Random Facts Flashcards
Cleft lips
Failure of the midline intermaxillary segment (fused medial nasal prominence) to fuse with the maxillary prominences - occurs more commonly on the left.
NSAID-induced nephropathy
Concentrates in the medulla; decreased prostaglandin synthesis causes vasoconstriction of the medullary vasa recta and papillary necrosis; also uncouples the mitochondria to cause direct cellular damage. Chronic interstitial nephritis
Papillary necrosis
Elevated serum creatinine Fanconi syndrome Mild proteinuria Colicky pain Gross hematuria Tissue fragments on urinalysis
S. epidermidis antibiotics sensitivity
Often not sensitive to methicillin-class antiotics; first line treatment is vancomycin or rifampin
Beta-thalassemia cause
Usual mutations affect mRNA splicing and premature translational termination
Courvoisier’s sign
1) Palpable nontender gallbladder 2) Weight loss 3) Obstructive jaundice Together they mean adenocarcinoma at the head of the pancreas.
Risk factors for pancreatic adenocarcinoma
1) Age 2) Smoking 3) Diabetes 4) Chronic pancreatitis 5) Genetic predisposition
Production of propionic acid
Isoleucine Valine Threonine Methionine Cholesterol Odd-chain fatty acids
Glucagonoma
Hyperglycemia (diabetes diagnosis) Stomatitis Cheilosis Abdominal pain Necrolytic migratory erythema
E. coli virulence factor for meningitis
K-1 capsular antigen Inhibits complement and phagocytosis Antibodies against capsule are protective
Anaplasia
Neoplastic cells that completely lack any signs of differentiation (pleomorphism, large N/C ratios, loss of polarity, mitotic figures and multinucleated giant cells)
Cerebellar Purkinje cell degeneration paraneoplastic syndrome
Anti-Yo (ovarian and breast) Anti-P/Q (lung) Anti-Hu (lung)
PABA sunscreen protection
PABA protects against UVB only Zinc oxides protects against UVB and UVAI & UVAII Avobenzone protects against UVAI & UVAII only
Neutrophil chemotaxis
1) Margination (histamine & prostaglandin vasodilation) 2) Rolling (Sialyl Lewis X & Selectins) 3) Activation (Chemokines) 4) Crawling (CD18 b2 integrins MAC-1 or LFA-1 & ICAM1) 5) Transmigration (PECAM-1 at intercellular junctions)
Thioridazine
Retinal deposits (looks like retinitis pigmentosa)
Chlorpromazine
Corneal deposits
Quetiapine
HAM blockage and cataracts
Pulmonary embolism ABG/Chem
Hypoxemia > increased respiration > respiratory alkalosis Serum bicarb takes time to decrease to compensate
Low serum C1 esterase inhibitor
Autosomal dominant hereditary angioedema Painless, non-pitting, well-circumscribed edema Face, neck, lips, tongue and internal organs Respiratory obstruction is fatal GI tract is abdominal pain, N/V and diarrhea C1 esterase inhibitor -| kallikrein Kallikrein catalyzes kininogen to bradykinin and plasminogen to plasmin DO NOT use ACE inhibitors
Aflatoxin mechanism
G-T transversion in p53 causing hepatocellular carcinoma
Porcelain gallbladder
Intramural calcification due to chronic inflammation 11-33% chance of gallbladder carcinoma
Differentiate vibrio vs. campylobacter
Both comma-shaped, gram-negative, and oxidase-positive Only vibrio grows on alkalinized media
Atherosclerosis spots
Abdominal aorta > coronary > popliteal > internal carotid > circle of willis
Parvo arthritis
Symmetric inflammation of PIP, MCP, wrist, knee and ankle like RA but resolves spontaneously in < one month\
Reversible vs. irreversible change
Disaggregation or aggregation of nuclear elements is REVERSIBLE Mitochondrial vacuolization is irreversible
First line pharmaco-intervention for gestational diabetes
Insulin
Most common cause of MS and MR
MS: rheumatic fever MR: myxomatous degeneration
Osteoporosis PTH vs. Ca2+
DEXA scan over 2.5 SD of normal Normal PTH and Ca2+ balance in serum
Components of cystathionine
Homocysteine and serine via B6 condensation Then cystathionase (B6) to cysteine
Pure red cell aplasia (PRCA)
Inhibition of erythropoietic precursors by IgG autoantibodies or cytotoxic T cells. Associated with thymomas and lymphocytic leukemias. Also could be from Parvo B19 infection.
EPO-producing tumors
Uterine fibroids Cerebellar hemangioblastomas Renal cell carcinomas Hepatocellular carcinoma
Test for lipoprotein lipase activity
Heparin causes vascular endothelium release of LPL which is negative in congenital deficiencies. Shows eruptive skin xanthomas, HSM and pancreatitis
Hypercholesterolemia vs. Hyperlipidemia
Arcus senilis vs. lipemia retinalis Tendinous xanthomas and xanthelasma vs. eruptive cutaneous xanthomas Coronary artery disease vs. pancreatitis
Livedo reticularis
Aggravated by cold and found on lower extremities 1) Polyarteritis nodosa 2) SLE 3) RA 4) Dermatomyositis 5) Pancreatitis 6) Amantadine 7) Cryoglobulinemia 8) Arteriosclerosis (cholesterol emboli) #1 causes is idiopathic in young women during winters
Glucokinase deficiency
MODY and gestational diabetes
Most common tumor of the pineal gland
Germinomas - Precocious puberty - Parinaud syndrome - Aqueductal compression w/ hydrocephaly
Serum marker for mast cell degranulation
Tryptase
Gastric structure
Gastric pit connects to multiple gastric glands 1) Upper glandular layer contains parietal cells 2) Lower glandular layer contains chief cells
T-ALL
More likely to form large anterior mediastinal mass that compresses surrounding structures
Coin lesions in non-smoker lung
Hamartoma (pulmonary chondroma)
Polyarteritis nodosa sparing
Spares the pulmonary arteries and rarely involves the bronchial arteries
Post-strep RPGN
More severe in adults and progress to chronic forms
Metyrapone
Blocks 11-b-hydroxylase in adrenal cortex to test HPA axis Should see increase in urinary 17-hydroxycorticosteroids
Halothane-associated hepatitis
Type 1: elevated AST and ALT but mild or no symptoms Type 2: rapid atrophy of bladder w/ centrilobular necrosis and inflammation of the portal tracts. Marked increase in AST and ALT and prolonged PT. Thought to be hypersensitivity reaction to drug leading to autoimmune attack on hepatocytes
Pituitary apoplexy
Bleeding into a pre-existing pituitary adenoma leading to ACTH dysregulation and insufficient stress response and severe hypotension
Pilocytic astrocytomas
Cystic and nodular component on MRI Rosenthal fibers pathomnemonic
Brain CT
Hemorrhage = hyperdense Ischemia = hypodense
Turner’s heart problems
Most common = bicuspid aortic valve Second most = aortic coarctation Non-damaged bicuspid AV still has early systolic ejection high frequency click over the cardiac apex
Foul-smelling sputum
Abscess formation
Green color of sputum
Myeloperoxidase is green in color because it is a heme based protein
TImeline of neuronal ischemia
12-48 hours = red neurons (eosinophilic, pyknotic, loss of Nissl substance) 48-72 hours = necrosis and neutrophilic infiltration 3-5 days = macrophage infiltration and clean up 1-2 weeks = reactive gliosis and vascular proliferation (liquefactive necrosis w/ soft area) > 2 weeks = glial scar (cystic area surrounded by gliosis)
Early changes in myocardial infarction
0-4 hours = no change 4-12 hours = edema, wavy fibers, hemorrhage, necrosis 12-24 hours = coagulative necrosis, contraction bands
Depth limit on gastric erosion
Erosions cannot extend beyond the muscularis mucosa; further becomes ulcers
Bronchoalveolar carcinoma
Looks like pneumonia consolidations and arises on the periphery of the lung Arises from alveolar epithelium and is well-differentiated Minimally invasive of the vasculature or stroma
germ cell tumors and hyperthyroidism
Germ cell tumors secrete hCG that is structurally related to FSH, LH and TSH and can stimulate the TSH receptor. FSH cannot.
Primary cause of lacunar infarcts
Chronic hypertension resulting in arteriolar sclerosis
Cavernous hemangioma of the brain and viscera
Associated w/ von Hippel Lindau syndrome Blue in color because of dermis (deep) location
Cholecystenteric fistula treatment
Surgical removal of the stone at ileocecal valve Typically does not require cholecystectomy or fistula repair
Common peroneal nerve damage
Foot inversion and plantarflexion (Equinovarus) Foot drop Anterolateral leg loss of sensation
Meningioma origins
Arachnoid villi
Sciatic nerve contributions
L4 to S3
Splenium of corpus callosum lesion
Alexia without agraphia
Supraspinatus testing
Empty can supraspinatus test 1) Abduct arm to 90 2) Flex arm to 30 3) Point thumbs down 4) Apply downward force on the arm
Aortic rupture location
Isthmus of the aortic arch after the left subclavian
Spleen
Intraperitoneal Derived from the mesoderm
Superior laryngeal nerve innervation
Cricothyroid muscle Sensory innervation above the vocal cord
Favorite location of schwannomas
Cerebellopontine angle Affects CN V, VII and VIII
Nursemaid’s elbow
Radial head subluxation Traction while elbow is pronated and extended Children hold their arms in this position to stop hurting Reduction achieved by supination and flexion
Delineation of the anterior 2/3 to posterior 1/3 tongue
Terminal sulcus which contains the foramen cecum
Infancy hydrocephalus
Typically due to congenital malformations like Arnold-Chiari and aqueductal stenosis Can lead to hyperreflexia and spasticity due to pyramidal tract stretching
Parotid gland nerve pathway
Inferior salivatory nucleus - IX - otic ganglion - auriculotemporal (V) - parotid gland
Submandibular gland nerve pathway
Superior salivatory nucleus - VII chorda tympani - lingual - submandibular ganglion
Prepatellar bursitis
Housemaid’s knee (common in roofers, carpeters, plumbers and gardeners) Prepatellar bursitis between skin and prepatellar tendon
Lung and pleura locations
Left and right are the same PARIETAL PLEURA Mid-clavicular = 7 Mid-axillary = 10 Para-vertebral = 12 LUNGS Lungs are always 2 spaces above
Superior mesenteric artery syndrome
SMA compression of transverse duodenum against the aorta Caused by low body weight, weight loss and lordosis (from scoliosis surgery)
External ear canal innervation
External canal and outer membrane = mandibular V3 (auriculotemporal branch) Posterior part of external canal = small auricular of X Inner membrane = tympanic of IX
Reflex levels (lower extremity)
Anal = S2-S4 Knee = L3-L4 Achilles = S1-S2
Lacunar infarct causes
Lipohyalinosis and microatheromas (Diabetes and hypertension)
What structures lie posterior to the duodenal bulb
Common bile duct Portal vein Gastroduodenal artery (damaged by posterior ulcer)
Piriform recesses
Small cavities beside the epiglottis on the esophageal side - food tend to get stuck here Underneath is the internal laryngeal (X) of the superior laryngeal (X) and is responsible for sensation above the vocal cords - afferent of the cough reflex
Body’s smallest bone and skeletal muscle
Stapedius (VII) and stapes
V3 somatic motor
Muscles of facial expression and tensor tympani
Lower trunk of brachial plexus
C8 and T1 and contributes to median and ulnar - all intrinsic muscles of the hand
Intraventricular hemorrhage in newborns
Associated with prematurity ( < 32 weeks) and/or low birth weight (< 1500 g), and almost always occurs within 5 days of birth. Due to rupture of the germinal matrix - highly cellular and vascular region w/o glial support of blood vessels in the subventricular zone (SVZ).
Cardinal sign of CHF in the lung
Batwing opacity and Kerley B lines
Most common shoulder dislocation
Anterior is most common - falling onto outstretched hands The axillary nerve is often damaged
Sensory component of the phrenic nerve
Diaphragmatic and mediastinal pleura referring to C3-5 (shoulder and neck) All other pleural sensory is done by the intercostal nerve
Sensory location of musculotaneous nerve
Lateral forearm
Urethral segments
Posterior (prostatic -> membranous) Anterior (bulbous -> penile) The joining component is the weakest and can be damaged by pelvic trauma
Intracytoplasmic P bodies
Site of mRNA storage and degradation Contains microRNA apparatus and other nucleases that affects mRNA stability and half life
Linkage disequilibrium
Two alleles inherited together more than chance alone would dictate 1) Proximity on the same chromosome 2) Selection pressure for them to be together
Polyol pathway
Aldose reductase reduces glucose into sorbitol with NADPH, which cannot leave the cell and increases the osmolarity of the cytoplasm Polyol dehydrogenase, which has lower activity, converts sorbitol into FRUCTOSE 1) Seminal vesicles 2) Lens
Myelin electrical properties
DECREASE capacitance INCREASE length constant (distance until 1/e old amp) DECREASE time constant (time until 1-1/e new amp)
Pro-collagen formation
Disulfide bond formation between the C-terminal propeptides of 3 a-chains brings them into formation for triple helix formation
Mitochondrial disorders
1) Leber hereditary optic neuropathy 2) Myoclonic epilepsy w/ ragged red fibers 3) Mitochondrial encephalomyopathy w/ lactic acidosis and stroke like episodes
Etoposide
Topoisomerase II inhibitor (double-stranded breaks)
Irinotecan Topotecan
Topoisomerase I inhibitor (single-stranded breaks)
MEN I
Mutation: Menin Parathyroid Pancreatic Pituitary
MEN IIA
Mutation: RET Parathyroid Pheochromocytoma Medullary carcinoma of the thyroid
MEN IIB
Mutation: RET Pheochromocytoma Medullary carcinoma of the thyroid Marfanoid habitus and mucosal neuromas
Methods of acquiring CJD
1) Corneal transplants 2) Neural implants 3) Bovine growth hormones
CJD
Spongiform degeneration Myoclonic seizures and rapidly progressive dementia Cytoplasmic vacuoles Long incubation period but rapidly progressive NO inflammatory changes
Paget’s disease complication
Affected bone has increased fibrosis and vascularity Proliferation of fibroblasts and endothelial cells due to cytokine release by osteoclasts - AV shunting and HIGH OUTPUT HEART FAILURE - High density but fragile bone leading to fractures - Increased risk of osteosarcoma
Renal acid secretion
Minimum pH is approximately 4.5 Increase bicarbonate absorption Increase titratable acid secretion (HPO4 and NH3)
HEV
Hepevirus ssRNA+ noneveloped icosahedral structure
Adenovirus in close quarters
Pharyngoconjunctival fever
Femoral nerve
Comes out between psoas and iliacus From roots L2-L4 Weakness in quadriceps group (knee buckling) Loss of sensation anterior medial thigh and leg Diminished patellar tendon reflex (L3-4 mostly 4)
Dopamine
Low = D1 activation = UP RBF, UP GFR, UP sodium excretion, UP mesenteric flood flow Med = B1 activation = UP contractility, UP systolic blood pressure, SAME diastolic blood pressure HIGH = A1 activation = UP vasoconstriction
Polymyositis
Unknown antigen stimulates autoimmunity against muscle Macrophage and CD8 T cell infiltration of the endomysium Symmetric proximal muscle weakness of the arm and leg Anti-Jo1 antibody Increased MHC I expression on sarcolemma Increased general risk of malignancies
Trihexyphenidyl
Centrally acting anti-cholinergic (like benztropine)
GLUT3 expression pattern
Brain Kidney Placenta
Platelet factors that induce atherosclerosis
PDGF: SMC migration and proliferation TGB-b: SMC migration and collagen synthesis
Theca interna products
LH induced testosterone and progesterone production
Carotid sinus syncope
Hypersensitivity of carotid sinus (internal carotid) w/ afferent through the Hering’s nerve (IX) causing increased inhibition (increased firing) in the solitary nucleus in the medulla, leading to decreased HR and vasodilation and decreased BP
Monomeric insulins
Aspart (Novolog), Lispro (Humalog), Glulisine (Apidra) Starts 15 min - peaks 60 min - lasts 4 hours
Regular insulin
Regular insulin Starts 30 min - peaks 2 hours - lasts 8 hours
Intermediate insulin
NPH (Neutral protamine Hagedorn) Starts 2 hours - peaks 8 hours - lasts 16 HOURS Lente (Novalin) Starts 1.5 hours - peaks 6 hours - lasts 24 hours
Long acting insulin
Detemir Starts 2 hours - peaks 8 hours - lasts 24 hours
Peakless insulin
Glargine (Lantus) (low pH and forms microprecipitate) 24 hours peakless
Factors causing acne
1) Follicular epidermal hyperplasia 2) Excessive sebum production 3) Inflammation 4) Propionibacterium acnes
Aging skin histology
1) Thinning of the dermis and epidermis 2) Flattening of the dermoepidermal junction 3) Decreased number of fibroblasts 4) Reduced synthesis of collagen and elastin
