Final Countdown Flashcards
What must you monitor on a pt. who is taking clozapine?
Abs. Neutrophil count.
pyrrolidonyl arylamiase (PYP) postitive ==> ?
S. pyogenes
low serum ceruloplasmin ==>
Wilson’s disease
fluoxetine: ?
SSRi
Deferozamine: ?
DOC for iron overdose; chelating agent that binds irons and converts it to water-sol.
Edetate calcium disodium: ?
DOC for lead poisoning; increases urinary excretion of lead.
cell body rounding; peripheral displacement of nuclei; dispersion of Nissl Substance to periphery of cell ==???
Axonal reaction.
Pt. with Hx of either: sickle cell, vasculitis, glucocorticoid Tx, alcoholism; presents with femoral head bone pain. ==> ???
Osteonecrosis (avascular necrosis)
Peds; fever for more than 5 days; bilat. conjuctivitis; swelling of hands and feet; cervical LAD, rash, mucositis (“strewberry” tongue) == >???
Kawasaki’s
Berkson’s bias: ?
type of selection bias that can be created by selecting hospitalized pt. as the control group.
What is the major risk factor for the dev. of intimal tears leading to aortic dissection?
HYPER-fucking-TENSION!
infection starts following organism’s penetration of the skin by filariform (infection-stage) larva and can be ddX by finding rhanditiform (non-infectious) larvaw in the stool. What organism?
Stronglyloides stercoralis
infection starts following organism’s penetration of the skin by filariform (infection-stage) larva and can be ddX by finding rhabditiform (non-infectious) larvaw in the stool. What organism?
Stronglyloides stercoralis
What personality disorder ~ magical beliefs, social anxiety, eccentric behaviors, and odd perceptual experiences?
Schizotypal personality disorder!
Lipid-filled intimal plaque = ?
atheromas=lipid-filled intimal plaques that bulge into the arterial lumen ==> create fixed stenosis ==> Claudication.
t(14;18) ==>
follicular lymphoma; a non-hodgkins lymphoma; bcl-2 overexpression
Malignant tumors of the parotid gland compresses what nerve and causes what?
CN7; causes ipsilateral facial droop
Malignant tumors of the parotid gland compresses what nerve and causes what?
CN7; causes ipsilateral facial droop
What is the drug that is responsible for the major part of the clot lysis in an acute MI?
tPA
What issue of the heart leads to increased LA pressure and increase PCWP?
mitral stenosis!
What vitamin/mineral overload is seen in sarcoidosis?
HyperCa2+; activated macrophages increase expression of a-alpha-hydroxylase, leads to excess 1,25-vitamin-D. (happends in other granulomatous disease too.
What vitamin/mineral overload is seen in sarcoidosis?
HyperCa2+; activated macrophages increase expression of a-alpha-hydroxylase, leads to excess 1,25-vitamin-D. (happends in other granulomatous disease too.
Uricosuric agents (eg. probenecid)
increase renal excretion of uric acid; 2nd DOC; contra in Pt. with Hx of renal stones.
D-penicillamine to Tx:
Wilson’s disease; Cu+ chelator.
Uricosuric agents (eg. probenecid)
increase renal excretion of uric acid; 2nd DOC; contra in Pt. with Hx of renal stones.
Failure of the left and right maxillary prominences to merge in the fetus causes what?
cleft palate
cleft palate is due to what embryo issue?
Failure of the left and right maxillary prominences to merge in the fetus
Pancreatic divisum is the most common congenital malformation of the pancreas, occurring in approximately 7% of the population. It is caused by what?
the failure of the ventral pancreatic duct to merge with the dorsal pancreatic duct.
Cleft ___ is the consequence of failed fusion between the medial nasal eminence and the maxillary process
Cleft lip
Cleft lip is the consequence of failed fusion between what two structures?
the medial nasal eminence and the maxillary process
failed fusion between the medial nasal eminence and the maxillary process ==> ???
Cleft Lip
Zygote is formed at day ZERO! when does implantation happen?
day 6-8; zygote is now called a blastocyst; each blastocyst forms it’s own placenta.
each blastocyst forms it’s own placenta, so if a prego shows only one placenta, when did splitting occur?
on or after day 5. If splitting occurred before the the blastocyst stage (eg. before implantation), there would be two chorions/placentas.
thryoid gland is derived from what germ cells?
endoderm
what structures are derived from neuroectoderm?hint: “COARNEE”
CNS nuerons;
Oligodendrocytes;
Asterocytes;
Retina, iris, & optic nerve;
Neurohypophysis (post. pit);
Epithalamus (pineal gland);
Ependymal cells;
Mammary glands are from?
surface ectoderm
Oral cavity epithelium, from?
surface ectoderm
Olfactory epithelium, from?
surface ectoderm
Distal anal canal below the pectinate line, from?
surface ectoderm
Enamel (ameloblasts are derived from surface ectoderm), from?
surface ectoderm
Adenohypophysis (via Rathke pouch), from?
surface ectoderm
Distal male urethra, from?
surface ectoderm
Parotid salivary glands, from?
surface ectoderm
Epidermis and accessory structures (e.g. hair, nails, sweat glands, sebaceous glands), from?
surface ectoderm
Ear; both the internal and external ear (not middle ear), from?
surface ectoderm
Lens of the eye, from?
surface ectoderm
Pia mater, Peripheral nervous system neurons, Arachnoid mater, are from?
neural crest cells
Schwann cells, are from?
neural crest cells
Sympathetic chain (autonomic postganglionic neurons), are from?
neural crest cells
Dorsal Root ganglia, are from?
neural crest cells
Adrenal Medulla chromaffin cells (vs. adrenal cortex, which is derived from mesoderm), are from?
neural crest cells
Facial and skull bones & Facial cartilage, are from?
neural crest cells
Parafollicular C cells, are from?
neural crest cells
Endocardial cushions of the heart, are from?
neural crest cells
Spiral septum (aorticopulmonary septum), are from?
neural crest cells
Odontoblasts (creates dentin), are from?
neural crest cells
Pigment cells (melanocytes), are from?
neural crest cells
round ligament of the liver is the remnant of what fetal structure?
the left umbilical vein
The structure that carries oxygenated blood from the placenta to the fetus becomes what?
the left umbilical vein ==> ROUND LIGAMENT
The intermediate mesoderm, develops into the urogential ridge, which derives what structures?
Kidneys Adrenal cortices Superior ureters Superior one third of the vagina Uterus and cervix Testes Ovaries
Cells of an Aldo producing adrenal adenoma are derived from what?
urogential ridge of the intermediate mesoderm, of mesoderm.
The developing embryo is most susceptible to teratogens during weeks __________, when the major organ systems, including the nervous system, gastrointestinal system, and cardiovascular system begin to develop and orient within the embryo.
weeks 3-8, the embryonic period
What is the mcc of a pure sensory stroke?
lacunar infarct of the thalamus.
What is the thalamus derived from?
diencephalon
The myelencephalon gives rise to the?
medulla and the lower portion of the 4th ventricle. myel- is below mete–
What gives rise to the cerebellum and pons?
metencephalon
The zygote is from what?
fertilization of the ovum; occurs at the ampulla of the fallopian tube.
gastric varices; ONLY in the FUNDUS ==?
splenic vein thrombosis leading to dilation of the SHORT GASTRIC veins.
The main pancreatic duct and common bile duct will join to become what?
the hepatopancreatic ampulla of Vater
The ventral pancreatic bud gives rise to the:(3)
Uncinate process; Lowerpart of the head; Main pancreatic duct
What parts of the pancrease is from endoderm?
Exocrine pancreas & Pancreatic islet cells (alpha, beta, etc.)
What does the midbrain and the cerebral aqueduct come from?
Mesencephalon
microglia from?
mesoderm
The umbilical arteries are a branch of what artery?
internal iliac a.
dorsal–ventral differentiation of the spinal cord is d/t what?
Sonic Hedgehog signalling pathways; mut & defects ==> CNS and facial defects; holoprosencephly.
Cerebellum, Pons, Upper-portion of 4th ventricle comes from what?
metecephalon; “CPU”; redditors love new CPUs man, thats so META.
spleen ~ greater omentum b/c???
both from dorsal mesentary
The medial umbilical ligaments is the post-natal remnant of what?
the right and left umbilical arteries
Which umbillical vein obliterates during fetal dev.?
RIGHT umbilical vein
Thalamus; 9Hypothalamus; Epithalamus (pineal gland); Third ventricle;Retina (please see Eye Development) comes from what?
diencephalon, which is below the telencephalon.
the embryonic neural tube and neural crest cells are derived from what?
Neural plate folds
Sclerotome, myotme, dermatome are from what?
Paraxial mesoderm
gastrulation starts/occurs at what week?
week 3; makes 3 germ layers; EPIBLASTs==> ecto, meso, endoderm
what week of dev. do genitalia show male/female characteristics?
week 10
What cells form the primary yolk sac?
Hypoblast cells that migrate along the Cytotrophoblasts
During gestational week 2, what happens to the embryoblast?
the embryoblast differentiates into 2 distinct cell layers, the epiblast and the hypoblast, forming a bilaminar embryonic disk. Think bilaminar occurs during the 2nd week.
The blastocyst usually implants within wht part of the uterus?
the posterior superior wall of the uterus
what are the two embryonic components form the placenta?
syncytiotrophoblasts &cytotrophoblast
Of the two embryonic components form the placenta which one does not divide mitotically?
syncytiotrophoblasts
Of the two embryonic components form the placenta which one divides mitotically?
cytotrophoblast; aids growth of the syncytiotrophoblast
Creation of the trilaminar disc is initiated when what happens?
the epiblast invaginates to form the primitive streak.
What embryonic components of the placenta produces human chorionic gonadotropin and human placental lactogen.
syncytiotrophoblast
Which type of twins divide prior to the formation of the chorion, which occurs 0-4 days after fertilization?
Dichorionic diamniotic monozygotic twins
Which type of twins divide after the formation of the chorion, which occurs 4 - 8 days after fertilization?
Monochorionic diamniotic monozygotic twins
Dizygotic, or fraternal, twins develop from two zygotes (two eggs and two sperm), this yields???
yielding 2 chorions (and therefore 2 placentas), and 2 amniotic sacs.
laryngeal inlet is from?
The respiratory diverticulum maintains a small, superior communication with the distal pharynx, which will become the laryngeal inlet.
Celiac artery; Superior mesenteric artery; Inferior mesenteric artery come from?
Vitelline arteries
4th arch arteries?
Aorta and RIGHT Subclavian “fOUR rhymes with AOR for Aorta. fouRS for Right Subclavian.”
3rd arch arteries?
Common Carotid; “C is the 3rd letter”
1st and 2nd arch arteries?
1st arch artery ~ maxillary artery
2nd arch artery ~ stapedial artery
“First is Max & Second is Stapedial”
Pulmonary trunk and RIGHT pulm artery is from which arch?
6th arch;
7th arch arteries?
“7 is S.”; Seventh InterSegmental Subclavian!
The development of the recurrent laryngeal nerve is closely related to arterial development. The left recurrent laryngeal nerve loops laterally to the ductus arteriosus (ligamentum arteriosum in adults) under [what?] before traveling superiorly.
aortic arch 6
what is elevated in asteocytes in pt. with hyperammoniemia?
Glutamate
skin finding ~w/ PBC?
Pruritis (itchy skin); PBC Sx: hepatomegaly, steatorrhea, portal HTN.
Venous drainage above the dentate line?
Superior rectal v –> internal iliac/inferior mesenteric.
Venous drainage BELOW the dentate line?
inferior rectal v. ==> intermal pudendal vein ==> internal iliac v.
Villous Atrophy, Crypt Hyperplasia, Intraepitheial lymphocyte infiltration ==?
Celiacs
“double bubble sign” ~?
duodenal atresia ~ Down Synd.
“Apple-peel: deformity == ?
Apple Peel atresia; occlusions of SMA
If you have an elevated alk phos, what is the next test you should order?
Gamma-glutamyl transpeptidase (GGTP)
if neonate passes meconium thru iumbilicus after birth, this is what?
persistent vitelline duct
Xanthelasma…what disease?
PBC; also ~w/ ADEK def, d/t fat mal.abs
what is the molecular mechanism of VIP, from a VIPoma?
Binds to Gs, activating AC and increasing cAMP
What is in the Hepatoduodenal ligament?
the portal triad (common bile duct, hepatic artery, hepatic portal vein)
If a patient is still bleeding after the Pringle maneuver, what is the source of the bleeding (2)?
IVC or hepatic veins
patent processus vadinallis ==>
Indirect inguinal hernias
weakness of transversalis fascia ==> ?
DIRECT inguinal hernias
what covers a DIRECT inguinal hernia?
external spermatic fascia
what covers indirect inguinal hernias?
all 3 spermatic layers; internal, cremasteric, external
air in the biliary tree =?
gallstone ileus
HSV-1 esophagitis endoscopy shows?
small vesicles–>punched out ulcers
papable, but NON-tender gallbladder = ?
Courvoisier Sign == Pancreatic malignancy
epigastic calcifications on imaging in an alcoholic?
chronic alcoholic pancreatitis
What Inhibits cholesterol 7-alpha hydroxylase which catalyzes the RLS in the synthesis of bile acids–> decreases bile acid production results in decreased cholesterol solubility–>cholesterol stones.
Fibrates
Gemfibrozil and fenofibrates are what?
Fibrates
SIBO causes def. in all vitamins, except for what?
Vit,K & Folate, these INCREASE b/c bacteria are growing and producing a shit ton.
CD16 & CD56 == ?
NK cells
defect in linea alba covered by skins; incomplete closure of umbilical ring ==>
Umbilical hernia (in peds)
L.O.F. mut. in MTP gene ==>
abetalipoproteinemia; acanthocytes
foul-smelling stools, ADEK def., ataxia, retinitis pigmentosa are signs of?
abetalipoproteinemia; labs will have low lipid panel and ABSENT apoV and VLDL
Histo of: Basal Zone hyperplasia; Lamina propria hyperplasia; Eosinophils/PMNs ==> ?
GERD
histo: islands of cells
eosinophilic cytoplasm and oval-to-round stippled nuclei ==>
Carcinoid tumors
“currant jelly stool” ==> ?
intussusception
Transmural inflamm & non-caseatnig granuloms ==> ?
Crohns; cobblestone mucosa on gross.
finely granular, diffusely homogenous, pale eosinophilic cytoplasm (ground glass hepatocytes) ~w/
HepB
cricopharyngeal motor dysfunc. —>
Zankers diver.
gram positive actinomycete; Diastase resistant = what bug?
T. whippelii
Pathway of NOD2?
NF-kB –> cytokine prod.; ~w/ crohns
CREST syndrome?
Calcinosis/Anti-centromere ab Raynaud Phenomenon Esophageal Dysmotility Sclerodactyly-finger ulcers w/ skin tightening Telangiectasia
Councilman & Apoptotic cell bodies are seen on histo of what diz process?
Seen on H&E of actue viral hepatitis
What does the Sabin (live) vaccine increase that the Salk (killed) doesn’t?
mucosal IgA
What does the onset of action of gas anesthetic depend one?
solubility in blood (blood/gas coefficient); High b/g coefficients are more soluble in blood, slower equilibration with brain, and longer onset
Almost all volatile anesthetics increase what physiological parameter?
Cerebral blood flow; this is an undesirable effect as it results in increased ICP.
What is the mc benign lung tumor, “coin lesion”, called and what are they made of.
Harmartomas. disorganized cartilage, fibrous and adipose tissue.
What anti-arrhythmic drug also shortens phase 3 re-polarization (blockade of “plateau” Na+ current)
Class 1B;l Lidocaine, mexiletine
What anti-arrhythmic drug has a strong polongation of phase 0 depol, and results in no changes to the length of the AP?
Class 1C; Flecainide, propanfenone.
Which anti-arrhythmics also have moderate K+-ch. blocking activity?
Class 1A; quinidine, procainamide, disopyramide. moderate phase 0 block and prolonged AP length.
intracerebral hemorrhage, progressive neurological deficits, located at basal ganglia, cerebellum, thalamus, pons = ??
Charcot-Bouchard aneurysms. Qid 498
reddish-pink, PAS (+) granules of unsecreted polymers in the periportal hepatocytes == ?
Alpha-1 antitrypsin def. (ATT), in lungs as interalveolar septa destruction.
bronchial hyperreactivity is a hallmark of what?
chronic asthma
interstitial infiltration is a finding in what?
interstitial pneumonitis
intraalveolar substance accumulation is a finding in what?
alveolar proteinosis
rupture of the left ventricular free wall occurs how many days post MI?
5-14 days. causes profound hypotension and shock, leading to death.
Synaptophysin is a protein found where?
presynaptic vesicles of neurons, nueroendocrine and neuroectodermal cells.
Asterocytomas, ependymomas, and oligodendrogliomas are of what origin?
Glial origin; stain positive for GFAP.
non-lactose fermenting, non-motile, gram negative rod == ?
Shigella
motile, oxidase positive, gran-negative rod == ?
Pseudomonas
chest pain that is sharp and pleuritic, and may be exacerbated by swallowing or relieved by leaning forward = ?
pericarditis. can be d/t pericardial inflammation overlaying the necrotic segment of the myocardium post MI.
acute hyper-sensitivity reaction to drugs like, opioids, radiocontrast agents, and some ABX can be due to what?
IgE-independent mast cell activation; induces mast cells to degranulate by activating protein kinase A and PI3 kinase.
IgE mediated degranulation is ~w/ what?
environmental exposures like food or plants, and some meds like beta-lactam and sulfonamide ABX.
what is characterized histologically by spongiosis?
Acute eczematous dermatitis; S/Sx of papulovesicular, weeping lesions. seen in type 4 HSR.
white blood cell casts are only form in the renal tubules and are pathognomonic for __________________when accompanied by symptoms of acute UTI.
acute pyelonephritis
pyramidal cells of the hippocampus and the neocortex and the Purkinje cells of the cerbellum are at risk for what?
hypoxic-ischemic encephalopathy in global cerebral ischemia. hippocampus is first to be damaged
easy fatigability, constipation, back pain, elevated serum protein, azotemia in elderly pt. should raise suspicion for what?
Multiple myeloma.
large eosinophilic cast obstructing the tubular lumen is a sign of what?
multiple myeloma; those are Bence-Jones proteins.
What classically presents with muddy brown, granular, and epithelial cell casts and free tubular epithelial cells in the urine?
Ischemic tubular necrosis
NSAIDs can cause what two renal issues?
chronic interstitial nephritis or acute papilary necrosis.
What does Pauci-immune RPGN mean?
no Ig or complement deposits on the basement membrane. Most pt. will have ANCA in their serum.
What is a simple partial seizure?
aka simple focal. no loss of consciousness, motor jerking.
Triad of low hemoglobin, thrombocytopenia, and absent hematopoietic cells in the bone marrow == ?
aplastic anemia; “dry tap”
cataracts, gonadal atrophy, sustain muscle contraction == ??
myotonic dystrophy [AD}
on histo: aggregates of packed follicles that obscure the normal lymph node archtecture == ?
Follilcular lymphoma. t(14;18), overexpression of anti-apoptotic BCL-2 protein.
Hematogenous osteomyelitis occurs where in the bone?
long bone metaphysis in peds. (vertebral bodies in adults is the more common location)
Hypophosphorylated Rb protein does what?
active; Rb protein prevents damage cells from proceeding pas the g1 to S check point.
