Last minute things I struggle with Flashcards
Leads that show anterior wall MI
V1 - V4, V5
Leads that show inferior wall MI
II, III, aVF
Leads that show lateral wall MI
aVL, V5, V6
Leads that show posterior wall MI
need a right precordial lead, V4
What artery supplies the anterior wall of heart?
Left anterior descending (LAD)
What artery supplies the lateral wall of the heart?
left circumflex artery
What artery supplies the inferior wall of the heart?
right coronary artery
What artery supplies the posterior wall of the heart?
posterior descending artery
WAGR complex
Wilms tumor, aniridia, genitourinary malformations, retardation
Different factors that are deficient in Hemophilia A, B, and C
A - Factor 8
B - Factor 9
C - Factor 11
results in increased PTT, hemarthroses, easy bruising, bleeding after trauma
Factors measured by PT, factors measured by PTT
PT - I, II, V, VII, X (common and extrinsic)
PTT - XII, XI, IX, VIII, X, V, II (common and intrinsic) –> all factors except 7 and 13
Effect on PT and PTT with Vit K def.
increase both
Seizures, intellectual disability, angiofibromas (triad)
-also ash leaf spots, hamartomas, cardiac rhabdomyoma, mitral regurgitation
Tuberous sclerosis
-increased risk for subependymal astrocytomas and ungual fibromas
Things that cause hemolytic anemia in pts with G6PD def.
“Spleen Purges Nasty Inclusions From Damaged Cells”
-Sulfonamides, Primaquine, Nitrofurantoin, Isoniazid, Fava beans, Dapsone, Chloroquine
Classic triad of reactive arthritis
urethritis, conjunctivitis, arthritis (usually following diarrheal infection) – not the same as septic arthritis
- is a seronegative spondylarthropathy
- caused by shigella, salmonella, yersina, campylobacter, or chlamydia
1 cause of septic arthritis
neisseria gonorrhoeae
What effect does leptin generated by adipocytes have on the hypothalamus?
stimulates ventromedial area and inhibits lateral area –> satiety
Councilman bodies
viral hepatitis
Dementia + eosinophilic inclusions in neurons
Lewy body dementia
Tumors associated with Tuberous sclerosis
cardiac rhabdomyosarcoma, renal angiomyolipoma
Recurrent sinusitis, situs inversus, bronchiectasis
Kartagener syndrome - defect in dynein arm of cilia, can see infertility too
Different types of tissue composed of the four types of collagen
Type 1 - bone, skin, tendon, dentin, cornea (strong)
Type 2 - cartilage, vitreous body, nucleus pulposus (slippery)
Type 3 - blood vessels, uterus, fetal tissue, reticular fibers, scars (stretchy)
Type 4 - basement membrane (BM)
What amino acids are high in collagen?
proline, glycine, hydroxyproline
Not enough production of Type 1 collagen, autosomal dominant
Osteogenesis imperfecta
-bowed legs, blue sclera, multiple fractures, hearing loss, tooth abnormalities
Problem crosslinking collagen, defect in Type I and V collagen
Ehlers-Danlos - hemorrhages, easy bruising, hyperextensible joints, arterial rupture, berry aneurysms
Defect in fibrillin, which forms sheath around elastin
Marfan syndrome
Berry aneursysms + cystic kidney and liver
Autosomal dominant polycystic kidney disease
Mutation in fibroblast growth factor receptor 3
Achondroplasia
Default if you don’t know inheritance pattern
Dominant - issue in structural gene
Recessive - issue in enzyme activity
Cystic medial necrosis of aorta –> aortic incompetence + floppy mitral valve + aortic regurgitation (midsystolic click)
Marfan syndrome
-can see subluxation of lens upward and temporally
Cafe-au-lait spots, cutaneous neurofibromas, optic gliomas, pheochromocytomas, pigmented iris hamartomas
NFM 1 (on chromosome 17 - called von Recklinghausen disease)
Bilateral acoustic schwannomas, juvenile cataracts, meningiomas, ependyomomas
NFM 2
Seizures + intellectual disability + ash-leaf spots
Tuberous sclerosis
Different tumors with different MEN syndromes
MEN 1 - parathyroid adenoma, pituitary adenoma, pancreatic tumors
MEN 2A - medullary thyroid cancer, pheocromocytoma, parathyroid adenomas
MEN 2B - medullary thyroid cancer, pheocromocytoma, mucosal neuromas
Decrease alpha-fetoprotein and estriol, increase inhibin A and beta-HCG on quad screen; genetic defect due to meiotic nondisjunction
Down syndrome
Rocker bottom feet, micrognathia, prominent occiput, intellectual disability, decrease in all quad screen levels
Trisomy 18 - Edward syndrome (election age = 18)
Rocker bottom feet, microcephaly, cleft lip/palate, holoprosencephaly, polydactyly, decrease in beta-HCG and PAPP-A
Trisomy 13 - Patau Syndrome (puberty = 13)
Microencephaly, intellectual disability, high-pitched crying/mewing (like a kitten), epicanthal folds, VSD
Cri du chat - due to microdeletion of short arm of chromosome 5 (5p-)
Elfin facies, hypercalcemia, extreme friendliness with strangers, intellectual disability
Williams syndrome (think about Will ferrel in Elf - nice and friendly + elfin face) - due to deletion of long arm of chromosome 7
Increase AFP on quad screen
abdominal wall defect, neural tube defect, multiple gestations, incorrect dating
Defects seen in DiGeorge Syndrome
CATCH 22 - cleft palate, abnormal facies, thymic aplasia (recurrent infections), cardiac defects, hypocalcemia (missing parathyroids)
-due to 22q11 deletion and defect in development of 3rd and 4th branchial/pharyngeal pouches
Cause of pseudotumor cerebri
Vit A OD – increase ICP
What transports nitrogen in the body?
alanine (to liver), glutamate (to urea cycle)
Musty body odor, intellectual disability, growth retardation, seizures, fair skin, eczema
Defect in phenylalanine hydroxylase (aromatic acid metabolism) - PKU
tx = increase tyrosine (becomes essential) + increase BH4 supplement (cofactor)
Defect in tyrosinase
Albinism
Bugs that don’t gram stain well
Mycoplasma, Mycobacteria, Rickettsia, Treponema, Legionella, Chlamydia
Encapsulated bacteria
“Even Some Pretty Nasty Killers Have Shiny Bodies” - E. coli, Salmonella, Pseudomonas, Neisseria, Klebsiella, Hib, Strep pneumo, Group B strep (step agalactiae)
Bacteria that make spores
Bacillus, Clostridium (need to autoclave to kill spores - 121 C for 15 min with steam)
Jones criteria for rheumatic fever
J - joints (polyarteritis) O - heart shape (pancarditis) N - nodules E - erythema marginatum (ring rash that gets bigger) S - syndenham chorea
Causes of neonatal sepsis
E. coli, Group B strep, Listeria
Tx pseudomonas
CAMPFIRE - Carbapenems, Aminoglycosides, Monobactams, Polymyxins, Fluoroquinolones, thIrd generation cephalosporin and fourth (ceftazidime, cefepime), Extended-spectrum penicillin (piperacillin, ticarcillin)
Arthritis + urethritis + Uveitis
Reactive arthritis
-Chlamydia, Shigella, Salmonella, Yersinia, Campylobacter
Perinuclear clearing seen on stain - seen in HPV
koilocytes
Organisms not covered by Cephalosporins generation 1-4
LAME - Listeria, Atypicals (mycoplasma, chlamydia), MRSA, Enterococci
Covered by 1st gen cephalosporins
PEcK - Proteus, E. coli, Klebsiella and Gram + cocci
Cefazolin, Cephalexin
Covered by 2nd gen cephalosporins
HENS PEcK - H. flu, Enterobacter, Neisseria spp., Serratia, Proteus, E. coli, Klebsiella and Gram + cocci
Cefoxitin, Cefuroxime
Covered by 3rd gen cephalosporins
Serious Gram (-) = Meningitis, Gonorrhea, Lyme’s (Ceftriaxone)
Cephalosporins that covers Pseudomonas
Ceftazidime (3rd gen), Cefepime (4th gen)
Which protein synthesis inhibitors inhibit which ribosomal subunit?
30S - Aminoglycosides (GNATS), Tetracyclines
50S - Chloramphenicol, Clindamycin, Erythromycin (macrolides), Linozolid
Tx anaerobic infections
Above diaphragm - Clindamycin (aspiration pneumo)
Below diaphragm - Metronidazole
Drugs with sulfa allergy
“Sulfa Pills Frequenty Cause Terrible Allergy Symptoms” - Sulfonamides, Probenicid, Furosemide, Celecoxib, Thiazides, Acetazolamide, Sulfonylureas
4 R’s of Rifampin
Ramps up Cyp450, Red/orange body fluids, RNA pol inhibitor, Rapid resistance if used alone
What causes persistence of granulomas?
TNF-alpha secreted by macrophages (anti-TNF drugs could cause disseminated dz)
Cause of exudate and transudate fluid
Exudate (thick, think extra stuff) - infection, cancer, lymph obstruction
Transudate (thin) - HF, sodium retention, cirrhosis, nephrotic syndrome (too much hydrostatic or not enough oncotic pressure)
Anticholinergic Drugs
Atropine, TCAs, H1-blockers (diphenhydramine), antipsychotics
mad as a hatter, dry as a bone, bloated as a toad, tachy as a polyester suit, red as a beet, hot as a hare, blind as a bat
How do different drugs impact NE at synaptic cleft?
Amphetamine, ephedrine - reverse pump to cause more NE to be pushed out
Cocaine, TCAs, SNRIs - block reuptake
Too much cholinergic activity (i.e. cholinesterase inhibitor poisoning)
everything gets leaky (DUMBBELSS) - diarrhea, urination, miosis, bronchospasm, bradycardia, excitation of skeletal muscle, lacrimation, salivation, sweating
-seen in farmers, tx with pralidoxime + atropine
Systolic murmurs
Aortic and pulmonic stenosis, Mitral and tricuspid regurg (both holosystolic), VSD, mitral valve prolapse (midsystolic click)
Diastolic murmurs
Aortic regurg (head bobbing, water hammer pulse), pulmonic regurgitation, mitral stenosis (opening snap), tricuspid stenosis
What nerves transmit signals from carotid and aortic baroreceptors?
carotid - glossopharyngeal
aortic - vagus
-decrease in pressure leads to increase sympathetic firing (increase HR and BP)
What do the central and peripheral chemoreceptors detect?
Peripheral - decrease PO2, increase PCo2, decrease pH
Central - pH and PCo2
-affects respiratory rate
Causes of R –> L shunts (blue babies)
5 Ts - Truncus arteriosus, Transposition of the great vessels, Tricuspid atresia, Tetralogy of fallot, Total anomalous pulmonary venous return
Things seen in Tetralogy of Fallot
1) Pulmonic valve stenosis
2) RVH - boot shape on CXR
3) Overriding aorta
4) VSD
- due to defect in infundibular septum
- only right to left shunt during crying, fever, exercise due to exacerbation of RV outflow obstruction; squatting improves cyanosis
Glut receptors
GLUT-4 = skeletal muscle, adipose (need insulin)
GLUT 2 = Beta islet cells pancreas, liver, kidney, small intestine
GLUT 3 = brain and placenta
GLUT 1 = RBCs, brain, cornea
Presentation for Congenital Adrenal Hyperplasias
11beta-hydroxylase def - HTN, masculinization
17alpha-hydroxylase def - HTN, feminization
21alpha-hydroxylase def - masculinization, hypotension, salt wasting
Major cause of low Vit D and low calcium
chronic renal failure - can’t make active Vit D, can’t absorb Ca2+
-will have high PTH
Main cause for hypercalcemia
Parathyroid adenoma/hyperplasia
Retroperitoneal structures
SAD PUCKER - Suprarenal gland, Aorta/IVC, Duodenum (2-4th part), Pancreas, Ureters, Colon, Kidneys, Esophagus, Rectum
Direct vs. Indirect inguinal hernias
Direct - protrudes thru inguinal triangle, medial to epigastric vessels, goes thru superficial ring (older dudes)
Indirect - goes thru deep inguinal ring, superficial inguinal ring, and into scrotum; lateral to epigastric vessels (baby boys due to defect in processus vaginalis)
Plummer-Vinson syndrome
esophageal webs + anemia + dysphagia (increased risk of squamous cell carcinoma)
Key lab finding with Wilson disease
decrease ceruloplasmin (mutation in ATP7B gene prevents copper transport from hepatocytes)
Cirrhosis + diabetes mellitus + skin pigmentation; can cause dilated cardiomyopathy
Hemochromatosis - mutation in HFE gene causes too much iron absorption
Most common causes of pancreatitis
increased triglycerides, alcohol, ERCP, gallstones, scorpion sting, mumps
Neutrophil chemotactic factors
IL-8, LTB4, Kallikrein, platelet-activating factor, C5a
Structure of fetal and adult hemoglobin
fetal - 2 alpha, 2 gamma = HbF (higher affinity for O2, lower affinity for 2,3-bpg)
adult - 2 alpha, 2 beta = HbA1
Decreased IQ, growth impairment, abdominal pain, hearing problems, wrist and foot drop, basophilic stippling on smear + microcytic anemia
Lead poisoning - inhibits ALA dehydratase and ferrochelatase
Decrease iron, decreased TIBC, increased ferritin
Anemia of chronic dz - iron is sequestered in macrophages due to increased hepcidin
Symptoms of TTP
FAT RN - fever, anemia, thrombocytopenia, renal and neuro symptoms
-defect in ADAMTS13 –> can’t cleave vWF
Reed sternberg cells (owl’s eyes), CD15+, CD30+
Hodgkin lymphoma
Renal failure + bone lytic lesions/back pain + hypercalcemia + anemia
Multiple Myeloma
Causes of ectopic EPO
Pheocromocytoma, Renal cell carcinoma, Hepatocellular carcinoma, Hemangioblastoma
Keratin cysts (horn cysts)
Seborrheic keratosis
Drugs causing SJS
penicillins, allopurinol, seizure drugs, sulfa drugs
Skin cancer that appears as a pink pearly lesion with rolled edges, possible central ulceration; histology shows palisading nuclei
Basal cell carcinoma - unlikely to metastasize
Skin cancer that appears as ulcerative lesions on face, lips, ears, hands; histo shows keratin pearls
Squamous cell carcinoma - risk factor is actinic keratosis
Skin cancer that commonly originates from moles; histo shows nests of melanocytes; S-100 tumor marker
Melanoma - least common, most likely to metastasize
Cause of resp. alkalosis-metabolic acidosis
Salicylates (aspirin)
Stabilizes microtubules to prevent neutrophil chemotaxis
Colchicine - tx for acute and preventative gout
Bilateral cape-like loss of pain and temp sensation in upper extremities
Syringomyelia - associated with Chiari I malformation, obstructs anterior white commissure at C8-T1
Innervations of Tongue
Anterior 2/3 - taste from VII, sensation V3 (branchial arches 1 & 2)
Posterior 1/3 - taste and sensation IX (glossopharyngeal); extreme posterior is CN X (branchial arches 3 & 4)
Motor innervation of tongue
CN XII (hypoglossal) does all motor innervation except for palatoglossus (innervated by CN X)
Stages of Sleep
awake - beta waves
eyes close - alpha waves
N1 - theta waves
N2 - sleep spindles and K complexes; bruxism
N3 - deepest non-REM, sleepwalking, night terrors, bedwetting; delta waves
REM - beta waves, loss of motor tone; dreaming, night mares, erection, narcolepsy
Functions of limbic system
Fleeing, Fighting, Feeling, Fornication, Feeding
Lesion in subthalamic nucleus of basal ganglia
hemiballismus (contralateral lacunar stroke)
Essential tremor vs. Intention tremor vs. Resting tremor
Essential - occurs with movement and at rest, often familial
Intention - worse with movement (cerebellar dysfunction)
Resting - better with movement (Parkinson)
Hemispatial neglect
damage to non-dominant parietal cortex - ignore left side of world if lesion on right
Damage to dominant parietal cortex
Gerstmann syndrome - agraphia, acalculia, finger agnosia, left-right disorientation (lesion usually on left side)
Cause of subarachnoid hemorrhage
rupture of berry aneurysm - most likely at bifurcation of ACA and anterior comm. artery, trauma or AVM w/ hx of Osler-Weber-Rendu, worst HA of their life, blood in spinal tap
Rupture of middle meningeal artery
Epidural hematoma - lucid interval, lens shape that does not cross suture lines, often secondary to skull fracture
Rupture of bridging veins
Subdural hematoma - associated with mild trauma in elderly and shaken babies, crescent shape hemorrhage that CROSSES suture lines
What is damaged in someone with HTN and intraparenchymal hemorrhage?
basal ganglia and internal capsule
Urinary incontinence + dementia/confusion + ataxia with magnetic gait
Normal pressure hydrocephalus - elderly, reversible dementia with shunt (wet, wobbly, wacky)
Layers of lumbar puncture
skin –> fascia –> supraspinatous ligament –> interspinous ligament –> flavum ligamentum –> epidural space –> dura –> subdural space –> arachnoid –> subarachnoid (CSF)
Staggering gait, frequent falls, DM, hypertrophic cardiomyopathy, kyphoscoliosis in childhood
Fredreich ataxia - trinucleotide repeat in frataxin gene
Difference between delusions and hallucinations
Delusions - false belief despite facts stating otherwise
Hallucinations - perception of external stimuli (auditory most common with psych illness)
Bipolar I vs. Bipolar II
Bipolar I - at least 1 manic episode +/- hypomanic or depressive episode
Bipolar II - hypomanic and a depressive episode
Cafe-au-lait spots, Lisch nodules (pigmented iris hamartomas), cutaneous neurofibromas, optic gliomas, pheocromocytomas
NFN - type 1
-neurofibromas originate from neural crest cells
First line tx for open angle glaucoma
latanoprost (PGF2alpha) - increases aqueous humor outflow; can see darkening of the iris (browning)
Timolol (beta blocker) - decrease synthesis
Defect in POTTER sequence
Pulmonary hypoplasia Oligohydramnios Twisted face Twisted skin Extremity defects Renal agenesis
Causes of hyperkalemia
Digitalis, Hyperosmolarity, Lysis of Cells, Acidosis, Beta-blockers, high blood sugar
- see peaked T waves on ECG
- tx with Ca2+ to stabilize heart and then give beta agonist, IV insulin and dextrose, IV bicarb
Defect in acidosis and alkalosis
low pH + low HCO3 = metabolic acidosis
low pH + high PCO2 = resp. acidosis
high pH + high HCO3 = metabolic alkalosis
high pH + low PCO2 = resp. alkalosis
Compensation for acid-base
metabolic acidosis = hyperventilate (Lower pCO2)
metabolic alkalosis = hypoventilate (raise PCO2)
resp. acidosis = retain HCO3 (delayed effect)
resp. alkalosis = excrete HCO3 (delayed)
Neural crest derivatives
MAGIC COPS - Melanocytes, Aorticopulmonary septum, Ganglia, Iris, Cromaffin cells, Cranial nerves, Ossicles/odontoblasts, Parafollicular cells, Sclera
Defects seen in Turner syndrome
streak ovary (ovarian dysgenesis), bicuspid aortic valve, coarctation of aorta (femoral
