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By: MKDReyes

Clerks Final Examination: Name: ________________________________________ Date: _______________________

BONUS (2pts): What is the scientific name of hiccups? a. Balkus b. Dobultus c. Singultus d. Quatroskus ENUMERATION and IDENTIFICATION: Case I (TOTAL: 6pts): A 43 year old man presents to the physicians clinic with complaints of epigastric pain. After thorough workup, the patient is diagnosed with peptic ulcer disease. He is started on a medication that inhibits proton pump of the stoma ch. What is the proton pump described above? Clue: what electrolytes are involved?H+-K+ ATPase What type of cell membrane transport would this medication be blocking? (eg.Secondary active transport) Primary active transport 3. What are the four types of transport across a cell membrane? a. Simple diffusion b. Facilitated diffusion c. Secondary active transport co-transport/ countertransport d. Primary active transport -----------------------------------------------------------------------------------------------------------------------------------------Physiology: (2pts) 4. In a patient with diarrhea, the oral administration of a solution containing NaCl and glucose is more effective in preventing dehydration than is the administration of a solution containing only NaCl. Which of the following facts best explain this observation? a. Administration of NaCl and glucose solution reduces stool output b. Glucose is used as a fuel to effect the cotransport of Na and Cl across the apical membrane of intestinal epithelial cells c. The cotransport of glucose and Na across the apical membrane of intestinal epithelial cells facilitates Na and water absorption d. The NaCl and glucose solution empties from the stomach at a faster rate than does a solution containing NaCl alone. 5. The rate of absorption of a drug taken orally is found to increase up to a point where further increases in dose result in no further increases in the rate of absorption. Absorption does not appears to result in the splitting of ATP. Which of the following processes best describes the drug absorption? a. Facilitated diffusion b. Primary active transport c. Restricted diffusion d. Secondary active transport e. Simple diffusion ---------------------------------------------------------------------------------------------------------------------------------------Pharmacology: Case II: (5pts) A 12 year old girl presents to your office with a sore throat and fever. You diagnose her with pharyngitis caused by group A -hemolytic streptococcus. She is given an IM injection of penicillin. Approximately 5 minutes later, she is found to be in respiratory distress and audibly wheezing. Her skin is mottled and cool, she is tachycardic and her BP has fallen to 70/20mmHg. You immediately diagnose her as having an anaphylactic reaction to the penicillin and give an SC injection of epinephrine. 6. What effect will epinephrine have on this patients vascular system? a. Vasodilation b. Vasoconstriction c. Vasospasm d. Rupture 7. Which adrenoceptor primarily mediates the vascular response? a. Alpha1 b. Alpha2 c. Beta1 d. Beta2 e. D1r 8. What effect will epinephrine have on her respiratory system? a. Bronchospasm b. Bronchial muscle relaxation c. Bronchoconstriction d. Sputum collection 9. Which adrenoceptor primarily mediates respiratory system response? a. Alpha1 b. Alpha2 c. Beta1 d. Beta2 e. D1r 1. 2.

By: MKDReyes

MNEMONICS: You have ONE heart and TWO lungs- B1 is primarily cardiac and B2 is lungs 10. Epinephrine and Norepinephrine are catecholamines synthesized from which amino acid? a. Phenylalanine b. Tyrosine c. Alanine d. Tryptophan MNEMONICS: Pare, True Love Does Not Exist- synthesis of hormones start from P-henylalanine then this is exposed to phenylalanine hydroxylase to form Tyrosine then tyrosine decarboxylase makes Levodopa and from Levodopa comes Dopamine. Norepinephrine and Epinephrine come from Tyrosine. Kasi di nmn amino acid ang Levodopa and Dopa. 11. BONUS 2 (2pts): If there is a 1 and 2 receptor, what is 3 receptor responsible for? MNEMONICS: Si B1 and B2 ay healthy pero si B3 hindi. Because B3 is found in fat cells! Pathology: CASE III: (3pts) A 42 year old policeman has been seen by his family physician for a 5-year history of heartburn. He has been intermittently taking ranitidine, a histamine-2 blocking agent, with some relief. An upper endoscopic examination that was performed revealed some reddish discoloration and friability of the lower region. A biopsy of the lower esophagus was performed, and the microscopic examination revealed COLUMNAR CELLS containing GOBLET CELLS. 12. What is the most likely diagnosis? Barrett esophagus 13. What is the long-term complication of this process? Adenocarcinoma of esophagus 14. What is the most likely mechanism of this process?repeated acid reflux to distal esophagus leading to metaplasia of the normal squamous epithelium to columnar epithelium CASE IV: (2 pts) You have a batchmate who persistently has halitosis even when she uses mouthwash and brushes her teeth regularly. When you were having a conversation, she coughs out a piece of granola which she noted she had taken from breakfast 5days ago. She shamefully admitted she consulted a Gastroenterologist and was noted to have an outpouching near the upper esophageal sphincter. 15. This outpouching is likely called: a. Meckel diverticulum b. Zencker diverticulum c. Rathkes diverticulum d. Ranches diverticulum 16. What is the most common cell type of esophageal carcinoma worldwide? Squamous cell CA 17. A 55 year old salesman is noted to have a cancer of the lower third of the esophagus. He is a non-smoker and occasionally drinks alcohol. Which of the following is the most likely cell type? a. Adenocarcinoma b. Melanoma c. Metastatic cancer d. Sarcoma e. Squamous cell CA 18. An 18 year old man presents with difficulty swallowing over the last 3 days. He denies ingestion of unusual substances and complains of pain even when swallowing liquids. He is an IV drug user and has been taking several medications to help his immunity. Which of the following is the most likely finding on esophageal endoscopy? a. Brown blotches scattered throughout the esophagus b. Normal-appearing esophagus c. Red patches in the distal esophagus d. Reddish streaks throughout the pharynx and upper esophagus e. White patches adherent to the esophagus: this patient probably has HIV and the clinical syndrome of painful and difficult swallowing is consistent with Candida esophagitis. Other causes of esophagitis include Herpes, CMV, etc. --------------------------------------------------------------------------------------------------------------------------------------Matching type. (7pts- 0.5 each)Match the medical term with the definition that best describes it. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Schuffners granules B. Rosenthal syndrome A. Quinckes disease D. Quinckes sign C. Quellung reaction F. Adsons sign E. Bartters syndrome H Bergmans triad G. (fat embolism) Bernheim effect J. Bernstein test I. Boston sign L. Angelman syndrome K. Carey-Coombs N. Takotsubo syndrome M. a. factor XI deficiency b. pigment in trophozoite, seen in P. vivax c. Aortic regurgitation d. Angioedema e. thoracic outlet syndrome f. swelling of bacterial capsule exp to antibody g. dyspnea, petechiae, mental status changes h. hypokalemic, hypochloremic metab alkalosis i. GERD j. rare; Right ventricular failure precedes left; AS k.Happy puppet deletion of mat. 15q11-13 l. jerking of lagging lid in thyrotoxicosis m. Broken heart syndrome n. rheumatic heart disease

BONUS (3 pts): Define SOMOGYI phenomenon (encircle the best word)- It is the rebound HYPERGLYCEMIA/ HYPOGLYCEMIA following an episode of HYPERGLYCEMIA/ HYPOGLYCEMIA due to corregulatory hormone release. MNEMONIC: Somogyi is

By: MKDReyes

same as sayingSOMOBRA ang insulin nung gabi kaya naghypoglycemia tapos nagrebound hyperglycemia in the morning 19. Antimicrobials for suspected atypical pathogens causing pneumonia EXCEPT: a. macrolide or azalide b. antipneumococcal fluroquinolone c. tetracycline d. beta lactam ----------------------------------------------------------------------------------------------------------------------------Fill in the blanks: (refer to page 31 of CAP Guidelines) Low risk CAP Presence of: Stable vital signs RR<30(1) PR<125 (2) Temp >36 or <40 deg C SBP>/=90(3) DBP>60(4) Clinically: No altered mental state No suspected aspiration No or stable comorbid condition Chest Xray: localized (5) infiltrates No evidence of pleural effusion, abscess Moderate risk CAP Any of the following: Unstable vital signs RR>/=30 (6) PR>/=125 (7) Temp>/= 40(8) SBP<90mmHg DBP</=60mmHg Clinically: Altered mental state of acute onset Suspected aspiration Decompensated co-morbid condition Chest Xray: multilobar infiltrates pleural effusion or abscess High risk CAP Any of the criteria under moderate risk CAP category plus Severe Sepsis(9) and Septic Shock(10)

Need for mechanical ventilation

20. This is the early biomarker for acute kidney injury. It rises 2 hours post-injury: a. CREA b. BUN c. NGAL: Neutrophil gelatinase associated lipocalin d. Human neutrophil gelatinase-B 21. What electrolyte is responsible for generating the action potential in cardiac myocytes? a. Chloride b. Sodium c. Calcium d. Potassium 22.What electrolyte is responsible for generating the action potential in cardiac pacemaker cells? a. Chloride b. Sodium c. Calcium d. Potassium 23.What is the dreaded side effect of Metformin that makes it hazardous for CKD patients? a. Gastric upsets b. Lactic Acidosis c. Metabolic Alkalosis d. Hyperthyroidism 24. What is NOT a sign of pulmonary embolism in CXR? a. Westermarks sign b. Pallas sign c. Mc Connells sign d.Hamptons hump 25. This is a pulmonary embolism sign is found in 2d echo which is a distinct echocardiographic finding described in patients with acute PE. There is a distinct regional pattern of right ventricular dysfunction, with akinesia of the mid free wall (centerline excursion, 0.20.8 mm; P=0.0001 versus normal) but normal motion at the apex (centerline excursion, 5.70.8 mm; P=NS versus normal). a. Westermarks sign b. Pallas sign c. Mc Connells sign d. Hamptons hump 26.Which is NOT sign of Aortic regurgitation? a. Hills b. Traubes c.De Mussets d.Mullers

By: MKDReyes

e.NOTA 27.Which thyroid hormone is 100% synthesized in the thyroid gland, making it a good indicator of thyroid function? a.T4 b.T3 c.TRH d.TSH 28. Thyreos the Greek word from which thyroid came from means: a. Shield b. Fortress c. Metabolic d. Follicular 29. At which part of the renal tubules does Bumetanide work at? a. Loop of Henle: ends with an ideparang Furosemide b. Distal Convoluted Tubules c. Proximal Tubules d. Collecting Tubules 30. At which part of the renal tubules does Carbonic anhydrase work at? a. Loop of Henle b. Distal Convoluted Tubules c. Proximal Tubules d. Collecting Tubules 31. At which part of the renal tubules does the parathyroid hormone exerts its effect on? a. Loop of Henle b. Distal Convoluted Tubules c. Proximal Tubules d. Collecting Tubules 32. What is the cutoff for correction of Hgb in patients without co-morbids? a. 8 b. 9 c. 10 d. 12 33. Interpret this ABG of a patient at the ER, at room air: 7.2/pCO2 66/pO2 40/HCO3 22 a. Respiratory alkalosis with hypoxemia b. Respiratory acidosis with adequate oxygenation c. Respiratory acidosis with inadequate oxygenation d. Respiratory acidosis with hypoxemia- room air kasi. Inadequate oxygenation is used for those with O2 support 34. Procainamide comes from what Class of anti-arrhythmics? a. Class IA b. Class IB c. Class II d. Class III 35. Potassium channel blockers are what class of anti-arrhythmics? a. Class I b. Class II c. Class III d. Class IV 36. Sotalol belongs to what Class of anti-arrhythmics? a. Class I b. Class II c. Class III: It has both Class II and II properties but it is essentially Class III d. Class IV 37. Angiotensin I is converted to Angiotensin II in which organ of the body? a. Liver b. Kidneys c. Pituitary d. Lungs 38. What is the triad of the pathophysiology of asthma? a. Bronchial injury, hypersecretion, inflammation b. Bronchoconstriction, hypersecretion, inflammation c. Bronchoconstriction, inflammation, capillary dilation d. Bronchoconstriction, obstruction, hyposecretion 39. This bruit, when auscultated in a patient diagnosed with RHD reflects poor prognosis for the patient: a. Austin-Flint b. Carey-Coombs c. Opening snap d. Machinery-like murmur 40. Criteria for diagnosing Pulmonary Embolism is called:56

By: MKDReyes

a. Weils criteria b. Wells criteria c. ACA Criteria d. GOLD Criteria 41. A significant Q wave to indicate past MI measures: a. of R wave b. More than of R wave c. 1/3 of R wave d. More than 1/3 of R wave

42. Interpret this ECG: (also indicate walls affected) inferior wall MI

43. Interpret ECG: atrial flutter

44. Interpret ECG: PVCs in Triplets

45. Interpret ECG: Ventricular Tachycardia

By: MKDReyes

46. Interpret ECG: Ventricular fibrillation

47. For tracing in number 46, what is the treatment? DEFIBRILLATION- There are only 2 instances when you need defibrillation: PUlseless Vtach and Vfib. REMEMBER THAT 48. Interpret ECG: 1st degree AV block

49. Interpret ECG: 2nd degree AV block, Mobitz I

50. Interpret ECG: 3rd degree AV block

Bonus (5pts): Draw the renal tubules (plus 5 if you can draw the major transporters per segment- ALL or nothing)

Good luck! Congratulations!