2/18 Flashcards
Satiety center of hypothalamus
- Ventromedial area.
- “If you zap your ventromedial area, you will grow both ventrally and medially”.
- stimulated by leptin.
- damage may be caused by craniopharyngioma.
Hunger center of hypothalamus
- Lateral area.
- “If you zap your lateral nucleus, you will shrink laterally.”
- inhibited by leptin.
- Lat makes you Fat.
Ant. hypothalamus
-cooling, parasymp.
Post. hypothalamus
-heating, sym.
Stroke to PCA
- occipital cortex, visual cortex.
- contralat. hemianopia w/macular sparing.
Where can the great saphenous vein be harvested from?
-just inferolateral to the pubic tubercle.
Whats a common way to get Klumpke palsy and what are symptoms?
- grabbing tree branch while falling.
- Lower trunk (C8-T1) of brachial plexues.
- total claw hand. clumsiness of hand.
What is the only muscle innervated by the ext. branch of the sup. laryngeal nerve?
Cricothyroid muscle
What nerve is at risk during a thyroidectomy?
External branch of superior laryngeal nerve. Due to its proximity to the superior thyroid a/v.
-this nerve inn. the cricothyroid muscle. Which is the only muscle of the larynx not inn. by the reccurent laryngeal.
Where does thoracic duct enter thorax?
- aortic hiatus
- so does azygos vein.
Where does vagus n. enter abdominal cavity?
-T10, esophageal hiatus.
Portocaval anastomoses (PCAs): esophageal varices
- portal circ: left gastric vein
- systemic circ: esophageal vein
PCAs: hemorrhoids
- portal circ: superior rectal vein
- systemic circ: middle & inferior rectal veins
PCAs: caput medusae
- portal circ: paraumbilical veins
- systemic circ: superficial & inferior epigastric veins
Obturator n.
- nerve roots
- muscules
- L2-L4. “Kobe is a smooth obturator”.
- adductors
Common peroneal (fibular) n.
- nerve roots
- muscles
- how to injure?
-L4–S2
-tibialis anterior = only need to know muscle.
-Trauma or compression of lateral aspect of leg,
fibular neck fracture
-you get foot drop.
Tibial n.
- roots
- how to injure
- problems s/p injury
-L4-S3
-Knee trauma, Baker cyst (proximal lesion); tarsal tunnel syndrome (distal lesion).
-Inability to curl toes and loss of sensation on sole
of foot. In proximal lesions, foot everted at rest
with loss of inversion and plantarflexion.
Diseaes that can damage superior gluteal nerve?
Polio
PED
Peroneal Everts and Dorsiflexes; if injured, foot drop PED
TIP
Tibial Inverts and Plantarflexes; if injured, can’t stand on TIPtoes.
Which responds to aspirin (pain-wise):
Osteoid osteoma or osteoblastoma?
osteoid osteoma.
Whats the only tumor we need to know about that arises in the epiphysis of bone?
Giant cell tumor.
- locally aggressive yet benign tumor often around the knee.
- “Soap bubble” appearance on x-ray.
- Multinucleated giant cells.
Where to find osteosarcoma?
-Metaphysis of long bones, often around knee. -malignant prolif. of osteoblasts. -region of growth plate = metaphysis. -codman triangle (elevation of periosteum) -sunburst pattern on x ray
What are the 2 most common bone malignancies in children?
Osteosarcoma & ewings sarcoma.
Ewings sarcoma
- who gets it?
- where does it appear?
- what do cells look like?
- is it responsive to chemo?
- boys <15 yo
- diaphysis
- Anaplastic small blue cell malignant tumor
- it IS responsive to chemo
-“Onion skin” appearance in bone.
-Associated with t(11;22) translocation.
(11 + 22 = 33 (Patrick Ewing’s jersey number).
juvenile rheumatoid (idiopathic) arthritis
- is rheumatoid factor always present?
- ANA still positive?
rheumatoid factor is often absent. ANA still positive.
RA can get bakers cyst in popliteal fossa
-what are other possible Sxs?
subQ rheumatoid nodules = fibrinoid necrosis.
- fever, fatigue, pleuritis, pericarditis.
- spiking/remitting fevers = possible.
Whats the most specific test for RA?
anti–cyclic citrullinated peptide antibody test.
HLA association w/RA?
HLA-DR4
Physical finding in Sjogrens
- dry eyes
- dry mouth
- bilateral parotid gland enlargement.
- dental caries
Gout: joints problems due to which cell?
neutrophils
Gout: birefringence?
neg. birefringence
- yellow under parallel light
- blue under perpendicular light.
Psuedogout
-what type of crystals?
- calcium pyrophosphate crystals
- rhomboid crystals
Infectious arthritis vs lyme disease?
-what distinguishes them apart?
Lyme disease = polyarthritis
Infectious arthritis = mono
-IA: S. aureus, Streptococcus, and Neisseria gonorrhoeae
Psoriatic arthritis
- symmetics or asymmetric?
- other Sxs?
- Asymmetric and patchy involvement.
- Dactylitis (“sausage fingers”), “pencil-in-cup” deformity on x-ray.
Ankylosing spondylitis
-other Sxs
- uveitis
- aortitis/aortic regurg.
- bamboo spine (vertebral fusion)
3 common drugs that induce lupus?
hydralazine, procainamide, isoniazid
2 types of nephritis caused by SLE
- Nephritic—diffuse proliferative glomerulonephritis.
- Nephrotic—membranous glomerulonephritis.
-10-30% of lupus pts have Lupus Anticoagulant = the
most frequent cause of prolonged PTT & false pos.
VDRL test.
Lupus anticoagulant can cause an
antiphospholipid Ab syndrome leading to
hypercoaguability & repeated miscarriages.
Drug induced lupus: which auto-ab?
anti-histone Ab
SLE: C3 and C4 levels?
dec. C3, C4, and CH50 due to immune complex
formation.
hydroxychloroquine
- Treatment for lupus.
- anti-malarial
Sarcoidosis
-associated Sxs
- restrictive lung disease (interstitial fibrosis),
- erythema nodosum
- lupus pernio
- Bell palsy
- epithelioid granulomas containing microscopic Schaumann and asteroid bodies
- uveitis
- hypercalcemia
Is there muscle weakness in Polymyalgia rheumatica?
no
-also, normal CK
Lab values in Polymyalgia rheumatica (50+yo)
- inc. ESR
- inc. CRP
- normal CK
Fibromyalgia (20-50yo)
- better or worse w/exercise?
- emotion/sleep disturbances
- Tx?
- worse w/exercise
- treat w/exercise, anti-depressants, anti-convulsants
*multiple, symmetric tender spots.
Polymyositis
-CD8 or CD4?
CD8
- shoulders
- cant brush hair.
Dermatomyositis
-CD8 or CD4?
CD4
- malar rash (similar to SLE),
- Gottron papules
- heliotrope (erythematous periorbital) rash
- “shawl and face” rash ,
- “mechanic’s hands.”
- risk of occult malignancy.
serum chemistry in polymyositis/dermatomyositis
inc.CK, (+) ANA, (+) anti-Jo-1, (+) anti-SRP,
(+) anti-Mi-2 antibodies.
LEMS
-dont forget about autonomic problems.
dry mouth, impotence.
Diffuse scleroderma, Ab?
Scl-70 antibody (anti-DNA topoisomerase I antibody)
Freckle
macule
Acanthosis
-diffuse epidermal hyperplasia with increased thickness of the stratum spinosum.
Hyperkeratosis
-thickening of the stratum corneum, often associated with a qualitative abnormality of the keratin.
Parakeratosis
-seen in what?
- keratinization with retained nuclei in the stratum corneum. On mucous membranes, parakeratosis is normal.
- psoriasis, actinic keratosis.
Spongiosis
-Epidermal accumulation of edematous fluid in
intercellular spaces.
Acantholysis
Separation of epidermal cells
melanin protects against which type of light?
UVB
Melasma (chloasma)
-Hyperpigmentation associated with pregnancy (“mask of pregnancy) or OCP use.
Melanin production is stimulated by:
- Sun exposure
- MSH (Melanocyte Stimulating Hormone)
- ACTH (Adrenocorticotropic Hormone)
- Estrogen
- Progesterone
Verrucae
warts (HPV)
congenital nevus vs. melanoma
congenital nevus can have hair.
-melanoma will never have hair growing from it.
Ephelis
freckle
- normal # of melanocytes.
- too much melanin/too many melanosomes.
Bullous pemphigoid
- spares which mucosa?
- blisters contain which cell type?
- oral mucosa
- eosinophils
Erythema multiforme
- most commonly associated w/which infection?
- which drugs?
- HSV
- sulfa drugs, phenytoin, beta-lactams.
Acanthosis nigricans
-associated w/too much of what hormone?
- insulin
- also w/visceral malignancy.
Erythema nodosum
- classic location?
- associated with?
-ant. shins.
-sarcoidosis, coccidioidomycosis, histoplasmosis, TB,
streptococcal infections, leprosy, and Crohns disease.
Lichen Planus
- what are 6 Ps?
- what virus is it associated with?
- Pruritic, Purple, Polygonal, Planar, Papules, and Plaques
- Wickham striae (reticular white lines).
- Sawtooth infiltrate of lymphocytes at dermal-epidermal
junction. - Associated with hepatitis C.
PABA containing sunscreens only protect against ____
- UVB (sunburn)
- on another note, UVA = tanning & photoaging.
Whats the most common skin cancer?
Basal cell carcinoma
Basal cell
- how would you describe their nuclei?
- upper or lower lip?
- “palisading” nuclei
- upper lip
Melanoma
- tumor marker?
- common mutation?
- treatment for BRAF V600E?
- S-100
- BRAF kinase mutation
- vemurafenib (BRAF kinase inhibitor)
Do you give an asthmatic aspirin or tylenol?
aspirin is contraindicated in asthma b/c stops COX so everything goes to lipooxygenase, which means lots of leukotrienes which are cause bronchoconstriction (Gq pathway). So tylenol given instead of aspirin to asthmatics.
Side effects of bisphosphonates
- corrosive esophagitis
- osteonecrosis of jaw
*remember to administer Ca w/bisphosphonates.
Give aspirin to gout pts?
-Do not give salicylates
-all but the highest doses depress uric acid clearance. Even high doses (5–6 g/day) have only minor uricosuric
activity.
*low doses prevent secretion of uric acid into renal tubules. Its a weak acid so it competes for secretion.
Infliximab
-whats another TNF-alpha mab?
adalimumab
