DIT other - no pics Flashcards
P450 inhibitors - mneumonic
CRACK AMIGOS Cipro Amiodarone Ritonavir (protease inhibitor) Cimetidine Ketoconazole Acute alcohol use Macrolides (erythromycin) Isoniazid Grapefruit juice Omeprazole Sulfonamides
P450 inducers - mnuemonic
Guiness, Carona, and PBRs induce Chronic Alcoholism Griseofulvin Carbamezepine Phenytoin Barbituates Rifampin St. John's Wort (vs depression) Chronic alcoholism
R-L Shunts (early cyanosis)
5 T's persistent Truncus arteriosis Transposition of the great vessels Tricuspid atresia Tetralogy of Fallot Total anomalous pulmonary venous return
Pregnant mother conditions cause congenital defects
lithium - Ebstein anomaly
alcohol - TF, VSD, ASD, PDA
pregestational diabetes - Transposition of great vessels
Congenital baby conditions with congenital defects
congenital rubella - PDA, Pulmonary artery stenosis
DiGeorge - TF, TA
Turner Syndrome - coarctation aorta, bicuspid aortic valve
Trisomy 21 - endocardial cushion defect (creates 4 chambers but leaves 2 small openings)
HF - L vs R
Left - Sx are pulmonary related (pulm edema, DOE, cardiac dilation, orthopnea, paroxysmal nocturnal dyspnea)
Right - Sx are peripheral related (JVD, peripheral edema, hepatic congestion/nutmeg liver)
Tx acute CHF - mnuemonic
NO LIP NO Oxygen Loop diuretics Inotropic Drugs Positioning
CHF drugs that prove survival benefit vs Symptomatic
all these drus are used for chronic tx
ACEI ARBs Aldosterone inhibitors (spironolactone) Selective B blockers (carvedilol) \\\\ Diuretics Digoxin Vasodilators
Starling forces on capillaries/what causes them (4)
inc Pc -CHF, venous thrombosis, vein compression
inc Kf - septic shock, toxins, burns
inc interstitial oncotic P - lymphatic obstruction
dec interstitial onctotic P - liver dz, pr malnutrition, nephrotic syndrome
ECG - axis lead positions and nrm/left/right axis deviation strategy
aVR, aVF, aVL - make a Y (going clockwise) right - aVL, I bottom - II, avF (mid), III left - aVR strategy: 1 - positive deflection, use std position and go out 90 degrees both directions for 180 total 2 - negative deflection, flip std position and go out 180 3 - match the leads, area of most overlap = nrm/left/right left deviation = -30 to -90 nrm = -30 to + 90 right deviation = +90 to +180 *remember electric goes down to left
Diffuse scleroderma
anti-Scl-70 / anti-DNA Topoisomerase 1 Abs
CREST syndrome
anti-centromere Ab
Sjogren Syndrome
Dry - eyes, mouth arthritis "cant see, cant spit, cant climb shit" anti-SSA (anti-Ro) anti-SSB (anti-La)
Polymyositis
anti-Jo-1 Abs
Pemphigus vulgaris - mnemonic
“DAMN is a vulgar word”
desmosomes, mouth lesion, + nikolsky sign,
histo: Acantholysis (loss intracellular connections)
Which drugs are eliminated zero order? mnemonic
PEA (top of P looks like a zero)
Phenytoin
Ethanol
ASA
F pelvic ligaments (5):
Cardinal lig - cervix to pelvic sidewall (w/ uterine vessels B/V)
Infundibulopelvic lig - “suspensory lig of ovary”, ovary to pelvic side wall (w/ ovarian vessels B/V) *risk torsion
Ovarian lig - ovary to uterus (from gubernaculum)
Round lig of uterus - PATH: uterus, through inguinal canal, to labia majorum (from gubernaculum)
Broad lig - connects everything to the pelvic wall (uterus, fallopian tube, ovaries), covers everything (ovarian lig, round lig, infundibulopelvic lig)
Major pelvic nerves (2)
pudendal - M/S (helps w/base penis muscle ejaculation) cavernous nerves (ANS - penis errection), from: inf hypogastric plexus -> posterior plexus -> cav N's (can cut during prostate Sxx)
gonad drainage - veins
right ovary/teste -> right gonadal vein -> IVC
left ovary/teste -> left gonad vein -> L renal V -> IVC
(*bc left gonad vein is longer, higher P, greater chance “bag of worms” vericocele)
Artery supply to gonads and penis
AA -> ovarian/testicular A’s
Internal iliac A supplies most penis
gonadal lymph drainage
O/T -> paraaortic LN’s
- upper 2/3 vagina, uterus, cervix, prostate to ext/int iliac LN (hypogastric)
- low 1/3 vagina/scrotum ->superficial inguinal nodes
hessel back triangle
inguinal ligament, lateral border rectus abdominus, inf epigastric vessels
femoral hernia
NAVeL
“e”
Testicular pathology: major features seminoma embryonal yolk sac choriocarcinoma teratoma leydig sertoli testicular lymphoma
seminoma - fried egg (like koilocyte), most common
embryonal - nrm AFP, inc hCG, painful, alveolar or tubular appearance, papillary convolutions
yolk sac - schill-duval bodie (glomer), inc AFP, <3yo
choriocarcinoma - inc hCG, syncytiotrophoblasts
teratoma - teeth and hair
leydig - test secretions, crystaloids of Ranke, gold/brown, gyncomastia (peripheral to E)
sertoli - E secretions (Peutz-Jager)
testicular lymphoma - most common old man met
sarcoma botryoides - mnemonic
“Grab and Bunch of Grapes”
-embryonalrhabdomyosarcoma
Endometritis - px, hx
inflame, inf acute = post-partum =C-section/abortion chronic = PID, retained foreign body **HISTO** - Plasma cells in endometrium tx - broad abx
endometriosis - key features
endometrioma - chocolate cyst
“gun powder burn” - laparoscopy
leiomyoma - Histo
“whorled pattern”
theca-luteal cyst, increase what?
B-hcG
PCOS
1 cause infertility in F
2/3 Sx Dx
1 - Oligo-ovulation or anovulation (irreg menstrual or infertility)
2 - Hyperandrogenism (hirsutism, doesn’t need to be virilizaiton)
3 - US: see enlarged ovary with cysts (string of pearls sign)
Risk = unopposed estrogen
Tx - progestins, spironolactone, metformin,
clomiphene (for fertility) - SERM, blocks E feedback at AP = inc LH, FSH
SFx - hot flashes, visual issues
Asherman syndrome
Post-op intrauterine adhesions (ex - post D&C)
-reason for infertility
Hormonal changes in PCOS
- Inc LH (LH:FSH ration inc >2)
- inc adrogens
- inc Estrone
- dec sex horome-binding globulin (more H free in system)
- inc insulin (this activates androgen production)
Mittelschmerz
midcycle pelvic pain associated with ovulation
epithelial tumor - serous cyst adenocarcinoma
psammoma body
fallopian-tube-like epithelium
“lined with fallopian tube-like epithelium”
epith tumor - mucinous
pseduomyxoma peritinei (abundant mucus ascities)
epith tumor - endometrioid
co-occurrence with endometrial CA
looks like endometrial tube glands
epith tumor - clear cell
cells w/clear cytoplasm
epith tumor - brenner
hammertoma
contain urinary-tract like epitheliu
“Brenner = Bladder”
Germ cell tumor - teratoma
sebaceous, hair dermoid cyst (nrm tissue) vs malig type(immature tissue) struma ovarii - hyperthyroidism
germ cell tumor - dysgerminoma
makes hCG, LDH
fried eggs HISTO
germ cell tumor - yolk sac
endometrial sinus tissue
inc AFP
schiller-duval bodies (glomerulus - central vessel surrounded by tumor cells)
germ cell tumor - choriocarcinoma
make hCG
met to lung
sex cord stroma tumor - granulosa theca cell tumor
make E -> precocious puberty/post-meo bleed
yellow (cholesterol)
Call-Exner body (granulosa cells surround oocyte trying to make follicle = rosettes surround eiosinophilic spaces”
sex cord stromal tumor - sertol-leydig cell tumor
make androgen/testosterone -> virilization
yellow
looks like seminiferous tubules
sex cord stromal tumor - fibroma
Gross appearance - firm/encapsulated
*Meigs syndrome: ovary tumor, ascities, hydrothorax
sex cord stromal tumor - thecoma
make E -> precocious puberty/post meno bleed
spindle cells
Mom serum testing - quad screen TII 15-20wk
AFP - abd wall defects (gastrochesis, omephacele)
- neural tube defects
- multiple gestation
- incorrect dating
Also check: estrol (placenta), hCG, inhibin
Quad screen - finds: Down Syndrome, Edward, Patau
AFP, B-hCG, estriol, inhibin
down, down, down, Edward Syndrome (18)
down, up, , down, up Down Syndrome (21)
(follows pattern, alpha order)
Patau Syndrome (13)
B-hCG - down
PAPPA - down
nuchal translucency - up (also with 21)
Polyhydramnios - whats it mean/cause?
Esophageal/duodenal atresia Anencephaly Multiple gestations uncontrolled maternal DM congenital infection (ToRCHEs) - Parvovirus B19 Fetal anemia due to Rh alloimmunization
Oligohydramnios
Placental insufficiency
Bilateral renal agenesis –> POTTER sequence
Obstruction urine outflow (pre-urethral valves)
Placental implantation abn types “3” with saying
placenta accrete - adheres
increta - invades
percreta - penetrates
HELLP Syndrome
Hemolysis, Elevated Liver enzymes, Low Platelets
Double Y
47, XYY
M
tall
severe acne
*anti-social behavior
Cri-de-Clut syndrome
microcephaly
high pitched crying like mewing cat
5p deletion
William sydrome
think Will Ferrel in Elf "elfian facies" hypercalcemia very friendly with improved social skills CV - valve defects microdeletion long chrome 7
Klienfelter vs Turner Syndrome
KS - M, XXY, tall, long extremities, testicular atrophy, gyno issues
TS - F, XO, web neck, short, amenorrhea
Five branches facial nerve - mnemonic
To Zanzibar By Motor Car temporal zygomatic buccal mandibular cervical
Familial adenomatous polypsos
MT APC gene
Gardner syndrome
“gardener growing bumpy plants everywhere”
Hereditary hemorrhagic telangiectasia
recurrent epistaxis due to abn blood vessel formation
HD -“c”
Cognitive decline, caudate atrophy, chorea, CAG repeats, Chromosome 4, average age 40, dec aCh
Neurofibromatosis type 1
mt gene chrome 17
café-au-lait spots, neural tumors, lisch nodules
Autosomal Dominant
neurofibromatosis type II
bilateral acoustic neuroma
mt chrom 22
Genetic anticipation Dz’s (4)
HD, myotonic dystrophy, fragile X syndrome, fredreich ataxia
Fabry dz
x-linked recessive
def alpha-galactosidase - accum ceramide trihexoside
peripheral neuropathy, renal failure HTN, CM, angiokeratomas
Gaucher dz
AR
lysosomal storage Dz
def glucocerebrosiase -> accum glucocerebroside
hepatosplenomegaly, thrombocytopenia, painful bone lesions
*prominenet blue cytoplasmic fibrils HISTO
Niemann-Pick Dz
AR
def sphingomelinase
hepatosplenomegaly, cerebellum defects (ataxia, dysarthria, dysphagia)
*cherry red spot - on macula
Tay-Sachs Dz
AR
def hexosaminidase A -> accum GM2 ganglioside
worsening mental and physical **no hepatosplenomegaly
cherry red spot on macula
Krabbe Dz
AR
def galactocerebrosidase -> accum galactocerebroside
vs myelin sheaths -> periph neurop, seizures
sx start 3-6mo, die 2 yo
Metachromatic leukodystrophy
def Arylsulfatase
vs myelin sheath, dementia, vision loss
die after 1 yo
Hurler syndrome
AR
def alpha-L-iduronidase -> sulfate accum
coarse facial features, hepatosplenomegaly, looks like dwarfism, corneal clouding
Hunter syndrome
x-linked recessive
def iduronate sulfatase -> sulfate accum
mild form Hurler
“Hunters see clearly and aggressively aim for the X”
X-linked recessive disorders - mnemonic
Oblivious Female Will Give Her Boys Her (x)Linked Disorders Ocular albinism Fabry dz Wiskott-Aldrich G6PD deficiency Hunter syndrome Bruton agammaglobulinemia Hemophilia A/B Lesh-Nyhan Syndrome Duchenne muscular dystrophy
lateral medullary syndrome
(Wallenberg syndrome)
spinothalamic tract damage
spinal trigeminal nucleus damage: loss pain and temp over ipsilateral face
nucleus ambiguous damange (CN IX, X)
Descending sympathetic tract dmg: ipsilateral horner syndrome
vestibular nuclei damage: vertigo, nystagmus, N/V
inf cerebellar peduncle damage: ipsilateral cerebellar defects (ataxia, past pointing)
Weber syndrome
anterior midbrain infarction -> occlusion of paramedical branches of the posterior cerebral artery
cerebral peduncle lesion:
corticobulbar tract dmg: dysphagia, dysphonia, dysarthia
corticospinal tract dmg: contralateral spastic hemiparesis
CN III palsy: ipsilateral ptosis, pupillary dilation, later strabismus (eye looks down and out)
HACEK organisms
infective subacute endocarditis Haemophilus Aggrigatibacter Cardiobacterium Eikenella Kingella
most common cause of meningitis
streptococcus pneumoniae
TORCH inf
T – Toxoplasmosis / Toxoplasma gondii
- O – Other infections (see below)
- R – Rubella
- C – Cytomegalovirus
- H – Herpes simplex virus-2 or neonatal herpes simplex
Coxsackievirus HSV Chlamydia HIV Parvovirus B19 Syphilis
Sonic hedgehog gene
anterior / posterior limb
Produced at base of limbs in zone of polarizing activity. Involved in patterning along anteroposterior axis and CNS development; mutation can cause holoprosencephaly
Wnt-7 gene
dorsal/ventral limb
Produced at apical ectodermal ridge (thickened ectoderm at distal end of each developing limb). Necessary for proper organization along dorsal-ventral axis.
FGF gene
limb lengthening
Produced at apical ectodermal ridge. Stimulates mitosis of underlying mesoderm, providing for lengthening of limbs.
Homeobox (Hox) genes
cranial/caudal skeleton alignment
Involved in segmental organization of embryo in a craniocaudal direction. Code for transcription factors. Hox mutations appendages in wrong locations.
chlamydophila psittici
psittacosis - fever, dry cough
spread by birds
“psittici Parrots”
G-, slow vs fast fermenters: mnemonic
“macConKEE’S”
Fast = KEE: Klebsiella, E. coli, Enterobacter
Slow = C/S: Citrobacter, Serratia
Raw Chicken transmission + reptiles
raw chk - salmonella, campylobacter
reptiles (turtles) - salmonella
enteric diarrhea - major path
inc cAMP, inc cGMP -> electrolytes out of interstitum into lumen, followed by water –> watery diarrhea
mnemonic for hand and foot rash
"You drive Kawasaki, CARS with your feet and hands" Kawasaki Coxsackie A Rocky mountain spotted fever Secondary syphilis
syphilis screening FP (VDRL, RPR)
VDRL Virus (EBV) Drugs Rheumatic fver Lupus (any AI dz)/Leprosy
Rifampin “4 R’s”
RNA polymerase inhibitor
induce p450 (hepatotoxicity)
Red-orange secretions
Rapid resistance if used alone
Isoniazid
target mycolic acid
Sfx: hepatotoxicity, peripheral neuropathy, SHIPP*
**always give with Vit B6 (pyridoxine)
Pyrazinamide
TB tx
Sfx - hepatotoxicity, hyperuricemia
Ethambutol
TB tx
sfx - optic neuropathy (green-blue blindness, loss visual acuity)
Mycobacterium avium-intracellulare (MAI)
CD4 <50
prophylaxis Azythromycin
Negative PPD? TN, FN
TN - nontuburcular mycobacterium, sarocoidosis
FN - ImS, Rx (GCs)
Rickettsial triad
fever, headache, rash
Reactive arthritis - who gets it?
Chlamydia
G - enteric: campylobacter, salmonella, shigella, yersinia
3 types of atypical PNA
Legionella
chlamydophilus
**Mycoplasma pneumonia
Which organisms do not take up Gram stain?
mycoplasma - no cell wall
treponema - too small
chlamydia/legionella - intracellular
mycobacterium - very high lipid content
Lymphatic drainage: arm + lateral breast lateral dorsal foot thigh stomach duodenum + jejunum sigmoid colon upper rectum lower rectum (above PTL) lower rectum (below PTL) testes scrotum right arm + right head
arm + lateral breast - axillary nodes lateral dorsal foot - popliteal thigh - superficial inguinal stomach - celiac duodenum + jejunum - superior mesenteric sigmoid colon - inferior mesenteric upper rectum - pararectal lower rectum (above PTL) - internal iliac lower rectum (below PTL) - superficial iliac testes - para-aortic scrotum - superficial inguinal right arm + right head - right lymphatic duct
peyer’s patches - only found here
ilieum - lamina propria + submucosa
HLA - DR3 + DR4
type 1 DM, paracrine cells
langherhan cell excessive proliferation
tennis racket cells
Surface molecules expressed: dendritic cells: NK cells: Tcell: CD8+: TH: Macrophage: B cell:
dendritic cells: CD40, MHC I, MHC II, B7 (80/86)
NK cells: CD16 (vs Ab coated cells), CD 56
Tcell: CD3, TCR, CD28
CD8+: CD3, TCR, CD8
TH: CD3, TCR, CD28, CD4, CD40L
Macrophage: CD14, MHC II, B7, CD40
B cell: CD19/20/21, CD40, B7, MHC II, IgM, IgG
FOXP3 MT
x-chrome txn factor -> control Treg MT = IPEX syndrome Immune dysregulation Polyendorinopathy Enteropathy X-linked
Heart defects assoc w disorder: Chromosome 22q11: Trisomy 21: Congenital rubella: Turner syndrome: Marfan syndrome:
Chromosome 22q11 : truncus arteriorsus, ToF
Trisomy 21: endocardial cushion
Congenital rubella: PDA, pulm artery stenosis
Turner syndrome: coarc aorta, bicuspid valve
Marfan syndrome: aortic insufficiency
VDJ recombination - controlled by:
RAG1/2 act on Recombination Signal Sequences flank VDJ coding regions
Live attenuated vaccines mnemonic:
“Attention! Please Vaccinate Young Infants with MMR Regularly”
"Attention! Please Vaccinate Young Infants with MMR Regularly" attenuated vaccine varicella yellow fever intranasal influenza MMR rotavirus
Can give live vaccines to HIV pts with CD4 ABOVE 200
varicella
yellow fever
MMR
Egg vaccines
yellow fever
influenza
Inactivated/killed vaccines (4)
IM flu
hep A
rabies
salk/ polio
Why do we conjugate thyroid independent Ag vaccines?
LPS (g -) = independent endotoxin, weak immune response, we CONJUGATE with a peptide to induce stronger immune response (w T cells)
HSR
TI - Ag onto IgE on mast cells and basophils
TII - Ab to cell Ag (complement, macrophage, NK)
TIII - Ab vs soluble Ag (immune complex deposition)
*arthus rxn - dermal vaccine=local necro and immune complex deposition
TIV - T cell mediated, delayed
C3a
stim mast cells and basophils = dec BP, inc edema
macrophage CD14 vs CD40
CD 14 - bind LPS, secrete: IL1/6/TNFa/IL12, APC
CD 40 - kills: phagocytosis, Ab-dep cell mediate cytotoxicity, form granuloma
Dx eosinophilia
“CANADA-P”
CANADA-P Collagen vascular Dz Atopic Dz Neoplasm Adrenal insufficiency Drugs Acute interstitial nephritis Parasites
IL 4
“bEG Four it”
IgE, IgG
+B cell proliferation, Th0->Th2
IL 5
SNOT
inc IgA, inc complement, B cell proliferation
T cell diseases:
(DiGeorge)
Chronic mucocutaneous candidiasis
IL-12 receptor deficiency
Chronic mucocutaneous candidiasis -T cell dysfunction vs C. albicans tx: ketoconazole IL-12 receptor deficiency mycobacterial and fungal inf
Bruton agammaglobulinemia
x-linked
B cell deficiency -> no tyrosine kinase gene, low lvl Ig’s
-recurrent bacterial inf after 3-6mo
Selective Ig deficiencies
IgA def #1
- appear healthy
- assoc atopy, asthma
Severe combined immunodeficiency (SCID)
adenosine deaminase deficiency defect early stem cell differentiation Px: triad 1-severe recurrent inf 2-chronic diarrhea 3-failure to thrive *no thymic shadow on x-ray
Ataxia-telangiectasia (A’s and T’s)
ATAXIA
IgA deficiency, T cell deficiency ATAXIA Ataxia Telangectiasia, Tracking eye difficulty Acute leukemias and lymphoma risk X-ray sensitivity IgA deficiency AFP inc
Wiskott-Aldrich syndrome “WAITER”
WAITER W A ImD Thrombocytopenia and purpora Eczema Reccurent pyogenic inf *no IgM vs bacterial capsular polysaccharides *dec/abn small platelets
Chronic granulomatous Dz
x-linked
lack NADPH oxidase - phagocytes cant destroy catalase positive microbs (s. aureus, aspirgillus)
Dx - negative nitroblue tetrazolium test
(will not see yellow to blue oxidation)
Tx - bacrtim, itraconazole
Chediak-Higashi syndrome
def LYST gene (lysosomal transport)
def phagocytic lysosome -> see giant cytoplasmic granules in PMNs
Pain Triad:
1-partial albinism
2-recurrent respiratory tract and skin inf
3-neurologic Ds
Hyper-IgE syndrome (Job)
MT - STAT3 (JAK/STAT pathway) impaired neutrophils high lvl IgE and eosinophils Px triad: 1-eczema 2-recurrent cold s. aureus 3-coarse facial features: prom forhead (frontal bossing)/broad nose, "doughy" skin **retain primary teeth --MANY TEETH
Leukocyte adhesion deficiency syndrome
Abn integrins -> inability to phagocytes to exit circulation
**delayed separation of umbilical cord (after a couple of months)
G prs and their paths
Gq ->PLA2->PIP3->DAG->PrKC
->IP3->inc Ca->PrKC
Gs->inc adenylate cyclase->inc cAMP->PrKA
Gi->inhib adenylate cyclase
Tuberous sclerosis
AD, incomplete penetrance MT TSC1 (hamartin pr), TSC2 (tuberin pr) Px triad: seizures, ID, angiofibromas *hypomelanotic macules (ash-leaf spots) *assoc with tumors everywhere
Trigeminal neuralgia
“lightning pain” to light touch
tx - carbamazepine or anticonvulsant
Status epilepticus tx
benzodiazepine (lorazepam) –rev w flumazenil
tx eclampsia
MgSO4
S-Weber syndrome
congential neuro and skin dz
MT - GNAQ gene
mech: vascular malformations/too many capilaries
px: port-wine stain on face, glaucoma, seizure
CN V1/2
Polio
ant horn
Sx - LMN
Dx - CSF: inc pr, nrm glucose, lymphocytic pleocytin
spinal muscular atrophy (wendy-hoffman)
AR
ant horn
infantile flaccid paralysis
MS
vs oligodendrocytes (AI), anywhere in CNS
F 20-30
charcot’s triad: scanning speech, nystagmus, intention tremor
MLF injury
CSF: inc pr (Ig LC’s)
ALS
**NO sensory deficit
2: motor N ant horn, cotricospinal tract
MT - SOD1
Px: UMN, LMN
tx - Riluzole (vs presynaptic glutamate release)
Tabes Dorsalis
3 syphilis
lose dorsal column
+ Romberg
Ant Spinal Artery Occlusion
no pain/temp
complete motor paralysis below lesion
+UMN/LMN
syryngomyelin
myelin sheath (or tonisilar herniation), CSF obstruction cervical "cape-like distribution" - lose pain/temp in UE
Brown-sequarde syndrome
hemisection SC
Ipsilateral loss: UMN sx below lesion, loss tactile/vibration/proprioception, loss pain/temp at site and 2/3 segments below
Contralateral loss: pain/temp starting 2/3 segments below lesion
*LMN sx at level of lesion
VPL
VPM
LGN
MGN
VPL - sensory
VPM - movement
LGN - light/visual
MGN - music/auditory (medial)
deep nuclei of cerebellum from medial to lateral
mnemonic
“Fast Gerbils Exercise Daily”
Fastigial, Globose, Emboliform, Dentate
General flow info through cerebellum
strx for major output
side of body with lesion
General flow info through cerebellum:
input (cerebral cortex, SC)->cerebellar cortex->deep nuclei->out targets (VLN)
strx for major output:
sup cerebellar peduncle->cont VL thalamus
side of body with lesion:
ipsilateral motor loss
vestibulocerebellum
spinocerebellum
cerebrocerebum
vestibulocerebellum - balance
spinocerebellum - posture stability
cerebrocerebum - lesion-loss of coordination(intention tremor)
substantia nigra pars compacta lesion
hypokinesia, chorea
subthalamic nucleus lesion
hemibalismus
Synthesis meperidine - sfx
MTPP - metabolized to MPP (by MAO)
destroys DA cells in substantia nigra -> PD Sx
Tx with seleginine -> inhibits MAO
Reflexes achielles patella triceps bicep
achielles - S1
patella - L4
triceps - C7
bicep - C5
Merkel Meissner Ruffini Pacinian Free nerve ending
Merkel-slow, static pressure, superficial/hair/melanocyte
Meissner-rapid, light touch, superficial
Ruffini-slow, pressure position, deep/spindle
Pacinian-rapid, vibration, deep/onion
Free nerve ending - A-delta: rapid, sharp-cold
- C-fiber: slow, dull-warm
flow of aqueous humor
ciliary body
from posterior chamber -> anterior chamber -> trabecular meshwork
glaucoma = obstruction in path
acute vs open angle glaucoma
acute - lens goes fwd, emergency, “angry eye” inc pressure, tx with lazer (holes for humor) (st-timolol)
open - dec permeability of trabechular meashwork
cup:disk ratio (should be less than 50%), gradual loss peripheral vision, chronic
Dx - tonometry
Tx - Beta blockers, PG (other - alpha antagonists, acetazolamide, cholinergic agonist - pilocarpine)
cataract
-lens becomes opacified
bilateral, painless decrease vision, gain near sightedness
macular degeneration
age related decrease central vision
dry - druse accum between retina and choroid
wet - rapid, neovascularization
tx - stop smoking, antioxidants
cotton wool spots
retinal ischemia (DM)
DM retinopathy
cotton wool spots, well defined yellow exudates
progressive - see neovascularizaiton
retinal detachment
trauma/DM
“floaters, lights”
pale appearance
central retinal artery occlusion
see pale with cherry red spot macula
bc ischemia
brain lesion
frontal eye
PPRF
superior colliculus
frontal eye - eyes toward lesion
PPRF - eyes away from lesion
superior colliculus -Nerd who is good at calculous
-paralysis of upward gaze
uveitis - causes
inf - CMV, toxo, cat scratch
PAIR
Weber and Rinne test
Weber - sensorineural hearing loss (contralateral)
Rinne - conductive hearing loss (ipsilateral)
acute otitis externa
wetness / swimmers ear
pseudomonas, s aureus
acute otitis media
bacterial/viral
TM immobility +
s pneumo, nontypable H flu
tx - amox, claulanic acid, cephalosporins
cholesteatoma
keratin debris in middle ear -> erosion
chronic middle ear inf
“pearly” lesion behind TM
Vertigo
benign paroxysmal positional vertigo
Meniere dz
central vertigo
benign paroxysmal positional vertigo - debris vestibule
Meniere dz - intermittent vertigo, tinnitus, hearing loss
central vertigo - brainstem and cerebellum lesion
Tongue origin taste sensation motor
anterior 2/3 origin - brachial arch 1 taste - CN 7 sensation - CN V3 (maxillary) motor - CN 12
posterior 1/3 origin - brachial arch 3+4 taste - CN 9 (back = CN 10) sensation - CN 9 motor - CN 12
Glossitis
vit B and iron deficiencies
Whats in saliva?
alpha amylase bicarb mucin IgA growth factor
Sialadenitis
s. aureus, s. viridans
tumors of salivary gland
most in parotid gland
#1 - pleomorphic adenoma with “pleomorphic epithelial and mesenchymal cells, can lead to CN 7 injury”
Mucoepidermoid carcinoma -#1 malignant
Location of tumor:
if in parotid gland = 30% chance malignancy
if in salivary gland = 70% chance malignancy
Nose tx
intranasal steroids
cocaine and nose
potent vasoconstrictor -> ischemia -> perforation of nasal mucosa
cleft lip
cleft palate
cleft lip - failure fuse: maxillary, medial nasal processes
cleft palate - L/M + nasal
lateral and medial palatine process + nasal septum
Innervation and blood supply to GI tract
foregut
midgut
hindegut
foregut
-E, stomach, 1/2 duodenum, liver, panc, GB
-celiac trunk blood, PSNS-vagus, SNS-splanchnic
midgut
-3/4 duodenum, ileum, appendix, prox 2/3 colon (flexur)
-sup mesenteric A, PSNS-vagus, SNS-splanchnic
hindegut
-distal 1/3 colon, rectum to pectinate line
-IMA blood, PSNS - pelvic splanchnic, SNS-lumbar splanchnic
malrotation of midgut
appendix and cecum in upper abd, assoc with volvulus
around SMA
boerhaver syndrome
complete tear of esophagus
Plummer-vinson syndrome
1 - dysphagia (E web)
2 - glossitis
3 - Fe def anemia
tx - dilation E, iron supplementation
Esophageal diverticula (3)
zenker - above UES, false
traction - midpoint, true
epiphrenic - below LES, false
Bx E with large, pink intranuclear inclusions and host cell chromatin that pushed to the edge of the nucleus
HSV esophagitis
Bx E with enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo
CMV esophagitis
Bx E = lack of ganglion cells between inner and outer muscular layers
(lack Auchbach plexus)
Achalasia
A PAS stain on Bx of E = hyphate organisms
candida esophagitis
E adenocarcinoma
E SCC
E adenocarcinoma - most common CA in U.S.
E SCC - most common CA worldwide
Receptors on parietal cells
H2 (Gs) for ECL cells Gi for PG Somatostatin R CN X receptors -M3 R -cholecystokinin Type B
what induces G cells to secrete gastrin?
Tryptophan, Phenylalanine, Calcium (hypercalcemia increases gastrin secretion)
Arteries off celiac trunk (3) + (3) + (2)
Celiac trunk: -left gastric artery -splenic A -common hepatic A Off Common hepatic A -proper hepatic A -right gastric A -gastroduodenal A Off gastroduodenal A -right gastro-omental A -anterior/superior pancreaticoduodenal A
P450 Substrates - mnemonic
"Always Think When Outdoors" Anti-epileptics Theophylline Warfarin OCPs
Segmented viruses = ?
Segmented = reassortment
This causes genetic shift (instead of drift = pt MT)
orthomyxovirus, reovirus, bunyavirus, reovirus (rotavirus most common), arenavirus
*are capable for genetic shifts… rapid, huge swaps of:
hemaglutnin and neuramidase
Adult Brain Tumors - mnemonic + 3
MGM Studios
met - #1 brain CA
Glioblastoma - astrocytes, GFAP+, cerebral hemisphere, image: irreg mass, necro center, surrounded by edema
histo: pseudopalisading pattern
Meningioma - arachnoid cells, brain surface, risk with NeuroFibro II
histo - whorled pattern, psammona bodies
Schwannoma - benign, sheath tumor
*acoustic neuroma -CN8
+S100, NeuroFibro II
Oligodendroglioma - frontal lobes
histo: perinuclear halos, fried-egg
(also seen with HSV and seminoma)
Pituitary Adenoma
Hamangioblastoma -von-hipple-lindau syndrome \+/- EPO --> PV Hist: foamy cell bilateral renal cell CA**
Pediatric tumors - mnemonic
Prepubescent Minds Eaten with Cancer
Pilocytic Astrocytoma - +GFAP, posterior fossa
histo: rosenethal fibers (eiosinophils, corkscrew looking fibers)
Medublastoma = +/- 4th ventricle compression
histo: Homer-Wright rosette (fiber in center)
Ependymoma - +/- 4th ventricle compression
histo: peri-vascular pseudo-rosette (vessel middle)
Craniopharynegioma - Rathke’s pouch,
+/- compression optic chiasm, *supratentorial tumor 1
Neck anatomy - triangles
Posterior: SCM, Trap, clavicle
contains - brachial plexus, subclavian vein, ext jugular, inf omohyoid
Anterior: mandible, midline, SCM
contains - posterior/anterior digastric muscles, middle-sternothyroid muscle, sternohyoid muscle, superior omohyoid muscle (-> becomes inf omohyoid)
Collagen
strong, slippery, stretchy, BM
1 = bone, scar tissue 2 = cartilage (eye) 3 = B/V, skin, uterus, granulation tissue 4 = basement membrane
Cavernous Sinus - mnemonic
O TOM CA(T) Oculomotor nerve Trochlear nerve Opthalmic (V1) Maxillary (V2) Internal carotid A Abducens N
BMPR2 Gene MT
Primary Pulmonary HTN
