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Designated study period: daily cards > March 27 - Odds and Ends > Flashcards

March 27 - Odds and Ends Flashcards

1
Q

Hypogastric nerve

A

Carries sympathetic fibers from T10 to T12. Responsible for emission prior to ejaculation

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2
Q

Pelvic splanchnic nerves

A

Carry parasympathetic fibers from S2 to S4. Responsible for bladder, motility in rectum and sigmoid colon, erection

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3
Q

Innervation of ear

A

Cervical spinal cord gives off great auricular n and lesser occipital n which provide sensory to external ear.

V3 of trigeminal gives off auriculotemporal nerve which provides sensory to external auditory canal and external tympanic membrane

CNX supplies posterior part of external auditory canal. Stimulation can cause vasovagal syncope

CNVII provides motor innervation to stapedius

CNVIII provides hearing and vestibular proprioception

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4
Q

Liver pathology in alpha1 antitrypsin def

A

Polymeraized AAT accumulates in hepatocytes. Stains with PAS and resists digestion by diastase

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5
Q

Embryology of cleft lip and palate

A

Lip and palate form in 5th to 6th week. Cleft lip is failure of one of the maxillary prominences to fuse with the intermaxillary segment. Cleft palate is failure of palatine shelves to fuse with one another or with primary palate.

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6
Q

Cricothyrotomy

A

Go through skin, superficial and deep cervical fascia, platysma muscle, and cricothyroid membrane. Do not go through cartilages

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7
Q

Anatomy of orbit and imprlications during trauma

A

Bounded:

  • superiorly by thick frontal bone
  • laterally by thick sphenoid bone
  • inferiorly by thin bone that borders maxillary sinus
  • medially by thin bone that borders ethmoid air clels

Trauma most frequently fractures inferior or medial orbit which have thinnest bone. Thus, orbital contencts can herniate down into maxillary sinus or medially into ethmoid air cells

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8
Q

Rat poison

A

Contains “superwarfarin” - causes mucosal bleeding and ecchymoses

Treat with FFP

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9
Q

How to reduce wrong site surgeries

A

Independent verification of patient, procedure, and site by two different people

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10
Q

Causes of vertigo: Meniere disease vs benign positional vertigo vs vestibular neuritis

A

Meniere

  • caused by increased endolymph volume/pressure
  • recurrent vertigo + unilateral hearing loss/tinnitus

Benign positional vertigo

  • otoliths in semicircular canals
  • triggered by head movement; no auditory symptoms

Vestibular neuritits

  • vestibular nerve inflammation
  • single episode lasting days
  • no hearing loss
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11
Q

Noise induced hearing loss

A

High frequency hearing loss. Trauma to sterocilia cells in organ of corti

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12
Q

Tympanic membrane damage

A

Occurs due to infection, trauma, pressure changes, sudden loud noises. Conductive hearing loss

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13
Q

Lithium toxicity

A

Presentation: GI, ataxia, tremors, confusion

Causes: coadministration with thiazides, ACE-Is or NSAIDs that impair renal clearance. Lithium similar to Na+ and is reabsorbed in prox tubules of kidney. Thiazides cause mild dehdration, increasig reabsorption of Na+ and lithium in prox tubules

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14
Q

ARDS pathogenesis

A

Primary causes are pulmonary infection and sepsis. In sepsis, inflammatory mediators travel back to heart and first capillary bed they get pumped to is pulmonary, where they can interact with endothelial cells and cause damage.

Results in capillary leak which leads to pulmonary edema and V/Q mismatch/shunting

Inflammation damages type II pneumocytes, decreasing surfactant production and thus decreasing compliance leading to a stiff and difficult to ventilate lung

Scarring decreases diffusion capacity leading to hypoxia

Fibrin deposition causes permanent thickening of alveolar capillary membrane which decreases diffusion capacity and compliance long term

Acute respiratory failure lasts a few days but fibrosis can cause chronic lung disease

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15
Q

Nitroprusside

A

Parenteral vasodilator used for hypertensive emeregency. MEtabolized to NO and cyanide ions. Thus, at high doses, cyanide toxicity can be seen

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16
Q

Treatment of cyanide posioning- three options

A
  1. Sodium nitrite: increases methemoglobin
  2. Sodium thiosulfate: sulfer donor, increases conversion to excretable metabolite
  3. Hydroxycobalamin: cobalt binds CN- ions
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17
Q

Leg compartments

A

Anterior compartment: deep peroneal nerve, anterior tibial artery and vein

Lateral compartment: superficial peroneal nerve

Posterior compartment: tibial nerve, peroneal artery and nerve, posterior tibial artery and vein

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18
Q

Epistaxis anatomy

A

Most commonly anterior from Kiesselbach plexus in nasal septum.

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19
Q

Milrinone

A

PDE3 inhibitor used as an inotrope in HF. Increases cAMP in cardiac myocytes. Also causes systemic vasodilation- both arterial and venous

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20
Q

HAART side effect

A

Fat redistribution from periphery to central

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21
Q

Thiazolinedione MOA

A

Go to nucleus and activate PPAR gamma. PPAR gamma increases insulin sensitivity

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22
Q

Hereditary orotic aciduria

A

AR disorder of de novo pyrimidine synthesis
Presents with: physical and mental retardation, megaloblastic anemia, increaesd urine orotic acid.

Distinguished from ornithing transcarbamylase def by lack of hyperammonemia.

Treat by suppementing uridine which bypasses defective enzyme

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23
Q

Ornithine transcarbamylase deficiency

A

Urea cycle disorder in which carbamoyl phosphate builds up and is converted to orotic acid resulting in high urine orotic acid.

Ammonia increases resulting in encephalopathy

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24
Q

Hydroxyurea MOA and USe

A

MOA: inhibitis ribonucleotide reductase

Use: polycythemia vera and essential thrombocytopenia to decrease red cell production. Sickle cell disease to increase fetal hemoglobin

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25
Q

5-fluorouracil MOA

A

mimics uracil structure. Inhibits thymidylate synthase

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26
Q

Glycerol kinase

A

Enzyme that converts glycerol to glycerol-3-phosphate which can go to gluconeogenesis or to glycolysis

27
Q

Acetyl coA carboxylate

A

Converts acetyl coA to malonyl coA in fatty acid synthesis

28
Q

Cholestyramine

A

Binds to bile acids in GI tract, inhibiting enterohepatic recirculation. Increases trigs as side effect

29
Q

Antithyroid med side effects and MOA

A

Both: agranulocytosis

Methimazole: teratogenic
PTU: hepatic failure

MOA: inhibits thyroid peroxidase, impairing iodine organification. PTU also decreases T4 to T3 conversion and so is preferred in thyroid storm

30
Q

Neurophysin

A

Carrier protein for oxytocin and ADH. PRoduced by the hypothalamic nuclei

31
Q

Meglitinidines

A

Similar MOA to sulfonylureas - closes ATP-dependent K+ channels and increases insulin release. Short half life makes it good for controlling post-prandial hyperglycemia

32
Q

TZD side effects

A

Fluid retention causing weight gain, edema, and worsened CHF. Also can cause adipose weight gain

33
Q

Modafanil

A

Non-amphetamine stimulant used to treat narcolepsy

34
Q

Metyrapone stimulation test

A

Metyrapone inhibits cortisol synthesis by blocking 11-beta hydroxylase. Look for ACTH production and increased 17-OH in the urine (can’t be converted to cortisol so builds up)

35
Q

Ethanol and hypoglycemia

A

Ethanol increases NADH/NAD+ ratio: inhibits gluconeogenesis but not glycogenolysis (can maintain glucose initially after a binge but then goes down)

36
Q

Perchlorate

A

Inhibits Na+-I- symporter responsible for iodine uptake in thyroid gland

37
Q

Acromegaly presentation

A 
Glucose intolerance
Coarsened facial features
Joint pain
Increased hand and foot size
Macroglossia which can lead to OSA
38
Q

First generation sulfonylureas

A

Chlorpromide and tolbutamide. Can cause disulfiram like reaction

39
Q

Lower extremity lymphatic drainage

A

Medial leg drains superficially, following veins to superomedial and superolateral nodes.

Lateral leg drains deep, following arteries to popliteal nodes and then deep inguinal nodes

40
Q

Latissimus dorsi

A

Extends from the iliac crest to spinous processes and attaches to humerus. Innervated by thoracodorsal nerve. Extends, adducts, and internally rorates arm

41
Q

Trapezius

A

Muscle in upper back and neck. Elevates, rotates, and stabilizes scapula. Innervated by CNXI

42
Q

Succinylcholine: MOA and ADRs

A

Depolarizing NMJ blocker. Works in two phases. In phase I, it depolarizes the membrane, holding the channel open. In phase II it gets repolarized but is still unresponsive to ACh.

Opens the nACHR channel which is a non-selective cation channel, so K+ can exit and cause hyperkalemia and arrhythmia. Can cause malignant hyperthremia. Can aaffect symp or parasymp systems leading to increase or decrease in HR.

43
Q

Non-depolarizing NMJ blockers

A

-curium. Antagonize ACh at nicotinic receptor. Side effects include histamine release and anticholinergic activity

44
Q

Baclofen

A

Muscle relaxant. Acts at spinal cord GABA receptors

45
Q

Polymyalgia rheumatica

A

Seen in 50% of those with temporal arteritis. Achy shoulder and hip girdle pain

46
Q

Ulnar nerve injury - locations

A

Most common is funny bone. Can also be caused by damage in Guyon’s canal between hook of hamate and pisiform

47
Q

COX enzymes

A

COX-1: housekeeping

COX-2: induced by inflammation

48
Q

Colchicine MOA

A

inhibits MT formation, impairing PMN mitosis and chemotaxis

49
Q

Deep brachial artery

A

Also called profunda brachii. Branches from brachial artery and travels with radial nerve. Also can be injured with midshaft fracture

50
Q

Thoracic outlet syndrome

A

Thoracic outlet is space between first rib and clavicle. Lower trunk comppression results in arm numbness/tingling/weakness. Subclavian vein compression results in upper extremity swelling. Subclavian artery comppression causes exertional arm pain. Most often occurs in scalene triangle.

51
Q

ACL and PCL

A

PCL: posterior intercondylar tibia to anterolateral medial condyle of femur

ACL: anterior intercondylar tibia to posteromedial lateral condyle of femur

52
Q

Blood supply to head of femur

A

Medial circumflex artery

53
Q

Cyclophosphamide

A

alkylating agent. Forms DNA crosslinks, interfering with replication

54
Q

MLF lesion

A

Results in decreased adduction of ipsilateral eye

55
Q

Clotting factor with shortest half life

A

Factor VII

56
Q

Vital capacity

A

Max air you can exhale = TV + IRV + ERV

57
Q

pleural pressure

A

Always negative; gets more negative with inspiration. Alveoli go back and forth between pos during inspiration and neg during expiration

58
Q

Things leaving diaphragm

A

T8: IVC
T10: esophagus, vagus nerve
T12: aorta, thoracic duct, azygous vein

59
Q

Pulmonary artery anatomy

A

R ant to R bronchus

L sup to L bronchus

60
Q

Lung compliance: what makes go up and down

A

Increased: emphysema, aging
Decreased: pneumonia, pulmonary edema, pulmonary fibrosis

61
Q

Causes of crackles

A

Airways open after collapse. Edema, fibrosis, pneumonia

62
Q

Rhonchi

A

Caused by secretion in large airways. COPD

63
Q

Bronchophony and egophany

A

Heard in effusion and pneumonia

64
Q

Fremetius

A

Increased in pneumonia

Decreased in most other things

Designated study period: daily cards (32 decks)

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