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1
Q

What diuretic is used for pseudotumor cerebri?

A

acetazolamide

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2
Q

heart defects w/ Chromosome 22q11 deletions

A

Tetrology of fallot

truncus arteriosus

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3
Q

congenital rubella causes what heart defects?

A

PDA

PA stenosis

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4
Q

Turner’s Syndrome causes what heart defects?

A

infantile coarctation of aorta

bicuspid atresia

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5
Q

boot-shaped heart

A 
tetrology of fallot (infant) 
RV hypertrophy (adult; COPD)
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6
Q

most common congenital cause of early cyanosis

A

tetrology of fallot

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7
Q

equations for Cardiac Output

A 
CO = SV * HR
CO = rate of O2 consumption / arterial O2 - venous O2
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8
Q

where do dorsal columns decussate?

A

medulla

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9
Q

where do lateral corticospinals decussate?

A

medullary pyramids

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10
Q

MAP equations

A 
MAP = CO * TPR
MAP = 2/3 diastolic + 1/3 systolic
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11
Q

derivatives of 3rd aortic arch?

A

common carotid artery

proximal part of internal carotid

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12
Q

derivatives of 4th aortic arch?

A 
L = arch of adult aorta
R = proximal part of R subclavian artery
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13
Q

derivatives of 6th aortic arch?

A

proximal part of pulmonary arteries

ductus arteriosus

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14
Q

what’s the antidote for toxins: t-PA, streptokinase

A

aminocaproic acid

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15
Q

what’s the antidote for toxins: digitalis

A

anti-digoxin Antibody fragments

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16
Q

what ligaments are typically injured during an ankle sprain?

A

anterior talofibular ligament

Always Tears First Ligament

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17
Q

whats the leading cause of knee pain in patients under 45?

A

patellofemoral syndrome

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18
Q

what ligament contains uterine vessels?

A

cardinal ligament

-connects cervix to side wall of pelvis

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19
Q

what does the round ligament connect?

A

uterine fundus to the labia majora

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20
Q

what is associated w/ extrophy of the bladder? what is extrophy of the bladder?

A

epispadias

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21
Q

lymphatic drainage of the ovaries/testes

A

para-aortic lymph nodes

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22
Q

lymphatic drainage of the distal 1/3 of the vagina/vulva/scrotum

A

superficial inguinal nodes

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23
Q

lymphatic drainage of the proximal 2/3 of the vagina/uterus

A

obturator
external iliac
hypogastric nodes

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24
Q

seminoma

testicaular germ cell tumor

A 
malignant
painless
males 15-35yo
"fried-egg" appearance 
increased PLAP = placental alkaline phosphatase
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25
``` yolk sac (endodermal sinus) tumor testicaular germ cell tumor ```
Schiller-Duval bodies --> resemble glomeruli | high AFP
26
Choriocarcinoma | testicaular germ cell tumor
malignant, high hCG hematogenous spread to the lungs hCG = LH analog --> gynecomastia
27
teratoma | testicaular germ cell tumor
males = malignant benign in children high hCG AFP in 50% cases
28
embryonal carcinoma | testicaular germ cell tumor
malignant, painful glandular/papillary morphology often mixed w/ other types may have high hCG + high AFP when mixed
29
leydig cell | non-germ cell testicular tumor
Reinke crystals androgen --> gynecomastia in men, precocious puberty in boys golden brown color
30
What bacteria are encapsulated?
Even Some Pretty Nasty Killers Have Shiny Bodies ``` E.Coli Strep Pnemoniae Pseudomonas Aeruginosa Neisseria Meningitidis Klebsiella Pneumoniae Haemophilus Influenzae Type B Salmonella Typhi Group B Strep ```
31
What disorders result from trinucleotide repeats?
``` X-Girlfriends First Aid Helped Ace My Test Fragile X = CGC Friedreich Ataxia = GAA Huntington's = CAG Myotonic Dystrophy = CTG ```
32
What 6 bacteria secrete enterotoxins (exotoxin that causes water and electrolyte imbalances of intestinal epithelium resulting in diarrhea)?
``` VIbrio Cholerae ETEC Staph Aureus Shigella Yersenia Clostridium Difficile ```
33
what are the 3 main causes of bacterial neonatal sepsis?
Group B Strep E.Coli Listeria Monocytogenes
34
what are the 4 MC bacterial causes of UTI?
E.Coli Staph Saprophyticus Klebsiella Proteus Mirabilis
35
What are the sulfa-drug allergies?
Sulfa Pills Frequently Cause Terrible Acute Symptoms ``` Sulfasalazine Probenecid Furosemide Celecoxib Thiazides/TMP-SMX Acetazolamide Sulfonylureas ```
36
What diseases can cause Bells Palsy?
``` my Lovely bell Had An STD Lyme Disease Herpes Zoster AIDS Sarcoidosis Tumors Diabetes ```
37
what are T-cell markers?
``` CD3 TCR Helper = CD4 + CD40 ligand (activating B cells) Cytotoxic = CD8 CD28 (costim --> binds to B7 on APC) ```
38
HLA B27
``` PAIR Psoriatic Arthritis Ankylosing Spondylitis Inflammatory Bowel Disease Reiter's Syndrome ```
39
HLA DR3
Graves's Disease | Type 1 Diabetes Mellitus
40
HLA DR4
Rheumatoid Arthritis | Type 1 Diabetes Mellitus
41
what markers are on dendritic cells?
MHC 1 | APC = MCHII + B7
42
what cytokines do Th1 cells secrete?
IL-2 + IFNgamma --> kill stuff | IL-10 --> don't make Th1
43
what cytokines do Th2 make?
IL-4 --> more TH2 IL-5 IL-10 --> don't make Th1
44
What are B cell surface markers?
CD19, CD20, CD21 Ig APC = MCHII + B7 CD40 (T cell activate B cell)
45
NK cell markers?
CD56 | CD16 (binds Fc of IgG)
46
Macrophage cell markers?
CD14 CD40 APC = MHCII + B7
47
what protein initiates recombination of V(D)J sequences?
RAG-1 and RAG-2 | Recombination Activating Gene Complex's
48
what bacteria works by inhibiting/disabling Gi?
Bordetella Pertussus
49
what bacteria works by having bacterial adenylate cyclase (no G protein involved)
Bacillus Anthracis
50
what diseases can you gets shots for protective PASSIVE immunity? (4)
"To Be Healed Rapidly" Tetanus toxin Botulinum toxin HBV (give active + passive immunity) Rabies Virus (give active + passive immunity)
51
Live Viral Vaccines (6)
``` Varicella = chicken pox Small Pox influenza (intranasal) Polio (Sabin = oral) MMR = measles, mumps, rubella Yellow Fever ```
52
Inactivated/killed vaccines (5)
``` be CHIPR they're dead so you don't have to be Cholera Hepatitis A Influenza (intramuscular) Polio (Salk= injected) Rabies ```
53
when can you give live vaccines to AIDs patients? What should you give? What do you always give to HIV infants?
CD4 > 200 MMR Varicella = chicken pox Yellow Fever rotavirus recommended for all infants w/ HIV
54
egg-based vaccines
influenza vaccine yellow fever egg allergy --> do skin test first
55
what gives rise to the jugular venous a, c, v waves?
``` a = atrial contraction c = ventricular contraction v = atrial filling against closed tricuspid valve ```
56
what happens if you have a C1 esterase inhibitor deficiency?
hereditary angioedema | ACE inhibitors are contraindicated
57
What happens if you have a C3 deficiency?
lots of sinus and respiratory tract infections -Strep. Pneumo -H. Influenza increased suceptibility to type 3 hypersensitivity rxns
58
what do you get if you have C5-C9 deficiencies?
recurrent NEISSERIA bacteremia infections
59
what do you get if you are deficient in DAF (CD55) = GPI anchored enzyme
complement against your own RBC | paroxysmal noctural hemoglobinuria (PNH)
60
Hot T-Bone stEAk
``` Hot = IL-1 = fever T = IL-2 --> T cells Bone = IL-3 --> stimulates BM E --> IL-4 --> IgE production A --> IL-5 --> IgA production ``` note that IL-4 --> stimulates IgE production while IL-5 --> stimulates eosinophils
61
neutrophil chemotactic agents
IL-8 "cleanup on isle 8!" C5a Leukotriene B4
62
what bands do you find actin and myosin? Where do they attach to?
An Interesting Zoo Actin, alone in I-band, attaches to Z-line Must Have Mammals Myosin, alone in H-band, attaches to M-line
63
slow adapting receptors on skin?
``` superficial = merkel (pressure, position) deep = ruffini ```
64
fast adapting receptors on skin?
``` superficial = meissner (light touch) deep = Pacinian (vibration, pressure) ```
65
what 3 things can stimulate gastrin secretion?
phenylalanine tryptophan calcium
66
patient has UTI caused by proteus vulgaris. What type of renal stone will she get?
Ammonium Magnesium Phosphate stone --> staghorn calculus
67
what structures are retroperitoneal?
``` A DUCK PEAR Adrenal glands Duodenum Ureters Colon Kidneys Pancreas Esophagus Aorta Rectum ```
68
In the stomach, what's released by the: I cells S cells D cells
I cells --> CCK S cells --> secretin D cells --> somatostatin
69
what are the 4 obligate anaerobic bacteria?
``` "Nagging Pests Must Breathe" Nocardia Pseudomonas Aeruginosa Mycobacterium Tuberculosis Bacillus ```
70
Characteristics of Whipple's Disease
``` Foamy Whipped cream in a CAN PAS+ foamy macrophages in intestinal lamina propria C = cardiac symptoms A = arthralgias N = neurologic symptoms MC in white older men ``` diarrhea lymphadenopathy pathognomic: oculomasticatory myorhythmia
71
common causes of small bowel obstruction?
``` ABCO Adhesions Bulge/hernia Cancer/tumors Other = volvulus, intussusception, Crohn's.. ```
72
Symptoms of Carcinoid Syndrome?
``` BFDR Bronchospasm Flushing Diarrhea Right sided heart disease/murmur ```
73
Necrotizing enterocolitis
necrosis intestinal mucosa usally colon neonates, "feed too early" may cause Pneumatosis Intestinalis = air in bowel wall
74
Down Syndrome GI problems
Duodenal atresia Hirschsprung Annular Pancreas Celiac
75
mechanism of Reye syndrome?
asprin metabolites inhibit mitochondrial enzymes | decreased beta-oxidation
76
triad of Multiple Sclerosis
Scanning speech intention tremor nystagmus bowel + bladder incontinence internuclear opthalmoplegia optic neuritis
77
what gene mutation causes primary pulmonary HTN?
BMPR2 gene
78
what's the alveolar gas equation? whats a normal A-a gradient?
PAO2 = 150 - PaCO2/ 0.8 | normal A-a = PA02 - Pa02 = 10-15mmHg
79
presents at birth as a floppy baby
werdnig hoffman LMN lesions only = destruct anterior horns flaccid paralysis
80
when do you see an S1Q3T3? What does it mean?
Pulmonary Embolism (20% of cases) EKG Lead 1 --> large S wave Lead 3 --> large Q + inverted T
81
What things can cause eosinophilia?
``` DNAAACP Drugs Neoplasms Atopic diseases Addison's Acute interstitial nephritis Collagen vascular disease Parasites (Ascaris Lumbriocoides, Strongyloides Stercoralis, hookworms) ```
82
anthracosis - who gets it? - where does it hit? - increased risks?
coal miners upper lungs A/W: RA NOT A/W: smoking or lung CA
83
Silicosis - who gets it? - where does it hit? - increased risks?
foundries (metal casting), sandblasting, mines silica impairs phagolysosome formation by macrophages upper lobes increased risk: TB, lung cancer
84
asbestosis - who gets it? - what does it look like? - increased risks?
shipbuilding, roofing, plumbing pathogonomic = "ivory white" calcified pleural plaques increased risk = bronchogenic CA, mesothelioma
85
berylliosis - who gets it? - what does it look like? - increased risks?
``` aerospace industry (works for NASA) noncaseating granulomas in the lung, hilar LNs, and systemic organs increased risk for lung cancer ```
86
4 MC locations for lung CA metastasis?
brain bone adrenals liver
87
Small Cell CA - histo - who gets it? - where does it grow? - associations?
- poorly diff. small cells, from neuroendocrine (Kulchitsky) cells - male smokers - central - Secretes: ADH or ACTH, eaton-lambert syn.
88
squamous cell CA - histo - who gets it? - where does it grow? - associations?
- keratin pearls or intercellular bridges - Male smokers - central - PTHrP -> hyperCalcemia
89
adenocarcinoma - histo - who gets it? - where does it grow? - associations?
- glands or mucin - nonsmokers + females - Peripheral - activating K-RAS mutation - A/W clubbing
90
large cell carcinoma - histo - who gets it? - where does it grow? - associations?
- poorly diff. large cells (pleomorphic giant cells) - smoking - peripheral
91
bronchioalveolar Ca - histo - who gets it? - where does it grow? - associations?
- columnar cells grow along preexisting bronchioles and alveoli. From Clara cells. - not related to smoking - peripheral - CXR: ground-glass opacity
92
Carcinoid Tumor - histo - who gets it? - where does it grow? - associations?
- neuroendocrine cells, chromogranin + - central or peripheral - forms polyp-like mass in the bronchus - can cause carcinoid syndrome
93
Mesothelioma - histo - who gets it? - where does it grow? - associations?
- PSAMMOMA BODIES - not related to smoking!!!! - peripheral - A/W asbestosis - causes hemorrhagic pleural effusions and pleural thickening
94
what organism causes lobar pneumonia?
S. pneumoniae MC | Klebsiella
95
what organism causes bronchopneumonia?
S. pneumoniae S. aureus H. influenza Klebsiella
96
what organism causes interstitial (atypical) pneumonia?
``` "walking pneumonia" Viral = influenza, RSV, adenoviruses Mycoplasma Legionella Chlamydia ```
97
Cushing reaction triad
hypertension bradycardia respiratory depression bc of increased intracranial pressure
98
infarct location = anterior wall - what artery? - what leads have Q waves?
LAD | V1-V4
99
infarct location = anteroseptal wall - what artery? - what leads have Q waves?
LAD | V1-V2
100
infarct location = anterolateral wall - what artery? - what leads have Q waves?
Left Circumflex | V4-V6
101
infarct location = lateral wall - what artery? - what leads have Q waves?
Left Circumflex | I, aVL
102
infarct location = interior wall - what artery? - what leads have Q waves?
Right Coronary Artery | leads II, III, aVF
103
what organisms can cause culture-negative endocarditis?
``` HACEK Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella ```
104
ST elevation in all leads
pericarditis
105
EKG shows electrical alterans
Cardiac Tamponade
106
Odds Ratio
A*D/ B*C | case control
107
Relative Risk
A/(A+B) / C/(C+D)
108
Attributable Risk
A/(A+B) - C/(C+D)
109
Number Needed to Treat
``` NNT = 1 / ARR ARR = absolute risk reduction ARR = C/(C+D) - A/(A+B) ```
110
Hawthorn effect
patients change their behavior as a result of being watched or included in the study
111
berkson's bais
bias when cases and/or controls selected from hospitals. If hospital based cases/controls is taken into consideration, they will have different rate of exposures than normal population of that area.
112
how do you reduce bias?
randomize double blind control group
113
what are the stages of grief?
``` Death Always Brings Great Acceptance Denial Anger Bargaining Grief Acceptance ```
114
what substances do you need to make a purine?
``` Aspartate-N Glutamine-N Glycine-C CO2-C tetrahydrofolate-C ```
115
what substances do you need to make pyrimidines?
Aspartate Glutamine CO2 ATP
116
what bacteria does tetracycline kill?
``` VACUUM THe BedRoom Vibrio Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumonae Tularemia H.Pylori Borrelia Burgdorferi Rickettsiae Rickettsii ```
117
what bacteria does macrolides kill?
PUS P = pneumoniae = legionella, mycoplasma, chlamydia U = URI = GAS S = STD = gonorrhea, chlamydia
118
Name X-linked Recessive Diseases
Oblivious Females Will Give Her Boys Her X-Linked Disorders ``` Ocular albinism Fabry Disease Wiskott-Aldrich G6PD deficiency Hunter syndrome Bruton agammaglobulinemia Hemophilia A and B X- Lesch-Nyhan Syndrome Duchenne Muscular Dystrophy ```
119
What are the criteria for Major Depressive DIsorder?
``` SIG E CAPS Sleep Interest (anhedonia) Guilt Energy Concentration Appetite/weight Psychomotor retardation or agitation Suicidal ideations ``` need 5/9 for at least 2 weeks with either depressed mood or anhedonia
120
risk factors for suicide completions
``` Sex (males) Age (teens and elderly) Depression Previous Attempt Ethanol or drug use Rational thinking (loss) Sickness Organized plan** No spouse/social support Stated future intent ```
121
what are the manifestations of CREST scleroderma?
``` Calcinosis Raynauds Esophageal Dysmotility Sclerodactyly telangiectasias ```
122
what diseases have psammoma bodies?
P - papillary adenocarcinoma of thyroid S- serous cystadenoma of the ovary M - meningioma M- mesothelioma
123
what diuretics affect calcium levels?
loops loose calcium | thiazides retain calcium
124
what shifts K out of cells?
``` DO Insulin LAB Digitalis hyperOsmolarity Insulin deficiency Lysis of cells Acidosis B-adrenergic antagonist ``` note: hyperkalemia can be caused by ACE inhibitors and K-sparing diuretics
125
what shifts K into cells?
INsulin shifts K INto cells note: hypokalemia can be caused by loop diuretics, thiazides
126
what can cause a high anion gap?
``` MUDPILES Methanol Uremia Diabetic ketoacidosis Propylene glycol Iron tablets or INH (isoniazid) Lactic acidosis (antifreeze, oxalic acid) Ethylene glycol Salicylates (aspirin) ```
127
what can cause a normal anion gap? Not adding acids but losing bicarb
``` HARD-ASS Hyperalimentation Addison's Renal tubular acidosis Diarrhea Acetazolamide Spironolactone Saline infusion ```
128
what are the co-factors for: pyruvate dehydrogenase (def --> lactic acidosis) a-ketoglutarate DH
``` TLC for Nobody TTP (active form of thiamine) = Vit B1 Lipoic acid Coenzyme A = Vit B5 FAD = Vit B2 NAD = Vit B3 ``` note: lipoic acid is a co-factor for branched chain ketoacid DH (def --> maple syrup urine disease).
129
what do see in Kwashiorkor?
``` Kwashiorkor results from a protein-deficient MEAL Malnutrition Edema Anemia Liver (fatty) ``` clinical image = skinny child w/ a huge belly
130
essential AAs
``` PVT TIM HALL P - Phenylalanine V - Valine T - Threonine T - Tryptophan I - Isoleucine M - Methionine H - Histidine A - Arginine L - Leucine L - Lysine ```
131
what does tryptophan give rise to?
(B6) Niacin --> NAD | (BH4) Serotonin --> melatonin
132
what does histidine give rise to?
(B6) --> histamine
133
what does glycine give rise to?
(B6)--> porphyrin --> heme
134
what does arginine give rise to?
creatinine urea NO
135
what does glutamate give rise to?
(B6) --> GABA | Glutathione
136
what does phenylalanine give rise to?
tyrosine --> DOPA --> Dopamine ---> NE --> Epi
137
what RNA viruses are positive stranded?
I went to a RETRO TOGA party, where I drank FLAVored CORONA and ate HIPPY CALIfornia PICkles ``` retrovirus togavirus flavivirus coronavirus hepevirus calicivirus picornavirus ```
138
what viruses are naked (no envelopes)?
give PAPP smears and CPR to a NAKED HEPpy ``` DNA Papillomavirus Adenovirus Parvovirus Polyomavirus ``` ``` RNA Calcivirus Picornavirus Reovirus Hepevirus ```
139
what are the DNA virus families?
``` HHAPPPPy Hepadna (circular DNA) Herpes Adeno Pox (non-icosahedral, replicates in cytoplasm) Parvo (ssDNA) Papilloma (circular DNA) Polyoma (circular DNA) ```
140
more DNA viruses are linear dsDNA, what are the exceptions?
``` parvovirus = ssDNA papillomavirus = circular DNA polyomavirus = circular DNA hepadnavirus = circular DNA ```
141
what are the picornaviruses?
``` PERCH Poliovirus (enterovirus) Echovirus (enterovirus) Rhinovirus Coxsackievirus (enterovirus) HAV ```
142
what disease cause rash on the palms and soles?
"You drive CARS with your palms and soles" CA- Coxsackievirus A R- Rickettsia Rickettsii S- Syphilis (secondary)
143
Causes of DIC?
``` STOP Making Thrombi Sepsis Trauma OB Pancreatitis Malignancy Transfusion ```
144
what infections are A/W birds?
``` Histoplasma Cryptococcus C. Psittaci West Nile Virus H5N1 influenza ```
145
what nematodes can you get from ingestion?
EAT Enterobius Ascaris Trichinella
146
What nematodes do you get from the sand/walking?
these get into your feet from the SANd Strongyloides Ancylostoma Necator
147
fetal erythropoesis
``` Young Liver Synthesizes Blood Yolk Sac (3-8wk) Liver Spleen BM (wk28) ```
148
what can cause an elevated EPO --> PV?
``` Potentially Really High Hematocrit Pheochromocytoma Renal Cell CA Hepatocellular CA Hemangioblastoma ```
149
Classic triad for HUS? Pentad for TTP?
``` FAT RN Fever Anemia Thrombocytopenia Renal Failure Neurological Symptoms ``` note: TTP = ADAMTS13 deficiency -> can't break vWF into monomers
150
Paroxysmal Nocturnal Hemoglobinuria (PNH) triad?
hemolytic anemia pancytopenia venous thrombosis
151
Multiple myeloma findings (4)?
``` CRAB hyperCalcemia Renal insufficiency Anemia Bone lytic lesions/Back pain ``` Multiple Myeloma: Monoclonal M protein spike
152
What are the causes of transitional cell CA?
``` A/W problems in your Pee SAC Phenacetin Smoking Aniline dyes Cyclophosphamide ```
153
What's the APGAR score based on?
``` APGAR Appearance Pulse Grimace Activity Respiration score 4-6 = assist/stimulate ```
154
rank the speed of conduction of different locations in the heart?
Purkinjie Atria Ventricles AV node
155
persistent yolk stalk? | persistent allantosis remnant?
``` yolk stalk (vitelline duct)--> meconium/meckel's yolk sac --> allantois --> urachus --> pee ```
156
HIV Virus: - env - gag - pol
``` env = gp120 (attach to CD4) + gp41 (fusion/entry) gag = p24 = capsid protein pol = rev trans, asp protease, integrase ```
157
MEN 1
Pituitary Parathyroid Pancreas
158
MEN 2A
Parathyroid Pheochromocytoma Medullary thyroid carcinoma
159
MEN 2B
Pheochromocytoma Medullary thyroid carcinoma Oral/intestinal ganglioneuromatosis (A/W marfinoid habitus)
160
hyperaldosteronism
HTN low K metabolic alkalosis
161
causes of lipodystrophy
decreased leptin | HIV meds = protease inhbitors

DIT (3 decks)

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