Random First Aid Facts Flashcards
1
Q
Amino acids necessary for purine synthesis?
A
GAG = Glycine, Aspartate, Glutamine
2
Q
Where is the action of Leflunomide?
A
It inhibits dihydroorotate dehydrogenase and interferes with synthesis of orotic acid from carbamoyl phosphate thereby inhibiting pyrimidine synthesis.
3
Q
What is the effect of alpha-amanatin toxin and where does it come from?
A
Comes from the mushroom Amantia phalloides (death cap mushroom) and inhibits RNA pol II. Results in severe hepatotoxicity if ingested
4
Q
What are P-bodies?
A
They are cytoplasmic bodies with exonucleases, decapping enzymes, and microRNAs that act as a quality control check point and storage reservoir for mRNAs.
5
Q
Describe tRNA structure:
A
Amino acid bound to the 3’ end. Going 3’ to 5’ we have amino acid, T-arm (binds to ribosome), Variable arm, anti-codon loop, and D-arm (dihydrouracil residues for recognition by tRNA synthetase).
6
Q
What is the pathophysiology of I-cell disease?
A
Defect in phosphotransferase so the Golgi can’t phosphorylate mannose residues and therefore nothing can be traficked to lysosomes. Get accumulation of lysosomal enzymes in the blood. Coarse facial features, clouded corneas, decreased joint mobility. Fatal in childhood.
7
Q
Where is Collagen Type 1 found
A
Bone, Skin, Tendon, fascia, cornea, late wound repair
8
Q
Collagen Type 2:
A
Cartillage, vitreous body, nucleus pulposus
9
Q
Collagen Type 3:
A
Reticulin (Skin), blood vessels, uterus, fetal tissue, granulation tissue. Implicated in the rare vascular type of Ehlers-Danlos syndrome
10
Q
Collagen Type 4:
A
Basement membrane, lens of the eye
11
Q
What three processes happen to Collagen in the RER?
A
Synthesis, hydroxylation, and Glycosylation and formation of the triple helix. It is now procollagen. Defects in this point cause OI.
12
Q
What disease do problems with collagen crosslinking lead to?
A
Ehlers-Danlos Syndrome
13
Q
What is the pathophysiology of most common cause of OI?
A
Autosomal dominant with decreased production of otherwise normal Type 1 collagen.
14
Q
What are the three types of Ehlers-Danlos Syndrome?
A
1) Hypermobility type (most common)
2) Classical Type (joint and skin symptoms); Type V collagen issues
3) Vascular type (vascular and organ rupture); Type III collagen.
15
Q
What is Menkes disease?
A
It is due to impaired Cu absorption and transport thereby decreasing the activity of lysyl oxidase. Brittle, “kinky” hair, growth retardation, hypotonia
16
Q
When should we consider Uniparental disomy?
A
When an individual is manifesting a recessive disorder and only one parent is a carrier! Note can be a meisosis 1 error (Heterodisomy) or meisosis 2 error (Homodisomy)
17
Q
According to H-W equilibrium, what is the freqneyc of an X-linked recessive disease in Males and Females?
A
Males = q and females = q^2
18
Q
What acid base abnormality can CF present with?
A
Contraction alkalosis and hypokalemia due to the decreased ECF H2O and Na+ content.
19
Q
What is the treatment for CF?
A
N-Acetyl Cysteine can loosen mucous plugs and dornase alfa (DNAse) to clear leukocyte debris.
20
Q
Why is the the dystrophin protein at an increased risk of spontaneous mutations?
A
It is the longest coding region of any human gene
21
Q
What is the pathophysiology of Myotonic Dystrophy?
A
CTG trinucleotide repeat expansion in the DMPK gene (AD inheritance).
Sx: Myotonia ( slow relaxation!), wasting, frontal balding, cataracts, testicular atrophy, arrhythmia.
Type 1 fibers more affected
22
Q
What is the various trinucleotide Repeat sequences:
A
X-Girlfriends First Aid Helped Ace My Test Fragile X: CGG Friedreich ataxia: GAA Huntingtons: CAG Myotonic Dystrophy: CTG
23
Q
What is the Leser-Trelat sign?
A
Sudden appearance of multiple seborrheic karatoses can indicate an underlying malignancy (e.g. GI, lymphoid)
24
Q
What skin condition is associated with celiac disease?
A
Dermatitis Herpetiformis (IgA deposition at the tips of the dermal papillae). Pruritic papules, vesicles, and bullae.
25
What differentiates Toxic Epidermal Necrosis from Stevens-Johnson syndrome?
In TEN, >30% of the body surface area is involved
26
What are the 6 P's of Lichen Planus?
Pruritic; Purple Polygonal Planar Papules and Plaques.
Also might see reticular white lines on mucosa (Wickham striae). Sawtooth infiltrate of lymphocytes at dermal-epidermal junction. HCV associated.
27
What does UVA vs. UVB cause?
UVA - tanning and photoaging
| UVB - sunburn
28
What is the ABCDE of melanoma?
Asymmetry, Border Irregularity, Color Variation, Diameter > 6 mm, Evolution over time
29
What amino acid is Vitamin B3 derived from?
Tryptophan, but it requires vitamin B2 and B6 in the process
30
Deficiency of what vitamin is associated with "Burning Feet Syndrome"?
Vitamin B5 (Pantothenate)
31
What does Arsenic due to glycolysis?
It causes glycolysis to produce zero net ATP. It also inhibits lipoic acid (i.e. inhibits Pyruvate Dehydrogenase and others).
32
What are the poisons of Oxidative Phosphorylation?
```
Rotenone - Complex One
Antimycin A - Complex III
Cyanide - Complex IV
Oligomycin - Complex V
Aspirin, 2,3-DNP, Thermogenin - Uncoupling Agents
```
33
What is the mechanism of action of lactulose?
Acidifies the GI tract and traps NH4+ for excretion in the feces
34
What direction is lens subluxation in hyperhomocysteinemia?
Down and in = "Down to Home"
35
What is Cheyne-Stokes respiration?
It is periods of apnea and normal breathing due to slowed respiratory feedback loop. Seen in neurologic and cardiac disease and it is a poor prognostic sign.
36
What is an Osler node?
Tender raised lesions on finger or toe pad. Vs. Janeway lesions which are small painless erythematous lesions on palms and soles
37
What is Beck's Triad of Cardiac Tamponade?
Hypotension, distended neck veins, and distant heart sounds
38
What is Kussmal's Sign?
A paradoxical rise in JVP upon inspiration. Usually due to failure to transmit negative intrathoracic pressure to the heart (e.g. constrictive pericarditis, restrictive cardiomyopathies, tumors)
39
What is a pyogenic granuloma?
is a vascular lesion that occurs on both mucosa and skin, and appears as an overgrowth of tissue due to irritation, physical trauma or hormonal factors (e.g. pregnancy). Can ulcerate and bleed
40
What is a Glomus tumor?
Red-blue tumor under fingernails that is painful. From modified smooth muscle of the glomus body
41
What changes are seen in GnRH pulses with exercise-induced vs. ovarian defect ammenorrhea?
Exercise-induced: decreased amplitude and frequency
| Ovarian defect: increased amplitude and frequency
42
What are the symptoms of glucagonoma?
Necrolytic migratory erythema, erythematous rash in groin, hyperglycemia, stomatitis, cheilosis, abd pain
43
What is a physical exam difference between neuroblastoma and Wilms tumor?
Wilms tumor is smooth and unilateral wheras neuroblastoma is irregular and can cross the midline
44
What is the Jod-Basedow phenomenon?
Thyrotoxicosis in a patient with iodine deficiency goiter when made iodine replete
45
How do you treat thyroid storm?
The 3 p's = Propranolol, Propylthiouracil, Prednisolone (steroids)
46
What is Chvostek's sign?
tapping of facial nerve leads to contraction of facial muscles (hypocalcemia sign)
47
What is Trousseau's sign?
occlusion of brachial artery with BP cuff leads to carpal spasm (hypocalcemia sign)
48
What is the rule of 1/3s of carcinoid tumors?
1/3 metastasize, 1/3 present with 2nd malignancy, 1/3 are multiple.
49
What drug is prefered over metforim in renal failure patients?
Glipizide, as it undergoes hepatic clearance
50
What effects do glitazones have on blood lipids?
Decrease triglycerides and increase HDP, also decrease CRP
51
What enzyme catalyzes rate limiting step in bile synthesis?
Cholesterol 7-alpha hydroxylase
52
What is Menetrier disease?
Gastric hypertrophy with parietal cell atrophy. It is precancerous and the rugae of stomach are hypertrophied so they look like brain gyri
53
What is the Peutz-Jeghers syndrome?
Multiple non-malignant hamartomas along GI tract, hyperpigmented mouth, lips, hands, genitalia. Increased malignancy risk. AD
54
What is Gardner syndrome?
FAP + osseous and soft tissue tumors + congenital hypertrophy of retinal pigment epithelium
55
Turcot syndrome?
FAP + malignant CNS tumors
56
What are Mallory bodies?
Intracytoplasmic eosinophilic inclusions in hepatocytes due to long-term alcohol use
57
What are some triggers of hepatic encephalopathy due to increased NH3 production?
GI bleeding, constipation, high protein meal, infection
58
What are some triggers of hepatic encephalopathy due to decreased NH3 removal?
Renal failure, diuretics, post-TIPS
59
What is rifaximin and what is it used for?
Antibiotic that kills intestinal bacteria, used to treat hepatic encaphalopathy by reducing NH3 load (also Rx travelers diarrhea)
60
What is the mechanism of NH3 induced encephalopathy?
Increases glutamine in astrocytes thereby decreasing the total pool of glutmate stores in the brain and depleting alpha-ketoglutarate needed for Kreb's cycle. It also causes mitochondrial swelling and dysfunction in astrocytes.
61
What liver tumor to OCPs commonly cause?
Hepatic Adenoma, rupture can lead to shock
62
What is a notable physical exam finding in Budd-Chiari syndrome?
No JVD! since the obstruction is in the hepatic vein.
63
What are some causes of Budd-Chiari syndrome?
Hypercoagulable states, polycythemia vera, pregnancy, HCC
64
What is a hepatoblastoma?
It is a liver tumor seen in Kids that is associated with FAP and Beckwith-Wiedman syndrome. Fatal if not resected
65
What two diseases should PAS + globules make you think of?
Whipple's disease and alpha-1 antitrypsin deficiency
66
What vitamin should infants receiving phototherapy be treated with?
Vitamin B2
67
What drug can be used to treat type II Criegler-Najjar?
Phenobarbital
68
Does Rotor or Dubin-Johnson syndrome cause a black liver?
Dubin-Johnson syndrome causes a black liver
69
What can the motor symptoms of Wilson's disease be characterized as?
Parkinsonian symptoms due to degeneration of the Basal Ganglia
70
What is the genetic associations of hemochromatosis?
C282Y or H63D mutation on the HFE gene which senses iron levels and is involved inregulation. HLA-A3 association
71
What are the characteristics of Beckwith-Wiedmann Syndrome?
macroglossia, macrosomia (birth weight and length greater than the 90th percentile), midline abdominal wall defects (omphalocele/exomphalos, umbilical hernia, diastasis recti), ear creases or ear pits, and neonatal hypoglycemia (low blood sugar after birth)
72
What is the histologic pattern of bile duct fibrosis in PSC?
Onion Skin pattern is seen. Also see alternating strictures and dilation with "beading" of both extra and intra hepatic bile ducts on ERCP
73
What color are the stones in biliary infection?
brown, radio-lucent
74
What is the Charcot triad of cholangitis?
Jaundice
Fever
RUQ Pain
75
What are the causes of acute pancreatitis?
GET SMASHED
Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion, Hypercalcemia/Hypertriglyceridemia, ERCP, Drugs (e.g. sulfa)
76
What is the lining of a pancreatic pseudocyst?
Granulation tissue, not epithelium, hence not true cyst
77
What is Courvoisier's sign?
Obstructive jaundice with a palpable non-tender gallbladder (sign of Pancreatic CA)
78
What population usually has cis deletions in alpha thalasemia?
Asians.
Africans have trans
79
What is the difference between Hb Barts and HbH?
Hb Barts = 4-gamma globins
| HbH = 4 beta globins
80
What is the basophilic stippling seen in lead poisoning caused by?
rRNA aggregates that form due to inhibition of their breakdwon
81
What are some features of Lead poisoning?
Lead Lines on Gingivae and metaphysis of long bones
Encephalopathy
Abdominal Colic
Basophilic stipling and Sideroblastic Anemia
Wrist and foot Drops
82
What do labs shows in sideroblastic anemia?
Increased Iron
Normal TIBC
Increased ferritin
83
What is the treatment for sideroblastic anemia?
pyridoxine to improve heme synthesis
84
What is the Eosin-5-maleimide binding test used for?
Screening for Hereditary Spherocytosis
85
What is eculizumab?
It is a terminal complement inhibitor used for the rx of PNH (binds C5 and inhibits cleavage)
86
What two hematologic conditions are associated with a "crew cut" skull on X-ray?
Sickle Cell and Thalasemias
87
What is transferrin saturation?
= serum iron / (TIBC or Transferrin levels)
88
What medication and conditions causes increased transferrin production?
OCPs and Pregnancy, this in turn results in decreased % saturation
89
What effect do corticosteroids have on blood counts?
Neutrophilia (decreased migration), Lymphopenia (apoptosis of lymphs), Eosinopenia (sequester in LNs)
90
What is the defect in X-linked sideroblastic anemia?
delta-ALA synthase deficiency
91
What are the two precusors of ALA?
Glycine and Succinyl-CoA
92
True or false, a 1:1 dilution of patients blood will fix a clotting factor deficiency?
Yes, b/c most factors can decrease by 60% w/o changing coag studies at all
93
What are the symptoms of acute intermittent porphyria?
```
5P's:
Painful abdomen
Port wine colored urine
Polyneuropathy
Psychological disturbacnes
Precipitated by drugs, EtOH, starvation
```
94
What is the treatment for acute intermittent porphyria?
Give glucose and heme which inhibit ALA synthase
95
What is the color of urine in porphyria cutanea tarda?
Tea-colored
96
What is the result of a ristocetin cofactor assay on someone with vWD?
There is decreased agglutination of platelets as the vWF is not present or not functional. Note that in Type 2B, there is increased agglutination on this assay and it is diagnostic
97
How do you differentiate a leukemoid reaction from CLL?
In a normal leukemoid reaction, ALP is increased, whereas it is decreased in CML
98
What differentiates waldenstrom macroglobulinemia from Multiple Myeloma?
The M spike is IgM instead of IgG or IgA and there are no lytic bone lesions. Hyperviscosity symptoms predominate
99
What is the pseudo-pelger-huet anomaly?
Neutrophils with bilobed nuclei connected with thin chromatin filament. Seen after chemo
100
What is the treatment of Hairy Cell Leukemia?
Cladribine, an adenosine analog
101
What are common presentations of Langerhans Cell Histiocytosis?
1) Lytic bone lesion and skin rash
| 2) recurrent otitis media with mass involving mastoid
102
What markers are expressed by langerhans cells?
S-100 and CD1a
103
What are the symptoms of essential thrombocytosis?
Bleeding and thrombosis due tot he overproduction of abnormal platelets
104
True or false, LMWH binds thrombin?
False! LMWH binds factor Xa only! They hve a longer half life and better bioavailability
105
What is a Housemaids Knee?
Due to prepatellar bursitis
106
What causes Anserine Buristis?
Commonly obesity or athletic overuse. Medial knee pain
107
What is the most common location of rib fracture?
Anterior to the angle of the rib - we need to anasthetize it lateral to the angle of the rib
108
Why is clawing seen best with distal lesions of the median or ulnar nerve?
The remaining extrinsic flexors of the wrist exagerrate the loss of the lumbricals. For proximal lesions, they are more pronounced during voluntary flexion
109
What compartments does the common peroneal nerve innervate?
The anterior (deep peroneal) and lateral (superficial peroneal) compartments. Injured in a fibular neck fracture
110
Where is it safest to give a gluteal injection?
The superolateral quadrant to avoid the superior gluteal (superomedial) and sciatic (inferomedial)
111
Is the lesion contra or ipsilateral to the side that drops in a trandelenburg sign?
It is contralateral to the hip that drops
112
What nerve roots are the achiles reflex and patellar reflex testing?
Achiles - S1
| Patellar - L4
113
What are the polriazed light findings in gout and pseudogout?
Gout - yellow when parallel to the light (negative)
| Pseudogout - blue when parallel to the light (positive)
114
What is the classic x-ray finding in psoriatic arthritis?
A pencil-in-cup deformity
115
What are the two types of lupus nephritis?
Nephritis - diffuse proliferative glomerulonephritis
| Nephrotic - membranous glomerulonephritis
116
How does inflammation in polymyositis differ from dermatomyositis?
Polymyositis - Endomysial, CD8+ T-Cells
| Dermatomyositis - Perimysial inflamm + atrophy, CD4+ T Cells
117
What is myositis ossificans?
Metaplasia of skeletal muscle to bone following muscular trauma
118
Are melanocyte numbers normal or abnormal in albinism?
Normal number with decreased melanin production (unless potentially caused by failure of cell migration in development)
119
What is Melasma/Chloasma?
Hyperpigmentation associated with pregnancy (Mask of Pregnancy)
120
In Urticaria, is edema in the dermis or epidermis?
Dermis
| vs. the epidermis (spongiosis) in Eczema
121
What causes increased coloration in an Ephelis/Frekel?
Increased melanin production in a normal number of melanocytes
122
What is Auspitz sign?
Pinpoint bleeding spots from exposure of the dermal papillae when scales are scraped off in psoriasis
123
What is the difference microscopically between staph scalded skin syndrome and TEN?
In scalded skin syndrome, attachments only destroyed in stratum granulosum vs. TEN which destroys dermal-epidermal junction
124
What infectious disease is Lichen Planus associated with?
HCV
125
What is pityriasis rosea?
It presents with a herald path followed by christmas tree distribution and self-resolves in 6-8 weeks
126
What is keratoacanthoma?
A variant of SCC that grows rapidly and may regress spontaneously over months
127
What are the drivatives of the 5 secondary brain vesicles?
```
Telencephalon - Cerebral Hemispheres
Diencephalon - Thalamus
Mesencephalon - Midbrain
Metencephalon - Pons and cerebellum
Myelencephalon - Medulla
```
128
What maternal condition is Anencephaly associated with?
Type 1 Diabetes
129
What is a Dandy-Walker malformation?
Agenesis of cerebellar vermis with cystic enlargement of 4th ventricle
130
What is Wallerian degeneration?
Degeneration of a PNS axon distal to the injury and retraction proximally
131
What effect does myelin have on nerve conduction constants?
Increases the space constant and conduction velocity
132
What do Meissner corpuscles sense?
Dynamic fine/light touch, position sense on Glabrous skin
133
What do pacinian corpuscles sense?
Vibration and pressure in the deep skin layers, ligaments, joints
134
What do Merkel discs sense?
They are slow adapting. Pressure, deep static touch, position sense
135
What two areas of the brain are not protected by the BBB?
OVLT (osmolality sensor) and Area Postrema (Vomiting Center)
136
What is the lateral are of the hypothalamus for?
Controls hunger sensation, inhibited by leptin
137
What is the ventromedial area for?
Controls satiety, stimulated by leptin
138
What happens if you destroy the posterior hypoathalmus?
You become cold-blooded (poikilotherm) like a snake
139
What is a sign of a lateral cerebellar lesion?
Propensity to fall towards the ipsilateral/injured side
140
What is the genetics of early onset Parkinson's?
Autosomal Recessive disease with defects in the ubiquitin-proteasome pathway genes (e.g. Parkin, PINK-1, DJ-1)
141
What does the abnormal huntigtin protein cause?
Decreased transcription of other genes via histone hypermethylation
142
When is myoclonus commonly seen?
With metabolic abnormalities like renal or liver failure
143
What is the treatment of essential/postural tremor?
Beta blockers, primidone, (Self-medicate with EtOH)
144
Are Broca's and Wernicke's areas found in the dominant or non-dominant hemisphere?
Dominant
145
What is Gerstmann Syndrome?
Lesion of the Left (dominant) parietal-temporal cortex causing agraphia, acalculia, finger agnosia, and left-right disorientation
146
What results from correcting sodium to fast?
From low to high your pons will die
| From high to low your brain will blow (cerebral edema/herniation)
147
Is repetition good or poor in transcortical aphasias?
It is good
148
What nerve runs between the PCA and superior cerebellar artery?
CN III
149
What is the artery of percheron?
It is a variant artery from the PCA that can supply thalami and dorsal midbrain
150
What main artery supplies the thalamus?
The PCA
151
What are patients with acute cerebral edema hyperventilated?
Because this drops PCO2 and causes cerebral vasoconstriction and decreased ICP
152
Strokes of which artery are associated wtih dysphagia and hoarsness?
PICA due to involvement of the nucleus ambiguus
153
What symptoms are specific to an AICA lesion?
Facial nucleus affects
154
Which aneurysms are associated with focal deficits and which with headache?
Headache - Berry Aneurysm
| Focal Deficits - Charcot-Bouchard
155
What is seen on histology of lacunar infarcts?
Lipohyalinosis and microatheromas
156
What is Ataxia-Hemiplegia syndrome?
Caused by infarcts at the base of the pons usually due to HTN
157
What is Dysarthria-Clumsy Hand Syndrome?
Caused by infarcts at the base of pons or genu of internal capsule, usually due to HTN
158
What is the pterion?
It is the meeting place of the frontal, temporal, parietal, and sphenoid bones. Middle meningeal is deep to the pterion
159
What do you treat a vasospasm with due to subarachnoid hemhorrage?
Nimodipine
160
What is the most common cause of lobar intraparenchymal hemhorage?
Amyloid angiopathy
161
What is the progression of histologic features of a stroke?
12-48 hrs: Red Neurons
24-72 hrs: Necrosis + Neutrophils
3-5 Days: Macrophages
1-2 wks: Reactive gliosis + vascular proliferation
162
What is a clue towards an embolic stroke?
Multiple vascular territories can be affected
163
What enzyme defect can lead to ALS?
Superoxide dismutase 1
164
What drug can be used to treat ALS?
Riluzole (decreases glutamate release)
165
Which spinal cord region is the ASA water shed territory?
The upper thoracic territory
166
What muscle disorder should pes cavus and kyphoscoliosis point you towards?
Friedrichs Ataxia
167
Does uvula deviate to same or opposite side for a CN X lesion?
The opposite side
168
What are the signs of cavernous sinus syndrome?
Ophthalmoplegia and decreased corneal and maxillary sensation. Normal visual acuity
CN 6 most commonly affected
169
What nerve is involved in coughing that lies in the piriform recess?
The internal laryngeal nerve
170
What is Amarosis Fugax?
Painless transient monocular vision loss due to embolus to ophthalmic artery
171
What does the directional term for INO refer to?
To the eye which is paralyzed (i.e. not the nystagmus eye)
172
What protein is defective in Lewy Body Dementia?
alpha-synuclein
173
What is a striking feature of CJD?
Startle Myoclonus
174
What are the symptoms of Progressive Supranuclear Palsy?
EPS and dystonia of neck with paralysis of downward gaze
175
What happens to nerve impulses in MS?
Decreased length constant, increased time constant = slower conduction
176
Can autonomic function be affected in GBS?
YES
177
What is the classic CSF finding in GBS?
albuminocytologic dissociation
178
What is the most common site of inflammation in ADEM?
Periventricular
179
What are two musculoskeletal association of Charcot-Marie-Tooth?
Scoliosis and foot deformities (arch problems) (Note ddx would include Friedrich's Ataxia)
180
What is the inheritence pattern and metabolic defect in Adrenoleukodystrophy?
X-Linked. Impaired VLCFA metabolism
181
What is the most common cause of seizure by age group?
Children: Genetic
Adults: Tumors
Elderly: Stroke
182
What does positional testing reveal for peripheral vertigo?
Delayed horizontal nystagmus
183
What does positional testing reveal for central vertigo?
Immediate nystagmus in any direction (may CHANGE directions) + focal neuro findings
184
What gene is mutated in Sturge-Weber Syndrome?
GNAQ (activating mutation), usually somatic/non-inherited
185
What is the brain tumor seen in Sturge-WEber Syndrome?
Leptomeningeal angioma
186
What is the brain tumor seen in Tuberous Sclerosis?
Subependymal Hamartomas
187
What cells do meningiomas arise from?
Arachnoid cells
188
What brain tumors can result in secondary polycythemia?
Hemangioblastoma (produce EPO)
189
What is the capillary pattern of an oligodendroglioma?
Chicken-wire capillaries
190
What is the gross structure of a pilocytic astrocytoma?
It is cystic + solid
191
What is the classic histologic finding for Medulloblastomas?
Homer-Wright Rosettes (small round blue cells, vs. ependymoma)
192
What is the classic histologic finding for ependymomas?
Perivascular rosetttes
193
What is the "false localization sign"
Uncal herniation compresses contralateral crus cerebri leading to ipsilateral paralysis
194
What are the ultimate symptoms of Metachromatic Leukodystrophy?
Ataxia and Dementia
195
What are prophylactic strategies for migranes?
Propranolol, Topiramate, CCB, Amitryptyline
196
What differentiates negative reinforcement from punishment?
Negative Reinforcement - Behavior produces removal of aversive stimulus
Punishment - Unwanted behavior produces aversive stimulus to extinguish it
197
What differentiates sublimation from reaction formation?
Reaction formation is unconsciously derived
198
In cases of physical child abuse, who is the most frequent abuser?
Biological Mother
199
Are the tics in Tourette syndrome rhythmic?
No
200
Is the EEG abnormal in Delerium?
Yes
201
What class of drugs can often cause delerium?
Anticholinergics
202
What are the reversible causes of dementia?
NPH, B12 deficiency, hypothyroidism, neurosyphilis, HIV
203
What are two situations where tactile halluciations are common?
1) EtOH withdrawal
| 2) Cocaine abuse
204
What is bipolar I disorder?
At least 1 manic episode with or without a hypomanic or depressive episode
205
What is bipolar II disorder?
Defined by the presence of a hypomanic and a depressive episode
206
What are the sleep changes in depression?
Increased total REM
Decreased slow-ave sleep
Early morning awakening
207
Can hallucinations be part of normal bereavement?
Yes, simple hallucinations can
208
What is required in addition to a panic attack to diagnose panic disorder?
Presistent concern about an attack, worrying about consequences, or changes in behavior related to attack
209
In specific phobia, does the person recognize that the fear is excessive?
Yes
210
How can you remember the three clusters of personality disorders?
Weird, Wild, and Worried
211
How do you differentiate dellusional disorder and paranoid personality disorder?
In paranoid, all of the interactions of the person are permeated by the paranoia
212
What disorder is lanugo (fine body hair) associated with?
Anorexia nervosa
213
What phase of sleep do terrors occur in?
Slow-wave sleep so no memories of arousal (vs. REM)
214
What causes narcolepsy?
Decreased orexin production in lateral hypothalamus
215
What is used to treat narcolepsy at night?
sodium oxybate (GHB)
216
What are the stages of overcoming substance addiction?
1. Pre-contemplation
2. Contemplation
3. Preparation/Determination
4. Action/willpower
5. Maintenance
6. Relapse
217
What are serum markers of EtOH abuse?
GGT and AST>ALT
218
What is buprenorphine?
It is a partail opioid agonist used to help treat addiction. It has less abuse potential than methadone. Mixed with naloxone in pill to prevent IV administration
219
What is the treatment of cocaine overdose?
Benzodiazepines
220
What are some key features of PCP intoxication?
Vertical and Horizontal Nystagmus, psychosis, delerium, homicidality. "Acute Brain Syndrome" of disorientation and poor judgement
221
What can treat PCP intoxication?
Benzodiazepines and rapid-acting antipsychotics
222
What is the order of symptom progression in delerium tremens?
ANS -> psychotic symptoms -> confusion
223
What is the most frequent site of urinary obstruction in a fetus?
The Ureteropelvic junction (last to canalize)
224
What causes multicystic dysplastic kidney?
Abnormal interaction between ureteric bud and metanephric mesenchyme
225
What structures does the ureter pass under?
The uterine artery and the vas deferens
226
Does the ureter pass under or over the gonadal vessels?
Passes under them ontop of the psoas
227
Does the ureter run over or under the common illiac?
Over
228
What percentage of extracellular fluid is plasma volume?
1/4 of it
229
What compound can be used to measure the extra-cellular volume?
Inulin
230
What is a normal GFR?
100 mL/min
231
Does creatinine clearance over or under estimate GFR?
Overestimates it b/c of moderate secretion
232
Does the ERPF underestimate the true renal plasma flow?
Yes, by about 10%
233
What happens to the clerance of a secreted substance as the plasma [ ] continues to increase?
It approaches that of inulin b/c the transporters become saturated
234
Do NSAIDs cause a decrease in FF?
No b/c the prostaglandins normally increase both RPF and GFR
235
Is glucosuria and aminoaciduria normal in pregnancy?
Yes
236
What happens to renal arterioles when MAP increases?
Macula dense constricts afferent and decreases renin dilates efferent thus the GFR and FF are maintained
237
What drives Mg and Ca reabsorption in Thick ascending limb?
Lumen + due to K backleak
238
Which nephron segment generates and excretes NH3?
PCT
239
What acid base abnormality does Bartter and Gitelman syndrome result in?
Hypokalemia and metabolic alkalosis
240
What is the inheritance pattern of Liddle syndrome?
AD
241
Does Cl get absorbed at the same rate as Na early in the proximal tubule?
No
242
Is there a reflex bradycardia with AT II pressor effect?
No, it limits this by affecting barroreceptor function
243
What drugs shift K out of cells?
Digoxin and B-adrenergic antagonists
244
what can happen with hypomagenesemia?
Tetany, Torsades
245
What is Winter's formula?
PCo2 = 1.5 [Bicarb] + 8 +/- 2 (Resp compensation for met acidosis)
246
What are the causes of normal gap acidosis?
```
HARD-ASS
Hyperalimentation
Addison disease
RTA
Diarrhea
Acetazolamide
Spironolactone
Saline infusion
```
247
Other than diabetic glomerulonephropathy, what glomerular disease can have PAS+ staining?
Membranous nephropathy
248
What autoantibody is associated with membranous nephropathy?
Anti-PLA2 receptor
249
What is tubular proteinuria?
LMW proteins (B2, Ig light chain) in urine that appear when PCT function is disrupted
250
What is the most common cause of death in SLE?
Diffuse proliferative glomerulonephritis ("Wire looping" of capillaries)
251
What type of stones precipitate at increased pH?
Ca Phosphate, Struvite
252
What type of stones precipitate at decreased pH?
Ca Oxalate, Uric Acid, Cystine
253
What are some urease positive bugs?
Proteus, Staphylococcus, Klebsiella
254
What type of tumor is described as eosinophilic cells with lots of mito and no perinuclear clearing?
Renal oncocytoma - benign
255
What are risk factors for SCC of the bladder?
Schistosoma haematobium, chronic cystitis, smoking, chronic nephrolithiasis
256
What bug is associated with UTI in sexually active young women?
E. Coli > S. Saprophyticus
257
What is the likely etiology of diffuse cortical necrosis?
DIC + Vasospasm
258
What is the goal of a "renal failure diet"?
Control nitrogen production (E.g. gluconeogenesis prevention) and phosphate balance
259
What is medullary cystic disease?
Inherited disease causing tubulointerstitial fibrosis and shrunken kidneys
260
Why do complex cysts require removal?
Risk of RCC development
261
What is a frequent iatrogenic cause of metabolic alkalosis?
Loop or thiazide diuretics
262
Which type of diuretic can cause hyponatremia?
Thiazides
263
Which diuretic is contraindicated in renal failure?
Spironolactone
264
What causes paradoxical aciduria in diuretic use?
In a low K state, H is exchanged for Na in cortical collecting tubule
265
What is bradykinins vasoactive effect?
Vasodilator, hence risk of angioedema on ACE inhibitors
266
What drug should be avoided in bilateral renal artery stenosis?
ACE inhibitors b/c these patients are depending on AT II to maintain GFR
267
Which type of beta blockers increase the risk for hyperkalemia?
Non-selective beta blockers (recall, shifts K out of cells)
268
Where is airway resistance the lowest?
At the small airways/bronchioles due to large number in parallel
269
Where dose airway smooth muscle and cili extend to?
To the terminal bronchioles
270
What type of epithelial cell is found in the respiratory bronchioles?
Cuboidal cells
271
Where do aspirated foreign bodies lodge when supine?
Superior portion of right inferior lobe
272
What is the relation of the pulmonary artery to the bronchus?
RALS - Right Anterior Left Superior
273
What is the largest contributor to functional deadspace?
Apex of a healthy lung
274
What is alveolar ventilation?
Minute Ventilation - Dead Space Ventilation
275
What two drugs are given in cyanide toxicity?
Nitrites are used first followed by thiosulfate
276
Why might newborns develop methemoglobinemia?
Due to NO treatment to treat pulmonary HTN
277
What direction does CO shift the Hemoglobin curve?
Left shift (hence bright red appearance)
278
What is the typical O2 binding capacity of blood?
20.1 mL O2/dL
279
How do emphysema and fibrosis affect diffusion capacity?
Emphysema - decreased SA > decreased DLCO
| Fibrosis - Increased Thickness > decreased DLCO
280
What happens to the apical V/Q in exercise?
It approaches 1 due to capillary dilation
281
Does 100% O2 improve PO2 in a shunt or dead space?
In dead space only
282
What is the Haldane Effect?
Dissociation of H+ from Hb in lungs promotes CO2 formation and Hb loading. Opposite of Bohr effect
283
What changes occur to blood gas during exercise?
None! There is an increase in venous CO2 content and decrease in venous O2 content though
284
What is the most common causes of sinusitis?
Viral URI and superimposed infection with S. Pneumo, H. Flu, and M. Catarrhalis
285
What is Homan's sign?
Dorsiflexion of the foot leading to calf pain, sign of DVT
286
What is the classic triad of fat embolus?
Hypoxemia, Neurological Abormalities, Petechial rash
287
What distinguishes pre and post-mortem thrombi?
Lines of Zahn. Interdigitated fibrin/platelets and RBCs. Only pre-mortem thrombi
288
What leads to cor pulmonale in COPD?
Chronic hypoxic vasoconstriction
289
What is the diagnostic criteria for chronic bronchitis?
Productive cough > 3 months per year for > 2 years
290
What type of reaction is hypersensitivity pneumonitis?
Mixed Type III/IV. Think farmers and birds
291
What is Caplan's Syndrome?
Rheumatoid arthritis, pneumoconioses, intrapulmonary nodules
292
Histologically what does berylliosis resemble?
Sarcoidosis
293
What is the breathing rate patterns for restrictive and obstructive disease?
Restrictive - high rate low volume (minimizes work)
| Obstructive - low rate high volume (minimizes work)
294
What differentiates OSA and Obesity hypoventilation syndrome?
In OSA, blood gas is normal during the day, but not in OHS
295
What is the only situation with increased fremitus?
Consolidation (lobar pneumonia or pulmonary edema). NOT pleural effusion (which moves lung away from chest wall)
296
What is the most common type of cancer in the lung?
Metastases (breast, colon, prostate, bladder)
297
What lung cancer is associated with hypercalcemia?
SCC
298
What oncogene is amplified in small cell lung cancer?
L-myc
299
What is the cell of origin of small cell lung cancer?
Kulchitsky cells
300
What do bronchial carcinoid tumors stain + for?
Chromogranin
301
What structures are seen in mesothelioma histology?
Psammoma bodies
302
Which type of pneumonia has a patchy distribution and involves bronchioles and adjacent alveoli?
Bronchopneumonia
