missed questions 1 Flashcards
what nerve traverses the cribriform plate?
I
what nerves and vessels traverse the optic canal
II, ophthalmic a, central retinal v.
what nerves and vessels traverse the SOF?
III, IV, V1, VI
ophthalmic v.
what nerve traverses the foramen rotundum?
V2
what nerve traverses the foramen ovale?
V3
what vessels traverse the foramen spinosum?
middle meningeal a. & v.
what nerves traverse the internal acoustic meatus
VII, VIII
what nerves and vessel traverse the jugular foramen?
IX, X, XI
jugular v.
what nerve traverses the hypoglossal canal?
XII
what nerve and vessel traverse the foramen magnum?
XI
brainstem
vertebral a.
what is the consequence of a lesion to the upper trunk of the brachial plexus? What nerves are affected?
Erb palsy (waiter’s tip)
Musculocutaneous, axiallary, radial, median
what is the consequence of a lesion to the lower trunk of the brachial plexus? What nerves are affected?
Claw hand (Klumpke palsy, all fingers flexed)
Axillary, radial, median, ulnar
What is the consequence of a lesion to the posterior cord of the brachial plexus? What nerves are affected?
Wrist drop
axillary, radial
What is the consequence of a lesion to the long thoracic nerve? What are the nerve roots?
Winged scapula
C5, 6, 7
What is the consequence of a lesion to the axillary nerve?
Deltoid muscle impairment
What is the consequence of a lesion to the radial nerve?
Wrist drop (“Saturday night palsy”)
What is the consequence of a lesion to the musculocutaneous nerve?
Elbow flexion impairment, loss of sensation on lateral forearm
What is the consequence of a lesion to the median nerve?
Pope’s blessing (inability to make a fist with thumb, second and third digit)
What is the consequence of a lesion to the ulnar nerve?
Ulnar claw (inability to extend the fourth and fifth digits)
What neoplasms can cause secondary dermatomyositis?
COLL = colorectal, ovarian, Non Hodgkin lymphoma, lung
What is the most common pineal mass and in what demographic is this most prevalent?
germinoma, young boys
What are examples of merocrine glands?
salivary, eccrine sweat glands, apocrine sweat glands
What are examples of apocrine glands?
mammary glands
what are examples of holocrine glands?
Sebaceous glands, meibomian glands
In CO poisoning, how are dissolved O2 (PO2), % Hb saturation (O2 binding capacity), and total O2 content affected?
PO2 is normal, % sat is decreased but may appear normal on testing, O2 content is decreased
In anemia, how are PO2, %sat, and O2 content affected? What disorder mimics anemia?
PO2 is normal, %sat is normal, and O2 is decreased. Methemoglobinemia mimics anemia because the metHb can not bind O2.
what type of collagen is in scar tissue?
Type I
what is the pathophysiology of emphysema?
macrophages and neutrophils secrete proteases that destroy alveoli
How are the leads in a biventricular pacemaker placed?
RA
describe Hib’s virulence factor
PRP (polyribosylribitol phosphate) in the capsule binds factor H, which degrades C3b and prevents opsonization
describe clostridium perfringens virulence factor
lecithinase (toxin A) lyses cell membranes and causes gas gangrene
describe streptococcus virulence factor
M protein binds factor H, which degrades C3b and prevents opsonization
describe staph aureus virulence factor
Protein A binds the Fc portion of Ig
describe mycobacterium tuberculusis virulence factor
trehalose dimycolate in the cell wall prevents macrophage killing and promotes formation of granulomas
what is the difference between schizophrenia, schizophreniform disorder, and schizoaffective disorder?
schizophrenia > 6 months
schizophreniform < 6 months
schizoaffective = schizophrenia + major depressive disorder or manic episode + delusions or hallucinations in the absence of mood sx for > 2 weeks
what are neurophysins?
the Uber drivers of hormones that travel in neurons from the HT –> PP (ADH, oxytocin)
what cells have highly developed smooth endoplasmic reticulum?
cells that synthesize steroids
what are cholesteatomas? are they made of cholesterol?
growths in the middle ear that may be congenital or secondary to infection, trauma, or surgery. They are NOT MADE OF CHOLESTEROL, they are composed of squamous cell debris.
what is the formula for resistance in a vessel?
R = nL / r4
what are the findings in POTTER sequence?
pulmonary hypoplasia oligohydramnios twisted face (flat face, low-set ears) twisted skin (wrinkly skin) extremities (club feet) renal agenesis
what spinal tracts are affected in B12 deficiency?
dorsal columns and lateral corticospinal tract
What changes occur in the axon and in the neuronal body when an axon becomes severed due to trauma?
axon –> Wallerian degeneration (swelling and irregularity, eventual digestion by Schwann cells and macrophages, occurs up to the closest node of Ranvier)
neuronal body –> axonal reaction (edema, peripheral displacement of the nucleus and Nissl substance)
what are two consensus sequences of the promoter region?
CAAT box, TATA box
what is the start codon and what are the stop codons?
start = AUG stop = UAA, UAG, UGA
what are the crescents composed of in rapidly progressive glomerulonephritis
glomerular parietal cells, monocytes, macrophages, fibrin
what are the different insulin types?
Long acting:
- NPH (2x/day)
- glargine, detemir (1x/day)
short-acting:
- regular (peak 2-5 hours, IV)
- lispro, aspart, glulisine (peak 0.5-3 hours, best for postprandial hyperglycemia)
how does rat poison work? What is the antidote?
“superwarfarin,” give fresh frozen plasma
How are Langhans giant cells formed in the setting of mycobacterium tuberculosis infection?
Macrophages phagocytose and present to Th1 cells. The Th1 cells stimulate macrophages and endow them with the ability to kill intracellular mycoplasma organisms. Activated macrophages form Langhans giant cells.
Are Langhans giant cells a specific finding for mycobacterium tuberculosis infection?
No, they are a nonsepecific finding in granulomatous conditions.
Are Langhans giant cells the same as Langerhans cells?
NO!
What are symptoms associated with thaimine (B1) deficiency?
Wernicke-Korsakoff syndrome (confusion, ataxia, oculomotor abnormalities, memory deficits)
dry beriberi (peripheral neuropahty)
wet beriberi (cardiac involvement)
What are the symptoms of niacin (B3) deficiency?
Pellagra
what are the symptoms of pyridoxine (B6) deficiency?
cheilosis, stomatitis, glossitis
what are the symptoms of folate (B9) deficiency?
megaloblastic anemia, NTDs
what are the symptoms of cobalamin (B12) deficiency?
megaloblastic anemia with neurologic deficits
what are the symptoms of vitamin C deficiency?
scurvy
What type of receptor is the opioid receptor?
Gi
What is the effect of opiate binding to receptors on the presynaptic and postsynaptic membranes?
presynaptic–> block Ca2+ influx
postsynaptic –> open K+ channels causing membrane hyperpolarization and potassium efflux
what genes are associated with pheochromocytoma?
VHL
RET
NF1
what is the MOA of ribavirin in the treatment of HepC?
ribavirin is a nuceloside antimetabolite drug that interferes with duplication of viral genetic material. It also directly inhibits HCV RNA polymerase
are pigmented gall stones associated with hereditary spherocytosis?
yes
what are the first and second generation antihistamines?
first generation = hydroxyzine, promethazine, chlorpheniramine, diphenhydramine
second generation = loratadine, cetirizine
what is the MOA of fibrates?
activate ppar-a, deading to decreased hepatic VLDL and increased LPL activity, used to decrease TG levels
what is the MOA of ezetimibe?
selectively blocks intestinal cholesterol absoprtion
what is the MOA of bile acid-binding resins (eg cholestyramine)
increase fecal loss of cholesterol derivatives by binding bile acids in the intestine and disrupting enterohepatic bile acid circulation
what is the MOA of PCSK9 inhibitors?
monoclonal antibodies that reduce LDL receptor degradation in the liver (affect mainly cholesterol not TGs)
what is the MOA of statins?
inhibit HMG-CoA reductase, decreasing hepatic cholesterol synthesis (moderate affect on TGs)
is neuroblastoma a brain cancer?
NO! It is a cancer of the adrenal medulla typically presenting in children < 2
what findings are seen on light microscopy of a liver biopsy in Reye’s syndrome?
microvesicular steatosis (small fat vacuoles in the cytoplasm of hepatocytes)
what are the signs of congenital hypothyroidism?
none at first (have maternal T4), after about 2 months, nonpitting edema, umbilical hernia, protruding tongue, large anterior fontanelle
what cytokine is critical for fibroblast migration, proliferation, and connective tissue synthesis?
TGF-B
what malignancy has a t(11;14) translocation
Mantle cell lymphoma (results in activation of the cyclin D gene)
what is prophylaxis for MAC in HIV patients with CD4 < 50 cells and how does it present?
azithromycin, presents with fever, weight loss, and diarrhea. anemia, HSM, elevated alk phos and LDH are also common.
how does theophylline treat COPD?
it is an adenosine receptor antagonist and PDE inhibitor that causes bronchodilation by increasing intracellular cyclic AMP levels (similar to B-adrenergic agonists)
what are the steps of leukocyte passage into inflamed tissues?
- margination
- rolling (L-selectin, E-selectin/P-selectin)
- activation
- tight adhesion and crawling (Mac-1, LFA-1/CD 18, ICAM-1)
- transmigration (PECAM-1)
dermatitis herpetiformis is associated with what GI disorder?
celiac disease
what is the distinct histopathologic finding in chronic Hepatitis B infection?
accumulation of hep B surface antigen within hepatocytes, resulting in the appearance of a finely granular, diffusely homogeneous, pale eosinophilic cytoplasm (“ground glass” hepatocytes)
what are the derivatives of the 1st, 2nd, 3rd, 4th, and 6th aortic arches?
1 = maxillary a. 2 = hyoid a., stapedial a. 3 = common carotid a., internal carotid a. 4 = (L) aortic arch, (R) R subclavian a. 6 = proximal pulmonary a.'s, (L) ductus arteriosus
what drugs can cause DRESS?
seizure drugs (phenytoin), sulfonamides, allopurinol
what is the effect of prostaglandins in the eye?
increase outflow of aqueous humor
what is the most common cause of spontaneous lobar hemorrhage in adults >60?
amyloid angiopathy (B-amyloid deposition in walls of small to medium-sized cerebral arteries)
Auer rods are associated with which hematologic malignancy and stain for _____?
AML, peroxidase
what hematologic malignancy stains positive for terminal deoxynucleotidyl transferase (TdT)
ALL
hairy cell leukemia stains positive for what?
tartrate resistant acid phosphatase (TRAP)
platelet-derived growth factor receptor mutations play a role in which hematologic malignancy?
CML
how does vitamin E deficiency present?
neuromuscular disease + hemolytic anemia
what is the cause of Mallory-Weiss tears?
rapid increase in intraabdominal and intraluminal gastric pressure (such as occurs during vomiting)
In albinism, are melanocytes present in the skin? What about in vitiligo?
YES, but they do not make melanin. In vitiligo, there is an absence of melanocytes.
what does a PAS stain highlight?
PAS oxidizes carbon-carbon bonds, so it is really good at highlighting polysaccharides in fungal cell walls, mucosubstances secreted by epithelia, and basement membranes.
what intracellular pathway is activated by growth factor?
JAK-STAT
What antibiotics are used for MRSA, what are their MOAs and what are their side effects?
vancomycin - blocks polymerization by binding D-alanyl-D-alanine - red man syndrome, nephrotoxicity
daptomycin - depolarizes cell membrane by creating transmembrane channels - elevated CPK, myopathy
linezolid - binds 50s, inhibits initiation of translation - thrombocytopenia, optic neuritis, serotonin syndrome
what antihypertensive can cause peripheral edema
calcium channel blockers
what is the inheritance pattern of G6PD deficiency?
X-linked recessive
cataracts, frontal balding, and gonadal atrophy?
myotonic dystrophy, autosomal dominant (CTG repeat expansion)
what is the sequence of colorectal adenoma to carcinoma?
- normal mucosa to small adenomatous polyp = APC mutation
- increase in size of adenoma = KRAS mutation
- malignant transformation = P35 mutation
muddy brown casts are pathognomonic for which renal pathology?
acute tubular necrosis, affecting the PCT and the medulla in response to ischemic injury
which cell type is responsible for the intense inflammatory response seen in patients with gout?
neutrophils
