6/16 UWorld

Question 1

What is the difference between simple focal and complex focal seizures

Answer 1

• Simple
  
  • No LOC or postictal state
  • Motor, sensory, autonomic, or psychic symptoms
• Complex
  
  • LOC and postictal state
  • May have automatisms (e.g. lip smacking)

Question 2

Describe presentation of tonic-clonic vs. myoclonic seizure

Answer 2

• Tonic-clonic
  
  • LOC and postictal state
  • Diffuse muscle contraction of limbs (tonic) followed by rhythmic jerkin (clonic)
• Myoclonic
  
  • No LOC or postictal state
  • Brief jerking movements

Question 3

What are the broad spectrum anti-epileptics that can be used to treat focal, tonic-clonic, and absence seizures

Answer 3

Valproic acid

Lamotrigine

Recall festival and Llamas outside of Ethosuximide classroom

Question 4

First line therapy for absence seizures

Answer 4

Ethosuximide

Question 5

First line treatment for focal seizures

Answer 5

Carbamazepine

Question 6

First line treatment for tonic-clonic seizures

Answer 6

Phenytoin, Valproic acid

Question 7

First line treatment for status epilepticus

Answer 7

Phenytoin - 1st line prophylaxis

Benzos - 1st line for acute

Question 8

MOA and uses of Gabapentin

Answer 8

• SKetchy = Grab a pint ice cream truck
• Mechanism of action:
  
  • Narrow spectrum anti-epileptic
  • Bind and block voltage-gated calcium channels, stopping inward calcium current, stopping NT release
  • Does NOT bind to GABA receptors
• Uses:
  
  • Anti-seizure
  • Neuropathic pain (e.g. diabetic neuropathy)
  • Fibromyalgia
  • Post-herpetic neuralgia (VZV)

Question 9

MOA and uses of Vigabatrin

Answer 9

• Sketchy = V cab
• Narrow spectrum antiepileptics
• Mechanism of action:
  
  • Irreversible inhibitor of GABA-transaminase, enzyme responsible for degradation of GABA
    
    • = raised CAB
    • = V cab “transmission”
  • This produces and increase of GABA in the CNS, producing tonic inhibition
• Uses:
  
  • Adjunctive treatment for partial seizures

Question 10

MOA and uses of Tiagabine

Answer 10

• Sketchy = tied up cab driver
• Narrow spectrum antiepileptics
• Mechanism of action:
  
  • Inhibits GABA reuptake, increasing GABA concentration in CNS
• Uses:
  
  • Adjunctive treatment for partial seizures

Question 11

Cause and presentation of Hyper IgE syndrome

Answer 11

o Deficiency in IFN-y lead to impaired neutrophil recruitment

o Presentation à FATED

§ F – coarse Facies

§ A – Abscesses

§ T – retained primary Teeth

§ E – increased IgE (all other immunoglobulins are normal)

§ D – dermatologic problems (eczema)

Question 12

Release and function of TNF-a

Answer 12

§ Secreted by activated macrophages

§ Mediates septic shock

§ Causes neutrophil and lymphocyte recruitment

§ Responsible for fever, anorexia, corticotrophin releasing hormone, septic shock, and cachexia

Question 13

MOA and uses of Infliximab

Answer 13

• THINK: TNF = The NetFLIX Friday
• TNF-a inhibitor
  
  • Recall: TNF-a is an acute phase reactant produced by activated macrophages to mediate inflammation by accelerating neutrophil migration, and facilitate lymphocyte proliferation; TNF-a is responsible for fever, anorexia, corticotropin releasing hormone, septic shot, and cachexia
• Mechanism of action:
  
  • Is a monoclonal antibody to TNF-a
• Uses:
  
  • Used for autoimmune conditions due to anti-inflammatory effect
  • Rheumatoid arthritis, psoriasis, ankylosing spondylitis

Question 14

What are the 2 drugs that inhibit IL-2 transcription

Answer 14

Cyclosporine and Tacrolimus

• THINK: you use a toilet paper roll (Tacrolimus) to make yourself look like a cyclops (Cyclosporine) instead of having 2 eyes (IL-2)

Question 15

What 2 drugs prevent IL-2 response

Answer 15

Sirolumus and Dacluzimab

Question 16

What is the use of drugs that inhibit IL-2

Answer 16

Transplant rejection prophylaxis, psoriasis, rheumatoid arthritis

Question 17

Describe the defect and presentation fo Wiskott Aldrich syndrome

Answer 17

o X-linked recessive immunodeficiency due to mutation in WASp gene

o Leukocytes and platelets unable to reorganize actin skeleton = defective antigen presentation

o WATER - Wiskott Aldrich, Thrombocytopenia, Eczema (especially truncal), Recurrent infections

Question 18

Antibody associated with mixed connective tissue disease

Answer 18

Anti-U1 RNP (ribonucleoprotein)

Question 19

What are the different defects that cause homonymous hemianopia with macular involvment vs homonymous hemianopia with macular sparing

Answer 19

E: homonymous hemianopia with macular involvement is consistent with involvement of the temporal lobe (e.g. occlusion of the middle cerebral artery)

H: homonymous hemianopia with macular sparing is consistent with occlusion of the posterior cerebral

Question 20

When after fertilization will b-hCG become positive in materal serum vs. urin

Answer 20

8 days = serum

14 days = urine

Question 21

What murmur is associated with an opening snap vs. an ejection click

Answer 21

Opening snap = mitral stenosis

Ejection click = aortic stenosis

Question 22

What is the most common location of patients infected with Babesia

Answer 22

NE United States (NE on maltese cross on floor)

Question 23

Presentation of carcinoid syndrome

Answer 23

• Symptoms = BFDR
  
  • Bronchospasm
  • Flushing
  • Diarrhea
  • Right-sided heart disease/murmur

Question 24

Where is the inflammation and with what T-cell (CD4+ or CD8+) is inflammation caused by in Dermatomyositis vs. Polymyositis

Answer 24

• Dermatomyositis
  
  • Perimysial (THINK: periphery b/c of muscle + skin involvement) inflammation with CD4+ T cells
• Polymyositis
  
  • Endomysial inflammation with CD8+ T cells
  • Think of the 8 as multiple bulging muscles

Question 25

What human leukocyte antigen is associated with the seronegative spondyloarthropathie

Answer 25

HLA-B27

Question 26

What human leukocyte antigen is associated with Rheumatoid arthritis

Answer 26

HLA-DR4 Think of a doctor kneeling on the floor

Question 27

Where do each of the 6 EKG leads point? (aVR, aVF, aVL, I, II, III)

Answer 27

Question 28

What leads will you see affected in an infarct to each of the following areas: * Lateral heart (LCX) * Anterior/septal heart (LAD) * Inferior heart (RCA)

Answer 28

* Lateral (LCX) = I, aVL * Anteroseptal infarct (LAD) = V1-V4 * Inferior (RCA) = II, III, aVF

Question 29

Hormones that use the cAMP pathway (Gs and Gi)

Answer 29

* Most hormones of anterior pituitary * FSH, LH, ACTH, TSH, hCG, MSH, GHRH, CRH, PTH, calcitonin, glucagon, V2 vasopressin receptor * THINK: FLAT ChAMP * FSH, LH, ACTH, TSH, CRH and calcitonin, hCG, ADH (V2), MSH, PTH

Question 30

Hormones that use the IP3 pathway

Answer 30

* Hormones of posterior pituitary minus V2 * GnRH, TRH, oxytocin, V1 vasopressin receptor, H1 histamine receptor, angiotensin II, gastrin * THINK: GOAT HAG * GnRH, Oxytocin, ADH (V1), TRH, Histamine (H1), Angiotensin II, Gastrin

Question 31

Hormones that have steroid receptos

Answer 31

* Estrogens, progesterone, testosterone, glucocorticoids, aldosterone, thyroid hormone (T3/T4), vitamin D * THINK: VETTT CAP * Vitamin D, Estrogen, Testosterone, T3, T4, Cortisol, Aldosterone, Progesterone

Question 32

Hormones with tyrosine kinase receptors

Answer 32

* Insulin, insulin-like growth factor (IGF-1), platelet derived growth factor (PDGF), fibroblast growth factor (FGF) * THINK: insulin + all the –GF’s

Question 33

Hormones with non-receptor tyrosine kinase (JAK/STAT)

Answer 33

* Prolactin, cytokines (IL-2, IL-6, IFN), GH, G-CSF, Erythropoietin, Thrombopoeitin * THINK: PIGGLET * Prolactin, Immunomodulators (cytokines, IL-2, IFN), Growth hormone, Granulocyte colony stimulating factor, (No L), EPO, Thrombopoietin

Question 34

MOA of Docusate

Answer 34

Stool softener Facilitates the penetration of stool by water and lipids

Question 35

MOA of Bismuth

Answer 35

MOA: Binds to ulcer base, providing physical protection and allowing HCO3- secretion to reestablish pH gradient in the mucus layer USES: Increased ulcer healing Traveler's diarrhea

Question 36

MOA of Exanatide and Liraglutide

Answer 36

"-tide" = GLP-1 agonists * These drugs activate GLP-1 receptor (glucagon-like peptide receptor) – opposite of glucagon * Increases insulin release and satiety * Decreases glucagon release and gastric emptying

Question 37

MOA of Sitagliptin and Linagliptin

Answer 37

"-gliptin" = DDP-4 inhibitors * DPP-4 (dipeptidyl peptidase) is the enzyme that breaks down endogenous GLP-1 * If you inhibit DPP-4, you will have more endogenous GLP * Increased insulin and decreased glucagon * Increased satiety and delayed gastric emptying

Question 38

MOA of Pramlintide

Answer 38

* Amylin analog * Amylin is a peptide normally present in insulin secretory granules and secreted along with insulin * At pharmacologic doses, it reduces glucagon secretion, gastric emptying, and appetite * Used to control postprandial glucose spike in both Type I and Type II DM

Question 39

MOA of alpha-glucosidase inhibitors (Acarbose and Miglitol)

Answer 39

Sketchy: A-carb wigglers MOA: Inhibition of a-glucosidase on the intestinal brush border decreases the conversion of disaccharides to absorbable monosaccharides --\> delayed carbohydrate absorption USES: Type 2 DM ADVERSE EFFECTS: Diarrhea, flatulence (due to fermentation of undigested carbs)

Question 40

MOA of SGLT2 inhibitors ("-flozin")

Answer 40

Sketchy: Flossing teacher and Salty Glucose Co. bag MOA: Inhibition of the sodium-glucose cotransporter in the proximal tubule USES: Type 2 DM ADVERSE EFFECTS: UTI Vaginal candidiasis Dehydration

Question 41

What are the rapid-acting, intermediate-acting, and long-acting insulins

Answer 41

* Rapid acting = Girls and Lads * Glulisine, Aspart, Lispro * Intermediate acting = Rest Now * Regular insulin, NPH * Long acting = Don't Go * Detemir, Glargine

Question 42

Describe the different effects on Phase 0 slope and effective refractory period of Class IA, IB, and IC antiarrhythmics

Answer 42

* Class IA: * Intermediate Na+ channel binding – moderately decreased phase 0 slope * Also block K+ channels – prolonged refractory period * Class IB: * Weakest Na+ channel binding – minimally decreased phase 0 slope * Cause shortened refractory period * Class IC: * Strongest Na+ channel blocking – significantly decreased phase 0 slope * No effect on refractory period

Question 43

Describe what part of the action potential each class of Anti-arrhythmics works on (which electrolyte channel and which phase)

Answer 43

THINK: No Bad Boy Keeps Clean * Class I * Na+ channel blockers * Phase 0 of myocytes * Class II * Beta blockers * Phase 4 of pacemakers * Class III * K+ channel blockers * Phase 2 and 3 of myocytes * Class IV * Ca2+ channel blockers * Phase 0 of pacemakers

Question 44

What drugs are Class III anti-arrhythmics

Answer 44

* Amiodarone * = Amigos * “-tilide” suffix (e.g. Dofetilide and Ibutilide) * = “til I die” note * Sotalol * = soda * Is also a beta blocker (-lol suffix) * Muted bugle

Question 45

What are the Class I antiarrhythmics (IA, IB, IC)

Answer 45

IA - Quinidine, Procainamide, Disopyramide IB - Lidocaine, Mexiletine, Phenytoin IC - Flecainide, Propafenone

Question 46

Are the Class IV anti-arrhythmics dihydropyridines or non-dihydropyridines

Answer 46

Non-dihydropyridines