1.

Northwestern Medical Review, Triology Answer Key, 2005

Supplement And Answer Key
Physiology and Pharmacology With Relevant Pathology: Triology Review Notes

Note: Answers to many of the questions and filling-blank options are presented after the questions in your textbook.

Page Notes
10 Neither!
15 Alzheimers, low ACh
Depression, low Norepinephrine and Low
Serotonin
Parkinsons, Low Dopamine
Huntington, Low ACh and GABA
Bipolar Dz, Low Serotonin
Schizophrenia, High Dopamine
19 Matching:
1 E, 2 A & D, 3 C, 4 B and 5 B
21 Multiple Choice (Top-right panel): [B]
21 Question: Since ganglionic blockers abolish the
entire autonomic output, how do we predict their
effect on various bodily systems?
Answer: 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.
23 Phenylephrine!
25 Multiple Choice: [A]
26 Coombs:
Procainamide, Quinidine and Methyldopa
26 Multiple Choice: [D]
29 Multiple Choice: [E]
30 1.Reserpine; 2.Methyldopa; 3.Clonidine, and
4.Propranolol
32 Endothelium Derived Relaxing Factor
32 Pilocarpine enters CNS. May cause hallucination,
convulsion and generalized cholinergic effect.
33 Tubocurarine is not used prior to anesthesia
because paralysis of skeletal muscles alarms the
patient.
Antidote is physostigmine
34 Wait for new enzyme to be generated; use 2-PAM
early during toxicity.
35 Multiple Choice: [E]
35 Edrophonium
36 Anticholinergics cause delirium and potentially
promote dementia!
36 TCAs and neuraleptics, among other things,
inhibit cholinergic receptors. Hence, they promote
delirium and dementia.
37 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!
37 Multiple Choice: [C]
37 Case of the patient who is exposed to high levels
of parathion:
Cholinergic crisis symptoms (SLUDge!): see pp.
35 for description of SLUDge!
Slow heart, bronchoconstriction and Loss of
accommodation. etc.
How can we help the patient?
Atropine reverses SLUDge;
ATM! medications (Albuterol, Terbutaline and
Metaproterenol) dilate bronchioles.
Cholinergic slowdown glycogen degradation in the
liver and promote hypoglycemia; hence
administration of glucagons would be helpful to
raise sugar.
38 Diabetes, glaucoma and trachoma
38 Closed angle glaucoma
38 Pilocarpine
38 Rapid miosis
39 Atropine for Dilation of iris
39 Organophosphate=Echothiophate
39 Multiple Choice [E]
39 Last set of questions: Echothiophate or
Isoflurophate
43 Multiple Choice: [D]
48 There is no or less parasympathetic effect on the
ventricles
51 V1 and aVR
53 In left axis deviation, II registers more downward
deviation.
53 Downward deflection of QRS in I is due to right
deviation
53 The net cardiac electrical activity is to the left (to
the side of more mass) and away from V1
53 V1 shows upward deflection in right ventricular
hypertrophy
53 V1 shows exaggerated downward P in left atrial
hypertrophy
53 V6 shows lowest positive amplitude in right
ventricular hypertrophy
53 AVR and axis of normal depolarization
diametrically oppose each other.
54 Multiple Choice: [B]
56 Adenosine and verapamil
57 Multiple Choice: Ventricular premature beats
60 Multiple Choice: [D]
64 Multiple Choice: [A]
65 Multiple Choice: [D]
66 Correction: Replace fixed Split in line 2 under
the topic of Fixed Split to ASD . The line 2 should
read ASD causes a left to right shunt.
69 [D]
69 [B]
70 Left! Wedge pressure is not increased in right
failure.
74 Correct Title: Prevention of Orthostatic
Hypotension
78 Cant use digitalis for ventricular fibrillation or
bradycardia.
79 Nifedipine has most pronounced effect on
arterioles
2. Northwestern Medical Review, Triology Answer Key, 2005
80 Multiple Choice: [D]
80 Verapamil
81 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
81 Inhibit P450: Chloramphenicol, Cimetidine,
phenylbutazone and metronidazole
81 Induce P450: Alcohol, barbiturate, Phenytoin,
Rifampin, and Griseofulvin
83 Matching: A4, B5; C1; D3; E2
84 Bradycardia treatment: Atropine and beta1-
agonists
Tachycardia Treatment: Antiarrhythmics
85 IA most notorious in dropping contractility:
Disopyramide
85 IA indications: Ventricular tachycardia and
prophylaxis of supraventricular arrhythmias
87 Top tested: Quinidine, Procainamide, Phenytoin,
Lidicaine and Amiodarone
87 Two major conditions increasing digitalis toxicity:
Calcium blockers and hypothyroidism
87 Cause lupus: Procainamide, Hydralazine,
Minoxidil, INH and Phenytoin
88 Matching: Sodium Blockers: A, C, E and G
Potassium Channels blockers: F
Calcium blocker: D
Beta-locker: B
88 Multiple choice: [D]
94 Multiple Choice: [D]
95 Multiple Choice: [C]
96 Correction: Right panel title: Change Extrinsic to
Final Pathway
98 Multiple Choice: [D]
99 Second Multiple Choice: [A]
100 All coagulation factors are made by the livers
except von Willebrands
100 Multiple Choice: [E]
101 Factors XII, XI, X, and IX are in the intrinsic
pathway. Hence, heparin increases PTT.
105 Bowmens Colloid Pressure: 0
105 Multiple Choice: [D]
106 A hypertensive treated with ACE: Decrease
108 Multiple Choice: [E]
111 Correction: Upper Left panel Drawing. Change the
direction of Potassium flow in distal to outside to
inside to indication active distal excretion for K+
113 Multiple Choice: [B]
115 Multiple Choice: [B]
116 Multiple Choice: [E]
119 Multiple Choice: [D] and [B]
122 If bicarb and pH are lowMixed respiratory and
metabolic acidosis
122 If bicarb and pH are highMixed respiratory and
metabolic alkalosis
122 Anion Gap determines the cause of acidity
122 Acids that increase with increased anion gap are
non-carbonic acids
123 [E]
123 All metabolic acidosis increase the gap except
hyperchloremic
124 Multiple Choice: [A]
125 Multiple Choice: [D]
126 Glucose for cholera
127 Case of 21-year-old female:
Metabolic acidisis
Normal gap unless she starves herself (and get
ketoacidosis)
Increased chloride
Acidosis causes hyperkalemia
Tall T
129 Case: Patient has metabolic alkalosis
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.
144 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.
146 Multiple choice [D]
157 Multiple choice [B]; she has Glucagonoma
157 Growth Hormone uses tyrosine kinase
162 Multiple choice [A], [B] and [C]
164 Multiple choice [E]
166 Multiple choice [C]
168 Multiple choice [A]
175 Multiple choice [A]; Hashimoto
179 After Occlusion: Hypocalcemia; Trousseaus
After Tapping: Hypocalcemia; Chevosteks
180 Multiple choice [C]
188 Multiple choice [D], and [B]
189 Multiple choice [B]
189 Multiple choice [B]
190 Multiple choice [A]; Clomiphene
195 Multiple choice [C]
196 Multiple choice [C]
205 Multiple choice [C] and [A]
207 Multiple choice options: [Secretin]
All antibacterial answers are at the end of the
chapter.
249 Amantadine does not act on Influenza B
249 Uncoating and penetration are the early phases of
viral infection and they are affected by
Amantadine.
249 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 it is too late to
3. Northwestern Medical Review, Triology Answer Key, 2005
apply medications.
250 Herpes medications: Acyclovir, Famiciclovir,
Ganciclovir, Vidarabin, and Foscarnet.
251 Correction: Last line of left column; Nevirapine is
a non-nucleoside reverse transcriptase inhibitor.
254 Multiple Choice: [D] and [A]
255 Who am I: Candida
256 30-year-old case: Cryptococcos neoformans
256 The antifungals was Amphotericin
Concomitant medication was Flucytosine
256 The two Cs are: candid and Cryptococcos
256 Meningeal inflammatory reactions require patent
immune system
256 Elderly and very young children
257 Disrupt mitosis: vincristine, Paclitaxel,, Colchicine
and Griseofulvin
257 Two oral azoles: Ketoconazole and Fluconazole
257 Topical: Nystatin, Miconazole and Clotrimazole
257 Teratogen: Griseofulvin
257 Ketoconazole requires acidic environment but
Fluconazole does not.
258 Left Panel: Fluconazol; Cyclosporine, Phenytoin,
Terfenadine, Sulfonyluria and Warfarin
258 Nystatin, Miconazole, and Clotrimazole
259 Malaria is the number 1 fatal infection
260 Quinidine and quinine
261 Giardia lamblia
262 Put your favorite picture of Tom Cruz here!
263 EAT: Enterobiasis, Ascaris and Trichuris
263 Larval penetration of skin: Necator, Strongyloides
and Ascaris.
263 Infect humans: Strongyloides and pinworm
263 Emigrate to lungs: Necator, Strongyloides and
Ascaris
263 Crawl out of anus: Pinworm
266 Case:
Leukopenia, thrombocytopenia, and anemia
Early leucoverin application
Psoriasis and Rheumatoid arthritis
266 Mercaptopurine for gout
267 Case:
Bleomycin is inactivated by a hydrolase that is
deficient in lung and skin tissues.
Alopecia and hyper-pigmentation
Discontinue treatment and use steroids
267 Case: Doxorubicin
267 Doxorubicin and Dactinomycin
268 Hodgkins for MOPP
270 Tamoxifen is not that effective in a 30-year-old
woman
270 Use of estrogens: Prostate cancer
270 Note: Change C to P
Second cancer of males is prostate:
270 Flutamide
271 Ototoxicity and peripheral neuropathy
271 Aminoglycosides; cause ototoxicity
271 5 aminoglycosides:
Amikacin. Gentamicin, neomycin, streptomycin,
and tobramycin
271 Use of loop diuretics is prohibited
271 Cause both oto and Nephrotoxicity: Cisplatin, loop
diuretics and aminoglycosides
271 Used in combo with cisplatin: Vinblastine
271 Pulmonary fibrosis:
Amiodarone, Bleomycin and methotrexate
271 Streptozocin for insulinoma
271 Cisplatin for COMLEX and Cyclophosphamide for
USMLE
278 Who am I: Coffee
278 IV medication: Ketamine
Describes effect of Ketamine: Dissociative
anesthesia
Common use of Ketamine: Relatively painful
pediatric procedures (e.g. change of wound
dressing)
278 Two drugs: Ketamine and PCP
Treatment: Diazepam and haloperidol
278 Case of 22-year-old man: Cocaine
279 High dopamine; associated with D2
279 Anticholinergic
Bethanechol that is a cholinergic agonist
280 Extrapyramidal effects
280 Tic douloureaux (Trigeminal neuralgia)
280 Partial and tonic clonic
280 Orthostatic hypotension; light-headedness, and
failure to ejaculate
280 Low affinity for D2s
280 Inhibition of pituitary dopamine
Inhibition on prolactin release
Prolactin Inhibitory factor
281 Carbamazepine, Clozapine, Colchicine,,
Chloramphenicol.
281 The other must-0know dug is Phenylbutazone
281 Multiple Choice: [D]
281 Bed-wetting: Imipramine
282 Cardiac arrest: desipramine
283 Least sedative: desipramine
283 Aggression: Clomipramine
283 Painful erection: Trazodon
283 Fatal with the other two: MAOIs
283 Insomnia: SSRIs
283 Widely used: Fluoxetine (Prozak)
283 Denominating effect: Anticholinergic
283 Physostigmine for TCA Anticholinergic effects
283-
284
Neuraleptics malignant syndrome
Drug of choice for NMS: dantrolene and
Bromocriptine
285 Alprazolam for panic
285 Diazepam for alcohol withdrawal
285 Intermediate
285 Who am I: Buspirone
285 Thiopental for induction
286 Phenobarbital for maintenance
286 Benzodiazepines are safer
286 Earliest signs: nystagmus and ataxia
286 Barbiturates are notorious for Porphyria attacks
286 Induce p-450: Phenytoin, Carbamazepine,
Rifampin, Quinidine.
Others: Alcohol and Griseofulvin
288 Gingival hyperplasia: phenytoin
Other two causes: nifedipine and cyclosporine
(immune -suppressant)
288 Valproic acid
Cant prescribe to pregnant woman
289 Hepatic necrosis: Acetaminophen, halothane and
Valproic acid
4. Northwestern Medical Review, Triology Answer Key, 2005
289 Carbamazepine
289 Non-cancer drugs causing Aplastic anemia:
Phenylbutazone, Chloramphenicol, Trimethoprim,
Clozapine, and Colchicine.
289 Who am I: Steven-Johnson
289 Sulfonamide and penicillin
289 Mycoplasma pneumoniae
289 Drugs Causing Lupus: Phenytoin, Hydralazine,
Isoniazid, minoxidil and Procainamide
289 Multiple Choice: [C]
290 Who am I: Lithium
290 Teratogen: Lithium
290 The antiviral is Amantadine
290 Haloperidol and chlorpromazine
291 Biperiden and Trihexyphenidyl
291 Antiparkinsons drug that causes emesis:
Levodopa