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K Flashcards

1
Q

Function of serratura anterior

A

Protraction and rotation scapula

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2
Q

Rhomboid major and minor

A

Addicted scapula

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3
Q

Serratura posterior

A

Depresses the lower ribs

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4
Q

Elevator scapula

A

Elevates scapula

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5
Q

Altissimi dorsi

A

Adducts extends and medically rotates arm

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6
Q

Trapezius and elevator scapula

A

Elevate scapula

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7
Q

Depression scapula

A

Trapezius

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8
Q

Thor’s odors always nerve

A

Altissimi dorsi which adducts, medically rotates and extends arm

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9
Q

Compression fracture wedge fracture

A

Vertebral bodies

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10
Q

Ligamentous flavum

A

Connects laminate of two vertebra for posterior wall makes direct contact with vertebral foramen .

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11
Q

Dorsal scapular nerve

A

Innervate rhomboids major and minor retraction of scapula

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12
Q

Disc herniation

A

Protrusion of nucleus purposes through annulus fibrosis psoterolaterally into spinal canal or intervertebral foramen

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13
Q

What is in vertaberal canal

A

Meninges, spinal cord, ligaments

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14
Q

Where lumbar puncture

A

L4 5

Supra spinous is gone through

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15
Q

Conus medullaris

A

Stop at l2 with the denticulate ligament

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16
Q

Anterior spinal artery vs vertebral arteries

A

Anterior is anterior vertebral through transverse foramina

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17
Q

Nichel ligament

A

Extension of supraspinatus above c7

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18
Q

Ligamentous flavum

A

Posterior aspect of vertebral canal associated with laminate

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19
Q

Cruciform/cruciate ligament

A

Stabilizing c1/c2 attaches pedicles and helps stabilize dens

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20
Q

Spodylolysis

A

Anterior displacement of vertebra

Vertical small and oblique axis

Lumbar

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21
Q

Where is internal vertebral plexus of Bateson

A

Surround dura in spinal epidural space

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22
Q

Posterior intercostal arteries

A

Deep back which extend and laterally bend trunk

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23
Q

T4 articulates with what rib

A

5

And facets of own t5

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24
Q

Where is hepcidin from

A

Acute phase reactant! Hepatic parenchyma cells

Turns off feroportin by internalizing it -decrease intestinal absorption and release by macrophages

A little from bile

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25
Q

How absorb iron

A

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

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26
Q

Iron recycling

A

When rbc destroyed by macrophages iron into reticuloendotheial system for use in new erythroid precursors.

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27
Q

Lactoferrin and PCT

A

Binds iron in urine

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28
Q

Broca vs wernicke vs arcuate fasciculations

A

Broca-motor speech

Wernicke-understanding speech and using correct words

Arcuate-links

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29
Q

Broca lesion

A

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

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30
Q

Wernicke lesion

A

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

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31
Q

Arcuate fasciculus lesion

A

Conduction aphasia
Fluent with phonemic errors

Can comprehend

POOR repetition

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32
Q

Lesion postcentral gurus

A

Sensation loss in contra lateral body

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33
Q

Precentral gyrus lesion

A

Slurred speech (dysarthria) due to paresis/paralysis of the skeletal muscles in overeats of the mouth , tongue, andlarynx,

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34
Q

Where is frontal eye field

A

Middle frontal gyrus anterior to percentuale sulcus 6 and 8

Eyes deviate to ipsilateral side

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35
Q

Where is broca

A

Inferior frontal gyrus of dominant (usually left) hemisphere)

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36
Q

Down syndrome inheritance

A

Meiotic nondisjunction (old mom
Unbalanced translocation (high chance of recurrent if balance is present in one parent)
Mosaicism(regular population_
-nondisjunction in mitosis

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37
Q

Interstitial lung disease

A

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

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38
Q

Galactose metab

A

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

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39
Q

Galaktokinase defiency

A

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

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40
Q

Galactose 1 p uridyl transferase defiency

A

Serious
Accumulation of galactose 1 p causes hepatic and enal dysfunction

Early neonatal period vomiting lethargy and failure tot hrive

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41
Q

Aldo last b defiency

A

Hereditary fructose intolerance
Can’t metabolize fructose and get hypoglycemia, hypophosphatemia and failure to thrive

No cataracts, but have reducing substance in urine

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42
Q

Alpha galactosidase a defiency

A

Xr
Fabry
Cataracts-neurological findings and angiokeratomas BLACK MOLE THING

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43
Q

Fructokinase defiency

A

Essential fructosuria benign positive test for reducing substance but not cataracts

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44
Q

Glucose 6 phosphatase defiency

A

Glycogen storage type 1 von girete

Hypoglycemia, lactic acidosis hepatomegaly and hypertriglyceridemia
No cataracts

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45
Q

Hexosaminidase a defiency

A

Ray sachs

Retinal cheery loss of motor skills
No cataracts

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46
Q

Sphingomyelinase defieny

A

Neumann pick

Accumulation sphinngomyelin

Hepatosplenomegaly, motor neuropathy, anemia macular cherry red spots

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47
Q

What is hypoxemia

A

PaO2<75

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48
Q

Treat arsenic poisoning

A

From pesticides, will water, pressure treated wood

Dimercaprol
DMA

Garlic breath , skin, vomiting watery diarrhea, WT prolongation

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49
Q

What type of collagen is used in healing after MI

A

Type I collagen 2 weeks after. Fibrosis continues till two months creating a dense collagenous scar

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50
Q

Granulation tissue Lymphatics, bone marrow lungs intestines skin

A

Type III collagen

Helmer’s Danilo’s type 3 and 4

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51
Q

Vermpamilf or MI

A

NO

Use BB

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52
Q

Left dominant vs right dominant circulation. If av node blocked in left vs right where did atherosclerosis come from

A

Left Left circumflex artery

Right coronary artery

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53
Q

What should zollinger Ellison syndrome patients undergo testing fo

A

MEN1

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54
Q

Glucogonomas

A

Rare pancreatic alpha cell tumors present with DM and raised erythematous rash affects groin (necrologio migratory erythema)

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55
Q

Insulinomaspancreatic beta cell tumors secrete insulin autonomously . High circulating insulin and c peptide and symptoms of hypoglycemia

A

Ok

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56
Q

Somatostatinomas

A

Pancreatic d cells DM cholelithiasis and diarrhea/steatorrhea

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57
Q

Turner heart

A

Bicuspid valve more common

Coarctaiton

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58
Q

Stable angina

A

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

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59
Q

Acute MI and stress test

A

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

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60
Q

Vasospastic angina

A

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

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61
Q

Focal myocardial fibrosis

A

From previous MI

Contractillity impaired in fibrosis myocardium, leading to a persistent wall motion defect similar to that of MI

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62
Q

Normal cardiac stress test dobuatmine

A

Increase contractility and o2 demand is met by increased supply via increased flow. Transient increase in ejection fraction

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63
Q

Fatty acids that bind calcium and form calcium salt

A

Acute interstitial pancreatitis -edematosi pancreas

Focal fat necrosis and ca on LM

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64
Q

Acute necrotic pancreatitis

A

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

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65
Q

Dull gray edematosi granular intestinal seriose

A

Creeping fat crowns

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66
Q

TTP

A 
Adamts13 down uncleared vWF 
Fever
Anemiaschistocytes
Thrombocytopenia
Renal failure
Neurologic manifestations

Need hemolytic anemia and thrombocytopenia without other cause

Treat with palsmaexchange, glucocorticoids, rituximab

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67
Q

SIADH

A

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)

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68
Q

Calcium sensing receptors

A

CaSR are Gq regulate PTH

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69
Q

Familial hypocalciuric hypercalcemia

A

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

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70
Q

Opposite direction of replication fork

A

Multiple short DNA fragments

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71
Q

How prevent tachyphlaxis

A

When using NO have dru free intervals

Stop decongestant that are a agonists

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72
Q

MDR1

A

ATP dependent effluì pump p glycoprotein

In BBB too prevent foreign compounds into CNS

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73
Q

Why no give k sparing directive with ace inhibitor

A

Hyper K

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74
Q

Psoas abscess

A

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

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75
Q

councilman bodies what causes it in IV drug user

A

T cell mediated apoptosis

Hepatitis acute

Chronic-inflammation around portal triad . Ground glass appearance or fat.

Hep b or c

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76
Q

Normal SV

A

70

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77
Q

What ration is 2:1 at birth

A

P:S

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78
Q

Jugular foramen syndrome

A

IX X and XI

Taste posterior tongue
Loss gag
Dysphasia
Hoarse
Uvulas toward the normal side X
Sternoclidomastoid and trapezius XI
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79
Q

Cerebellopontine angle lesion

A

Sensorineural hearing loss and tinnitus from CNVIII

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80
Q

Piriformis recess

A

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

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81
Q

Superior laryngeal nerve vs recurrent and external

A

Recurrent and external-carry motor fibers to the muscles in vocal cord function

Internal-sensory and autonomic
(Superior)

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82
Q

Neonatal tetanus

A

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

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83
Q

Pramipexole for Parkinson

A

Stimulates dopamine receptors

Ergot compounds-bromocroptine

Nonergot compounds-pramipexole and ropinirole

Delay need to start levodopa

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84
Q

Cheyenne stokes breathing

A

Cyclic breathing chronic hyperventilation and hypocapnia

Followed by increasing then decreasing today volumes until next Aeneid period.

HEART FAILURE

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85
Q

Warfarin induced skin necrosis

A

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

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86
Q

Precocious puberty

A

Secondary sex at below 7

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87
Q

Cholesterol stones

A

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

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88
Q

Pigment stones

A

Calcium salts of unconjugated bilirubin soft and dark brown to black secondary

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89
Q

Brown pigment

A

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

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90
Q

Pigment stone no infection

A

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

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91
Q

Anxiety disrderr\

A

WORRY for over 6 months

Restlessness feeling on edge
Fatigue
Difficulty concentrating
Muscle tension
Sleep disturbance
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92
Q

ARR

A

Control rate-exp rate

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93
Q

Tardive dyskinesia

A

Face stuff writhing chronic use

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94
Q

Akathisia

A

Can’t sit still

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95
Q

Nucleolus

A

Basophilic rrna

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96
Q

FAS mutation

A

Can’t get activation induced T cell death apoptosis

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97
Q

Regulation glycogen phosphorylase

A

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

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98
Q

Von fierce

A 
Glucose 6 p 
Hepatomegaly and steatosis
Fasting hypoglycemia
Lactic acidosis
Hyperuricemia and hyperlipidemia

Can’t turn g6p tp g

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99
Q

Pompe II

A

Bad acid a glucosi dash

Normal glucose levels
Severe cardio eagle
Glycogen accumulation in lysosomes

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100
Q

Type III cori

A

Debranching enzymes

Hepatomegaly
Ketotoic hypoglycemia
Hypotonia and weakness
Abnormal glycogen with very short outer chains

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101
Q

Type V mcardle

A

Muscle phosphorylase defiency
Glycogen phosphorylase

Weakness and fatigue with exercise
No rise in blood lactate levels after exercise

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102
Q

Diabetic gastroparesis

A

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

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103
Q

Most common primary cerebral neoplasm in adults

A

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

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104
Q

Brain metastasis

A

Most adult brain tumors
Lung breast kidney skin

Multiple well circumscribed masses at junction of gray and white matter

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105
Q

Meningiomas

A

Benign well circumscribed neoplasma of adults from arachnoid cells

On brain surface a site of rural reflection

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106
Q

Oligodendrogliomas

A

Slow growing tumors of adults involve white matter of the cerebral hemorphseres. Well circumscribed and gray

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107
Q

Primary central nervous system lymphoma

A

Immunocompromised

Multiple lesions involving deep brain matter, white matter and cortex

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108
Q

Schwannomas

A

Benign from VIII at cerebellopontine angle. Have sensorineural hearing loss and tinnitus

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109
Q

Treat or nothing transcarbamylase

A

No protein in diet so don’t get ammonia to accumulate in blood resulting in progressive lethargy vomiting seizures and cerebral edema

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110
Q

HIV baby

A

Oral thrush interstitial pneumonia and lymphopenis in first year. IV drug user .

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111
Q

Rib 11-12, rib 9-11

A

Kidney
Spleen

12th rib gets kidney

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112
Q

After MI why get MV regurg

A

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

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113
Q

S3

A

Decomp heart failure

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114
Q

Increased flow velocity aortic valve

A

Stenosis crescendo d murmur

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115
Q

MR in setting of abcterial endocarditis CT or acute MI

A

Rupture chordae tendinae

Doesn’t resolve wiht diuretics and caso dilators need Ruggero

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116
Q

HPV throat

A

TRUE vocal cords

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117
Q

Decompensated HF

A

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

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118
Q

Emphysema

A

Destruction intraalveolar walls

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119
Q

What kind of infection get with neutropenia and systemic chemo

A

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

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120
Q

TCA heart death

A

Sodium channel inhibition

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121
Q

Amiodarone

A

Prolong qt, but less torsades than other

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122
Q

Treat trigeminal neuralgia-sharp pain from food or brushing teeth on side of face does away in a few seconds stabbing electric shock

A

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

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123
Q

Jervell and lange Nielsen syndrome

A

Mutations encode voltage gated k channels. Long qt

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124
Q

Brugada

A

Mutation l type ca channels

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125
Q

Glucorticorticoids for graves

A

Improve inflammatory infiltrate reduce extraocular volume

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126
Q

Boy, bleeding after tooth, bruises dad and grandma had it

A

Von willie brand AD

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127
Q

Graves dermopatie

Graves opthalmopathy

A

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

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128
Q

Diarrhea tea colored odorless and watery stools. No fever or pain. No gastric acid!

A

WDHA.
Too much VIP
Hypokalemia and achylorhydia

Treat with somatostatin

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129
Q

What substance causes TB granuloma

A

IFN-y B.C. activate macrophages

Which make TNFa, which helps recruit

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130
Q

Excretion rate

A

(Insulin clearance)(plasma concentration)-tubular reabsorption

131
Q

Inferior thyroid artery ligament near what nerve

A

Recurrent laryngeal nerve

132
Q

Surgical land mark for appendix

A

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

133
Q

Health care proxy or family

A

Health care proxy

134
Q

Superior gluteal nerve injury

A

Left hip drop superiormedial corner butt

135
Q

AE nitrates for stable angina

A

HA bad , cutaneous flushing, lightheaded,hypotension, reflex tachycardia

136
Q

Treat arsenic

A

Dmiercaprol

137
Q

Mefloquine

A

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

138
Q

Test diabeti nephropathy

A

Urine albumin

Glucosi Rai shows poor glycemic control not renal damage

139
Q

Sheehan

A

Pituitary ischemic necrosis

Panhypopituitarism

140
Q

When get rouleaux

A

Multiple myeloma and waldenstrom macroglobulinemia

Have high monoclonal paraprotein (Is)

141
Q

Bleeding after bowel resection

A

ADEK loss no bit k

142
Q

HIV dementia

A

Micro grills cells multinucleated release neurotoxic compounds

143
Q

Cerebral amyloid angioapthy

A

Beta amyloid in cortical bv. Associated wiht intracerebral hemorrhag or Alzheimer’s.

144
Q

Alzheimer’s

A

Congo red beta amyloid surrounded by dystrophic neuritis . Often in hippocampus.
Older with memory loss and higher cortical dysfunction (aphasia, agnosia, apraxia)

145
Q

G6pd

A

Xrg6p to 6 phosphogluconate

146
Q

Galactosemia

A

Baby vomiting and lethargy after breastfeeding. Accumulate galactose 1 p impaired liver function predisposed to E. coli sepsis

Bilirubin transumanis

147
Q

Galactokinase

A

Cataracts, pseudotumor cerebri galactitol accumulation

148
Q

Baby intracranial GI cutaneous umbilical and surgical bleeding .

A

Low vitamin K prevent with intramuscular vitamin k at birth

If not get impaired clotting factor carboxylation

149
Q

Baby lethargy and irritability with fever or hypothermia

A

Bacterial meningitis

150
Q

Intra entri usar hemorrhage in premature infants

A

Germinal matrix fragility. Which starts involuti get at twenty eight weeks and disappears b full term

151
Q

Cataracts

A

Long standing hyperglycemia from poorly controlled diabetes.

152
Q

Dorsal column loss

A

Position/vibration sense

153
Q

Spinocerebellar tract loss

A

Ataxia

154
Q

Lateral corticospinal tract loss

A

Spastic paresis

155
Q

Cholesteatoma

A

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

156
Q

Cholesterol granuloma middle ear

A

After hemorrhage bluish black gelatinous material behind tympanic

No lipid or cholesterol

157
Q

Facial neuroma

A

In middle ear as facial nerve courses . Unilateral facial paralysis

158
Q

Squamous cell arcinoma ear

A

Ulcerated plaque or nodule. Pain

159
Q

Granulomatous disease ear

A

Sarcoidosis, granulomatosis , langerhanc cell histiocytosis

160
Q

Diabetes HLA

A

DR3 and 4

161
Q

Amyloid. Pancreatic islet cells

A

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

162
Q

POSTERIOR ROSTAL PONS NEAR LATERAL FLOOR OF FOURTH VENTRICLE

A

MAKE NE IT IS THE LOCUS CERULEUS0IN PONS

163
Q

Cholera poop

A

Mucus and no erythrocytes or leukocytes

164
Q

Treat delirium

A

Even in old ppl haloperidol first gen antipsychotics

Antipsychotics

165
Q

Old person hospitalized in an out agitated

A

Delirium

166
Q

Reduce mortality after MI

A

ACE, ARB, angiotensin receptor blocker, bb, spironolactone

NOT DIURETICS OR DIGOXIN

167
Q

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

A

Serotonin syndrome

168
Q

Migratory thrombophlebitis

A

Adenocarcinoma of pancreatic, colon and lung

Hypercoagulability bc adenocarcinoma makes a thrombophlebitis like substance capable of causing chronic intravascular coagulations

Trousseau syndrome

169
Q

Granule containing cells with crystals

A

Charcot Leyden crystals in eosinophilia

Crystals are bipyramidal accumulation of eosinophilia membrane protein

170
Q

SOB and hard to breath no triggers

A

Asthma

171
Q

Panic attack why get neurologic sequela e with weakness, blurred vision, presyncope and syncope

A

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

172
Q

Burnt sugar small in diaper, dehydrated vomiting and lethargy

A

MSUD don’t give branched chain aa leucine isoleucine and valine

No branched chain a ketoacid DH

173
Q

Methylphenidate MOA

A

Decreased appetite, weight loss and insomnia

174
Q

Stanford a aortic dissection

A

Aortic dissections any part of ascending

Sinotubular junction

175
Q

Stanford b

A

All dissections in descrnding aorta

Usually left subclavian artery

176
Q

COPD exacerbation viral and bacterial

A

Rhinovirus, influenza, parainfluenza

haemophilus influenza, morazxella, strep pneumonia

Yellow sputum

177
Q

Osmoalirity plasma normal

A

280-300

178
Q

SIADH

A

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

179
Q

Flaccid vs spastic bladder

A

Flaccid-large residual volume

Spastic-frequent incontinence throughout day

180
Q

Peeing throughout the day urge incontinence

A

Bladder hypertonic

181
Q

Colchicine AE

A

Diarrhea, nausea, ab pain

182
Q

SSRI that doesn’t cause sex prob

A

Bupropion NE-D reputate inhibitor for depression associated wiht hypersonic and low energy

183
Q

What causes bronchoconstriction

A

Vagus send ach to muscarinic receptors

What blocks action of ach for asthma
-ipratropium

184
Q

Treat trigeminal neuralgia

A

Carbamazepine-inhibits neuronal high frequency firing by reducing ability of na channels to recover from inactivation
-bone marrow suppression

185
Q

Where is heme made

A

Mitochondria and cytoplasm

186
Q

Wallerian degeneration

A

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

187
Q

Subarachnoid hemorrhage

A

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

188
Q

Normal FEV1/FVC

A

70 or 80

189
Q

Hyperacute, acute and chronic rejection

A

Preformed antibodies, humoral/cellular, chronic low grade immune response refractory to immunosuppressants

190
Q

Prevention of cardiovascular events drug

A

Aspirin

Colpi dogare L if aspirin allergy

191
Q

When get sickling with sickle cell anemia

A

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

192
Q

How treat seizure

A

Simple and complex-carbamazepine, gabapentin, phenobarbital, phenytoin

Tonic clonicand myocllonis-lamotrigine, levetiracetam, topiramate, valproic acid

Absence-ethos I die

193
Q

Wide splitting s2 not better with inspiration

A

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

194
Q

Eisenmenger

A

Chronic pulmonary HTN shift from l to r shunt to r to left

Worry about pulmonary vessels

195
Q

Dystrophy calcification

A

Necrosis in normal calcium

Psammoma bodies

Metastatic-normal tissue high calcium

196
Q

Modafinil

A

Nonamphetamine stimulant for narcolepsy

197
Q

Occlusion anterior cerebral artery

A

Sensory and motor function of contralateral leg and food

Urinary incontinence and behavioral issues if frontal micturition center is affected

198
Q

Middle cerebral artery occlusion

A

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

199
Q

Niacin in TCA cycle

A

Isocitrate DH needs it

NAD NADH

200
Q

Why get Huntington

A

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

201
Q

Swelling in hydrocele is in what

A

Tunica vaginali

202
Q

Febrile neutropenia

A

Pseudomonas erythema gangrenous necrosis and ulceration

203
Q

Trazodone vs premature ejeculation

A

Trazodone priapism not premature

204
Q

Schizoids are not__

A

Paranoid

205
Q

Man doesn’t want to know results of his test

A

Ok that’s fine

206
Q

A fib embolism

A

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.

207
Q

Radial artery

A

Deep brachial

208
Q

VPL

A

Spinothalmic and dorsal columns

209
Q

VPM

A

Trigeminal pathway

210
Q

VPM and VPL

A

Send somatosensory projection to the cortex via thalamocortical fibers
Complete contralateral sensory loss and severe proprioceptove defects cause unsteady gait

211
Q

Base of pons injury

A

Contralateral weakness and ataxia bc of descending motor tracts and pontocerebellar fibers

212
Q

Caudate nucleus damage

A

Behavioral abnormalities, speech language, movement

213
Q

Frontal cortex

A

Social disinhibition and deficits in attention and executive function

214
Q

Anterior 2/3 of posterior limb of internal capsule

A

Motor fibers of cortisospinal tract

215
Q

Posterior 1/3 limb internal capsule

A

Sensory fibers (thalamocortical tract)

Small lesions contralateral pure sensory deficits most result in pure motor or combined sensorimotor deficits

216
Q

Lacune

A

<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

217
Q

Lipohyalinosis and microatheroams

A

Cause lacunae infarcts

LIQUIFEACTIVE necrosis

218
Q

Lipohyalnosis

A

Secondary to leakage of plasma proteins through damaged endothelium hyaline thickening , collage out, accumulation of mural foamy macrophages

219
Q

Microatheromas

A

From atherosclerotic accumulation of lipid laden macrophages within the intima layer of a penetrating artery near its origin off the parent vessel.

220
Q

Spinal stenosis

A

Ligamentous flavum

221
Q

Median nerve courses between what at antebrachial fossa

A

Flexor ditto rum superficialis and flexor digitorum profundus

222
Q

Ventral pons

A

V-VIII, corticospinal tract and medial Lemnos is and lateral spinothalmic tract trough here

223
Q

Dorsal midbrain

A

Superior and inferior caniculi

224
Q

Gastric varies in portal HTN vs pancreatic, pancreatic cancer and ab tumors

A

Left gastric. Veins cause gastric and esophageal vari se

Splenic vein thrombosis which drain the short gastrics cause them only at the fundus

225
Q

Azygos vein

A

Drain esophageal veins into superior vena cava

Enlarged with caval obstruction

226
Q

Blockage of some

A

Lower stomach

227
Q

Ration 2/1 for lung maturity

A

L/S

228
Q

Why b12 cause anemia

A

Diminished thymidine synthesis

229
Q

What id behind esophagus

A

Descending aorta travels down a nterior vertebral column

230
Q

Where is SVC

A

Behind first costal cartilage by merge of brachiocephalic veins

231
Q

Severe hypotension and refractory shock. Ab pain, vomiting, weakness fever. How treat

A

Fluid and glucocorticoid with hydrocortisone or dexamethasone

232
Q

Hypothyroid bipolar

A

Lithium

233
Q

Kid proteinuria after infection and albumin

A

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

234
Q

Target cell

A

EXCESSICE surface area to volume ratio, so cell membrane fold on itself

235
Q

Epiglottis kid

A

H influenza didn’t get vaccinated

236
Q

Tetanus stops release of what

A

Glycine and GABA not glutamine

237
Q

Lacrimato in, anxious, ab pain, hyperactive bowel

A

Opioid withdrawal

238
Q

Why mcburney point hurt

A

Inflammation of the parietal peritoneum

239
Q

FEV1/C asthma

A

Usually<70 but variable in asthma

240
Q

If physician is wrong should u ignore him or follow orders

A

Don’t follow but discuss with them on how t proceed

241
Q

Risk of developing AZ from a four chart

A

A/a+b

Not same as relative risk=—=po

242
Q

Effect modification

A

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

243
Q

Case control vs case series

A

Case series purely descriptive and cant establish associations. Tracks patients with a known condition to document the natural history or response

244
Q

Cumulative incidence

A

Number new/number ppl at risk AT BEGINNING OF TIME

245
Q

Probability of not having disease when test negative

A

NPV

246
Q

Given a positive test result, what is probability have disease

A

PPV

247
Q

What is a control group

A

Subject without disease regardless of exposure

248
Q

Stratification

A

Partitioning of subjects and results by a factor other than treatment given

249
Q

ANOVA

A

Analysis of variance for measuring several means

250
Q

Calculate RR

A

A/a+b/c/c+d

251
Q

Ecological study

A

Observational population level association between exposure and outcome. Population level data rather than individual like national cancer registries and GDP

252
Q

Ecological fallacy

A

Ecological studies can generate hypothesis but not for conclusions regarding individuals within these populations

253
Q

Biggest mortality reduction you can do for anyone who smokes

A

Stop smoking

254
Q

Power

A

Detect a difference when one exists

Reject null when it is false

255
Q

Arr

A

Control-treatment rate

256
Q

Err

A

Arr/control rate

257
Q

Rr

A

Treatment/control

258
Q

Nnt

A

1/arr

259
Q

Precision vs accuracy

A

Precision is reliability

Accuracy is validity

260
Q

T tubule

A

Junction a and I bands

261
Q

Micro villi

A

Microfilaments

262
Q

Secretory vesicles

A

Micro tubes

263
Q

Amniocentesis acetylcholine staraste up

A

Neural plate not fusing

264
Q

Field defect

A

Holoprosencephaly?

Initial embryonic disturbance leads to multiple malformations by disruption the development of adjacent tissue

265
Q

What give mom when rupture of membranes prematurely

A

Dexamethasone

266
Q

Hirschprung section of body no ncc

A

Rectum

267
Q

Cafe at lait spots

A

NF1 from

C

268
Q

Cutaneous neurofibromas

A

NF1 <2 cm nerve sheath neoplasma Schwann cells NEURAL CREST

269
Q

Ige and receptor triggers vasoactive releas how

A

Receptor aggregation

270
Q

Cd18

A

Leukocyte adhesion defiency, cd18 necessary for integrin formation

271
Q

What do when cant control postpartum hemorrhage : wht Linate

A

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.

272
Q

Ligation external iliac

A

Cut off pelvis and lower extremity but not uterus

273
Q

Injury to pudendal artery during childbirth

A

Vulvar hematoma

274
Q

Ligation ovarian artery

A

Only supply to ovaries yikes lose ovary this is what happens in ovarian torsion

275
Q

How treat neonatal absence syndrome

A

Opioid therapy.. morphing or methadone

276
Q

When use naloxone

A

Acute opioid intoxication or overdose and for diagnosing

If give to withdrawal can get more symptoms

277
Q

Nipple discharge

A

Intraductal papilloma

Papilllary cells with fibrovascular core

278
Q

Atypical cells infiltrating nipple sikin

A

Pager

279
Q

Cysts lined by meta plastic apocrine cells

A

Fibrocystic changes cause cyclic breast pain

280
Q

Fat necrosis nipple

A

Liquefatti e necrosis of adipocytes and hemorrhage

281
Q

Starò al proliferation breast compressing ducts to slits

A

Fibroadenoma

282
Q

Why pregnant woman gallstone

A

Estrogen induced cholesterol hypersecretion and progesterone induced gallbladder hypomotility

283
Q

Theca interna vs externa

A

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

284
Q

Biggest cervical risk

A

Sex

285
Q

Who gets Edward

A

Secondary meiotic nondisjunction maternal age >35

286
Q

Meiotic nondisjunction vs translocation downs

A

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

287
Q

Warfarin

A

Nasal hypoplasia, stipples epiphysis

288
Q

Methotrexate

A

Limb, craniofacial, NT, abortito

289
Q

Nico Trentino in

A

Microcephalic, thymic hypoplasi, small ears, hydrocephalus

290
Q

Neural tube defects

A

Microcephalic, thymic hypoplasia, small ears hydrocephalus

291
Q

Lithium

A

Epstein, nephrotoxic diabetes insipidus, hypothyroid

292
Q

Phenytoin

A

NT, orofacial clefts, microcephalic, nail or digit hypoplasia

293
Q

Why thyroid problem cause germ cell tumor

A

Hcg and TSH share homologous

Hcg bind and activate thyroid from choriocarinoma or germ cell tumor

294
Q

LDH teste

A

Yes involved in anaerobic glycolysis increased levels occur in seminoma tours and non seminoma tours tumors of testes not interact wiht TSH

295
Q

ALP genital

A

Testicular seminoma no homologous TSH

296
Q

Girl normal no period never had sex but pain every moth at sixteen

A

Imperforate hymen

297
Q

Posterior testicular tender

A

Epididymitis

298
Q

Metronidazole and disulfiram

A

Yup

299
Q

Deep inguinal ring vs superficial

A

Transversals fascia

External oblique aponeurosi

Pull testi through external oblique aponeurosi in Christ orchid is

300
Q

Treat PCOS

A

Estrogen receptor modulation if want pregnant clomiphene

If not pre non oral contraceptive

301
Q

Baby hurts to turn head

A

Torticolis from fetal malpositioning

302
Q

Turner mosicism

A

Somatic

303
Q

Normal vagina env

A

Gram positive lactobacilli three point eight to four point five

304
Q

What causes candida vagina

A

Antibiotic, high estrogen, DM, immunosuppressive, diabetes pregnancy

305
Q

How antibiotic cause Candia

A

Reduction gram positive lactobacilli

PH unchanged

306
Q

Granulosa tumor

A

Firm yellow call extra bodies

307
Q

Fibroadenoma histology

A

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

308
Q

Origin gonadal arteries and veins

A

Arteries aorta

Vein renal and ivc

309
Q

Consequences of hyperphosphatemia in CKD

A

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

310
Q

What part of kidney absorb most water

A

PCT

REGARDLESS OF HYDRATION STATUS AND ADH

311
Q

Allantois vs omphalomesenteric

A

Allantois bladder

Omphalomesenteri cmeckel

312
Q

I old patient painless hematuria

A

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

313
Q

Effect of prostate on kidney

A

Parenchyma atrophy

314
Q

Sevelamer

A

Decreased intestinal absorption of phosphorus

Nonabsorbable anion exchange resin

315
Q

Insulin and mannitol

A

No tubular reabsorption or secretion

Filtered amounts is excreted amount

316
Q

Glucose Na and urea

A

Net tubular reabsorption

Excreted amount less than filtered

317
Q

PAH and Cr

A

Net tubular secretion

Excreted>filtered

318
Q

Calcium stone

A

Normocalcemia and hypercalcuria

Hypercalcuria is most common ris factor for calcium stones in adults

319
Q

PH HCO3 and H2PO4 in diabetic ketoacidosis after 2 days urine

A

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

320
Q

Carbonic anhydride

A

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

321
Q

Gamma hemolysis

A

No hemolysis

322
Q

Atherosclerosis risks, postprandial pain and weight loss.

A

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

323
Q

Good pasture

A

Alpha chain type IV collagen

Anti GBM

Boards Q (2 decks)

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