Rx 65

Acute tubular necrosis =

Big FeNa

Alcoholic + Multiple sexual partners = Hepatitis B leads to

Cirrhosis

C. Increased risk of infection with Clostridium difficile D. Increased serum concentration of cyclosporine E. Reduced risk of renal failure

D. Increased serum concentration of cyclosporine P450 Substrate = cyclosporine P450 Inhibitor = Erythromycin

Impetigo =

Gram Positive cocci in chains = streptococcus

Gram Positive cocci in chains =

Hematuria

Elevated PTT =

Heparin

B. Hematuria

Impetigo - Gram Positive cocci in chains

12) A 51-year-old woman presents to her physician after finding a lump in her breast. On physical exam, the nipple appears irregular. Mammography, ultrasound, and biopsy are consistent with cancer metastatic to ipsilateral lymph nodes.

The physician begins her on a course of chemotherapeutic drugs that act on specific phases of the cell cycle. Which pairs of drugs both act as specific mitotic phase inhibitors of the cell cycle?

D. Vincristine

**M Phase**

Aortic dissection complication =

**Shock** -because the dissection will hemorrhage

How does Kidney CONTRIBUTE to metabolic Alkalosis?

- Increase H+ Secretion - Increase Bicarb production

How is the Kidney WORSENING the problem =

- Increase H+ Secretion - Increase Bicarb production = BOTH of these Increase the pH worsening the problem

3) A 43-year-old woman with a history of lupus developed a steroid-nonresponsive nephropathy. As a result, she underwent kidney transplantation 1 year ago. She is now on long-term immunosuppressant therapy. Which of the following medications is she taking?

A. 5-Fluorouracil B. Azathioprine C. Cyclophosphamide D. Cytarabine E. Methotrexate

B

Acute tubular necrosis = intrinsic renal = Big FeNa

1) A 42-year-old woman is diagnosed with infiltrating ductal carcinoma of the breast. Several lymph nodes are removed and found to contain rapidly dividing cells. An imaging test reveals multiple masses in the liver. Chemotherapy is started and begins to shrink the liver masses.

After 6 months, however, the tumors have returned to their original size and are growing even more rapidly. Molecular analysis of one of the tumors reveals a mutation in β-tubulin. Which drug was a part of initial chemotherapy?

E. Obstructive shock

Aortic dissection

asymmetric pulses in the patient's upper extremities =

Aortic dissection

A. γ-Aminobutyric acid B. Acetylcholine C. Dopamine D. Glycine E. Serotonin

B. Acetylcholine - Blocking Acetylcholine = causes Bronchodilation

A. Early proliferative endometrium B. Early secretory endometrium C. Follicular phase endometrium D. Late proliferative endometrium E. Menstrual endometrium

B. Early secretory endometrium Vacuoles within glands, indicates its getting ready to SECRETE something

14) A 32-year-old woman and her husband are attempting to conceive a child. Because she has not conceived after nearly 12 months of trying, her gynecologist obtains an endometrial biopsy, histology specimens from which are shown in the image.

Based on the histology of the biopsy, the gynecologist can tell the exact point of the woman's menstrual cycle. What endometrial phase is represented in these images?

8) A 9-month-old full-term girl is brought by her mother to the pediatrician for evaluation of abnormal stature and growth. The mother comments that she has noticed her child's stature being "different from her peers ever since birth."

Both labor and pregnancy were uncomplicated. She has remained below the third percentile for height in all of her pediatric visits to date. Both parents are of above-average height and they wonder if she will eventually "outgrow" this phase.

A. Bone resorption B. Collagen formation C. Endochondral ossification D. Membranous ossification E. Mucopolysaccharide degradation

C. Endochondral ossification **Achondraplasia**

Which of the following best describes the pathologic process occurring in this patient's liver? A. At this stage in disease, hepatocytes fail to regenerate B. Lipid deposition is taking place

C. Mallory bodies are commonly seen in this condition D. Persistent activation of stellate cells is a hallmark E. The liver will be enlarged

D. Persistent activation of stellate cells is a hallmark

Cirrhosis

5) A 52-year-old heart transplant patient receiving chronic immunosuppressive therapy presents with persistent coughing, facial pain, and nasal congestion. He is diagnosed with bacterial sinusitis. His only other medication is cyclosporine. Physician starts him on erythromycin.

Concurrent use of these two medications would lead to which of the following? A. Increased risk of QTc prolongation B. Increased intracellular concentration of cyclophilin

Vacuoles=

***Secretory endometrium**

Blocking Acetylcholine,causes

**Bronchodilation**

C. Effect of antidiuretic hormone (ADH) on collecting duct D. Increased activity of Na/K/2Cl transporter in ascending limb E. Increased excretion of H+ in the collecting duct

E. Increased excretion of H+ in the collecting duct Metabolic Alkalosis- Vomiting - Increase H+ Secretion - Increase Bicarb production

A. Busulfan B. Cisplatin C. Doxorubicin D. Etoposide E. Paclitaxel

E. Paclitaxel - Beta-Tubulin mutation

A. 5-Flourouracil and 6-mercaptopurine B. 5-Fluorouracil and methotrexate C. Busulfan and bleomycin D. Busulfan and cyclophosphamide E. Taxanes and vinca alkaloids

E. Taxanes and vinca alkaloids BOTH act on M Phase

**ACHONDRaplasia**=

EndoCHONDRAL ossification

**Achondraplasia**

EndoCHONDRAL ossification

13) A 51-year-old man presents with increased abdominal girth. On physical examination, some lower extremity edema is evident, as well as shifting dullness of his abdomen.

He admits to having several recent sexual partners and has never been tested for sexually transmitted diseases. He also reports drinking a "few" drinks a night. Results of a liver biopsy are shown in the image.

6) A 15-year-old boy with a history of asthma presents to the emergency department with severe episodes of coughing. On physical exam, there is significant expiratory wheezing and intercostal retractions. The patient's respiratory rate is 25/min.

He is given a medication to help alleviate his respiratory distress. The action of which neurotransmitter is blocked by this medication?

On exam, you evaluate a child of short stature with rhizomelic limb shortening and a prominent forehead. She appears to be on pace with cognitive milestones, babbling during the visit and laughing when the mother plays peek-a-boo with her.

Her exam is otherwise unremarkable. Abnormalities in which of the following is the most likely diagnosis of this infant's condition?

10) After 3 days of flu-like symptoms, a patient is feeling unsteady on her feet and dizzy when she attempts to stand up. During her illness she has eaten very little and has had frequent emesis. Blood tests reveal an arterial pH of 7.5 and a partial pressure of carbon dioxide of 53 mm Hg.

In addition to the a primary alkalosis from vomiting, how does the kidney contribute to the acid-base disturbance? A. Decreased bicarbonate reabsorption by the proximal tubule B. Decreased sodium reabsorption in the collecting duct

B. Azathioprine

Used for Treating Immunosipressed patients with Kidney transplant

Lab tests show: Hb: 15 g/dL Hct: 49% MCV: 90 μm³ Reticulocytes: 1% Platelet count: 210,000/mm³ WBC count: 5,000/mm³ Bleeding time: 5 min PT: 12 sec PTT: 50 sec

Which of the following drugs would reverse this patient's anticoagulation status? A. Aminocaproic acid B. Andexanet alfa C. Fresh frozen plasma D. Protamine sulfate E. Vitamin K

9) A 73-year old man is brought into the emergency department by his daughter after a minor fall at home. His temperature is 98°F, blood pressure is 140/80 mmHg, and pulse is 102/min. Physical examination reveals the image shown.

Neither the daughter nor the patient is sure what medications he is taking, but he states that he was given a number of drugs during a week's stay in the hospital for an unrelated illness. The last shot was given shortly before his discharge yesterday evening.

D. Protamine sulfate

PTT is elevated = Heparin

Cirrhosis

Persistent activation of stellate cells is a hallmark

11) A 49-year-old alcoholic consumes antifreeze and is subsequently found unconscious on the sidewalk. He is taken to a nearby hospital, where he is found to be in florid renal failure. Despite emergency dialysis, he ultimately goes into torsade de pointes and dies.

Postmortem renal biopsy shows diffuse tubular necrosis. Which laboratory findings in the table above would you expect to see in the patient on admission? A B C D E

Heparin Induced Thrombocytopenia. how to reverse?

Protamine sulfate

4) A 61-year-old man with a history of hypertension and diabetes presents to the emergency department 1 hour following the onset of severe chest pain. The medical intern is startled when he finds asymmetric pulses in the patient's upper extremities.

What is the directly fatal complication of the patient's condition? A. Acute myocardial infarction B. Aneurysm formation C. Aortic insufficiency D. Arrhythmia E. Obstructive shock

2) A 38-year-old woman finds a lump on her left breast during her first pregnancy. She is diagnosed with breast cancer. After pregnancy, she begins radiation treatment and chemotherapy. One of the drugs used, interrupts cell growth by promoting microtubule stabilization.

Which other chemotherapeutic inhibits same phase of cell cycle as the drug described? A. 5-Fluorouracil B. Bleomycin C. Busulfan D. Vincristine

**Kidney transplant** how to treat?

give **Azathioprine**

7) A 6-year-old girl presents to her family physician complaining of a lesion on her chin for 5 days. Physical examination reveals a lesion on the jaw line with a thick adherent crust and several enlarged cervical lymph nodes. Gram stain of the culture is shown.

What is sequela of this infection? A. Dental caries B. Hematuria C. Jaundice D. Meningitis E. Otitis media F. Scalded skin syndrome G. Valvular heart disease