Random 1 (12/16) Flashcards
1
Q
Treponema pallidum
A
Single Ulcer with indurate borders
Bilateral, nontender inguinal lympadenopathy
Tx: Penicillin
2
Q
Haemophilius Ducreyi
A
Large, deep ulcer with well demarcated borders and exudate
Severe and suppurative lymphadenopathy
Tx: Azithromycin or Ceftriaxone
3
Q
Hereditary fructose intolerance presentation
A
Infant tries fruit, gets hypoglycemia (tiredness, vomitting, diaphoresis)
Autosomal recessive, absense of aldolase B so gets fructose-1-phosphate build up
4
Q
Papillary carcinoma
A
- Empty-appearing nuclei with central clearing
-Psammoma bodies (hollow nuclei and laminar calcified bodies)
-BRAF mutatuion
5
Q
Medullary carcinoma
A
-Originates from parafollicular “C cells”
-Calcitonin is a tumor marker
-RET proto-oncogene mutation
6
Q
Calcium oxalate stones
A
-Can result from ethylene glycol
-X-ray= radioopaque
-Shape: Envelope
Tx: Thaizides and Citrate
7
Q
Intention Tremor
A
Location: Cerebellar lesion
Gets worse with: Goal directed movement
8
Q
35 y/o fatigue, pruritis, and RUQ abdominal discomfort
A
Primary biliary cholangitis, characterizzed by T-lymphocyte-mediated autoimmune destruction of intralobular bile ducts
-Abnormal liver function tests, elevated ALP
-Anti-mitochondrial antibodies
9
Q
Anticentromere Antibodies
A
-Limited cutaneous scleroderma
-CREST (Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia)
10
Q
Anti-ds DNa antibodies
A
SLE
11
Q
Anti-histone antibodies
A
Drug induced SLE
Hydralazine+ Procainamide
12
Q
Anti-microsomal antibodies
A
Hashimoto thyroiditis
13
Q
Anti-Jo-1 (Histidine-tRNA ligase)
A
Dermatomyositis, polymyositis
14
Q
Leiomyoma
A
Hx of menorrhagia and recurrent pregnancy loss, CT shows calcified pelvic mass
-Benign, soft tissue mass composed of smooth muscle and fibroblasts
15
Q
Interactions with tyramine-containing foods, such as wine and aged cheese with an MAO-I (phenelzine) can result in severe HTN
A
Tx: Phenolamine, a reversible nonselective alpha blocker
16
Q
Type 1 interferons: IFN-a and IFN-b
A
Innate immune cytokines that inhibit viral replication and increase MHC class 1 expression
-Secreted by Th1 helper cells
-Responsbole for phagocytosis by mactophages and granuloma formation
17
Q
Asherman syndrome
A
Results from intrauterine adhesions that arise secondary to trauma and stratum basalis of the endometruum–> absence of the stratum basalis layer of the endometrium
18
Q
Brown-Sequard syndrome
A
-Loss of ipsilateral upper motor neuron below lesion (CST)
-Loss of ipsilateral vibration and proprioception (Dorsal Spinal Columns)
-Loss of contralateral pain and temp 2-3 levels below level of lesion (STT)
19
Q
The umbilical cord and contents
A
2 umbilical arteries arising from the internal iliac arteries (carry deoxygenated blood from fetus to the placenta) and 1 umbilical vein, which carries oxygenated, nutrient rich blood from placenta to the fetus
20
Q
Lambert-Eaton myasthetic syndrome
A
-presynaptic disorder in which the presynaptic nerve terminals release a reduced amount of AcH–>antibodies against voltage gated calcium channels so you get leg wakeness, pain and stiffness, dry mouth, impotence
-Associated with heavy smoking
21
Q
Bacterial meningitis findings
A
Opening pressure: Increased
Cell type: Neutrophuls
Protein: Increased
Glucose: Decreased
22
Q
Viral meningitis/ encephalitis
A
Opening pressure: Normal or increased
Cell type: Lymphocytes
Protein: Normal or increased
Glucose: Normal
23
Q
Barrets esophagus
A
Metaplastic change of esophageal mucosal lining from normal squamous epithelium to columnar epithelium
24
Q
Acetazolamide
A
Acts on the PCT of the nephron and results in sodium bicarbonate diuresis that can lead to metabolic acidosis
25
Carcinoid syndrome
caused by a neuroendocrine tumor that secretes vasoactive substances, such as serotonin. Typical symptoms include episodic upper body flushing, telangiectasis, diarrhea, and broncospasm
Tx: Octeotide
26
Primary Sclerosing cholangitis
biliary tract disease associate with ulcerative colitis; idopathic disorder characterized by inflammation fibrosis, and trictures of medium and large ducts in the intrahepatic andf extrahepatic ducts-->beads on a string
27
Anti-topoisomerase
Associated with systemic sclerosis--> thickening and hardened skin and raynaud phenomon
28
Paraneoplastic syndrome from squamous cell carcinoma causing hypercalcemia
Pts findings of pulmonary mass and symptoms of hypercalcemia (constipation, abd pain, polyuria, and mentation changes)---> releases parathyroid hormone-related peptide acts like PTH but serum PTH levels would be supressed
29
Myxomas
90% occur in the left atrium and are prone to embolization can can lead to complications such as embolic stroke
-Syncopal episodes happen and there is a diastolic murmur that changes in frequency with movement
30
Schistosomiasis
Pt with history of swimming in an african river and examination findings of eosinophilia, hematuria, and lower abd pain
-Tx: Praziquantel
31
Monckeberg arteriosclerosis characterized by calcification of the internal elastic lamina and the tunica media of arteries
no symptoms just something to be aware of
32
Tetralogy of Fallot
-Boot shaped heart
-Left upper sternal border harsh systolic murmur
-cyanotic episodes
-pulmonary stenosis
-overriding aorta
-VSD
-Right ventricular hypertrophy
Associated with Digeorge syndrome (22q11)
33
Acute intermittent porphyria
Affected enzyme: Porphobilinogen deaminase
Accumlated: Porphobilinogen and ALA
Clinical presentation: ABD pain, polyneuropathy, port wine colored urine, EtOH and smoking make worse
34
Cardiogenic Shock
Preload: Increases
SVR: Increases
CO: Decreases
35
Hypovolemic Shock
Preload: Decreases
CO: Decreases
SVR: Increases
36
Distributive Shock
Preload: No change/ Decreases
CO: Increases
SVR: Decreases
37
Obstructive Shock
Preload: Decreases
CO: Decreases
SVR: Increases
38
Eosinophililic Granulomatosis with Polyangitis
p-ANCA small and medium vessel vasculitis; characterized by significant eosinophilia and chronic rhinosinutis and asthma
39
Granulomatosis with Polyangiitis (Wegner)
c-ANCA presents with sinus, lung, and kidney involvement associated with saddle nose deformity, hemoptysis, and renal failure
Tx: Cyclophosphamide
40
DiGeorge Syndrome
Autosomal Dominat condition caused by a 22q11.2 microdeletion resulting in cardiac defects, abnormal facies, thymic hypoplasia, cleft palate, and hypocalcemia
3rd and 4th pouches
Decreased T cells; recurrent viral and fungal infections
41
Zollinger-Ellison Syndrome
Caused by a gastrin-secreting tumor; suspected when patients have refractory epigastric pain and ulcers throughout the duodenum; Gastrin is normally produced by G cells in the PYLORIC ANTRUM and then stimulates the parietal cells to produce gastric acid in the fundus of stomach
42
Wallenberg Syndrome
Infarction of the lateral medulla of the brainstem due to occlusion of the PICA, associated with acute onset of vertigo
PE shoes nystagmus, ipsilateral Horner syndrome (ptosis,miosis,and anhidrosis), ipsilateral limb ataxia adn sensory loss of pain and temp sensation on ipsilateral face (spinal trigeminal nucleus) and contralateral trunk(spinothalamic tract)
43
Septal
Artery: Left anterior descending--> V1/V2
44
Anterior
Artery: Left anterior descending-->V3/V4
45
Lateral
Artery: Left Circumflex--> I, aVL, V5 and V6
46
Inferior
Artery: Right Coronary--> II,III, and aVF
47
Posterior
Artery: Posterior descending--> V1-V3 and posteior leads V7-V9
48
Placenta accreta
Placental villi attach to the surface of the myometrium
49
Placenta increta
Chorionic villi penetrate into the myometrum
50
Placenta Percreta
Chorionic villi penetrate through the myometrium to the uterine serosa
51
Young pt with paresthesias, weakness, urinary incontinence, intermittent vision loss
Multiple sclerosis, MRI shows periventricular plaques
52
Severe combined immunodeficiency
Deficiency in adenosine deaminase, pts present with recurrent viral, bacterial, fungal, protozoal infections, along with diarrhea and failure to thrive
-No thymic shadow
Reduced levels of B and T lymphocytes and natrual killer cells
53
Chronic granulomatous disease
-Lack of nicotinamide adenine dinucleotide phosphate oxidase
-Decreases ROS leading to recurrent infections with catalase-positive organisms (Staph aureus, pseudomonas, klebsiella)
54
Phenylalanine hydroxylase deficiency
Converts Phe to Tyrosisne and deficiency results in condition known as classic PKU
-pts have hypopigmentation of skin due to lack of tyrosine but is associated with peculiar body odor
55
Erythema infectiosum (Fifth Disease)
Begins with fever, headache, and coryza, and erythematous malar rash with circumoral pallor 2-5 days later
-Results in fetal anemia-->hydrops fetalis
-Slapped Cheek
-Parvovirus B19
56
Duodenal atresia
Failure to recanalize the distal duodenum, and affected infants present with bilious emesis and abd distention--> abd imaging reveals collections of air in stomach and proximal duodenum (double bubble sign)
57
Cholecystoenteric fistula
Gallstones enter the intestine and pts may develop a mechanical SBO within the ileum or ileocecal valve
58
Roseola Infantum
-Causative Agent: Herpesvirus Type 6 (Enveloped, linear dsDNA virus)
-Presents with high fever followed by a macular rash over the body
-The fever lasts for 3-5 days then rash appears (Starts on trunk then spreads outward)
-cervical lyphadenopathy
59
Measles (Rubeola)
Agent- Enveloped, linear ssRNA virus
-Prodrome of cough, coryza, conjunctivitis along with Koplik spots
-Rash starts on head then moves downward
60
Overproduction of Gastrin
Gastrinomas in MEN-1 causes increased acid secretion by G cells, leading to peptic ulcers
61
Uncal Herniations
Medial aspect of the temporal lobe herniates across the tentorium cerebelli; initially results in ptosis, mydriasis, lateral strabismus, and contralateral hemiparesis of extremities
62
Fusion inhibitors
Maraviroc--> Binds CCR5 (Inhibits interaction with gp120 preventing viral binding)
Enfuviritide--> Binds gp41-->inhibits viral entru into host cell
63
Type I dyslipidemia
-Elevated chyomicrons and TGs
-Caused by reduction of lipoprotein lipase
64
Type IIa and IIb
IIa- high total cholesterol, high LDL, NORMAL TGS
IIb- high total cholesterol, high LDL/VLDL, and high TGS
65
Disruption of trochlear nerve
Pts will complain of diplopia when they try to look downard
Superior oblique is controlled by CN4 which is the trochlear
66
MEN 1
3 P's: Pituatary adenoma, Parathyroid hyperplasia, and Pancreatic involvement
Prolactinomas are most common and cause bitemporal hemianopsia, the Gastrinomas are most common pancreatic tumor
67
Subacute Granulomatous Thyroiditis
Caused by a release of pre-formed thyroid hormone from an inflamed thyroid gland; follows flu-like illness
ONLY ONE THAT PRESENTS WITH PAINFUL,ENLARGED, THYROID GLAD
Tx: NSAIDs+Beta vlockers
68
MEN 2A
Mutation: RET
-Medullary thyroid cancer (Inc calcitonin)
-Pheochromocytoma
-Primary hyperparathyroid
69
MEN 2B
Mutation: RET
-Medullary thyroid cancer
-Pheochromocytoma
-Mucosal Neuromas
-Marfanoid body habitus
70
Henoch-Schonlein Purpura
Occurs in children following viral infection, there is a purpuric rash, arthritis, GI pain
RENAL BIOPSY shows IgA deposits in the mesangium in the glomeruli producing hematuria
71
Membranoproliferative glomerulonephritis(MPGN)
accompanied by significant proteinuria--> dense deposit of C3 in the center of the basement membrane
72
Poststreptococcal glomerulonephritis
Hypercellular glomeruli with neutrophils and large, coarse (lumpy-bumpy) subepithelial feposits
73
Membranous glomerulopathy
Imaging: spike and dome IgG deposits in the basement membrane
-idiopathic but can be seen in hepatitis B and C, and SLE
74
Polyarteritis nodosa
-Medium sized vasculitis
-spares the lings but displays palpable purpura
-associated with hepatis B
75
Mallory-Weiss Tear
Focal submucosal lesion of the distal esophagus
76
Tuberous Sclerosis
-Autosomal dominant defect in the tumor supressor gene due to a TSC1 mutation (chromosome 9) or TSC2 (chromosome 16)
Clinical: hamartomas in CNS, angiofibromas, ash leaf spots, cardiac rhabdomyoma, renal angiomyolipomas, seizures
-Cardiac rhabdomyoma most common cardiac tumor in children
77
Pemphigus vulgaris
-Caused by IgG antibodies against desmosomes located on the surface of kerantinocytes, resulting in flaccid bullae and erosions on the skin/oral mucosa
-Nikolsky sign in which gentle pressure causes epidermis to sep off
78
Bullous pemphigoid
linear dermal distribution, antibodies against hemidesmosomes-->tense bullae
79
Eisenmenger syndrome
-dyspnea,cyanosis, and pulmonary htn-->caused by reversal of blood flow through ASD
-fixed split S2, indicitive of ASD (most common cause of ASD is failure of closure of the ostium secundum)
80
21 hyroxylase deficiency
-Characterized by hypotension, hyperkalemia, and increased renin activity, ambigious genitalia
-decreased conversion of progesterone to deoxycortisone= decreased aldosterone
-decreased conversion of 17-hydroxyprogesterone to 11-deoxycortsol which leads to absent cortisol production
81
McCune-Albright syndrome
-Mutation in GNAS gene-->Increase production of pituitary hormones
-Clinical features: precocious puberty, cafe au lait maculrs, and history of long bone fractures secondary to fibrous dysplasia
82
Airway/Resistance
Radial traction, airway resistance decreases as lung volume increases, therefore airway resistance is the least at the point of MAXIMAL inspiration
83
Primary brain vesicles
Prosencephalon (forebrain)
Mesencephalon (midbrain)
Rhombencephalon (hindbrain)
84
Secondary Brain Vesicles
Diencephalon (thalamus and hypothalamus)
Mesencephalon (midbrain)
Metencephalon (pons and cerebellum)
Myelencephalon (medulla)
85
Epidural hematoma
-Lucid interval, middle meningiel artery, biconvex lens shaped hematoma
-pterion: frontal,parietal, temporal, sphenoid (origin of middle meningeal artery)
86
Dialated cardiomyopathy
-common with alcohol use disorder
-S3 heart sound, show pronounced left ventricular dilation, increased LV mass, and systolic impairment
87
Focal segmental glomerulosclerosis (FSGS)
HIV patient with nephrotic range proteinuria, peripheral edema, and hypoalbuminemia
-Sclerosis of podocytes-->disruption of the glomerular charge barrier
-effacement of podocyte foot processes
88
Arnold-Chiari Malformation
Congential disorder characterized by a structural abnormailty at the spinomedullary junction, resulting in downward displacement of cerebellar tonsils through the foramen magnum-->causes compression of neural structures and obstruction of normal CSF flow
89
Serotonin syndrome
Triad of cognitive impairment, autonomic instability,
-hyperreflexia, disorientation, vomitting, and autonomic instability (HTN and dever)
Tx: cyproheptadine which antagonizes serotonin and can be used in toxicity
90
Clozapine
Used to treat schizophrenia, but can cause AGRANULOCYTOSIS, Wt gain, and Neuroplectic malignant syndrome
-MOA is both antagonism of serotonin 2A and dopamine receptors
91
Iron deficiency anemia
Koilinychia, fatigue, and malaise, dyspnea, and tachy, glosittis
Iron panel shows: Elevated transferrin, elevated TIBC, low iron, and low ferritin
92
TIBC
measures bloods capacity to bind iron with transferrin correlates with transferrin leveles
93
Transferrin
Major transporter of iron trafficing through plasma and hepatic synthesis of transferrin is increased in iron deficient state
94
Ferritin
cellular storage protein for iron
95
Rib Dysfunctions/Muscles
Rib 1: Anterior and Middle Scalene
Rib 2: Posterior Scalene
Rib 3-5: Pec Minor
Rib 6-9: Serratus anterior
Rib 10-11: Latissimus Dorsi
Rib 12: Quadratus Lumborum
96
Alveolar-Arterial Gradient
A-a gradient: PAO2- PaO2 (A=partial presence of oxygen, a=partial pressure of o2 in arterial blood)
Normal is: 4-15
Causes of hypoxemia with normal A-a gradient: Alveolar hypoventilation (opios, obesity) and Low FiO2 (high altititude)
Causes of hypox with increased A-a gradient: Dead space vent (PE), Diffusion limitiation (pulm fibrosis), Intrapulm shunt (pneumonia/edema)
97
Marcus Gunn Pupil
Alternating constriction and dilation of both pupils with swinging flashlight test is characteristic of relative afferent pupillary defect with damage to optic nerve
-When penlight is directed into the eye on affected eye, pupils appear to dilate
98
Hereditary Spherocytosis
Autosomal dominatn results in abnormalities in cytoskeleton of RBC--> pt presents with hemolytic anemia, jaundice, and splenomegaly (spherocytes on blood smear and positive osmotic fragility test)
99
Elhers-Danlos Syndrome
-Type V collagen or Type 3 collegen
-Hyperextensible joints/ easy bruising
-Complications: Berry aneurysms-->SAH, MVP, hernias, Uterine rupture, retinal detachment
100
Diabetic nephropathy
The basement membrane in glomeruli thickens and becomes more permeable to protein, Kimmelstein-wilson nodules--> mesangial expansion
101
Dermatis herpetiformis
Papulovesicular,pruritic skin rash on elbows and knees; associated with celiac disease and involves development of IgA antibodies that react against gliadin and cause micro abscess formation at the dermal papillae tips
102
Drug of choice to treat myasthenia gravis
-Pyridostigmine (AcH inhibitor) adverse effects of AcH inhibitors include increased salvation, lacrimation, miosis, diarrhea, urination, bradycardia, and bronchoconstriction
103
Rotor Syndrome
Chronic conjugated and unconjugated hyperbilirubinemia
-altered ability to transport bilirubin glucuronides into bile canaliculi
-total urinary coproporphyrin excertion is increased
104
Squamous cell lung carcinoma
Long smoking history, radiating flank pain, wt loss, and circular hilar mass on chest radigraph (central location)--> can lead to release of parathyroid hormone related protein leading to kidney stones
Histo shows Keratin pearls and intercellular bridges
105
Acute HIV
Presents with fever, body rash, generalized lymphadenopathy, pharyngitis, and diarrhea
-HIV is an enveloped virus comprised of 2 molecules of ssRNA
-The reverse transcriptase enzyme an RNA dependent DNA poly is packaged in the virus particle, and upon entry into a CD4 T+ cell or macrophage is responsible for copying ssRNA into proviral dsDNA
106
Nocardia
-Gram positive, weakly acid fast with a filamentous appearance--->cause pulm infections in immunocompromised pts and are treated with TMP-SMX
107
Basal nucleus of meynert
Releases Ach which is invilved in learning, memory, and muscle movement
108
Locus ceruleus
Norepinephrine
109
Aneurysm of posterior communicating artery
Compresses the occulomotor nerve and cause lateral strabismus, ptosis, and pupillary dilation
110
Pts with COPD and their x-ray
-bilateral hyperinflation, flattening of the diaphram, and a narrow cardiac sihouette
111
Alpha 1 receptor stimulation (via phenylephrine)
-Tx for nasal congestion
Can cause pupillary dilation, urinary retention, and increased BP due to Vasoconstriction
112
Anion gap formula
Na- (Cl+HCO3)
Normal: 8-12
113
Tetracyclines (Doxycycline/Minocycline)
MOA: 30S inhibitor prevents elongation (bacteriostatic)
Coverage: Myoplasma, Rickettsia, Chlamydia, Borrelia, and Brucella)
DO NOT GIVE TO PREGNANT
114
Macrolides (Azithromycin, erythromycin, and clarithromycin)
MOA: 50S inhibitor prevents translocation (bacteriostatic)
Coverage: Mycoplasma, Chlamydia, H.Pylori, Legionella, Neissera, Cornybac dip)
115
Fluoroquinolones( ciprofloxin, oflocacin,)
MOA: inhibit DNA gyrase and topoisomerase IV (bacteriacidal)
Coverage: B.anthracis, mycoplasma, chlamydia, ricketssia, shigella,
116
A child with recent history of bloody diarrhea and triad of anemia, thrombocytopenia, and renal dysfunction
-Hemolytic uremic syndrome caused by E.Coli O157:H7
117
Damage to the primary motor cortex
-Dysarthria (difficulty speaking) and weakness of the contralateral upper extremity due to MCA stroke
118
Broca area (Brodmann areas 44 and 45)
-Fluency: impaired
-Repetition: impaired
-Comprehension: intact
119
Wernicke area (Brodmann area 22)
-Fluency: intact
-Repetition: impaired
-Comprehension: impaired
120
Tamoxifen
Selective estrogen receptor modulator used to treat estrogen receptor positive breast cancer; as a result of partial agonist activity within the endometrium, treatment with tamoxifen may result in postmenopausal BLEEDING
-Estrogen receptor antagonist in breast
-Estrogen receptor agonist in bone and endometrium
121
Bupropion
Increased risk of seizures in pts with anorexia or bulimia
122
Carbidopa
Irreversible inhibitor of peripheral DOPA decarboxylase-->prevents breakdown of peripheral levodopa and increases its bioavalaibility
123
Riboflavin deficiency (Vitamin B2)
angular chelillitis, glossitis, stomatitis, seborrheic dermatitis, and normocytic anemia
124
Baclofen
Muscle relaxant, binds to GABA type B receptors and reduces release of excitatory neurotransmitters
125
Vinca alkaloids (Vincristine)
-Chemo to treat diffuse large B-Cell lymphoma
-Act during M-phase of cell cycle by binding B-tubilin and prevent polymerization of microtubles (inhibit mitotic spindle formation)
-Can cause peripheral nueropathy
126
Antifungal medications
1. Azole: inhibits ergosterol synthesis
2. Echinocandin: inhibits synthesis of beta-1,3-D-glucan
3. Griseoflulvin: Disrupts mitosis by interfering with microtubule function
4. Polyene: Binds ergosterol, causing leakage of electrolytes through membrane pores
5. Terbinafine: inhibits the fungal enzyme squalene epoxidase
127
Oligodendroglioma
-Most commonly located in the frontal lobes, histo will reveal presence of rounded cells with perinuclear halos--> fried egg appearance and they will have prescence of finely branching capillaries that look like chicken wire
-4th to 6th decade of life
128
Exits of CN's through skull base
Anterior--> Cribriform plate--> Olfactory (CN 1)
Middle cranial fossa:
Optic canal--> CN 2
-Superior orbital fissure: CN 3,4,V(1), 6
-Foramen rotundum: Maxillary branch of Trigeminal (CN V2)
-Foramen ovale: Mandibular branch of Trigeminal (CN V3)
Posterior Cranial fossal
-Internal acoustic meatus: CN 7+8
-Jugular foramen: CN9, 10,11
-Hypoglossal canal: CN 12
129
Organophosphate poisoning
-inhibits acetylcholinesterase causing AcH to build up in the synapse (DUMBELLS)
Tx: Atropine (inhibit muscuranic receptors) and pralidoximine to reactivate acetylcholinesterase)
130
Glioblastoma
-Consists of pseudopalisading, pleomorphic cells of astrocytic origin that border central areas of necrosis
131
Memingiomas
-Arise from the arachnoid cap cells of the meningies---> densely packed cells in sheets with no disticnt borders, intravasular vaculoles, and psammoma bodies
-incidence peak at 45 years of age
132
Anal cancer
BELOW Pectinate line metastasize to superficial inguinal lymph nodes
ABOVE pectinate line metastasize to internal iliac lymph nodes
133
Pyruvate dehydrogenase deficiency
Characterized by failure to convert pyruvate to acetyl-CoA
-Excess pyruvate becomes lactate and results in lactic acidosis
134
GI Tract Blood supply
-Celiac trunk: supplies blood to stomach, part of duodenum, liver gallbladder, spleen, and pancreas
-SMA: supplies blood to portions of the SI, the cecum, the ascending colon, and the transverse colon to the point of the splenic flexure
-IMA: supplies blood to portions of the SI, descending colon, sigmoid colon, and parts of the rectum
135
Alzheimer disease histo
Senile plaques (extracellular B-amyloid)
136
Frontotemporal dementia
-Pick bodies (hyperpigmented tau intracellular inclusion bodies)
-behavioral changes, irrtiability
-young pts 50-60 y/os
137
Lewy body dementia
-Parkinsonian symptoms+ hallucinations
-Lewy bodies (intracellular eosinophilic inclusion bodies)
138
Axillary Nerve
-Arrises from Posterior cord
-C5-C6
-Abduction of shoulder: Deltoid + Teres minor
139
Long thoracic
-C5-C7
- Protraction of scapula
-Serratus anterior
-Damage leads to winged scapula
140
Median Nerve
-C5-T1
-Flexion of wrist, fingers, and thumb
-Flexor of forearm
-Abductor pollicis brevis
141
Musculocutaneous
-C5-C7
-Flexion of elbow and supination of forearm
-Biceps
142
Radial
-Extension of the elbow, wrist, and fingers, and thumb
-Triceps, Extensor muscles of the forearm and hand
-Abductor pollicis longues
143
Patient with vertical gaze palsy, insomnia, and worsening headaches
-Pineal gland tumor: regulates the circadian rhythm, and the sleep-wake cycle
144
IL-1
-Fever, inflammation, activates osteoclasts
145
IL-6
-Fever and stimulates production of acute phase proteins
-Responsible for ESR and C-reactive protein increases
146
TNF-alpha
-Activates endothelium and WBC recruitment
-Maintains granulomas in TB
147
IL-12
-Activates NK cells
-Casues T cells to differentiate into TH1 cells
148
IFN-gamma
-Stimulates mactophages to kill phago pathogens
-stimulates granuloma formation
-Activates NK to kill virus infected cells
-Increase MHC expression
149
Patients with portal hypertension
-Develop esophageal varices, as blood from the left gastric vein is diverted through portosystemic anastomoses into the azygous vein
150
Middle Cerebral Stroke
-presents with contralateral hemiparesis/paralysis and hemianesthesia with the face being more affected than the lower extremity
-can present with aphasia if dominant sphere affected
151
Alkaptonuria
-Results in elevated levels of homogentisate
-autosomal recessive
152
Fragile X syndrome
-X-linked dominat
-Gene: FMR1
-Trinucleotide: CGG
-Large protuding chin, large genetalia, hypermobile joints, MVP, Intellectual disability
153
Friedreich ataxia
-Autosomal recessive
-Chromosome 9
-Gene: FXN
-GAA
-Ataxic gait, HOCM
154
Chediak-Higashi Syndrome
-Autosomal recessive, defect in lysosomal trafficking regylator gene-->microtubule dysfunction
-Clinical: Oculotanenous albinism, recurrent pyogenic infections and progessive neurodegeneration
-Lab: Giant granules in leukocytes and granulocytes
155
Dopamine pathways and changes in schizophrenia
Mesolimbic: Dopamine Increased--> positive symptoms (delusions and hallucinations)
Mesocortical: Dopamine Decreased---> negative symptoms (anhedonia)
Nigrostriatal: Dopamine decreased---> EPS and Tardive dyskinesia
156
Rett syndrome
-Mutations in the MECP2 gene
-Affects females only
-Mild hypotonia, reduced social interactions, constant midline hand activity
157
Alpha 1 antitrypsin deficiency
-In lungs, decreased alpha 1 antitrypsin= uninhibited elastase in alveoili--> decreased elastic tissue---> panacinar emphysema
-in turn you get increased levels of elastase
158
Somatostatininomas (Triad)
-Glucose intolerance, cholelithiasis, and steatorrhea
-Choleithiasis may result from inhibition of CCK release, which reduces gallbladder contractility
159
Fanconi Syndrome
-Dysfunction of PCT-->impaired reabsorption of glucose and presents with polyuria, polydipsia, and dehydration
-Expired tetracyclines can cause this
160
Atrial Fibrillation on COMLEX
-appear on ECG as irregular irregular rhythm with narrow QRS complexes and no organized P waves
-the ventricular rate is determined by AV node refractory period
-Ectopic foci that precipitate AF located near the ostia of the pulmonary veins in LA
-Left atrial dilation (HTN, mitral regurg, dilated cardiomyopathy)
161
Nodular Sclerosis Hodgkin Lymphoma
presents with wt loss, fever, night sweats, and painless lymphadenopathy is characterized by excisional lymph node biopsy revealing lacunar cells in a background of fibrotic collagen bands
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Paroxysmal nocturnal hemoglobinuria
-Acquired mutation in PIGA gene leading to impaired attachment of CD55 and CD59---> complement mediated hemolysis
163
Plantar fasciitis
-heel pain that is typically worse when initating ambulation
-and upon passive dorsiflexion of the 1st metatarsophalangeal joint
164
Obstructive Lung Diseases
-Asthma, Bronchiectasis, Chronic Bronchitis, Emphysema
RV: Increased
FRC: Increased
TLC: Increased
FEV1/FVC: DECREASED
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Restrictive Lung Disease
-Hypersensitivity pneumonitis, obesity, pulmonary fibrosis, sarcoidosis, and scoliosis
RV: Decreased
FRC: Decreased
TLC: Decreased
FEV1/FVC: Normal or increased
166
Autosomal Dominant Disorders
"Very DOMINANT Human"
V: Von Hippel-Lindau and Von Wiliebrand disease
D: Ehlers-Danlos syndrome
O: Osler-Weber-Rendu and Osteogenesis imperfecta
M: Marfan syndrome, MEN, and Myotonic dystrophy
I: Intermittent Porphyria
N: Neurofibromatosis
A: Achondroplasia, ALS, ADPKD
N: Noonan
T: tuberous Sclerosis
H: Hereditary nonpolyposis colorectal, hereditaty spherocytosis, huntingtons disease
167
Adson Test
-Pts shoulder is slightly extended, externally rotated and abducted
Thoracic outlet syndrome: impingement on neurovascular bundle btwn anterior and middle scalene muscles
168
Acute Tubular Necrosis
BUN-Creatinine Ratio: 10:1
FENa: > 2%
Microscopy: Muddy Brown Casts
169
Hashimoto Thyroiditis
-Presence of anti TPO antibodies
-Thyroid Peroxidase (TPO) is found mainly in the thyroid gland where it participates in the iodination of thyroglobulin
170
Acute Lymphoblastic Leukemia (ALL)
-Peripheral blood and bone marrow with increased lymphocytes
-Tdt+
-CD 10+ (marker of pre-B cells)
-Mediastinal mass
-MCC in children
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Chronic Lymphoblastic Leukemia (CLL)
-Smudge cells in peripheral blood smear
-Autoimmune hemolytic anemia
-CD20+,CD23+,CD5+
-Older than 60 y/o
172
Acute Myeloid Leukemia (AML)
-Increase circulating myeloblasts on peripheral smear
-APML: Auer rods and MPO +
-Age: 65 y/o
173
Chronic myeloid Leukemia (CML)
-Philadelphia Chromosome t(9:22), BCR ABL
-presents with dysregulated production of mature and maturing granulocytes
-Tx: BCR-ABL inhibitors (imatinib
174
Williams Syndrome
Deletion in the long arm of chromosome 7
-Elfin facies, intellectual disabilites, very friendly
-Cardiovascular: supravulval aortic stenosis, pulmonary stenosis, and renal artery stenosis
175
Gilbert Syndrome
Results in intermittent periods of jaundice/scleral icterus with midly elevated unconjugated hyperbilirubinemia
-Due to reduced hepatic uridine 5 UDP transferase activity
-reduced addition of glucoronic acid bilirubin
176
Medulloblastomas
-Most common malignant brain tumor of childhood and are located exclusively in the cerebellum
-Histo would show Homer-Wright rosettes
177
Medium-chain acyl-CoA dehyrogenase deficiency
-Reveals hypoketoic hypoglucemia and dicarboxylic acids on urinalysis
-Decrease in MCAD causes decreased ability to break down fatty acids into acetyl-CoA
178
Basal cell carcinoma
-characterized by palisading nuclear arrangements at the periphery of tumor lobules arising from the stratum basale
179
Congenital Adrenal Hyperplasia
-characterized by underproduction of cortisol and aldosterone but overproduction of androgens
-LACK of CORTISOL reduces negative feedback to the hypothalamus to inhibit CRH and to anterior pituitary to inhibit ACTH
-Oversecretion of ACTH leads to hyperplasia of adrenal cortex+ overproduction of androgens
-TX: Hydrocortisone
180
Asprin toxicity
-presents as GI distress, tinnitus, hyperthermia, tachypnea, respiratory alkalosis, metabolic acidosis
-Aspirin blocks the synthesis of prostaglandins shifting the arachidonic acid metabolites down the pathway that produces increased leukotrines-->bronchospasm
181
Vault Hold Placement
2. Second digit (index): greater wing of sphenoid
3. Third digit (middle finger): squamous portions of the temporal bone (front of ear)
4. Fourth digit (ring finger): petrous portion of temporal bone (behind ear)
5. Fifth digit (pinky): squamous portion of occiput
182
Polycystic ovarian syndrome
-high levels of LH, low levels of FSH, high testosterone, and high estrogen
183
Blood Supply of Ureter
1. Proximal: branches of renal artery
2. Middle: supplied by common iliac arteries
3. Distal: supplied by superior vesical arteries
184
Craniopharyngiomas
-benign primary brain tumors of childhood
-consist of epithelial-squamous lined cystic masses filled with cholesterol crystals and viscous fluid
185
Chronic Granulomatous Disease
-X-linked recessive mutation of NADPH oxidase
-Impaired respiratory burst--> impaired O2 dependent phagocytic intracellular killing
-Reccurent infections with CATALASE- Positive organisms (Aspergillius + Staph aureus)
186
Chediak-Higashi
-defect in phagocytosis due to microtubule polymerization dysfunction
-leads to dysfunction of phagosome-lysosome integration
-pts present with light skin, silvery hair, neuropathy
-Pts experience recurrent GRAM +, Gram - bacterial, and fungal infections
187
Fabry Disease
-deficiency of a-galactosidase
-accumulation of globosides in the lysosomes of smooth muscle and vascular endothelial cells
-Clinical: red-purple-skin rash, kidney, and heart failure
188
Acute pancreatitis
release of lipase leads to fat necrosis and precipitation of insoluble Ca2+ salts---> histo shows chalky white lesions while microscopic evaluation can show adipose cell destruction
189
Myotonic Dystrophy
-Autosomal dominant myopathy caused by CTG trinucleotide repeat on DMPK gene on chromosome 19
-due to maternal meiosis
190
Friedreich Ataxia
-Autosomal recessive
-Chromosome 9
-Gene: FXN
-GAA
-Ataxic gait, Dysarthia, kyphoscolosis, HOCM
191
Huntington Disease
-Autosomal Dominant
-Chromosome 4
-Gene: HTT
-CAG
-Chorea, Akinesia
-Paternal Meiosis
192
Facial Nerve+ Glossopharyngeal Nerve
-Facial: Taste to anterior 2/3rds of tongue via chorda typani branch
-Glossopharyngeal nerve: Taste to posterior 1/3rd of tongue
193
Chron Disease
-Nonbloody diarrhea, abd pain, fever
-Discontinous inflammation ("skip lesions)
-Can involve any area of GI tract (mouth to anus)
-Histology shows: transmural, noncaseating granulomas, giant cells, neutrophilic inflammation
194
Vitamin B12 deficiency
-Pernicious anemia, pancreatic insufficency, terminal ileum damage (chron diseases)
-subacture combined degeneration of the cord
-decreased Hb, Hct, increased MCV, hypersegmented neurophils and
INCREASED HOMOCYSTEIN AND METHYLMALONIC ACID
195
Paroxysmal nocturnal hemoglobinuria
-characterized by complement-mediated hemolysis
-acquired mutation in the PIGA gene that results in decreased synthesis of the GPT anchor protein
-TRIAD of Coombs test-negative hemolytic anemia, large vein thrombosis, and pancytopenia
-TX: Eculizumab
196
Graft vs Host Disease
-Triad of rash, GI disturbances, and abnormal liver function
-occurs when immunologically competent donor T cells are transplanted into an immunocompromised host and attack
-DONOR T cells attacking host
-Wi
197
Hyperacute rejection
-Major Target: Donor surface proteins on graft or cells
-24 hours after transplantation
-MOI: Receipient pre-exsisting antibodies and complement fixation
198
Acute rejection
-Donor human leukocyte antigens
-Within 1-2 weeks
-Recipient B and T cell responses
199
Chronic rejection
-Donor human leukocyte antigents
-within months to years
-Reciepent B and T cell responses
200
von-Hippel- Lindau
-Autosomal dominant mutation that results in deletion of the VHL gene on chromosome 3p
-Hemangioblastomas, angiomatosis, BILATERAL renal cell carcinomas, and pheochromocytomas
201
Alcoholic ketoacidosis
-depletion of NAD and elevation of the NADH:NAD ratio, shunting acetyl coA to ketone body formation
202
Goodpasture Syndrome
-Cough,dyspnea, hemoptysis, hematuria, nephritic syndrome
-Anti-GBM antibodies and LINEAR IgG along GBM
203
Branches of external carotid artery
Some Anatomists Like Freaking Out Poor Medical Students
S: superior thyroid
A: Ascending pharyngeal
L: Lingual
F: Facial
O: Occipital
P: Posterior Auricular
M: Maxillary
S: Superfical Temporal
204
Type 1 Hypersens
-Allergies, Asthma, Anaphylaxis
205
Type 2
Acute hemolytic transfusion rxn, hyperacute rejection, ITP
206
Type 3
Serum sickness, SLE
207
Indirect Inguinal Hernia
-Herniation through internal inguinal ring
-Transverse through inguinal canal
-Enters the inguinal ring lateral to the inferior epigastric vesses
-Patency of processus vaginalis
208
Direct Inguinal Hernia
-Herniation through external inguinal ring
-Enters the inguinal canal MEDIAL to inferior epigastric vessels
-passes through the abdominal wall
209
Femoral hernia
-Herniation through femoral ring
-Passes under inguinal canal, direct passing through abd wall
210
Diabetic Nephropathy
Renal biopsy shoes uniform thickening of basement membrane
-Mesangial nodules (kimmelstein-Wilson nodules)
211
Intraperiotoneal structures
Stomach, jejunum, ileum, cecum, appendix, transverse colon, sigmoid colon, liver, spleen, and gallbaldder
-Middle colic artery-->transverse colon
212
Hepatic encephalopathy
-excessive conversion of ammonia to glutamine
-presents with asterixis (flapping tremor)
213
Parathyroid Hormon
-Acts on kidneys stimulating adenylate cyclase to increase cAMP---> increased Ca2+ absorption in the distal tubule
214
Menopause
-decline in granulosa cells
-decreased levels of estrogen
-FSH LEVELS RISE
215
Loauasus
-Deer Fly
-Cerebral swellings, itching
-visualization of worms
216
Onchocerciasis
-Black fly
-inguinal and femoral lymp
-dooping of atropic skin of groin
-Rx: Ivermectin
217
Lesion of lateral PRECENTRAL gyrus
-upper motor neuron signs in the CONTRALATERAL UE and muscles of facial expression in the lower face
-SPARES the Lower Extremity
218
