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1

What is the difference between a promoter region and an enhancer region? (FA15 p68) (FA16 p54)

promoter: Site where RNA polymerase II and multiple other transcription factors bind to DNA upstream from gene locus (AT-rich upstream sequence with TATA and CAAT boxes)
enhancer: Stretch of DNA that alters gene expression by binding transcription factors.

2

What medications are considered first line in the treatment of ADHD?

amphetamine/dextroamphetamine (indirect sympathomimetics)
clonidine (sympatholytic (α2-agonists), stimulants (e.g., *methylphenidate), CBT, atomoxetine, (selective NE reuptake inhibitor)

3

What are the signs of right-sided heart failure? What are the signs of left-sided heart failure? What is most often the cause of right-sided heart failure? (FA15 p297) (FA16 p292)

R: Hepatomegaly (nutmeg liver) JVD, Peripheral edema

Orthopnea, Paroxysmal nocturnal dyspnea, Pulmonary edema
*most common cause of RHF is LHF*

4

What abnormal lab values would lead you to suspect alcoholic hepatitis? (FA15 p369) (FA16 p367)

AST>ALT

5

How many umbilical vessels are there? Which umbilical vessel has the highest oxygen content? (FA15 p563) (FA16 p567)

2 umbilical arteries
1 umbilical vein (from placental, more oxygen)

6

What organisms are particularly known for causing infective endocarditis? (FA15 p128-130, 147) (FA16 p119-121, 137)

Staph aureus (30%)
Strep viridans (mutans) (20-30%)
enterococci (10%)
CoNS (S. epidermidis) (5-10%)
also HACEK (harder to Cx)

7

A 60-year-old male long-time patient of yours comes to your office complaining of sexual dysfunction. What is the differential diagnosis? What drugs are known for causing sexual dysfunction? (FA15 p516) (FA16 p520)

Drugs (e.g., antiHTNs, B-blockers, neuroleptics, SSRIs, ethanol) 􏰃 Diseases (e.g., depression, diabetes, STIs, hyperprolactenemia, dec. testosterone)
Psychological (e.g., performance anxiety)

8

A 44-year-old woman is seen in the ER for shortness of breath, malaise, and high fever. Chest x-ray reveals a right-sided consolidation, and her labs reveal a WBC count of 12,000. Which organism is overall the most common cause of lobar pneumonia? What organisms are the most common causes of interstitial (walking) pneumonia? (FA15 p616) (FA16 p624)

S. pneumo (also Legionella, Kleb)
atypical: Viruses (influenza, CMV, RSV, adenoviruses),
Mycoplasma, Legionella, Chlamydia

9

Which type of lymphoma has a presentation that is very similar to CLL and fewer constitutional signs/symptoms? (FA15p402)(FA16p402)

SLL (small lymphocytic leukemia)

10

A 30-year-old man is at an inpatient facility for opioid addiction. What symptoms might this patient experience while discontinuing opioids? (FA15 p518) (FA16 p522)

Sweating, dilated pupils, piloerection (“cold turkey”), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (“flu-like” symptoms). Treatment: long-term support, methadone, buprenorphine.

11

Ceftriaxone is used for the treatment of sexually-transmitted N. gonorrhea infections. Which generation of cephalosporin is ceftriaxone? Which generation of cephalosporin is effective against Pseudomonas? Are cephalosporins bacteriostatic or bactericidal? (FA15 p182) (FA16 p172)

3rd generation
3rd gen. ceftazidime (and cefeperazone) and *4th gen cefepime* are effective against pseudomonas
-bacteriocidal

12

A 35-year-old white woman presents with a dull ache in her jaw that is made worse by chewing. She states that this pain corresponds to her recent promotion and increase in responsibilities. What is the most likely diagnosis?

giant cell arteritis? too young
TMJ syndrome, 2nd most common cause of facial pain after ha
-exacerbated by stress
-have nocturnal bruxism, may have jaw clicking

13

A patient is undergoing treatment with recombinant interferon for his hepatitis C. In what ways do interferons interfere with viral protein synthesis? (FA15 p207-208) (FA16 p200-201)

-produce RNA protein kinase (inhibits viral protein synthesis)
-trigger pro-apoptotic pathways
-influence activities of macrophages and dendritic cells

14

Your patient develops a cough with the new antihypertensive drug you prescribed her. What are some other side effects associated with this medication? (FA15 p555) (FA16 p559)

(ACE inhibitor)
SEs: Cough, Angioedema (contraindicated in C1 esterase inhibitor deficiency), Teratogen (fetal renal malformations), ^^􏰄Cr (dec. 􏰃GFR), Hyperkalemia, and Hypotension. Avoid in bilateral renal artery stenosis, because ACE inhibitors will further dec. GFR􏰃-->􏰅renal failure
"Captopril’s CATCHH"

15

In regard to seizures, what do the terms partial, generalized, simple and complex mean? (FA15 p489) (FA16 p494)

-partial: affects single area of the brain (Most commonly originate in medial temporal lobe)
-simple partial (consciousness intact): motor, sensory, autonomic, psychic
-complex partial (impaired consciousness)
-generalized: diffuse

16

How is thyroid hormone made and stored?

(see video 17) made in the follicles of thyroid release stimulated by TRH (hypothalamus)-->TSH (pituitary)-->follicular cells
stored as T4, activated in tissue to T3 (active form)

17

A 35-year-old man is seen in the office for his chronic, recurrent peptic ulcer disease. It has been refractory to conventional treatment with PPIs. Your attending mentions that this might be caused by a tumor. Which type of tumor may be responsible for this condition? If this patient also presented with kidney stones and signs of hypogonadism, what syndrome might you suspect? (FA15 p336-337) (FA16 p332-333)

ZES: gastrin-secreting tumor (gastrinoma)
-associated with MEN1: 3 P’s: Pituitary (PRL, GH, hypogonadism), Parathyroid (could be causing ^^Ca2+-->stone formation), and Pancreas tumors (ZES)

18

What is the role of clomiphene in the treatment of PCOS? What is the mechanism of action of clomiphene? (FA15 p596) (FA16 p601)

Antag. at estrogen receptors in hypothalamus; prevents normal feedback inhib. and 􏰄release of LH and FSH from pituitary, which stimulates ovulation. Used to treat infertility due to an ovulation (*PCOS*). May cause hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances.
PCOS: polycystic ovaries, androgen excess, anovulation/oligoovulation

19

A 49-year-old trauma patient comes into the ER unconscious and in need of surgery. What are the exceptions to informed consent? (FA15 p56) (FA16 p40)

-pt lacks decision-making capacity or is legally incompetent
-implied consent in an emergency
-therapeutic privilege: withholding info when disclosure would severely harm the pt or undermine informed decision-making capacity
-waiver—patient explicitly waives the right of informed consent

20

What are the side effects of amiodarone, and what testing should be performed periodically on patients taking it? (FA15 p309) (FA16 p303)

(Class III antiarrhythmic, K+ channel blocker)
SEs: pulmonary fibrosis, hepatotoxicity, hypothyroidism/ hyperthyroidism (amiodarone is 40% iodine by weight), acts as hapten (corneal deposits, blue/ gray skin deposits resulting in photodermatitis), neurologic effects, constipation, CV effects (bradycardia, heart block, HF).
*check PFTs (PF), LFTs (heptox), and TFTs(thy. dysfunc)*

21

INF clinical uses

IFN-α: chronic hepatitis B and C, Kaposi sarcoma, hairy cell leukemia, condyloma acuminatum, renal cell carcinoma, malignant melanoma.
IFN-β: multiple sclerosis.
IFN-γ: chronic granulomatous disease.

22

INF-γ:

Secreted by NK cells in response to IL-12 from macrophages; stimulates macros to kill phagosed pathos; Also activates NK cells to kill virus-infected cells. Increases MHC expression and Ag pres. by all cells.

23

INF α,β:

part of innate host defense against both RNA and DNA viruses. INFs are glycoproteins syn. by virus-infected cells that act locally on uninfected cells, “priming them” for viral defense by helping to selectively degrade viral nucleic acid and protein.
Essentially results in apoptosis, thereby disrupting viral amplification.

24

When is a fetus most susceptible to damage from teratogens? What drug used in the treatment of hypertension is a teratogen? What effect does this have on the fetus? (FA15 p560) (FA16 p564)

1st trimester: Most susceptible in 3rd–8th weeks (embryonic period—organogenesis) of pregnancy. Before week 3, “all-or-none” effects. After week 8, growth and function affected.

ACE inhibitors (also ARBs)
renal damage

25

How is the body affected by a prolonged stay in space at zero gravity?

-decrease in blood volume
-decrease in RBC mass
-dec. in musc. strength and work capacity
-dec. in max cardiac output
-loss of Ca2+ and phosphate from bones-->loss of bone mass

26

What is the most common gynecologic neoplasm? What is the typical histological pattern? Is it benign or malignant? (FA15 p588) (FA16 p594)

leiomyoma (fibroid)
benign
Whorled pattern of smooth muscle bundles with well-demarcated borders

27

Describe how the following diuretics affect the nephron function. (FA15 p553-554) (FA16 p557-558)
Acetazolamide
Mannitol
Furosemide
Hydrochlorothiazide (thiazides)
Potassium sparing
ADH antagonists

Acetazolamide: CA inhibitor-->NaHCO3- diuresis
Mannitol: osmotic diuretic-->inc. urine flow
Furosemide: loop, inhibits Na+/K+/2Cl- cotransporter-->prevents urine concentration (asc. limb of loop of Henle)
Hydrochlorothiazide (thiazides): inhibit NaCl reabsorption in early DCT-->reduce diluting capacity of nephron
Potassium sparing: competitive aldosterone rec. antagonists and block Na+ channels in cortical collecting tubule
ADH antagonists: block ADH receptor action

28

How are the following relative component levels in the blood of a polycythemia vera patient different from normal: plasma volume, RBC mass, O2 saturation, and endogenous erythropoietin? (FA15 p404) (FA16 p404)

^^plasma volume
^^RBC mass
O2 sat normal
decreased endogenous erythropoietin

Disorder of ^^ HCT, often associated with JAK2 mutation. May present as intense itching after hot shower (due to ^ 􏰄basophils). Rare but classic symptom is erythromelalgia (severe, burning pain and red-blue coloration) due to episodic blood clots in vessels of the extremities
2° polycythemia is via natural or artificial ^ 􏰄in EPO levels.

29

What synthetic agent is used both as a pituitary hormone analog and as a treatment for von Willebrand disease? (SU p189) (GG p712)

Desmopressin

30

What agent can be given as an inhaled drug to loosen mucus plugs, can be given orally to treat acetaminophen overdose, and can be given orally as prophylaxis against IV contrast-induced nephropathy in those with preexisting renal disease? (FA15 p257, 620) (FA16 p251, 627)

N-acetylcysteine (replenishes glutathione)

Mucolytic—can loosen mucous plugs in CF patients by disrupting disulfide bonds.