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7/26/2019 DIT Day 1 FlashCards
1/314
What are the four "must
know" Pharm equations?
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1. Volume of Distribution2. Clearance
3. Loading Dose4. Maintenance Dose
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What is the equation for
Volume of Distribution?
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Vd= (amt drug given IV)/
(drug plasma concentratio
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What is the equation for
Clearance?
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Cl= (0.7 x Vd) / t1/2
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What is the equation for
loading dose?
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LD= Css x Vd
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What is the equation for
maintenance dose?
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MD= Css x Cl
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What happens to a basic dr
if the urine pH is low and le
than the pKa?
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The drug gets trapped in th
urine.
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What happens to an acidi
drug if the urine pH is hig
and more than the pKa?
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The drug gets trapped in th
urine.
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What effects does the
sympathetic nervous syste
have on the heart? The
parasympathetic nervous
system effects?
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Symp= increased HR &contractility
Para= decreased HR &contractility (vagus nerve
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What effects does the
sympathetic nervous syste
have on the eye? The
parasympathetic nervous
system effects?
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Symp=mydriasis (dilatespupil)
Para= miosis (constrictspupil)
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What effects does the
sympathetic nervous syste
have on salivary glands? T
parasympathetic nervous
system effects?
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Symp= viscous secretion
Para= watery secretion
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What effects does the sympathetinervous system have on bronchio
smooth muscle? The
parasympathetic nervous systemeffects?
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Symp= relaxation
Para= constriction
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What effects does the
sympathetic nervous syste
have on the bladder? The
parasympathetic nervous
system effects?
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Symp= prevents urinatio
Para= urination
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What effects does the
sympathetic nervous syste
have on the male GU? Th
parasympathetic nervous
system effects?
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Symp= ejaculation
Para= erection
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What effects does the
sympathetic nervous syste
have on the GI tract? The
parasympathetic nervous
system effects?
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Symp= decreased digestio
smooth mm. relaxation,
increased sphincter tone &
decreased secretion
Para= Opposite of above
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What are the sx of excess
parasympathetic activity
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DUMBBELSS: Diarrhea, UrinatioMiosis, Bronchospasm, Bradycard
Excitation (sk mm. & CNS),Lacrimation, Sweating, Salivation
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What drugs can cause exce
parasympathetic activity
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1. Direct muscarinic agonists:
Bethanechol, Pilocarpine,Carbechol, methacholine
2. Anti-chonlinesterases:Neo/Pyrido/Physostigmine,
Edrophonium, Echothiophate
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What threeanticholinesterases used t
treat Alzheimer's disease
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DonepezilGalantamine
Rivastigmine
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What causes MyastheniaGravis? Symptoms? How is
diagnosed?
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1. Antibodies to Ach Receptors2. Common sx= ptosis or diplopli
that worsens throughout the day
3. Dx with edrphonium. If strengttemporarily increases.
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What are 3 asssociatedpathologies for Myasthen
Gravis?
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1. Thymic hyperplasia2. Thymic atrophy
3. Thymoma
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What is Myasthenic crisis
What is used to treat MG
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1. Rapidly progressing weakness-
respiratory difficulty
2. Tx: Ach-esterase inhibitors
(Pyridostigmine), CorticosteroidsThymectomy, Plasmapheresis
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What drug regeneratesacetylcholinesterases afte
organophosphate poisonin
7/26/2019 DIT Day 1 FlashCards
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Pralidoxime
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What are the symptoms oinhibited parasympatheti
activity?
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Hot as a Hare; Dry as a bone; Reda beet; Blind as a bat; Mad as a
hatter; Bloated as a toad;
"The patient gets leaky everywher
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What drugs inhibitparasympathetic activity a
what is their use?
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1. Atropine, hmoatropine, tropicamide,
ipratroprium= eye
2. Benztropine= CNS for Parkinson's
3. Scopalomine= CNS motion sickness, end o
to decrease secretions and control
nausea/vomiting4. Ipratroprium= Lung for asthma and COPS
5. Oxybutynin= GU for urge incontinence
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What anticholinergics arused in the treatment of ur
type urinary incontinence
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OxybutyninTolterodine
Darifenacin & SolifenacinTrospium
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In what patientpopulations/disease is
atropine contraindicated
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Glaucoma
BPHGI obstruction
DementiaInfant with fever
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What other medications ha
anticholinergic side effect
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1. 1st generation H1 blockers:
benadryl, doxylamine (Unisom),chlorpheniramine
2. Traditional neuroleptics
3. TCA's
4. Amantadine
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Name 3 direct cholinergi
agonists.
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PilocarpineBethanechol
Carbechol
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Name 7 anti-Ach-esterase
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Physostigmine, Neostigmine,
PyridostigmineEchothiophate
Edrophonium
Donepezil & Rivastigmine
(Alzheimer's)
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Name 9 anti-muscarinic
drugs.
Oxybutynin
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Oxybutynin
Atropine
DarifenacinIpratropium
Tropicamide
Benztropine
Scopalomine
Tolteridine
Trospium
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Name the cholinesterase
regenerator.
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Pralidoxime
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A gardener presents withSOB, salivation, miosis an
diarrhea. What caused thiand what is the MOA?
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1. Cause= parathion/
organophosphate poisoning2. MOA= increased parasympath
stimulation by inhibiting Ach-
esterase--> Muscarinic receptor
stimulation
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Atropine is not effective ireversal of organophospha
poisoning. What drug woubest help this patient?
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Parlidoxime (Tupam) to
regenerate Ach-esterase
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What drug would helpimprove FEV1 in a patien
with COPD?
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Ipratropium
h
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A 30yo patient with
schizophrenia now hasurinary retention due to h
neuroleptic drug. What dyou treat it with?
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Bethanechol
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In the dark, both pupils are dilate
In the light, the control pupil is
miotic with the pupil given drug X
remains mydriatic. What type ofdrug is drug X?
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Pilocarpine, muscarinicantagonist, anti-cholinerg
drug or a sympathetic
agonist.
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What toxin stimulates Acrelease from presynaptic
cholinergic neurons?
inhibits?
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Stimulates= Black widowtoxin
Inhibits= Botulinum
Wh t i th l
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What is the general
byproduct of phase Imetabolism and what
reactions take place durinthis phase?
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1. Byproduct- generally yields
slightly polar water-soluble
metabolites that may still be activ
2. Reduction, oxidation & hydrolyreactions (cyto P450)
Wh t i th l
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What is the general
byproduct of phase IImetabolism and what
reactions take place durinthis phase?
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1. Usually yields very polar inactivemtabolites that are renally excre
2. acetylation, glucouronidation,
sulfation (conjugations)
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What phase of livermetabolism do geriatric
patients tend to lose first
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Phase I metabolism
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What questions are askedduring the 4 clinical phase
of drug development?
Phase 1 Is it safe
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Phase 1- Is it safe
Phase 2- Does it workPhase 3- Is it more effectiv
Phase 4- Long-termmonitoring
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Name 5 drugs that inhibiAch-esterase and the clinic
application for each drug
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1. Edrophonium- to dx Myasthenia Gravis
(tensilon test)2. Neostigmine- post-op ileus reversal & post
NM blockade reversal, urinary retention
3. Pyridostigmine- Myasthenia Gravis
4. Physostigmine- Glaucoma and Atropine O
5. Echothiophate- Glaucoma
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What are the various clinic
applications of atropine?
1 Eye= to dilate and cycloplegia
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1. Eye= to dilate and cycloplegia
2. Airway= decrease secretion(anesthesia)
3. Bladder= decrease bladder
spasms4. Organophosphate poisoning
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What G-protein classes dalpha and beta receptors
stimulate?
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alpha-1= Gq
alpha-2= Gi
Beta-1= Gs
Beta-2= Gs
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What G-protein classes tomuscarinic and dopamin
receptors stimulate?
M1= Gq
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M1= Gq
M2- GiM3- Gq
D1- GsD2- Gi
How many half-lives does i
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How many half-lives does i
take for a drug infused at aconstant rate to reach 94%
steady state? What variabledetermine the t1/2?
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1. 4 half lives
2. Vd & Clearance
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How does Hexamethoniu
affect BP, CO, Urine outpu
the eye and GI motility? Ho
does it affect heart rate?
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1. It decreases BP, CO, Urin
output, GI motility and
causes mydriasis
2. It increases Heart Rate
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Which receptors are
stimulated by Clonidine?
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alpha-2
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Which receptors are
stimulated by dopamine?
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D1=D2
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Which receptors arestimulated by
phenylephrine?
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alpha-1 > alpha-2
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Which receptors arestimulated by albuterol an
terbutaline?
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Beta-2
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Which receptors are
stimulated by norepi?
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alpha-1/alpha-2 > B1
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Which receptors are
stimulated by isoprotereno
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Beta-1 = Beta-2
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Which receptors are
stimulated by epinephrine
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All alpha and Betas
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Which receptors are
stimulated by dobutamine
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Beta-1 > Beta-2
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Which sympathomimetic given as a nebulizer for
asthma?
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Albuterol and epi (in extrem
cases)
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Which sympathomimetic the drug of choice for
anaphylaxis?
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Epinephrine
Which sympathomimetic
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Which sympathomimetic
the most common first lin
agent for pts in cardiogen
shock?
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Dobutamine
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Which sympathomimetic most common first line age
for pts in septic shock?
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NE
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Which sympathomimetic
given subQ for asthma?
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Terbutaline
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Which sympathomimetic used by ENT to vasoconstr
nasal vessels?
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Cocaine or phenylphrine
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Which sympathomimetic
used to tx ADHD?
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Amphetamine
Which of the following dru
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Which of the following dru
would be most appropriate
a pt in shock because it
maintains renal blood flow
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Dopamine
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Outline the flow of aqueou
humor.
Formed in capillary bed of ciliary
bod > secreted into posterior
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body-> secreted into posterior
chamber-> flows between the ang
of lens and iris diaphragm->
anterior chamber-> reabsorbed bcanal of Schlemm
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What is the pathogenesis
glaucoma?
Blocked canal of Schlemm
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aqueous humor notreabsorbed-> increased
pressure-> atrophy of optnerve
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What is Open angle
glaucoma? Risk factors?
1. Common, insidious form
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,
almost always bilateral
2. Risks- >40yo, black,
diabetes
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What are the sx in the earstage of Open angle
glaucoma? Late stage?
Early= asymptomatic
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Late= areas ofreduced/absent vision,
contraction of visual fieldfrom peripheral->centra
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What is acute angle-closuglaucoma? Symptoms?
It's an emergency.
Sx= abrupt onset of pain, nausea,
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colored halos and rainbows arounlight
Signs= red, teary eye with hazy
cornea, fixed mid-dilated pupil tha
film to palpation
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How is glaucoma diagnose
Via tonometry;
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y;
Opthalmoscopy with cuppiof optic disc (cup:disc rati
>1:2)
A 60yo male has a hard tim
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y
driving at night because oeye pain with oncoming
headlights. What is the dx
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Cataracts
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What drug category ends inane?
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Inhaled anesthetics
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What drug category ends inazine?
7/26/2019 DIT Day 1 FlashCards
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Neuroleptics/ Anti-emetic
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What drug category ends inbarbital?
7/26/2019 DIT Day 1 FlashCards
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Barbiturates
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What drug category ends incillin?
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Penicillins
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What drug category ends inipramine?
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TCA's
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What drug category ends iolol?
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Beta blockers
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What drug category ends inoxin?
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Cardiac glycosides (inotropagents)
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What drug category ends inpril?
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ACE inhibitors
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What drug category ends intidine?
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H2 antagonists
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What drug category ends intropin?
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Pituitary hormones
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What drug category ends indronate?
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Bisphosphonates forosteoporosis
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What drug category ends inchol?
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Cholinesterase inhibitors
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What drug category ends inmustine?
7/26/2019 DIT Day 1 FlashCards
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Notrosurea (crosses BBB ttx brain tumors)
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What drug category ends instatin?
d
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HMG-CoA reductaseinhibitors
h d d i
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What drug category ends inbendazole?
i h l i h
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Anti-helminths
h d d i
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What drug category ends inazepam?
B
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Benzos
Wh d d i
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What drug category ends inazole?
A i f l
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Anti-fungals
Wh d d i
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What drug category ends incaine?
L l th ti
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Local anesthetics
Wh t d t d i
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What drug category ends incycline?
A tibi ti ( t i th
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Antibiotics (protein syntheinhibitors)
Wh t d t d i
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What drug category ends innavir?
P t i hibit
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Protease inhibitors
Wh t d t d i
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What drug category ends inoperidol?
H ld l/ l ti
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Haldol/neuroleptics
Wh t d t d i
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What drug category ends inphylline?
Meth l anthines
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Methylxanthines
What drug category ends in
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What drug category ends interol?
Beta 2 agonist
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Beta-2 agonist
What drug category ends in
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What drug category ends intriptyline?
TCA's
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TCA s
What drug category ends in
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What drug category ends inzosin?
Alpha 1 antagonists
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Alpha-1 antagonists
What drug category ends in
7/26/2019 DIT Day 1 FlashCards
189/314
What drug category ends insartan?
Angiotensin II receptor
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Angiotensin-II receptorantagonist
What drug category ends in
7/26/2019 DIT Day 1 FlashCards
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What drug category ends instigmine?
Anti cholinesterase
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Anti-cholinesterase
What drug category ends in
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What drug category ends incurium/curonium?
Non-depolarizing NM
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Non-depolarizing NMblockers
What drug category ends in
7/26/2019 DIT Day 1 FlashCards
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What drug category ends inglitazone?
Diabetes drugs that increa
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Diabetes drugs that increatarget cell response to insu
What drug category ends in
7/26/2019 DIT Day 1 FlashCards
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What drug category ends indipine?
Calcium channel blocker
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Calcium channel blocker
What does the proximal
radial nerve innervate an
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radial nerve innervate anwhat is seen if this nerve i
damaged?
1. Triceps and skin of posterior ar
2. Damage-> cannot extend
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2. Damage > cannot extendforearm, lose triceps reflex and w
drop
What is innervated by the
deep branch of the radia
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deep branch of the radianerve and what is seen if th
nerve is damaged?
1. BEST muscles: Brachioradialis,Extensors of wrist and fingers,
Supinator and Triceps, abductor
pollicus longus skin of post forea
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pollicus longus, skin of post. forea
2. loss of brachioradialis reflex, wr
drop, loss of sensation of posteriorforearm
What is innervated by the
superficial branch of the
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superficial branch of theradial nerve and what is se
if this nerve is damaged?
1. Skin of lateral and
posterior hand
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posterior hand2. loss of sensation of later
and posterior hand
What is Saturday Night
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What is Saturday NightPalsy?
Radial nerve compression against spiral groove of the humerus-> we
wrist and finger extension, weak
brachioradialis reflex but normal
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brachioradialis reflex, but normal
triceps. From passing out with you
arms over the back of a chair orbench.
What is innervated by the
ulnar nerve and what is se
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ulnar nerve and what is se
if this nerve is damaged?
1. Flexor carpi ulnaris and the
medial 1/2 of flexor digitorum
profundus & lumbricles (PAD/DAdd
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p ( /2. CLAW HAND, cannot adduct
thumb, cannot ab/aduct fingers a
loss of sensation of medial hand
What is innervated by the
median nerve and what i
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median nerve and what iseen if this nerve is
damaged?
1. Flexor muscles, thumb muscles
and pronators
2. Loss of pronation, wrist flexionA O C O A
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p ,HAND OF BENEDICTION, APE
HAND, loss of sensation on latera
palm and distal first 3.5 digits
What is carpal tunneld
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What is carpal tunnelsyndrome?
Median nerve entrapment at the
carpal tunnel (enclosed by inelastfl i l ll d
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p yflexor retinaculum ventrally and t
carpal bones dorsally.
An elderly woman with chronicosteoarthritis and diffuse pain now
presents with numbness and tingli
over the lateral digits of her right
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g g
hand that sometimes radiated up t
the elbow. Exam reveals wasting othe thenar eminence. What is the d
Carpal tunnel syndrome
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C p y
What is innervated by the
musculocutaneous nerve ah i if hi i
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what is seen if this nerve i
damaged?
1. Biceps, brachialis,
coracobrachialis and skin of later
forearm2 W k d f fl i
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2. Weak arm and forearm flexion
and weak supination and loss of
sensation of the lateral forearm
What nerve is damaged wh
a patient presents with clah d? A h d? W i t
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p phand? Ape hand? Wrist
drop? Scapular winging?
1. Claw hand= ulnar nerve
2. Ape hand= median nerv
3. Wrist drop= radial nerve
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3 p
4. Scapular winging= long
thoracic n. (serratus anteri
What nerve is damaged when a
patient presents with the inability
wipe butt? Loss of forearm
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p
pronation? Cannot ab- or adduct
fingers? Loss of arm abduction?
1. Wipe butt= Thoracodors
nerve (lats dorsi)2 F ti
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( )2. Forearm pronation=
median nerve
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1. Lateral rotation= suprascapula
nerve
2. Arm/forearm flexion=
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musculocutaneous nerve
3. Forearm extension= radial ner
What nerve is damaged when a
patient presents with trouble
initiating arm abduction? Inabilitto abduct arm beyond 10 degrees
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to abduct arm beyond 10 degrees
Inability to raise arm above
horizontal?
1. Initiate arm abduction= Suprascapul
nerve (supraspinatus m)
2. Arm abduction >10 degrees= Axillar
nerve (deltoid m)
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3. Raise arm above horizontal= Long
thoracic nerve (serratus ant) + spinal
accessory nerve (trapezius m)
What nerve runs with theposterior circumflex artery
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posterior circumflex artery
Axillary nerve
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y
What nerve runs with thedeep brachial artery?
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deep brachial artery?
Radial nerve
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What nerve runs with thebrachial artery?
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brachial artery?
Median nerve
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What nerve runs with the
posterior interosseous
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artery?
Deep branch of the radianerve
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nerve
What nerve is most at risk
injury with a fracture to th
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shaft of the humerus?
Radial nerve
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What nerve is most at risk
injury with a fracture to thsurgical neck of the
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surgical neck of the
humerus?
Axillary artery
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What nerve is most at risk
injury with a fracture to thsupracondyle of the
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supracondyle of the
humerus?
Median nerve
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What nerve is most at risk
injury with a fracture to thdi l i d l
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medial epicondyle?
Ulnar nerve
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What nerve is most at risk
injury with an anteriorh ld di l i ?
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shoulder dislocation?
Axillary nerve
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What nerve is most at risk
injury with injury to thel l?
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carpal tunnel?
Median nerve
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A gymnast sustains an
anterior shoulder dislocatioWhat nerve is most likely
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y
have been injured?
Axillary nerve (+ posteriocircumflex artery)
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y)
An adolescent falls while
skateboarding and injures his elb
He can't feel the medial part of hipalm Which nerve is damaged an
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palm. Which nerve is damaged an
what is the injury?
Ulnar nerve and medial
epicondyle fracture ofh
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humerus
A high-school athlete falls on hisarm during practice. In the ER a
radiograph shows a mid-shaft breof the humerus. Which nerve and
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which artery have the highest risk
being damaged?
Radial nerve and deepbrachial artery
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y
What are the 5 classes ofdrugs used to tx glaucoma
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g g
1. alpha agonists (Epi, brimonidine)2. beta-blockers (-olol)
3. Diuretics (CA inhibitors, mannitol)
4. Cholinomimetics (pilocarpine,carbachol, physostigimine, echothiopha
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, p y g , p
5. Prostaglandins (latanaprost=
PFF2alpha)
How does blood pressure response
phenylephrine administration cha
if an alpha-blocker is administeredbefore hand? Why is this different
h h h h i i
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than the change seen when epi is
used rather than phenylephrine?
With PE+alpha-agonist, BP is
suppressed but not reversed
With Epi+ alpha agonist, there is net decrease in BP because of
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net decrease in BP because of
unopposed beta-2 action
What are common sideeffects of beta-blockers?
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Impotence, asthma
exacerbation, sedation, slealterations, Bradycardia an
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AV block
Which pt populations shou
use caution when takingbeta blockers?
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beta-blockers?
1. Diabetics-masks sx of hypoglycemia
2. Asthmatics- only if non-selective is u
3. Heart block or on calcium channelblockers
4 Pt with Pheochromocytoma
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4. Pt with Pheochromocytoma
5. Cocaine abusers
What are the various clinic
uses for thesympathomimetic
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dopamine?
Hypovolemic shock andheart failure
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What are the various clinic
uses for thesympathomimetic clonidin
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sympathomimetic clonidin
HTN in renal disease
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What are the various clinic
uses for thesympathomimetic
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amphetamine?
ADD/ADHD, narcolepsy a
depression (while waiting fSSRI to kick in)
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SSRI to kick in)
What are the various clinic
uses for thesympathomimetic
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terbutaline?
Tocolysis to prevent
premature uterinecontractions and subQ in
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asthma
What are the various clinic
uses for thesympathomimetic
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epinephrine?
Anaphylaxis, use with loca
anesthetics forvasoconstriction, Open ang
l
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glaucoma
What pathology is associat
with the following key wordbilateral hilar
l h d h
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lymphadenopathy?
Sarcoidosis
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What pathologies are
associated with the followi
key words: cherry-red spo
l ?
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on macula?
Tay-Sachs
Niemann-Pick's
Central retinal artery
l i
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occlusion
What pathology is associat
with the following key
words:slapped cheeks ras
hild?
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on a child?
Fifth's disease/ Parvo B-1
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What pathology is associat
with the following key
words:organism from dog
t bit ?
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cat bite?
Pasturella multocida
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What pathology is associat
with the following key word
facial muscle spasm upon
t i th h k?
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tapping the cheek?
Chvostek's sign for
hypocalcemia
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What pathology is associat
with the following key wordcough, conjunctivitis, coryz
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g , j , y
Measles
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What pathology is associat
with the following key word
nephritis, hearing loss,
cataracts?
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cataracts?
Alport's Syndrome (Type I
collagen mutation) "Can'see, Can't pee, Can't hear
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What primary hormone i
increased or decreased inCushing's syndrome?
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Increased cortisol
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What primary hormone i
increased or decreased inConn's syndrome?
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Increased aldosterone
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What primary hormone i
increased or decreased inAddison's disease?
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Decreased aldosterone an
cortisol
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What primary hormone i
increased or decreased inGrave's disease?
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Decreased TSH, Increase
T3/4
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What is the function of
MacConkey's agar?
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Selective medium for Gram
) and lactose ermenters
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Your patient has facialangiofibroma, ash-leaf spots of sk
depigmentation, hx of seizures an
MR. What condition does this pt
have? What neoplasms is this pt a
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risk of developing?
Dx= Tuberous Sclerosis
Risk= Cardiac
rhabdomyoma, astrocytom
and angiomyolipoma
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and angiomyolipoma
What is the cause of
achalasia? How is it dx?
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Loss of myenteric/Auerba
plexus
Dx= Barium swallow with
bird's beak or manometr
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bird s beak or manometr
Compare the leading COD
ages 15-24 to those in age25-64.
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15-24= Injuries, homicide
suicide, cancer, heart dz
25-64= Cancer, heart dz
injuries, suicide, stroke
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injuries, suicide, stroke
In which glomerular disea
would you expect to see th
following changes: anti-GM
Abs on IF?
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Abs on IF?
Goodpasture Syndrome
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In which glomerular diseawould you expect to see th
followingchanges:Kimmelstiel-Wils
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lesions on LM?
Diabetic nephropathy
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In which glomerular disea
would you expect to see th
following changes: 'spike a
dome' appearance on EM
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pp
Membranous
glomerulonephritis
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In which glomerular diseawould you expect to see th
following changes: 'tramtrack' of subendothelial
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humps on EM?
Membranoproliferative
glomerulonephritis
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In which glomerular disea
would you expect to see th
following changes:
subepithelial humps on EM
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p p
Acute post-streptococcal
glomerulonephritis
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What are the clinical uses f
metronidazole?
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"GET GAP on the Metro":
Giardia
Enatamoeba
TrichamonasGardnerella
Anaerobes
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H. Pylori
What are the two most
common complications aft
an MI? What is Dressler'
Syndrome?
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1. Arrhythmia and V-fib (anLV failure)
2. Dressler's= autoimmundz weeks post-MI that lead
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to fibrinous carditis
What is the WAGR comple
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Mnemonic for what is seen witWilm's Tumor (2-4yo)
Wilm's
Aniridia
Genitourinary malformation
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Retardation