Questions Flashcards
Splitting
Sorts people into categories of all good or all bad
Immature Defense Mechanism
Projection
Denies unwanted feelings in the self and attributes them to others
Regression
Returns to an earlier developmental level of functioning to avoid unwanted feelings
Repression
Hides thoughts and feelings from the consciousness
Fixation
Partial display of more childish level of development for age
Identification
Adopts and models behaviors of another person (usually of authority)
Idealization
Only focusing on positive traits of self or others and overlooking their flaws
Acting out
Expressing unwanted feelings via behaviors
Displacement
Transferring an unwanted feeling from one to another usually one in a neutral position
Reaction formation
Turns unacceptable feelings into their opposite
Rationalization
Justifying behavior to avoid difficult truths
Intellectualization
Focusing on non-emotional aspects to avoid distressing feelings
Humor
Makes light of uncomfortable thoughts or feelings
Mature
Altruism
Doing things for others as a way to deal with painful feelings or thoughts
Mature
Sublimation
An uncomfortable thought or feeling goes directly from unconsciousness to consciousness in a useful or productive form
Mature
Suppression
A conscious and purposeful decision to put a thought or feeling out of one’s mind
Mature
Blastomycosis (Location and Clinical Features)
Location: Great lakes region (Michigan), Ohio River basin, Mississippi River Basin
Clinical: Constitutional symptoms (fever, night sweats)
Inflammatory lung disease (granulomas)
Verrucous skin lesions
Lytic bone lesions
Obturator Nerve (level, sensory area, and motor innervation)
L2-4
Medial thigh
Motor: obturnator externus, adductor longus, adductor brevis, gracilis, pectineus, adductor magnus
Femoral Nerve (level, sensory area, and motor innervation)
L2-4
anterior thigh, medial leg
quadriceps, iliacus, pectineus, sartorius
Sciatic (level, sensory area, and motor innervation)
L4-S3
No sensory
Semitendinosus, semimembranous, biceps femoris, adductor magnus
Common peroneal/fibular (level, sensory area, and motor innervation) Superficial branch
L4-S2
Superificial - innervates lateral portion of leg
Sensory dorsum of foot
Motor - peroneus longus and brevis
Common peroneal/fibular - deep branch ((level, sensory area, and motor innervation)
L4-S2
Deep - innervates anterior portion of leg
Web space between hallux and second digit
Tibialis anterior
Tibial (level, sensory area, and motor innervation)
L4-S3
Sole of foot
Biceps femoris (long head), triceps surae, plantaris, popliteus, flexor muscle of foot
Familial dysbetalipoproteinemia defect
defect in apo E
Familial dysbetalipoproteinemia Lab values
Elevated chylomicron remnants, VLDL, IDL and LDL
Normal HDL
Fracture at midshaft of humerus results in what nerve e being damaged?
Radial nerve - innervates hand and wrist extensors
Fracture at the surgical neck of the humerus results in what nerve being damaged?
Axillary nerve
Innervates the deltoid and teres minor muscles - weakness of external rotation and abduction of the arm
This can also happen with anterior shoulder dislocation
Direct Inguinual Hernia
Medial to inferior epigastric vessel, transverse inguinal (Hesselbach) triangle, covered by peritneum
Indirect Inguinal hernia
Lateral to inferior epigastric vessel, transverse deep and superficial ring, covered by peritoneum and spermatic fasciae
Femoral Hernia
enters anterior thigh through femoral ring, inferior to inguinal ligament
Epigastric hernia
near midline passing around linea alba
Migraine headaches increase the risk of what neuro thing?
Cerebral vascular accidents
Pts with hypovolemic shock from volume depletion present with (inc/dec CO, Inc/dec cardiac index, inc/dec systemic vascular resistance, and low/high cardiac filling pressure)
Low CO, low cardiac index, high systemic vascular resistance, tachycardia, and low cardiac filling pressure
Remember
decreased blood volume -> dec filling pressures and CO -> dec arterial BP and volume -> inc sympathetic activity (inc peripheral resistance, HR, contractility) & inc release of ADH (inc water retention) & inc renin release (inc aldosterone)
Hyperimmunoglobulinemia E (Job’s syndrome) triad
eczema, eosinophilia, and recurrent skin and pulmonary infections
Autosomal dominant
Wiskott-Aldrich syndrome
thrombocytopenic purpura, eczema and frequent infections. Usually see decreased IgM X-linked recessive
Chronic granulomatous disease
Lack of NADPH oxidase (negative nitroblue tetrazolium dye test)
Suspectible to infections by catalase positive organisms (S. aureus, E. coli, Aspergillus)
Chediak-Higashi
Partial albinism, peripheral neuropathy, and recurrent infections by staph or strep species.
Autosomal recessive
Defect in microtubular function -> dysfunctional phagocytosis
Chapmans Point for Larnyx
second rib near the costochondral junction
v wave on JVP waveform reflects what?
Right atrium
Will be accentuated v wave with tricuspid regurg
when does v wave occur on JVP
when the RA is filling behind the closed tricuspid valve
Infraspinatus and teres minor do what?
Externally rotate the arm
Subscapularis does what to arm?
Internally rotates arm
Primary hypothyroidism labs
Decreased T4 and increased TSH. T3 not usually affected since it is produced by conversion from T4 in peripheral tissues
Dihydropridines (drug names and MOA)
nifedipine, amlodipine, felodipine
inhibit the L-type Ca channels on arterial smooth muscle causing vasodilation with little or no effect on cardiac conduction or contractility
Nondihydropyridines (drug names and MOA)
Verapamil, diltiazem
inhibit the L-type calcium channel, affect the myocardium slowing HR (negative chronotropic effect) and reducing contractility (negative ionotropic effect)
Postpartum thyroiditis (pathophysiology and labs)
autoimmune destruction of thyroid follicles and release of preformed thyroid hormone
lymphocytic infiltrates +/- germinal centers
Has a brief hyperthyroid phase, then hypothyroid phase, then return to euthyroid state
DX: inc serum thyroglobulin, dec radioiodine uptake
US show diffuse thyroid enlargement with dec blood flow
What is a good initial therapy for pt with DM neuropathy
SNRI, gabapentinoids, or tricyclic depressants
Ventricular Septal defect description of defect
loud blowing holosystolic murmur at the mid to lower left sternal border and no symptoms. Usually not heard at birth but 4-10 days later
Kluver-Bucy syndrome (location of lesion and symptoms)
bilateral lesions of the amygdalae, and pts present with an absence of emotions including decreased fear and aggression, loss of facial animation, hyperoralitiy, and a marked increase in sexual drive and libido
Actions of biceps femoris
knee flexion and hip extension
Anterior radial head dysfunction forearm prefers pronation or supination?
Prefers supination and is restricted in pronation
Medial umbilical ligaments are remnants of what?
Umbilical arteries
Median umbilical ligament is a remnant of what?
Urachus
Ligamentum arteriosum is a remnant of what?
ductus arteriosus
Ligamentum teres (round ligament of the liver) is a remnant of what?
Umbilical vein
Ligament venosum is a remnant of what?
ductus venosus running in the porta hepatis
Muscle used in exhalation rib ME for rib 1
anterior and middle scalenes
Muscle used in exhalation rib ME for rib 2
posterior scalene
Muscle used in exhalation rib ME for rib 3-5
pectoralis minor
Muscle used in exhalation rib ME for rib 6-8
serratus anterior
Muscle used in exhalation rib ME for rib 9-10
latissimus dorsi
Muscle used in exhalation rib ME for rib 11-12
quadratus lumborum
Chediak Higashi syndrome
Autosomal recessive
affects vesicle fusion and lysosome transport that results in neurologic abnormalities, partial albinism, and immunodeficiency caused by defective neutrophil and natural killer cell function. Have recurrent pyogenic infections
Letrozole MOA and effect
aromatase inhibitor, acts on the ovary and peripheral adipose tissue to inhibit androgen to estrogen conversion by the enzyme aromatase, the subsequent decrease in estrogen production causes the pituitary to release more FSH and LH -> stimulating ovulation
Increases in physiologic dead space occur in what lung diseases?
Pulmonary embolism, emphysema, and acute respiratory distress syndrome
Low tidal volume (increases or decreases) dead space ventilation?
increases
Increased levels of what substance the helps to improve oxygen carrying capacity are typically seen in COPD
Erythropoietin by interstitial cells in the renal medulla and cortex release erythropoietin to stimulate bone marrow to increase RBC production. Secondary polycythemia
Which thyroid condition has a painful thyroid enlargement?
Subacute granulomatous (de Quervain) thyroiditis
What does the biopsy show with subaucte granulomatous thyroiditis?
Mixed inflammatory infiltrate with macrophages and multinucleated giant cells
What does the biopsy show with Hashimoto thyroiditis
Lymphocytic infiltrate with well-developed germinal centers
PCP (phencyclidine) class and intoxication symptoms
Hallucinogen
Violent behavior, dissociation, hallucinations, amnesia, nystagmus, ataxia
LSD class and intoxication symptoms
Hallucinogen
Visual hallucinations, euphoria, dysphoria/panic, tachycardia, HTN
Cocaine class and intoxication symptoms
Stimulant
Euphoria, agitation/psychosis, chest pain, seizures, tachycardia/HTN, mydriasis
Methamphetamine class and intoxication symptoms
Stimulant
Violent behavior, psychosis, diaphoresis, tachycardia/HTN, choreiform movements, teeth decay
Marijuana class and intoxication symptoms
Cannabinoid
Increased appetite, euphoria, dysphoria/panic, slow reflexes, impaired time perception, dry mouth, conjunctival injection
Heroin (class and overdose symptoms)
Opioid
Euphoria, depressed mental status, miosis, respiratory depression, constipation
Most common cause of ASD is failure of closure of what?
Ostium secundum
Eisenmenger syndrome
caused by reversal of blood flow through an uncorrected ASD, VSD, or patent ductus arteriosus. Results in dyspnea, cyanosis and pulmonary hypertension
Fixed splitting of the S2 heart sound characteristic of what?
ASD
Sheehan syndrome
infarction of the pituitary gland, secondary to significant postpartum bleeding causing hypoperfusion of the pituitary gland - cause a decrease in hormones produced by the anterior pituitary (FSH, LH, ACTH, TSH, prolactin, and GH).
MEN2B
Mucosal neuromas, marfanoid body habitus, medullary thyroid carcinoma, pheochromocytoma
Mutation in RET (proto-oncogene)
Autosomal dominant
MEN2A
Parathyroid hyperplasia
Medullary thyroid carcinoma
Pheochromocytoma
Mutation in RET (Proto-oncogene)
MEN1
3 P's Pituitary adenoma Parathyroid hyperplasia Pancreatic tumors (gastrinoma, insulinoma, vipoma, glucagonoma) Mutation in MEN1 gene
Pathophysiology of edema in nephrotic syndrome
decreased plasma protein -> leads to decreased oncotic pressure thus less force for pulling fluid back into capillaries
Acute idiopathic thrombocytopenic purpura
follows a recent viral infection, seen in young kids
Antibody against GbIIb/IIIa that triggers splenic destruction of platelets. Leads to bone marrow production of platelets being increased and increased megakaryocytes in the marrow
Leydig cells produce what?
Testosterone
rod-shaped intracytoplasmic crystal-like inclusions with rounded ends. Describes what and what diagnosis is it associated with?
Reinke crystals and Leydig tumor (sex cord-stromal tumor, MC)
Sickle cell disease mutation? Is sickle cell AR or AD?
Point mutation in hemoglobin causing glutamic acid to be replaced by valine
Autosomal recessive
What is located at the same level as the angle of Louis
bifurcation of the trachea (carina)
Loop diuretic (names, MOA, and where in kidney)
Furosemide, bumetanide, torsemide
Inhibit Na/K/2Cl at thick ascending loop of Henle
Decrease preload and Ca reabsorption in the kidney
Ethyacrynic acid can be used in pt with sulfa allergy!!
Loop diuretic adverse effects (remember mnemonic)
OHH DANG
Ototoxicity, hypokalemia, hypomagnesemia, dehydration, allergy (sulfa), metabolic alkalosis, nephritis (interstitial), gout
Foreign bodies are most likely to enter which lobe and why?
lower lobe of the R lung since the right mainstem bronchus is more vertical than the L mainstem bronchus
Supracondylar humeral fractures commonly occur after hyperextension of the elbow as a result of fall onto an outstretched arm and damage what nerve?
Radial nerve (runs along anterolateral aspect of the elbow)
Test used to compare the means of 2 groups
two sample t test
Majority of water reabsorption in the nephron occurs where?
Proximal tubule
Medial geniculate nucleus of thalamus receives what input?
Auditory input and delivers it to the auditory cortex of the temporal lobe
Pentad for thrombotic thrombocytopenic purpura
FAT RN
Fever, anemia, thrombocytopenia, renal failure, neurologic symptoms (headache, confusion)
APC tumor suppressor or oncogene?
Tumor suppressor
Friedrich ataxia (mutation, symptoms, most common cause of death)
AR disorder caused by trinucleotide repeat GAA that causes poor mitochondrial function. Staggering gait, nystagmus, pes cavus, and hammer toes are characteristic. Most common cause of death is hypertrophic cardiomyopathy
Disseminated gonococcal infection symptoms and what usually causes it?
migratory polyarthralgia, septic arthritis, tenosynovitis, and dermatitis (vesiculopustular eruption on palms, arms, and legs)
Neisseria gonorrhoeae
Tx with ceftriaxone
In sacral torsion with positive spring test or backward bending is sacrum flexed or extended and is L5 following Type 1 or 2 fryettes?
Extended
L5 following type 2 and will be rotated and sidebent the same way as the axis so if R on L will be sidebent and rotated L
Symptoms of thoracic outlet syndrome are due to neurovascular compression between what 2 muscles?
Anterior and middle scalenes
Celiac artery supplies what abdominal organs?
stomach
liver
spleen
portions of pancreas and duodenum
Superior mesenteric artery supplies what abdominal organs?
Portions of the duodenum, pancreas, and ascending and transverse colone
Inferior mesenteric artery supplies what abdominal organs?
transverse colon, descending and sigmoid colon and rectum
Posterior cord of brachial plexus is composed of which nerves
Axillary and radial
So issues with shoulder abduction and elbow, wrist and finger extension
Colchicine MOA and side effects
inhibits tubulin polymerization into microtubules and can be used for acute treatment and prophylaxis of gout. Important side effects of colchicine include nausea, abdominal pain, and diarrhea
Noncardiogenic pulmonary edema will have elevated or normal pulmonary capillary wedge pressure? Examples?
Normal
Acute respiratory distress syndrome, high altitude pulmonary edema
Cardiogenic pulmonary edema will have elevated or normal pulmonary capillary wedge pressure? Examples?
Elevated
decompensated left ventricular failure, volume overload
Zolpidem MOA
short acting nonbenzodiazepine hypnotic agent that is a GABAa agonist.
Pilocystic astrocytoma in kids or adults? Benign or malignant? Where do they occur? What is on CT or MRI?
Most common benign in kids.
Usually occur in cerebellum
Unilocular or multiocular cyst with an associated tumor nodule
Histology seen in 2-4 hrs after MI
abundant granulocyte emigration
Histology seen in 4-12 hrs after MI
early coagulative necrosis is seen upon histologic evaluation as neutrophils begin to migrate towards the recently infarcted area to degrade tissue.
Histology seen 5-10 days after MI
neutrophils replaced by macrophages
Histology seen 7-10 days after MI
fibroblasts with type III collagen synthesis
Histology seen 7-8 weeks after MI
dense type I scar tissue
Rett syndrome mutation and symptoms
Deletion of MECP2 gene on X chrosome
Female child presents with regression of milestones and constant midline hand movements (clapping or wringing)
APGAR (what does it stand for?)
Appearance Pulse Grimace Activity Respirations
Axillary nerve (compartment of arm and primary action)
shoulder
abduct, flex, extend shoulder
C5-6
surgical neck fracture or anterior humerus dislocation causes issues
Radial nerve (compartment of arm and primary action)
C5-T1
posterior arm and posterior forearm
Extend elbow wrist, thumb digits
Axilla or midshaft fracture causes issues
Musculocutaneous nerve (compartment of arm and primary action)
Anterior arm (biceps, brachialis, coracobrachialis) flex elbow
Ulnar nerve (compartment of arm and primary action)
anterior forearm (minor) and palm of hand
ulnar deviation of wrist, gripping, abduction and adduction of digits 2-5
C8-T1
fall on outstretched hand (damage hamate) or medial epicondylar fracture causes issues
Ulnar claw - unable to flex digits 4-5
Median nerve (compartment of arm and primary action)
Anterior forearm and palm of hand (minor)
1/2LOAF (1st and 2nd lumbricals, opponens pollicus, abductor pollicus brevis, flexor pollicus brevis)
flex wrist, flex digits, flexion, abduction, opposition of thumb
C5-T1
Supracondylar fracture causes issues - benediction sign unable to flex first 3 digits
Von Hippel Lindua disease (AD or AR), where is deletion (what chromosome) and clinical features
AD
deletion of VHL gene on chromosome 3p
Hemangioblastomas, bilateral renal cell carcinomas, pheochromocytomas
Nephroblastoma/Wills Tumor
Peak age 3-4 years
Mass seldom crosses midline
Intrinsic to kidney on imaging (claw sign)
Rings have true lumens
Calcifications and paraneoplastic effects are rare
Neuroblastoma
Peak age <2 yo mass often crosses midline extrinsic to kidney on imaging calcifications are common rings contain neural filaments paraneoplastic effects (neurologic) are common
Becks Triad (symptoms and what they dx)
hypotension
jugular venous distension
distant or muffled heart sounds
Pericardial tamponade (or cardiac tamponade)
Obstructive Lung Disease PFT findings and example
Emphysema and COPD
Increasing airway resistance and lung compliance
decreased FEV1/FVC
Increases in TLC, FRC and RV
Thiamine is a cofactor for what enzymes (5 things)
transketolase, alpha-ketoglutarate, dehydrogenase, branched chain ketoacid dehydrogenase and pyruvate dehydrogenase
Wernicke encephalopathy
what is it caused by and symptoms?
thiamine (vit B1) deficiency is characterized by dementia, nystagmus, and/or ophthalmoplegia and ataxia. The symptoms can be precipitated or worsened when a malnourished pt receives glucose before being supplemented with thiamine
Ewing sarcoma (malignant or benign) what is translocation associated with it? Population it affects and part of bone (metaphysis, epiphysis, or diaphysis)?
Malignant bone tumor in young males
Affects diaphysis of long bones
t(11;22) translocation - transcription factor
Histologically - anaplastic, small blue cells
Indirect coombs tests for what?
Used to test for antibodies in a serum
antibodies to Rh+ cells test whether these antibodies are present in the maternal serum
Direct coombs
Test for antibodies attached to red blood cells
Substances that are chemotactic for neutrophils
C5a, N-formyl-methionyl peptides from bacteria, leukotriene B4, fibrinopeptides, and interleukin-8
Rate limiting step of heme synthesis?
Aminolevulinic acid synthase (glycine + succinyl-CoA to aminolevulinic acid in mitochondria)
Affected enzyme in acute intermittent porphyria
Porphobilinogen deaminase leads to buildup of prophobilinogen during heme synthesis
5 P’s of acute intermittent porphyria
Painful abdomen Port wine colored urine Polyneuropathy Psychologic disturbances Precipitated by drugs (cyto P450 inducers, alcohol, starvation)
Porphyria cutanea tarda - affected enzyme and symptoms
uroporphyrinogen decarboxylase
Most common porphyria
blistering cutaneous photosensitivity and hyperpigmentation
associated with Hep C
Amyotrophic lateral sclerosis (ALS) is a demyelinating disease that affects what part of the spinal cord and what area of the brain?
Anterior horns of spinal cord (LMN symptoms)
Motor areas of cortex and brainstem (UMN symptoms)
Hyperparathyroidism mnemonic
bones, stones, abdominal groans and psychologic moans (kidney stones, bone pain, GI disturbances -peptic ulcer disease, and psychiatric symptoms)
Labs in central hypothyroidism and some common causes of it?
Low TSH and T4 levels
Causes: Sheehan syndrome (pituitary infarction), sarcoidosis, hemochromatosis, pituitary surgery/trauma, mass lesions (pituitary adenoma)
RCA perfuses what part of heart?
inferior wall of the LV and majority of the RV. Proximal occlusion can cause right ventricular MI
SIADH lab findings and drugs that commonly cause it
hypotonic hyponatremia (low serum osmolality and serum sodium), concentrated urine (high urine osmolality) and euvolemia Drugs - Carbamazepine, SSRI, NSAIDs, cyclophosphamide and CNS disturbances (Stroke, hemorrhage, trauma)
What is the rate limiting enzyme in the pentose phosphate pathway? What is it a major source of?
Glucose-6-phosphate dehydrogenase
NADPH
Which heart failure is characterized by normal left ventricular (LV) ejection fraction, normal LV end diastolic volume and elevated LV filling pressures? What are some important causes?
Diastolic heart failure
Causes - hypertension, obesity, and infiltrative disorders (transthyretin-related amyloidosis, sarcoidosis)
Severe diarrhea causes what acid/base disturbance?
Metabolic acidosis - loss of bicarbonate in the stool
Name of nontender, macular, and erythematous lesions typically located on the palms and soles of pts with acute infective endocarditis?
Janeway lesions - result of septic embolization from valvular vegetations
Western blotting is used to identify
Proteins
Northern blotting identifies
Specific RNA sequences
Southern blotting identifies
specific DNA sequences in an unknown sample
Essential fructosuria (benign or life-threatening?) What enzyme is deficient?
Benign
Fructokinase
Equation for sensitivity
TP/ (TP + FN)
Sensitivity of a test determines how well the test categorizes pts who have the disease of interest
Equation for specificity
TN/ (FP + TN)
How is dobutamine used during stress tests?
Dobutamine mimics the effects of exercise and increase myocardial oxygen demand. It can be used during stress testing to provoke areas of ischemic myocardium, which can be recognized on imaging by a localized and transient decrease in contractility
Stable angina results from what?
Fixed coronary artery stenosis that limits blood flow to downstream myocardium, preventing the myocardial oxygen supply from increasing during exertion
Barrett esophagus
esophageal squamous epithelium is replaced by columnar epithelium in response to chronic acid exposure
Osler-Weber-Rendu syndrome (AR or AD) and symptoms?
autosomal dominant condition marked by the presence of telangiectasias in the skin as well as the mucous membranes of the lips, oroasopharynx, respiratory tract, GI tract, and urinary tract. Rupture of these telangiectasias may cause epistaxis, GI bleeding, or hematuria.
Failure of (blank) closure causes spina bifida
caudal neuropore
Isometric muscle contraction definition
when the forces applied between the physician and pt are equal; this results in increased muscle tension with no approximation of origin and insertion
Restrictive Lung disease PFT findings
TLC decreased Residual volume decreased FEV1 decreased (dec same or less than FVC) FVC decreased FEV1/FVC normal or increased compliance decreased
Obstructive Lung disease PFT findings
TLC increased Residual volume increased FEV1 decreased (dec more than FVC) FVC decreased FEV1/FVC decreased Compliance increased
Pt with portal hypertension may develop esophageal varices due to increased blood flow from the (blank) vein of the portal venous system into the (blank) vein of the systemic venous system
Left gastric and azygous
How do low estrogen levels in postmenopausal women lead to osteoporosis?
Estrogen normally inhibits osteoclast, so lack of estrogen means that osteoclast will work and have increased bone resorption
What are the labs seen when checking for Down’s syndrome. Maternal serum alpha fetoprotein (up or down), estriol (up or down), B-hCG (up or down) and inhibin A (up or down)
low levels of maternal serum alpha-fetoprotein and estriol and increased levels of B-hCG and inhibin A
harsh ejection type systolic murmur heard best at the base of the heart with radiation to the carotid arteries
Aortic stenosis
gastric tumor that has metastasized to the ovary and can present with unintentional weight loss, epigastric pain, and adnexal masses. What is this? What is the histology?
Krukenberg tumor
Histology - metastatic tumor cells have large amounts of mucin with displaced nuclei, resulting in a signet ring appearance
Anion gap equation and normal value
Anion gap = Na - (Cl+HCO3) normal is 10-14
Common causes of normal anion gap metabolic acidosis
due to loss of bicarbonate
Causes: severe diarrhea, renal tubular acidosis, excessive saline infusion
Will often have high chlorine levels with it
Common causes of elevated anion gap metabolic acidosis
Mechanism -> accumulation of unmeasured acidic compounds
Lactic acidosis, diabetic ketoacidosis, renal failure (uremia), methanol, ethylene glycol, salicylate toxicity
What causes left shift of oxygen-hemoglobin dissociation curve?
Decreased H (increased pH)
Decreased 2,3-BPG
Decreased temperature
What is the major blood supply to the femoral head and neck?
Medial circumflex femoral artery and its branches
1st line therapy for pyelonephritis with flank pain and pyruria
fluoroquinolones (ciprofloxacin or levofloxacin)
Gerstmann syndrome (where is lesion located) and symptoms expected with lesion
dominant inferior parietal lobe and is characterized by agraphia, acalculia, finger agnosia, and left-right disorientation
Lactose breaks down into?
Galactose and glucose
What type of aphasia is Broca’s aphasia
expressive non-fluent aphasia
Spinal dural attachments are at what 4 places?
foramen magnum, C2, C3, and S2
Leser-Trelat sign what is it and what is it associated with?
explosive onset of multiple seborrheic keratoses and is most often associated with adenocarcinoma of the stomach
In BPH will GFR (inc, dec, or no change), RPF (inc, dec or no change) and FF (inc dec or no change)
GFR decrease
Renal plasma flow - no change
FF - decrease
Which nephrotic syndrome is associated with HIV infection?
Focal segmental glomerulonephritis
Bilateral destruction of amygdala? What is name of disease and symptoms
Kluver Bucy syndrome which is characterized by visual agnosia, hyperorality, hypersexuality, and docility
AR disorder caused by defective transportation of cystine, ornithine, argnine, and lysine across the intestinal and renal tubular epithelium. What is this and what is the only clinical symptom?
Cystinuria and only symptom is nephrolithiasis
AR disorder resulting from a defect in DNA repair genes. The DNA of these pts is hypersensitive to ionizing radiation. Manifestations include cerebellar ataxia, oculocutaneous telangiectasias, repeated sinopulmonary infections, and increased incidence of malignancy
Ataxia-telangiectasia
Flutamide MOA
nonsteroid anti-androgen that acts as a competitive inhibitor of testosterone receptors.
Decrease in prevalence causes (increase or decrease) of positive predictive value?
Decreased PPV
characterized by personality and behavioral changes, deteriorating impulse control, and atrophy of the frontal and temporal lobes
Frontotemporal dementia
Painful vaginal bleeding in 3rd trimester and a tender and firm uterus
abruptio placentae - premature placental separation from uterus
Painless vaginal bleeding in 3rd trimester with no uterine tenderness
Placental previa - placental implantation over the cervix
Metabolic alkalosis labs (pH, HCO3)
pH > 7.45
HCO3 high >24
Respiratory alkalosis (pH, PaCO2)
pH >7.45
PaCO2 <40
Respiratory acidosis (pH, PaCO2)
pH <7.35
PaCO2 >40
Metabolic acidosis (pH, HCO3)
pH <7.35
HCO3 <24
Kidney stone usually seen in woman with multiple upper UTIs
Struvite stone
UTI infection by urease producing organisms (Proteus, Klebsiella). Alkalinizes urine (pH >7)
Which palsy presents with vertical diplopia when the affected eye looks down and toward the nose (walking downstairs, up close reading)? What muscle does this nerve innervate?
Trochlear nerve palsy
Innervates superior oblique muscle which causes the eye to internally rotate and depress while adducted
Epidural hematoma vessel typically involved? Location? Clinical manifestation? Presentation on CT scan?
Middle meningeal artery
between skull and dura mater
lucid interval, followed by loss of consciousness
biconvex hematoma
Subdural hematoma vessel typically involved? Location? Clinical manifestation? Presentation on CT scan?
Bridging cortical veins btw dura mater and arachnoid mater acute: coma at onset Chronic: gradual onset of headache and confusion Crescent shaped hematoma
Subarachnoid hemorrhage vessel typically involved? Location? Clinical manifestation? Presentation on CT scan?
Aneurysm or AV malformation of anterior or posterior communicating arteries or MCA
Between arachnoid mater and pia mater
severe headache (worst of my life), nuchal rigidity
Blood in the basal cisterns
Where is myenteric (Auerbach) plexus located?
between the longitudinal and circular layers of muscularis externa in GI tract.
This is where the the ganglions are absent and lead to absence of relaxation in Achlasia
Where is Meissner plexus?
Submucosal
Responsible for regulating local secretion, blood flow, and absorption
21-B hydoxylase deficiency CAH
Dec mineralocorticoids and glucocorticoids Inc androgens Inc ACTH Salt wasting Hyperkalemia, hyponatremia hypotension Ambiguous genitalia in girls
11-B hydroxylase deficiency CAH
Inc mineralocorticoids (11-deoxycorticosterone) and androgens Dec glucocorticoids Inc ACTH Hypertension Hypokalemia Ambiguous genitalia in girls
17-a-hydroxylase deficiency in CAH
Inc mineralocorticoids Dec androgens and glucocorticoids Hypertension Hypokalemia ambiguous genitalia in boys; absent puberty
Trick for CAH deficiencies if it starts with a 1 (17 or 11 hydroxylase deficiency) does it have HTN or hypotension
If it ends with a 1 does it cause virilization in females or nah?
HTN (17 and 11)
Virilization in females (21 and 11)
subjects are grouped by their disease status
Case control study
group subjects by the exposure or risk factor
Cohort study
Which Cholangitis is associated with ulcerative colitis?
Primary sclerosis cholangitis
Which cholangitis occurs most commonly in middle-aged females and presents with pruritus, jaundice, and hepatosplenomegaly?
Primary biliary cholangitis
Autoimmune disorder that leads to lymphocytic infiltration and granulomas that destroy the bile ducts in portal triads. Have anti-mitochondrial antibodies
Balanced ligamentous tension direct or indirect?
Indirect
Still technique direct or indirect?
Both
Start in indirect and then take into direct (restrictive barrier)
Blood brain barrier comprises tight junctions between?
non-fenestrated capillary endothelial cells, a thick basement membrane, and astrocyte processes
What is drug of choice for hyperaldosteronism? What is a side effect?
Spironolactone (K-sparing diuretic)
may result in blocking androgens leading to menstrual cycle irregularities in females or gynecomastia in males
Equation for SV
EDV - ESV
Equation for Ejection fraction (EF)
EF = SV/EDV
Prostaglandins dilate or constrict afferent arterioles?
Dilate
So if taking NSAID then it will constrict afferent arteriole and cause dec RPF and GFR
What drug is used to treat chronic gout when the cause is under secretion of uric acids?
Probenecid
Keloids result from excessive collagen formation during the remodeling phase of wound healing, which occurs due to overexpression of (blank) and excessive (blank)
transformation growth factor beta and excessive fibroblast proliferation
What psychiatric disorder is characterized by magical thinking, eccentric behavior, and paranoia
schizotypal personality disorder
(blank) is produced by the Sertoli cells and is a physiological inhibitor of FSH secretion
Inhibin B
(blank) stimulates the release of testosterone from (blank) cells
LH and Leydig cells
most common cause of encephalitis outbreaks in the US
Arboviruses, small RNA viruses transmitted by biting arthropods
Leakage with coughing, lifting, sneezing? Which incontinence and etiology
Stress
Decreased urethral sphincter tone, urethral hypermobility
Sudden, overwhelming urge to urinate? Which incontinence and etiology
Urge
detrusor hyperactivity
Incomplete emptying & persistent involuntary dribbling
Which incontinence and etiology
Overflow
Impaired detrusor contractility, bladder outlet obstruction
Hartnup disease is caused by impaired transport of neutral amino acids in the small intestine and proximal tubule of the kidney. Symptoms include (blank) and (blank), which occur as a result of (blank) deficiency. The dx can be confirmed through detection of excessive amounts of neutral amino acids in the urine
pellagra-like skin eruptions and cerebellar ataxia
niacin
Which marker for HBV is seen in immunized individuals?
HbsAB (IgG) will also see this in resolved HBV infection with IgG HBcAB
Which marker for HBV is seen during the window period?
HBcAB (IgM)
Head and Neck sympathetic reflex
T1-4
Heart sympathetic reflex
T1-5 (left)
Respiratory system sympathetic reflex
T2-7
Esophagus sympathetic reflex
T2-8
Upper GI tract sympathetic reflex
T5-9
Middle GI tract sympathetic reflex
T10-11
Lower GI tract sympathetic reflex
T12-L2
Appendix/Cecum sympathetic reflex
T10-12
Arms sympathetic reflex
T2-8
Kidneys/Upper ureters/gonads sympathetic reflex
T10-11
Lower ureters sympathetic reflex
T12-L1
Bladder sympathetic reflex
T11-L2
Uterus/Cervix sympathetic reflex
T10-L2
Erectile tissue sympathetic reflex
T11-L2
Prostate sympathetic reflex
T12-L2
Legs
T11-L2
What consists of the portal triad? What ligament is it in?
Common bile duct, hepatic artery, portal vein
Hepatoduodenal ligament
Postglomerular obstruction (kidney stone or ureteral strictures) causes (increased or decreased) hydrostatic pressures with Bowman’s space -> leads to (increase or decrease) in net ultrafiltration pressure and GFR
Increased
Decreased GFR
Reactivation TB affects upper or lower lobes of lung?
Upper lung
What bones come together to form the jugular foramen? What CN exit here?
Occipital and temporal
CN IX, X, XI
Which CN’s course through the cavernous sinuses?
CN III, VI, V1, V2, VI
DOC for trigeminal neuralgia?
Carbamazepine
Mechanism by which most indirect inguinal hernias occur is
patent processus vaginalis
Mechanism by which most direct inguinal hernias occur is
weakened abdominal musculature
Most sensitive marker for pancreatic cancer is
CA 19-9
What marker does this describe? sialylated form of Lewis blood group antigen a
Ca19-9 Pancreatic cancer marker
Ovarian cancer marker?
CA 125
Medullary thyroid cancer marker?
calcitonin
Colorectal cancer marker?
CEA
Marcus Gunn pupil is caused by lesion to what?
Optic nerve (CN II), afferent pupillary response defect
Classic position to treat anterior lumbar tenderpoints AL2,4,5 is to
stand on opposite side of table, flex knees to 90 degrees, sidebend the ankles away, and rotate torso toward the tenderpoint
BRCA1 (tumor suppressor or proto oncogene) and function?
Tumor suppressor
homologous recombination mediated repair
Addison Disease
insufficiency of adrenal cortex, leads to low levels of glucocorticoids, mineralocorticoids, and adrenal androgens. In response to low production of adrenal cortex hormones, the pituitary increases production of ACTH and melanocyte stimulating hormone leading to increased pigment production
Cholinergic Toxicity Mnemonic
DUMBBELS Diarrhea/diaphoresis Urination Miosis Bronchospasm Bradycardia Emesis Lacrimation Salivation
Anesthetics with (high or low) tissue solubility are characterized by large arteriovenous concentrations gradients and (slower or faster) onsets of action?
High
Slower
Dorsal interossei are responsible for (blank) the fingers
abducting
Meissner corpuscle
detection of light discrimatory touch by the palms and digits of the hands and the soles of the feet
Bosentan treats pulmonary HTN by competitively (antagonizing or agonizing) (blank) receptors, thus, decreasing pulmonary vascular resistance
antagonizing endothelin-1 receptors
Blank is the most common breast tumor in women under age 25. Histology findings?
Fibroadenoma
firm, rubbery, motile, well-demarcated mass
thoracic duct is responsible for draining what?
lower limbs, pelvis, abdomen, left thorax, left upper limb, and L side of the head and neck
Drug Half life (t1/2) equation
(0.7 * Vd) / Cl
Vd is volume of distribution
Cl is clearance
(Blank) carcinoma is the most common skin cancer, but fortunately has low risk of metastasis
Basal cell
Characteristic of basal cell carcinoma
incidence of sun exposure, rolled edges, central umbilication, telangiectasia, and friability, pearly
Medial ankle (eversion) sprains cause damage to what ligament?
Deltoid ligament group
Danazol MOA and what condition does it treat?
synthetic steroid that acts by negatively inhibiting the anterior pituitary, leading to suppression of FSH and LH release
Endometriosis
unilateral, sudden loss of vision described by pts as “window shade coming down on the eye”
Retinal detachment involves separation of the retinal layer from the epithelial layer
Associated with Marfan Syndrome
Specificity equation
SPIN -> rule in
TN/ (TN+FP)
Sensitivity equation
SNOUT -> rule out disease
TP/ (TP+FN)
Kallman syndrome (pathophysiology, symptoms)
form of hyopgonadotropic hypogonadism caused by decreased synthesis and impaired migration of gonadotropin-releasing hormone in the hypothalamus -> dec synthesis GnRH -> decreased FSH and LH from anterior pituitary
Absent or delayed puberty
Lack of sense of smell
What is used to treat TCA overdose?
Sodium bicarbonate
Whipple disease (what is it caused by and what are symptoms)
Tropheryma whippelii malabsorption syndrome (steatorrhea), joint pain, and CNS symptoms. Small intestinal biopsy shows PAS positive staining
R sided heart murmurs (increase or decrease) in intensity during inspiration?
Increase
and they decrease during expiration
P53 tumor suppressor or oncogene? Which part of cell cycle does it affect?
Tumor suppressor
arrests the cell cycle at the G1/S point in order for repair or apoptosis to occur
RAS tumor suppressor or proto-oncogene?
Protooncogene
Activation encourages cell growth -> continuous activation leads to uninhibited cell growth
Rb tumor suppressor or proto-oncogene?
tumor suppressor
during G1 phase of cell cycle
Antibody seen in Graves disease?
Anti-thyroid stimulating hormone receptor antibodies
Which CN’s are responsible for the afferent and efferent part of corneal reflex
Afferent -> CN V1
Efferent -> CN VII
Hemiballismus What is it? Where is the lesion? Most common cause?
unilateral flailing of a limb
caused by disruption of the contralateral subthalamic nucleus (which is part of Basal Ganglia)
The MCC of hemiballismus is lacunar infarct
(blank) artery and (blank) nerve run together along the posterior aspect of the humerus. Midshaft fractures of the humerus risk injury to these structures
Deep brachial and radial
Mnemonic for normal pressure hydrocephalus symptoms?
Wet, wacky/weird, and wobbly
Normal pressure hydrocephalus presents classically with gait difficulty, cognitive disturbance, and urinary incontinence
Mnemonic for multiple myeloma defining symptoms?
CRAB
hypercalcemia, renal dysfunction, anemia, bone pain or fracture
(Irreversible or reversible) inhibition decreases Vmax, while (competitive or noncompetitive) inhibition increases Km
Irreversible
Competitive
Starling equation for net filtration
Net filtration = (Pc - Pi) - (Oc -Oi) Pc is capillary hydrostatic pressure Pi is interstitial hydrostatic pressure Oc is capillary oncotic pressure Oi is interstitial oncotic pressure
Ehlers Danlos syndrome (what collagen does it affect? Symptoms?)
Types III and V
presents with hypermobile joints, elastic skin, and frequent bruising. Also causes weakness of vessels, leading to aneurysm formation and rupture
Posterior S1 TP (location and tx position)
medial to PSIS at S1 level
Posterior to anterior pressure on opposite ILA
Posterior S2,3,4 midline TP (location and tx position)
Midline on sacrum at corresponding level
PS2: posterior to anterior pressure midline to the sacral apex
PS3: flexion or extension
PS4: posterior to anterior pressure midline on sacral base
PS5 TP (location and tx position)
Medial and superior to ILA
Posterior to anterior pressure on opposite sacral base
Thyroglossal ducts cysts are derived from the epithelial remnants of the thyroglossal duct that forms during gestation from the (blank) and (blank) pharyngeal pouches
1st and 2nd
Meiniere disease (symptoms)
causes episodic vertigo, unilateral hearing loss, ear fullness or pressure, and tinnitus. It is thought to be result from excess endolymphatic fluid
(Blank) casts on UA are associated with chronic renal failure
Broad waxy
Tx of choice for nocturnal enuresis is (blank) which is an ADH analog and (increases/decreases) urine osmolarity (concentrates urine)
Desmopressin
increases
Drugs with (high or low) blood/gas partition coefficients are more soluble in the blood, demonstrate slower equilibration with the brain and have longer onset times
High
Leukemoid reaction is a significant leukocytosis (>50,000) that occurs in response to an underlying condition, commonly severe infection. Blood smear often shows (blank) as well as increased neutrophil precursors (bands, metamyelocytes, myelocytes). The leukocyte alkaline phosphate score is normal or decreased
neutrophilia with reactive features (Dohle bodies -basophilic oval inclusions in mature neutrophils)
HVLA is a (direct or indirect) and (passive or active) technique
Direct and passive
MC form of testicular cancer? What is a risk factor for it?
Seminoma
cryptorchidism
Plummer-Vinson syndrome is characterized by (blank), and (blank) anemia. Findings associated with (blank) deficiency include koilonychia (spoon shaped nails) and shiny red tongue
dysphagia (esophageal web formation), and iron deficiency
Iron
SLE renal pathology?
diffuse proliferative glomerulonephritis (Class IV lupus nephritis)
Wire loop lesions
Aspirin can increase (blank) production, leading to bronchospasm in pts prone to allergies or asthma
leukotriene
Charcot triad and what disease it is associated with?
Fever, jaundice, and RUQ pain
Acute ascending cholangitis is a bacterial infection of the biliary tree, occurring most often as a result of a stone in the common bile duct,
Treatment Position for Posterior rib 2-10 TP
sidebend away, rotate away, and minimal flexion
Treatment position for anterior rib 2-10 TP
sidebending toward, rotate toward, and varying degrees of flexion
Hypertrophic cardiomyopathy
Systolic or diastolic murmur?
Louder or softer with squatting/leg raising?
Louder or softer with valsalva?
Systolic
Softer (inc preload)
Louder (dec preload)
(Blank) is the most common cause of osteomyelitis in children with sickle cell disease
Salmonella
Commonly tested reportable diseases:
STD (HIV, gonorrhea, syphilis) Hepatitis - A,B,C Childhood (mumps, measles, rubella, chicken pox) diarrhea (Salmonella, Shigella) Tuberculosis
Caloric restriction leads to increased (blank) levels along with decreased (blank) and (blank) levels
Ghrelin
Insulin and leptin
Ghrelin stimulates appetite and promotes weight gain. Leptin and insulin act in the CNS to decrease appetite.
Primary hyperaldosteronism causes increased (blank) reabsorption in the renal collecting tubules, leading to increased urinary excretion of (blank and blank). Pts typically have secondary hypertension as well as hypokalemia and metabolic alkalosis. The serum Na concentration remains normal due to aldosterone escape
Na
K and H
The normal V/Q ratio at the apex of the lung is (blank) and at the base of the lung it is close to (blank). Increases in ventilation or decreases in perfusion will (increase or decrease) V/Q
3.0
0.6
Increase
Tx position for posterior C1 inion TP and location
inferior nuchal line, just lateral to inion
Flexion of OA
PC1 TP occiput location and treatment position
inferior nuchal line midway btw inion and mastoid on splenius capitis
Extension of OA
PC2 occiput TP location and treatment position
Inferior nuchal line within semispinalis capitis muscle
Extension of OA
Treatment of PC2- 8 midline and lateral TP
Extension SARA
Treatment of PC3 midline TP
Flexion SARA
Brown-Sequard syndrome involves spinal cord (blank) injury that results in (ipsilateral/contralateral) hemiplegia, (ipsilateral/contralateral) loss of vibration light touch and proprioception, and (ipsilateral/contralateral) loss of pain and temp sensation
hemi-section
Ipsilateral
Ipsilateral
Contralateral
Positive symptoms of schizophrenia include
hallucinations, delusions, and disorganized behavior
Tx position for posterior rib 1 TP
sidebend away, rotate towards, and slight extension
The (blank) vein of the portal venous system anastomoses with the (blank) veins of the systemic venous system. Portal HTN may lead to engorgement of these vessels, causing caput medusae.
paraumbilical
epigastric
darkening of urine after exposure to air, blue-black discoloration of cartilage and skin, and debilitating osteoarthropathy (pigment deposition in spine and large joints)? What disease is this? What is the deficiency?
Alkaptonuria is an AR disorder due to a defect in homogenitisic acid dioxygenase (impaired tyrosine metabolism)
DX by inc homogenitisic acid levels in urine
Why is heparin preferred over warfarin for anticoagulant in pregnancy?
Heparin has a high molecular weight and cannot cross the placenta
Tx position of inguinal TP
flexion, adduction, and internal rotation
Leads V1-4 -> location of MI and artery
Anterior
LAD
Leads V1-2 -> location of MI and artery
Septum
LAD
I, aVL, V5, V6 -> location of MI and artery
Left lateral
Left circumflex
II, III, aVF -> location of MI and artery
Inferior
RCA
aVR and V1 -> location of MI and artery
right atrium
RCA
MC thyroid cancer? What mutation does it have?
Papillary thyroid cancer
BRAF
(What immunoglobulin) can cross the placenta, directly opsonize pathogens, and indirectly enhance phagocytosis by activating complement
IgG
(Blank) causes destruction of oligodendrocytes, cell located in the (CNS or PNS) that produce myelin
Multiple sclerosis
CNS
Grave’s disease will have serum that has (high/ow) T4, (high/low) free T4, (high/low) TSH, and (high/low) I-123 uptake
High T4
High free T4
Low TSH
High I-123 uptake
During craniosacral flexion does AP diameter of the head increase or decrease? What do paired cranial bones do? Does transverse diameter increase or decrease? Sacrum movement?
AP diameter decrease
Externally rotate
Transverse increase
Sacrum moves posterior and counternutates
