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Last minute things I struggle with Flashcards

1
Q

Leads that show anterior wall MI

A

V1 - V4, V5

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2
Q

Leads that show inferior wall MI

A

II, III, aVF

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3
Q

Leads that show lateral wall MI

A

aVL, V5, V6

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4
Q

Leads that show posterior wall MI

A

need a right precordial lead, V4

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5
Q

What artery supplies the anterior wall of heart?

A

Left anterior descending (LAD)

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6
Q

What artery supplies the lateral wall of the heart?

A

left circumflex artery

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7
Q

What artery supplies the inferior wall of the heart?

A

right coronary artery

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8
Q

What artery supplies the posterior wall of the heart?

A

posterior descending artery

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9
Q

WAGR complex

A

Wilms tumor, aniridia, genitourinary malformations, retardation

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10
Q

Different factors that are deficient in Hemophilia A, B, and C

A

A - Factor 8
B - Factor 9
C - Factor 11

results in increased PTT, hemarthroses, easy bruising, bleeding after trauma

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11
Q

Factors measured by PT, factors measured by PTT

A

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

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12
Q

Effect on PT and PTT with Vit K def.

A

increase both

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13
Q

Seizures, intellectual disability, angiofibromas (triad)

-also ash leaf spots, hamartomas, cardiac rhabdomyoma, mitral regurgitation

A

Tuberous sclerosis

-increased risk for subependymal astrocytomas and ungual fibromas

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14
Q

Things that cause hemolytic anemia in pts with G6PD def.

A

“Spleen Purges Nasty Inclusions From Damaged Cells”

-Sulfonamides, Primaquine, Nitrofurantoin, Isoniazid, Fava beans, Dapsone, Chloroquine

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15
Q

Classic triad of reactive arthritis

A

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
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16
Q

1 cause of septic arthritis

A

neisseria gonorrhoeae

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17
Q

What effect does leptin generated by adipocytes have on the hypothalamus?

A

stimulates ventromedial area and inhibits lateral area –> satiety

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18
Q

Councilman bodies

A

viral hepatitis

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19
Q

Dementia + eosinophilic inclusions in neurons

A

Lewy body dementia

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20
Q

Tumors associated with Tuberous sclerosis

A

cardiac rhabdomyosarcoma, renal angiomyolipoma

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21
Q

Recurrent sinusitis, situs inversus, bronchiectasis

A

Kartagener syndrome - defect in dynein arm of cilia, can see infertility too

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22
Q

Different types of tissue composed of the four types of collagen

A

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)

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23
Q

What amino acids are high in collagen?

A

proline, glycine, hydroxyproline

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24
Q

Not enough production of Type 1 collagen, autosomal dominant

A

Osteogenesis imperfecta

-bowed legs, blue sclera, multiple fractures, hearing loss, tooth abnormalities

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25
Q

Problem crosslinking collagen, defect in Type I and V collagen

A

Ehlers-Danlos - hemorrhages, easy bruising, hyperextensible joints, arterial rupture, berry aneurysms

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26
Q

Defect in fibrillin, which forms sheath around elastin

A

Marfan syndrome

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27
Q

Berry aneursysms + cystic kidney and liver

A

Autosomal dominant polycystic kidney disease

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28
Q

Mutation in fibroblast growth factor receptor 3

A

Achondroplasia

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29
Q

Default if you don’t know inheritance pattern

A

Dominant - issue in structural gene

Recessive - issue in enzyme activity

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30
Q

Cystic medial necrosis of aorta –> aortic incompetence + floppy mitral valve + aortic regurgitation (midsystolic click)

A

Marfan syndrome

-can see subluxation of lens upward and temporally

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31
Q

Cafe-au-lait spots, cutaneous neurofibromas, optic gliomas, pheochromocytomas, pigmented iris hamartomas

A

NFM 1 (on chromosome 17 - called von Recklinghausen disease)

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32
Q

Bilateral acoustic schwannomas, juvenile cataracts, meningiomas, ependyomomas

A

NFM 2

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33
Q

Seizures + intellectual disability + ash-leaf spots

A

Tuberous sclerosis

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34
Q

Different tumors with different MEN syndromes

A

MEN 1 - parathyroid adenoma, pituitary adenoma, pancreatic tumors
MEN 2A - medullary thyroid cancer, pheocromocytoma, parathyroid adenomas
MEN 2B - medullary thyroid cancer, pheocromocytoma, mucosal neuromas

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35
Q

Decrease alpha-fetoprotein and estriol, increase inhibin A and beta-HCG on quad screen; genetic defect due to meiotic nondisjunction

A

Down syndrome

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36
Q

Rocker bottom feet, micrognathia, prominent occiput, intellectual disability, decrease in all quad screen levels

A

Trisomy 18 - Edward syndrome (election age = 18)

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37
Q

Rocker bottom feet, microcephaly, cleft lip/palate, holoprosencephaly, polydactyly, decrease in beta-HCG and PAPP-A

A

Trisomy 13 - Patau Syndrome (puberty = 13)

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38
Q

Microencephaly, intellectual disability, high-pitched crying/mewing (like a kitten), epicanthal folds, VSD

A

Cri du chat - due to microdeletion of short arm of chromosome 5 (5p-)

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39
Q

Elfin facies, hypercalcemia, extreme friendliness with strangers, intellectual disability

A

Williams syndrome (think about Will ferrel in Elf - nice and friendly + elfin face) - due to deletion of long arm of chromosome 7

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40
Q

Increase AFP on quad screen

A

abdominal wall defect, neural tube defect, multiple gestations, incorrect dating

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41
Q

Defects seen in DiGeorge Syndrome

A

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

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42
Q

Cause of pseudotumor cerebri

A

Vit A OD – increase ICP

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43
Q

What transports nitrogen in the body?

A

alanine (to liver), glutamate (to urea cycle)

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44
Q

Musty body odor, intellectual disability, growth retardation, seizures, fair skin, eczema

A

Defect in phenylalanine hydroxylase (aromatic acid metabolism) - PKU
tx = increase tyrosine (becomes essential) + increase BH4 supplement (cofactor)

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45
Q

Defect in tyrosinase

A

Albinism

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46
Q

Bugs that don’t gram stain well

A

Mycoplasma, Mycobacteria, Rickettsia, Treponema, Legionella, Chlamydia

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47
Q

Encapsulated bacteria

A

“Even Some Pretty Nasty Killers Have Shiny Bodies” - E. coli, Salmonella, Pseudomonas, Neisseria, Klebsiella, Hib, Strep pneumo, Group B strep (step agalactiae)

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48
Q

Bacteria that make spores

A

Bacillus, Clostridium (need to autoclave to kill spores - 121 C for 15 min with steam)

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49
Q

Jones criteria for rheumatic fever

A 
J - joints (polyarteritis) 
O - heart shape (pancarditis) 
N - nodules
E - erythema marginatum (ring rash that gets bigger) 
S - syndenham chorea
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50
Q

Causes of neonatal sepsis

A

E. coli, Group B strep, Listeria

51
Q

Tx pseudomonas

A

CAMPFIRE - Carbapenems, Aminoglycosides, Monobactams, Polymyxins, Fluoroquinolones, thIrd generation cephalosporin and fourth (ceftazidime, cefepime), Extended-spectrum penicillin (piperacillin, ticarcillin)

52
Q

Arthritis + urethritis + Uveitis

A

Reactive arthritis

-Chlamydia, Shigella, Salmonella, Yersinia, Campylobacter

53
Q

Perinuclear clearing seen on stain - seen in HPV

A

koilocytes

54
Q

Organisms not covered by Cephalosporins generation 1-4

A

LAME - Listeria, Atypicals (mycoplasma, chlamydia), MRSA, Enterococci

55
Q

Covered by 1st gen cephalosporins

A

PEcK - Proteus, E. coli, Klebsiella and Gram + cocci

Cefazolin, Cephalexin

56
Q

Covered by 2nd gen cephalosporins

A

HENS PEcK - H. flu, Enterobacter, Neisseria spp., Serratia, Proteus, E. coli, Klebsiella and Gram + cocci
Cefoxitin, Cefuroxime

57
Q

Covered by 3rd gen cephalosporins

A

Serious Gram (-) = Meningitis, Gonorrhea, Lyme’s (Ceftriaxone)

58
Q

Cephalosporins that covers Pseudomonas

A

Ceftazidime (3rd gen), Cefepime (4th gen)

59
Q

Which protein synthesis inhibitors inhibit which ribosomal subunit?

A

30S - Aminoglycosides (GNATS), Tetracyclines

50S - Chloramphenicol, Clindamycin, Erythromycin (macrolides), Linozolid

60
Q

Tx anaerobic infections

A

Above diaphragm - Clindamycin (aspiration pneumo)

Below diaphragm - Metronidazole

61
Q

Drugs with sulfa allergy

A

“Sulfa Pills Frequenty Cause Terrible Allergy Symptoms” - Sulfonamides, Probenicid, Furosemide, Celecoxib, Thiazides, Acetazolamide, Sulfonylureas

62
Q

4 R’s of Rifampin

A

Ramps up Cyp450, Red/orange body fluids, RNA pol inhibitor, Rapid resistance if used alone

63
Q

What causes persistence of granulomas?

A

TNF-alpha secreted by macrophages (anti-TNF drugs could cause disseminated dz)

64
Q

Cause of exudate and transudate fluid

A

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)

65
Q

Anticholinergic Drugs

A

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

66
Q

How do different drugs impact NE at synaptic cleft?

A

Amphetamine, ephedrine - reverse pump to cause more NE to be pushed out
Cocaine, TCAs, SNRIs - block reuptake

67
Q

Too much cholinergic activity (i.e. cholinesterase inhibitor poisoning)

A

everything gets leaky (DUMBBELSS) - diarrhea, urination, miosis, bronchospasm, bradycardia, excitation of skeletal muscle, lacrimation, salivation, sweating
-seen in farmers, tx with pralidoxime + atropine

68
Q

Systolic murmurs

A

Aortic and pulmonic stenosis, Mitral and tricuspid regurg (both holosystolic), VSD, mitral valve prolapse (midsystolic click)

69
Q

Diastolic murmurs

A

Aortic regurg (head bobbing, water hammer pulse), pulmonic regurgitation, mitral stenosis (opening snap), tricuspid stenosis

70
Q

What nerves transmit signals from carotid and aortic baroreceptors?

A

carotid - glossopharyngeal
aortic - vagus
-decrease in pressure leads to increase sympathetic firing (increase HR and BP)

71
Q

What do the central and peripheral chemoreceptors detect?

A

Peripheral - decrease PO2, increase PCo2, decrease pH
Central - pH and PCo2
-affects respiratory rate

72
Q

Causes of R –> L shunts (blue babies)

A

5 Ts - Truncus arteriosus, Transposition of the great vessels, Tricuspid atresia, Tetralogy of fallot, Total anomalous pulmonary venous return

73
Q

Things seen in Tetralogy of Fallot

A

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

74
Q

Glut receptors

A

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

75
Q

Presentation for Congenital Adrenal Hyperplasias

A

11beta-hydroxylase def - HTN, masculinization
17alpha-hydroxylase def - HTN, feminization
21alpha-hydroxylase def - masculinization, hypotension, salt wasting

76
Q

Major cause of low Vit D and low calcium

A

chronic renal failure - can’t make active Vit D, can’t absorb Ca2+
-will have high PTH

77
Q

Main cause for hypercalcemia

A

Parathyroid adenoma/hyperplasia

78
Q

Retroperitoneal structures

A

SAD PUCKER - Suprarenal gland, Aorta/IVC, Duodenum (2-4th part), Pancreas, Ureters, Colon, Kidneys, Esophagus, Rectum

79
Q

Direct vs. Indirect inguinal hernias

A

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)

80
Q

Plummer-Vinson syndrome

A

esophageal webs + anemia + dysphagia (increased risk of squamous cell carcinoma)

81
Q

Key lab finding with Wilson disease

A

decrease ceruloplasmin (mutation in ATP7B gene prevents copper transport from hepatocytes)

82
Q

Cirrhosis + diabetes mellitus + skin pigmentation; can cause dilated cardiomyopathy

A

Hemochromatosis - mutation in HFE gene causes too much iron absorption

83
Q

Most common causes of pancreatitis

A

increased triglycerides, alcohol, ERCP, gallstones, scorpion sting, mumps

84
Q

Neutrophil chemotactic factors

A

IL-8, LTB4, Kallikrein, platelet-activating factor, C5a

85
Q

Structure of fetal and adult hemoglobin

A

fetal - 2 alpha, 2 gamma = HbF (higher affinity for O2, lower affinity for 2,3-bpg)
adult - 2 alpha, 2 beta = HbA1

86
Q

Decreased IQ, growth impairment, abdominal pain, hearing problems, wrist and foot drop, basophilic stippling on smear + microcytic anemia

A

Lead poisoning - inhibits ALA dehydratase and ferrochelatase

87
Q

Decrease iron, decreased TIBC, increased ferritin

A

Anemia of chronic dz - iron is sequestered in macrophages due to increased hepcidin

88
Q

Symptoms of TTP

A

FAT RN - fever, anemia, thrombocytopenia, renal and neuro symptoms
-defect in ADAMTS13 –> can’t cleave vWF

89
Q

Reed sternberg cells (owl’s eyes), CD15+, CD30+

A

Hodgkin lymphoma

90
Q

Renal failure + bone lytic lesions/back pain + hypercalcemia + anemia

A

Multiple Myeloma

91
Q

Causes of ectopic EPO

A

Pheocromocytoma, Renal cell carcinoma, Hepatocellular carcinoma, Hemangioblastoma

92
Q

Keratin cysts (horn cysts)

A

Seborrheic keratosis

93
Q

Drugs causing SJS

A

penicillins, allopurinol, seizure drugs, sulfa drugs

94
Q

Skin cancer that appears as a pink pearly lesion with rolled edges, possible central ulceration; histology shows palisading nuclei

A

Basal cell carcinoma - unlikely to metastasize

95
Q

Skin cancer that appears as ulcerative lesions on face, lips, ears, hands; histo shows keratin pearls

A

Squamous cell carcinoma - risk factor is actinic keratosis

96
Q

Skin cancer that commonly originates from moles; histo shows nests of melanocytes; S-100 tumor marker

A

Melanoma - least common, most likely to metastasize

97
Q

Cause of resp. alkalosis-metabolic acidosis

A

Salicylates (aspirin)

98
Q

Stabilizes microtubules to prevent neutrophil chemotaxis

A

Colchicine - tx for acute and preventative gout

99
Q

Bilateral cape-like loss of pain and temp sensation in upper extremities

A

Syringomyelia - associated with Chiari I malformation, obstructs anterior white commissure at C8-T1

100
Q

Innervations of Tongue

A

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)

101
Q

Motor innervation of tongue

A

CN XII (hypoglossal) does all motor innervation except for palatoglossus (innervated by CN X)

102
Q

Stages of Sleep

A

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

103
Q

Functions of limbic system

A

Fleeing, Fighting, Feeling, Fornication, Feeding

104
Q

Lesion in subthalamic nucleus of basal ganglia

A

hemiballismus (contralateral lacunar stroke)

105
Q

Essential tremor vs. Intention tremor vs. Resting tremor

A

Essential - occurs with movement and at rest, often familial
Intention - worse with movement (cerebellar dysfunction)
Resting - better with movement (Parkinson)

106
Q

Hemispatial neglect

A

damage to non-dominant parietal cortex - ignore left side of world if lesion on right

107
Q

Damage to dominant parietal cortex

A

Gerstmann syndrome - agraphia, acalculia, finger agnosia, left-right disorientation (lesion usually on left side)

108
Q

Cause of subarachnoid hemorrhage

A

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

109
Q

Rupture of middle meningeal artery

A

Epidural hematoma - lucid interval, lens shape that does not cross suture lines, often secondary to skull fracture

110
Q

Rupture of bridging veins

A

Subdural hematoma - associated with mild trauma in elderly and shaken babies, crescent shape hemorrhage that CROSSES suture lines

111
Q

What is damaged in someone with HTN and intraparenchymal hemorrhage?

A

basal ganglia and internal capsule

112
Q

Urinary incontinence + dementia/confusion + ataxia with magnetic gait

A

Normal pressure hydrocephalus - elderly, reversible dementia with shunt (wet, wobbly, wacky)

113
Q

Layers of lumbar puncture

A

skin –> fascia –> supraspinatous ligament –> interspinous ligament –> flavum ligamentum –> epidural space –> dura –> subdural space –> arachnoid –> subarachnoid (CSF)

114
Q

Staggering gait, frequent falls, DM, hypertrophic cardiomyopathy, kyphoscoliosis in childhood

A

Fredreich ataxia - trinucleotide repeat in frataxin gene

115
Q

Difference between delusions and hallucinations

A

Delusions - false belief despite facts stating otherwise

Hallucinations - perception of external stimuli (auditory most common with psych illness)

116
Q

Bipolar I vs. Bipolar II

A

Bipolar I - at least 1 manic episode +/- hypomanic or depressive episode
Bipolar II - hypomanic and a depressive episode

117
Q

Cafe-au-lait spots, Lisch nodules (pigmented iris hamartomas), cutaneous neurofibromas, optic gliomas, pheocromocytomas

A

NFN - type 1

-neurofibromas originate from neural crest cells

118
Q

First line tx for open angle glaucoma

A

latanoprost (PGF2alpha) - increases aqueous humor outflow; can see darkening of the iris (browning)
Timolol (beta blocker) - decrease synthesis

119
Q

Defect in POTTER sequence

A 
Pulmonary hypoplasia
Oligohydramnios 
Twisted face
Twisted skin
Extremity defects
Renal agenesis
120
Q

Causes of hyperkalemia

A

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
121
Q

Defect in acidosis and alkalosis

A

low pH + low HCO3 = metabolic acidosis
low pH + high PCO2 = resp. acidosis
high pH + high HCO3 = metabolic alkalosis
high pH + low PCO2 = resp. alkalosis

122
Q

Compensation for acid-base

A

metabolic acidosis = hyperventilate (Lower pCO2)
metabolic alkalosis = hypoventilate (raise PCO2)
resp. acidosis = retain HCO3 (delayed effect)
resp. alkalosis = excrete HCO3 (delayed)

123
Q

Neural crest derivatives

A

MAGIC COPS - Melanocytes, Aorticopulmonary septum, Ganglia, Iris, Cromaffin cells, Cranial nerves, Ossicles/odontoblasts, Parafollicular cells, Sclera

124
Q

Defects seen in Turner syndrome

A

streak ovary (ovarian dysgenesis), bicuspid aortic valve, coarctation of aorta (femoral

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