Comlex Level 1 Exam Solutions 2024

cysteine stone - ANS - *Hexagonal* stones - *Ground, glass appearance* - *(+) urinary cyanide nitroprusside test - Defect in renal transport of COLA: Cysteine, Ornithine, Lysine, Arginine - Does NOT respond to shock wave therapy angiodysplasia - ANS most common cause of lower GI bleeding in pt's >60 superior mesenteric artery - ANS supplies the lower portion of the duodenum, jejunum, ileum, cecum, ascending colon, and transverse colon to the splenic flexure pancreatic cancer - ANS -usually arises in the *head* of the pancreas -is associated with *jaundice and pain* due to obstruction of the common bile duct - it is the *4th* most common cause of cancer -has a very poor prognosis 1. Calcium channel blockers--> specifically smooth muscle antagonists--> SM dilation 2. Alpha adrenergic receptor blockers --> cause dilation of vessels instead of constriction 3. Beta 2 agonists: causes dilation of smooth muscle vessels - ANS Patients with GERD normally have a dysfunction with LES sphincter tone that allows acid to reflux into the esophagus, thus drugs that affect sphincter tone would make GERD worse. What are the name of three drug categories that do this? celiac disease - ANS malabsorption syndrome caused by an immune reaction to gliadian protein in gluten -Tissue transglutaminase -results in villous atrophy of small intestine mucosa and causes steatorrhea, diarrhea, bloating and abdominal pain -*also associated with other autoimmune disorders like hashimotos thyroiditis* make NPO, Place on an NG tube and suction obstruction out--> this will usually resolve obstruction - ANS after a patient comes to the ER with sudden onset of pain and abdominal distention W/O peritoneal signs and after x-ray you diagnose her with a small bowel obstruction. What do you do next? Low total calcium due to low albumin levels from cirrhosis (95% of Ca2+ is bound to albumin) and normal ionized Ca2+ because PTH regulates free ionized Ca2+ independently--> that is why there are no signs go hypocalcemia - ANS In a patient with liver cirrhosis what calcium levels would you expect to see? Would there be signs of hypocalcemia--> tetany, paresthesias, abdominal cramps? T5-T11 - ANS where would you find a viserosomatic reflex resulting in placatory changes of the pancreas? Deferoxamine (Desferal) - ANS iron chelating agent used in the treatment of iron intoxication short leg syndrome - ANS when a patient presents with a flexible scoliotic curve it is important to evaluate for... inferior trunk--> encompasses broadmann areas 22,39,40 which are in the temporal region - ANS Infarct to what trunk of the Left MCA results in Wernicke's aphasia? Superior division--> encompasses brooks area, frontal eye field, primary motor cortex and primary somatosensory cortex - ANS Infarct to what trunk of the Left MCA results in Broca's aphasia? Osteosarcoma - ANS bone tumor that is present in young adult males that involves the metaphysis of the long bones Ewing's sarcoma t(11;22) - ANS bone tumor that is present in young adult males that involves the *diaphysis(mid-shaft)* of the long bones. fibrosarcoma - ANS malignant fibroblasts within a collagenous matrix chondrosarcoma - ANS osseous sarcomas that affect older patients and has a predilection for flat bones in the *shoulders and pelvis* tyrosine, due to a defect in phenylalanine hydroxylase - ANS PKU presents as failure to thrive, mental retardation, gapped teeth, etc. What is the amino acid that needs to be supplemented due to a defect in what enzyme? Rib 2 - ANS where does the posterior scalene attach to? Paclitaxel - ANS used in the treatment of breast and ovarian cancer MOA: hyper stabilization of polymerized microtubules--> prevents the breakdown of the mitotic spindle restrictive barrier - ANS maximum distance a patient can actually move a joint, can be pathologic narcissistic personality disorder - ANS patterns of grandiosity, need for admiration, lack of empathy for others A carotid massage causes an increase in stretch of the carotid baroreceptors which causes a reflexive PARASYM response which slows down the conduction velocity through the AV node this slowing down Heart Rate--> used in paroxysmal supra ventricular tachycardia - ANS what does a carotid massage do and how does it affect the AV node? Chronic myelogenous leukemia t(9;22)--> Philly chx - ANS a form of leukemia characterized by the accumulation of abnormal, mature granulocytes (granulocytes are a type of white blood cell), mild anemia, thrombocytosis and basophilia. What is the associated chromosomal translocation? Burkitt's lymphoma t(8;14) - ANS germinal B celll lymphoma that is associated with a translocation between c-MYC and the Ig heavy chain on which two chromosomes? It is endemic in the continent of Africa which produces this follicular lymphoma t(14;18) - ANS second most common lymphoma in the US, arises from germinal center B-cells. Presents with painless peripheral lymphadenopathy w/ a history of lymph node enlargement . Positive for CD 10, CD 19 and CD 20 expression. Results in what chromosomal translocation evolving the BCL-2 gene? Acute promyelocytic leukemia t(15;17) - ANS PML/RARA fusion gene associated with DIC, characteristic folded, bilobed nuclei are found in these certain type of cells. Coarse azurorophilic granules and multiple Auer rods are also present on histo Clopidogrel - ANS inhibits platelet aggregation by irreversibly blocking the P2Y12 component of ADP receptors Bacillus anthracis, tendonopathy - ANS textile industry worker that develops a low-grade fever, non-productive cough and substernal chest pain have what bug? Treatment is with a fluroquinolone and why are frequently associated with what ADR? G-6-PD deficiency - ANS X-linked recessive disorder present in AAs and Mediterraneans that cause an inability to generate reduced glutathione and lead to acute hemolysis when stress occurs. You will see bite cells and Heinz bodies on peripheral blood smear. Itranuclear opthalmoplegia - ANS seen in those with MS, causes impaired horizontal eye movement w/ weak adduction of the affected eye and abduction nystagmus of the contralateral eye. Due to a lesion in the MLF in the dorsomedial brainstem tegmentum of wither the pons or the midbrain lead poisoning - ANS causes lethargy, seizures, or coma--> can also develop distal motor neuropathies. -leads to denaturation of the enzyme ribonuclease which causes ribosomes to persist in the the RBCs and lead to basophilic stippling myofasical release, BLT, FPR, counterstain - ANS what are indirect OMM techniques? Articulatory technique - ANS OMM technique classified as low velocity, moderate to high amplitude pericarditis - ANS EKG presents with PR depression, ST segment elevation and PR elevation in lead II. They also have sharp, midsternal, non-radiating chest pain and mild lethargy. What do they have? Bottom rib in ISD/ Top rib in ESD - ANS BITE mnemonic is used for rib dysfunction treatments, what is it? pectoralis minor muscle - ANS what muscle connects to ribs 3-5? rib dysfunctions are named by where they are stuck while rib restrictions are named by which motion they do not experience! - ANS how are rib dysfunctions named and how do they differ from rib restrictions? decreases due to decreased transport - ANS In Wilson's disease there is a decrease in copper exportation which results in low biliary copper, what happens to the transport protein ceruloplasmin? Digoxin - ANS positive inotrope for a failing heart inhibits Na/K Atpase pumps and causes an increase in intracellular Ca2+ while also causing parasympathetic effects ADR: has a narrow therapeutic window and can cause GI distress, visual disturbances, AV Block and bradycardia Mercury poisoning - ANS Patient went on a seafood binge for a few days at a shady restaurant and present to the hospital with neurotoxicity and acute renal injury which presents as tremors or oliguria and elevated creatinine methanol poisoning - ANS * Symptoms: *Severe metabolic acidosis, retinal damage (blindness).* Lab Values: ** Pathophysiology: *Toxicity via formic acid. Severe acidosis, retinal damage.* Treatment: *Ethanol, dialysis, fomepizole. pilocarpine - ANS muscarinic agonist Use: contracts ciliary muscle to help increase the outflow of aqueous humor at the canal of schlem--> Used to treat glaucoma SIde note: Beta blockers are used to decrease production of aqueous humor to decrease intra-ocular pressure rationalization - ANS defense mechanism that offers rational explanations in an attempt to justify attitudes, beliefs, or behaviors that may otherwise be unacceptable factitious disorder - ANS Condition in which a person acts as if he or she has a physical or mental illness when he or she is not really sick Caveat: the symptoms don't interfere with daily life--> if it does and the symptoms are very severe it is somatic symptom disorder Subacute sclerosing panencephalitis - ANS serious complication of the measles virus that usually develops 6-10 years after infection anterior talofibular ligament (lateral ligament) - ANS Inversion sprain, "Low ankle sprain", most common -pain with inversion of foot and dorsiflexion Gemfibrozil - ANS MOA: enhances LPL and hydrolyzes fatty acid from VLDL -enhances uptake of fatty acids and increases conversion into Triglycerides which leads to less triglycerides in the serum Ebola virus - ANS filovirus -enveloped nonsegmented negative sense RNA genome -one of the most virulent pathogen of humans, endemic to West Africa -infections culminate into multiple organ failure dysfunction syndrome and shock due to production of high levels of inflammatory cytokines in response to infection Amytriptyline - ANS post herpetic neuralgia treatment bactericides fragility and fusobacterium species - ANS gram negative rods grown on aerobic media that can cause infectious sinusitis Tx: clindamycin acute chest syndrome - ANS complication of sickle cell disease characterized by a syndrome of fever, chest pain, hypoxemia, wheezing, cough and respiratory distress in the setting of new pulmonary infiltrate Tetralogy of Fallot - ANS PROVe -pulmonary stenosis (crescendo-decrescendo murmur) -Right Ventricular Hypertrophy -Overriding Aorta -VSD *most common cyanotic congenital heart disease in children* -can be seen in kids w/ DiGeorges syndrome -CXR: boot-shaped heart parathyroid-like hormone - ANS causes elevations in calcium levels with a decrease in PTH levels due to negative feedback -can be secreted by squamous cell carcinomas posterior fibular head - ANS fibular head moves posteriorly with ease while anterior lateral malleolus is restricted in posterior springing or gliding ease in plantar flexion and inversion restriction in dorsiflexion and inversion anterior fibular head - ANS fibular head moves anteriorly with ease while anterior lateral malleolus is restricted in anterior springing or gliding ease in dorsiflexion and eversion restriction in plantar flexion and inversion olecranon bursitis - ANS can be acute or chronic presents as focal, painless swelling that is tender to pressure rotational side of the transverse process of the dysfunctional vertebrae involved - ANS In short lever HVLA, you set the patient up to their barrier and place your thenar eminence on what side? Moves into external rotation, treated as a paired bone - ANS during the flexion phase of cranial motion, the SBS moves cephalad, causing the midline bones (sphenoid, occiput, ethmoid, vomer) to move into flexion while the paired bones (temporal, parietal, maxillae, zygoma) move into external rotation. How does the frontal bone move? metopic suture (frontal suture) - ANS what suture allows for frontal bone motion as a paired bone? Deltoid ligament of ankle (medial ligament) - ANS eversion injuries are typically caused by damage to which ligament? It results in pain with plantar flexion and eversion of the ankle William syndrome - ANS micro deletion on chromosome 7 (elastin gene) presents with Elfin like face, mental developmental delays with well developed verbal skills (Will Ferrel from Elf) Labs: high Ca2+ due to inc sensitivity to vitamin D Pancoast tumor/ Superior sulcus tumor - ANS Horner's syndrome along with weakness or pain in the upper extremity is describing what type of lung cancer? common bile duct, hepatic artery and the portal vein (the portal triad) - ANS what travels through the hepatoduodenal ligament? broad waxy casts - ANS found on urinalysis and pathogenic for chronic renal failure autosomal recessive - ANS what is the inheritance of leukocyte adhesion deficiency? Berger's disease (IgA nephropathy) - ANS most common cause of acute glomerulonephritis in the US Px: painless visible or microscopic hematuria, swelling in the peri-orbital region and lower extremities and HTN following an URI immediately after Finasteride - ANS flutamide is a non steroidal competitive inhibitor for the binding of DHT to testosterone and is used for metastatic prostate cancer while ______ is a 5 alpha reductase inhibitor that decreases the conversion of DHT to testosterone and is used mainly for BPH Pericardial tamponade - ANS patient with severe hypotension, JVD, and distant heart sounds has Beck's triad which is a sign for what pathology? - Due to free wall rupture, papillary muscle rupture 3-14 days after an MI (macrophage cleaning up debris makes myocardium vulnerable) M protein of S. pyogenies activating B and T cells to cause immune mediated damage to the valves - ANS In rheumatic heart disease, due to infection with strep pyogenes, what is the immunologic activity that leads to the mitral valve and subsequent mitral regurgitation (holosystolic murmur that radiates to the axilla)? First degree AV block - ANS prolonged PR interval but no dropped beat, asymptomatic Wenkebach/ Mobitz Type I (2nd deg heart block) - ANS Progressive, prolongation of the PR interval followed by a dropped beat -"Longer, Longer, Longer Drop, Whats my name ______" Mobitz Type II - ANS - Dropped beats that are not preceded by a change in the length of the PR interval - Often found as a 2:1 block, where there are 2 or more P waves to 1 QRS complex. - Treatment: pacemaker Third degree AV block - ANS -No p waves produce QRS waves -complete dissociation of the atria and the ventricles Left Bundle Branch Block - ANS wide QRS complex with R and R' waves, found mainly in V6 (bunny ears) Right bundle branch block (RBBB) - ANS Right ventricular depolarization is delayed Criteria: - Wide QRS - RSR' in V1, V2 ("bunny ears") with ST depression and T wave inversion - Late S waves in I, aVL, V5, V6 (reciprocal changes) aortic regurgitation - ANS Heart sound: high pitched diastolic decrescendo murmur heard at left sternal border Px: angina, head bobbing, quinicke sign therapeutic pulse - ANS felt during counterstain -it is intune with the patients Heart rate Granulomatosis with polyangiitis (WeCener) - ANS Involves the nasopharynx, the lungs and the kidneys -small vessel vasculitis that presents with sinusitis, hemoptysis and glomerulonephritis (hematuria) -associated with C-ANCA mutation in the voltage activated K+ channel (Romano Ward or Jervell and Lange Nielson--> deafness) - ANS -patient presents with seizures, palpitations and syncope -Hx: congenital deafness -ECG shows prolonged Qt interval -What is this patient most likely suffering from? PTU (propylthiouracil) - ANS Used for treatment of hyperthyroidism in pregnant patients MOA: inhibits iodine organification and coupling in the thyroid gland as well as blocks peripheral conversion of T4 to T3 Methimazole - ANS used for treatment of hyperthyroidism MOA: inhibition of iodine organification and coupling in the thyroid glans ADR: teratogenic, hepatotoxicity, agranulocytosis sinusitis - ANS medial clavicle and superior border of rib 2 Chapmans point correlates with retina and conjunctiva - ANS head of humerus chapman point correlates with lateral femoral cutaneous nerve - ANS nerve that is compressed in neuralgia parasthetica FSART - ANS classic AL2, AL3, AL4 tender point set up FSTRA - ANS Al-1 counterstain tender point set up FSARA - ANS AL5 counterstain setup F with some side bending/rotation - ANS AT2 counterstain tender point (manubrium) set up sinus tarsi - ANS lateral ankle tender point above the proximal third of the clavicle - ANS chapman point for otitis media Lassa fever - ANS viral hemorrhagic fever named for their endemic fever Px: low fever, malaise, headache, pharyngitis, cough, nausea, vomiting, etc member of Arenaviridae Looks like grains of sand--> Has 2 segments (L and S) of circular, single-stranded RNA accidental injury - ANS most common cause of death in patients between the ages of 1-44 are congenital anomaly - ANS most common causes of death in children less Than 1 years old heart disease - ANS leading cause of death in persons aged 65 years and older neoplasm - ANS for individuals aged 45 to 64 years old, the leading cause of death is right leg flexed at the hip and knee and internally rotated at the hip - ANS right inferior pubic shear treatment set up 1. Flex or extend knee? 2. Internally or externally rotate hip? Type II hypersensitivity - ANS what type of hypersensitivity is graves disease? Idiopathic Intracranial Hypertension (pseudotumor cerebri) - ANS presents with symptoms such as headache, papilledema and visual loss affects overweight women in their third decade of life Its have diplopia and abducens nerve palsy (weak lateral rectus)--> presents with medial strabismus (adduction at rest) Beta Blockers - ANS these drugs are used for *rate* control of supra ventricular tachyarrhythmias and leads to masking of a hypoglycemic state in those with DM type II Amiodarone - ANS class III antiarrythmic, potassium blocking agent used to treat ventricular tachycardia atrial fibrillation - ANS absent a wave on JVP is indicative of Gardner syndrome - ANS autosomal dominant, numerous adenomatous polyps along with osteomas and soft tissue tumors, dental abnormalities and hypertrophy of the retinal epithelium p230 Peutz-Jeghers syndrome - ANS autosomal dominant disorder characterized by the development of benign harmatorous polyps in the GI tract as well as hyper pigmented macule on the lips and oral mucosa Turcot syndrome - ANS FAP that presents with CNS malignancies such as medulloblastoma or malignant glioma Cowden syndrome - ANS presence of hamartomatous polyps in the GI tract associated with the *PTEN gene*; increased risk of breast/ovarian cancer in females Rotor syndrome - ANS congenital hyperbilirubinemia (conjugated), similar to Dubin-Johnson, but no discoloration of the liver Px: non-puritic jaundice with elevated coprporphyrin I in urine Primary sclerosing cholangitis - ANS affects both intrahepatic and extra hepatic bile ducts -Fibrosis of extrahepatic ducts leads to classic beading -fibrosis of intrahepatic ducts leads to dying of cells and leakage of bile into the blood--> puritis, elevated conjugated bilirubin, and inc ALP and GGT -Histo shows onion skinning Schilling's test - ANS used to diagnose VitB12 def (pernicious anemia) 1. oral B12 w/ IF 2. IM B12 3. should result in normal excretion of cyanocobalamin Ascending cholangitis - ANS presents with Charcot's triad: fever, jaundice, RUQ pain -due to a bacterial infection of the biliary tree--> caused by a stone in the common bile duct Primary Biliary cholangitis - ANS autoimmune disease classically presents in middle-aged women Sx: puritis, jaundice, dark urine, light stools, hepatosplenomegaly Pts typically present with concurrent autoimmune diseases such as CREST syndrome Secondary biliary cirrhosis - ANS long standing biliary obstruction from various causes( cystic fibrosis, carcinoma of head of pancreas, etc) that lead to liver disease that may progress to cirrhosis -results in increased pressure in the intrahepatic bile ducts that leads to stasis and fibrosis quadrangular space - ANS houses the axillary nerve and posterior circumflex humeral artery Triangular space - ANS houses the circumflex scapular artery triangular interval - ANS houses the radial nerve and profunda brachii artery Dupuytren's contracture - ANS fibromatosis of palmar fascia leading to the inability to extend the the fourth and fifth digits Lisker's sign - ANS deep venous thrombosis - tenderness on percussion of antero-medial tibia Homan sign (DVT) - ANS patient experiences calf pain with dorsiflexion of the foot adductor pollicus (thumb) - ANS what is the only muscle of the thenar eminence that is innervated by the ulnar nerve? abduction/adduction - ANS the ulnar nerve roots (C8-T1) are responsible for what action of the fingers? musculocutaneous nerve (C5-C7) - ANS weakness in elbow flexion and *decreased sensation of lateral forearm* occurs in what nerve compression? dorsal scapular artery - ANS this artery divides around the levator scapula muscle and descends along the medial aspect of the scapula C3-C5 - ANS what nerve roots is the "nerve to levator scapula derived from"? anterior interosseous nerve (branch of median nerve) - ANS inability to make the A-OK sign due to trauma to the mid shaft/ distal forearm is caused by a defect of which nerve? LOAF lumbricals 1 and 2, Opponens pollicis, aBductor pollicis brevis, flexor pollicis brevis - ANS What are the muscles innervated by the median nerve in the hand? dorsiflexion of foot - ANS with this motion, the tibia and fibula externally rotate while the talus glides posteriorly ACL tender point - ANS located on the superior aspect of the popliteal fossa, either medial or lateral to the hamstrings myofascial release - ANS passive technique that is either direct or indirect, can be used for plantar fasciitis pain on the spinous process of the segment above - ANS the midline tender points of the posterior cervical counterstain points are located... glides posteriorly - ANS as the lateral malleolus moves anterior and the foot inverts and plantar flexes, what happens to the Proximal fibula head? glides anteriorly - ANS the foot everts and dorsiflexes (supination), what happens to the proximal fibula? inominate inflares - ANS associated with a medially displaced ASIS and ipsilateral anterior inominate rotations inominate out flares - ANS associated with a laterally displaced ASIS and ipsilateral posterior nominate rotations Type 1 - ANS forward sacral torsions have L5 dysfunctions that are what type of freyette rule? Type 2 - ANS backward sacral torsions have L5 dysfunctions that are what type of freyette rule? 1. When L5 is sidebent, a sacral oblique axis is engaged on the SAME side as the side bending 2. When L5 is rotated, the sacrum rotates the opposite way on the oblique axis 3. the seated flexion test is found on the opposite side of the oblique axis - ANS what are the rules of L5 on the sacrum? a plane is the direction in which the motion is occurring while the axis is the fixed structure around which the plane of motion occurs - ANS what is the difference between a plane and an axis in regards to motion? cranium, foramen magnum, C2(axis), C3, and S2 - ANS what are the attachments of the dura that allows for craniosacral motion slightly flexed, adducted and pronated - ANS how will a patient with a radial head subluxation hold their arm? Sulfonylureas (Glyburide) - ANS what class of diabetic drugs are most likely to cause hypocglycemia? Px: tachycardia, diaphoresis, inc appetite, dizziness and tremor Crohn's disease and 10th intercostal space on the right (ileum) - ANS patient presents with diffuse crampy pain and weight loss as well as erythematous raised nodules on his shins. What does he have and where is the Chapmans point? Type A - ANS what blood type is associated with gastric adenocarcinoma? Type O - ANS what blood type is associated with peptic ulcer disease FSARA - ANS what is the treatment setup for posterior rib tenderpoints? FSTRT - ANS what is the treatment setup for anterior rib tender points? ESARA - ANS how are posterior lateral tender points on the transverse processes T1-T12 treated? Hawkin's Kennedy Test - ANS compression of the supraspinatus tendon against the coracoacromial ligament to assess the possibility of impingement of the subacromial bursa 1. sacral base unleveling 2. lumbar side bending away from the lesion 3. anterior innominate dysfunctions (ASIS inferior and PSIS superior) - ANS what are the structural findings in short leg syndrome anterior talus (posterior tibia on talus) - ANS decreased dorsiflexion and tenderness and tenderness over the anterior ankle is indicative of what somatic dysfunction heart and lungs respectively( T6 and T7 encompass the lower portion of the lungs) - ANS T1-T5 describes what sympathetic level while T2-T7 describes what other sympathetic level? Iliacus tenderpoint - ANS 1/3 distance of ASIS to midline iliopsoas tenderpoint - ANS 2.3 distance of ASIS to midline inguinal tenderpoint - ANS Flexion of hips with contralateral thigh crossed over ipsilateral thigh. Causes flexion, adduction, internal rotation posterior rib 1 tenderpoint - ANS tender point on the rib set up as extension, side bend away, rotate towards on PC1 inion - ANS tender point located inferior to the nuchal line and lateral to the inion with counterstain setup as FSTRA is describing which tender point? Being that blood flows from the LV into the LA during MR at much lower pressures causes a decreased afterload - ANS what happens to after load in mitral regurgitation? spinal accessory nerve - ANS what encompasses the posterior triangle of the neck? Posterior inferior cerebellar artery (PICA) - ANS presents with ipsilateral facial analgesia and contralateral body analgesia as well as dysarthria, dysphagia and ataxia AKA lateral medullary syndrome Anterior inferior cerebellar artery (AICA) - ANS presents with ipsilateral facial analgesia and contralateral body analgesia as well as *ipsilateral facial hemiparesis and ipsilateral deafness* Chylothorax pleural effusion - ANS leakage of lymphatic fluid from the thoracic duct that contains *increased triglycerides* on fluid analysis and is milky white in appearance. This is most commonly due to lymphoma or trauma caused by thoracic surgery MEN1=pituitary adenoma, parathyroid hyperplasia and pancreatic tumor - ANS patient with stomach pain not relieved by a H2 blocker, recurrent kidney stones, bitemporal hemianopsia, high PTH and high Ca2+ levels should clue you into what kind of syndrome? MEN 2A - ANS Parathyroid hyperplasia, medullary thyroid carcinoma, pheochromocytoma MEN 2B (autosomal dominant RET mutation) - ANS Medullary thyroid carcinoma, pheochromocytoma, mucosal neuromas and marafanoid habitus knee flexion, hip extension short head: common fibular of sciatic long head: tibial nerve of sciatic - ANS action of biceps femoris and nerve that innervates both heads knee extension - ANS action of the quadriceps muscles Actinic Keratosis (AK) - ANS premalignant lesion that has a slow-developing thickening and scaling due to chronic sun exposure, common breeding ground for invasive squamous cell carcinoma Hydroxychloroquine - ANS DMARD that causes retinal deposits ant tinnitus Locus Ceruleus (LC) of the pons - ANS noritryptilline is a TCA that preferentially inhibits norepinephrine reuptake, where in norepinephrine secreted from? edema toxin - ANS produced by bacillus anthracis via adenylate cyclase that increases cAMP levels by catalyzing the reaction of ATP to cAMP pneumothorax will always have absent lung markings and you can trace the pleural line of the collapsed lung - ANS how do you differentiate between a pneumothorax and lung cancer on CXR? Rhabdomyolysis - ANS what is the number one side effect of statin therapy that can cause ATN? Methhemoglobinemia - ANS a deficiency in cytochrome b5 protein that results in the inability to deliver O2 to tissues do to the change of Fe2+ into the Fe3+ form. Sx: hypoxia, cyanotic in face, nails, lips and blood has a muddy brown appearance Conversion Disorder (Functional Neurological Symptom Disorder) - ANS psychological disorder that presents with a motor or sensory dysfunction (blindness, paralysis, seizure, etc) that is incompatible with any known medical diagnosis. Neurologic symptoms are often transient and may manifest with different neurologic symptoms over time. the V/Q ratio increases due to a decrease in perfusion - ANS what happens to the V/Q ratio with a PE? Because of decreased vascular resistance in skeletal muscles, the SBP increases - ANS why is there a fall in DBP during exercise? rate control with CCB or Beta Blockers, if that fails then use antiarrythmics and if the patient becomes unstable, direct cardio version - ANS What is the first thing to do in a STABLE patient with atrial flutter? Black widow spider and alpha latrotoxin - ANS mom was outback gardening and got bit by a bug. It hurt initially and then lead to a swollen finger along with muscle twitching and Gi symptoms. What bug bit her and what was the exotoxin associated? 3-8 weeks (first trimester) - ANS during embryogenesis, teratogens such as retinoid acid have their greatest effect. At how many weeks quantifies embryogenesis Klebsiella granulomatis( gram negative bacillus) aka granuloma inguinale - ANS patient presents with ulcerated lesions on genitalia. -they are friable with an erythematous base -ulcer exudate reveals macrophages containing bodies highlighted by bipolar stain What is this patient infected with? H. ducreyi - ANS manifests as a painful lesion with lymphadenopathy and on light microscopy forms clumps and long parallel strands producing a school of fish appearance above, so C6 nerve root exits between C5 and C6, below - ANS cervical nerve roots exit one level _____ their vertebrae, except for C8 which exits ______ vertebrae and between T1 schedule regular medical evaluations - ANS how should a person with illness anxiety disorder be treated? exogenous hyperthyroidism - ANS young patient presents with signs of hyperthyroidism but there is no enlargement of the thyroid gland, he is worried about maintaining his weight and his mother also has a thyroid condition. What does this patient have? Francisella tularensis and ulcer with swollen regional glands - ANS patient presents with fever, malaise and myalgia after a hunting trip. He consumed rabbit and deer meat and was bitten by ticks. He has anorexia, nausea, vomiting and abdominal pain. He has a high fever but *normal* heart rate. There are elevations in WBC count, AST and ALT and buffered charcoal yeast extract agar identify a *gram negative pleomorphic rod*. What was this patient infected with? and what would be seen? pre-synaptic membrane (Ca2+ channels) - ANS morning weakness of proximal muscles of legs and arm and difficulty elevating arms. Weakness can be overcome with repeated attempts at activity. X-ray reveals mass in the left lung. Patient has LEMS which are antibodies against.... 1. routine admin at 28 weeks gestation 2. immediately following invasive procedures (amniocentesis or chorionic villus sampling) 3. elective abortion or spontaneous miscarriage 4. ectopic pregnancy 5. threatened abortion at 12 weeks gestation 6. within 72 hours after delivery of Rh positive fetus - ANS what are the indications for RhoGAM admin? (6) Subacute Granulomatous (De Quervain) Thyroiditis - ANS patient with a recent flu-like illness develops weight loss, diarrhea, chest pain, fever and chills. Patient also has tachycardia and a painful enlarged thyroid. What does this patient have? Reidel thyroiditis - ANS thyroid gland is replaced with fibrous tissue patient presents with a fixed, firm, *painless* goiter *results in hypothyroidism* a maneuver that increases after load would dec the intensity of AS because there would be a reduction in the pressure gradient from the LV to the aorta resulting in less ejection through the stenotic aortic valve (sustained handgrip, valsalva, holding breath on inhalation) maneuvers that increase preload or dec after load will cause an increase in the intensity because it increases the preexisting pressure gradient - ANS what maneuver would decrease the intensity of AS, what maneuver would increase it? Theophylline - ANS used in COPD patients MOA: increases catecholamines and blocks adenosine (reduce histamine release and indirectly reverse bronchospasm) -high levels inhibit phosphodiesterase which results in elevation of cAMP and consequent adrenergic stimulation and bronchodilaton ADHD (Attention-Deficit Hyperactivity Disorder) - ANS Absence seizures are frequently misdiagnosed as liquefactive necrosis - ANS commonly results from ischemic injury to nerve and glial cells in brain; injured cells release hydrolases that digests brain tissue; tissue becomes soft, liquefies, and segregates, forming cysts. May be caused by staph, strep, or E. coli infections. luminal obstruction leading to inflammation - ANS what causes appendicitis? histoplasmosis capsulatum - ANS dimorphic fungus that presents with hilar and mediastinal adenopathy and is found in the Ohio and Mississippi River valleys Pott's disease due to TB - ANS Patient with recent travel to Mexico present with B symptoms and this. What does this patient have? TCAs--> binds to alpha 1 adrenergic receptors - ANS Doxepin is what class of anti-depressant? patient's hip and knee are flexed while the foot and distal leg externally rotated. During the thrust, a downward force is then applied to the distal fibula while the fibular head is simultaneously brought anterior with the physician's index finger - ANS what is the treatment for HVLA for a posterior fibular head? dopamine, think about the numerous D2 Rc blockers - ANS what neurotransmitter is increased in schizophrenia? H2 Rc blockers - ANS Ranitidine, cimetidine, nizatidine, and famotidine are __________ blockers that decrease gastric acid secretion H1 receptor antagonists - ANS loratadine and diphenhydramine are collecting tubule - ANS spironolactone is an aldosterone receptor blocker that acts on the ______? ADR:displaces androgen from the androgen receptor and sexual-hormone-binding globulin and causes increased metabolic clearance of testosterone and higher estradiol production. collecting duct - ANS "Vaptins", Vasopressin 2 receptor blockers acts on the ______? ADR: inhibits the aquaporins thus results in water excretion intraluminally, can result in polyuria, thirst and dehydration Nitroglycerin - ANS activates myosin light chain phosphatase to cause peripheral venous and arterial dilation -increases coronary blood flow and oxygenation through vasodilation of the vascular smooth muscle and peripheral veins and arteries cabergoline, bromocriptine - ANS D2 receptor agonists, treat acromegaly, inhibit secretion of GH from pituitary, also inhibit prolactin release 2-4 hrs post MI - ANS neutrophil migration and extensive coagulative necrosis occurs at ________ after an MI 5-10 days post MI - ANS soft yellow/brown granulation tissue due to macrophage degradation and the necrotic tissue is susceptible to free wall papillary rupture, tamponade, and septum rupture occurs at.... ticeracillin - ANS extended spectrum penicillins like ______ are susceptible to degradation by the enzyme penicillinase Mucinous cystadenocarcinoma - ANS malignant ovarian tumors of epithelial origin that secrete mucous material Pacitaxel - ANS prevents depolymerization of cellular microtubules, which results in DNA, RNA, and protein synthesis inhibition. Malaria - ANS hemoglobin-hungry merozoites is another way to say.... Alpha feoprotein - ANS tumor marker for hepatocellular carcinoma Alkaline phosphatase - ANS tumor marker for cancer that mets to the bone, obstructive biliary disease, and Paget's disease of the bone externally rotate the right arm - ANS neuropraxia of the upper trunk of the brachial plexus is referring to nerve roots C5-C6, patient presents with Erb duchene palsy and the inability to.... tuberous sclerosis - ANS autosomal dominant, ashleaf spots, HAMARTOMAS (hemangiomas, adenoma, mitral regurge, ashleaf spots, cardiac rhabdomioma, tuberous sclorsos, autosomal dominant, mental retardation, *renal angiomyolipomas*, seizures) von Hippel-Lindau disease - ANS Autosomal Dominant characterized by hemangiomas in the skin and other organs and can be associated with bilateral renal cell carcinoma or hemangioblastoma in the retina. medial epicondylitis, golfer's elbow - ANS medial elbow pain that affects the flexor mechanism of the patient's wrist Wilms tumor (nephroblastoma) - ANS a malignant kidney tumor due to deletion of the Wt-1 gene on chromosome 11 presents as an abdominal mass or swelling and rarely crosses the midline activation of RAAS (elevated angiotensin II levels) - ANS 21- hydroxylase deficiency leads to the lack of mineralocorticoids and hypotension which leads to.... lateral to the costal cartilage between ribs 7 and 8 on the right - ANS chapman's point for the pancreas sternoclavicular notch - ANS anterior T1 tenderpoint sternum at the angle of Louis - ANS anterior T2 tenderpoint inc in capillary hydrostatic pressure - ANS IN CHF, the major cause of transudative pleural effusion is... Doxycyline and Aminoglycosides - ANS binds to the 30 subunit and prevents aminoacyl tRNA attachment and thus preventing elongation Azithromycin - ANS binds to the 50 S subunit and blocks dissociation of peptidyl tRNA from ribosomes Fluroquinolones - ANS used for outpatient treatment of UTI and inhibits DNA topoisomerase and cause QT prolongation and torsades de pointes -Atropine & pralidoxime - ANS used for cholinesterase inhibitor poisoning i.e jimsyn weed overdose Physiostigmine - ANS AChE inhibitor: Tertiary Amine (enters CNS) Rx:Glaucoma; antidote to an *atropine overdose* Action: Increases endogenous ACh Hunter's syndrome - ANS X-linked disease causes by deficient breakdown of mucopolysaccharides from lack of Iduronate Sulfatase activity presents W/O corneal clouding with additional aggressive behavior Stigaliptin - ANS DDP-4 inhibitors cause a reduction in incretin breakdown and decreased gastric emptying Exanetide - ANS incretin mimetic with similar properties as GLP-1 which increases glucose dependent insulin secretion from pancreatic beta cells Pityriasis Rosea - ANS is a self-limited exanthematous reaction that, with an initial herald patch, spreads into a diffuse rash with a "Christmas tree" pattern. Inc serum methionine and homocysteine and Vitamin B6 (pyridoxine) - ANS homocystinuria is due to a deficiency of the enzyme cystathionine beta synthase. Px: vision difficulty, bilateral dislocated lens, marfanoid habits What will be seen on serum and what can lower the levels of homocysteine? Klumpke's palsy - ANS damage to the C8-T1 nerve roots results in -hyperextension of MCP and hyper flexion of the interphalangeal joints Erb's Palsy - ANS damage to the C5-C6 nerve roots results in - results in dysfunction of the suprascapular, musculocutaneous, and axillary nerves This results in an arm that hangs by the side and is rotated medially with a forearm that is extended and pronated. they can cause bronchospasm due to preventing bronchodilaton of Beta-2 blockade - ANS non-selective Beta blockers like propanol are contraindicated in those with asthma and COPD because dissociative amnesia with dissociative fugue - ANS inability to recall important autobiographical information that should be successfully stored in memory and would ordinarily be readily remembered characterized by bewildered wandering or sudden, unexpected travel away from home or workplace, combined with inability to recall one's past. Primary hyperaldosteronism and secondary hyperaldosteronism - ANS is due to an adrenal tumor causing excess secretion of aldosterone resulting in hypokalemia, hypertension, metabolic alkalosis and low renin while _____ is due to kidneys sensing a low volume state and causes an activation of the RAAS thus causing an increase in renin decrease in compliance resulting in atelectasis - ANS respiratory distress syndrome is due to a decrease in pulmonary surfactant which results in a decreases lung volume and subsequent.... Small cell carinoma - ANS of neuroendocrine cell origin and has associations with male smokers associated with multiple paraneoplastic syndromes such as increased ADH and ACTH secretion cerebellum - ANS intention tremors are most characteristic of damage to the.... CGG repeat - ANS Fragile X codon CAG - ANS Huntington codon GAA - ANS Friedrich's ataxia codon coarctation of the aorta - ANS manifests with a *thickened aortic wall*, hypertension in the upper extremities, weak and distant pulses in the lower extremities, claudication, pain, and cramping. REM latency - ANS patients with narcolepsy have a decrease in ______ and enter REM sleep almost immediately after falling asleep free radical injury resulting in retinopathy and blindness - ANS supplemental O2 therapy can cause what in neonates with RDS? Increased Urine osmolality would be expected with desmopressin admin (causes H2O to be reabsorbed thus causing an increase in urine concentration/ osmolality) - ANS what is expected in a patient with Diabetes Insipidous when desmopressin (synthetic ADH) is administered? the extent of sclerosis, systemic sclerosis involves the internal organs as well - ANS the difference between CREST syndrome and diffuse systemic sclerosis is? Calcinosis Raynaud Phenomeon Esophageal dysmotility Sclerodactyly Telangiectasia - ANS What does CREST stand for? Systemic Sclerosis (Scleroderma) - ANS anti-DNA topoisomerase or anti- Scl 70 is the antibody that is highly specific for... limited scleroderma (CREST syndrome) - ANS anticentromere antibodies are more characteristic of 2 umbilical arteries that branch off the internal iliac arteries ( oxygenated blood travels via 1 umbilical vein) - ANS deoxygenated fetal blood passes to the placenta via... mesoderm ( includes connective tissue, cartilage, bone, striated and smooth muscle, heart, blood lymphatic vessels, kidneys, ovaries, etc) - ANS what is the embryological origin of the spleen? Sulfonylureas (ADR is hypoglycemia) - ANS tolbutamide, chloropropramide, glyburide, glimepridie and glipizide bronchoalveolar carcinoma - ANS tumor cells that grow along the alveolar walls without invasion and causes symptoms like persistent productive cough W/O hemoptysis adenocarcinoma - ANS most common lung cancer in non-smokers manifests in the periphery of the lungs associated with PE findings such as clubbing, Trousseau syndrome of hypercoagulability binding of Antithrombin III which inhibits thrombin(lesser effect) and factor Xa - ANS MOA of LWMH MRI - ANS scaphoid fractures are often radiographically occult on exams, what should be done to confirm a scaphoid fracture and prevent avascular necrosis? IV magnesium sulfate - ANS Treatment for severe preeclampsia is Microsporum - ANS a cause of tinea capitis that presents as many large football shaped macroconidia ApoE CII - ANS located on chylomicrons, VLDL, and HDLs; necessary for LPL enzyme in order to remove triglycerides and cholesterol for extra hepatic tissues ApoB48 and ApoE - ANS needed in order for chylomicrons to be reuptaken by the hepatic cells LDL receptor fungal especially candida - ANS intertrigo is a rash typically seen on the skin folds and is associated with poor air circulation, moisture and friction, it is caused by what organism? Lichen Planes - ANS characterized as purple, puritic, polygonal, flat topped papules that can be treated with corticosteroids Typically affects the solar wrists and ankles surgically - ANS basal cell carcinoma is characterized as being on areas of sun exposure and having a pearly appearance, it generally has a good prognosis and is removed.... weight loss and elevated serum *creatinine kinase-MM* - ANS dermatomyositis is an idiopathic inflammatory disorder marked by proximal muscle weakness and characteristic skin findings, what symptom is commonly associated and what is the associated lab findings? Legionella pneumophila - ANS aerobic, *facultatively intracellular*, gram negative rods that contaminate water supplies and cause atypical pneumonia via infection of alveolar macrophages 25-hydroxycholecalciferol - ANS if you have kidney issues what product of vitamin D metabolism will be built up? Streptococcus sanguinis (S. viridans) - ANS what causes small vegetations on the aortic valve after tooth extraction? posterior limb of internal capsule - ANS affected in spontaneous hypertensive hemorrhage and contains the descending corticospinal tract of the upper motor neurons for the extremities as well as all ascending somatosensory pathways for the body and face gene of the internal capsule - ANS contains the descending corticobulbar tract and upper motor neurons for the face Osteoarthritis (OA) - ANS Decrease in joint space due to cartilage erosion and bony sclerosis affects the PIP( Bouchard's nodes) and DIP (Herberden's nodes) joints, does not affect the MCPs affects large, weight bearing joints like the hips and knees causes morning stiffness lasting approximately 15 minutes rheumatoid arthritis - ANS results in inflammatory pannus formation (anti-CCP antibodies) affects the MCP and PIP joints and spares the DIP joints ( Swann neck and boutonniere) has morning stiffness greater than 30 minutes have inflammatory markers such as CRP or ESR squamous cell bladder cancer (due to schistosomiasis) - ANS What should be expected in patients who present with painless, gross hematuria and a history of travel to the Middle East, smoking, etc as well as an abdominal mass... CMV - ANS most common cause of congenital infections and commonly results in periventricular calcifications, growth restriction, and sensorineural hearing loss Varicella-Zoster infection - ANS in a newborn presents with mild chickenpox-like disease or more severe disseminated diseases, erupts asynchronously and consists of macule, vesicles, papules and pustules that crust over while healing Leukotrienes (cause bronchospasm) - ANS ASA Toxicity presents as GI distress, fever, hyperapnea, tinnitus etc, being that it is an irreversible COX inhibitor, what pathway does it shift the AA metabolites down? ketoconazole - ANS fastest pharmocotherapeutic option inhibits 17- alpha hydroxylase and 17,20 lyase which effectively stops adrenal and testicular androgen production *used in prostate cancer to achieve castration* Bicalutamide - ANS Antiandrogen used in the treatment of advanced prostate cancer HIV-1/HIV-2 antibody differentiation immunoassay - ANS The next test performed after a patient is positive for HIV1/2 antigen/antibody combo immunoassay is.... laryngotracheobronchitis (croup), parainfluenza virus - ANS inflammation of the larynx, trachea, and bronchi -infant presents with a persistent nonproductive cough and with lungs clear to auscultation with an erythematous oropharynx - Cough sounds bark and *Seal like* What is this called and what is the common cause of infection? headache - ANS The most common side effect of ECT(Electroconvulsive therapy produces a generalized cerebral seizure) Na--> in order to decrease stone formation, decrease NA intake - ANS A diet high in what ion predisposes calcium oxalate stones by increased urinary excretion of calcium? median umbilical ligament - ANS remnant of urachus, runs from the bladder to the umbilicus along the anterior abdominal wall medial umbilical ligaments - ANS remnants of fetal umbilical arteries ligamentum teres - ANS remnant of the umbilical vein which runs within the falciform ligament Elevation in the NADH:NAD+ ratio due to the excessive metabolization of ethanol - ANS Alcoholic ketoacidosis usually occurs in malnourished patients with chronic alcoholism who have a history of binge alcohol ingestion. What causes increased ketogenesis and an abnormally high B-hydroxybutyrate:acetoacetate ratio? primaquine - ANS used to treat hypnozoites and is the current drug of choice for P ovale infections Atovaquone/Proguanil - ANS traditionally used to treat babesia, it is also an alternative treatment for malaria if first line agents fail Chloroquine - ANS considered the drug of choice for the treatment of the erythrocytic forms of all non-falciparum species of plasmodium but there is a high rate of *resistance* so other meds should be considered first Mefloquine - ANS used for prophylaxis and treatment for all susceptible malaria species associated with sleep disturbances and not effective against hypnozoites quinidine - ANS class Ia antiarythmic and antimalarial used IV for severe forms *Vd=dose/Co*, A high Vd means a smaller percent remains in the plasma (small Co) and thus is less likely to be bound to plasma - ANS what does a drug with a high Volume distribution mean? illness anxiety disorder (hypochondriasis) - ANS a disorder in which a person interprets normal physical sensations as symptoms of a disease Generally SOMATIC SYMPTOMS ARE NOT PRESENT Delusional disorder, somatic type - ANS delusions that the person has some physical defect or general medical condition for at least 1 month DOES NOT FOCUS ON A CONCRETE ILLNESS hypercapneic respiratory failure secondary to status asthmaticus---> Will see an elevated serum hydrogen concentration due to failure to blow off CO2 due to respiratory muscle weakening - ANS patient with a history of asthma presents with diaphragm flattening, a rib somatic dysfunction and viserosomatic changes as well as increased breathing rate, high BP, fast HR and decreased O2 sat on room air. What is this patient suffering from Churg-Strauss Syndrome - ANS aka allergic granulomatous angiitis, necrotizing vasculitis, variant of polyarteritis nodosa, involves *pulmonary vasculature,* peripheral eosinophilia*, and asthma p128 Characterized by increased ESR, neuropathy and associated with p-ANCA calcium gluconate - ANS Antidote for magnesium sulfate Loss of deep tendon reflexes - ANS Signs of magnesium toxicity include respiratory paralysis, coma and _______ *It is important to test for this once Mg Sulfate is administered to patients with eclampsia* croup - ANS most common infectious cause of stridor in children younger than 3 years of age. Commonly caused by parainfluenza virus and radiographs show the classic steeple sign which is caused by laryngotracheal edema LABA (salmeterol, formoterol) - ANS Patient presents with difficulties controlling her daily asthma symptoms of coughing and wheezing. Her SABA and low dose corticosteroid are not working, what is the next medication that should be tried in order to control her symptoms Asthmatic bronchospasm due to ASA sensitivity and treatment is *zafrilukast* - ANS a child presents with poorly controlled asthma, recent illness with fever and UR symptoms as well as nasal polyps. She has also been given Aspirin today to help with her myalgias what is going on and what is the treatment? imipenem - ANS beta-lactamase resistant cell wall inhibitor Cilastatin, inhibitor of renal dehydropeptidase I - ANS What is Imipenem always administered with? WeCner's Granulomatosis aka granulomatosis w/polyangiitis and c-ANCA - ANS mucosal ulcers, sinusitis and rapidly progressive findings are classic findings of what vasculitis? What is the associated finding? Crohn's disease - ANS type of inflammatory bowel disease that presents with watery diarrhea, arthritis, skin rashes, uveitis and abdominal pain *postitive for ASCA antibodies* There is a compensatory increase in sodium reabsorption in the distal tubule and chloride follows sodium so this causes hyperchloremia - ANS acetazolamide prevents reabsorption of bicarbonate and causes excessive loss of bicarbonate and sodium at the proximal tubules. As a side effect what happens to Chloride? thymoma - ANS myasthenia graves is associated with a mass situated in the chest known as a.... an ACH esterase inhibitor would cause ACH to be available longer and thus would lead to cholinergic symptoms so: DUMBELLS - ANS what is a side effect of pyridostigmine? Non-nucleoside reverse transcriptase inhibitor (NNRTI) - ANS Efavirenz, delavirdine, nevirapine, rilpivirine Nucleoisde- reverse transcriptase inhibitor (NRTI) - ANS Abacavir, didanosine, emtricitiabine, Lamivudine, stavudine, tenofovir, zalcitabine and zidovudine incorporates itself into the growing DNA chain and causes chain termination Protease inhibitors - ANS Navir's- Nelfinavir, saquinavir inhibits enzymes that cleave newly formed proteins to prepare them for assembly into the final virion Fusion inhibitors - ANS enfuvritide integrase inhibitors - ANS Raltegravir CCR5 antagonist - ANS Maraviroc gluteus medius - ANS hip abductors gluteus maximus and majority of the hamstrings - ANS primary hip extensors intestinal conjugase - ANS phenytoin inhibits this enzyme in the jejunum that is responsible for converting the polyglutumate folate into its monoglutumate form