healthy baby.


1375
The deficiency of what vitamin typically produces osteomalacia in adults?

a) Vit D!


1376
A pediatric teen comes to you with CERVICAL LYMPHADENOPATHY, FEVER, PHARYNGITIS. You think she has been having sex with a lot of boys and she got mononucleosis. The fastest test for diagnosis is....?
1) IgM to core antigen
2) IgG to core antigen
3) C reactive protein levels

a) If you get an ACUTE case of EBV virus in mono, IgM antibodies should appear quickly.


1377
You see an older female with long term CHF (congestive heart failure)...(wait, did I ask this question before?). She's eating digoxin and a sulfa drug diuretic. Her heart is beating way too fast, and she has edema on her ankles. How will you treat?

a) Give her an ACE inhibitor. They dilate arterioles AND veins. This reduces preload and slows aldosterone production. This reduces overall blood volume. You can also add a B-Blocker!


1378
Patient is a animal lover and a veterinarian coming to YOU with the flu (I rhymed), and fever too. She also has malaise (tired), and headache. Labs show elevated white count and thrombocytopenia. Which one is the cause?
1) Chlamydia psittaci
2) Coxiella burnetii

a) Coxiella burnetii, or Q Fever.


1379
A patient comes in named Mr. Gladiator who says he can't move his right eye to the right. Also, you note that the right side of his face has no expression. IMAGINE that you are looking at a USMLE brain stem slide....
1) Where is the lesion, and point to it....
Dorsal pons?
2) Medial midbrain?

a) it is the dorsal pons! The lateral rectus muscle is gone and the lesion hits the facial nerve just around the motor nucleus of CN VI. So both of these cranial nerves are lesioned.


1380
A peds patient of yours named Dennis DeYoung is being evaluated for developmental delay. The boy has big everted ears and a long face and big testes and mandible. Is this dx ...?
1) Turner's
2) Klinefelter's
3) Fragile X