4/1 Neuro, Endocrine, Psych Flashcards
1
Q
Acne, infertility, anovulation
A
PCOS
2
Q
Myasthenic crisis
A
Intubate them!
triggered by infection or other stressor–> profound weakness of respiratory muscles
3
Q
old man with acute unilateral pain in eye with decreased vision, pupil dilation, conjunctival injection and tearing
A
Acute angle closure glaucoma
tx: beta antagonist (carteolol, timolol)
4
Q
What do the boxes mean on EKG?
A
small box=0.04 sec
large box=0.2 sec
(300, 150, 100, 75, 60, 50)
Normal QT interval 2 large boxes
5
Q
Prolonged QT interval DD
A
Drugs
Genetic:
-Romano-ward syndrome (AD)
–Jervell and lange-Nielsen syndrome (AR + deafness)
6
Q
contraindication for sumatriptan
A
ischemic heart disease, stroke, prinzmetal angina, uncontrolled HTN
(vasoconstrictive MOA)
7
Q
LLQ pain, focal colonic thickening, increased soft tissue density of pericolonic fat, fever, leukocytosis
A
Acute diverticulitis
8
Q
Glomus body
A
small encapsulated neuromuscular organ found in dermis of nail bed, pads of fingers and toes and ears
thermoregulation
9
Q
physiology of urticaria
A
increased perm of microvasculature leading to edema of the superficial dermis
mixed inflammatory infiltrate surrounding superficial dermal venules
10
Q
Spongiosis
A
intercellular epidermal edema
eczematous dermatitis
11
Q
What are janeway lesions?
A
Associated with infective endocarditis
contender macular erythematous lesions on palms and soles
Cause: septic embolization from valvular vegetation’s
i.e. microabscesses
12
Q
what causes osler nodes?
A
IE
immune complex deposition in the skin
PAINFUL
13
Q
Renal metabolism of what aa maximizes acid excretion in the setting of acidosis ?
A
Glutamine to glutamate–> producing ammonium and bicarb to buffer acids in blood
14
Q
goal of a granuloma?
A
wall off offending agent
15
Q
Left frontal lobe injury
A
apathy and depression along with changed personality
16
Q
Right frontal lobe injury
A
disinhibited behavior with changed personality
17
Q
Treatment for delirium
A
Haloperidol if necessary
delirium is acute onset and waxing and waining
18
Q
mechanism of action of PCP
A
N-methyl-D-aspartate receptor antagonist
inhibit reuptake of NE, DA, 5-HT
19
Q
treatment for phobia
A
CBT
20
Q
Psychodynamic psychotherapy
A
developing insight into unresolved conflicts that started in childhood
21
Q
major depression criteria
A
SIG E CAPS Sleep disturbances decreased Interest Guilt or worthlessness Energy decreased Concentration Appetite/weight changes decreased Psychomotor Suicidal ideations
depressed mood
22
Q
Mania criteria
A
DIG FAST Distractibility Irresponsibility Grandiosity Flight of ideas Activity towards a goal increased decreased need Sleep Talkative or pressured speech
23
Q
tx for tourette syndrome
A
Atypical antipsychotics, tetrabenazine, clonidine
24
Q
TCAD suffix
A
-ipramine, -iptiline, -oxepin
25
tx for serotonin syndrome
cyproheptadine
26
RA, neck pain, stiffness, radicular pain
Atlantoaxial joint subluxation
Chronic RA can involve the cervical spine
27
What can worsen cervical spine subluxation?
extension of the neck during endotracheal intubation
compression of the spinal cord and/or vertebral arteries
28
What sites degenerate in Friedrich ataxia?
Spinocerebellar and lateral corticospinal tract-->ataxia and spastic muscle weakness
Degeneration of dorsal columns and dorsal root ganglia
29
Mutations in SOD1
familial ALS
30
what is broken down to make propionic acid
Valine, Isoleucine, threonine, methionine, cholesterol, odd-chain FA
31
MAOIs
Tranylcypromine
Phenelzine
Isocarboxozid
Selegiline
SE: Hypertensive crisis
32
When is K+ ion permeance highest in the neuron?
During the repolarization phase
33
what is the length constant for an axon?
Also called the space constant
measure of how far along an axon an electrical impulse can propagate
Myelin increases space constant by decreasing charge dissipation (increasing membrane resistance)
myelin also increases conduction velocity
34
Lateral nucleus of the hypothalamus
mediates hunger
damage=anorexia
35
ventromedial nucleus of the hypothalamus
mediates satiety
damage=hyperphagia
36
Arcuate nucleus of the hypothalamus
secretes DA, GHrH and GnRH
37
supraoptic nucleus of the hypothalamus
ADH and oxytocin
38
Decerebrate posture
Injury below the red nucleus (midbrain, pons)
extensors predominate
39
Treatment for malnourished alcoholic
Give Thiamine with glucose
Thiamine is cofactor for enzymes involved in glucose metabolism--> glucose w/o thiamine can make wernicke worse
40
kid with severe intellectual disability, seizures and hypo pigmented substantia viagra, locus ceruleus, vagal nucleus dorsalis
PKU
decreased melanin synthesis
catecholaminergic brain nuclei produce neuromelanin
41
Ulcerative colitis
```
ULCCCERS
Ulcers
Large intestines
Continuous
Carcinoma
Crypt abscess
Extends proximally
Red diarrhea
Sclerosing choliangitis
```
42
Smooth muscle contraction vs. skeletal muscle
Smooth muscle uses voltage gated ca channels to activate calmodulin and then myosin light chain kinase--> phosphorylates myosin--> contraction
In skeletal muscle there is no phosphorylation of myosin instead the actin binds directly to the myosin in order to contract
43
Side effects of PPI
Atrophic gastritis (hypergastrinemia)
GI issues
carcinoid tumors
HA
44
Which drug is contraindicated in the presence of cholesterol gallstones?
Fibrates
| increase the amount of cholesterol in the bile
45
Where are VIPomas usually found?
In the tail of the pancreas
VIP increases water and electrolyte secretions in the small intestines and relaxes smooth muscle
46
Primary treatment for Enterococcus
Ampicillin
```
HHELPSS kill enterococci
H. influenza
H. pylori
E. coli
Listeria
Proteus mirabilis
Salmonella
Shigella
```
47
Trendelenburg gait
superior gluteal
48
Treatment for B. cereus
Supportive because it is a preformed toxin
49
Vasogenic cerebral edema vs. cytotoxic
Vasogenic--> BBB damaged (Trauma tumors, inflammation, HTN, high altitude)
Cytotoxic--> BBB intact, disruption of metabolism
ischemic stroke, Reye's, toxins, hypothermia, encephalopathy
Swelling of cells
50
treatment for Huntington
Tetrabenazine and reserpine--> inhibit VMAT--> less dopamine release
Haloperidol--> D2 receptor antagonist
51
Synaptophysin
transmembrane glycoprotein found in presynaptic vesicles of neurons, neuroectodermal and neuroendocrine cells.
52
Galactocerebroside accumulation
Krabbe dz
progressive neurodegenreation with peripheral neuropathy and optic atrophy
53
what is responsible for the the toxic effects of N. meningitis?
Lipooligosaccharide (LOS)
levels of LOS in the blood correlate with morbidity and mortality
54
Where does the rabies virus bind?
Nicotinic ACh receptor
55
SE of inhaled anesthetics
Halothane--hepatotoxicity
Methoxyflurane--neprhotoxicity
enflurane--proconvulsant
N2O--expansion in body cavity
Malignant hyperthermia
56
MAO of ketamine
block NMDA R
57
MOA Propofol
potentiates GABAa and inhibits NMDA R
used for sedation in ICU, rapid anesthesia and short procedures
58
Esters
procaine, cocaine, tetracaine
59
Amides
-Caine with an extra i
nerve block in small myelinated first
1)pain, 2)temperature 3)touch 4)pressure
60
Vitamin E deficiency
ataxia (degeneration of spinocerebellar tracts)
loss of position and vibration sense (degeneration of dorsal columns)
loss of deep tendon reflexes (peripheral nerves)
hemolysis
can look like Friedreich ataxia
61
Poliomyelitis
damage to anterior horn--> asymmetrical flaccid paralysis and hyporeflexia
sensation preserved
62
mandibular nerve function
Motor and sensory!
muscles of mastication + tensor veil palatine and tensor tympani
sensation to TMJ and teeth and floor of mouth
63
Maxillary nerve function
mainly sensory to cheeks, nares, upper lip and teeth and the pharyngeal palate and max sinus
64
optic tract lesions
contralateral homonymous hemianopia
| afferent pupillary defect
swinging flashlight test
65
Lesion to lateral geniculate nucleus
contralateral homonymous hemianopia
NORMAL pupillary light reflex
66
Kulchitsky cells
Enterochromaffin cells
Activated by gastrin to produce Histamine to activate acid secretion in the stomach
67
ANP, BNP
released in response to increased volume
check on RAAS
relaxes smooth muscle via cGMP--> increases GFR decreases renin
68
Metoclopramide
D2 agonist
treat nausea and vomiting
increases gastric motility
69
Metolazone
thiazide like drug for CHF and HTN
70
Rosacea
inflammatory facial skin redness with papule and pustules
facial flushing with alcohol and heat
71
Pityriasis rosea
"Herald patch" followed by scaly erythematous plaques
self resolves
72
Warm agglutinin
IgG (warm weather is Greater)
chronic hemolytic anemia seen in SLE and CLL
73
Cold agglutinin
IgM
acute anemia triggered by cold (periphery)
mycoplasma pneumonia and mono
74
Renal cell carcinoma pathogenesis
Loss of VHL--> increased IGF-1 (growth) and HIF (increase VEGF and PDGF) (angiogenesis)
75
Regulation of Hormone-sensitive lipase
Activated by catecholamines (epi) and ACTH
inhibited by insulin
releases TGs from adipose tissue
76
Where is glucose synthesized?
Liver
Kidney
(from odd chain fatty acids)
77
Mutation causing beta thalassemia
point mutation in splice site and promoter sequences--> decreased beta globin synthesis
mRNA defect
78
21-hydroxylase deficiency
usually early onset but can be late onset and less severe
high renin and 17-hydroxyprogesterone
hypotension and hyperkalemia
Infancy--salt wasting
childhood--precocious puberty
adulthood--clitoral enlargement and hirsutism
79
Blistering cutaneous photosensitivity
Porphyria cutanea tarda
Deficiency in uroporphyrinogen decarboxylase
increased uroporphyrin (tea-colored urine)
(defect in heme synthesis)
80
Pathophys of Hemochromatosis
Mutation C282Y or H63D on HFE gene (A3)
increased intestinal absorption of iron (over active transferrin)
81
Post MI complications day 1-3
fibrinous pericarditis
friction rub
82
Post MI complications day 4-7
Rupture!
ventricular wall (cardiac tamponade)
inter ventricular septum
papillary muscle
83
Effects of hCG in men
stimulates leydig cells to synthesize testosterone
tx for hypogonadism or fertility
84
lesion in internuclear ophthalmoplegia
ipsilateral medial longitudinal fasciculus
85
first sign of puberty in females
breast bud development
THEN pubic hair
86
First sign of puberty in males
testicular enlargement
87
Pelvic splanchnic
Parasympathetic to rectum and sigmoid colon
damage--constipation
88
where does heme synthesis take place?
mitochondria and the cytoplasm
89
Which nerves are in the anterior compartment of the leg?
Deep peroneal
| Anterior tibial
90
Endothelin
Vasoconstrictor that increases BP
increased in pulmonary hypertension and hypertrophic cardiomyopathy (along with c-jun and beta-mysocin heavy chain)
balanced by NO and prostacyclin
91
Lab findings for primary hyperaldosteronism
Normal Na (aldo escape)
HTN
Hypokalemia
metabolic alk
92
effect of hypokalemic alkalosis
weakness and paresthesias
93
In pancreatic beta cells what activates the potassium channels?
ATP made from glycolysis
94
What is Reverse T3
in active form of T3 that is made from conversion or T4
95
Immune effects of corticosteroids
Neutrophilia (due to degranulation
Immunosuppression
increased risk of infection
96
MOA meglitinides
block the closing of ATP-dependent K+ channel in pancreatic beta cells
increase insulin release
97
role of DHT
Development of the external male genitalia
prostate
male pattern baldness
produced via 5-alpha reductase
deficiency=male pseudohermaphroditism
98
Role of human parental lactogen (hPL)
modifies metabolic state of mother during pregnancy to supply baby with energy
anti-insulin-->Insulin resistance!!!
99
Squamous cell carcinoma paraneoplastic syndromes
PTHRP and dermatomyositis
| hypercalcemia--> kidney stones
100
effect of hypocalcemia
QT prolongation
tetany
seizures
101
treatment for severe hypocalcemia
1. Mg (need to replace otherwise won't absorb Ca)
2. Ca2+
3. activated Vit D (calcitriol)
102
Small cell lung cancer paraneoplastic syndromes
ADH, ACTH, GH
103
Membranous nephropathy on histology
Sub epithelia spikes and domes
104
Diabetic eye injury
Retinopathy
Vitreous Hemorrhage
Causes: trauma, retinal tear, vitreous detachment
or retinal neovascularization (DM)
diminished red reflex
105
treatment for vitreous hemorrhage
partial or total vitrectomy
106
Child with lytic bone lesion and skin rash or recurrent otitis media
Langerhans cell histiocytosis
proliferation of DC
s-100+
Birbeck granules
