K Flashcards
Function of serratura anterior
Protraction and rotation scapula
Rhomboid major and minor
Addicted scapula
Serratura posterior
Depresses the lower ribs
Elevator scapula
Elevates scapula
Altissimi dorsi
Adducts extends and medically rotates arm
Trapezius and elevator scapula
Elevate scapula
Depression scapula
Trapezius
Thor’s odors always nerve
Altissimi dorsi which adducts, medically rotates and extends arm
Compression fracture wedge fracture
Vertebral bodies
Ligamentous flavum
Connects laminate of two vertebra for posterior wall makes direct contact with vertebral foramen .
Dorsal scapular nerve
Innervate rhomboids major and minor retraction of scapula
Disc herniation
Protrusion of nucleus purposes through annulus fibrosis psoterolaterally into spinal canal or intervertebral foramen
What is in vertaberal canal
Meninges, spinal cord, ligaments
Where lumbar puncture
L4 5
Supra spinous is gone through
Conus medullaris
Stop at l2 with the denticulate ligament
Anterior spinal artery vs vertebral arteries
Anterior is anterior vertebral through transverse foramina
Nichel ligament
Extension of supraspinatus above c7
Ligamentous flavum
Posterior aspect of vertebral canal associated with laminate
Cruciform/cruciate ligament
Stabilizing c1/c2 attaches pedicles and helps stabilize dens
Spodylolysis
Anterior displacement of vertebra
Vertical small and oblique axis
Lumbar
Where is internal vertebral plexus of Bateson
Surround dura in spinal epidural space
Posterior intercostal arteries
Deep back which extend and laterally bend trunk
T4 articulates with what rib
5
And facets of own t5
Where is hepcidin from
Acute phase reactant! Hepatic parenchyma cells
Turns off feroportin by internalizing it -decrease intestinal absorption and release by macrophages
A little from bile
How absorb iron
Diva lent metal transporter DMT-1
In cell-ferritin and remain in enterocyte-excreted in stool as enterocytes slough off and are replaced
Or enter circulation through ferroportin (basolateral transporter). Transported in blood by transferrin which interacts and becomes internalized after interacting wiht transferrin receptors o all cells
Iron recycling
When rbc destroyed by macrophages iron into reticuloendotheial system for use in new erythroid precursors.
Lactoferrin and PCT
Binds iron in urine
Broca vs wernicke vs arcuate fasciculations
Broca-motor speech
Wernicke-understanding speech and using correct words
Arcuate-links
Broca lesion
Expressive phasing
Infarct superior division left MCA
Can understand
Speech slow slurred
Frustrated B.C. know something wrong
Slow slurred
RIGHT hemiparesis of face and upper limb
Impaired repetition
Wernicke lesion
Receptive aphasia
Infarct of inferior division left MCA
Word salad don’t know anything wrong
Fluent voluminous by lacks meaning
Can’t comprehend
Can’t repeat
Right superior visual field defect
Arcuate fasciculus lesion
Conduction aphasia
Fluent with phonemic errors
Can comprehend
POOR repetition
Lesion postcentral gurus
Sensation loss in contra lateral body
Precentral gyrus lesion
Slurred speech (dysarthria) due to paresis/paralysis of the skeletal muscles in overeats of the mouth , tongue, andlarynx,
Where is frontal eye field
Middle frontal gyrus anterior to percentuale sulcus 6 and 8
Eyes deviate to ipsilateral side
Where is broca
Inferior frontal gyrus of dominant (usually left) hemisphere)
Down syndrome inheritance
Meiotic nondisjunction (old mom
Unbalanced translocation (high chance of recurrent if balance is present in one parent)
Mosaicism(regular population_
-nondisjunction in mitosis
Interstitial lung disease
Cladding, diffuse reticular opacities, fine crackers, dyspnea progressice,
Pulmonary fibrosis with thickening and stiffening of pulmonary interstitial.
Increased lung recoil and airway widening from increased outward pull (radial traction)
THIS IS A RESTRICTIVE lung disease
Galactose metab
Lactose to galactose and glucose
Galactose phosphorylated to galactose 1 p by galactokinase
Or made to galactitiol by Aldo se reductase
Galactose 1 p made to glucose 1 p by galactose 1 p uridyl transferase (using UDP galactose to UDP glucose by UDP galactose 4 epimerase)
Glucose 1 p to glucose 6 p by phosphoglucomutase
Glucose 6 p to pyruvate
Galaktokinase defiency
Galactose buildup and conversion to galactic or , an osmotic agent causes cataracts
Galactose in urine and test positive for reducing substance
Not serious just cataracts
Late presentation normal growth
Checked in newborn screen
Galactose 1 p uridyl transferase defiency
Serious
Accumulation of galactose 1 p causes hepatic and enal dysfunction
Early neonatal period vomiting lethargy and failure tot hrive
Aldo last b defiency
Hereditary fructose intolerance
Can’t metabolize fructose and get hypoglycemia, hypophosphatemia and failure to thrive
No cataracts, but have reducing substance in urine
Alpha galactosidase a defiency
Xr
Fabry
Cataracts-neurological findings and angiokeratomas BLACK MOLE THING
Fructokinase defiency
Essential fructosuria benign positive test for reducing substance but not cataracts
Glucose 6 phosphatase defiency
Glycogen storage type 1 von girete
Hypoglycemia, lactic acidosis hepatomegaly and hypertriglyceridemia
No cataracts
Hexosaminidase a defiency
Ray sachs
Retinal cheery loss of motor skills
No cataracts
Sphingomyelinase defieny
Neumann pick
Accumulation sphinngomyelin
Hepatosplenomegaly, motor neuropathy, anemia macular cherry red spots
What is hypoxemia
PaO2<75
Treat arsenic poisoning
From pesticides, will water, pressure treated wood
Dimercaprol
DMA
Garlic breath , skin, vomiting watery diarrhea, WT prolongation
What type of collagen is used in healing after MI
Type I collagen 2 weeks after. Fibrosis continues till two months creating a dense collagenous scar
Granulation tissue Lymphatics, bone marrow lungs intestines skin
Type III collagen
Helmer’s Danilo’s type 3 and 4
Vermpamilf or MI
NO
Use BB
Left dominant vs right dominant circulation. If av node blocked in left vs right where did atherosclerosis come from
Left Left circumflex artery
Right coronary artery
What should zollinger Ellison syndrome patients undergo testing fo
MEN1
Glucogonomas
Rare pancreatic alpha cell tumors present with DM and raised erythematous rash affects groin (necrologio migratory erythema)
Insulinomaspancreatic beta cell tumors secrete insulin autonomously . High circulating insulin and c peptide and symptoms of hypoglycemia
Ok
Somatostatinomas
Pancreatic d cells DM cholelithiasis and diarrhea/steatorrhea
Turner heart
Bicuspid valve more common
Coarctaiton
Stable angina
Fixed coronary artery stenosis in setting of atherosclerotic CAD. Limiting blood supply to myocardium, which causes a mismatch of oxygen supply and demand with exercise
Discomfort, SOB
Dobutamine-increase HR and contrattilità normally. Myocardium without blood flow good though transient decrease in contractlity, reduced ejection fraction
Acute MI and stress test
Coronary artery occlusion due to plaque rupture and thrombosis leads to acute MI
Total occlusion and blocked o2 supply, a persistent rather than transient (before during and after dobutamine) wall motion defect detected
Vasospastic angina
Coronary artery vasospasm and can mimic stable angina that results from atherosclerotic CADl however vsospastic angina is in ppl under 50
Do imagine not really a1 and unlikely to trigger
Focal myocardial fibrosis
From previous MI
Contractillity impaired in fibrosis myocardium, leading to a persistent wall motion defect similar to that of MI
Normal cardiac stress test dobuatmine
Increase contractility and o2 demand is met by increased supply via increased flow. Transient increase in ejection fraction
Fatty acids that bind calcium and form calcium salt
Acute interstitial pancreatitis -edematosi pancreas
Focal fat necrosis and ca on LM
Acute necrotic pancreatitis
Inflammatory process continues blood flow to pancreatic acini compromised ischemia damaged acinar cells and causes abnormal intracellular activation fo trypsin . Trypsin activates other proteolytic anzi se initiating auto digestion.
Destruction of bv hemorrhage into encrotic areas. White chalky fat necrosis which spread to mesentery and ab. Black hemorrhages also
Dull gray edematosi granular intestinal seriose
Creeping fat crowns
TTP
Adamts13 down uncleared vWF Fever Anemiaschistocytes Thrombocytopenia Renal failure Neurologic manifestations
Need hemolytic anemia and thrombocytopenia without other cause
Treat with palsmaexchange, glucocorticoids, rituximab
SIADH
Hyponatremia and lung mass
SCC release ADH hyponatremia decreased plasma osmolarity and increased urine osmolality (normally less than100)
Inappropriately concentrated.
Altered mental status, HA, weakness,
Increased adh excessive water absorption by kidneys leading to a transient sub in iCal hyperbole is. Which sutures reining ald and stimulated ANP leading to excreting in urine
Clinicallly normal extracellular fluid volume and low plasma osmolality (EUVOLEMIC HYPONATREMIA)
Calcium sensing receptors
CaSR are Gq regulate PTH
Familial hypocalciuric hypercalcemia
AD benign defective CaSR in PTH and kidney
High Ca required to suppress PHT
Raise set point of regulation
Mild asymptoatmic hypercalcemia, reduced urinary excretion and high normal or mild up PTH
Opposite direction of replication fork
Multiple short DNA fragments
How prevent tachyphlaxis
When using NO have dru free intervals
Stop decongestant that are a agonists
MDR1
ATP dependent effluì pump p glycoprotein
In BBB too prevent foreign compounds into CNS
Why no give k sparing directive with ace inhibitor
Hyper K
Psoas abscess
Flexor
From spread of infection from adjacent structure or hematogenous or lymphatic seeding from distant site.
Fever, flank sin, pain wiht fuel ion and extension hip. Extension at hippsoas sign.
Can be in appendicitis B.C. appendix right on psoas
councilman bodies what causes it in IV drug user
T cell mediated apoptosis
Hepatitis acute
Chronic-inflammation around portal triad . Ground glass appearance or fat.
Hep b or c
Normal SV
70
What ration is 2:1 at birth
P:S
Jugular foramen syndrome
IX X and XI
Taste posterior tongue Loss gag Dysphasia Hoarse Uvulas toward the normal side X Sternoclidomastoid and trapezius XI
Cerebellopontine angle lesion
Sensorineural hearing loss and tinnitus from CNVIII
Piriformis recess
Cavities on either side of laryngeal orifice
Bound medically by aryepiglottic folds and laterally by the thyroid cartilage and thyrohyoid membrane.
Food goes from piriform recess to esophagus by epiglottis to avoid airway.
Mucosa on piriformis protects the internal laryngeal nerves a branch of superior laryngeal nerve
Has sensory and autonomic fibers afferent limb cough reflex from mucosa superior to vocal cords
Internal laryngeal nerve damage when foreign bodies lodge in inmpair cough
Superior laryngeal nerve vs recurrent and external
Recurrent and external-carry motor fibers to the muscles in vocal cord function
Internal-sensory and autonomic
(Superior)
Neonatal tetanus
Arched back
Dorsiflexed feet
Major death in underdeveloped countries frmoumblicol cord hygiene
Vaccinate pregnant women B.C. they will give igg to baby first 6 months if breast feed
Pramipexole for Parkinson
Stimulates dopamine receptors
Ergot compounds-bromocroptine
Nonergot compounds-pramipexole and ropinirole
Delay need to start levodopa
Cheyenne stokes breathing
Cyclic breathing chronic hyperventilation and hypocapnia
Followed by increasing then decreasing today volumes until next Aeneid period.
HEART FAILURE
Warfarin induced skin necrosis
Protein c or s defiency
Early loss leads to transient hypercoagulable state and get micro vascular occlusion
BIG PAINFUL RASH
Stop warfarin and FFP or protein C concentrate
Precocious puberty
Secondary sex at below 7
Cholesterol stones
Abilitati of bile salts to solubilize cholesterol is overwhelmed by high concentrations of cholesterol in bile
Yellow to pale gray and hard
7 a hydroxylase which converts cholesterol to bile acids
Pigment stones
Calcium salts of unconjugated bilirubin soft and dark brown to black secondary
Brown pigment
Brown pigment are composed of calcium salts of unconjugated bilirubin and arise secondary to abcterial or helminthis infection of biliary tract. Beta glucuronidase released by injured hepatocytes and abcteria hydrolysis bilirubin glucuronides to unconjugated bilirubin. Liver fluke clonorhis sines is in east Asia
Pigment stone no infection
Excess bilirubin is excreted chronic hemolytic anemia . Conjugated bilirubin normally becomes deconjugated by endogenous beta glucuroidase in biliary tract. When large amounts of conjugated bilirubin are excreted into bile, enough becomes deconjugated to promote black pigment stones
Anxiety disrderr\
WORRY for over 6 months
Restlessness feeling on edge Fatigue Difficulty concentrating Muscle tension Sleep disturbance
ARR
Control rate-exp rate
Tardive dyskinesia
Face stuff writhing chronic use
Akathisia
Can’t sit still
Nucleolus
Basophilic rrna
FAS mutation
Can’t get activation induced T cell death apoptosis
Regulation glycogen phosphorylase
In skeletall muscles Phosphorylase kinase active p not active dephosphorylation
Phosphorylase kinase on with Ca and cAMP
Glycogen phosphorylase dec with ATP and g-6p and inc with AMP
But in liver PK activated by epi and glucagon binding to gs to increase camp concentrations
Von fierce
Glucose 6 p Hepatomegaly and steatosis Fasting hypoglycemia Lactic acidosis Hyperuricemia and hyperlipidemia
Can’t turn g6p tp g
Pompe II
Bad acid a glucosi dash
Normal glucose levels
Severe cardio eagle
Glycogen accumulation in lysosomes
Type III cori
Debranching enzymes
Hepatomegaly
Ketotoic hypoglycemia
Hypotonia and weakness
Abnormal glycogen with very short outer chains
Type V mcardle
Muscle phosphorylase defiency
Glycogen phosphorylase
Weakness and fatigue with exercise
No rise in blood lactate levels after exercise
Diabetic gastroparesis
Autonomic neuropathy destruction of enteric neurons
Failure of relaxation in fungus and uncoordinated peristalsis
Postprandial bloating and vomiting
Early satiety
Do a nuclear gastric emptying study : delayed transit to duodenum
Destruction from chronic hyperglycemia
Most common primary cerebral neoplasm in adults
Glioblastoma
From astrocytes and is in cerebral hemispheres. Can be large wiht ass effects
Node midline shift
If cross corpus calosum is a butterfly gloom a
See necrosis and hemorrhage
Highly malignant poor prognosismost die
Brain metastasis
Most adult brain tumors
Lung breast kidney skin
Multiple well circumscribed masses at junction of gray and white matter
Meningiomas
Benign well circumscribed neoplasma of adults from arachnoid cells
On brain surface a site of rural reflection
Oligodendrogliomas
Slow growing tumors of adults involve white matter of the cerebral hemorphseres. Well circumscribed and gray
Primary central nervous system lymphoma
Immunocompromised
Multiple lesions involving deep brain matter, white matter and cortex
Schwannomas
Benign from VIII at cerebellopontine angle. Have sensorineural hearing loss and tinnitus
Treat or nothing transcarbamylase
No protein in diet so don’t get ammonia to accumulate in blood resulting in progressive lethargy vomiting seizures and cerebral edema
HIV baby
Oral thrush interstitial pneumonia and lymphopenis in first year. IV drug user .
Rib 11-12, rib 9-11
Kidney
Spleen
12th rib gets kidney
After MI why get MV regurg
Secondary stretched chordae tendinae
Dilation mitral annulus and restricted movement of chordae tendinae get insufficient closure
DIURETICS TO REDUCE LVEDV AND VASODILATORS to reduce BP resolve
S3
Decomp heart failure
Increased flow velocity aortic valve
Stenosis crescendo d murmur
MR in setting of abcterial endocarditis CT or acute MI
Rupture chordae tendinae
Doesn’t resolve wiht diuretics and caso dilators need Ruggero
HPV throat
TRUE vocal cords
Decompensated HF
Dyspnea, orthopnea with flat, jugular venous dissension, cardiac heave, peripheral edema
REDUCES renal perfusion o increase renin ang I in systemic circulation and converted to ANGII in small pulmonary vessels . In pulmonary vein than artery
Emphysema
Destruction intraalveolar walls
What kind of infection get with neutropenia and systemic chemo
Endogenous bacterial flora
Gram neg enteric bacilli like pseudomonas, staph up or are us
Neutropenic fever-fever only sign of infection *** on chemo only fever B.C. weak response to infection no inflammation
Give prophylactic antibiotics on chemo
TCA heart death
Sodium channel inhibition
Amiodarone
Prolong qt, but less torsades than other
Treat trigeminal neuralgia-sharp pain from food or brushing teeth on side of face does away in a few seconds stabbing electric shock
Carbamazepine. Inhibits neuronal high frequency firing by reducing the ability of na channels to recover from inactivation p450 inducer that increases metabolism of many other meds
Second line baclofen and valproic acid
Jervell and lange Nielsen syndrome
Mutations encode voltage gated k channels. Long qt
Brugada
Mutation l type ca channels
Glucorticorticoids for graves
Improve inflammatory infiltrate reduce extraocular volume
Boy, bleeding after tooth, bruises dad and grandma had it
Von willie brand AD
Graves dermopatie
Graves opthalmopathy
Dermopatie-stimulation of fibroblasts, adipocytes and T cells to makes glycosaminoglycans and adopgenesis. Get indurationa don thickening of skin over shins. Pretibial myxedema
Ophthalmology-expansion of retro-orbital tissues displacing the globe
TRAb
Diarrhea tea colored odorless and watery stools. No fever or pain. No gastric acid!
WDHA.
Too much VIP
Hypokalemia and achylorhydia
Treat with somatostatin
What substance causes TB granuloma
IFN-y B.C. activate macrophages
Which make TNFa, which helps recruit
Excretion rate
(Insulin clearance)(plasma concentration)-tubular reabsorption
Inferior thyroid artery ligament near what nerve
Recurrent laryngeal nerve
Surgical land mark for appendix
Tendinae coli
Longitudinal muscle surrounding rectum but split int here longitudinal bands travel on outside of entire colon before converginat root of vermiform appendic
Follow tendinae doli to origin
Health care proxy or family
Health care proxy
Superior gluteal nerve injury
Left hip drop superiormedial corner butt
AE nitrates for stable angina
HA bad , cutaneous flushing, lightheaded,hypotension, reflex tachycardia
Treat arsenic
Dmiercaprol
Mefloquine
Destroys replication parasites within rbc for malaria
But inactivated in liver
Can’t work with hepatic schizonts. So must continue it for 4 weeks to ensure al parasites from liver are destroyed
Works with p falciparum
Test diabeti nephropathy
Urine albumin
Glucosi Rai shows poor glycemic control not renal damage
Sheehan
Pituitary ischemic necrosis
Panhypopituitarism
When get rouleaux
Multiple myeloma and waldenstrom macroglobulinemia
Have high monoclonal paraprotein (Is)
Bleeding after bowel resection
ADEK loss no bit k
HIV dementia
Micro grills cells multinucleated release neurotoxic compounds
Cerebral amyloid angioapthy
Beta amyloid in cortical bv. Associated wiht intracerebral hemorrhag or Alzheimer’s.
Alzheimer’s
Congo red beta amyloid surrounded by dystrophic neuritis . Often in hippocampus.
Older with memory loss and higher cortical dysfunction (aphasia, agnosia, apraxia)
G6pd
Xrg6p to 6 phosphogluconate
Galactosemia
Baby vomiting and lethargy after breastfeeding. Accumulate galactose 1 p impaired liver function predisposed to E. coli sepsis
Bilirubin transumanis
Galactokinase
Cataracts, pseudotumor cerebri galactitol accumulation
Baby intracranial GI cutaneous umbilical and surgical bleeding .
Low vitamin K prevent with intramuscular vitamin k at birth
If not get impaired clotting factor carboxylation
Baby lethargy and irritability with fever or hypothermia
Bacterial meningitis
Intra entri usar hemorrhage in premature infants
Germinal matrix fragility. Which starts involuti get at twenty eight weeks and disappears b full term
Cataracts
Long standing hyperglycemia from poorly controlled diabetes.
Dorsal column loss
Position/vibration sense
Spinocerebellar tract loss
Ataxia
Lateral corticospinal tract loss
Spastic paresis
Cholesteatoma
Squamous cell debris pearly mass behind tympanic membrane in mild ear
Squamous epithelium migrates or is in wrong place
Pain otorrhea. Conductive hearing loss. Vertigo or facial palsies if out of control
Cholesterol granuloma middle ear
After hemorrhage bluish black gelatinous material behind tympanic
No lipid or cholesterol
Facial neuroma
In middle ear as facial nerve courses . Unilateral facial paralysis
Squamous cell arcinoma ear
Ulcerated plaque or nodule. Pain
Granulomatous disease ear
Sarcoidosis, granulomatosis , langerhanc cell histiocytosis
Diabetes HLA
DR3 and 4
Amyloid. Pancreatic islet cells
Amyloid stored in insulin secretory granules and co secreted with insulin in type II D have too much insulin so get amyloid in beta cell apoptosis situation
POSTERIOR ROSTAL PONS NEAR LATERAL FLOOR OF FOURTH VENTRICLE
MAKE NE IT IS THE LOCUS CERULEUS0IN PONS
Cholera poop
Mucus and no erythrocytes or leukocytes
Treat delirium
Even in old ppl haloperidol first gen antipsychotics
Antipsychotics
Old person hospitalized in an out agitated
Delirium
Reduce mortality after MI
ACE, ARB, angiotensin receptor blocker, bb, spironolactone
NOT DIURETICS OR DIGOXIN
Agitated ad delirious with severe abdominal cramps and diarrhea HR up temp up BP up. Diaphoretic and tremulous pupils dilated. Had a med. hyperreflexia and clonnus
Serotonin syndrome
Migratory thrombophlebitis
Adenocarcinoma of pancreatic, colon and lung
Hypercoagulability bc adenocarcinoma makes a thrombophlebitis like substance capable of causing chronic intravascular coagulations
Trousseau syndrome
Granule containing cells with crystals
Charcot Leyden crystals in eosinophilia
Crystals are bipyramidal accumulation of eosinophilia membrane protein
SOB and hard to breath no triggers
Asthma
Panic attack why get neurologic sequela e with weakness, blurred vision, presyncope and syncope
Decrease in arterial PaCO2. Breathing more get hypocapnia wiht causes decreased cerebral perfusion.
Cerebral blood flow is constant over a wide variety of perfusion rpressure and mainly influenced by arterial paco2.
Hypercapnia-increase CBF to remove toxins and hypocapnia triggers decrease in CBF
*why cerebral edema patients often hyperventilated to decrease intracranila pressure and prevent brain hematoma
Burnt sugar small in diaper, dehydrated vomiting and lethargy
MSUD don’t give branched chain aa leucine isoleucine and valine
No branched chain a ketoacid DH
Methylphenidate MOA
Decreased appetite, weight loss and insomnia
Stanford a aortic dissection
Aortic dissections any part of ascending
Sinotubular junction
Stanford b
All dissections in descrnding aorta
Usually left subclavian artery
COPD exacerbation viral and bacterial
Rhinovirus, influenza, parainfluenza
haemophilus influenza, morazxella, strep pneumonia
Yellow sputum
Osmoalirity plasma normal
280-300
SIADH
Scc
Too much adh->water retention->inc total body water->extracellular fluid expansion->decreased aldosterone and NP->increased urinary Na excretion ->normalize extracellular fluid volume
EUVOLEMIC HYPONATREMIA
Flaccid vs spastic bladder
Flaccid-large residual volume
Spastic-frequent incontinence throughout day
Peeing throughout the day urge incontinence
Bladder hypertonic
Colchicine AE
Diarrhea, nausea, ab pain
SSRI that doesn’t cause sex prob
Bupropion NE-D reputate inhibitor for depression associated wiht hypersonic and low energy
What causes bronchoconstriction
Vagus send ach to muscarinic receptors
What blocks action of ach for asthma
-ipratropium
Treat trigeminal neuralgia
Carbamazepine-inhibits neuronal high frequency firing by reducing ability of na channels to recover from inactivation
-bone marrow suppression
Where is heme made
Mitochondria and cytoplasm
Wallerian degeneration
Axon damaged. Peripheral degrade their myelin and secrete cytokines and chemokines that recruit macrophages.
Clear stimulate growth of cone from stump of proximal axon and nerve regen
CNS-phagocytes macrophages/microclima slow B.C. of BBB. Removal of myelin debris persist for years and suppress atonal growth. Glial scar
Subarachnoid hemorrhage
Most common berry aneurysm rupture.
Abruptly thunderclap HA, confusion, blood in subarachnoid space
A few days later get arterial vasospasm from vasoconstrictive factors from damaged erythrocytes in subarachnoid space and inability to make vasodilators.
Delayed cerebral ischemia and focal neurological deficits.
CT no sig changes
Normal FEV1/FVC
70 or 80
Hyperacute, acute and chronic rejection
Preformed antibodies, humoral/cellular, chronic low grade immune response refractory to immunosuppressants
Prevention of cardiovascular events drug
Aspirin
Colpi dogare L if aspirin allergy
When get sickling with sickle cell anemia
Low oxygen, increased acidity, low volume. Organs with high o2 demands where there is a lot of o2 unloading get sickling like brain muscles placenta
How treat seizure
Simple and complex-carbamazepine, gabapentin, phenobarbital, phenytoin
Tonic clonicand myocllonis-lamotrigine, levetiracetam, topiramate, valproic acid
Absence-ethos I die
Wide splitting s2 not better with inspiration
ASD
Left to right shunt and increased blood flow to pulmonary artery which may be damaged
Increase pulmonary resistance over systemic and get a shift to right to left shunt late onset cyanosis with clubbing and polycythemia. This is called eisenmenger
Sclerosis irreversible and bad
Eisenmenger
Chronic pulmonary HTN shift from l to r shunt to r to left
Worry about pulmonary vessels
Dystrophy calcification
Necrosis in normal calcium
Psammoma bodies
Metastatic-normal tissue high calcium
Modafinil
Nonamphetamine stimulant for narcolepsy
Occlusion anterior cerebral artery
Sensory and motor function of contralateral leg and food
Urinary incontinence and behavioral issues if frontal micturition center is affected
Middle cerebral artery occlusion
Motor control of hand-gripping, face mouth0whistling, and throat-swallowing
Can cause broca aphasia , anosognosia and spatial neglect of contralateral side, conjugate gaze deviation toward side f stroke and contralateral homonymous hemianopsia
Niacin in TCA cycle
Isocitrate DH needs it
NAD NADH
Why get Huntington
CAG repeats result gain of expression of proteins polyglutamine region leads to pathological nteraction with other proteins
Transcriptional silencing his tone deacetylation silencing genes necessary for neuronal survival
Maybe can treat with his tone deacetylase inhibitors help upregulate survival genes
Swelling in hydrocele is in what
Tunica vaginali
Febrile neutropenia
Pseudomonas erythema gangrenous necrosis and ulceration
Trazodone vs premature ejeculation
Trazodone priapism not premature
Schizoids are not__
Paranoid
Man doesn’t want to know results of his test
Ok that’s fine
A fib embolism
Give long term anticoagulation
Get from left atrial enlargement, stasis of blood from ineffective atrial contraction and atrial inflammation and fibrosis
Left atrial appendage-small saclike structure in left atrium susceptible to thrombus formation 90% of left atrial thrombi found here.
Radial artery
Deep brachial
VPL
Spinothalmic and dorsal columns
VPM
Trigeminal pathway
VPM and VPL
Send somatosensory projection to the cortex via thalamocortical fibers
Complete contralateral sensory loss and severe proprioceptove defects cause unsteady gait
Base of pons injury
Contralateral weakness and ataxia bc of descending motor tracts and pontocerebellar fibers
Caudate nucleus damage
Behavioral abnormalities, speech language, movement
Frontal cortex
Social disinhibition and deficits in attention and executive function
Anterior 2/3 of posterior limb of internal capsule
Motor fibers of cortisospinal tract
Posterior 1/3 limb internal capsule
Sensory fibers (thalamocortical tract)
Small lesions contralateral pure sensory deficits most result in pure motor or combined sensorimotor deficits
Lacune
<15 mm cavity infarcts in basal ganglia , posterior limb of internal capsule, pons and cerebellum. In small penetrating arteries that supply brain in HTN and diabetes
Lipohyalinosis and microatheroams
Cause lacunae infarcts
LIQUIFEACTIVE necrosis
Lipohyalnosis
Secondary to leakage of plasma proteins through damaged endothelium hyaline thickening , collage out, accumulation of mural foamy macrophages
Microatheromas
From atherosclerotic accumulation of lipid laden macrophages within the intima layer of a penetrating artery near its origin off the parent vessel.
Spinal stenosis
Ligamentous flavum
Median nerve courses between what at antebrachial fossa
Flexor ditto rum superficialis and flexor digitorum profundus
Ventral pons
V-VIII, corticospinal tract and medial Lemnos is and lateral spinothalmic tract trough here
Dorsal midbrain
Superior and inferior caniculi
Gastric varies in portal HTN vs pancreatic, pancreatic cancer and ab tumors
Left gastric. Veins cause gastric and esophageal vari se
Splenic vein thrombosis which drain the short gastrics cause them only at the fundus
Azygos vein
Drain esophageal veins into superior vena cava
Enlarged with caval obstruction
Blockage of some
Lower stomach
Ration 2/1 for lung maturity
L/S
Why b12 cause anemia
Diminished thymidine synthesis
What id behind esophagus
Descending aorta travels down a nterior vertebral column
Where is SVC
Behind first costal cartilage by merge of brachiocephalic veins
Severe hypotension and refractory shock. Ab pain, vomiting, weakness fever. How treat
Fluid and glucocorticoid with hydrocortisone or dexamethasone
Hypothyroid bipolar
Lithium
Kid proteinuria after infection and albumin
Minimal change loss of anions in GBM immune dyes regulating increas il13 damages podocyte and an ionic properties of GMN
Selective albuminuria
Other nephrotic syndromes have non selective proteinuria
Target cell
EXCESSICE surface area to volume ratio, so cell membrane fold on itself
Epiglottis kid
H influenza didn’t get vaccinated
Tetanus stops release of what
Glycine and GABA not glutamine
Lacrimato in, anxious, ab pain, hyperactive bowel
Opioid withdrawal
Why mcburney point hurt
Inflammation of the parietal peritoneum
FEV1/C asthma
Usually<70 but variable in asthma
If physician is wrong should u ignore him or follow orders
Don’t follow but discuss with them on how t proceed
Risk of developing AZ from a four chart
A/a+b
Not same as relative risk=—=po
Effect modification
Effect of an exposure on an outcome is modified by another variable
Identified using stratified analysis as different strata will have different measures of association
Case control vs case series
Case series purely descriptive and cant establish associations. Tracks patients with a known condition to document the natural history or response
Cumulative incidence
Number new/number ppl at risk AT BEGINNING OF TIME
Probability of not having disease when test negative
NPV
Given a positive test result, what is probability have disease
PPV
What is a control group
Subject without disease regardless of exposure
Stratification
Partitioning of subjects and results by a factor other than treatment given
ANOVA
Analysis of variance for measuring several means
Calculate RR
A/a+b/c/c+d
Ecological study
Observational population level association between exposure and outcome. Population level data rather than individual like national cancer registries and GDP
Ecological fallacy
Ecological studies can generate hypothesis but not for conclusions regarding individuals within these populations
Biggest mortality reduction you can do for anyone who smokes
Stop smoking
Power
Detect a difference when one exists
Reject null when it is false
Arr
Control-treatment rate
Err
Arr/control rate
Rr
Treatment/control
Nnt
1/arr
Precision vs accuracy
Precision is reliability
Accuracy is validity
T tubule
Junction a and I bands
Micro villi
Microfilaments
Secretory vesicles
Micro tubes
Amniocentesis acetylcholine staraste up
Neural plate not fusing
Field defect
Holoprosencephaly?
Initial embryonic disturbance leads to multiple malformations by disruption the development of adjacent tissue
What give mom when rupture of membranes prematurely
Dexamethasone
Hirschprung section of body no ncc
Rectum
Cafe at lait spots
NF1 from
C
Cutaneous neurofibromas
NF1 <2 cm nerve sheath neoplasma Schwann cells NEURAL CREST
Ige and receptor triggers vasoactive releas how
Receptor aggregation
Cd18
Leukocyte adhesion defiency, cd18 necessary for integrin formation
What do when cant control postpartum hemorrhage : wht Linate
Well the uterine arteries are branches fo the internal iliac so bl ligation of internal iliac arteries should stop blood slow . Will be fine by collateral blood flow from ovarian arterier which will maintain uterus. All structures supplied by internal iliac have collateral circulation.
Ligation external iliac
Cut off pelvis and lower extremity but not uterus
Injury to pudendal artery during childbirth
Vulvar hematoma
Ligation ovarian artery
Only supply to ovaries yikes lose ovary this is what happens in ovarian torsion
How treat neonatal absence syndrome
Opioid therapy.. morphing or methadone
When use naloxone
Acute opioid intoxication or overdose and for diagnosing
If give to withdrawal can get more symptoms
Nipple discharge
Intraductal papilloma
Papilllary cells with fibrovascular core
Atypical cells infiltrating nipple sikin
Pager
Cysts lined by meta plastic apocrine cells
Fibrocystic changes cause cyclic breast pain
Fat necrosis nipple
Liquefatti e necrosis of adipocytes and hemorrhage
Starò al proliferation breast compressing ducts to slits
Fibroadenoma
Why pregnant woman gallstone
Estrogen induced cholesterol hypersecretion and progesterone induced gallbladder hypomotility
Theca interna vs externa
Externa lies outside the theca interna and does not participate in steroidogenesis. Theca externa is made of a smooth muscle fibroblast cells. Connective support structure for follicle
Biggest cervical risk
Sex
Who gets Edward
Secondary meiotic nondisjunction maternal age >35
Meiotic nondisjunction vs translocation downs
Old mom
Inherited
Fusion 2 long arms 14q and 21q and two short arms 14p and 21p
3 effective copies 21 when fertilized by sperm
46xx1421
Warfarin
Nasal hypoplasia, stipples epiphysis
Methotrexate
Limb, craniofacial, NT, abortito
Nico Trentino in
Microcephalic, thymic hypoplasi, small ears, hydrocephalus
Neural tube defects
Microcephalic, thymic hypoplasia, small ears hydrocephalus
Lithium
Epstein, nephrotoxic diabetes insipidus, hypothyroid
Phenytoin
NT, orofacial clefts, microcephalic, nail or digit hypoplasia
Why thyroid problem cause germ cell tumor
Hcg and TSH share homologous
Hcg bind and activate thyroid from choriocarinoma or germ cell tumor
LDH teste
Yes involved in anaerobic glycolysis increased levels occur in seminoma tours and non seminoma tours tumors of testes not interact wiht TSH
ALP genital
Testicular seminoma no homologous TSH
Girl normal no period never had sex but pain every moth at sixteen
Imperforate hymen
Posterior testicular tender
Epididymitis
Metronidazole and disulfiram
Yup
Deep inguinal ring vs superficial
Transversals fascia
External oblique aponeurosi
Pull testi through external oblique aponeurosi in Christ orchid is
Treat PCOS
Estrogen receptor modulation if want pregnant clomiphene
If not pre non oral contraceptive
Baby hurts to turn head
Torticolis from fetal malpositioning
Turner mosicism
Somatic
Normal vagina env
Gram positive lactobacilli three point eight to four point five
What causes candida vagina
Antibiotic, high estrogen, DM, immunosuppressive, diabetes pregnancy
How antibiotic cause Candia
Reduction gram positive lactobacilli
PH unchanged
Granulosa tumor
Firm yellow call extra bodies
Fibroadenoma histology
Benign appearing cellular or my old stroma that encircles epithelium lined glandular and cystic spaces. Well defined border but may compress epithelium . As women age te epithelium a trophies and stroma becomes more hyalinized
Origin gonadal arteries and veins
Arteries aorta
Vein renal and ivc
Consequences of hyperphosphatemia in CKD
Bind ca and precipitate in soft tissue causing vascular calcification and stiffness-carpal tunnel
Increased release of FGF23 from bone which acts to lower p by inhibiting renal expression of 1ahydrozylase reduced calci trial leading to reduced intestinal calcium absorption
But hypocalcemia cause excitability cramps, chvostek, trousseas, qt long and seizures
What part of kidney absorb most water
PCT
REGARDLESS OF HYDRATION STATUS AND ADH
Allantois vs omphalomesenteric
Allantois bladder
Omphalomesenteri cmeckel
I old patient painless hematuria
Urothelial bladder cancer
Identify erythematous sessile modular or papillary lesions on cystoscope. Pleomorphic and have hyperchromatic nuclei, increased N/C ratio and disrupted orientation and polarity. Frequent mitotic figures
Cigarette and occupation exposure to rubber, plastics, aromatic amine dyes, textiles, leather
Effect of prostate on kidney
Parenchyma atrophy
Sevelamer
Decreased intestinal absorption of phosphorus
Nonabsorbable anion exchange resin
Insulin and mannitol
No tubular reabsorption or secretion
Filtered amounts is excreted amount
Glucose Na and urea
Net tubular reabsorption
Excreted amount less than filtered
PAH and Cr
Net tubular secretion
Excreted>filtered
Calcium stone
Normocalcemia and hypercalcuria
Hypercalcuria is most common ris factor for calcium stones in adults
PH HCO3 and H2PO4 in diabetic ketoacidosis after 2 days urine
PH down HCO3down H2PO4 up
Buffer in urine HPO4 and NH2
HPO4 is a titratable acid that combines with H to form H2PO4. NH3 is generated by the proximal tubular cells via metabolism of glutamine and combines with H to for NH4
NH3 more important
Carbonic anhydride
HCO3 and H H2CO3 in cell goes to H2O and CO2. In cells carbonic anhydrase returns to H2CO3 which breaks to H and HCO2. HCO2 into systemic not
Gamma hemolysis
No hemolysis
Atherosclerosis risks, postprandial pain and weight loss.
Chronic mesenteric ischemia.
Reduced blood flow to intesting intestinal angina
But also coronary artery stenosis, carotid stenosis, peripheral vascular disease, renal artery stenosis.
RÃS-asssociated with atherosclerotic plaques at the junction of the aorta and renal artery. -if a young wom
Good pasture
Alpha chain type IV collagen
Anti GBM
