What nerves are involved in each of the following reflexes? Achilles Patellar Biceps/brachioradialis Triceps Cremasteric Anal wink

Clinical reflexes: Achilles reflex = S1, S2 (“buckle my shoe”) Patellar reflex = L3, L4 (“kick the door”) Biceps and brachioradialis reflexes = C5, C6 (“pick up sticks”) Triceps reflex = C7, C8 (“lay them straight”) Cremasteric reflex = L1, L2 (“testicles move”) Anal wink reflex = S3, S4 (“winks galore”)

6/21 UWorld Flashcards by Giselle McIntyre

What is the name and cause of damage to the superior trunk of the brachial plexus

Erb-Duchenne Palsy (“waiter’s tip”)
- Injury to superior trunk (C5-C6)
- Causes:
  - Lateral neck traction during delivery of babies
  - Trauma in adults

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Muscle/functions innervated by superior gluteal m/

Innervates:
- Hip abduction and medial rotation of thigh = tensor fasciae lata, gluteus minimus, gluteus medius
Lesion:
- Posterior hip dislocation, polio
- Leads to Trendelenburg sign:
  - Contralateral hip drops when you are standing on leg ipsilateral to lesion

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Muscle/function innervated by inferior gluteal

Innervates:
- Hip extension and lateral rotation of thigh à gluteus maximus
Lesion:
- Posterior hip dislocation
- Hard time getting up from sitting position

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Damage to what nerve caused Trendelenberg gait

Superior gluteal (respsonsible for gluteus medius and minimus, which do hip abduction)

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What nerve gets damaged with knee injury

Tibial (is located posterior to knee)

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What nerve gets damaged with fibula neck fracture

Deep or superficial peroneal

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What nerves are involved in each of the following reflexes?

Achilles
Patellar
Biceps/brachioradialis
Triceps
Cremasteric
Anal wink

Clinical reflexes:

Achilles reflex = S1, S2 (“buckle my shoe”)
Patellar reflex = L3, L4 (“kick the door”)
Biceps and brachioradialis reflexes = C5, C6 (“pick up sticks”)
Triceps reflex = C7, C8 (“lay them straight”)
Cremasteric reflex = L1, L2 (“testicles move”)
Anal wink reflex = S3, S4 (“winks galore”)

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Innervation of teres minor

Axillary nerve

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Defect and presentation of Atazia telangectasia

Immunodeficiency = decreased T-cells and IgA
Defect in ATM gene = failure to repair DNA double strand breaks = cell cycle arrest
- THINK: the “T” in aTaxia and Telangiectasia is a dsDNA
Triad:
· Cerebellar defects – ataxia
· Spider angiomas – telangiectasia
· IgA deficiency

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Structures formed by meso- and metanephros

Mesonephros
- Forms temporary kidney during 1^st trimester
- Later contributes to male genital system – Wolffian ducts
- Caudal end becomes the ureteric bud which gives risk to ureter, pelvises, calyces, collecting ducts
Metanephros
- Interaction with the ureteric bud (caudal portion of mesonephros) induces differentiation and formation of glomerulus, Bowman’s space, proximal tubule, loop of Henles, and distal convoluted tubule

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What type of drug is Chlordiazopoxide

Benzo

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Histology of granulosa-theca cell tumor

Call-Exner bodies

Granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles

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Histology of Sertoli-Leydig cell tumor

Reinke crystals

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What does HELLP syndrome stand for and what is the reasoning behind the symptoms

Stands for:
- H - Hemolysis (anemia)
- EL - Elevated Liver enzymes (RUQ pain, jaundice)
- LP - Low Platelets (bruising bleeding)
Preeclampsia + thrombotic microangiopathy
- Hemolysis = thrombi causing schistocytes
- Liver enzymes = lack of RBCs leads to infarction of liver tissue
- Platelets = all used up in thrombi

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What is Meigs syndrome

Triad of: ovarian fibroma, ascites, pleural effusion

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Mutation and presentation of Williams syndrome

Microdeletion of long arm of chromosome 7 (deletion includes elastin gene)

“Elfin” facies, intellectual disability, hypercalcemia, well-developed verbal skills, extreme friendliess with strangers

THINK: Will Ferrel in the movie elf

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Describe presentation of Tuberous sclerosis

Due to mutated hamartin (or tuberin) gene
- TSC1/TSC2 mutation on chromosome 16
Triad:
- Angiofibromas, mental retardation, seizures
  - Vs. VHL which is angiomatosis
Other symptoms: Ash-leaf spots, hamartomas of CNS and skin, angiomyolipoma
Incomplete penetrance and variable presentation

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What is the equation for incidence

Incidence = number of new cases during a specific time period
- (# of new cases) / (# of people at risk)

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Equation for number needed to treat

1/ARR

NOT 1 - ARR!!

Differentiate between case-control study and cohort study

Case control = compare a group with disease to group without disease and look for prior exposures/risk factors (is retrospective)

Cohort study = compare a group with risk factor to a group without risk factor and look for likelihood of disease (can be prosepective or retrospective)

Describe difference between T-test, ANOVA, and chi-square

T-test:
- Tests for differences between means of 2 groups with continuous variables
- THINK: Tea is meant for 2
ANOVA:
- Tests for differences between means of 3 or more groups with continuous variables
- THINK: 3 words in “Analysis Of Variance”
Chi-square:
- Checks differences between 2 or more percentages or proportions of categorical outcomes (not mean values)
- THINK: Chi-tegorical

Medicare vs. Medicaid

Medicare = elderly + those with certain conditions and end-stage disease

Medicaid = low income

What is a Cushing ulcer

Gastric ulcer due to brain injury

Brain injury = increased vagal stimulation = increased ACh = increased H+ production

What is Menetrier disease

Menetrier disease:
- Gastric hyperplasia of mucosa cells of the stomach
  - Leads to hypertrophied rugae which look like brain gyri
- Atrophy of parietal cells à decreased gastric acid production
- Increased risk of gastric carcinoma

Where is VIP produced and what is its function

* Produced by smooth muscle cells in gut and parasympathetic ganglia * Relaxes smooth muscle and sphincters throughout the GI tract * Causes copious diarrhea

Presentation of tropical sprue

* Unknown cause – probably infectious * Looks like celiac but: * Affects the entire small bowel * Vs. Celiac which mainly affects distal duodenum and proximal jejunum * Responds to antibiotics

Presentation of Whipple disease

* Infection with Tropheryma whipplei * Symptoms: * Weight loss, lymphadenopathy, hyperpigmentation, cardiac symptoms, arthralgias, neurologic symptoms * Histology: * PAS (+) foamy macrophages in intestinal lamina propria

What is boerhaave syndrome

Transmural, usually distal esophageal rupture Due to violent retching Surgical emergency

What is the enzyme that converts glucose to sorbitol? Sorbitol to fructose?

Glucose --\> (aldose reductase) --\> Sorbitol Sorbitol --\> (sorbitol dehydrogenase) --\> Fructose

What bug stains with aniline dye

Diptheria Metachromatic granules will stain red and the rest of the cell will stain blue

What are the possible karyotypes of a partial mole

69, XXX (1 X from egg and 2 X from sperm) 69, XXY (1 X from egg, 1 X from sperm, 1 Y from sperm) 69, XYY (1 X from egg, 2 Y from sperm)

What are the possible karyotypes of a complete mole?

* Empty ovum fertilized by sperm – 46 chromosomes(90% of cases) * Can be fertilized by one sperm which then duplicates * 46, XX * 46, YY zygote would not survive * Can be fertilized by two sperm * 46, XX or 46, XY

What is the drug Baclofen used fo

GABA-B receptor agonist Treats spasticity secondary to both brain and spinal cord disease, including multiple sclerosis

What is the pathogenesis of thrombotic thrombocytopenic purpura (TTP)

Platelets used up in pathologic formation of microthrombi in small vessels Due to decreased ADAMTS13, enzyme that normally cleaves vWF for degradation No vWF degradation = abnormal platelet adhesion = microthrombi

What is the pathogenesis behind immune thrombocytopenia (ITP)

IgG autoantibodies to GP2b3a Antibodies produced by plasma cells of spleen and antibody-bound platelets consumed by macrophages of spleen

What is the defect in Bernard-Soulier syndrome

Defect of glycoprotein 1b Platelet can’t bind to vWF on collagen = defect of platelet plug formation Platelet count is only slightly low – moderate thrombocytopenia Large platelets

What is the defect in Glanzmann thrombasthenia

Genetic GP2b3a deficiency Defect in platelet aggregation Platelet count is normal (they aren’t being destroyed, just can’t aggregate)

Describe drainage in pancreas divisum

* Ventral and dorsal parts fail to fuse * Dominant dorsal duct opens into the duodenum via the major papilla and is responsible for draining the majority of the pancreas * Smaller ventral duct opens into the major papilla and drains the inferior/posterior head and uncinated process

Describe the role that troponin and tropomyosin play in muscle contraction

Tropomysin sits in the myosin-binding sites of actin Troponin molecules are situated alongside tropomyosin When Ca2+ binds to troponin C, the Troponin-Ca2+ complex pulls tropomyosin away, exposing the myosin-binding site

What bases (A, G, T, U) are present at the 5' and 3' splice site of the intron

5' splice site = GU 3' splice site = AG

What disorder is asociated with decreased levels of hypocretin

Narcolepsy * Diagnostic criteria * Recurrent lapses into sleep or naps * Minimum 3x per week for 3 months * At least 1 of the following: * Cataplexy: Brief loss of muscle tone precipitated by strong emotion (e.g. laughter excitement) * Low CSF levels of hypocretin * Shortened REM sleep latency

What is the defect and presentation of multiple myeloma

* Malignant proliferation of monoclonal plasma cell within the marrow * Recall: Plasma cells = mature B-cells that produce immunoglobulin * Classic presentation: * Anemia – plasma cells packed in bone marrow inhibit production of other cells * Renal insufficiency – excessive antibodies plug up kidney and form casts * Back pain – plasma cells stimulate osteoclasts * Hypercalcemia – plasma cells stimulate osteoclasts

What disease is associated with Bcl-2 mutation?

Follicular lymphoma t(14;18) THNK: 18 y/o is when you can buy a gun and start killing people (apoptosis) Apoptosis occurs in the follicle

What is the MOA of Rifaximin in hepatic encephalopathy

Is a poorly absorbed antibiotic that will remain in the GI lumen and can eradicate ammonia producing intestinal bacteria Used to treat hepatic encephalopathy

An interscalane nerve block, targeting the brachial plexus and used to anesthetize the shoulder and upper arm, may also cause paralysis to what structure?

Diaphragm Causes transient ipsilateral diaphragmatic paralysis in nearly all patients by anesthetizing the roots of the phrenic nerve as they pass through the interscalene sheath This nerve block should be avoided in patients with chronic lung disease or contralateral phrenic nerve dysfunction

Is Zollinger-Ellison syndrome more likely to cause gastric ulcers or duodenal ulcers

Duodenal - ZE is a tumor of pancreas or duodenum

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6/21 UWorld Flashcards

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