Supplement And Answer Key

Physiology And Pharmacology With Relevant Pathology: Triology Review Notes

Page Notes
10 Neither!
16 Alzheimers, low ACh
Depression, low Norepinephrine and Low
Serotonin
Parkinsons, Low Dopamine
Huntington, Low ACh and GABA
Bipolar Dz, Low Serotonin
Schizophrenia, High Dopamine
21 Matching:
1 E, 2 A & D, 3 C, 4 B and 5 B
25 Beta stimulationexcept in the heart where it
causes contraction, and kidney where it stimulates
renin secretion (beta1 effect)
25 Beta2 relaxespressure throughincreased
contractility and increased renin secretion (beta1
effect)
25 Multiple Choice (Top-right panel): [B]
25 By reference to dominant tone that is inhibited.
Heart; Parasympathetic is dominant; inhibition
causes tachycardia.
Vasculature; Sympathetic; vasodilation.
Eye; parasympathetic, mydriasis and Cycloplegia.
Sweat Gland, Sympathetic; Dry skin.
GI, Parasympathetic; Reduced secretion and
motility.
28 Phenylephrine causes reflex bradycardia
29 Phenylephrine; causes vasoconstriction
30 Note: Lower-Right Drawing
Please pay attention to the fact that centrally
acting sympatholytics (Methyldopa, Clonidine and
Reserpine) work in the medulla and
hypothalamus. The nerve stemming off the midline
is for illustrative purposes only.
31 Make a Note of it:
What would be a common denominating
psychiatric manifestation effect of all centrally and
peripherally and centrally acting sympatholytics:
Depression
31 Do you expect a hypertensive patient receiving
methyldopa get depression?
Yes
31 Do you expect Clonidine to have anti-anxiety
effect? Yes
31 Epinephrine raises sugar.
32 Multiple Choice: [A]
32 Coombs:
Procainamide, Quinidine and Methyldopa
33 Multiple Choice: [D]
34 Multiple Choice: [C]
34 Treatment of bradycardia: Isoproterenol
35 Male patient who receives yohimbine: Anxious
36 Multiple Choice: [A, B and C]
38 Multiple Choice: [E]
38 1.Reserpine; 2.Methyldopa; 3.Clonidine, and
4.Propranolol
40 Endothelium Derived Relaxing Factor
41 Pilocarpine enters CNS. May cause hallucination,
convulsion and generalized cholinergic effect.
42 [B] Indirect effect.
43 Tubocurarine is not used prior to anesthesia
because paralysis of skeletal muscles alarms the
patient.
Antidote is physotigmine
43 Multiple Choice: [E]
44 Wait for new enzyme to be generated; use PAM2
early.
44 Multiple Choice: [E]
45 Edrophonium
Edrophonium
46 Anticholinergics cause delirium and potentially
promote dementia!
46 TCAs and neuraleptics, among other things,
inhibit cholinergic receptors. Hence, they promote
delirium and dementia.
47 No sweat made him hot. Adrenergics
vasoconstrict skins capillaries, hence, no heat
conduction (alpha effect). Also, via b2 dilate
muscle vessels. He got flushed but no sweat.
Hence, he looked like a beet!
47 Multiple Choice: [C]
48 Diabetes, glaucoma and trachoma
48 Closed angle glaucoma
49 Pilocarpine
49 Rapid miosis
49 Atropine fro Dilation of iris
50 Organophosphate=Echothiophate
50 Multiple Choice [E]
50 Last set of questions: Echothiophate or
Isoflurophate
53 Multiple Choice: [D]
60 There is no or less parasympathetic effect on the
ventricles
62 V1 and aVR
64 In left axis deviation, II registers more downward
deviation.
64 Downward deflection of QRS in I is due to right
deviation
65 The net cardiac electrical activity is to the left (to
the side of more mass) and away from V1
65 V1 shows upward deflection in right ventricular
hypertrophy
65 V1 shows exaggerated downward P in left atrial
hypertrophy
65 V6 shows lowest positive amplitude in right
ventricular hypertrophy
65 AVR and axis of normal depolarization
diametrically oppose each other.
66 Multiple Choice: [B]
68 Adenosine and verapamil
70 Multiple Choice: Ventricular premature beats
71 Multiple Choice: [D]
77 Multiple Choice: [A]
80 Multiple Choice: [D]
81 Multiple Choice: [B]
82 Left! Wedge pressure is not increased in right
failure.
89 Cant use digitalis for ventricular fibrillation or
bradycardia.
1. Northwestern Medical Review, Triology Answer Key, 2004
90 Nifedipine has most pronounced effect on
arterioles
91 Multiple Choice: [D]
91 Verapamil
92 Agonists for CHF: Dobutamine and dopamine
(beta-agonists). Only used for acute cases.
Beta-blockers cannot be used for CHF. The only
exception to the rule is Carvedilol.
92 Digitalis: lidocaine (or phenytoin) and K+
Cyanide: Amyl nitrite
Iron: Deferoxamine
Arsenic: BAL
Opioids: Naloxone
Benzodiazepine: Flumazenil
Acetaminophen: Acetyl-Cysteine
Methanol and ethylene glycol: Ethanol
Warfarin: Vitamin K
Heparin: Protamine
TCAs: Sodium bicarbonate and Clonidine
Atropine: Physostigmine
92 Inhibit P450: Chloramphenicol, Cimetidine,
phenylbutazone and metronidazole
92 Induce P450: Alcohol, barbiturate, Phenytoin,
Rifampin, and Griseofulvin
95 Bradycardia treatment: Atropine and beta1-
agonists
Tachycardia Treatment: Antiarrhythmics
96 IA most notorious in dropping contractility:
Disopyramide
96 IA indications: Ventricular tachycardia and
prophylaxis of supraventricular arrhythmias
97 IA and IB difference: IB lacks Anticholinergic
effect.
Best indication for IB is ventricular tachycardia.
97 Lidocaine is preferred treatment for Digitalis-
induced arrhythmias
Heart failure decreases hepatic flow
Mexiletine has no first-pass metabolism and can
be given orally
All IB members selectively act on super-active
muscles.
98 Top tested: Quinidine and Procainamide
98 Two major conditions increasing digitalis toxicity:
Calcium blockers and hypothyroidism
98 Cause lupus: Procainamide, Hydralazine,
minoxidil
99 Multiple choice: [D]
99 Matching: Sodium Blockers: A, C, E and G
Potassium Channels blockers: F
Calcium blocker: D
Beta-locker: B
101 Lack of nitric oxide production raises systolic
pressure
103 2 conditions with no left to right shunt:
Eisenmenger and infantile Coarctation
103 21-year-old case: VSD
The most common adult congenial heart disease:
VSD
103 35-year-old patient case: ASD
Second common cause: ASD
104 16-year-old: PDA
Third common cause: PDA
104 Maternal infection: German Measles
106 Valve commonly affected congenitally: Pulmonic
106 Multiple Choice: [D]
108 Multiple Choice: [C]
111 Multiple Choice: [D]
111 Second Multiple Choice: [A]
113 Multiple Choice: [E]
114 Presence of circulating antibodies against
streptokinase
115 Factors XII, XI, X, and IX are in the intrinsic path.
116 Teratogen: Warfarin
118 Bowmens Colloid Pressure: 0
118 Multiple Choice: [D]
120 A hypertensive treated with ACE: Decrease
120 Multiple Choice: [C]
122 Multiple Choice: [E]
128 Multiple Choice: [B]
130 Multiple Choice: [B]
133 Multiple Choice: [E]
135 Multiple Choice: [D] and [B]
138 If bicarb and pH are lowMixed respiratory and
metabolic acidosis
138 If bicarb and pH are highMixed respiratory and
metabolic alkalosis
138 Anion Gap determines the cause of acidity
138 Acids that increase with increased anion gap are
non-carbonic acids
139 All metabolic acidosis increase the gap except
hyperchloremic
140 Multiple Choice: [A]
141 Multiple Choice: [C]
142 Multiple Choice: [D]
142 Glucose for cholera
144 Case: Patient has metabolic acidosis
KCl, Acetazolamide and Ammonium chloride
Alkalosis causes hypokalemia and if accompanied
by vomiting causes Hypochloremia.
Vomiting cause Hypochloremia and
Acetazolamide produces Hyperchloremia
Ammonium chloride is a urinary acidifier; it is used
to treat metabolic alkalosis.
147 Multiple Choice: [B]
153 The first 150 comes from dead space
153 FRC, RV and TLC are not assessed with
Spirometry
154 Multiple Choice: [C]
154 Multiple Choice: [B]
154 Multiple Choice: [D] and [A]
156 Multiple Choice: [E]
160 Organ with lowest resistance to blood flow: Lung
Highest resistance to flow: Skin and myocardium
161 Multiple Choice: [A]
Pulmonary embolism leads to lung hypertension,
which causes right heart hypertrophy, and
increased P2.Decreased lung perfusion leads to
increased PCO2; hence, compensatory
tachypnea. Decreased lung flow causes
decreased left return, cardiac output, and pressure
(hypotension), and reflex tachycardia.
164 Multiple choice [D]
175 Multiple choice [E]
177 Growth Hormone uses tyrosine kinase
178 Multiple choice [B]; she has Glucagonoma
183 Multiple choice [A], [B] and [C]
2. Northwestern Medical Review, Triology Answer Key, 2004
184 Multiple choice [E]
185 Multiple choice [C]
186 Conns Medication: Spironolactone
Cant prescribe to Addisons patient
188 Multiple choice [A]
196 Multiple choice [A]; Hashimoto
200 After Occlusion: Hypocalcemia; Trousseaus
After Tapping: Hypocalcemia; Chevosteks
210 Multiple choice [C]
211 Multiple choice [D], and [B]
212 Multiple choice [B]
213 Multiple choice [B]
213 Multiple choice [A]; Clomiphene
217 Renal toxicity is due to inhibition of PG
218 Multiple choice [C]
220 Multiple choice [C]
230 Multiple choice [C] and [A]
231 Multiple choice options: [Secretin]
241 Pens are not that effective against intercellular
bugs
241 Patient on anti-anxiety medication: Pens inhibit
GABA; Benzodiazepine potentiates GABA. The
two contract each others effect.
241 Patient on anticonvulsant: They antagonize each
others effect
241 Pens act on all Bacteroides except Fragilis
Pens can pass through inflamed meninges
Beta-lactamase and penicillinase are similar from
standpoint of their overall effect. Penicillinase is
secretory form and intercepts Penicillins outside
the cell wall.
241 PBP and transpeptidase for physiological
purposes are similar (have similar effects)
242 Methicillin causes interstitial nephritis
243 Clavulanic acid, Sulbactam and Tazobactam
243 Amox + Clavulanic acid= Augmentin
243 Spectrum of anti-pseudomonal Pens: Gram-
negative bacilli; but cants act on Klebsiella
because it produces penicillinase
243 Case: Neisseria gonorrhea (use Pens for
treatment.
#1 cause: Chlamydia trachomatis
#2 cause: Gonorrhea
# 1 cause of preventable blindness: Trachoma
IM Penicillin was: PG
Probenecid: Prolongs penicillins effect
Patient later had: Serum sickness that is treated
with epinephrine (subcutaneous)
244 Next DOC for Neisseria: IM Ceftriaxone
Viridans family for heart valve
244 Amox for viridans and dental extraction
If allergic to PG: Vancomycin
Best choice for MRSA: Vancomycin
Clostridium perfringens: Penicillin or Clindamycin
Clostridium difficile: Vancomycin or metronidazole
245 Decerebrate! Because you dont need logic to help
you to identify the cause! It has a very broad
spectrum!
245 Vancomycin and Clindamycin
246 Aminoglycosides; Both act on Aerobes
246 4 Aerobes are:
Pseudomonas, Neisseria, Legionella and Brucella
246 # 6 is Aztreonam
246 DOC of Brucella: Doxycycline or Gentamicin
246 DOC of Listeria: Ampicillin or TMP/SMX
247 Multiple Choice: Preferably [B] and also [D]
248 Two Cephalosporins: Cefaclor; Cefuroxime
248 Multiple Choice: Cefoperazone [A]
248 Disulfiram: Cefamandole, Cefotetan, and
Cefoperazone
248 Other antimicrobial causing Disulfiram:
Metronidazole
249 All excreted renally except: Ceftriaxone and
Cefoperazone.
249 Anti-pseudomonal: Ceftazidime and Cefoperazone
249 When cant differentiate the cause: cefuroxime
249 Infants Case:
Neisseria meningitidis
H flu
3
rd
generation
250 Multiple Choice: [C]
251 Four negative Rods treated with aminoglycosides:
Enterobacter aeroginosa, E coli, Klebsiella
pneumonia, Proteus mirabilis, Serratia
marcescens
251 All are parenteral except Neomycin
251 In MG you should abstain from aminoglycosides
because they decrease acetylcholine release.
251 In patient with MG who has been treated with
streptomycin, the antidote is neo or Physostigmine
252 DOC for MRSA: Vancomycin
252 Antibiotic added to Vancomycin to enhance
spectrum is Aztreonam
252 Who am I: Staph epidermidis
253 Who am I: Impetigo
253 Treatment for impetigo: Dicloxacillin or Cephalexin
254 The only tetracycline for renally compromised can
be treated (only) would be Doxycycline
255 Kidney-related syndrome: Fanconi
255 # 1 Who am I: Lyme
255 #2 Who am I: Acne vulgaris
255 #3 Who am I: Mycoplasma pneumoniae
255 #8 disease treated by tetracycline: Acne vulgaris
(Corynebacterium acnes)
255 Rickettsia prowasekii causes epidemic typhus
255 Q-fever: Coxiella burnetti
256 Uniqueness of Coxiella: Causes pneumonia, does
not react to Weil-Felix, has no arthropod vector
256 SIADH treatment: Heparin, alcohol, and lithium
256 Potentiate SIADH: Carbamazepine,
chlorpropamide and clofibrate
256 Who am I: Rocky Mountain Spotted Fever
257 Cipro and Tetracycline are contraindicated
because they deposit in bone and teeth
258 Shared fact for all cited microorganisms: Gram-
negative
258 STDs (Chlamydia and gonococcus)
Osteopmyelitis and soft tissue diseases
UTIs
Prostatitis
Diarrhea (Enterobacteriaciae)
258 Strep pneumo and staph aureus
258 Cipro and tetracycline: Both inhibited by aluminum
or magnesium anacids, and Iron or zinc
supplements; both contraindicated in pregnancy.
258 H FLU DOC: Cephalosporins (3
rd
), Amox and
3. Northwestern Medical Review, Triology Answer Key, 2004
Ampicillin, and TMP/SMX
258 Tendon rupture: Cipro
259 Case of 2-wk female infant:
Chlamydia trachomatis
Topical eye application of erythromycin
(prevention)
Tetracycline (treatment)
259 Multiple Choice: [D]
260 50S ribosome affected by both Chloramphenicol
and erythromycin
260 Treatable by Chloramphenicol: H Flu, Neisseria
meningitidis and Streptococcus pneumonia
260 No; Chloramphenicol is not the primary choice. It
is used only when the patient is seriously allergic
to penicillin and cephalosporin and the identity of
the causative agent is not known.
260 Multiple Choice: [D]
261 Multiple Choice: [E]; [D] is partially true.
261 Erythromycin and Chloramphenicol both interfere
with P-450
262 Who am I: Bacteroides fragilis
263 No sulfas pass the placenta
263 Antimicrobials causing photosensitivity:
Sulfonamide and tetracycline.
Non antimicrobial: Amiodarone
264 Case: E coli infection
The most common cause is E coli
Treatment: TMP/SMX
266 Patient with PPD Reaction: Ethambutol
267 Case TB: Yes they are a normal consequence
Vitamin B6 administration inhibits neuritis.
Hydralazine and Procainamide also cause lupus.
Resistant bugs are treated with cycloserine.
267 Who am I: Steven-Johnson Syndrome
273 Amantadine does not act on Influenza B
273 Uncoating and penetration are the early phases of
viral infection and they are affected by
Amantadine.
273 Antiviral medications are less effective than
antibacterial drugs because viral symptoms
appear late and after completion of the replication
process. While most conventional antiviral drugs
act by disrupting the replication process. Hence,
by the time we see the symptoms its is too late to
apply medications.
274 Herpes medications: Acyclovir, Famiciclovir,
Ganciclovir, Vidarabin, and Foscarnet.
279 Multiple Choice: [D] and [A]
280 Who am I: Candida
281 30-year-old case: Cryptococcos neoformans
281 The antifungals was Amphotericin
Concomitant medication was Flucytosine
281 The two Cs are: candid and Cryptococcos
281 Meningeal inflammatory reactions require patent
immune system
282 Elderly and very young children
282 Disrupt mitosis: vincristine, Paclitaxel,, Colchicine
and Griseofulvin
282 Two oral azoles: Ketoconazole and Fluconazole
282 Topical: Nystatin, Miconazole and Clotrimazole
283 Teratogen: Griseofulvin
283 Ketoconazole requires acidic environment but
Fluconazole does not.
284 Malaria is the number 1 fatal infection
285 Quinidine and quinine
286 Giardia lamblia
287 Put your favorite picture of Tom Cruz here!
288 EAT: Enterobiasis, Ascaris and Trichuris
288 Larval penetration of skin: Necator, Strongyloides
and Ascaris.
288 Infect humans: Strongyloides and pinworm
288 Emigrate to lungs: Necator, Strongyloides and
Ascaris
288 Crawl out of anus: Pinworm
291 Causes purine degradation and hyperuricemia
292 Methotrexate for folate deficiency
293 Case:
Leukopenia, thrombocytopenia, and anemia
Early leucoverin application
Psoriasis and Rheumatoid arthritis
294 Mercaptopurine for gout
295 Case:
Bleomycin is inactivated by a hydrolase that is
deficient in lung and skin tissues.
Alopecia and hyper-pigmentation
Discontinue treatment and use steroids
296 Case: Doxorubicin
296 Doxorubicin and Dactinomycin
297 Hodgkins for MOPP
300 Tamoxifen is not that effective in a 30-year-old
woman
300 Use of estrogens: Prostate cancer
300 Note: Change C to P
Second cancer of males is prostate:
301 Flutamide
301 Who am I: Clomiphene
301 Ototoxicity and peripheral neuropathy
302 Aminoglycosides; cause ototoxicity
302 5 aminoglycosides:
Amikacin. Gentamicin, neomycin, streptomycin,
and tobramycin
302 Use of loop diuretics is prohibited
302 Cause both oto and Nephrotoxicity: Cisplatin, loop
diuretics and aminoglycosides
302 Used in combo with cisplatin: Vinblastine
302 Pulmonary fibrosis:
Amiodarone, Bleomycin and methotrexate
302 Streptozocin for insulinoma
302 Cisplatin for COMLEX and Cyclophosphamide for
USMLE
308 Top 4: Bipolar Disorder, Alzheimers, Major
Depressive, and Schizophrenia.
309 Who am I: Coffee
309 IV medication: Ketamine
Describes effect of Ketamine: Dissociative
anesthesia
Common use of Ketamine: Relatively painful
pediatric procedures (e.g. change of wound
dressing)
310 Two drugs: Ketamine and PCP
Treatment: Diazepam and haloperidol
310 Case of 22-year-old man: Cocaine
310 High dopamine; associated with D2
311 Anticholinergic
Bethanechol that is a cholinergic agonist
311 Extrapyramidal effects
4. Northwestern Medical Review, Triology Answer Key, 2004
311 Tic douloureaux (Trigeminal neuralgia)
312 Partial and tonic clonic
312 Orthostatic hypotension; light-headedness, and
failure to ejaculate
312 Low affinity for D2s
312 Inhibition of pituitary dopamine
Inhibition on prolactin release
Prolactin Inhibitory factor
313 Carbamazepine, Clozapine, Colchicine,,
Chloramphenicol.
313 The other must-0know dug is Phenylbutazone
313 Multiple Choice: [D]
313 Bed-wetting: Imipramine
313 Cardiac arrest: desipramine
314 Least sedative: desipramine
314 Aggression: Clomipramine
314 Painful erection: Trazodon
314 Fatal with the other two: MAOIs
314 Insomnia: SSRIs
314 Widely used: Fluoxetine (Prozak)
314 Denominating effect: Anticholinergic
315 Physostigmine for TCA Anticholinergic effects
315 Neuraleptics malignant syndrome
Drug of choice for NMS: dantrolene and
Bromocriptine
316 Alprazolam for panic
316 Diazepam for alcohol withdrawal
316 Intermediate
316 Who am I: Buspirone
317 Thiopental for induction
317 Phenobarbital for maintenance
317 Benzodiazepines are safer
317 Earliest signs: nystagmus and ataxia
317 Barbiturates are notorious for Porphyria attacks
317 Induce p-450: Phenytoin, Carbamazepine,
Rifampin, Quinidine.
Others: Alcohol and Griseofulvin
319 Gingival hyperplasia: phenytoin
Other two causes: nifedipine and cyclosporine
(immune -suppressant)
320 Valproic acid
Cant prescribe to pregnant woman
320 Hepatic necrosis: Acetaminophen, halothane and
Valproic acid
320 Carbamazepine
320 Non-cancer drugs causing Aplastic anemia:
Phenylbutazone, Chloramphenicol, Trimethoprim,
Clozapine, and Colchicine.
320 Who am I: Steven-Johnson
320 Sulfonamide and penicillin
320 Mycoplasma pneumoniae
320 Drugs Causing Lupus: Phenytoin, Hydralazine,
Isoniazid, minoxidil and Procainamide
321 Multiple Choice: [C]
321 Who am I: Lithium
321 Teratogen: Lithium
321 The antiviral is Amantadine
321 Haloperidol and chlorpromazine
322 Biperiden and Trihexyphenidyl
322 Antiparkinsons drug that causes emesis:
Levodopa

5. Northwestern Medical Review, Triology Answer Key, 2004