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STEP > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Order of neurovasculature in femoral triangle

A

vein, artery, nerve (medial to lateral)

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2
Q

location of cricothyroid membrane (for cricothyroidotomy if someone is choking)

A

superior to cricoid cartilage inferior to thyroid cartilage (vignettes 22)

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3
Q

paraesophageal hernia

A

Fundus protrudes into thoracic cavity. GEJ remains fixed below diagram unlike in sliding hiatal hernia.

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4
Q

Femoral nerve palsy: 1) common scenario 2) dysfunction

A

1) Pelvic fracture
2) weakness in right leg and lack of sensation in anterior area of thigh + weakness with extension of right knee + weak hip flexion

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5
Q

klumpke vs erb palsy

A

klumpke is an abduction injury; Erb palsy is an adduction injury

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6
Q

Jugular foramen (Vernet) syndrome

A

lesion to jugular foramen, thus CN 9, 10, 11 affected

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7
Q

Jugular foramen (Vernet) syndrome presentation

A

dysphagia + hoarseness + dysarthria + loss of gag reflex on ipsilateral side + deviation of uvula toward normal side + atrophy of sternocleidomastoid muscle and trapezius.

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8
Q

unhappy triad

A

ACL + MCL + medial meniscus

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9
Q

compartment syndrome presentation

A

Persistent leg pain + swollen, tense, and warm region + decreased anterior tibial pulse.

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10
Q

causes of compartment syndrome

A

crush injury + fracture + chronic vigorous exercise

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11
Q

FDS vs. FDP

A
  • FDS wraps around PIP.

- FDP goes all the way to the end and flexes wrist + MCP + interphalangeal joints.

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12
Q

ACL location

A

lateral femoral condyle –> anterior tibia.

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13
Q

PCL location

A

medial femoral condyle –> posterior tibia.

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14
Q

Lachman test

A

Tests for ACL injury, at 30 degree angle

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15
Q

valgus/varus

A

lateral force/medial force

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16
Q

McMurray test

A

1) pain, “popping” on external rotation –> medial meniscal tear.
2) pain, “popping” on internal rotation –> lateral meniscal tear.

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17
Q

Baker cyst

A

Popliteal fluid collection in gastrocnemius-semimembranous bursa, commonly communicating with synovial space and related to chronic joint disease.

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18
Q

most common rotator cuff injury?

A

supraspinatus

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19
Q

test for supraspinatus tear?

A

“empty/full can” test.

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20
Q

infranspinatus innervation

A

suprascapular nerve

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21
Q

Most common pitching injury

A

infraspinatus

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22
Q

teres minor innervation

A

axillary

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23
Q

subscapularis innervation

A

upper and lower subscapular nerves

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24
Q

SITS muscle innervated by

A

C5-C6

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25
Q

bone palpated in anatomic snuff box

A

scaphoid

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26
Q

lunate dislocation

A

Can cause carpal tunnel syndrome

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27
Q

damage to hook of hamate

A

ulnar nerve injury (common with fall on outstretched hand).

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28
Q

axillary innervation

A

C5-C6

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29
Q

musculocutaneous innervation

A

C5-C7

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30
Q

loss of supination suggests…

A

musculocutaneous damage

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31
Q

decreased grip strength suggests

A

radial nerve injury (wrist extension necessary for maximal action of flexors)

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32
Q

Median innervation

A

C5-T1

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33
Q

supracondylar fracture of humerus damages

A

median

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34
Q

location of radial nerve deep branch

A

supinator canal, where it can be injured with repetitive pronation/supination (such as using a screwdriver).

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35
Q

ulnar innervation

A

C8-T1

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36
Q

radial deviation of wrist upon flexion indicates…

A

ulnar injury

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37
Q

Nerve responsible for abduction and adduction of fingers

A

Interossei muscle, innervated by ulnar.

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38
Q

recurrent branch of median nerve innervation

A

C5-T1

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39
Q

recurrent branch of median nerve 1) scenario 2) presentation

A

1) superficial laceration of palm

2) “ape hand”, loss of thenar muscle group: oppostion, abduction, and flexion of thumb. *no loss of sensation

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40
Q

medial antebrachial cutaneous nerve distribution

A

FA 442

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41
Q

Damage to posterior cord causes…

A

Wrist drop

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42
Q

erb palsy muscle deficit

A

deltoid, supraspinatus, infraspinatus, biceps brachii

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43
Q

klumpke palsy nerve damage

A

C8-T1

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44
Q

lumbricals function

A

Flex MCP joints, extend DIP and PIP joints.

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45
Q

klumpke palsy muscle deficit

A

intrinsic hand muscles; lumbricals, interossei, thenar, hypothenar

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46
Q

TOS functional deficit

A

atrophy of instrinsic hand muscles; ischemia, pain, and edema due to vascular compression.

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47
Q

pope’s blessing seen with

A

proximal median nerve injury

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48
Q

hand presentation for proximal ulnar nerve injury

A

“OK gesture” (digits 1-3 flexed)

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49
Q

dorsal vs. palmar interossei

A

Dorsal abduct fingers, palmars adduct (DAB PAD)

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50
Q

Obturator innervation

A

L2-L4

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51
Q

Pelvic surgery nerve at risk

A

obturator

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52
Q

femoral innervation

A

L2-L4

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53
Q

Nerve at risk with pelvic fracture

A

femoral

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54
Q

femoral injury presentation

A

decreased thigh flexion and leg extension

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55
Q

common peroneal roots

A

L4-S2

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56
Q

tibial roots

A

L4-S3

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57
Q

tarsal tunnel syndrome

A

distal lesion to tibial nerve

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58
Q

tibial nerve damage presentation

A

Inability to curl toes and loss of sensation on sole of foot.

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59
Q

tibial nerve proximal lesion

A

Foot everted at rest with loss of inversion and plantarflexion.

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60
Q

superior gluteal nerve roots

A

L4-S1

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61
Q

localizing trendelenburg

A

lesion is contralateral to side of hip that drops, ipsilateral to extremity on which patient stands

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62
Q

Inferior gluteal roots

A

L5-S2

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63
Q

nerve at risk with posterior hip dislocation

A

inferior gluteal

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64
Q

inferior gluteal lesion presentation

A

difficulty climbing stairs + rising from seated position + loss of hip extension

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65
Q

superior gluteal innervates..

A

gluteus medius, minimus + tensor fascia latae.

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66
Q

inferior gluteal nerve innervates…

A

gluteus maximus

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67
Q

sciatic nerve roots

A

L4-S3

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68
Q

sciatic path and innervation

A

innervates posterior thigh, splits into common peroneal and tibial nerves.

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69
Q

pudendal roots

A

S2-S4

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70
Q

Best location for IM gluteal injection

A

superolateral quadrant

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71
Q

Presentation of L3-L4 herniation

A

Weakness of knee extension, decreased patellar reflex.

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72
Q

Presentation of L4-L5 herniation

A

weakness of dorsiflexion, difficulty in heel-walking

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73
Q

Presentation of L5-S1 herniation

A

weakness of plantarflexion, difficulty in toe-walking + decreased achilles reflex

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74
Q

long thoracic nerve travels with…

A

lateral thoracic artery

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75
Q

axillary nerve travels with

A

posterior circumflex artery

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76
Q

radial nerve travels with

A

deep brachial artery

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77
Q

median nerve location

A

distal humerus/cubital fossa

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78
Q

median nerve travels with

A

brachial artery

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79
Q

tibial nerve travels with

A

popliteal artery

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80
Q

distal tibial nerve location

A

posterior to medial malleolus

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81
Q

tibial nerve travels with

A

posterior tibial artery

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82
Q

skeletal muscle triad

A

1 T-tubule + 2 terminal cisternae

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83
Q

cardiac muscle dyad

A

1 T-tubule + 1 terminal cisterna

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84
Q

release Ca effect in muscle cell physiology…

A

Binds to TROPONIN C, causing conformational change that moves tropomyosin out of the myosin-binding groove on actin filaments.

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85
Q

Muscle cell physiology

A

tropomysin complex mooves out of myosin-binding groove —> myosin releases bound ADP and Pi –> displacement of myosin on actin filament (power stroke) –> contraction results in shortening of H and I bands between Z lines but A band remains the same (A band Always same length).

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86
Q

Next step after contraction in muscle cell?

A

Binding of a new ATP molecule causes detachment of myosin head from actin filament. Hydrolysis of bound ATP –> ADP, myosin head adopts high-energy cocked position for the next contraction cycle.

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87
Q

Type 1 vs type II muscle fibers

A

codebook

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88
Q

NO synthase

A

activates L-arginine to nitric oxide

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89
Q

smooth muscle relaxation pathway

A

agonist binds to receptor –> calcium released –> calcium activates NO synthase –> NO diffuse through endothelial cell and into smooth muscle cell –> NO activates GTP to cGMP –> cGMP activates myosin-light-chain phosphatase (MLCP) –> MLCP dephosphorylates myosin II causing relaxation.

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90
Q

myosin-light-chain phosphatase (MLCP)

A

Enzyme that initiates smooth muscle cell relaxation

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91
Q

smooth muscle contraction pathway

A

Membrane depolarization –> Ca enters through L-type voltage gated channels –> forms calcium-calmodulin complex –> activates myosin-light-chain-kinase (MLCK) –> phosphorylates Myosin

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92
Q

endochondral ossification bones

A

codebook

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93
Q

defective process in achondrplasia

A

endochondral ossification

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94
Q

intramembranous ossification bones

A

codebook

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95
Q

endochondral ossification process

A

cartilaginous model –> woven bone –> lamellar bone

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96
Q

woven bone found in…

A

1) fractures

2) Paget disease

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97
Q

membranous ossification process

A

woven bone formed directly –> lamellar bone

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98
Q

origin of osteoblasts

A

differentiate from mesenchymal stem cells in periosteum

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99
Q

osteoclast mechanism

A

dissolves bone by secreting H+ and collagenases

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100
Q

osteoclast origin

A

Differentiates from a fusion of monocyte/macrophage lineage precursor.

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101
Q

PTH action

A

1) At low, intermittent levels, exerts anabolic effects (builds bone) through indirect mechanism.
2) chronic high PTH levels cause catabolic effects (osteitis fibrosa cystica)

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102
Q

osteitis fibrosa cystica

A

Presentation of primary hyperparathyroidism. Characteristic findings = subperiosteal erosions/thinning of phalanges + granular “salt-and-pepper” skull + osteolytic cysts in long bones.

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103
Q

estrogen mechanism in relation to bone.

A

Inhibits apoptosis in bone-forming osteoblasts and induces apoptosis in bone resorbing osteoclasts.

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104
Q

estrogen deficiency in relation to osteoporosis

A

Causes excess cycles of remodeling. Bone resoprtion leads to osteoporosis.

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105
Q

achondroplasia mechanism

A

Constitutive activation of fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation. So it’s actually a gain of function mutation.

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106
Q

achondroplasia genetics

A

> 85% occur sporadically; autosomal dominant with full penetrance (homozygosity is lethal).

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107
Q

trabeuclar bone

A

spongy bone

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108
Q

osteoporosis bone pathophys

A

There’s normal mineralization and lab values but trabecular and cortical bone lose mass and interconnections.

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109
Q

levothyroxine SE

A

osteoporosis

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110
Q

osteoporosis diagnosis

A

Bone mineral density scan (dual energy x-ray absorptiometry) with a T-score of less than or equal to -2.5 OR fragility fracture of hip or vertebra.

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111
Q

osteoporosis treatment

A

Bisphosphonates + teriparatide + SERMS + rarely calcitonin + denosumab.

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112
Q

Colles fracture

A

Fracture of distal radius; classic sign of osteoporosis.

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113
Q

Osteopetrosis

1) etiology
2) presentation
3) treatment

A

o Coded character: walls made out of sponges/persistence of the primary spongiosa in the medullary cavity with no mature trabeculae. Dead zombies lining perimeter + page is weaving + woven bones all along back wall/caused by defective osteoclastic bone resorption, which results in accumulation of woven bone and diffuse skeletal thickening. /autosomal recessive and dominant forms. Skeleton with really thick bones on couch + covered in casts/causes thickened and dense bones that are prone to fracture. Skeletons bones look like below + big Erlenmeyer flasks on table/ends of long bones are misshapen and bulbous (“Erlenmeyer flask deformity”). Casts all over skeleton/although bone turnover is decreased, tissue becomes weak and predisposed to fractures. /cranial foramen decrease in size, leading to CN palsies. Huge spleen to the left of the couch + huge hippo on couch/hepatosplenomegaly. He has a pan on top of his head/bone fills marrow space pancytopenia + extramedullary hematopoiesis. /mutations (eg carbonic anhydrase II) impair ability of osteoclast to generate acidic environment necessary for bone resorption. Big pile of bones on top with Jo-Jo sitting on top/treatment = bone marrow transplant (osteoclasts derived from monocytes).

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114
Q

osteoid

A

unmineralized, organic portion of bone matrix that forms prior to maturation (mineralization) of bone.

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115
Q

lab profile in osteomalacia/rickets

A

lab profile = low levels of vitamin D and phosphate + low or normal level of calcium + elevated alkaline phosphatase

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116
Q

“looser zones”

A

pseudofractures, found in osteomalacia.

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117
Q

lab profile in paget’s

A

normal Ca, phosphorus, PTH, + increased ALP.

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118
Q

fractures in paget’s

A

long bone chalk-stick fractures

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119
Q

stages of paget’s

A

lytic (osteoclasts) –> mixed (osteoclasts + osteoblasts) –> sclerotic (osteoblasts) –> queiescent (minimal osteoclast or blast activity)

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120
Q

causes of avascular necrosis

A

1) corticosteroids
2) alcoholism
3) sickle cell disease
4) trauma
5) the bends “caisson/decompression disease)
6) Legg-Calve-Perthes disease (idiopathic)
7) Gaucher disease
8) Slipped capital femoral epiphysis

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121
Q

Osteopetrosis lab values

A

everything normal except low/normal serum Calcium

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122
Q

Paget lab values

A

everything normal except increased ALP

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123
Q

“Brown tumors”

A

characteristic finding in osteitis fibrosa cystica due to fibrous replacement of bone, subperiosteal thinning.

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124
Q

Primary hyperparathyroidism lab values

A

calcium, ALP, PTH up, phosphate down

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125
Q

secondary hyperparathyroidism lab values

A

decreased serum calcium, increased phosphate, ALP, PTH

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126
Q

Hyperphosphatemia in secondary hyperparathyroidism pathophys

A

pathophys = phosphate clearance declines due to fall in GFR increased phosphate binds free serum Ca2+, further exacerbating hypocalcemia.

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127
Q

lab profile in osteomalacia/ricktes

A

low serum ca + phosphate, high ALP, high PTH

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128
Q

Causes of hypervitaminosis D

A

1) Oversupplementation

2) Granulomatous disease (eg sarcoidosis)

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129
Q

lab profile in hypervitaminosis D

A

High serum calcium and phosphate, normal ALP, high PTH.

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130
Q

osteochondroma epidemiology

A

Most common benign bone tumor. Males

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131
Q

osteochondroma characteristics

A

Bony exostosis with cartilaginous (chondroid cap). rarely transforms to chondrosarcoma.

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132
Q

Giant cell tumor epidemiology, location, other name

A

20-40 years old, epiphyseal end of long bones, often around knee, “osteoclastoma.” Locally aggressive benign tumor.

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133
Q

osteosarcoma –> epidemiology, RF’s, location, management, characteristic findings

A

o Code: Evan Olmstead/Bimodal distribution: Peak incidence between 13 and 16, greater than 65 years old. Evil Dr. Hink in suit along wall + evil page/Rb + SIS oncogenes. Taryn with parrot on her shoulders slacklining above/teriparatide is a risk factor. Big devil behind Evan/malignant mesenchymal neoplasm of bone origin (osteoblasts). Aggressive. /second peak of incidence occurs in older adults + is associated with Paget + bone infarcts + ionizing radiation. Masses on his knees + femor/usually arise around knee + distal femur or proximal tibia. Bone stuck in ground with arrow through metaphyseal region/metaphyseal region. Tumors on shoulder + jaw/may also arise in shoulder + proximal femur + jaw. Evil anna petroveks attacking him/histology = anaplastic cells forming osteoid matrix. Below pattern as wallpaper/x-ray = “sunburst” pattern. Codman’s triangle in front of door/Codman’s triangle. /Other predisposing factor = bone infarcts. Surgeon cutting out evan’s back + he’s in a chemo chair/Treat with surgical en bloc resection (with limb salvage) + chemotherapy.

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134
Q

Fusion protein in Ewing’s

A

EWS-FLI i

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135
Q

Giant cell tumor location

A

Epiphysis

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136
Q

osteoarthritis presentation/symmetry

A
  • asymmetric

- knee cartilage loss begins medially (“bowlegged”)

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137
Q

synovial fluid in osteoarthritis

A

non-inflammatory (WBC

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138
Q

joints involved in osteoarthritis

A

DIP, PIP, 1st CMC, NOT MCP.

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139
Q

osteoarthritis treatment

A

acetaminophen + NSAIDs + intra-articular glucocorticoids

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140
Q

pannus

A

proliferative granulation tissue seen in RA

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141
Q

RA RF’s

A

smoking + silica exposure + female + HLA-DR4

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142
Q

DMARDS

A

methotrexate, sulfasalazine, hydroxychloroquine, leflunomide

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143
Q

Joint findings in RA

A

Bone and cartilage erosions + juxtaarticular osteopenia + joint space narrowing + soft tissue swelling + subchondral cysts + pannus formation + increased synovial fluid.

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144
Q

synovial fluid in RA

A

inflammatory (WBC>2000)

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145
Q

fibrinoid necrosis

A

necrosis arising from immune complex deposition.

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146
Q

fibrinoid necrosis occurs in..

A

polyarteritis nodosa, malignant hypertension, preeclampsia, hyperacute transplant rejection

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147
Q

rheumatoid nodule histology description

A

fibrinoid necrosis with palisading histiocytes. Occurs in subcutaneous tissue.

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148
Q

extraarticular manifestations of RA

A

ILD, pleuritis, pericarditis, anemia of chronic disease, neutropenia, splenomegaly, amyloidosis, Sjogren’s, scleritis, carpal tunnel syndrome.

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149
Q

Felty syndrome

A

splenomegaly + RA

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150
Q

Joint findings in OA

A

thickened capsule + slight synovial hypertrophy + osteophytes + ulcerated cartilage + sclerotic bone + joint space narrowing + subchondral bone cyst

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151
Q

RA deformities

A

Deformities include subluxation, fingers with ulnar deviation, swan neck, boutonniere’s.

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152
Q

what mediates degradation and inadequate repair in OA?

A

chondrocytes

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153
Q

Gouty nephropathy pathophys

A

Urate crystals are deposited in the renal medullary interstitium where they can form intratubular precipitates, inflammatory tophi, or uric acid renal stones. Tubular obstruction leads to cortical atrophy and scarring, so 20% of people with chronic gout eventually die of renal failure

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154
Q

Hyperuricemia in gout epidemiology and pathophys

A

1) 90% caused by underexcretion of uric acid–largely idiopathic; can be exacerbated by meds.
2) overproduction of uric acid (10% of patients)–Lesch-Nyhan, PRPP excess, increased cell turnover (tumor lysis syndrome), von Gierke’s.

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155
Q

Tophi, etiology and location

A

Gout –> Accumulation of crystals in soft tissues), most commonly on external ears. Also olecranon bursa + achilles tendon.

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156
Q

What precipitates gout?

A

Alcohol consumption or large meal.

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157
Q

alcohol and gout pathophys

A

alcohol metabolites compete for same excretion sites in kidney as uric acid leading to decreased uric acid secretion.

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158
Q

Other name for pseudogout

A

calcium pyrophosphate deposition disease.

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159
Q

pseudogout associations

A

1) hemochromatosis
2) hyperparathyroidism
3) joint trauma

160
Q

most commonly affected joint in calcium pyrophosphate deposition

A

knee

161
Q

x-ray findings for calcium pyrophosphate deposition disease

A

chondrocalcinosis (cartilage calcification)

162
Q

prophylaxis for calcium pyrophosphate deposition

A

colchicine

163
Q

calcium pyrophosphate deposition acute treatment

A

same as gout: NSAIDs, colchicine, GC’s

164
Q

keratomalacia

A

eye disorder resulting from vitamin A deficiency

165
Q

eye finding in sjogren’s

A

keratoconjunctivitis sicca (decreased tear production and subsequent corneal damage)

166
Q

xerostomia

A

decreased saliva production

167
Q

sjogren’s can be secondary to…

A

RA, SLE, systemic sclerosis

168
Q

MALT presentation

A

parotid enlargement, can be complication of sjogren’s

169
Q

common causes of septic arthritis

A

S. aureus + streptococcus + neisseria gonorrhea

170
Q

synovial fluid in septic arthritis

A

purulent (WBC>50,000/mm3)

171
Q

gonococcal arthritis

A

STI presenting either as purulent arthritis or triad of polyarthralgias + tenosynotivis (eg, hand) + dermatitis

172
Q

commonalities among seronegative spondylarthritis

A

inflammatory back pain (morning stiffness improving with exercise) + periphral arthritis + enthesitis + dactylitis + uveitis

173
Q

enthesitis

A

Inflamed insertion sites of tendons (eg achilles)

174
Q

reactive arthritis post…

A

shigella + salmonella + yersinia + campylobacter + chlamydia

175
Q

anti-smith antibodies

A

antibodies to spliceosomal snRNPs

176
Q

lupus antibodies

A

anti-nuclear antibody (ANA) + anti-DNA antibodies + anti-phospholipid + **anti-smith (anti-SM) antibodies (specific) + anticardiolipin

177
Q

lupus HLA associations

A

DR2 and DR3

178
Q

libman sacks vegetation locations

A

usually on mitral or aortic valves

179
Q

lupus nephritis

A

glomerular deposition of anti-DNA immune complexes

180
Q

Most common and severe type of lupus nephritis

A

Diffuse proliferative

181
Q

other finding in lupus I don’t often think of…

A

serositis (inflammation of serous tissue)

182
Q

Antinuclear antibodies in lupus sensitivity/specifity

A

sensitive, not specific

183
Q

Anti-dsDNA antibodies in lupus sensitivity/specifity

A

specific, poor prognosis (renal disease)

184
Q

Anti-Smith antibodies in lupus sensitivity/specifity

A

Specific, not prognostic (directed against snRNPs)

185
Q

Antihistone antibodies in lupus sensitivity/specifity

A

sensitive for drug-indcued lupus (eg, hydralazine, procainamide).

186
Q

complement deficiency in lupus

A

C3, C4, CH50

187
Q

lupus treatment

A

NSAIDS, steroids, immunosuppressants, hydroxychloroquine

188
Q

Lab findings in APA syndrome

A

lupus anticoagulant + anticardiolipin + antiB2 glycoprotein antibodies

189
Q

treatment for APA syndrome

A

systemic anticoagulation

190
Q

false positives on VDRL

A

viral infection (mono, hepatitis) + drugs (chlorpromazine; procainamide) + rheumatic fever + lupus + leprosy + anticardiolipin antibodies (APA syndrome).

191
Q

speckled ANA

A

anti-U1 RNP antibodies

192
Q

hypercalcemia in sarcoidosis pathophys

A

expression of 1-alpha-hydroxylase by activated macrophages.

193
Q

fibrosis affect on lung function

A

INCREASED elasticity + decreased compliance

194
Q

sarcoidosis on ECG

A

shortened QT interval (hypercalcemic)

195
Q

sarcoidosis pathophys

A

pathophys = interactions between macrophages and Th1 CD4+ cells via MHC class II result in production of cytokines that favor the production of granulomas. Th1 cells secrete IL-2 + interferon-gamma (IFN-gamma).

196
Q

lavage fluid findings in sarcoidosis

A

elevated ACE + elevated CD4/CD8 ratio.

197
Q

common presentation of sarcoidosis

A

asymptomatic except for enlarged lymph nodes. No need to treat if not symptomatic!

198
Q

lupus pernio

A

skin lesions of face resembling lupus (characteristic of sarcoidosis)

199
Q

granulomas in sarcoidosis

A

epithelioid granulomas containing microscopic schaumann and asteroid bodies

200
Q

lab findings in polymyalgia rheumatica

A

elevated ESR + elevated CRP + normal CK

201
Q

fibromyalgia treatment

A

gradual, incremental aerobic exercise. Antidepressants (TCA’s + SNRI’s) + anticonvulsants in more severe cases.

202
Q

proposed mechanism for fibromyalgia

A

abnormal central processing of painful stimuli

203
Q

Lab findings in polymyositis/dermatomysitis

A

Increased CK + positive ANA + positive anti-Jo-1 + positive anti-SRP + anti-MI-2 antibodies

204
Q

treatment for polymyositis/dermatomysitis

A

steroids followed by long-term immunosuppressant therapy (methotrexate)

205
Q

most common site of involvement of polymyositis

A

shoulders

206
Q

other findings in dermatomyositis

A

malar rash (like SLE) + gottron papules + heliotrope (erythematous periorbital rash) + shawl and face rash + mechanic’s hands.

207
Q

Inflammatory differences between poly and dermatomyositis

A

polymyositis –> endomysial inflammation w/ CD8+ T cells.

Dermatomyositis –> perimysial inflammation and atrophy with CD4+ T cells.

208
Q

potential sequela of dermatomyositis

A

risk of occult malignancy

209
Q

MG diagnosis

A

edrophonium

210
Q

MG treatment

A

pyridostigmine

211
Q

which improves and which worsens with muscle use

A

MG worsens with muscle use, LEMS improves.

212
Q

Frequency of MG vs LEMS

A

MG common, LEMS rare.

213
Q

LEMs etiology

A

autoantibodies to presynaptic Ca2+ channel, leads to decrease ACh release.

214
Q

Treatment for LEMS

A

can’t do much, not in FA at least

215
Q

LEMS presentation

A

proximal muscle weakness + autonomic symptoms (dry mouth, impotence)

216
Q

suspicious mass at site of previous trauma suggests…

A

myositis ossificans

217
Q

scleroderma (systemic sclerosis)

A

Triad of autoimmunity + noninflammatory vasculopathy + collagen deposition with fibrosis. Includes both diffuse scleroderma and limited scleroderma.

218
Q

Limited scleroderma

A

Limited skin involvement confined to fingers and face. This is the type that occurs with CREST syndrome

219
Q

derm findings in scleroderma

A

puffy, taut skin WITHOUT wrinkles + fingertip pitting.

220
Q

scleroderma epidemiology

A

75% female

221
Q

CREST acronym

A

calcinosis, Raynauds, esophageal dysmotility, sclerodactyly, telangiectasia

222
Q

Color transition in raynaud’s

A

white (ischemia) –> blue (hypoxia) –> red (reperfusion)

223
Q

Raynaud’s pathophys

A

decreased blood flow to skin due to arteriolar vasospasm in response to cold or stress.

224
Q

Raynaud disease vs. raynaud syndrome

A 
disease = primary (idiopathic)
syndrome = secondary
225
Q

digital ulceration

A

critical ischemia seen in secondary raynaud’s (raynaud syndrome)

226
Q

Other names for subcutaneous fat

A

hypodermis, subcutis

227
Q

Epidermis layers from surface to base

A

Corneum –> Lucidum –> Granulosum –> spinosum –> basale (californians like girls in string bikinis)

228
Q

where is keratin found?

A

stratum corneum (uppermost layer)

229
Q

where are desmosomes found?

A

stratum spinosum

230
Q

stem cell site

A

stratum basale

231
Q

zonula occludens

A

area of tight junction

232
Q

composition of tight junctions

A

claudins + occludins

233
Q

function of tight junctions

A

prevent paracellular movement of solutes

234
Q

adherens junction

1) location
2) function

A

1) below tight junction

2) forms belt connecting actin cytoskeletons of adjacent cells with cadherins

235
Q

CADherins

A

Ca2+-dependent adhesion proteins.

236
Q

clinical significance of loss of E-cadherin expression

A

promotes metastasis

237
Q

zonula adherens

A

adherens junction

238
Q

macula adherens

A

desmosome

239
Q

desmosome

1) function
2) protein composition

A

1) structural support via intermediate filament interactions.
2) cytokeratin + desmoplakin

240
Q

gap junction

A

composed of channel proteins called connexons that permit electrical and chemical communication between cells

241
Q

hemidesome function

A

connects keratin in basal cells to underlying basement membrane

242
Q

Integrins

A

Membrane proteins that maintain integrity of basolateral membrane by binding to collagen and laminin in basement membrane.

243
Q

macule

A

flat lesion with well-circumscribed change in skin color

244
Q

patch

A

macule > 1 cm (eg congenital nevus/birthmark)

245
Q

papule

A

elevated solid skin lesion

246
Q

plaque

A

papule > 1 cm (psoriasis)

247
Q

vesicle

A

small fluid-containing blister

248
Q

bulla

A

large fluid-containing blister >1 cm (bullous pemphigoid)

249
Q

pustule

A

vesicle containing pus (pustular psoriasis)

250
Q

wheal

A

transient smooth papule or plaque (Hives)

251
Q

scale

A

flaking off of stratum corneum (eczema, psoriasis, SCC)

252
Q

crust

A

dry exudate (impetigo)

253
Q

psoriasis can be pustular

A

ok

254
Q

hyperkeratosis

1) characteristics
2) examples

A

1) increased thickness of stratum corneum

2) psoriasis, calluses

255
Q

parakeratosis

1) characteristics
2) examples

A

1) hyperkeratosis with retention of nuclei in stratum corneum
2) psoriasis

256
Q

Hypergranulosis

1) characteristics
2) examples

A

1) increased thickness of stratum granulosum

2) lichen planus

257
Q

spongiosis

1) characteristics
2) examples

A

1) epidermal accumulation of edematous fluid in intercellular spaces
2) eczematous dermatitis

258
Q

acantholysis

1) characteristics
2) examples

A

1) separation of epidermal cells

2) pemphigus vulgaris

259
Q

acanthosis

1) characteristics
2) examples

A

1) epidermal hyperplasia (increased thickness of spinosum)

2) acanthosis nigricans

260
Q

albinism etiology

A

normal melanocyte number, decreased melanin production

261
Q

chloasma

A

melasma

262
Q

vitiligo etiology

A

autoimmune destruction of melanocytes. Complete absence of melanocytes.

263
Q

acne description

A

pilosebaceous follicles with increased sebum, eratin.

264
Q

acne treatment

A

retinoids + benzoyl peroxide + antibiotics

265
Q

location of atopic dermatitis

A

flexural surface

266
Q

lab findings in atopic dermatitis

A

increased IgE

267
Q

presentation of atopic dermatitis in infancy

A

appears on face and then antecubital fossa

268
Q

common triggers of ACD

A

nickel, poison ivy, neomycin

269
Q

medical term for common mole

A

melanocytic nevus

270
Q

difference between intradermal nevi and junctional nevi

A 
intradermal = papular
junctional = flat
271
Q

derm findings in psoriasis

A

1) acanthosis with parakeratotic scaling (nuclei still in stratum corneum)
2) Munro microabscesses
3) increased stratum spinosum
4) decreased stratum graunlosum
5) Auspitz sign – pinpoint bleeding spots from exposure of dermal papillae when scales are scraped off.
6) can be associated with nail pitting

272
Q

rhinophyma ssociated with..

A

phymatous rosacea

273
Q

rosacea description

A

erythematous papules and pustules

274
Q

horn cysts

A

keratin-filled cysts, found in seborrheic keratosis

275
Q

leser-trelat associated with

A

GI + lymphoid malignancy

276
Q

characteristics of verrucae

A

epidermal hyperplasia + hyperkeratosis + koilocytosis

277
Q

condylomata acuminata

A

verrucae on genitals

278
Q

feature differentiating bacillary angiomatosis from kaposi’s

A

neutrophilic infiltrate in bacillary

279
Q

glomus tumor

A

Mom: big globe hanging from ceiling above her/glomus tumor. she has super long nails and a red-blue tumor under them/benign, painful, red-blue tumor under fingernails. Globe is a thermostat + wrapped in smooth muscle/arises from modified smooth muscle cells of the thermoregulatory glomus body.

280
Q

infiltrate in kaposi sarcoma

A

lymphocytic

281
Q

pyogenic granuloma

A

Big hole in ground with a massive pie in it/pyogenic granuloma. Page’s finger looks like below/polypoid capillary hemangioma that can ulcerate and bleed. Page on the couch, pregnant + being hit by Toby with a bat/associated with trauma + pregnancy.

282
Q

pyogenic granuloma description

A

polypoid lobulated capillary hemangioma.

283
Q

kaposi’s

A

Neoplastic growth associated with HIV. Can also be caused by HHV-8.

284
Q

strawberry hemangioma epidemiology

A

1/200

285
Q

strawberry hemangioma timeline

A

Initial rapid growth then regress spontaneously by 5-8 yo

286
Q

cystic hygroma

A

cavernous lymphangioma

287
Q

bullous impetigo causative organism

A

s aureus

288
Q

erysipelas

1) area of location
2) organism
3) presentation

A

1) upper dermis and superficial lymphatics
2) s pyogenes
3) well-defined demarcation between infected and normal skin

289
Q

cellulitis causative organisms

A

s pyogenes + s aureus

290
Q

cellulitis area of involvement

A

deeper dermis + subcutaneous tissues

291
Q

staphylococcal scalded skin syndrome pathophys

A

exotoxin destroys keratinocyte attachments in stratum granulosm only (vs. toxic epidermal necrolysis, which destroys epidermal-dermal junction).

292
Q

staphylococcal scalded skin syndrome

1) presentation
2) prognosis
3) epidemiology

A

1) fever + generalized erythematous rash with sloughing of upper layers of epidermis.
2) heals completely
3) newborns and childrens + adults with renal insufficiency

293
Q

hairy leukoplakia vs. leukoplakia

A

leukoplakia is cancerous.

294
Q

zinc derm presentation

A

acrodermatitis enteropathica

295
Q

acanthosis nigricans etiology

A

epidermal hyperplasia causing symmetric hyperpigmentation

296
Q

acanthosis nigricans associations

A

diabetes, obesity, Cushing syndrome, gastric adenocarcinoma

297
Q

erythema nodosum

A

painful inflammatory lesions of subcutaneous fat, usually on shins

298
Q

erythema nodosum associations

A

sarcoidosis, coccidioidomycosis, histoplasmosis, TB, streptococcal infections, leprosy, IBD

299
Q

wickham striae

A

reticular white lines. manifestation of lichen planus

300
Q

underlying condition in lichen planus

A

sawtooth infiltrate of lymphocytes at dermal epidermal junction

301
Q

lichen planus association

A

hep c

302
Q

pityriasis rosea prognosis

A

self resolves in about 6 weeks

303
Q

UVA

A

tanning and photoaging

304
Q

UVB

A

sunburn

305
Q

sunburn pathophys

A

causes DNA mutations, inducing apoptosis of keratinocytes

306
Q

BCC characteristic behavior

A

locally invasive, but rarely metastasizes.

307
Q

BCC presentations

A

1) pink, pearly nodules with telangiectasias, rolled borders, central ulcerations or cursting
2) nonhealing ulcers with infiltrating growth
3) scaling plaque

308
Q

SCC RF’s

A

aresnic, immunosuppression, sunlight

309
Q

SCC locations

A

face, lower lip, ears, hands

310
Q

SCC characteristic behavior

A

locally invasive, may spread to lymph nodes. Rarely metastasize.

311
Q

SCC presentation

A

ulcerative red lesions with frequent scale.

312
Q

SCC presentation

A

chronic draining sinuses.

313
Q

keratoacanthoma

A

variant of SCC that grows rapidly (4-6 weeks) and may regress spontaneously over months.

314
Q

diameter cutoff for melanoma

A

6 mm

315
Q

different types of melanoma

A

1) Superficial spreading
2) nodular
3) lentigo maligna
4) acral lentiginous

316
Q

melanoma treatment

A

resection with appropriately wide margins

317
Q

vemurafenib used in..

A

metastatic or unresectable melanoma in patients with BRAF V600E mutation

318
Q

LTB4, leukotriene B4

A

neutrophil chemotactic agent

319
Q

PGI2

A

Platelet-gathering Inhibitor. Inhibits platelet aggregation and promotes vasodilation

320
Q

acetaminophen MOA

A

reversibly inhibits cyclooxygenase, mostly in CNS, inactivated peripherally

321
Q

aspirins effect on coagulation

A

increased bleeding time. Effect lasts until new platelets are produced.

322
Q

aspirin clinical use

A 
low dose (less than 300 mg/day): decreases platelet aggregation.
Intermediate dose (300-2400 mg/day): antipyretic  and analgesic
High dose (2400-4000 mg/day): anti-inflammatory.
323
Q

aspirin AE’s

A

gastric ulceration + tinnitus. chronic use can lead to ARF, interstitial nephritis, GI bleeding.

324
Q

good things about celecoxib

A

spares gastric mucosa + spares platelet function (TXA2 production depends on Cox-1

325
Q

meloxicam

A

NSAID

326
Q

piroxicam

A

NSAID

327
Q

NSAID clinical use

A

antipyretic, analgesic, anti-inflammatory

328
Q

NSAIDs AEs

A

interstitial nephritis + gastric ulcer + renal ischemia

329
Q

leflunomide MOA

A

reversibly inhibits dihydroorotate dehydrogenase, preventing pyrimidine synthesis. Suppresses T-cell proliferation

330
Q

leflunomide AE’s

A

diarrhea + HTN + hepatotoxic + teratogenicity

331
Q

bisphosphonates MOA

A

pyrophosphate analogs, bind hydroxyapatite in bone, inhibiting osteoclast activity

332
Q

bisphosphonates clinical use

A

osteoporosis, hypercalcemia, paget’s, metastatic bone disease, OI

333
Q

bisphosphonates AE’s

A

esophagitis + osteonecrosis of jaw + atypical stress fractures

334
Q

guidelines for oral bisphosphonates

A

take with water + remain upright for 30 minutes

335
Q

teriparatide MOA

A

recombinant PTH analog that increases osteoblastic activity

336
Q

teriparatide route

A

given subcutaneously daily

337
Q

teriparatide clinical use

A

osteoporosis, unlike antiresorptive therapies, it causes increased bone growth.

338
Q

allopurinol MOA

A

competitive inhibitor of xanthine oxidase, decreases covnersion of hypoxanthine and xanthine to urate. Increases concentrations of azathioprine and 6-MP (both normally metabolized by xanthine oxidase).

339
Q

pegloticase MOA

A

recombinant uricase that catalyzes metabolism of uric acid to allantoin (more water-solube product)

340
Q

probenecid MOA

A

inhibits reabsorption of uric acid in PCT.

341
Q

probenecid caveats

A

1) Inhibits secretion of penicillin.

2) can precipitate uric acid calculi

342
Q

NSAIDs to give for gout and caveat

A

naproxen + indomethacin. Don’t give salicylates.

343
Q

gout prophylaxis

A

colchicine

344
Q

colchicine MOA

A

binds and stabilizes tubulin to inhibit microtubule polymerization, impairing neutrohil chemotaxis and degranulation.

345
Q

Problem with TNF-alpha inhibitors and pathophys

A

Predispose to infection, including reactivation of latent TB, since TNF is important in granuloma formation and stabilization.

346
Q

etanercept mechanism

A

fusion protein (receptor for TNF-alpha + IgG1 Fc) produced by recombinant DNA. Decoy receptor.

347
Q

etanercept clinical uses

A

RA, psoriasis, ankylosing spondylitis

348
Q

adalimumab

A

anti-TNF-alpha monoclonal antibody

349
Q

infliximab, adalimumab clinical uses

A

IBD, RA, ankylosing spondylitis, psoriasis

350
Q

rasburicase MOA

A

recombinant uricase that catalyzes metabolism of uric acid to allantoin.

351
Q

Xanthine oxidase

A

catalyze hypoxanthine to xanthine, and then xanthine to plasma uric acid

352
Q

Purine metabolism pathway

A

purine –> hypoxanthine –> xanthine –> plasma uric acid

353
Q

drainage area of superficial lymph nodes

A

tumors of penis + skin of vagina + anal canal BELOW the dentate line drain to the superficial inguinal lymph nodes. /superficial inguinal lymph nodes also drain the lower extremity + gluteal region + skin below the umbilicus.

354
Q

lymphatic drainage of legs

A

• /generally follows the course of the superficial veins (see below). /most venous drainage is to great saphenous vein. Accompanying lymphatics drain into the superficial group of the inguinal lymph nodes. Paint the lateral foot and back of leg green/however, skin drained by small saphenous vein, including lateral aspect of dorsum of foot is an exception to this rule. Lymphatic fluid from this area drains into lymphatics accompanying the small saphenous vein, then drains into lymph nodes behind the knee in the popliteal fossa.

355
Q

pouch of douglas

A

rectouterin pouch

356
Q

leg compartments

A

Lateral – superficial peroneal nerve
Anterior – anterior tibial
Deep posterior – Posterior tibial nerve + posterior tibial artery

357
Q

Jaw muscle anatomy

A

lateral pterygoid function = pulls mandible forward in the process of opening the jaw against resistance + protracts mandible + pulls mandible side to side. /unilateral action of the lateral pterygoid results in deviation of the mandible to the opposite side. /all other jaw muscles (masseter + medial pterygoid + temporalis) act to CLOSE THE JAW.

358
Q

gastrocolic ligament and what it contains

A

portion of the greater omentum between the greater curvature of the stomach and the transverse colon. Contains the gastroepiploic vessels.

359
Q

gastrohepatic ligament and what it contains

A

portion of the lesser omentum between the liver and lesser curvature of the stomach. Contains the right and left gastric vessels.

360
Q

splenorenal ligament and what it contains

A

mesentery that connects the spleen to the posterior abdominal wall. Contains the splenic artery and splenic vein + tail of the pancreas.

361
Q

Salivary gland anatomy

A

sublingual gland full of mucous/as you move from the midline laterally, acini in sublingual gland are almost pure mucous cells serous blacks cut in half/acini in submandibular gland contain a mixture of serous and mucous cells. Serous blacks in all acini of parotid gland/acini in parotid gland are mostly pure serous cells.

362
Q

Sensory supply of ear

A

Massive ear on back wall of anatomy lab. /vestibulocochlear = hearing and motion sense. Small oxe nailed to top of auricle/lesser occipital = upper part of the auricle. Giant orating at base/greater auricular = lower part of the auricle. Ears stuck to clocks on anterior half of canal/auriculotemporal = anterior half of external ear canal. Vagus signs lighting up posterior half of canal/auricular branch of vagus nerve = posterior half of the external ear canal.

363
Q

esophageal histology

A

Indians in chains lining esophagus/nonkeratinized stratified squamous epithelium. /striated muscle in upper 1/3, smooth muscle in bottom 2/3.

364
Q

Epithelia of rectum

A

columns above dentate line/mucosa above dentate (pectinate) line = simple columnar epithelium. Indians covered in poop below dentate line/below dentate line = squamous.

365
Q

Epithelia of respiratory tract

A

o nose and nasopharynx lined with columns/nose, paranasal sinuses, nasopharnyx, most of larynx, and tracheobronchial tree = pseudostratified columnar, mucus-secreting. Oropharynx and below lined with Indians + Indians in chains singing and standing around vocal folds + lining anterior and posterior epiglottis/oropharynx + laryngopharynx + anterior epiglottis + upper half of posterior epiglottis + vocal folds (true vocal cords) = stratified squamous epithelium. This is to protect it from abrasive swallowing of food. /So it’s pretty much all pseudostratifeid columnar except oropharynx/laryngopharynx area. Imagine alveoli and respiratory bronchioles lined with cubes/past the terminal bronchioles, in respiratory bronchioles and alveolar duct, epithelia transitions to cuboidal cells. Imagine Indians lining alveolar sacs/alveoli = simple squamous.

366
Q

Epithelia of the female reproductive tract

A

imagine ovary lined with cubes/ovary = simple cuboidal (rapidly proliferate to repair ovulatory surface defects). Imagine fallopian tube lined with columns/fallopian tube = simple columnar. Imagine uterus lined with columns/uterus = simple columnar. ectocervix lined with a circle of native americans + circle of columns behind them/cervix = ectocervix = stratified, squamous non-keratinized, endocervix = simple columnar. Indians in chains lining vagina/vagina = stratified squamous non-keratinized. Imagine Hannah Mcdermotts in transformation zone/transformation zone = squamocolumnar junction (most common area for cervical cancer)

367
Q

recurrent laryngeal supplies…

A

recurrent laryngeal nerves are branches of the vagus (X) and supply all intrinsic muscles of the larynx except the cricothyroid. /damage (such as in thyroid surgery) can cause hoarseness.

368
Q

Musculocutaneous

A

jacked due from brachial plexus memory palace: he has super biceps + his lateral forearms are on fire/innervates major forearm flexors (biceps, brachialis) and coracobrachialis + provides sensory innervation to the lateral forearm. He’s a baseball player/often injured by trauma or strenuous upper extremity exercise (baseball).

369
Q

Distal location of median nerve

A

before the median nerve enters the carpal tunnel, it lies between the tendons of the palmaris longus + flexor carpi radialis. Local anesthetic may be injected at this point to achieve anesthesia in the cutaneous region supplied by the median nerve.

370
Q

phrenic nerve innervation and damage

A

panicky method with a ham bone + it’s hailing/arises from C3-C5 segments of the spinal cord and innervates the Ipsilateral hemidiaphragm. He has wings on + is hiccupping intensely/damage causes hiccups + diaphragmatic paralysis with dyspnea + referred pain to the shoulder. /affected hemidiaphragm will be elevated on CXR.

371
Q

recurrent laryngeal location

A

left recurrent laryngeal arises from the vagus as the vagus crosses in front of the arch of the aorta. /right recurrent laryngeal nerve arises from right vagus nerve as it crosses anterior to the right subclavian artery.

372
Q

Layers of anterior abdominal wall

A

1) skin. Bunch of people camping in front with fat everywhere/2) superficial fascia of Camper (fatty layer). Climbers climbing up tunnel after them/3) superficial fasca of Scarpa (membranous layer). External oblique muscle (angled up and down)/4) external oblique muscle/aponeurosis. Internal oblique muscle (angle up and down but opposite to external)/5) internal oblique muscle/aponeurosis. Tranny stretched out across tunnel with a jacked 6 pack (it’s transverse/horizontal stretching out across tunnel)/6) transversus abdominis muscle/aponeurosis. Then a thick layer of fascia/7) fascia transversalis. Then a thick layer of fat/8) extraperitoneal fatty tissue. Into the north/9) peritoneum.

373
Q

Temporomandibular disorder (TMD):

A

o /arises from problems involving the temporomandibular joint, the muscles of mastication, and the nerves that supply the jaw. He has a trident stuck into his jaw/affected nerve = mandibular division of the trigeminal nerve. Wearing headphones + axe in his jaw + screw through his head/presentation = otologic symptoms (ear discomfort) + jaw pain + unilateral facial pain worsening with jaw movement + headache.

374
Q

Vagus nerve respiratory action

A

main efferent action is bronchoconstriction and increased bronchial mucus secretion.

375
Q

Cranial nerves and locations of exit through the skull.

A

o big hole in ceiling and gram taking a duce through it + playing crocae + Dr. Soohoo peaking his head over + huge eye with motor dangling from it/oculomotor (CN III) + ophthalmic nerve (CNV1) + trochlear (CN IV) + abducens (CN VI) enter the orbit via the superior orbital fissure. Blue blood vessel attached to hanging eye/superior ophthalmic vein also passes through the superior orbital fissure to enter the orbit. Really fat Max in far right corner/foramen rotundum transmits the maxillary division of the trigeminal nerve (CN V2). Big oval hole in back wall with mandible hanging in it and trident stuck into it/foramen ovale transmits mandibular branch of the trigeminal nerve (V3). Huge nose stuck on wall to right with plate through it midway/CN 1 olfactory bundles traverse cribriform plate. /foramen spinosum = middle meningeal artery + vein. Huge jacked magnus bench pressing in middle covered in shiny accessories/foramen magnum = spinal roots of CN XI (enter brain through foramen magnum) + brain stem + vertebral arteries. Big jug of milk in far left corner + vegas sign above it + Kelsey fitzgibbons sucking dick + milk jug covered in shiny accessories/jugular foramen = CN IX + X + XI (leaves through jugular foramen) + jugular vein. Ears on face with chunks meat stuck to them/internal auditory meatus = CN VII + VIII.

376
Q

eye muscles + innervation

A

/remember that oculomotor also innervates skeletal muscle found in the levator palpebrae superioris.
/from the abducted position, the superior rectus is the only muscle that can elevate the eye.
/inferior oblique is only muscle that can elevate the eye in the adducted position.

377
Q

location of IVC

A

L4/L5

378
Q

Lungs anatomic location

A

Picture nasty hair filling horizontal fissure/Horizontal fissure of right lung lies at the level of the 4th rib. Ivy on midaxial/lower border at midaxillary line located at rib 8. Hash block stuck into bottom/lower border along midclavicular located at rib 6. Tie hanging off backside at paravertebral line/lower border at 10th rib on paravertebral line.

379
Q

functions that occur in the cytoplasm

A

Big pool in entryway: machine spitting out bacon + cholesterol eggs + steak/glycolysis + fatty acid synthesis + protein synthesis (RER) + steroid synthesis (SER) + cholesterol synthesis.

380
Q

Vesicular trafficking proteins

A

COP with a sombrero forcing traffic backwards/COPI: Golgi golgi (retrograde) + cis-golgi ER. Cop in chicken suit forcing traffic forward/COPII: ER cis-Golgi (anterograde). Kate throws steak intos into the lysosome hottub + circle of trannies around her/Clathrin: trans-Golgi lysosomes.

381
Q

cerebellar anatomy and lesions

A

/neocerebellum/cerebrocerebellum rests is responsible for fine movements of the hand and face. Lesions would cause dysdiadochokinesis (impairment in rapidly alternating hand movements) and intention tremor. /acute lesion to the cerebellar vermis causes truncal + gait ataxia. Put horns on flocculonodular lobe/involvement of the flocculonodular lobe causes vertigo/nystagmus due to dysregulation of the vestibular nuclear complex.

382
Q

sertoli cell functions

A

White guys from star wars shooting up a fish/produce Inhibin B, which downregualtes FSH synthesis and inhibits FSH secretion. they’re shooting up a uterus hanging from the ceiling/secrete Mullerian inhibiting factor. They’re covered in roses/testosterone is aromatized in sertoli cells to produce estrogen. /secrete androgen binding protein. /nurture developing sperm.

383
Q

2 cell hypothesis

A

/theca cells are stimulated by LH to secrete androgens androstenedione and testosterone these diffuse into the granulosa cells where they are aromatized to estrogens. This conversion is stimulated by FSH action on granulosa cells.

384
Q

granulosa cell functions

A

pile of grains on either side of entrance to Ben’s house/female equivalent of sertoli cells. Anna covered in floors on top/produce estrogen. /FSH stimulates aromatase in granulosa cells to synthesize estrogen. Big egg on top of the area with chicken bursting out/as the follicle approaches ovulation, LH receptors begin to be expressed by granulosa cells. Response of granulosa cells to LH, which favors progesterone production is required for maturation of the dominant follicle, ovulation, and then luteinization.

385
Q

estrogen types

A 
o	Estradiol: huge pile of grains by window/synthesized by granulosa cells. Arnold Schwarzenegger standing in middle of the room/precursor = testosterone.
o	Estrone (aka estradione): tons of really fat people walking around and big stones everywhere/synthesized by adipocytes. Andrew black standing in middle/precursor = androstenedione. Old granny at counter/only estrogen still detectable in menopausal women since it’s synthesized in peripheral adipocytes. 
o	Estriol (E3): huge placenta on floor/synthesized by placenta. Tosh.0 dressed as a military commander screaming and yelling at the class/precursor = 16-alpha-OH-DHEAS.
386
Q

androgen synthesis in females

A

o Picture the follicle and then islands of flowers within huge granular mounds of sands/LH stimulates the theca interna cells of the ovarian follicle to produce androgens. aromatase within the follicle’s granulosa cells subsequently converts these androgens to estradiol under FSH stimulation.

387
Q

Marker for osteoclast activity

A

Hydroxyproline

388
Q

osteitis deformans

A

Paget’s

389
Q

Juvenile Idiopathic Arthritis (JIA) AKA Juvenile Rheumatoid Arthritis (JRA)

A

o Coded character: Kiya (Sarah’s daughter)/more common in females and usually in kids under 16. She’s in a wheelchair + 1920s wagon full of kids covered in a rash/presentation = joint pain + joint swelling + migratory rash. Newts crawling around everywhere and walls made of sand/labs = elevated ESR + neutrophils. she has motorcycle goggles on/uveitis that may lead to blindness can be a serious complication.
o Location: Grassy area at AZ hotel

390
Q

Vertebral subluxation:

A

o Code: Two EMT’s holding Cam + he has a c spine collar on/severe chronic RA can involve the cervical spine and cause joint destruction with vertebral malalignment (subluxation). Huge globe on a car axis/the atlantoaxial joint is often involved and more prone to subluxation because the atlas (C1) has a high degree of mobility relative to the axis. IV pole next to him + he’s paralyzed + axe in his neck/anterior movement of the atlas can cause spinal cord compression, presenting with neck pain + stiffness + radicular pain + paralysis with decreased or absent reflexes beleververtow the level of the compression (areflexic paralysis) + hypotension (due to loss of sympathetic tone) + and/or sudden death.
o Location: Entrence of Res dinner

391
Q

osteoporosis risk factors

A

1) Age
2) Gender. **NBME answer for greatest RF. Women are at much higher risk of osteoporosis than men.
3) Smoking
4) ethnicity

392
Q

Genitofemoral supplie

A

sensation to upper anterior thigh + skin of anterior scrotum + mons pubis

393
Q

pudendal nerve

A

Carries sensation from the external genitalia of both sexes + skin around anus and perineum.

394
Q

Name the spinal ligaments.

A

…

395
Q

p53 actions

A

1) Inhibits apoptosis
2) Inhibits progression from G1–>S
3) Stimulates cell-cycle repair

396
Q

Proteinase 3

A

epitope of anti-neutrophil cytoplasmic antibodies of c-ANA so relevance = Wegener’s granulomatosis

397
Q

Prader willi other mechanism of inheritance

A

MATERNAL uniparental disomy

STEP (85 decks)

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