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1
Q

P450 inhibitors - mneumonic

A 
CRACK AMIGOS
Cipro
Amiodarone
Ritonavir (protease inhibitor)
Cimetidine
Ketoconazole
Acute alcohol use
Macrolides (erythromycin)
Isoniazid
Grapefruit juice
Omeprazole
Sulfonamides
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2
Q

P450 inducers - mnuemonic

A 
Guiness, Carona, and PBRs induce Chronic Alcoholism
Griseofulvin
Carbamezepine
Phenytoin
Barbituates
Rifampin
St. John's Wort (vs depression)
Chronic alcoholism
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3
Q

R-L Shunts (early cyanosis)

A 
5 T's
persistent Truncus arteriosis
Transposition of the great vessels
Tricuspid atresia
Tetralogy of Fallot
Total anomalous pulmonary venous return
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4
Q

Pregnant mother conditions cause congenital defects

A

lithium - Ebstein anomaly
alcohol - TF, VSD, ASD, PDA
pregestational diabetes - Transposition of great vessels

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5
Q

Congenital baby conditions with congenital defects

A

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)

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6
Q

HF - L vs R

A

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)

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7
Q

Tx acute CHF - mnuemonic

A 
NO LIP
NO
Oxygen
Loop diuretics 
Inotropic Drugs
Positioning
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8
Q

CHF drugs that prove survival benefit vs Symptomatic

all these drus are used for chronic tx

A 
ACEI
ARBs
Aldosterone inhibitors (spironolactone)
Selective B blockers (carvedilol)
\\\\
Diuretics
Digoxin
Vasodilators
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9
Q

Starling forces on capillaries/what causes them (4)

A

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

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10
Q

ECG - axis lead positions and nrm/left/right axis deviation strategy

A 
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
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11
Q

Diffuse scleroderma

A

anti-Scl-70 / anti-DNA Topoisomerase 1 Abs

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12
Q

CREST syndrome

A

anti-centromere Ab

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13
Q

Sjogren Syndrome

A 
Dry - eyes, mouth
arthritis
"cant see, cant spit, cant climb shit"
anti-SSA (anti-Ro)
anti-SSB (anti-La)
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14
Q

Polymyositis

A

anti-Jo-1 Abs

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15
Q

Pemphigus vulgaris - mnemonic

A

“DAMN is a vulgar word”
desmosomes, mouth lesion, + nikolsky sign,
histo: Acantholysis (loss intracellular connections)

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16
Q

Which drugs are eliminated zero order? mnemonic

A

PEA (top of P looks like a zero)

Phenytoin
Ethanol
ASA

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17
Q

F pelvic ligaments (5):

A

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)

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18
Q

Major pelvic nerves (2)

A 
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)
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19
Q

gonad drainage - veins

A

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)

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20
Q

Artery supply to gonads and penis

A

AA -> ovarian/testicular A’s

Internal iliac A supplies most penis

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21
Q

gonadal lymph drainage

A

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
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22
Q

hessel back triangle

A

inguinal ligament, lateral border rectus abdominus, inf epigastric vessels

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23
Q

femoral hernia

A

NAVeL

“e”

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24
Q 
Testicular pathology: major features
seminoma
embryonal
yolk sac
choriocarcinoma
teratoma
leydig
sertoli
testicular lymphoma
A

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

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25
Q

sarcoma botryoides - mnemonic

A

“Grab and Bunch of Grapes”

-embryonalrhabdomyosarcoma

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26
Q

Endometritis - px, hx

A 
inflame, inf
acute = post-partum =C-section/abortion
chronic = PID, retained foreign body
**HISTO** - Plasma cells in endometrium
tx - broad abx
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27
Q

endometriosis - key features

A

endometrioma - chocolate cyst

“gun powder burn” - laparoscopy

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28
Q

leiomyoma - Histo

A

“whorled pattern”

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29
Q

theca-luteal cyst, increase what?

A

B-hcG

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30
Q

PCOS

A

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

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31
Q

Asherman syndrome

A

Post-op intrauterine adhesions (ex - post D&C)

-reason for infertility

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32
Q

Hormonal changes in PCOS

A
  • 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)
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33
Q

Mittelschmerz

A

midcycle pelvic pain associated with ovulation

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34
Q

epithelial tumor - serous cyst adenocarcinoma

A

psammoma body
fallopian-tube-like epithelium
“lined with fallopian tube-like epithelium”

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35
Q

epith tumor - mucinous

A

pseduomyxoma peritinei (abundant mucus ascities)

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36
Q

epith tumor - endometrioid

A

co-occurrence with endometrial CA

looks like endometrial tube glands

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37
Q

epith tumor - clear cell

A

cells w/clear cytoplasm

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38
Q

epith tumor - brenner

A

hammertoma
contain urinary-tract like epitheliu
“Brenner = Bladder”

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39
Q

Germ cell tumor - teratoma

A 
sebaceous, hair
dermoid cyst (nrm tissue) vs malig type(immature tissue)
struma ovarii - hyperthyroidism
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40
Q

germ cell tumor - dysgerminoma

A

makes hCG, LDH

fried eggs HISTO

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41
Q

germ cell tumor - yolk sac

A

endometrial sinus tissue
inc AFP
schiller-duval bodies (glomerulus - central vessel surrounded by tumor cells)

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42
Q

germ cell tumor - choriocarcinoma

A

make hCG

met to lung

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43
Q

sex cord stroma tumor - granulosa theca cell tumor

A

make E -> precocious puberty/post-meo bleed
yellow (cholesterol)
Call-Exner body (granulosa cells surround oocyte trying to make follicle = rosettes surround eiosinophilic spaces”

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44
Q

sex cord stromal tumor - sertol-leydig cell tumor

A

make androgen/testosterone -> virilization
yellow
looks like seminiferous tubules

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45
Q

sex cord stromal tumor - fibroma

A

Gross appearance - firm/encapsulated

*Meigs syndrome: ovary tumor, ascities, hydrothorax

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46
Q

sex cord stromal tumor - thecoma

A

make E -> precocious puberty/post meno bleed

spindle cells

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47
Q

Mom serum testing - quad screen TII 15-20wk

A

AFP - abd wall defects (gastrochesis, omephacele)
- neural tube defects
- multiple gestation
- incorrect dating
Also check: estrol (placenta), hCG, inhibin

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48
Q

Quad screen - finds: Down Syndrome, Edward, Patau

A

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)

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49
Q

Polyhydramnios - whats it mean/cause?

A 
Esophageal/duodenal atresia
Anencephaly
Multiple gestations
uncontrolled maternal DM
congenital infection (ToRCHEs) - Parvovirus B19
Fetal anemia due to Rh alloimmunization
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50
Q

Oligohydramnios

A

Placental insufficiency
Bilateral renal agenesis –> POTTER sequence
Obstruction urine outflow (pre-urethral valves)

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51
Q

Placental implantation abn types “3” with saying

A

placenta accrete - adheres
increta - invades
percreta - penetrates

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52
Q

HELLP Syndrome

A

Hemolysis, Elevated Liver enzymes, Low Platelets

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53
Q

Double Y

47, XYY

A

M
tall
severe acne
*anti-social behavior

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54
Q

Cri-de-Clut syndrome

A

microcephaly
high pitched crying like mewing cat
5p deletion

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55
Q

William sydrome

A 
think Will Ferrel in Elf
"elfian facies"
hypercalcemia
very friendly with improved social skills
CV - valve defects
microdeletion long chrome 7
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56
Q

Klienfelter vs Turner Syndrome

A

KS - M, XXY, tall, long extremities, testicular atrophy, gyno issues
TS - F, XO, web neck, short, amenorrhea

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57
Q

Five branches facial nerve - mnemonic

A 
To Zanzibar By Motor Car
temporal
zygomatic
buccal
mandibular
cervical
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58
Q

Familial adenomatous polypsos

A

MT APC gene

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59
Q

Gardner syndrome

A

“gardener growing bumpy plants everywhere”

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60
Q

Hereditary hemorrhagic telangiectasia

A

recurrent epistaxis due to abn blood vessel formation

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61
Q

HD -“c”

A

Cognitive decline, caudate atrophy, chorea, CAG repeats, Chromosome 4, average age 40, dec aCh

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62
Q

Neurofibromatosis type 1

A

mt gene chrome 17
café-au-lait spots, neural tumors, lisch nodules
Autosomal Dominant

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63
Q

neurofibromatosis type II

A

bilateral acoustic neuroma

mt chrom 22

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64
Q

Genetic anticipation Dz’s (4)

A

HD, myotonic dystrophy, fragile X syndrome, fredreich ataxia

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65
Q

Fabry dz

A

x-linked recessive
def alpha-galactosidase - accum ceramide trihexoside
peripheral neuropathy, renal failure HTN, CM, angiokeratomas

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66
Q

Gaucher dz

A

AR
lysosomal storage Dz
def glucocerebrosiase -> accum glucocerebroside
hepatosplenomegaly, thrombocytopenia, painful bone lesions
*prominenet blue cytoplasmic fibrils HISTO

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67
Q

Niemann-Pick Dz

A

AR
def sphingomelinase
hepatosplenomegaly, cerebellum defects (ataxia, dysarthria, dysphagia)
*cherry red spot - on macula

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68
Q

Tay-Sachs Dz

A

AR
def hexosaminidase A -> accum GM2 ganglioside
worsening mental and physical **no hepatosplenomegaly
cherry red spot on macula

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69
Q

Krabbe Dz

A

AR
def galactocerebrosidase -> accum galactocerebroside
vs myelin sheaths -> periph neurop, seizures
sx start 3-6mo, die 2 yo

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70
Q

Metachromatic leukodystrophy

A

def Arylsulfatase
vs myelin sheath, dementia, vision loss
die after 1 yo

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71
Q

Hurler syndrome

A

AR
def alpha-L-iduronidase -> sulfate accum
coarse facial features, hepatosplenomegaly, looks like dwarfism, corneal clouding

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72
Q

Hunter syndrome

A

x-linked recessive
def iduronate sulfatase -> sulfate accum
mild form Hurler
“Hunters see clearly and aggressively aim for the X”

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73
Q

X-linked recessive disorders - mnemonic

A 
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
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74
Q

lateral medullary syndrome

A

(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)

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75
Q

Weber syndrome

A

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)

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76
Q

HACEK organisms

A 
infective subacute endocarditis
Haemophilus
Aggrigatibacter
Cardiobacterium
Eikenella
Kingella
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77
Q

most common cause of meningitis

A

streptococcus pneumoniae

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78
Q

TORCH inf

A

T – Toxoplasmosis / Toxoplasma gondii

  1. O – Other infections (see below)
  2. R – Rubella
  3. C – Cytomegalovirus
  4. H – Herpes simplex virus-2 or neonatal herpes simplex
Coxsackievirus
HSV
Chlamydia
HIV
Parvovirus B19
Syphilis
79
Q

Sonic hedgehog gene

A

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

80
Q

Wnt-7 gene

A

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.

81
Q

FGF gene

A

limb lengthening

Produced at apical ectodermal ridge. Stimulates mitosis of underlying mesoderm, providing for lengthening of limbs.

82
Q

Homeobox (Hox) genes

A

cranial/caudal skeleton alignment

Involved in segmental organization of embryo in a craniocaudal direction. Code for transcription factors. Hox mutations appendages in wrong locations.

83
Q

chlamydophila psittici

A

psittacosis - fever, dry cough
spread by birds
“psittici Parrots”

84
Q

G-, slow vs fast fermenters: mnemonic

A

“macConKEE’S”
Fast = KEE: Klebsiella, E. coli, Enterobacter
Slow = C/S: Citrobacter, Serratia

85
Q

Raw Chicken transmission + reptiles

A

raw chk - salmonella, campylobacter

reptiles (turtles) - salmonella

86
Q

enteric diarrhea - major path

A

inc cAMP, inc cGMP -> electrolytes out of interstitum into lumen, followed by water –> watery diarrhea

87
Q

mnemonic for hand and foot rash

A 
"You drive Kawasaki, CARS with your feet and hands"
Kawasaki
Coxsackie A
Rocky mountain spotted fever
Secondary syphilis
88
Q

syphilis screening FP (VDRL, RPR)

A 
VDRL
Virus (EBV)
Drugs
Rheumatic fver
Lupus (any AI dz)/Leprosy
89
Q

Rifampin “4 R’s”

A

RNA polymerase inhibitor
induce p450 (hepatotoxicity)
Red-orange secretions
Rapid resistance if used alone

90
Q

Isoniazid

A

target mycolic acid
Sfx: hepatotoxicity, peripheral neuropathy, SHIPP*

**always give with Vit B6 (pyridoxine)

91
Q

Pyrazinamide

A

TB tx

Sfx - hepatotoxicity, hyperuricemia

92
Q

Ethambutol

A

TB tx

sfx - optic neuropathy (green-blue blindness, loss visual acuity)

93
Q

Mycobacterium avium-intracellulare (MAI)

A

CD4 <50

prophylaxis Azythromycin

94
Q

Negative PPD? TN, FN

A

TN - nontuburcular mycobacterium, sarocoidosis

FN - ImS, Rx (GCs)

95
Q

Rickettsial triad

A

fever, headache, rash

96
Q

Reactive arthritis - who gets it?

A

Chlamydia

G - enteric: campylobacter, salmonella, shigella, yersinia

97
Q

3 types of atypical PNA

A

Legionella
chlamydophilus
**Mycoplasma pneumonia

98
Q

Which organisms do not take up Gram stain?

A

mycoplasma - no cell wall
treponema - too small
chlamydia/legionella - intracellular
mycobacterium - very high lipid content

99
Q 
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
A 
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
100
Q

peyer’s patches - only found here

A

ilieum - lamina propria + submucosa

101
Q

HLA - DR3 + DR4

A

type 1 DM, paracrine cells

102
Q

langherhan cell excessive proliferation

A

tennis racket cells

103
Q 
Surface molecules expressed:
dendritic cells: 
NK cells: 
Tcell: 
CD8+: 
TH: 
Macrophage: 
B cell:
A

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

104
Q

FOXP3 MT

A 
x-chrome
txn factor -> control Treg
MT = IPEX syndrome
Immune dysregulation
Polyendorinopathy
Enteropathy
X-linked
105
Q 
Heart defects assoc w disorder:
Chromosome 22q11:
Trisomy 21: 
Congenital rubella: 
Turner syndrome: 
Marfan syndrome:
A

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

106
Q

VDJ recombination - controlled by:

A

RAG1/2 act on Recombination Signal Sequences flank VDJ coding regions

107
Q

Live attenuated vaccines mnemonic:

“Attention! Please Vaccinate Young Infants with MMR Regularly”

A 
"Attention! Please Vaccinate Young Infants with MMR Regularly"
attenuated vaccine
varicella
yellow fever
intranasal influenza
MMR
rotavirus
108
Q

Can give live vaccines to HIV pts with CD4 ABOVE 200

A

varicella
yellow fever
MMR

109
Q

Egg vaccines

A

yellow fever

influenza

110
Q

Inactivated/killed vaccines (4)

A

IM flu
hep A
rabies
salk/ polio

111
Q

Why do we conjugate thyroid independent Ag vaccines?

A

LPS (g -) = independent endotoxin, weak immune response, we CONJUGATE with a peptide to induce stronger immune response (w T cells)

112
Q

HSR

A

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

113
Q

C3a

A

stim mast cells and basophils = dec BP, inc edema

114
Q

macrophage CD14 vs CD40

A

CD 14 - bind LPS, secrete: IL1/6/TNFa/IL12, APC

CD 40 - kills: phagocytosis, Ab-dep cell mediate cytotoxicity, form granuloma

115
Q

Dx eosinophilia

“CANADA-P”

A 
CANADA-P
Collagen vascular Dz
Atopic Dz
Neoplasm
Adrenal insufficiency
Drugs
Acute interstitial nephritis
Parasites
116
Q

IL 4

A

“bEG Four it”
IgE, IgG
+B cell proliferation, Th0->Th2

117
Q

IL 5

A

SNOT

inc IgA, inc complement, B cell proliferation

118
Q

T cell diseases:
(DiGeorge)
Chronic mucocutaneous candidiasis
IL-12 receptor deficiency

A 
Chronic mucocutaneous candidiasis
-T cell dysfunction vs C. albicans
tx: ketoconazole
IL-12 receptor deficiency
mycobacterial and fungal inf
119
Q

Bruton agammaglobulinemia

A

x-linked
B cell deficiency -> no tyrosine kinase gene, low lvl Ig’s
-recurrent bacterial inf after 3-6mo

120
Q

Selective Ig deficiencies

A

IgA def #1

  • appear healthy
  • assoc atopy, asthma
121
Q

Severe combined immunodeficiency (SCID)

A 
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
122
Q

Ataxia-telangiectasia (A’s and T’s)

ATAXIA

A 
IgA deficiency, T cell deficiency
ATAXIA
Ataxia
Telangectiasia, Tracking eye difficulty 
Acute leukemias and lymphoma risk
X-ray sensitivity
IgA deficiency
AFP inc
123
Q

Wiskott-Aldrich syndrome “WAITER”

A 
WAITER
W
A
ImD
Thrombocytopenia and purpora
Eczema
Reccurent pyogenic inf
*no IgM vs bacterial capsular polysaccharides
*dec/abn small platelets
124
Q

Chronic granulomatous Dz

A

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

125
Q

Chediak-Higashi syndrome

A

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

126
Q

Hyper-IgE syndrome (Job)

A 
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
127
Q

Leukocyte adhesion deficiency syndrome

A

Abn integrins -> inability to phagocytes to exit circulation

**delayed separation of umbilical cord (after a couple of months)

128
Q

G prs and their paths

A

Gq ->PLA2->PIP3->DAG->PrKC
->IP3->inc Ca->PrKC
Gs->inc adenylate cyclase->inc cAMP->PrKA
Gi->inhib adenylate cyclase

129
Q

Tuberous sclerosis

A 
AD, incomplete penetrance
MT TSC1 (hamartin pr), TSC2 (tuberin pr)
Px triad: seizures, ID, angiofibromas
*hypomelanotic macules (ash-leaf spots)
*assoc with tumors everywhere
130
Q

Trigeminal neuralgia

A

“lightning pain” to light touch

tx - carbamazepine or anticonvulsant

131
Q

Status epilepticus tx

A

benzodiazepine (lorazepam) –rev w flumazenil

132
Q

tx eclampsia

A

MgSO4

133
Q

S-Weber syndrome

A

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

134
Q

Polio

A

ant horn
Sx - LMN
Dx - CSF: inc pr, nrm glucose, lymphocytic pleocytin

135
Q

spinal muscular atrophy (wendy-hoffman)

A

AR
ant horn
infantile flaccid paralysis

136
Q

MS

A

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)

137
Q

ALS

A

**NO sensory deficit
2: motor N ant horn, cotricospinal tract
MT - SOD1
Px: UMN, LMN
tx - Riluzole (vs presynaptic glutamate release)

138
Q

Tabes Dorsalis

A

3 syphilis
lose dorsal column
+ Romberg

139
Q

Ant Spinal Artery Occlusion

A

no pain/temp
complete motor paralysis below lesion
+UMN/LMN

140
Q

syryngomyelin

A 
myelin sheath (or tonisilar herniation), CSF obstruction
cervical "cape-like distribution" - lose pain/temp in UE
141
Q

Brown-sequarde syndrome

A

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

142
Q

VPL
VPM
LGN
MGN

A

VPL - sensory
VPM - movement
LGN - light/visual
MGN - music/auditory (medial)

143
Q

deep nuclei of cerebellum from medial to lateral

mnemonic

A

“Fast Gerbils Exercise Daily”

Fastigial, Globose, Emboliform, Dentate

144
Q

General flow info through cerebellum
strx for major output
side of body with lesion

A

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

145
Q

vestibulocerebellum
spinocerebellum
cerebrocerebum

A

vestibulocerebellum - balance
spinocerebellum - posture stability
cerebrocerebum - lesion-loss of coordination(intention tremor)

146
Q

substantia nigra pars compacta lesion

A

hypokinesia, chorea

147
Q

subthalamic nucleus lesion

A

hemibalismus

148
Q

Synthesis meperidine - sfx

A

MTPP - metabolized to MPP (by MAO)
destroys DA cells in substantia nigra -> PD Sx
Tx with seleginine -> inhibits MAO

149
Q 
Reflexes
achielles
patella
triceps
bicep
A

achielles - S1
patella - L4
triceps - C7
bicep - C5

150
Q 
Merkel
Meissner
Ruffini
Pacinian
Free nerve ending
A

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

151
Q

flow of aqueous humor

A

ciliary body
from posterior chamber -> anterior chamber -> trabecular meshwork
glaucoma = obstruction in path

152
Q

acute vs open angle glaucoma

A

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)

153
Q

cataract

A

-lens becomes opacified

bilateral, painless decrease vision, gain near sightedness

154
Q

macular degeneration

A

age related decrease central vision
dry - druse accum between retina and choroid
wet - rapid, neovascularization
tx - stop smoking, antioxidants

155
Q

cotton wool spots

A

retinal ischemia (DM)

156
Q

DM retinopathy

A

cotton wool spots, well defined yellow exudates

progressive - see neovascularizaiton

157
Q

retinal detachment

A

trauma/DM
“floaters, lights”
pale appearance

158
Q

central retinal artery occlusion

A

see pale with cherry red spot macula

bc ischemia

159
Q

brain lesion
frontal eye
PPRF
superior colliculus

A

frontal eye - eyes toward lesion
PPRF - eyes away from lesion
superior colliculus -Nerd who is good at calculous
-paralysis of upward gaze

160
Q

uveitis - causes

A

inf - CMV, toxo, cat scratch

PAIR

161
Q

Weber and Rinne test

A

Weber - sensorineural hearing loss (contralateral)

Rinne - conductive hearing loss (ipsilateral)

162
Q

acute otitis externa

A

wetness / swimmers ear

pseudomonas, s aureus

163
Q

acute otitis media

A

bacterial/viral
TM immobility +
s pneumo, nontypable H flu
tx - amox, claulanic acid, cephalosporins

164
Q

cholesteatoma

A

keratin debris in middle ear -> erosion
chronic middle ear inf
“pearly” lesion behind TM

165
Q

Vertigo
benign paroxysmal positional vertigo
Meniere dz
central vertigo

A

benign paroxysmal positional vertigo - debris vestibule
Meniere dz - intermittent vertigo, tinnitus, hearing loss
central vertigo - brainstem and cerebellum lesion

166
Q 
Tongue
origin
taste 
sensation
motor
A 
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
167
Q

Glossitis

A

vit B and iron deficiencies

168
Q

Whats in saliva?

A 
alpha amylase
bicarb
mucin
IgA
growth factor
169
Q

Sialadenitis

A

s. aureus, s. viridans

170
Q

tumors of salivary gland

A

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

171
Q

Nose tx

A

intranasal steroids

172
Q

cocaine and nose

A

potent vasoconstrictor -> ischemia -> perforation of nasal mucosa

173
Q

cleft lip

cleft palate

A

cleft lip - failure fuse: maxillary, medial nasal processes
cleft palate - L/M + nasal
lateral and medial palatine process + nasal septum

174
Q

Innervation and blood supply to GI tract
foregut
midgut
hindegut

A

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

175
Q

malrotation of midgut

A

appendix and cecum in upper abd, assoc with volvulus

around SMA

176
Q

boerhaver syndrome

A

complete tear of esophagus

177
Q

Plummer-vinson syndrome

A

1 - dysphagia (E web)
2 - glossitis
3 - Fe def anemia
tx - dilation E, iron supplementation

178
Q

Esophageal diverticula (3)

A

zenker - above UES, false
traction - midpoint, true
epiphrenic - below LES, false

179
Q

Bx E with large, pink intranuclear inclusions and host cell chromatin that pushed to the edge of the nucleus

A

HSV esophagitis

180
Q

Bx E with enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo

A

CMV esophagitis

181
Q

Bx E = lack of ganglion cells between inner and outer muscular layers

A

(lack Auchbach plexus)

Achalasia

182
Q

A PAS stain on Bx of E = hyphate organisms

A

candida esophagitis

183
Q

E adenocarcinoma

E SCC

A

E adenocarcinoma - most common CA in U.S.

E SCC - most common CA worldwide

184
Q

Receptors on parietal cells

A 
H2 (Gs) for ECL cells
Gi for PG
Somatostatin R
CN X receptors 
-M3 R
-cholecystokinin Type B
185
Q

what induces G cells to secrete gastrin?

A

Tryptophan, Phenylalanine, Calcium (hypercalcemia increases gastrin secretion)

186
Q

Arteries off celiac trunk (3) + (3) + (2)

A 
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
187
Q

P450 Substrates - mnemonic

A 
"Always Think When Outdoors"
Anti-epileptics
Theophylline
Warfarin
OCPs
188
Q

Segmented viruses = ?

A

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

189
Q

Adult Brain Tumors - mnemonic + 3

A

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**
190
Q

Pediatric tumors - mnemonic

A

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

191
Q

Neck anatomy - triangles

A

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)

192
Q

Collagen

A

strong, slippery, stretchy, BM

1 = bone, scar tissue
2 = cartilage (eye)
3 = B/V, skin, uterus, granulation tissue
4 = basement membrane
193
Q

Cavernous Sinus - mnemonic

A 
O TOM CA(T)
Oculomotor nerve
Trochlear nerve
Opthalmic (V1)
Maxillary (V2)
Internal carotid A
Abducens N
194
Q

BMPR2 Gene MT

A

Primary Pulmonary HTN

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