March 3, 2011- Set 16

1. A 45-year-old male complains of epistaxis, shortness of breath, hemoptysis and hematuria for two days. A urine analysis identifies RBC casts and proteinuria. The patient also undergoes pulmonary function testing which reveals restrictive lung disease. What renal pathology is characteristic of RBC casts and proteinuria? (FA p467)

2. Diagram the phases of a myocardial action potential and describe which ion channels are responsible for each phase. (FA p260)

3. A 33-year-old male is diagnosed with Hodgkins lymphoma and treated with doxorubicin, bleomycin, vincristine, cyclophosphamide and etoposide. While undergoing treatment, the patient develops a paralytic ileus and neurotoxicity from the treatment regimen. Which chemotherapy agent most likely is the cause of these sequelae? What is the characteristic pathology finding of Hodgkins lymphoma? (FA p366, FA p367, FA p 357)

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March 3, 2011- Set 16

4. A 50-year-old male complains of intermittent hematuria over the past four weeks. However, he says that what brought him in today was right-sided flank pain. On exam you notice a palpable right-sided flank mass. What is the most common renal malignancy in adults? What is the associated gene deletion with this malignancy? (FA p469)

5. Describe how the following diuretics affect the nephron function? (FA p473-475) Diuretic Acetazolamide Mannitol Furosemide Hydrochlorothiazide (thiazides) Potassium sparing ADH antagonists Nephron Effect

6. A 1-month-old female presents with an anterior neck enlargement. Your exam reveals a pale infant with enlarged abdominal girth and a protruding umbilicus. You think this patient might have cretinism. In cretinism, would the patients TSH be elevated or decreased? What is the cause of endemic cretinism? What is the cause of sporadic cretinism? (FA p297, FA p298)

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March 3, 2011- Set 16

7. A 43-year-old male presents with visual difficulties and decrease in libido. The patient reports that he is unable to see in the outer half of both sides of his visual fields. A brain MRI reveals a tumor. Would you expect the patients GnRH to be decreased or increased? (FA p300) This tumor will often cause infertility. What is the role of LH and FSH in spermatogenesis? What is an easy way to remember which cells LH and FSH stimulate during spermatogenesis? (FA p481)

8.

In patients with a prolactinoma, what pharmacologic agent can be used to inhibit the release of prolactin? In normal physiology, how is prolactin secretion regulated? (FA p290)

9.

An 85-year-old female has been on long-term medical therapy for seizure disorder with phenytoin, a cytochrome 450 inducer. She has been stable with her dosage of the medication and has a serum level checked every three months. However, her most current phenytoin level is elevated. You will need to decrease her phenytoin dosage because she is beginning to lose her ability to metabolize the medication. What phase of drug metabolism do geriatric patients lose first? Which phase of drug metabolism makes a slightly polar metabolite by oxidation, reduction, or hydrolysis? (FA p233)

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March 3, 2011- Set 16

10. A 34-year-old obese white female develops urinary retention after undergoing a laparoscopic cholecystectomy. Which cholinergic agonist can be used to treat post-op ileus and urinary retention? What conditions can be made worse by using cholinomimetic agents? (FA p238)

11. A 37-year-old obese white male complains of inflammation and pain in his first right toe joint (1st MTP) after having a steak dinner and three glasses of red wine the previous night. He is not currently on any medications for this condition but had been on chronic treatment with allopurinol that worked well in the past. This is the third flare-up in six months and he wants to begin taking allopurinol again because it reduced the number of flares he had in the past. What agents are used for the acute treatment versus chronic treatment of this condition? Why is allopurinol sometimes used in patients with leukemia and lymphoma? (FA p384, FA p392)

12. A 22-year-old international student from Uganda presents to the emergency room complaining of worsening chest and abdominal pain. He reports that he has experienced several similar episodes in the past. The peripheral smear shows sickled RBCs, anisocytosis and poikilocytosis. What is the definition of anisocytosis and poikilocytosis? What is the life span of an RBC? Describe the RBC life cycle. (FA p342, I-5 and FA p352)

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March 3, 2011- Set 16

13. A 50-year-old female develops a new onset of lower back pain without a specific injury. A lumbar X-ray reveals lytic lesions which raise suspicion for multiple myeloma. What is the characteristic finding on electrophoresis with multiple myeloma? What is the classic finding in the urine of a patient with multiple myeloma? (FA p358)

14. The different hereditary hyperbilirubinemias can all present with jaundice and scleral icterus. What is the underlying cause in the following hyperbilirubinemias, and what form of bilirubin is elevated in the serum in each disease? (FA p333) Hereditary Cause Hyperbilirubinemia Gilberts syndrome Bilirubin (unconjugated or conjugated)

Crigler-Najjar syndrome (type I) Dubin-Johnson syndrome

15. A 35-year-old patient is on highly active antiretroviral therapy (HAART) including zidovudine, didanosine and ritonavir. A routine CBC to monitor the HAART reveals a megaloblastic anemia. Which medication is the most likely cause of the ill effect? What is the mechanism of action of zidovudine and didanosine? What is the mechanism of action of ritonavir? (FA p197)

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