Q-bank Flashcards
What is an common GI complication of UC that should be diagnosed w/ plain film x-ray?
Toxic Megacolon
Presents w/ fever, diarrhea, signs of shock
Physcians are ethically and legally obligated to report impaired colleagues to _______
Physician HealthProgram
What can most minor consent to w/o parental consent or notification?
Prenatal care
STI tx
Contraception
Drug/Alcohol rehabilitation
Can most minors consent to abortion?
No. 2/3 of the states require parental consent for abortion
From what cells do Renal Cell Carcinomas originate?
Epithelial cells of the PCT
What is the most common type of kidney tumor?
Clear Cell Carcinoma
Which renal cells cancers often form Papillary Tumors?
Transitional Cell Carcinomas
What is the cause of calcifications causing Aortic Stenosis?
Dystrophic calcification on damaged/necrotic tissue in the setting of NORMAL Ca levels
Describe the normal change that occur due to agin of the heart
Decreased LV chamber apex-to-base dimension
Development of sigmoid-shaped ventricle septum
Myocardial atrophy
Increased Collagen deposition
Accumulation of cytoplasmic Lipofuscin pigment
Vegetations associated w/ bacterial endocarditis are made up of what?
Fibrin and platelet deposition
How do Support and Empathy differ?
Support: expressing concern independent of understanding
Empathy: Physician expressed understanding and vicarious experience
In Acute Hepatitis, what is seen on microscopy?
Ballooning degeneration
Mononucular cell infiltrate
Councilman bodies (eosinophilic Apoptotic hepatocytes)
Chronic NSAID-use can lead to what in the kidney?
Papillary Necrosis
Interstitial Necrosis
Describe the murmur of Aortic Stenosis
(Diamond-shaped) Crescendo-decrescendo systolic murmur
For Hypertrophic Cardiomyopathy, what types of maneuvers will increase the murmur?
Those that decrease preload or afterload (Increase outflow tract obstruction)
Which maneuvers decrease preload and afterload?
Sudden standing
Valsalva
Nitroglycerine
Which maneuvers increase preload and afterload?
Squatting
Hand Grip
Passive leg raise
List the early findings in Rheumatic Fever
Migratory arthritis
Pancarditis
Sydenham chorea
What do the Brachiocephalic Veins drain?
Ipsilateral Jugular and Subclavian veins
Which areas do the External Jugular veins drain?
Scalp and lateral face
How do Strawberry-type Capillary Hemangiomas progress?
Initially grow in proportion to growth of child, then usually regress completely by age 7.
Crohn’s Disease is assoc w/ what in the kidney? How?
Ca-oxalate kidney stones–> Impaired bile acid reabs–> more lipids in gut–> lipids bind to Ca–> Calcium cannot bind oxalate for excretion–> oxalate reabs. and forms renal stones
Why do myocardial cells swell in MI?
ATP deficiency–> Ion pump failure–> increased intracellular Na and Ca –> draws in free H2O–> cells swell
What 3 questions should you ask to screen for elder abuse?
- Do you feel safe at home?
- Who prepares your meals?
- Who handles your checkbook?
Compare the complications of an anterior and posterior duodenal ulcer
Anterior: Perforation
Posterior: Hemorrhage of Gastroduodenal Artery
Describe the course of the ureters as they come out of the kidney
Cross UNDER the gonadal vessels and Uterine vessels in females
Cross OVER the Common/External Iliac Arteries
Anteriolateral to internal iliac vessels
Medial to ovarian Vessels
What kind of acid-base disturbances or Salicylate Intoxication cause?
Acute Resp. Alk–> then Metabolic acidosis
If the PaCO2 level is the LESS than predicted by Winter’s Formula, what does that mean?
There is a concurrent Resp. Alkalosis.
Are physicians required to provide medical services that are against their beliefs?
No
Which form of IBD is more assoc w/ an increased risk of colorectal carcinoma?
UC
How does UC-assoc. Colorectal carcinoma compare to sporadic CRC?
UC-assoc. CRC:
- More likely to affect younger pts
- progress from flat to non-polypoid dysplasia
- histologically appear mucinous/signet ring
- Develop early p53, late APC (reverse of sporadic)
- Be multifocal in nature
- Be in Proximal colon (esp. w/ Crohn’s)
The left kidney lies immediately deep to the tip or which rib?
12th
How do you calculate the Net Excretion Rate of a substance?
(GFR x Plasma conc) - Tubular Reabsorption
What is the current treatment for Hep C?
Interferon-alpha and Ribavirin
What is Ribavirin used to treat?
Hep C and RSV
What are the mech of action for Ribavirin?
- Lethal hypermutation
- Inhibiting RNA Polymerase
- Inhibiting Inosine Monophosphate DHase (depletes GTP)
- Defective 5’-cap formation
- More effective immune response (enhances Th1 immunity and inhibits Th2 cytokine production)
How is PAH handled by the kidneys?
It is freely filtered, and actively secreted by the PCT (CARRIER-mediated—> can become saturated!!!)
NOT reabsorbed at all in the nephron.
What does CREST stand for?
C= Calcinosis R= Raynaud's E= Esophageal Dysmotility S= Sclerodactyly T= Telangiectasia
Which hormone has trophic effects on Parietal Cells?
Gastrin
What stimulates release of Secretin?
Increased duodenal H+ conc.
What does increased Secretin cause?
Pancreatic Bicarbonate secretion
How do pancreatic secretions compare to plasma in terms of tonicity?
Isotonic
Same conc. of Na and K
Increased HCO3-, decreased Cl-
Gallbladder hypomotility can cause ______
Biliary sludge and bile precipitation
What are some risk factors for gallbladder hypomotility?
Pregnancy
Rapid weight loss
High Spinal cord injuries
Prolonged parenteral nutrtion
What reduces the likelihood of gallstone formation?
Decreased cholesterol levels
Increased bile salts and Phosphatidylcholine levels
Why do Renal Cell Carcinoma cells appear clear?
They are filled w/ glycogen and lipids
How does Niancin (Vit. B/Nicotinic Acid) work in the tx of hyperlipidemia?
Inhibits VLDL production and increases HDL levels
How do Statins tx hyperlipidemia?
Inhibit cholesterol synthesis (HMG-CoA Reductase)–> up-regulate LDL-receptors in liver
What are common side effects of Niacin?
Flushing and Pruritis
What are side effects of Bile-binding resins?
Constipation, bloating, hypertriglyceridemia, cholesterol gallstones, vit. K malabsorption
What is Oseltamivir (Tamiflu)?
Neuaminidase Inhibitor
Slow viral penetration of mucous secretions and protect resp. epi.
Used to treat/prevent Influenza A and B
What is Calcineurin?
Activator of IL-2, which promotes growth and differentiation of T-cells
How does Calcineurin work?
Calcineurin–> NFAT–> IL-2–> growth and proliferation of T-cells
What measure would lead to decreased rates of Hepatocellular Carcinoma worldwide?
Vaccination of children against HBV
Which cells are primarily responsible for the uptake of Shigella?
M-cells on Peyer’s Patch
A positive “whiff” test (fishy odor) w/ addition of KOH on vaginal discharge is a sign of________
Bacterial vaginosis (most commonly caused by Gardnerella vaginalis)
What is the toxic component of LPS?
Lipid A
How do Bile acid-binding resins affect Triglyceride levels?
Increase triglyceride levels
How does Chronic Cholestasis from Biliary Obstruction lead to night blindness?
Decreased fat absorption–> decreased vit. A absorption
How does the Beta-adrenergic pathway affect the RAAS pathway?
B-adrenergic pathway–> stimulates RAAS through Beta-1 receptors on JG-cells
B-Blockers inhibit this–> decrease RAAS–> Decrease HTN
What do the Superficial Inguinal lymph nodes drain?
All skin from the umbilicus to the feet, including the anus up to Dentate line, including scrotum, but NOT including:
Posterior calf–> drains into the Popliteal lymph nodes–> Deep Inguinal
Glans penis –> Deep Inguinal
Testes –> Para-aortic
Fistulas are more commonly seen in Crohn’s Disease or UC?
Crohn’s Disease
List the indicators of Liver Function
Prothrombin time
Albumin levels
Bilirubin
List the indicators of hepatocellular injury
AST
ALT
List the indicators of Biliary injury
GGT
Alkaline Phosphatase
In the Crescent form of Rapidly Progressive Glomerulonephritis, what do the Crescents consist of?
Fibrin
Glomerular Parietal Cells
Monocytes/Macrophages
Which artery supplies blood proximal 1/3 of the ureter?
Renal Artery
For this reason, the donor’s proximal 1/3 ureter is preserved in renal transplant
In a Renal Transplant, which arteries/veins are anastomosed?
Donor’s Renal Artery/Vein to Recipient’s External Iliac Artery/Vein
What is the function of the Poly-A tail?
Protects mRNA from degradation w/in cytoplasm after exiting the nucleus
What is the 5’-Cap that is added to mRNA?
7-methyl-Guanosine
What is the Filtration Fraction?
FF= GFR/RPF
How does the Filtration Fraction change in hypovolemia?
It INCREASES I b/c FF=GFR/RPF and GFR decreases less that RPF b/c of compensatory RAAS that maintains GFR
What inputs go to the VPL of the thalamus?
Spinothalamic and Medial Lemniscus
What inputs go to the VPM of the thalamus?
Trigeminal and gustatory pathways
Failure of neural tube closure in week___ of fetal life leads to neural tube defects.
4th
What is a Persistent Vitelline Duct/Fistula?
Complete failure of vitelline duct to close–> small connection b/t intestine and outside of body
What is a Vitelline Sinus?
Partial closure of vitelline duct. Patent portion open at umbilicus.
What is a Vitelline Duct Cyst?
Peripheral portions of vitelline duct obliterate, but central part remains
What is the difference b/t enhancers/repressors and promoters?
Enhancer/repressors: can be located ANYWHERE
Promoters: Typically 25-70bp upstream
What composes the Lesser Omentum?
Hepatogastric ligament
Hepatoduodenal ligament
How do you calculate the total resistance for resistors that are in parallel?
1/Total= 1/R1 + 1/R2 + 1/R3….
What are the 1st and 2nd most common brain tumors in adults?
1st: Glioblastoma
2nd: Meningioma
What do meningiomas arise from?
Arachnoid villi
What is a characteristic feature of Mengiomas?
Psammoma bodies (concentric laminar calcifications)
How is DNA methylation carried out?
DNA Methyltransferase transfers methyl group from donors (like S-adenosyl-methionine) to cytosine
Describe the genetics of Classical Galactosemia
Autosomal recessive
What causes Classical Galactosemia?
Defective Galactose-1-P Uridyltransferase
CanNOT convert Galactose-1-P –> UDP-Galactose
Describe the genetics of Lesch-Nyhan syndrome.
X-linked recessive
Describe the genetics of Leber Hereditary Optic Neuropathy
MT inheritance
Describe the inheritance of Huntington’s Disease
Autosomal Dominant
When does implantation usually occur after fertilization?
6-7days
When is B-hCG usually detectable after ovulation if fertilization occurs?
8 days
Does ALS affect sensation?
NO!
What are the signs of Syringomyelia?
Upper Extremity: Loss of pain/temp sensation, LMN signs Lower Extremity (with expansion of syrinx): weakness and HYPERreflexia
Measures of what two markers allow for prenatal diagnosis of Neural Tube Defects? Which one can be detected in Maternal Serum?
Amniotic Fluid: a-FP and Acetylcholinesterase
Maternal serum: a-FP (can cross placenta)
What is the treatment of choice for Diabetic Ketoacidosis?
Insulin and IV hydration
What does Insulin do in the setting of DKA?
Decreases serum glucose, osmality, and K+
Increases serum HCO3-
Beta-endorphin is an endogenous opioid that is derived from what? What else is derived from this?
POMC
ACTH and MSH are also derived from this
What are Brunner’s Glands?
Compound tubular gland in duodenum
Submucosa layer
Secrete alkaline mucous
Mucous–> Submucosa–> crypts of Lieberkuhn–> duodenal lumen
What 3 mutations have been assoc w/ early-onset Alzheimer Disease/
Amyloid Precursor Protein (APP)- Chrom 21
Presenilin 1- Chrom 14
Presenilin 2- Chrom 1
All promote production of A Beta-amyloid
What mutation(s) are assoc w/ late-onset Alzheimer Disease?
E4 Apolipoprotein
Are jejunal, ileal, and colonic atresias (distal to duodenal) caused by abnormal fetal development?
No. They are caused by vascular accidents in utero.
What is the cause of intestinal atresias distal to the duodenum?
Vascular accidents in utero
What happens in Intestinal atresia distal to duodenum?
Blind-ending intestinal pouch w/ absence of long length of small bowel and dorsal mesentery
Distal portion assumes spiral configuration around ileocecal vessel
What kind of visual defect do macula lesions cause?
Central Scotomas
Dizygotic twins always have ___ amnions and ___ chorions.
2 amnions and 2 chorions
For monozygotic twins, separation at 0-4 days results in ____ chorions and ____ amnions.
2 chorions
2 amnions
For monozygotic twins, separation at 4-8 days results in ____ chorions and ____ amnions.
1 chorion
2 amnions
For monozygotic twins, separation at 8-12 days results in ____ chorions and ____ amnions.
1 chorion
1 amnion
For monozygotic twins, separation at >13days days results in ____ chorions and ____ amnions.
Conjoined twins
1 chorion
1 amnion
Vertigo is commonly due to dysfunction of the __________.
Vestibular system
In Fragile X, where are the trinucleotide repeats located?
Long arm of the X-chrom
Where does the name “Fragile X” come from?
In cytogenetic studies, the area of increased repeats does not stain–> appears broken–> “fragile X”
What is an example of Uniparental disomy?
Complete hydatidiform mole
What are the causes of Down Syndrome?
- Trisomy 21 (95%)
- Unbalanced Robertsonian translocation. Have 46 chrom, but an extra arm of chrom 21 is attached to another chrom.
- Mosaicism
Damage to the Frontal Eye fields causes the eyes to deviate to the ______________ side.
Ipsilateral
Frontal Eye fields control visual attention and eye movements of the ______________ side.
Contralateral
What is Superior Mesenteric Artery Syndrome?
Transverse portion of the duodenum is entrapped b/t the SMA and aorta.
What can cause Superior Mesenteric Syndrome?
Diminished mesenteric fat
Pronounced lordosis
Surgical correction of scoliosis
Tay-Sachs Disease is due to a deficiency in what?
Beta-hexosaminidase A
In Tay-Sachs disease you have accumulation of what?
GM2-ganglioside
What is the inheritance of Tay Sachs?
Autosomal recessive
What is Fabry Disease?
X-linked
Deficiency: a-galactosidase
Accumulated: Ceramide trihexoside
What is Gaucher Disease?
Autosomal recessive
Deficient: B-glucocerbrosidase
Accumulated: glucocerbroside
What is Hurler Syndrome?
Autosomal recessive
Deficient: a-L-iduronidase
Accumulated: Dermatan and Heparan sulfate
What is Hunter Syndrome?
X-linked
Deficient: iduronate sulfatase
Accumulated: Dermatan and heparan sulfate
What is Niemann-Pick Disease?
Autosomal recessive
Deficient: Sphingomyelinase
Accumulated: Sphingomyelin
What is Krabbe Disease?
Autosomal Disease
Deficient: Galacto-cerbrosidase
Accumulated: Galactosyl-sphingosine and galactocerbroside
What is Metachromatic Leukodystrophy?
Autosomal recessive
Deficiency: Arylsufatase A
Accumulated: Cerbroside sulfate
Symptoms: muscle wasting, dementia, ataxia
What are the symptoms of Tay Sachs?
Cherry-red spot in macula
Progressive neurodegeneration
NO hepatosplenomegaly
What is the typical Filtration Fraction for a healthy individual?
20%
How can RPF be calculated using PAH?
RPF= PAH clearance
How can you calculate urinary clearance?
Clearance= (Urine conc x Urine flow) / Plasma conc.
How do you calculate GFR from the Starling Equation?
GFR= Kf ((Pg - Pb)- (oncotic press in Glom - oncotic press in Bowman’s))
How are lipids handled by the GI system?
Digested in duodenum
Absorbed in the jejunum
How do Bile Acids affect lipid absorption?
Necessary for lipid absorption
How does cholecystectomy affect lipid digestion?
Little effect on digestion and absorption
Difficult to eat large meal
What kind of changes occur after cholecystectomy?
Increased rate of enterohepatic circulation
Constantly released into duodenum b/c no storage place
What are the 2 muscles of the middle ear?
Tensor tympani and Stapedius
What innervated the Stapedius muscle?
CN VII
What innervates the Tensor tympani?
CN V3
What is Hyperacusis?
Increased sensitivity to sound
What can cause hyperacusis?
Paralysis of the Stapedius muscle (CN VII, Bell’s Palsy, etc)
What delineates the anterior 2/3 and posterior 1/3 tongue?
Terminal sulcus/ Foramen cecum
Which nerve collects GUSTATORY inputs from anterior 2/3 of tongue?
Chorda tympani of VII
Which nerve collects GUSTATORY inputs from posteriod 1/3 of tongue?
CN IX
Which nerve collects GUSTATORY inputs from posterior area of tongue root and taste buds of larynx?
CN X
Which nerve collects SENSORY inputs from anterior 2/3 of tongue?
CN V3 (Mandibular branch)
Which nerve collects SENSORY inputs from posterior 1/3 of tongue?
CN IX
Which nerve collects SENSORY inputs from root of the tongue?
CN X
The 3rd cranial nerve courses through which two arteries?
Posterior Cerebral and Superior Cerebellar
What are the symptoms of 3rd Nerve Palsy?
Unilateral HA Eye pain Diplopia Dilated, nonreactive pupil Ptosis Ipsilateral eye down and out
Which 2 organs are protected from the general circulation?
Brain and Testes
What is the equation for Loading Dose?
Loading Dose= Cp x (Vd/F)
Cp= Target plasma conc. Vd= vol. of distribution F= Bioavailability
What is the equation for Maintenance Dose?
Maintenance Dose= Cp x (Cl/F)
Cp= Target plasma conc. Cl= Clearance F= bioavailability
What is the equation for Clearance of a Drug?
Clearance= Rate of drug elim/ Plasma drug conc.
How do maintenance and loading doses change if a patient has hepatic or renal insuff?
Same loading dose
Decreased maintenance dose
What is used to treat CO poisoning?
100% O2, Hyperbaric O2
What is used to treat Cyanide toxicity?
Amyl nitrite and Sodium Nitrite–> prevent and reverse binding of cyanide to cytochrome oxidase
Sodium thiosulfate–> accelerates detox of cyanide to thiocyanate
Hydroxocobalamin–> chelates cyanide, forming cyanocobalamin
What is used to treat Methanol poisoning?
Ethanol (competitive antagonist for Alcohol DHase)
Fomepizole (inhibits Alcohol DHase)
What is Strychnine?
Competitive anatagonist of Glycine in CNS
What is used to treat Strychnine toxicity?
Benzodiazepines and Neuromuscular block
What is the mechanism of Arsenic poisoning?
Interferes w/ Oxidative Phosphorylation
What are the symptoms of Arsenic poisoning?
Early: Garlic breath, bloody diarrhea
Late: Hair loss, neuropathy, hyperpigmentation, lung cancer
What is used to treat Arsenic poisoning?
Dimercaprol,
Dimercaptosuccinic acid
D-penicillamine
In terms of Calcium levels, when do Neuromuscular Hyperexcitability become apparent?
Calcium </= 7
What is the most common cause of hypocalcemia?
Primary Hypoparathyroidism
How is Cryotococcal meningitis stained?
India ink–> Negative stain technique due to thick capsule
In Cryptococcal infections, are CSF Leukocyte counts increased or decreased?
Decreased
Lymphocytes predominate
Esp. in HIV pts
How do you treat Cyptococcual meningitis?
Amp B and Flucytosine
Long-term: Fluconazole
Patients w/ both sporadic and hereditary (VHL-assoc) Renal Cell Carcinmoa are found to have deletions of the _______ gene on chrom_____.
VHL (tumor suppressor)
Chrom. 3p
Defects in VHL-gene are found in the majority of patients (40-50%) w/ ______________
Sporadic Renal Cell Carcinoma
What is the cause of Wilson’s Disease?
Mutation in ATP7B
Chrom. 13
Decreased Ceruloplasmin and Decreased secretion of Cu into biliary system–> Less Cu metabolism–> Cu causes oxidant damage to liver–> Cu leaks from injured hepatocytes into blood–> goes to various tissues (brain and eyes)
What are the symptoms of Wilson’s Disease?
Neurological: ataxia, slurred speech, personality change, rigidity/catatonia
Liver: cirrhosis, hepatitis, portal HTN, liver fcn abnormalities
What causes Annular Pancreas?
Abnormal migration of the ventral pancreatic duct
What can happen to the gallbladder in hospitalized patients?
Acute acalculous cholecystitis (Acute inflammation)
Which cytokines are thought to be anti-inflammatory?
TGF-beta
IL-10
Which cytokines are thought to be pro-inflammatory? Which of these acts systemically to promote acute phase repsonse?
IL-1 (acts systemically to promote fever, etc) IL-4 IL-5 IL-12 TGF-alpha
What produces TGF-alpha?
Pro-inflammatory cytokine produced by T-cells and Monocytes
Which organisms are known to infect w/ a very small inoculum?
Shigella (10) Campylobacter jejuni (500) Entamoeba histolytica (1) Giardia lamblia (1)
How can you calculate Renal Plasma Flow from Renal Blood Flow?
RPF= (1-Hct)(RBF)
What are the 3 areas that control bladder function?
- Sacral micturition center
- Pontine Reticular Micturition center
- Cerebral cortex
Which areas stimulate urination?
- Sacral micturition center–> Bladder contraction.
2. Pontine Reticular Formation–> coord. relaxation of External urethral sphincter.
Which inhibits urination?
Cerebral cortex—> inhibits sacral micturition center
What effects do Loop Diuretics have in the kidney?
Inhibit Na-K-Cl symporters
Stimulate PG release
What is Gallstone ileus?
Mechanical bowel obstruction caused when large gallstone erodes into intestinal lumen.
Air in the biliary tract (pneumobilia) is suggestive of this
What is Thalamic Syndrome?
Total sensory loss on contralateral side of body
Proprioception loss
No motor deficits
What vessel abnormalities cause lacunar infarcts?
Small vessel lipohyalinosis
Atherosclerosis
What is the inheritance of Neurofibromatosis Type 1?
Autosomal dominant
Defect in NF-1 gene on chrom. 17
Neurofibromas are tumors of ___________ cells.
Schwann cells
What is Sucrose?
Fructose + Glucose
What is Lactose?
Galactose + Glucose
What is Maltose?
Glucose + Glucose
Aldolase B Deficiency results in ________ intolerance. What should be excluded from their diet?
Fructose intolerance.
Fructose and sucrose should be eliminated from diet.
In cerebral necrosis, what forms glial scar along periphery of cystic space?
Astrocytes
3-5 days after ischemic injury to the brain, which cells will be hyper-dense on Lipid Staining?
Microglia
Phagocytose myelin, dead neurons
What helps to accelerate fetal lung maturity?
Both fetal and maternal Cortisol
Which hormones help accelerate fetal lung development?
Glucocorticoids (BIGGEST effect) PRL Insulin Estrogens Androgens Thyroid Hormones Catecholamines
How do Achalasia and Gastroesophageal Reflux compare in terms of resting pressure?
Achalasia: Increased resting pressure
GERD: Decreased resting pressure
What slows the progression of Hemochromatosis in women?
Menstruation
What is used to stain Iron?
Prussian Blue
Activation of which enzyme is the central event in Acute Necrotizing Pancreatitis?
Trypsinogen–> activates all of pancreatic enzymes
What converts Trypsinogen to Trypsin?
Enteropeptidase
What is Conn’s Syndrome?
Primary Hyperaldosteronism
What are the symptoms of Conn’s Syndrome?
Primary Hyperaldosteronism
Na+ retention–> HTN
K+ secretion–> Hypokalemia–> parasthesia, muscle weakness
What are the 3 most common causes of meningitis in infants (0-3mts)?
- Group B Strep
- E. coli
- Listeria
Which virulence factor allows E. Coli to cause meningitis in infants?
K1 Capsule antigen–> allows bacteria to survive in blood and go to CSF
What are the STOP codons?
UGA
UAG
UAA
What kinds of FA’s cannot be oxidized in the MT?
Very Long Chain Fatty Acids
FA’s w/ branch points at odd-numbered carbons (e.g. Phytanic acid)
What kinds of defects do Peroxisomal Diseases cause?
Neurological defects from improper CNS myelination
What is another name for Lactose?
Galactosyl-Beta-1,4-Glucose
What are the functions of Hypocretin 1/2 (Orexin-A/B)?
Promote wakefulness
Inhibit REN sleep-related phenomena
Where are Hypocretin 1/2 (Orexin-A/B) produced?
Lateral Hypothalamus
What can you measure to diagnose Narcolepsy?
Hypocretin 1/2 (Orexin-A/B) levels in CSF
Where does Hypocretin 1/2 (Orexin-A/B) circulate?
CSF
NOT in blood or peripheral tissues
How do Females and Males differ in their presentation of Non Salt-wasting 21-Hydroxylase Deficiency?
Males: 2-3yrs w/ early virilization, increased linear growth, elevated 17-hydroxyprogesterone and androgens
Females: Ambiguous genitalia at birth (w/ or w/o sal-wasting)
How do you treat Congenital Adrenal Hyperplasia?
Low doses of exogenous corticosteroids to suppress excessive ACTH and reduce stimulation of adrenal cortex.
The virilizing effects of Congential Adrenal Hyperplasia are due to what?
Excessive ADRENAL androgen production
Which artery serves the Internal Capsule?
Anterior Choroidal Artery
What is a Craniopharyngioma?
Tumor arising from Rathke’s Pouch
How is the Pituitary Gland formed?
Out-pouching of the pharyngeal roof (Rathke’s Pouch)
How is the Posterior Pituitary formed?
Extension of hypothalamic neurons
What are the 3 characteristics of Craniopharyngiomas?
Solid
Cystic
Calcified
How do Craniopharyngiomas usually present?
Childhood
Mass effect, visual deficits
What is the onset of Hyperacute transplant rejection?
Minutes to hours
What is the mechanism of Hyperacute Transplant Rejection?
Preformed Abs (usually anti-ABO or anti-HLA) Hypersensitivity Type II
The Phrenic nerve arises from which spinal cord segments?
C3-C5
Involvement/Irritation of the Phrenic Nerve can cause what?
Hiccups (ipsilateral diaphragm)
Dyspnea
Shoulder pain
The Brachial Plexus includes which nerve roots?
C8-T2
What are some neonatal complications of gestational diabetes?
Premature delivery Fetal Macrosomia Hypocalcemia Hypoglycemia Polycythemia Neural tube defects (including Caudal/Sacral Regression Syndrome) Resp. Distress Transient hypertrophic cardiomyopathy
What are the symptoms of Pompe’s Disease?
Acid-Maltase (alpha-glucosidase) deficiency Hepatomegaly Cardiomegaly Macroglossia Hypotonia Mental Retardation
What is the most common extracranial tumor in children?
Neuroblastoma
What do neuroblastomas develop from?
Adrenal Medulla
N-myc proliferation
Opsoclonus-myoclonus is a _______________ syndrome associated w/ _______________.
Paraneoplastic Syndrome
Neuroblastoma
What symptoms does Creutzfelt-Jakob cause?
Rapidly progressive dementia
Myoclonic jerks
What is the most common cause for elevated alpha-Fetoprotein?
Underestimation of gestational age
When should a Pregnancy Triple Test be performed?
16-18 weeks
What is included in a Triple Test during pregnancy?
alpha-FP
hCG
Estriol
What produces alpha-FP?
Early gestation: Fetal liver, GI tract, yolk sac
Maternal AFP increases w/ gestational age
What causes increases alpha-FP?
Neural tube defects
Anterior abdominal wall defects
Multiple gestation
What do Estriol levels reflect in pregnancy?
Placental and fetal function
What produces hCG?
Trophoblast
What are increased hCG levels assoc. with?
Multiple gestation
Hydatidiform mole
Choriocarcinoma
What is C-peptide formed from?
Proinsulin
When do patients w/ Aldolase B deficiency present?
When fructose-containing foods are introduced into the diet.
What are the symptoms of Fructose Intolerance (Aldolase B deficiency)?
Vomiting
Hypoglycemia
20-30min after fructose ingestion
Hepatomegaly
What does Aldolase B Deficiency cause?
Fructose Intolerance
How does Fructose Intolerance lead to hypoglycemia?
Intracellular accumulation of Fructose-1-P and depletion of inorganic phosphate–| glycogenlysis and gluconeogenesis
____% of all values are w/in 1 SD of the mean.
68%
____% of all values are w/in 3 SD’s of the mean.
99.7%
What is the definition of Negative Predictive Value?
Probability of being disease free if the test result is negative.
What affects Negative Predictive Value?
Pre-test Probability
Prevalence (b/c it is directly related to the pre-test probability)
How long to glycogen stores last when fasting?
12-18hrs
Once glycogen stores have been depleted, how does your body produce glucose?
Gluconeogenesis
What are the main steps in gluconeogenesis?
Pyruvate–> Oxaloacetate–> Malate–> (MT to cytosol)–> covert back to Oxaloacetate–> PEP–> Glucose
______________ proteins are involved in the posttranslational processing of oxytocin and vasopressin.
Neurphysins
Which nuclei of the hypothalamus produce ADH and Oxytocin?
ADH: Supraoptic nuclei
Oxytocin: Paraventricular nuclei
What cells give rise to Medullary Thyroid Cancer?
Parafollicular calcitonin-secreting C-cells
What are the characteristics of Medullary Thyroid Cancer microscopically?
Uniform polygonal or spindle-shaped cells
Extracellular Amyloid deposits
MEN 1 syndrome is characterized by tumor of what organs?
Pituitary
Parathyroid
Pancreas (usually Gastrin, sometimes VIP)
How do Gastrinomas present? What is a specific finding?
Upper GI ulcerations, abd pain and diarrhea
Jejunal ulcers are VERY specific
Gastrinomas can be assoc. w/ what syndrome?
MEN1
Should do work-up of: Calcium, Pituitary hormones, PTH hormones
Which medications are strongly assoc. w/ Body Fat Redistribution Syndrome?
HIV-1 Protease Inhibitors
Glucocorticoids
What is the most common cell type in the normal pituitary?
Somatotrophs (Somatostatin)
What are the characteristics of Thyroiditis?
Elevated ESR
Thyroid tenderness
Reduced Radioactive uptake
Mixed cellular infiltrate w/ occasional multinucleate giant cells
In Diabetic Ketoacidosis, what happens to body K+ stores?
Total body K+ DEFICIT
Normal to increased serum K+
Low intracellular levels
This happens b/c increased serum osm–> mov’t of H2O out of cells–> K+ follows so that intracellular levels remain the same
What does Permissive mean in terms of drug effects?
Allows a drug to act at its full potential
What is necessary for two compounds to be synergistic or additive?
Each must be able to elicit effect alone
What kind of bone changes do you see in Hyperparathyroidism?
Osteitis fibrosa cystica
Involves cortical (compact) bone
Subperiosteal thinning and cystic degeneration
What kind of bone changes do you see w/ Osteoporosis?
Trabecular thinning w/ fewer interconnections
What is the Sorbitol (Polyol pathway)?
Glucose—> (Aldolase)–> Sorbitol–> (Sorbitol DHase/Polyol DHase)–> Fructose
Where is the Polyol/Sorbitol pathway esp. active?
Seminal vesicles (sperm) Lens in eyes--> but can become overwhelmed--> cataracts in pts w/ Diabetes
What tissues contain low levels of Sorbitol DHase?
Retina
Renal Papilla
Schwann Cells
How are vit. D, Ca, Phos, and PTH levels affect in patients w/ Celiac Disease ?
Decreased Vitamin D absorption
Decreased Ca and Phos
Increased PTH
What should always be checked before/ monitored in patients taking Amiodarone?
Thyroid Function Tests
What side effects is Amiodarone assoc/ with?
Thyroid Dysfunction Corneal micro-deposits Blue-gray Skin discoloration Drug-related hepatitis Pulmonary Fibrosis
How can Amiodarone affect the thyroid?
Hypothyroidism in iodine-SUFFICIENT areas
Thyrotoxicosis (increased TH) in iodine-DEFICIENT areas
How do sex hormones affect growth?
Promote growth AND Epiphyseal closure
How does Precocious puberty affect growth?
Initial growth spurt–> then short stature b/c promotes epiphyseal plate closure
What histologic change is characteristic of Type II DM?
Pancreatic islet amyloid deposition
Islet amyloid polypeptide=Amylin
Which cells secrete Inhibin?
Sertoli cells
What are the functions of Sertoli cells?
Maintain spermatogenesis
Release Inhibin
Secrete MIF
What is the function of Aldosterone?
Increase Na+ reabs.
Increase K+ and H+ secretion
What is the Aldosterone escape?
High Aldo–> increase Na and H2O reabs–> increase RBF and GFR–> increase rate of Na excretion
What does the overproduction of Aldosterone cause?
- Na+ retention
- HTN
- Metabolic alkalosis
- Hypokalemia
What is the function of the HMP shunt?
Generate NADPH and pentose sugars
Which processes rely on NADPH?
Anabolic rxns that use NADPH as e- donor, such as:
Cholesterol synthesis
FA synthesis
Reduce Glutathione (oxidative damage in G6PD deficiency)
What is the mechanism of Thiazolidinediones?
Bind to Peroxisome Proliferator-Activated Receptor-gamma (PPAR-gamma)
Controls metabolism of Sugar and lipids
Part of steroid and thyroid superfamily nuclear receptors
What is the most important gene regulated by PPAR-gamma?
Adiponectin- a cytokine secreted by fat
Low levels in Diabetes–> increase w/ TZDs
How does Tamoxifen affect Bone, Breast, Endometrium, and Vasculature?
Bone: prevents osteoporosis (pro-estrogen)
Breast: Anti-estrogen
Endometrium: pro-estrogen–> may cause hyperplasia/cancer
Vascular: pro-thrombotic
What is a side effect of Risperidone?
Hyperprolactinemia–> amenorrhea and breast tenderness
What is the treatment of choice for Gestational Diabetes id diet/exercise change as not worked?
Insulin
What are Canagliflozin and Dapagliflozin?
SGLT-inhibitors
Oral anti-diabetic drugs
How do SLGT2 inhibitors work?
Decrease PCT reabsorption of glucose–> promote urinary loss
What must you monitor when patients are taking SGLT2 inhibitors?
Serum Cr and BUN
The mech of action of these drugs is in the kidney
Where does rT3 come from?
T4
How does Cortisol affect Insulin?
Can increase insulin resistance
How does DECREASED Aldosterone affect Na+, K+, HCO3-, Cl-, and H+ levels?
Decreased Na+ Increased K+ Increased H+ Decreased HCO3- Increased Cl-
How does Finasteride work?
5-alpha-reductase inhibitor
Suppressed PERIPHERAL conversion of Testosterone to DHT
What is MEN 2A?
Medullary carcinoma of Thyroid (Calcitonin)
Pheochromocytoma
Parathyroid tumor
What is MEN 2B?
Medullary Carcinoma of Thyroid (Calcitonin)
Pheochromocytoma
Marfanoid habitus/Mucosal neuromas
What drugs are used to treat Grave’s Disease ophthalmopathy?
High-dose gluccorticoids
Decrease inflammation due to lymphocyte infiltration and extraocular volume
What is Anastrozole?
Inhibitor of Aromatase
Used in treatment of metastatic breast cancer
What is Ketoconazole?
Anti-fungal
Decreases androgen synthesis
What is Trastuzumab?
Inhibitor of EGF and HER2/Neu pathways
Apoptosis of breast cancer cells
What is the difference between the causes of Transient and Permanent Central Diabetes Insipidus?
Transient: Posterior Pituitary
Permanent: Hypothalamus
Lipoic Acid is a co-factor for which MT enzymes?
- Pyruvate DHase–> deficiency causes lactic acidosis
- Alpha-Ketoglutarate DHase–> deficiency causes Maple Syrup Urine Disease
- Branched Chain Ketoacid DHase
Where are Thyroid Hormone Receptors located? How des this differ from other Steroid Hormones?
Thyroid Hormone Receptor–> located in nucleus
Other Steroid Receptors–> located in Cytoplasm and translocate to nucleus
What is the most common cause of Hypothyroidism?
Hoshimoto’s Thyroiditis
What is characteristic of Hoshimoto’s histologically?
Intense mononuclear infiltrate w/ Lymphocytes and Plasma cells (Mononuclear)
Well-developed Germinal Centers
What is Kallmann Syndrome?
Absence of GnRH secretory neurons in Hypothalamis
Defective migration of olfactory placode
Symptoms: Central hypogonadism, Anosmia, delayed puberty
How does Botulism toxin work?
Blocks release of ACh from nerve terminal at NMJ
Cerebellar hemangioblastoma is assoc w/ cysts of the kidneys, liver, and/or pancreasis highly suggestive of…..
von Hippel-Lindau Disease
Vin Recklinghausen’s Disease (NF-1)
Inherited PNS tumor syndrome
Presentation: Neurfibromas, optic nerve gliomas, Lindau nodules (pigmented nodules in iris), and cafe-au-lait spots, Pseudoarthrosis
NF-2
Autosomal dominant
Bilateral CN VIII schwannomas
Multiple meningiomas
Sturge-Weber syndrome
“Encephalotrigeminal angiomatosis”
Presentation: Cutaneous facial angiomas (typically CN V1 and V2), leptomeningeal angiomas, mental retardatiion, seizures, hemiplegia, skull radiopacities
Tuberous Sclerosis
Autosomal dominant
Presentation: Kidney, liver, pancreatic CYSTS, BILATERAL renal Angiomyolipomas, CORTICAL subependymal hamartomas, CUTANEOUS angiofibromas and Ash-leaf patches, visceral cysts, cardiac rhabdomyomas
Seizures (major complication)
Osler-Weber-Rendu Syndrome
Hereditary Hemorrhagic telangiectasia
Autosomal Dominant
Telangiectasia Ruptures can cause epistaxis, GI bleed, hematuria
NO cysts
Friedriech Ataxia
Autosomal recessive Cerebellar ataxia Loss of position/vibration sense Kyphoscoliosis Hypertrophoc cardiomyopathy Foot abnormalities DM
Which nerves control the Cremaster Reflex?
L1, L2
What connects the Lateral and Third Ventricle?
Foramen of Monro
What connects he Third and Fourth Ventricle?
Cerebral Aqueduct
What is the mechanism of Opiod Tolerance?
Possibly increased Phos pf Opiod Receptor–> increase AC–> increased NO levels
Activation of NMDA by Glutamate enhances morphine tolerance
What is Ketamine?
NMDA receptor blocker (block action of Glutamate)
Decrease morphine tolerance
Subacute Cerebellar Degeneration
Paraneoplastic Syndrome
Assoc. Small cell lung cancer, breast cancer, uterine cancer
Usually targets Purkinje Cells of cerebellum
Anti-Yo, Anti-P/Q, Anti-Hu Antibodies
What does the Meningitis vaccine contain?
N. meningitidis capsule polysaccharides from 4 diff. serotypes.
Conjugated to Diptheria Toxin
In AIDS pts, the radiographic finding of ring-enhancing lesions in both cerebral hemispheres is most often…….
Toxoplasmosis
What is the 1st line tx for Toxoplamsmosis?
Primethamine and Sulfadiazine
What is the difference b/t DNA polymerase I and III?
I: only one that has 5’–> 3’ exonuclease activity to remove RNA primer
III: 3’–>5’ exonuclease activity to remove mismatched bp
What is found on histology in Wenicke’s Encephalopathy?
Foci of hemorrhage and necrosis in mamillary bodies and periaqueductal gray matter
What is the main function of Thiamine (B1) ?
Glucose utilization
In Thiamine Deficiency you have decreased function which 3 enzymes
- Transketolase
- Pyruvate DHase
- alpha-ketoglutarate DHase
What enzyme can be measured to diagnose Thiamine Deficiency?
Erythrocyte transketolase activity
Which enzymes are inactivated by lead? (Lead poisoning)
Delta-Aminolevulinate DHase
Ferrochelatase
What accumulates in lead poisoning?
Delta-ALA
Protoporphyrin IX
What is the rate-limiting step enzyme in Heme Synthesis pathway?
Delta-Aminolevulinate SYNTHASE
What is Maple Syrup Disease?
Defect: Alpha-keto Acid DHase
Inability to degrade branched a.a. beyond alpha-keto acid state
Presents: Dystonia, poor feeding, maple-syrup urine
What are the symptoms of Vitamin A OVERDOSE?
Intracranial HTN
Skin changes
Hepatosplenomegaly
What are the symptoms of Naicin deficiency?
3 D’s
Dementia
Dermatitis
Diarrhea
What are the symptoms of Vitamin B2 (Riboflavin) deficiency?
Cheilosis Stomatitis Glossitis Dermatitis Corneal vascularizaion
The 1st Pharyngeal Arch is assoc. with the _____________ Nerve.
Trigeminal Nerve
The Neural Crest Cells of the 1st Pharyngeal Arch forms what?
Maxilla Zygoma Mandible Vomer Palatine Incus Malleus Mesodermal: mastication, ant. digastric, mylohyoid, tensor tympani, tensor veli palatini
What structures does the 2nd Pharyngeal Arch from?
Styloid process
Lesser horn of the Hyoid
Stapes
Muscles of fascial expression, stylohyoid, stapedius, posterior digastric
The 2nd Pharyngeal Arch is assoc. w/ the ___________ Nerve.
Facial (CN VII)
What do the 4th and 6th Pharyngeal Arches form?
Cartilaginous Structures of the larynx
What is the most common cause of sporadic encephalitis?
HSV-1 (predisposition of Temporal Lobe)
Edema, hemorrhagic necrosis
What are the anatomic landmarks for CN V?
Lateral aspect Middle Cerebral Peduncle
Which Hypothalamic Nuclei secrete ADH and Oxytocin?
Paraventricular and Supraoptic
What does the Arcuate nucleus of the Hypothalamus release?
DA
GHRH
GnRH
What does the Paraventricular nucleus of the Hypothalamus release?
ADH
Oxytocin
TRH
CRH
What are the most common causes of Aseptic (viral) Meningitis?
Enteroviruses (Coxsackievirus, Echovirus, Enterovirus, Poliovirus)
In Huntington’s Disease you have loss of ______-containing neurons in the________ due to __________ in Chrom ___.
GABA-containing neurons in the STRIATUM
Trinucleotide repeats of glutamate
HD gene in Chrom 4
Which 2 childhood brain neoplasms affect the cerebellum?
Pilocytic astrocytoma (1st most common brain neoplasm of childhood) Medulloblastoma (2nd most common brain neoplasm in children)
What is the difference between Medulloblastoma and Pilocytic Asytocytoma?
Medulloblastoma: often at the vermis. Sheets of small, blue cells. Poorly differentiated.
Pilocytic Astrocytoma: Rosenthal fibers. Low-grade, well-differentiated.
What embryologic tissue is Rathke’s pouch derived from?
Surface Ectoderm
What is derived from surface epithelium?
Rathke's Pouch (Ant. Pit.) Lens and Cornea Inner ear Sensory organs Olfactory epithelium Nasal/Oral epithelium Epidermis Salivary, sweat, mammary glands
What is derived from Neural Tube?
Brain and Spinal cord
Post. Pit.
Pineal Gland Retina
What are the skull bones derived from?
Neural crest
What kind of Immune Deficiency can lead to recurrent infections w/ Neisseria?
Complement factors that form MAC (C5b-C9)
“Clasp-knife” spasticity represents what kind of motor lesion?
Upper Motor Lesion
What is Incidence?
Number of new cases/ total pop. at risk
What Chrom is the Frataxin (Friedreich Ataxia) on?
Chrom. 9
Which areas of the brain are most susceptible to ischemia?
- Pyramidal cells of the Hippocampus and Neocortex
2. Purkinje cells of Cerebellum
What is the first area of the brain to be damaged during global ischemia?
Hippocampus
What kind of virus is JC virus? What is it assoc. w/?
DNA virus
Assoc. w/ Progressive Multifocal Leukoencephalopathy
Subacute Sclerosing Panencephalitis (SSPE)
Rare complication of Measles infection
Several yrs after infection–> accumulation of nucleocaspids
Oligoclonal bands of Measle virus (RNA virus) in CSF
Hemagglutinin and Matrix Protein
Presents: Dementia, various neurologic deficits, rapidly progressive, fatal
What kind of virus is the Measles virus?
RNA virus
What are complications of Measles?
- Primary measles pneumonia
- Secondary bacterial infection
- Neurologic: Encephalitis (days), Acute Disseminated Encephalomyelitis (weeks), SSPE (years)
Describe the Measles virus
Live attenuated
In brain ischemia, when do the first sign of macro and micro changes become visible? What is the first change you see?
12-48hrs
“Red Neurons” is the first change you see.
In brain ischemia what tissue changes happen?
12-48hrs: Red Neurons 24-72hrs: Necrosis and Neurtrophilic infiltration 3-5days: Macrophage infitration 1-2weeks: Reactive gliosis More than 2 weeks: scar
Ornithine Transcarbamoylase Deficiency
Most common disorder or Urea Cycle
High blood ammonia levels
Presents: Severe neurologic abnormalities
Increased Urine Orotic Acid excretion
What are the symptoms of Carpal Tunnel Syndrome?
BILATERAL
Median N. (Compression–> Nerve ISCHEMIA)
Sensory impairment, pain, parasthesias
Palmar surface of 1st 3 digits and half of 4th digit
Motor weakness during thumb abduction/opposition and thenar atrophy
(+) Tinel and Phalen signs
Which protein is involved with Prion Diseases?
PrP (Prion Protein)
Normally in a-helix form–> Beta-pleated sheaths–> resistant to proteases
What co-factor is used by the enzymes in this 2-step rnx? Phenylalanine–> Tyrosine–> DOPA
Tetrahydrobiopterin(B4)
Made by Dihydrobiopterin Reductase
Leber Hereditary Optic Neuropathy
MT Disease
Bilateral vision loss
Myoclonic Epilepsy With Ragged-Red Fibers
MT Disease
Myoclonic seizures and myopathy assoc. w/ excercise
Skeletal muscle has irregularly shaped muscle fibers (“Ragged Red Fibers”)
Mitochondrial Encephalomyopathy with Lactic Acidosis and Stroke-like Episodes (MELAS)
MT Disease
Stroke-like episodes w/ residual neurological deficit
Muscle weakness
Increase serum Lactate
What is the triad of Ataxia Telangiectsia? What is mutated in this disease?
IgA deficiency- Upper and Lower infections
Ataxia
Telangiectasia
Mutation: ATM (Ataxia Telangiectasia Mutated) gene–> DNA break repair
Delirium
Acute
Reversible
Acute-onset confusional state
Fluctuating consciousness
Deficits in attention, memory, executive function
Indicates underlying MEDICAL condition that must be addressed
What kinds of neonatal infections are acquired DURING delivery?
HSV Chlamydia Neisseria Viruses Group B Strep
How is Congenital Toxoplasmosis acquired?
ONLY If mother is infected during first 6mts of pregnancy
In-utero
What is the classic triad for Congenital Toxoplasmosis?
Intracranial calcifications
Chorioretinitis
Hydrocephalus
In tRNA- what are the functions of the 3’ and 5’ ends?
3’- Amino acid attachment
5’- Terminal Guanosine
What is the Cryptococcus found in nature?
Pigeon droppings and soil
What is the primary entry site for Cryptococcus?
Lungs
Even though it usually caused meningitis
What are the clinical manifestations of Rabies Encephalitis?
Restlessness
Agitation
Dysphagia
Progresses to coma 30-50days after exposure to bats
What kind of vaccine for Rabies?
Inactivated virus
Various strains of Rhabdovirus
What is the Length Constant (Space Constant)?
Measure of how far along an axon an electrical impulse can propagate
What neuronal property does Myelin affect?
Length Constant/Space Constant
Increases the distance an electrical impulse can propagate
What is Propionyl-CoA?
Derived from amino acids (Val, Ile, Met, Thr), odd-numbered FA, cholesterol side chains
Precursor for Methylmalomyl-CoA–> Succinyl-CoA–> TCA
Congenital Deficiency of Propionyl-CoA Carboxylase
Cannot convert Propionyl-CoA to Methylmalonyl-CoA
Propionic acidemia–> Poor-feeding, vomiting, hypotonia, lethargy, dehydration, Anion-Gap acidosis
Which CN control the salivary glands?
CN VII: Submandibular and Sublingual glands
CN IX: Parotid gland
What do Craniopharyngiomas arise from? What organ is derived from the same tissue
Rathke’s Pouch
Anterior Pituitary is also derived from Rathke’s Pouch
What is the cellular receptor for the Rabies virus?
NAch Receptors on peripheral nerves–> travels retrograde to CNS
What is Marcus Gunn pupil?
No consensual defect
What is the first step of the Urea Cycle? What activates this step?
CO2+NH3+ATP–> Carbomyl-phosphate
ACTIVATED by N-acetylglutamate (made by N-acetylglutamate synthase)
What is Synaptophysin?
Protein found in neurons, neuroendocrine, and neuroectodermal cells
(+) staining indicated Neuronal origin
Cauda Equina Syndrome
Low back pain Saddle anesthesia Loss of anocutaneous reflex Loss of ankle-jerk reflex Assoc. w/ damage to S2-S4
Cauda Medullaris Syndrome
Lesion at L2
Flaccid paralysis of bladder, rectum
Impotence
Saddle anesthesia
When is Vertical Diplopia most noticeable?
When affected eye looks toward the nose Reading newspaper, walking downstairs Trochlear Nerve (CN IV) palsy
What are the motions of the Superior Oblique and Inferior Oblique muscles?
Superior Oblique: Down and In
Inferior Oblique: Up and In
What is the significance of the Pterion?
Where frontal, parietal, temporal, and sphenoid bones come together
Where Middle Meningeal Artery is located
The Middle Meningeal Artery is a branch of which arteries?
Direct branch of the Maxillary Artery (branch of External Carotid Artery)
Where does the Middle Meningeal Artery enter the skull?
Foramen Spinosum
Where does Succinyl-CoA in the TCA come from?
Methylmalonic acid (Methylmalonyl CoA) ISOMERIZATION to form Succinyl-CoA
How does CN III Diabetic neuropathy/Nerve Ischemia present?
Acute onset diplopia
“Down and out” position (Somatic fibers located CENTRALLY)
Ptosis
NORMAL light and accommodation reflexes (Parasym fibers on PERIPHERY)
Describe the tomography of CN III in terms of somatic and parasympathetic innervation.
CENTRAL: Somatic. Ischemia–> Eye down and out, ptosis. Normal pupil size and light/accommodation reflexes.
PERIPHERAL: Parasympathetic. Compression–> Dilated pupil w/ Loss of accommodation.
Polymyalgia Rheumatica
Occurs in more than 50% pts w/ Temporal Arteritis
Neck, torso, shoulder, pelvic girdle pain
Morning stiffness
Fatigue, wt loss
What is the most feared complication of Temporal Arteritis?
Blindness
What are the 2 enzymes involved in Orotic Aciduria?
Orotate phosphoribosyl transferase
OMP Decarboxylase
Which step is inhibited in Orotic Aciduria?
Orotate–> UMP
How do you treat Orotic Aciduria?
Uridine Supplements–> converted to UMP–> Negative FB–> inhibits Carbomoyl-Phosphate Synthetase-II to attenuate orotic aciduria
Can subarachnoid hemorrhages present w/ nuchal rigidity?
Yes b/c blood in subarachnoid space–> meningeal irritant
What does Strep. pneumo look like on Gram Stain?
Gram +
Lancet-shaped cocci in pairs
What is Conversion Disorder?
Unconscious manifestation of neurologic symptoms when pathophysiological explanations cannot be found.
After significant life stress.
Which part of the spinal cord does B12 Deficiency affect?
Dorsal columns
Corticospinal tract
Symptoms: loss of position and vibration sensation, ataxia, spastic paresis
What is a severe complication of Subarachnoid Hemorrhage? How to prevent?
Vasospasm 4-12 days after
Prevention: Ca+ Channel Blocker
Lambert-Eaton is most commonly associated w/ what other illness?
Underlying malignancy, usually Small cell lung cancer
What is Myasthenia Gravis assoc. with?
Risk of Thymoma
Tetrodotoxin
Pufferfsh
Binds to Na+ channels–> INHIBIT Na+ influx–> prevent AP
Saxitoxin
Dinoflagellates in “Red Tide”
Binds to Na+ channels–> INHIBIT Na+ influx–> prevent AP
Ciguatoxin
Exotic fish, Moray eel
Binds to Na+ channel–> Keep OPEN–> persistent depolarization
Batrachotoxin
South America frogs
Binds to Na+ channel–> Keep OPEN–> persistent depolarization
What kind of teratogenic effects does Valproate cause?
Neural Tube defects
Inhibits absorption of Folic Acid
What is DRESS Syndrome?
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
Occurs 2-8wks after exposure to drug
Drugs: Anticonvulsants (Phenytoin, Carbamazepine), Allopurinol, Sulfonamides (Sulfasalazine), Abx (Minocycline, Vancomycin)
Symptoms: Fever, generalized lymphadenopathy, facial edema, diffuse skin rash, Eosinophilia, organ dysfunction
In terms of congenital defects, what is “Malformation”?
Primary defect in the cells or tissues that form an organ. Intrinsic developmental abnormality
Ex) Holoprosencephaly, Congenital heart defects, anencephaly, polydacyly
In terms of congenital defects, what is “Deformation”?
Fetal structural anomalies that occur due to extrinsic mechanical forces
Ex) Congenital hip dislocation, Potter Syndrome, clubbed feet
In terms of congenital defects, what is “Disruption”?
Secondary breakdown of a previously normal tissue/structure
Ex) Amniotic band syndrome due to amnion rupture
In terms of congenital defects, what is “Sequence”?
A number of abnormalities result from a single primary defect
Ex) Potter Syndrome
In terms of congenital defects, what is “Agenesis”?
Complete absence of an organ
Ex) Renal agenesis
What kind of changes do you see in the brain with Compression Atrophy?
Decrease in number and size of neurons
What is Axonal Reaction?
Changes in the cell body of a neuron that has been severed
Enlarged, rounded cells w/ peripherally located nucleus and dispersed finely granular Nissl substance
Reflects increased protein synthesis for axonal repair
When do you see the biggest amount of change in the axons of severed neurons?
12days after injury
For amino acid reactions, what is vit. B6 (Pyridoxine) important for?
Transamination and Decarboxylation reactions
What is the most common location for Neonatal Intraventricular Hemorrhage?
Germinal Matrix (becomes less prominent 24-32 weeks) The risk of intraventricular hemorrhage increases w/ decreased weight and birth weight (PREMATURITY)
What are the symptoms of PKU?
Normal birth, presents at 6mts
Mental impairment, hyperactivity, seizures, decreased pigmentation of hair/skin, eczema, “Mousy” odor
Which amino acid is essential in pts w/ PKU?
Tyrosine
Which enzyme is most commonly deficient in PKU?
Phenylalanine Hydroxylase
What are the different functions of the Deep and Superficial branches f the Radial Nerve?
Deep branch: Arises near lateral epicondyle of humerus/top of radius. Purely MOTOR innervation of forearm extensor compartment muscles. NO sensory.
Superficial branch: Purely SENSORY to radial half of dorsal hand (EXCEPT distal 1st-3rd digits). NO motor!
In the Urea Cycle, where is the Nitrogen derived from?
NH3 and Aspartate
During an Action Potential, when is the membrane of a neuron most permeable to K+?
Repolarization period
What increases and decreases in Lesch-Nyhan Syndrome?
Decreases: HGPRT, purine salvage pathway
Increases: Degradation of Hypoxanthine and Guanine to uric acid, PPRP levels, and PRRP Amidotransferase activity
CN V3 exists through which foramen?
Forman Ovale
Pick Disease
Rare cause of dementia
Symptoms: social disinhibition, speech abnormalities, emotional flattening
Pronounced atrophy of frontal-temporal regions
What is commonly found in the brains of pts with Alzheimer’s Disease?
Amyloid
What is the most common cause of Intracranial Hemorrhage?
HTN through formation of Charcot-Bouchard psudoaneurysms in small arterioles in basal ganglia and thalami
What is the difference between rupture of Saccular Aneurysm and Charcot-Bouchard Pseudoaneurysm?
Saccular: Subarachnoid hemorrhage
Charcot-Bouchard: sudden onset of focal deficits (basal ganglia, internal capsule, thalamus, pons
What is the key difference between Physostigmine and Neostigmine/Edrophonium? How are they similar?
ALL: AChE inhibitors
Physostigmine: can reverse BOTH CNS and peripheral effect of severe Atropine toxicity
Neostigmine/Edrophonium: Have a quaternary ammonium stx that limits CNS penetration
What is the drug of choice for Trigeminal Neuraliga?
Carbemazepine
Carbemazepine
Mech: Inhibits high-freq firing by reducing ability of Na+channels to recover from inactivation
Uses: first-line treatment for Trigeminal Neuralgia, other uses also
Side Effects: Aplastic anemia, P450-inducer
What is the genetic mechanism of Fragile-X?
Increased number of CGG repeats lead to hypermethylation of Cytosine bases–> Gene inactivation
What side effects can Atropine (anti-cholinergics) have in the eye?
Mydriasis–> Close-angle glaucoma
Cylcoplegia (paralysis of accommodation)
What distinguishes Listeria from Corynebacterium?
Both are Gram + with V or L formations
BUT Listeria have tumbling motility!
Drug-Induced Parkinsonism
Caused by medications that block D2 receptors (more common w/ 1st generation anti-psychotics)
Management: Decreasing/stopping offending drug. Benztropine or Amantadine
Contraindicated: Do NOT give Levodopa or DA-agonists–> will precipitate psychosis
List the Dopamine Agonists
Stimulate DA-receptors
Ergot compounds: Bromocrptine and Pergolide
Nonergot Compounds: Pramipexole and Ropinirole
How do bacteria gain resistance to Cephalosporins?
Change in structure in Penicillin-Binding Proteins
What is the signaling pathway for the following receptors: a1, b2, b2, mAChR, NAChR
a1: IP3–> Ca+
b1: cAMP–> PKA
b2: cAMP–>PKA
mAChR-1/3: IP3–> PKC
mAChR-2: cAMP (decrease)
NAChR: Ion channel–> Na, Ca, K
What is a pathological finding in Creutzfeldt-Jacob Disease?
Large intracytoplasmic vacuoles
How are the side effects of Levodopa affected by adding Carbidopa?
Carbidopa can DECREASE most peripheral side effects of Levodopa
However, behavioral effects can INCREASE b/c more DA (agitation, anxiety, confusion, insomnia, delusion, hallucinations)
What are the symptoms of Vitamin E Deficiency?
Neuromuscular disease (skeletal myopathy, spinocerebellar ataxia, pigmented retinopathy)
Hemolytic anemia
In Wernicke-Korsakoff Syndrome, which symptoms are reversible?
Reversible (Wernicke-syndrome): oculomotor dysfunction, ataxia, confusion
Irreversible (Korsakoff-syndrome): Memory loss, confabulation
Describe HA’s of Brain Tumors
Involve entire head
Progress slowly over time
Lying down (recumbent) makes it worse
May be accompanied by papilledema, vomiting, cognitive decline
What are the 2 types of exacerbations that can occur when treating Myasthenia Gravis? How do you distinguish?
Myasthenic crisis: due to undertreatment
Cholinergic crisis: due to overtreatment
Distinguish: Edophorium will improve Myasthenic crisis, but NOT Cholinergic crisis
What is the most common cause of Communicating Hydrocephalus?
Dysfunction or obliteration of subarachnoid villi
Usually a sequelae of meningeal infection
CYP 450 Inducers
Carbamazepine Phenobarbital (and other Barbituates) Phenytoin Rifampin Griseofulvin
CYP 450 Inhibitors
Cimetidine Ciprofloxacin Erythromycin Azole Antifungals Grapefruit juice Isoniazid Ritonavir (Protease Inhibitors)
What is a common side effect of SSRI’s?
Sexual dysfunction
Selegiline
MAO, Type B
Can prevent MPTP-induced damage of DA-neurons
Used to clinically delay progression of Parkinson’s
Used in 1st line tx of Parkinson’s with Anti-Cholinergics and Amantadine
In opioid use, you NEVER develop tolerance to which side effects?
Constipation
Miosis
Penicillin and Cephalosporins IRREVERSIBLY bind to which proteins?
Penicillin-binding proteins, such as transpeptidases
How do Lipid Solubility and Blood Solubility affect general anesthetics?
DECREASE Blood Solubility: Rapid induction and recovery
INCREASE Lipid Solubility: IncreasePotency
Ataxia Telangiectasia
Autosomal recessive
Defect in DNA-repair genes
DNA is hypersensitive to radiation
Cerebellar ataxia, oculocutaneous telangiectasias, repeated sinopulmonary infections, increased incidence of malignancy
Pneumocystic pneumonia is practically diagnostic for……
HIV
What tests can you use to diagnose Cryptococcus neoformans?
India ink (round or oval budding yeast)
Latex agglutination–> polysaccharide capsule
Culture (Sabouraud’s agar)
Methenamine (GMS), mucicarmine stains of tissue
What is the Blood/Gas Partition coefficient?
Onset of action of a gas anesthetic depends on its solubility
HIGH Blood/Gas Partition Coefficients are MORE soluble in blood–> SLOWER equilibrium in the brain–> LONGER onset time
Transentorial Herniation
Uncal herniation
Medial temporal lobe (uncus) herniates through crus cerebri and tentorium
Compression of: CN III, Posterior Cerebral Artery, Brainstem hemorrhage (stretching Basilar Artery), Contralateral Cerebral Peduncle (ipsilateral hemiparesis)
Subfalcine Herniation
Cingulate gyrus herniates
Under Falx Cerebri
Compression of: Anterior Cerebral Artery
Tonsillar Herniation
Cerebellar tonsils
Through Foramen Magnum
Compression of: Medulla
Arginase Deficiency
Arginase converts Arginine to urea + ornithine
Increase Arginine levels
Symptoms: Spasticity, athetosis
Tx: Low protein, NO Arginine
What is Ornithine transport used for?
Urea Cycle
Transport Ornithine into MT to combine w/ Carbomyl Phosphate to form Citrulline
In Maple Syrup Urine Disease, what gives the urine the sweet smell?
Isoleucine metabolite
What cofactors are important for Branched-Chain alpha-ketoacid DHase, Pyruvate DHase, and alpha-ketoglutarate DHase?
Thiamine Lipoate Coenzyme A FAD NAD
What kinds of drugs can increase Lithium concentrations?
Drugs that increase PCT absorption of Na+
NSAIDs
Thiazide diuretics
ACE-Inhibitors
Common Peroneal Nerve
Most commonly injured leg nerve
Injury: Lateral aspect of leg, Fibular neck fractures, external pressure due to prolonged immobility
Presentation: “Foot Drop”, Plantarflexed and Inverted, Decreased sensation to anteriolateral leg and dorsum of foot
What causes the rapid plasma decay of Thiopental?
Redistribution of drug throughout the body, NOT metabolism!!!
What is the mechanism of Timolol and other Beta-Blockers in Glaucoma tx?
Decrease Aqueous humor production by Ciliary Epithelium
Where are Alpha-1 Receptors located?
Peripheral Vasculature (constriction)
Bladder
Eye (Myadriasis)
Where are Beta-1 Receptors located?
Heart
Where are Beta-2 Receptors located?
Peripheral vasculature (skeletal muscle-vasodilation)
Bronchi
Uterus (Relaxation)
What is the effect of Renal Agenesis on amniotic fluid levels?
Oligohydranminos (too little amniotic fluid)
Not able to produce urine
Waterhouse-Friderichsen Syndrome
Caused by meningococcal sepsis with N. meningitidis
Symptoms: Sepsis, hemorrhagic Adrenal gland destruction, DIC, shock
Does not necessarily cause meningitis
Which drugs are metabolized by CYP450?
Warfarin Phenytoin Propranolol Metoprolol Quinidine Theophylline
What is a side effect of Cimetidine?
Gynecomastia
Pentazocine
Opioid narcotic designed for analgesic effects, but NO Abuse Potential
Partial agonist and weak antagonist activity at Mu-Receptors
Can cause withdrawal symptoms in pts with tolerance or dependence on opioids
Primidine
Anti-convulsant AND 1st-line for Essential Tremor
Active metabolites: Phenobarbital and Phylethylmalonamide
SE: Sedation from phenobarbital
Germinomas
Most common location–> PINEAL gland region
Histologically, similar to testicular seminomas
Symptoms: Precocious puberty, Parinaud Syndrome, obstructive hydrocephalus
Parinaud Syndome
Paralysis of upward gaze and Convergence
Due to compression in tectal area of midbrain (dorsal)
Common of symptom of Pineal Tumors (Germinomas)
First Generation H1-Histamine Receptor antagonists
Diphenhydramine and Chlopheniramine
Can cause significant sedation, esp. when used with other CNS-depressors (Benzodiazepines, etc)
Severe Vitamin E deficiency can mimic…….
Friedriech Ataxia
Dorsal columns, peripheral nerves, and Spinocerebellar tracts
What are some long-term sequelae of Hydrocephalus?
Hypertonicity, Hyperreflexia, learning disabilities, visual disturbances
Damage to Periventricular pyramidal tracts
Myotonic Dystrophy
Autosomal Dominant
Trinucleotide repeat for Myotonia-Protein Kinase
2nd most common inherited muscle disease (after Muscular Dystrophy)
Muscle Atrophy, Type 1 Fibers affected (NO muscle necrosis/fatty replacement like myscular dystrophy
Presenting Symptoms: Can’t let of doorknob/hand during handshake, Cataracts, Frontal Balding
1st generation Antihistamines (Diphenhydramine, Chlorpheniramine) also have what kind of actions?
Antimuscarinic (dry mouth, pupil dilation, constipation, blurry vision), urinary retention)
Anti-Serotonergic
Anti-alpha adrenergic
What are the effects of Antimuscarinic effects?
Dry mouth Pupil dilation Constipation Blurry vision Urinary retention
What is the cause of decreased ACh release in Alzheimer’s?
Decreased activity of Choline Acetyltransferase
Meniere’s
Vertigo
Tinnitus
Sensorial hearing loss
Cause: Increase volume and pressure in endolymph in vestibular apparatus
How do you treat Hyperpyrexia (Temp >40C)?
1st: Cold blankets
2nd: Anti-pyretics (Aspirin, Acetaminophen)
What is the first-line treatment for Narcolepsy?
Frequent naps
Modafinil (Psychostimulants)
How/When does Neimann-Pick Disease present?
When: Infancy
Present: Cherry-red macular spot, hypotonia, loss of motor skills, hepatosplenomegaly
Foamy Histiocytes on microscopy
Death by Age 3
Neuroleptic Malignant Syndrome
Most commonly assoc. w/ Haloperidol Mech: Anti-DA effects Symptoms: Hyperthermia, generalized rigidity, autonomic instability, altered mental status Tx: Dantrolene, Bromocriptine NO way to prevent!
How long can it take to see the effects of Buspirone?
2-several weeks
How does Phenytoin cause Gingival Hyperplasia?
Causes increased expression of PDGF–> Gingival macrophages–> Stimulate proliferation of gingival cells an alveolar bone
What are the main side effects of Phenytoin?
Cerebellar and Vestibular
Nystagmus and Gait instability
What are the durations of the different Benzodiazpeines?
Triazolam: short Lorazepam: Intermediate Diazepam: Long Flurazepam: Long Chlordiazapoxide: Long
Organophosphates
Insecticides
AChE-Inhibitors
Symptoms: Excessive salivation, lacrimation, diaphoresis, urinary incontinence, diarrhea, emesis, miosis, bradychardia
What are the mechanisms of Diabetic Neuropathy?
- Microangiopathy- non-enz glycosylation–> hyalinization and narrowing–> nerve ischemia
- Intracellular hyperglycemia–> Aldolase Reductase–> Glucose converted to Sorbitol and Fructose–> Sorbitol increases osm–> water influx–> osm damage
Which Anticonvulsants can be used to treat Absence seizures?
Ethosuximide
Valproic acid
Lamotrigine
Essential Tremor
Autosomal Dominant
Slowly progressive symmetric postural or kinetic tremor
Tx: Propranolol (Beta-adrenergic antagonist)
What are the side effects of Buproprion?
Psychosis
Seizures (esp. w/ increase dose)
Dry mouth
Which drugs are known to cause seizures?
Buproprion (anti-depressant) Clozapine (antipsychoic at high doses) Isoniazid (Anti-TB, if given w/o Pyridoxine) Ciprofloxacin (Abx) Imipenem (Abx)
What are the symptoms of Atypical Depression?
Mood Reactivity
Criticism/Rejection sensitivity
Increased sleep
Increased appetite
What is used to treat Atypical Depression?
MAO-Inhibitors
What are some things that can worsen the symptoms of Multiple Sclerosis?
Hot showers
Strenuous exercise
Heat exposure
What chemical changes can occur in the brain due to long-term alcohol use?
Downregulation of GABA Rec
Upregulation NMDA Rec (EtOH usually inhibits NMDA)
Increase synthesis of excitatory mediators (NE, Serotonin, DA)
What is the timeline for EtOH withdrawal symptoms?
Within 5-10hrs
- Tremulousness
- GI distress, anxiety, autonomic disturbance
- Delirium Tremens 48-72hrs
How does Listeria stain on blood agar plate?
Narrow-zone of Beta-hemolysis
What kind of immune reaction does Listeria require to fully eradicate?
Cell-mediates
Listeria is a Facultative Intracellular
How does Listeria survive in Macrophages?
Listeriolysin-O
Pore-forming toxin that is activated in acidified phagosomes
What kind of cytokines does Listeria infection stimulate?
IFN-gamma
TNF-Beta
IL-2
How does temperature affect Listeria?
22C: Tumbling motility
4C: Can multiply
How can you prevent spreading N. meningiditis to close contacts?
Rifampin!!!!!
How do the Lateral and Ventromedial nuclei of the Hypothalamus affect food intake? How does Leptin affect them?
Lateral–> Hunger. Inhibited by Leptin.
Ventromedial–> Satiety. Activated by Leptin.
Cerebral Amyloid Angiopathy
Common cause of recurrent hemorrhage
Hemorrhages are smaller than those seen in those caused by HTN
Usually in cerebral hemispheres, not basal ganglia
In First generation Antipsychotics, what is the difference in side effects of the low- and high-potency drugs?
Low-Potency: “Make you feel low” Sedation, Anticholinergic, Orthostatic hypotension
High-Potency: Increase Extrapyramidal symptoms (dystonia, akinesia, tardive dyskinesia
How do Muscarinic-ACh receptors affect the endothelium?
mAChR of endothelial surface
Release Nitric Oxide (Endothelium-Derived Relaxation Factor)–> GC–> cGMP–> Ca+ Efflux–> Vascular Relaxation
What kind of diagnosis if Tetanus? Is there a serum toxin you can measure?
Clinical
There is NO serum toxin that you can meausure
Besides Antidepressants, what other kind of drugs can cause Serotonin Syndrome?
Tramadol (analgesic)
Ondansetron (antiemetic)
Linezolid (Abx)
How does N. meningitidis gain access to the meninges?
Pharynx–> blood–> choroid plexus–> meninges
“Red Ragged” Muscle fibers- what are they characteristic of?
Seen in MT diseases!!
MERRF (Myoclonic Epilepsy with Red Ragged Fibers)
MT Disease
What is the mechanism of Botulinum poisoning?
Blocks presynaptic exocytosis of ACh
BOTH NACh and mACh effects!
What are symptoms of Nicotinic ACh blockade?
Diplopia
Dysphagia
Describe the acute and prophylactic tx for migraines.
Acute: Triptans (Sumatriptan)
Prophylaxis: Beta-blocker, Antidepressants (Amitryptyline, Venlafaxine), Anticonvulsants (Valproate, Topiramate)
What are the similarities/differences between Entacapone and Tolcapone?
BOTH are COMT-Blockers
Entacapone: ONLY decreases peripheral degradation of L-Dopa
Tolcapone: ALSO decreases degradation of DA centrally
What kinds of Antidepressants should not be used in pts with BPH?
TCAs should not be used because have higher Anticholinergic effects–> urinary retention
What is the cause of Homocystinuria? What are the symptoms?
Cystathionine Synthetase Deficiency
Symptoms: Resemble Marfan Syndrome, ectopic lentis, developmental delay, increased risk for thromboembolus
About 50% of pts with Homocystinuria respond to tx with ___________.
Vitamin B6 (Pyridoxine)
Besides Lithium, which other Anti-convulsants can be used for Bipolar Disorder?
Valproate
Carbemazepine
Lamotrigine
What Chromosome is the NF-2 gene on?
Chromosome 22!
Cocaine Intoxication (Symptoms)
Agitation Tachycardia HTN Light-responsive mydriasis Myocardial Ischemia (possible) If used nasally, overtime can lead to nasal mucosa atrophy--> perforation
What is the mechanism of Cocaine?
Inhibits reuptake of NE, DA, and Serotonin
What kind of psychiatric problem can Anti-depressants cause?
Mania
Esp. in those susceptible for Bipolar Disorder
Which drugs are used to treat Alzheimer’s?
Memantine: NMDA-Antagonist
Donepezil, Galantamine, Rivastigmine: AChE-Inhibitors
Vitamin E: Antioxidant
What kinds of drugs should be avoided in pts with Alzheimer’s?
Drugs with depressive effects (Benzodiazepines, etc) UNLESS using to treat anxiety or insomnia
Akathisia
Extrapyramidal side effect of antipsychotic meds
Inner restlessness and inability to sit or stand in one position
***Often misdiagnosed!!! Can make worse if increase drug dose!
What is a rare, but very severe complication of Halothane exposure?
Massive Hepatic necrosis
What causes PKU?
Deficiency of Phenylalanine Hydroxylase OR Tetrahydrobiopterin/Dihydropteride Reductase
How does a Central Retinal Artery Occlusion present?
Acute, painless monocular vision loss
Cherry-red macula
Pale retina
Acute Neonatal Narcotic Withdrawal Syndrome
Pupillary dilation Rhinorrhea Sneezing Nasal stuffiness Diarrhea Nausea Vomiting Chills, tremors, jittery movements Tx: Opium solution (Diluted tincture)
Which virulence factor is responsible for toxic effects seen in meningitis and meningicoccemia?
Lipooligosaccharide (LOS)
What causes liquefactive necrosis in hypoxic brain tissue?
Release of lysosomal enzymes from ischemic neurons
In Organophosphate intoxication, Atropine will NOT reverse which effects?
Muscle paralysis (NAChR)
What is the mnemonic for the symptoms of Organophosphate intoxication?
D=diarrhea U=urination M=muscle paralysis B=bronchospasm E=emesis L=lacrimation S=salivation/ Sweating
What is good and bad about short-acting benzodiazepines?
Good: Less drowsiness
Bad: INCREASED risk for developing dependence
What is the most important virulence mechanism for Staphylococcus epidermidis?
Ability to form BIOLFILMS
If you are suspicious of Temporal Arteritis, what test should you order?
ESR (Erythrocyte Sedimentation Rate)
How can Pancoast Tumors present?
Can manifest as Horner’s Syndrome and/or ipsilateral compressive brachial plexopathy
What do Schwannomas look like histologically?
Biphasic pattern of high cellularity (Antoni A area) and myxoid region (Antoni B)
Elongated, spindle cells
+ S-100
List the 3 Dopaminergic Systems
Mesolimbic-Mesocortical–> Behavior–> Schizophrenia
Nigrostrtiatal–> Coord of voluntary mov’t–> Parkinson’s
Tuberoinfundibular–> Prolactin release–> Hyperprolactinemia
Thiopental (where does it go after going to the brain?)
Barbiturate
Used for SHORT-acting general anesthesia
After equilibrium w/ the brain–> fat and muscle–> quick recovery
What does the Arteriovenous Concentration Gradient tell you about a drug?
Reflects overall tissue solubility of anesthetic–> High tissue solubility–> High arteriovenous conc. gradient–> Slower onset of action
Clozapine (What is the MAJOR side effect you must monitor?)
Atypical Antipsychotic
Blocks D4 DA-receptors( NOT D2 like typical antipsychotics)
Less likely to cause DA-side effects (Pseudoparkinsonism, Tardive dyskinesia, hyperprolactinemia)
SIDE EFFECT: Agranulocytosis–> MUST check WBC
What are the 1st and 2nd generation Antihistamines?
1st: Chloropheniramine, Diphenhydramine, Promethazine
2nd: Fexofenadine
2nd, Do NOT cross BBB, non-sedating, NO antimuscarinic, antiserotoniergic, no anti-alpha adrenergic
SOB, wheezing, and prolonged expirations are indicative of………….
An asthma attack
Why do patients have to wait 2 weeks after discontinuing an MAO before initiating an SSRI?
Allow time for MAO to regenerate/ increase synthesis
To avoid Serotonin Syndrome
Treatment for Alcohol Withdrawal
Benzodiazepines
First-line: Long-acting Benzos (Chlorodiazepoxide, Diazepam)
Liver Dysfunction: Short-acting (Lorazepam, oxazepam)
What are the 3 big side effects of Lithium?
- Hypothyroidism
- Diabetes Insipidus (Nephrogenic)
- Tremors
What is the treatment for Motion Sickness?
Antimuscarinic
OR Antihistamines w/ Antimuscarinic effects (First generation)
How do you prevent cerebral vasospasm after Subarachnoid Hemorrhage?
Ca-Channel Blocker!
Nimodipine!
What is the most common cause of Aseptic Meningitis?
Enteroviruses (Poliovirus, Coxsackivirus Echovirus)
Where do Enteroviruses get their name from?
Fecal-oral transmission
They do NOT typically cause gastroenteritis
Which areas of the brain does Wilson’s Disease affect?
Basal ganglia
What is a common side effect of Trazadone that makes it bad for Adolescent boys?
Priapism
With Trendelenburg’s Sign, which nerve is injured? Which muscles affected?
Superior Gluteal
Gluteus medius, gluteus minimus, tensor fasciae latae
Treatment for TCA-assoc. Cardiac Abnormalities
Bicarbonate
for QRS prolongation, reverse hypotension, ventricular dysrhymias
“On-Off” Phenomenon in Parkinson’s patients with Levodopa
Long-term tx w/ Levodopa
Fluctuations in motor function
Consequence of Nigostrial Neurodegeneration–> decreased therapeutic window for Levodopa–> small changes in drug levels–> bradykinesia
UNPREDICTABLE!!!
Symptoms of Serotonin Syndrome
Confusion Agitation Tremor Tachycardia HTN Clonus Hyperreflexia Hyperthermia Diaphoresis
How doe you treat Serotonin Syndrome?
Cyproheptadine (Antihistamine w/ anti-serotonergic properties)
Serotonin receptor antagonist
What is Phenotypic mixing b/t viruses?
Co-infection of a host cell w/ two viral strains, resulting in progeny virion that contains nucleocapsid proteins from one strain and the genome of the other strain
What are the 3 most important side effects of ALL Protease Inhibitors?
- Hyperglycemia (Insulin resistance)
- Fat redistribution/ Lipodystrophy
- P-450 Inhibitor
How does an Abortive Viral Infection present?
Does NOT cause significant cytopathic effects
No change in host cell
How does a primary HSV-1 infection usually present?
Vesiculoulcerative lesions of oral mucsa
Gingivostomatitis
Cervical lymphadenopathy
Fever
What kind of cells do you see on microscopy with HSV and VZV?
Multinucleated giant cells with intranuclear inclusions
Which Blot Test should be used to assess gene expression?
Northern Blot
How does HBV aid in the infection with HDV?
HDAg must be coated with HBAg
What do the Homeobox genes code for? What is their purpose?
DNA-binding transcription factors
Role in morphogenesis
What is a rare, but serious adverse effect of ACE-Inhibitors?
What is the cause?
Angioedemia (facial, tongue, lips, eyelids swelling)
Sometimes laryngeal edema
Cause: Bradykinin accumulation
What type of antivirals are currently recommended for primary genital herpes?
Nucleoside analogs (e.g. Acyclovir)
What is the mechanism of Nucleoside analogs?
Incorporated in newly replicated DNA–> terminate viral DNA synthesis
Require activation by Viral Thymidine Kinase
What is Thayer-Martin medium? What does it contain?
Used to isolate Neisseria species
Chocolate agar with:
1. Vancomycin: inhibit Gram +
2. Colistin (Polymyxin): inhibit Gram - (E. coli)
3. Nystatin: inhibit Fungi
4. Trimethoprim: inhibit Gram - other than Neisseria (Proteus)
Enterobius vermicularis (Enterobiasis)
Occurs frequently in school-age children
Presentation: Perianal pruritis
Diagnosis: Scotch Tape Test
Tx: Albendazole (1st), Pyrantel Pamoate (Pregnant women)
In HBV, which marker indicates infectivity?
HBeAg
HBsAg- What does it indicate?
Detectable during ACUTE infection
Persistence >6mts–> CHRONIC
Anti-HBs- What does it indicate?
Appearance indicates resolution of acute infection
Confers long-term immunity
Present after vaccination
Anti-HBc IgM- What does it indicate?
Present during ACUTE infection and window phase when both HBsAg and Anti-HBs are absent
Anti-HBc IgG- What does it indicate?
Detectable w/ Anti-HBs and Anti-HBe after recovery from acute infection
Present w/o Anti-HBs in chronic infection
HBeAg- What does it indicate?
Appears after HBsAg during ACTUTE infection
Marker of viral replication activity
Detectable in chronic infection w/ high infectivity
Anti-HBe- What does it indicate?
Present after recovery from acute infection
HBeAg/Anti-Hbe–> transition of chronic infection from high to low viral replication and infectivity
What is the mechanism of Penicillins?
Inhibit Transpeptidase
Structural analogs of D-ala-D-ala
Failed synthesis of bacterial peptidoglycan cell wall
Reactive Arthritis
Triad: Non-Gonococcal urethritis, Conjunctivitis, Arthritis
HLA-B27
Seronegative Spondyloarthropathy (including Ankylosing Spondylitis)
Presentation: Occurs several weeks after genitourinary OR enteric infection
Complication: Sacroiliitis (20%)
What is the most common outcome of HBV infection in adults?
Acute hepatitis w/ mild or subclinical symptoms that completely resolve
>95%
What is the current treatment for sexually transmitted urethritis?
Cetriaxone (N. gonorrhea)
Doxycycline/Azithromycin (C. trachomatis)
Neonatal HBV
Transmission usually during fetal passage, but also transplacentally
High levels of HBV replication
MILDLY elevated liver enzymes
High risk of chronic infection (> 90% higher than adults and children)
What is the p24 protein in HIV?
Nucleocapsid protein
“gag” gene
What is N-myc?
Transcription Factor
What kind of proteins are c-Jun and c-Fos?
Nuclear transcription factors
Bind DNA via Leucine Zipper Motif
