NEW HY INCORRECT Flashcards
1
Q
What is the most common congenital anomaly of the GI tract?
A
Meckel’s Diverticulum
True Diverticulum (all 3 layers) – Persistence of the VITELLINE DUCT
Abnormal fibrous connection b/t ILEUM & Umbilicus
Can cause Vitelline duct cysts
TERMINAL ILEUM
Can cause Iron Deficiency anemia
2
Q
Markers for Down Syndrome?
A
INCREASED HCG & Inhibin
DECREASED AFP & Estriol
AML most common BEFORE 5 years old
Atrial Septal Defect
3
Q
Pancoast Tumor affects what part of the lung?
MC Symptoms?
A
Carcinoma that occurs in APEX of lung
SHOULDER pain is MC sx – Unilateral symptoms d/t damage to AUTONOMIC GANGLIA
Stellate Ganglion damaged – LMN pattern
Hoarseness (Recurrent laryngeal nerve)
Horner syndrome – Ipsilateral ptosis, Miosis, Anhidrosis
– Pupil Asymmetry more prominent w/ DIM LIGHT
4
Q
Erythema Multiforme most commonly presents with which type of infection?
A
Herpes Simplex Virus
Rash looks like Targets with rings surrounding them
5
Q
G6PD deficiency labs?
What type of Anemia?
A
Normocytic – Intrinsic hemolytic anemia
Patients present with back / abdominal pain along with DARK URINE a few days after oxidant stress i.e. Sulfa Drugs, Dapsone, Fava beans
Increased Reticulocyte count produced by bone marrow in response to the anemia
Increased Indirect bilirubin from the hemoglobin degradation
Increased Lactate dehydrogenase – breakdown of hemoglobin
DECREASED Haptoglobin – Haptoglobin binds free hemoglobin, so naturally it decreases due to hemoglobin destruction
Heinz Bodies – Denatured hemoglobin inclusions
Bite Cells
6
Q
Posterior Hip Dislocation affects what nerve?
A
Sciatic nerve & Inferior gluteal nerve (Gluteus maximus)
Affected leg appears shortened & internally rotated
7
Q
Arginase Deficiency is a part of what cycle?
A
Urea Cycle
Arginase is a urea cycle enzyme that produces Urea & Ornithine from Arginine
Deficiency leads to spastic diplegia, growth delay, & abnormal movements
8
Q
Huntington Disease Inheritance?
Neurotransmitter’s that are high? low?
Presentation?
A
Autosomal Dominant – CAG repeats – Toxic Gain of Function
INCREASED dopamine (Hence the Chorea)
DECREASED GABA & Acetylcholine
Chorea, Psychiatric symptoms, & Subsequent dementia
Atrophy of the CAUDATE & Putamen
9
Q
Albinism caused by deficiency of what enzyme?
A
Tyrosinase
Tyrosinase is responsible for conversion of DOPA to Melanin – w/o it you don’t get melanin you stupid fuck
10
Q
What is Potter Sequence?
A
Due to severe Oligohydramnios
Urinary tract anomaly – Bilateral renal agenesis = Decreased Urine output = Very low amniotic fluid = Baby is getting crushed and everything is flat
Lungs get crushed, Pulmonary Hypoplasia = Hypoxia, which is the MCC death
11
Q
Polyhydramnios associated with which fetal malformations?
A
Esophageal & Duodenal atresia
So now baby can’t swallow amniotic fluid which results in a LOTTTT of it
Also associated with Anencephaly
12
Q
What is HY about Charcot-Marie-Tooth?
A
Abnormal function of Myelin Protein
Progressive hereditary nerve disorders d/t defective production of proteins needed for peripheral nerves / myelin sheath
HY association – Foot Deformities – Hammer toe & Pes Cavus (High Foot Arches that don’t flatten)
LE weakness & Sensory deficits
CMT1A is most common
Differentiate from Duchenne & Becker because these disorders have PSEUDOHYPERTROPHY rather than Atrophy of the calf muscles
13
Q
Toxic Shock Syndrome pathogenesis?
A
Superantigens (Exotoxins) bind to MHC-II & then nonspecifically activate T cells – This activation causes a huge release in inflammatory cytokines
14
Q
Left-Dominant Heart supplies AV node by which artery?
Right-Dominant Heart supplies AV node by which artery?
A
Left Circumflex in left heart
Right coronary in right heart (90%)
15
Q
Tenofovir main SE?
A
Can damage Proximal Tubule – AKI
Specific focal damage to the proximal tubule is the key here
16
Q
PTH given in a PULSATILE manner has what affect on bone?
A
ANABOLIC
Stimulates osteoblast proliferation & Increases formation of new bone
- literally opposite of what PTH normally does. Regularly, Increased PTH would induce osteoclasts to breakdown bone which then increases serum calcium
17
Q
HY for Membranous Nephropathy?
A
If it’s Primary = IgG-4 Antibodies to Phospholipase-A2 receptor
Secondary = NSAID, Penicillamine, HEPATITIS, SLE
GMB Thickening
GRANULAR d/t immune deposition
SUBEPITHELIAL DEPOSITS
18
Q
How to Differentiate Kawasaki vs. Hand/foot/mouth
A
HFM has Oropharyngeal sores
19
Q
Kawasaki HY?
A
FEVER for MORE than 5 days – Doesn’t subside w/ medication
Children UNDER 5 YO
Bilateral Conjunctivitis
Fissured lips w/ STRAWBERRY tongue
Distal Extremity changes – erythema & edema
20
Q
Gastric surgery to place a band around the stomach must pass through which structure?
A
Lesser Omentum – Divided into hepatogastric & hepatoduodenal ligaments
21
Q
VSD Murmur type? pathology?
A
Holosystolic murmur @ left lower sternal border (Tricuspid Area)
Insufficient development of inter-ventricular septum
22
Q
H. Pylori is Urease positive which means what?
A
Urease splits Urea into Co2 & AMMONIA – Neutralizes local acidic gastric pH
23
Q
How to Glucocorticoids lead to loss of bone density?
A
They inhibit replication & differentiation of OSTEOBLAST precursor cells, Increase osteoclast activity & promote renal calcium wasting
24
Q
Which diuretic is used for its beneficial effect on calcium homeostasis - thus helping fight osteoporosis?
A
Thiazide Diuretics – HCTZ
Inhibits NaCl reabsorption in DCT – DECREASES CALCIUM EXCRETION
SE = Hyperglycemia, Hyperlipidemia, Hyperuricemia, Hypercalcemia
Hypokalemic metabolic alkalosis
25
What cells proliferate during lung injury?
**Type II Pneumocytes**
Source of pulmonary surfactant & produce Type I Pneumocytes
When they mention alveolus / alveolar in the question... Pick TYPE 2 2 2 2 22 2 2 2 22 2 2 2 2 2
26
What results in an abnormal connection b/t the bladder & the umbilicus?
**Patent Urachus** (Median umbilical ligament)
if it's fully patent -- Urinary leakage through your belly button
Partial patency results in bladder diverticulum & Increases UTI risk
27
Patients with previous BCG vaccination can have what type of TB test?
FALSE POSITIVE -- not false negative
28
Why would a patient with an active TB infection have a negative TB test?
Impaired **cell mediated** immune response -- Inadequate lymphocytic response
29
Hyperthyroidism causes an up-regulation of beta-adrenergic receptor expression -- Leads to increased catecholamine effect
So giving a patient Propranolol works by doing what?
**Reduce the conversion of T4 to T3** by inhibiting 5-Monodeiodinase in peripheral tissues (Similar to PTU & Glucocorticoids)
30
Candida Vulvovaginitis signs / symptoms?
Labs?
Treatment?
Pruritic w/ inflammation & **Thick white COTTAGE CHEESE PUSSY**
Normal pH & Pseudohyphae
Associated w/ **Recent antibiotic use** that decrease gram (+) Lactobacillus
**FLUCONAZOLE**
31
Bacterial Vaginosis signs / symptoms?
Labs?
Treatment?
Thin white discharge with **FISHY SMELLY PUSSY**
**Clue cells** with pH >4.5 (Alkaline) & (+) KOH whiff test
**Metronidazole** / Clindamycin
32
Trichomonas Vaginitis signs / symptoms?
Labs?
Treatment?
Inflamed **STRAWBERRY PUSSY**
Frothy **YELLOW GREEN foul discharge**
Motile Pear-shaped & pH >4.5 (Alkaline)
**Metronidazole & Treat SEXUAL PARTNERS**
33
What causes neonatal hypoglycemia?
Infants of **Diabetic mothers**
Maternal hyperglycemia causes fetal hyperglycemia w/ a **compensatory HYPERFUNCTIONING PANCREAS**
This hyperfunctioning causes **hyperinsulinemia** -- so after birth this increased insulin leads to transient hypoglycemia
34
Growth of Candida on sputum cultures almost always indicates what?
Oral contamination of normal flora rather than pulmonary infection
35
Normal morphological changes of an aged heart?
**Decreased LV chamber**
**Sigmoid** shaped ventricular septum
Myocardial atrophy w/ collagen deposition
**Brown Lipofuscin pigment** (lipid oxidation)
36
Which NRTI is contraindicated in patients with the HLA-B*57:01 Allele?
Abacavir
37
Which Hepatitis virus Lacks a 3'-5' Exonuclease activity?
**Hepatitis C**
-- So it can't proofread, which then causes antigenic variation of the **enveloped proteins**
38
Cavernous sinus syndrome has what affect on CN?
Compresses / stretches the **Abducens Nerve** causing weakness of the Lateral rectus muscle
39
What effect does low BP have on Baroreceptor firing & ANP?
Low BP = Decreased arterial distension = **REDUCED** firing of aortic & carotid baroreceptors
This leads to **Increase in sympathetics** = Increased contractility
& since we have Hypovolemia, there is less atrial stretch which means DECREASED ANP
Overall -- INCREASED contractility & DECREASED baroreceptor firing & ANP
40
Narcolepsy CSF levels of Hypocretin-1?
**DECREASED Hypocretin-1** in CSF
Shortened REM latency -- knocking the fuck out fast
Cataplexy
41
Urinary concentration of which substance is indicative of early diabetic nephropathy?
ALBUMIN
42
Polymyositis characterized by what?
Most often involves what body part?
Overexpression of **MHC-1** leads to infiltration with **CD8+ T Lymphocytes** w/ **endomysial inflammation**
**Anti-Jo-1**
43
How to differentiate b/t Polymyositis & Dermatomyositis?
Dermatomyositis Involves **Gottron papules** -- Heliotrope edema of the eyelids
Hyperkeratosis of the skin
**Perimysial inflammation** w/ **CD4+ T cells**
(Vs. CD8+ in Polymyositis)
44
Polymyalgia Rheumatica characterized by? What does it NOT have that polymyositis has?
Myalgias of the shoulder & pelvic girdle w/ fever & weight loss
**NO WEAKNESS** (differ from polymyositis)
Almost exclusively in **patients over 50 (& Females)**
Increase in ESR & CRP
45
Digoxin MOA & SE?
Direct inhibition of Na/K ATPase
Increases intracellular calcium to increase contractility. Stimulates Vagus nerve = Decreases HR
**HYPERKALEMIA** -- sign of digoxin toxicity
**Blurry yellow vision**
| Underlying Hypokalemia is the MCC of Digoxin toxicity
46
How does infection lead to leukocytosis?
Neutrophils are most prominent in blood, however, the vast **majority are held in reserves in the BONE MARROW**
Infection mobilizes the BM -- Mediated by increased cytokines i.e. **TNF alpha** -- This then **demarginalizes** **neutrophils** from endothelial attachment & **contributes to leukocytosis**
47
What is the greatest risk factor for infection from Clostridium Septicum?
Underlying **colonic malignancy**
C. Septicum is the MCC of spontaneous gas gangrene
48
Spironolactone in patients w/ cirrhosis is used to induce natriuresis without blocking what?
**W/o blocking the critical vasoconstrictive effects of Angiotensin**
Commonly used w/ Furosemide (Loop)
Background: Cirrhosis -- Portal hypertension leads to splanchnic vasodilation -- this decreases the effective arterial volume & Lowers BP -- This drop causes RAAS activation which promotes vasoconstriction (Angiotensin) & Fluid & sodium retention by kidneys (Aldosterone)
Aldosterone antagonist (Spironolactone) interrupts the cycle but allows the vasoconstriction to occur while getting rid of the ascites
49
HOCM leads to obstruction of what?
**Left ventricular outflow tract** d/t hypertrophied interventricular septum & **abnormal anterior motion** of the **MITRAL VALVE**
50
Placental abruption pathophysiology?
**Rupture** of the **maternal vessels** @ the uteroplacental interface -- Leads to placental separation from the myometrium
Tender & firm uterus
Abrupt, **Painful** vaginal bleeding in **3rd trimester**
51
Placenta Accreta pathophys?
Trophoblast attaches to myometrium **w/o invading it**
Diagnosed after baby delivery -- Postpartum hemorrhage
52
Placenta Previa pathophys?
Extension of placental tissue over the cervix
MCC of **PAINLESS** vaginal bleeding in the 3rd trimester
53
Hyper-IgM Syndrome pathophysiology?
Labs?
**Defective CD40L on CD4+ Lymphocytes** -- Impaired T cell activation of B cells
**NO GERMINAL CENTERS**
ONLY increased IgM, **everything else is decreased**
Recurrent Sinopulmonary infections, GI **(Giardia)** & Pneumocystis
Fungal & CMV
Background - CD40 Ligand is on the surface of CD4 cells. This CD40 Ligand binds to the CD40 on B cells -- a necessary step for class-switching, allowing them to produce IgE, IgA, & IgG INSTEAD of IgM & IgD
So, defective CD40L defectiveness is unable to generate anything other than IgM
| CD40 is expressed on B cells. CD40-Ligand is expressed on T cells
54
Nonclassical congenital adrenal hyperplasia is due to a mild deficiency in what enzyme?
21-Hydroxylase
21-Hydroxylase converts Progesterone to 11-Deoxycorticosterone
It also converts 17-Hydroxyprogesterone into 11-Deoxycortisol
Since this is Nonclassical (Meaning not @ birth) -- Presents as **adolescent girls w/ signs of Hyperandrogenism** (Hirsutism, acne)
**INCREASE in 17-Hydroxyprogesterone & Testosterone**
Increase in **potassium** & sex hormones
Decrease in mineralocorticoids & BP & **Cortisol**
55
Which enzyme converts Testosterone to Estradiol?
**Aromatase**
Aromatase deficiency therefore leads to primary amenorrhea, NO breasts, & virilized genitalia (BIG CLIT)
56
What is a Pathognomonic finding of Chediak-Higashi syndrome?
**GIANT CYTOPLASMIC GRANULES** within neutrophils
CHS = Defect in lysosomal trafficking
**Microtubule dysfunction** in phagosome-lysosome fusion
**ALBINISM** & Neurologic sx (Nystagmus)
Background: Neutrophil phagosome-lysosome fusion is defected = prevents release of cytotoxic granules = Can't kill bacteria
57
What's the best medication to use in patient's having a Hypertensive emergency but *with Renal insufficiency*?
**Fenoldopam** -- **Peripheral Dopamine-1 Receptor** **AGONIST**
**Vasodilates** systemic & RENAL ARTERIOLES to lower BP but also increasing renal perfusion & NATRIURESIS
58
Donepezil is 1st line TX for?
Alzheimer's -- provides **improvement of cognitive symptoms** BUT does NOT alter the inevitable disease progression
AChE Inhibitor
59
When you hear FIXED WIDE SPLITTING OF S2 -- Automatically what?
What murmur is associated?
**ASD**
Midsystolic ejection murmur -- due to increased flow from pulmonic valve
Background: ASD cause fixed wide splitting of S2 d/t right-sided volume overload d/t left-to-right shunting
When left uncorrected, defects lead to **irreversible hypertrophy** of the **pulmonary arteries** w/ pulmonary HTN & reversal right-to-left shunting (i.e. Eisenmenger syndrome)
60
Old man with bilateral flank pain & Renal dysfunction - What is causing it?
Urethral compression due to BPH
61
NF type 1 has what type of inheritance?
**Autosomal Dominant** w/ 100% penetrance -- Gene located on **Chromosome 17**
* Cafe Au Lait Spots
* Optic gliomas
* Seizures
* Pheochromocytomas
NF type **2** is also AD but on CH. **22**
62
During skeletal muscle contraction -- Calcium released from SER binds to what?
Calcium binds to **Troponin C** -- Allowing the binidng of actin to myosin
63
Lats innervated by what nerve?
**Thoracodorsal Nerve**
64
What is a Capitation Payment model?
The Payor pays a fixed & predetermined fee to provide all services required by a patient
Used by some HMOs
65
MEN Type 1 classified by what?
Primary **Hyperparathyroidism** (Parathyroid adenomas or hyperplasaia)
**Pitutiary** tumors (Prolactin, visual defects)
**Pancreatic** tumors (Gastrinomas)
| Only MEN with Pituitary & Pancreatic involvement & MEN-1 Mutation
66
MEN type 2 classifed by what?
**Medullary thyroid cancer** (Calcitonin)
**Pheochromocytoma**
Primary Hyperparathyroidism
| RET Mutation
67
MEN type 3 classified by what?
Medullary Thyroid cancer (Calcitonin)
Pheochromocytoma
**Mucosal Neuromas & Marfanoid habitus**
| RET mutation -- Only one without hyperparahyroidism
68
What is the most common cause of T1D?
**Autoimmune Insulitis** w/ Progressive beta cell loss
**Leukocytic infiltration** of islets by inflammatory cells is called insulitis
69
PPI MOA? SE?
**Irreversibly** inhibit parietal cell **Hydrogen-Potassium-ATPase**
MALABSORPTION of **Calcium**, Iron, **Magnesium**, & **B12**
However, **enhances Fat absorption** in patients given pancreatic enzyme replacement therapy
Pneumonia, Osteoporosis
70
Loperamide MOA?
Opioid AGONIST -- Binds to **mu opiate receptors** -- inhibits the release of Acetylcholine release -- **Slows Peristalsis**
**Traveler's Diarrhea**
**DOES NOT CROSS BBB** -- Avoiding systemic opiate-related adverse events
71
Jersey Finger affected tendon?
**Flexor Digitorum Profundus**
Susceptible to rupture when an actively flexed DIP joint is **forcefully hyperextended**
| Rupture = Inability to flex
72
Guillain-Barre Syndrome mechanism? Presentation?
Immune mediated polyneuropathy due to cross reacting Antibodies -- **MOLECULAR MIMICRY**
Following Viral illness or mainly **Campylobacter**
Affects Schwann cells & Myelin sheaths
**SYMMETRICAL ASCENDING WEAKNESS** beginning @ legs
73
Postpartum thyroiditis differentiating features?
Hyperthyroid phase for first 1-3 months d/t release of **PREFORMED THYROID HORMONE**
Hypothyroid phase d/t depletion of thyroid hormone stores
Recovery phase w/ euthyroid state
Autoimmune disorder w/ lymphocytic thyroid inflammation
**DECREASED Radioiodine uptake** & **Decreased blood flow** on doppler US
Positive TPO
74
Polyarteritis Nodosa mainly involves which vessels?
What is it commonly associated with?
Typically involves **Renal** & Visceral vessels -- NOT pulmonary
Transmural inflammation w/ Fibrinoid necrosis
**Hepatitis B** Seropositivity (Sometimes Hep C)
75
Rhabdomyolysis pathogenesis? Cause?
Myoglobin, Electrolyte release d/t myocyte injury
Common with crush injuries, **SEIZURES**, & **Statins**
Can cause **ATN** due to heme pigment released from myoglobin
**Positive BLOOD** on urine dipstick in the **ABSENCE** of **RBC** suggests myoglobinuria
76
Severe tetraology of Fallot neonate w/ cyanosis immediate administration of which drug?
Prostaglandin E1 -- **Prevents closure** of the ductus arteriosus
77
Regardless of hydration status -- majority of water reabsorption in the nephron occurs where?
Proximal tubule
78
Apixaban, Edoxaban, & Rivaroxaban MOA?
Uses?
Reversal?
Binds active site of Xa & **Prevents the conversion of Prothrombin to Thrombin**
Used as **stroke prophylaxis** in patients w/ **AFib**
Bleeding reversed with **AndeXAnet**
79
Acute Promyelocytic Leukemia is associated with which translocation?
Responds to what?
MC presentation?
**15;17** Translocation
Responds to **All-Trans Retinoic Acid**
**DIC** is the most common presentation
80
Glucocorticoids increase the Apoptosis of which cells?
Increase the production of which Interluekin?
Eosinophils, T cells, & Monocytes
Increase IL-10 (Anti-inflammatory)
81
Testes drain into?
Scortum drains into?
Testes = Para-Aortic
Scrotum = Superificial inguinal
82
Anytime SVR is decreased + SVO2 Increased -- What type of shock is it?
**Distributive Shock** -- Sepsis / Anaphylaxis
83
Why is the Right Ventricle relatively protected after an MI?
Because it is **perfused throughout** the cardiac cycle
| Vs. the LV only diffused during diastole
84
21-Hydroxylase catalyzes the conversion of what?
Conversion of **Progesterone to 11-Deoxycorticosterone** (Aldosterone precursor) -- Zona Glomerulosa
Also Converts **17-Hydroxyprogesterone to 11-Deoxycortisol** (Cortisol Precursor) -- Zona Fasiculata
## Footnote
Deficiency means ACTH levels are increased as a result of low cortisol levels
High serum 17-Hydrooxyprogesterone confirms the DX
85
Barrett Esophagus epithelium?
What type of cancer are you prone to when you have Barrett's?
You go from Nonkeratinized Stratified Squamous epithelium to **Nonciliated COLUMNAR epithelium w/ Goblet cells**
Increased risk of **Esophageal ADENOCARCINOMA**
Adenocarcinoma of the Distal 1/3 of Esophagus
86
Hydralazine MOA?
**ARTERIAL Vasodilator** that has little effect on veins
Increases cGMP & **Reduces Afterload**
87
Nitroprusside MOA?
SE?
Strong acting Vasodilator for both arteries & veins
SE = **Cyanide poisoning**
TX = Amylnitrite w/ B12 & then Methylene blue
88
What is Acanthosis Nigricans?
Hyperpigmented plaques @ flexural areas -- Neck / & Armpit
Associated with Diabetes, Obesity, Malignancy
89
What is Actinic Keratosis?
Hyperkeratotic lesions in SUN EXPOSED areas of scalp, ears, face, & hands
Unpigmented
Risk of squamous cell carcinoma
90
What is Lichen Planus?
**Polygonal**, Planar, **Pruritic**, **Purplish** Plauqes on wrists, hands, trunk, legs
**Fine white lines** (Wickham Striae) present on plaque surface
91
Which nerve root is MC affected in patients with cervical radiculopathy?
C7 root
Deficits across the median & radial distributions
92
What arterial blood gas has the most powerful effect on cerebral blood flow?
**PaCO2**
Drop in PaCO2 d/t hyperventilation causes vasoconstriction
Lowering PaCO2 is one of the measures employed to reduce ICP in mechanically ventilated patients with cerebral edema
93
Which test can you run to confirm the diagnosis of Chronic Granulomatous disease?
**Absence** of **fluorescence** on **dihydrorhodamine** flow cytometry = Confirmatory
94
Carcinoid tumors are typically confined to the intestine -- The secretory products of these tumors go through 1st pass metabolism and therefore don't reach systemic circulation -- But when they do, it is now called what?
Carcinoid Syndrome
METS has already reached the liver -- **Avoid 1st pass** metabolism & now systemic issues
Flushing, Diarrhea, Bronchospasm
Increased **5-HIAA** in urine
Can also cause **Pellagra** -- **Niacin deficiency**
TX = **Octreotide**
95
Hepatic Angiosarcoma associated with exposure to?
Vinyl Chloride / Arsenic
Express CD31
96
Hepatic Adenoma MC in which population?
What are main risk facotrs?
Women
OCP's & Steroids
| Rupture & shock
97
What is increased in Hemophilia?
Only **PTT**; all other tests normal
| Autosomal Recessive
98
Colorectal cancer has bad prognosis when the tumor penetrates what strcuture?
Muscularis Propria
99
Anal Squamous Cell Carcinoma strong association with which virus?
Histology?
Strong **HPV** association
Presents w/ Rectal **bleeding**, **Pruritis**, **Pain**, Ulcerated anal lesion
Histology will show **Eosinophilic squamous cells** arranged in **islands**
100
VIPoma Leads to hypersecretion of VIP -- What electrolyte abnormalities do you see?
Increased VIP = Excess **chloride LOSS** in the **stool** along w/ **Water, Na+ & K+**
**HYPOKALEMIA**
**WATERY DIARRHEA**
VIP **inhibits** Gastric acid secretion
TX = Somatostatin
101
Glucokinase where?
Hexokinase where?
Glucokinase -- **Liver**
Hexokinase -- Brain, Heart, Kidney
102
D-Xylose in stool is a sign of what?
Osmotic Diarrhea
D-Xylose test is ABNORMAL in Celiac disease
103
4 causes of Secretory diarrhea?
Vibrio Cholera -- Curved
VIPoma
ETEC - E. Coli
Cryptosporidium
V-VEC
104
Increase in Insulin & C-Peptide?
Endogenous insulin production / Insulinoma
i.e. Sulfonyureas (Glyburide)
This is considered endogenous because these medications are increasing insulin production -- therefore it is also producing C-peptide vs. exogenous insulin which is just an analog
| Also increased in Insulinomas
105
Increase in insulin but LOW C-Peptide?
Factitious -- Injecting yourself w/ Insulin
| This is exogenous because it is an insulin analog
106
cAMP works w/ Sympathetics & Catabolic processes
cAMP activates what?
Activates **Protein Kinase A**
**Magnesium** as a cofactor
Phosphodiesterase **1**
107
cGMP works w/ Parasympathetic & Anabolic Processes
Phosphodiesterase 5
Guanylate cyclase
108
Exogenous Thyrotoxicosis i.e. Levothyroxine use -- Labs?
**Increased T4/T3**
**Decreased TSH** (-) feedback
**RAIU** is **LOW**
RAIU correlates w/ synthesis of new thyroid hormone so w/ exogenous administration, **endogenous synthesis is suppressed**, making RAIU low
Thyroglobulin serves as a source of tyrosine residues for thyroid synthesis -- So w/ exogenous abuse, serum **thyroglobulin** is **LOW**
109
What does Aortic Regurgitation do to diastolic BP?
**Reduces diastolic BP** w/ a *compensatory* **increase** in **LV stroke volume**
Widened pulse pressure
**Head bobbing**
Pistol shot femoral pulses
110
Buzz word for Ebstein anomaly?
**Atrialization**
Lithium exposure in utero
Tricuspid Regurgitation
111
Rhonchi seen in?
Obstructive
Air over mucus
112
Crackles seen in?
Restrictive
Collapsed airways popping open
113
Fremitus
Consolidation on which side?
Atelectasis on which side?
**Consolidation** on **same** side
**Atelectasis** on **opposite** side
Seen in Lobar Pneumonia & Pulmonary Edema
114
Fat Embolism syndrome presentation?
24-72 hours after long bone / pelvic fracture
115
Which artery supplies the Posteromedial papillary muscle?
Which artery supplies the Anteromedial papillary muscle?
Which one of these muscles is more prone to ischemic infarct?
**Posteromedial** is solely supplied by the **posterior descending artery**
**Anteromedial** is supplied by both the **left anterior descending artery** & the **left circumflex**
Since the posteromedial is supplied exclusively by one artery, it is more susceptible to ischemic infarct
116
What is the MCC of Bronchiolitis in babies <2 YO?
RSV
Paramyxoviruses
117
Effects of Glucocorticoids?
118
Filtration Fraction is usually what % in healthy adults?
20%
119
TMJ disorder presentation?
Nerve dysfunction?
Facial pain, HA, Ear pain / Muffled hearing
d/t Hypersensitivity of the **Mandibular Nerve CN V3** (**Trigeminal**)
120
IVC is formed by the union of?
**Right** & **Left common iliac veins** @ the level of L4-L5
121
Proto-oncogenes & Tumor Suppressor associations
122
Streptococcus chart
123
Leuprolide
Pulsatile for...
Continuous for...
Pulsatile for **PREGNANCY**
Continuous for **CANCER**
GnRH **Agonist** in **Pulsatile**
GnRH **Antagonist** in **continuous**
124
Anti-Centromere Antibodies seen in?
CREST Syndrome
125
Metabolic effects of administering Glucagon in a patient with Hypoglycemia?
Primarily **Increases Glycogenolysis**
126
What bug causes Achalasia & Megacolon?
T. Cruzi
127
Babesiosis spread by which tick?
**Ixoides Tick**
128
Octreotide MOA & SE?
Long-acting **Somatostatin analog**
Causes **indirect vasoconstriction** by inhibiting splanchnic vasodilatory hormones
Used in Acute variceal bleeds to decrease portal blood flow
SE = **Cholelithiasis** d/t ***CCK inhibition***
129
MifepristONE MOA? Indication?
**Competitive inhibitor** of Progestin @ ProgesterONE receptors
Used for abortion
Used with Misoprostol (Prostaglandin E1 agonist)
130
If a child with absence seizures also develops tonic-clonic seizures, what is the best long-term management?
Valproic Acid -- Treats both types
Increases Na+ channel inactivation
Increases GABA concentration by inhibiting GABA transaminase
SE = Hepatotoxic, Pancreatitis, P-450 inhibitor, Tremor
131
Huntington's repeat of what gene?
Which NT are increased? What is decreased?
What gets atrophied?
AD ***CAG*** repeat's -- Toxic gain of function
**Increase** in **dopamine**
Decrease in GABA & ACh
Neuronal death via NMDA-R binding & glutamate excitotoxicity
**Caudate atrophy** -- Results in enlargement of the frontal horns of the lateral ventricle
132
How to differentiate Asbestos from Silica exposure?
Asbestos -- Interstitial pattern in the LOWER zones
Silica -- Nodules in the UPPER lobes
133
Romberg sign indicates what?
**Sensory Ataxia**
Defects in the **posterior columns** or **peripheral nerves**
Classically **Tabes Dorsalis** & **Vitamin B12 deficiency**
134
Gastroesophageal reflux in infants is due to what?
Physiologic (normal) low tone in lower esophageal sphincter
135
**Sesnsation** from **anterior** 2/3 of tongue?
**Taste** from **anterior** 2/3 of tongue?
Taste & Sensation from **posterior** 1/3 of tongue?
Mandibular division of trigeminal (V)
Facial (VII)
Glossopharyngeal (IX)
136
Intention tremor is d/t dysfunction of what?
**Cerebellar** dysfunction
Intention tremors described as **low frequency**
Tremor increases as hand reaches target
137
Resting tremor is due to dysfunction of what?
**Basal Ganglia**
Seen in Parkinson's
Loss of Dopaminergic neurons in sunstantia nigra
138
**Serratus anterior** innervated by what nerve? What procedure is commonly associated?
Damage to **long thoracic nerve** (C5-C7) Wings of heaven
Commonly seen in **axillary node dissection after mastectomy**
| Impaired Abduction of arm
139
Villous Adenomatous polyps aka Villous Adenoma present how?
Villous adenomas produce prostaglandin E2 -- which increases MUCIN & secretory diarrhea
Mucin is a potassium rich glycoprotein; excessive production leads to hypoproteinemia & hypokalemia
140
CNS lesions typically cause upper or lower facial weakness?
**LOWER facial weakness** that *SPARES* the **forehead** on one side of the face
141
HPV Viral protein E6 binds what?
HPV viral protein E7 binds what?
E6 Binds TP53 = unregulated cell growth
E7 binds to RB = Promotes unregulated DNA replication
142
Craniopharyngioma presentation & histology?
**Cystic** masses w/ **brown** & **yellow** fluid d/t **cholesterol crystals**
**Dystrophic calcificiation** of the cysts are highly characteristic
Embryological precursor to **anterior pituitary**
143
High dose dexamethasone test in a patient w/ ACTH & Small cell lung cancer?
**NO change** in ACTH or cortisol
ACTH & Cortisol will **remain elevated**
144
Anterior cerebral artery stroke presentation? Lesion occurs proximal or distal to Acom?
CONTRALATERAL LOWER limb weakness / sensory loss
**Distal** to Acom = more severe / symptomatic
Also presents with Urinary incontinence
145
Basal Cell Carcinoma presentation?
Likely progression?
Pink, **pearly nodules**
Appear as **nonhealing ulcers** w/ infiltrating growth
**Palisading** nuclei
Local growth w/ tissue destruction
| Rarely metastasizes
146
Klinefelter chromosomal structure?
Lab findings?
Male -- **47 XXY**
Infertility, gynecomastia, long LE, small & firm testes
Destruction of Seminiferous tubules
Sertoli cell damage causes decreased Inhibin B -- **Increase in FSH**
Leydig cell damage causes decreased testosterone -- **Increase in LH**
| Azoospermia (Absent sperm)
147
Which type of beta blockers should you use in acute MI w/ underlying COPD?
**Cardioselective** (A-M)
Predominantly affect **beta-1** receptors
| Metoprolol
148
SGLT-2 MOA?
SE?
Blocks reabsorption of glucose in **PCT** -- thereby decreasing blood glucose levels
SE = Glucosuria (UTIs & **Vulvovaginal candiadiasis**)
Orthostatic hypotension
Caution w/ **Renal insufficiency** -- Always check **serum creatinine**
| CanagliFLOZIN, DapagliFLOZIN, EmpagliFLOZIN
149
What ages exhibit magical thinking about death?
Ages <6
They don't understand the finality of death usually until age 7
So before this, it is age appropriate to have magical thinking that they will come back to life
150
Lambert-Eaton pathophysiology?
Association?
Autoantibodies to **PRE-synaptic Ca2+** channel
**Proximal** muscle weakness w/ **HYPOreflexia**
Associated w/ **SCLC**
151
What causes metabolic alkalosis?
1. Vomiting
2. Loop / Thiazide diuretics
3. Antacids
4. Hyperaldosteronism
152
Asbestos pathognomonic
Risk of what cancer?
Which lobes affected?
Sputum sample shows what?
Causes **pulmonary fibrosis**
Ivory white, calcified, **supradiaphragmatic**, & pleural plaques are pathognomonic
Risk of **bronchogenic carcinoma**
Affects **LOWER** lobes
**Ferruginous** bodies
153
Berylliosis what type of granulomas?
Affects what lobes?
Granulomatous (noncaseating)
**Upper** lobes
Associated w/ aerospace & manufacturing industries
| All affect upper except Asbestos
154
Coal worker's pneumoconiosis have macrophages laden with what?
Affects what lobes?
Macrophages laden w/ **CARBON**
Upper lobes
Small rounded nodular opacities
155
Silicosis associated with what?
Affects what lobes?
CXR?
Associated w/ Sandblasting, foundries, mines
Fibrosis -- Increased susceptibility to **TB**
Upper lobes
Eggshell **calcification** of **hilar lymph** nodes on CXR
156
Normal Pressure Hydrocephalus pathogenesis?
ELDERLY
CSF Pressure is episodically elevated; NO increase in subarachnoid space volume
VENTRICLE EXPANSION
WET WOBBLY WACKY
| Form of communicating hydrocephalus
157
Neonatal manifestations of Toxoplasma gondii?
**CHORIORETINITIS**
Hydrocephalus
Intracranial calcifications
| +/- blueberry muffin rash
158
Neonatal manifestations of Rubella?
Cataracts
Deafness
PDA
| +/- blueberry muffin rash
159
Neonatal manifestations of CMV?
Hearing loss
Seizures
Blueberry muffin rash
Chorioretinitis
Periventricular calcifications
160
Neonatal manifestation of HIV infection?
Chronic diarrhea
161
Neonatal manifestations of HSV-2?
Meningoencephalitis
Herpetic vesicular lesions
162
Neonatal manifestations of syphilis?
Hydrops fetalis
Facial abnormalities -- Saddle nose & Malformed teeth
CN VIII deafness
163
Which 2 bugs cause neonatal conjunctivitis?
**Neisseria** = 3-5 days
**Chalmydia** = Anything after 5 days
164
Bisphosphonates MOA? SE?
**Inhibit Osteoclast activity** / Increase osteoclast apoptosis
**Esophagitis** - remain upright for 30 min
***OSTEONECROSIS*** OF THE JAW
Atypical femoral stress fractures
165
Which structure should be ligated prior to Oophrectomy
Suspensory ligament of the Ovary -- Infundibulopelvic
166
Opioid MOA?
SE?
Toxicity TX? Relapse TX?
Agonists @ opioid receptors
**CLOSE** Presynaptic **Ca2+** channels
**OPEN** Postsynaptic **K+** channels = **Efflux** of K+ = **Hyperporalize**
Pruritis (histamine release), Constipation
Treat **toxicity** w/ **Naloxone**
Treat **relapse** w/ **Naltrexone** once detoxified
167
What is unique about the labs in Intravascular hemolysis?
Extravascular hemolysis?
*Intravascular*: Paroxysmal nocturnal hemoglobinuria & Microangiopathic hemolytic anemias
**Decreased Haptoglobin**
Increase in **schistocytes**
Characteristic **hemoglobinuria**
*Extravascular*: Herditary sphocytosis & autoimmune hemolytic anemia
**Macrophages** in the spleen are clearing RBCs = **Splenomegaly**
**Spheroocytes**
NO hemooglobinuria
168
Interferon-Gamma action?
Activates macrophages
169
TGF-Beta action?
Attenuate inflammatory response -- Along with IL-10
170
Tuberous sclerosis pathophysiolgy?
Mutation in tumor suppressor genes
**Hamartomas** in CNS
**Ash-Leaf** spots
**Renal angiomyolipoma**
Seizures
171
What inclusions on histology are highly specific for Hepatitis B?
Homogenous, **pale eosinophilic cytoplasm**
**Ground glass hepatocytes**
172
Criteria for exudative pleural effusions?
High pleural fluid protein
High lactate dehydrogenase
173
What is Ex Vacuo Ventriculomegaly?
NOT a CSF disorder
There is an apperance of increased CSF but it is **actually due to decreased brain tissue & neuronal atrophy**
Alzheimers, **advanced HIV**, huntingtons
ICP is normal
174
Key finding in Acute Tubular Necrosis?
What happens in each of the 3 phases?
**Granular** casts -- **Muddy brown**
1. Inciting event
2. Maintenance phase = **OLIGURIC**; lasts for 1-3 weeks. Risk of **Hyperkalemia**, Metabolic acidosis. Volume overload
3. Recovery phase = **POLYURIC**; Risk of **Hypokalemia**
Why hypokalemia in recovery phase? Because GFR is restored before the tubular resorptive capacity is restored. Thus you're peeing a lot and not reabsorbing potassium
175
Subarachnoid hemorrhage d/t rupture of?
Vasospasm occurs when?
Drug used to prevent vasospasm?
Rupture of **Saccular (Berry) Aneurysm**
**Vasospasm** occurs **3-10 days** after
**Nimodipine** (CCB) Dihydropyridine (which acts on vascular smooth muscle)
| Blood pools in the Cerebral Sulci or Basal Cisterns
176
CF in infancy & early childhood MC bug?
CF in adulthood MC bug?
S. Aureus in children (Sometimes HIb)
**Pseudomonas in Adults**
177
Cystic Fibrosis autosomal recessive -- Defect in what gene?
Diagnosis?
Presentation?
Defect in **CFTR gene** on chromosome **7**
Diagnosis = **Increased Cl- concentration** in Pilocarpine-induced sweat test
**Meconium ileus** in newborn
**DECREASED FECAL ELASTASE** = DX for pancreatic insufficiency (diarrhea)
Nasal Polyps, Hyperinflated lungs, Barrel chest, Digital clubbing
178
Montelukast MOA?
Uses?
**Block Leukotriene receptors** on bronchial smooth muscle -- Reduces bronchoconstriction
Good for **exercise-induced asthma**
179
Fluticasone & Budesonide MOA?
1st line?
Inhibit synthesis of all cytokines
**Inactivates NF-kB** (needed for production of TNF-Alpha)
**Decreases** activity of **Phospholipase A2**
1st line for **chronic asthma**
180
Tiotropium & Ipratropium MOA?
Uses?
**Stimulate Bronchodilation** by competitively **blocking muscarinic receptors** (block ACh binding to muscarinic receptors)
More so used for **COPD** than asthma
| Tio is longer acting
181
Capsaicin decreases release of what?
Used in what?
**Decreases Substance P release**
Used for musculoskeletal & neuropathic pain
182
Pleural effusion:
Breath sounds?
Tactile Fremitus?
Percussion?
Breath sounds **decreased**
Tactile fremitus **decreased**
**Dullness** to percussion
183
What is the only lung pathology with INCREASED breath sounds & Tactile Fremitus?
**Consolidation (Pneumonia)**
Suggests Alveolar consolidation
184
What is the only lung pathology w/ HYPERRESONANCE on percussion?
**Pneumothorax**
185
MC viral infection of the GI tract in a patient w/ advanced AIDS?
**CMV** (Herpesvirus)
CMV Colitis is the second most common reactivation syndrome after CMV retinitis
186
What is the treatment for diabetic gastroparesis?
Metoclopramide -- **D2 receptor antagonist**
**Increases gastric emptying**
187
Aortic Dissection pathophysiology?
Presenting symptoms?
Longitudinal **INTIMAL TEAR**
Intimal tear = Cleavage of aortic *Tunica Media*
Associated w/ **HTN**, CT disorders (**Marfan**)
Sudden chest pain **radiating** to the **back**
**UNEQUAL BP** in arms
CXR = **Mediastinal widening**
Type A = Ascending aorta -- Proximal
Type B = Descending aorta -- Distal -- Below subclavian artery (MCC trauma)
188
Thoracic aortic aneurysm pathophysiology?
Presentation?
**Cystic MEDIAL degeneration**
Associated with **Tertiary syphilis** -- Obliteration of **vasa vasorum** & Associated with **Marfans**
189
Abdominal aortic aneurysm pathophysiology?
Presentation?
**Transmural** inflammation
**Palpable Pulsatile** abdominal mass
Most often **Infrarenal**
Presents w/ Resistant HTN
190
Repetitive pronation/supination of forearm i.e. screwdriver use affects which nerve?
Presentation?
Weakness of **finger** & **thumb** **EXTENSION**
Occurs @ the **SUPINATOR** muscle
**NO** wrist drop or sensory deficits
| Radial = C5-T1
191
Desmopressin for tx of vWF has what MOA?
Releases vWF stored in endothelium
| vWF carries & protects Factor VIII
192
Aplastic Anemia -- What type of anemia?
Labs show what?
What viruses?
Splenomegaly?
vs. aplastic criss?
Destruction of Hematopoietic stem cells
**EBV**, HIV, **Hepatitis B**
**Decreased reticulocyte** count / **Increased EPO**
**Pancytopenia** (pale lips), leukopenia, thrombocytopenia (Vs. aplastic criss which causes anemia only)
**HYPOCELLULAR** Bone marrow w/ **Fatty infiltration**
**NO splenomegaly** bc stem cells are damaged & unable to generate in any organ
193
MCC of hyponatremia after subarachniood hemorrhage?
SIADH
**LOW SERUM OSMOLALITY**
HIGH URINE OSMOLALITY w/ high urine sodium
194
Paroxysmal Nocturnal Hemoglobinuria is what type of anemia?
Common Triad?
Labs?
INCREASED COMPLEMENT intravascular hemolysis
Deficiency in CD55 & CD59
Triad of hemolytic anemia, hypercoaguability, & Pancytopenia
Coombs (-)
| Flow cytometry is gold standard
195
DOC for alcohol withdrawal seizures?
**ChlorDIAZepoxide**
| a Benzodiazepine
Can Also use Diazepam
196
What is the difference between Transference & Countertransference?
Transference describes how the **PATIENT** reacts to the provider
Counter describes how the **PROVIDER** reacts to the patient
197
What is Achalasia?
Motility Disorder caused by reduced number of inhibitory Ganglion cells = **INCREASED LES TONE** = incomplete relaxation
Degeneration of the **Muscularis Externa** = **Absent Peristalsis**
**Absent relaxation** of LES during swallowing
198
Pathology of Hirschsprung disease?
Clinical features?
* Failure of **neural crest cell migration**
* Absent parasympathetic ganglia (unable to relax) in affected **SUBMUCOSAL** (Meissner) & **Myenteric** (Auerbach) plexus
* Chronically contracted colonic segment -- Narrow rectum & dilated bowel proximal to obstruction
* **Failure to pass meconium** within 48 hours
* Chronic constipation
* (+) Squirt sign (+) RET mutation
| Rectosigmoid is most commonly involved
199
Mercury toxicity symptoms?
Treatment?
Mercury toxicity leads to increased serum & urinary **epi & NE** (similar to Pheochromocytoma)
Diaphoresis, tachycardia, hypertension, & anxiety
**Crosses BBB** = Insomnia, tremor
**Hypersensitivity rash** = **Desquamating, pink rash on palms & soles** = HY
200
Pathogenesis of Parkinson disease?
Presentation?
Treatment?
Loss of dopaminergic neurons of the **substantia Nigra** of the **basal ganglia** (**DECREASE in Dopamine**)
**Resting tremor**, Akinesia, Postural instability, shuffling gait
Dementia is a **late finding**
Lewy bodies: **Eosinophilic** inclusions of **Alpha-Synuclein**
TX = Non-ergot = Pramipexole & Ropinirole
**Levodopa** (immediate precursor to dopamine) is used & is rapidly metabolized in PERIPHERAL tissues to dopamine via COMT -- so only a small amount reaches the brain
**COMT inhibitors** such as **ENTACAPONE** & TOLCAPONE & CARBIDOPA (DOPA decarboxylase inhibitors) = DECREASE the peripheral levodopa degradation & **Increase** the amount of Levodopa available to **cross the BBB**
Carbidopa is almost always used with Levo -- But if more is needed then you add ENTACAPONE
201
Infection Associated Glomerulonephritis features?
**Type III** HS rxn -- Hypocomplementemia (**C3 decreased**)
Immune complex deposition -- **Subepithelial humps**
**Granular** deposition along GBM & mesangium due to **IgG, IgM, & C3**
202
IgA Nephropathy (Berger Disease) features?
IgA immune complex deposition in mesangium
**EPISODIC hematuria** that usually occurs concurrently with respiratory or GI infection
Recurrent self-limited **painless hematuria**
203
RPGN Featres?
Crescents in **Bowman** **space**
**Crescents** composed of **fibrin** & **macrophages** -- **CRESCENT FORMATION IS DIAGNOSTIC**
**LINEAR** -- Goodpasture syndrome (**Type II** HS) = Antibody against collagen in glomerular BM, presents as hematuria & hemoptysis in young adult males
**GRANULAR** -- PGSN or diffuse proliferative = subendothelial; most common type of renal disease in SLE
204
Diffuse Proliferative glomerulonephritis features?
Often due to **SLE**
**Wire looping** of capillaries
**Subendothelial** IgG based often with C3 deposition
205
Alport Syndrome features?
Inherited defect in **type IV collagen**
Thinning & Thickening splitting of BM
Isolated hematuria, **sensory hearing loss**, **ocular disturbances**
| Can't see, Can't pee, Can't hear a bee
## Footnote
`
206
MPGN features?
Nephritic syndrome that presents with nephrotic syndrome
Type 1 = **Hepatitis B** or **C** infection = **Subendothelial** IC deposits w/ **granular** IF
Type 2 = **C3 nephritic factor** (IgG autoantibody that stabilizes c3 convertase -- persistent complement activation -- **Decreased C3 levels**)
Intramembranous deposits
**Tram track** (AKA GBM splitting) appearance in both
207
Focal segmental glomerulosclerosis features?
**Abeed**
Associated w/ **HIV, Sickle cell, obesity**
**Segmental sclerosis** & hyalinosis
Focal deposits of **IgM, C3, & C1**
**Effacement of foot processes** similar to MCD
MC Nephrotic disease
208
Membranous nephropathy AKA membranous glomerulonephritis features?
**Antibodies to phospholipase A2 receptor** (primary) or **NSAIDs, penicillamine, HBC, HCV** (secondary)
Diffuse **GMB thickening**
**Granular** due to immune complex deposition
Spike & dome of **SUBEPITHELIAL DEPOSITS**
209
Diabetic glomerulonephroaphy features?
Nonenzymatic glycosylation of vascular BM = Hyaline arteriosclerosis
**Efferent affected** more than afferent = Increase in GFR
**Microalbuminumeria**
**Eosinophilic nodular glomerulosclerosis**
**Kimmelstiel Wilson lesions** -- Sclerotic eosinophilic nodules w/ Central Acellular region
| Nephrotic Syndrome
210
Rheumatoid Arthritis Characterized by?
Clinical features?
Lab findings?
Hallmark is synovitis leading to **Pannus** formation
Associated with **HLA-DR4**
Morning stiffness that **improves** w/ **activity**
PIP joints -- Swan neck
MCP joints -- Boutonniere
**Ulnar finger deviation**
Loves to attack the **cervical spine**
**IgM antibody** that targets IgG Fc region
**Anti-CCP** is most specific
Rheumatoid factor for disease activity
TX = **Methotrexate** or TNF-alpha inhibitor (**Infliximab**)
| SPARES the DIP
211
Herpes Zoster Opthalmicus caused by?
**VZV**
Latent in dorsal root or **trigeminal ganglia; CN V1** of Trigeminal nerve
Painful rash w/ corneal ulceration
212
Complete vs Partial mole?
Complete: **46 XX** (Enlarged uterus)
Duplicates paternal DNA (**Maternal is absent**)
Extremely HIGHHHHH B-HCG
**Diffuse** trophoblastic proliferation & **Edematous chorionic villi**
**NO fetal parts** -- P57 NEGATIVE
Partial: **69 XXX** (Normal uterus)
Focal trophoblastic proliferation
**Maternally expressed** -- **P57 POSITIVE**
Fetal parts are seen
213
Retroperitoneal structures?
SAD PUCKER
1. Suprarenal (adrenal) glands
2. Aorta & IVC
3. Duodenum (**Except 1st part**)
4. Pancreas (**Except tail**)
5. Ureters
6. Colon
7. Kidneys
8. Esophagus
9. Rectum
214
LAD occlusion leads to infarct of what part of heart?
Right coronary artery leads to infarct of what part of heart?
Anterior wall & Anterior septum of LV
Posterior wall, Posterior septum, & **papillary muscles** of the LV
215
Which muscle becomes abscessed due to HIV infection / IV drug use?
**Psoas abscess** due to hematogenous spread
Psoas is a primary **hip flexor**
216
Fragile X syndrome caused pathogenesis?
**CGG** *Trinucleotide repeat* causes *Hypermethylation* & Silences **FMR1**
**Self-mutilation** is common & can be confused w/ Lesch-Nyhan syndrome
| MCC of inherited cause of intellectual disability
217
Edwards syndrome findings?
Hypertonia
Clenched fists
Rocker bottom feet
Every prenatal screening is decreased
| Death usually occurs by 1 -- VSD vs. ASD in Down's
218
Urothelial carcinoma of the bladder arises from?
Major risk factor?
Presentation?
Also called **Transitional cell carcinoma**
Arises from urothelial lining of the renal pelvis, ureter, **bladder**
Major risk factor is **cigarette smoke** / Long term **cyclophosphamide** use
Classically presents with **painless hematuria**
P53 mutation
219
How does Uterine Rupture present?
Risk factors?
Presents w/ painful vaginal bleeding
**Fetal HR abnormalities**, easily palpable fetal parts, **loss of fetal station**
**Prior C section** = Increased risk (usually occurs during labor in a subsequent pregnancy)
220
Vasa Previa presentation?
**PAINLESS** vaginal bleeding (Fetal blood from injured vessels)
**Absent Wharton Jelly**
Fetal HR abnormalities
Path = **Fetal vessels** run over the internal cervical OS
221
Pemphigus Vulgaris pathophysiology?
Morphology?
Autoimmune destruction of desmosomes b/t keratinocytes
**IgG** antibodies against **Desmoglein** (**Type II HS**)
Acantholysis (separation) of **stratum spinosum**
**Oral mucosa** is involved
Nikolsky sign **(+)**
Reticular pattern around epidermal cells
222
Bullous Pemphigoid pathophysiology?
Morphology?
**Less severe** than Pemphigus vulgaris
**IgG** antibodies against **hemidesmosomes** (Epidermal BM -- "Bullow")
Oral mucosa is **Spared**
Nikolsky sign **(-)**
**Linear** pattern @ epidermal-dermal junction
| Basal Layer is detached
223
Median Nerve causes of injury?
Presentation?
**Supracondylar** fracture of humerus -- Proximally
LOSS of **wrist flexion**
Weakness of **thumb flexion** & **Thumb opposition**
**Opponens pollicis, Abductor Pollicis Brevis, Flexor Pollicis Previs**
224
Acute bacterial prostatitis in older males?
Younger males?
**E. Coli** in **older** males
C. Trachomatis & N. Gonorrhoeae in younger males
225
S4 in patients who are under 70 years old indicates what?
Ventricular wall stiffening d/t concentric **left ventricular hypertrophy** in response to chronic hypertension
i.e. aortic Stenosis / Restrictive Cardiomyopathy
226
Which murmurs Increase with Hand grip?
**AR** -- Heard at base or left sternal border
**MR** -- Loudest @ apex, radiate toward axilla
**VSD** -- Holosystolic harsh sounding murmur, loudest @ left lower sternal border
Hand grip Increases **afterload** & **Increases LV volume**
AS Decreases w/ Hand grip
227
Pathogenesis of Theca Lutein Cysts?
Caused by **overstimulation** from **high levels of hCG**
Patient w/ recent history of spontaneous abortion & elevated B-hCG levels
Found within the ovary - also associated w/ Hydatidiform mole, choriocarcinoma
228
Which receptors activate the Gs pathway?
Gi?
Gq?
Gs = All the **betas**, **D1, H2, V2**
Gi = **2 MAD** (**m**2, **a**2, **D**2)
Gq = **HAV 1 M&M** (H1, a1,V1,M1, M3)
229
Which genital lesions are painful?
Which are painless?
**Painful** = HSV-2 (Multiple & vesicular) & Chancroid (Haemophilus Ducreyi)
Chancroid usually a solitary lesion w/ Gray exudate
**Painless** =
Granuloma Inguinale -- Beefy red ulcer that **bleeds easily** (Klebsiella granulomatis)
Lymphogranuloma Venerum -- **Painful lymphadenopathy** but not painful lesion (C.
Trachomatis (**L1-L3**)
Primary syphilis
Secondary Syphilis - **Condyloma Lata**
HPV (**Condylomata acuminata**)
230
Obstrutive vs. restrictive lung disease PFTs?
**Obstructive** -- **FEV1 is decreased more** than FVC
**Restrictive** -- Literally everything decreases
FEV1/FVC ratio is **normal** in restrictive
231
Erythema Nodosum description & disease associatons?
**Painful inflammatory** lesion of **subcutaneous** fat -- usually on **anterior shins**
**Sarcoidosis**, **Coccidiodomycosis**, Histoplasmosis, **TB**, Streptococcal, Leprosy, & **IBD**
232
What type of cardiac tumor is present in an INFANT with tuberous sclerosis?
Cardiac **Rhabdomyoma** (Smaller word for smaller baby)
Rhabdomyosarcoma is the MC sarcoma in children
233
Umbilical cord arteries and veins?
**2 Umbilical arteries** -- From internal iliac (Carry deoxygenated blood from fetus to placenta)
**1 Umbilical vein** (carries oxygenated blood from placenta to fetus
Both vessels surrounded by Wharton Jelly
234
Posterior columns convey which sensations? Ipsilateral or Contrlateral?
**Light touch, vibration, proprioception** from the **IPSILATERAL** extremities
235
Left Anterior descending ECG leads?
V1-V4
236
Left circumflex ECG leads?
I, aVL, V5, V6
237
Right coronary ECG leads?
2,3, aVF
238
Posterior descending ECG leads?
V1-V3
Posterior Leads V7-V9
239
Cushing disease Low-dose dexamethasone test?
ONLY condition that will have **ELEVATED cortisol** (AKA no suppression) levels with **low** dose test
**Suppressed cortisol** w/ high dose
240
Go Find Rex--Make Good Sex
Make = Mineralocorticoids
Good = Glucocorticoids, sex hormones
Zona Glomerulosa secretes aldosterone
Zona Fasiculata secretes cortisol
Zona retiruclaris secretes sex hormones
241
Ankle Sprain Grading?
Grade 1/2/3?
Grade 1 -- Little or no loss of function, able to **bear weight fully** or partially
Grade 2 -- Partial tearing. Swelling, instability & **difficulty bearing weight**
Grade 3 -- **Complete tear** or rupture of the ligament. Severe swelling & **inability to bear weight without severe pain**
242
Location of APTM murmurs?
HY AF
243
De Quervain Tenosynovitis muscles involved?
**aBductor Pollicis Longus** (ABPL)
**Extensor Pollicis Brevis** (EPB)
ABPL & EPB
Abductor Pollicis Brevis -- Seen in severe carpal tunnel
244
V1 V2 V3 foramina?
V1 = **Superior orbital fissure**
V2 = Foramen **Rotundum** (R2)
V3 = Foramen **Ovale** (b**O**ttm) of face
245
The presence of multiple masses almost always points toward...
Metastatic Cancer vs. Single solitary lesion indicates primary
246
BP medications indicated in pregnancy?
Labetalol (Acute)
Hydralazine (Acute) (Arterioles) (Decreases Afterload)
Nifedipine (CCB, Dihydropyridine = Vascular smooth muscle)
Methyldopa
246
Urinary Findings in:
Carcinoid syndrome?
Paget Disease of bone?
Parathyroid adenoma? (primary hyperparathyroidism)
Pheochromocytoma?
247
What does Central Venous Pressure represent?
BP in the VENA Cava
Increased CVP when **blood becomes congested on the right side of the heart**
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Trendelenburg (+) is a weakness with what?
Hip **ABduction**
Gluteus **Medius**
Innervated by the Superior Gluteal Nerve (L4-S1)
Pelvis drop to the side **contralateral** to the weak gluteus Medius muscle
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Median Nerve LOAF?
**1st & 2nd** Lumbricals
Opponens Pollicis
**Abductor** Pollicis brevis
**Flexor** Pollicis Brevis
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CAG
CGG
CTG
GAA
Huntington's = **CAG**
Fragile X = **CGG**
Myotonic dystrophy = **CTG**
Friedreich Ataxia = **GAA**
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Autosomal recessive disorders often present earlier & with more severe symptoms
**Autosomal Dominant** disorders either have **less severe symptoms** or **later age of onset** -- allowing disease to be passed to subsequent generations
X-linked usually found in males & generally closer to recessive disorders in terms of severity and age of onset
Y-linked found in all male offspring
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Differences b/t Marfan & Homo
253
Typical antipsychotics end in?
Atypical?
Typical -- **AZINE** (Fluphenazine)
Atypical = **APINE** & **IDONE** (Quetiapine, Risperidone)
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Absorption of:
Iron
Folate (B9)
B12
Iron -- Duodenum
Folate -- Jejunum
B12 -- Ileum
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Adrenal cortex layers: GFR = ACA
Adrenal medulla produces what?
G for Glomerulosa = Aldosterone
F for Fasiculata = Cortisol
R for Reticularis = Androgens (DHEA)
Adrenal Medulla produces Catecholamines (Epi, NE)
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Sacral diagnosis associated w/ Childbirth?
Bilateral Sacral Flexion
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Most popular example of zero-order drugs?
Ethanol (Alcohol)
Phenytoin
Aspirin
Half life is directly prorportional to the dose -- Half life decreases as the dose decreases
| Constant **Amount** vs. Constant **fraction** in 1st order
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Lesions in the Cortex & Thalamus cause Contralateral abnormalities
Lesions of the Cranial Nerves & CN Nuclei cause ipsilateral abnormalities
The trochlear nerve is an exception -- As it crosses midline when exiting the dorsal aspect of the midbrain
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Menopause Levels of Estrogen, FSH, & LH?
Decreased Estrogen
Increased FSH & LH
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Anterior Horn = LMN
Lateral Corticospinal Tract = UMN
Dorsal columns = Fine Touch / vibration
Spinothalamic = Pain, Temp, Crude Touch
