COMSAE ALL
COCAINE intoxication - correct answer impaired judgement, pupil dilate, hallucination (coke bugs)
sudden cardiac death; paranoid ideations, angina
Tx: alpha blockers/ benzos
caution B block bc can cause unopposed alpha
Osteoporosis histo - correct answer trabecular and cortical bone lose mass and interconnection despite
normal bone mineralization
assoc w/ Colles fracture- distal radial fracture; fracture of femoral neck
Gilbert Syndrome - correct answer mild dec UDP glucuronosyltransferase conjugation and impaired
bilirubin uptake; asymptomatic or mild jaundice>> inc unconjugated bilirubin w/o hemolysis; w/ fasting
and stress
Crigler Najjar - correct answer ABSENT UDP glucuronsyltransferase; early in life; die few years
find: jaundice, kernicterus (in brain) inc unconjugated bilirubin;
tx: plasmapheresis and phototherapy; type II respond phenobarbital
Dubin Johnson - correct answer Conjugated hyperbilirubinemia b/c defective liver excretion;
grossly black liver
Benign
Rotor syndrome - correct answer milder in presentation w/o black liver
,impaired hepatic uptake and excretion
wilson Disease - correct answer copper transporting ATPase; ATP7B on Chromosome 13
s/s: before 40 yo, liver dz, neurodisease, psych dz, Kayser Fleischer ring, hemolytic anemia, renal dz;
find: dec serum ceruloplasmin, inc urine copper
tx: chelation w/ penicillamine or Tridentine, oral zinc
Hemochromatosis - correct answer recessive, HFE, chromosome 6; abnormal iron sensing, increase
intestinal absorb
find: inc ferritin, inc iron, dec TIBC, inc transferrin saturation
identify w/ Prussian blue stain/ liver MRI
Hemochromatosis finds - correct answer after age 40
>20 iron;
triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy, hypogonadism, arhtropathy; HCC is
common cause death
Treatment Hemochromatosis - correct answer repeat phlebotomy, chelation deferasirox, deferoxamine,
oral deferiprone
Wolff Parkinson White Syndrome - correct answer MC ventricular pre excitation syndrome
abnml fast atria to ventricle (bundle of Kent); bypasses AV node>> ventricles begin partially
depolarization earlier (NOTED BY DELTA WAVE ON EKG) widened QRS and shortened PR
Conduction pathway heart - correct answer SA node> atira> AV node> bundle HIS, R and L bundle
branches> purkinje fibers> ventricles
,L branch anterior/posterior fascicles
Edema - correct answer inc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
Celiac Disease - correct answer setting: 14 mo kid losing weight eating lots of foods;
histology: crypt abnormalities (hyperplasia); villous atrophy, lymphocytic infiltration
presents as malabsorbtion (diarrhea etc in kids)
in adults= short stature, anemia delayed puberty
Musculocutaneous nerve C5-C7 - correct answer upper trunk compression cause injury; loss forearm
flexion/supination; loss sensation over lateral forearm
Axillary nerve C5-C6 - correct answer flat deltoid; loss arm abduction, loss sensation over deltoid and
lateral arm
Radial C5-T1 - correct answer mid shaft fracture humerus, compression axilla
find: dec grip, loss extension (wrist drop); loss sensation posterior arm, dorsal hand
Median C5-T1 - correct answer supracondylar fracture humerus (proximal) CTS, wrist laceration (distal)
ape hand pope's blessing
loss wrist flexion, flex of lateral fingers, thumb opposition, lumbricals 2nd and 3rd digit; loss sensation
over thenar eminence and dorsal and palmar aspects of lateral 3 1/2 fingers w/ proximal
, Ulnar C8-T1 - correct answer Fracture medial epicondyle humerus; fractured hook hamate (distal lesion)
ulnar claw on extension; radial deception wrist upon flexion (proximal lesion)
loss wrist flex, flex of medial fingers, abduction and adduction fingers; medial 2 lumbricals;
loss sensation over 1 1/2 fingers including hypothenar eminence
Recurrent branch median nerve - correct answer superficial laceration palm
ape hand; loss thenar muscles
no loss sensation
Treatment glaucoma: alpha agonists; epinephrine, brimonidine - correct answer dec AH synthesis>
vasoconstriction; mydriasis alpha 1 (don't use in closed angle glaucoma) blurry vision, ocular hyperemia,
foreign body sensations ocular allergy, pruritis
Beta blockers: timolol, betaxolol, carteolol - correct answer dec AH synthesis; no pupil/vision changes
Diuretics; acetazolamide - correct answer dec AH synthesis by inhibiting carbonic anhydrase; no
vision/pupil change
Cholinomimetics M3; direct pilocarpine carbachol; indirect physostigmine, echothiophate - correct
answer inc outflow of AH via contraction of ciliary muscle/open trabecular mesh; pilocarpine in ER--very
effective open meshwork into Canal schlemm,
lead to miosis--and cyclospasm
Prostaglandin- bimatoprost, iatanoprost PGF2 alpha - correct answer inc outflow AH; darken iris (brown);
eyelash growth
