Area of Opp review Flashcards
1
Q
What do ACTH MSH Beta-endorphin all have in common
A
Their precursor is POMC polypeptide :0
2
Q
Internal hemorrhoids drain via
A
middle and superior rectal to internal iliac and inferior mesenteric, respectively
3
Q
External hemorrhoids drain via
A
inferior rectal veins to internal iliac veins
4
Q
Glucocorticoids effect on muscle
A
increase breakdown - oppose effect of insulin in skeletal muscle to increase glucose
5
Q
The splenic red pulp is for? (2)
A
destroying abnormal erythrocytes
clearance circulating bacteria
6
Q
tick born infection - thrombocytopenia with intraerythrocytic parasites -
A
babesiosis
caused by babesia microti
7
Q
3 treatments for C Diff
A
metronidazole (DNA damage via toxic free radicals - good for anaerobes and also antiprotazoal)
Vancomycin
fidaxomicin (macrolide like)
8
Q
Diphtheria toxin
A
A/B toxin
B bind
A - ADP ribosylation of EF2
9
Q
Most common cause of hair loss -
A
androgenic alopecia
meaning androgen + genes
polygenic
10
Q
MEN Type I
A
Primary hyperPTH (hypercalcemia) Pituitary tumors (prolactinomas) Pancreatic tumors (gastrinomas - think Zollinger Ellison)
11
Q
MEN Type IIa
A
Medullary thyroid
Pheo
HyperPTH
12
Q
MEN Type IIB
A
Medullary thyroid
Pheo
Marfanoid / Mucosal Nueromas
13
Q
3’ end of tRNA
A
CCA tail
14
Q
If i have enlarged popliteal and inguinal nodes, did I have a sore on my medial or lateral foot?
A
lateral drain through popliteal
medial drain direct up to inguinal
15
Q
in the citric acid cycle, which is the only enzyme that use FAD (rather than NAD)
A
Succinate dehydrogenase uses FAD to convert succinate to fumerate
16
Q
PPAR-gamma
A
peroxisome proliferator-activated receptor-gamma alters gene transcription by binding the promoter region or target genes and improves insulin sensitivity
17
Q
Gq activates?
A
phospholipase C, which then cleaves PPB into IP3-DAG - IP3 then increases calcium while DAG activates PKC
18
Q
Blood smear showing intraerythrocyte pleomorphic ring forms and cross sign in someone who has anemia?
A
babesiosis
19
Q
If my patient has esophageal varices because of liver cirrhosis, through which vein is their blood being diverted from the portal ciruclation
A
left gastric
20
Q
if my patient has hemorrhoids because of liver cirrhosis, through which vein is their blood being diverted from the portal circulation
A
superior rectal
21
Q
if my patient has caput medusa because of liver cirrhosis, through which vein is my patients blood being diverted from their protal circulation
A
paraumbilical veins
22
Q
what is methylmalonic acid
A
substrate for methylmalonyl-CoA mutase in making succinyl CoA,
Elevated in B12 deficiency because B12 cofactor of enzyme
rxn important for myelin
23
Q
elevated homocystein in VitB12 deficiency?
A
need B12 as cofactor for conversion of homocysteine to methionine using methyl-tetrahydrofolate (m-THF) -
Results in impaired DNA synthesis and megaloblastic anemia
24
Q
main effects of marijuana (4)
A
conjunctival injection
tachycardia
hyperphagia
dry mouth
25
what would i give someone with listeria?
ampicillin or amoxiicllin
26
what is alkaptouria
AR disorder lack or homogentisic acid dioxygenase --> blocks the metabolism of tyrosine - leads to black urine, black pigmentation, ochronotic arthorpathy
27
what would we see in the acid schiff stain of someone with AAT?
we would see the accumulation of the antitypsin protein in the hepatocytes and it would not be destroyed by diastase - which breaks down glycogen - cirrhosis second leading cause of death?
28
Crutch palsy
radial nerve - wrist drop - weakness of triceps reflex - c5-t1 - supination - thumb abduction - sensation dorsal forearm dorsal aspect of hand
29
when do you hydroxylate proline for collagen synthesis
rer
30
ehlers danlos is a defect in
type v collagen defect
31
Zenker diverticulum
abnormal spasm or diminished relaxation of cricopharyngeal muscle when swallow can evenutally lead to herniation of the back of the pharyngeal mucosa and food accumulates in this little pouch :(
32
achalasia -
degenerative changes in myenteric plexus with impaired lES relaxation - bird beak esophagus
33
when you ingest too much inorganic phosphate what do i give you immediately
atropine and pralidoxime (AChE reactivator)
34
what is dangerous in insecticides? and why
arsenic
| inhibits pyruvate dehydrogenase
35
signs and symptoms of arsenic poisoning
watery diarrhea
hypotension (from dehydration)
QT prolongation
garlic odor of breath
36
first line therapy for arsenic poisoning
dimercaprol - chelator
37
lead poisoning - signs
constipation / anemia / irritablity and confusion
38
lead poisoning - tx
CaNa2EDTA
39
Iron poisoning - tx
Deferoxamine
40
Cyanide poisoining - signs and treatment
cherry red skin
give
hydroxycolbalmin -
41
methylene blue is indicated treatment for
methemoglobinemia - which presents as gray or blue colored skin - chocolate colored blood
42
what oxidaiton state shouldl iron be in?
Fe2+
43
in a patient with mitral regurg - holosystolic radiating to axilla - the most reliable auscultory finding indicating high regurgitant volume (severe MR) would be?
S3
| note: the bigger the regurgitant volume the quieter the murmur so don't use that!
44
In the medical setting hypoglycemia is treated with IV glucose (50% dextrose ampule) what about in emergency outide hospital?
glucagon - IM
45
Orotic aciduria
| presentatation
physical and mental retardation
megaloblastic anemia
evelated urinary orotic acid
46
orotic aciduria
| cause?
AR defect in de novo pyrimidine synthesis -
| defect in 5-UMP synthase *makes ump from orotic acid
47
Orotic acid tx?
uridine supplemantion
48
calcipotriene
used to treat psoriasis - vitamin D analog that increases keratinocyte differenation while inhibiting prolifeartion
49
most common cause of lacunar stroke
HTN and DM
50
Hemiballism
damage to subthalamic nucleus --> decrease excitiation to GPin --> decrease inhibition of Thalamus --> incrased exciation of contralateral movement
Frequent consequent of lacunar stroke
51
rate limiting enzyme in bile acid synthesis
7alpha hydroxylase
52
which two things increase cholesterol solubility and decrease risk of gallstones
phosphates/phosphatidylcholine
| bile acid
53
Cocaine mechanism?
monoamine reuptake inhibitor - can also cause vasospasm and platelet aggregation :( - coronary artery vasospasm
54
Ovarian torsion typically involves twisting of the ____, often due to the weight of a large adnexal mass. resulting in?
infundibular ligament (Suspensory ligament)
resulting in occlusion of blood and nerve supply to ovary and leading acute ischemia and pain :(
55
c-Jun and c-Fos
leucine zipper TFs
| proto-oncogenes
56
Ras codes for?
a membrane-bound g protein
| activates transcription via activation of MAP kinase pathway
57
B1 receptor messenger?
Gs-->AC-->increased cAMP
58
lymphatic drainage proximal to dentate line?
internal iliac and inferior mesenteric
59
lymphatic drainage distal to the dentate line?
inguinal
60
5 basic steps in Nucleotide excision repair in order
```
glycosylase
endonuclease
lyase
prolimerase
ligase
```
61
what does lyase do?
cleave the 3' sugar phosphate after glycosylase removes the base leaving the apurinic site
(i.e. its a phosphodiesterase)
62
phenoxybenzamine
treat pheos
| irreversibly block alpha
63
right sided frontal lobe lesions lead to?
disinhibited behavior results from these lesions
64
left sided frontal lobe lesions lead to?
apathy results from lesions to this area :(
65
why is citalopram tricky
because it is an ssri
| it sounds like a benzo though :/
66
what specific gestationally produced thing :) causes a state of insulin resistance in preggos, which can lead to gestational diabetes
human placental lactogen
67
HELLP
Hemolysis
elevated liver enzymes
Low platelets
68
ARE noncaseating granulomas found in ulcerative colitis?
no - they are found in crohns
69
children with rhabdomyosarcoma - may increase likelihood they have?
tuberous sclerosis
70
NF2
Bilateral acoustic schwammomas.
71
Von Hippel Lindaue patients often have cerebellar hemangioblastomas, retinal hemangiomas, and livers cysts, but they are at uber increased risk of?
bilateral renal cell carcinomas
von hippel lindaue disease
AD
C3 VHL deletion
72
hereditary hemorrhagic telangiectasia - osler weber rendu syndrome
AD
multiple telangiectasias on skin and mucosa
recurrent epistaxis and gi bleeding (melena)
73
sign of basilar skull fracture?
battle sign - brusing behind ear at mastoid and periorbital ecchimoisis
74
what makes bile acids?
the liver via cholesterol catabolism
75
where are bile acids reabsorbed? and what blocks this?
terminal ileum
| cholestyramine - via binding resin
76
Cholesterol 7alpha hydroxylase
catalyzes the rate limiting step in bile acid biosynthesis (in liver for cholesterol excretion)
note - that it is inhibited by fibrates
77
what doe fibrates do?
upregulate lipoprotein lipase resulting in incrased fatty acid oxidation - note though that they also inhibit cholesterol 7-alpha-hydroxylase and thus might increase risk for gall stones (cholesterol)
78
what is beta-glucuronidase?
it is an enzyme that deconjugates bilirubin - free bilirubin then precipitates with calicum in bile to form pigmented gallstones
released by damaged hepatocytes and bacteria in infected bile
79
thiolase
catalyzes the first step in cholesterol synthesis via condensation of 2 acetyl-coa
note - third acetyl-coa yields HMG-CoA
80
Inhibition of uterine contractions - tocolysis - is a result of _______ receptor stimulation?
Beta - 2
81
Beta 1 receptor agonists?
dobutamine
dopamine
epinephrine
isoproteranol
82
```
Beta 2 receptor agonists
effect on
heart
lung
uterus
```
vasodilate
bronchodilate
relax (tocolysis)
e.g. isoproteronol
torbutiline
ritodrine
83
```
alpha 1 - agonist
effect on
peripheral vasculature
bladder
eye
```
vasoconstriction
internal urethral sphincter contraction
mydriasis
84
methoxamine
alpha-1 agonist
85
fundal varices are caused by thromboses in which vein?
splenic
86
rx of choice for dvts in preggos??
lmwh
| e.g. enoxaparin
87
dabigatran
direct thrombin inhibitor
88
apixaban
factor x inhibitor
89
clopidogrel
blocks ADP receptor - limiting platelet aggregation
90
asprin given to preggos with preeclampsia - why?
i dont know look
91
rx for narcolepsy?
modafinil
92
amatoxins - in death mushrooms
liver - concentrate - halt mRNA synthesis via binding rna pol ii
93
ricin
cleaves rRNA component of 60s ribosome - halts protein synthesis
94
who has EF2 toxin via ADP-ribosylation
diphtheria
| psuedomonas
95
giardiasis rx
metronidazole
96
why doesn't metronidazole hurt me?
because it has to be reduced to active form by pyruvate ferrodoxin oxidoreductase - which is only in bugs :)
97
octreotide
somatostatin analog that decreases gut motility / gi functions
98
sulfasalazine
5-aminosalicylate that blocks cytokine / prostaglandin and leukotriene synthesis during inflammation - used for chrohns and ulcerative colitis
99
5-aminosalicylate
sulfasalazine and mesalamaine
100
my patient smells like garlic - what do you think
arsenic - insecticide
101
what do you give to patient with arsenic poisoning
dimercaprol - chelating agent
102
how does arsenic fuck you up?
binds to sulfhydryl groups - specifically inhibiting pyruvate dehydrogenase
103
what is hydroxycobalamin used for
B12 precursor
| can be used for cyanide poisoning - binds and forms non-toxic excretable form - theme
104
Methimazole
Inhibits thyroid peroxidase
105
I am thyroid peroxidase, what are my responsibilities and who inhibits me
I organify iodine - i.e. couple it with Tyrosine in thyrogloublin and I also couple iodotyrosines :) to make thyronines
I am blocked by thionamides - methimazole and propylthiouracil
106
propylthiouracil
thionamide - inhibits thyroid peroxidase
| also decreases conversion of T4 to T3
107
Perchlorate and pertechenetate
inhibit Na couples I transport into thyroid cell
108
ipodate
contrast agent that inhibits conversion of t4 to t3
109
common drugs that inhibit t4 to t3
beta blockers
110
Stewart Treves
angiosarcoma / lymphosarcoma - in ipsilateral arm of mastectomy many years later :(
111
ferrochelatase -
attaches iron to protophorphyrin ring in mitochondria -
note - if limitation in protoporphyrin (e.g. synthsis problemo) or inhibition of attachment via lead poison - you will have sideroblasts - iron ringed mitochondria in rbcs
112
here is a really good question :) why would we see sideroblastic anemia in isoniazid treatment?
because the metabolite of isoniazid form complexes with b6 that are excreted when we pee -
b6 is a cofactor for ALA synthase -
ALA synthase is necessary for protoporphyrin production -
not enough protoporphyrin to attach to iron in mitochondria -
get sideroblastic anemia
113
Why would you not see sideroblasts in blood smear in lead poisoning when i just explained why you would have them?
because they are in the bone marrow not the peripheral blood
114
Basophilic stypling???
lead poisoning
or
thalassemias and myelodysplastic syndrome
buildup of RNA
115
what effect to anasthetics have on my heart
they decrease me heart output - can lead to hypotension
116
what effects do anasthetics (inhaled) have on my breathing?
they decrease my respiratory drive :( - may also inhibit mucociliary clearance --> post-atelectasis
117
why are halothane and sevoflurane preferred for anasthesia in pateints with asthma?
bronchodilate so minimize effect of post-op atelectasis from inhibited mucociliary clearance
118
what do inhaled anasthetics do to my cabeza?
increased Cerebral BF - can lead to increased ICP
119
What do inhaled anesthetics do to my kidney
decrease all desirable things :( increased renal vascular resistance
120
what do inhaled anesthetics do to my liver?
decrease its blood flow :(
121
5 Undesirable effects of volatile anesthetics/
```
increased ICP
myocardial depression
decreased renal BF
decreased hepatic BF
decreased respiration
```
122
potency of anesthetic?
determined by minimum alveolar concentration (MAC)
| potency = 1/MAC
123
What is meant by the minimum alveolar concentration of an inhaled anesthetic?
concentration of the anesthetic in the alveoli that renders 50% of patients unresponsive to painful stimuli (ED50) inversely proportional to potency
124
Common extradermal mainfestations of psoriasis
nail pitting
psoriatic arthritis
uveitis
hla-b27
125
common locale of dermatitis herpetiformis?
knees / elbows but also butt and upper back
126
retinitis in AIDS?
CMV
127
Macrophages loaded with PAC positive granules in lamina propria?
Tropheryma whippelli - gram positive actinomycete - penicillin :)
whipples disease
128
I have ipsilateral sensorineural hearing loss and tinnitus -
i might also have vertigo, dysequilirbium and nystagmus
acoustic neuroma - schwann cell tumor
129
bilateral acoustic neuroma?
NF2
130
why would a lesion to cranial nerve VII make you hyperacusis?
because you lose innervation to the stapedius, which helps prevent damage to ear durm
131
inability to elevate soft palate?
X
132
head rotation direction when XI damaged?
turn toward leasion and ipsilateral shoulder droop
133
a. indirect inguinal
presentation
pathos
anatomy
p - male infants
pa - patent processues vaginalis
a - content protrudes through deep inguinal ring traveling lateral to inf epigastrics
- only covered by external spermatic fascia
134
direct inguinal
presentation
pathos
anatomy
older men
weakness of transversalis fascia
ana - content protrudes through hasselbach trianlge - medial to inf. epigastrics
- covered by all three layers of spermatic fascia
135
femoral groin hernia
presentaiton
pathos
anatomy
p - wommen
pathos - weakness of proximal femoral canal
ana - content protrudes through the femoral ring
- travels inferior to inguinal ligament
136
6 key complications of prematurity
respiratory distress syndrome
patent ductus arteriosus
bronchopulmonary dysplasia
intraventricular hemorrhage - germinal matrix
necrotizing enterocolitis
retinopathy of prematurity
137
germinal matrix
highly cellular and vascularized layer in the subventricular zone from which neurons and glial cells migrate out during brain development - risk of hemorrhage in pre-me
138
signs of intravascular hemorrhage in pre me
```
altered conscious
hypotonia
bulging anterior fontanelle
hypotension
etc
```
139
ovarian torsion ligament?
infundibular ligament (suspensory)
140
Aneurysms causing CNIII palsy most frequently involve ???
PCA - compressive
141
Vancomycin red man syndrome mediated by?
non IgE mediated mast cells releasing histamine
142
what distinguishes conduct from oppositional defiant disorder?
aggression -
| Conduct disorder - the behaviors are more severe and aggressive - steal/lie/destroy/creulty
143
Drugs associated with drug induced ANCAs associated vasculitis (3)
porpylthiuracil
methimazole
(both used to treat hyperthyroidism)
and hydralazine
144
gas in biliary tree in an old person with a tympanic abdomen likely tells you they have?
gallstone ileus - fistula allowed passage into duodenum then moved to ileum and lodged
145
Charcot triad for cholangitis
fever
jaundice
RUQ pain
146
Cirrhosis causes boobs because
it causes a state of hyperestrinism - this can also lead to testicular atrophy and decreased body hair AS WELL AS SPIDER ANGIOMATA
147
Spider angiomata
associated with
consequence of
liver cirrhosis
| elevated estrogen
148
Landmark for lumbar puncture
iliac crest
| L3,4,5 keeps the spinal cord alive
149
Works by blocking PDE-3 -- increasing inotropy and leading to vasodilation
Milrinone
150
Trauma to knee resulting in injury to tibial n - l4-s3 - presenation
lot of sensation to plantar surface of foot
- foot inversion
- plantar flexion
- toe flexion
151
Trauma to the lateral leg resulting in injury to the common peroneal n -
```
foot drop
- loss of dorsiflexion
- loss of sensation on dorsum
- foot eversion
loss of sensation to external frontal calf
- loss of toe extension
```
152
hematoma or mass involving iliopsoas/iliacus muscle - compressing femoral - l2-l4 - consequence
flexion of thigh
extension of leg
medial frontal surface of leg
153
anterior hip dislocation disrupting obturator n - l2-l4 consequence
loss of thigh abduction and a little sensation of the superior internal thigh
154
Retroperitoneal organs
```
SADPUCKER
Superior adrenals
Aorta and IVC
Duodenum
Pancreas (head and body)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus
Rectum
```
155
Lesions of the jugular foramen would fuck with CN IX X and XI what would you see
this is called Vernet syndrome
1. loss of gag reflex (aff - ix eff - x)
2. loss of taste to post 1/3 tongue (ix little x)
3. deviation uvula to effected side (x)
4. dysphagia (ix x)
5. dysphonia / hoarse (x)
6. sternocleidomastoid and trapezius paralysis (xi)
156
Wilson's disease target which area of brain?
lentiform nucleus (globus pallidus and putamen)
157
Lateral striate arteries emerge from the middle meningeal and supply the internal capsule and basal ganglia - how would we harm them with hemorrhage / why would we hemorrhage here?
HTN increased risk of hemorrhage here
158
Restless leg syndrome has been associated with what vitamin deficiency
iron
159
restless leg syndrome rx
dopamine agonists
- pramipexole
- ropinirole
160
rx for antipsych induced akathisisa
beta agonist - propanolol
161
Cataplexy???
key feature of narcolepsy = sudden loss of muscle tone and often triggered by strong emotions
162
compression causing Horner - likely under which two common circumstances
pancoast tumor
| internal carotid arter dissections
163
in danger during thyroid surgery???
recurrent laryngeal - hoarseness if nicked -
| stridor if bilateral because paralyze vocal cords
164
TREATMENT OF PANIC disorder
ssri
165
how does milrinone work/
PDE 3 inhibiitor so increases cAMP which has positive inotropic effect on heart and also causes vasodilation systemically
166
how can amitryptyline kill you?
it inhibits fast sodium channel conduction, (in cardiac myocytes and His Perkinje system) slowing down myocardial depolarizaiton and leading to cardiac arrhythmias - decreased cardiac contractility
167
why does amitryptiline make you faint?
peripheral alpha-1 adrenergic receptors are antagonized --> peripheral vasodilation
168
why does amitryptiline make you hungry and tired
inhibit histamine receptors H1
169
Gerstmann syndrome - damage to the angular gyrus of predominate parietal lobe - 4
agraphia
acalculia
finger agnosia
left-right disorientation
supplied by MCA
170
Wallenberg syndrome - dorsolateral medulla
supplied by pICA
- loss of P/T ipsilateral face and contralateral body - spinal trigeminal and spinothalamic tracts
- ipsilateral bulbar muscle weakness - nucleaus ambiguus
Ipsilateral limb ataxia - inferior cerebellar peduncle
horner syndrome - descedning sympathetic
vertigo - vestibular nuclei
171
strokes to dorsolateral thalamus present as
contralateral hemisensory loss - usually
172
superior colliculus strokes
upward gaze palsy
absent pupillary reflex
imparied convergence
= prinaud syndrome
173
Mechanism of tetracylcine resistance?
Efflux pumps or altered proteins (30s)
174
Mechanism of aminoglygocisde resistance?
incactivation by aminoglycoside-modifying enzymes
pseudomonas can decrease cell entry :(0
175
Tzanck smear
multinucleated giant cells with and keritinocytes with intranuclear inclusions - herpes
acantholysis would also be seen and intraepidermal vesicles
176
Two markers of biliary tract intactness
alkaline phosphatase
| gamma-glutamyl transferase
177
if a patient has an elevated alkaline phosphatase, you dont know if it is from a neoplasm, a bone problemo, etc. so what test would you order
gamma-glutamyl transpeptidase
178
what is gamma glutamyl transpeptidase? GGTP
enzyme predominately present in hepatocytes and biliary epithelia - useful in determining whether elevated alk phos is of bone or hepatic origin
179
schizophreniform
same symptoms as schizophrenia but lasting between 1-6 months
180
schizoaffective disorder
major depressive or manic episode concurrent with schizophrenia
BUT
Also lifetime history of delusions or hallucinations >2 weeks in the absence of major depressive / manic episode
181
Child - female - regression at 10 . months - stereotyped hand ringing - ataxia?
Rett syndrome
X linked
MECP2 gene
182
Obturator nerve
passes through?
comes from?
is responsible for?
passes through obturator canal
comes from l2-l4
responsible for adduction of thigh
sensation distal medial thigh
183
Locus Ceruleus - NT?
Norepinephrine
184
Patient comes in with difficult releasing grip
you also not that they have cataracts
what are you thinking?
what would you see on histo?
Myotonic dystrophy
AD DMPK gene
Trinucleotide repeat
Selective atrophy type I fibers - slow twitch
frontal balding and gonadal atrophy common
My tone my testicles my toupee
185
If a patient presents with pure motor weakness of unilateral leg, arm, and lower face - what are you thinking?
internal capsule stroke - presentation - contralateral side effected
186
Craniopharyngioma - found in ?
derived from ?
signs and symptoms
found in you people
remnants of rathkes pouch
often cystic with brownish yellow oily cholesterol crystals
187
High characteristic finding of craniopharyngiomas on imaging
calcified cysts
188
what makes a post pancreatitis cyst a pseudo?
not lined by epithelium - lined by granulation tissue!
189
at low dose does alpha-1 or beta-2 stimulation predominately effect diastolic blood pressure?
beta-2 induced dilation of skeletal muscle vasculature wins at low doses -
at high doses - alpha-1 constriction of visceral and cutaneous wins and you get elevated blood pressure
***remember this when giving people epinephrine who are on beta blockers
190
tinea versicolor
Caused by Malassezia - yeast like fungus - (not a dermatophyte) -
causes degradation of lipid membrane via acid secretion which fucks with melanocytes
which leads to hypopigmentation of the skin
Spaghettic and Metaball on microscope
191
Tinea Veriscolor rx
```
topical antifungals or oral
nystatin
clortrimazole
miconazole
or
selenium sulfide
```
192
how do azole work again
they disrupt ergosterol biosynthesis (cell membrane component via p450 enzyme inhibition)
193
if you are looking for clues as to whether a child has group A strep or Kawasakis disease... what could clue you into Kawasakis?
fever last 5 days or longer
bilateral nonexudative conjunctivitis
erythema or edema of hands / feet
194
Putaminal hemorrhage - likely due to a bleed involving HTN induced Charcot bouchard anuerysm from the lenticulostriate arteries of the middle cerebral - almost always involve?
the adjacent internal capsule - leading to contralateral hemiparesis and hemianesthesia due to disruption of the corticospinal and somatosensory fibers in the posterior limb
195
lobar hemorrhages are most frequently associated with?
amyloid angiopathy in the elderly (cortical branches of the major cerebral - usually parietal and occipital)
196
Rett gene
MECP2
197
Aflatoxn of aspergillosis associated with hepatocellular carcinoma and mutation
b1
p53
codon 249
G:C --> T:A
198
Nuer-endocrine associations with small cell lung cancer
SIADH
Cushings
Also Lambert Eaton!!
199
Lambert Eaton is associated with which lung cancer?
small cell
200
which lung cancer shows hypercalcemia?
squamous cell
201
locations of lung cancer?
small cell and squamous - central - makes sense since associated with smoking
adeno and large cell - periphery
202
associations with large cell lung cancer
gynecomastia
galactorrhea -
large ladies :)
203
associations with adenocarcinoma of the lung?
clubbing and
| hypertrophic osteoarthropathy
204
precarious placement of pudendal?
curving course around ischeal spine to return to pelvis can stretch
205
If you are going to intubate someone with rheumatoid arthritis what should you consider?
They may have subluxation of the atlanto-axial joint and then when you put the tube in, you may make this worse and then the spine may get compressed and then you will have spinal shock!!! oh no
206
The most characteristic biochemical feature of huntingtons?
decreased GABAergic neurons in the caudate nucleus :(
they have elevated dopamine as well?
HD gene on chromosome 4
207
modafinil
narcolepsy rx (non-amphetimine)
208
my patient comes in and has hypertriglycerides - but can't tolerate fibrates - what should i DO?
Niacin - lowers Hyperlipidemia / raises HDL
TEll him to also take aspirin because Niacin effect of PGD2 and PGE2 can cause flushing warmth and itching :
209
Red man syndrome
non-IgE mediated histamine response to vanco
210
substance p?
polypeptide neurotransmitter - mediates pain signals in the PNS and CNS - topical capsaicin causes release of substance P
211
chronic lung rejection ???
brochiolitis obliterans - targets the airways not the vasculature
212
If we take macrophages from our patients lungs (or anywhere i suppose) and they turn dark blue with prussian blue staining - what can we conclude???
They are hemosiderin laden macrophages - i.e. they are siderophages - i.e. they have been chomping up red blood cells and are now filled with iron - thus he was likely experiencing LHF with subsequent pulmonary edema
213
Ribavirin
used in HepC - inhibits synthesis of guanine nucleotides and interferes with viral RNA dependent RNA polymerase
remember
HCV is a flavivirus - enveloped +ssRNA
214
where does the axonal reaction occur and what does it look like?
proximal to the transection (i.e. the neuronal body) - see swollen and rounded body - nucleus displaced to periphery - nissle substance dispersion - preparing to produce protein to regrow
215
where does wallerian degeneration occur?
distal to the transection
- degeneration of axon and myelin distal to point of injury - fragments are digested by schwann cells and macs (i.e. only pNS)
216
What differentiates wallerian degeneration from neuron cell death :(
neurons manifest with shrinkage of the neuronal body
deep eosinophilia of cytoplasm
pyknosis of the nucleus
loss of Nissle
217
cytokine secreted by hyperactive T cells in crest syndrome that cause?
TGF-Beta
| collagen deposition - particularly effecting small arterioles and capillaries early
218
characteristic finding in ion channel myopathy
positive PAS vacuoles in cytoplasm
219
what causes subcortical dementia in non-compliant AIDS?
Microglial nodules - resulting from inflammatory activation of microglial cells - inflammatory cytokine release
220
Pulsion diverticula
false diverticula usually in the colon due to pressure pushing the mucosa and submucosa through a weakness in the muscle wall - most common in diverticula of old people - and also same as zenker diverticula of upper esophagus
221
where are diverticula most common
sigmoid colon
222
what is a true diverticula
a traction diverticula where inflammation and subsequent scarring of the gut wall yields outpouching of all gut layers - may occur in the midesophagus due to medistinal lymphadentitis caused by TB or fungal infection
223
Ground glass hepatocytes with homogeneous pale eosinophilic cytoplasm?
characteristic histopath of HepC
224
Clumped amorphous eosinophilic intracytoplasmic inclusions in hepatocytes?
mallory bodies
| alcoholic steothepatitis
225
small vesicles of fat within hepatocytes
hepatic steatosis - characteristic histo
226
where is acetylcholine decreased in alzheimers
hippocampus
nucleus basalis of meynert
deficiency in choline-acetyltransferase
227
depleted in Huntington
NMDA receptors are depleted in the striatum
228
characteristic histopath of reyes
microvesicular steatosis without inflammation
229
Cushing's triad - brainstem compression
hypertension
bradycardia
respiratory depression
230
Mid brain and upper pons compression?
flexural posturing and fixed dilated pupils - loss of inhibition to upper limb flexors
231
At or below red nucleus (midbrain tegmentum / pons) = compression?
extensor posturing - loss of excitation to upper limb flexors - so extensory predominate
232
schwannomas may aris within any cranial nerve except
ii
233
location usually of brain mets
grey white border
234
tension pneumothorax or pleural effusion can efface the x-ray in a manner similar to a lung collapse do to a right mainstem bronchus obstruction- how would you be able to distinguish?
tension pneumothorax wil push mediastinal structure and trachea away (so will a pleural effusion)
lung collapse from bronchus obstructions will pull mediastinal structures toward side
235
PRIMARY defense mechanism in giardia?
IgA
236
Riedel thyroiditis
thyroid replaced by fibrous tissue
| IgG4 related systemic disease - autoimmune pancreatitis / retroperitoneal fibrosis, non-infectious aortitis
