Practice Test 3 Flashcards
What are the sleep stages and what are the characteristics of each?
Non-REM
-1-Theta wave, light sleep
-2-Spindles, K complexes, bruxism (involuntary teeth grinding)
-3-Delta wave, nocturnal enuresis, sleepwalking, night terrors
REM-Beta wave, loss of muscle tone, changing pulses/BP, inc O2 to brain, dreaming/nightmares,
What effect do benzos have on sleep?
Increase stage 2 sleep
decrease stage 3
When is the beta wave seen other than during REM?
When eyes open
Abnormalities in REM are associated with what disorders?
Narcolepsy and obstructive sleep apnea
Nocturnal enuresis
- Typically due to developmental delay
- Primary-never had a dry period
- Secondary-had a dry period then regressed
- Tx-desmopressin
Choroid plexus papilloma
- Benign neoplasm of choroid plexus villi (produce CSF)
- Increase CSF prod. and obstruct CSF outflow ->hydrocephalus
- Also likely impact the hypothalamus
Hypothalamus
-Controls hunger, thirst, anterior and posterior pituitary regulation, autonomics, temperature, sexual urges, osmolarity regulation, and nausea from area postrema
Anterior hypothalamic nucleus
- Heat loss center (especially pre-optic area)
- controls body temp through vasodilation and sweating
- Damage-> hyperthermia
Posterior hypothalamic nucleus
Produces body heat and controls body temp through vasoconstriction and shivering
- No input from central thermoreceptors
- Inhibited by anterior hypothalamus when body temp increases
- Damage -> poikilothermia (inability to regulate body temp)
Ventromedial nucleus
- Controls satiety
- Damage -> hyperphagia, weight gain
Amygdala
Located beneath the medial temporal lobe of cerebral cortex
- Memory and emotional reactions, erection, ejaculation
- Damage-> Kluver-Bucy syndrome
Kluver-Bucy syndrome is associated with infection by what pathogen?
HSV-1
Basal ganglia
Important for voluntary movements and postural adjustments
- Composed of the caudate nucleus, putamen, globus pallidus, SN, and subthalamic nucleus
- Damage -> resting tremor, chorea, and purposeless movements of athetosis (slow writhing of the fingers)
Cerebellum
- Located above the 4th ventricle
- Responsible for balance and fine motor movements
- Damage of the cerebellar hemisphere -> ipsilateral deficits such as falling toward the side of the lesion
- Can also cause intention tremor, limb ataxia, and ataxic gait
Hippocampus
- Adajacent to the inferior temporal horn of the lateral ventricle
- Forms the ventral surface of the inside of the lateral ventricle (elongated portion of the cerebral cortex)
- Plays a major role in the limbic system (responsible for feeding, fleeing, fighting, feeling, and sex drive)
- Damage -> anterograde amnesia (inability to make new memories)
Fibrocystic changes
- Occur in women of childbearing age
- Sx-breast tenderness and masses that change in size during menses
- Nodular breast tissue
Fibroadenoma
- Most common benign breast tumor
- Characteristics-Firm, painless, mobile, solitary mass
- Usually found in women between 15 and 35 y/o
- Contain glandular and fibrous tissue
- Usually regresses after menopause
Intraductal papilloma
- Present with nipple discharge and breast pain
- Occasionally there will be a palpable mass but it does not change with menses
Lipoma
- Benign tumor composed of adipose tissue
- Freely mobile with well-defined borders
- Non-tender
- Does not change with menses
Lobular carcinoma
- Palpable immobile mass with possible nipple discharge, nipple retraction, or peau d’orange
- Can be asymptomatic until late stages
Anti-cholinergic OD
- Atropine, ipratropium
- Sx-“Dry as a bone, mad as a hatter, blind as a bat, hot as a hare”
- Antidote-physostigmine (AchE inhibitor)
What is the antidote for ethylene glycol toxicity?
Fomepizole
Ventral posterior medial nucleus
Relays taste and face sensation to the primary sensory cortex
-pain from face -> trigeminal nerve -> pons (brainstem) -> spinal trigeminal tract -> medulla -> second neuron crosses midline -> contralateral VPMN of thalamus -> PSC
Lateral geniculate nucleus
Relays info regarding vision from the optic nerve to the calcarine sulcus via the optic radiations
Medial geniculate nucleus
Relays info regarding hearing from the inferior colliculus to the auditory cortex
Posterior part of VLN
- Receives input from deep cerebellar nuclei and projects to the primary motor area of the cortex
- Relays info regarding regulation of movement from the cerebellum
Ventral part of posterior lateral nucleus
Receives sensory input from the body and projects it to the primary sensory cortex
-Transmits info regarding pain and temp and proprioception via the spinothalamic and dorsal columns/ML pathways
What is the effect of hypovolemic shock (excessive blood loss) on diastolic time?
Hypovolemic shock -> decreases diastolic (more than systolic)
-Decreased preload relates to a decrease in CO and increased SVR
What is the HLA subtype associated with MS?
HLA-DR2
Hereditary hemochromatosis
- AR, assoc. with HLA-A3
- Inc intestinal absorption of Fe
- S/Sx-inc Fe deposition in tissues, (liver, heart, pancreas, and pituitary)
- Liver dz, skin pigmentation, DM (bronze diabetes), arthropathy, male impotence, cardiac enlargement and possible HF/conduction defects
Grave’s disease
- HLA-B8
- Hyperthyroidism, goiter, eye dz and pretibial or localized myxedema, proptosis/exophthalmos, periorbital edema
- Abs to the TSH receptor -> hyperthyroidism, inc thyroid hormone production
What diseases are associated with HLA-B27?
- Psoriatic arthritis
- Ankylosing spondylitis
- Inflammatory Bowel Disease
- Reiter’s syndrome
Psoriatic arthritis
- Inflammatory arthritis assoc. with psoriasis
- Morning stiffness, >30 mins
- Alleviated by physical activity
- Skin lesions present before arthritis
- Characteristic features affecting the nail bed-nail pits, onycholysis, hyperkeratosis, and splinter hemorrhages
Ankylosing spondylitis
- A form of spondyloarthritis
- Chronic inflammatory disease affecting the axial skeleton-back pain/stiff spine, hips, and shoulders
- Assoc. with uveitis
Crohn’s disease
- Usually affects the terminal ileum (never affects the rectum)
- Non-caseating/non-necrotizing granulomas, transmural inflammation, possible perforation
- Sx-non-bloody diarrhea
Ulcerative colitis
- Usually involves the distal GI tract (rectum)
- Collections of neutrophils within crypts of Lieberkuhn (abscesses)
- Sx-Bloody diarrhea, fatigue, anemia
Reiter’s syndrome
- AKA reactive arthrits
- Arthritis that arises following an infx (c trachomatis, yersinia, salmonella, shigella, campylobacter, e coli, c difficile, and c pneumo)
- Asymmetric oligoarthritis, 1-4 weeks after infx
T1DM
- HLA-DR3
- Insulin deficiency following the destruction of pancreatic beta cells
- Present with insidious onset of polyuria, thirst, and weakness but can also present with DKA (AMS, dehydration, and respiratory failure)
What is interferon-beta used to treat?
Multiple sclerosis
What is interferon-alpha used to treat?
Hepatitis B and C
What is interferon gamma used to treat?
Chronic granulomatous disease
What is muronomab-CD3 (OKT3) used for?
Immunosuppression after renal transplant
What is trastuzumab used to treat?
HER-2 overexpressing breast cancer
Hirschsprung disease is associated with what genetic abnormality?
Trisomy 21
Cholestyramine
- Bile acid sequestering resin
- Decreases LDL by preventing reabsorption of LDL from the brush border of the small intestine
- Common side effects-GI discomfort and foul taste
Colestipol
- Bile acid sequestering resin
- Major side effects-GI discomfort and foul taste
Ezetimibe
- Involved in preventing the absorption of cholesterol
- Can cause elevated LFTs (rare)
Niacin
- Most effective in increasing HDL
- Common side effect-redness and flushing of face (can typically be prevented with co-administration of aspirin and/or slow titration of effective dose)
Allen’s test
Occlusion of the radial and ulnar arteries with the pumping of the fist then releasing one artery
-positive test is a delay or absence of blood returning to the palm, suggestive of compromised flow of blood within the released artery
A positive phalen’s test is indicative of?
Carpal tunnel syndrome
Watson’s test
Pushing of the scaphoid anteroposterior with the wrist in radial or ulnar deviation
-If the scaphoid subluxes or reduces, this suggests carpal ligament injury
What are the tendons involved in deQuervain’s tenosynovitis?
AKA radial styloid tenosynovitis
Abductor pollicis longus and extensor pollicis brevis
Abductor pollicis brevis
- Largest muscle in the thenar eminence
- Commonly atrophied in severe carpal tunnel
Extensor pollicis longus
-Forms the ulnar border of the anatomical snuff box (the other borders are the abductor pollicis longus and extensor pollicis brevis)
What is the protocol when a patient presents with pain in the anatomical snuff box?
- Fracture until proven otherwise
- Need urgent x-ray to rule out scaphoid (navicular) fracture because this region has poor blood supply and can result in necrosis
What is the underlying mechanism of the production of struvite renal stones?
- Gram negative rods capable of splitting urea into ammonium (proteus, pseudomonas, and klebsiella) (NOT e coli)
- Associated with chronic UTIs
- Struvite stones are composed of Mg-ammonium-phosphate
Compare the pH of the urine in a patient with a uric acid stone to the pH of a patient with a struvite stone
- Urine pH with a uric acid stone-acidic
- Urine pH with a struvite stone-basic
What is montelukast?
Leukotriene receptor antagonist
-Used for maintenance therapy
