Combank 2 Flashcards
mutation in the beta-2 integrin receptor - dx?
what do integrins do?
Leukocyte adhesion deficiency
responsible for adhesion of leukocytes to endothelial cells and, thus, result in mobilization to extravascular sites of inflammation
A lesion in the dorsomedial hypothalamic nuclei would cause…
decreased aggression and feeding
A lesion in the lateral hypothalamic nuclei would cause…
decreased feeding
A lesion in the supraoptic hypothalamic nuclei would cause…
What does this nucleus normally produce?
diabetes insipidus
normally produces oxytocin and antidiuretic hormone for transport to the circulatory system
A lesion in the ventromedial hypothalamic nuclei would cause…
increased feeding
Pts with androgen insensitivity syndrome (AIS) are genetically male, but due to the androgen receptor defect, they display normal appearing female external genitalia. Why/where would testes develop?
testes develop due to the presence of the SRY gene on the Y chromosome and are often found within the labia, inguinal canal, or intra-abdominally.
Male internal genitalia is present due to the presence of…
Mullerian inhibiting factor
Cisplatin MOA?
AE?
How would I prevent nephrotoxicity?
antineoplastic that alkylates and cross-links DNA
nephrotoxicity, acoustic nerve damage and resultant tinnitus, and peripheral neuropathy which can result in foot or wrist drops
use of free radical scavenger amifostine and chloride diuresis
MOA and AEs of bleomycin
antineoplastic agent that inhibits DNA synthesis through free radical formation that induces single-strand breaks in DNA. it inhibits DNA, RNA, and protein synthesis in the G2 and M phases of the cell cycle
pulmonary fibrosis resulting in restrictive lung disease
Busulfan MOA and AE
antineoplastic that works by alkylating and cross-linking strands of DNA and is cell-cycle nonspecific
pulmonary fibrosis and hyperpigmentation
cyclophosphamide MOA and AE
alkylating agent that prevents cell division by covalently cross-linking DNA strands at the guanine N-7 location, and thus, decreasing DNA synthesis;
requires initial activation by the liver
myelosuppression and hemorrhagic cystitis (due to metabolite acrolein) - prevented with hydration and rx mesna
Tx for tourette’s?
risperidone - D2 receptor antagonist
or if severe fluphenazine or haloperidol
What does hemisection of the spinal cord cause?
- ipsilateral spastic paralysis below lesion
- ipsilateral loss of touch and vibration below the lesion
- CL loss of pain and temp sensations below the lesion
Why would ACE level be elevated in a pt with sarcoidosis?
ACE is produced by the granulomas in sarcoidosis and is elevated in up to 75% of untreated pts.
Where are oligodendrogliomas MC found? What will they appear as on examination?
MC in frontal lobes, exam will reveal the presence of rounded cells with perinuclear halos giving them a ‘fried egg’ appearance; they also have the presence of finely branching capillaries, which looks like ‘chicken wire’
“fried eggs and chicken wire”
Rathke’s pouch is an embryological collection of oral ectoderm that gives rise to…
a primitive neuroectodermal tumor arising in this area is called..
what is a distinctive feature?
anterior pituitary gland
craniopharyngioma
MRI-indicated supra-cellar calcifications
Rosenthal fibers are corkscrew-shaped intracytoplasmic inclusions that are seen in …
optic gliomas of NF-1 and pilocystic astrocytomas
anti-mitochondrial abs are a marker in pts with
primary biliary cirrhosis
anti-microsomal abs are positive in pts with
Hashimoto’s thyroiditis
What innervates the biceps femoris?
common fibular branch and tibial branch of sciatic nerve
Where do thiazide diuretics act?
What is a common AE?
antihypertensive acting on the distal tubule by blocking the thiazide-sensitive Na-Cl symporter; decreases NaCl reabsorption and causes a diuresis as the tubular fluid will be drawn osmotically to follow the Na being excreted
hyperuricemia and gout
What crystals does pseudogout have?
calcium pyrophosphate dihydrate (CPPD) crystals, rhomboid shaped and positively birefringent
milky fluid on thoracentesis
chylothorax - presence of chyle and increased triglycerides within pleural space
In primary hypothyroidism, what will the labs be?
increased TSH and TRH with low T4 and T3; increased serum prolactin level
HTN, hypokalemia, metabolic alkalosis, and low renin
dx?
primary hyperaldosteronism/Conn syndrome
damage to C8 and T1 nerve roots
dx?
presentation?
Klumpke palsy;
hyperextension at the metacarpophalangeal joints and hyperflexion at the proximal and distal interphalangeal joints of second to fifth digits
which hemorrhoids are painful?
external hemorrhoids are painful
When would I see granular casts?
acute tubular necrosis
due to direct damage to renal tubular epithelial cells
GIST (GI stromal tumor) is MC non-epithelial benign neoplasm of GIT.
what are ssx?
what mutation is a/w?
what morphology do they have?
older individuals, symptoms of early satiety, abdominal bloating then GI bleeding or obstruction
inherited mutations in KIT gene
80% have spindle-shaped morphology
mutations in what gene are a/w Peutz-Jegher’s syndrome?
mutated STK11 allele, and inactivation of the other allele leads to disruption of cells polarity
jaundice and RUQ pain with ulcerative colitis
primary sclerosing cholangitis
chronic and progressive disorder characterized by an inflammatory process of the biliary ducts leading to fibrosis and stricturing of the intrahepatic and extrahepatic biliary ducts
postinfectious glomerulonephritis on light microscope
lumpy-bumpy deposits
test to confirm dx of postinfectious glomerulonephritis?
antistreptolysin O test
young age, diagnosed with poorly differentiated tumors in the R (proximal colon), tumors contain mucin, and has a family hx
dx?
genetics?
Hereditary nonpolyposis colorectal cancer
(HNPCC or Lynch syndrome)
autosomal dominant disorder of DNA mismatch repair genes which causes an error in nucleotide pairing, commonly leading to colorectal cancer in 80% of patients
purine salvage defects are commonly seen in what disease?
Lesch-Nyhan syndrome
deficiency in HGPRT
alternative splicing occurs when different exons are combined to make unique proteins, commonly seen in…
beta-thalassemia
nucelotide excision repair defect, which is involved in removing a group of damaged bases, is commonly seen in….
this deficiency prevents…
leading to…
xeroderma pigmentosum
prevents repiar of thymidine dimers caused by UV light
leading to various skin cancers
Where does ALS cause demyelination?
in the anterior horn of the spinal cord and motor areas of the cortex and brainstem
What drug is used to keep the ductus arteriosus patent if some surgical repair is needed to be done?
alprostadil - PGE1 analog
fungus with halo sign in the lungs
Aspergillus
The infraorbital nerve is a terminal branch of …
it reaches superficially by what path?
maxillary (V2) division of trigeminal
maxillary N. exits cranium through foramen rotundum into pterygopalatine fossa, where infraorbital N. originates
nerve courses through the inferior orbital fissure to reach the orbit, then to the infraorbital canal toe xit the skull at the infraorbital foramen, just inferior to the orbit
The infraorbital nerve conveys sensory info from what structures?
lower eyelid, side of the nose, and upper lip
Phenelzine MOA and precautions
MAO-I used to tx atypical depression;
if taken with tyramine (wine and cheese) it can cause hypertensive crisis
imipramine drug class
TCA
Paroxetine MOA and AE
SSRI used to tx depression;
serotonin syndrome
thioridazine indication and AEs
antipsychotic used to tx schizophrenia
neuroleptic malignant syndrome, characterized by autonomic instability, rigidity, myoglobinuria, and hyperpyrexia
In benign prostatic hyperplasia, what is increasing?
What kind of drug can reduce symptoms?
the numbers of cells in both glands and stroma increase
alpha-1 antagonists
a hypertrophic gastropathy in which significant protein is lost via the GIT, leading to diarrhea, weight loss, and edema - dx?
what happens to stomach rugae?
Menetrier disease
increase in size and may resemble cerebral gyri
What will you see on microscopic exam of Menetrier disease?
several cork-screw shaped glands composed of mucous cells, and decreased numbers of parietal and chief cells; very few inflammatory cells are present
Dupuytren’s contracture
painless thickening and contracture of plamar fascia beneath the skin leading to inability to extend fourth, fifth, then third digits
bilateral ovarian mets from a GI tract adenocarcinoma - dx?
what type of adenocarcinoma is a/w this?
Krukenberg tumor
usually the diffuse subtype of gastric adenocarcinoma composed of individually invasive, mucin-filled, signet ring cancer cells
acanthosis nigricans in the absence of insulin resistance?
suggests mucin-producing GI tumor
MC primary ovarian cancer?
papillary serous cystadenocarcinoma, often bilateral
they mimic the cells and fimbraie of teh oviduct and usually show papillary and microcystic growth patterns
concentrically-laminated microcalcifications (psammoma bodies) often seen
What do Call-Exner bodies indicate?
these miniature follicles indicate granulosa-cell origin
When the fibular head moves posterior, the lateral malleolus moves…
anterior and is restricted in posterior glide
How do you differentiate Grave’s disease from thyroid storm?
Graves disease does not have AMS and autonomic instability including HTN and tachycardia/afib and elevated temperature;
thyroid storm can lead to HF, arrhythmia, and death if it is allowed to progress
why would hyperoxemia be bad in a neonate with decreased surfactant?
may cause free radical injury resulting in retinopathy and blindness
Where are initial atherosclerotic lesions found?
MC at branch points, at sites of high shear where a predilection to plaque formation has been observed;
disease progression occurs more rapidly in teh aorta, followed by the coronary arteries and femoral arteries
progression occurs least in the carotid and intracerebral arteries
Where are changes in arterial pressure detected?
What does the valsalva maneuver do to cardiac output?
baroreceptors in the carotid sinus which, via the CNS, alters cardiac activity to compensate
initially increases, then decreases CO, which normally causes an increase in heart rate and contractility
What receptors respond to large decreases in arterial PO2?
chemoreceptors in carotid and aortic bodies;
cause a sympathetic response leading to increased heart rate and BP
What does Hering’s nerve do and what is it a branch of?
part of CN IX, responsible for carrying the signals from the baroreceptors in the carotid sinus to the vasomotor centers in the brain
What is the only muscle of the thenar eminence innervated by the ulnar nerve?
adductor pollicis
Forearm supination is a function of what nerve and muscles?
musculocutaneous nerve innervating biceps brachii;
only form of thyroiditis that is painful?
what is the pathophys behind this?
subacute granulomatous de Quervain thyroiditis
due to the leakage of thyroid hormone from an inflamed thyroid gland, followed by euthyroid state, then an eventual hypothyroid state once hormones have been depleted
Tx for subacute granulomatous de Quervain thyroiditis?
supportive with NSAIDs and Beta blockers
trigger finger is aka
stenosing flexor tenosynovitis
rupture of the flexor digitorum profundus tendon at point of attachment to the distal phalanx
jersey finger
rupture of the terminal extensor tendon at the distal interphalangeal joint?
results from a traumatic blow to the distal phalanx resulting in hyperflexion of teh extensor digitorum tendon; may be associated with an avulsion fx of the distal phalanx
Mallet finger
Muscle energy for an exhaled rib 3?
doc places inferior traction at the posterior angle of rib 3 while the pt holds their breath at full inhalation, engaging the restrictive barrier, and contracting the pec minor against counter-force
MC mucopolysaccharidosis caused by an autosomal recessive, inherited nonsense mutation that results in decreased/absence of alpha-L-iduronidase
dx?
what does this cause?
mucopolysaccharidosis Type I, Hurlers syndrome
prevents lysosomal breakdown of GAGs, specifically dermatan sulfate and heparn sulfate
OMM tx for IBS?
superior mesenteric ganglion release
T10-11 via the lesser splanchnic nerve
supplies the middle GI tract; ligament of Treitz to the mid transverse colon;
How does narcolepsy affect REM sleep?
decrease REM latency and enter REM sleep almost immediately after falling asleep
pain and temp sensation from the face are conveyed by …
spinal trigeminal nucleus and tract
lesion of the solitary nucleus would cause…
loss of taste sensation
lesion of the trigeminal principal sensory nucleus would cause…
loss of light touch, vibration, and position sense
Occlusion of which artery causes lateral medullary syndrome/Wallenberg syndrome?
what are ssx?
PICA
face loses pain and temp sensation ipsilateral to the lesion, body loses pain and temp sensation contralateral to the lesion
What is a common cranial nerve palsy with sarcoidosis?
What lab value is commonly elevated, though not diagnostic?
CN VII Bell’s palsy
75% of untreated sarcoidosis pts will have elevated ACE levels; this is due to the increased production of ACE by the non-caseating granulomatous cells found in the various organ systems
What percentages of observations will lie within standard deviations in normal distribution?
68% of all observations lie within one standard deviation, 95% lie within two standard deviations, and 99.7% lie within three standard deviations from the mean
Why would the BUN:Cr level be elevated in an upper GI bleed?
hemoglobin is digested into urea and reabsorbed from the GIT into the bloodstream
What is Bruch’s membrane in the retina?
nortriptyline MOA and drug class
what is the best initial tx for an acute manic episode?
an antipsychotic, benzodiazepine or valproate;
olanzapine, risperidone, and haloperidol are more efficacious than others
olanzapine MOA
acts through combination of DA and 5-HT2 receptor site antagonism
maintanence for preventing mania, acute mania, and schizophrenia
AE: wt gain, hypertriglyceridemia, hypercholesterolemia, somnolence and extrapyramidal ssx
Lurasidone indication
second gen atypical antipsychotic
typically used for cases of bipolar depression (not tx mania)
t(14:18)
diffuse large B cell lymphoma
autoimmune disease that classicly presents in middle-aged women, ssx including pruritis, jaundice, dark urine, light stools, and hepatosplenomegaly
dx?
what do labs usually show?
any concurrent illnesses?
what is elevated in 95% of PBC cases?
primary biliary cholangiitis (PBC)
labs display a cholestatic pattern with normal cholangiography and US findings
concurrent autoimmune diseases such as CREST syndrome, which occurs in 15% of pts with PBC;
antimitochondrial antibody concentration is elevated in 95%
long standing biliary obstruction from various causes may result in liver disease that may progress to cirrhosis - what is this phenomenon called?
what does this cause?
secondary biliary cirrhosis (SBC)
chronic obstruction causes an increase in pressure in the intrahepatic bile ducts that leads to bile stasis and fibrosis;
ascending cholangiitis is a potentially fatal complication of SBC
What is secreted by T cells to support growth and differentiation of bone marrow immature hematopoietic progenitor stem cells?
IL-3
What does squamous cell carcinoma of the skin usually originate as?
actinic keratosis (solar keratosis) - a patch of epidermis where the cells show features of precancer but have not yet invaded
What is the most reliable routine lab test to predict the mortality in acute pancreatitis?
BUN
What is tx for PS1?
apply pressure anteriorly on CL ILA in order to rotate the sacrum around an oblique axis
What is the tx for PS5 tender point?
posterior to anterior pressure on opposite sacral base
what is the disease modifying anti-rheumatoid drug that causes retinal deposits?
hydroxychloroquine
unknown mech. - possibly act through antigens responsible for hypersensitivity reactions
AE of ethambutol
optic neuritis
What is the Mackler triad?
vomiting, thoracic pain, and subq emphysema
Boerhaave syndrome
L on L sacrum means what for L5?
L5 NSLRR
R on R sacrum means L5 dx
L5NSRRL
L on R sacrum means what L5
L5F/ESRRR
R on L sacrum means what L5
L5F/ESLRL
For sacral torsions, the rules for L5 states that it..,.
rotates opposite the sacrum and sidebends toward the oblique axis
crescendo/decrescendo systolic murmur best heard at right upper sternal border and can radiate to the carotids
aortic stenosis
low pitched decrescendo diastolic murmur with opening snap
dx and presentation?
mitral stenosis
atrial enlargement, LV volume probs normal
murmur begins in diastole with opening snap of teh mitral valve followed by decreascendo low pitched rumbling that reflects the falling pressure gradient during ventricular filling
crescendo/decrescendo systolic murmur that increases with Valsalva
hypertrophic cardiomyopathy
terazosin, prazosin, and doxazosin MOA
smooth muscle relaxation through inhibition of a1 receptors
lower BP and improve symptoms with BPH
What drug actually is show to increase hospital rates and worsen heart failure, increasing mortality?
diltiazem (Non-DHP CCB) first gen
due to negative inotropic effect
CO equation using O2 consumption and content
CO = O2 consumption / (O2 content arterial - O2 content venous)
CO = O2 consumption / (Ca-Cv)
pencil-in-cup deformities
psoriatic arthritis
Heberden and Bouchard nodes - bony hypertrophy of distal and proximal interphalangeal joints present in…
osteoarthritis
dx Ulcerative Colitis with noting…
collections of neutrophils within crypts of Lieberkuhn
What lung pt has better compliance? COPDer or IPF?
COPD has more compliance. IPF is restrictive in nature (scarring, fibrosis, and capillary destruction)
chlorpropramide MOA and AE
is a sulfonylurea (insulin secretagogue) inhibits the beta cell K-ATP channel thereby stimulating insulin release from beta-islet cells and increase circulating insulin levels
first gen - binds with lower affinity than second gen - so must be given in higher doses
AE: hypoglycemia, rash, diarrhea, nausea, dizziness, and wt gain
dr. turns infants head to one side, infant’s extremities on that side extend, while those on the CL side flex; present from birth to 4-9 months
fencer response - asymmetrical tonic neck reflex
infant is suspended in the prone position, paravertebral area on one side is stroked, and infants back sidebends toward that side, eliciting what reflex
Galant reflex
tx for right inferior pubic shear with muscle energy?
R leg flexed at the hip and knee and internally rotated at the hip
What is SMA syndrome?
with abdominal trauma, scoliosis surgery, or periotoneal adhesions, the angle between the abdominal aorta and SMA can shift, causing compression of the duodenum
localized pain at bite site, muscle pain, and GI symptoms
what bit her? what toxin?
black widow spider
alpha-latrotoxin
harsh, blowing holosystolic murmur radiating to the axilla
mitral regurg
drugs a/w disulfram-like reaction to alcohol
cefoperazone, cefamandole (third and second gen cephalosporins), procarbazine, first gen sulfonylureas, and metronidazole
Gemfibrozil and other fibrates MOA
tx hypertriglyceridemia
enhances activity of lipoprotein lipase which hydrolyzes fatty acids from VLDL; promotes uptake of fatty acids by adipose tissue and increases their conversion into triglycerides
What are the proteins that pXO1 plasmid codes for in anthrax?
protective antigen (PA), lethal factor (LF), and edema factor (EF)
What are the combinations of proteins in anthrax that develop toxins?
PA and EF form edema toxin and PA and LF form lethal toxin
zinc dependent protease that cleaves mitogen activated protein kinase, leasing to cell death
lethal toxin (PA + LF of anthrax)
edema toxin is a calmodulin-dependent adenylate cyclase that catalyzes the reaction of
ATP to cAMP inside host cells, resulting in edema
MCC of achalasia?
loss of nitric oxide synthase producing neurons in myenteric plexus
What are the Standford classifications of aortic aneursyms?
Type A involves the asceding aorta and are surgical emergencies
Type B do not involve the ascending aorta and can generally be initially tx’d medically with heart rate and BP control
Tender point a/w TFL somatic dysfuncction are treated with
flexion and abduction of the hip
an action that has both negative and positive consequences may be ethically justified if the intention is to achieve the positive effect
this is called…
ethical prinicple of double effect
use of intermittent sedation to control symptoms; pt is rendered unconscious for a short period of time, in order to manage refractory symptoms
respite sedation
AEs of opioids?
decreased respiratory rate, miosis, constipation, nausea, and somnolence
AE of haloperidol and other typical antipsychotics?
hyperprolactinemia causing gynecomastia and/or lactation
What benzos are preferred in pts with liver disease?
why?
lorazepam and oxazepam
they go directly to phase II metabolism, bypassing the phase I metabolism of the P450 enzymes system, and only create inactive metabolites
first line tx for panic disorders?
SSRIs (paroxetine)
tx for post-herpetic neuralgia?
TCAs, gabapentin or pregabalin, or lidocaine patches
allopurinol interferes with metabolism of what drug?
mercaptopurines, greatly increasing their toxicity
midfacial underdevelopment, microcephaly, and delayed CNS development; dysmorphic facial features often include a small philtrum, thin vermillion border, and small palpebral fissures;
dx?
Fetal alcohol syndrome
What does the Meyerding classification system score?
grades spondylolisthesis in increments of 25%
Where does the degenerative form of spondylolisthesis/type III most often occur?
L4-L5
What are the types of spondylolisthesis?
- Type I: dysplastic spondylolithesis
- sequela of an anatomic anomaly of S1, with rouding of the superior and ventral aspect, allowing L5 to slip forward
- Type II: isthmic spondylolithesis
- MC in young athletes
- subtyped into IIa and IIb
- Type III: degenerative
- segmental instability at the L4-L5 level, usually secondary to arthritic degeneration of the facet joints
- middle to older aged female typically
- Type IV: traumatic
- at any level
- Type V: pathologic
- generalized bone disease (osteoporosis or osteopetrosis)
- lytic osseous lesions possible
personality disorder characterized by a lack of personal relationships with a lack of desire for them; pts are loners and appear emotionally detached
schizoid personality disorder
Cluster A disorder: characterized by at least five of
- odd beliefs or magical thinking
- perceptual experiences
- odd thinking and speech
- suspiciousness of others
- constricted affect
- odd behavior
- lack of close friends
- social anxiety
schizotypal personality disorder
Cluster C disorder; dx made when the pt has at least four of the following:
- avoidance of occupational activities
- resistance to close interpersonal relationships unless certain of being liked
- fear of being shamed in intimate relationships
- preoccupation with the fear of being criticized or rejected
- inhibition in new situations
- persistence of a self-view of being socially inept or inadequate
- reluctance to take risks
avoidant personality disorder
pattern of behaviors that violates the basic rights of others or deviates from societal norms that leads to impairment in social, academic, or occupational functioning
conduct disorder
cluster B personality disorder where individuals repeatedly violate the rights of others, refuse to conform to social norms, and lack remorse for actions that may harm others
antisocial personality disorder
six month period of hostile and defiant behaviors with four or more criteria including frequent loss of temper, arguing with adults, defying adults, deliberately annoying people, anger, spitefulness, blaming others, and easy annoyance
oppositional defiant disorder
A larger volume of distribution means a …. percent remains in the plasma
smaller
pain caused by the abnormal implantation of endometrial glandular and stomal tissue within the myometrium
what is this and who is this more common in?
adenomyosis
multiparous women, over the age of 35, and those with a hx of uterine surgeries
what is the mechanism of pathogenesis for rheumatic fever?
cross-reaction of abs developed against M protein of S. pyogenes
abs bind caridiac tissue, are recognized by circulating monocytes which then initiate an inflammatory response that leads to fever, erythema marginatum, subcutaneous nodules, chorea, migratory polyarthritis, elevated ESR, and valvular damage
pts have a major mood episode (either depressive episode or mania) concurrent with symptoms of schizophrenia (delusions, hallucinations, disorganized speech, disorganized behavior, and/or negative ssx)
schizoaffective disorder
Cluster A personality type in which individuals are detached from social relationships and have difficulty expressing emotions
schizoid disorder
dx of this disorder requires two or more of the following:
- delusions
- hallucinations
- disorganized speech
- grossly disorganized or catatonic behavior
- negative symptoms
lasting 3 months+
schizophreniform disorder
Acute tx for cluster HA
100% oxygen at 10-12 L/min for 15-20 minutes, subcutaneous or intranasal sumatriptan, or intranasal zolmitriptan
What tenderpoint is located superior or superior lateral tip of C2 spinous process?
PC2 midline spinous process
What tenderpoint is inferior or inferolateral tip of C2 spinous process?
PC3 midline spinous process
What tenderpoint is at the inferior nuchal line within the semispinalis capitis muscle?
PC2 occiput
What tenderpoint is at the inferior nuchal line midway between the inion and mastoid on the splenius capitis?
PC1 occiput
What tender point is on the inferior nuchal line lateral to the inion?
PC1 inion
What rx to tx gram negative anaerobes in a sinusitis infection?
clindamycin
Why does the pacemaker potential (phase 4) of the SA node develop?
because of the increasing membrane permeabilities of Na+ (funny channels) and Ca2+ and the decreasing membrane permeability of K+ that gradually depolarizes the membrane until membrane potential reaches the threshold for an AP
exemestane indication and MOA
aromatase inhibitor used to tx ER+ BRCA in postmenopausal women
oxandrolone indication and MOA
anabolic-androgenic steroid, to increase protein synthesis in muscle, increase muscle mass, and accelerate wound healing after burn injury
can also be used for HRT for hypogonadism, and many other things needing increased protein production
testicular atrophy is MC AE
peripheral neuropathy which can manifest as foot or wrist drop, delirium, hallucinations, or hypersomnolence could be from overexposure to …
this can result in what on a peripheral blood smear?
why is this apparent?
lead toxicity
basophilic stippling of RBCs on peripheral blood smear
from denaturation of the enzyme ribonuclease, which results in the inability of the enzyme to break down ribosomes
Pts with resorption atelectasis have both…
ipsilateral diaphragm elevation and ipsilateral tracheal deviation due to lung collapse
resorption/obstructive atelectasis is likely from
postop mucus plug which prevents air from reaching the terminal alveoli, eventually causing the collapse of the lung after preexisiting air is reabsorbed back through the alveoli
the shortest antero-posterior diameter through which the fetal head must pass and extend from the sacral promontory to the closest point on the convex posterior surface of the symphysis pubis
obstetric conjugate
how do you get the measurement of the obstetric conjugate?
obtained by subtracting 1.5 to 2 cm from the digitally measured diagonal conjugate; typical obstetric conjugate is 10.5cm
what measurement extends from the middle of the sacral promontory to the superior surface of the pubic symphysis?
anatomic conjugate/true conjugate
what extends from the middle of the sacral promontory to the inferior surface of the pubic symphysis?
diagonal conjugate
What measurement is from teh SI joint to the opposite iliopectineal eminence?
oblique diameter
spleen is derived from
mesoderm
aplasia or hypoplasia of the cerebellar vermis and cystic dilation of the fourth ventricle
dx?
what is this occassionally a/w?
Dandy walker malformation
truncal ataxia
a form of hypogonadotropic hypogonadism that is a/w decreased FSH, LH, T, and sperm count
dx?
what is a distinguishing feature of this syndrome?
Kallman syndrome
anosmia
what describes feelings that conincidental unrelated occurences have strong personal significance
ideas of reference
Primary v Secondary v Tertiary prevention
- primary prevention - take prior to onset of dz to decrease possibility of occurrence
- vaccine
- secondary prevention - performed to find and help halt progression of a disease at its onset
- screening
- tertiary prevention - used to reduce progression of a dz in advanced stages,
- HF clinic
avascular necrosis of the femoral head is aka….
and commonly affects/presents as
Legg-Calve-Perthes disease
boys 3-12 yo and present with hip pain and a limp of either acute or insidious onset; pain in knee occurs due to referred pain from the obturator nerve; pain is worse with activity, no infectious signs
MC in overweight or obses AA boys 10-16 yo; presents with limp of insidious onset, impaired internal rotation, and anterior hip or knee pain
dx?
Slipped capital femoral epiphysis
Differentiate between SCFE and Legg-Calve-Perthes disease
SCFE will have older pts (10-16 yo) and pts will likely be obses
LCP (3-12 yo) and will have normal BMI
In Legg-Calve-Perthes disease, why is there a tender point noted 7 cm medial to the ASIS?
represents dysfunction of the iliacus muscle, which attaches to the lesser trochanter of the femur
More common in women, this leads to patellofemoral syndrome with anterior knee pain
what is this due to?
chondromalacia
weakness of the vastus medialis oblique muscle, resulting in increased lateral subluxation of the patella
What connects the cervix to the pelvic side wall and contains uterine vessels?
Located at the base of the broad ligament, damage to this is a/w what?
cardinal ligament
pelvic organ prolapse
bilateral structures that connect the cervix to the posterior surface of the pubic symphysis are…
pathology of this ligament is related to vaginal prolapse due to…
pubocervical ligaments aka anterior ligament
due to a reduction in collagen within the structure over time but does not house the arterial supply or veins
What does the round ligament do and what does it contain?
connects the uterine fundus with the labia majora, running through the inguinal canal
contains the artery of Sampson
rash that erupts synchronously and starts in the moth and then spreads to the face and extremities
smallpox/variola virus
Where does intussusception MC occur and how does it present?
how can you detect it?
MC at ileocecal junction;
classic presentation is triad of vomiting, abdominal pain, and passage of blood per rectum;
dx made on US - target sign
AE of phenelzine
hypertensive crisis - tyramine (found in aged cheese and wine) is ingested along with MAOIs
MAO enzyme found in GIT responsible for metabolizing this potent sympathomimetic aa is inhibited, allowing tyramine to enter the general circulation, leading to severely elevated BP and stroke or stroke like ssx
Imipramine drug class, indication, AE/toxicity
TCA used for MDD and bedwetting
blocks the reuptake of NE and 5-HT
AE include sedation and anticholinergic effects
toxicity results in convulsions, coma, and cardiotoxicity
What is the preferred tx for hypertensive crisis?
phentolamine, a reversible nonselective alpha blocker
MC vascular abnormality of the GIT?
where does it most often occur?
angiodysplasia - degenerative lesion of blood vessels
cause of lower GI bleeding in pts over 60 and MC occurs in R colon; chronic venous obstruction may play a role in precipitating
The SMA supplies what structures?
lower portion of duodenum, jejunum, ileum, cecum, ascending colon, and transverse colon to the splenic flexure
What structures does the celiac artery supply?
part of esophagus through stomach, including liver, spleen, and pancreas
What structures does the IMA supply?
What are its anastomoses?
IMA anastomes with SMA at the splenic flexure
IMA supplies descending colon and sigmoid;
IMA forms an anastomosis with the middle and inferior rectal arteires which are supplied by the internal iliac artery
What anastomoses with the L colic artery?
from the IMA and supplies descending colon and distal part of transverse colon;
anastomoses with the middle colic artery and sigmoid arteries
Carbidopa MOA
inihibits peripheral decarboxylation of levodopa; decreases plasma dopamine levels by inhibiting DOPA decarboxylase
